Toward a Climate-Ready Health Care System: Institutional Motivators and Workforce Engagement.

Policy Points The US health care system faces mounting pressure to reduce greenhouse gas emissions and adapt to the impacts of climate change; motivated institutions and an engaged health care workforce are essential to the development, implementation, and maintenance of a climate-ready US health care system. Health care workers have numerous profession-specific and role-specific opportunities to address the causes and impacts of climate change. Policies must address institutional barriers to change and create incentives aligned with climate readiness goals. Institutions and individuals can support climate readiness by integrating content on the health care implications of climate change into educational curricula.

Portland's Response to the Western North American Heatwave: A Brief Report.

BACKGROUND: In June of 2021, a heatwave resulted in high mortality across the Pacific Northwest region. The city of Portland, Oregon, had many advantages: emergency response personnel, science-based policies, political support for climate change adaptation, and collaboration among municipal, county, state, and federal authorities. Though the city's response likely prevented many deaths, heat-related mortality was high. METHODS: This study presents a retrospective case analysis of the 2021 Western North American Heatwave in Portland, Oregon. Specifically, the study examines the limitations of current heatwave response paradigms by means of a narrative review of the heatwave response and impacts. RESULTS: Most deaths occurred at home, and most of those who died lived alone. Most of the deceased did not have access to functioning air conditioning. CONCLUSIONS: Heatwaves exhibit high predictability in the demographics of those most affected and have rising rates of recurrence. Given the effectiveness of residential cooling systems in preventing heat-related mortality, findings suggest that future public health and policy initiatives should put increased focus on the primary prevention of heat exposure.

Extramural US Federal Research Grants For Health Outcomes Associated With Climate Change Inadequate, Too Narrow In Focus.

Climate change causes and exacerbates disease, creates and worsens health disparities, disrupts health care delivery, and imposes a significant disease burden in the US and globally. Critical knowledge gaps hinder an evidence-based response and are perpetuated by scarce federal research funds. We identified and described extramural US federal research funding (that is, grants provided to organizations and institutions outside of federal agencies) that both addressed health outcomes associated with climate change and was awarded between 2010 and 2020. During this eleven-year period, 102 grants met our criteria, totaling approximately $58.7 million, or approximately $5.3 million per year (2020 adjusted US dollars). Federal investments in climate change and health research during this period failed to address the breadth of climate-sensitive exposures, health outcomes, and impacts on vulnerable populations. Moving forward, in addition to increasing investment in climate and health research across all known hazards, critical attention should be placed on vulnerable populations and health equity. To achieve this, increased federal research coordination and cooperation are needed, as well as a mechanism to track this funding.

Wildfire Threat to Inpatient Health Care Facilities in California, 2022.

Objectives. To assess wildfire risks to California inpatient health care facilities in 2022. Methods. Locations of inpatient facilities and associated inpatient bed capacities were mapped in relation to California Department of Forestry and Fire Protection fire threat zones (FTZs), which combine expected fire frequency with potential fire behavior. We computed the distances of each facility to the nearest high, very high, and extreme FTZs. Results. Half (107 290 beds) of California's total inpatient capacity is within 0.87 miles of a high FTZ and 95% (203 665 beds) is within 3.7 miles of a high FTZ. Half of the total inpatient capacity is within 3.3 miles of a very high FTZ and 15.5 miles of an extreme FTZ. Conclusions. Wildfires threaten a large number of inpatient health care facilities in California. In many counties, all health care facilities may be at risk. Public Health Implications. Wildfires in California are rapid-onset disasters with short preimpact phases. Policies should address facility-level preparedness including smoke mitigation, sheltering measures, evacuation procedures, and resource allocation. Regional evacuation needs, including access to emergency medical services and patient transportation, must also be considered. (Am J Public Health. 2023;113(5):555-558. https://doi.org/10.2105/AJPH.2023.307236).

Building capacity of healthcare professionals and community members to address climate and health threats in The Bahamas: Analysis of a green climate fund pilot workshop.

Climate change is a preeminent threat to health and health systems in The Bahamas. Climate and health resilience depends upon a knowledgeable and coordinated healthcare system and workforce that is highly connected and coordinated with a knowledgeable and empowered community. We present the methodology and results of a novel educational workshop, designed to increase the knowledge and awareness of health care professionals and community members with the goal of empowering them to engage in climate mitigation and adaptation strategies. Following the training, participants demonstrated increased knowledge of the causes of climate change, health exposures, climate-sensitive diseases, and vulnerable populations relevant to The Bahamas. Further, participants reported high levels of willingness and readiness to tackle climate change and its health consequences. Results from this workshop suggest that such a model may serve as a guide for building grass-roots resilience in communities worldwide.

Where are People Dying in Disasters, and Where is it Being Studied? A Mapping Review of Scientific Articles on Tropical Cyclone Mortality in English and Chinese.

BACKGROUND: Tropical cyclones are a recurrent, lethal hazard. Climate change, demographic, and development trends contribute to increasing hazards and vulnerability. This mapping review of articles on tropical cyclone mortality assesses geographic publication patterns, research gaps, and priorities for investigation to inform evidence-based risk reduction. METHODS: A mapping review of published scientific articles on tropical cyclone-related mortality indexed in PubMed and EMBASE (English) and SINOMED and CNKI (Chinese), focusing on research approach, location, and storm information, was conducted. Results were compared with data on historical tropical cyclone disasters. FINDINGS: A total of 150 articles were included, 116 in English and 34 in Chinese. Nine cyclones accounted for 61% of specific event analyses. The United States (US) reported 0.76% of fatalities but was studied in 51% of articles, 96% in English and four percent in Chinese. Asian nations reported 90.4% of fatalities but were studied in 39% of articles, 50% in English and 50% in Chinese. Within the US, New York, New Jersey, and Pennsylvania experienced 4.59% of US tropical cyclones but were studied in 24% of US articles. Of the 12 articles where data were collected beyond six months from impact, 11 focused on storms in the US. Climate change was mentioned in eight percent of article abstracts. INTERPRETATION: Regions that have historically experienced high mortality from tropical cyclones have not been studied as extensively as some regions with lower mortality impacts. Long-term mortality and the implications of climate change have not been extensively studied nor discussed in most settings. Research in highly impacted settings should be prioritized.

Who's at Risk in a Changing Climate? Mapping Electricity-Dependent Patient Populations in a Coastal City.

BACKGROUND: Climate change is causing increasingly frequent extreme weather events. This pilot study demonstrates a GIS-based approach for assessing risk to electricity-dependent patients of a coastal academic medical center during future hurricanes.  Methods: A single-center retrospective chart review was conducted and the spatial distribution of patients with prescriptions for nebulized medications was mapped. Census blocks at risk of flooding in future hurricanes were identified; summary statistics describing proportion of patients at risk are reported.  Results: Out of a local population of 2,101 patients with prescriptions for nebulized medications in the preceding year, 521 (24.8%) were found to live in a hurricane flood zone.  Conclusions: Healthcare systems can assess risk to climate-vulnerable patient populations using publicly available data in combination with hospital medical records. The approach described here could be applied to a variety of environmental hazards and can inform institutional and individual disaster preparedness efforts.

Climate Change and Health in New England: A Review of Training and Policy Initiatives at Health Education Institutions and Professional Societies.

BACKGROUND: There has been increasing interest in climate change among healthcare professionals, but it is unclear to what extent resources on this topic are available to students and clinicians in New England. METHODS: Structured review of publicly available information regarding climate change and health activity at schools of medicine, public health, and physician assistant studies and in state medical and physician assistant societies in New England. RESULTS: Of 39 programs reviewed, 18 (46%) had at least one climate-related initiative. Six universities accounted for 87% of climate change and health initiatives in the region. Three out of 12 state professional associations had committees or position statements addressing climate change. CONCLUSION: There is substantial activity related to climate change and health in New England, but it is concentrated in a small number of locations. Opportunities exist to improve access to education on this topic and increase involvement of health professional associations.

Evidence-Based Heatstroke Management in the Emergency Department.

INTRODUCTION: Climate change is causing an increase in the frequency and intensity of extreme heat events, which disproportionately impact the health of vulnerable populations. Heatstroke, the most serious heat-related illness, is a medical emergency that causes multiorgan failure and death without intervention. Rapid recognition and aggressive early treatment are essential to reduce morbidity and mortality. The objective of this study was to evaluate current standards of care for the emergent management of heatstroke and propose an evidence-based algorithm to expedite care. METHODS: We systematically searched PubMed, Embase, and key journals, and reviewed bibliographies. Original research articles, including case studies, were selected if they specifically addressed the recognition and management of heatstroke in any prehospital, emergency department (ED), or intensive care unit population. Reviewers evaluated study quality and abstracted information regarding demographics, scenario, management, and outcome. RESULTS: In total, 63 articles met full inclusion criteria after full-text review and were included for analysis. Three key themes identified during the qualitative review process included recognition, rapid cooling, and supportive care. Rapid recognition and expedited external or internal cooling methods coupled with multidisciplinary management were associated with improved outcomes. Delays in care are associated with adverse outcomes. We found no current scalable ED alert process to expedite early goal-directed therapies. CONCLUSION: Given the increased risk of exposure to heat waves and the time-sensitivity of the condition, EDs and healthcare systems should adopt processes for rapid recognition and management of heatstroke. This study proposes an evidence-based prehospital and ED heat alert pathway to improve early diagnosis and resource mobilization. We also provide an evidence-based treatment pathway to facilitate efficient patient cooling. It is hoped that this protocol will improve care and help healthcare systems adapt to changing environmental conditions.

Training Clinical And Public Health Leaders In Climate And Health.

The effects of climate change are accelerating and undermining human health and well-being in many different ways. There is no doubt that the health care sector will need to adapt, and although it has begun to develop more targeted strategies to address climate-related challenges, a broad knowledge gap persists. There is a critical need to develop and cultivate new knowledge and skill sets among health professionals, including those in public health, environmental science, policy, and communication roles. This article describes specific initiatives to train future leaders to be proficient in understanding the linkages between climate change and health. We present an agenda for expanding education on climate and health through health professional schools and graduate and postgraduate curricula, as well as in professional and continuing education settings. Our agenda also identifies ways to promote sustainability in clinical practice and health care management and policy. Throughout, we cite metrics by which to measure progress and highlight potential barriers to achieving these educational objectives on a larger scale.

Climate Change, Migration, and Civil Strife.

PURPOSE OF REVIEW: In this article, we examine the intersection of human migration and climate change. Growing evidence that changing environmental and climate conditions are triggers for displacement, whether voluntary or forced, adds a powerful argument for profound anticipatory engagement. RECENT FINDINGS: Climate change is expected to displace vast populations from rural to urban areas, and when life in the urban centers becomes untenable, many will continue their onward migration elsewhere (Wennersten and Robbins 2017; Rigaud et al. 2018). It is now accepted that the changing climate will be a threat multiplier, will exacerbate the need or decision to migrate, and will disproportionately affect large already vulnerable sections of humanity. Worst-case scenario models that assume business-as-usual approaches to climate change predict that nearly one-third of the global population will live in extremely hot (uninhabitable) climates, currently found in less than 1% of the earth's surface mainly in the Sahara. We find that the post-World War II regime designed to receive European migrants has failed to address population movement in the latter half of the twentieth century fueled by economic want, globalization, opening (and then closing) borders, civil strife, and war. Key stakeholders are in favor of using existing instruments to support a series of local, regional, and international arrangements to protect environmental migrants, most of whom will not cross international borders. The proposal for a dedicated UN agency and a new Convention has largely come from academia and NGOs. Migration is now recognized not only as a consequence of instability but as an adaptation strategy to the changing climate. Migration must be anticipated as a certainty, and thereby planned for and supported.

Management and Outcomes of Acute Surgical Patients at a District Hospital in Uganda with Non-physician Emergency Clinicians.

INTRODUCTION: Acute surgical care services in rural Sub-Saharan Africa suffer from human resource and systemic constraints. Developing emergency care systems and task sharing aspects of acute surgical care addresses many of these issues. This paper investigates the degree to which specialized non-physicians practicing in a dedicated Emergency Department contribute to the effective and efficient management of acute surgical patients. METHODS: This is a retrospective review of an electronic quality assurance database of patients presenting to an Emergency Department in rural Uganda staffed by non-physician clinicians trained in emergency care. Relevant de-identified clinical data on patients admitted directly to the operating theater from 2011 to 2014 were analyzed in Microsoft Excel. RESULTS: Overall, 112 Emergency Department patients were included in the analysis and 96% received some form of laboratory testing, imaging, medication, or procedure in the ED, prior to surgery. 72% of surgical patients referred by ED received preoperative antibiotics, and preoperative fluid resuscitation was initiated in 65%. Disposition to operating theater was accomplished within 3 h of presentation for 73% of patients. 79% were successfully followed up to assess outcomes at 72 h. 92% of those with successful follow-up reported improvement in their clinical condition. The confirmed mortality rate was 5%. CONCLUSION: Specialized non-physician clinicians practicing in a dedicated Emergency Department can perform resuscitation, bedside imaging and laboratory studies to aid in diagnosis of acute surgical patients and arrange transfer to an operating theater in an efficient fashion. This model has the potential to sustainably address structural and human resources problems inherent to Sub-Saharan Africa's current acute surgical care model and will benefit from further study and expansion.

High-Amplitude Atlantic Hurricanes Produce Disparate Mortality in Small, Low-Income Countries.

OBJECTIVES: Hurricanes cause substantial mortality, especially in developing nations, and climate science predicts that powerful hurricanes will increase in frequency during the coming decades. This study examined the association of wind speed and national economic conditions with mortality in a large sample of hurricane events in small countries. METHODS: Economic, meteorological, and fatality data for 149 hurricane events in 16 nations between 1958 and 2011 were analyzed. Mortality rate was modeled with negative binomial regression implemented by generalized estimating equations to account for variable population exposure, sequence of storm events, exposure of multiple islands to the same storm, and nonlinear associations. RESULTS: Low-amplitude storms caused little mortality regardless of economic status. Among high-amplitude storms (Saffir-Simpson category 4 or 5), expected mortality rate was 0.72 deaths per 100,000 people (95% confidence interval [CI]: 0.16-1.28) for nations in the highest tertile of per capita gross domestic product (GDP) compared with 25.93 deaths per 100,000 people (95% CI: 13.30-38.55) for nations with low per capita GDP. CONCLUSIONS: Lower per capita GDP and higher wind speeds were associated with greater mortality rates in small countries. Excessive fatalities occurred when powerful storms struck resource-poor nations. Predictions of increasing storm amplitude over time suggest increasing disparity between death rates unless steps are taken to modify the risk profiles of poor nations. (Disaster Med Public Health Preparedness. 2016;10:832-837).