[Impact of extreme temperatures on primary care requirement in France: the CHAUFOS Study (2010-2018).] / Impact des températures extrêmes sur la demande de soins primaires en France : l'étude CHAFO (2010-2018).

INTRODUCTION: The health impact of cold and hot waves is major. Nevertheless, the respective impact of extreme high and low temperatures remains controversial. METHOD: The daily number of (1) patients managed by SAMU 93 dispatching centre – primary care requirement indicator, (2) Mobile Intensive Care Unit (MICU) interventions – patient severity indicator and (3) number of deaths have been recorded. Daily minimum and maximum temperatures were recorded from 2010 to 2018. The analysis covered the 10 warmest and coldest days of each year (2 × 70 days), and the 30 warmest and coldest days of the total period (2 × 30 days). RESULTS: Over 2,702 days, 1,513,070 patients, 89,478 MICU interventions and 7,350 deaths were analysed. Median temperature: 16.0[10.4-21.6]°C.The coldest days were associated with a significant increase in patients managed (665[609-764] vs 538[474-619]; P < 0.001), MICU interventions (35[32-39] vs 33 [28-38]; P = 0.006) and deaths (3[2-5] vs 2[1-4]; P = 0.0008) considering the 10 days of extreme temperatures in each year and a significant increase in patients managed 615[580-698] vs 542[475-627]; P < 0.001) considering the 30-day extreme of the period.The hottest days were associated with a significant decrease in patients managed (484[443-549] vs 538[474-619]; P < 0.001), MICU interventions (31[25-37] vs 33[28-38]; P = 0.006) and deaths (2[1-3] vs 2[1-4]; P = 0.0008) considering the 10 extreme days of each year and a significant decrease in patients managed (536[479-576] vs 542[475-627]; P < 0.001) considering the 30 extreme days of the period. CONCLUSION: Primary care requirement, number of severe patients and mortality increased significantly with extreme low of temperature.

[Impact of the Air Quality on Health - Analysis of the activity of a SAMU-Center 15 in Paris area - the IQUASS Study]. / Impact de la QUalité de l'Air sur la Santé ­ Analyse de l'activité d'un SAMU-Centre 15 d'Île-de-France ­ Étude IQUASS.

INTRODUCTION: The atmospheric pollution is a growing public health problem. The highly urbanized regions such as Paris area seem particularly exposed. However, the overall health impact is poorly documented. OBJECTIVE: To investigate the influence of air quality degradation on the demand for primary care. METHOD: Site: medical dispatching center SAMU 93-Center 15. Related population: 1.6 million inhabitants. DATA: daily number of medical regulation records (DRM) and daily air quality index (AQI) using the Airparif® database from January 2014 to February 2017. The AQI is classified into five levels. Level 4 corresponds to the threshold of information and recommendations to reduce certain sources of polluting emissions and level 5 to the alert threshold setting up measures of restriction or suspension of the activities contributing to the pollution including vehicles circulation. RESULTS: The analysis covered 1134 consecutive days and a total of 639,576 DRM. Average daily DRM number: 564 (507-643). IQA≥4 for 56 (5%) days and≥5 for 4 (0.4%) days. The number of DRM was very closely correlated with the IQA (R2=0.91); the daily median varied from 502 (494-621) for an IQA of level 1 to 650 (540-704) for an IQA≥4. CONCLUSION: Degradation of air quality was significantly correlated with demand for primary care. The environmental alert is also a health alert. The impact was major (DRM +30%) considering all pathologies, all the pollutants on a departmental scale.

Impact of a general practitioners' strike and of terrorist attacks on a call centre.

OBJECTIVE: We aimed to evaluate the impact of the same-day GPs' strike and terrorist attacks on a call centre's activity. METHODS: We compared the number of calls received, the number of patient's medical files (PMFs) created and the number of mobile ICU (MICU) dispatched per hour on Friday, 13 November, to the repository established on the five previous Fridays. As previously published, the variation criterion was set to an activity variation above 20% for more than 2 h. RESULTS: On Friday, 13 November, 1745 calls were received compared with 1455 calls, on average, for the five previous Fridays. The number of calls received increased after the terrorist attacks (≤90%) and remained above the threshold for 3 h. The number of PMFs exceeded the threshold from 10:00 a.m. to 05:00 p.m., but was not affected by the attacks. The number of MICUs dispatched exceeded the threshold (>500%) in the first hour after the attacks. CONCLUSION: The GPs' strike and the terrorist attacks did not impact our call centre's activity in the same manner. The strike increased the number of PMFs without increasing the number of calls received. The attacks increased the number of calls received and MICU dispatched without increasing the number of PMFs. Many markers are at the disposal of call centres to evaluate the impact of healthcare events.