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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
England's Heatwave Plan has probably made a difference
- Mike W Gill, Brian McCloskey (11 August 2006)
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Heat waves and hospital staff
- J Cleo Oliver, Venkat S.S. Neelapala (16 August 2006)
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Part of the problem, or part of the solution ?
- Jon M Orrell (18 August 2006)
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Mike W Gill, Regional Director of Public Health Department of Health, SW1 2NS, Brian McCloskey
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Your editorial ‘Heatwaves and Health Protection (Kovats 12th August) raises some important issues about public health action in response to severe weather. The article states that in July the UK experienced a more severe heatwave than in 2003. In fact while the ‘average’ temperature for July broke all records for any month, the temperatures in 2003 were higher for longer. This distinction is recognised in the Heatwave Plan for England where alerts are based on duration as well as on day- and night- time temperature. It is obviously very early to be drawing firm conclusions about the impact of the Plan, just over two weeks after the last ‘Level 3’ in England, but we are currently carrying out a rapid evaluation. There are some signs that it may well have had the intended effects. Preliminary reports from Inspectors and Regulation Managers in the Commission for Social Care Inspection, for example, suggest a high level of awareness among care home managers and staff about what to do - with many homes taking special steps to keep residents hydrated, cool with fans, and out of the sun. The increase in heat and sun stroke-related calls to NHS Direct was a little less than the peak levels experienced during August 2003, and at the peak of temperatures, still accounted for less than 1% of all calls. Reports of heatstroke during the hottest week amounted to only 30 cases from 460 practices (HPA - QRESEARCH Bulletin 89, week 30). As Kovats states, vulnerable people need to be actively identified and cared for in a heatwave and this is what we have built into the Plan. Kovats says there is ‘much confusion about identifying people at risk as well as the specific advice to be given’ but it is not clear on what basis she says this. Our early impressions are that some of the very specific advice in the Plan has been well understood and acted upon - to the benefit of some of the most vulnerable. She is right that we do not have real time mortality data. Improvements in the systems for handling death registration data nationally may help from next year. What data we do have for July is impossible to interpret, but at a national level variation appears to be within normal limits. Further analysis including regional age-specific analysis will will be completed as soon as data become available over the next few weeks. Kovats is also right to highlight that climate change needs to be taken into account in health protection – this is a significant public health challenge we must acknowledge. This year the Heatwave Plan was launched with much encouragement to those responsible for its implementation to ‘mainstream’ it, and get it perceived in the same sort of light as the Pandemic Flu plan. Those individuals and organisations with responsibility for enhancing our overall resilience need to ‘own’ the Plan. Fortunately the July Heatwave did not reach the highest level, level 4. In future years it may well. As Kovats implies, it is not just the health service and social care which need to be prepared. Competing interests: Mike Gill was the main architect of the Heatwave Plan for England |
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J Cleo Oliver, SpR General Surgery Gwynedd Hospital, Bangor, LL57 2PW, Venkat S.S. Neelapala
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Editor – We read with interest Kovats’ review of the impact of the recent heat wave on public health[1]. We noticed several patients on the general surgical ward during this period with fevers up to 38ºC but normal inflammatory markers. This led us to investigate the temperatures of the staff in the hospital. We assessed the tympanic temperature, using the Kendall Genius First Temp Tympanic Thermometer, of 21 members of staff at 8:30 pm on 19th July 2006, the end of the hottest day in North Wales. A few weeks later on a cold day, temperatures were taken at the same time of day from 10 further staff members. Out of the 21 temperatures recorded on the hot day, only 4 were normal (below 37ºC). The mean temperature was 37.33 ºC and the maximum temperature was 37.9 ºC. Among the temperatures recorded on the cooler day, the mean temperature was 36.36 and the maximum temperature was 37. The difference between the 2 samples was statistically significant using an unpaired t test (p<0.001). Although are our sample sizes are small there is statistically significant evidence to show unexpectedly high temperatures in healthy staff members during the recent heat wave. This may be due to the sudden increase in temperature after a long cold winter in North Wales. These results are important to remember when managing patients with high temperatures but normal inflammatory markers during a heat wave to avoid inappropriate use of antibiotics. 1. Kovats, R.S., Heat waves and health protection. BMJ, 2006. 7563: p. 314-5. Competing interests: None declared |
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Jon M Orrell, GP Royal Crescent Surgery, Weymouth, Dorset, DT34BG
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The best health protection that the medical system could deliver would be to cease contributing to the problem, rather than waiting for the next heatwave. As the article correctly states; inefficient air conditioning is not the answer, as this contributes to burning fossil fuels and raises the temperature of the planet. We must design energy efficient buildings using passive and active solar energy, high insulation standards and renewable power generation. Avoidance of car use and switching to walking, cycling and use of public transport by doctors and nurses would also help. We can all take direct individual action in our homes and corporately in our Hospital design to prevent global warming. "Small things thave such massive consequences that I am tempted to think there are no small things" Anon. Competing interests: None declared |
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