title: Emergency ambulance dispatches and apparent temperature: a time series analysis in Emilia-Romagna, Italy.
abstract: BACKGROUND
  Increases in mortality associated with oppressive weather have been widely investigated in several epidemiological studies. However, to properly understand the full public health significance of heat-related health effects, as well as to develop an effective surveillance system, it is also important to investigate the impact of stressful meteorological conditions on non-fatal events. The objective of our study was to evaluate the exposure-response relationship of ambulance dispatch data in association with biometeorological conditions using time series techniques similar to those used in previous studies on mortality.
  
  
  METHODS
  Daily data of emergency ambulance dispatches for people aged 35 or older in the summer periods from 2002 to 2006 were collected for the major towns in the Emilia-Romagna region. In the first stage of the analysis, the city-specific relationship between daily ambulance dispatches and increasing apparent temperature was explored using Generalized Additive Models while controlling for air pollution, seasonality, long-term trend, holidays and weekends. The relationship between ambulance dispatches and apparent temperature was approximated by linear splines. The effects of high temperatures on health were evaluated for respiratory and cardiovascular diseases as well as for all non-traumatic conditions. In the second stage of the analysis, city-specific effects were combined in fixed or random effect meta-analyses.
  
  
  RESULTS
  The percent change in the ambulance dispatches associated with every 1 °C increase in the mean apparent temperature between 25 and 30 °C was 1.45% (95% confidence interval: 0.95, 1.95) for non-traumatic diseases and 2.74% (95% CI: 1.34, 4.14) for respiratory diseases. The percent increase in risk was greater on days in which the mean apparent temperature exceeded 30 °C (8.85%, 95% CI: 7.12, 10.58 for non-traumatic diseases). In this interval of biometeorological conditions, cardiovascular diseases became positively associated with the apparent temperature. The risks increased with age. The increase in risk for the non-traumatic diseases reached 13.34% for people aged 75 or older compared to 4.75% for those aged 35-64.
  
  
  CONCLUSIONS
  Time series analysis techniques were adopted for the first time to investigate emergency ambulance dispatches to evaluate the risks associated with biometeorological discomfort. Our findings show a strong relationship between biometeorological conditions and ambulance dispatches.
authors.affiliation: Regional Agency for Environmental Protection of Emilia-Romagna, Regional Center for Environment and Health, Modena, Italy. ealessandrini@arpa.emr.it
authors.forename: Ester
authors.initials: E
authors.lastname: Alessandrini
authors.forename: Stefano
authors.initials: S
authors.lastname: Zauli Sajani
authors.forename: Fabiana
authors.initials: F
authors.lastname: Scotto
authors.forename: Rossella
authors.initials: R
authors.lastname: Miglio
authors.forename: Stefano
authors.initials: S
authors.lastname: Marchesi
authors.forename: Paolo
authors.initials: P
authors.lastname: Lauriola
mesh_terms: D000328:Adult; D000397:Air Pollution; D000552:Ambulances; D002980:Climate; D004632:Emergency Medical Services; D006801:Humans; D007558:Italy; D012621:Seasons; D013696:Temperature