title: Forest Fire Smoke Exposures and Out-of-Hospital Cardiac Arrests in Melbourne, Australia: A Case-Crossover Study.
abstract: BACKGROUND
  Millions of people can potentially be exposed to smoke from forest fires, making this an important public health problem in many countries.
  
  
  OBJECTIVE
  In this study we aimed to measure the association between out-of-hospital cardiac arrest (OHCA) and forest fire smoke exposures in a large city during a severe forest fire season, and estimate the number of excess OHCAs due to the fire smoke.
  
  
  METHODS
  We investigated the association between particulate matter (PM) and other air pollutants and OHCA using a case-crossover study of adults (≥ 35 years of age) in Melbourne, Australia. Conditional logistic regression models were used to derive estimates of the percent change in the rate of OHCA associated with an interquartile range (IQR) increase in exposure. From July 2006 through June 2007, OHCA data were collected from the Victorian Ambulance Cardiac Arrest Registry. Hourly air pollution concentrations and meteorological data were obtained from a central monitoring site.
  
  
  RESULTS
  There were 2,046 OHCAs with presumed cardiac etiology during our study period. Among men during the fire season, greater increases in OHCA were observed with IQR increases in the 48-hr lagged PM with diameter ≤ 2.5 μm (PM2.5) (8.05%; 95% CI: 2.30, 14.13%; IQR = 6.1 μg/m(3)) or ≤ 10 μm (PM10) (11.1%; 95% CI: 1.55, 21.48%; IQR = 13.7 μg/m(3)) and carbon monoxide (35.7%; 95% CI: 8.98, 68.92%; IQR = 0.3 ppm). There was no significant association between the rate of OHCA and air pollutants among women. One hundred seventy-four "fire-hours" (i.e., hours in which Melbourne's air quality was affected by forest fire smoke) were identified during 12 days of the 2006/2007 fire season, and 23.9 (95% CI: 3.1, 40.2) excess OHCAs were estimated to occur due to elevations in PM2.5 during these fire-hours.
  
  
  CONCLUSIONS
  This study found an association between exposure to forest fire smoke and an increase in the rate of OHCA. These findings have implications for public health messages to raise community awareness and for planning of emergency services during forest fire seasons.
authors: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors: Martine
authors: M
authors: Dennekamp
authors: Lahn D
authors: LD
authors: Straney
authors: Bircan
authors: B
authors: Erbas
authors: Michael J
authors: MJ
authors: Abramson
authors: Melita
authors: M
authors: Keywood
authors: Karen
authors: K
authors: Smith
authors: Malcolm R
authors: MR
authors: Sim
authors: Deborah C
authors: DC
authors: Glass
authors: Anthony
authors: A
authors: Del Monaco
authors: Anjali
authors: A
authors: Haikerwal
authors: Andrew M
authors: AM
authors: Tonkin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000009:adverse effects*; D018592:Cross-Over Studies; D004781:Environmental Exposure; D005260:Female; D005390:Fires; D065928:Forests; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology* / Q000209:etiology; D010316:Particle Size; D052638:Particulate Matter / Q000009:adverse effects*; D012737:Sex Factors; D012906:Smoke / Q000009:adverse effects*; D014739:Victoria / Q000453:epidemiology
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D012906:Smoke