Characteristics of Prehospital Heat Illness Cases During the Annual Heat Wave Period in Telangana, India

Abstract

Objectives: Global warming and more intense heat wave periods impact health. Heat illness during heat waves has not been studied in the prehospital setting of a low- and middle-income country (LMIC). Early intervention in the community and in the prehospital setting can improve outcomes. Hence, this paper aims to describe the characteristics of heat illness patients utilizing the ambulance service in Telangana state, India with the aim of optimizing public prevention and first aid strategies and prehospital response to this growing problem. Methods: This retrospective observational study reviewed patients presenting to Telangana’s prehospital emergency care system with heat illness symptoms during the heat wave period from March through June in 2018 and 2019. Descriptive analysis was done on the prehospital, dispatch, and environmental data looking at the patients’ characteristics and prehospital intervention. Results: There were 295 cases in 2018 and 230 cases in 2019 from March-June. The overall incidence of calls with heat illness symptoms was 1.5 cases per 100,000 people. The Scheduled Tribes (ST) had the highest incidence of 4.5 per 100,000 people. Over 96% were from the white income group (below poverty line) while two percent were from the pink income group (above poverty line). From geospatial mapping of the cases, the highest incidence of calls came from the rural, tribal areas. However, the time to response in rural areas was longer than that in an urban area. Males with an average age of 47 were more likely to be affected. The three most common symptoms recorded by the first responders were vomiting (44.4%), general weakness (28.7%), and diarrhea (15.9%). The three most common medical interventions on scene were oxygen therapy (35.1%), oral rehydration salt (ORS) solution administration (26.9%), and intravenous fluid administration (27.0%), with cold sponging infrequently mentioned. Conclusion: This descriptive study provides a snapshot of the regions and groups of people most affected by heat illness during heat waves and the heterogeneous symptom presentation and challenges with management in the prehospital setting. These data may aid planning of prehospital resources and preparation of community first responders during heat wave periods.

Prehospital Emergency Care in Low- and Middle-Income Countries: A Systematic Review

“…Also, difficult terrain or geography and challenging weather can greatly affect prehospital transport, which is evident in the findings of studies conducted in Sierra Leone, 81 Iran, 85 and India. 84 Most of the studies suggested that the health outcome following prehospital care in LMICs is generally poor. Survival following cardiac emergencies like OHCA and severe trauma was low.…”

“…Also, difficult terrain or geography and challenging weather can greatly affect prehospital transport, which is evident in the findings of studies conducted in Sierra Leone, 81 Iran, 85 and India. 84 …”

“…59,81,82 Factors that affected response times included the distance from the hospital, location, type of emergency, and ambulance mechanism. Additionally, several studies found that response times in rural areas were generally longer than those in urban areas [83][84][85] (Table 3 38,39,59,61,63,69,74,[79][80][81][82][83][84][85][86][87][88][89][90][91][92][93] ).…”