A deadly Australian Heatwave in 2009: Planning to Prevent Heatwave Health Impacts

Dr Simon Slota-Kan – Environmental Health Unit

Department of Health, State Government of Victoria

Australia

Victoria’s Heatwave Framework

Climate change impacts on Victoria, Australia

Regional climate change has occurred

Since 1950s, 0.9°C warming• Increased hot days/nights,

decreased frosts• Decrease in rain in southern and

eastern Australia• Sea level risen 70mm.

Increased extreme events

Droughts, heatwaves, fires, floods, cyclones and hail

Heatwaves

Heatwave:

a period of abnormally and uncomfortably hot weather that could impact on human health, community infrastructure and services

Expected to increase in frequency and magnitude

Potentially catastrophic impacts:

35,000 excess deaths in Southern Europe 2003374 excess deaths in Victoria 2009

Challenge to recognise vulnerable groups, and to measure incidence of heat-related illness.

Chief Health Officer Report

The population health impact of 2009 heatwave was assessed by collecting available data from five different sources:

Assessments by Ambulance VictoriaLocum doctor visits Public Hospital Emergency Department presentations Reportable deaths to the State Coroner’s OfficeDeath registrations collated by the Victorian Registry of Births,

Deaths and Marriages.Data was compared to the same period in previous years and

shows substantial morbidity and mortality with associated demands on health services.

Available at: http://www.health.vic.gov.au/chiefhealthofficer/publications/heatwave.htm

Mortality related to heat

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*Deaths data from BDM and reports to SCO

All deaths* between 26 Jan and 1 Feb Expected (mean of 2004-08) vs. Observed (2009)

Graph demonstrating the relationship between extreme heat and increased mortality

Risk Factors – heatwave vulnerability

Age >65 years, infants

Pre-existing illness

Unfit

Overweight

Some drugs e.g. anti-psychotics, diuretics

Living alone

Working or exercising outdoors

Type of housing

Availability of air–conditioning

Urban environment

Melbourne Urban Heat Island Temperatures at 1 am on 23 March 2006 Local council heatwave plans

• Councils funded A$1.99 M to develop local heatwave plans

• Heatwave Planning Guide developed and distributed to all Victorian councils to support local plan development

-background-preparing a plan-communication strategy-recommended elements of a plan-heatwave planning checklistAvailable at:http://www.health.vic.gov.au/environment/heatw

ave/agencies/projects.htm#guide

Heatwave Plan for Victoria 2009-2010Protecting health and reducing harm from heatwaves

• Details the roles & responsibilities of the government sector during a heatwave with reference to relevant agencies

• Brings together resources, actions, plans and initiatives to ensure a coordinated state-wide approach to heatwaves

• Elements include heat health alert system, local government planning, community registers, public heath messaging and communication resources, heat health intelligence surveillance system

• http://www.health.vic.gov.au/environment/downloads/heatwave_plan_vic.pdf

Heat threshold for Melbourne

Daily death rates (per 100,000 persons) of

over 64-year-olds in Melbourne,

for 2°C ranges of mean

temperature

Nicholls et al 2007.

Heat thresholds for regional Victoria (Loughnan et al 2009)

10%3518%44Mildura (Mallee)

18%285%32Ballarat(Central highlands)

15%3036%43Shepparton(Goulburn)

15%2810%40Geelong (Barwon)

7%3015%38Lakes Entrance(East Gippsland)

7%345%42Hamilton(Western District)

10%3210%38Horsham(Grampians)

18%3016%36Latrobe Valley (Gippsland)

None identified 3020%40Wodonga (Hume)

18%328%40Bendigo (Loddon)

Mortality increaseMeanTMortality

increaseTmax

Threshold temperatureMajor centre (SD)

Early detection and warnings for forecast heatwaves

• Heat health alerts issued up to 6 days ahead of forecast heatwave

• Heatwave defined as mean temp 30°C or above for Melbourne, 32°C or above for Mildura area

• If heatwave declared an emergency, existing State Emergency ManagementArrangements activated

Consistent community heat-health messages

• Community publications via service providers – e.g. Councils, GPs, pharmacies, Information Victoria, Seniors Victoria

• Heat-health messages consistent between Ambulance Victoria, CFA, Victoria Police, Nurse-on-call

Enhancement of Services

Funding of $1 million towards new and expanded community registers

Support to services that provide health and wellbeing checks including the ‘Keeping in Touch’program and Personal Alert Victoria

Residential ages care heatwave ready resource has been developed to support residential aged care service providers put heatwave plans in place

Fact sheet for clinicians

Heat health surveillance system (during a heatwave)

Melbourne Medical Deputising Service (MMDS)

State Coroner’s Office

Nurse-on-call

Ambulance Victoria

Registry of Births, Deaths and Marriages

MMDS (After Hours General Practitioners)

Figure 1: MMDS total service call outs, Melbourne.

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MMDS (After Hours General Practitioners)

Figure 2: MMDS heat-related service call outs, Melbourne.

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Heat-related call outs Mean temperature Heatwave threshold

Nurse-on-Call

Figure 4: Heat-related Nurse on Call phone calls, Victoria.

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Total no. calls Heatwave threshold Mean temperature

State Coroner’s Office

Figure 3:Death referrals to the State Coroner, Melbourne.

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Total no. referrals Mean temperature Heatwave threshold

Ambulance Victoria

Figure 5: Total ambulance priority dispatch cases, Melbourne.

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Total no. cases Mean temperature Heatwave threshold

Heatwaves and Code Red

Messages developed to clarify different approaches between heatwave and fire responses

Bushfire safety takes precedence and may require relocation

Heatwave management does not require relocation

Next Steps

Evaluation of Victoria’s heatwave framework and its components

Review the Heatwave Plan for Victoria after every summer to ensure its effectiveness in minimising the public health impact of heatwaves

Health professionals awareness and education program – strategy being developed

Acknowledgements and Resources

Miranda Fraser-Adams & Environmental Health Unit Department of Health Victoria

Community resources, brochure, posters, fact sheets

http://www.health.vic.gov.au/environment/heatwave/agencies/resources/index.htm

http://www.health.vic.gov.au/environment/heatwave/agencies/resources/poster.htm

Heat wave ready resource for aged care facilities

http://www.health.vic.gov.au/agedcare/publications/racsheatwave/index.htm

Heatwave fact sheet for clinicians

http://www.health.vic.gov.au/environment/heatwave/agencies/professionals.htm

An EHO’s Role & Response to an Australian Bushfire

- a Natural DisasterIngrid Makowski

Senior Environmental Health Officeri.makowski@yarraranges.vic.gov.au

40 km

20 km

40 km

20 km Healesville

Lilydale Warburton

Yarra Glen

UpweyMonbulk

Yarra Junction

Melbourne

20.000

kilometers

Warragul

Pakenham

Portsea

Queenscliff

Geelong

Werribee

BacchusMarsh

Melton

Whittlesea

Frankston

PortPhillipBay

Shire of Yarra Ranges

Satellite image of Melbourne and surrounds

Dates Captured: 27 March and 22 April 2009Satellite: Landsat 5

Courtesy: Herald Sun

Courtesy: Herald Sun

Courtesy: Herald Sun

Preparation

• Municipal Emergency Management Plan• Public Health Sub-plan

– Derived from Environmental Health Aust. (EHA) template

– Co-ordinator & Deputies – Our Responsibilities– Standard Operating Procedures

Preparation

• Annual Involvement

– Review of Emergency Management Plan

– Inspection of relief centres

– Participate in training exercises in Municipal Emergency Co-ordination Centre (MECC)

Incident - 7 February 2009 Black Saturday

MECCRelief Centres

Short Term Relief Centres

Temp. Camp Ground

Incident - Statistics • Population: 149,000 • Approx. 5,000 affected • 12 deaths (Statewide 173)• 194 houses destroyed • 482 sq kms (186 sq miles) burnt - 20% of Shire• 2nd worst affected Shire in the State• Municipal Emergency Co-ord Centre (MECC)

open for 27 days

• 8 Shire EHOs + 14 EHOs from other Councils

Incident - Operational Hours• Day 1 - 4 24 hours/day • Day 5 - 27 8 am - 8 pm

• 1 EHO in MECC • 1 EHO in 2 Relief Centres

Briefings at

9 am & 3 pm

Environmental Health Officer (EHO) Role

• Initial Response – Support to ‘regain’ human dignity

• Personal Hygiene• Water & Food

• Secondary Response– Support for Safe Living Environment

• Water & Food • Housing• Disease Prevention

EHO - MECC• Drinking water• Medical assistance at Relief Centres

– Drs rostered via local GP Association– St John’s Ambulance

• Liaising with Red Cross - food service• Organise field staff• Rubbish disposal • Health information for local media

EHO - Relief Centres

• Drinking water• Additional local refrigeration• Medical assistance • Rubbish disposal• Donated food• Food prep supervision (Red Cross)• Community showers/toiletries

EHO - Relief Centres

• Answer residents questions– water

• safety of existing tank water • replacement of supplies

– food – waste water disposal - septics– asbestos

• Personal Protective Equipment (PPE) Kits

EHO in the Field

• High visual tabards • Logo on vehicles

Water - Quality & Amenities

• Rural area – tank, creek, bore, dam, aqueduct, mains

• Drinking water collection points – 4 locations - bottled water & stand pipe

• Water deliveries - bottled & water tanker• Temporary toilets & showers

– 3 locations

Information to Residents

• State Dept. of Health advice sheets – disconnect downpipe to water tank– safety of water (ash/debris)– cleaning of water tanks– asbestos – treated pine - CCA timber

(copper, chrome, arsenate)

Information to Residents• State Dept. of Health advice sheets

– Household repairs/tools of the trade funding– Counseling services

• State Department of Primary Industry– Dam water information

• Yarra Ranges Council– Location of water supply– Small business information

AsbestosCCA timber (treated pine)- copper, chrome, arsenate

Dam water fact sheets (Department of Primary Industry)

Home Visits• Should home visits be done?• If so, when?

• EHO resource kits

Home Visits• Teams of 2 EHOs• Information packs for residents • 240 visits conducted• Personal Protective

Equipment Kits• Survey forms

• “LISTENERS”

Waste Water Management - Septic Tanks & Drains

• Sub surface installations not affected• Treatment plants

– above ground connections melted

Dead Stock Disposal • Poultry Farm

– 50,000 dead chickens– Supervision of stock burial

Temporary Camping Sites

• Army tents

Recovery & Rebuilding

• 1 dedicated EHO (12 months)– septics and rebuilding

• 200+ site visits • >100 permits issued

• 2 temporary EHOs (12 months)

Reviewed Council Emergency Management Plan

• Reviewed Council Emergency Mgt Plan – Endorsed by Council June 2010– Shorter + referenced appendices– Web site link:http://www.yarraranges.vic.gov.au/General/Search_

Results?keyword=emergency+management+plan

Reviewed Council Emergency Management Plan• More EHO involvement with Council’s

Emergency Management Team – Planning and Review

• Relief Centre(s) - Location & Facilities– Water & Power supply– Showers/toilets/kitchen– Suppliers of resources

• hygiene resources/toiletries, water etc…

Reviewed Public Health Emergency Management Plan

• Strategic Public Health Emergency Management Plan for all emergencies

• Role & Responsibility Statement• Standard Operating Procedures• Update resources/contact list

Reviewed Public Health Emergency Management Plan• Memo of Understanding

– Other Councils - EHOs– Medical Services e.g. Local GP Association– Fire Fighting Authorities

• camp sites - food/accommodation

• Reviewed Public Health Plan - January 2010

Post Event Improvements

• Roster work - with max. 8 hour shifts• EHO(s) in Co-ordination Centre

– Emergency operations only• Note issues of consequence

– Emergency Management Plan

Post Event Improvements

• Improve Communication – handover in & between Co-ord & Relief Centre/s

• Review with staff - ‘training’/scenario

• Laptop with remote access

How it Affected Us

• Fears– What would I see/hear?– Would my EHO knowledge be adequate?– How would I cope?

How it Affected Us

• Some staff living in areas under fire threat• Tiredness/memory loss/lack of patience• 3am “Bright Idea Syndrome”• “Stunned Salmon” effect• “Hitting the Wall”• Time Out

Summary• Decision making in a dynamic situation

• Using established public health principles – Preventing illness– Safe living environment

• EHO care (physical & emotional)

• As an EHO we can make a difference to our community

Heat WaveEducating a Community

Ingrid MakowskiSenior Environmental Health Officer

i.makowski@yarraranges.vic.gov.au

2009 Heatwave Plan

• State Govt funding to Councils (one off)• Plan to be completed within 5 months

– Prior to summer 2009/2010– Support Government messaging– Assess local risks– Address local needs

Vulnerable Groups• Elderly• Unwell• Young• Disabilities• Living in caravans• Lack of cooling facilities

– or not using fans/air conditioners• Isolated

Reaching the Community

• Support State Government messaging

• Survey vulnerable residents – Receiving home care services– Aged and/or with disabilities

• Improve community resilience– Encouraging people to look after each other

Council Initiatives

• “Beat the Heat” flyers - 22,000• “Beat the Heat” information in Council

newsletter to 30,000 households • Survey - council clients• Children’s drawing• Modified work practices for home care

workers

Flyer• 17,000 Mail out with

rate notice in November

• 2,000 - home care services & maternal child health

• 3,000 - shops– Food– Hardware– Timber yards– Opportunity shops– Council service centres

Flyer• Information to

general public

• Cost: 9 cents per notice ($A ≈ $CAN)

Survey

• “How do you Cope with the Heat?” survey• People receiving home & community

support• 1786 sent out• 41% returned• Results: 72 % coped well,

28 % did not cope well

Children’s Drawing

• Improve children’s awareness

• Distributed via Children’s Week activities

Heatwave Strategy & Action Plan 2010-2015

• Council developed this year– Strategy for next 5 years

• Reviewed after 5 years or after Heatwave ‘incident’

• Action plan reviewed annually– Risk management for Council Staff– Relief centre/s only opened if there a

declared emergency• Similar to forest fire