1. Department of Health The Heatwave Plan for 2010 Dr John Carnie Director, Health Protection Branch & Chief Health Officer

2. Heatwave conditions across Europe in August 2003 Excess Mortality: France 14,800 Italy 10,000 Spain & Portugal 5,000 Greatest impact felt in Paris with a 130% increase in expected mortality Heatwave: Europe August 2003

3. Urban Heat Island Effect

4. Risk Factors – Heatwave vulnerability Age >65 years, infants Pre-existing illness Unfit Overweight Some drugs e.g. anti-psychotics, diuretics Living alone Urban environment Type of housing Availability of air–conditioning Working or exercising outdoors

5. Health Effects

7. Estimates of confidence in projected changes in extreme weather and climatic events Changes in phenomenon Confidence in projected changes (during the 21st century) Higher maximum temperatures and more hot days over nearly all land areas Very likely Higher minimum temperatures, fewer cold days and frosty days over nearly all land areas Very likely Reduced diurnal temperature range over most land areas Very likely Increase in heat index (combination of temperature and humidity) over land areas Very likely in most areas

8. Victoria January 2009 4 day period from the 27/1 to the 30/1 with 3 days of temperatures in extreme range. Followed by a further extreme spike on 7/2/09 with subsequent catastrophic impacts associated with Black Saturday.

9. Lead up activity in January 09 Significant media for the Chief Health Officer in preparing the community in lead up Agreed health messages developed with Ambulance Victoria Nurse-on-call scripts revised Departmental Emergency Coordination Centre operating Agreement with Bureau of Meteorology to post Victorian heatwave alert on bureau web site - visited 38,517 times Engagement with Local Government’s with pilot Heatwave plans

10. Other activity undertaken Health, community and emergency service actions and responses to heatwave alert Identification of vulnerable individuals and their carers A communication strategy to initiate alert, response and recovery phases of the plan Community awareness and education component Post event rapid health impact assessment reviewing data from a range of sources - Chief Health Officer report

11. Chief Health Officer Report The population health impact of this extreme heat event was assessed by collecting available data from five different sources: –assessments by Ambulance Victoria (AV) metropolitan paramedics –Locum doctor visits by the Melbourne Medical Deputising Service (MMDS) –Public Hospital Emergency Department presentations as collected in the Victorian Emergency Minimum Dataset (VEMD) –reportable deaths to the State Coroner’s Office (SCO) and –death registrations collated by the Victorian Registry of Births, Deaths and Marriages (BDM). Data for the week of the heatwave, 26 January to 1 February 2009, was compared to the same period in previous years. The results of this analysis have shown that there was substantial morbidity and mortality related to the heatwave, with associated demands on health services.

12. Ambulance Ambulance Victoria metropolitan emergency case load: –a 25% increase in total emergency cases and a 46% increase over the three hottest days –a 34 fold increase in cases with direct heat-related conditions (61% in those 75 years or older); –a 2.8 fold increase in cardiac arrest cases.

13. Locum GP Locum GP attendances by MMDS: –an almost 4 fold increase in attendances for direct heat ‑ related conditions (65% in those 75 years or older); –an almost 2 fold increase in calls to attend a deceased person.

14. Emergency Departments Emergency Department presentations: –a 12% overall increase in presentations, with a greater proportion of acutely ill patients and a 37% increase in those 75 years or older; –an 8 fold increase in direct heat-related presentations (46% in those aged 75 years and over); –an almost 3 fold increase in patients dead on arrival (69% being 75 years or older).

15. Total All Cause Mortality Total all-cause mortality: –There were 374 excess deaths over what would be expected: a 62% increase in total all-cause mortality. –The total number of deaths was 980, compared to a mean of 606 for the previous 5 years. –The greatest number of deaths occurred in those 75 years or older, representing a 64% increase; –Included in these total deaths were 179 deaths reported to the State Coroner’s Office; a 77% increase from the 101 deaths reported for the same period in 2008. Reportable deaths in those 65 years and older more than doubled.

16. Mortality All deaths* between 26 Jan and 1 Feb Expected (mean of 2004-08) vs. Observed (2009) Total all cause mortality is 374 excess deaths (above expected)

17. Victorian Heatwave Strategy Sustainability Action Statement released in 2006 which committed to: develop a Victorian Heatwave Plan involving communities and local government build the capacity of communities and individuals to self manage their response to heatwaves develop a system to provide an appropriate level of coordinated support from health, community and emergency services identify and carry out required research to support these objectives in the longer term host a national climate change & health conference

18. Heatwave Plan for Victoria 2009-2010 Protecting health and reducing harm from heatwaves Details the roles & responsibilities of the government sector during a heatwave with reference to relevant agencies which interact with the government sector Brings together resources, actions, plans and initiatives to ensure a coordinated statewide approach to heatwaves

19. Plan actions include: Early detection and provision of warnings for forecast heatwaves Enhancement of services provided to people at risk of heat-related illnesses Delivery of consistent community messages about the serious health impacts of extreme heat and how people can protect themselves, their families and community –Targeting individuals most at risk, their carers and health and community service providers

20. 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 Management Arrangements activated

21. Consistent community heat health messages Significant media for the Chief Health Officer in preparing the community in lead up to heatwaves Heat health messages consistent between Ambulance Victoria, CFA, Victoria Police, Nurse-on-call Agreement with Bureau of Meteorology to post Victorian heatwave alert on bureau web site Community publications via service providers – e.g. LGAs, GPs, pharmacies, Information Victoria

22. Heat Health Surveillance

23. Pilot Projects The Department of Health provided funding for 22 councils to undertake a pilot planning process. The councils undertook planning to incorporate heatwave responses into municipal planning processes that met the needs of those members of their communities most at risk of heat related illness. These plans were trialled during January/February 2009 heatwaves.

24. Enhancement of Services A Heatwave Planning Guide has been developed and distributed to all Victorian Councils. The remaining 57 councils who had not been part of the pilot project were provided with grants to undertake a planning process using the guide.

25. Local Heatwave Plans

26. Core Elements of Heat Action Plans (from “Heatwave Plan for England” 2009) Agree a lead body to coordinate multi-agency collaboration Accurate and timely alerting systems Reduce indoor heat exposure (short to medium term) Particular care for vulnerable groups Preparedness of the health and social care system Heat related health information plan Long term urban planning Real time surveillance and evaluation

27. Proposed next steps Review the Heatwave Plan for Victoria after every summer and continuously modify and revise to ensure its effectiveness in minimising the public health impact of heatwaves Health and community service professionals awareness and education program