Stormy weather: a retrospective analysis of demand for emergency medical services during epidemic thunderstorm asthma
Open accessAbstract
OBJECTIVES: To describe the demand for emergency medical assistance during the largest outbreak of thunderstorm asthma reported globally, which occurred on 21 November 2016. DESIGN: A time series analysis was conducted of emergency medical service caseload between 1 January 2015 and 31 December 2016. Demand during the thunderstorm asthma event was compared to historical trends for the overall population and across specific subgroups. SETTING: Victoria, Australia. MAIN OUTCOME MEASURES: Number of overall cases attended by emergency medical services, and within patient subgroups. RESULTS: On 21 November 2016, the emergency medical service received calls for 2954 cases, which was 1014 more cases than the average over the historical period. Between 6 pm and midnight, calls for 1326 cases were received, which was 2.5 times higher than expected. A total of 332 patients were assessed by paramedics as having acute respiratory distress on 21 November, compared with a daily average of 52 during the historical period. After adjustment for temporal trends, thunderstorm asthma was associated with a 42% (95% confidence interval 40% to 44%) increase in overall caseload for the emergency medical service and a 432% increase in emergency medical attendances for acute respiratory distress symptoms. Emergency transports to hospital increased by 17% (16% to 19%) and time critical referrals from general practitioners increased by 47% (21% to 80%). Large increases in demand were seen among patients with a history of asthma and bronchodilator use. The incidence of out-of-hospital cardiac arrest increased by 82% (67% to 99%) and pre-hospital deaths by 41% (29% to 55%). CONCLUSIONS: An unprecedented outbreak of thunderstorm asthma was associated with substantial increase in demand for emergency medical services and pre-hospital cardiac arrest. The health impact of future events may be minimised through use of preventive measures by patients and predictive early warning systems.
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On 21 November 2016, Melbourne, Australia, experienced a thunderstorm asthma health emergency that exceeded all previously reported thunderstorm asthma events.
“On the 21st of November 2016, Melbourne, Australia, experienced a thunderstorm asthma health emergency (106, 107) that exceeded all previously reported thunderstorm asthma events [mainly in the UK and Australia (135, 136)].”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [107]
Thunderstorm asthma is the outcome of a complex interaction between multiple factors but not necessarily any one of them individually.
““Thunderstorm asthma” (106, 107) is the outcome of a complex interaction between multiple factors but not necessarily any one of them individually.”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [107]
There was a 4.3-fold increase in emergency attendances for acute respiratory distress symptoms after adjustment for temporal trends.
“In addition to a 4.3-fold increase in emergency attendances for acute respiratory distress symptoms after adjustment for temporal trends (107), nine deaths over the subsequent 10-day period were attributed to asthma as the primary cause (137).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [107]
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- Authors
- Andrew, E., Nehme, Z., Bernard, S., Abramson, M. J., Newbigin, E., Piper, B., Dunlop, J., Holman, P., & Smith, K.
- Affiliations
- Ambulance Victoria (AU)
- The Alfred Hospital (AU)
- Monash University (AU)
- The University of Melbourne (AU)
- Corresponding author
- Andrew, Emily
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2017-12-13
- Volume
- 359
- Pages
- j5636
- ISSN
- 1756-1833 (ISSN-L)
- 0959-8138
- PMC
- PMC5727436
- OpenAlex
- W2772230228
- Cited by
- 77
- References
- 39
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 3 · 2023: 13 · 2022: 8 · 2021: 12 · 2020: 14 · 2019: 11 · 2018: 8
- FWCI
- 6.67
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Monash University Research Portal (Monash University) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Pfizer
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Keywords
- thunderstorm asthma, emergency medical services, emergency department demand, acute respiratory distress syndrome, prehospital cardiac arrest, out-of-hospital cardiac arrest, asthma, bronchodilator use, paramedic assessment, emergency transport, general practitioner referral, early warning systems, Victoria, Australia
- MeSH terms
- Adolescent, Adult, Aged, Asthma, Australia, Child, Child, Preschool, Disease Outbreaks, Emergency Medical Services, Female, Health Services Needs and Demand, Humans, Infant, Male, Middle Aged, Retrospective Studies, Weather, Young Adult
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