Implementation of the Montreal Heat Response Plan During the 2010 Heat Wave

Abstract

xtreme heat episodes result in significant morbidity, especially in northern latitudes or areas influenced by more temperate climates. 1,2 A recent meta-analysis showed that both environmental factors, such as the absence of air conditioning, and population risk factors, such as having cardiovascular or psychiatric co-morbidities, increase the probability of heat-related deaths. 3 Following the European heat wave of 2003, 15,000 excess deaths were reported in 12 European countries during the first week of August and approximately 24,000 during the second week. 4,5 This event prompted many countries to initiate or reinforce heat health watch warning systems to avoid high levels of excess mortality. 6,7 To counter the effect of extreme heat, the Montreal public health department has developed a heat response plan in collaboration with the regional and local public health network and municipal partners. This plan has been in effect since 2004. Its development was prompted by the large increase in mortality following the 2003 heat wave in Europe. Although preventive measures following Environment Canada's heat warnings have been issued to the population since 1994 and a communication campaign was initiated in 2002, the Montreal health department heat plan was undertaken by public health authorities to describe actions under different alert levels with local partners. Indeed, although the heat response plan is addressed to the public health network, public health actions are coordinated with municipal and civil security partners. Health and weather surveillance is an important component of the plan, both for immediate intervention and for updating the plan. These indicators serve as a basis for determination of different levels of action during the summer period. The main objective of the Montreal heat response plan (MHRP) is to reduce heat-related mortality and morbidity. In order to attain this objective, the plan must clearly identify and coordinate actions to be undertaken under different alert levels by partners at the regional public health and municipal level. The MHRP also serves as a guide for the health and social services network (e.g., hospitals or health and social services centres) to develop their own local heat plan for the people they serve. The following paper presents a brief overview of the Montreal heat response plan and its implementation in Montreal during the July 2010 heat wave, which was the first time the Intervention level was

A Difference-in-Differences Approach to Assess the Effect of a Heat Action Plan on Heat-Related Mortality, and Differences in Effectiveness According to Sex, Age, and Socioeconomic Status (Montreal, Quebec)

“…We also did not distinguish actions undertaken > 30°C. Moreover, the Montreal HAP has been revised and updated yearly since 2007 (Price et al 2013); this was not specifically considered in the present study. Further research could consider how incremental changes in policies affected mortality reduction, if at all.…”

“…The European heat wave of 2003 prompted the Montreal Public Health Department (PHD) to develop a HAP to reduce heat-related mortality and morbidity (Price et al 2013). Implemented in 2004, the HAP comprises a spectrum of interventions triggered at different alert levels based on temperature forecasts of Environment Canada.…”

“…Implemented in 2004, the HAP comprises a spectrum of interventions triggered at different alert levels based on temperature forecasts of Environment Canada. Important interventions undertaken as part of the HAP by the Montreal PHD and partners are triggered at the alert level (called “Active watch” level in the Montreal HAP), when daily temperatures exceed 30°C (Price et al 2013). These interventions include, for example, public advisories via different media about preventive measures, and intensified surveillance and implementation of preventive measures in health care facilities (Appendix 1).…”

“…The program is automatically triggered by meteorological conditions, and targets the entire population of the Island of Montreal. Although implemented in 2004, mortality attributable to heat continues to be observed in Montreal (Benmarhnia et al 2014b), with 105 heat-related deaths occurring during a 5-day heat wave in 2010 (Price et al 2013) suggesting the need to evaluate this program. Evidence about the effectiveness of the HAP is essential to improve this program.…”

A proposed case-control framework to probabilistically classify individual deaths as expected or excess during extreme hot weather events

“…Ultimately, however, it would be ideal if we could test and refine this approach in a context where other, more conventional epidemiologic methods have been used to identify excess deaths. For example, Price et al identified 106 of the 304 deaths as being heat-related via chart review after the 2010 event in Montreal [25]. Alternatively, the methods could be optimized using simulated data, in which the excess and expected deaths have been clearly defined.…”