Proposed Study OutofHospital Cardiac Arrests and Wildfires Sumi

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Proposed Study: Out-of-Hospital Cardiac Arrests and Wildfires Sumi Hoshiko, MPH Center for Healthy Communities

Proposed Study: Out-of-Hospital Cardiac Arrests and Wildfires Sumi Hoshiko, MPH Center for Healthy Communities California Department of Public Health California Conference of Local Health Officers Fall Semiannual Conference October 3, 2018 Ventura, CA California Department of Public Health

DISCLOSURES • No conflicts of interest The contents of this presentation are solely the

DISCLOSURES • No conflicts of interest The contents of this presentation are solely the responsibility of the author and do not necessarily represent the official views of the California Department of Public Health. The published research described in this presentation has been reviewed by the California Department of Public Health and approved for publication. Approval does not signify that the contents necessarily reflect the views and policies of the agency. California Department of Public Health

CDPH researchers are planning a health study of cardiac arrests and wildfires using data

CDPH researchers are planning a health study of cardiac arrests and wildfires using data from the surveillance system, Cardiac Arrest Registry to Enhance Survival (CARES) Respiratory outcomes typically seen in wildfire smoke studies, but inconsistent results for cardiovascular outcomes. California Department of Public Health

BACKGROUND AND SIGNIFICANCE Wildfire is a natural part of the ecosystem Climate change is

BACKGROUND AND SIGNIFICANCE Wildfire is a natural part of the ecosystem Climate change is increasing the wildfire season Wildfire-PM 2. 5 projected to increase 160%-400% in Western US in 2046– 2051 California Department of Public Health

INCREASING WILDFIRE RISK Acres burned each year 11, 000 9, 000 7, 000 5,

INCREASING WILDFIRE RISK Acres burned each year 11, 000 9, 000 7, 000 5, 000 3, 000, 000 1965 1985 2005 California Department of Public Health

Wildfires now contribute 20% of the particulate matter in ambient air pollution. California Department

Wildfires now contribute 20% of the particulate matter in ambient air pollution. California Department of Public Health

PARTICULATE MATTER IN THE LUNGS • Penetrates deep into the lung • Crosses into

PARTICULATE MATTER IN THE LUNGS • Penetrates deep into the lung • Crosses into the blood stream Wegesser TC et al, California wildfires of 2008: coarse and fine particulate matter toxicity. Environ Health Perspect. . 2009; 117: 893 -7 California Department of Public Health

Pathophysiology PM 2. 5 in lungs Autonomic system activation Systemic inflammation Direct bloodstream effects

Pathophysiology PM 2. 5 in lungs Autonomic system activation Systemic inflammation Direct bloodstream effects Blood clot formation Sources: Brook et al, 2004, Brook et al, 2010, Qasim et al 2017 15 -17 California Department of Public Health

Pathophysiology PM 2. 5 in lungs Autonomic system activation • • • Increased heart

Pathophysiology PM 2. 5 in lungs Autonomic system activation • • • Increased heart rate Cardiac dysfunction Arrhythmia Sources: Brook et al, 2004, Brook et al, 2010, Qasim et al 2017 Direct bloodstream effects Systemic inflammation • • • Coagulation factors Platelet activation Endothelial dysfunction Blood clot formation 15 -17 California Department of Public Health

Pathophysiology PM 2. 5 in lungs Autonomic system activation • • • Increase heart

Pathophysiology PM 2. 5 in lungs Autonomic system activation • • • Increase heart rate Cardiac dysfunction Arrhythmia Direct bloodstream effects Systemic inflammation Coagulation factors Platelet activation Endothelial dysfunction • • • Clinical outcomes: • Coronary artery disease • Pulmonary embolism • Stroke Clinical outcomes: • Heart failure • Cardiac arrest • Stroke Sources: Brook et al, 2004, Brook et al, 2010, Qasim et al 2017 Blood clot formation 15 -17 California Department of Public Health

PROPOSED RESEARCH In California in 2015 - 2017, were wildfires smoke exposures associated with

PROPOSED RESEARCH In California in 2015 - 2017, were wildfires smoke exposures associated with out-of-hospital cardiac arrests? A study using surveillance data from Cardiac Arrest Registry to Enhance Survival (CARES). CDPH research staff in collaboration with USEPA and CARES California Department of Public Health

DATA SOURCE: CARES SURVEILLANCE SYSTEM CARES -helping communities advance standard of care & increase

DATA SOURCE: CARES SURVEILLANCE SYSTEM CARES -helping communities advance standard of care & increase survival rates CARES initiated in 2004 as collaboration between Centers for Disease Control and Prevention and Emory University California Department of Public Health

CARES SURVEILLANCE SYSTEM CARES is a web-based data management system in which participating communities

CARES SURVEILLANCE SYSTEM CARES is a web-based data management system in which participating communities enter local data. • Emergency Department and Hospitalization Data • 911 dispatch data • EMS data California Department of Public Health

California Department of Public Health

California Department of Public Health

Current California CARES Participants

Current California CARES Participants

California Department of Public Health

California Department of Public Health

Counties solicited for study - CARES participant for at least one year between 2015

Counties solicited for study - CARES participant for at least one year between 2015 – 2017 Location of large wildfire or nearby De-identified data Alameda Amador Calaveras Contra Costa Mariposa Mendocino Napa San Francisco San Luis Obispo San Mateo Santa Barbara Solano Sonoma Stanislaus Ventura California Department of Public Health

Exposure data • NOAA Hazard Mapping System 18 • Daily PM 2. 5 -

Exposure data • NOAA Hazard Mapping System 18 • Daily PM 2. 5 - satellite imagery: PM 2. 5 range • Light 0 - 10 µg/m 3 • Medium 10. 5 - 21. 5 µg/m 3 • Dense 22+ µg/m 3 California Department of Public Health

EXPOSURE DATA 2015 – data from previous study PM 2. 5 # Smoky Days

EXPOSURE DATA 2015 – data from previous study PM 2. 5 # Smoky Days per County May 1 – Sept 30, 2015 Wettstein ZS, Hoshiko S, Fahimi J, Harrison RJ, Cascio WE, Rappold AG. Cardiovascular and Cerebrovascular Emergency Department Visits Associated With Wildfire Smoke Exposure in California in 2015. J Am Heart Assoc. 2018 Apr 11; 7(8). California Department of Public Health

Cardiovascular and other ER visits ↑ Risks from light, medium and dense smoke --

Cardiovascular and other ER visits ↑ Risks from light, medium and dense smoke -- Adults 65+ (results from previous study of California wildfires in 2015) California Department of Public Health

Additional information provided by CARES about how it works

Additional information provided by CARES about how it works

EMS Dataset • CARES event is: • Non-traumatic cardiac arrest • Resuscitation attempt by

EMS Dataset • CARES event is: • Non-traumatic cardiac arrest • Resuscitation attempt by 911 responder • 2 -3 min data entry • EMS entry “initiates” event

Hospital Component • CARES software emails the primary contact at destination hospital • When

Hospital Component • CARES software emails the primary contact at destination hospital • When CARES dataset is complete, identifiers are removed

CARES Automated Reporting: Hospital Benchmarking Report

CARES Automated Reporting: Hospital Benchmarking Report

Current CARES Participants

Current CARES Participants

Interested In Joining CARES? California CARES Coordinator – Joanne Chapman – joanne. chapman@sonoma-county. org

Interested In Joining CARES? California CARES Coordinator – Joanne Chapman – joanne. chapman@sonoma-county. org – 707. 321. 8665 Contact your Local EMS Agency (LEMSA)

THANK YOU! Questions? Sumi Hoshiko, MPH Caitlin Jones, MPH Sumi. Hoshiko@cdph. ca. gov California

THANK YOU! Questions? Sumi Hoshiko, MPH Caitlin Jones, MPH Sumi. Hoshiko@cdph. ca. gov California Department of Public Health

references 1. Westerling AL, Hidalgo HG, Cayan DR, Swetnam TW. Warming and Earlier Spring

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