Heatwaves And Emergency Departments in Italy (HEAT-ED IT) : strategies to identify determinants of overload and mitigate impact

Due to global warming and climate change, periods of unusual heat called heatwaves are increasing in frequency and intensity, pose an important risk for population health and are associated with an increased demand for emergency care. This overload on prehospital emergency medicine (PHEM) and emergency departments (EDs) during heatwaves has been retrospectively confirmed, but evidence on how to mitigate this effect still needs to be provided. This PhD project aimed at finding the factors causing PHEM and ED overload during heatwaves using qualitative methods. First, an online Delphi study included 15 experts in emergency medicine, disaster medicine, or public health. Thirty-one statements were obtained after content analysis. The experts agreed on 18 statements, mostly focusing on the input section of patient processing and identifying stakeholders, the population, and primary care as targets of potential interventions. Since the re-sults of the Delphi study mainly dealt with the ED, a multicentric study using semi-structured interviews was performed to shed light on PHEM systems. Thirteen PHEM doctors and nurses working in Veneto region, Northern Italy, were interviewed. After content analysis, their perspectives were categorized in: perception of heatwaves; clinical impact of heatwaves; social factors and heatwaves; heatwaves and emergency medical service (EMS). According to the interviewees, the strain on EMS during heatwaves may be partially reduced by interventions targeting vulnerable populations, primary care, social networks, and education and information. Specific actions could fol-low the surge science principles of staff, stuff, structure, and system to help policymakers improve EMS surge capacity planning, preparedness, and response against heatwaves. Overall, these findings could be used in the future to implement heat-health action plans and reduce emergency care dysfunction during heatwaves.