Extreme weather - City of Ottawa

Report to/Rapport au :
Ottawa Board of Health
Conseil de santé d’Ottawa
March 18, 2013
18 mars 2013
Submitted by/Soumis par:
Dr./Dre Vera Etches
Acting Medical Officer of Health/Médecin chef en santé publique interim
Contact Person / Personne ressource:
Siobhan Kearns,Manager/Gestionnaire
Environment, Health Protection & Outbreak Management / Direction de
l'environnement, de la protection de la santé et de la gestion des éclosions
Ottawa Public Health/Santé publique Ottawa
613-580-2424, ext./poste 23483, [email protected]
CITY WIDE / À L’ÉCHELLE DE LA VILLE
SUBJECT:
EXTREME WEATHER IN OTTAWA
OBJET :
CONDITIONS EXTRÊMES À OTTAWA
Ref N°: ACS2013-OPH-EHP-0002
U
REPORT RECOMMENDATIONS
That the Board of Health for the City of Ottawa Health Unit receive this report for
information.
RECOMMANDATIONS DU RAPPORT
Que le Conseil de santé de la circonscription sanitaire de la ville d’Ottawa
prenne connaissance du présent rapport à titre d’information.
EXECUTIVE SUMMARY
Environmental factors, such as extreme heat, extreme cold, ultraviolet radiation and
the quality of the air we breathe, can have a negative impact on individual’s
health. Extreme weather can exacerbate pre-existing conditions, such as heart
disease, respiratory problems and diabetes, putting certain residents at higher risks. In
addition, the elderly, children and the homeless are often more vulnerable in extreme
weather events because of their reduced ability to regulate body temperature,
restricted mobility, or limited access to warm or cool indoor areas.
Each year in Ottawa there are approximately 40 emergency room visits directly related
to exposure to extreme heat, such as heat exhaustion and heat stroke and
approximately 60 visits per year directly related to extreme cold, such as hypothermia
and frostbite. However, most of the adverse health effects of extreme weather are a
result of aggravation of heart disease and/or respiratory problems, which results in
additional visits to hospitals.
Given the burden that extreme weather can have on health, especially the health of
some of the most vulnerable, Ottawa Public Health (OPH) works with other City
departments to ensure the public, media and partners who work directly with
vulnerable populations are informed about extreme weather events. More specifically,
OPH issues public notifications when the weather is forecasted to exceed a Humidex
of 40 or a windchill of -35 or lower. OPH also informs residents when the air quality in
the Ottawa-Gatineau region is poor and when UV index is high to ensure that residents
are aware and can take steps to protect themselves. Ottawa residents can also receive
live extreme weather updates via OPH’s Twitter account @ottawahealth.
RÉSUMÉ
Les facteurs environnementaux tels qu’une chaleur torride, un froid sibérien, les
rayons ultraviolets et la qualité de l’air peuvent être néfastes pour la santé. Des
phénomènes météorologiques extrêmes peuvent exacerber des problèmes
préexistants, comme une maladie cardiaque, des troubles respiratoires ou le diabète.
Par conséquent, certaines personnes sont plus vulnérables que d’autres. En outre, les
aînés, les enfants et les sans-abri sont souvent plus susceptibles que le reste de la
population d’éprouver des problèmes lorsque les conditions météorologiques sont
extrêmes en raison de la capacité réduite de leur organisme de réguler sa
température, de leur mobilité restreinte ou d’un accès limité à des lieux intérieurs
chauffés ou rafraîchis.
Chaque année, les salles d’urgence d’Ottawa reçoivent environ 40 personnes ayant un
problème directement causé par une chaleur extrême, comme de l’épuisement ou un
coup de chaleur, et environ 60 personnes ayant un problème directement causé par
un froid extrême, comme de l’hypothermie ou des gelures. Toutefois, la plupart des
effets néfastes des phénomènes météorologiques extrêmes découlent de l’aggravation
d’une maladie cardiaque ou de troubles respiratoires et entraînent une augmentation
des consultations à l’hôpital.
Étant donné le fardeau que peuvent représenter les phénomènes météorologiques
extrêmes pour la santé, en particulier dans le cas des personnes les plus vulnérables,
Santé publique Ottawa (SPO) collabore avec d’autres services municipaux pour
s’assurer que le public, les médias et les partenaires qui offrent directement des
services aux groupes vulnérables soient informés de ces phénomènes. Plus
particulièrement, SPO diffuse des avis publics lorsqu’il est prévu que, compte tenu de
l’indice humidex, la température ressentie sera de plus de 40 ou que, compte tenu de
l’indice de refroidissement éolien, la température ressentie sera de -35 ou moins. SPO
met également en garde les résidents de la région d’Ottawa-Gatineau lorsque la
qualité de l’air est mauvaise ou que l’indice UV est élevé, de sorte qu’ils puissent
prendre des mesures pour se protéger. Les résidents d’Ottawa peuvent également
recevoir des mises à jour sur les conditions météorologiques extrêmes en direct par le
biais du compte Twitter de SPO à @ottawasante.
BACKGROUND
Under the Ontario Public Health Standards, Ottawa Public Health (OPH) is required to
increase public awareness of health risks associated with extreme weather, outdoor air
quality and exposure to ultraviolet radiation. For over ten years, OPH has assisted
community partners in reducing Ottawa’s vulnerable residents’ exposure to these
health hazards. OPH has achieved this by conducting surveillance and working with
City and community partners to raise awareness of the health risks associated with
extreme weather and by notifying community partners and the public of extreme
weather events.
Extreme heat can cause dehydration, heat stroke, heat exhaustion, exacerbate other
health conditions, such as heart disease, respiratory problems and diabetes, and can
even cause death. Extreme cold can cause frostbite which can lead to severe injuries
such as brain damage, amputations and even death.
Some people are at increased risk of experiencing these weather-related health
impacts. Certain populations – the elderly, children and the homeless – can be at
higher risk because of thier reduced ability to regulate body temperature, restricted
mobility, or limited access to warm or cool indoor areas. New Canadians or visitors are
also at increased risk because they may not be acclimatized to the region’s weather.
Also, residents taking certain medications such as anti-Parkinson medications, antidepressants and psychiatric medication, as well as people with dementia and mental
health illnesses and those working outdoors are at higher risk. While public health
initiatives strive to reach all residents and visitors, it can take a targeted approach to
reach groups at higher risk to ensure that they are equipped with the necessary
supports to reduce the burden of health issues associated with extreme weather.
To increase awareness of the health risks associated with extreme weather and poor
air quality, OPH leads a coordinated and integrated health response to extreme
weather events. This ensures that the general public and community partners who
work with vulnerable populations have up-to-date extreme weather forecasts and
information on how vulnerable populations can be supported during these times. In
2002, the City of Ottawa established an Extreme Weather Committee, which is led by
OPH. Membership of the commitee includes the Ottawa Paramedic Service;
Community and Social Services Department; Parks, Recreation and Cultural Services
Department; Corporate Communications Department; the Salvation Army; and the Red
Cross. In 2008, the City’s Environmental Policy & Programs Unit of the Environmental
Services Department joined the committee to provide expertise on local climate
change issues. The committee also works with numerous community partners,
including local school boards, municipal and private childcare providers and domiciliary
hostels to ensure community supports are in place for vulnerable populations during
extreme weather events.
DISCUSSION
Extreme Heat and Cold
There is no standardized definition of extreme weather events among health units in
Ontario. Most health units declare extreme weather events based on the potential for
the weather to result in adverse health impacts, such as heat exhaustion or frostbite.
As Ontario is diverse and the health impacts of environmental factors, such as
temperature, solar radiation, wind speed, humidity and air pollution, may vary between
jurisdictions, Ontario health units use different triggers to prevent weather-related
health risks. Triggers for extreme heat and cold can include the timing, intensity,
duration, forecasted maximum or minimum temperatures as well as possible
synergistic impacts on health risks, such as poor air quality, and contributing factors
such as water shortages or power outages.1
As illustrated in Table 1, OPH uses the projected humidex as a trigger for notifying
residents of extreme heat and the temperature with wind chill as a trigger for notification
of extreme cold.
Table 1- Heat and Cold Triggers in the City of Ottawa
Type of Alert
Forecast Criteria for OPH
Heat Advisory
2 or more days humidex forecast to be 36 or greater
Heat Warning
2 or more days humidex forecast to be 40 or greater
Heat Emergency
Cold Weather Caution
Frostbite Advisory
Frostbite Warning
Humidex forecast to be 45 or greater or situational factors
(e.g. power outage)
The first time each season that the temperature is forecast
to be -15°C or colder
Wind chill forecast to be -25 or colder
Wind chill forecast to be -35 or colder
Extreme Heat
The thresholds for the advisory and warning levels for heat are based on the
relationship between humidex values and changes in mortality in Ottawa. Figure 1 2
(Document 1) shows that when the humidex values exceed 36, mortality increases
substantially. As a result, a humidex of 36 was selected as the threshold for heat
advisories.
To advise community partners and the public of the health implications associated with
heat, OPH issues notifications of hot weather events. In 2012, OPH issued four heat
advisories which covered 12 days and four heat warnings which covered 8 days.
Document 1 illustrates the number of heat notifications since 2002 (Figure 2Document 1). No heat emergencies have been issued since 2003 - when a City-wide
power outage occurred during very hot weather.
Before and during these events, OPH staff distribute Hot Weather Resource Kits to
community partners. These kits include screening tools for heat related illnesses, a list
of medications that may put individuals at higher risk of heat-related illness, information
about the City plan to assist people who are homeless or at risk of becoming
homeless, and suggestions of places to visit for respite from the heat. During each
notification, OPH encourages residents to check on family, friends and neighbours who
may be isolated or vulnerable to the heat and may need help accessing places to cool
down. OPH also advises Ottawa residents to keep cool and healthy during these hot
days, including drinking plenty of fluids and avoiding strenuous physical activity
outdoors.
OPH and the Extreme Weather Committee also work with public and private partners
to help residents avoid heat-related illnesses associated with extreme weather. Last
summer, in partnership with Rainbow Cinemas, the committee distributed 750 free
movie tickets for residents. These tickets allowed residents to access the air
conditioned theatre and provided respite from the heat. Also in periods of extreme
heat, the City of Ottawa’s Parks, Recreation and Cultural Services Department cancels
all adult swims and opens all lanes for leisure swimming. This measure aims to
accommodate the increased number of residents who seek City pools to cool down.
Extreme Cold
The thresholds for cold advisories and warnings are based on the risks of frostbite and
hypothermia. Cold related mortality occurs most often in the elderly with chronic
conditions, such as cerebrovascular diseases, ischemic heart disease, and respiratory
illness.3 At -15oC, there is an increased concern of hypothermia and prolonged
exposure to cold temperatures can results in severe injury and even death. With a
wind chill of -25, the risk of frostbite increases substantially. OPH issues a frostbite
advisory to local agencies and community partners whose clients are the most
vulnerable to the cold, such as the homeless and small children. When the wind chill
reaches -35, exposed skin can freeze in less than ten minutes. At this point, a frostbite
warning is issued to Ottawa residents to advise them to take extra precautions against
the cold.
In 2011-2012, OPH issued five frostbite alerts and no frostbite warnings (Figure 3Document 1). Similar to the response to extreme heat, OPH distributes Cold Weather
Resource Kits to community partners and the public at large. These kits include winter
driving tips, information about the City plan to assist people who are homeless and or
at risk of becoming homeless, as well as frostbite and hypothermia facts sheets.
When OPH issues a frostbite advisory or warning, OPH encourages residents to dress
for the weather, monitor weather forecasts and be cautious of slippery conditions.
As a result of the notification of a frostbite advisory and warning, key service providers
trigger internal responses in accordance with their respective policies and procedures.
For instance, during a frostbite warning, the Salvation Army outreach van extends its
hours to a 24 hour service. During frostbite advisories, local shelters work to ensure
that everyone has a warm place to sleep by setting up additional beds and allowing
clients to stay at the shelter during the day.
In addition, Ottawa residents are encouraged to call the Help for the Homeless Phone
Line at 613-580-2626, if they know of any residents who do not have housing.
Residents can also call 3-1-1 if they see someone living outdoors in extreme cold and
staff will make referrals to the appropriate service providers.
Smog and Outdoor Air Quality
In 2004, Council adopted the 2004 Action Plan for Smog and Heat and approved
ongoing planning and coordination of longer term smog and heat mitigation activities
(ACS2004-PEO-HEA-0006). Since that time, OPH, in conjunction with the Extreme
Weather Committee, have continued to increase public awareness of health risk
factors associated with poor outdoor air quality.
In Ontario, there are two measures of air quality: the Ontario Ministry of Environment’s
Air Quality Index and Environment Canada’s Air Quality Health Index (AQHI). OPH
issues notification when levels for these indexes are high.
Smog advisories are issued in Ontario when the Air Quality Index forecasts poor air
quality for a region. When OPH receives notification from Ministry of the Environment
that poor air quality is expected, this information is distributed through the extreme
weather distribution network, which includes over 100 service providers and a public
service announcement is issued to the public.
Since 2010, OPH also receives air quality information from Environment Canada,
based on the AQHI. The AQHI measures risk on a scale of 1 to 10 (Figure 1,
Document 2). When the AQHI reaches a level of 6 or higher, OPH advises the extreme
weather distribution network and issues a public service announcement. Through
these announcements, OPH aims to make all residents aware of Local Air Quality
Information. Hourly updates of the AQHI measures are available at airhealth.ca. This
website provides daily air quality forecasts that are especially relevant for individuals
with pre-existing heart and lung disease, outdoor athletes and residents who work
outdoors, as well as parents and caregivers.
Since 2010, the Ministry of the Environment has issued two smog advisories for
Ottawa and OPH has advised residents once that the AQHI rating exceeded 6. The
AQHI announcement was issued in 2010 as a result of smoke that migrated to Ottawa
from a forest fire in Quebec.
Ultraviolet (UV) Radiation Advisories
Exposure to UV radiation can have a negative impact on health and is associated with
sun burns and skin cancers, such as melanoma. The incidence of melanoma in Ottawa
is higher than the rest of Ontario. In addition, in 2010, 35 per cent of Ottawa adults 18
and older reported being sunburned in the last 12 months.4 Environment Canada
provides the public with UV information through the use of the UV Index which
provides a figure ranging from 0 to 11+ to represent the intensity of the sun’s UV
radiation (Figure 2, Document 2).
In 2012, as part of a larger sun safety and melanoma prevention initiative, OPH began
monitoring UV levels. Although no level of UV radiation is considered safe, OPH
consulted with Environment Canada to establish a level whereby the public should be
advised of increased risk from sun exposure. Using the UV Index, OPH now issues a
UV advisory when an index of 10 or higher is forecast. The advisory provides
information on the harmful effects of UV exposure and encouraging residents to
increase the use of personal protection. During the summer of 2012, the UV index did
not meet the advisory threshold. OPH will continue to monitor the UV levels and be
prepared to alert the population of increased risk.
NEXT STEPS
OPH and the City of Ottawa’s Extreme Weather Committee continue to engage with
internal and external stakeholders and review literature on best practices for
preventing injury, illness and deaths associated with extreme weather events. In 2013,
the committee is planning several initiatives to improve its understanding of extreme
weather risks in Ottawa:
Heat Island Mapping – In partnership with Health Canada, OPH will map the
areas of the City that are ‘hot spots’ during summer months with the goal of then
identifying mitigation strategies that could help cool down these areas.
Evaluation – The existing extreme weather plan will be evaluated in 2013 to
ensure the plan is responsive to community needs.
Mock Heat Emergency – OPH is working with Health Canada and the City of
Ottawa’s Security and Emergency Management Branch to conduct a heat
emergency simulation exercise. This exercise is scheduled to take place in 2014.
Extreme Weather Committee Capacity Building – In the spring of 2013, OPH is
hosting a training and capacity building session for all agencies involved with the
extreme weather committee. Health Canada will be presenting best practices for
extreme heat events.
LEGAL IMPLICATIONS
There are no legal impediments to receiving the information in this report.
FINANCIAL IMPLICATIONS
There are no technology implications related to this report.
ACCESSIBILITY IMPACTS
Accessibility has been considered as part of this report.
TECHNOLOGY IMPLICATIONS
There are no technology implications to this information report.
TERM OF COUNCIL PRIORITIES
This report supports the term of Council Priority to create Healthy and Caring
Communities.
BOARD OF HEALTH STRATEGIC PRIORITES
This report supports the Board of Health’s Strategic Priority to B5: Reduce health risks
related to preventable infectious and non-infectious diseases.
SUPPORTING DOCUMENTATION
Document 1: Extreme Heat and Cold Notifications for the City of Ottawa
Document 2 : Environment Canada Resources
DISPOSITION
That Ottawa Public Health will continue to work with community partners and the
Extreme Weather Committee to monitor, evaluate and address the impacts of Ottawa
weather on the health of residents.
1
Health Canada. Heat Alert and Response Systems to Protect Health: Best Practices
Guidebook. Ottawa: Health Canada; 2012. [cited 2013 Feb 27]. Available from:
http://www.hc-sc.gc.ca/ewh-semt/pubs/climat/response-intervention/index-eng.php
2
Casati, B. and Yagouti, A. Analysis of extreme temperature indices in nine Canadian
communities using the Canadian Regional Climate Model projections for public health
planning; Internal Report, Scenario Group, Consortium Ouranos, Montreal (QC); 2010.
3
The Eurowinter Group. Cold exposure and winter mortality from ischaemic heart
disease, cerebrovascular disease, respiratory disease, and all causes in warm and
cold regions of Europe. Lancet 1997;349(9062):1341-6.
4
Ottawa Public Health. Cancer in Ottawa 2012. Ottawa: Ottawa Public Health; 2012.
[cited 2013 Feb 27]. Available from
https://app06.ottawa.ca/calendar/ottawa/citycouncil/obh/2012/0116/5863_OPH_Cancer_Report_Eng_PRESS_Jan_4-12.pdf