Validation of a Temperature Prediction Model for Heat Deaths in Undocumented Border Crossers

Understanding the burden of traumatic injuries at the United States-Mexico border: A scoping review of the literature

ABSTRACT

The US-Mexico border is the busiest land crossing in the world and faces continuously increasing numbers of undocumented border crossers. Significant barriers to crossing are present in many regions of the border, including walls, bridges, rivers, canals, and the desert, each with unique features that can cause traumatic injury. The number of patients injured attempting to cross the border is also increasing, but significant knowledge gaps regarding these injuries and their impacts remain. The purpose of this scoping literature review is to describe the current state of trauma related to the US-Mexico border to draw attention to the problem, identify knowledge gaps in the existing literature, and introduce the creation of a consortium made up of representatives from border trauma centers in the Southwestern United States, the Border Region Doing Research on Trauma Consortium. Consortium members will collaborate to produce multicenter up-to-date data on the medical impact of the US-Mexico border, helping to elucidate the true magnitude of the problem and shed light on the impact cross-border trauma has on migrants, their families, and the US health care system. Only once the problem is fully described can meaningful solutions be provided.

Developing a geospatial measure of change in core temperature for migrating persons in the Mexico-U.S. border region

Although heat exposure is the leading cause of mortality for undocumented immigrants attempting to traverse the Mexico-U.S. border, there has been little work in quantifying risk. Therefore, our study aims to develop a methodology projecting increase in core temperature over time and space for migrants in Southern Arizona using spatial analysis and remote sensing in combination with the heat balance equation-adapting physiological formulae to a multi-step geospatial model using local climate conditions, terrain, and body specifics. We sought to quantitatively compare the results by demographic categories of age and sex and qualitatively compare them to known terrestrial conditions and prior studies of those conditions. We demonstrated a more detailed measure of risk for migrants than those used most recently: energy expenditure and terrain ruggedness. Our study not only gives a better understanding of the 'funnel effect' mechanisms, but also provides an opportunity for relief and rescue operations.

Analysis of Prehospital Care of Migrants Who Arrive Intermittently at the Coasts of Southern Spain

Background: The aim of this study is to identify the sociodemographic characteristics and the most frequent diseases and nursing interventions carried out on migrants arriving by sea at southern Spain. Method: Cross-sectional, descriptive, and retrospective study based on the database of the Spanish Red Cross Intervention Activation System. All migrants who arrived on the coasts of a southern province during 2016 and were assisted by the Red Cross were included. Results: A total of 2027 people were registered, mostly males, aged between 18 and 40 years. Of these, 4.9% required healthcare, and 2.9% were referred to hospital. Highlighted diagnoses were headaches (15.6%), pregnancy (12.8%), and lower-limb wounds (6.4%), and outstanding nursing interventions were “care of wounds” (24.7%), “pain management” (21.9%), and “prenatal care” (15.2%). Statistically significant relationships were found between the diagnosed diseases and gender, geographic area of origin, and seasonal time of the year, as well as between nursing interventions performed and those three variables. Conclusions: Although in general, a good health condition was observed in most of the migrants treated, the most frequent health situations attended were related to dermatological, gynecological, and headache problems. The most performed nursing interventions were related to skin/wound care and promotion of physical comfort, requiring a low need for hospital transfers. Female gender, origin from sub-Saharan Africa and arrival in the summer period carry a greater risk of suffering health problems when migrants reach Spanish coasts.

Impact of Temperature in Summer on Emergency Transportation for Heat-Related Diseases in Japan

Background:

In Japan, the demand for emergency transportation for people with heat-related illness has recently increased. The purpose of this study was to investigate the relationship between incidents of heat-related illness and the daily maximum temperature.

Methods:

The daily maximum temperatures in Japan's 11 districts over the past 10 years were classified into four categories, with cutoff points at the 50^th, 75^th, 95^th, and higher than 95^th percentiles. We then conducted a logistic regression analysis of emergency transportation demand in each temperature category by age group, using the 50^th percentile as the reference category for each area.

Results:

There were 42,931 cases of emergency transportation due to heat-related diseases during the study period. Classified by age, 12.5%, 43.4%, and 44.1% of cases involved children, adults, and elderly people, respectively. The analysis showed that the number of cases of emergency transportation for people with heat-related diseases (per 100,000 people; corresponding to a 1.0°C increase in the daily maximum temperature) was 0.016–0.106 among children (24.9–169.9 children required emergency transportation for heat-related diseases), from 0.013 to 0.059 among adults (19.8–98.2 adults required emergency transportation), and from 0.045 to 0.159 among elderly persons (30.0–145.4 elderly people required emergency transportation). The risk was highest for elderly persons, followed by children and finally adults. Cases of emergency transportation due to heat-related illness increased by 2.4–8.9 times when the daily maximum temperature was approximately 1.5°C above the mean daily maximum temperature. In fact, the daily maximum temperature had a larger effect than the daily relative humidity level on emergency transportation for people with heat-related diseases.

Conclusion:

Public health organizations and health-care services should support elderly people and children, two high-risk groups for heat-related diseases.

Environmental Hyperthermia in Prehospital Patients with Major Traumatic Brain Injury

BACKGROUND

Traumatic brain injury (TBI) results in an estimated 1.7 million emergency department visits each year in the United States. These injuries frequently occur outside, leaving injured individuals exposed to environmental temperature extremes before they are transported to a hospital.

OBJECTIVE

Evaluate the existing literature for evidence that exposure to high temperatures immediately after TBI could result in elevated body temperatures (EBTs), and whether or not EBTs affect patient outcomes.

DISCUSSION

It has been clear since the early 1980s that after brain injury, exposure to environmental temperatures can cause hypothermia, and that this represents a significant contributor to increased morbidity and mortality. Less is known about elevated body temperature. Early evidence from the Iraq and Afghanistan wars indicated that exposure to elevated environmental temperatures in the prehospital setting may result in significant EBTs, however, it is unclear what impact these EBTs might have on outcomes in TBI patients. In the hospital, EBT, or neurogenic fever, is thought to be due to the acute-phase reaction that follows critical injury, and these high body temperatures are associated with poor outcomes after TBI.

CONCLUSION

Hospital data suggest that EBTs are associated with poor outcomes, and some preliminary reports suggest that early EBTs are common after TBI in the prehospital setting. However, it remains unclear whether patients with TBI have an increased risk of EBTs after exposure to high environmental temperatures, or if this very early "hyperthermia" might cause secondary injury after TBI.

Extreme heat and cultural and linguistic minorities in Australia: perceptions of stakeholders

Background

Despite acclimatisation to hot weather, many individuals in Australia are adversely affected by extreme heat each summer, placing added pressure on the health sector. In terms of public health, it is therefore important to identify vulnerable groups, particularly in the face of a warming climate. International evidence points to a disparity in heat-susceptibility in certain minority groups, although it is unknown if this occurs in Australia. With cultural diversity increasing, the aim of this study was to explore how migrants from different cultural backgrounds and climate experiences manage periods of extreme heat in Australia.

Methods

A qualitative study was undertaken across three Australian cities, involving interviews and focus groups with key informants including stakeholders involved in multicultural service provision and community members. Thematic analysis and a framework approach were used to analyse the data.

Results

Whilst migrants and refugees generally adapt well upon resettlement, there are sociocultural barriers encountered by some that hinder environmental adaptation to periods of extreme heat in Australia. These barriers include socioeconomic disadvantage and poor housing, language barriers to the access of information, isolation, health issues, cultural factors and lack of acclimatisation. Most often mentioned as being at risk were new arrivals, people in new and emerging communities, and older migrants.

Conclusions

With increasing diversity within populations, it is important that the health sector is aware that during periods of extreme heat there may be disparities in the adaptive capacity of minority groups, underpinned by sociocultural and language-based vulnerabilities in migrants and refugees. These factors need to be considered by policymakers when formulating and disseminating heat health strategies.

Vulnerability to extreme heat and climate change: is ethnicity a factor?

Background

With a warming climate, it is important to identify sub-populations at risk of harm during extreme heat. Several international studies have reported that individuals from ethnic minorities are at increased risk of heat-related illness, for reasons that are not often discussed.

Objective

The aim of this article is to investigate the underpinning reasons as to why ethnicity may be associated with susceptibility to extreme heat, and how this may be relevant to Australia’s population.

Design

Drawing upon literary sources, the authors provide commentary on this important, yet poorly understood area of heat research.

Results

Social and economic disparities, living conditions, language barriers, and occupational exposure are among the many factors contributing to heat-susceptibility among minority ethnic groups in the United States. However, there is a knowledge gap about socio-cultural influences on vulnerability in other countries.

Conclusion

More research needs to be undertaken to determine the effects of heat on tourists, migrants, and refugees who are confronted with a different climatic environment. Thorough epidemiological investigations of the association between ethnicity and heat-related health outcomes are required, and this could be assisted with better reporting of nationality data in health statistics. Climate change adaptation strategies in Australia and elsewhere need to be ethnically inclusive and cognisant of an upward trend in the proportion of the population who are migrants and refugees.