The utilisation of ambulance data to quantify the impact of temperature and air pollution on human health in urban environments.

This research will examine how two environmental factors, air pollution and temperature, affect human health in urban environments as measured by ambulance call outs. A substantial amount of research has been undertaken to understand the relationship between air pollution, temperature and health but this has focused on hospital data, general practice (GP) data and calls to telephone health services such as NHS 111.
Ambulance data is an underutilised resource for studying the impact of environmental factors on human health, which this research aims to change. Ambulance data captures a different set of people (generally with more serious conditions than GP data and more acute than the hospital admissions data, which is often planned). Approximately half of the health events picked up in ambulance data do not get recorded in any other dataset as people get treated by the paramedic and do not go on to access any other services. Finally, one of the biggest advantages of ambulance data is that the geographical data collected is where something happened, unlike all other health datasets where the location recorded is the person's residential address. This can be important, for example, if increased temperatures in the centre of a city (as temperatures can be exacerbated by large amounts of concrete and asphalt in built up areas) cause increased rates of people fainting from heatstroke. Looking at hospital data might not pick up this issue. Although people may be affected in the city centre (for example as that is where they work and/or shop), they could live all over the city so the signal is diluted and spread over a large area. However, ambulance data would highlight this cluster of data as, regardless of where people happen to live, the ambulances will all be called out to the centre of the city if this is where people were experiencing the symptoms and this is the postcode that is recorded. Ambulance data could also prove effective in picking up issues during cold weather, for instance you would collect data on where people fall when it is icy or for air pollution incidents, if for example toxic fumes were being given off by a factory fire and people walking nearby were being exposed.
Studies historically have looked at air pollution and temperature in isolation but this study will also be examining the relationship between the two. This is important as one factor can affect the other, with higher temperatures affecting the concentrations of pollutants like ozone. Furthermore, people who are more likely to be exposed to extreme temperatures are also more likely to be exposed to air pollution (such as people who spend a lot of time outdoors, for example builders).
As the relationship between environmental factors and health can change across the different climates in the UK, the research will be carried out in three cities situated in a rough line from the south to the north - London, Birmingham and Glasgow. Examining patterns across a range of locations will increase the applicability of the research findings to other cities across the UK.
The Metrological Office has also produced UK Climate Projections with projections for future temperatures in 2020, 2050 and 2080. These projections will be used to predict how ambulance call out figures might change in the future so we can better understand the future burden of disease due to climate change.
These findings can then be used to inform the surveillance of the health of the population, advice given to susceptible people with chronic conditions (for example what temperatures or air population concentrations warnings should be provided by health organisations) and thresholds for warnings (for instance heat health alerts) given to the general public. These interventions can alter people's behaviour so their exposure is lowered and the burden of disease is decreased.

General public
Better advice from health organisations that will lead to more effective behavioural change to reduce exposure and sensitivity.
Ambulance Services
Better understandings on both the volume and types of calls they will receive.
Health organisations
Improved risk characterisation data to enable improved public health information messages to be relayed to the general population. This could include improved heat and cold health messages.
Potential to use ambulance data for syndromic surveillance purposes to better predict the burden of disease in the near future/real time
Environment and health researchers
Highlight and demonstrate the potential for ambulance data to be used to explore the relationship between environmental hazards and health