NRDC: Ahmedabad Heat Action Plan

AHMEDABAD
HEAT ACTION PLAN 2016
GUIDE TO EXTREME HEAT PLANNING IN AHMEDABAD, INDIA
EASY READ VERSION
EXECUTIVE SUMMARY
Climate change is leading to an increase in average temperatures and increased possibilities of severe
heat waves. Extreme heat can lead to dangerous, even deadly, health consequences, including heat
stress and heatstroke. The city of Ahmedabad had a major heat wave in May 2010, which led to
1,344 additional deaths registered in the city during the month of May.1 The 2010 heat wave was a
wakeup call that intergovernmental agency action, preparedness, and community outreach was
needed to save lives. Rising to this challenge of climate change and increasing heat waves, the
Ahmedabad Municipal Corporation (AMC) is working to prepare health systems and residents
against dangerous heat waves. The first Heat Action Plan (HAP or Plan) was prepared in 2013 by the
AMC with help from national and international academic experts and learning from global best
practices on early warning systems and heat adaptation.
The 2016 Heat Action Plan is an updated version of the first comprehensive early warning system
and preparedness plan for extreme heat events in India launched in Ahmedabad in 2013. The Plan
creates immediate and longer-term actions to increase preparedness, information-sharing, and
response coordination to reduce the health impacts of extreme heat on vulnerable populations.
The Heat Action Plan aims to implement four key strategies:
Ø Building Public Awareness and Community Outreach to communicate the risks of heat waves
and implement practices to prevent heat-related deaths and illnesses. Disseminating public
messages on how to protect people against extreme heat through media outlets and informational
materials such as pamphlets and advertisements on heat stress prevention. New efforts being
launched as part of this year’s Plan include the use of modern media such as SMS, text messages,
email, radio and mobile applications such as WhatsApp. Special efforts will be made to reach
vulnerable populations through inter-personal communication as well as other outreach methods.
Ø Initiating an Early Warning System and Inter-Agency Coordination to alert residents of
predicted high and extreme temperatures. The AMC has created formal communication channels
to alert governmental agencies, the Met Centre, health officials and hospitals, emergency
responders, local community groups, and media outlets of forecasted extreme temperatures.
Ø Capacity Building Among Health Care Professionals to recognize and respond to heat-related
illnesses, particularly during extreme heat events. Such trainings focus on primary medical
officers and other paramedical staff, and community health staff so they can effectively prevent
and manage heat-related cases so as to reduce mortality and morbidity.
Ø Reducing Heat Exposure and Promoting Adaptive Measures by launching new efforts
including mapping of high-risk areas of the city, increasing outreach and communication on
prevention methods, access to potable drinking water and cooling spaces during extreme heat
days. Collaboration with non-governmental organizations is also identified as a means to expand
outreach and communication with the city’s most at-risk communities. 1
Azhar GS, Mavalankar D, Nori-Sarma A, Rajiva A, Dutta P, et al. Heat-Related Mortality in India: Excess All-Cause
Mortality Associated with the 2010 Ahmedabad Heat Wave. PLoS ONE (2014) 9(3): e91831. doi:
10.1371/journal.pone.0091831: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0091831#abstract0
i
Please see attached 2016 Heat Action Plan Updates for more details of new actions and strategies
added in this year’s Plan.
Ahmedabad had a major heat wave in May 2010, when the temperature reached 46.8°C (more than
116°F). The following graph shows the May 2010 temperatures and mortality as compared to the
averages in May 2009 and 2011. The graph of mortality shows a large rise in daily mortality in 2010
coinciding with the heat wave.
Fig 1; Temperature and all-cause mortality correlation during the 2010 heat wave in Ahmedabad as compared to 2009
and 2011.
Preliminary evaluation of the 2013 and 2014 Heat Action Plans is already showing positive
outcomes in reducing mortality during the hottest months of the year. During India’s historic heat
wave in 2015, responsible for over 2,300 deaths across the country, Ahmedabad reported fewer than
20 heat-related deaths. Future responses must be based on an understanding of actions and evidence
of their impacts.
How the HAP is organized and implemented:
As the lead agency, the Health Department has the overarching responsibility for the coordination of
heat wave related health activities. This includes monitoring forecasts and sending heat health alerts
and disseminating public health messages to local departments and community service providers, as
well as working with the AMC press office to increase media around preparedness.
The Plan serves to focus attention on those individuals who are most at risk during heat waves,
including slum communities, outdoor workers, elderly and children. The Plan also focuses on
individuals and organizations, such as Urban Health Centres (UHCs) and link workers, who
frequently work with at-risk populations and can provide early diagnosis of heat-related illnesses and
preliminary treatment.
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Individuals, community groups, and the media are also essential in fighting the effects of extreme
heat. Individuals can take specific preventative steps to protect themselves, their families, and their
communities from harmful heat waves including learning about early signs of heat exhaustion,
limiting heavy work during extreme heat, drinking water, staying out of the sun; wearing light
clothing, checking on neighbors, and informing their fellow community members about how to keep
cool and protect themselves from heat. The media is vital in spreading the word about the harm heat
poses to health, and protecting people against dangerous heat waves. The media plays an essential
awareness-building role by sharing news about health threats, and increases public protection by
running ads and providing local resources information.
Key stakeholders who helped develop the HAP:
The Heat Action Plan is part of a broader collaboration between AMC and public health and policy
experts at the Indian Institute of Public Health, Gandhinagar, Public Health Foundation of India,
Natural Resources Defense Council, Icahn School of Medicine at Mount Sinai, and supported by the
Climate and Development Knowledge Network. This network of partnering institutions was formed
following the deadly May 2010 heat wave in Ahmedabad to develop local responses to extreme heat.
Additional activities have been supported by the Good Energies Foundation and the Indo-US Science
and Technology Forum.
In support of the Heat Action Plan, four related issue briefs entitled Rising Temperatures, Deadly
Threat, were also released by the partners in 2013. These briefs outline key strategies and policy
interventions that form the basis for the Heat Action Plan, focusing on the most vulnerable groups.
These issue briefs are located at: http://www.nrdc.org/international/india/extreme-heat-preparedness/
From start to finish, this project is about saving lives and helping the people of Ahmedabad to create
healthier communities, more secure from the dangers of extreme heat, even as climate change bears
down on cities like Ahmedabad, and states like Gujarat, all around the world. It is the hoped that this
action plan will guide other cities and rural areas in India and other developing countries to adapt and
develop their own heat action plans. Through preventative action such as the HAP, countless lives
can be saved as the weather becomes increasingly hot and more extreme.
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INTRODUCTION
Higher daily peak temperatures and
longer, more intense heat waves are
becoming increasingly frequent globally
due to climate change.2 Extreme heat
events already have a significant impact
in India. After a deadly heat wave hit the
city of Ahmedabad in May 2010, the
Ahmedabad Municipal Corporation
(AMC) has taken the initiative to
develop a comprehensive heat action
plan for extreme heat events, the first
city in India to do so.
To protect and prepare Ahmedabad for
Ahmedabad community members, July 2011.
extreme heat events, AMC and its partners
Credit: Gulrez Shah Azhar & Kathy Tran
have undertaken the following activities to
develop this Heat Action Plan:
§ Epidemiological analysis of the health
effects of heat exposure among Ahmedabad’s residents;
§ Examination of specific vulnerability factors among slum dwellers and highly exposed
occupational workers;
§ Exploration of longer-term forecasting options to give earlier warnings;
§ Development of heat illness management training for health professionals; and
§ A review of heat action plans around the world.
From this work it is clear that coordinated action is needed among government agencies on the
municipal level to reduce the devastating health effects of heat stress on local residents. A practical
plan of targeted policy interventions can increase information-sharing, communication, preparedness,
and response coordination to improve the most vulnerable populations’ resilience to rising
temperatures.
PURPOSE
This Heat Action Plan aims to provide a framework for the implementation, coordination, and
evaluation of extreme heat response activities in Ahmedabad that reduce the negative health impacts
of extreme heat. The Plan’s primary objective is to alert those populations most at risk of heat-related
illness that extreme heat conditions either exist or are imminent, and to take appropriate precautions.
Extreme heat planning includes:3
§ Identifying vulnerable populations and the health risks specific to each group;
§ Developing effective strategies, agency coordination, and response planning to shape a Heat
Action Plan that addresses heat-health risks;
§ Implementing the Heat Action Plan and activating heat alerts; and
§ Evaluating and updating the Heat Action Plan regularly.
2
IPCC, “Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change
Adaptation,” March 8, 2012: http://www.ipcc-wg2.gov/SREX/.
3
State of Victoria Department of Human Services, “Heatwave Planning Guide: Development of heatwave plans in local
councils in Victoria [Australia],” 2009, http://www.health.vic.gov.au/environment/climate/heatwave.htm.
1
AHMEDABAD BACKGROUND
One of India’s fastest growing cities, Ahmedabad is the economic center of the state of Gujarat.
Ahmedabad district, including the surrounding suburban and rural areas, is home to 7.2 million
people.4 Ahmedabad is predicted to be one of the world’s nineteen fastest growing urban areas in the
coming decade, according to Forbes magazine.5 Located in the arid Northwest region of India,
Ahmedabad’s warm, dry conditions are conducive to heat waves. While summer is defined as
spanning March, April, and May, Ahmedabad’s hottest temperatures can run from March through
June, with temperatures generally peaking in May and warm days through November.6 Across India,
higher daily peak temperatures and longer, more intense heat waves are becoming increasingly
frequent globally due to climate change; thus the deadly extreme heat events already impacting
Ahmedabad are expected to increase in intensity, length, and frequency in the coming decade.7
Criteria for Heat Wave
(as defined by Indian Meteorological Department)
Heat wave need not be considered till maximum temperature of a station reaches at least 40º C for Plains and at
least 30º C for Hilly regions.
When normal maximum temperature of a station is less than or equal to 40º C
• Heat Wave Departure from normal is 5º C to 6º C
• Severe Heat Wave Departure from normal is 7º C or more
When normal maximum temperature of a station is more than 40º C
• Heat Wave Departure from normal is 4º C to 5º C
• Severe Heat Wave Departure from normal is 6º C or more
When actual maximum temperature remains 45ºC or more irrespective of normal maximum temperature, heat
wave should be declared.
Source: Indian Meteorological Department, http://www.imd.gov.in/doc/termglossary.pdf. The Meteorological Centre,
Ahmedabad (“Met Centre”) currently determines whether to declare a heat wave once the daily maximum temperature
exceeds a 40˚C (104˚F) threshold.8
4
Office of the Registrar General & Census Commissioner, “Census of India 2011: Provisional Populations Totals,
Ranking of Population Districts, 2001-2011,” Government of India: http://www.censusindia.gov.in/2011-provresults/prov_data_products_gujarat.html (last accessed July 26, 2012).
5
Kotkin, Joel, “The World’s Fastest Growing Cities,” Forbes, October 7, 2010:
http://www.forbes.com/2010/10/07/cities-china-chicago-opinions-columnists-joel-kotkin.html.
6
See “Weather and Climate in Ahmedabad,” Maps of India: http://www.mapsofahmedabad.com/generalinformation/weather.html.
7
IPCC, “Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change
Adaptation,” March 8, 2012: http://www.ipcc-wg2.gov/SREX/.
8
Meteorological Centre, Ahmedabad: http://www.imdahm.gov.in/# (click on About MC Tab) (last visited July 30, 2012).
Terminologies and Glossary, India Meteorological Department: http://www.imd.gov.in/doc/termglossary.pdf.
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HEAT ACTION PLAN (HAP)
Successful implementation of a Heat Action Plan in Ahmedabad requires coordinated action between
many diverse stakeholders, including government departments; health care professionals including
emergency medical personnel, health center staff, and hospital staff; and community groups.
Following the forecasting of an extreme heat event, immediate notification of the public and all those
participating in the response is critical to ensure the plan is activated.
Color Signals for Heat Alert
The AMC will issue heat alerts, based on thresholds determined by the AMC, as an additional means
of communication by using the following color signal system
YELLOWALERT
HotDayAdvisory
41.1˚C–43˚C
ORANGEALERT
HeatAlertDay
43.1˚C–44.9˚C
REDALERT
ExtremeHeatAlert ≥45˚C
Day
Beherampura UHC (South Zone, Ahmedabad) Credit: Nilesh Vilas Thube
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Communication Plan When the AMC Nodal Officer Activates a Heat Alert
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Launching the Heat Action Plan:
The AMC has appointed an AMC Nodal Officer to head the Heat Action Plan. The appointed nodal
officer is responsible for coordinating and communicating ahead of, and during, extreme heat events,
and provide support staff through the Nodal Office as necessary. The AMC Nodal Officer is
considering adopting the following preparations under the 2016 Heat Action Plan (see attached 2016
Heat Action Plan Updates and Agency Action Checklists for more detail).
Phase 1: Pre-Heat Season (Annually from January through March)
AMC Nodal Officer:
§ Convene key agency leaders to respond to extreme heat events.
§ Reengage state and local agencies to facilitate internal communications.
§ Organize preventative training and outreach efforts for health workers, link workers, school
children, and the local community with the Health Department.
§ Distribute multilingual pamphlets and posters with tips to prevent heat stress to hospitals,
schools, and professional associations (see pamphlets attached).
§ Create a list of the high-risk areas of the city vulnerable to heat waves for more focused
activities on heat prevention.
Media and AMC Press Officer:
§ Increase public communication including distributing the multilingual pamphlet and
advertisements on heat stress prevention and tips for health protection during extreme heat
events (see pamphlets and ads attached). Focus outreach efforts in identified high-risk areas.
§ Provide information and heat communication materials developed by the AMC to the public.
§ Increase the number of installed LED screens with rolling updated temperature forecasts
available to the public.
AMC Health Department and Medical Professionals:
§ Enhance targeted training programs, capacity building efforts and communication on heat
illness for medical staff at local hospitals and Urban Health Centres (UHCs), based on the
Framework of AMC Medical Professionals and Health Workers (see attachment). These
efforts should include nursing staff, paramedics, field staff and link workers, and consider the
susceptibility of particular wards.
§ Have hospitals update their admissions and emergency case records to track heat-related
morbidity and mortality. Train hospitals to improve expedience of recording of cause of death
certificates. Explore creation of simple, user-friendly means to track daily heat-related data
and behavioral change impacts. The training could also include recording information
education & communication (IEC) efforts.
§ Adopt heat-focused examination procedures at local hospitals and urban health centers.
§ Purchase and distribute reusable soft plastic ice packs for the citywide UHCs, 108 emergency
centres, ambulances and hospitals.
§ Explore creation of ice pack dispensaries to increase access to vulnerable communities.
AMC Labour & Employment Department:
§ Organize training for employers, outdoor laborers and workers regarding health impacts of
extreme heat and recommendations to protect themselves during high temperatures.
§ Utilize maps of construction sites to identify more high-risk outdoor workers. Potentially
overlay with irradiation map from IMD or heat island map. Conduct publicity campaigns
during high-risk days to these specific areas.
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108 Emergency Service:
§ Create displays on ambulances during local events to build public awareness (see ad
attached)
§ Identify at-risk areas of vulnerable populations, in part by utilizing the list of high-risk areas.
Community Groups and Individuals:
§ Lead child-friendly educational preventative trainings and distribute heat protection materials
at local schools. For example, potentially design a “Teach the Teachers” workshop designed
to equip teachers with knowledge with heat protection tips and materials that they can
disseminate in classrooms on heat protection, and activities that can engage students on
health dangers of extreme heat.
§ Conduct training workshops and outreach sessions with community groups and mobilizers
such as Mahila Arogya Samiti, Self-Employed Women's Association (SEWA), ASHA
workers, aanganwadis, and municipal councils to help inform and get vulnerable
communities more actively involved. Incorporate other sectors such as higher education, nonprofits, and community leaders to increase reach to communities.
§ Encourage individuals’ discussion of the early signs of heat exhaustion with their local doctor
or Urban Health Centre.
§ Inform fellow community members about how to keep cool and protect oneself from heat.
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Phase 2: During the Heat Season (Annually from March through July)
AMC Nodal Officer:
§ Activate a heat alert and the local response citywide when extreme heat events are forecast
by notifying the key agency leaders, AMC Deputy Municipal Commissioners and the Gujarat
state agencies in accordance with the Communication Plan above.
§ Monitor and increase the heat alert level when necessary to match the severity of the
forecast and threshold established, and have the Municipal Commissioner convene a special
meeting with key agency leaders.
§ Activate “cooling centers,” such as temples, public buildings, malls, during a heat alert
and/or AMC-run temporary night shelters for those without access to water and/or electricity.
§ Expand access to shaded areas for outdoor workers, slum communities, and other vulnerable
populations. For example, confirm that night shelters stay open all day for migratory
populations during a heat alert.
§ Hold a frequent, possibly daily, conference call to discuss reports and breaking developments
during a heat alert, and ensure that communication channels remain operational.
§ Identify and set up public displays of temperature and forecasts, such as LED electronic
scrolling boards.
§ Continue surveillance of temperature data and forecasts.
§ Communicate the suspension of all non-essential uses of water (other than drinking, keeping
cool) via the AMC Water Project’s protocol procedures during any water shortage.
§ Increase efforts to distribute fresh drinking water to the public. For example, expand potable
water access during a heat alert at religious spaces including temples and mosques, BRTS
transit stations, pouch handouts to the poor, and high-risk areas (identified by the mapping of
high-risk areas).
§ Communicate the local utility protocol to prioritize maintaining power to critical facilities
(such as hospitals and UHCs).
§ Notify the Steering Committee and relevant agencies when the heat alert is over.
Media and AMC Press Officer:
§ Commence public messaging to the public about the dangers of heat-related illness with the
AMC Nodal Officer via AMC press conferences.
§ Circulate warnings via text alerts or WhatsApp mobile messages, in collaboration with
private sector telecom companies utilizing centralized mobile databases, in addition to
traditional media during a heat alert.
§ Circulate warnings in bulk to the public via centralized email databases during a heat alert.
§ Develop an SMS alert system to send direct messages to private practitioners in addition to
the medical professionals at public hospitals and UHCs.
§ Utilize local radio FM broadcasts to disseminate heat protection tips and high temperature
warnings to the city’s at-risk populations during a heat alert.
§ Explore other means of communications, such as broader use of social media, for example,
Facebook and the WhatsApp mobile application.
AMC Health Department and Medical Professionals:
§ Post heat-related illness prevention tips and how to stay cool around hospitals and UHCs (see
poster attached).
§ Ensure adequate medical supplies available.
§ Produce weekly reports of the public health impact for AMC Nodal Officer during a heat
alert.
§ Increase staffing at hospitals and UHCs to attend to the influx of patients during a heat alert,
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§
§
if feasible.
Increase link worker and community health worker outreach in at-risk neighborhoods during
a heat alert, if feasible.
Have zonal health officer visit UHCs to confirm proper preparation has been made for heatrelated illness and conduct case audits during heat season.
108 Emergency Service:
§ Ensure adequate supply of ice packs and IV fluids.
§ Disseminate SMS text messages to warn local residents during a heat alert.
AMC Labor & Employment Department:
§ Encourage employers to shift outdoor workers’ schedules away from peak afternoon hours
(1pm – 5pm) during a heat alert.
§ Pilot project to provide emergency ice packs and heat-illness prevention materials to traffic
police, BRTS transit staff and construction workers.
Community Groups and Individuals:
§ Keep cool and hydrated during the heat season by drinking water, staying out of the sun, and
wearing light clothing.
§ Check on vulnerable neighbors, particularly during a heat alert.
§ Limit heavy work in direct sun or indoors if poorly ventilated, especially during a heat alert.
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Phase 3: Post-Heat Season (Annually in July through September)
AMC Nodal Officer:
§ Organize an annual Heat Action Plan evaluation meeting with key agency leaders and
relevant stakeholders.
§ Evaluate the Plan process based on performance and revise accordingly.
§ Evaluate the reach and impact of the Plan and revise accordingly.
§ Post the revised Plan to the AMC website ahead of the 2016 heat season for stakeholders.
§ Build on the “Green Cover” activity to establish tree-plantation campaign in hotspot areas
such as roadsides and during plantation festival in June. Incorporate student volunteers or
incentivize builders to plant trees to help effect this effort.
§ Discuss establishing cooling center facilities in high-risk areas around city.
AMC Health Department and Medical Professionals:
§ Perform an epidemiological case review of heat-related mortalities during the summer.
§ Conduct and gather epidemiological outcomes from the data on heat risk factors, illness and
death, based on average daily temperatures.
§ Incorporate data and findings into future versions of the Heat Action Plan.
§ Measure mortality and morbidity rates based on data before and after the Plan’s interventions.
Conclusion:
In Ahmedabad, strong local government leadership has enabled the effective implementation of the
Heat Action Plan since 2013. Buy-in from the city leadership elevates coordinated action that is
essential to protect communities, especially their most vulnerable members, from the dangerous
health effects of extreme heat.
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LIST OF ATTACHMENTS
•
•
•
•
•
•
•
•
2016 Heat Action Plan Updates
“How to Protect Yourself” Poster (English and Gujarati)
Heat Awareness Advertisement for Newspapers (English and Gujarati)
Heat Awareness Advertisement for Buses and Rickshaws (Gujarati)
Medical Heat Awareness Pamphlet (English and Gujarati)
Framework of AMC Medical Professionals and Health Workers
Case Definitions
Agency Action Checklists
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2016 Heat Action Plan Updates
New and enhanced efforts proposed to be launched as part of the Plan this year include:
Building Public Awareness and Community Outreach
• Frequent use of print, electronic media and FM radio to increase general awareness among
public over heatwaves and its health-related issues.
• Use of AMC’s Social Media Platform like Facebook, Twitter and WhatsApp in reaching
larger masses of people.
• School Children Awareness programs.
• Reaching out to targeted communities at higher risk with the help of locally working NGOs
for generating awareness.
• Building awareness among various vulnerable occupational groups.
Initiating an Early Warning System and Inter-Agency Coordination • Indian Meteorological Department of Ahmedabad will provide the Five Days Maximum
Temperature Forecast for Ahmedabad Heat Action Plan from this year onwards.
• Press advisory to be issued of heatwave alerts on Heat Alert Days (Orange Alert) in print
media and on Extreme Heat Alert Days (Red Alert) in both print and electronic media.
• A feedback mechanism on heatwave alerts to be established among Inter-Agencies.
• AMC’s Social Media Platform also to be used in issuing heatwave alerts.
• New potential key agencies to be identified and added in the early warning and coordination
system.
Capacity Building Among Healthcare Professionals
• To hold sensitization workshops for various associations of private healthcare providers.
• Daily death reporting and 108 calls data to be used to keep watch on mortalities and
morbidities with rise in temperatures.
• To strengthen surveillance of heatwave related morbidity and mortality through engaging
private healthcare providers in reporting system.
• Medical officers of UHCs located around Industrial zones to be trained for specific
occupational heat health hazards.
• All AMC healthcare facilities to be strengthened with equipment, staff and medicinal supply
to handle potential increases in patient demand specifically during heatwave days.
Reducing Heat Exposure and Promoting Adaptive Measures
• Locations for provision of safe drinking water at public places to be increased over 2015
levels.
• Night shelters to be mapped and made functional.
• Ensure sufficient water supply in whole city, specifically on heatwave days.
• Ensure no power cuts in whole city, specifically on heatwave days.
• To arrange for rest during peak hot hours of the day for various government and nongovernment vulnerable occupational groups.
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“How to Protect Yourself” Poster (English and Gujarati)
12
Heat Awareness Advertisement for Newspapers (English and
Gujarati)
13
Heat Awareness Advertisement for Buses and Rickshaws
(Gujarati)
14
Medical Heat Awareness Pamphlet (English)
15
Medical Heat Awareness Pamphlet (Gujarati)
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Framework of AMC Medical Professionals and Health Workers
This organizational mapping serves as a framework to coordinate communication of heat protection
tips and early warnings of heat wave response among of medical workers and health clinics involved
in the Heat Action Plan. This framework shows the linkages between the AMC as the nodal
government institution down to grassroots-level response teams of medical officers, link workers,
and auxiliary nurse and midwifes in urban health centres located in each of the six city’s geographic
zones. This map of actors can help guide trainings and future action based on the susceptibility of
particular wards.
AMC
MedicalOfficerof
Health
WestZone– DyHO,
AHO,PHM
NewWestZone–
DyHO,AHO,PHM
SouthZone– DyHO,
AHO,PHM
NorthZone– DyHO,
AHO,PHM
EastZone– DyHO,AHO,
PHM
CentralZone– DyHO,
AHO,PHM
10UHCs
10UHCs
10UHCs
12UHCs
11UHCs
9UHCs
Medicalofficerwith2025LinkWorkersand1
AuxiliaryNurseand
Midwife(ANM)
Medicalofficerwith2025LinkWorkersand1
AuxiliaryNurseand
Midwife(ANM)
Medicalofficerwith2025LinkWorkersand1
AuxiliaryNurseand
Midwife(ANM)
Medicalofficerwith2025LinkWorkersand1
AuxiliaryNurseand
Midwife(ANM)
Medicalofficerwith2025LinkWorkersand1
AuxiliaryNurseand
Midwife(ANM)
62UHCs
Medicalofficerwith2025LinkWorkersand1
AuxiliaryNurseand
Midwife(ANM)
1500Workers
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Case Definitions
Heat Illness - Typical Presentations
Clinical
Age
Entity
Range
Heat rash All, but
frequently
children
Cardinal
Symptoms
Hot
Itchy rash with
environment; small red bumps at
+/- insulating pores in setting of
clothing or
heat exposure;
swaddling
bumps can
sometimes be
filled with clear or
white fluid
Heat
All
Hot
Painful spasms of
cramps
environment, large and
typically with frequently used
exertion, +/- muscle groups
insulating
clothing
Heat
All
Hot
Feeling
exhaustion
environment; overheated,
+/- exertion; lightheaded,
+/- insulating exhausted and
clothing or
weak, unsteady,
swaddling
nauseated, sweaty
and thirsty,
inability to
continue activities
Heat
Typically Hot
Feeling hot and
syncope
adults
environment; weak;
+/- exertion; lightheadedness
+/- insulating followed by brief
clothing or
loss of
swaddling
consciousness
Heat
stroke
All
Setting
Hot
environment;
+/- exertion;
+/- insulating
clothing or
swaddling
Severe
overheating;
profound
weakness;
disorientation,
obtundation,
seizures, or other
altered mental
status
Cardinal Signs
Pertinent Negatives Prognosis
Diffuse maculopapular
rash, occasionally
pustular, at hair
follicles; pruritic
Not focally
distributed like a
contact dermatitis;
not confluent patchy;
not petechial
Uncomfortable
appearance, may have
difficulty fully
extending affected
limbs/joints
No contaminated
wounds/tetanus
exposure; no seizure
activity
Full recovery
with
elimination of
exposure and
supportive
care
Sweaty/diaphoretic;
No coincidental signs Full recovery
flushed skin; hot skin; and symptoms of
with
normal core
infection; no focal
elimination of
temperature; +/- dazed, weakness; no
exposure and
+/- generalized
aphasia/dysarthria;
supportive
weakness, slight
no overdose history care;
disorientiation
progression if
continued
exposure
Brief, generalized loss No seizure activity, Full recovery
of consciousness in hot no loss of bowel or with
setting, short period of bladder continence, elimination of
disorientation if any
no focal weakness, exposure and
no aphasia/dysarthria supportive
care;
progression if
continued
exposure
Flushed, dry skin (not No coincidental signs 25-50%
always), core temp
and symptoms of
mortality
≥40°C; altered mental infection; no focal
even with
status with
weakness; no
aggressive
disorientation, possibly aphasia/dysarthria;
care;
delirium, coma,
no overdose history significant
seizures; tachycardia;
morbidity if
+/- hypotension
survive
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Full recovery
with
elimination of
exposure and
supportive
care
Heat Illness - Case Definitions
Clinical
Entity
Heat rash
Heat
cramps
Heat
exhaustion
Heat
syncope
Heat stroke
Case Definition
Diffuse, pruritic, maculopapular or vesicular rash in the setting of heat exposure, often with insulating
clothing or swaddling.
Painful contractions of frequently used muscle groups in the setting of heat exposure, often with exertion
Syndrome of generalized weakness and or exhaustion, often with lightheadedness, limiting functioning in a
hot environment, without history of recent infection. May or may not be exertional.
Brief loss of consciousness in the setting of heat exposure without evidence of seizure activity, stroke, or
medication overdose.
Altered mental status (including disorientation, delirium, seizure, obtundation) with elevated core body
temperature ≥ 40°C in the setting of heat exposure, without signs of stroke, history of infection, or signs of
medication overdose. May or may not be exertional.
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Heat Illness – Treatment Protocol
Recognizing that treatment protocols may vary slightly according to the setting (EMS, health center,
clinic, hospital emergency department, etc.), the following should apply generally to any setting and
to all patients where there is a potential concern for heat illness. Special thanks to Drs. Arthur
Yancey and Nee-Kofi Mould-Millman of Grady Emergency Medical Services, Emory University
Department of Emergency Medicine, Atlanta, GA USA
1. Initial patient assessment – primary survey (airway, breathing, circulation, disability,
exposure), vital signs, including temperature
2. Consider heat illness in differential diagnosis if:
a. Presenting with suggestive symptoms and signs (see table)
b. Patient has one or more of the following risk factors:
i. Extremes of age (infants, elderly)
ii. Debilitation/physical deconditioning, overweight or obese
iii. Lack of acclimatizationto environmental heat (recent arrival, early in summer
season)
iv. Any significant underlying chronic disease, including psychiatric,
cardiovascular, neurologic, hematologic, obesity, pulmonary, renal, and
respiratory disease
v. Taking one or more of the following:
1. Sympathomimetic drugs
2. Anticholinergic drugs
3. Barbiturates
4. Diuretics
5. Alcohol
6. Beta blockers
3. Remove from environmental heat exposure and stop physical activity
4. Initiate passive cooling procedures
a. Cool wet towels or ice packs to axillae, groin, and around neck; if patient is stable,
may take a cool shower, but evaluate risk of such activity against gain and availability
of other cooling measures
b. Spray cool water or blot cool water onto skin
c. Use fan to blow cool air onto moist skin
5. If temperature lower than 40°C, repeat assessment every 5 minutes; if improving, attempt to
orally hydrate (clear liquids, ORS can be used but not necessary; cool liquids better than
cold)and observe
6. If temperature 40°C or above, initiate IV rehydration and immediately transport to emergency
department for stabilization
20
Agency Action Checklists
Checklist for AMC Nodal Officer
Checklist for Medical Colleges and Hospitals
Pre-summer
ü Adopt heat-focused examination materials
ü Get additional hospitals and ambulances ready
ü Update surveillance protocols and programs, including to
track daily heat-related data
ü Establish more clinician education
ü Continue to train medical officers and paramedics
Pre-Summer
ü Designate heat health point of contact for each department
ü Reengage key agencies to facilitate communications and
schedule monthly meetings
ü Establish heat mortality tracking system and update datasets
ü Establish Heat Action webpage on AMC website
ü Educate school children and send home age-appropriate
pamphlets about the heat season
ü Create list of high-risk areas of city heat-wise
During Heat Event
ü Adopt heat-illness related treatment and prevention protocols
ü Equip hospitals with additional materials
ü Deploy all medical staff to be on duty
ü Keep emergency ward ready
ü Monitor water borne diseases, malaria and dengue
ü Keep stock of small reusable ice packs to apply to PULSE
areas
ü Report heat stroke patients to AMC daily
ü Expedite recording of cause of death certificates
During Heat Event
ü Contact point person in each department announcing heat
event at least five days in advance
ü Maintain contact with department points of contact for
updates on conditions
ü Ensure staff presence and availability of supplies with each
department – including distributing fresh drinking water
ü Communicate locations of emergency facilities and cooling
centers/shaded areas with each department
ü Monitor heat alert and increase level when severe forecast
Post-summer Evaluation
ü Participate in annual evaluation of heat action plan
ü Review revised heat action plan
Post-Summer Evaluation
ü Review quantitative and qualitative data for process
evaluation and improvements
ü Call meeting for annual evaluation of heat plan with key
agency leaders and community partners
ü Post revised heat action plan online for stakeholders
21
Checklist for Public Health Managers
Pre-summer
ü Identify areas that are vulnerable
ü Check inventories of medical supplies in health centers
ü Identify cooling centers and barriers to access cooling
centers
ü Community involvement for workers and trainers education
Checklist for Urban Health Centres and Link Workers
Pre-summer
ü Distribute pamphlet and other materials to community
ü Sensitize link workers and community leaders
ü Develop and execute school health program
ü Dissemination of materials in slum communities
ü Coordinate outreach efforts with other community groups,
non-profits, and higher education
During Heat Event
ü Prepare rapid response team
ü Distribute “Dos and Don’ts” to community
ü Effectively send a “Don’t Panic!” message to community
ü Ensure access to Medical Mobile Van in the Red Zone
ü Ensure additional medical vans available
During Heat Event
ü Recheck management stock
ü Modify worker hours to avoid heat of day
ü Visit at-risk populations for monitoring and prevention
ü Communicate information on tertiary care and 108 service
Post-summer Evaluation
ü Participate in annual evaluation of heat action plan
ü Review revised heat action plan
Post-summer Evaluation
ü Participate in annual evaluation of heat action plan
ü Review revised heat action plan
22
Checklist for AMC Press Officer
Pre-Summer
ü Secure commercial airtime slots for public service
announcements
ü Identify areas to post warnings and information during heat
season
ü Organize training for health workers and medical
professionals
ü Activate telephone heat hotline
ü Begin placing temperature forecasts in newspapers
ü Increase installed LED screens with scrolling temperature
data
Checklist for Labor Department
Pre-Summer
ü Heat illness orientation for factory medical officers and
general practitioners
ü Generate list of factory medical officers and contractors to
include in heat action communications from Nodal Officer
ü Communicate directly about heat season with non-factory
workers
ü Utilize maps of construction sites to identify more high-risk
outdoor workers.
ü Conduct publicity campaigns during high-risk days in
identified high-risk areas
During Heat Event
ü Issue heat warnings in heat and electronic media
ü Contact local FM radio and TV stations for announcements
ü Use SMS, text and WhatsApp mobile messaging and
centralized mobile databases to send warnings
ü Contact BRTS and transport department to place warnings
on buses
During the Heat Season
ü Provide water at work sites
ü Request use of A/C at factory facilities
ü Extended hours at Occupational Health Centers
ü Consider extended afternoon break or alternate working
hours for workers
Post-Summer Evaluation
ü Evaluate reach of advertising to target groups and other
means of communication such as social media
ü Participate in annual evaluation of heat action plan
ü Review revised heat action plan
Post-Summer Evaluation
ü Participate in annual evaluation of heat action plan
ü Review revised heat action plan
ü Pilot project to provide emergency ice packs and heat-illness
prevention materials to traffic police, BRTS transit staff and
construction workers
23
Checklist for 108 Emergency Service
Pre-Summer
ü Prepare handouts for paramedics about heat illness
ü Create displays on ambulances to build public awareness
during major Spring events
ü Establish Dynamic Strategic Deployment Plan for
ambulances
ü Ensure adequate supply of IV fluids
ü Identify at-risk areas
ü Prepare SMS messages to disseminate during emergencies
ü Identify media point of contact
During the Heat Season
ü Ready medicine stocks
ü Keep accurate records of pre-hospital care
ü Send messages to all employees alerting them of heat action
plan
ü Activate Dynamic Strategic Deployment Plan
ü Staff surplus employees and restrict leave
Post-Summer Evaluation
ü Provide data to key agency leaders
ü Participate in annual evaluation of heat action plan
ü Review revised heat action plan
24
Partnering Organizations
Ahmedabad Municipal Corporation
The Ahmedabad Municipal Corporation (AMC) is the municipal governing body of Ahmedabad, responsible
for the city’s civic infrastructure and administration. Led by its mayor and commissioner, AMC has pioneered
the development of heat vulnerability reduction strategies and an early warning system for extreme heat
events to protect its residents. http://www.egovamc.com/
Indian Institute of Public Health, Gandhinagar
The Indian Institute of Public Health, Gandhinagar (IIPH) is a leader on public health education, advocacy
and research on public health. IIPH pushes the mandate of equity in public health, applying strategy, resources
and networks to the issues and practice of public health in India. IIPH’s programs aim to make education and
research activities relevant to India in content and context.
Public Health Foundation of India
The Public Health Foundation of India (PHFI) is a public-private partnership structured as an independent
foundation. PHFI is the hub of teaching, research, sharing knowledge and experiences in areas at the cuttingedge of public health in India. PHFI has launched four institutes of public health, including IIPHGandhinagar. http://www.phfi.org
Natural Resources Defense Council
The Natural Resources Defense Council (NRDC) is one of the most effective environmental groups,
combining 1.3 million members and online activists with the expertise of more than 350 scientists and other
professionals. NRDC is a leader in public health research, policy, and advocacy- including building resilience
in local communities and fighting climate change. In 2009, we launched our India Initiative focused on
climate change and clean energy with projects on climate change preparedness and adaptation and energy
efficiency. With our partners, we advocate for increased policy development and implementation to protect
communities from environmental threats. http://www.nrdc.org
Mount Sinai School of Medicine
The Mount Sinai School of Medicine is internationally recognized as a leader in groundbreaking clinical and
basic science research and is known for its innovative approach to medical education. With a faculty of more
than 3,400 in 38 clinical and basic science departments and centers, Mount Sinai is a top-ranked medical
school based in New York City. http://www.mssm.edu/
Climate & Development Knowledge Network
This publication was funded by the Climate & Development Knowledge Network (CDKN), which is
supported by the UK Department for International Development (DFID) and the Netherlands DirectorateGeneral for International Cooperation (DGIS) for the benefit of developing countries. CDKN supports and
promotes innovative thinking and innovative action on climate change and development issues.
25
ONLINE RESOURCES
Heat Action Plan and Research Materials are available at:
http://www.nrdc.org/international/india/extreme-heat-preparedness/
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Natural Resources Defense Council
Rollins School of Public Health of Emory University
Icahn School of Medicine at Mount Sinai
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Ahmedabad’s Heat
Action Plan
City Resilience Toolkit:
Response to Deadly Heat
Waves and Preparing for
Rising Temperatures
Inside Story: Addressing
heatrelated health risks
in urban India: Ahmedabad’s
Heat Action Plan
Expert Committee
Recommendations for a
Heat Action Plan based on
the Ahmedabad Experience
Evaluation of Ahmedabad’s
Heat Action Plan: Assessing
India’s First Climate
Adaptation and Early Warning
System for Extreme Heat
CUTTING EDGE SCIENTIFIC RESEARCH AND JOURNAL ARTICLES
!
Int. J. Environ. Res. Public Health 2014, 11, 3473-3492; doi:10.3390/ijerph110403473
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3,5
3,5
Kim Knowlton
*, Suhas P. Kulkarni , Gulrez Shah Azhar , Dileep Mavalankar ,
Anjali Jaiswal 1,3, Meredith Connolly 1,3, Amruta Nori-Sarma 2,3,5, Ajit Rajiva 3,5, Priya Dutta 3,5,
Bhaskar Deol 1,3, Lauren Sanchez 1,3, Radhika Khosla 1,3, Peter J. Webster 6, Violeta E. Toma 6,
Perry Sheffield 3,7, Jeremy J. Hess 3,8,9 and the Ahmedabad Heat and Climate Study Group 3
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Research Article
Neonates in Ahmedabad, India, during the 2010 Heat Wave: A
Climate Change Adaptation Study
Khyati Kakkad,1 Michelle L. Barzaga,2 Sylvan Wallenstein,2 Gulrez Shah Azhar,3,4 and
Perry E. Sheffield2,4
1
Department of Paediatrics, Smt S.C.L. General Hospital, Saraspur, Ahmedabad 380053, India
2
Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
3
Indian Institute of Public Health, Gandhinagar 380054, India
4
Ahmedabad Heat and Climate Study Group, Gandhinagar 380054, India
Correspondence should be addressed to Perry E. Sheffield; perry.sheffield@mssm.edu
Natural Resources Defense Council, New York, NY 10011, USA; E-Mails: ajaiswal@nrdc.org (A.J.);
bdeol@nrdc.org (B.D.); laurenksanchez@gmail.com (L.S.); radhika.khosla@gmail.com (R.K.);
mconnolly@nrdc.org (M.C.)
Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University,
New York, NY 10032, USA
Ahmedabad Heat and Climate Study Group, Gandhinagar, Gujarat 380054, India
Ahmedabad Municipal Corporation, Medical Officer of Health, Ahmedabad, Gujarat 380001, India;
E-Mail: suhaspkulkarni@gmail.com
Indian Institute of Public Health, Gandhinagar, Gujarat 380054, India;
E-Mails: gsazhar@iiphg.org (G.S.A.); dmavalankar@iiphg.org (D.M.);
amrutasri.nori-sarma@yale.edu (A.N.-S.); arajiva@iiphg.org (A.R.); priyadutta@iiphg.org (P.D.)
School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA;
E-Mails: pjw@eas.gatech.edu (P.J.W.); vt25@mail.gatech.edu (V.E.T.)
Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
E-Mail: perry.sheffield@mssm.edu
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta,
GA 30322, USA; E-Mail: jhess@emory.edu
Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
* Author to whom correspondence should be addressed; E-Mail: kknowlton@nrdc.org;
Tel.: +1-212-727-4579; Fax: +1-212-727-1773.
Received: 26 January 2014; in revised form: 26 February 2014 / Accepted: 4 March 2014 /
Published: 25 March 2014
Received 31 May 2013; Revised 5 December 2013; Accepted 7 January 2014; Published 10 March 2014
Academic Editor: Luis Gabriel Cuervo
Copyright © 2014 Khyati Kakkad et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Health effects from climate change are an international concern with urban areas at particular risk due to urban heat island effects.
The burden of disease on vulnerable populations in non-climate-controlled settings has not been well studied. This study compared
neonatal morbidity in a non-air-conditioned hospital during the 2010 heat wave in Ahmedabad to morbidity in the prior and
subsequent years. The outcome of interest was neonatal intensive care unit (NICU) admissions for heat. During the months of
April, May, and June of 2010, 24 NICU admissions were for heat versus 8 and 4 in 2009 and 2011, respectively. Both the effect of
moving the maternity ward and the effect of high temperatures were statistically significant, controlling for each other. Above 42
degrees Celsius, each daily maximum temperature increase of a degree was associated with 43% increase in heat-related admissions
(95% CI 9.2–88%). Lower floor location of the maternity ward within hospital which occurred after the 2010 heat wave showed a
protective effect. These findings demonstrate the importance of simple surveillance measures in motivating a hospital policy change
for climate change adaptation—here relocating one ward—and the potential increasing health burden of heat in non-climatecontrolled institutions on vulnerable populations.
Heat-Related Mortality in India: Excess All-Cause
Mortality Associated with the 2010 Ahmedabad Heat
Wave
Project partners:
International Journal of
Environmental Research and
Public Health: Development
and Implementation of
South Asia’s First HeatHealth Action Plan in
Ahmedabad (Gujarat, India)
(January 2014)
Recommendations for Slum Communities in Ahmedabad
Gulrez Shah Azhar1,2*, Dileep Mavalankar1,2, Amruta Nori-Sarma1,3, Ajit Rajiva1, Priya Dutta1,
Anjali Jaiswal4, Perry Sheffield5, Kim Knowlton3,4, Jeremy J. Hess 6,7, on behalf of the Ahmedabad
HeatClimate Study Group"
1 Indian Institute of Public Health, Ahmedabad, Gujarat, India, 2 Public Health Foundation of India, New Delhi, India, 3 Columbia Mailman School of Public Health, New
York, New York, United States of America, 4 Natural Resources Defense Council, New York, New York, United States of America, 5 Icahn School of Medicine at Mount Sinai,
New York, New York, United States of America, 6 Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America,
7 Department of Environmental Health, Emory University School of Public Health, Atlanta, Georgia, United States of America
New Delhi
Abstract
AbstractIntroduction: In the recent past, spells of extreme heat associated with appreciable mortality have been
documented in developed countries, including North America and Europe. However, far fewer research reports are available
from developing countries or specific cities in South Asia. In May 2010, Ahmedabad, India, faced a heat wave where the
temperatures reached a high of 46.8uC with an apparent increase in mortality. The purpose of this study is to characterize
the heat wave impact and assess the associated excess mortality.
Methods: We conducted an analysis of all-cause mortality associated with a May 2010 heat wave in Ahmedabad, Gujarat,
India, to determine whether extreme heat leads to excess mortality. Counts of all-cause deaths from May 1–31, 2010 were
compared with the mean of counts from temporally matched periods in May 2009 and 2011 to calculate excess mortality.
Other analyses included a 7-day moving average, mortality rate ratio analysis, and relationship between daily maximum
temperature and daily all-cause death counts over the entire year of 2010, using month-wise correlations.
Ahmedabad
Results: The May 2010 heat wave was associated with significant excess all-cause mortality. 4,462 all-cause deaths occurred,
comprising an excess of 1,344 all-cause deaths, an estimated 43.1% increase when compared to the reference period (3,118
deaths). In monthly pair-wise comparisons for 2010, we found high correlations between mortality and daily maximum
temperature during the locally hottest ‘‘summer’’ months of April (r = 0.69, p,0.001), May (r = 0.77, p,0.001), and June
(r = 0.39, p,0.05). During a period of more intense heat (May 19–25, 2010), mortality rate ratios were 1.76 [95% CI 1.67–1.83,
p,0.001] and 2.12 [95% CI 2.03–2.21] applying reference periods (May 12–18, 2010) from various years.
Conclusion: The May 2010 heat wave in Ahmedabad, Gujarat, India had a substantial effect on all-cause excess mortality,
even in this city where hot temperatures prevail through much of April-June.
Citation: Azhar GS, Mavalankar D, Nori-Sarma A, Rajiva A, Dutta P, et al. (2014) Heat-Related Mortality in India: Excess All-Cause Mortality Associated with the
2010 Ahmedabad Heat Wave. PLoS ONE 9(3): e91831. doi:10.1371/journal.pone.0091831
Editor: Suminori Akiba, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
Received October 3, 2013; Accepted February 15, 2014; Published March 14, 2014
Copyright: ! 2014 Azhar et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
1. Introduction/Background
Climate change is a growing international concern with current and future global effects. The Intergovernmental Panel
on Climate Change (IPCC) reports unequivocal evidence
for the warming of climate systems with a global mean
temperature rising 0.74∘ C between 1906 and 2005, and the 11
years 1995–2006 have been reported as being among the 12
warmest years since 1850 [1]. These rising temperatures are
especially disconcerting for urban areas.
Specifically, in urban areas the warming from climate
change increases the risk of heat waves by compounding the
existing problem of urban heat islands—a result of urban
areas being hotter than surrounding rural areas due to more
impervious and heat absorbing surfaces that retain and subsequently reradiate incident solar radiation, less vegetation,
and more local heat production [2, 3]. As such, climate change
affecting these areas will have far-reaching consequences, as
the proportion of the global population living in urban areas
increases. For example, the urban proportion of the global
population increased from 30% in the 1950s to over 50% in
the early 2000s and, by the year 2030, 60% of the world’s
population is expected to live in cities, according to the
United Nations (2001) World Population Prospects Revision
Report [4].
One city of importance is Ahmedabad, India, with a
population of 7.2 million [5]. Ahmedabad is the largest city
in Gujarat and among the fastest growing cities in India [6].
Located in the arid Northwest region of India, Ahmedabad’s
warm, dry conditions often include heat waves. Ahmedabad’s
hot season typically runs from March to June, with an average
monthly maximum of 38.8∘ C (101.8∘ F) during this period
Funding: This work is funded by a grant from the Climate Knowledge Development Network. The funders had no role in study design, data collection and
analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: gsazhar@iiphg.org
" Membership of the Ahmedabad Heat and Climate Study Group is provided in the Acknowledgments
Journal of Environmental
and Public Health: Neonates
in Ahmedabad, India, during
the 2010 Heat Wave: A
Climate Change Adaptation
Study (January 2014)
through the 21st century, including increasing extreme heat events
[7].
Temperature extremes are a major underlying weather-related
cause of mortality in much of the world and the leading cause of
directly-mediated weather-related mortality [8,9,10,11,12,13].
Heat related morbidity and mortality can be due to either direct
or indirect effects [14]. Direct effects include a spectrum of heat
illness ranging from heat exhaustion to heat stroke; the indirect
effects occur when heat exposure stresses underlying physiological
systems and results in other specific manifestations such as renal
Introduction
Weather extremes can have significant public health impacts
[1,2,3]. The global frequency of extreme weather events, including
extreme precipitation, drought and resulting crop failure, tropical
cyclones, and flooding has been increasing in recent years,
consistent with anthropogenic climate change [4,5]. These trends,
which exhibit significant regional variability, are expected to
continue in future as climate change becomes more pronounced
[6]. A national assessment conducted by the Indian government
on climate change projects increasing temperatures for India
PLOS ONE | www.plosone.org
International Journal of
Environmental Research
and Public Health: A CrossSectional, Randomized
Cluster Sample Survey of
Household Vulnerability to
Extreme Heat among Slum
Dwellers in Ahmedabad,
India (June 2013)
MARCH 2013
IB:13-01-C
Rising Temperatures, Deadly Threat:
1
Supported in part by:
March 2014 | Volume 9 | Issue 3 | e91831
PlosOne: Heat-Related
Mortality in India: Excess
All-Cause Mortality
Associated with the 2010
Ahmedabad Heat Wave
(March 2014)
Rising Temperatures, Deadly
Threat: Series of Four Issue
Briefs of Recommendations
for Heat Adaptation in
Ahmedabad
Supported in part by:
This document is an output from a project funded by the
UK Department for International Development (DFID)
and the Netherlands Directorate-General for International
Cooperation (DGIS) for the benefi t of developing
countries. However, the views expressed and information
contained in it are not necessarily those of or endorsed by
DFID, DGIS or the entities managing the delivery of the
Climate and Development Knowledge Network, which
can accept no responsibility or liability for such views,
completeness or accuracy of the information or for any
reliance placed on them.