Background: Millions of people can potentially be exposed to smoke from forest fires, making this an important public health problem in many countries.

Objective: In this study we aimed to measure the association between out-of-hospital cardiac arrest (OHCA) and forest fire smoke exposures in a large city during a severe forest fire season, and estimate the number of excess OHCAs due to the fire smoke.

Methods: We investigated the association between particulate matter (PM) and other air pollutants and OHCA using a case-crossover study of adults (≥ 35 years of age) in Melbourne, Australia. Conditional logistic regression models were used to derive estimates of the percent change in the rate of OHCA associated with an interquartile range (IQR) increase in exposure. From July 2006 through June 2007, OHCA data were collected from the Victorian Ambulance Cardiac Arrest Registry. Hourly air pollution concentrations and meteorological data were obtained from a central monitoring site.

Results: There were 2,046 OHCAs with presumed cardiac etiology during our study period. Among men during the fire season, greater increases in OHCA were observed with IQR increases in the 48-hr lagged PM with diameter ≤ 2.5 μm (PM_2.5) (8.05%; 95% CI: 2.30, 14.13%; IQR = 6.1 μg/m³) or ≤ 10 μm (PM₁₀) (11.1%; 95% CI: 1.55, 21.48%; IQR = 13.7 μg/m³) and carbon monoxide (35.7%; 95% CI: 8.98, 68.92%; IQR = 0.3 ppm). There was no significant association between the rate of OHCA and air pollutants among women. One hundred seventy-four “fire-hours” (i.e., hours in which Melbourne’s air quality was affected by forest fire smoke) were identified during 12 days of the 2006/2007 fire season, and 23.9 (95% CI: 3.1, 40.2) excess OHCAs were estimated to occur due to elevations in PM_2.5 during these fire-hours.

Conclusions: This study found an association between exposure to forest fire smoke and an increase in the rate of OHCA. These findings have implications for public health messages to raise community awareness and for planning of emergency services during forest fire seasons.

Citation: Dennekamp M, Straney LD, Erbas B, Abramson MJ, Keywood M, Smith K, Sim MR, Glass DC, Del Monaco A, Haikerwal A, Tonkin AM. 2015. Forest fire smoke exposures and out-of-hospital cardiac arrests in Melbourne, Australia: a case-crossover study. Environ Health Perspect 123:959–964;  http://dx.doi.org/10.1289/ehp.1408436

Address correspondence to M. Dennekamp, Monash University, Level 6, 99 Commercial Rd., Melbourne, VIC 3004, Australia. Telephone: 613 9903 0166. E-mail: Martine.Dennekamp@monash.edu

We thank Ambulance Victoria, Environment Protection Authority Victoria, CSIRO Marine and Atmospheric Sciences, and the Bureau of Meteorology for providing data.

The study was funded by the National Health & Medical Research Council. M.D. is supported by the Centre for Air quality and health Research and evaluation. M.J.A. holds unrelated research grants from Pfizer and Boehringer Ingelheim.

The authors declare they have no actual or potential competing financial interests.

Received: 17 March 2014 Accepted: 17 March 2015 Advance Publication: 20 March 2015 Final Publication: 1 October 2015

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