The impact of air pollutants on ambulance dispatches: A systematic review and meta-analysis of acute effects

A number of systematic reviews have investigated the association between air pollutants and health impacts, these mostly focus on morbidity and mortality from hospital data. Previously, no reviews focused solely on ambulance dispatch data. These data sets have excellent potential for environmental health research. For this review, publications up to April 2019 were identified using three main search categories covering: ambulance services including dispatches; air pollutants; and health outcomes. From 308 studies initially identified, 275 were excluded as they did not relate to ambulance service dispatches, did not report the air pollutant association, and/or did not study ambient air pollution. The main health outcomes in the remaining 33 studies were cardiac arrest (n = 14), cardiovascular (n = 11) and respiratory (n = 10) dispatches. Meta-analyses were performed to summarise pooled relative risk (RR) of pollutants: particulate matter less than 2.5 and 10 μm (PM₂.₅, PM₁₀), the fraction between PM₁₀ and PM₂.₅ (coarse) and suspended particulate matter (SPM) per 10 μg/m³ increase, carbon monoxide (CO) per 1 ppm increase and of sulphur dioxide (SO₂), nitrogen dioxide (NO₂), and ozone (O₃) per 10 ppb increment and ambulance dispatches. Statistically significant associations were found for ambulance dispatch data for all-respiratory and PM₂.₅ at 1.03 (95% CI:1.02–1.04) and at 1.10 (95% CI:1.00–1.21) for asthma and NO₂ associations. For dispatches with subsequent paramedic assessment for cardiac arrest with PM₂.₅, CO and coarse dispatches at 1.05 (95% CI:1.03–1.08), 1.10 (95% CI:1.02–1.18) and 1.04 (95% CI:1.01–1.06) respectively. For dispatches with subsequent physician diagnosis for all-respiratory and PM₂.₅ at 1.02 (95% CI:1.01–1.03). In conclusion, air pollution was significantly associated with an increase in ambulance dispatch data, including those for cardiac arrest, all-respiratory, and asthma dispatches. Ambulance services should plan accordingly during pollution events. Furthermore, efforts to improve air quality should lead to decreases in ambulance dispatches.