User:Triptothecottage/2016 Melbourne thunderstorm asthma epidemic

On 21 November 2016, a thunderstorm asthma epidemic occurred in Melbourne, Australia following the release of large quantities of pollen into the atmosphere near the city. Although the thunderstorm asthma phenomenon had been described previously, both in Melbourne and in several other cities, the Melbourne event was unprecedented in scale. Nearly 10,000 people sought medical treatment during the evening of 21 November, overwhelming the city's health system and leading officials to describe the event as a natural disaster. 10 deaths were eventually linked to the epidemic, and the crisis prompted the development of early warning systems and awareness campaigns designed to prevent any future atmospheric event from escalating to a public health emergency.

Background
Towards the end of the 20th century and into the early 2000s, medical research identified a number of conditions that would produce thunderstorm asthma epidemics. The condition occurs when pollen produced by grasses near residential areas is swept up by the outflow associated with a storm front, and the pollen particles are ruptured into smaller particles able to be inhaled. The air mass containing the tiny particles is then concentrated close to the ground, producing severe allergic reactions in the respiratory systems of people with sensitivity to pollen.

Several incidences of thunderstorm asthma had occurred in Melbourne prior to the 2016 event. Epidemics in 1984, 1987, 1989, 2003 and 2010 had affected varying numbers of residents, with the most severe episode in spring 1989 resulting in some 277 patients arriving at emergency departments. The 1987 event was the first time the term "thunderstorm asthma" was applied to the phenomenon, and a single death was recorded during a 2002 epidemic in the United Kingdom. After the 2010 Melbourne incident, asthmatics were warned to call emergency services immediately if they experienced breathing difficulty during thunderstorm conditions.

Incident
Around 5.30pm 21 November 2016, a band of storms swept across the western suburbs of Melbourne. Although the front had been forecast days in advance by the Bureau of Meteorology, rapidly changing conditions led to a storm warning being issued at 5.13pm predicting damaging winds and rain with possible hail. In the hour following the passing of the storm front, the number of calls made to Ambulance Victoria services via Triple Zero began to increase astronomically. Staff at the Emergency Services Telecommunications Authority (ESTA) call centre suspected an equipment malfunction as computer-aided dispatch systems showed an enormous volume of emergency calls, but the increase was made up of patients reporting respiratory distress and asthma symptoms. By 7pm, the western ambulance region of Melbourne had been completely overwhelmed, with no Mobile Intensive Care Ambulances (MICAs) or standard paramedics available to respond to further calls.

In the period between 7.00pm and 7.15pm, ESTA answered 201 emergency calls for ambulances, at an average rate of a call every 4.5 seconds. Victoria Police officers and firefighters from the Metropolitan Fire Brigade trained in first aid responded when authorities were unable to call back patients who had been told an ambulance was not available. However, because no obvious event had triggered the surge in calls, ESTA managed the epidemic as though it was a "busy night", without implementing crisis protocols.

Meanwhile, at public hospital emergency departments across the city, thousands of patients had begun to present with asthma symptoms, many in a serious condition. Many of these presentations were driven by advice from the Nurse On Call service operated by the Department of Health And Human Services, which experienced a rate of calls 45% higher than usual across the night of 21 November, and, in addition to instructing patients to immediately attend a hospital, also referred a number of callers directly to Triple Zero for ambulance attendance.

The scale of the crisis led Ambulance to describe the unfolding event as a state-scale "disaster" unlike anything previously experienced.

By 23 November, three people remained in intensive care, as government responses to the epidemic began to emerge.

Death toll
Initial reports on the night of 21 November identified two deaths in the western suburbs of Melbourne, although ambulance commanders told media that there would certainly be further fatalities. An eighth victim died in hospital on 29 November, and a ninth on 25 January 2017. Then, in October 2017, at the opening of the coronial inquest, the Coroners Court of Victoria announced it would investigate a total of ten deaths linked to the epidemic.

Response reviews
The pressure on medical services during the epidemic exceeded any other incident in Victoria's history, including the 2009 Black Saturday bushfires.