Victoria suffered a record-breaking heatwave in January 2009 including three days with a recorded temperature in excess of 43 degrees for the first time in history and Melbourne’s hottest day on record.
Hundreds of people were hospitalised as a result of the heatwave with 374 deaths attributed. Ambulance Victoria (AV) paramedics saw an increase in workload of more than 70 per cent during this time while the 000 call process was also flooded with non-urgent calls for information or advice.
AV saw the need to increase public awareness of appropriate behaviours and actions during a heatwave as a method of demand management and to help save lives. Research established the most at risk audiences, including elderly, the sick and children.
The in house Corporate Communications department quickly developed and implemented a strategy targeting these audiences with a message for people to respect the heat.
The campaign was a success with AV providing 112 media comments and receiving 1,656 media mentions. Of these, 83 per cent contained at least one safety message. There was also an attributable increase in calls to a medical information phone line once the campaign started.
Melbourne experienced an unprecedented heatwave in January 2009. Over a 12 day period from 27 January to 8 February there were only two days with maximum temperatures under 30 degrees, a record breaking streak of three days over 43 degrees (28-30 January) and Melbourne’s hottest day on record (7 February) at 46.4 degrees.
These conditions had a drastic impact on public health and the work of AV. In the three days over 43 degrees, ambulance call-outs increased by 71 per cent and there were 374 heat related deaths. This led to delayed responses for less urgent cases.
The 000 call process was inappropriately used by callers seeking information or advice, making it difficult for genuine callers.
AV saw a requirement to provide accurate community advice and education to not only fulfil its legislative requirements as an ambulance service but also assist in reducing call-outs. As always, the driving force was to save lives.
Given the political nature of the messaging and the extensive media coverage the situation was receiving, the project required support of many partners. These included
- the Victorian Government
- the Minister for Health
- Department of Human Services
- other emergency services including Victoria Police
- essential services including public transport providers
Ambulance Victoria regularly reviews key safety messages for specific emergencies and emergency preparedness. As part of this, AV met with the Department of Human Services (DHS) Environmental Sciences Department on 15 January to discuss media management of a heatwave crisis.
This led to AV reviewing research into the potential consequences of a heatwave and identification of most at risk audiences as the basis for primary safety messages.
AV Corporate Communications spent time with the DHS Environmental Science experts and representatives of the AV Emergency Management Department as part of primary research to further understand the heatwave issues. This was done on the basis of gaining a better long-term understanding and was opportune to have been conducted prior to the heatwave commenced some two weeks later.
Given timeframes and budget restraints it was not a viable option to undertake unique primary research to measure public understanding prior to the heatwave.
Extensive qualitative secondary research uncovered relevant targeted information. This included heatwave advice on websites of agencies such as America’s Federal Emergency Management Agency, the UK’s National Health Service and Department of Health and Australia’s Federal Department of Health and Ageing. This was then expanded on with specific research into the target audiences.
A review of the 2003 French heatwave commissioned by the Ministry of Health demonstrated specific medical and social trends. A 2008 UK report into perceptions of heatwave risks based on interview studies of older people also showed that ‘few respondents considered themselves either old or at risk from the effects of heat, even though many had some form of relevant chronic illness’.
AV had utilised extensive media coverage in previous summers, including advice to prevent children being locked in cars. Previous media experience and relationships had established that AV paramedics were recognised as industry experts on health advice for extreme heat and that the paramedic uniform carried a level of trust not available to other health department bureaucrats.
 Journal of Public Health, ‘Perceptions of heatwave risks to health: interview-based study of older people in London and Norwich, UK’, 20 January 2009 http://jpubhealth.oxfordjournals.org/cgi/content/abstract/31/1/119
The primary target audiences for this campaign were those identified in research as being at risk. These included the elderly, the sick, children and their parents and tourists who lived in or were visiting Victoria at the time of the heatwave.
These target audiences were specified in the campaign goals. There inclusion was supported by primary and secondary research.
Secondary audiences included the paramedic workforce, state and federal politicians and other emergency services and public service agencies. These were selected to win support for the campaign and their ability to endorse the campaign and assist distribution of key messages.
The key message for the campaign was that people needed to treat heat with respect.
This was supported with the use of key messages outlining the best way to minimise the impact of extreme heat:
- Stay out of the sun
- Dress appropriately for the weather
- Avoid over-exertion
- Drink plenty of non-alcoholic fluids
- Check on older, sick and frail people who may need help
- Never leave anyone in a parked car;
A secondary message was to encourage appropriate ambulance usage. This included promoting that AV was busy, delays were expected for non-urgent cases and alternate services such as Nurse On-Call 1300 60 60 24 were available for advice.
Given the extent of the crisis, mainstream media coverage was identified as the optimum channel to communicate quickly to a large audience. The heatwave had a quick onset meaning that alternate communications were not a realistic option. The heatwave effects were felt statewide, meaning localised campaigns required broad management and staffing hours that were not available.
To maximise impact with target audiences, it was determined that visual demonstrations of the impact heat can have on people was required. This was based on the research that most people believed it would not happen to them. This was the basis of the personal safety needs campaign.
Paramedics in uniform were selected as spokespeople. This was based on the evidence that paramedics are ranked as the most trusted profession. This brought an air of credibility to the messaging.
AV is a member of Victoria’s Emergency Management Joint Public Information Committee. AV was the lead agency in regard to this manner of emergency and utilised other agencies and essential services to assist in distributing key messages.
The heatwave crisis also provided a unique opportunity for AV to demonstrate to politicians the organisation’s emergency management capability and planning, the strategic approach to demand management and to pitch for additional funding.
The campaign strategy was implemented through a variety of tactics to maximise exposure of messages. These actions included:
- Regular media updates
AV quickly established a daily scheduled release of data and comment to accommodate media needs. This was done as a written media release containing number of total cases and number of heat cases. This was released at 5.30am, 9.30am, 3.00pm and 5.45pm (Appendix A).
These times were selected for maximum media suitability with the 5.30am release accommodating morning radio news, the 9.30am released prior to whole of government daily media conference, the 3.00pm for afternoon radio and 5.45pm for television news.
In addition, paramedics were made regularly made available for media comment. This included a daily media conference at 3.00pm. Paramedics were also provided for use on all morning radio news, morning TV news programs Sunrise and Today and to specific media outlets upon request.
- Targeted media observer shifts
AV accommodated media observer shifts to allow a first hand portrayal of the type of workload paramedics were encountering. This resulted in positive media coverage on Channel 7, Channel 9 and ABC nightly news, with replays on Sky News.
- Use of support agencies
In addition to media management, key messages were also distributed through secondary communication channels of other agencies. These included public transport providers Connex and Yarra Trams (public announcements and website), Victoria Police (media), Victorian Government (media and aged care facilities), Parks Victoria (messages at National Parks) and Tourism Victoria (emails of messages to all registered tourism operators).
The cooperation with agencies such as Parks Victoria and Tourism Victoria were essential in reaching international tourists who may have not been familiar with the risk of the harsh Australian climate.
- Ministerial briefings
Over the course of the heatwave emergency, AV provided regular briefings to the Health Minister, Premier and DHS Secretary. The Health Minister and DHS Secretary were also provided with a tour of the Ambulance Emergency Operations Centre, the central management point of the crisis.
While this did not directly correlate to the specific goal of increasing awareness among the at risk audiences, it did lay the foundation for negotiation of funding for future campaigns on heat awareness and emergency management. This was considered as central to the ongoing goal of AV, which is to save lives.
- Internal communications to paramedics
Paramedics are the interface between the ambulance service and the public. This required them to be fully briefed on the actions AV was taking to address the heatwave crisis and to ensure they delivered consistent messages.
This was done through the distribution of daily staff bulletins. In addition, managers went to hospital emergency departments and provided paramedics with water to ensure their own safety and to deliver key messages and information.
Given the severity and complex nature of the situation, the campaign achieved pleasing results.
Over the 12 day period, AV provided 112 media comments and received 1,656 media mentions directly related to the heat crisis (a representative sample of these mentions are included in Appendix A).
Of particular note was the success of the use of media observers to provide a realistic, visual representation of the impact of the heatwave. The Channel 7 news (Appendix A) demonstrated this exceptionally well with all key messages delivered.
The safety messages developed by AV were also disseminated through media by Victoria Police, DHS and the Victorian Government.
Support agencies and essential services assisted to deliver key messages, especially the public transport companies through station and on train/tram announcements and Parks and Tourism Victoria through their member networks.
The use of the Nurse On-Call information service also saw an increase in call rates by 49 per cent over the period 27-31 January (Table of Nurse On Call figures included in Appendix A)
In any campaign like this it is difficult to directly establish how successful it has been in preventing deaths or illness.
In the aftermath of the heatwave with 374 deaths recorded in the state as a direct result, it is easy to say that the campaign did not achieve its goals. AV firmly believes however that this number would have been significantly higher if the campaign had not been delivered.
While unable to be measured, it is expected that the extensive media coverage inevitably led to an increased awareness of appropriate behaviours during a heatwave.
Of the 1,656 recorded media mentions, 83 per cent contained at least one safety message.
The increase in calls to Nurse On Call demonstrates a success in the promotion of this service. Of particular note was that between January 27-29 calls had increased only 16 per cent. From January 29 ,the time that AV commenced active promotion of the Nurse On-Call service for information as opposed to 000 and calls, increased significantly.
AV also received third party endorsement of the campaign.
In his report, Victoria’s Chief Health Officer, Dr John Carne, noted the work done in public education and media coverage prior to and during the heatwave stating
‘In the lead-up to the forecast extreme heat period in January this year there were repeated warnings issued to Victorians about the measures they should take to protect themselves from the heatwave.
’The messages were directed to all community members, but in particular communities and carers were urged to check on older, sick and frail people who may have needed help coping with the heat.’
Victoria’s Health Minister, Daniel Andrews also praised the campaign (full letter in Appendix A):
‘…Ambulance Victoria played a pivotal role in educating Victorians on appropriate actions to minimise the impact of heat.
‘Both before and during the heatwave, Ambulance Victoria utilised numerous avenues to provide the community with consistent, simple and effective health advice to assist them through unprecedented weather conditions.’
AV has recognised the likelihood of more frequent heatwave emergencies and is undertaking planning for pre-emptive education campaigns.
 Department of Human Services Media Releases, ‘Heatwave report: impact on the health of Victorians’, Monday April 6 2009 http://hnb.dhs.vic.gov.au/web/pubaff/medrel.nsf/LinkView/5FFD8EC17CFE42A8CA25759100086579?OpenDocument