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Chapter 21 - Impact of Weather and Climate Change on Mass Gathering Events

Published online by Cambridge University Press:  11 April 2024

By
John W. Martel  and
J. Matthew Sholl
Edited by
William J. Brady ,
Mark R. Sochor ,
Paul E. Pepe ,
John C. Maino II  and
K. Sophia Dyer
William J. Brady
Affiliation:
University of Virginia
Mark R. Sochor
Affiliation:
University of Virginia
Paul E. Pepe
Affiliation:
Metropolitan EMS Medical Directors Global Alliance, Florida
John C. Maino II
Affiliation:
Michigan International Speedway, Brooklyn
K. Sophia Dyer
Affiliation:
Boston University Chobanian and Avedisian School of Medicine, Massachusetts
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Summary

Weather plays a major role in the safe execution of mass gathering events (MGE). It poses notable health-related challenges due to forecasting reliability and relative unpredictability, but risks can be mitigated with thoughtful planning and threat assessment, bolstered by the presence of appropriate on-scene medical resources and transport plans. Although MGE have historically been cultural and recreational events, climate change and a variety of downstream impacts have also led to nearly continuous large-scale human migration. Mobile MGE are now present at any given time throughout the world and many are amassed on nation-state borders. It is likely that this will increasingly become the norm, and lessons learned from more conventional MGE medical responses will help meet the needs of this new frontier in mass gathering medicine.

Keywords

weather-related illnessextreme weather eventshealthheat strokehypothermiamass gatheringclimate change
Type
Chapter
Information
Mass Gathering Medicine
A Guide to the Medical Management of Large Events
 , pp. 305 - 319
Publisher: Cambridge University Press
Print publication year: 2024

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References

Hutton, A., Ranse, J., Gray, K. L., Turris, S. A., Lund, A., Munn, M. B. Environmental Influences on Patient Presentations: Considerations for Research and Evaluation at Mass-Gathering Events. Prehospital and Disaster Medicine. 2019;34(5):552–556. doi: 10.1017/S1049023X19004813.CrossRefGoogle ScholarPubMed
Soomaroo, L., Murray, V. Weather and Environmental Hazards at Mass Gatherings. PLoS Curr. 2012;4:e4fca9ee30afc4. doi: 10.1371/4fca9ee30afc4.CrossRefGoogle ScholarPubMed
Milsten, A. M., Maguire, B. J., Bissell, R. A., Seaman, K. Mass-Gathering Medical Care: A Review of the Literature. Prehospital and Disaster Medicine. 2002;17(3):151–162. doi: 10.1017/s1049023x00000388.CrossRefGoogle ScholarPubMed
Arbon, P. The Development of Conceptual Models for Mass-Gathering Health. Prehospital and Disaster Medicine. 2004;19(3):208–212. doi: 10.1017/s1049023x00001795.CrossRefGoogle ScholarPubMed
Aitsi-Selmi, A., Murray, V., Heymann, D., McCloskey, B., Azhar, E. I., Petersen, E., et al. Reducing Risks to Health and Wellbeing at Mass Gatherings: The Role of the Sendai Framework for Disaster Risk Reduction. International Journal of Infectious Diseases. 2016;47:101–104. doi: 10.1016/j.ijid.2016.04.006.CrossRefGoogle ScholarPubMed
Intergovernmental Panel on Climate Change. Special Report on Global Warming of 1.5°C. www.ipcc.ch/sr15/chapter/chapter-1/. 2018. Accessed July 1, 2021.Google Scholar
Kjellstrom, T. Impact of Climate Conditions on Occupational Health and Related Economic Losses: A New Feature of Global and Urban Health in the Context of Climate Change. Asia Pacific Journal of Public Health. 2016;28:28S–37S. doi: 10.1016/j.ijid.2016.04.00610.1177/1010539514568711.CrossRefGoogle Scholar
King, A. D., Harrington, J. The Inequality of Climate Change from 1.5 °C to 2 °C of Global Warming. Geophysical Research Letters. 2018;45:5030–5033. doi: 10.1029/2018GL078430.CrossRefGoogle Scholar
Perkins-Kirkpatrick, S. E., Lewis, S. C. Increasing Trends in Regional Heatwaves. Nature Communications. 2020;11:3357. doi: 10.1038/s41467-020-16970-7.CrossRefGoogle ScholarPubMed
Vicedo-Cabrera, A. M., Scovronick, N., Sera, F., et al. The Burden of Heat-Related Mortality Attributable to Recent Human-Induced Climate Change. Nature Climate Change. 2021;11:492–500. doi: 10.1038/s41558-021-01058-x.CrossRefGoogle ScholarPubMed
Dangerous humid heat extremes occurring decades before expected. NOAA Research News May 8, 2020. https://research.noaa.gov/article/ArtMID/587/ArticleID/2621/Dangerous-humid-heat-extremes-occurring-decades-before-expected. Accessed July 1, 2021.Google Scholar
Kman, N. E., Russell, G. B., Bozeman, W. P., et al. Derivation of a Formula to Predict Patient Volume Based on Temperature at College Football Games. Prehospital and Emergency Care. 2007;11(4):453–457. doi: 10.1080/00207450701537043.CrossRefGoogle ScholarPubMed
Perron, A. D., Brady, W. J., Custalow, C. B., Johnson, D. M. Association of Heat Index and Patient Volume at a Mass Gathering Event. Prehospital and Emergency Care. 2005;9(1):49–52. doi: 10.1080/10903120590891976.CrossRefGoogle Scholar
National Weather Service. “Heat Index Chart.” www.weather.gov/safety/heat-index. Accessed December 5, 2021.Google Scholar
National Weather Service Glossary. “Heat Wave.” https://forecast.weather.gov/glossary.php?letter=h. Accessed December 8, 2021.Google Scholar
Vaidyanathan, A., Malilay, J., Schramm, P., Saha, S. Heat-Related Deaths: United States, 2004–2018. Morbidity and Mortality Weekly Report. 2020;69(24):729–734. doi: 10.15585/mmwr.mm6924a1.CrossRefGoogle ScholarPubMed
Zhao, Q., Guo, Y., Ye, T., Gasparrini, A., Tong, S., Overcenco, A., et al. Global, Regional, and National Burden of Mortality Associated with Non-Optimal Ambient Temperatures from 2000 to 2019: A Three-Stage Modelling Study. Lancet Planet Health. 2021;5(7):e415–25. doi: 10.1016/S2542-5196(21)00081-4.CrossRefGoogle ScholarPubMed
United States Environmental Protection Agency. Heat island effect. 2021. www.epa.gov/heatislands. Accessed August 15, 2021.Google Scholar
World Health Organization. International statistical classification of diseases and related health problems (ICD). 2021. www.who.int/standards/classifications/classification-of-diseases. Accessed 5 August, 2021.Google Scholar
Bergeron, M. F. Exertional Heat Cramps: Recovery and Return to Play. Journal of Sport Rehabilitation. 2007;16(3):190–196. doi: 10.1123/jsr.16.3.190.CrossRefGoogle ScholarPubMed
Schwellnus, M. P., Drew, N., Collins, M. Muscle Cramping in Athletes: Risk Factors, Clinical Assessment, and Management. Clinical Journal of Sports Medicine. 2008;27(1):183–194. doi: 10.1016/j.csm.2007.09.006.CrossRefGoogle ScholarPubMed
Lau, W. Y., Kato, H., Nosaka, K. Effect of Oral Rehydration Solution versus Spring Water Intake During Exercise in the Heat on Muscle Cramp Susceptibility of Young Men. Journal of the International Society of Sports Nutrition. 2021;18(1). doi: 10.1186/s12970-021-00414-8.CrossRefGoogle ScholarPubMed
Montain, S. J., Laird, J. E., Latzka, W. A., Sawka, M. N. Aldosterone and Vasopressin Responses in the Heat: Hydration Level and Exercise Intensity Effects. Medicine and Science in Sports and Exercise. 1997;29(5):661–668. doi: 10.1097/00005768-199705000-00012.CrossRefGoogle ScholarPubMed
Lipman, G. S., Eifling, K. P., Ellis, M. A., Flavio, G. G., Otten, E. M., Grissom, C. K. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Heat Related Illness: 2014 Update. Wilderness and Environmental Medicine. 2014;25:S55–65. doi: 10.1016/j.wem.2014.07.017.CrossRefGoogle ScholarPubMed
Leon, L. R., Bouchama, A. Heat Stroke. Compr Physiol 2015;5:611–647. doi: 10.1002/cphy.c140017.CrossRefGoogle ScholarPubMed
Epstein, Y., Yanovich, R. Heatstroke. N Engl J Med. 2019;380(25):2449–2459. doi: 10.1056/NEJMra1810762.CrossRefGoogle ScholarPubMed
Whitman, S., Good, G., Donoghue, E. R., Benbow, N., Shou, W., Mou, S. Mortality in Chicago Attributed to the July 1995 Heat Wave. Am J Public Health. 1997;87(9):1515–1518. doi: 10.2105/ajph.87.9.1515.CrossRefGoogle Scholar
Office of Climate, Water, and Weather Services. Weather fatalities 2018. National Weather Service. www.nws.noaa.gov/om/hazstats.shtml; 2019. Accessed August 15, 2021.Google Scholar
Yang, J., Zhou, M., Ren, Z., Mengmeng, L., Boguang, W., De Li, L., et al. Projecting Heat-Related Excess Mortality Under Climate Change Scenarios in China. Nat Commun 2021;12:1039. doi: 10.1038/s41467-021-21305-1.CrossRefGoogle ScholarPubMed
Kravchenko, J., Abernethy, A. P., Fawzy, M., Lyerly, H. K. Minimization of Heatwave Morbidity and Mortality. Am J Prev Med. 2013;44:274–282. doi: 10.1016/j.amepre.2012.11.015.CrossRefGoogle ScholarPubMed
Hosokawa, Y., Adams, W. M., Belval, L. N., et al. Exertional Heat Illness Incidence and On-Site Medical Team Preparedness in Warm Weather. Int J Biometeorol. 2018;62: 1147–1153. doi: 10.1007/s00484-018-1517-3.CrossRefGoogle ScholarPubMed
Nadesan, K., Kumari, C., Afiq, M. Dancing to Death: A Case of Heat Stroke. J Forensic Leg Med. 2017;50:1–5. doi: 10.1016/j.jflm.2017.05.008.CrossRefGoogle Scholar
Huisse, M. G., Pease, S., Hurtado-Nedelec, M., Arnaud, B., Malaquin, C., Wolff, M., et al. Leukocyte Activation: The Link Between Inflammation and Coagulation During Heatstroke – A Study of Patients During the 2003 Heat Wave in Paris. Crit Care Med. 2008;36:2288–2295. doi: 10.1097/CCM.0b013e318180dd43.CrossRefGoogle ScholarPubMed
Proulx, C. I., Ducharme, M. B., Kenny, G. P. Effect of Water Temperature on Cooling Efficiency During Hyperthermia in Humans. J App Physiol. 2003;94:1317–1323. doi: 10.1152/japplphysiol.00541.2002.CrossRefGoogle ScholarPubMed
Casa, D. J., McDermott, B. P., Lee, E. C., Yeargin, S. W., Armstrong, L. E., Maresh, C. M. Cold Water Immersion: The Gold Standard for Exertional Heatstroke Treatment. Exerc Sport Sci Rev. 2007;35:141–149. doi.org: 10.1097/jes.0b013e3180a02bec.CrossRefGoogle ScholarPubMed
Douma, M. J., Aves, T., Allan, K. S., Bendall, J. C., Berry, D. C., Chang, W. T., et al. First Aid Cooling Techniques for Heat Stroke and Exertional Hyperthermia: A Systematic Review and Meta-Analysis. Resuscitation. 2020;148:173–190. doi: 10.1016/j.resuscitation.2020.01.007.CrossRefGoogle ScholarPubMed
Ito, C., Takahashi, I., Kasuya, M., Oe, K., Uchino, M., Nosaka, H., et al. Safety and Efficacy of Cold-Water Immersion in the Treatment of Older Patients with Heat Stroke: A Case Series. Acute Med Surg. 2021;8(1):e635. doi: 10.1002/ams2.635.CrossRefGoogle ScholarPubMed
Bouchama, A., Dehbi, M., Chaves-Carballo, E. Cooling and Hemodynamic Management in Heatstroke: Practical Recommendations. Crit Care. 2007;11(3):R54. doi: 10.1186/cc5910.CrossRefGoogle ScholarPubMed
Van Remoortel, H., Scheers, H., De Buck, E., Haenen, W., Vandekerckhove, P. Prediction Modelling Studies for Medical Usage Rates in Mass Gatherings: A Systematic Review. PLoS ONE. 2020;15(6): e0234977. doi: 10.1371/journal.pone.0234977.Google ScholarPubMed
Alkassas, W., Rajab, A. M., Alrashood, S. T., Khan, M. A., Dibas, M., Zaman, M. Heat-Related Illness in a Gathering Event and the Necessity for New Diagnostic Criteria: A Field Study. Environ Sci Pollut Res. 2021;28:16682–16689. doi: 10.1007/s11356-020-12154-4.CrossRefGoogle Scholar
Hartman, N., Williamson, A., Sojka, B., et al. Predicting Resource Use at Mass Gatherings Using a Simplified Stratification Scoring Model. Am J Emerg Med. 2009;27:337–343. doi: 10.1016/j.ajem.2008.03.042.CrossRefGoogle ScholarPubMed
Milsten, A. M., Seaman, K. G., Liu, P., Bissel, R. A., Maguire, B. J. Variables Influencing Medical Usage Rates, Injury Patterns, and Levels of Care for Mass Gatherings. Prehosp Disaster Med. 2003;18(4):334–346. doi: 10.1017/S1049023X00001291.CrossRefGoogle ScholarPubMed
Grundstein, A., Williams, C., Phan, M., Cooper, E. Regional Heat Safety Thresholds for Athletics in the Contiguous United States. Appl Geogr. 2015;56:55–60. doi: 10.1016/j.apgeog.2014.10.014.CrossRefGoogle Scholar
National Weather Service Weather Prediction Center, Heat Index Calculator. 2020. www.wpc.ncep.noaa.gov/html/heatindex.shtml. Accessed 28 August, 2021.Google Scholar
Schwartz, B., Nafzinger, A., Milsten, A., Luk, J., Yancey, A. Mass Gathering Medical Care: Resource Document for the National Association of EMS Physicians Position Statement. Prehosp Emerg Care. 2015;19(4):559–568. doi: 10.3109/10903127.2015.1051680.Google Scholar
Toffoli, C. A. Optimizing Mission-Specific Medical Threat Readiness and Preventive Medicine for Service Members. US Army Med Dep J 2018; Jan-Jun(1-18):49-54.Google Scholar
Cooper, E. R., Ferrara, M. S., Casa, D. J., et al. Exertional Heat Illness in American Football Players: When Is the Risk Greatest? J Athl Train. 2016;51(8):593–600. doi: 10.4085/1062-6050-51.8.08.CrossRefGoogle ScholarPubMed
Occupational Health and Safety Administration. OSHA Outdoor WBGT Calculator. 2008. www.osha.gov/heat-exposure/wbgt-calculator. Accessed August 28, 2021.Google Scholar
Convergence of Climate-Health-Vulnerabilities. Wet Bulb Global Temperature (WBGT) Tool. University of North Carolina. 2021. https://convergence.unc.edu/tools/wbgt/. Accessed August 28, 2021.Google Scholar
Tong, S., Prior, J., McGregor, G., Shi, X., Kinney, P. Urban Heat: An Increasing Threat to Global Health. BMJ. 2021;375:n2467. doi: 10.1136/bmj.n2467.CrossRefGoogle ScholarPubMed
Memon, R. A., Leung, D. Y., Chunho, L. A Review on the Generation, Determination and Mitigation of Urban Heat Island. J Environ Sci (China). 2008;20(1):120–128. doi: 10.1016/s1001-0742(08)60019-4.Google ScholarPubMed
Thompson, J. M., Savoia, G., Powell, G., Challis, E. B., Law, P. Level of Medical Care Required for Mass Gatherings: The XV Winter Olympic Games in Calgary, Canada. Ann Emerg Med. 1991;20:385–390. doi: 10.1016/s0196-0644(05)81660-9.CrossRefGoogle ScholarPubMed
Grissom, C. K., Finoff, J. T., Murdock, D. C., Culberson, J. Nordic Venue Medical Services During the 2002 Winter Olympics. J Emerg Med. 2005;30:203–210. doi: 10.1016/j.jemermed.2005.08.005.CrossRefGoogle Scholar
Petrone, P., Asensio, J. A., Marini, C. P. In Brief: Hypothermia. Curr Probl Surg. 2014;51(10):414–415. doi: 10.1067/j.cpsurg.2014.07.005.CrossRefGoogle Scholar
Zafren, K. Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia. Emerg Med Clin North Am. 2017;35(2):261–279. doi: 10.1016/j.emc.2017.01.003.CrossRefGoogle ScholarPubMed
Gocotano, A. E., Dico, F. D., Calungsod, N. R., Hall, J. L., Counahan, M. L. Exposure to Cold Weather During a Mass Gathering in the Philippines. Bull World Health Organ. 2015;93(11):810–814. doi: 10.2471/BLT.15.158089.CrossRefGoogle ScholarPubMed
Dow, J., Giesbrecht, G. G., Danzl, D. F., Brugger, H., Sagalyn, E. B., Walpoth, B., et al. Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update. Wilderness Environ Med. 2019;30(45):S47–S69. doi: 10.1016/j.wem.2019.10.002.CrossRefGoogle ScholarPubMed
National Weather Service Glossary, “Wind Chill.” 2009. https://forecast.weather.gov/glossary.php?letter=w. Accessed December 8, 2021.Google Scholar
National Weather Service, “Wind Chill Chart.” www.weather.gov/safety/cold-wind-chill-chart. Accessed December 8, 2021.Google Scholar
Healy, J. D. Excess Winter Mortality in Europe: A Cross Country Analysis Identifying Key Risk Factors. J Epidemiol Community Health. 2003;57(10):784–789. doi: 10.1136/jech.57.10.784.CrossRefGoogle ScholarPubMed
Vanggaard, L., Eyolfson, D., Xu, X., Weseen, G., Giesbrecht, G. G. Immersion of Distal Arms and Legs in Warm Water (AVA Rewarming) Effectively Rewarms Mildly Hypothermic Humans. Aviat Space Environ Med. 1999;70(11):1081–1088.Google ScholarPubMed
Danzl, D. F., Pozos, R. S. Accidental Hypothermia. N Engl J Med. 1994;331(26):1756–1760. doi: 10.1056/NEJM199412293312607.CrossRefGoogle ScholarPubMed
Olson, Z., Kman, N. Immersion Foot: A Case Report. J Emerg Med. 2015;49(2):45–48. doi: 10.1016/j.jemermed.2015.02.040.CrossRefGoogle ScholarPubMed
Michael, T. P. Chapter 208: Cold Injuries. In: Tintinalli’s Emergency Medicine: a Comprehensive Study Guide, 8th Edition. Tintinalli J. E., Stapczynski J. S., Ma O., Yealy D. M., Meckler G. D., Cline D. M. (eds.). New York: McGraw-Hill Education; 2016. https://accessemergencymedicine.mhmedical.com/Content.aspx?bookid=1658§ionid=109385692. Accessed December 10, 2021.Google Scholar
Jurkovich, G. J. Environmental Cold-Induced Injury. Surg Clin North Am. 2007;87(1):247–267. doi: 10.1016/j.suc.2006.10.003.CrossRefGoogle ScholarPubMed
Imray, C., Handford, C., Thomas, O., Castellani, J. Nonfreezing Cold-Induced Injuries. In: Auerbach’s Wilderness Medicine, 7th Edition. Auerbach, P. S., Cusing, T. A., Harris, S. (eds.), New York: Elsevier; 2016. pp. 222–234.Google Scholar
McIntosh, S. E., Hamonko, M., Freer, L., Grissom, C. K., Auerbach, P. S., Rodway, G. W., et al. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite. Wilderness Environ Med. 2011;22(2):156–166. doi: 10.1016/j.wem.2011.03.003.CrossRefGoogle ScholarPubMed
National Weather Service Weather Prediction Center, Wind Chill Calculator. 2020. www.wpc.ncep.noaa.gov/html/windchill.shtml. Accessed August 28, 2021.Google Scholar
State of Minnesota Special Event and Mass Gathering Medical Care Plan. 2015. https://mn.gov/boards/assets/Special%20Events%20and%20Mass%20Gathering%20Matrix%20-%202015_tcm21-28041.pdf. Accessed on 8 December, 2021.Google Scholar
National Oceanic and Atmospheric Administration. Science on a Sphere. Lightning Flash Rate. https://sos.noaa.gov/catalog/datasets/lightning-flash-rate/. Accessed December 10, 2021.Google Scholar
Romps, D. M., Seeley, J. T., Vollaro, D., Molinari, J. Projected Increase in Lightning Strikes in the United States due to Global Warming. Science. 2014;346(6211):851–854. doi: 10.1126/science.CrossRefGoogle ScholarPubMed
Jensen, J. D., Thurman, J., Vincent, A. L. Lightning Injuries. Treasure Island (FL): StatPearls Publishing; 2021. www.ncbi.nlm.nih.gov/books/NBK441920/. Accessed September 22, 2023.Google Scholar
Kubilius, D., Rimdeika, R. Simultaneous Lightning Injury in a Group of People: Case Report. Burns. 2012;38(3):e9–12. doi: 10.1016/j.burns.2012.01.011.CrossRefGoogle Scholar
Ritenour, A. E., Morton, M., McManus, J. G., Barillo, D. J., Cancio, L. C. Lightning Injury: A Review. Burns. 2008;34(5):585–594. doi: 10.1016/j.burns.2007.11.006.CrossRefGoogle ScholarPubMed
Cherington, M., Yarnell, P. R., London, S. F. Neurologic Complications of Lightning Injuries. West J Med. 1995;162(5):413–417.Google ScholarPubMed
Zafren, K., Durrer, B., Herry, J. P., Brugger, H., ICAR and UIAA MEDCOM. Lightning Injuries: Prevention and On-Site Treatment in Mountains and Remote Areas. Official Guidelines of the International Commission for Mountain Emergency Medicine and the Medical Commission of the International Mountaineering and Climbing Federation (ICAR and UIAA MEDCOM). Resuscitation. 2005;65(3):369–372.CrossRefGoogle ScholarPubMed
Lederer, W., Kroesen, G. Emergency Treatment of Injuries Following Lightning and Electrical Accidents. Anaesthesist. 2005;54(11):1120–1129. doi: 10.1007/s00101-005-0910-6.CrossRefGoogle ScholarPubMed
Moore, K. Hot Topics: Electrical Injuries in the Emergency Department. J Emerg Nurs. 2015;41(5):455–456. doi: 10.1016/j.jen.2015.06.006.CrossRefGoogle ScholarPubMed
Watanabe, N., Inaoka, T., Shuke, N., Takahashi, K., Aburano, T., Chisato, N., et al. Acute Rhabdomyolysis of the Soleus Muscle Induced by a Lightning Strike: Magnetic Resonance and Scintigraphic Findings. Skeletal Radiol. 2007;36(7):671–675. doi: 10.1007/s00256-006-0247-5.CrossRefGoogle ScholarPubMed
Jost, W. H., Schönrock, L. M., Cherington, M. Autonomic Nervous System Dysfunction in Lightning and Electrical Injuries. NeuroRehabilitation. 2005;20:19–23.CrossRefGoogle ScholarPubMed
Davis, C., Engeln, A., Johnson, E., et al. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries: 2014 Update. Wilderness Environ Med. 2014;25(4 Suppl):S86–95. doi: 10.1016/j.wem.2014.08.011.CrossRefGoogle ScholarPubMed
Elsom, D. M., Webb, D. C. J. Deaths and Injuries from Lightning in the UK, 1988–2012. Weather. 2014;69:22–26. doi: 10.1002/wea.2254.CrossRefGoogle Scholar
Zimmermann, C., Cooper, M. A., Holle, R. L. Lightning Safety Guidelines. Ann Emerg Med. 2002;39(6):660–664. doi: 10.1067/mem.2002.124439.CrossRefGoogle ScholarPubMed
Gookin, J. Backcountry lightning risk management. 21st Annual Lightning Detection Conference. April 19–20, 2010, Orlando, Florida.Google Scholar
O’Keefe Gatewood, M., Zane, R. D. Lightning Injuries. Emerg Med Clin North Am. 2004;22(2):369–403. doi: 10.1016/j.emc.2004.02.002.CrossRefGoogle ScholarPubMed
Mach, K. J., Kraan, C. M., Adger, W. N., Buhaug, H., Burke, M., Fearon, J. D., et al. Climate as a Risk Factor for Armed Conflict. Nature. 2019;571(7764):193–197. doi: 10.1038/s41586-019-1300-6.CrossRefGoogle ScholarPubMed
Broeker, W. Climate Change: Are We on the Brink of a Pronounced Global Warming? Science. 1975;189(4201):460–463. 189;4201:460–463. doi: 10.1126/science.189.4201.460.CrossRefGoogle Scholar
Watts, N., Amann, M., Arnell, N., Ayeb-Karlsson, S., Belesova, K., Boykoff, M., et al. The 2019 Report of the Lancet Countdown on Health and Climate Change: Ensuring That the Health of a Child Born Today Is Not Defined by a Changing Climate. Lancet. 2019;394(10211):1836–1878. doi: 10.1016/S0140-6736(19)32596-6.CrossRefGoogle ScholarPubMed
Cutler, S. J., Fooks, A. R., van der Poel, W. H. Public Health Threat of New, Reemerging, and Neglected Zoonoses in the Industrialized World. Emerg Infect Dis. 2010;16(1):1–7. doi: 10.3201/eid1601.081467.CrossRefGoogle ScholarPubMed
Office of the Director of National Intelligence. Annual Threat Assessment of the Intelligence Community. April 9, 2021. www.dni.gov/files/ODNI/documents/assessments/ATA-2021-Unclassified-Report.pdf. Accessed April 12, 2021.Google Scholar
World Economic Forum. The Global Risks Report 2021 16th edition, Insight Report. 2021. www.weforum.org/reports/the-global-risks-report-2021. Accessed January 24, 2021.Google Scholar
Food and Agriculture Organization of the United Nations. The State of Food Insecurity in the World. 2015. www.fao.org/3/a-i4646e.pdf. Accessed January 24, 2021.Google Scholar
Food and Agriculture Organization of the United Nations. The State of Food Insecurity and Nutrition in the World. 2019. www.fao.org/3/ca5162en/ca5162en.pdf. Accessed January 24, 2021.Google Scholar
Rigaud, K. K., de Sherbinin, A., Jones, B., et al. Groundswell: Preparing for Internal Climate Migration. World Bank: Washington, DC; 2018. https://openknowledge.worldbank.org/handle/10986/29461. Accessed January 24, 2021.Google Scholar
Podesta, J. The Climate Crisis, Migration, and Refugees. July 25, 2019. The Brookings Institution. Washington, DC. www.brookings.edu/wp-content/uploads/2019/07/Brookings_Blum_2019_climate.pdf. Accessed January 24, 2021.Google Scholar
United Nations Development Programme. Human Development Report 2020, The Next Frontier: Human Development and the Anthropocene, December 15, 2020. http://hdr.undp.org/sites/default/files/hdr2020.pdf. Accessed January 24, 2021.Google Scholar
Flores, R., Sanchez, R. Thousands of Migrants Held in Squalor Under Texas Bridge. 2021. www.cnn.com/2021/09/17/us/texas-del-rio-migrants-bridge/index.html. Accessed January 24, 2022.Google Scholar

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