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Lauren Lewis, MD, MPH
Health Studies BranchEnvironmental Hazards and Health EffectsNational Center for Environmental Health
Centers for Disease Control and Prevention
Improving Disaster Surveillance: An Environmental Epidemiology Perspective
Health Studies Branch(HSB)Disaster Epidemiology and Response
Types of disasters Natural (extreme weather events) Technological (chemical and radiologic events) Complex emergencies
Focus: epidemiologic support to state and local public health Accurate data for public health decision-making
Types of Epidemiologic Activities
Public health surveillance Track illness, injury and death Identify outbreaks Syndromic, laboratory, morbidity, mortality
Rapid needs assessments Identify shelter, community and health care needs to
allocate resources CASPER
Program evaluations Assess success and identify barriers to improve
response efforts Epidemiologic research
Identify risk/protective factors for injury , illness and death• Case-control, cohort, outbreak investigations, case series
Utility of Epidemiologic Data
• Justify and target resources
• Improve mitigation strategies to prevent future illness and death
• Provide situational awareness
• Guide individual, community and PH preparedness
Prepared-ness
Response
Recovery
Mitigation
# deaths and illnesses, identify vulnerable pop or acute threats
Estimate unmet infrastructure and health care needs
Identify risk and protective factors
Evaluate interventions
Surveillance
Rapid needs
assessments
Program evaluations
Epidemiologic research
Why Conduct Disaster Surveillance?
Provide situational awareness Track morbidity and mortality Detect disease outbreaks
Determine action items such as resource allocation
Target interventions
Facilitate future disaster planning
Data Flow Mortality•ME/coroners• Hospitals• Nursing home• Funeral home• DMORT office•ARC
Public Health• County• Region• State
Emergency Operations/
IMS
Morbidity• Hospitals•Clinics•Shelters• Service delivery sites
CDCOther States
Report
Data Data
Current HSB Disaster Surveillance Activities
Build capacity Provide surveillance tools and training
Provide technical assistance during disasters
Conduct surveillance Partner with American Red Cross (ARC) and poison centers Utilize National Poison Data System (NPDS)
Analyze data and disseminate findings
Evaluate surveillance efforts
Provide Surveillance Tools and Training
Provide standardized disaster surveillance forms Includes morbidity and mortality Modifiable for any type of disaster Available at http://www.bt.cdc.gov/disasters/surveillance
Conduct disaster epidemiology training Includes surveillance and CASPER
Conduct Surveillance with American Red Cross
Monitor and analyze ARC mortality reports
Facilitate morbidity surveillance in ARC shelters
Conduct Poison Center Surveillance
National Poison Data System (NPDS) Monitors calls to poison centers from clinicians and the
public Provides national, near real-time surveillance data
Poison center utility during disasters Track CO poisonings Monitor public concern Provide hotline support
Radiologic Disaster Surveillance
Enhanced NPDS to detect and monitor radiologic events
Developed a standardized data collection tool Collect data at community reception centers Multipurpose: surveillance, acute triage, and long-term
follow-up Available at
www.emergency.cdc.gov/radiation/crc/vcrc.asp
Exploring strategies to improve screening capacity
Disaster Surveillance Challenges
Absent baseline information
Denominator data difficult to obtain
Damaged healthcare infrastructure
Need for rapid information
Disaster Surveillance Challenges
Competing priorities
Data collection varies between states and events
No incentive to share data with CDC
No electronic mechanism for data sharing
Potential Strategies to Improve Disaster Surveillance
Develop surveillance guidance
Increase utilization of existing surveillance during disasters Biosense, National Poison Data System (NPDS), American
Red Cross data, Environmental Public Health Tracking (EPHT), State-based syndromic surveillance, NCHS mortality data
Explore the utility of nontraditional sources Track internet and social media reports
Active mortality surveillance
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