Disaster Preparedness: Participation of Public Health

Departments in Epidemiologic Data

Collection

Los Angeles County Department of Public HealthBureau of Toxicology and Environmental AssessmentToxics Epidemiology Program

Background

Evaluation of subjects, gathering samples, and recording of data is a serial process

Any step can be rate-limiting Public health agencies must maximize

efficiency of data collection during disasters Little evidence comparing efficiency and utility

of data collection tools in a disaster

Incident: Marble Challenge

Improvised nuclear device in Indianapolis, IN

Expectation of fear and panic among the public

Projection of people fleeing the area, without notice

Background

Incident: Marble Challenge

People may flee to multiple locations

Some fleers may be more determined than others– Look for immediate means of transportation– Get as far away from incident as possible

Incident: Marble Challenge

“Load up the truck and move to…”

Incident: Marble Challenge

Barstow

Incident: Marble Challenge

Incident: Marble Challenge

Radiation portal monitors used for passive screening of cars entering California at Barstow

Public Health screening of occupants of “hot” cars

Incident: Marble Challenge

LA County DPH assisted CDC in processing victims

CDC sent spiked urine samples and devised an array of victims’ symptoms

3 survey tools were designed, to collect health information and to prioritize

Incident: Marble Challenge

Incident: Marble Challenge

Paper/handwritten format Handheld/PDA Laptop

Each victim was evaluated through all 3 health screens and asked to note preferred format

Data collectors rotated, using all 3 health screens, and asked to note preferred format

Incident: Marble Challenge

Completion of epidemiologic screening

Urine sample prioritizations with data transfers to laboratories

Sr-90 and uranium spiked urine samples sent to LA County DPH, CA DPH, and CDC labs

Incident: Marble Challenge

All 3 methods were equally accurate (>90% for each format) and able to identify high priority samples

Collector preferences:– 57% laptop, 43% handheld, 0% paper

Victim preferences:– 21% laptop, 29% handheld, 21% paper

Incident: Marble Challenge

Conclusion: Data Collection

All methods were effective

Electronic methods were preferred overall for the collection of epidemiologic and laboratory sampling data

Questions Raised

How do we optimize local IDs/other logistics?

How do we format data for transfer to other agencies?

How can we best coordinate victim tracking, for medical management, sampling, and other triage issues?

Potential Benefits of Electronic Data Collection

Immediate compilation of results Potential to ask more questions in less time Elimination of data re-entry Rapid transmission of results Rapid statistical analysis Linkage of data sets, GIS mapping “Red-flag” detection