1

Beneficial Practices for

Improving Biosurveillance

Natural Disasters March 25, 2014

2

Webinar Series Hosts

Edward L. Baker, MD, MPHDirector, North Carolina Preparedness and Emergency Response Research Center

Research Professor, Health Policy and Management, University of North Carolina at Chapel Hill

3

Webinar Series Hosts

Perry F. Smith, MDResearch Professor, Epidemiology, State University of New York at Albany Former New York State Epidemiologist

4

NCPERRC Research on Biosurveillance 2013 research project with Public

Health Informatics Institute to: Identify guiding principles and best

practices Provide recommendations for

biosurveillance system improvement

5

What did we learn?

Information systems used during event should be used every day

Relationships leading to data sharing should be nurtured well in advance of event

Continued investment in systems and staff needed to assure that systems are prepared

6

Translating Research into PracticeSeries of 4 webinars presented by:

North Carolina Preparedness and Emergency Response Research Center (NCPERRC) at UNC-Chapel Hill

Supported by Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response

7

Focus of Our Research -Improving Biosurveillance During Public Health Emergencies:

Mass Gatherings Natural Disasters Outbreaks

8

NCPERRC Webinar Series: Improving Biosurveillance Systems

Educate public health practitioners regarding: Information and information systems

needed to manage event Investments needed to assure systems are

ready for next event Focus on PHPR Capability #13- Public

Health Surveillance and Epidemiologic Investigation

9

Summary of Boston Marathon Case Study• What best practices were seen?• What guiding principles does

the case exemplify?

10

Today’s Webinar Agenda

Natural Disaster Case Study with Guests from New York City

Information Needs and Systems for Situational Awareness during Natural Disasters

Your Questions Use question box to enter questions

Where to Find Additional Information

11

Today’s Case Study –Natural Disasters Superstorm Sandy, 2012

12

Audience PollAs a public health worker, have you had experience responding to a natural disaster, and if so, what type(s) of disasters? (choose one)

Hurricanes, Floods Tornadoes, Earthquakes Winter Storms Forest Fires Multiple Types or Other Types Not responded to natural disasters

13

Today’s guestsFrom the New York City Department of Health and Mental Hygiene

Tom Matte MD, MPH Assistant Commissioner for Environmental Surveillance and Policy

Mitch StriplingDirector, Emergency Planning Unit

14

Superstorm Sandy

Category 3 Hurricane 72 fatalities in 8 states

43 in NYC 80 mph winds Third costliest hurricane in US history

15

Superstorm Sandy What information was needed by

public health? How did you provide that

information? What had you done in advance to

build your information systems to meet these needs?

NYC Sandy impacts and hazards Record storm surge, wind-downed

trees and power lines, drowning and injury risk

Congregate sheltering Health care facility evacuation Disruption of health care access and

transportation

NYC Sandy impacts and hazards Sheltering in place in buildings without

power or heat and without elevators and running water in high rise buildings

Potential respiratory hazards: supplemental heat, power, flood damage cleanup, demolition, debris movement

Exposure to floodwater Stress

Public Health Operations:Surveillance, Response, Recovery Syndromic surveillance Healthcare Evacuations, Repatriation, and Patient

Tracking Shelter Operations and Surveillance Door-to-Door Canvassing and surveys

Public Health Operations:Surveillance, Response, Recovery

Availability of Primary Care Services N95 Respirator Distribution Ambient air quality monitoring and coordination

Public Health Operations:Surveillance, Response, Recovery

Mortality surveillance Community Outreach & Public Information Resume routine surveillance and services

Syndromic Surveillance: Immediate Response

Keep routine system runningReceipt of data, staffing

Hurricane specificSyndromes developed during IreneLook for visits outside pre-defined syndromesIncreased emphasis on system usageRespond to ICS system

Syndromic SurveillanceEmergency Response

Syndromes of interest Healthcare Needs

Medications Dialysis Oxygen

Mental Health Stress (including PTSD) Anxiety Psychotic Psych evaluation Suicide

Syndromic SurveillanceEmergency Response Alcohol and Drug

Methadone and withdrawal

Exposures Cold stress Carbon Monoxide Respiratory irritants

Syndromic SurveillanceEmergency Response

Defining “Impacted areas” Inundation areas Population

displacement Power system outage Destruction Condemnation Conversion to zip

codes

Syndromes Related to Health Care Needs

Syndromes Related to Respiratory Illness

Public Information

Hypothermia Increases “Carbon Monoxide Poisoning Cases

Soar in City After Hurricane”

Challenges and lessons learned

Need to quickly define impact areas and populations, which may change over time

Need to continually develop and improve syndrome definitions

Challenges and lessons learned Hospital closures, other healthcare disruption and

population displacement can impact health and complicate syndromic data interpretation

Defining ‘baseline’ and ‘expected’ What findings are actionable and how to

communicate them

30

Rebuilding and Improving Resiliency Special Initiative for Rebuilding and

Resiliency Syndromic Data Power and System Outages Vulnerable Population Outreach Ongoing Research

31

Implications for Action

What should others do to prepare for hurricanes?

32

Audience Poll How prepared is your jurisdiction to monitor information for situational awareness during an unexpected natural disaster?

Very prepared Moderately prepared Somewhat unprepared Very unprepared

33

Ask the Experts

Use chat box to enter question We will recognize audience members

and direct questions to panel

34

Key Points

Core information needs Health Status Health Risks and Hazards Health Services

35

Key Points

Core information sources Emergency department activity Notifiable disease Lab reporting Health system information

36

Summary of Superstorm Sandy Case Study• What best practices were seen?• What guiding principles does

the case exemplify?

37

Post-webinar resources

Knowledge Repository Contributions from panelists Archived webinar and slides Online resources Public Health Informatics Institute course Talk about it – Facebook and Twitter login Research report and more

38

Post-webinar resources Knowledge Repository

biosurveillance.weebly.com

39

Post-webinar resourcesPublic Health Informatics Institute www.phii.org

40

Upcoming Webinars

April 24, 2-3:30pm EST Outbreaks - Seasonal Flu Lessons learned from Marion County, IN

June 5, 2-3:30pm EST Prioritizing your biosurveillance

enhancements Insights from national experts Dr. Chesley Richards, CDC Deputy

Director

41

Conclusion

Thanks to guests Thanks to CDC for support Thanks to audience And lastly… please complete the

post-webinar evaluation!

Contact us at NCPERRC@email.unc.edu