Upload
veronica-lucas
View
215
Download
0
Tags:
Embed Size (px)
Citation preview
Superstorm Sandy: Public Health Practice and Response, NJ
4th Annual National
CSTE Disaster Epidemiology Workshop
May 9, 2013
Outline
• Background and NJDOH Recovery Plan
• Environmental Health Task Force
• Outreach and training (environmental health issues)
• Mosquito-borne disease issues
• Surveillance activities
http://nj.gov/health/commiss/video/sandy.html
NJDOH Recovery Plan• Ensure that people and services are connected despite the
storm’s impact• Characterize environmental health issues associated with
Sandy; mitigate environmental health concerns caused by Sandy
• Restore NJ’s licensed healthcare and public health partners to normal operation
• Provide the public and DOH stakeholders with information on recovery activities and opportunities
• Identify potential mitigation opportunities to increase community resiliency
• Document disaster response and recovery costs of healthcare, public health and EMS providers in order to obtain any and all available financial assistance
Environmental Health Task Force
• In immediate weeks after storm, numerous meetings among partners redundancies, communication challenges identified
• Recognition of need to convene partners regularly – Federal: HHS (e.g., CDC/ATSDR, ASPR,
NIH/NIEHS), FEMA, OSHA, EPA– State: NJDEP, NJDOE, NJDCA, NJDCF, NJDOL,
UMDNJ-SPH– Local: health officer and environmental health
associations
Outreach and Training (1)
• Indoor environmental issues (namely mold) identified as priority
• Agencies and stakeholders had existing training opportunities information sharing among EHTF
Available at: http://nj.gov/health/ceohs/documents/mold_guidelines.pdf
Outreach and Training (2)
• Messages to local health departments– Retail food, tanning, body art
establishments– Swimming pools, natural bathing waters
• Messages to youth camp operators
• Identification of additional resources (e.g., HUD/CDBG and HHS/SSBG funding, ASPR funding)
Mosquito-Borne Disease Issues: Partners
• NJDEP Office of Mosquito Control Coordination (and county counterparts): mosquito surveillance and abatement (integrated pest management)
• NJDA: equine/camelid/veterinary surveillance
• NJDOH: human and avian surveillance• Interagency Vectorborne Disease Work
Group
Mosquito-Borne Disease Issues: Planning
• Identification of additional resources (e.g., FEMA public assistance, CDBG/SSBG funding)
• Enhancement of existing abatement, surveillance and education activities
Challenges to Surveillance in Disaster Settings
Infrastructure damage Widespread power outages Damage to phone lines
Travel challenges Roads flooded, washed away Roads blocked with downed trees and power lines Gasoline shortages and rationing
Constantly changing network of shelters
Objectives
Conduct shelter-based surveillance to track morbidity and provide daily feedback
Create and implement sustainable methods to report remotely
Methods
Each shelter, 24-hour time period
Health service visit = interaction in which medical attention provided to shelter client
Health need = injury, symptom, or chronic illness for which medical attention was sought
For each health service visit, recorded Basic demographic information (sex, age category) Disposition and referral information All health need(s) addressed
Daily reports produced and distributed
Results: Shelters Included
8 independent shelters
93 NJ shelters
26 shelters visited
70 shelters
21 shelters included
23 shelters closed
18 Red Cross shelters
5 declined participation
44 shelters excluded
Demographics of Health Service Visits
Characteristics No. (%)Sex (n=4629)
F 2384 (52)Age group, years (n=4449) 0–2 63 (1) 3–18 295 (7)
19–64 3167 (71) 65 and older 924 (21)
Categories of Health Needs Addressed (n=6825)
Category No. (%)
Acute Symptoms 3563(52
)
Follow-up Care 2257(33
)Exacerbation of Chronic Illness
756(11
)Injury 249 (4)
Most Common Health Needs (n=6825)
Syndrome No. (%)Pain 1161 (16)Respiratory/ILI 776 (11)Medication Refill 750 (11)Any Mental Health 717 (11)
Gastrointestinal Symptoms
183 (3)
Use of Data by State/Local Health Agencies
Signage, resources for public health promotion provided
Several outbreaks suspected and/or identified reported to local health departments rapid response to disease outbreaks
Mental health and medical concerns referred to various resources (e.g., county human service agency involvement, mobile pharmacy vans)
Summary
Project brought together partners for data sharing American Red Cross NJ Department of Health and local health departments Centers for Disease Control and Prevention
Timely data sharing fostered public health interventions Every disaster is different
Two Fatal Occupational Injury Two Fatal Occupational Injury Surveillance SystemsSurveillance Systems
Census of Fatal Occupational Injuries (CFOI)Purpose: count and describe fatal work-related injuriesStates funded by the U.S. Bureau of Labor Statistics
Fatality Assessment and Control Evaluation (FACE)Purposes: investigate factors involved in selected fatal work-
related injuries, make and promote recommendations for prevention
Nine states funded by the National Institute for Occupational Safety and Health (NIOSH)
Primary Sources of Primary Sources of Work-Related Fatal Injury DataWork-Related Fatal Injury Data
News mediaOSHADeath certificates/Bureau of Vital StatisticsMedical Examiners
Superstorm Sandy Superstorm Sandy Work-Related Fatal InjuriesWork-Related Fatal Injuries
Six work-related fatal injuries in New Jersey Dates of injuries range from Oct. 29 to Dec. 28All males, age range 41-69 yearsFour of six deaths among landscape/tree care/clean-
up workersTwo deaths from tree-cutting accidentsTwo deaths from being struck by motor vehicles
Syndromic Surveillance DataSyndromic Surveillance DataReal-time data from electronic health records (EHR)
to enable health departments to detect and respond to outbreaks
EpiCenter (Health Monitoring Systems, Inc.) EHR data feeds from NJ Emergency Departments75 facilities currently active in EpiCenter Limitation: several key hospitals in Ocean and
Monmouth counties not yet active
MethodsMethodsDozens of syndromes under surveillance:
Influenza-like illnessImmediately notifiable diseases (e.g., anthrax)Traumatic injuriesGastrointestinal illnessesHeat-related illness
Monitors key words in patient’s chief complaint field
On-going statistical analysis detects anomalies and triggers notifications and investigations
Definition of “Hurricane” SyndromeDefinition of “Hurricane” Syndrome
Developed in anticipation of Superstorm Sandy
Requested EDs to use “Sandy” in chief complaint field for storm-related visits
“Hurricane” syndrome includes visits in which chief complaint included:“sandy”; “storm”; "flood“; "carbon monoxide“;
"carbon dioxide“; "power outage“; or "hurricane"
Counts of Sandy-Counts of Sandy-Related ED Visits by Related ED Visits by Day and CategoryDay and Category
Data from EpiCenter Syndromic Surveillance System, Oct. 28 – Nov. 10, 2012
Daily Counts of Sandy-Related Daily Counts of Sandy-Related ED Visits by CategoryED Visits by Category
Data from EpiCenter Syndromic Surveillance System, Oct. 28 – Nov. 10, 2012
Emergency Department UB Data for COEmergency Department UB Data for CO
Data from EpiCenter Syndromic Surveillance System and 2012 UB File , Oct. 28 – Nov. 10, 2012
Future Considerations Future Considerations Continuing use of findings to guide communication
messages and public health actionDeveloping suite of weather-related outcomes
Carbon monoxide exposure/poisoningHeat- and cold-related illnessStorm-related injuriesHealth care system impacts (e.g., oxygen needs,
dialysis, medicine refills)Identifying potentially vulnerable populations
Summary
• Post-storm period poses wide range of issues for immediate and long-term recovery
• Post-storm activities require involvement of numerous partners to optimize quality of responses
Challenges
• Many resources available; timely identification and utilization were issues
• Characterizing requests for assistance was sometimes difficult
Opportunities
• Connections among partner groups are critical to future preparedness and response efforts
• Recovery activities will inform and ideally streamline future responses to natural disasters
Acknowledgments
NJDOHAndria ApostolouMiranda ChanJoe EldridgeJerry FaglianoDenise GaronTeresa HambyGary LudwigFernando McLean, Jr.Shereen SempleFaye SorhageStella Tsai
CDCDiana BensylKris BisgardCindy ChiuTala FakhouriLauren LewisMichelle MurtiRebecca NoeSatish PillaiAmy SchnallAlice ShumateNiu TianJoanna WatsonAmy WolkinEllen Yard
American Red CrossMary Casey-LockyerNancy MeiningerTeresa SchrefflerEsther TanJo West
Questions?
Tina Tan, MD, MPHState Epidemiologist/Assistant CommissionerNJDOH Division of Epidemiology, Environmental and
Occupational [email protected]
Master Sgt. Mark C. Olsen/USAF/NJ National Guard