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Azarian Taj

Previous reports have demonstrated the media’s influence on emergency departments (ED) visits in situations such as dramatized acetaminophen overdose, media report of celebrity suicides, television public announcements for early stroke care and cardiac visits following President Clinton’s heart surgery. No previous study has demonstrated the influence of media-publicized trauma on ED visits. On 16 March 2009, the actress Natasha Richardson suffered a traumatic brain injury leading to her death on 18 March; these events were widely publicized by national news sources. The health departments of New York City, Boston, Duval County and Seattle monitor ED visits daily, and capture 95, 100, 100 and 95% of all ED visits, respectively. The data collected include basic demographic information, chief complaint and in some cases ICD-9 diagnosis codes.

 

Objective

This study describes an increase in head trauma-related visits to ED in New York City, New York; Boston, Massachusetts; Duval County, Florida; and Seattle, Washington following the widespread media coverage of actress Natasha Richardson’s head injury and subsequent fatal epidural hematoma.

Referenced File
Submitted by hparton on

The Duval County Health Department (DCHD) serves a community of over one million people in Jacksonville, FL, USA. Each year, DCHD Epidemiology Program reports an average of 1133 (4-year average) notifiable diseases and conditions (NDC) with the exception of STD/HIV, TB, and viral hepatitis. Within Duval County, emergency medical care is provided by eight local hospitals, including one pediatric facility and a level-1 trauma center. These facilities contribute syndromic surveillance (SS) chief complaint (CC) data to the Electronic Surveillance System for Early Notification of Community-based Epidemics of Florida.

Historically, evaluations of SS systems have used ICD-9 diagnoses as the gold standard to determine predictive values. However, limited studies have surveyed reports of NDC to identify related emergency department (ED) visits and subsequent CC-based syndrome categorization. These data may provide public health investigators insight into health seeking behaviors, interpretation of SS signals, and prevalence of NDC within ED data.

 

Objective

This paper characterizes ED utilization among individuals diagnosed and reported with NDC. Furthermore, it evaluates the subsequent assignment of SS syndromes based on the patient’s CC during their ED visit.

Referenced File
Submitted by hparton on

In the last decade, the scope of public health (PH) surveillance has grown, and biosurveillance capacity has expanded in Duval County. In 2004, the Duval County Health Department (DCHD) implemented a standalone syndromic surveillance (SS) system which required the manual classification and entry of emergency department (ED) chief complaints by hospital staff. At that time, this system, in conjunction with other external systems (e.g. CDC ILInet, FluStar, NRDM) were used to conduct surveillance for health events. Recommendations from a 2007 ISDS panel were used to strengthen surveillance within Duval County. Later that year, the Florida DOH moved to a statewide SS system and implemented ESSENCE which has been expanded to include 1) ED record data from 176 hospitals (8 within Duval County); 2) Reportable disease case records from Merlin; 3) Florida Poison Information Network consultations; and, 4) Florida Office of Vital Statistics death records (1). ESSENCE has subsequently become a platform for rapid data analysis, mapping, and visualization across several data sources (1). As a result, ESSENCE has improved business processes within DCHD well beyond the initial scope of event detection. These improvements have included 1) expansion of the ability to create visualizations (e.g. epi-curves, charts, and maps); 2) reduction in the time required to produce reports (e.g. newsletters, media responses); 3) reduction in staff training needs; and 4) augmentation of epidemiology processes (e.g. active case finding, emergency response, quality improvement (QI)), and closing the PH surveillance loop.

Objective

This paper reviews the evolution of biosurveillance in Duval County, FL and characterizes the subsequent improved execution of epidemiology functions as a result of the implementation of the Early Notification of Community-based Epidemics (ESSENCE) system.

Referenced File
Submitted by elamb on

In 2004, the BioDefend (BD) syndromic surveillance (SS) system was implemented in Duval County hospitals (Jacksonville, FL). Daily emergency department chief complaints are manually classified and entered into the BD system by triage personnel. As part of a statewide implementation, the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) began collecting data in the Jacksonville area during the winter of 2007-08. ESSENCE uses an automated data collection, chief complaint parsing and analysis process for data management and analysis. The use of two systems during the same period of time in one area provided a unique opportunity to retrospectively analyze characteristics of the BD and ESSENCE systems.

 

Objective

To compare detection of a community outbreak of influenza-like illness using two SS systems, one using a clinician’s classification of reason for visit and the other using an automated chief complaint parsing algorithm.

Referenced File
Submitted by elamb on

Many syndromic surveillance systems have been developed and are operational, yet lack concise guidelines for investigating and conducting followups on daily alarms. Daily emergency department visits from six reporting hospitals in the Duval County area are assessed and classified into a BioDefend (BD) system entry by triage personnel. Alarms are categorized into alerts, 3 SD above a 30 day rolling mean, or warnings, 2-3 SD above the mean. Signals are monitored and in response, public health investigations and recommended interventions are initiated.

 

Objective

To evaluate the protocol that the Duval County Health Department (DCHD) epidemiology staff uses to respond to BD syndromic surveillance system alarms. The response protocol utilizes all signals detected by BD and its secondary resources, within the DCHD jurisdiction.

Referenced File
Submitted by elamb on

This panel member consultation is an International Society of Disease Surveillance (ISDS) sponsored project. It involved expert personnel in their respective area to address specific, priority questions confronting researchers, developers, and public health practioners in the field of syndromic surveillance (SS). The objective of this consultation will be to develop expert, consensus-based recommendations that address specific, unsettled problems or unanswered questions that hinder advances in utilization of syndromic surveillance data in combination with other data sources. Recommendations arising from the consultation should facilitate efforts by researchers, developers, or practitioners to be able to stride ahead and make progress.

Referenced File
Submitted by elamb on

In the event of a large-scale public health crisis, successfully detecting and assessing health threats and monitoring population health status over a sustained period of time is likely to require integration of information from multiple sources. In addition, this information must be shared at varying levels of detail both among different agencies or organizations within an affected locality and among response participants at local, state, and federal levels of government. In early 2007, the International Society for Disease Surveillance (ISDS) proposed a project to support member initiated consultations on priority unresolved questions in the field of syndromic surveillance (SS) research, development, or practice. The Duval County Health Department sought and obtained ISDS support to address the use of SS data in combination with other human health and veterinary surveillance data, environmental sampling data, and plume modeling results in the event of an airborne bioterrorist (BT) attack. To date, the development of SS in Florida has mainly focused on systems that monitor information from emergency department (ED) visits. In addition, because SS development was decentralized and managed primarily by county health departments, various systems were used in Florida, including ESSENCE, STARS, EARS and BioDefend.

Objective

The objective of this consultation was to develop expert, consensus-based recommendations for use of SS in combination with other human health, animal health, and environmental data sources to improve situational awareness in the event of a large-scale public health emergency. The consultation, convened by the Duval County, Florida, Health Department, involved other local and state public health offi cials from Florida who addressed this question in the context of a hypothetical BT attack scenario in Duval County. Insights arising from the consultation will be used to strengthen public health surveillance capacities as part of both local and state emergency preparedness efforts in Florida. The approach used by the consultation may be useful to other health departments seeking to enhance their emergency situational awareness capacity.

Referenced File
Submitted by uysz on
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