Haas Adam

The EPA Water Security initiative contamination warning system detection strategy involves the use of multiple monitoring and surveillance components for timely detection of drinking water contamination in the distribution system. The public health surveillance (PHS) component of the contamination warning system involves the analysis of health-related data to identify disease events that may stem from drinking water contamination. Public health data include hospital admission reports, infectious disease surveillance, emergency medical service reports, 911 calls and poison control center calls. Automated analysis of these data streams results in alerts, which are investigated by health department epidemiologists. A comprehensive operational strategy was developed to describe the processes and procedures involved in the the initial investigation and validation of a PHS alert. The operational strategy established specific roles and responsibilities, and detailed procedural flow descriptions. The procedural flow concluded with the determination of whether or not an alert generated from surveillance of public health data streams is indicative of a possible water contamination incident.

Objective

To develop standard operating procedures to identify or rule out possible water contamination as a cause for a syndromic surveillance alarm.

The Public Health Surveillance (PHS) component (one of five monitoring and surveillance components deployed in the Cincinnati drinking water contamination warning system) functions to detect public health incidents resulting from exposure to toxic chemicals that produce a rapid onset of symptoms. Within the PHS component, four data streams were monitored: 911 calls, Emergency Medical Services (EMS) logs, Local Poison Control Center call data, as well as Emergency Department data (via EpiCenter). The focus of this paper centers on the 911 and EMS surveillance tools. The 911 data is dependent on information provided by the caller and the information entered by the dispatcher. EMS data, on the other hand, is recorded by a medical professional, and although not provided as rapidly as 911 data, provides more detailed information. The data included in 911 and EMS alerts, when utilized together, can provide timely and beneficial information during investigation of a possible drinking water contamination incident.

Objective

This paper describes the design, application and use of 911 and EMS data in a drinking water contamination warning system.

The U.S. Environmental Protection Agency (EPA) designed a program to pilot multi-component contamination warning systems (CWSs), known as the “Water Security initiative (WSi).” The Cincinnati pilot has been fully operational since January 2008, and an additional four pilot utilities will have their own, custom CWSs by the end of 2012. A workshop amongst the pilot cities was conducted in May 2012 to discuss lessons learned from the design, implementation, operation, maintenance, and evaluation of each city’s PHS component.

Objective

This paper describes the lessons learned from operation and maintenance of the public health surveillance (PHS) component of five pilot city drinking water contamination warning systems (CWS) including: Cincinnati, New York, San Francisco, Philadelphia, and Dallas.

Healthcare seeking behavior is important to understand when interpreting public health surveillance data, planning for healthcare utilization, or attempting to estimate or model consequences of an adverse event, such as widespread water contamination. Although there is evidence that factors such as perceived susceptibility and benefits affect healthcare seeking behavior, it is difficult to develop accurate assumptions due to a lack of published research on this topic. Current conceptual behavior models, such as the health belief model, are not easily translated into quantifiable terms.

Objective

This paper describes analyses of health seeking behaviors from two surveillance datastreams: Poison Control Center (PCC) calls and Emergency Department (ED) visit records. These analyses were conducted in order to quantify behaviors following the development of symptoms after water contamination exposure and to understand the motivation, decision-making and timing behind healthcare seeking behaviors.