Emergency Preparedness

In early May of 2013, two chemical spills occurred within high schools in Atlantic county. These incidents, occurring within a week of each other, highlighted the need to strengthen statewide syndromic surveillance of illnesses caused by such exposures. In response to these spills, a new 'chemical exposure' classifier was created in EpiCenter, New JerseyÕs syndromic surveillance system, to track future events by monitoring registration chief complaint data taken from emergency department visits. The primary objective behind creation of the new classifier is to provide local epidemiologists with prompt notification once EpiCenter detects an abnormal numbers of chemical exposure cases.

Objective

To describe the development of a new chemical exposure classifier in New Jersey's syndromic surveillance system (EpiCenter).

Located along the Gulf Coast, Louisiana is home to strong traditional industries, such as agriculture, petrochemicals and energy, and is also home to the largest single port in the United States (Louisiana Department of Economic Development, 2009). All of these industries use hazardous materials as part of their standard operating procedure. No matter how safe an industry is, accidents do happen, and when working with hazardous materials, these accidents can be disastrous. The Louisiana Department of Health and Hospitals (LDHH) has recently developed and implemented emergency response guidelines for handling hazardous chemical emergencies. These guidelines were developed as an expansion of a collaborative agreement with the Centers for Disease Control and Prevention / Agency for Toxic Substances and Disease Registry (CDC / ATSDR). The cooperative agreement, known as the National Toxic Substance Incidents Program (NTSIP) collects and combines information from many resources to protect people from harm caused by spills and leaks of toxic substances and is modeled partially after CDC / ATSDRÕs Hazardous Substances Emergency Events Surveillance (HSEES) Program (1990-2009). Objective: In order for there to be immediate public health involvement during hazardous chemical emergencies, the Louisiana Department of Health and Hospitals (LDHH) has recently developed and implemented emergency response guidelines for handling hazardous chemical emergencies.

The role of public health in preparing for, responding to, and recovering from emergencies has expanded as a result of the massive impact recent disasters have had on affected populations. Nearly every large-scale disaster carries substantial public health risk and requires a response that addresses immediate effects of the disaster on a population (e.g., mass casualties and severe injuries, lack of shelter in severe weather), as well as subsequent secondary physical effects (e.g., carbon monoxide poisoning due to improper operation or location of carbon monoxide-producing devices such as generators) and emotional effects (e.g., grief, anxiety, and post-traumatic stress disorder) caused by the disaster. Disaster epidemiology has been identified as an evolving field that integrates a variety of data sources and technological and geospatial resources to expedite reporting and to increase the accuracy of information collected and used by emergency planners and incident managers. As the national organization that supports the activities of applied epidemiologists in state, tribal, local, territorial, and federal public health agencies, the Council of State and Territorial Epidemiologists (CSTE) assembled a Disaster Epidemiology Subcommittee of public health experts and practitioners from diverse fields of applied epidemiology to discuss the use of epidemiologic methods in all phases of the disaster management cycle. In 2012, the Subcommittee assessed state-level disaster epidemiology capacity with a focus on surveillance. 

Objective

The panel will discuss the current status of disaster surveillance capabilities at local and state health departments in the United States and will provide an overview of current resources available to epidemiologists for surveillance.

Emergency management during a disaster entails innumerable challenges. Each disaster uniquely shapes the types and timing of information needed both to manage the disaster and to measure the impact on available resources, the environment, and community systems. Traditional public health surveillance methods typically preclude providing a real-time, comprehensive estimate of public health impacts related to the disaster while the disaster is unfolding. Traditional methods can also be resource intensive, costly, require active cooperation of medical systems involved in a disaster response, and are often conducted post-disaster.

Syndromic surveillance of emergency department chief complaints and over-the-counter medication sales was reinstituted in the Austin area in the fall of 2010. In 2011, the Austin area was hit with three natural disasters: a winter ice storm; a summer of extreme heat/extended drought; and a week of significant wildfires. Each disaster varied greatly in type, size, intensity, and duration. The Austin/Travis County Health and Human Services Department, in partnership with Austin/Travis County EMS, was able for the first time to provide near-real time data to emergency managers on the potential health impact during each of the 2011 disasters using the syndromic and EMS electronic data systems. The data were used to provide situational awareness and guide selected response actions during the course of the disaster, as well as, document potential areas for future mitigation efforts.

Objective

Using case studies of three natural disasters that occurred in the Austin, Texas Metro area in 2011, demonstrate the role syndromic surveillance and emergency medical services data played during the response to each different type of disaster.

NPDS is a national database of detailed information collected from each call, uploaded in near real-time, from the 57 participating regional poison centers (PCs) located across the US. NPDS is owned and operated by the American Association of Poison Control Centers (AAPCC). Since 2001, scientists from the Centers for Disease Control and Prevention collaborated with AAPCC to use NPDS for surveillance of chemical, poison and radiological exposures. In March of 2011, a 9.0 magnitude earthquake and tsunami damaged the reactors at the Fukushima Daiichi nuclear power plant in Japan, causing a radiological incident classified as a "major accident" according to the International Nuclear Event Scale. The incident resulted in the release of radioactive iodine (I-131) into the global environment, which was detected in precipitation in parts of the United States. While no adverse health effects were expected, concerned citizens contacted public health officials at the local, state and federal levels. Many started to acquire and use potassium iodide (KI) and other iodide-containing products intended for thyroid protection from I-131, even though this was not a public health recommendation by state and federal public health agencies. Shortly after international media coverage began, regional PCs began receiving calls regarding the Japan radiological incident. State and federal health officials were interested in identifying health communication needs and targeting risk communication messages to address radiation concerns and KI usage recommendations as part of the public health response. This was done in part through NPDS-based surveillance.

Objective

To describe how the National Poison Data System (NPDS) was used for surveillance of individuals with potential incident-related exposures in the United States resulting from the Japan earthquake radiological incident of 2011. Our secondary objective is to briefly describe the process used to confirm exposures identified through NPDS-based surveillance.

In 2011, March 11th, the big earthquake attacked eastern Japan, and forced a lot of people to live in evacuation sites. Since those evaluation sites have high density of population and sanitary condition was poor in these sites, outbreaks of influenza, noro virus or other infectious diseases were concerned.

Objective

For an early detection and control of an infectious disease outbreak, we developed and have been operating syndromic surveillance for evacuation sites, "evacuation site surveillance."

In 2011, March 11th, the big earthquake attacked eastern Japan followed by huge tsunami and nuclear plant accident. Consequently a lot of people could not help living in evacuation sites. Since those evaluation sites have high density of population and were not necessarily good in sanitary condition, outbreaks of influenza, norovirus or other infectious diseases were concerned.

Objective

For an early detection and control of an infectious disease outbreak, we developed and have been operating syndromic surveillance for evacuation sites, "evacuation site surveillance."

Description: The Centers for Disease Control and Prevention (CDC) works to save lives and protect people during major public health events. In an effort to support these processes, CDC established the Countermeasure Tracking Systems (CTS), which is maintained within the Division of Informatics Solutions and Operations, in the Public Health Informatics and Technical Program Office. CTS consists of four system components which interoperate to improve communications and event response efficiency while still functioning independently, recognizing the unique requirements and use cases for each system. Collectively, the data consolidated from these systems can show population coverage, numbers of untreated individuals, drug and equipment shortages, need for resupply and more. The Web-based applications are deployed centrally at CDC and use the CDC's secure data access method for security.

The first of these components is the Inventory Management and Tracking System (IMATS), currently under development. IMATS provides state and local public health providers with a tool to track medical and non-medical countermeasure inventory and supplies during daily operations or an event. The solution tracks quantities of inventory, monitors reorder thresholds, and facilitates warehouse operations including receiving, staging, and storing of inventory.

The Communications Portal is a web based content management system in development which consolidates important event response details into one place and will provide timely and adequate information to states and other jurisdictions. This system is complementary to the IMATS as it manages communications related to, but not limited to, Emergency Use Authorization, Investigational New Drug and recall notices.

Objective

To describe the CDC CTS, and the impact of its four closely related informatics components toward enhancing federal, state, and local public health capacity to track and manage medicine and other medical or non-medical supplies during daily operations and all hazards public health events.

The purpose of the National Collaborative for Bio-preparedness (NCB-P) is to enhance biosurveillance and situational awareness to better inform decision-making using a statewide approach. EMS represents a unique potential data source because it intersects with patients at the point of insult or injury, thus providing information on the timing and location of care. North Carolina uses a standardized EMS data collection system, the Prehospital Medical Information System (PreMIS), to collect information on EMS encounters across the state using the National EMS Information System (NEMSIS) template. Since NEMSIS is planned to be incorporated by EMS agencies in every state, an EMS-based approach to biosurveillance is extensible nationally.

Objective

To develop a statewide biosurveillance system based on emergency medical services (EMS) information which employs both symptom-based illness categorization and spatiotemporal analysis.

The CDC's BioSense Program receives near real-time health care utilization data from a number of sources, including Department of Defense (DoD) healthcare facilities from around the globe and non-federal hospital emergency departments (EDs) in the US, to support all-hazards surveillance and situation awareness. Following the tsunami in Japan on March 11, 2011, the BioSense Program modified its surveillance protocols to monitor: 1) injuries and possible radiation-associated health effects in Japan-based DoD facilities and 2) potential adverse health effects associated with the consumption of potassium iodide (KI), a salt used to prevent injury to the thyroid gland in the event of radiation exposure, among persons attending participating EDs in the US. We present the findings from that enhanced surveillance.

Objective

To demonstrate the utility of the BioSense Program for post-disaster response surveillance.