Chief Complaint

The Florida Department of Health (FDOH) previously monitored Florida Poison Information Center (FPICN) data for timely detection of increases in carbon monoxide (CO) exposures before, during, and after hurricanes. Recent analyses have noted that CO poisonings have also increased with generator use and improper heating of homes during cold winter months in Florida. Similarly, increases in CO poisoning cases related to motor vehicles have been observed during summer months. CO is an odorless, colorless, poisonous gas causing sudden illness and death, if present in sufficient concentration in ambient air. The most common signs and symptoms include headache, nausea, lethargy/fatigue, weakness, abdominal discomfort/pain, confusion, and dizziness. 

Objective

This presentation summarizes Florida’s experience in identifying CO poisoning clusters using ESSENCE-based syndromic surveillance.

The Florida Department of Health (FDOH) previously monitored Florida Poison Information Center (FPICN) data for timely detection of increases in carbon monoxide (CO) exposures before, during, and after hurricanes. Recent analyses have noted that CO poisonings have also increased with generator use and improper heating of homes during cold winter months in Florida. Similarly, increases in CO poisoning cases related to motor vehicles have been observed during summer months. CO is an odorless, colorless, poisonous gas causing sudden illness and death, if present in sufficient concentration in ambient air. The most common signs and symptoms include headache, nausea, lethargy/fatigue, weakness, abdominal discomfort/pain, confusion, and dizziness. This presentation summarizes Florida’s experience in identifying CO poisoning clusters using ESSENCE-based syndromic surveillance.

In November 2006, Ohioans supported a statute that set into law a requirement that all public places, and places of employment in Ohio prohibit smoking.1 The law took effect in December 2006; however, the rules for implementation were not finalized until June 2007. The primary purpose of the law was to protect employees in all workplaces from exposure to environmental tobacco smoke. When determining how best to evaluate the health impact of a smoke-free law as it relates to secondhand smoke exposure, most studies have reviewed the incidence of heart attacks or AMIs. In the 2006 Surgeon General’s Report, ‘The Health Consequences of Involuntary Exposure to Tobacco Smoke,’2 secondhand smoke exposure is causally associated with cardiovascular events, including AMI. The Institute of Medicine also released a report in 2009 from a meta-analysis, ‘Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence,’3 of 11 epidemiologic studies, reviewing the incidence of acute coronary events following the passing of a smoke-free law. Each of the 11 studies showed a decrease in heart attack rates after implementation of smoke-free laws. The purpose of this study was to evaluate this relationship in Ohio.

Objective

The objective of this study, after completion of the preliminary analysis, was to evaluate whether or not the smoke-free law in Ohio has made a positive change in reducing the effects of secondhand smoke exposure by comparing syndromic surveillance data (trends for emergency department, and urgent care chief complaint visits), related to heart attack and/or acute myocardial infarction (AMI) before and after the smoking ban.

NC DETECT provides near-real-time statewide surveillance capacity to local, regional and state level users across NC with twice daily data feeds from 119 (99%) emergency departments (EDs), hourly updates from the statewide poison center, and daily feeds from statewide EMS runs, select urgent care centers and veterinary lab data. The NC DETECT Web Application provides access to aggregate and line listing analyses customized to users’ respective jurisdictions. Several reports are currently available to monitor the health effects of heat waves. Heat wave surveillance is essential as temperature extremes are expected to increase with climate change.

Objective

To examine the utilization of NC emergency departments for heat-related illness by age, disposition and cause based on chief complaint and triage note categorization.

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.

Florida Department of Health has developed a statewide syndromic surveillance system based on the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE). Authorized users can currently access data from the Florida Poison Information Center Network (FPICN), Emergency Room chief complaints, Florida reportable disease system (Merlin) and the Florida death records through ESSENCE under one portal. The purpose of this paper is to summarize efforts to enhance statewide real-time chemical surveillance by incorporating FPICN data into ESSENCE.

The Syndromic Surveillance Program (SSP) of the Acute Disease Epidemiology Section of the Georgia Division of Public Health, provides electronic influenza- like- illness (ILI) data to the Center for Disease Control and Prevention’s Influenza-like Illness Surveillance Network Program that characterizes the burden of influenza in states on a weekly basis.

ILI is defined as a fever of 1001, plus a cough or sore throat. This definition is used to classify ILI by the SSP, as well as in diagnosis at the pediatric hospital system. During the 2009 H1N1 pandemic, the SSP was provided a daily data transfer to the Center for Disease Control and Prevention to heighten situational awareness of the burden of ILI in Georgia. Throughout the peak of the pandemic, data from the pediatric hospital system identified when the percentage of daily visits for ILI had substantively increased. The data includes patient chief complaint (CC) data from emergency department visits for two facilities at Facilities A and B. The data received by SSP does not include diagnosis data.

Patient emergency department discharge data (DD) for ‘FLU’ was provided to SSP retrospectively to compare with the CC data routinely collected and analyzed. The data was derived from the pediatric health system’s month end, internal, syndromic surveillance report based upon emergency department visits, and including physician’s diagnosis at the time of patient’s discharge. The case definition of ‘FLU’ from the pediatric health system facilities is acute onset of fever, with cough and/or sore throat in the absence of a known cause other than influenza.

Objective

The objective of this study is to describe the difference between patient CC, ILI data provided daily to the Georgia SSP during the 2009 H1N1 pandemic, and patient DD subsequently provided for comparison with the SSP from its participating pediatric hospital system, and its two affiliated emergency rooms.