Emergency Medical Service (EMS)

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.

Beginning on March 13, 2011, ACDC experienced an unusual increase in reported bacterial meningitis cases in Los Angeles (LA) County. Early in the investigation, there were few epidemiological links between the cases. Three cases were homeless; two resided at the same Skid Row shelter in downtown LA. ACDC assessed its syndromic surveillance databases to help gauge the scope of the outbreak and detect potentially overlooked cases.

Objective

To describe the complementary usage of electronic emergency department (ED) data, Coroner deaths, and 911 dispatch call center data in a bacterial meningitis outbreak.

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.

NC DETECT is the Web-based early event detection and timely public health surveillance system in the North Carolina Public Health Information Network. The reporting system also provides broader public health surveillance reports for emergency department visits related to hurricanes, injuries, asthma,  vaccine-preventable diseases, environmental health and others. NC DETECT receives data on at least a daily basis from four data sources: emergency departments, the statewide poison center, the statewide EMS data collection system, a regional wildlife center and laboratory data from the NC State College of Veterinary Medicine. Data from select urgent care centers are in pilot testing.

Objective

Managers of the NC DETECT surveillance system wanted to augment standard tabular Web-based access with a Web-based spatial-temporal interface to allow users to see spatial and temporal characteristics of the surveillance data. Users need to see spatial and temporal patterns in the data to help make decisions about events that require further investigation. The innovative solution using Adobe Flash and Web services to integrate the mapping component with the backend database will be described in this paper.

In 2003, the need for a system to track and manage patient status and location was identified by Boston Emergency Medical Services (Boston EMS) and the Conference of Boston Teaching Hospitals. After consultation with EMS (municipal, fire based, and private), hospital, local and state public health and emergency management stakeholders, a core group from Boston EMS and Boston Public Health Commission (BPHC) developed guidelines for a Metro Boston Patient Tracking System. The goal was to provide a system to reunite family members and serve as a tool for managing short term/high impact mass casualty incidents and protracted disease outbreaks.

Since 2004, BPHC Communicable Disease Control Division (CDC) has effectively managed several mass prophylaxis clinics in response to infectious disease outbreaks. However patient data was largely collected on paper based forms, limiting the availability of real-time clinic data to incident command. To address these challenges BPHC CDC began meeting with Boston EMS to define the business processes and information needs during public health emergencies.

Objective

To describe the electronic patient tracking system configured by Boston EMS and the BPHC CDC to address information needs during public health emergencies.

The United States Environmental Protection Agency (U.S. EPA) has developed a prototype contamination warning system (CWS) for drinking water in response to Homeland Security Presidential Directive 9 (HSPD9). The goal of HSPD9 and the CWS is to expedite contamination containment and emergency response, thereby minimizing public health and economic impacts.

U.S. EPA’s conceptual CWS system, named WaterSentinel, is currently being pilot tested by U.S. EPA and its research partners. WaterSentinel is a multi-faceted approach involving water quality monitoring at optimal locations throughout the drinking water distribution system, enhanced security monitoring at key water utility infrastructure assets, consumer complaint surveillance, and innovative uses of public health surveillance data streams.

Objective

This paper summarizes the use and evaluation of various types of public health surveillance data for the early detection of chemical and biological contamination of drinking water.

Safe drinking water is essential for all communities. Intentional or unintentional contamination of drinking water requires water utilities and local public health to act quickly. The Water Security (WS) initiative of the U.S. Environmental Protection Agency is a multi-faceted approach involving water utilities and local public health officials (LPH) to identify, communicate, contain, and mitigate a drinking water contamination event. Components of WS include: online water quality monitoring, enhanced security monitoring, consumer complaint surveillance, and innovative uses of public health surveillance data streams. LPH already use multiple surveillance data systems to recognize disease events in a timely manner. However, few of these systems can be integrated or specifically designed for detection of drinking water contamination incidents.

Objective

This poster describes the integration of public health surveillance data as a component of an early warning system for detection of a drinking water contamination incident.

On 12/14/06, a windstorm in western Washington caused 4 million residents to lose power; within 24 hours, a surge in patients presented to emergency departments (EDs) with carbon monoxide (CO) poisoning. As previously described, records of all patients presenting to King County EDs with CO poisoning between 12/15/06 to 12/24/06 (n=279) were abstracted, of which 249 met the case definition and eligibility requirements. We attempted to identify each of the 249 confirmed cases of CO poisoning in our syndromic ED data set by comparing the hospital name, date, time, age, sex, zip code, chief complaint, and diagnoses across the two data sets. We designated each record as an exact match, likely match, possible match, or unmatched on the basis of the available fields.

Objective

We evaluated ED and emergency medical services data for describing an outbreak of CO poisoning following a windstorm, and determined whether loss of power was followed by an increase in other health conditions.

Although the majority of work in syndromic surveillance has been its application to bioterrorism and infectious diseases, one of the emerging priorities for its use is for the monitoring of environmental health conditions. Heat-related illness (HRI) is of growing public health importance, especially with global warming concerns and increased frequency of heat waves. Ambient temperatures are responsible for significant morbidity and mortality, as was demonstrated during the 1995 heat wave in Chicago that resulted in over 700 excess deaths and 33,000 emergency room visits due to HRI. A syndromic surveillance system that is able to detect early indications of excess HRI may start the public health response earlier, and thus reduce associated morbidity and mortality. The utility of 911 ambulance dispatch data for the early detection of heat-related illness was explored.

Objective

This paper describes the use of 911 ambulance dispatch data for the early detection of HRI in Toronto, Ontario, Canada.