Shelter Surveillance

Timely outbreak detection, and monitoring of morbidity and mortality among Katrina evacuees, and needs assessment for better planning and response were urgent information intensive priorities during Katrina relief efforts at Houston, and called for immediate deployment of a real-time surveillance and needs assessment system ad hoc, in order to collect and analyze relevant data at the scene. Initial requirement analysis revealed the following capabilities as essential to sustain effective response within the shelters:

• The ability to securely collect and integrate data from evacuees seeking any form of health services from all care providers (academic, volunteers, federal, NGOs and international aid organizations, etc), including demographic information, vital signs, chief complaints, disabilities, chronic conditions, current and past medications, traumas and injuries, exposure to toxic materials, clinical laboratory results, past medical history, discharge notes and diagnoses, and ability to collect free text entries for any other information (similar to a full-blown electronic medical records system).

• Proactive survey of demographic profile, physical and mental health status, as well as special needs assessment (e.g., dialysis, medications, etc) from all evacuees.

• The ability to collect uniform information, using any network-enabled device available: PCs, tablets, and handheld devices. 

• The ability to classify observations by processing sign and symptom, chief complaint, medication, and other diagnostic data (including free text entries) through ad-hoc definition of concepts such as (Gastrointestinal, Respiratory, Fever and Rash, etc). 

Objective

This paper presents lessons learned from leveraging Internet-based technologies and Services Oriented Architecture in providing timely, novel, and customizable solutions, just in time and for preparedness against unprecedented events such as natural disasters (e.g., Katrina) or terrorism.

On Monday, August 29, 2005, Hurricane Katrina struck the Gulf Coast. Outside of the affected areas of TX, LA, MS, and AL, GA received the largest number of these evacuees, approximately 125,000. By August 30, 2005, GA began receiving a total of approximately 1,300 NDMS patients from flights arriving at Dobbins Air Force Base. Within days, Georgia established 13 shelters for evacuees. Crowded shelters can increase the risk for communicable diseases. In addition, many evacuees left behind needed medications, thus increasing the risk for chronic disease exacerbations.

Objective

To assess public health needs among sheltered evacuees, the GA Department of Human Resources, Division of Public Health recommended daily surveillance.

Hurricane Harvey made landfall along the Texas coast on August 25th, 2017 as a Category 4 storm. It is estimated that the ensuing rainfall caused record flooding of at least 18 inches in 70% of Harris County. Over 30,000 residents were displaced and 50 deaths occurred due to the devastation. At least 53 temporary refuge shelters opened in various parts of Harris County to accommodate displaced residents. On the evening of August 29th, Harris County and community partners set up a 10,000 bed mega-shelter at NRG Center, in efforts to centralize refuge efforts. Harris County Public Health (HCPH) was responsible for round-the-clock surveillance to monitor resident health status and prevent communicable disease outbreaks within the mega-shelter. This was accomplished through direct and indirect resident health assessments, along with coordinated prevention and disease control efforts. Despite HCPH’s 20-day active response, and identification of two relatively small but potentially worrisome communicable disease outbreaks, no large-scale disease outbreaks occurred within the NRG Center mega-shelter.

Objective:

1) Describe HCPH’s disease surveillance and prevention activities within the NRG Center mega-shelter;

2) Present surveillance findings with an emphasis on sharing tools that were developed and may be utilized for future disaster response efforts;

3) Discuss successes achieved, challenges encountered, and lessons learned from this emergency response.