Wisconsin experienced severe flooding from August 17 to September 20, 2018. This flood caused an estimated $232 million in damage and affected 21 counties. Floods can have negative health impacts on a population, such as increased skin infections, communicable diseases, gastroenteritis, and zoonotic infections.1 They can also have negative impacts on health infrastructure and cause displacement.1
Hospital discharge data and the Wisconsin Ambulance Run Data System (WARDS) are excellent sources of data used by the Wisconsin Department of Health (DHS), but they do not supply rapid data.2 In cases of natural disasters, current data is crucial for timely community recovery.
DHS uses BioSense, a database that contains syndromic surveillance data. This database consists of nearly 700 reporting facilities in Wisconsin and approximately 85% of emergency rooms. BioSense is operated and maintained by the Centers for Disease Control and Prevention.
After the flooding, the emergency preparedness team within DHS set a goal to restore the community’s regular systems and activities to their normal state as quickly as possible.2 They used the Early Notification of Community based Epidemics (ESSENCE), a tool within BioSense, to track flood-related incidents. The query used was a modified version of a flood query published by the International Society for Disease Surveillance (ISDS).3
A total of 297 emergency department visits related to the flood were detected.2 A case screening process was then applied to these visits, eliminating those that did not fit the case definition.2 For example, a visit was picked up by the query that said, “No one else in the house is sick and patient has not been traveling out of the country. Nor does patient live or work in the local flooded areas.”2 After the case screening process, a total of 58 cases remained for possible follow-up and intervention.2
The Division of Care and Treatment Services (DCTS) within DHS used this data to apply for the Crisis Counseling Assistance and Training Program (CCP) grant with the Substance Abuse and Mental Health Services Administration (SAMHSA).4 This grant is available in the event of a presidential declaration of disaster, which was given on October 18. CCP also awarded a longer term grant to DCTS to use syndromic data. These grants will aid in the current and future flood responses. The next step for DCTS is to submit an abstract to the Council of State and Territorial Epidemiologists (CSTE) detailing the flood and response.
In the future, syndromic data will be used in disaster response efforts at DHS. Alerts for natural disasters and disease outbreaks are being set up through ESSENCE. There is an effort to get more DHS employees signed up for BioSense and expand its use. Success stories such as this will encourage more people to utilize syndromic data.
Syndromic data is an excellent source of timely data since emergency care events can be rapidly detected during and after a crisis. It can also be used as an initial point of detection in a public health intervention. While syndromic data does provide a great starting point, data quality can present certain limitations. It is important to check data completeness and validity and compare with hospital discharge data, if possible, when moving forward with a public health intervention.
Syndromic data can be used to apply for grants and inform future department activities. Applying for grants using this data can result in more resources for a department during future events. Since syndromic data can serve as the alert system for an event, it can influence a department’s immediate reaction to a crisis.
Resources:
1. Paterson, D. L., et al., (2018). Health Risks of Flood Disasters. Clinical Infectious Diseases, 67(9), pp 1450-1454. Retrieved from: https://doi.org/10.1093/cid/ciy227.
2. Tatar, J., et al. (2018). Syndromic Surveillance in Action: Examining ED Visits Due to Wisconsin Flooding. Office of Preparedness and Emergency Health Care.
3. International Society for Disease Surveillance. (2018). Storms - Kansas Department of Health and Environment. ISDS Knowledge Repository. Retrieved from: https://www.surveillancerepository.org/storms-kansas-department-health-and-environment.
4. U.S. Department of Health & Human Services. (2018). Crisis Counseling Assistance and Training Program (CCP). Substance Abuse and Mental Health Services Administration. Retrieved from: https://www.samhsa.gov/dtac/ccp.