Michael Heumann, MPH, MA. HeumannHealth Consulting Portland, OR

Transcription

1 Michael Heumann, MPH, MA HeumannHealth Consulting Portland, OR

2 1. Define disaster epidemiology (DE) and its role in pre-disaster, disaster, and recovery phases. 2. Identify how a variety of standard epidemiologic methods are being applied in the public health response to disasters and in DE research 3. Discuss the role of DE in responding to an incident and it s function under the emergency management system. 4. Describe how DE works in partnership throughout the disaster management cycle

3 Established in 1951 by CDC s first director of epidemiology and charged with developing and updating the Nationally Notifiable Conditions list CSTE Mission: Promote effective use of epidemiologic data to guide public health practice, develop standards for practice, and support public health surveillance and epidemiologic practice through training, capacity development, and peer consultation

4 Goals: Strengthen capacity to respond by integrating DE into the emergency management cycle Help public health and emergency management leadership understand essential role of DE Identify common set of capabilities to support collection of epidemiologic information during emergency response situations

5 The use of epidemiology to assess short- and longterm health effects of disasters and to predict consequences of future disasters Goals of DE: Prevent or reduce deaths, illnesses and injuries caused by disasters Provide timely and accurate health information for decision-makers (situational awareness & resource alloc.) Improve prevention and mitigation strategies for future disasters by gaining information for response preparation

6 Collect data on health and resource needs during a disaster & provide situational Address short- and long-term needs to prevent further morbidity and mortality Identify risk factors and improve prevention and mitigation strategies for future disasters

7 Data Challenges Absence of baseline information Denominator data difficult to obtain Limited electronic health data, lack of disaster-relatedness on medical/death records Infrastructure damage Power outages Damage to phone and cell lines Damage to internet connectivity Logistics constraints Environmental hazards Roads blocked Fuel shortages Competing priorities

8 Public Health Local/county, Tribal, State, Federal Hospitals Academic partners Industrial hygiene and safety professionals Emergency managers Responders Voluntary organizations

9 Framework describes the applications of epidemiology in disaster settings Developed in collaboration: Centers for Disease Control & Prevention (CDC)/National Center for Environmental Health (NCEH) and Council for State and Territorial Epidemiologists (CSTE)

10 Disaster Epidemiology Activities The Disaster-Management Cycle* Humanitarian Action Sustainable development Tracking Rehabilitation Recovery Response Epidemiologic studies and Registries Prevention/ Mitigation Preparedness Surveillance - Affected communities - Responders Rapid needs assessments Disaster Impact Evaluation studies - Relief programs - Other interventions Studies to compare efficacy of control strategies and interventions * The Role of Applied Epidemiology Methods in the Disaster Management Cycle, AJPH. In Press

11 DE Resource Rapid Needs Assessment Shelter Surveillance Morbidity/ Mortality Surveillance Responder Safety & Health Surveillance Example Assessment of community public health needs after massive Texas wildfire Set-up post Hurricane Sandy monitored for outbreaks, illnesses, exacerbations of chronic conditions Tracking in Moore, Oklahoma after 2013 tornados Roster and track >55,000 workers during Gulf oil spill

12 DE Resource Descriptive and Analytic Studies Evaluation and Impact Studies Registries Example Description of injuries and fatalities resulting from fertilizer plant explosion in Texas Evaluation of long-term community recovery after Hurricane Andrew Post 9/11 WTC registry created to monitor health effects of survivors

13 Community Assessment for Public Health Emergency Response (CASPER) National Center for Environmental Health (NCEH) Emergency Responder Health Monitoring and Surveillance (ERHMS) National Institute for Occupational Safety and Health (NIOSH) Assessment of Chemical Exposures (ACE) Agency for Toxic Substances and Disease Registry (ATSDR)

14 Epidemiologic technique designed to provide rapid and low cost, household-based information about community needs in a simple format for decision-makers Goals of CASPER Obtain rapid information about needs in affected communities Produce population-based estimates for decision-makers Assess new or changing needs during the recovery period b/disaster/casper.htm

15 Two-stage probability sampling 30 clusters (census blocks) 7 households per block Household-interview Data weighting to adjust for non-random sampling and obtain population estimates Report generated within two days of data collection Report shared with partners

16 A health monitoring and surveillance framework for protecting responders through all phases of a response National Response Team Technical Assistance Document

17 Pre-deployment Rostering and credentialling Assessment for fitness and ability to safely deploy Train for anticipated hazards and protective measures Deployment Approaches for centralized tracking and rostering Surveillance and monitoring for exposures and health effects Post-deployment Out-processing assessments Follow-up or long-term surveillance for delayed adverse effects

18 Training and Response developed by ATSDR Maintains toolkit for DE assessments after chemical releases Surveys Consent forms, Medical chart abstraction form Interviewer training manual Databases

19 Rapid Response Registry Survey of exposed individuals/households Medical/veterinary record review Survey of responding hospitals Industrial hygienist walk through Clinical testing GIS support/mapping Data management with Epi Info 7

20 DE response/research now widely practiced Most local and state health departments carry out some forms of DE CDC deploys field teams, upon request by state/local PH CDC support role for large incidents Universities partner with PH agencies DE training is spreading among state & local PH departments How do we better link PH practice and research at all points on the cycle?

21 ICS and Public Health Local State Federal engagement Health Departments and academia Applied public health and research Disaster epidemiology and social science research

22 How do we build on the work already being done? How do we increase coordination between PH agencies and academic institutions? How do we collaborate on response planning, implementation, analysis and communication?

23 Thank You. Questions? Michael Heumann HeumannHealth Consulting LLC, Portland, OR For the Council of State and Territorial Epidemiologists (CSTE)