Enhanced Informatics Response to Disasters through Collaboration of Public Health Response Teams

1. Enhanced Informatics Response to Disasters through Collaboration of Public Health Response Teams 

2. Overview Disaster Surveillance Exercise / Training Evaluation of surveillance tool Multi-state /Multi-agency collaboration Recommendations

3. Importance of Active Surveillance During a Disaster Complement to regular reporting mechanisms Rapidly detect outbreaks and define health problems Identify groups at risks for adverse health events Determine needs of special populations

4. Importance of Active Surveillance During a Disaster (2) Optimize the relief response Monitor the effectiveness of the relief effort Respond to public concerns and media inquiries Facilitate planning for future disasters

5. Use of Informatics in Disasters Real-time and accurate epidemiologic data is critical to decision making Delivery of appropriate public health services during emergency events such as disease outbreaks or disasters is essential. Agencies must receive data from the field quickly and have the ability to compare results across jurisdictions when multiple states are affected.

6. Validating systems A field-tested, electronic standardized system of data collection is essential for early event detection, emergency response, and public health decision making. With the rapid advancement of informatics capabilities, it is essential to systematically validate the methods that are most effective.

7. Project Objective Evaluate the usefulness and acceptance of GIS/GPS equipped handheld computers for disaster surveillance through the collaboration of public health teams.

8. Collaboration Two agencies CDC Association of State and Territorial Directors of Nursing (ASTDN) Three states Georgia Tennessee Kentucky Three disciplines Nurses Epidemiologists Environmental Health Specialists

9. Equipment Equipment purchased using funds provided by CDC�s Coordinating Office for Terrorism Preparedness and Emergency Response. Laptop computers: Six Dell Precision M6300 notebooks Each state received two laptops. Software: ESRI ArcView software Arc GIS GeoAge Field Adapted Survey Toolkit (FAST) SAS 9.1 Microsoft Office Pro Handheld Devices: Thirty-one Trimble Geocollector submeters ArcPad and Trimble GPS correct for ArcPad

10. Training / Exercise Three-day comprehensive training & exercise 2 days of Geographic Information System (GIS) � day of handheld computer training Global Positioning System (GPS) FAST (GeoAge) software to create a data-collection form Natural Disaster Morbidity Report Form template � day of tornado disaster exercise collected, imported, analyzed, & mapped data.

11. Exercise Scenario Setting: Twisterville The area has been under a tornado watch since 1:15 p.m. Since that time, a large storm system moving through this portion of the state has begun moving in a direction that is taking over portions of Tornado county, including Twisterville.

13. On-scene police units report limited access into the damaged area due to large pieces of debris and nails littering the streets.

14. Local and State health officials have been asked to assist with setting up active surveillance at designated shelters which have been set up for tornado victims.

15. You have been assigned to work at one of three shelters. You will be interviewing patients for active surveillance Enter data from the interview using the handheld Trimble computer and the form that was Developed in training.

16. Natural Disaster Morbidity Report Form 12 injury trauma conditions with detailed etiology 19 illness disease syndromes 5 chronic disease conditions 5 mental health conditions Routine/Follow-up care Obstetrics/Gynecology Severity and disposition 12 injury trauma conditions with detailed etiology 19 illness disease syndromes 5 chronic disease conditions 5 mental health conditions Routine/Follow-up care Obstetrics/Gynecology Severity and disposition

17. Patient Scenario

18. Handheld Computer

19. Evaluation Methods Evaluation of overall project a paper questionnaire four epidemiologists and three nursing supervisors in the three states Evaluation of the GIS and GPS training and exercise Evaluation of GIS/GPS training and exercise consisted of four questionnaires which were administered to training attendees in each state: 1) Pre-Training: GIS 2) Post-Training: GIS 3) Pre-Training: GPS 4) Post-Training: GPS and Exercise Attendees in Georgia and Kentucky responded to the questionnaires via an online survey, while those in Tennessee filled out paper questionnaires. Responses for all attendees were combined and entered in Excel Quality control assessment to examine accuracy of the data entered by participants during the exercise

20. Evaluation Results 7 coordinators felt that the project enhanced the capability of their state to facilitate emergency response activities & improved collaboration. 78 participants for the training/exercise Participants were enthusiastic about conducting this type of exercise, gave positive feedback for use of this technology and felt it would facilitate collaboration and enhance state capability to respond to disasters. Quality control assessment showed accuracy in all three states.

21. What Worked? Patient cards � easy to distribute controlled test data for quantitative, retrospective analysis of the validity of the exercise Pre-assigning teams for the exercise based on roles Interactive exercises of both GIS and FAST/GPS PDA� enjoyed by the trainees Allowing trainees to upload data from the handheld devices into the computer (TN and KY) � to see the ease of data transfer Demonstration of the form used in the exercise with the Trimble PDA emulator on screen

22. What didn�t work? Format of patient scenario data was difficult to work with. GIS training was thought to be too compressed by most of the trainees Many people were frustrated with capturing GPS coordinates. Trimble unit screens were hard to read small screen glare from the sun Participants were confused about applicability to their jurisdiction given that there was a limited amount of hardware and software that was granted through the project funds Participants needed more detailed explanation of did not adequately grasp the Natural Disaster Morbidity Report Form & found many gaps and limitations

23. What should we do differently in the future & why? Task participants to bring a form often used in the field which they can use to build a FAST survey Allow an extra day for the full GIS training � the training was too rushed and complicated for most; 3 days is the original length of the GIS training Provide GIS training tailored specifically to public health � relevance for public health audience Demonstrate using data gathered in FAST in other analytical software, say with a pre-fabricated SAS program � to demonstrate usefulness of application and technology Integrate other technologies already in use in the public health arena (i.e., software � OMS, hardware � barcode readers, etc.) to further enrich training

24. Recommendations Implement GIS/GPS equipped handheld computers can expand collaboration among public health officials within states, between states, and with federal partners. Enhance the capacity of state and local health departments to meet public health preparedness goals and capture data in a more rapid format. Train staff and practice using equipment on a regular basis

25. Acknowledgements Douglas Thoroughman � CDC/COTPER (Kentucky) Araceli Rey � CDC/NCPHI David Kim � CDC/COTPER (Georgia) John Dunn - Tennessee Pat Drehobl � CDC/OWCD Beth Stover � CDC/OWCD Linda Karr � ASTDN Carl Kinkade � CDC/NCPHI Meeyong Park � CDC/NCPHI

26. QUESTIONS????