Disaster Preparedness: Participation of Public Health Departments in Epidemiologic Data Collection

1. Disaster Preparedness: Participation of Public Health Departments in Epidemiologic Data Collection Los Angeles County Department of Public Health Bureau of Toxicology and Environmental Assessment Toxics Epidemiology Program

2. Background • Evaluation of subjects, gathering samples, and recording of data is a serial process • Any step can be rate-limiting • Public health agencies must maximize efficiency of data collection during disasters • Little evidence comparing efficiency and utility of data collection tools in a disaster

3. Incident: Marble Challenge • Improvised nuclear device in Indianapolis, IN • Expectation of fear and panic among the public • Projection of people fleeing the area, without notice

4. Background

5. Incident: Marble Challenge • People may flee to multiple locations • Some fleers may be more determined than others • Look for immediate means of transportation • Get as far away from incident as possible

6. Incident: Marble Challenge • “Load up the truck and move to…”

7. Incident: Marble Challenge • Barstow

8. Incident: Marble Challenge

9. Incident: Marble Challenge • Radiation portal monitors used for passive screening of cars entering California at Barstow • Public Health screening of occupants of “hot” cars

10. Incident: Marble Challenge • LA County DPH assisted CDC in processing victims • CDC sent spiked urine samples and devised an array of victims’ symptoms • 3 survey tools were designed, to collect health information and to prioritize

11. Incident: Marble Challenge

12. Incident: Marble Challenge • Paper/handwritten format • Handheld/PDA • Laptop • Each victim was evaluated through all 3 health screens and asked to note preferred format • Data collectors rotated, using all 3 health screens, and asked to note preferred format

13. Incident: Marble Challenge • Completion of epidemiologic screening • Urine sample prioritizations with data transfers to laboratories • Sr-90 and uranium spiked urine samples sent to LA County DPH, CA DPH, and CDC labs

14. Incident: Marble Challenge • All 3 methods were equally accurate (>90% for each format) and able to identify high priority samples • Collector preferences: • 57% laptop, 43% handheld, 0% paper • Victim preferences: • 21% laptop, 29% handheld, 21% paper

15. Incident: Marble Challenge

16. Conclusion: Data Collection • All methods were effective • Electronic methods were preferred overall for the collection of epidemiologic and laboratory sampling data

17. Questions Raised • How do we optimize local IDs/other logistics? • How do we format data for transfer to other agencies? • How can we best coordinate victim tracking, for medical management, sampling, and other triage issues?

18. Potential Benefits of Electronic Data Collection • Immediate compilation of results • Potential to ask more questions in less time • Elimination of data re-entry • Rapid transmission of results • Rapid statistical analysis • Linkage of data sets, GIS mapping • “Red-flag” detection