Beneficial Practices for Improving Biosurveillance

1. Beneficial Practices for Improving Biosurveillance Natural Disasters March 25, 2014

2. Webinar Series Hosts Edward L. Baker, MD, MPHDirector, North Carolina Preparedness and Emergency Response Research CenterResearch Professor, Health Policy and Management, University of North Carolina at Chapel Hill

3. Webinar Series Hosts Perry F. Smith, MDResearch Professor, Epidemiology, State University of New York at AlbanyFormer New York State Epidemiologist

4. NCPERRC Research on Biosurveillance • 2013 research project with Public Health Informatics Institute to: • Identify guiding principles and best practices • Provide recommendations for biosurveillance system improvement

5. What did we learn? Information systems used during event should be used every day Relationships leading to data sharing should be nurtured well in advance of event Continued investment in systems and staff needed to assure that systems are prepared

6. Translating Research into Practice Series of 4 webinars presented by: North Carolina Preparedness and Emergency Response Research Center (NCPERRC) at UNC-Chapel Hill Supported by Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response

7. Focus of Our Research -Improving Biosurveillance During Public Health Emergencies: Mass Gatherings Natural Disasters Outbreaks

8. NCPERRC Webinar Series: Improving Biosurveillance Systems • Educate public health practitioners regarding: • Information and information systems needed to manage event • Investments needed to assure systems are ready for next event • Focus on PHPR Capability #13- Public Health Surveillance and Epidemiologic Investigation

9. Summary of Boston Marathon Case Study • What best practices were seen? • What guiding principles does the case exemplify?

10. Today’s Webinar Agenda • Natural Disaster Case Study with Guests from New York City • Information Needs and Systems for Situational Awareness during Natural Disasters • Your Questions • Use question box to enter questions • Where to Find Additional Information

11. Today’s Case Study –Natural Disasters Superstorm Sandy, 2012

12. Audience Poll As a public health worker, have you had experience responding to a natural disaster, and if so, what type(s) of disasters? (choose one) • Hurricanes, Floods • Tornadoes, Earthquakes • Winter Storms • Forest Fires • Multiple Types or Other Types • Not responded to natural disasters

13. Today’s guests From the New York City Department of Health and Mental Hygiene Tom Matte MD, MPH Assistant Commissioner for Environmental Surveillance and Policy Mitch Stripling Director, Emergency Planning Unit

14. Superstorm Sandy • Category 3 Hurricane • 72 fatalities in 8 states • 43 in NYC • 80 mph winds • Third costliest hurricane in US history

15. Superstorm Sandy What information was needed by public health? How did you provide that information? What had you done in advance to build your information systems to meet these needs?

16. NYC Sandy impacts and hazards • Record storm surge, wind-downed trees and power lines, drowning and injury risk • Congregate sheltering • Health care facility evacuation • Disruption of health care access and transportation

17. NYC Sandy impacts and hazards • Sheltering in place in buildings without power or heat and without elevators and running water in high rise buildings • Potential respiratory hazards: supplemental heat, power, flood damage cleanup, demolition, debris movement • Exposure to floodwater • Stress

18. Public Health Operations:Surveillance, Response, Recovery Syndromic surveillance Healthcare Evacuations, Repatriation, and Patient Tracking Shelter Operations and Surveillance Door-to-Door Canvassing and surveys

19. Public Health Operations:Surveillance, Response, Recovery Availability of Primary Care Services N95 Respirator Distribution Ambient air quality monitoring and coordination

20. Public Health Operations:Surveillance, Response, Recovery Mortality surveillance Community Outreach & Public Information Resume routine surveillance and services

21. Syndromic Surveillance: Immediate Response Keep routine system running Receipt of data, staffing Hurricane specific Syndromes developed during Irene Look for visits outside pre-defined syndromes Increased emphasis on system usage Respond to ICS system

22. Syndromic SurveillanceEmergency Response Syndromes of interest • Healthcare Needs • Medications • Dialysis • Oxygen • Mental Health • Stress (including PTSD) • Anxiety • Psychotic • Psych evaluation • Suicide

23. Syndromic SurveillanceEmergency Response • Alcohol and Drug • Methadone and withdrawal • Exposures • Cold stress • Carbon Monoxide • Respiratory irritants

24. Syndromic SurveillanceEmergency Response Defining “Impacted areas” • Inundation areas • Population displacement • Power system outage • Destruction • Condemnation • Conversion to zip codes

25. Syndromes Related to Health Care Needs

26. Syndromes Related to Respiratory Illness

27. Public Information Hypothermia Increases “Carbon Monoxide Poisoning Cases Soar in City After Hurricane”

28. Challenges and lessons learned • Need to quickly define impact areas and populations, which may change over time • Need to continually develop and improve syndrome definitions

29. Challenges and lessons learned • Hospital closures, other healthcare disruption and population displacement can impact health and complicate syndromic data interpretation • Defining ‘baseline’ and ‘expected’ • What findings are actionable and how to communicate them

30. Rebuilding and Improving Resiliency Special Initiative for Rebuilding and Resiliency Syndromic Data Power and System Outages Vulnerable Population Outreach Ongoing Research

31. Implications for Action • What should others do to prepare for hurricanes?

32. Audience Poll How prepared is your jurisdiction to monitor information for situational awareness during an unexpected natural disaster? • Very prepared • Moderately prepared • Somewhat unprepared • Very unprepared

33. Ask the Experts Use chat box to enter question We will recognize audience members and direct questions to panel

34. Key Points • Core information needs • Health Status • Health Risks and Hazards • Health Services

35. Key Points • Core information sources • Emergency department activity • Notifiable disease • Lab reporting • Health system information

36. Summary of Superstorm Sandy Case Study • What best practices were seen? • What guiding principles does the case exemplify?

37. Post-webinar resources • Knowledge Repository • Contributions from panelists • Archived webinar and slides • Online resources • Public Health Informatics Institute course • Talk about it – Facebook and Twitter login • Research report and more

38. Post-webinar resources Knowledge Repository biosurveillance.weebly.com

39. Post-webinar resources Public Health Informatics Institute www.phii.org

40. Upcoming Webinars • April 24, 2-3:30pm EST • Outbreaks - Seasonal Flu • Lessons learned from Marion County, IN • June 5, 2-3:30pm EST • Prioritizing your biosurveillance enhancements • Insights from national experts • Dr. Chesley Richards, CDC Deputy Director

41. Conclusion Thanks to guests Thanks to CDC for support Thanks to audience And lastly… please complete the post-webinar evaluation! Contact us at NCPERRC@email.unc.edu