Superstorm Sandy: Public Health Practice and Response, NJ

4th Annual National

CSTE Disaster Epidemiology Workshop

May 9, 2013

Outline

• Background and NJDOH Recovery Plan

• Environmental Health Task Force

• Outreach and training (environmental health issues)

• Mosquito-borne disease issues

• Surveillance activities

http://nj.gov/health/commiss/video/sandy.html

NJDOH Recovery Plan• Ensure that people and services are connected despite the

storm’s impact• Characterize environmental health issues associated with

Sandy; mitigate environmental health concerns caused by Sandy

• Restore NJ’s licensed healthcare and public health partners to normal operation

• Provide the public and DOH stakeholders with information on recovery activities and opportunities

• Identify potential mitigation opportunities to increase community resiliency

• Document disaster response and recovery costs of healthcare, public health and EMS providers in order to obtain any and all available financial assistance

Environmental Health Task Force

• In immediate weeks after storm, numerous meetings among partners redundancies, communication challenges identified

• Recognition of need to convene partners regularly – Federal: HHS (e.g., CDC/ATSDR, ASPR,

NIH/NIEHS), FEMA, OSHA, EPA– State: NJDEP, NJDOE, NJDCA, NJDCF, NJDOL,

UMDNJ-SPH– Local: health officer and environmental health

associations

Outreach and Training (1)

• Indoor environmental issues (namely mold) identified as priority

• Agencies and stakeholders had existing training opportunities information sharing among EHTF

Available at: http://nj.gov/health/ceohs/documents/mold_guidelines.pdf

Outreach and Training (2)

• Messages to local health departments– Retail food, tanning, body art

establishments– Swimming pools, natural bathing waters

• Messages to youth camp operators

• Identification of additional resources (e.g., HUD/CDBG and HHS/SSBG funding, ASPR funding)

Mosquito-Borne Disease Issues: Partners

• NJDEP Office of Mosquito Control Coordination (and county counterparts): mosquito surveillance and abatement (integrated pest management)

• NJDA: equine/camelid/veterinary surveillance

• NJDOH: human and avian surveillance• Interagency Vectorborne Disease Work

Group

Mosquito-Borne Disease Issues: Planning

• Identification of additional resources (e.g., FEMA public assistance, CDBG/SSBG funding)

• Enhancement of existing abatement, surveillance and education activities

Challenges to Surveillance in Disaster Settings

Infrastructure damage Widespread power outages Damage to phone lines

Travel challenges Roads flooded, washed away Roads blocked with downed trees and power lines Gasoline shortages and rationing

Constantly changing network of shelters

Objectives

Conduct shelter-based surveillance to track morbidity and provide daily feedback

Create and implement sustainable methods to report remotely

Methods

Each shelter, 24-hour time period

Health service visit = interaction in which medical attention provided to shelter client

Health need = injury, symptom, or chronic illness for which medical attention was sought

For each health service visit, recorded Basic demographic information (sex, age category) Disposition and referral information All health need(s) addressed

Daily reports produced and distributed

Results: Shelters Included

8 independent shelters

93 NJ shelters

26 shelters visited

70 shelters

21 shelters included

23 shelters closed

18 Red Cross shelters

5 declined participation

44 shelters excluded

Demographics of Health Service Visits

Characteristics No. (%)Sex (n=4629)

F 2384 (52)Age group, years (n=4449) 0–2 63 (1) 3–18 295 (7)

19–64 3167 (71) 65 and older 924 (21)

Categories of Health Needs Addressed (n=6825)

Category No. (%)

Acute Symptoms 3563(52

)

Follow-up Care 2257(33

)Exacerbation of Chronic Illness

756(11

)Injury 249 (4)

Most Common Health Needs (n=6825)

Syndrome No. (%)Pain 1161 (16)Respiratory/ILI 776 (11)Medication Refill 750 (11)Any Mental Health 717 (11)

Gastrointestinal Symptoms

183 (3)

Use of Data by State/Local Health Agencies

Signage, resources for public health promotion provided

Several outbreaks suspected and/or identified reported to local health departments rapid response to disease outbreaks

Mental health and medical concerns referred to various resources (e.g., county human service agency involvement, mobile pharmacy vans)

Summary

Project brought together partners for data sharing American Red Cross NJ Department of Health and local health departments Centers for Disease Control and Prevention

Timely data sharing fostered public health interventions Every disaster is different

Two Fatal Occupational Injury Two Fatal Occupational Injury Surveillance SystemsSurveillance Systems

Census of Fatal Occupational Injuries (CFOI)Purpose: count and describe fatal work-related injuriesStates funded by the U.S. Bureau of Labor Statistics

Fatality Assessment and Control Evaluation (FACE)Purposes: investigate factors involved in selected fatal work-

related injuries, make and promote recommendations for prevention

Nine states funded by the National Institute for Occupational Safety and Health (NIOSH)

Primary Sources of Primary Sources of Work-Related Fatal Injury DataWork-Related Fatal Injury Data

News mediaOSHADeath certificates/Bureau of Vital StatisticsMedical Examiners

Superstorm Sandy Superstorm Sandy Work-Related Fatal InjuriesWork-Related Fatal Injuries

Six work-related fatal injuries in New Jersey Dates of injuries range from Oct. 29 to Dec. 28All males, age range 41-69 yearsFour of six deaths among landscape/tree care/clean-

up workersTwo deaths from tree-cutting accidentsTwo deaths from being struck by motor vehicles

Syndromic Surveillance DataSyndromic Surveillance DataReal-time data from electronic health records (EHR)

to enable health departments to detect and respond to outbreaks

EpiCenter (Health Monitoring Systems, Inc.) EHR data feeds from NJ Emergency Departments75 facilities currently active in EpiCenter Limitation: several key hospitals in Ocean and

Monmouth counties not yet active

MethodsMethodsDozens of syndromes under surveillance:

Influenza-like illnessImmediately notifiable diseases (e.g., anthrax)Traumatic injuriesGastrointestinal illnessesHeat-related illness

Monitors key words in patient’s chief complaint field

On-going statistical analysis detects anomalies and triggers notifications and investigations

Definition of “Hurricane” SyndromeDefinition of “Hurricane” Syndrome

Developed in anticipation of Superstorm Sandy

Requested EDs to use “Sandy” in chief complaint field for storm-related visits

“Hurricane” syndrome includes visits in which chief complaint included:“sandy”; “storm”; "flood“; "carbon monoxide“;

"carbon dioxide“; "power outage“; or "hurricane"

Counts of Sandy-Counts of Sandy-Related ED Visits by Related ED Visits by Day and CategoryDay and Category

Data from EpiCenter Syndromic Surveillance System, Oct. 28 – Nov. 10, 2012

Daily Counts of Sandy-Related Daily Counts of Sandy-Related ED Visits by CategoryED Visits by Category

Data from EpiCenter Syndromic Surveillance System, Oct. 28 – Nov. 10, 2012

Data from EpiCenter Syndromic Surveillance System

Emergency Department UB Data for COEmergency Department UB Data for CO

Data from EpiCenter Syndromic Surveillance System and 2012 UB File , Oct. 28 – Nov. 10, 2012

Future Considerations Future Considerations Continuing use of findings to guide communication

messages and public health actionDeveloping suite of weather-related outcomes

Carbon monoxide exposure/poisoningHeat- and cold-related illnessStorm-related injuriesHealth care system impacts (e.g., oxygen needs,

dialysis, medicine refills)Identifying potentially vulnerable populations

Summary

• Post-storm period poses wide range of issues for immediate and long-term recovery

• Post-storm activities require involvement of numerous partners to optimize quality of responses

Challenges

• Many resources available; timely identification and utilization were issues

• Characterizing requests for assistance was sometimes difficult

Opportunities

• Connections among partner groups are critical to future preparedness and response efforts

• Recovery activities will inform and ideally streamline future responses to natural disasters

Acknowledgments

NJDOHAndria ApostolouMiranda ChanJoe EldridgeJerry FaglianoDenise GaronTeresa HambyGary LudwigFernando McLean, Jr.Shereen SempleFaye SorhageStella Tsai

CDCDiana BensylKris BisgardCindy ChiuTala FakhouriLauren LewisMichelle MurtiRebecca NoeSatish PillaiAmy SchnallAlice ShumateNiu TianJoanna WatsonAmy WolkinEllen Yard

American Red CrossMary Casey-LockyerNancy MeiningerTeresa SchrefflerEsther TanJo West

Questions?

Tina Tan, MD, MPHState Epidemiologist/Assistant CommissionerNJDOH Division of Epidemiology, Environmental and

Occupational Healthchristina.tan@doh.state.nj.us609-826-5967

Master Sgt. Mark C. Olsen/USAF/NJ National Guard