Federal Epidemiology Response to Hurricane Sandy Amy Wolkin, MSPH Disaster Epidemiology and Response Team Health Studies Branch National Center for Environmental Health Centers for Disease Control and Prevention Good morning. National Center for Environmental Health Division of Environmental Hazards and Health Effects

Federal Response 3

Disaster Epidemiology Activities Rapid Needs Assessment NYC assess mental health impact Modified CASPER sampling strategy Surveillance Future studies with Supplemental Sandy funds

Disaster Epidemiology Activities Rapid Needs Assessment NYC assess mental health impact Modified CASPER sampling strategy Surveillance Future studies with Supplemental Sandy funds

Surveillance Challenges to Surveillance in Disaster Settings Sources 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 Sources American Red Cross Morbidity Surveillance American Red Cross Mortality Surveillance

American Red Cross Shelter Surveillance Since 1987 CDC has collaborated with Red Cross on disaster health surveillance MOU to advance coordination of post disaster surveillance activities Data on disaster-related fatalities collected during condolence visits by Red Cross volunteers Data collected from shelters with medical stations using client health data transmitted to CDC, analyzed at CDC, and reported back to Red Cross and partners

Shelter Surveillance- New Jersey Red Cross volunteers in NJ overwhelmed; requested assistance from CDC to collect shelter surveillance data CDC collaborated with NJ DOH to collect shelter data and implement a sustainable method for remote reporting Field team focused on largest shelters, those expecting to remain open the longest and those with Red Cross Health Services (21 of 93 NJ shelters) Data sent daily to CDC; data was aggregated and summarized in daily report

Shelter Surveillance- New Jersey Aggregate, syndromic data Captured health needs: acute, follow-up, exacerbation of chronic condition, injury About 50% presented with acute symptoms; 33% follow-up care Data collection more complete and timely with deployed staff; once established, process continued with smart phones Based on recommendations, simplified surveillance form and created additional training materials Alice Shumate will present results at conference – Wednesday 10:30 Environmental Health Session

Shelter Surveillance- New York NY data collected via Red Cross volunteers (CDC not deployed to assist) Surveillance in Red Cross shelters, NY shelters (after 2 first 2 weeks) Surveillance with outreach services Includes household visits, hotline calls, distribution centers, hotel visits Outreach teams targeted multiple geographic areas Most common reason for visits were follow-up care, mental health and exacerbation of chronic conditions

EOC Surveillance Reports Collate data from various surveillance sources Create comprehensive national picture Difficult because of varied data collection methods

Red Cross Mortality Surveillance Red Cross tracks disaster-related deaths to provide condolence services to surviving family members Actively search for reports of deaths (e.g., funeral home directors, FEMA, hospitals, media) Red Cross Condolence Teams (health services, disaster mental health, spiritual care) complete Mortality Forms Captured demographics, circumstance of death, categorized as direct/indirect, location of injury/death

Deaths Associated with Hurricane Sandy Red Cross surveillance captured 117 deaths in 6 states up to Nov. 30, 2012 57% directly-related (34% drowning, 16% trauma) 32% indirectly-related (e.g., CO poisoning, fall)

Deaths Associated with Hurricane Sandy- Findings Despite advances in hurricane warning and evacuation system, drowning remains leading cause of hurricane-related deaths (1/3 of deaths) Over half of drowning deaths occurred in decedent's home Majority of homes were located in NYC evacuation zone that flooded Hurricane response plans should ensure persons receive and comprehend evacuation messages and have necessary resources to comply with them

Future studies with Supplemental Sandy funds Characterization of morbidity and mortality among populations impacted by Sandy FOA to provide research in priority areas to aid recovery from the public health impact of Sandy Characterize outcomes, mental health impact, risk factors Study with Poison Centers to investigate CO exposures Survey CO exposures to understand circumstance of exposure Determine risk factor and prevention strategies Mortality surveillance evaluation Compare death certificates, Red Cross data, and media reports Determine accuracy of media reports for use as timely data

Questions? Contact information Amy Wolkin ajf9@cdc.gov 770-488-3402 The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention