1. The Use of Epidemiologic Methods in Disasters Eric K. Noji, M.D., M.P.H Office of the US Surgeon General US Public Health Service August, 2003

2. Noji Eric K., M. D., M. P. H. Office of the US Surgeon General US Public Health Service

3. Learning objectives: Define disaster epidemiology Give historical overview of disaster epidemiology Discuss applications of epidemiological methods to disasters (before, during, and after the events) Learn about challenges and problems facing epidemiologists following a disaster

4. Epidemiology and its applications in measuring the effects of disasters EpidemiologyEpidemiology -The quantitative study of the distribution and determinants of health related events in human populations

5. Epidemiology and its applications in measuring the effects of disasters Disaster Epidemiology- Disaster Epidemiology- The use of epidemiology in disaster situations. Epidemiologic methods can be used to measure and describe the adverse effects of natural and human-caused disasters. September 11, 2001, New York Earthquake in Armenia 1980’s

7. Types of Studies in Disaster Epidemiology Surveillance Public health impact evaluationimpact evaluation Natural history evaluation Analytic studies of risk factors Clinical investigation Population based study Studies of psychological effects of disasters

8. Historical Developments of Disaster Epidemiology 1950-early review of the role of epidemiology during disasters (Saylor and Gordon) Late 1960’s –Civil War in Nigeria-practical application of epidemiology in disaster management Nigeria Civil War refugees

9. Historical Developments of Disaster Epidemiology (continued) Early 1970- Establishment of the Centre for Research on the Epidemiology of Disasters 1976 – Earthquake in Guatemala-important epidemiologic studies 1980 –Eruption of Mt. St. Helens –major milestone in shaping government’s response to disasters Railroad destroyed by earthquake in Guatemala Eruption on Mt. St. Helens

10. Application of Epidemiologic Methods to Disasters Before a Disaster Hazard Analyses-collecting and assessing data on the nature, causes, frequency, distribution, and effects of past events in order to make predictions about future events Vulnerability Analysis- analysis of a population’s risk when a hazard of a given magnitude occurs

11. Application of Epidemiologic Methods to Disasters During a Disaster Damage assessment Information collection Public Health surveillance

12. Application of Epidemiologic Methods to Disasters After a Disaster Utilization of cross-sectional survey methods to study the frequency of deaths, illnesses, injuries and other adverse health effects a disaster Analytic epi. studies (case-control, cohort) to identify risk factors for death and injury to develop evidence-based prevention strategies

13. Challenges and Problems Facing Epidemiologists Following a Disaster Political environment Changing social conditions and demographics Difficulty in applying standard epidemiologic techniques in the context of great destruction Lack of time for organizing epidemiologic investigation Absence of well defined population counts Lack of active collaboration between scientists from different disciplines

14. Critical Knowledge Gaps and Research Priorities in Disaster Epidemiology Steps that can make the results of disaster epidemiology more precise: -Development of standardized protocols for gathering information -Standardization of disaster terminology, technologies, methods and procedures -Conduction of more extensive evaluation studies -Making greater use of existing disaster information systems

15. Conclusions Epidemiology can provide much needed information on which a rational, effective, and flexible policy for the management of disasters is based. In particular, epidemiology provides the tools for rapid and effective problem solving during public health emergencies such as natural and technological disasters

16. References References Allegra, D.T., P. Nieburg, M. Grabe M, Eds. (1983) Emergency refugee health care -- a chronicle of the Khmer refugee assistance operation. Centers for Disease Control, Atlanta. Autier, P., M. Ferir, A. Hairapetien, et al. (1990) Drug supply in the aftermath of the 1988 Armenian earthquake. Lancet 335, 1388-90. Boss, L., M.J. Toole, R. Yip. (1994) Assessments of mortality, morbidity, and nutritional status in Somalia during the 1991- 1992 famine: recommendations for standardization of methods. JAMA 272,371-376. Buist, A.S. and R.S. Bernstein (1986) Health effects of volcanoes: An approach to evaluating the health effects of an environmental hazard. Am J Public Health 76(Suppl), 1-90.