1. Severe Weather Event Public Health Response: Kentucky’s Experience CAPT (USPHS) Doug Thoroughman, PhD, MS CDC Career Epidemiology Field Officer Kentucky Department for Public Health

2. Ice Storm Impact on Kentucky Jan 26, 2009 Ice storm moves across state Leaves nearly 800,000 without power Worst natural disaster in Kentucky’s history 36 Storm Related Deaths 101 counties declared state of emergency

5. Statewide Impact

6. Tornado Impact on Kentucky March 2, 2012 severe weather event moves across state 15 tornados spawned –1 tracked 86 miles –Even affected “hollers” 22 Tornado related deaths 650 Homes destroyed (1600 more damaged) Two communities destroyed

7. Background 7

8. West Liberty, KY 8

9. 9

10. Disaster Data Collection Shelter surveillance –Environmental –Infectious disease CASPER Rapid Needs Assessments Carbon Monoxide Poisoning Surveillance Tornado Injury Surveillance Mortality surveillance 10

11. CASPER Community Assessment for Public Health Emergency Response Epidemiologic technique to provide household-based information about an affected community’s needs after a disaster. — Identify needs — Prioritize responses — Plan for distribution of resources Based on WHO-EPI method

12. When to Conduct a CASPER Effect of disaster on population is unknown Health status and basic needs are unknown Concerns about specific groups or individuals (e.g. older adults, children, pregnant women) Response and recovery efforts evaluation Information needed for planning

13. Multi-stage Cluster Sampling  Define sampling frame (population of concern)  Political boundaries  Geographic boundaries  Subpopulation of affected area  30 clusters/region  census block  probability proportional to estimated number of housing units  7 households/cluster  Data weighted to:  account for incomplete sampling  provide population estimates of data collected

14. CASPER in Kentucky 2 Emergency Response Uses –2009 Ice Storm –2012 Tornado Response 1 Health Impact Assessment 2 Preparedness/Functional Needs Assessments –USPHS Response Team Training Missions –National Level Exercise: Western KY –Training Mission in Eastern KY Strategic Plan – non-disaster CASPER use to increase PH Preparedness

15. CO Poisonings By Day

16. Sources of CO Poisoning Deaths (%) HBOT’s (%) KRPC Incidents (% of incidents) Generator8 (80%)16 (57%)20 (31%) Kerosene heater 1 (4%)29 (45%) Propane heater1 (10%)11 (17%) Propane cooking device 5 (18%) Indoor charcoal use 1 (10%)5 (18%) Vehicle running in garage 1 (4%)

17. Tornado Injury Surveillance Night of March 2 nd adapted CDC Mortality Surveillance Form Revised, vetted and distributed before noon March 3 rd Tasked regional Epi’s with data collection Hospital ICP’s, LHD Epi’s submitted reports daily 17

18. Surveillance Findings 18 Table 1. Submitted injury surveillance forms 3/23/33/43/53/63/73/8 Total FSaSuMTWTh Type of Facility Long-Term Care Facilities03014124222120 (59) Hospitals313329912372 (35) Shelters/Other Facilities001721011 (6) Total3 (1)43 (21)5 (2)77 (38)35 (17)15 (7)25 (12)203

19. Surveillance Findings 19 Table 2. Frequencies of storm-related injuries by severity 3/23/33/43/53/63/73/8Total FSaSuMTWTh Injury Severity Minor26561211002107 Serious2273200034 Life Threatening1101000012 Total31921813022158