Injury Surveillance after Disasters

Mick Ballesteros, PhDNational Center for Injury Prevention and Control

Centers for Disease Control and PreventionAtlanta, Georgia

December 12, 2005

Disasters and Injuries

• Disaster - acute event than can cause adverse health impacts on a population and widespread destruction to the environment

• Natural or man-made• Rare events, occurrence somewhat unpredictable

• Related Injuries:• Direct

• E.g. drownings, lacerations, fractures• Indirect

• E.g. during clean-up, response/relief workers, due to infrastructure damage

Why Do Surveillance?

• Surveillance data can be used in planning, implementing, and evaluating public health programs.

• Response (this disaster) versus research (the next disaster)?

Response

• Understanding needs and matching resources (personnel and supplies)

• Identifying of emerging hazards• Preventing of secondary health effects• Stopping rumors and focusing attention on real

health problems

Research

• Lessons for future disasters• Provisions for future medical care (volume and

types of injuries)• Risk factors (population characteristics and

circumstance information)

• IRB?

Core Data Elements?

• Demographics• Facility Information• Method of Arrival• Disposition• Patient Symptoms

• Description of injury event

• Intent of Injury• Mechanism of Injury• Nature of Injury• Body Region

Surveillance in Thailand after the Tsunami

• 22 health outcome categories, 19 infectious disease-related• Poor injury indicators

• (1) drown, (2) injury, (3) bite (insect or animal)

Post Hurricane Katrina Injury Surveillance

• Surveillance activities in:• Louisiana• Mississippi• Texas

Post Hurricane Katrina Injury Surveillance Data Example, New Orleans

Daily Averages, 10/4 10/10/2005 Number Percent

MVA 29 10.0%

Blunt Trauma 35 11.9%

Cut/Pierce 67 22.8%

Fall 64 21.7%

Bite/Sting 20 6.7%

Fire/Burn 5 1.6%

Intentional Injury 6 2.2%

Electrical Exposure 1 0.2%

Other Classifiable 47 15.9%

Not Classifiable 21 7.0%

Total 295 100.0%

General Surveillance at Shelters

• On 9-2-05, 27,100 evacuees were in 4 large shelters in Houston, 3 in Reliant Park

• 10,000 visits to Medical Clinics• 13,300 medication dispensed, injuries not an issue

Post Hurricane Rita Data Report Preliminary Numbers and Percentages of Patients Seen by Selected Common

Chief Complaints, Jefferson and Orange Counties, Texas, 2005

10/6/05 9/24 – 10/6/05

Number % Number %

Injuries 147 31.8 1184 25.5

Bites (Insects) 15 3.3 167 3.6

Motor Vehicle Crash 14 3.0 81 1.7

Carbon Monoxide Poisoning 6 1.3 43 0.9

Bites (Non-insects) 1 0.2 44 1.0

Medication Refills 23 5.0 395 8.5

Skin Complaints 33 7.1 336 7.2

Heat/Dehydration 4 0.9 178 3.8

GI Complaints 21 4.6 146 3.1

Mental Health 4 0.9 71 1.5

Challenges

• Timeliness versus Accuracy• Absence of baseline and denominator data• Logistical constraints