David Sugerman, MD MPH FACEPHealth Systems Team Lead
Division of Unintentional Injury Prevention
CSTE WorkgroupMay 9, 2013
Improving Post-disaster Injury Morbidity and Mortality
Surveillance
National Center for Injury Prevention and Control
Division of Unintentional Injury Prevention
Background
“Deaths associated with natural disasters, particularly rapid-onset disasters, are overwhelmingly due to blunt trauma, crush-related injuries, or drowning. Deaths from communicable diseases after natural disasters are less common.”
Watson JT, Gayer M, Connolly MA. Epidemics after natural disasters. Emerg Infect Dis. Jan, 2007
Background Provision of emergency trauma care is the
immediate need following a disaster Search and rescue Triage Emergency medicine care and surgery
High injury events Earthquakes/Tornados (crush syndrome, traumatic
amputations, fractures) Floods (drownings) Tsunamis/Hurricanes (mixed events)
Current Surveillance Systems for PH Emergencies
Death certificate-based databases County/state hospital discharge databases National discharge databases (HCUP,
NHAMCS) ED-based syndromic surveillance (ID
focused) Biosense ESSENCE SendSS (State Electronic Notifiable Disease Surveillance
System) Poison control center based databases for
toxic chemical and nuclear exposures NPDS (National Poison Data System) Toxic Exposure Surveillance System (TESS)
State Trauma Registries
Active Case Finding Retrospective
Hospital chart review Hospital EHR review
State/local Hospital Associations (de-identified counts) Ideal if injuries made notifiable by HD
Finding Population Controls Reflect background exposure frequency Sampling options
Community cluster sample Shelter lists
• American Red Cross (ARC) Individual assistance lists
• FEMA / ARC Random digit dialing Friend / Associate/ Relatives
• Respondent driven sampling (RDS)
FEMA Individual Assistance List
FEMA Individual Assistance List
Map of Hospitals Contacted
Declined (n=7)
Participated (n=39)
Recruitment of Cases for Survey
Patient data abstracted from hospital charts 14 hospitals 408 case contacts
Invitation letter sent by hospital 4 hospitals 4 case contacts
Declined patient contact 21 hospitals
Neighborhood Controls
Field Limitations
Phone interviews Ensure mental health referral services
Landline limitations• Cell phone only homes (25-50%)• Unlisted numbers (young women > others)• Home destroyed without call forwarding
Responder bias
Injury Center Work in Post-earthquake Haiti
Haiti National Sentinel Site Surveillance System Collaboration with NCEH/HSB and CGH/DGDDER on
injury 51 sites selected from 99 PEPFAR facilities January 25-April 24, 2010 5,065 injuries (12% total)
University of Miami / Project Medishare Field Hospital Data sharing agreement Paper records abstracted 6 months after earthquake January 13- May 28,2010 1,369 admissions / 581 injuries (162 earthquake related)
Centers for Disease Control and Prevention (CDC). Launching a National Surveillance System after an earthquake --- Haiti, 2010. MMWR Morb Mortal Wkly Rep. 2010 Aug 6;59(30):933-8. Erratum in: MMWR Morb Mortal Wkly Rep. 2010 Aug 13;59(31):993
Centers for Disease Control and Prevention (CDC). Post-earthquake injuries treated at a field hospital --- Haiti, 2010. MMWR Morb Mortal Wkly Rep. 2011 Jan 7;59(51):1673-7.
NSSS and Medishare Field Hospital
Nature of injury and treatment
National Sentinel Site Surveillance (1/25-4/24/2010)
Project Medishare Field Hospital(1/13-5/28/2010)
51 sites 1 site
Fracture(s) 467 227
Concussion 27 -----
Laceration from weapon
111 30
Amputation 14 45
Burns 149 25
Wounds (infected) 3,061 169
Crush injury syndrome
88 50
Surgical procedures ------- 413
Final disposition ------- 581
Total 5,065 581
Surgical Response Evaluation —Handicap International / DFID
Background / Methods 274 organizations provided healthcare, ?# provided
surgical care Qualitative (patient interviews) Quantitative (8 surgical providers contacted, 4
participated) Results
Amputation rates (1% to 45%) Lowest among orthopedic and plastic surgery combined
teams Primary treatment for complex severe wounds and
fractures in salvageable limb Secondary treatment for infected wounds and compart.
syndrome Many Guillotine amputations that required complex
repair
Knowlton LM, Gosney JE, Chackungal, et al. Consensus statements regarding the multidisciplinary care of limb amputation patients in Disasters. Prehosp and Dis Med. Dec 2011.
For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Thank you
National Center for Injury Prevention and Control
Place Descriptor Here
David [email protected]
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