1. 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

3. Federal Response 3

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

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

6. 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

7. 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

8. 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

9. 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

10. 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

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

12. 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

13. 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)

14. 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

15. 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

16. Questions?
Contact information
Amy Wolkin
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