1. Injury Surveillance after Disasters Mick Ballesteros, PhD National Center for Injury Prevention and Control Centers for Disease Control and Prevention Atlanta, Georgia December 12, 2005

2. 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

3. Why Do Surveillance? Surveillance data can be used in planning, implementing, and evaluating public health programs. Response (this disaster) versus research (the next disaster)?

4. 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

5. Research Lessons for future disasters Provisions for future medical care (volume and types of injuries) Risk factors (population characteristics and circumstance information) IRB?

6. 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

7. 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)

8. Post Hurricane Katrina Injury Surveillance Surveillance activities in: Louisiana Mississippi Texas

9. Post Hurricane Katrina Injury Surveillance Data Example, New Orleans Daily Averages, 10/4  10/10/2005 NumberPercent MVA2910.0% Blunt Trauma3511.9% Cut/Pierce6722.8% Fall6421.7% Bite/Sting206.7% Fire/Burn51.6% Intentional Injury62.2% Electrical Exposure10.2% Other Classifiable4715.9% Not Classifiable217.0% Total295100.0%

10. 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

11. Post Hurricane Rita Data Report Preliminary Numbers and Percentages of Patients Seen by Selected Common Chief Complaints, Jefferson and Orange Counties, Texas, 2005 10/6/059/24 – 10/6/05 Number% % Injuries14731.8118425.5 Bites (Insects)153.31673.6 Motor Vehicle Crash143.0811.7 Carbon Monoxide Poisoning61.3430.9 Bites (Non-insects)10.2441.0 Medication Refills235.03958.5 Skin Complaints337.13367.2 Heat/Dehydration40.91783.8 GI Complaints214.61463.1 Mental Health40.9711.5

13. Challenges Timeliness versus Accuracy Absence of baseline and denominator data Logistical constraints