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: cdcinfo@cdc.gov 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 Sugermanggi4@cdc.gov