CSTE Shelter Surveillance WorkgroupAlicia Lepp
Epidemiologist
North Dakota Department of Health
Workgroup History2014 Annual Disaster Epidemiology Workshop
First call on November 20, 2014
Meet on a monthly basis
Goal to create a shelter surveillance guidance document
Goals and ObjectivesDefining shelter surveillance and other terms
Identifying existing resources
Reaching out to partners
Creating guide for shelter surveillance
Identifying training resources and gaps
Making the case for shelter surveillance as an important part of disaster response
DefinitionsShelter : Communities must plan for the eventuality that some residents will lack the means or opportunity to find their own temporary accommodations in a disaster. To meet this need, communities open emergency shelters. Not only do emergency shelters provide immediate refuge from a threatened or actual incident, but may also provide food, water, and access to community services.
Shelter resident: Red Cross definition is head on the bed at midnight
Issues of public health concern: Population monitoring, environmental health and safety assessment, and accessibility for populations with special needs.
Outline of Guidance Document Introduction
Operations and Logistics Considerations
How to Gather Data
How to Get Data to Appropriate People
How to Analyze and Interpret the Data
How to Communicate Results
IntroductionPurpose
Audience
Definitions
Operations and Logistics ConsiderationsOperational, safety, and resource challenges
Emergency Service Functions
Mechanisms to request assistance
How to Gather DataReadiness
Conduct readiness activities on a routine basis before a disaster to build relationships with partners and establish collaborations
Partners to Engage
Recognize partners to engage with
Identify groups that can help fill human resource needs
Starting and Stopping Data
Conduct surveillance on shelters that are open for at least 3 days
Initiate surveillance within 24 hours of activation
How to Gather Data, cont. Process in the Shelter
Who implements surveillanceC-MIST model
CommunicationMaintaining HealthIndependenceSafety, Support, and Self DeterminationTransportation
Data CollectionWhen and how often to collect dataFactors that influence timing of data collection
Types of Data Collection
Aggregate Morbidity Report Form
Provides information on demographics
Tally section record CMIST groups
Natural Disaster Morbidity Surveillance Individual Form
Individual level data
Visits to first aid or medical unit
Large number of medical conditions
Natural Disaster Morbidity Surveillance Line ListAbbreviated version of individual form
Summary information
Natural Disaster Morbidity Surveillance Tally Sheet
Similar to American Red Cross
Summary level data
Natural Disaster Morbidity Surveillance Summary Report
Aggregate Data
Reporting Purposes
Situational Awareness
Environmental Health Shelter Assessment
Aggregate Data
Reporting Purposes
Situational Awareness
How to Gather Data, cont. Challenges and Solutions
Limited resources
Competing priorities
Damage to shelter or surrounding areas
How to Get Data to Appropriate PeopleReceiving the Data
Identify who should receive data and analyze
Keep list of individuals and contact information
Data Transfer
Send to one or more individuals vs. sending to dedicated email
Preferred method for data transfer
How to Get Data to Appropriate People, cont.Timing of Data Transfer
How frequent
Timing intervals
Needs of partners & stakeholders
Operational period of ICS
Challenges and Solutions
Logistics
Confidentiality and personal identifiers
How to Analyze and Interpret Data
Data Entry
Data Collection Format Data Entry
Paper Form Collection Enter data into an electronic dataset using software that
is familiar, easily accessible, and maintainable.
Build the data entry platform prior to conducting field
work.
Train data entry staff so they are familiar with the
software and use proper techniques to promote quality
and accuracy during entry.
Electronic Device Collection Merge collected data into a single file for analysis
How to Analyze and Interpret Data, cont.
Data AnalysisConsider technical capacity, complexity of analysis, frequency of analysis
Measure Definition
Incident cases† The occurrence of new cases of disease or injury in a population over a
specified period
Prevalent cases† The existing cases of disease, or injury in a population over a specified period
Incidence rate (new cases)‡ The number of new cases of a disease or injury that occur during a specified
period per unit of person-time at risk (can be stratified by age and sex)
Prevalence or prevalence rate
(total existing cases)†
The proportion of people in a population who have a particular health
condition at a specified point in time or over a specified period
Age-specific morbidity rate (<5
years, >5 years)‡
A morbidity rate limited to a particular age group (e.g., under-5 mortality rate
[U5MR] is the rate of death among children younger than 5 years in a
population)
Incidence proportion (attack
rate, generally used for
infectious conditions)†
The proportion of an initially disease-free population that develops disease,
becomes injured, or dies during a specified (usually limited) period
Proportional morbidity§ The proportion of all new or existing cases in a specified population over a
period attributable to a specific cause
Health facility utilization rate‡ The number of outpatient visits per person per year (if it is possible,
distinguish between new and old visits and use new visits to calculate the
rate)
Number of consultations per
clinician per day‡
The average number of total consultations (new and repeat cases) seen by
each clinician per day
How to Analyze and Interpret Data, cont.
Epi InfoUser-friendlyOn-line tutorialsFree
Interpreting Results for Action (when do we pull the trigger?)Changes in trends of illness in shelterTwo or more cases, from different family groups, with similar symptomsTwo or more cases, with similar symptoms, that are linked (i.e., similar activities, what and where they ate)Symptoms or syndromes indicating the potential for communicable disease outbreaks
How to Analyze and Interpret Data, cont.Respiratory
Cough, runny nose, water eyes
Fever (Temp >101.1⁰F) and cough in adults
Fever (Temp >101.1⁰F) and cough in children
Fever (Temp >101.1⁰F), cough with bloody sputum, and weight loss
Diarrhea or Vomiting
Vomiting
Loose or unformed stools
o Water or explosive stools, with or without blood
Skin
Fever (Temp >101.1⁰F) and rash
Fever (Temp >101.1⁰F), upper chest rash, and stiff/sore neck
Eye infections (drainage from eye)
Draining wound/lesion
Itchy rash without fever
How to Analyze and Interpret Data, cont.
Challenges and Solutions
Denominator data
Baseline health information
Competing priorities
How to Communicate ResultsAudience
Writing a ReportFormatHow much information to includeTechnical levelAvoid internal jargon/acronyms
Dissemination MethodsESF-8 Meetings, phone calls, web-site updatesPublic
Web Site postingsTV and radioSocial media
Challenges and SolutionsControlling media rumors
AppendixCMIST
American Red Cross Disaster Health Services Aggregate Morbidity Report Form
Natural Disaster Morbidity Surveillance Individual Form
Natural Disaster Morbidity Surveillance Line List
Natural Disaster Morbidity Surveillance Tally Sheet
Natural Disaster Morbidity Surveillance Summary Report
Environmental Health Shelter Assessment
AcknowledgementsCSTE Shelter Surveillance Workgroup
Amy SchnallAshley ConleyDoug ThoroughmanErica ThomassonJessica WursterJessica HelmsMary Casey LockyerMelissa MorrisonMiguel CruzNamitha ReddyNicole NakataTracy Miller