Enhanced Informatics Response to Disasters through Collaboration of Public Health Response Teams

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Enhanced Informatics Response to Disasters
through Collaboration of Public Health Response
Teams
LCDR Margaret A. Riggs, PhD, MPH, MS Career
Epidemiology Field Officer CDC / COTPER Kentucky
Dept. for Public Health
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Overview

• Disaster Surveillance
• Exercise / Training
• Evaluation of surveillance tool
• Multi-state /Multi-agency collaboration
• Recommendations

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Importance of Active Surveillance During a
Disaster

• Complement to regular reporting mechanisms
• Rapidly detect outbreaks and define health
  problems
• Identify groups at risks for adverse health
  events
• Determine needs of special populations

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Importance of Active Surveillance During a
Disaster (2)

• Optimize the relief response
• Monitor the effectiveness of the relief effort
• Respond to public concerns and media inquiries
• Facilitate planning for future disasters

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Use of Informatics in Disasters

• Real-time and accurate epidemiologic data is
  critical to decision making
• Delivery of appropriate public health services
  during emergency events such as disease outbreaks
  or disasters is essential.
• Agencies must receive data from the field quickly
  and have the ability to compare results across
  jurisdictions when multiple states are affected.

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Validating systems

• A field-tested, electronic standardized system of
  data collection is essential for early event
  detection, emergency response, and public health
  decision making.
• With the rapid advancement of informatics
  capabilities, it is essential to systematically
  validate the methods that are most effective.

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Project Objective

• Evaluate the usefulness and acceptance of GIS/GPS
  equipped handheld computers for disaster
  surveillance through the collaboration of public
  health teams.

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Collaboration

• Two agencies
• CDC
• Association of State and Territorial Directors of
  Nursing (ASTDN)
• Three states
• Georgia
• Tennessee
• Kentucky
• Three disciplines
• Nurses
• Epidemiologists
• Environmental Health Specialists

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Equipment

• Equipment purchased using funds provided by CDCs
  Coordinating Office for Terrorism Preparedness
  and Emergency Response.
• Laptop computers
• Six Dell Precision M6300 notebooks
• Each state received two laptops.
• Software
• ESRI ArcView software
• Arc GIS
• GeoAge Field Adapted Survey Toolkit (FAST)
• SAS 9.1
• Microsoft Office Pro
• Handheld Devices
• Thirty-one Trimble Geocollector submeters
• ArcPad and Trimble GPS correct for ArcPad

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Training / Exercise

• Three-day comprehensive training exercise
• 2 days of Geographic Information System (GIS)
• ½ day of handheld computer training
• Global Positioning System (GPS)
• FAST (GeoAge) software to create a
  data-collection form
• Natural Disaster Morbidity Report Form template
• ½ day of tornado disaster exercise
• collected, imported, analyzed, mapped data.

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Exercise Scenario Setting Twisterville

• The area has been under a tornado watch since
  115 p.m. Since that time, a large storm system
  moving through this portion of the state has
  begun moving in a direction that is taking over
  portions of Tornado county, including
  Twisterville.

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Exercise Scenario
Several homes have been affected. There have
been reports of a number of people being injured,
and displaced individuals are wandering around
the stricken area.
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Exercise Scenario

• On-scene police units report limited access into
  the damaged area due to large pieces of debris
  and nails littering the streets.

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Exercise Scenario

• Local and State health officials have been asked
  to assist with setting up active surveillance at
  designated shelters which have been set up for
  tornado victims.

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Exercise Scenario

• You have been assigned to work at one of three
  shelters.
• You will be interviewing patients for active
  surveillance
• Enter data from the interview using the handheld
  Trimble computer
• and the form that was
• Developed in training.

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Natural Disaster Morbidity Report Form
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Patient Scenario
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Handheld Computer
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Evaluation Methods

• Evaluation of overall project
• a paper questionnaire
• four epidemiologists and three nursing
  supervisors in the three states
• Evaluation of the GIS and GPS training and
  exercise
• Evaluation of GIS/GPS training and exercise
  consisted of four questionnaires which were
  administered to training attendees in each state
• 1) Pre-Training GIS
• 2) Post-Training GIS
• 3) Pre-Training GPS
• 4) Post-Training GPS and Exercise
• Attendees in Georgia and Kentucky responded to
  the questionnaires via an online survey, while
  those in Tennessee filled out paper
  questionnaires. Responses for all attendees
  were combined and entered in Excel
• Quality control assessment to examine accuracy of
  the data entered by participants during the
  exercise

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Evaluation Results

• 7 coordinators felt that the project enhanced the
  capability of their state to facilitate emergency
  response activities improved collaboration.
• 78 participants for the training/exercise
• Participants were enthusiastic about conducting
  this type of exercise,
• gave positive feedback for use of this technology
  and
• felt it would facilitate collaboration and
  enhance state capability to respond to disasters.
• Quality control assessment showed accuracy in all
  three states.

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What Worked?

• Patient cards easy to distribute controlled
  test data for quantitative, retrospective
  analysis of the validity of the exercise
• Pre-assigning teams for the exercise based on
  roles
• Interactive exercises of both GIS and FAST/GPS
  PDA enjoyed by the trainees
• Allowing trainees to upload data from the
  handheld devices into the computer (TN and KY)
  to see the ease of data transfer
• Demonstration of the form used in the exercise
  with the Trimble PDA emulator on screen

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What didnt work?

• Format of patient scenario data was difficult to
  work with.
• GIS training was thought to be too compressed by
  most of the trainees
• Many people were frustrated with capturing GPS
  coordinates.
• Trimble unit screens were hard to read
• small screen
• glare from the sun
• Participants were confused about applicability to
  their jurisdiction given that there was a limited
  amount of hardware and software that was granted
  through the project funds
• Participants needed more detailed explanation of
  did not adequately grasp the Natural Disaster
  Morbidity Report Form found many gaps and
  limitations

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What should we do differently in the future why?

• Task participants to bring a form often used in
  the field which they can use to build a FAST
  survey
• Allow an extra day for the full GIS training
  the training was too rushed and complicated for
  most 3 days is the original length of the GIS
  training
• Provide GIS training tailored specifically to
  public health relevance for public health
  audience
• Demonstrate using data gathered in FAST in other
  analytical software, say with a pre-fabricated
  SAS program to demonstrate usefulness of
  application and technology
• Integrate other technologies already in use in
  the public health arena (i.e., software OMS,
  hardware barcode readers, etc.) to further
  enrich training

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Recommendations

• Implement GIS/GPS equipped handheld computers can
  expand collaboration among public health
  officials within states, between states, and with
  federal partners.
• Enhance the capacity of state and local health
  departments to meet public health preparedness
  goals and capture data in a more rapid format.
• Train staff and practice using equipment on a
  regular basis

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Acknowledgements

• Douglas Thoroughman CDC/COTPER (Kentucky)
• Araceli Rey CDC/NCPHI
• David Kim CDC/COTPER (Georgia)
• John Dunn - Tennessee
• Pat Drehobl CDC/OWCD
• Beth Stover CDC/OWCD
• Linda Karr ASTDN
• Carl Kinkade CDC/NCPHI
• Meeyong Park CDC/NCPHI

Disclaimer 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.
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QUESTIONS????