The OTIS and CDC Hurricane Response Project

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The OTIS and CDC Hurricane Response Project Lori
Wolfe, MS, CGC
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The OTIS and CDC Hurricane Response Project

• Presentation Outline
• Background
• Project Proposal
• Project Description
• Methods/Goals
• Results
• Future Directions

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The OTIS and CDC Hurricane Response Project

• OTIS Partnership with the CDC
• OTIS Quick Response Proposal for Public Health
  Issues that Involve the Potential for Pregnancy
  Exposures
• Drafted by Tina Chambers, Past President of
  OTIS
• The OTIS network is an established mechanism
  whereby women or health care providers who have
  concerns or questions following an emerging event
  can access immediate information. This Process
  could be enhanced and streamlined according to a
  pre-established general protocol to quickly
  respond in collaboration with the CDC to specific
  events as they occur in the future and to upgrade
  the capacity of the network to handle a rapid
  increase in the number of inquiries that are
  initiated.
• Early 2005 - Intent of emergency response project
• Inspiring events
• Anthrax attacks
• Flu vaccine shortage

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The OTIS and CDC Hurricane Response Project

• OTIS Partnership with the CDC
• CDC OTIS identify potential concerns, create
  standard responses and plan for unanticipated
  events.
• OTIS toll free routing system would be modified
  to accommodate specific concerns and influx of
  calls.
• Designate one or more OTIS first responder sites
  to receive calls from national toll free number
  and forwarded from regional OTIS centers.
• Publicize the OTIS toll free number as a resource
  for relating event to exposure risks.
• Data collection by OTIS throughout the project
  according to specified criteria with a summary
  provided to the CDC at completion of project.

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The OTIS and CDC Hurricane Response Project

• Publicizing the Project

• Target audience
• Pregnant women
• Women who are breastfeeding
• Women planning to become pregnant
• Partners/family members
• Obstetricians/physicians
• Shelters/temporary housing

• Newspaper ads
• TV ads
• On-line ads/Website links
• Posters/flyers
• Word of mouth by doctors
• Stress that this is a FREE service

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Hurricane Katrina August 24 30, 2005
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Path of Hurricane Katrina
http//en.wikipedia.org/wiki/ImageKatrina_2005_tr
ack.png
http//cimss.ssec.wisc.edu/tropic/archive/montage/
atlantic/2005/KATRINA-track.gif
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The OTIS and CDC Hurricane Response Project

• Decision to implement project Sept. 2005
• Projected obstacles with project
• No model as guide
• Communication systems down in New Orleans and
  surrounding areas
• Time
• Manpower

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Path of Hurricane Rita, September 20 24, 2005
Htttp//en.wikipedia.org/wiki/Hurricane_Rita
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The OTIS and CDC Hurricane Response Project

• OTIS/CDC Goals and Implementation for Hurricane
  Project
• Public Awareness
• Make toll-free phone counseling service known to
  pregnant/breastfeeding women and their
  Obstetricians, physicians, health professionals
• Generally increase visibility of OTIS toll free
  counseling service
• Enable OTIS triage system to accommodate
  hurricane-related concerns
• State with local Teratogen Information Service
  (TIS) - Texas
• No TIS calls routed to national toll-free
  number 866-626-6847
• Alabama, Florida, Louisiana, and Mississippi
• 9/28/05 ATT modifies 866 routing system to add
  the hurricane option
• Establish database of actual exposures/concerns
• Document reason of call
• Helpful in future disaster situations

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The OTIS and CDC Hurricane Response Project

• Who Was Involved?
• OTIS
• Board of Directors FY 05 - 06
• Dee Quinn, MS Executive Director Arizona TIS
• Tina Chambers, Ph.D. President California TIS
• Sharon Voyer Lavigne, MS President Elect
  Connecticut TIS
• Janine Polifka, Ph.D. Past President,
  Washington State TIS
• Lori Wolfe, MS Treasurer Texas TIS
• Donita Vogt, MS Former co-chair of Education
  Committee, Arizona TIS
• Other key players
• Hope Bergemann Chipman working on MS theses at
  Sarah Lawrence College
• Joanne Brochu Connecticut TIS
• Andy Valdini OTIS Webmaster
• CDC
• National Center on Birth Defects and
  Developmental Disabilities (NCBDDD)
• Jan Cragan, MD, MPH
• Sonja Rasmussen, MD
• Other Organizations
• American Red Cross

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The OTIS and CDC Hurricane Response Project

• Publicizing Success Word of Mouth and Web-based
• Word of Mouth
• WIC clinics flyer distribution
• Faith-Based Organizations flyer distribution
• Radio Public Service Announcements
• Web-based
• OTIS website
• CDC website
• State Departments of Health
• Alabama, Louisiana, Mississippi, Texas
• Response all have links to CDC on their websites
• Helpful links Good info for online self-help
• http//www.cdc.gov/ncbddd/katrina/women.htm
• major heading at top to have women talk to
  their doctor or call OTIS if they have
  questions
• http//www.cdc.gov/ncbddd/katrina/QandA_long.htm
• http//www.marchofdimes.com/pnhec/159_16943.asp

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The OTIS and CDC Hurricane Response Project

• OTIS Flyer
• E-mail distribution
• Regional NAACP
• NSGC
• Faith based organizations
• Hard copy distribution
• CDC hurricane response team
• March of Dimes

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The OTIS and CDC Hurricane Response Project

• OTIS Fact Sheets
• Potential hurricane-related exposures
• Brainstormed what potential exposures existed
• OTIS Board of Directors
• OTIS BOD further brainstorm with CDC
• Development of fact sheets
• Written by OTIS members
• Info must be written at 8th grade reading level
• Edit/re-edit
• Joint approval by OTIS and CDC
• Once approved, sheets posted on both websites,
  and available for downloading

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The OTIS and CDC Hurricane Response Project

• Hurricane-related Fact Sheets on OTIS Website
• Infectious Agents
• CMV
• Hepatitis A
• Influenza
• Listeria
• Lymphocytic Choriomeningities Virus (LCMV)
• Measles/Mumps/Rubella
• Staphylococcus Aureus
• Toxoplasmosis
• Vibrio
• West Nile Virus

• Maternal Medical Conditions
• Stress
• Hyperthermia
• Medications
• Acetaminophen
• Antiviral medications
• Benzodiazepines
• Flagyl
• Vaccines
• Other Exposures
• Breastfeeding following a natural disaster
• Lead
• Molds
• Pesticides
• Depression

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The OTIS and CDC Hurricane Response Project
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The OTIS and CDC Hurricane Response Project

• OTIS National Telephone Triage System
• 70,000 100,000 telephone inquiries annually
• OTIS toll free number routing system
• Changes to system for Hurricane Katrina
• 9/28 ATT modifies 866 routing system to add the
  Katrina option
• Touch tone choices for direct routing
• Primary response Arizona TIS (national office)
• Secondary response Texas TIS

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The OTIS and CDC Hurricane Response Project

• Calls Received
• 33 total calls received
• October 4, 2005 through
• April 27, 2006
• Arizona TIS 14 calls
• via OTIS national routing
• Texas TIS 19 calls

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Hurricane Related Calls Received October
December, 2005
Date Caller type/location Concerns Heard of Service?
10/4 Provider New York General information Unknown
10/6 Provider Baton Rouge General information Unknown
10/19 Male spouse Miami Low air pressure Unknown
10/26 Pregnant female NO Flood water OTIS
10/27 Planning female Houston Flood/drinking water OTIS
10/27 Planning female NY Water, lead, air, solvents, smoke Website
10/31 Pregnant female NO Soil, air, flood water Website
11/1 Planning male Houston Mold, flood water OTIS
11/9 Pregnant female NO Mold, flood water Pharmacist
11/11 Pregnant female NO Mold, water, lead, bacteria, air Website
11/14 Female Dallas Mold, general information Received e-mail
11/22 Female Berkeley, CA Group B strep, general information CDC website
12/5 Pregnant female NO Lead CDC website
12/7 Pregnant female NO Water, flood Website
12/20 Female Luling, LA Seafood, vibrio CDC website
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The OTIS and CDC Hurricane Response Project
Outreach trips to LouisianaMarch 8-9, 2006
Baton Rouge and New OrleansDr. Luther Robinson
and Hope Bergemann

• Baton Rouge March 8/9
• Department of Public Health
• Birth Surveillance Program
• Maternal and Child Health Department
• Family Road of Greater Baton Rouge (WIC clinic)
• Greater Baton Rouge Food Bank
• Phone conference with state breastfeeding
  coordinator

• New Orleans March 9
• Jefferson Parish Health Unit, Matairie (WIC
  clinic)
• Jefferson Parish Health Unit, Marrero (WIC
  clinic)
• Tour through hurricane-damaged areas of city

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The OTIS and CDC Hurricane Response
Project Reflections on Louisiana Outreach

• Louisiana Department of Health Employees without
  their offices
• Two of thirteen WIC clinics in New Orleans are
  open since hurricane
• 75 rise in Latino population since September
• High cost of rental housing leads many to live in
  unsafe living conditions
• Importance of faith and community during
  rebuilding

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The OTIS and CDC Hurricane Response
Project Outreach Trips to Louisiana March 28,
2006 New Orleans - Lori Wolfe

• Dr. Kevin Stephens Director of City of New
  Orleans Health Department
• Accepted flyers to hand out at pregnancy clinics
  catering to over 200 New Orleans women
• Discuss OTIS and Hurricane Response Project on
  local weekly television show aired April 6,
  2006
• Distribute OTIS 866 toll-free number
• Dr. Paula Zeanah Pediatric Consultation Liaison
  for Tulane University Louisiana Department of
  Public Health Maternal and Child Health Program
• Accepted flyers to distribute at Tulane and with
  DPH

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Hurricane Related Calls January April, 2006
1/12 Planning female Florida Water, mold Word of mouth
1/12 Concerned mother Louisiana Water Unknown
1/18 Planning female Connecticut Mold, bacteria CT TIS
2/16 Female Florida Mold, general info CDC website
2/16 Breastfeeding female LA, CA Vaccines, water, mold, DEET Website
2/21 Pregnant female NY Drinking water Physician
3/16 Provider Harvey, LA General info for health fair OTIS flyer
4/5 Male NO Lead paint in home and soil Dr. Stephens TV show
4/6 Male NO Lead Newspaper article
4/6 Female NO Lead in soil, dust in house Dr. Stephens TV show
4/6 Provider NO General info for patients OTIS flyer
4/6 Female NO Lead in soil Dr. Stephens TV show
4/6 Pregnant female NO Lead in air and soil, air quality Newspaper article
4/7 Female NO Lead in air and soil Newspaper article
4/12 Female NO General info Dr. Stephens TV show
4/12 Female NO Reproductive concerns Dr. Stephens TV show
4/12 Female NO Stress, heat, panic attacks Dr. Stephens TV show
4/27 Female NO General info OTIS website
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The OTIS and CDC Hurricane Response Project

• Project Analysis
• Advertising methods most effective
• In-person publicizing
• Television and newspaper publicity
• What worked
• Realistic exposure concerns were anticipated
• Methods of collecting data worked well limited
• Project received conference exposure
• What didnt work
• Not as many calls as anticipated
• Community outreach more time needed to meet
  with people in the regions, limited
  funding/manpower to effectively advertise on
  television

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The OTIS and CDC Hurricane Response Project

• Lessons learned
• United States has a poor set up for emergency
  response in such situations.
• We need to develop a streamlined approach to
  reach those in need in each state.
• Need of a calling or an e-mail tree system
  direct line of contact from providers/services to
  patients.

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The OTIS and CDC Hurricane Response Project
Acknowledgements

• Institutions/Organizations
• CDC
• OTIS
• U Conn Health Center
• Arizona TIS
• Texas TIS
• March of Dimes
• Sarah Lawrence College
• American Red Cross
• EPA

• Contributors
• Sharon Voyer Lavigne
• Dee Quinn
• Jan Cragan
• Sonja Rasmussen
• Andy Valdini
• Special Thanks to
• Hope Bergemann Chipman

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Questions?