Data for Decision Making in Disasters: Advances and Controversies

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Data for Decision Making in Disasters Advances
and Controversies

• Prevention of Disaster Threats Workshop
• Kaunas, Lithuania
• 08 August, 2005
• Eric K. Noji, M.D., M.P.H.
• Centers for Disease Control
• Washington, DC

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"The reason for collecting, analyzing and
disseminating information on a disease is to
control that disease. Collection and analysis
should not be allowed to consume resources if
action does not follow."

• William H. Foege, M.D.
• International Journal of Epidemiology 1976
  529-37

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Uses of Data in Disasters

• Assessment and Surveillance
• Injury and disease profiles
• Research methodologies
• Disaster management
• Vulnerability and hazard assessment

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Public Health Actions in Emergencies

• Before the disaster
• During the disaster
• After the disaster

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Data Needs Before the Disaster

• Hazard Analysis
• Vulnerability Analysis
• Training and Education

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Increasing disaster risk

• Increasing population density
• Increased settlement in high-risks areas
• Increased technological hazards and dependency
• Increased terrorism biological, chemical,
  nuclear?
• Aging population in industrialized countries
• Emerging infectious diseases (AMR)
• International travel (global village)

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While knowing the threat agent is important,
understanding how each threat expresses its toll
on the health and well being of communities, in
both the near term and the long run, is crucial
to our preparedness and response.
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IMMEDIATE RELIEF
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Next Steps

• Rapid needs assessment
• Disease Surveillance
• Public health interventions

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Rapid Needs Assessment

• The collection of subjective and objective
  information, limited in time, performed in acute
  situations, which requires immediate action to be
  taken to respond to the basic requirements of the
  affected population

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Objectives of Health Information Systems in
Emergency Populations

• Establish health care priorities
• Follow trends and reassess priorities
• Detect and respond to epidemics
• Evaluate program effectiveness
• Ensure targeting of resources
• Evaluate quality of health care

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Goal of CMR in Emergency Populations

• For lt 5 years of age Less than 2.0 per 10,000
  per day
• For gt 5 years of age Less than 1.0 per 10,000
  per day

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Morbidity AssessmentNecessary Information

• Diseases of public health importance
• Measles
• Diarrhea
• Acute Respiratory infections
• Injuries
• Malnutrition

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• Diseases of epidemic potential
• Cholera
• Dysentery
• Meningitis
• Yellow fever

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Program or process indicators

• Immunization coverage
• Supplementary feeding attendance
• Antenatal and postnatal clinic coverage
• ORS distribution
• Water consumation
• Caloric intake
• Latrine coverage

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The Assessment Process

• Identify information needs and resources
• Collect data
• Analyze and interpret
• Report conclusions
• Design/modify disaster response
• Back to the beginning of assessment
• Identify information needs and resources

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After the Disaster

• Lessons learned
• Improving future disaster response
• Preventing or mitigating loss of life, severe
  illness and injuries

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Epidemiologic Methods in Disasters

• After a disaster (Reconstruction Phase)
• Conducting post-disaster epidemiologic follow-up
  studies
• Identifying risk factors for death injury
• Planning strategies to reduce impact-related
  morbidity mortality
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• After a disaster (Reconstruction Phase)
• Developing specific interventions
• Evaluating effectiveness of interventions
• Conducting descriptive analytical studies
• Planning medical public health response to
  future disasters
• Conducting long-term follow-up of
  rehabilitation/reconstruction activities
• Source EK Noji, The Public Health Consequences
  of Disaster

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Myths and Realities in Disaster Situations Myths and Realities in Disaster Situations
Myth Foreign medical volunteers with any kind of medical background are needed.  Reality The local population almost always covers immediate lifesaving needs. Only medical personnel with skills that are not available in the affected country may be needed. 
Myth Any kind of international assistance is needed, and it's needed now!  Reality A hasty response that is not based on an impartial evaluation only contributes to the chaos. It is better to wait until genuine needs have been assessed. 
Myth Epidemics and plagues are inevitable after every disaster.  Reality Epidemics do not spontaneously occur after a disaster and dead bodies will not lead to catastrophic outbreaks of exotic diseases. The key to preventing disease is to improve sanitary conditions and educate the public. 
Myth Disasters are random killers.  Reality Disasters strike hardest at the most vulnerable group, the poor --especially women, children and the elderly. 
Myth Locating disaster victims in temporary settlements is the best alternative.  Reality It should be the last alternative. Many agencies use funds normally spent for tents to purchase building materials, tools, and other construction-related support in the affected country. 
 
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Epidemiologic Methods in Disasters

• Challenges for Epidemiologists
• Applying epidemiologic methods in the context of
• Physical destruction
• Public fear
• Social disruption
• Lack of infrastructure for data collection
• Time urgency
• Movement of populations
• Lack of local support and expertise
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• Challenges for Epidemiologists
• Selecting study designs
• Cross-sectional
• Studies of frequencies of deaths, illnesses,
  injuries, adverse health affects
• Limited by absence of population counts
• Case-control
• Best study to determine risk factors, eliminate
  confounding, study interactions among multiple
  factors
• Limited by definition of specific outcomes,
  issues of selection of cases controls
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• Challenges for Epidemiologists
• Selecting study designs
• Longitudinal
• Studies document incidence and estimate
  magnitude of risk
• Limited by logistics of mounting a study in a
  post-disaster environment and subject follow-up
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• Challenges for Epidemiologists
• Need standardized protocols for data collection
  immediately following disaster
• Need standardized terminology, technologies,
  methods and procedures
• Need operational research to inventory medical
  supplies and determine 1) actual needs, 2) local
  capacity, 3) needs met by national/international
  communities
• Need evaluation studies to determine efficiency
  and effectiveness of relief efforts and emergency
  interventions
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• Challenges for Epidemiologists
• Need databases for epidemiologic research based
  on existing disaster information systems
• Need to identify injury prevention interventions
• Need to improve timely and appropriate medical
  care following disaster (search rescue,
  emergency medical services, importing skilled
  providers, evacuating the injured)
• Need measures to quickly reestablish local health
  care system at full operating capacity soon after
  disaster
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• Challenges for Epidemiologists
• Need uniform disaster-related injury definitions
  and classification scheme
• Need investigations of disease transmission
  following disasters and public health measures to
  mitigate disease risk
• Need to study problems associated with massive
  influx of relief supplies and relief personnel
• Need cost-benefit and cost-effectiveness analyses
• Source EK Noji, The Public Health Consequences
  of Disaster