Monitoring Emergency Department Visits From Puerto Rico in the Aftermath of Hurricane Maria Using Syndromic Surveillance – New York City, 2017

Abstract

Objective:Syndromic surveillance has been useful for routine surveillance on a variety of health outcomes and for informing situational awareness during public health emergencies. Following the landfall of Hurricane Maria in 2017, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) implemented an enhanced syndromic surveillance system to characterize related emergency department (ED) visits.Methods:ED visits with any mention of specific key words (“Puerto,” “Rico,” “hurricane,” “Maria”) in the ED chief complaint or Puerto Rico patient home Zip Code were identified from the DOHMH syndromic surveillance system in the 8-week window leading up to and following landfall. Visit volume comparisons pre- and post-Hurricane Maria were performed using Fisher’s exact test.Results:Analyses identified an overall increase in NYC ED utilization relating to Puerto Rico following Hurricane Maria landfall. In particular, there was a small but significant increase in visits involving a medication refill or essential medical equipment. Visits for other outcomes, such as mental illness, also increased, but the differences were not statistically significant.Conclusions:Gaining this situational awareness of medical service use was informative following Hurricane Maria, and, following any natural disaster, the same surveillance methods could be easily established to aid an effective emergency response.

Powerless in the Virgin Islands: Emergency Department and Wound Care Clinic Utilization Following the 2017 Hurricanes Irma and Maria on St. Thomas, U.S. Virgin Islands

“…Previous studies implicate hurricanes with an increase in ED visits, largely attributed to substantial disruptions in essential community lifeline support services, including a heavily distressed healthcare system. [16][17][18][19][20]22,27,28,33,34,41 Although the U.S. Virgin Islands are frequently impacted by hurricanes, category 5 storms are uncommon. Thus, to enhance public health preparedness, it is important to understand how major hurricanes (category 4 and 5 storms) impact the prevalence of acute medical needs, and the factors and circumstances that influence decisions to seek medical care in their wake.…”

“…[18][19][20][32][33][34][35][36] Interrupted access to medical care and treatment, damaged or lost medications, and an inability to replenish prescription medications, all place vulnerable populations at increased risk for morbidity and developing acute medical needs in the days following a hurricane disaster, thus impacting ED inflow. 16,[18][19][20]22,28,[32][33][34][35][36] Moreover, disruptions to essential community lifeline support and services, including primary healthcare services rendered by skilled clinicians, could increase demands for alternative care at EDs. Accordingly, evidence is required to inform and enable preparedness, including personnel and medical resource requirements in EDs, for future hurricane disasters of the breadth and magnitude of Hurricanes Irma and Maria.…”

“…Substantial evidence shows the effects of power outages on healthcare delivery, home healthcare services, the public health infrastructure, and adverse health outcomes. [8][9][10][11][12][13] The effects of hurricanes on the increased utilization of EDs in New York, [14][15][16][17][18][19] New Jersey, [20][21][22] and Texas 23 ; across 9 U.S. states, 24 among Caribbean islands, [25][26][27][28][29][30] and the impact of a category 5 tropical cyclone on disaster related wounds, 31 have been recently investigated. The hurricane studies attributed the increased ED visits to disrupted access to care for a range of chronic diseases and conditions, including cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease (including ventilator dependence), renal disease, dementia, and mental disorders; disaster-related conditions (such as hypothermia or environmental exposures); carbon monoxide-related accidents; and a lack of prescription refills.…”

“…The hurricane studies attributed the increased ED visits to disrupted access to care for a range of chronic diseases and conditions, including cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease (including ventilator dependence), renal disease, dementia, and mental disorders; disaster-related conditions (such as hypothermia or environmental exposures); carbon monoxide-related accidents; and a lack of prescription refills. [15][16][17][18][19][20]22,28,[32][33][34] The tropical cyclone study provided evidence of post-disaster wound infections and chronic wound conditions associated with poor wound management and the disruption of access to care. 31…”

Pasos Hacia un Estudio Piloto: Limitaciones y Oportunidades de una Encuesta de Respuesta de Salud Mental para Puerto Rico Después del Huracán María

“…This was evidenced by the media coverage during the recovery phase, where it was revealed substantial discrepancies in death counts by the government of Puerto Rico (Robles, 2018). Since then, a growing attention towards the development of reliable measures and surveillance mechanisms to capture mental health symptoms and other health outcomes in the island have been documented (Adams et al, 2019;Carl et al, 2019;Wong & Parton, 2020).…”