Hurricanes' latent hazards tracked by poison centers
With the start of this year's hurricane season Thursday (June 1), Florida's residents are preparing for the all-too-familiar havoc the storms can wreak. But hurricanes cause more than flooding, high winds and power outages - they also spawn public health hazards that often aren't evident until days after winds die and storm waters recede.
Now, after fine-tuning it for the past two hurricane seasons, a University of Florida toxicologist and state Department of Health officials have pioneered a real-time system for monitoring storm-related public health hazards, including carbon monoxide inhalation and contaminated food and water supplies.
Using electronic data from Florida's Poison Information Center Network hotline, the experts designed a surveillance system to identify public health threats and make this information readily available over the Web to state health department epidemiologists.
Florida health officials, for example, were able to track 200 percent to 300 percent spikes in carbon monoxide and gasoline poisonings related to generator use after Hurricanes Katrina and Wilma made landfall last year in Florida, according to data recently published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. The CDC adopted the Florida model and used data provided by the American Association of Poison Control Centers to monitor other hurricane-prone coastal areas, including Gulf Coast regions in the aftermath of Katrina.
"The primary benefit is that you're not waiting and reporting on things that happened three days ago - you're seeing something and interacting in real time to stop it," said study co-author Jay Schauben, Pharm.D., a UF clinical professor of emergency medicine and pharmacy and director of the Florida Poison Information Center-Jacksonville. "The quicker you can identify a problem, the faster you can focus your attention, the more individuals you might spare doing the wrong thing which gets them into trouble, health-wise. And I think that's the concept here."
For example, higher-than-normal reports of gastrointestinal distress in a small geographic area may indicate problems with a municipal water supply, allowing health officials to warn residents to switch to bottled water until the local water source is cleared.
Florida Department of Health officials started reviewing data collected by the Florida Poison Information Center Network during the 2004 hurricane season. In 2005 the agencies began monitoring poison control center records daily to see if any were connected to storm-related health hazards.
"We monitored these hazards using a sophisticated, Web-based data-gathering system we already had in place here that was originally designed to characterize epidemiological information - the incidence and spread of disease - for our statewide poison control centers," Schauben said. "Now this same system provides valuable real-time information and surveillance to identify public health threats left in the wake of hurricanes."
Created by the Florida Legislature in 1989, the network includes three poison control centers in Miami, Tampa and Jacksonville. Health professionals and the public can call the network via the nationwide 24-hour, toll-free telephone "POISON HELP" hotline, 1ë‹¨ë‚¦ñ®Š–. Poison information specialists at each center gather exposure and substance information from callers and enter it into a local database that is then uploaded within seconds to a statewide database, housed at the Jacksonville site.
During the 2005 hurricane season, state health officials monitored exposure to carbon monoxide, hydrocarbon fuels, batteries, fire, matches and explosives, stings, snake bites, contaminated water and food poisoning. They compared exposures from 30 days before and up to one week after a hurricane's landfall.
The system provides a collaborative, online reporting system, displaying surveillance graphs and Geographic Information Systems mapping data with hour-to-hour updates that can be accessed in the office or on a laptop in a car, in an airport or in the field. Health officials rely on spikes in the data to help identify health-hazard incidences.
"Data spikes provide clues and allow us to zoom in on something exactly when it's happening in a certain location," said Schauben, adding that the system allows users to track patients' names and addresses and then alert the nearest local health department of the incident.
"For example, we'll tell the local health department that we've had five carbon monoxide cases in a certain area in the past 24 hours and ask them to get out there and educate the people about generators," Schauben said.
Operating generators in enclosed or poorly ventilated areas can lead to carbon monoxide poisoning. Twenty-eight incidents of carbon monoxide exposure were reported to the network in the two days after Hurricane Katrina made landfall in Florida.
"A couple of weeks after a hurricane hits, people start running out of gas because of gas shortages," Schauben added. "When we saw data spikes for inhalation of gasoline, we stepped up our messages about using proper siphoning equipment."
Department of Health epidemiologist Robyn Kay said that using a real-time, pre-existing sentinel surveillance system increases state health officials' ability to detect public health hazards and prevent deaths.
"Still, during emergencies and times of distress it's just as important for Floridians to think with a clear mind about how to approach each situation as it is for them to have emergency plans to help ensure their safety before, during and after the storm," she said.
Schauben said he sees a future for the system in other states. "Poison control centers are the only entities in the country that have an infrastructure to share data between 64 centers (the number of centers in the United States) in real time," he said. "We detect it, we see it and we move on it."