Conducting Research, Even When Disasters Strike
By Steve Ramsey, MPH, Project Manager and Senior Advisor for Epidemiological Field Studies, Social & Scientific Systems, Inc.
Disasters often unfold suddenly and unpredictably (explosions), with a short lead time to prepare (hurricanes) or over extended time periods (droughts). Each disaster event can present its own set of public health threats.
Natural disasters such as earthquakes and floods can cause widespread damage to critical infrastructure which may have impacts on public health that extend far beyond those immediately affected by the disaster event. The capacity of acute care facilities may be stretched thin by a large influx of disaster victims, resulting in a lack of available beds for other common hospitalizations such as heart attacks and strokes. Manmade disasters, such as accidental releases of hazardous chemicals, may have insidious long-term effects on the public’s health such as clusters of respiratory syndromes and malignancies that are not apparent at the time of their release.
Due to the unpredictability of disasters, healthcare providers and researchers must work rapidly to uncover initial health outcome and exposure data, as well as collect ongoing data during preparedness, response, and recovery. Data collection throughout each disaster event is imperative in disaster management, preparing for future disasters and understanding the short and long-term health impacts of past disasters.
Today’s Disaster Research Data
With the increased absorption of electronic health and medical records into clinical medicine, we are entering a new era of potentially useful disaster research data and, although the data may be fragmented and disparate, strong analytical software can standardize it. Now is the time for disaster researchers to start working with healthcare providers in their locality to determine the availability, type, and structure of data collection during healthcare encounters so they can plan how to best acquire and use the data to answer disaster-related questions that will inevitably arise during a disaster.
Data collected by healthcare providers can provide warning signs a disaster may be unfolding. For instance, increased emergency department visits for viral syndromes such as fever and respiratory distress may indicate exposure to a previously unrecognized biological agent is occurring in a population. Information and specimens collected by healthcare providers in the conduct of influenza surveillance can detect potential outbreaks and genetically characterize the circulating strains of the virus. Detection of other potential syndromes could be detected by monitoring the sale of over-the-counter medications from retail pharmacies. In addition to these examples, data collected on a community’s encounters with healthcare providers can provide much insight into the health impacts of disasters, but opportunities for research are often missed due to limited resources, the inability to identify subjects, and access to disaster sites.
Obstacles To Studying Disaster Health Impacts
The top priority of emergency managers is the preservation of life and property following a disaster. But researchers deploying to a disaster can create additional burdens for local emergency managers who may need to provide for the basic needs of researchers once they arrive in the disaster zone. This creates a disincentive for emergency managers to support disaster researchers, denying access to worksites and personnel critical to research operations.
Some disasters also create conditions that require populations to evacuate and relocate to areas outside the disaster zone, complicating the location of disaster victims and survivors and hampering research recruitment and retention activities. The inability to access sites which may be hazardous or considered off limits for research personnel creates yet another burden with disaster research.
For these reasons, it is imperative disaster researchers coordinate their efforts with emergency managers, first responders, first receivers, and other healthcare providers prior to a disaster to discuss and develop plans for conducting disaster-related research and ensure they incorporate any scientific questions the disaster-affected community may have into their research.
Collaboration Between Healthcare Providers, Researchers, And The Community
While disaster research data is primarily conducted by healthcare providers, understanding the health effects of disasters does not only fall on their shoulders. The research community should also get involved, especially when launching longer term health studies.
Community groups can provide valuable input into research efforts as it relates to data collection, protection, and dissemination. Instead of trying to collect data on their own, disaster health researchers should team up with existing units like the Red Cross, emergency management, health department personnel, hospital data managers, and others supporting the local disaster response to perform integrated data collection initiatives. This will impose less of a burden on the affected population as well as the emergency response personnel by creating a more efficient use of resources.
Mobile technology is also changing the face of disaster response and research as digital communities provide outlets for people to rapidly communicate with each other when disasters strike. Social media platforms like Facebook allow users affected by a disaster to let people know they are safe or in need of assistance. Photographs and videos uploaded through social media by affected populations can provide situational awareness and intelligence to responding organizations. Population movement can be monitored by knowing the area in which a particular device belongs and seeing where it goes. Instructions for evacuation or sheltering in place may also be broadcast via social media.
Crowdsourcing and citizen science also enable populations to collect information on behalf of responding organizations to inform the response or determine whether or not recommended interventions are working. Telemedicine applications not only afford the opportunity to provide a platform for communication between patient and provider during a disaster, but may also enable researchers to collect information regarding study consent, measurements of exposures, symptoms, and some clinical measurements such as blood pressure, heart rate, blood sugar, etc., as well as skin rashes or other conditions. In some instances, a picture may be worth a thousand words, eliminating a visit to a clinic for examination or treatment.
As cities expand into areas of naturally occurring disasters and manmade potential disaster sites, they’re also becoming more densely populated. As a result, many facets of disaster research are growing in significance. Whether increasing the resiliency of populations or understanding the impacts of emerging threats like climate change, nanotechnology or knowledge, beliefs and attitudes, research will continue to be an integral component of policy development, intervention utilization, and effectiveness and performance of our emergency management infrastructures. Furthermore, with the vast amounts of electronic data being collected by healthcare providers, new opportunities for collaborative disaster research are more readily available that can help us evaluate existing policies developed to prepare, respond and recover from disasters.
About The Author
Mr. Ramsey has dedicated his 18 years of public health experience to the areas of disaster preparedness, response, and public health research study implementation at the local, state, and federal levels. He leads the development and operations of quick-strike and scalable research protocols to rapidly collect environmental data and individual health and exposure data in response to environmental disasters. He has fielded data collection projects following the Deepwater Horizon oil spill, Hurricanes Katrina, Wilma, Floyd, and Charley, as well as the Iowa City flood of 2008 and the 2009 H1N1 influenza pandemic.
About Social & Scientific Systems, Inc.
Social & Scientific Systems, Inc. (SSS) is an employee-owned public health research company with a mission to improve public health worldwide. The company provides support for the public and private sectors in the area of public health. SSS has offices in Silver Spring, Maryland; Durham, North Carolina; and Kampala, Uganda. For more information, visit www.s-3.com.