Tracking Health Effects of Wildfires: The Oregon ESSENCE Wildfire Pilot Project

Melissa Powell; Laurel Boyd

摘要

Objective To build capacity to conduct syndromic surveillance at the local level by leveraging a health surveillance need. Introduction Wildfires occur annually in Oregon, and the health risks of wildfire smoke are well documented 1 . Before implementing syndromic surveillance through Oregon ESSENCE, assessing the health effects of wildfires in real time was very challenging. Summer 2015 marked the first wildfire season with 60 of 60 eligible Oregon emergency departments (EDs) reporting to ESSENCE. The Oregon ESSENCE team developed a wildfire surveillance pilot project with two local public health authorities (LPHAs) to determine their surveillance needs and practices and developed a training program to increase capacity to conduct surveillance at the local level. Following the training, one of the LPHAs integrated syndromic surveillance into its routine surveillance practices. Oregon ESSENCE also integrated the evaluation findings into the summer 2016 statewide wildfire surveillance plan. Methods Oregon ESSENCE staff recruited two LPHA preparedness coordinators whose jurisdictions are regularly affected by wildfire smoke to participate in the pilot project. A state public health emergency preparedness liaison served as facilitator in order to increase syndromic surveillance capacity among state preparedness staff. A pre-season interview assessed data and surveillance needs, risk communication practices, and typical response activities during wildfires. Initial project calls focused on determining specific queries that would meet local needs. Participants wanted total ED visit numbers and health outcomes including asthma, chest pain or heart problems. Both LPHAs were interested in using the data to assess health effects on vulnerable populations, including elderly, children, and migrant workers. Oregon ESSENCE staff also recommended queries that would be used if large numbers of people were displaced (e.g., medication refills, dialysis). Before the onset of wildfire season, Oregon ESSENCE epidemiologists created queries and a MyESSENCE page for each participant. LPHA staff practiced running the queries, modifying them, and discussed interpretation and data-sharing best practices. During wildfire season, brief weekly webinars enabled participants to ask questions and learn additional techniques including displaying time series as proportions and adjusting geographic parameters to focus on areas with poor air quality. Results 2015 was a severe wildfire season in Oregon, with over 685,000 acres burned 2 . For the first time, local and state public health were able to monitor and share near real-time health information on interagency smoke calls. In the post project evaluation, participants reported increased knowledge of syndromic surveillance, interpretation, and risk communications. There were no marked increases in total emergency department visits, or visits for asthma, heart palpitations, or other heart complaints. The public may have adhered to warnings and effectively protected themselves against exposure to wildfire smoke, or health effects may have been less severe and not reflected in emergency department data. Over the next several years, Oregon ESSENCE will integrate select urgent care data, which may better capture morbidity due to wildfire smoke. Conclusions Framing syndromic surveillance training around a health surveillance need was effective because participants were engaged around a high-priority health hazard. In summer 2016, Oregon ESSENCE integrated wildfire health surveillance into a biweekly ESSENCE seasonal hazard surveillance report and invited wildfire response partners to subscribe. Local ESSENCE users can use or modify the queries. In 2017, Oregon ESSENCE will incorporate air quality data from the Environmental Protection Agency so partners can monitor air quality and health effects simultaneously.

机译：目的通过利用健康监视需求来建立在本地进行症状监视的能力。引言俄勒冈州每年都会发生野火，有充分的证据证明野火烟雾对健康的危害1。在通过俄勒冈州ESSENCE实施症状监测之前，实时评估野火对健康的影响非常具有挑战性。 2015年夏季是第一个野火季节，在60个符合条件的俄勒冈州紧急部门（ED）中，有60个向ESSENCE报告。俄勒冈州ESSENCE小组与两个地方公共卫生部门（LPHA）共同制定了野火监视试点项目，以确定其监视需求和做法，并制定了培训计划以提高在地方一级进行监视的能力。培训结束后，其中一名LPHA将综合症状监测纳入其常规监测实践中。俄勒冈州ESSENCE还将评估结果纳入了2016年夏季的全州野火监视计划。方法俄勒冈州ESSENCE员工招募了两名LPHA备灾协调员，他们的辖区经常受到野火烟雾的影响，以参加该试点项目。州公共卫生应急准备联络员担任了调解人，以提高州准备工作人员的症状监测能力。季前采访评估了数据和监视需求，风险交流做法以及野火期间的典型响应活动。最初的项目调用着重于确定满足本地需求的特定查询。参与者希望获得ED访视总数以及包括哮喘，胸痛或心脏问题在内的健康结果。两个LPHA都对使用数据评估对包括老年人，儿童和移民工人在内的脆弱人群的健康影响感兴趣。俄勒冈州ESSENCE的工作人员还建议了如果大量人员流离失所时可以使用的查询（例如，药物补充，透析）。在野火季节开始之前，俄勒冈州ESSENCE流行病学家为每个参与者创建了查询和MyESSENCE页面。 LPHA员工练习了如何运行查询，对其进行修改，并讨论了解释和数据共享的最佳实践。在野火季节，每周进行的简短网络研讨会使参与者能够提出问题并学习其他技术，包括按比例显示时间序列并调整地理参数以关注空气质量差的区域。结果2015年是俄勒冈州的严重野火季节，烧毁了超过685,000英亩2。地方和州的公共卫生第一次能够监视和共享有关机构间吸烟通知的近实时卫生信息。在项目后期评估中，参与者报告了对综合征监测，解释和风险沟通的了解有所增加。急诊科，哮喘，心或其他心脏病患者的总访视次数没有明显增加。公众可能遵守警告并有效地保护自己免受野火烟雾的危害，或者对健康的影响可能不太严重，并且未反映在急诊部门的数据中。在接下来的几年中，俄勒冈州ESSENCE将整合精选的紧急护理数据，这可能会更好地捕获因野火烟雾而引起的发病率。结论围绕健康监测需求制定综合症状监测培训是有效的，因为参与者参与了高度优先的健康危害活动。 2016年夏季，俄勒冈州ESSENCE将野火健康监测纳入了每两周一次的ESSENCE季节危害监测报告中，并邀请野火响应合作伙伴进行订阅。本地ESSENCE用户可以使用或修改查询。 2017年，俄勒冈州ESSENCE将纳入环境保护局的空气质量数据，以便合作伙伴可以同时监测空气质量和健康影响。

Tracking Health Effects of Wildfires: The Oregon ESSENCE Wildfire Pilot Project

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