Injuries and Illnesses Related to Hurricane Andrew -- Louisiana, 1992

On August 26, 1992, Hurricane Andrew struck Louisiana. On August 24, in anticipation of hurricane-related injuries and illnesses, the Office of Public Health (OPH), Louisiana Department of Health and Hospitals, in cooperation with hospital emergency room (ER) and public utility personnel and coroners, established an active emergency surveillance system in 19 parishes to monitor these events. This report summarizes the findings from this emergency surveillance system.

A hurricane-related fatal or nonfatal injury/illness was defined as one that occurred from 12 noon August 24 through 12 midnight September 21 that resulted from the preparation for, impact of, or clean-up after the hurricane and required treatment in a hospital ER or caused death. The OPH developed a questionnaire to collect data on demographic variables (i.e., age, sex, marital status, and parish); nature of injury/ illness (i.e., cut, fall, electrocution, or rash); body part affected; location, etiology, and time of injury/illness; and reporting institution. To facilitate reporting of these hurricane-related events, the OPH made periodic telephone calls to ER personnel and coroners who had administered the questionnaire to or for persons with injuries/ illnesses that met the case definition.

Twenty-one (50%) of 42 hospital ERs, five (26%) of 19 coroners' offices, and one of two public utilities participated in the emergency surveillance system and reported a total of 462 hurricane-related events. Of 406 events with a reported date of occurrence, 15 (4%) occurred before landfall; 70 (17%), during the hurricane; and 321 (79%), after the hurricane (Figure 1, page 249). Of 310 events with a reported place of occurrence, 244 (79%) occurred outside, and most (237 {69%} of 343) occurred in or around the home.

Of the 462 hurricane-related events, 445 (96%) had nonfatal outcomes (Table 1, page 249). Of the 17 (4%) fatal outcomes, eight occurred before the hurricane made landfall: six were due to drowning; one, to an impact injury sustained in a motor-vehicle crash during the evacuation; and one, to a crush injury sustained during a tornado that preceded the hurricane (Figure 1). Of the 445 nonfatal events, 383 (86%) were injuries, and 62 (14%) were illnesses; 319 (72%) occurred among males. The most common nonfatal injury was a cut/laceration/puncture wound (184 {41%} of 445), followed by a strain/sprain (49 {11%}) (Table 1). The most common body parts reported affected by a nonfatal hurricane-related injury/illness were the upper extremities, including the fingers, hands, and arms (157 {38%} of 411), followed by the lower extremities, including the toes, feet, and legs, (89 {22%}).

Three parishes -- St. Mary's, St. John's, and Iberia -- had hurricane-related injury/illness rates higher than 200 per 100,000 population (Figure 2, page 250); two parishes -- Iberville and Assumption -- had rates of 50-200 per 100,000 population. All other affected parishes had rates less than 50 per 100,000 population.

Reported by: K Kelso, S Wilson, L McFarland, DrPH, State Epidemiologist, Office of Public Health, Louisiana Dept of Health and Hospitals. Disaster Assessment and Epidemiology Section, Health Studies Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health; Div of Field Epidemiology, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Emergency surveillance systems can facilitate public health decision- making during natural disasters and have an impact on policies for future disasters. For example, in this report, after Hurricane Andrew made landfall, Louisiana public health officials monitored for outbreaks of diarrheal illness to identify and repair damaged waste-disposal systems and determine allocation of potable water. In addition, previous surveillance during other hurricanes affected the public health response to Hurricane Andrew. Louisiana public health officials were aware that hurricanes trigger secondary effects (such as tornadoes and flash floods) that, together with storm surges, can cause fatalities (e.g., drownings), even before making landfall, and that most injuries/illnesses related to hurricanes occur during the postimpact (i.e., clean-up) phase (1,2). Using this information, officials alerted Louisiana residents through radio announcements before and after Hurricane Andrew made landfall to the dangers that would be present during the preimpact, impact, and postimpact phases (e.g., drownings, crush injuries, and electrocutions, respectively).

Information on natural disaster-related morbidity and mortality is available from many sources, including medical examiners' and coroners' reports, death certificates, the American Red Cross, meteorologic services, police and fire departments, and emergency medical services (3-5). However, these sources use different methods and criteria for case selection (e.g., each uses a different definition of disaster-related injury), and no one source collects complete information on deaths and injuries. Similarly, no universally accepted definition exists of a disaster-related death. For example, following Hurricane Hugo in 1989, two coroners in South Carolina reported "heart attacks" that occurred during the hurricane as caused by hurricane-induced stress, but coroners and medical examiners in other regions of the state did not consider any heart attacks hurricane-related, regardless of when they occurred, and did not report them as such (6). The lack of standardized definitions for disaster-related death and injury presents difficulties in enumerating related deaths and injuries following a natural disaster. Furthermore, comparison of death and injury data from different sources is problematic.

This report demonstrates the feasibility of collecting emergency surveillance data that can be used to prevent injury and death related to a natural disaster. Better epidemiologic knowledge of the types of injury and illness and causes of death related to hurricanes is essential for the planning and provision of public health responses (e.g., distribution of relief supplies, equipment, and personnel) during such disasters (7). To assist efficient data collection and to facilitate decisions made by emergency personnel following disasters, CDC, in collaboration with state health departments, has developed disaster-related injury/illness surveillance questionnaires that can be quickly modified for specific situations. In addition, to enable comparisons of disaster-related injury/illness data from different sources, CDC is standardizing surveillance variables and methods of data collection. Development of robust methods for collecting and analyzing these questionnaires should assist public health professionals in guiding their emergency responses during future disasters.

References

1. Seaman J. Epidemiology of natural disasters. Contributions of

Epidemiology and Biostatistics 1984;5:1-177.

2. CDC. Update: work related electrocutions associated with Hurricane Hugo -- Puerto Rico. MMWR 1989;38:718-20,725.

3. CDC. Hurricanes and hospital emergency-room visits -- Mississippi, Rhode Island, Connecticut (Hurricanes Elena and Gloria). MMWR 1986;34:765-70.

4. CDC. Preliminary report: medical examiner reports of deaths associated with Hurricane Andrew -- Florida, August 1992. MMWR 1992;41:641-4.

5. Patrick P, Brenner SA, Noji EK, Lee J. The American Red Cross-Centers for Disease Control natural disaster morbidity and mortality surveillance system {Letter}. Am J Public Health 1992;82:1690.

6. Philen R, Combs DL, Miller L, et al. Hurricane Hugo, 1989. Disasters 1992;15:177-9.

7. Noji EK. Disaster epidemiology: challenges for public health action. J Public Health Policy 1992:13:332-40.

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