Notes from the Field: Snowstorm-Related Mortality — Erie County, New York, November 2014

Gale R Burstein, MD1; Janinne Blank, MBA1; Tracy Fricano Chalmers, MS1; Tara Mahar, MD1; Martin C. Mahoney, MD, PhD2

During November 18–21, 2014, a narrow band of central and southern Erie County in New York received unprecedented amounts of snowfall. The duration of the storm and amount of snowfall rapidly exceeded weather service forecasts, with some areas receiving 60–84 inches (1.5–2.1 meters) of snow. The rapid accumulation resulted in stranded drivers, travel bans, and logistical challenges associated with snow removal. Sporadic power outages affected a limited number of households. Eleven deaths were linked to the snowstorm, including one that was directly related, nine that were indirectly related, and one that was classified as possibly storm-related.

Erie County has a population of nearly 923,000, with 16.3% of persons aged ≥65 years (1). On November 18, in anticipation of the storm, the Erie County Emergency Operations Center (EOC) was activated. The EOC monitored and coordinated county, state, city, town, and village disaster preparedness and relief efforts involving both governmental and nongovernmental organizations. On November 18, the EOC began receiving unconfirmed reports of storm-related deaths from police, fire, and other first responder agencies. To measure the burden of storm-related mortality, the Erie County Department of Health Medical Examiner's Office worked with local law enforcement, hospitals, and urgent care centers, first responders, funeral homes, and a nursing home to investigate and classify reports. Deaths that were directly caused by environmental forces (e.g., snow or cold) or by the direct consequences of these forces (e.g., structure collapse) were classified as directly storm-related. Deaths that occurred as a consequence of unsafe conditions (e.g., hazardous roads) or a disruption of services (e.g., loss of emergency transport services) caused by the storm were classified as indirectly storm-related (2). Deaths not classified as directly or indirectly storm-related were reported as possibly storm-related deaths.

During November 18–21, a total of 11 storm-related deaths occurred (Table). Decedents ranged in age from 30 to 92 years, (mean = 64 years; median = 60 years), and nine were male. One death, in which a person with hypothermia was found outside the home, was classified as directly storm-related. Nine deaths were indirectly storm-related: four involved shoveling or blowing snow; two carbon monoxide intoxication deaths occurred in stranded vehicles; two persons with acute medical emergencies died because they could not be transported to facilities with appropriate levels of care; and one death occurred during efforts to free a stuck vehicle. One possibly storm-related death occurred following an emergency relocation of nursing home residents. All 11 deaths occurred in areas that received the most snow. The number of deaths attributed to the storm might have been reduced as a result of widespread road closures, driving bans, and implementation of regional emergency response.

Although public health agencies commonly evaluate the impact of natural disasters such as hurricanes, tornadoes, and earthquakes, assessments of the impact of snowstorms are rarely reported (2). Most of the reported deaths that occurred during this storm were potentially preventable and provide an opportunity to reinforce community prevention and preparedness educational messages. Providers caring for persons with heart disease should caution their patients about the risks associated with shoveling snow or performing strenuous work in the cold, which is associated with cardiac-related deaths (3). Drivers should be aware of safety precautions to prevent hypothermia, including keeping extra clothing and blankets in their vehicles. Drivers who become stranded are advised to remain with their vehicles and to run the engine to generate heat for 10 minutes each hour, after checking that the window is slightly open and that snow is not blocking the exhaust pipe, to reduce risk of carbon monoxide poisoning. Stranded travelers should avoid eating unmelted snow because it lowers body temperature (4).

CDC has developed a checklist emphasizing advance preparedness for winter weather emergencies (5). This information can be incorporated into media messages from government agencies to inform and protect the public during extreme winter weather conditions.

1Erie County Department of Health, Buffalo, New York; 2University at Buffalo Department of Family Medicine, Buffalo, New York.

Corresponding author: Gale R. Burstein, gale.burstein@erie.gov, 716-858-6976.

References

1. US Census Bureau. State and county quickfacts. Available at http://quickfacts.census.gov/qfd/states/36/36029.html.
2. CDC. Surveillance of deaths attributed to a Nor'easter—December 1992. MMWR Morb Mortal Wkly Rep 1993;42:4–5.
3. Glass RI, Zack MM. Increase in deaths from ischaemic heart-disease after blizzards. Lancet 1979;1:485–7.
4. CDC. Hypothermia-related deaths—Utah, 2000, and United States, 1979–1998. MMWR Morb Mortal Wkly Rep 2002;51:76–8.
5. CDC. Emergency preparedness and response: winter weather checklists. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. Available at http://www.bt.cdc.gov/disasters/winter/beforestorm/supplylists.asp.