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ISDS Annual Conference Proceedings 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
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ISDS 2012 Conference Abstracts

When it Rains it Pours: Real-time Situational Awareness
for Two Weather Emergencies in Connecticut
Kristen Soto*, Jaime Krasnitski, Therese Rabatsky-Ehr and Matthew Cartter

Epidemiology, Connecticut Department of Public Health, Hartford, CT, USA

Objective
To characterize the utility of the Connecticut Hospital Emergency

Department Syndromic Surveillance (HEDSS) system for real-time
situational awareness during two weather-related emergencies.

Introduction
On August 28, 2011 Tropical Storm Irene made landfall in Con-

necticut. On October 29, 2011 Connecticut was impacted by Winter
Storm Alfred. Both of these storms included high winds and heavy
precipitation which resulted in prolonged power outages, disruption
of public drinking water systems, property damage, and widespread
debris throughout the state. The HEDSS System was utilized to pro-
vide real-time situational awareness during the response and recov-
ery phases of both storm events.

Methods
The HEDSS System receives electronic patient abstract data from

21 of 32 emergency departments on a daily basis. Free-text chief
complaint data are characterized into syndrome categories. ED visits
for carbon monoxide exposure (CO), gastrointestinal illness (GI), in-
jury, hypothermia, motor vehicle accidents (MVA), and asthma syn-
dromes were monitored throughout the response and recovery periods
of both storm. Odds Ratios were calculated using the two weeks pre-
and post-storm as reference dates. CO visits were further assessed for
geographic and demographic trends to target public health messages.
The HEDSS system was evaluated to make recommendations for
event monitoring during future public health emergencies.

Results
Following both storms there was a high completeness of daily

HEDSS reporting despite extensive power outages (96% post-tropi-
cal storm, 91% post-winter storm). Increased emergency department
utilization for CO (OR: 26.20, 95% CI: 3.57-192.64) was observed
post-tropical storm. Increased emergency department utilization for
CO (OR: 14.61, 95% CI: 7.43-28.72), hypothermia (OR: 17.02, 95%
CI: 3.01-359.30), and asthma (OR: 1.17, 95% CI: 1.05-1.30) were
observed following the winter storm. Regional increases in ED uti-
lization for injuries and MVA were observed following both storm
events; no increase in GI was associated with either storm event. 

During the 2 weeks post-tropical storm 28 cases of CO exposure
were reported through HEDSS and 5 cases through laboratory sur-
veillance; during the winter storm 131 cases were reported through

HEDSS and 162 through reportable disease surveillance. Of the 167
cases reported through laboratory surveillance, 111 (66%) were from
hospitals that sent data to HEDSS hospitals and 94(56%) were able
to be matched to a specific ED record; of these 22(20%) were char-
acterized as visiting the ED for CO syndrome, 13(14%) had symp-
toms consistent with CO as their chief complaint, 11(12%) had
smoke/gasoline inhalation exposures as their chief complaint and
2(2%) had unrelated chief complaints. During the post-storm period
the HEDSS systems detected 137 potential CO exposures that were
not reported through laboratory surveillance.

Conclusions
Tropical Storm Irene and Winter Storm Alfred both had signifi-

cant health impacts, particularly increased ED utilization for CO due
to prolonged power outages. The HEDSS system is the only all-haz-
ards surveillance system that was able to provide near-real time in-
formation during the storm response phase. In addition to the current
CO syndrome definition, where the chief complaint must specifically
mention the term CO, a broader definition should also be used in the
future to better assess the magnitude of CO-related exposures. The
broad definition should include symptomology and related exposures,
such as smoke inhalation, to improve case detection. The HEDSS
system should continue to be used in conjunction with reportable dis-
ease surveillance for situational monitoring during public health
emergencies.

Keywords
emergency department; public health practice; syndromic surveil-
lance; carbon monoxide; weather

Acknowledgments

Patricia Przysiecki, MPH; Brian Toal, MSPH

References

1.Witt Associates. Connecticut October 2011 Snowstorm Power Restora-
tion Report. December 21, 2011.http://www.wittassociates.com/as-
sets/860/CTPowerRestorationReport20111201_FINAL_1_.pdf

*Kristen Soto
E-mail: kristen.soto@ct.gov

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e97, 2013