Public Health Implementation of Disaster
Discussion Board Question.
Varney and Hirshon list seven general rationales for providing ED-based public health surveillance.
Surveillance is a critical form of communication for public health officials. Choose a real public health
outbreak, disaster, or crisis. Provide one example of how any of the concepts described in this paper were
actually used to improve public health. Describe the intervention for your classmates. Cite your reference.
10 minutes ago
Syndromic Surveillance - Flu
“Syndromic Surveillance describes a dynamic process in collecting real-time or near real-time data on
symptom clusters suggestive of biological disease outbreak (Update on Public Health Surveillance, 2006).”
The use of syndromic surveillance is to preemptively recognize a cluster of specific symptoms within a
community before definitive diagnosis has been made. This pre-recognition allows for size, spread and tempo
of an outbreak before it has occurred, allowing for faster response to mitigate the outcomes. The use of
syndromic surveillance was originally focused on bioterrorism. However, using this surveillance technique
and incorporating Emergency department data can greatly affect the surveillance scope for influenza
Traditionally the CDC and WHO would rely on primary care physicians (pcp) or laboratory tests to confirm
and track the seasonal and pandemic influenza cases. This data however limits the data of affected
population, to individuals and families able to afford a pcp and the laboratory tests to confirm. Additionally,
data collected from these sources pose a problem with reporting time, typically open with limited business
hours, results “historically lag one to two weeks behind real-world outbreaks (Katherine M. Hiller, 2013).”
With the rise of underinsured or uninsured individuals and families accessing the ED as acute care facilities.
ED’s are open 24/7 365, allowing for more accurate real-time results and tracking capabilities. Laboratory
tests and x-rays are all back within a few hours, allowing for a faster diagnoses and discharge. Additional data
that can be extracted from ED information is the ED volume, LPTMS rates, and ambulance dispatch
information (Katherine M. Hiller, 2013).
Katherine M. Hiller, L. S. (2013). Syndromic Surveillance for Influenza in the Emergency Department–A
Systematic Review. PLOS ONE.
Update on Public Health Surveillance. (2006). Emergency Medicine Clinic of N America. Retrieved from
19 minutes ago
During the 2014 West African Ebola Outbreak, emergency department (ED) -based
public health surveillance was one of the strategies that was used to contain the
epidemic. Initially, before Ebola was declared as an epidemic, surveillance was only
limited to three countries: Liberia, Sierra Leone, and Guinea. However, Integrated
Disease Surveillance and Response (IDSR) became a necessity in documenting the 14
priority conditions and diseases associated with the virus. It led to an improvement in
quality in terms of data analysis, presentation, and collation by the public health
Therefore it is clear that the implementation of ED-basic health surveillance resulted in
improved public health response due Ebola, which was a rapidly developing health
emergency not only in West Africa but also in other countries such as Nigeria, the
United Kingdom, Spain, Mali, Senegal, Italy, and the United States. Surveillance was
made possible by the coordinated response between the Centers for Disease Control
and Prevention(CDC), World Health Organization (WHO), nongovernmental
organizations, and governments. ED-basic health surveillance enabled district- and
national- level staff in the affected countries to identify contacts and cases, as well as
train in-country staff. The staff helped in the delivery of essential public health services.
Therefore, by helping the overwhelmed data, laboratory, public health, and clinical
systems ED-basic health surveillance proved to be effective in improving public health
Chertow, D. S., Kleine, C., Edwards, J. K., Scaini, R., Giuliani, R., & Sprecher, A.
(2014). Ebola virus disease in West Africa—clinical manifestations and management.
New England Journal of Medicine, 371(22), 2054-2057.
Frieden, T. R., & Damon, I. K. (2015). Ebola in West Africa--CDC's Role in Epidemic
Detection, Control, and Prevention. Emerging infectious diseases, 21(11), 1897-905.
1 hour ago
Public health surveillance is a necessary perspective of the health field. It helps to identify the
sectors in health systems that need to develop. Surveillance systems are used to prepare, execute,
and assess public health intervention programs and relay the collected information to decisionmakers. (Varney & Hirshon, 2006). So, one of the most combined methods of improving public
health is the use of health surveillance systems to prevent and manage the outbreak of an
epidemic. There was an outbreak of Ebola, particularly in West African countries. The public
health surveillance systems associated personnel affected to evaluate the spread levels of the
epidemic and suggested significant measures to help mitigate its spread. The reasons for active
surveillance are pointed at assuring response to an emergency and providing consistent support
to contain an epidemic before it spreads and causes adverse public health impacts.
Communication systems help us to discuss the health problem. In excellent communication, it is
simple to recognize the outbreak as early as possible and try measures that help reduce its spread.
For example, the outbreak of Ebola was identified by substantial communication amongst the
health personnel in various nations. They trained to recognize the source of the outbreak, and
communicate with locals in other nations to establish sanctions that bar people from entering the
countries without being screened. Such a measure helped reduce the possible spread as those
affected were confined before they could move to other nations. Moreover, it is through effective
communication that health personnel from other countries managed to organize and work
together towards responding to the outbreak. Acknowledging the fact that it was a public health
emergency, working with health personnel from different countries helped in developing
effective response and control of the epidemic.
McNamara LA, Schafer IJ, Nolen LD, et al. Ebola Surveillance — Guinea, Liberia, and Sierra
Leone. MMWR Suppl 2016;65(Suppl-3):35–43.
Varney, S. M., & Hirshon, J. M. (2006). Update on public health surveillance in emergency
departments. Emergency Medicine Clinics, 24(4), 1035-1052.
1 day ago
Polio Outbreak - W10
Surveillance systems implementation for public health is essential. These systems are used to prepare, execute, and
assess public health intervention programs, relay information to decision-makers, and play an important part in the
early detection of health issues (Varney & Hirshon, 2006). The Center for Disease Control and Prevention offers a
list of current outbreaks in the United States as well as internationally. As of October 2019, there is an alert for the
Polio outbreak in the Philippines, which means that the practice of enhanced precautions is recommended. This
outbreak is caused by vaccine-derived poliovirus (VDPV), a sign of low oral polio vaccine coverage in the country
(Center of Disease Control, 2019). The Philippines declared the outbreak on September 19, 2019, with two cases
confirmed (World Health Organization, 2019).
Data collection is still on-going. The World Health Organization (2019) mentioned the following response actions
from Public Health:
Acute flaccid paralysis (AFP) and environmental surveillance.
Field investigation to define the geographic scope.
Mass immunization campaigns – reinforced recommendation for all children.
WHO, the Global Polio Eradication Initiative (GPEI) and other organizations, are supporting the Department of
Health and local health authorities to investigate and support the efforts to enhance surveillance, strengthen routine
immunization, communicate risk to the public and implement outbreak response.
On May 14, 2019, the Emergency Committee agreed that the risk of international spread of poliovirus remains a
Public Health Emergency of International Concern (PHEIC); countries affected are required to declare the
emergency at a National level. As we can see with this outbreak, some of the rationales mentioned by Varney and
Hirshon (2006) are covered. Improved communication and collaboration for early detection, as well as sharing of
information, is critical locally and internationally to prevent the spread of the virus to those with no immunization,
especially children. Also, alerting travelers of these outbreaks helps to take appropriate actions to reduce the risks of
exposure when traveling from the place of the outbreak and vice-versa. This improves the public health response to
what could become a rapidly developing public health emergency (Varney & Hirshon, 2006). Finally, the
surveillance of this outbreak includes the environmental aspect due to the nature of the virus, improving their ability
to correlate events (Varney & Hirshon, 2006).
Center of Disease Control and Prevention. (2019). Polio in the Philippines. Retrieved from
Varney, S. M., Hirshon, J. M. (2006). Update on public health surveillance in emergency department.
Emergency Medicine Clinics of North America, 24(4), 1035-1052. Doi:10.1016/j.emc.2006.06.004
World Health Organization. (2019). Statement of the twenty-first IHR emergency committee regarding
the international spread of poliovirus. Retrieved from https://www.who.int/news-room/detail/29-052019-statement-of-the-twenty-first-ihr-emergency-committee
1 hour ago
Week 10 discussion
Public health surveillance is an important aspect that gives us a solid idea about the health
system, community health, and disease outbreaks. The surveillance prosses rely on collecting
and analyzing data from multiple resources such as EDs, hospitals admissions, and
pharmaceutical sales (Varney & Hirshon, 2006). Since the EDs count as one of the busiest health
departments, it is essential that the public health department conducts surveillance actions in the
EDs for ensuring the community health and detecting diseases outbreaks.
According to the Varney & Hirshon article, there are seven relations in developing EDbased surveillance. These relations will promote public health and will raise public security in
case of a disease outbreak (Varney & Hirshon, 2006). We will discuss one of these relations,
which applied in the current MERS-CoV outbreak in Saudi Arabia, which is improving the and
evaluation documentation in the ED visits
During the current MERS-CoV outbreak in Saudi Arabia, many things changed in
evaluating and documenting patients who visit the EDs in the country. The patients’ evaluation
method for patients who had any respiratory or flu symptoms used to be making the patient wait
in the waiting area with a face mask on his face if his case is not severe. After the outbreak, any
patient who presents to the ED with respiratory, flu-like symptoms, and/or fever will send to the
respiratory unite for evaluation, which usually outside the ED before he enters the ED (Ministry
of Health, 2015). Besides, a nasal swap will be taken by a healthcare professional when the
patient meets specific criteria (Ministry of Health, 2015).
The Ministry of Health (MOH) in Saudi Arabia named three hospitals to be the MERSCoV treating and specializing centers in the country (MOH, 2014). All these hospitals are
equipped with massive isolation and ICU rooms. The reason for naming these hospitals is to
improve the documentation and tracking of the MERS-CoV information and the outbreak
progress countrywide. Furthermore, the MOH in Saudi Arabia was able to connect ten family
members and a healthcare personal to a secondary MERS-CoV infection due to contacting with
an infected person (WHO,2018). This action shows us how the documentation prosses improved
during this outbreak.
From my personal experience in Saudi Arabia, when we worked with patients who are
suspected to have MERS-CoV, we were obligated to transport the patient to a designated
hospital for case documentation purpose. Also, we were compelled to present for MERS-CoV
unite to be tested as a safety measures ensure our safety.
Varney, S. M., & Hirshon, J. M. (2006). Update on public health surveillance in emergency
departments. Retrieved from https://bblearn.philau.edu/bbcswebdav/courses/19FL-DMM643-1-2-999/Public health surveillance in EDs.pdf.
Ministry of Health. (26 April 2014). Three Medical Centers Allocated for Coronavirus in
Riyadh, Jeddah and the Eastern RegionRetrieved
Ministry of Health. (June 2015). Infection Prevention and Control Guidelines for Middle East
Respiratory Syndrome Coronavirus (MERS-CoV) Infection Retrieved
World Health Organization. (Augest 2018). WHO MERS Global Summary and Assessment of
Risk Retrieved from https://www.who.int/csr/disease/coronavirus_infections/riskassessment-august-2018.pdf
Emerg Med Clin N Am
24 (2006) 1035–1052
Update on Public Health Surveillance
in Emergency Departments
Shawn M. Varney, Lt Col, USAF, MCa,*,
Jon Mark Hirshon, MD, MPHb,c
59 MDW/MCED, 2200 Bergquist Drive, Suite 1, Lackland AFB,
TX 78236-5500, USA
Division of Emergency Medicine, Department of Emergency Medicine
and Department of Epidemiology and Preventive Medicine,
University of Maryland School of Medicine, Baltimore, MD, USA
The Charles McC. Mathias, Jr. National Study Center for Trauma and EMS,
University of Maryland School of Medicine, 701 West Pratt Street,
Fifth Floor, Baltimore, MD 21201, USA
The systematic collection and analysis of health data are important
actions required to help understand the health needs of a population.
When it is done to investigate a problem to contribute to generalizable
knowledge, it is defined as research . If these activities are done
through the collection of health data in an ongoing manner to influence
the health of the public, it can be considered public health surveillance.
Considering that in 2003 there were an estimated 113.9 million emergency
department (ED) visits nationwide , EDs are an ideal location to collect de-identified information on the acute health needs and patterns of
the population of the United States. The systematic collection of data
from multiple EDs can also serve as a barometer of the overall status
of the US health system. While there are a number of logistical and infrastructural barriers that can impede the development of surveillance
systems, the potential benefits from these systems are significant. The
ability to analyze data; distribute results; and influence policy, funding,
and patients’ behavior are important outgrowths of public health surveillance in emergency departments.
* Corresponding author. Department of Emergency Medicine, 59 MDW/MCED, 2200
Bergquist Drive, Suite 1, Lackland AFB, TX 78236-5500.
E-mail address: firstname.lastname@example.org (S.M. Varney).
0733-8627/06/$ - see front matter ! 2006 Elsevier Inc. All rights reserved.
VARNEY & HIRSHON
What is public health surveillance?
Definition of surveillance
The Centers for Disease Control and Prevention (CDC) has defined public health surveillance as ‘‘the ongoing systematic collection, analysis and
interpretation of health data essential to the planning, implementation
and evaluation of public health practices, closely integrated with the timely
dissemination of these data to those who need to know. The final link in the
surveillance chain is the application of these data to prevention and control’’
. Surveillance systems are used to prepare, execute, and assess public
health intervention programs and relay the acquired information to decision
makers. In the present age of heightened security awareness and threats of
bioterrorism, surveillance systems play an additional role in the early detection of health use anomalies. Through the rapid recognition of multiple
patients with similar symptoms suggestive of an atypical or biologic agent,
alerts are triggered so that public health professionals are notified of a potential threat.
Surveillance system components
Surveillance systems may range from rudimentary to complexdie, from
manual collection and documentation on sheets of paper to automated realtime data delivery. The steps required for a public health surveillance system
include data acquisition on a periodic and ongoing basis, timely data collation and analysis, and the application of these data by the proper public
health professionals. The basic components of a surveillance system include
equipment, personnel, and the required resources for the personnel to
analyze the data, communicate promptly and eﬀectively, and maintain the
The ability to amass and analyze large amounts of information has markedly improved with the advent of current computer technology. Therefore,
essential equipment for an ED-based public health surveillance system now
includes a robust computerized database system with appropriate Internet
and networking capabilities, along with sophisticated software to analyze
data for areas of interest. The potential applications of data and the requirements for interoperability with collaborators, such as regional, state, or
national systems, dictate the necessary degree of complexity.
Fundamental personnel consist of individuals responsible for (1) data collection, (2) information analysis, and (3) timely response to material collected. Thus, many partners are involved, including health care providers
in physicians’ oﬃces and EDs and public health professionals in local, state,
and federal agencies, as well as laboratory workers, researchers, academicians, and information technology (IT) experts. The ability to maintain multidirectional communication flow among these team members is critical for
a functional system.
UPDATE ON PUBLIC HEALTH SURVEILLANCE IN THE ED
Required additional resources include financial, institutional, and IT
(encompassing communication, data management, and data analysis). To
be eﬀective, surveillance system development requires full endorsement
and involvement from interested public health, political, and private leaders
in many fields. Data sources may include standardized clinical databases
from hospitals, doctors’ oﬃces, EDs, pharmacies, telephone health lines,
and others. The integration of these databases into a cohesive system
requires significant time and eﬀort to garner support of critical partners
and to make the system fully operational.
Definition of syndromic surveillance
Syndromic surveillance describes a dynamic process of collecting real-time
or near real-time data on symptom clusters suggestive of a biological disease
outbreak. Ideally, these diseases will be detected early in the processdbefore
the definitive diagnosisdto enable a rapid response and mitigate adverse
outcomes [4,5]. Syndromic surveillance systems have secondary objectives
including determining the size, spread, and tempo of an outbreak, or even
providing reassurance that an outbreak has not occurred .
Initially, syndromic su ...
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