Enabling Rapid and Sustainable Public Health Research During Disasters Summary of a Joint Workshop by the Institute of Medicine and the U.S. Department of Health and Human Services (2015) / Chapter Skim
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3 Health Research Needs and Actions: Lessons from Recent Disasters
3 Health Research Needs and Actions: Lessons from Recent Disasters
Pages 21-40
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This chapter considers the lessons learned from recent disasters regarding health research needs and actions, including examples of strong cohort participation and elements to support rapid funding. Cases explored include the 9/11 terrorist attacks, Hurricane Katrina in 2005, the Deepwater Horizon oil spill in 2010, and Hurricane Sandy in 2012.
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David Prezant, chief medical officer for the Fire Department of New York City (FDNY) , shared his perspectives on research challenges and lessons learned based on his experiences during the World Trade Center (WTC)
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. Because FDNY has been capturing health data, including pulmonary function tests, systematically since 1996, this is the only cohort with pre-9/11 health data, Prezant noted.
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24 ENABLING RESEARCH DURING DISASTERS FIGURE 3-1 The World Trade Center Health Program for the Fire Department of New York. NOTE: DIS = Diagnostic Interview Schedule; EKG = electrocardiogram; MSW = master of social work; PFT = Physical Fitness Test; RN = registered nurse.
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to help secure local buy-in and public labor and management support. If we cannot monitor, assess, provide services, intervene, and reassess, we cannot provide what people need in a disaster, Prezant said.
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For example, blood banked during the first 6 months after 9/11 has been used for studies linking pulmonary function test outcomes to biomarkers that could potentially predict both susceptibility and resistance to disease (Cho et al., 2013; Nolan et al., 2012)
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Questions were designed so that the introductory phrase could be changed with a single-stroke command. In 2000, the phrase was "during your career of firefighting have you ever.…" or "in the last 12 months have you ever.…" Between 9/11/01 and 10/01/01, the phrases were changed to "after the World Trade Center.…" When FDNY was deployed to assist with the Hurricane Katrina response, the phrase was changed to "after Hurricane Katrina.…" The use of validated questionnaires is essential, but they are not as validated as we think, suggested Prezant.
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Katrina had a huge effect on many different systems, including critical infrastructure, health, education, and community systems, said David Abramson, deputy director of the National Center for Disaster Preparedness at Columbia University. Abramson shared his perspectives on engaging in rapid research based on his experiences during and after Hurricane Katrina.
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Researchers were also sure to have pens and hard copies of the survey they were administering. To quicken the time line and mobilize the research infrastructure more rapidly, Abramson used the infrastructure and expertise he already had in place for an HIV longitudinal cohort study happening in the New York City metropolitan area.
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Upon initial submission, the head of Columbia University Medical Center's IRB informed Abramson that his protocol for the Gulf Coast Child and Family Health Study would need to consider additional elements: addressing the vulnerability of the subjects; systematic referral of subjects to care; ability to identify crises as they occur; endorsement from the community or government; the safety, training, and preparation of the field team; and compliance with local "Duty to Report" laws regarding abuse and neglect (which may differ by state)
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Looking back, he realized it should have been more formalized, so for the more recent Hurricane Sandy Child and Family Health Study, he created the Public Partnership Group to make a more formal connection with the state agencies in New Jersey. This group is composed of the health department, children and families, and human services within the state, and has a more formal reporting structure so it will receive the data from the field within weeks to make sure it is actionable for policy and programmatic purposes.
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DEEPWATER HORIZON OIL SPILL Shortly after the Deepwater Horizon oil spill in April 2010, NIH Director Francis Collins pledged $10 million in NIH funding to initiate the Gulf Long-term Follow-up (GuLF) Study, in which NIEHS is conducting research on the health impacts of the spill on workers and volunteers cleaning it up, said Birnbaum of NIEHS.
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NIH was able to fund the extramural consortium within 8 months, but in most cases individual IRB and other necessary approvals added significant time, making it 18 to 20 months from the time of the spill for most of the extramural grantees to begin to recruit for their studies. Following a more nimble NSF model Abramson mentioned, where smaller amounts of money can be disbursed more quickly, could help to address this, as well as streamlining the IRB process so researchers do not have to gather approvals with different requirements.
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She also noted the need to develop better capabilities to rapidly evaluate the toxicity of the exposures. Howard of NIOSH at CDC added that NIOSH has done extensive intramural research on the Deepwater Horizon disaster from the perspective of worker safety, and referred participants to recent articles for further details (Decker et al., 2013a,b; King and Gibbons, 2011; Kitt et al., 2012; Michaels and Howard, 2012; NIOSH, 2011)
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That said, if there is no IRB, no human capital, and no electronic infrastructure following the disaster, then even those stakeholders familiar with the research proposal process will find it difficult to initiate or operationalize a new proposal in the traditional sense, Goldfrank noted. Goldfrank shared several examples of NYU research following Hurricane Sandy to illustrate his points about community.
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and the decision making necessary for the entire health community to function. Response Research Networks Goldfrank supported the calls for the establishment of a broader medical and public health emergency response research network locally and nationally.
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There have been numerous joint preparedness ventures among New York City public, private, and VA hospitals, and university and hospital affiliations move faculty and residents back and forth among hospitals, strengthening intellectual collaboration. The Poison Control Center and the Office of the Chief Medical Examiner are also key collaborators in research.
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The resources and people that local health departments can pool can be beneficial to researchers, and the information that researchers generate can be beneficial to local health departments. Prezant highlighted the need for funding streams for preparedness research and called for data-driven advocacy to establish and maintain credibility of the field after the initial emotional funding response subsides.
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Abramson added that emergency preparedness gives public health the opportunity to partner with emergency management and community-based groups to bring marginalized populations to the table to talk about how disasters affect all of us and begin to empower different elements within the community. Later, when public health wants to engage them in other chronic issues -- smoking, alcohol, nutrition, obesity -- relationships are already built.
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Concluding each section is a compilation of top items relative to the challenges and issues, opportunities for improvement, and critical partnerships and collaborations necessary to advance research response capabilities.
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