A Framework for Assessing Mortality and Morbidity After Large-Scale Disasters (2020) / Chapter Skim
Currently Skimming:
5 Meeting the Mission
5 Meeting the Mission
Pages 161-184
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From page 161... ...
Conversely, failure to capture mortality and significant morbidity data accurately and comprehensively undercuts the nation's capacity and moral obligation to proactively protect its population and acknowledge human suffering in a fair and consistent manner. Additionally, the increasing frequency and intensity of disasters underscores the financial imperative to reduce the direct and indirect costs of disaster by deploying data-guided mitigation and response practices informed by historical and prospective models of mortality and morbidity data.
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From page 162... ...
Individual counts, which estimate the total number of reported cases at an individual level and attribute the degree of relationship to the disaster for each, and population estimates, which apply statistical methods such as excess death to estimate the disaster impact at a population level, are the two main approaches for estimating mortality and morbidity. As discussed in Chapter 2 and in the subsequent chapters, each approach to assessment has unique benefits, weaknesses, and contexts for application.
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From page 163... ...
These recommendations couple short-term actions, which can be undertaken immediately for rapid impact, with long-term priorities, which are geared toward investments in the capacity and capability of the nation to capture, track, and use mortality and morbidity data to inform disaster management and save lives. Recommended immediate actions needed to address current gaps in policy, practice, and infrastructure for mortality and morbidity assessment include BOX 5-1 Foundational Challenges to the Assessment of Mortality and Morbidity Following Large-Scale Disasters • Pervasive variation across the nation in data collection and recording and reporting practices for mortality and significant morbidity at the state, local, tribal, and territorial (SLTT)
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From page 164... ...
3. Update of the Model State Vital Statistics Act and Regulations to facilitate more robust and uniform mortality data collection across the nation (Recommendation 3-2)
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From page 165... ...
These precepts prioritize access to detailed data to support mortality and morbidity attribution for all cases; real-time availability of data; interoperable data systems; functional tools to aid decision making using mortality and morbidity data; access to training and professional support; and universal stakeholder buy-in, among others. CONCLUSIONS AND RECOMMENDATIONS2 Organizational Leadership and an Enterprise Approach Critical to the success of the recommendations presented in this report is that the coordination of these disparate yet essential changes across multiple systems cannot be the responsibility of any one entity.
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From page 166... ...
Leverage morbidity data as well as mortality data to support response, recovery, mitiga tion, and preparedness Focusing exclusively on disaster-related mortality -- the traditional outcome of interest -- is shortsighted. Using morbidity data -- both during the crisis and in the inter disaster period -- to evaluate and guide disaster management efforts provides greater opportunities for reducing future mortality outcomes and increasing the resilience of the community.
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From page 167... ...
Adopt an enterprise approach to activate stakeholders and systems in times of crisis as well as during the inter-disaster period Effectively collecting and using mortality and morbidity data requires collaboration across the disparate institutions and organizations that are directly and indirectly involved in disaster response, recovery, mitigation, and preparedness. An enterprise approach across the disaster management enterprise would unite stakeholders under common goals and mitigate the complexity of operationalizing improved practices and methods.
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From page 168... ...
Conclusion 2-1: Current terminology and case definitions used to de scribe disaster-related mortality and morbidity fail to capture the dif ferences in assessment methods used and the totality and temporality of disaster-related deaths and significant morbidity. The lack of a uniform framework for assessing disaster-related health impacts undermines the quality and usability of these data in informing disaster management.
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From page 169... ...
entities; public health agencies; and death investiga tion and registration systems. To implement this uniform framework nationally, the National Center for Health Statistics in conjunction with state and local vital records offices, medical examiners and coroners, medical certifiers, and all relevant professional associations should jointly adopt and apply this framework to practice, including the rou tine use of uniform case definitions and data collection, recording, and reporting practices.
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Recommendation 2-2: Report Both Individual Counts and Population Estimates Both individual counts and population estimates should be used as accepted standards for reporting by state, local, tribal, and territorial entities and supported by the federal agencies as indicators of mor tality and morbidity to determine the impact of disasters over time. State and federal reporting of total mortality and morbidity estimates following disasters should use both individual counts of direct and indirect deaths and population estimates of mortality and morbidity as these data become available following a disaster.
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From page 171... ...
Conclusion 3-1: The heterogeneity of the nation's systems of death investigation and registration prevents the accurate recording and re porting of disaster-related mortality data and impedes the meaning ful analysis and use of these data to improve disaster management. Adoption of uniform practices for collecting, recording, and reporting mortality data is needed, as is improved vertical coordination across stakeholders and improved interoperability of electronic systems among medical certifiers, state vital records offices, and the national vital sta tistics system.
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From page 172... ...
In the case of individual-level mortality assessment, the committee feels strongly that these changes are unlikely to be achieved through mere modifications to the death certificate, which is a legal document that is legislated by each individual state. Instead, the committee recommends that the National Vital Statistics System should directly initiate the introduction of minimum data requirements by updating the Model State Vital Statistics Act to require medical certifiers to supply certain types of descriptive data to improve the attribution of a death to a particular disaster (see Chapter 3)
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From page 173... ...
, should lead an enterprise-wide initiative to strengthen existing death registration sys tems to improve the quality of disaster-related mortality data at state, local, tribal, and territorial levels. These efforts should prioritize the standardization of methods for data reporting and recording and to improve the capacity of death investigation and registration systems to capture more detail on contributing causes of death following disasters.
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From page 174... ...
To promote uniformity in definitions and practices for collecting and recording disaster-related mortality data and enhance the quality and comparability of these data, NCHS should revise the Model State Vital Statistics Act to provide clear guidance and data stan dards to state vital records offices and medical certifiers. These changes should include the use of automated flags, prompts, and drop-down options to collect data on the relationship of a death to a recent disaster and provide decision-making support for medical certifiers.
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From page 175... ...
making it difficult, but not impossible, to standardize policies and practices for data collection for reported cases of morbidities. Despite this variation, past research into disaster-related morbidity suggests that key morbidities may exist across common types of disasters and further suggests that these morbidities could be used to define a standard set of data that could be tracked to inform disaster management policy and practice.
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From page 176... ...
caution in advancing any particular measure or method as the single perfect solution. Developing an effective data and information structure for studying disaster impacts on mortality and morbidity should be a cornerstone of the nation's operational disaster response function.
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From page 177... ...
Recommendation 4-1: Fund and Conduct Research on Analytical Methods for Population Estimates The Centers for Disease Control and Prevention, the National Institutes of Health, and the National Science Foundation should es tablish a national research program to advance analytical methods for conducting population-level estimates of mortality and morbidity related to disasters. This national research program should include the development and refinement of minimum standard methods and pro tocols for conducting population-level mortality and morbidity assess ments as well as the creation and testing of tools for use by researchers, states, and localities to enhance their capabilities to carry out and use these analyses.
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From page 178... ...
Access to and Use of Mortality and Morbidity Data The committee strongly believes that the collection of mortality and morbidity data should be founded on the intention to use those data for the protection of human life and, in particular, that the data should be used in a manner that supports the resilience of vulnerable populations. Because disaster-related mortality and morbidity data are not yet systematically used in disaster management by SLTT entities, significant opportunity exists to formalize the use of mortality and morbidity data as an essential component
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From page 179... ...
For example, certain contextualizing data delivered alongside morbidity data could provide critical information about the characteristics of a specific zip code and lead to enhanced responses through more targeted public health interventions that raw individual counts of morbidity would be unable to provide alone. Research priorities include the initiation of pilot projects with evaluative components, cost-effectiveness research to secure the support of policy makers, and implementation research to evaluate the function of data systems and practices for using individual- and populationlevel mortality and morbidity data.
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From page 180... ...
should code and automatically provide, with the assistance of FEMA and ASPR, location-specific, baseline mortality data and up-to-date data on disaster deaths following a declared disaster and upon request, as well as offer ready to-use tools within a set time frame following disasters to states and localities. o NCHS should make available to researchers and SLTT investigators the mortality data from the National Death Index.
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From page 181... ...
As with mortality data, data-sharing challenges and the lack of interoperability of data systems at all levels remain substantial barriers to the use of morbidity data. Opportunities exist to use existing federal systems, such as CMS data systems, to collect valuable morbidity data following emergencies.
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From page 182... ...
Although there is no federal agency responsible for the oversight of these SLTT medicolegal systems, CDC, in collaboration with state vital records offices and professional organizations, is well positioned to serve in this training and support role. The collection and recording of disaster-related mortality data require the medicolegal workforce to value the need for these data and to have the capacity and capability to adopt standardized definitions, practices, and systems.
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From page 183... ...
• To promote more accurate death certification, the above agen cies should incentivize and support the conversion of coro ner systems to regionalized medical examiner systems staffed by forensic pathologists and medicolegal death investigators professionally trained to identify and classify disaster-related deaths per the framework described in Recommendation 2-1. Recommendation 3-5: Strengthen the Role of the Medicolegal Death Investigation and State Death Registration Systems in the Disaster Management Enterprise State, local, tribal, and territorial public health and emergency management departments should integrate the professionals and agen cies from the medicolegal death investigation and death registration systems in all aspects of preparedness and planning.
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