Use of Syndromic Surveillance to Provide Situational Awareness During Wildfire and Heat Related Illness: Monitoring of Health and Climate Data for Environmental Exposure and Illness Surveillance

Brief Summary
The Florida Department of Health uses the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) to track illness related to wildfire smoke and excessive heat.  The Florida ESSENCE system provides near-real time access to emergency department (ED) chief complaint data from hospitals throughout the state.  Syndromic surveillance, using the ESSENCE system, has been found to be useful in the early detection of infectious diseases and exposures to hazardous chemicals. During wildfire events or times of excessive heat in Florida, climate data are closely monitored.  For wildfire events, air quality data, specifically, fine particle pollution (PM2.5), from the Florida Department of Environmental Protection and smoke plume imaging maps from the National Oceanic and Atmospheric Administration (NOAA) are monitored.  Syndromic surveillance of respiratory-related illness (i.e., asthma, acute bronchitis, cough, shortness of breath, wheezing, and difficulty breathing sub-syndrome categories) are conducted when the Air Quality Index exceeds 100 (unhealthy air for sensitive populations).  Similarly, NOAAs graphical depiction of high temperatures and apparent temperatures are monitored for excessive heat.  Syndromic surveillance for heat-related illness (e.g., chief complaints of “heat exhaustion”, “heat cramps”, “sunburn”, and “overheated”) is conducted when the heat index exceeds 110 for a particular day.  Other evidences of poor air quality, such as media reports or concerns from the public, are also taken into consideration.  All environmental monitoring and subsequent syndromic surveillance are assessed at the county level.  If county specific data are unavailable, the closest county air monitoring data is used.  Syndromic surveillance in surrounding counties (in wildfire events) is also conducted. ESSENCE has been able to detect increases in ED visits for respiratory-related chief complaints during days when PM2.5 was elevated or when there was a presence of smoke from wildfires.  Similarly, ED visits with heat-related illness chief complaints were increased when the heat index was high.   ESSENCE has been very useful in monitoring ED visits during wildfire events and periods of excessive heat.  Surveillance reports have been distributed and used to inform Incident Command for situational awareness during times of emergency response and to assist with media inquiries.  The background and methods of wildfire- and heat-related syndromic surveillance will be shared and discussed in detail during the roundtable discussion.