Determining Cause of Death during Disaster Events Using Electronic Death Registration Systems

BACKGROUND: Accurate and timely death reporting is critical to guide disaster response efforts. Determining disaster-relatedness of a death is hindered by the lack of guidelines for determining and reporting disaster-relatedness on death certificates. Though Electronic Death Registration Systems (ERDS) improve timeliness and quality of death certificate data, initial investigations suggest that currently most existing EDRS cannot identify disaster-related deaths. We proposed a framework for enhancing existing EDRS to categorize disaster-related deaths accurately during and after a disaster.  

METHODS: A working group, comprised of federal agencies, state and local agencies, and medical examiners and coroners (ME/C) associations, was established to develop a framework for adapting EDRS for disasters. The data quality of death certificates and EDRS usage during prior disaster responses were discussed. Key priorities were to define disaster-relatedness and prepare guidance documents for EDRS developers and death certifiers. Enhanced EDRS would ideally capture direct and indirect disaster-related deaths and aid in gathering preliminary death counts prior to ICD coding of the death certificate. Bimonthly teleconferences and webinars to engage stakeholders are ongoing.

RESULTS: As of November 2014, 41/57 (72%) of vital records jurisdictions have an EDRS, although system usage varies. Using lessons learned from recent mass fatality disasters, such as the tornado outbreak in Alabama in 2011, Hurricane Sandy in New York City and New Jersey in 2012, and the tornado events in Oklahoma in 2013, we identified two priorities for improvement: the lack of consensus disaster-relatedness definitions and the need for guidance to death certifiers on how and where to document disaster-relatedness on death certificates. Advantages of EDRS include the ability to create flags and messages to remind certifiers to report disaster-relatedness, to rapidly file and certify death certificates, to access preliminary data during an event, and to share data promptly among states and federal agencies involved in response activities.

CONCLUSIONS: The framework has improved disaster-related mortality surveillance by identifying key gaps to be addressed. By the conference, we will establish guidelines for classifying disaster related deaths, consider disaster-related flags in EDRS to be used during disasters, and develop guidelines to aid death certifiers during and after a disaster. We anticipate developing a curriculum for certifiers based on these developments, which will increase the capacity of states to leverage EDRS for disaster mortality surveillance.