Integrating Long-Term Surveillance into Disaster Response Planning: Lessons Learned at the Minnesota Department of Health

Key Objectives:
It is necessary to plan early on for long-term surveillance in order to collect critical data that otherwise may be unavailable or lost; this ability for information gathering is crucial to the feasibility of surveillance or research following a large-scale disaster. In Minnesota, we developed a Long-term Surveillance (LTS) annex as part of the state All-Hazard Emergency Response and Recovery Plan. This annex initiates critical planning and protocol development, by chronic disease and injury epidemiologists, necessary for surveillance of health-related outcomes attributed to an emergency event, but occur months or years following the response and recovery period. Examples of events that would be likely to trigger these planning steps are events with recognized population exposure to chemical or physical agents, such as a major chemical spill or radiation release.  A component of this annex is the Rapid Response Roster (RRR), a survey tool that helps establish a roster of persons exposed, or potentially exposed, to chemicals or other harmful agents during catastrophic events. Using the CSTE disaster epidemiology framework, we review lessons learned from integrating long-term surveillance into disaster management planning.

Brief Summary:
Following a review of available survey tools, we developed an electronic, state-specific roster and a hard copy version for use in the field, both ready to be deployed in an emergency. We met with MDH division leads to identify the data elements for collection and for feedback on RRR implementation logistics. A draft of the roster survey and an implementation guide were completed for use in a tabletop exercise. The RRR was incorporated into the radiological tabletop exercise to understand how RRR can be applied to disaster response in a real-world example. To ensure that MDH incident managers consider initiating the LTS annex, information on it was added to the emergency response checklist. This checklist is reviewed immediately following an emergency and will ensure that consideration of long term surveillance is not overlooked. We increased the awareness of MDH incident response managers by introducing the LTS annex and adding the activation of the annex as an option on the emergency response checklist. We report on evaluation outcomes from including the RRR in the radiological tabletop exercise. We identify recommendations and barriers to implementation of the annex and the RRR, which include funding and survey software limitations.  By effectively including long-term surveillance into emergency planning, we can address the lack of early planning for long-term surveillance data needs.