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Nonfatal injuries following Hurricane Katrina—New Orleans, Louisiana, 2005

Authors:

Abstract

The Journal of Safety Research has partnered with the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA, to briefly report on some of the latest findings in the research community. This report is the fourth edition in a series of CDC articles. An active injury and illness surveillance system was established by the Centers for Disease Control and Prevention (CDC) along with the Louisiana Department of Health and Hospitals (LDHH) in the aftermath of Hurricane Katrina in functioning hospitals and medical clinics. The surveillance system recorded 7,543 nonfatal injuries among residents and relief workers between September 8-October 14, 2005. The leading mechanisms of injury identified in both groups were fall and cut/stab/pierce, with a greater proportion of residents compared to relief workers injured during the repopulation period. Clean-up was the most common activity at the time of injury for both groups. Injuries documented through this system underscore the need for surveillance of exposed populations to determine the injury burden and initiate injury prevention activities and health communication campaigns.
Special Report from the CDC
Nonfatal injuries following Hurricane Katrina—New Orleans,
Louisiana, 2005
Ernest E. Sullivent III *, Christine A. West, Rebecca S. Noe, Karen E. Thomas,
L.J. David Wallace, Rebecca T. Leeb
Centers for Disease Control and Prevention, Division of Injury Response, 4770 Buford Highway, NE, MS F-41, Atlanta, GA 30341, USA
Received 23 March 2006; accepted 23 March 2006
The Journal of Safety Research has partnered with the National Center for Injury Prevention and Control at the Centers for Disease
Control and Prevention (CDC) in Atlanta, Georgia, USA, to briefly report on some of the latest findings in the research community. This
report is the fourth in a series of CDC articles.
Background: An active injury and illness surveillance system was established by the Centers for Disease Control and Prevention (CDC)
along with the Louisiana Department of Health and Hospitals (LDHH) in the aftermath of Hurricane Katrina in functioning hospitals and
medical clinics. Results: The surveillance system recorded 7,543 nonfatal injuries among residents and relief workers between September 8-
October 14, 2005. The leading mechanisms of injury identified in both groups were fall and cut/stab/pierce, with a greater proportion of residents
compared to relief workers injured during the repopulation period. Clean-up was the most common activity at the time of injury for both groups.
Conclusion: Injuries documented through this system underscore the need for surveillance of exposed populations to determine the injury
burden and initiate injury prevention activities and health communication campaigns.
D2006 National Safety Council and Elsevier Ltd. All rights reserved.
Keywords: Hurricane Katrina; New Orleans; Injury surveillance
1. Background
Hurricane Katrina, a category 3 storm, struck the U.S. Gulf Coast on August 29, 2005. In addition to strong winds and
flooding from the storm surge, New Orleans experienced an unusually difficult post-hurricane recovery period due to the
breaching of the levee systems and the impact of a subsequent storm, Hurricane Rita. These factors resulted in delays in residents
returning to the city and the extended presence of a large number of relief workers. Due to the severe disruption of public health
infrastructure, the Centers for Disease Control and Prevention (CDC) helped the Louisiana Department of Health and Hospitals
(LDHH) establish an active injury and illness surveillance system among functioning hospitals and medical clinics (CDC,
2005a). In the storms’ aftermath, September 8-October 14, 2005, the surveillance system recorded 7,543 nonfatal injuries. This
report describes those injuries and injury prevention efforts carried out in the Greater New Orleans area. To reduce post-disaster
injuries, the public health response to disasters should include injury prevention efforts.
2. Methods
Surveillance data were collected in Greater New Orleans from 8 hospitals and 20 non-hospital acute care medical treatment
facilities, including 6 sites staffed by various disaster medical assistance teams. Data were collected for patient visits from
September 8-October 14, 2005. At most facilities, medical staff completed a one-page form for each visit that included
0022-4375/$ - see front matter D2006 National Safety Council and Elsevier Ltd. All rights reserved.
doi:10.1016/j.jsr.2006.03.001
* Corresponding author. Tel.: +1 770 488 1486; fax: +1 770 488 4338.
E-mail address: ESullivent@cdc.gov (E.E. Sullivent).
Journal of Safety Research 37 (2006) 213 – 217
www.elsevier.com/locate/jsr www.nsc.org
Table 1
Nonfatal injuries following Hurricane Katrina across time/phase and by various characteristics-New Orleans, Louisiana; September 8-October 14, 2005
Characteristic Time/phase Total
Post-Katrina (9/8– 9/19) Rita/post-Rita (9/20– 9/29) Repopulation (9/30– 10/14)
N (%*) N (%) N (%) N (%)
Total 1840 1759 3944 7543
Gender
Male 1232 (67.0) 1050 (59.7) 2354 (59.7) 4636 (61.5)
Female 563 (30.6) 647 (36.8) 1508 (38.2) 2718 (36.0)
Unknown 45 (2.4) 62 (3.5) 82 (2.1) 189 (2.5)
Age group (in years)
0 14 152 (8.3) 195 (11.1) 366 (9.3) 713 (9.5)
15 24 183 (9.9) 225 (12.8) 531 (13.5) 939 (12.4)
25 34 264 (14.3) 243 (13.8) 609 (15.4) 1116 (14.8)
35 44 322 (17.5) 315 (17.9) 750 (19.0) 1387 (18.4)
45 54 322 (17.5) 317 (18.0) 665 (16.9) 1304 (17.3)
55 64 197 (10.7) 159 (9.0) 400 (10.1) 756 (10.0)
65+ 192 (10.4) 193 (11.0) 428 (10.9) 813 (10.8)
Unknown 208 (11.3) 112 (6.4) 195 (4.9) 515 (6.8)
Responder status
Response/relief worker 337 (18.3) 211 (12.0) 449 (11.4) 997 (13.2)
Resident 632 (34.3) 553 (31.4) 1613 (40.9) 2798 (37.1)
Unknown 871 (47.3) 995 (56.6) 1882 (47.7) 3748 (49.7)
Mechanism of injury
Unintentional
Cut/pierce/stab 360 (19.6) 313 (17.8) 837 (21.2) 1510 (20.0)
Fall 320 (17.4) 359 (20.4) 816 (20.7) 1495 (19.8)
Struck by/against/crush 185 (10.1) 197 (11.2) 446 (11.3) 828 (11.0)
Bite/sting 276 (15.0) 140 (8.0) 261 (6.6) 677 (9.0)
Motor vehicle crash 112 (6.1) 125 (7.1) 347 (8.8) 584 (7.7)
Carbon monoxide poisoning 13 (0.7) 3 (0.2) 3 (0.1) 19 (0.3)
Other poisoning/toxic effect 27 (1.5) 15 (0.9) 22 (0.6) 64 (0.8)
Contact hot object/substance 24 (1.3) 25 (1.4) 55 (1.4) 104 (1.4)
Natural heat exposure 11 (0.6) 18 (1.0) 11 (0.3) 40 (0.5)
Smoke/fire exposure 4 (0.2) 0 7 (0.2) 11 (0.1)
Electrical current 2 (0.1) 2 (0.1) 7 (0.2) 11 (0.1)
Drowning/submersion 1 (0.1) 1 (0.1) 2 (0.1) 4 (0.1)
Intentional
Sexual assault 3 (0.2) 1 (0.1) 0 4 (0.1)
Other assault 25 (1.4) 27 (1.5) 63 (1.6) 115 (1.5)
Self-inflicted 4 (0.2) 2 (0.1) 8 (0.2) 14 (0.2)
Other 175 (9.5) 258 (14.7) 585 (14.8) 1018 (13.5)
Unknown 298 (16.2) 273 (15.5) 474 (12.0) 1045 (13.9)
Location
Outside 406 (22.1) 403 (22.9) 1105 (28.0) 1914 (25.4)
Residence
a
338 (18.4) 329 (18.7) 934 (23.7) 1601 (21.2)
Vehicle
b
174 (9.5) 174 (9.9) 413 (10.5) 761 (10.1)
Public/commercial building 75 (4.1) 91 (5.2) 243 (6.2) 409 (5.4)
Boat/watercraft 19 (1.0) 6 (0.3) 12 (0.3) 37 (0.5)
Other 37 (2.0) 71 (4.0) 166 (4.2) 274 (3.6)
Unknown 791 (43.0) 685 (38.9) 1071 (27.2) 2547 (33.8)
Disposition
Discharged 1441 (78.3) 1367 (77.7) 3191 (80.9) 5999 (79.5)
Hospitalized 71 (3.9) 60 (3.4) 139 (3.5) 270 (3.6)
Transferred 58 (3.2) 58 (3.3) 61 (1.5) 177 (2.3)
Left without being seen/AMA
c
45 (2.4) 26 (1.5) 104 (2.6) 175 (2.3)
Unknown 225 (12.2) 248 (14.1) 449 (11.4) 922 (12.2)
a
Includes manufactured, mobile, single-, and multiple-family homes.
b
Includes car, van, pickup truck, and heavy transport vehicle.
c
Against medical advice.
* Percentages might not total 100% due to rounding.
E.E. Sullivent III et al. / Journal of Safety Research 37 (2006) 213– 217214
diagnosis, patient disposition, mechanism of injury, demographic information, and activity and location at time of injury. At
some facilities, CDC personnel abstracted data from medical records. Data from each form were entered manually, analyzed,
and reported daily. Because the surveillance system did not capture all deaths, only nonfatal cases were analyzed. Detailed
descriptions of the surveillance system are available elsewhere (CDC, 2005b, 2005c).
Cases were defined as injury-related if: (a) the reason for the visit was injury, or both injury and illness; (b) the primary
mechanism of injury was identified; or (c) the primary clinical impression was carbon monoxide (CO) poisoning or heat
‘illness’’ (e.g., heatstroke). Cases were divided into three phases by date of visit: (a) post-Katrina, from the first day of
surveillance after Katrina (September 8, 2005) until prior to Hurricane Rita evacuation (September 19, 2005); (b) Rita/post-
Rita, from the first day of Hurricane Rita evacuation (September 20, 2005) until just prior to the return of New Orleans residents
(September 29, 2005); and (c) repopulation, from the first day most of the city was reopened to residents (September 30, 2005)
through the end of active surveillance (October 14, 2005). The surveillance system identified cases as either ‘‘relief worker/
responder’’ (i.e., paid military, paid civilian, self-employed, or volunteer) or ‘‘resident’’ (those who were not relief workers).
3. Results
From September 8-October 14, 2005, visits to medical treatment facilities totaled 26,192. Of these visits, 7,543 (29%) were
injury-related. Those injured were predominantly male, ranging from 67% prior to Hurricane Rita to 60% following
repopulation (Table 1). Those aged 2554 years sustained 50% of injuries, individuals 65 years accounted for 11%, and
children < 15 years comprised 9%. Common mechanisms of injury were cut/pierce/stab (20%), fall (20%), struck by/against/
Table 2
Nonfatal injuries* following Hurricane Katrina by relief worker status and various characteristics-New Orleans, Louisiana; September 8-October 14, 2005
Characteristic Relief worker
a
Yes No
N (%) N (%)
Total 997 2798
Gender
Male 800 (80.2) 1540 (55.0)
Female 151 (15.1) 1218 (43.5)
Unknown 46 (4.6) 40 (1.4)
Age group (in years)
0 – 14 5 (0.5) 427 (15.3)
15 24 176 (17.7) 312 (11.2)
25 34 215 (21.6) 358 (12.8)
35 44 235 (23.6) 425 (15.2)
45 54 138 (13.8) 476 (17.0)
55 – 64 56 (5.6) 309 (11.0)
65+ 18 (1.8) 388 (13.9)
Unknown 154 (15.4) 103 (3.7)
Mechanism of injury
Cut/pierce/stab 189 (19.0) 571 (20.4)
Fall 104 (10.4) 655 (23.4)
Struck by/against/crush 125 (12.5) 316 (11.3)
Bite/sting 129 (12.9) 208 (7.4)
Motor vehicle crash 35 (3.5) 241 (8.6)
Carbon monoxide poisoning 6 (0.6) 4 (0.1)
Other poisoning/toxic effect 20 (2.0) 20 (0.7)
Other 238 (23.9) 480 (17.2)
Unknown 151 (15.1) 303 (10.8)
Activity
b
Cleaning up 185 (18.6) 587 (21.0)
Repairing buildings, etc. 107 (10.7) 125 (4.5)
Operating power tools 26 (2.6) 27 (1.0)
Attempting rescue/recovery 67 (6.7) 13 (0.5)
Evacuating 1 (0.1) 31 (1.1)
Swimming/wading 4 (0.4) 10 (0.4)
Operating power generator 4 (0.4) 5 (0.2)
a
Relief worker status was unknown for 49.7% of injury-related visits.
b
Categories are not mutually exclusive.
*Percentages might not total 100% due to rounding.
E.E. Sullivent III et al. / Journal of Safety Research 37 (2006) 213– 217 215
crush (11%), bite/sting (9%), and motor-vehicle crash (8%). The proportion of motor-vehicle-related injuries increased steadily
from post-Katrina through repopulation, with the greatest proportion occurring during repopulation (9%). For the 992 fall-
related visits that included information about falls, 62 were from ladders, and 45 were from roofs. Overall, only four nonfatal
drowning/submersion incidents occurred. Carbon monoxide poisoning was relatively infrequent (19 incidents), with most CO
poisonings occurring early in the post-Katrina phase. Only 2% (133) of the injury visits were violence-related, with most being
nonsexual assaults. Most common locations at the time of injury were outside (25%), in-residence (21%), and in-vehicle
(10%). The most frequent injury diagnoses were laceration/abrasion (27%), sprain/strain/dislocation (17%), and bruise/
contusion (10%). Fractures accounted for 6% of injury-related visits (results not shown). Among those injured, 4% were
hospitalized, and an additional 2% were transferred to other facilities.
Relief workers/responders made 977 injury-related visits, and residents made 2,798 visits; for 50% of visits, relief worker
status was unknown (Table 2). Eighty percent of the relief workers injured were male, and almost half (45%) were aged 25 – 44
years. Leading mechanisms of injury for relief workers were cut/pierce/stab (19%), bite/sting (13%), struck by/against/crush
(13%), and fall (10%). Injuries to relief workers commonly occurred during cleanup activities (19%), repair work (11%), and
rescue attempts (7%).
The proportion of injuries involving relief workers was greatest post-Katrina, whereas the proportion of injuries to residents
increased during repopulation. A greater proportion of residents than relief workers were injured by falls (23% of residents vs.
10% of relief workers) and motor-vehicle crashes (9% vs. 4%). In contrast, a larger percentage of relief workers than residents
were injured by poisoning/toxic effect (2% vs. 0.7%) and bite/sting (13% vs. 7%). Cleanup was the most common activity at the
time of injury for both groups (19% for relief workers vs. 21% for residents); however, relief workers had a higher percentage of
injuries from making repairs (11% vs. 4%), attempting rescue/recovery (7% vs. 0.5%), and operating power tools (3% vs. 1%).
4. Discussion
Post-hurricane injuries such as electrocutions, CO poisoning, and lacerations have been documented previously (CDC,
1989, 1993, 2005a; U.S. Department of Labor, Occupational Safety and Health Administration [OSHA], 2005), underscoring
the need for surveillance of exposed populations to determine the injury burden and initiate injury prevention activities and
health communication campaigns. Active surveillance in the Greater New Orleans area identified the leading mechanisms of
injury as fall and cut/stab/pierce. Over time, an increasing proportion of injuries were caused by motor-vehicle crashes, and a
greater percentage of injuries were sustained by residents as the city was repopulated.
Injury prevention flyers were developed to address injuries expected during post-hurricane cleanup and identified by the
surveillance system (e.g., chainsaw injuries, motor-vehicle injuries, falls from ladders and roofs, electrocutions from downed
power lines, and CO poisoning from generators or pressure washers). Distribution links were established with the City of New
Orleans Emergency Operations Center (EOC), National Guard, New Orleans Police Department, Federal Emergency
Management Agency disaster assistance sites, Red Cross and Salvation Army centers, churches, clinics, emergency rooms,
health/job fairs, and local retail establishments (e.g., grocery stores, home improvement stores). Additionally, flyers were given
to nine LDHH Regional Injury Prevention Coordinators across Louisiana for distribution. From September 26-October 20,
2005, about 210,000 flyers were disseminated in English, 70,000 in Spanish, and 13,000 in Vietnamese.
Injury prevention messages were communicated through local media. Radio and television interviews were conducted with
CDC staff and the City of New Orleans Health Director. Public service announcements and talking points were developed to
highlight key injury issues (e.g., driving safety, domestic violence, home cleanup safety, and falls from roofs or ladders). When
surveillance revealed an increase in motor-vehicle-related injuries, the LDHH used this information to prioritize removal of
temporary stop signs when traffic lights became operational—thereby decreasing confusion at intersections.
Findings in this report are subject to at least three limitations. First, because an accurate population count for New Orleans
was unavailable during the surveillance period, rate calculations were not possible. Second, in about 50% of injury cases, the
status of relief worker/resident was not reported. Finally, detailed information about the injury circumstances was not
ascertained for most cases, which limited prevention efforts.
5. Recommendations
Injury surveillance and prevention activities are critical during post-hurricane cleanup. To improve injury prevention
response, we recommend:
1. Creating a standardized set of surveillance data elements to quickly and consistently capture the information necessary to
tailor injury prevention messages.
E.E. Sullivent III et al. / Journal of Safety Research 37 (2006) 213– 217216
2. Incorporating injury prevention strategies into the planning stages of deployment activities. Examples of injury prevention
flyers developed by CDC for Hurricane Katrina and other natural disasters are available at http://www.bt.cdc.gov/disasters/
hurricanes/injury.asp,http://www.bt.cdc.gov/disasters/injury.asp, and http://www.cdc.gov/niosh/topics/flood/. Additionally,
activities to evaluate the impact of prevention messages should be considered.
3. Assigning an injury prevention team member to attend local EOC meetings to establish relationships with potential
distribution links and facilitate identification of additional partners throughout post-disaster phases.
4. Collaborating across teams (e.g., Epidemiology/Surveillance, Occupational Health and Safety, Environmental Health,
Mental Health, Health Communications, and Injury Prevention) at the earliest phases to develop clear goals for use of injury
surveillance data and distribution of public health messages to residents and relief workers.
Acknowledgments
This report is based, in part, on the contributions of K. Stephens, MD, City of New Orleans Health Department; R. Ratard,
M. Doshani, S. Kirkconnell, P. Vranken, Louisiana Department of Health and Hospitals; emergency department staff and
infection control practitioners at East Jefferson General Hospital, Kenner Regional Medical Center, Northshore Regional
Medical Center, Ochsner Foundation Hospital, St. Charles Parish Hospital, Touro Infirmary, Tulane-Lakeside Hospital, West
Jefferson Medical Center; other acute care medical facilities; the CDC Greater New Orleans Public Health Support Team; and
Epidemic Intelligence Service Officers.
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Injuries and illness related to Hurricane Andrew-Louisiana, 1992
Centers for Disease Control and Prevention (CDC). (1993). Injuries and illness related to Hurricane Andrew-Louisiana, 1992. MMWR 42, 242 -243, 250 -251.
Carbon monoxide poisoning after Hurricane Katrina-Alabama
Centers for Disease Control and Prevention (CDC). (2005a). Carbon monoxide poisoning after Hurricane Katrina-Alabama, Louisiana, and Mississippi, August-September 2005. MMWR, 54, 996 -998.
Update: injury and illness surveillance following Hurricane Katrina
Centers for Disease Control and Prevention (CDC). (2005c). Update: injury and illness surveillance following Hurricane Katrina, New Orleans, Louisiana, September 25-October 15, 2005. MMWR, 55, 35 -38.