May 24th, 2013
posted by Paul Rega, MD, FACEP May 24, 2013 @ 12:44 am
http://www.noaanews.noaa.gov/stories2013/20130523_hurricaneoutlook_atlantic.html
NOAA predicts active 2013 Atlantic hurricane season
Era of high activity for Atlantic hurricanes continues
May 23, 2013
Hurricane Sandy as seen from NOAA’s GOES-13 satellite on October 28, 2012.
(Credit:NOAA/NASA)
In its 2013 Atlantic hurricane season outlook issued today, NOAA’s Climate Prediction Center is forecasting an active or extremely active season this year.
For the six-month hurricane season, which begins June 1, NOAA’s Atlantic Hurricane Season Outlook says there is a 70 percent likelihood of 13 to 20 named storms (winds of 39 mph or higher), of which 7 to 11 could become hurricanes (winds of 74 mph or higher), including 3 to 6 major hurricanes (Category 3, 4 or 5; winds of 111 mph or higher).
These ranges are well above the seasonal average of 12 named storms, 6 hurricanes and 3 major hurricanes.
“With the devastation of Sandy fresh in our minds, and another active season predicted, everyone at NOAA is committed to providing life-saving forecasts in the face of these storms and ensuring that Americans are prepared and ready ahead of time.” said Kathryn Sullivan, Ph.D., NOAA acting administrator. “As we saw first-hand with Sandy, it’s important to remember that tropical storm and hurricane impacts are not limited to the coastline. Strong winds, torrential rain, flooding, and tornadoes often threaten inland areas far from where the storm first makes landfall.”
Three climate factors that strongly control Atlantic hurricane activity are expected to come together to produce an active or extremely active 2013 hurricane season. These are:
- A continuation of the atmospheric climate pattern, which includes a strong west African monsoon, that is responsible for the ongoing era of high activity for Atlantic hurricanes that began in 1995;
- Warmer-than-average water temperatures in the tropical Atlantic Ocean and Caribbean Sea; and
- El Niño is not expected to develop and suppress hurricane formation.
“This year, oceanic and atmospheric conditions in the Atlantic basin are expected to produce more and stronger hurricanes,” said Gerry Bell, Ph.D., lead seasonal hurricane forecaster with NOAA’s Climate Prediction Center. “These conditions include weaker wind shear, warmer Atlantic waters and conducive winds patterns coming from Africa.”
NOAA’s seasonal hurricane outlook is not a hurricane landfall forecast; it does not predict how many storms will hit land or where a storm will strike. Forecasts for individual storms and their impacts will be provided throughout the season by NOAA’s National Hurricane Center.
New for this hurricane season are improvements to forecast models, data gathering, and the National Hurricane Center communication procedure for post-tropical cyclones. In July, NOAA plans to bring online a new supercomputer that will run an upgraded Hurricane Weather Research and Forecasting (HWRF) model that provides significantly enhanced depiction of storm structure and improved storm intensity forecast guidance.
Also this year, Doppler radar data will be transmitted in real time from NOAA’s Hurricane Hunter aircraft. This will help forecasters better analyze rapidly evolving storm conditions, and these data could further improve the HWRF model forecasts by 10 to 15 percent.
The National Weather Service has also made changes to allow for hurricane warnings to remain in effect, or to be newly issued, for storms like Sandy that have become post-tropical. This flexibility allows forecasters to provide a continuous flow of forecast and warning information for evolving or continuing threats.
“The start of hurricane season is a reminder that our families, businesses and communities need to be ready for the next big storm,” said Joe Nimmich, FEMA associate administrator for Response and Recovery. “Preparedness today can make a big difference down the line, so update your family emergency plan and make sure your emergency kit is stocked. Learn more about how you can prepare for hurricane season at www.ready.gov/hurricanes.”
Next week, May 26 – June 1, is National Hurricane Preparedness Week. To help those living in hurricane-prone areas prepare, NOAA is offering hurricane preparedness tips, along with video and audio public service announcements in both English and Spanish, featuring NOAA hurricane experts and the FEMA administrator at www.nhc.noaa.gov/prepare/.
NOAA’s outlook for the Eastern Pacific basin is for a below-normal hurricane season and the Central Pacific basin is also expected to have a below-normal season. NOAA will issue an updated outlook for the Atlantic hurricane season in early August, just prior to the historical peak of the season.
NOAA’s mission is to understand and predict changes in the Earth’s environment, from the depths of the ocean to the surface of the sun, and to conserve and manage our coastal and marine resources. Join us on Facebook, Twitter and our other social media channels.
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CHILDREN SEPARATED BY DISASTERS
Following Hurricane Katrina, the National Center for Missing and Exploited Children (NCMEC) was named the lead agency for child reunification during disasters in the Post Katrina Emergency Management Reform Act. NCMEC can offer technical assistance to emergency management and law enforcement agencies, disaster relief organizations, social services agencies, and the faith-based community to manage the daunting task of reunifying children who have been separated from their parents or guardians due to a disaster. With a multitude of resources and a network of partnerships, NCMEC can help to alleviate the burden on these agencies to field, assess, and investigate the multitude of phone calls and inquiries that would inevitably take up large amounts of time, energy, and resources in the midst of a disaster.
Working in collaboration with FEMA, NCMEC has developed the Unaccompanied Minors Registry (UMR) which is a free, online data collection tool – the first of its kind – that makes the swift reunification of children a top priority by creating a central location to share, store, and retrieve information on children separated as a result of a disaster. Utilizing the UMR tool is a key part to a best-practice approach to reunification outlined and endorsed by reunification leaders in the forthcoming publication titled, “2013 Post-Disaster Reunification of Children: A Nationwide Approach.”
For more information about:
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UMR: contact Sharon Hawa, Program Manager of Emergency Communications at NCMEC at 703-837-6269 or shawa@ncmec.org.
Source: Sharon Hawa, Program Manager of Emergency Communications at NMEC, http://www.missingkids.com/home.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6220a1.htm?s_cid=mm6220a1_e
Deaths Associated with Hurricane Sandy — October–November 2012
Weekly
May 24, 2013 / 62(20);393-397
On October 29, 2012, Hurricane Sandy* hit the northeastern U.S. coastline. Sandy’s tropical storm winds stretched over 900 miles (1,440 km), causing storm surges and destruction over a larger area than that affected by hurricanes with more intensity but narrower paths. Based on storm surge predictions, mandatory evacuations were ordered on October 28, including for New York City’s Evacuation Zone A, the coastal zone at risk for flooding from any hurricane (1). By October 31, the region had 6–12 inches (15–30 cm) of precipitation, 7–8 million customers without power, approximately 20,000 persons in shelters, and news reports of numerous fatalities (Robert Neurath, CDC, personal communication, 2013). To characterize deaths related to Sandy, CDC analyzed data on 117 hurricane-related deaths captured by American Red Cross (Red Cross) mortality tracking during October 28–November 30, 2012. This report describes the results of that analysis, which found drowning was the most common cause of death related to Sandy, and 45% of drowning deaths occurred in flooded homes in Evacuation Zone A. Drowning is a leading cause of hurricane death but is preventable with advance warning systems and evacuation plans. Emergency plans should ensure that persons receive and comprehend evacuation messages and have the necessary resources to comply with them.
Red Cross tracks deaths during disasters to provide services to surviving family members, including crisis counseling, assistance with disaster-related expenses, locating emergency housing, identifying recovery resources, and addressing disaster-related health needs. Red Cross volunteers search for reports of disaster-related deaths from sources such as funeral home directors, the Federal Emergency Management Agency (FEMA), hospitals, and news reports. Volunteers then obtain information about these deaths from sources including the medical examiner/coroner, physician, fire department/police, and family of the decedent (2).
Deaths included in this analysis were any Sandy-related death recorded on a Red Cross mortality form with a date of death up to November 30, 2012. Mortality forms included the decedent’s age, sex, race (white, black, Asian, other, or unknown), and date and location of death. Disaster-related deaths were categorized as direct or indirect. Directly related deaths are deaths caused by the environmental force of the disaster (e.g., wind or flood) or by the direct consequences of these forces (e.g., structural collapse). Indirectly related deaths are defined as deaths occurring in a situation in which the disaster led to unsafe conditions (e.g., hazardous roads) or caused a loss or disruption of usual services that contributed to the death (e.g., loss of electrical services) (2). Deaths without direct or indirect classification were reported as unknown or possibly related deaths. Daily counts of direct, indirect, and unknown/possibly related deaths were calculated based on the dates of each death. The characteristics of drowning deaths were compared with all deaths using chi-square tests of trend and t-tests. Home addresses of decedents whose drowning death occurred in the home were examined with respect to FEMA’s hurricane storm surge area (field-verified as of November 11, 2012 [3]) and known, geographically defined areas under evacuation order (i.e., New York City’s Evacuation Zone A) (1).
A total of 117 deaths were reported on Red Cross mortality forms. The source of information for the mortality forms was a medical examiner/coroner for 94 (80.3%) cases and the family of the decedent for 10 (8.5%) cases (Table). Most deaths occurred in New York (53 [45.3%]) and New Jersey (34 [29.1%]); the other deaths occurred in Pennsylvania, West Virginia, Connecticut, and Maryland. The deaths occurred during October 28–November 29, 2012 (Figure 1). Approximately half of the deaths (60 [51.3%]) occurred on the first 2 days of the storm’s landfall, with a peak of 37 deaths on October 30, 2012.
Decedents ranged in age from 1 to 94 years (mean: 60 years, median: 65 years); 60.7% were male, and 53.8% were white. Of the 117 deaths, 67 (57.3%) were classified as directly related deaths, and 38 (32.5%) were indirectly related to the storm. Of the directly related deaths, the most common mechanism was drowning (40 [59.7%]), followed by trauma from being crushed, cut, or struck (19 [28.4%]). Poisoning was the most common indirectly related cause of death; of the 10 poisonings, nine were caused by carbon monoxide. Most directly related deaths occurred during the first few days of the storm, whereas indirectly related deaths continued from the day before the storm into the middle of November.
Comparing the 40 drowning deaths to all Sandy-related deaths, the age, sex, and race distributions of decedents were similar (Table). The majority of drowning deaths (29 [72.5%]) also occurred in the initial phase of the storm, during October 29–31. Twenty-one (52.5%) drowning deaths occurred in the decedent’s home, and 11 (27.5%) occurred outside; one person drowned in a flooded commercial building lobby, and another person drowned while intentionally swimming off a storm-affected beach. For six deaths, circumstances of the drowning were not available. The location of drowning deaths by state was significantly different (p<0.05) compared with all Sandy-related deaths. The majority of drowning deaths (32 [80.0%]) occurred in New York, whereas deaths in New York accounted for only 27.3% of nondrowning deaths. Twenty decedents drowned in flooded homes in New York, and home addresses for 18 (90.0%) of them were located in Evacuation Zone A (Figure 2); the other two decedents’ homes were in or near areas of flooding and near Evacuation Zone A. Notes written by Red Cross volunteers on these 20 deaths captured decedents’ reasons for not evacuating, such as “afraid of looters,” “thought Hurricane Irene was mild,” and “unable to leave because did not have transportation.”
Editorial Note
The “perfect storm” weather conditions of Hurricane Sandy resulted in extensive damage to infrastructure and large flood zones (4). The direct and indirect impacts of the storm led to challenging, and sometimes deadly, conditions for residents, including prolonged power outages, storm surges, and disrupted services. More than half (51.3%) of deaths from Sandy occurred within the first 2 days of the storm, and the most common cause of death was drowning. Approximately half of the drowning deaths were in flooded homes located in areas that were under mandatory evacuation orders as of October 28, 2012, the day before Sandy’s landfall (1).
Before the 1970s, drowning from wind-driven storm surges was by far the most common cause of hurricane-related death (5). Advances in hurricane warning and evacuation systems have helped to reduce drowning deaths. Since that time, hurricanes have had other leading causes of death, such as trauma for the Florida hurricanes in 2004 and 2005, and carbon monoxide poisoning for Hurricane Ike in 2008 (6,7). However, drowning continues to be an important cause of death, and was the leading cause for Hurricane Katrina (2005) and Sandy (8).
The findings in this report are subject to at least two limitations. First, the number of deaths reported is limited to those captured through Red Cross mortality tracking, which is only activated in areas with a Red Cross Disaster Relief Operation. In an evaluation of Red Cross mortality tracking versus Texas’ active disaster-related mortality surveillance during Hurricane Ike, Red Cross had a sensitivity of 47% (Red Cross cases compared with Texas cases) and positive predictive value of 92% (Red Cross Ike cases compared with all Red Cross cases); thus, the cases presented in this report are likely to be actual cases but are unlikely to include all Sandy-related deaths (2). Media sources have reported 131 fatalities in the United States from the storm (9); Sandy mortality statistics, including death certificates, are pending official release. Second, the specific location of death was only available for decedents who died at home, limiting other geographic comparisons. Additionally, New York City’s Evacuation Zones provided the only geographic data available for identifying areas of evacuation; however, 95% of all drowning deaths at home were in or near these areas.
Hurricane-related drowning deaths in evacuation zones are preventable. A successful evacuation depends on officials providing timely messaging to all affected persons, on persons receiving those messages, and on persons having the capacity, resources, and willingness to evacuate. The penetration of evacuation messages to decedents or their communities was not assessed in this report, but future research should evaluate the effectiveness of the hurricane evacuation orders. Given the inability and unwillingness of some residents to evacuate, additional research is needed to identify barriers and motivators for persons during an evacuation and the effectiveness of interventions designed to assist these persons.
References
- Saul MH. Parts of New York City evacuated for Hurricane Sandy. Wall Street Journal; 2012. Available at http://online.wsj.com/article/SB10001424052970203880704578084701930663668.html
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- Farag NH, Rey A, Noe R, Bayleyegn T, Wood AD, Zane D. Evaluation of the American Red Cross disaster-related mortality surveillance system using Hurricane Ike data—Texas 2008. Disaster Med Public Health Prep 2012; December 7 [Epub ahead of print]
- Federal Emergency Management Agency. FEMA MOTF-Hurricane Sandy impact analysis. Washington, DC: US Department of Homeland Security, Federal Emergency Management Agency; 2012. Available at http://fema.maps.arcgis.com/home/webmap/viewer.html?webmap=307dd522499d4a44a33d7296a5da5ea0.
- Federal Emergency Management Agency. Hurricane Sandy: timeline; 2012. Washington, DC: US Department of Homeland Security, Federal Emergency Management Agency; 2012. Available at http://www.fema.gov/hurricane-sandy-timeline.
- National Oceanic and Atmospheric Administration. Hurricanes and tropical meteorology. Washington, DC: US Department of Commerce, National Oceanic and Atmospheric Administration; 2000. Available at http://www.aoml.noaa.gov/general/WWW000/nhurr00.html#imp2.
- Ragan P, Schulte J, Nelson SJ, Jones KT. Mortality surveillance: 2004 to 2005 Florida hurricane-related deaths. Am J Forensic Med Pathol 2008;29:148–53.
- Zane DF, Bayleyegn TM, Hellsten J, et al. Tracking deaths related to Hurricane Ike, Texas, 2008. Disaster Med Public Health Prep 2011;5:23–8.
- Brunkard J, Namulanda G, Ratard R. Hurricane Katrina deaths, Louisiana, 2005. Disaster Med Public Health Prep 2008;2:215–23.
- Reuters. Factbox: storm Sandy blamed for at least 132 deaths in U.S., Canada; 2012. Reuters; 2012. Available at http://www.reuters.com/article/2012/11/16/us-storm-sandy-deaths-idusbre8af0zx20121116.
- Fairchild AL, Colgrove J, Jones MM. The challenge of mandatory evacuation: providing for and deciding for. Health Aff (Millwood) 2006;25:958–67.
* Sandy evolved from a Category 3 hurricane in the Caribbean to an intense post-tropical cyclone before landfall in the United States.
Number of reported deaths related to Hurricane Sandy (direct, indirect, and unknown/possibly), by date — Connecticut, Maryland, New Jersey, New York, Pennsylvania, and West Virginia, October 28–November 30, 2012
What is already known on this topic?
Despite advances in hurricane warning and evacuation systems, drowning remains one of the leading causes of hurricane-related deaths.
What is added by this report?
A total of 117 deaths related to Hurricane Sandy were reported via the American Red Cross mortality tracking system. Drowning was the leading cause, accounting for approximately one third of the deaths. More than half (52.5%) of the drowning deaths occurred in the decedent’s home; the majority of these homes were located in New York City’s Evacuation Zone A.
What are the implications for public health practice?
Drowning is a preventable cause of hurricane-related death. Hurricane response plans should ensure that persons receive and comprehend evacuation messages and have the necessary resources to comply with them.
http://www.nytimes.com/2013/05/21/business/half-of-hospital-admissions-from-emergency-rooms.html?_r=0
May 20, 2013
E.R.’s Account for Half of Hospital Admissions, Study Says
“Emergency rooms account for about half of the nation’s hospital admissions and accounted for virtually all of the rise in admissions between 2003 and 2009, according to a study released on Monday.
Although emergency rooms are widely considered expensive places for diagnostic care, physicians are increasingly relying on them to determine whether a patient needs to be hospitalized.
The study’s findings raise important questions about how emergency rooms contribute to high health care costs in the United States and what their role will be in the future as the nation undergoes fundamental changes in health care delivery……………..
The report by the RAND Corporation………..was done for a consortium of emergency medicine physician organizations. RAND, which says it was chosen for its independence, says the sponsors had no say in the report’s findings……”
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