摘要：Disaster epidemiology (i.e., applied epidemiology in disaster settings) presents a source of reliable and actionable information for decision-makers and stakeholders in the disaster management cycle. However, epidemiological methods have yet to be routinely integrated into disaster response and fully communicated to response leaders. We present a framework consisting of rapid needs assessments, health surveillance, tracking and registries, and epidemiological investigations, including risk factor and health outcome studies and evaluation of interventions, which can be practiced throughout the cycle. Applying each method can result in actionable information for planners and decision-makers responsible for preparedness, response, and recovery. Disaster epidemiology, once integrated into the disaster management cycle, can provide the evidence base to inform and enhance response capability within the public health infrastructure. The public health role of preparing for and responding to emergencies has expanded in the face of massive impacts from recent disasters. The application of epidemiology in disaster settings, also known as disaster epidemiology, can provide actionable information for use by policymakers, planners, incident commanders, decision-makers, and affected community members ( Box 1 ). Although disaster epidemiology may date to the 1970s, descriptions of the role of the epidemiologist in disaster response to the 1980s, and overviews of epidemiological methods in public health and disaster response to the 1990s, systematic use of the term “disaster epidemiology” has helped to establish the discipline as a formal subset of epidemiology and to spur its application today. 4–9 Key Disaster Epidemiology Terms Epidemiology: The foundational science of public health, epidemiology is the study of the distribution and determinants of illness, injury, disability, and death in specified populations and the application of this study to minimize these outcomes. “Distribution” refers to analysis by time, place, and classes of persons affected. “Determinants” are the physical, biological, social, cultural, and behavioral factors that influence health. Epidemiological methods: Scientific approaches used in the practice of epidemiology, including surveillance, observation, hypothesis testing, analysis, and studies. Applied epidemiology: The application of epidemiological methods to characterize the nature and dynamics of the health consequences of an event. The information generated by applied epidemiology can directly inform decision-making on the behavioral, clinical, and environmental actions that can mitigate illness, injury, disability, and death in a disaster setting. Disaster: A defined event in space and time that threatens human health and exceeds the local capacity to respond, calling for outside assistance. A disaster is generally classified as a naturally occurring meteorological, geological, or biological event, or a manmade (unintentional or deliberate) event with mass casualty potential caused by biological, chemical, radiological, or nuclear forces, or by transportation incidents, engineering failure, or civil conflict. Disaster epidemiology: The practice of applied epidemiology during a disaster to generate scientifically sound information about the health effects of the disaster and to inform decisions about resource allocation and other mitigating actions. Public health surveillance: The systematic collection, analysis, and interpretation of deaths, injuries, illnesses, and exposures to provide actionable information about any adverse health effects related to a disaster event in a community. It allows us to assess the human health impacts of a disaster and evaluate potential problems related to planning and prevention. Environmental monitoring: The collection of environmental hazard data that can be linked to exposure and health effects in people affected by the disaster. Registries: Databases that allow for the longitudinal observation of exposed persons after a disaster event to identify medium- to long-term health consequences of the disaster. Registries inform the need for ongoing care or public health measures as well as developing health education and disease prevention measures. Open in a separate window Source. Last, 1 Gunn, 2 and Lechat. 3 Specifically, disaster epidemiology encompasses rapid needs assessment, surveillance, tracking, research, and evaluation, executed in response to a large-scale emergency or disaster. 2,3 These activities assist decision-makers by providing situational awareness for characterizing an incident’s immediate effects on human health, short- and long-term consequences, and impacts of targeted actions and interventions. For example, information generated by public health surveillance is useful for describing the types and severity of postdisaster injuries and illnesses and causes of mortality. Surveillance systems may rapidly detect outbreaks or clusters of illness in shelters for displaced populations or in base camps housing response workers. Epidemiological methods are used for measuring disaster-related impacts on affected populations and demands on health care delivery systems, as well as evaluating the effectiveness of health interventions and disease control efforts after an event. Evaluation of a response can also improve future public health preparedness planning. Disaster epidemiology provides a systematic and robust mechanism to gather accurate data to inform emergency responders.
