Hurricane Florence and Emergency Room Visits for Medicine Refills, North Carolina, 2018

Hurricane Florence made landfall near Wrightsville Beach, North Carolina, on September 14, 2018, as a Category 1 storm. Parts of eastern North Carolina got 20–30 inches of rain over 80 hours, a record storm surge of 9 to 13 feet, and maximum sustained winds of about 80 miles per hour. Tracking emergency department (ED) visits during a hurricane helps officials decide where to send resources and how to prepare better for the next disaster.

How visits were tracked

North Carolina's syndromic surveillance system, NC DETECT, receives near-real-time data from all 124 civilian emergency departments in the state. Investigators searched it for visits from September 7 to 28, 2018, whose chief complaint or triage notes mentioned "hurricane," "Florence," "flood" or "storm" (excluding "thyroid," to avoid thyroid storm). A visit counted as hurricane-related if it resulted from the storm's forces, such as wind and flooding; from their direct consequences, such as a collapsed structure; from disrupted services; from preparing for or cleaning up after the storm; from storm-related stress or anxiety; or from a need for shelter. Three state epidemiologists reviewed each visit and, by consensus, sorted the hurricane-related ones into injuries, illnesses, medication refills or other.

What they found

The search turned up 850 visits at 59 EDs, of which 443 were hurricane-related: 73 before the storm (September 7–13), 185 during it (September 14–17) and 185 after (September 18–28). The median patient age was 50.

Hurricane-related ED visits by reason, before, during and after Hurricane Florence, North Carolina, September 7–28, 2018. CDC, MMWR.

• Before the storm, 25% of hurricane-related visits were for injuries, 49% for illnesses and 14% for medication refills; the pattern after the storm was similar.
• During the storm, 31% of visits (58) were for medication refills — more than twice as common as before (prevalence ratio 2.3) or after (2.3), even after adjusting for age, sex, race and insurance. Injury and illness visits were similar across all three periods.
• Disrupted services — closed pharmacies, for example — accounted for 40 of the 58 refill visits (69%) during the storm.

Lessons

The state's Department of Public Safety had advised people, before, during and after the storm, to pack prescription medicines in their home emergency kits. Even so, nearly a third of storm-related ED visits during the hurricane were for refills. Messages to the public, health care providers and pharmacists before a hurricane should stress refilling prescriptions to last through the storm. North Carolina law allows insurance coverage for extra refills during a declared state of emergency, and automated pharmacy reminders to refill before a disaster have produced small increases in refills — an approach that might cut refill visits in future disasters.

The keyword query used here could be adapted for CDC's National Syndromic Surveillance Program BioSense Platform and for other states and other kinds of natural disasters, strengthening disaster surveillance nationwide.

Sources

• Tanz LJ, Hoffman MN, Dandeneau D, et al. "Notes from the Field: Hurricane Florence–Related Emergency Department Visits — North Carolina, 2018." MMWR 68(28). CDC.