CDC Disease Detective Helps Set Up Surveillance System in New York in Critical Hours Following September 11 Attacks

As an orthopedic surgeon, Dr. Sandra I. Berrios-Torres has dealt with plenty of emergency situations. But, the Puerto Rican native and current CDC disease detective found her skills as a public health professional tested on September 11 when she was one of the first two EIS officers, or disease detectives, deployed to New York City.

On the afternoon of September 11, 2001 the CDC team departed for New York City, in the only non-military aircraft in U.S. airspace at that time. There was a moment of tension when they approached the Washington, D.C. area.

"We could see two black dots in the distance heading toward us. We were relieved to finally realize they were fighter jets escorting us over the Washington, D.C. airspace," Berrios-Torres recalled.

Once in New York, Berrios-Torres and her colleagues joined the New York City Department of Health (NYCDOH) teams deployed to area hospitals to assess injuries treated in the ER in the hours immediately following the attacks. Working without benefit of phones, fax or Internet, the teams spent all night reviewing hundreds of charts and performing data entry to generate a summary report for the New York City Health Commissioner and Mayor to use in the morning press conference.

On Friday, September 14th, her assignment changed. Disaster Medical Assistance Teams (DMAT) had arrived to provide care at Ground Zero. For the next 28 days, Berrios-Torres and fellow EIS field officer Michael Phillips (EIS '00) monitored rescue workers for injuries and illness at the site.

That same afternoon, 34 EIS officers, the largest deployment ever at CDC, arrived in New York City. They assisted in syndromic surveillance – monitoring for symptoms that could indicate a bioteorrorism event – at multiple area hospital emergency rooms around the clock. By that evening, the Rescue Worker Injury/Illness Surveillance System was established at four area emergency departments and at Ground Zero. Berrios-Torres worked with the health department team every morning collecting the forms at Ground Zero and returning to the Health Department to assist in data entry and in generating a daily summary report.

The daily, 17-page report was filled with charts of data about the type of visits to these facilities. The information reported was current up to midnight of the previous day. Berrios-Torres explained that the timely collection and reporting of the data helped the health department guide public health interventions for ensuring continued rescue-worker safety, including the distribution and proper use of personal protective equipment such as respirator masks and providing medical equipment to facilitate diagnosis of eye injuries. Information provided by the team helped create a map showing the location of DMAT facilities so that fire, police and construction workers would know where to access health care at the site.

"It's just incredible that we got things done as efficiently and as effectively as we did, considering communication was virtually impossible without phones, fax, or Internet. The commutes were also a challenge, particularly for NYCDOH personnel and those EIS officers stationed in remote emergency departments," Berrios-Torres said.

She added that her experience as a surgeon helped. "I'm familiar with being in a crisis situation, focusing on the task at hand and putting everything else aside," she said.

Berrios-Torres, who remained in New York for 32 days, said the Rescue Worker Injury and Illness Surveillance System was probably the first system of this type to be established prospectively in a disaster situation. She applauded the strong collaborative spirit among the NYCDOH and CDC personnel.

"Teamwork was crucial – that's been one of the most rewarding aspects. Even though I departed on October 13, we continue to work as a team long distance."

Berrios-Torres' surveillance work didn't end in New York. She was deployed to Phoenix, Arizona, on October 26 with fellow EIS officer Maryam Haddad (EIS '01) to assist the Arizona Department of Health Services in establishing syndromic surveillance at hospital emergency departments before the start of the World Series.

"The goal was to implement early syndromic disease detection that could be indicative of a bioterrorist event and in this way facilitate a rapid public health response," she said. The surveillance continued for two weeks after the last game of the World Series.

Soon, Berrios-Torres will use her experience in sports medicine and injury surveillance when she works with the Utah Department of Health, at the XIX Olympic Winter Games in Salt Lake City, where she will assist in injury surveillance.

"We will assess injuries among spectators, athletes and other members of the Olympic family at the Winter Olympics," She said. "The data collected will be analyzed and reported continually to facilitate public health intervention. Lessons learned can be applied to future Winter Olympic events as well as other mass gatherings in winter settings," she said.

Berrios-Torres looks forward to a busy and productive final year as an EIS officer. Her current EIS assignment focuses on a continued collaboration with the NYCDOH on analysis of the Rescue Worker Injury/Illness Surveillance System and studies on injury among United States Hispanics.

"Injuries account for the top three leading causes of death among Hispanics between the ages of 15 and 24," Berrios-Torres said, and is an "under-recognized public health problem."

Berrios-Torres' injury work has extended into Latin America, where in collaboration with CDC Foundation International Fellow Carmen Clavel-Arcas, she helped establish an injury surveillance system in Nicaragua with. It is the first in the Americas to use World Health Organization Guidelines for Injury Surveillance in Less Resourced Environments. The system has since expanded to El Salvador.

Even with her busy schedule, Berrios-Torres will never forget her 32 days serving on the front lines of public health in New York. It was there that she experienced first-hand the impact public health can have on a community.

"The work we did and the timely information we provided to local, state and federal stakeholders was useful not only at the time of the crisis, but also has allowed us to learn valuable lessons that we can apply in future settings," she said.