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Surveillance of Morbidity During Wildfires -- Central Florida, 1998

Several large wildfires occurred in Florida during June-July 1998, many involving both rural and urban areas in Brevard, Flagler, Orange, Putnam, Seminole, and Volusia counties (1,2). By July 22, a total of 2277 fires had burned 499,477 acres throughout the state (Florida Department of Community Affairs, unpublished data, 1998). On June 22, after receiving numerous phone calls from persons complaining of respiratory problems attributable to smoke, the Volusia County Health Department issued a public health alert (2) advising persons with pre-existing pulmonary or cardiovascular conditions to avoid outdoor air in the vicinity of the fires. To determine whether certain medical conditions increased in frequency during the wildfires, the Volusia County Health Department and the Florida Department of Health initiated surveillance of selected conditions. This report summarizes the results of this investigation.

The surveillance system monitored the frequency of patient visits associated with selected conditions at seven hospitals in Volusia County and one hospital in Flagler County. The medical records departments of these eight hospitals furnished data about persons seen in the emergency departments (EDs) and/or admitted for the selected conditions during June 1-July 6, 1998. For comparison, the hospitals also provided the same information for June 1-July 6, 1997. Data from the eight hospitals were combined for analysis.

From 1997 to 1998, ED visits increased substantially for asthma (91%), bronchitis with acute exacerbation (132%), and chest pain (37%) (Table_1). ED visits for painful respiration decreased (27%). Changes in the number of admissions were minimal.

Reported by: B Sorensen, MD, M Fuss, Volusia County Health Dept; Z Mulla, MSPH, W Bigler, PhD, S Wiersma, MD, R Hopkins, MD, State Epidemiologist, Florida Dept of Health.

Editorial Note

Editorial Note: In response to the wildfires in Florida, infection-control practitioners and public relations professionals at these local hospitals were used as liaisons between the medical records staff at their respective hospitals and the health department. The data were used to quantify the extent of morbidity possibly related to the wildfires.

The findings in this report are subject to at least two limitations. First, the increase in the frequency of the conditions observed for this report did not necessarily result from the wildfires. Certain persons who suffered from these conditions may have never presented at a hospital because they chose not to seek medical care or were seen by their private physician. Second, coding practices differ slightly between hospitals and may change over time within the same hospital.

This report illustrates that rapid surveillance of nonreportable diseases and conditions is possible during a public health disaster. The surveillance strategy included 1) identifying key staff in local hospitals well in advance of a disaster, 2) developing connections with these persons to ensure rapid access to critical information, and 3) providing simple data collection instruments that minimize confusion.


  1. Karels J. 1998 wildland fire season in review. Florida Fire Service Today 1998;6:8-19.

  2. Minshew P, Towle J. The 1998 Wildfires in Central Florida -- Volusia County's own Armageddon. J Environ Health 1999 (in press).

Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

TABLE 1. Frequency of emergency department visits and hospital admissions for
selected conditions and percentage change -- Volusia and Flagler counties,* Florida,
June 1-July 6, 1997 and June 1-July 6, 1998
                                 Emergency department visits           Hospital admissions
                                 ---------------------------         -----------------------
Diagnosis (ICD-9-CM codes+)        1997    1998   % Change           1997    1998   % Change
Asthma (493-493.91)                  77     147      91                13      19       46
Acute bronchitis
 (466.0-466.19)                     134     107     -20                 5       4      -20
Bronchitis with acute
 exacerbation (491.21)               28      65     132                56      56       --
Carbon monoxide poisoning
 (986)                                2       2      --                 9       0     -100
Chest pain (786.50-786.59)          218     299      37                63      78       24
Conjuntivitis (372.30-372.39)        59      79      34                 0       0       --
Emphysema (492.0-492.8)               0       1      --                 2       0     -100
Chronic obstructive
 pulmonary disease (496)             17      17      --                11      11       --
Heat exhaustion (992.3-992.5)         7      19     171                 2       1      -50
Painful respiration (786.52)         74      54     -27                 7       3      -57
Palpitations (785.1)                 19      15     -21                 0       1       --
Shortness of breath/
 Wheezing (786.09)                   68      90      32                 1       1       --
Sinusitis (461.8-461.9)              46      55      20                 0       0       --

Total                               749     950      27               169     174        3
*  Seven hospitals in Volusia County and one in Flagler County.
+  International Classification of Diseases, Ninth Revision, Clinical Modification.

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