Using GIS Technology to Increase Response to Public Health and Extreme Weather Events

Originally developed in the wake of the SARS outbreak, the Acute Care Enhanced Surveillance (developed in 2004) and the Public Health Information Management Systems (developed in 2015) have provided Kingston, Frontenac, Lennox, and Addington Public Health with an effective means of tracking public health data and responding to extreme events. This system tracks in real-time public health indicators that can provide information on a variety of subjects such as communicable diseases, overdose deaths as a result of novel illicit drugs, and also the effects of climate related hazards such as heat waves and breathing problems associated with smoke from wildfires. Originally just a pilot program in the Kingston, Frontenac, Lennox, and Addington Public Health jurisdiction, this program has proven itself successful and has now been implemented all across Ontario.

Understanding and Assessing Impacts

These programs monitor a broad array of different public health indicators, many of which can be used to track the effects of climate change-induced hazards afflicting Ontario. The Acute Care Enhanced Surveillance Program (ACES) is designed so that it can both monitor broad-spectrum, diffuse health effects like the spread of a disease such as influenza through a community and also narrow its search down to isolate the effects of an acute incident such as the health problems that occur on account of air quality problems due to a forest fire. The Public Health Information Management System (PHIMS) has the ability to monitor potential health effects of air quality events, extreme heat and extreme cold events, storms, forest fires, and more. Many of these listed hazards are expected to increase in severity and frequency over time as a result of the changing climate. By having robust and responsive monitoring and alert systems such as ACES and PHIMES, Ontario is much more well-prepared to handle the perils posed by these hazards than it previously was.

Identifying Actions

In the wake of the Severe Acute Respiratory System (SARS) outbreak, a number of analysis reports concluded that Ontario’s public health system as a whole was dangerously underprepared for such an event and that changes needed to be made in order to reduce the impact of such outbreaks in the future. The Acute Care Enhanced Surveillance System (ACES) began its life as a two-year pilot program operating in just two Kingston-area emergency departments. This was a multi-stakeholder investment, being developed and funded by a collaboration between Kingston, Frontenac, and Lennox & Addington (KFL&A) Public Health, the Public Health Division of the Ministry of Health and Long-Term Care, Queen’s University, the Public Health Agency of Canada, Kingston General Hospital, and Hotel Dieu Hospital. The original ACES program, under a different name, was based on an open-source software package from the University of Pittsburgh’s Real-time Outbreak and Disease Surveillance system and adapted to local conditions through customized geospatial mapping and the optimization of alerts and syndrome classification. Since its initiation in 2015 as part of the infrastructure of the Pan-American Games, the Public Health Information Management System (PHIMS) has developed into a more general tool that now explicitly takes into account environmental health threats. The system has integrated meteorological data into its matrix alongside population data including marginalization layers. This allows it to monitor the potential health effects of air quality events, extreme heat and extreme cold events, storms, forest fires, and more.

Implementation

PHIMS provides decision makers with access to real-time weather feeds, socioeconomic data, demographic information and timely health outcome figures, allowing them to better predict, prepare, and respond to extreme weather events and other environmental emergencies. This is accomplished through a Geographic Information System (GIS) for the identification, visualization, and spatial analysis of environmental data with underlying population-based factors. If a particular region of the provinces is afflicted by a disaster in some form, the PHIMS program will allow decision makers to understand not just how many people are living in the affected area but also help them to get a clear picture of the underlying socioeconomic factors that can affect a person’s vulnerability to disaster. With this information, decision makers can make detailed emergency management plans base on the specific needs of the citizens in the affected areas. This system is complemented by ACES, which tracks such matters as emergency departments’ volume, admissions, surge capacity, and more. ACES bases its analysis on reported symptoms and not medical diagnosis, which increases the speed at which information is made available to decision makers because they do not have to wait for medical practitioners to come to a decision regarding diagnosis first. The combination of the two systems allows for a precise tracking of health outcomes in a disaster event, modelling of future environmental conditions, and also of sending out alerts and warnings to the necessary health agencies as situations changes and develop in real time.

Outcomes and Monitoring Progress

Since their implementations, the combination of ACES and PHIMS has been expanded to the entire Ontario provincial health system and, as of 2018, was operating in 160 hospital across the province. In addition to routine tasks such as monitoring the annual influenza outbreaks, these systems have also helped health officials deal with specific climate-related threats such as the F2 tornado that struck Midland, ON, in 2010, Kingston’s urban fire in 2013, and medical effects resulting from extreme heat and forest fires in 2018. The model also has mapping and modelling resources that has allowed it complete tasks such as modelling the distribution of airborne particles as a result of forest fires and also providing a map of those areas most affected by the urban heat island effect on hot days.

Resources


Understanding and Assessing Impacts

These programs monitor a broad array of different public health indicators, many of which can be used to track the effects of climate change-induced hazards afflicting Ontario. The Acute Care Enhanced Surveillance Program (ACES) is designed so that it can both monitor broad-spectrum, diffuse health effects like the spread of a disease such as influenza through a community and also narrow its search down to isolate the effects of an acute incident such as the health problems that occur on account of air quality problems due to a forest fire. The Public Health Information Management System (PHIMS) has the ability to monitor potential health effects of air quality events, extreme heat and extreme cold events, storms, forest fires, and more. Many of these listed hazards are expected to increase in severity and frequency over time as a result of the changing climate. By having robust and responsive monitoring and alert systems such as ACES and PHIMES, Ontario is much more well-prepared to handle the perils posed by these hazards than it previously was.

Identifying Actions

In the wake of the Severe Acute Respiratory System (SARS) outbreak, a number of analysis reports concluded that Ontario’s public health system as a whole was dangerously underprepared for such an event and that changes needed to be made in order to reduce the impact of such outbreaks in the future. The Acute Care Enhanced Surveillance System (ACES) began its life as a two-year pilot program operating in just two Kingston-area emergency departments. This was a multi-stakeholder investment, being developed and funded by a collaboration between Kingston, Frontenac, and Lennox & Addington (KFL&A) Public Health, the Public Health Division of the Ministry of Health and Long-Term Care, Queen’s University, the Public Health Agency of Canada, Kingston General Hospital, and Hotel Dieu Hospital. The original ACES program, under a different name, was based on an open-source software package from the University of Pittsburgh’s Real-time Outbreak and Disease Surveillance system and adapted to local conditions through customized geospatial mapping and the optimization of alerts and syndrome classification. Since its initiation in 2015 as part of the infrastructure of the Pan-American Games, the Public Health Information Management System (PHIMS) has developed into a more general tool that now explicitly takes into account environmental health threats. The system has integrated meteorological data into its matrix alongside population data including marginalization layers. This allows it to monitor the potential health effects of air quality events, extreme heat and extreme cold events, storms, forest fires, and more.

Implementation

PHIMS provides decision makers with access to real-time weather feeds, socioeconomic data, demographic information and timely health outcome figures, allowing them to better predict, prepare, and respond to extreme weather events and other environmental emergencies. This is accomplished through a Geographic Information System (GIS) for the identification, visualization, and spatial analysis of environmental data with underlying population-based factors. If a particular region of the provinces is afflicted by a disaster in some form, the PHIMS program will allow decision makers to understand not just how many people are living in the affected area but also help them to get a clear picture of the underlying socioeconomic factors that can affect a person’s vulnerability to disaster. With this information, decision makers can make detailed emergency management plans base on the specific needs of the citizens in the affected areas. This system is complemented by ACES, which tracks such matters as emergency departments’ volume, admissions, surge capacity, and more. ACES bases its analysis on reported symptoms and not medical diagnosis, which increases the speed at which information is made available to decision makers because they do not have to wait for medical practitioners to come to a decision regarding diagnosis first. The combination of the two systems allows for a precise tracking of health outcomes in a disaster event, modelling of future environmental conditions, and also of sending out alerts and warnings to the necessary health agencies as situations changes and develop in real time.

Outcomes and Monitoring Progress

Since their implementations, the combination of ACES and PHIMS has been expanded to the entire Ontario provincial health system and, as of 2018, was operating in 160 hospital across the province. In addition to routine tasks such as monitoring the annual influenza outbreaks, these systems have also helped health officials deal with specific climate-related threats such as the F2 tornado that struck Midland, ON, in 2010, Kingston’s urban fire in 2013, and medical effects resulting from extreme heat and forest fires in 2018. The model also has mapping and modelling resources that has allowed it complete tasks such as modelling the distribution of airborne particles as a result of forest fires and also providing a map of those areas most affected by the urban heat island effect on hot days.

Resources