Disaster casualtiesUniform Framework for Quantifying Disaster-Related Deaths, Illness

To more accurately quantify disaster-related deaths, injuries, and illnesses, the Federal Emergency Management Agency and other agencies supporting disaster response should adopt a uniform national framework of data collection approaches and methods for distinguishing direct from indirect disaster deaths, says a new congressionally mandated report from the National Academies of Sciences. The report, A Framework for Assessing Mortality and Significant Morbidity After Large-Scale Disasters, also examines the methods used to record and report COVID-19 cases and deaths.

In all disasters, disaster-related mortality and morbidity estimates can evolve. Hurricanes and wildfires can occur over days or weeks, and some death recording systems have lags, especially if they are paper-based. Disasters like Hurricane Maria, and more recently, the COVID-19 pandemic, have demonstrated how multiple methods for assessing mortality and morbidity can create confusion or the impression that data are being manipulated.

All Stafford Act declarations — which enable emergency spending — should require disaster-impacted states and regions to comply with the reporting requirements of individual counts and population estimates described in the report. It recommends that state, local, tribal, and territorial (SLTT) entities produce and use both individual counts and population estimates of deaths, illnesses, and injuries to more completely describe the impact of disasters. Individual counts are based on counts of individual incidences recorded in administrative systems (such as data from death records or case investigations), while population estimates are based on statistical approaches (such as estimation of “excess” death relative to a historic baseline or surveys of population samples). Both approaches for estimating mortality and morbidity following disasters have unique analytical strengths and uses, and they should be used in tandem to develop the fullest picture of disaster impacts.

SLTT entities should also establish standards for which mortality and morbidity data should be consistently tracked across common types of disasters, such as hurricanes and wildfires, as well as which data should be uniformly tracked across all disasters, the report recommends. Additionally, the incorporation of data on social determinants of health in morbidity and mortality assessments (including race, housing, and ZIP code) could be used to identify groups most at risk and help target public health efforts more successfully.