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Estimating medically fragile population in storm surge zones: A geographic information system application

James L. Wilson, PhD, Ruth Little, MPH, Lloyd Novick, MD, MPH


Objective: To develop a simple, cost-effective method for determining the size and geographic distribution of medically fragile (MF) individuals at risk from tropical storm surges for use by emergency management planners.

Design: The study used Geographic Information System (GIS) spatially referenced layers based on secondary data sources from both state and federal levels.

Setting: The study setting included the eastern North Carolina coastal counties that would be affected by tropical storm surges.

Subjects: The initial MF population was extrapolated from national estimates for five conditions and then applied to US Census block population. These conditions included insulin dependent diabetes, chronic obstructive pulmonary disease, congestive heart failure, end stage renal disease, and patients receiving long-term oxygen treatment.

Main outcomes: The main outcome of this study was a series of local and regional maps that portrayed the geographic distribution and estimated counts of potentially at-risk MF population from a tropical storm surge scenario.

Conclusions: Maps depicting the geographic distribution and potential numbers of MF individuals are important information for planning and preparedness in emergency management and potentially engaging the public.


GIS, medically fragile population, storm surge hazards mapping

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Parr AR: Disasters and disabled persons: An examination of the safety needs of a neglected minority. Disasters. 1987; 11(2): 148-159.

Van Willigen M, Edwards T, Edwards B, et al.: Riding out the storm: Experiences of the physically disabled during Hurricanes Bonnie, Dennis, and Floyd. Nat Hazards Rev. 2002; 3(3): 98-106.

Cefalu WT, Smith SR, Blonde L, et al.: The Hurricane Katrina aftermath and its impact on diabetes care: Observations from “ground zero”: Lessons in disaster preparedness of people with diabetes. Diabetes Care. 2006; 29(1): 158-160.

Greenough PG, Thomas DK: Public health response—Assessing needs. New Engl J Med. 2005; 353(15): 1544-1546.

Mokdad AH, Mensah GA, Posner SF, et al.; the Chronic Diseases and Vulnerable Populations in Natural Disasters Working Group: When chronic conditions become acute: Prevention and control of chronic diseases and adverse health outcomes during natural disasters. Prev Chronic Dis [serial online]. 2005: 2(SI). Available at Accessed May 25, 2012.

Baggett J: Florida disasters and chronic disease conditions [letter to the editor]. Prev Chronic Dis [serial online]. 2006; 3(2). Available at Accessed May 25, 2012.

Arrieta MI, Foreman RD, Crook ED, et al.: Insuring continuity of care for chronic disease patients after a disaster: Key preparedness elements. Am J Med Sci. 2008; 336(2): 128-133.

Renaissance Computing Institute (RENCI): About RENCI. Chapel Hill, NC: Renaissance Computing Institute. Available at Accessed May 18, 2012.

RENCI: Disaster impacts on public health (past projects). Greenville, NC: Renaissance Computing Institute at East Carolina University. Available at Accessed at May 18, 2012.

Hammiel J, Schiller D, Wheeler B: RENCI coastal impact on public health: At risk populations regional special needs registry proposal for eastern North Carolina. Greenville, NC: Department of Public Health, East Carolina University, 2007.

Cutter SL: Hazards, Vulnerability and Environmental Justice. Sterling, VA: Earthscan, 2006.

Greene RW: Confronting Catastrophe: A GIS Handbook. Redlands, CA: ESRI Press, 2002.

Cova TJ: GIS in emergency management. In Longley PA, Goodchild MF, Maguire DJ, Rhind DW (eds.): Geographic Information Systems. Vol 2. 2nd ed. New York:Wiley, 1999.

Cutter SL, Mitchell JT, Scott MS: Revealing the vulnerability of people and places: A case study of Georgetown county, South Carolina. Ann Assoc Am Geogr. 2000; 90(4): 713-737.

Emani SR, Samuel J, Clark GE, et al.: Assessing vulnerability to extreme storm events and sea-level rise using geographic information systems (GIS). GIS/LIS Proc. 1993; 1: 201-209.

US Census: Summary File 1 (SF-1). Suitland, MD: United States Census Bureau, Department of Commerce, 2010. Available at Accessed December 5, 2011.

NOAA/NWS: SLOSH Display program. National Oceanic and Atmospheric Administration. Silver Spring, MD: Department of Commerce, 2012. Available at Accessed May 25, 2012.

FEMA: HAZUS. Washington, DC: Department of Homeland Security, 2012. Available at Accessed May 25, 2012.

Sheppard E, Couclelis H, Graham S, et al.: Geographies of the information society. Int J Geogr Inf Sci. 1999; 13(8): 797-823.

Elwood S:Volunteered geographic information: Future research directions motivated by critical, participatory, and feminist GIS. GeoJournal. 2008; 72(3): 173-183.

Goodchild M: Citizens as sensors: The world of volunteered geography. GeoJournal. 2007; 69(4): 211-221.

Barrows HH: Geography as human ecology. Ann Assoc Am Geogr. 1923; 13(1): 1-14.

White GF: Human adjustment to floods: A geographical approach to the flood problem in the United States. Doctoral Dissertation Chicago, IL: University of Chicago, 1942.

Burton I, Kates RW, White GF: The Environment as Hazard. New York: Oxford University Press, 1978.

Palm R: Natural Hazards: An Integrative Framework for Research and Planning. Baltimore: Johns Hopkins University Press, 1990.

Cutter SL, Boruff BJ, Shirley WL: Social vulnerability to environmental hazards. Soc Sci Q. 2003; 84(2): 242-261.

Cutter SL, Finch C: Temporal and spatial changes in social vulnerability to natural hazards. Proc Natl Acad Sci. 2008; 105(7): 2301-2306.

Coppock JT, Rhind DW: The history of GIS. In Maguire DJ, Goodchild MF, Rhind DW (eds.): Geographical Information Systems: Principles and Applications. New York: John Wiley and Sons, 1991.

Alexander D: Natural Disasters. New York: Chapman & Hall, 1993.

Alexander D. Confronting Catastrophe: New Perspectives on Natural Disasters. New York: Oxford University Press, 2000.

NCCGIA: NC OneMap. Raleigh, NC: The North Carolina Center for Geographic Information and Analysis (NCCGIA), 2012. Available at Accessed May 20, 2012.

NOAA/NWS: Probabilistic hurricane storm surge. Silver Spring, MD: National Oceanic and Atmospheric Administration/National Weather Service, 2012. Available at Accessed May 20, 2012.

Garb JL, Cromley RG,Wait RB: Estimating populations at risk for disaster preparedness and response. J Homeland Secur Emerg Manag. 2007; 4(1): Article 3.

NOAA: Mapping Social Change in U.S. Coastal Counties: A Social Atlas of Coastal North Carolina. National Oceanic and Atmospheric Administration. Silver Spring, MD: Department of Commerce, 2008. Available at Social Change.pdf. Accessed May 25, 2012.

Honore RL: Health disparities: Barriers to a culture of preparedness [Editorial]. J Public Health Manag Pract. 2008; 14(6): S5-S7.

Clary C, Pui-Ka So A: Changing the nature of special needs: Utilizing a function based approach to special needs planning. J Emerg Manag. 2010; 8(2): 11-19.

Aldrich N, Benson WF: Disaster preparedness and the chronic disease needs of older adults. Prev Chronic Dis [serial online]. 2008; 5(1). Available at Accessed May 25, 2012.

NCDCCPS: Disability and Elderly Emergency Management (DEEM) Report of Recommendations. Raleigh, NC: NC Department of Crime Control and Public Safety Division of Emergency Management, 2008. Available at Accessed May 25, 2012.

O’Brien N: Emergency Preparedness in Older People. Brief. New York, NY: Mount Sinai School of Medicine, 2003.

McGuire LC, Ford ES, Okoro CA: Natural disasters and older US adults with disabilities: Implications for evacuation. Disasters. 2007; 31(1): 49-56.

Monmonier MS: Cartographies of Danger: Mapping Hazards in America. Chicago: University of Chicago Press, 1997.

Mennis J, Hultgren T: Intelligent dasymetric mapping and its application to areal interpolation. Cartogr Geogr Inf Sci. 2006; 33(3): 179-194.

Mennis J: Generating surface models of population using dasymetric mapping. Prof Geogr. 2003; 55(1): 31-42.

Mennis J: Dasymetric mapping for estimating population in small areas. Geogr Compass. 2009; 3(2): 727-745.

Hao Y, Ward E, Jemal A, et al.: U.S. congressional district cancer death rates. Int J Health Geogr. 2006; 5(1): Available at http://www.ij-healthgeogra

Chakraborty J, Maantay JA, Brender JD: Disproportionate proximity to environmental health hazards: Methods, models, and measurement. Am J Public Health. 2011; 101(S1): S27-S36.

Goodchild MF, Lam S-N: Areal interpolation: A variant of the traditional spatial problem. Geo-Processing. 1980; 1(3): 297-312.

Flowerdew R, Green M, Kehris E: Using areal interpolation methods in geographic information systems. Papers Reg Sci. 1991; 70(3): 303-315.

Microsoft: Access 10. Redmond,WA: Microsoft Corporation, 2010.

ESRI: ArcMap 10.0. Redlands, CA: Environmental Systems Research Institute, 2010.

Wingate MS, Perry EC, Campbell PH, et al.: Identifying and protecting vulnerable populations in public health emergencies: Addressing gaps in education and training. Public Health Rep. 2007; 122(3): 422-426.

Eisenman DP, Cordasco KM, Asch S, et al.: Disaster planning and risk communication with vulnerable communities: Lessons from Hurricane Katrina. Am J Public Health. 2007; 97: S109-S115.

Zarcadoolas C, Boyer J, Krishnaswami A, et al.: GIS maps to communicate emergency preparedness: How useable are they for inner city residents? J Homeland Security Emerg Manag. 2007; 4(3): Article 16.

Spence PR, Lachlan K, Burke JM, et al.: Media use and information needs of the disabled during a natural disaster. J Health Care Poor Underserved. 2007; 18(2): 394-404.

Brodie M, Weltzien E, Altman D, et al.: Experiences of Hurricane Katrina evacuees in Houston shelters: Implications for future planning. Am J Public Health. 2006; 96(8): 1402-1408.



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