Objectives Hurricane Sandy brought wide spread devastation in the region of New York and New Jersey in USA. To our knowledge, there have been no official reports of the health effects from Hurricane Sandy since the day of Hurricane arrival 10/29 in 2012.

Methods To rapidly assess the health impacts of Hurricane Sandy among recovery workers and residents in the affected area, we are building an expanded syndromic surveillance system that integrates the near real-time electronic Emergency Department (ED) visit records collected from 14 EDs within a large health system in NY, the air quality index data from the Environmental Protection Agency (EPA), and the weather data from the National Oceanic and Atmospheric Administration (NOAA). Recovery workers will be identified from billing database. Approximately 50% of occupational/industrial information of ED patients are missing, however patients with work-related injuries and illnesses required to provide this information according to Worker’s Compensation system in US. Through a multilevel case-crossover design, we aim to rapid identification of elevated health effects during four exposure windows we developed (the Pre-, During-, Short-term, and Long-term Post-Hurricane) by comparing ED records before (from 2005) and after Hurricane Sandy while adjusting for air pollution levels and weather conditions. The continuing monitoring during the fourth exposure window (i.e. Long-term Post- Hurricane) will ensure early detection of potential occurrences of chronic diseases stemmed from the initial disaster-related acute forms. The implementation of the syndromic surveillance within a large health system will not only improve the healthcare delivery, but also provide important information to the outside stakeholders such as public health agencies to enhance strategic planning for rapid post-disaster response.