Quick-Start Guide

CARA is designed to help public health departments, healthcare coalitions, and emergency managers evaluate and respond to a variety of risks across Wisconsin.

What This Tool Does

This tool provides:

• Comprehensive risk assessments for natural hazards, health risks, active shooter scenarios, and infrastructure vulnerabilities
• Geospatial visualization of risks across all Wisconsin counties and tribal areas
• Regional aggregation of data by Healthcare Emergency Readiness Coalition (HERC) regions
• Printable risk summaries for planning and reporting
• Compatibility with Kaiser Permanente HVA export for hospital preparedness programs
• Temporal risk analysis using the BSTA framework (Baseline, Seasonal, Trend, Acute)

Who Should Use This Tool

This tool is designed for:

• Local Health Department staff
• Tribal Health Center coordinators
• HERC coordinators and members
• Emergency management professionals
• Public health preparedness planners

The risk assessments are built on data from multiple authoritative sources:

Natural Hazards

• FEMA National Risk Index (exposure scores, health impact factors)
• NOAA NCEI Storm Events Database (county-level event counts, property damage, injuries, fatalities)
• OpenFEMA Disaster Declarations Summaries (federal disaster declaration history)
• OpenFEMA NFIP Redacted Claims (flood insurance claims and payments)
• OpenFEMA Hazard Mitigation Assistance Projects (mitigation project data)
• NOAA/IPCC AR6/WICCI/EPA climate projections

Health Risks

• Wisconsin Department of Health Services disease surveillance
• CDC COVID-19, influenza, and RSV activity reports (via Wisconsin DHS)
• Respiratory illness surveillance data (Flu, COVID, RSV)

Social Vulnerability

• CDC Social Vulnerability Index (SVI)
• U.S. Census Bureau American Community Survey data
• Housing and demographic data

Vector-Borne Disease

• Wisconsin DHS EPHT (WEDSS) — county-level Lyme disease and West Nile Virus incidence rates (lyme-county.csv, west-nile-data-county.csv)
• NOAA/IPCC AR6 climate range expansion projections for tick and mosquito habitat

Dam Failure

• WI DNR Dam Safety ArcGIS FeatureServer (primary) — dam inventory, hazard classification, condition ratings, EAP status
• USACE National Inventory of Dams (NID) ArcGIS FeatureServer (fallback)

Additional Risk Factors

• Gun Violence Archive (2023 mass shooting data)
• National Center for Education Statistics School Survey data (SSOCS 2019-2020)
• EPA AirNow API for air quality monitoring
• NOAA/NWS heat forecasting data
• Wisconsin DHS Heat Vulnerability Index

Data Refresh Schedule: Different data sources update at varying frequencies, from daily weather data to annual census information. The tool uses an intelligent caching system to maintain the most recent data while handling API limitations.

Accessing Jurisdiction Data

1. Start at the home page: The interactive map displays risk levels across Wisconsin.
2. Select a jurisdiction: Click on any county or tribal area to view its specific risk profile.
3. Explore the dashboard: Each jurisdiction dashboard provides detailed breakdowns of various risk factors.

Using HERC Regional Views

1. Access regional data: Use the HERC tab in the navigation to select a specific HERC region.
2. View aggregated risks: Regional dashboards show risk aggregated across all counties in the region.
3. Export HVA data: HERC coordinators can export risk data in Kaiser Permanente HVA format.

Generating Reports

1. Create printable summaries: Use the "Print Summary" button on any dashboard to generate a printer-friendly report.
2. Download data: Export options are available for data integration with other tools.
3. View action plans: Generate customized preparedness action plans based on identified risks.

Understanding Risk Scores

Risk scores range from 0.0 to 1.0 and are categorized as follows:

• 0.0 - 0.2: Very Low - Minimal risk; strong existing capacity.
• 0.2 - 0.4: Low - Low risk; preparedness measures are largely in place.
• 0.4 - 0.7: Moderate - Elevated risk; targeted improvements are recommended.
• 0.7 - 1.0: High - Significant risk; prioritized preparedness action is warranted.

Risk Score Calculation (EVR Framework)

Individual domain risk scores are calculated using the Exposure-Vulnerability-Resilience (EVR) formula:

Residual Risk = (Exposure × Vulnerability) × (2.0 − Resilience) × Health Impact Factor

Where:

• Exposure (0–1) - Hazard likelihood based on historical data and geographic factors
• Vulnerability (0–1) - Population and infrastructure susceptibility, including CDC SVI themes and Census demographics
• Resilience (0–1) - Community adaptive capacity; acts as an amplifier: low resilience (0.1) yields a 1.9× multiplier, high resilience (0.9) yields a 1.1× multiplier
• Health Impact Factor (0.8–1.5) - Derived from FEMA NRI data; adjusts for the specific health consequences of each hazard

Temporal Assessment (BSTA Framework)

Risk is evaluated across four timeframes:

• Baseline (60%) - Long-term risk over 1-10 years
• Seasonal (25%) - Cyclical risk patterns
• Trend (15%) - Real data trends from NOAA Storm Events, OpenFEMA, climate projections, and Census demographics (not applicable to infectious disease)
• Acute (0%/15%) - Context only for most domains; 15% weight for infectious disease using WI DHS surveillance data

HERC Region Integration

The tool integrates Wisconsin's seven Healthcare Emergency Readiness Coalition (HERC) regions for a broader view of healthcare preparedness:

• Aggregated risk scores across all counties in each HERC region
• Regional healthcare capacity data (when available)
• Links to HERC coordinators and resources
• Kaiser Permanente HVA export for Hospital Preparedness Program (HPP) planning

Understanding Aggregated Data

Regional data is aggregated using population-weighted averages of county-level data, with special consideration for:

• Population distribution differences across counties
• Regional healthcare resource availability
• Cross-county infrastructure dependencies
• Tribal areas that span multiple counties

Contact Information

For assistance with the tool or to provide feedback:

• Project Developer: Jaime Niedermeier, Georgetown University
• Email: jdn63@georgetown.edu

Additional Resources

• Frequently Asked Questions
• Risk Assessment Methodology