Disaster Epidemiology Workshop 57th Presidential Inauguration Health Surveillance: Strength through collaboration John O. Davies-Cole, PhD, MPH State Epidemiologist DC Department of Health

Introduction Every four years - District hosts the Presidential Inauguration Post 9/11 era - heightened security at high profile public events. Increased public health surveillance to detect possible exposure to bioterrorism disease agents such as anthrax, ricin, tularemia Weapons of mass destruction (WMD) Preparation for high profile event, DC DOH responsible for implementing active surveillance activities and conducting epidemiological investigations.

Health & Medical Subcommittee DHHS DC HSEMA US Capitol JOC US Capitol Police EOC DC DOH DC PHL DC EHS JTF NCR JOC DHS/Off of Hlth Affairs Veterans Affairs/VHA FBI WFO CDC FDA DoD MD DHMH VDH MD MIESS NVERS DC EMS

The combined Annex’s will support and complete the CONOPS. HEALTH SURVEILLANCE, INFORMATION SHARING & LABORATORY SUPPORT SERVICES WORKGROUP OBJECTIVES Analyze known and anticipated requirements to support the Pre-Event, Event, Incident within the Event, and Post-Event support activities. Develop planning document that will serve as an Annex following the guidance template. The combined Annex’s will support and complete the CONOPS.

TASKS Consider two scenarios when developing the CONOPS Winter weather (cold, snow, ice) followed by negative impacts on infrastructure (e.g. power loss) Multiple attacks – transportation system, bio-agent release, Each work group member will have access to the restricted share point site where documents and sharing of ideas, concepts, etc will be located.

Health Surveillance Activities January 7 – February 4, 2013 District of Columbia Base of Operation: Data Fusion Cell  Inaugural Event Field Surveillance Sites (Patient Tracking): National Mall Inaugural Parade Route Inaugural Balls

Health Surveillance Strategies Outline plan for disease surveillance Identify surveillance systems used for detecting possible bioterrorism events, tracking seasonal influenza, and preparing for pandemic flu outbreaks Describe the use of identified systems in detecting possible disease outbreaks associated with attendance at the 2013 Presidential Inauguration Discuss collaborative efforts for health surveillance

2013 Presidential Inauguration Health Surveillance Authorities and References: Section 319 of the Public Health Service Act: Title 42, section 247d Section 319F-3 of the Public Health Service Act (42 U.S.C. §247d-6d) Threat: No specific threats identified for this event beyond the typical threats faced by this region – weather, weather related affects on the infrastructure, extremists, and lone offenders.

Anticipated Attendance Anticipated attendance for the 57thPresidential Inauguration: Approx. 300,000-600,000 people . Based upon historical data for this event prior to the 56th Presidential Inauguration.

Surveillance Objectives To provide health surveillance activities related to the 57th Presidential Inauguration occurring two weeks prior and two weeks following January 21, 2013. To alert decision makes of any unusual health outcomes that may occur during the inaugural activities Provide a demographic and health profile of illness & injury Respond to disease outbreaks or other health emergencies

SYNDROMIC SURVEILLANCE

Hospital Emergency Department Syndromic Surveillance Sites Region No of Hospitals DC …………………................................5 Montgomery County, MD…………. 6 Prince Georges County, MD………… 3 Northern Virginia ……………………….15 Howard University Hospital

Data Collection Data include: Personal identification Demographics Chief complaints Symptoms Time/location variables Paper forms available as backup

Initiation Protocol

Initiation Protocol Initiation of protocol Data review protocol should be initiated no less than 2 hours prior to when report should be posted to allow time for consultation, if needed. The report should be posted to the Pebble site once per day no later than 1pm. The exception to the report schedule is the day of the Inaugural event (January 21) when data should be reviewed and a report posted twice per day (report times TBD).

Review Time Series for each of the following: Syndromes Sub – Syndrome Bot_Like Fever GI Hem_Ill Loc_Les Lymph Neuro Other Rash Resp SI_Death ILI Trauma

ESSENCE ANCR Report Generation Protocol   Creating a report for Pebble site A report can be generated by going to the “More” tab on the ANCR website tool bar then selecting the “Daily Report” option Geography of NCR Jurisdictions No jurisdictions should be highlighted; an explanation of NCR jurisdictions will be posted on the Pebble site header.

AID STATIONS

Data Sources HHS DoD ESSENCE Red Cross FDA EMS

Field Staffing Site Manager Site Coordinator Nurse Stationary EMT Roving EMT Administrative Assistant

Equipment Laptop computers: data from AID stations Communication Devices: To communicate among field staff, data collection staff and base staff

The Maryland Institute for Emergency Medical Services Systems (MIEMSS) Introduced HC Standard - HC Patient Tracking Application Provide real time (one minute delay) situational awareness Utilizes bar code scanners (such as the handheld Motorola MC75 3G) Scanners allow patient information to be entered, including patient demographics, vitals, chief complaints, field treatment, photographs, sound, and video.

Handheld scanner used in patient tracking

Reporting Epidemiologists responsible for generating descriptive reports Chief complaint description by time Total number of persons seen at AID stations Geographic distribution of persons seen at AID stations

What Worked Well Planning: Meetings well attended, productive, and ensured strong regional collaboration between DC, Maryland and Virginia. Credentialing: Proper credentialing made it easy to move from place to place Food Safety Response Team: FDA fully credentialed Data Fusion Center: One centralized data center Surveillance: First AID Station - Real time data transmission Surveillance: Enhanced ED Surveillance: epidemiologists from regional jurisdictions monitored the reports daily in an effort to detect any unusual disease pattern

Challenges Planning: strong participation from some of the federal agencies that played important roles in the event needed. Credentialing: major hindrance to a successful operation during this inauguration. Food Safety Response Team: FDA and DOH need to merge collection efforts. Data Fusion Center: Members of the Data Fusion Center were removed from TVs and therefore had a harder time following the progress of the day’s events. All data not received as planned. Surveillance: First AID Station - Patient trackers were not pre-deployed, therefore delaying data flow. Volunteers did not have proper training. Surveillance: Enhanced ED Surveillance: Not clear about the usefulness of the Pebble site .

QUESTIONS