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

2. 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.

3. 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

4. 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.

5. 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.

6. 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

7. 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

8. 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.

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

10. 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

11. SYNDROMIC SURVEILLANCE

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

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

14. Initiation Protocol

15. 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).

16. 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

17. 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.

18. AID STATIONS

19. Data Sources
HHS
DoD
ESSENCE
Red Cross
FDA
EMS

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

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

22. 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.

23. Handheld scanner used in patient tracking

24. 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

32. 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

33. 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 .

34. QUESTIONS