John O. Davies-Cole, PhD, MPH State Epidemiologist DC Department of Health

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

4. 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 InaugurationHealth 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. 300,000-600,000 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 DepartmentSyndromic Surveillance Sites RegionNo of Hospitals • DC …………………................................5 • 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:

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