56th Presidential Inauguration

Disaster Epidemiology Workshop

57th Presidential Inauguration Health Surveillance: Strength through collaborationJohn O. Davies-Cole, PhD, MPHState EpidemiologistDC Department of HealthIntroductionEvery four years - District hosts the Presidential InaugurationPost 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, tularemiaWeapons of mass destruction (WMD) Preparation for high profile event, DC DOH responsible for implementing active surveillance activities and conducting epidemiological investigations.

Health & Medical SubcommitteeDHHS

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

HEALTH SURVEILLANCE, INFORMATION SHARING & LABORATORY SUPPORT SERVICES WORKGROUP OBJECTIVESAnalyze 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 Annexs will support and complete the CONOPS. TASKSConsider two scenarios when developing the CONOPSWinter 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 ActivitiesJanuary 7 February 4, 2013District of Columbia Base of Operation: Data Fusion CellInaugural Event Field Surveillance Sites (Patient Tracking):National MallInaugural Parade RouteInaugural Balls

Health Surveillance StrategiesOutline plan for disease surveillanceIdentify surveillance systems used for detecting possible bioterrorism events, tracking seasonal influenza, and preparing for pandemic flu outbreaksDescribe the use of identified systems in detecting possible disease outbreaks associated with attendance at the 2013 Presidential InaugurationDiscuss collaborative efforts for health surveillanceAuthorities and References: Section 319 of the Public Health Service Act: Title 42, section 247dSection 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.

2013 Presidential InaugurationHealth SurveillanceAnticipated AttendanceAnticipated 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 ObjectivesTo 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 activitiesProvide a demographic and health profile of illness & injury Respond to disease outbreaks or other health emergenciesSYNDROMIC SURVEILLANCEHospital Emergency DepartmentSyndromic Surveillance SitesRegion No of Hospitals

DC ................................5

Montgomery County, MD. 6 Prince Georges County, MD 3Northern Virginia .15

Howard University HospitalData CollectionData include:Personal identificationDemographicsChief complaintsSymptomsTime/location variablesPaper forms available as backup

Initiation Protocol

Initiation ProtocolInitiation of protocolData 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:

SyndromesSub Syndrome Bot_LikeFeverGIHem_IllLoc_LesLymphNeuroOtherRashRespSI_Death

ILITraumaESSENCE ANCR Report Generation Protocol

Creating a report for Pebble siteA report can be generated by going to the More tab on the ANCR website tool bar then selecting the Daily Report optionGeography of NCR Jurisdictions No jurisdictions should be highlighted; an explanation of NCR jurisdictions will be posted on the Pebble site header.

AID STATIONSData SourcesHHSDoDESSENCERed CrossFDAEMS

Field StaffingSite ManagerSite Coordinator NurseStationary EMTRoving EMTAdministrative Assistant

EquipmentLaptop computers: data from AID stationsCommunication 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 ApplicationProvide 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

ReportingEpidemiologists responsible for generating descriptive reportsChief complaint description by timeTotal number of persons seen at AID stationsGeographic distribution of persons seen at AID stations

What Worked WellPlanning: 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 centerSurveillance: First AID Station - Real time data transmissionSurveillance: Enhanced ED Surveillance: epidemiologists from regional jurisdictions monitored the reports daily in an effort to detect any unusual disease pattern

ChallengesPlanning: 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 days 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