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

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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.

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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

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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 Annexs will support and complete the CONOPS.

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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.

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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

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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

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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. 2013 Presidential Inauguration Health Surveillance

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

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Surveillance Objectives To provide health surveillance activities related to the 57 th 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

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SYNDROMIC SURVEILLANCE

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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

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

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Initiation Protocol

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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).

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

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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.

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AID STATIONS

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Data Sources HHS DoD ESSENCE Red Cross FDA EMS

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

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

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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.

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Handheld scanner used in patient tracking

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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

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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

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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 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.

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QUESTIONS