Free text triggers that picked up RNC or Bio-Terror related key words entered by
9-1-1 ... Vinoy: start at corner of 7th Ave NE and Bay Shore Dr Ne; west to Beach.
Enhanced use of FirstWatch® Real-Time Early Warning System to Detect Infectious Diseases and Possible Bioterrorism Events During the 2012 Republican National Convention JoAnne Lamb, MPH1; Stephanie Anspaugh-Naples, MPH1; Steve Fravel2; Sharlene E. Edwards, MPH1 1Florida
Department of Health, Pinellas County; 2Pinellas County Public Safety Service
Introduction
Methods • In 2012, the Tampa Bay Area hosted the
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Republican National Convention (RNC) the week of August 26-30. The convention brought over 65,000 visitors to the area including: delegates, protestors, media, and first responders to both Pinellas and Hillsborough County.
FLDOH-PC worked with the Pinellas County Public Safety Services and FirstWatch® system administrators to create specific triggers for the RNC. Overall enhancements of FirstWatch® surveillance monitoring for the RNC included the addition of new triggers, increased hours of monitoring, and specific response protocol for alerts.
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New triggers added included: 150-yard buffer zones around the hotels known to be occupied by delegates Free text triggers that picked up RNC or Bio-Terror related key words entered by 9-1-1 dispatch or the paramedic
• To prepare for this National Special Security Event (NSSE), the Florida Department of Health, Pinellas County (FLDOH-PC), Epidemiology and Preparedness program implemented enhanced disease surveillance to appropriately monitor any public health threats and ensure the health and safety of residents and visitors in the area.
•As part of this enhancement,
Geo-fencing (or a virtual geographic perimeter) around specific delegate gathering locations within the county
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Enhanced surveillance monitoring was initiated the week before the RNC and continued until the week after the convention.
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Throughout this specified period of time, staff reviewed individual ‘dashboards’ that displayed all of the Pinellas County triggers in the First Watch® system.
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During the week of the RNC, FirstWatch® was monitored hourly from 8am to 11pm. Primary staff reviewing the triggers analyzed the available data and provided a summary email to RNC Operations staff; including details of the call and if additional response was necessary.
FirstWatch® dashboard displaying original and enhanced triggers for the RNC.
Alert Criteria RNC Specific Triggers Source: Google
Epidemiology and Preparedness staff expanded and modified all current surveillance systems to rapidly detect any unusual event or clusters of disease. Systems that were enhanced for monitoring included:
Trigger Name
FirstWatch ® Real Time Reporting System Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE)
Poison Control Information Network Real-time Outbreak and Disease Surveillance (RODS) Urgent Care Center Visits
Definition
1- RNC related words: Republican, Republican National Convention, RNC, RNC general, RNC asset, RNC detainee, RNC attendee, RNC protestor, Protester, RNC 0participant, Delegate, Convention, Tampa Bay Times Forum, Forum, Tropicana Field, Trop, Convention Center, Visiting, Visitor
Free Text: RNC Related words and Bio-Terrorism Related Words 2- Bio-Terrorism related words: Anthrax, Spores, Inhalation, Contaminated, White Substance, White Powder, Unknown Substance, Unknown agent, Botulism, Ricin, Virus, Infectious, Infection, Cluster, Agent, Exposure, Outbreak, Chemical, Airborne
Geo-Fence
Hotel Buffer Free Text
• Five calls within a 2 hour time period • Include priorities only • Problem/Nature Codes: Abdominal pain/problems, breathing problems, chest pain, convulsions/seizures, diabetic problems, Headache, Heart Problems/A.I.C.D., Sick Person, Stroke, Unconscious (Near), Unknown Problem (Man Down) • Five calls within a 2 hour time period • Include priorities only • Problem/Nature Codes: Any • Eliminate Non Emergencies No specified threshold to produce an alert. These triggers can be actively monitored.
FirstWatch® MethodsReal-Time Early Warning System •ThisThe software system allows authorized users a way monitor trends and two-stage cluster design used in most RNAs wastooriginally
• Vinoy: start at corner of 7th Ave NE and Bay Shore Dr Ne; west to Beach Dr NE; south to 5th Ave NE; east to Bay Shore Dr NE (next to Vinoy Park); north back to 7th Ave NE and Bay Shore Dr NE
patterns relatedbytothe emergency medicalimmunization services and calls received developed WHO to estimate coverage. Currentat 9-1-1 RNA centers. designs utilize a modified version of this sampling pre-hospital method. dispatch FirstWatch® collects and categorizes data about persons that call 9-1-1 dispatch (Police, Fire, and EMS).
Data Collection and Analysis •Pinellas County Public Safety Services (PCPSS), which houses the county’s • Door-to-door were administered a emergency medicalquestionnaires services, uses FirstWatch® astoa residents resource over management days period by field teamslogs 7 days thebased hurricane in Broward tool; 2monitoring their dispatch for after trends on pre-set criteria. The and 8 days after in Hendry.objective is to use this system as a means to health department’s primary monitor alerts that could anused incident or situation that most closely • PDAs equipped withindicate GPS were to navigate to assigned points or andortobioterrorism-related enter survey data. event. FirstWatch® is able to resembled anparcels, outbreak capture trends or geographical clusters that would • Allsuspicious data was analyzed using SAS. In addition, SUDAAN was require used rapid public response and sendsampling. an alert in real-time. in health Broward due to the cluster Samples were drawn to
• Beach/Bay Shore: start at corner of 5th Ave NE and Bay Shore Dr NE; west to Beach Dr NE; south to 2nd Ave NE; east to Bay Shore Dr NE; north back to 5th Ave NE and Bay Shore Dr NE
Map of 150 yard radius around one of the hotels where a state delegate was scheduled to stay while visiting the Tampa Bay Area for the RNC.
• Pier/Central: start at Pier 2nd Ave NE; west to 4th St N; south to 2nd Ave S; east to Bay Shore Dr NE; north back to 2nd Ave NE
• Mahaffey: start at corner of 2nd Ave SE and Bay Shore Dr SE; west to 1st St SE; south to 5th Ave SE; east to Bay Shore Dr SE; north back to 2nd Ave SE and Bay Shore Dr SE
•FirstWatch® is passively monitored. When trigger thresholds are met, an alert is generated and Epi and Preparedness staff is notified via email and text message. Alerts are reviewed 24 hours a day/7 days a week.
Trigger
Free Text: Bioterrorism Related Words Free Text: RNC Related Words Geo Fence Combo: RNC Geo Fence: Pier/Central Hotels: 150 Yard Radius GeoFence: Vinoy GeoFence: Trop Field Geo Fence: Beach/Bay Shore Geo Fence: Mahaffey
36 19 12 5 5 1 1 0 0
Overall, the enhancement and implementation of FirstWatch® surveillance measures proved useful. Moving forward, the models used to enhance surveillance during the RNC can be applied to future NSSE events.
• Trop Field: the entire perimeter of Tropicana Field
Hotel Buffer Zones
No unusual events or clusters of disease linked to the RNC were identified during the heightened surveillance time period. While there were no alerts generated for significant clusters or public health threats, staff were able to identify minor 9-1-1 calls related to delegates and RNC functions. The free text triggers captured the most events reported in 9-1-1 dispatch calls. Some of the words identified in the calls included, Tropicana, Exposure, and Infection. Each call was reviewed and data was analyzed to determine the appropriate action.
Total Number of Events
Events identified within the surveillance data did not warrant a public health response. These calls were categorized by location and reported to the Consequence Management Emergency Operations Centers (CMEOC) as part of the daily enhanced surveillance report.
Geo Fencing
desired absolute precision of 0.1 (±10%) for the point keywords. •Userensure defined triggers include dispatch codes based on EMS
estimates. These keywords are categorized into several different syndrome groups (i.e. respiratory, systemic, thresholds are set based onstate multiple • A summary reportetc.). was Alerting generated and distributed to local and authorities after collection and analysis were statistical tests immediately and classified bydata geographical location or symptoms of the completed in each county. caller.
Results
A 150-yard radius around each hotel occupied by delegates.
Acknowledgements Geo Fence Combo
A combination of all the geo fence and hotel buffer triggers. View of the Geo-Fence triggers around specific locations in Downtown St. Petersburg (Source: Google Earth)
Enhanced surveillance and monitoring for the RNC was a result of a collaboration among the Florida Department of Health, Pinellas County Public Safety Services, First Watch Solutions Operations and Support Staff, and local area hospitals, all of whom made significant contributions.
