Biological Preparedness and Responses in New York City: Information-Sharing During Emergencies

Size: px

Start display at page:

Download "Biological Preparedness and Responses in New York City: Information-Sharing During Emergencies"

Lorin Haynes
6 years ago
Views:

1 Biological Preparedness and Responses in New York City: Information-Sharing During Emergencies Joel Ackelsberg, MD, MPH NYC Department of Health and Mental Hygiene Bureau of Communicable Diseases

2 Private sector competitors Hospitals Local government agencies Most days within and between organizations and sectors information-sharing is considered maladaptive. State agencies Bureaus and divisions within agencies Academia Federal agencies

3 Information-Sharing Dynamics Within and Between Organizations Emergency Rules Routine Business Rules Information is power Sharing information may lead to loss of control and/or autonomy Unidirectional information flows preferred Sharing information is for chumps Knowledge is power Sharing information supports common missions, goals and objectives Multi-directional information flows preferred Common operating picture

4 Public Health Responses to a Covert Biological Release Detection Notification of key partners/public Rapid investigation(s) to: Confirm diagnosis Identify hazards and risk factors Track impacts Risk communication/safety recommendations Coordinated interventions Mass treatment/mass prophylaxis Recovery

5 Public Health Responses to a Covert Biological Release Detection Notification of key partners/public Rapid investigation(s) to: Confirm diagnosis Biosurveillance Identify hazards and risk factors Track impacts Risk communication/safety recommendations Coordinated interventions Mass treatment/mass prophylaxis Recovery

6 Public Health Responses to a Covert Biological Release Detection Notification of key partners/public Rapid investigation(s) to: Confirm diagnosis Identify hazards and risk factors Track impacts Risk communication/safety recommendations Coordinated interventions Mass treatment/mass prophylaxis Recovery Common Biosurveillance Focus

7 Public Health Responses to a Covert Biological Release Detection Notification of key partners/public Rapid investigation(s) to: Confirm diagnosis Identify hazards and risk factors Track impacts Risk communication/safety recommendations Coordinated interventions Mass treatment/mass prophylaxis Recovery Characterization. Complicated. Messy. Fewer instruments. People dependent. Information-sharing more challenging.

8 Public Health Preparedness Planning in NYC, Internal incident management structure instituted Interagency coordination with Mayor s Office of Emergency Management (OEM), law enforcement, NYC hospitals and regional public health agencies Enhanced surveillance systems (e.g., established syndromic surveillance system) Surveillance/epidemiologic response and mass antibiotic distribution, including joint investigation with law enforcement Biological threat agent (BTA) training for providers Enhanced internal/provider emergency communications (e.g., broadcast alerts, hotlines, 2-way radios) Frequent tabletop exercises and drills

9 NYC Health Department Transition to a To an Emergency Response Agency

10 Fall and Winter 2001

11 Immediate Public Health Challenges in NYC in Aftermath of WTC Attack Evacuated from lower Manhattan on 9/12 Relocated temporarily to uptown public health laboratory (PHL) Communicable Disease computers with broadcast fax software carried onto van Communication and information sharing Phone service lost in lower Manhattan Emergency wiring of PHL for network/phones/faxes; computers and other hardware moved and connected NYC s EOC destroyed; interagency coordination disrupted until temporary EOC established at Pier 92 Colleagues lost Dependent on 2-way radios and Unable to contact many of our own employees Difficult for public and providers to reach us

12 NYC Public Health Response to WTC Disaster Surveillance ED surveillance for acute injuries Hospital needs assessments Rescue worker injuries Environmental Monitored air, water and food safety Rodent and vector control Clinical First aid in DOH lobby Worker safety at site Communication Media advisories Health alerts Public hotlines Public website Sheltering DOH nurses staffed 12 shelters Mental health Crisis hotline Referral

13 Enhanced Biosurveillance in NYC in Weeks Following 9/11 Enhanced passive surveillance First broadcast alert on 9/12 underscored need to consider bioterrorism when evaluating patients Reinforced messages with periodic updates Emergency department (ED) syndromic surveillance EIS officers physically stationed and collecting data 24/7 in 15 EDs Unsustainable Active surveillance after confirmation of FL inhalation anthrax case Intensive care units Microbiology laboratories Infectious disease and infection control specialists Note: Dependable biosurveillance systems and processes are built around people, not simply gadgets.

14 Few Weeks Later

15 For Months, Multiple Simultaneous Investigations Site Date Started Interviews* Nasal swabs Prophylaxis initiated NBC Oct ABC Oct None CBS Oct None NY Post Oct Hospital Oct * Joint investigation teams and evaluation of suspected cases by NYU/Bellevue dermatologists

16 Followed By

17 Biosurveillance Components of Inhalation Anthrax Investigation Interviews Neighbors Colleagues Friends Ex-husband Churchgoers Canvassing Bronx, Chinatown Shops Analyses Metro cards Phone records Credit cards Receipts Environmental Apartment Hospital Subway stations Post offices Disease surveillance Hospital staff Apartment building Postal service Churches Shops Restaurants Metro transit system Friends Physicians hotline

18 Features of Inhalation Anthrax Investigation Intensive epidemiologic and environmental investigations at home, workplace, 3 postal facilities, and 5 subway stations Several integrated, public health/law enforcement joint investigation teams Collect and analyze data from interviews and environmental sampling Generate hypotheses Public health liaison to criminal investigation Unknown source of exposure? Contaminated letter? Sentinel case of an aerosolized release

19 Biosurveillance-Related Gaps Identified in Anthrax Investigations 1 For detection of small outbreaks (e.g., West Nile virus), physician reporting probably more important than non-traditional systems Outreach needed to dermatology community for enhanced surveillance of BTA-related diseases Rapid mobilization capacity needed across agency to handle surges in reported cases, including case management Enhanced data collection and data management tools needed, including integration with laboratory systems Enhanced laboratory surge capacity needed

20 Some Biosurveillance-Related Gaps Identified in Anthrax Investigations 2 Advisable for laboratory and law enforcement personnel to develop relationships prior to incident Potentially hazardous to deploy new surveillance systems during emergencies; alarms will occur frequently Reliable communication underlies all effective responses Key information must be disseminated more efficiently to medical community Improved information-sharing needed between investigations located in other jurisdictions (e.g., CT and NYC)

21 Hospital Preparedness Trends Following WTC Attack and Anthrax Institutions that competed against one another in routine times became genuine collaborators in preparedness activities Premium on information-sharing Reinforced during 2003 blackout, smallpox vaccination program, SARS and pandemic influenza planning and response

22 Enhanced Biosurveillance in Intervening Years

23 NYC Default: All-Hazards Public Health Preparedness Investments

24 NYC Default: All-Hazards Public Health Preparedness Investments Public health laboratory Information technology and communication Network Intranet and public website Program support Surveillance Electronic laboratory reporting Syndromic surveillance Data management systems Primary focus on hiring personnel

Units per 100,000 prescriptions 250000 200000 150000 Cipro Drug Sales During Anthrax Incident First anthrax case reported, 10/4/01.

42 increase in City tax 20000 100000 15000 250 9/11 CDC recommends doxycyline 10/28/01.

25 Units per 100,000 prescriptions Cipro Drug Sales During Anthrax Incident First anthrax case reported, 10/4/01. Doxycycline Tobacco Cessation Aid Sales and Tax Increases NRT $0.39 increase in State tax $1.42 increase in City tax /11 CDC recommends doxycyline 10/28/ /1/2001 7/29/2001 8/26/2001 9/23/ /21/ /18/ /16/2001 1/13/2002 Citywide Domestic Violence Trends /12/2000 9/9/ /7/ /4/ /2/ /30/2000 1/27/2001 2/24/2001 3/24/2001 4/21/2001 5/19/2001 6/16/2001 7/14/2001 8/11/2001 Week Ending 9/8/ /6/ /3/ /1/ /29/2001 1/26/2002 2/23/2002 3/23/2002 4/20/2002 5/18/2002 6/15/2002 7/13/2002 Syndromic Surveillance

26 Improved internal communication and between government agencies, providers and the public

27 BioWatch-Related Issues Decreased confidence in system reliability Incident characterization capacities limited and have not improved substantially Limited integration between jurisdictions

28 Joint Investigation Protocol

29 Examples of Current Information-Sharing Biosurveillance Activities Surveillance and outbreak management system enhancements (e.g., Maven) Internal commitment to using collaboration sites on agency s intranet Leveraging social networks for pushing messages and public health surveillance Electronic medical record initiative with 4 NYC Regional Health Information Organizations (RHIOS) 2,800 providers 600 practices Incorporating military operational planning doctrine into biological emergency planning activities

31 Location of Operational Centers of Gravity in Catastrophic Incidents Detection Notification of key partners/public Rapid investigation(s) to: Confirm diagnosis Identify hazards and risk factors Not in detection or notification Track impacts Risk communication/safety recommendations Coordinated interventions Mass treatment/mass prophylaxis Recovery

32 Information-Sharing Dynamics Within and Between Organizations Emergency Rules Routine Business Rules Information is power Sharing information may lead to loss of control and/or autonomy Unidirectional information flows preferred Sharing information is for chumps Knowledge is power Sharing information supports common missions, goals and objectives Multi-directional information flows preferred Common operating picture Where are we today?

Preparing For Pandemic Influenza: What the CDC and HHS Recommend You Can Do

Preparing For Pandemic Influenza: What the CDC and HHS Recommend You Can Do Based on current data and information from the Centers for Disease Control (CDC) and the U.S. Department Health and Human Services