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October 13, 2009
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Syndromic surveillance for pandemic illness

By Bob Smith
Director of Strategic Development, APCO International

With the vast interest and hype surrounding the current strain of H1N1 influenza impacting the country, a familiar buzz phrase has once again come to the forefront of emergency planning and response – syndromic surveillance. But what is syndromic surveillance and what does it have to do with public safety?

Syndromic surveillance is defined by the Centers for Disease Control and Prevention (CDC) as “...surveillance using health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response.”

With that definition in mind, the questions arise, “What implications, if any, does this have on today’s first response communities, and what role, if any, do today’s public safety communications centers play in syndromic surveillance?”

The training and procedures we have developed, trained on and used in our preparations for potential terrorist incidents could easily translate to pandemic outbreaks, including syndromic surveillance.

Syndromic surveillance is a specific type of call-trend analysis that allows communications personnel to detect those all-important signs and react accordingly. One of the first signs of an event involving a possible weapon of mass destruction or other terrorist act can be an influx of calls that are similar in nature and/or exceed typical call numbers. These can also be used to determine a potential pandemic outbreak. Examples of such calls include:

• An increased surge of medical calls (especially if the symptoms are similar in nature)
• Calls reporting large numbers of sick or dying people or animals
• Calls reporting seemingly distinct patterns of illnesses and common symptoms

Noting that these types of calls could possibly be related and an early heads-up notification up the chain of command on the part of communications personnel may play a pivotal role in the response to a pandemic incident or potential bioterrorism.

Most communications centers today are digitizing their data and replacing outdated, paper-dependent systems with the modern technology offered by computer-aided dispatch (CAD) systems, mobile data terminals (MDTs) and other software and computer-based systems. This often includes software used for caller triage and dispatch guidelines.

Many providers of such technology now offer an electronic syndromic surveillance system that interfaces with a CAD system and offers automated electronic monitoring. These programs assist the communications center and field agencies in call-trend analysis and create an electronic syndromic surveillance system. Most of these programs allow an agency to establish a baseline threshold of normal operations. The program uses these criteria to establish a threshold so it can monitor day-to-day transactions for trends that can be recognized as possible pandemic or “outbreak” situations or acts of biological or chemical terrorism.

To put this into real-world terms, in any given 24-hour period, an agency responds to an average of 15 “sick unknown” calls with patients complaining of difficulty breathing and flu-like symptoms. This criterion, 15 calls of this nature in 24 hours, would be considered a “norm,” and it can be set as the threshold for this type of call. So, if during a 24-hour period a 16th call matching this description were received by the agency, the threshold criterion would be met and the system would trigger an automatic response and notify the appropriate emergency personnel.

The personnel notified and the manner in which they are notified will vary by system and agency, but the activity remains essentially the same. For example, a rash of difficulty breathing or shortness of breath calls may activate notification of the Department of Health, local hospital emergency departments, fire chief and the local EMS supervisor. These individuals could be notified immediately via email, pager or cellular telephone, depending on the system in place.

It is essential that communications personnel and field agencies alike be trained in the essentials of syndromic surveillance and the importance of their role in early recognition of situations with the potential to affect a large proportion of the population.


Bob Smith is APCO International’s Director of Strategic Development. Contact him by email at smithr@apco911.org.

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