Public Health Emergency Preparedness and Response 2014 Annual Report

Introduction by the Director of Emergency Preparedness and Response We are pleased to present our second annual report regarding the planning, training, exercises and response coordination of the Tri-County Health Department’s (TCHD) Office of Emergency Preparedness and Response (EPR). As background, TCHD Environmental Health Staff have responded 24/7 to environmental issues that have potential public health and environmental impacts since the 1970’s. This historic strong connection to local fire, hazmat and law enforcement partners across our jurisdiction facilitated the development of more fully functional public health preparedness and response plans that were first implemented at TCHD during 20002002. Since that time the TCHD Office of Emergency Preparedness and Response (EPR) has refined these plans, developed numerous response agreements with community partners and assembled a scalable and fully functional Public Health Incident Management Team (PHIMT) that assures TCHD response to all incidents from disease outbreaks to natural disasters is effectively managed. Having an Office dedicated to Emergency Preparedness and Response wholly focused on the large scope of preparing for public health all hazard responses across our three counties and 26 municipalities and internally with all of our Divisions--including Nursing, Environmental Health, Nutrition, and Epidemiology, Planning and Communication (Disease Control)--has greatly enhanced our response to small incidents and large multi-state incidents alike. Additionally, EPR has developed procedures and infrastructure for supporting our response partners during non-public health led incidents like wildfires, flooding and mass casualty incidents. The diverse workforce at TCHD allows for agency support from a broad range of skills and abilities to allow for enhanced response to both public health led incidents and incidents with a public health impact. The primary benefit of our efforts is a better coordinated response system (state, county and local resources) and more rapid response from TCHD and our multidisciplinary partner agencies) to any incident impacting our communities. We are also pleased to share a video completed in 2014 that provides a brief overview of how we provide incident coordination and support across our agency: https://www.youtube.com/watch?v=5NGFqhwBQU. During 2014, we responded to a variety of incidents. The Ebola epidemic was most noteworthy both at TCHD and across the globe as the possibility of having a suspect or confirmed Ebola patient in our state and local jurisdiction translated into increased interest and activity in multidisciplinary efforts related to planning for and responding to an emerging infectious disease. It is important to continue to grow our culture of preparedness as an agency and a community. While our Office works on EPR efforts on a daily basis, we want to continue to maintain a workforce at TCHD that is always ready to respond in the event of an emergency or incident. It is important for us to foster and grow our network of partners. We want to continue to be a model through the good work we do for our partners statewide and nationally! We hope you enjoy reading our second annual report!

Michele M. Askenazi, MPH, CHES Director of Emergency Preparedness and Response

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Office of Emergency Preparedness and Response Overview

Mission To advance coordination and preparedness in order to support appropriate public-health response to incidents and emergencies in the Tri-County Health Department (TCHD) jurisdiction of Adams, Arapahoe, and Douglas Counties.

Program descriptions Public Health Emergency Preparedness (PHEP) Program This program promotes local preparedness for natural (e.g., wild fires, floods, disease outbreaks) and man-made (e.g., bioterrorism, radiological) disasters and emergencies through planning, training and exercises with a wide variety of local partners and TCHD as whole. These efforts also link to collaborative preparedness efforts between federal, state and local agencies and local health care providers throughout the North Central Region of Colorado. TCHD works to improve its capacity for early identification of disease outbreaks, rapid delivery of prophylaxis, and communication among first responders, health care personnel and public health agencies. This program integrates disease surveillance through the Colorado Electronic Disease Reporting System (CEDRS), 24/7 response capacity, and communication via the Health Alert Network (HAN). Emergency Preparedness assessment includes risk analysis and sharing of expertise and information with both the public and external partners before and during an event. Efforts also include the development of plans (including the public health emergency operations plan, continuity of operations, risk communication and mass prophylaxis) and agreements in preparation for events. Finally, assurance of emergency preparedness is accomplished through training, education, public messaging, exercising, and capacity- building events/activities. Each year, TCHD participates in numerous drills and exercises on topics such as the strategic national stockpile (a federal stockpile of medications and medical supplies), command/coordination/incident management, first responder drills, redundant communication, and other identified areas to improve training and planning.

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Cities Readiness Initiative The Centers for Disease Control and Prevention (CDC) Cities Readiness Initiative (CRI) is a federally funded program designed to enhance preparedness in the nation’s largest cities and metropolitan statistical areas where more than 50% of the U.S. population resides. Through CRI, state and large metropolitan public health departments have developed plans to respond to large-scale bioterrorist events by dispensing antibiotics to the entire population within 48 hours. The Office of Emergency Preparedness and Response has developed plans for receipt, storage and distribution of large quantities of medicine and medical supplies to protect the public in the event of a public health emergency. These resources will be delivered to any state in the U.S. in time for them to be effective.

BioSense 2.0 (Syndromic Surveillance) Program BioSense is a CDC program that tracks health problems as they evolve and provides public health officials with data, information and tools needed to better prepare for and coordinate responses to safeguard and improve the health of the American people. Mandated in the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, the CDC BioSense program was launched in 2003 to establish an integrated national public health surveillance system for early detection and rapid assessment of potential bioterrorism-related illness. BioSense serves to protect the health of the American people by providing timely insight into the health of communities, regions, and the nation by offering a variety of features to improve data collection, standardization, storage, analysis, and collaboration. The key components of the BioSense program include: 1) building health monitoring infrastructure and workforce capacity where needed at the state, local, tribal, and territorial levels; 2) facilitating the interchange of information that can be used to coordinate responses and monitor health-related outcomes routinely and during an event; 3) expanding the utility of BioSense data to multi-use [and all-hazard] beyond early event detection and to contribute information for public health situational awareness, routine public health practice and improved health outcomes and public health; 4) improving the ability to detect emergency health-related threats by supporting the enhancement of systems to signal alerts for potential problems; 5) increasing local and state jurisdictions participation in BioSense; and 6) advancing science and technology.

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TCHD EPR Funding

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Achievements CDC Local Technical Assistance Review (LTAR) of Emergency Preparedness and Response On February 12, 2014, CDPHE conducted the annual Local Technical Assistance Review (LTAR) to assess the evidence of overall readiness of TCHD for a Mass Prophylaxis response and our ability to manage, distribute and dispense Strategic National Stockpile (SNS) material during a public health emergency. Due to a significant Mass Prophylaxis planning update, the 2014 assessment included review and scoring of the Elbert County Health and Human Services plan which is now included in the TCHD plan as a Field Operating Guide. CDPHE reviewed planning elements that were scored “not met” and/or “partially met” from the LTAR assessment conducted by the Centers for Disease Control and Prevention in 2013. Examiners reviewed documentation such as policy letters, written agreements, standard operating procedures, operational plans, training plans, drill and exercise results, meeting minutes, checklists, and related databases. The annual review was conducted 9 months after the 2013 CDC assessment. The TCHD score increased from 97% to 99% and planning support and assistance from TCHD helped Elbert County Health and Human Services to raise their score from 65% to 95%. National Association of County and City Health Officials (NACCHO) Model Practice Recognition The TCHD EPR project titled Public Health Incident Management Team (PHIMT) was selected as a 2014 model practice by the National Association of County and City Health Officials (NACCHO). The purpose of the PHIMT is to promote response capacity, coordination, collaboration, and communication among all divisions in TCHD to ensure that TCHD can effectively respond to any public health incident and remains an effective partner to all other disciplines in the TCHD jurisdiction, specifically in its role of Emergency Support Function (ESF) #8 Lead. The goals of the program are to create depth in the management of and response to complex and long-term emergencies and incidents, and incorporate staff from each division/office within TCHD to foster a culture of emergency preparedness throughout the organization. The PHIMT consists of approximately 38 individuals from all TCHD Divisions and Offices who are assigned to Incident Command System (ICS) functional areas (i.e., Command or General staff positions) and trained on the management of that function. The PHIMT meets monthly for two hours. The meetings consist of a training or exercise designed to improve the PHIMT’s knowledge and understanding of ICS and how to respond to an incident. Dr. John M. Douglas, Michele Askenazi, and Sara Garrington attended the 2014 NACCHO Annual Conference to accept the plaque on behalf of the agency. 6

EPR’s Veronica Moody Named Colorado EPR Regional Staff Person of the Year Veronica Moody has brought a wealth of knowledge, skill, and experience to her position as a Regional Emergency Preparedness and Response staff person at TCHD. Over the course of the last year, she has demonstrated her ability to not only balance her workload of complex and challenging priorities, but to succeed in making dramatic advances in planning for the 3 counties serve d by TCHD and the North Central Region (NCR). With her focus on access and functional needs, home health, communications, and mass prophylaxis, she has worked diligently to assist in the regionalization of appropriate aspects of planning and response. Examples of the work Veronica has undertaken in the last year exemplify what it means to be the Colorado Regional Staff Person of the Year and she was recognized for her efforts by her peers and the CDPHE Office of Emergency Preparedness and Response (OEPR) at the spring state wide EPR Regional Staff meeting

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Partnerships 

Emergency Preparedness and Response Healthcare Coalition The TCHD EPR Healthcare Coalition exists to support and advance health and medical preparedness, response, and recovery in Adams, Arapahoe, Douglas, and Elbert Counties. This group of hospitals, coroners, behavioral health, first responders, emergency managers, community clinics, volunteer groups, and local public health partners work to align emergency preparedness efforts across municipal and county boundaries. Because of the efforts undertaken to more closely coordinate preparedness and response planning within the broader health and medical system, coalition members have been able to identify previously overlooked response partners, streamline systems to support response efforts, and coordinate the leveraging of limited resources. TCHD has taken the lead in facilitating the process, but the diverse and active coalition membership has validated the process and allowed efforts to progress beyond many expectations.

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Alternate Treatment Center Coalition In an effort to continually broaden our focus on better preparing our communities to respond to any type of disaster, TCHD has established an alternate treatment center coalition to include nursing homes, dialysis centers, and hospice centers alongside traditional healthcare coalition members. The purpose of this group is to share awareness of existing resources available for disaster planning and response, to train on processes and plans in place to access much needed support through the local health department, and to provide a networking opportunity with our community members as our primary local support system. In late 2014, in order to better meet this purpose, the decision was made to combine this coalition with similar groups in the Denver Metro Area to create the Regional Specialty Coalition. This larger group will hold its first meeting in January 2015.

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Health and Medical - Emergency Support Function (ESF) #8 The ESFs provide the structure for coordinating Federal interagency support for Federal response to an incident. They are mechanisms for grouping functions most frequently used to provide Federal support to States and Federal-to-Federal support, both for declared disasters and emergencies under the Stafford Act and for non-Stafford Act incidents. There are 15 ESFs identified by the federal government. TCHD has been identified as the ESF #8 lead in Adams, Arapahoe, Douglas, and Elbert Counties and the City of Aurora within the state of Colorado. This means it is our role to support any response activities or needs associated with the health and medical component of an incident or a planned event. We have worked with our partners to develop an operational annex to the 8

TCHD Public Health Emergency Operations Plan (PHEOP) to best fill this role. The purpose of this annex is to identify the ESF #8 agencies and partners within Adams, Arapahoe, Douglas, and Elbert Counties and to facilitate TCHD’s role as lead for these jurisdictions and municipalities in creating a comprehensive ESF #8 coordination system. This annex describes TCHD’s capacity or method for response to the ESF #8 component of any event or incident as requested by the affected jurisdiction(s). The key to this Operational Annex is that there is a single document providing operational procedures and how they interface with very different emergency management and incident management settings – and it works. In 2014, the Annex was reviewed and updated by a working group of subject matter experts and will be re-signed in early 2015 for formal adoption. 

Medical Reserve Corps The Rocky Mountain Medical Reserve Corps of Colorado (RMMRCCO), established in 2013 and sponsored by TCHD, focuses on providing a strong and willing volunteer force capable of supplementing the public health and emergency preparedness needs of Adams, Arapahoe, and Douglas Counties. While these three counties are the RMMRCCO’s primary focus, the services of the RMMRCCO can be requested by any jurisdiction requiring support. A Medical Reserve Corps (MRC) coordinates the skills of both medical and non-medical volunteers who are willing to volunteer during the phases of preparation, response, recovery and mitigation. In 2014 the MRC increased from 15 to 51 members, and held 8 MRC meetings where training was conducted. The MRC also supported several 5k races and held outreach events at the Elbert and Adams County Fairs and the City of Aurora National Preparedness Fair. For information on volunteering please visit: www.rockymountainmrc.com.

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North Central Region (NCR) Regional Coordination leadership activities The North Central All-Hazards Emergency Management Region (NCR) is one of nine emergency preparedness and response Regions within the State of Colorado. Prior to September 11th, Colorado's primary response capability was at the city and county level. In August 2002, Governor Owens announced the establishment of seven regions to support this response capability. These seven regions were later expanded to nine as part of the continuing effort to coordinate our response and foster the development of professional relationships. Governor Owens' Executive Order in July of 2003 designated each region as an All-Hazards Emergency Management Region. The NCR is comprised of a wide variety and diverse type of jurisdictions including mountainous, urban and rural communities. Effective integration of functional areas is accomplished through a collaborative, multi-functional approach to planning and analysis.

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The wide range of functional areas represented within the region include: o o o o o o o o o o o

Emergency Management Law Enforcement Fire Services Special Districts Public Health Emergency Medical Services Hospital Organizations Public Works Regional Transport Financial Services Coroners

As part of this Region-wide effort to coordinate all-hazards planning and response activities, TCHD EPR staff has assumed leadership roles in a number of regional committees in addition to the numerous committees that are attended on a regular basis. The committees in which we serve as leadership include: o o o o o o o o o

NCR Board of Directors (Board member on behalf of Adams County) NCR Public Health Committee (chair) Regional Radio Working Group (chair) NCR Access and Functional Needs (AFN) Committee (co-chair) Regional Home Health Emergency Preparedness Sub-Committee (chair) NCR Citizen Preparedness (co-chair) NCR Mass Fatality Planning Committee Statewide Healthcare Coalition Council (co-chair) Governor’s Expert Emergency Epidemic Response Committee (alternate Local Health Director)

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Incident Support and Response Operations Staff in EPR provided resources and support for the following responses in 2014: • •

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January Restaurant Norovirus Outbreak March Jefferson County Post Flood Community Assessment for Public Health Emergency Response (CASPER) April Legionella Outbreak July Pneumonic Plague Outbreak July Brighton Bottled Water Advisory 2014-2015 Ebola Response September White Powder Incident Enterovirus D68 Outbreak

Below are some key summaries to describe the type of response related efforts EPR conducts during nonroutine incidents: July Pneumonic Plague Outbreak TCHD was notified of a prairie dog die-off in Bennett, CO on June 27, 2014. The fleas from this site subsequently tested positive for plague. Dusting was completed at the site to kill fleas and two hundred flyers were distributed to the community members living in the area regarding the die off. Mapping of prairie dog colonies in the area is currently underway to determine whether others have been affected. In addition, several miles away, a dog developed pneumonic plague in late June, leading to an outbreak involving pneumonic plague in four persons, two of whom required hospitalization, one requiring a prolonged ICU stay. This outbreak generated national and international press attention and was remarkable for several reasons: rarity of dog-to-human transmission of pneumonic plague, at least one case of possible human-to-human pneumonic plague transmission (also rare), two cases with milder than expected illness, and over 100 persons requiring antimicrobial prophylaxis and/or fever monitoring due to exposure to the dog or one of the human cases. This was a successful coordinated effort as TCHD, working with CDPHE, the Colorado State University, the CDC, the Platte Valley Medical Center, and University Hospital of Colorado, investigated the source of exposure and identified those that may have been exposed through close contact with the individual. The CDC MMWR can be found here: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6416a1.htm?s_cid=mm6416a1_w

2014 Ebola Response Activities In response to the Ebola Virus Disease (EVD) outbreak currently being experienced in West Africa, TCHD worked to increase the jurisdiction’s level of readiness for a potential or confirmed Ebola patient. Activated members of the TCHD Public Health Incident Management Team (PHIMT), including all EPR staff members, shared 11

information and response guidance with external partners, tested communications capabilities and protocols, and determined our own local level of preparedness. In September 2014, TCHD initiated a communications drill with acute care and rehabilitation hospitals within Adams, Arapahoe, and Douglas Counties through the web-based situational awareness tool EMResource and via email. As part of this exercise, TCHD provided a survey to collect real world information regarding communication and resources related to the Ebola outbreak in West Africa and potential local impacts. As a follow-up to this exercise, EPR staff conducted an Ebola Table Top Exercise as part of the October 2014 Healthcare Coalition Meeting. This facilitated discussion walked through local response efforts to a suspected or confirmed case of Ebola from the moment 9-1-1 is notified of the potential illness through transport, hospital care, contact investigation, and the handling of remains. As a result of this exercise, several workgroups met to further explore preparedness gaps, identify solutions and protocols. Following CDC guidance, TCHD staff from Disease Control (DIS) and Nursing actively monitored all travelers coming from the countries impacted by the Ebola Outbreak. All 30 travelers monitored within our jurisdiction during 2014 were identified as low risk. TCHD staff from DIS, EPR and our Medical Epidemiologist also participated in site visits from the CDC Rapid Ebola Preparedness (REP) Team visits to review capabilities at the Children’s Hospital of Colorado and the University of Colorado Hospital to assess and treat suspected and confirmed patients with Ebola through the duration of their illness. Denver Public Health also participated in this process for the review at Denver Health. During the visit, CDC, state, and local public health staff were able to provide guidance on the strengths and areas for improvement at each facility and make recommendations regarding each facilities inclusion on the CDC Ebola Designated Treatment Center list.

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Training/Exercises/Presentations/Outreach A well- trained public health workforce is the basis for a strengthened infrastructure that has the capacity to prevent, protect, respond, and recover from a variety of hazards, whether natural or manmade, which may affect public health. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

TCHD Course: Utilizing Social Media during a Crisis TCHD ICS 100/700 for staff and partners Public Health Incident Management Team (PHIMT) Emergency Support Function (ESF) #8 Workshop Colorado Integrated Emergency Management Conference, ESF #8 Panel Presentation Alternate Care Facility Functional Exercise City of Brighton Integrated Response Table Top Exercise University Hospital of Colorado Burn Surge Table Top Exercise United States Postal Service (USPS) Biohazard Detection System (BDS) Exercise Denver International Airport Medical Surge Exercise Adams County March Functional Exercise Alternate Treatment Center MOU Training CDPHE MedSled Drill Arapahoe County Integrated Emergency Management Course/Exercise Ebola Communications Drill Adams County Public Information Drill University of Colorado School of Medicine Pandemic Influenza Table Top Exercise SkyRidge Medical Center Mass Casualty Incident Workshop Operation 317 Vaccination Exercise Series City of Aurora Havana Gardens Emergency Preparedness Day Operation Mountain Sync Full Scale Exercise Elbert County Functional Exercise TCHD ESF #8 EMS Table Top Exercise Aurora Emergency Operations Center Functional Exercise CDPHE Hosted Local Public Health Ebola Table Top Exercise TCHD ESF #8 Ebola Table Top Exercise 2014 Home Health Emergency Preparedness Workshop All Staff Emergency Notifications Drills Operation Rabbit’s Foot Revenge TCHD and Office of Emergency Management (OEM) Local Transfer Point (LTP) Drills Regional Emergency Trauma Advisory Council (RETAC) ESF-8 Mini Conference Master Exercise Practitioner Program (MEPP) All Hazards Incident Management Team Training (IMT Liaison Officer Course (956) 13

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Jefferson County CASPER Outreach Annual Zoonosis Workshop FEMA Continuity Exercise Design Course SNS Local Transfer Point (LTP) Exercise BioWatch Exercise Operation Sharp Point 6 Exercise Joint Risk Assessment Training Annual National Disaster Medical System (NDMS) Exercise Threat and Hazard Identification and Risk Assessment (THIRA) Training National Health Care Coalition Conference

Alternate Care Facility Functional Exercise On April 17, 2014, TCHD conducted an Alternate Care Facility (ACF) Functional exercise. The exercise consisted of 52 participants including TCHD PHIMT members and representatives from external partners within the TCHD jurisdiction. The partners included representatives from the Colorado Department of Health and Environment (CDPHE), local and county offices of emergency management, healthcare facilities, and local fire protection agencies. The exercise was developed to test TCHD’s ability to serve as the Emergency Support Function #8 (ESF #8) lead and activate the Alternate Care Facility Functional Annex, which is an annex to the TCHD Public Health Emergency Operations Plan (PHEOP). The exercise was based on a pandemic influenza and medical surge scenario and was designed to overwhelm local healthcare facilities and drive the need for the activation of the three alternate care facility locations within the Tri-County jurisdiction. Participants in this exercise included the TCHD Public Health Incident Management Team (PHIMT), local hospitals, behavioral health, coroner offices, EMS/Fire and Offices of Emergency Management (OEM). Other components of the ACF Functional annex tested include establishing the Medical Branch section of the PHIMT to determine patient acuity for the ACF sites in coordination with local hospitals, behavioral health, coroner’s offices, EMS/Fire and other healthcare facilities and evaluating the integration of the TCHD PHIMT Logistics section with local OEM during a public health led incident. The two major areas of improvement for this exercise include:  Continue to train on using WebEOC and EMResource systems.  Continue to identify medical concerns for both healthcare facilities and ACF locations through the Medical Branch Section.

Integrated Emergency Management Course (IEMC) The Integrated Emergency Management Course (IEMC), offered by the Emergency Management Institute of the Federal Emergency Management Agency (FEMA), was held in Arapahoe County from July 14-17, 2014, at the Arapahoe County Sheriff’s Office. The coursed is utilized to place public officials, emergency management personnel and key stakeholders in a realistic crisis situation within a structured learning environment and the scenario chosen for Arapahoe County was a severe weather incident, including tornadoes. Early in the course, an emergency scenario begins to unfold in sequence with classroom-style lectures, discussions and small-group workshops. As the course progresses, scenario-related events of increasing complexity, threat, and pressure 14

occur. Participants develop emergency policies, plans, and procedures to ensure an effective response. The course culminates into an emergency exercise designed to test participant knowledge, awareness, flexibility, leadership, decision-making, and interpersonal skills under rigorous pressure in the Emergency Operations Center (EOC) environment. There were an extensive number of participants, including County Commissioners, local elected officials, first responders and an extensive number of partners representing disciplines that provide key support during incident response and recovery. TCHD participants included Dr. John M. Douglas, Executive Director, as well as Michele Askenazi and Veronica Moody from the Office of Emergency Preparedness and Response and Brian Hlavacek from the Environmental Health Division.

2014 Home Health Emergency Preparedness Workshop The Home Health Emergency Preparedness Committee (HHEPC) was established after the 2013 Regional Evacuation Seminar sponsored by the Metropolitan Medical Response System (MMRS). The seminar was the first time home health agencies were invited to an emergency planning event and the response was overwhelmingly noted as “we want more of this”. The HHEPC was established in 2014 and TCHD chairs this monthly meeting for agencies that provide emergency preparedness resources for home health agency staff and clients. The core planners of the committee consist of local public health agencies, emergency managers and several home health agencies. Core planners devote their time to developing and deploying the resources and training for the entire group. A 6 hour workshop was developed to provide agencies information on lessons learned/best practices and how to train staff and clients to prepare for emergencies and enhance networking between agencies to encourage partnerships during emergencies.

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Communications Health Alert Network (HAN) 

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There were a total of 43 Health Alert Network messages disseminated throughout the year, the majority of which were Advisories (26). There were 5 Public Health Broadcasts, 4 Alerts, and 8 Updates. A total of 4886 recipients were reached through the Health Alert Network. All current HAN messages can be found online http://www.tchd.org/259/Health-Alert-Network as well as the two previous year’s HANs located at: http://www.tchd.org/580/Archived-HAN-Notices . The HAN messaging is divided into the following categories:  Health Alert: Conveys the highest level of importance; warrants immediate action or attention.  Health Advisory: Provides important information for a specific incident or situation; may not require immediate action.  Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action.  Info Service/Public Health Brief: Provides general information that is not necessarily considered to be of an emergent nature.  Other Broadcasts: Used to test the system and get updated info from providers, usually done annually.

Dialogics/Emergency Notification System 

TCHD has adopted a State hosted, emergency notification system. TCHD employees receive automated notifications requesting they follow specific prompts to determine if and when they can report to TCHD for incident operations. There were a total of 6 all staff call down tests performed for 2014, three held after hours and three held during business hours. Response rates averaged between 55 and 76%, with higher response rates occurring during the business hour drills. In July of this year, CDPHE, working with local partners, began contract negotiations on a new call down system that would replace the currently utilized emergency notification system. TCHD EPR Staff played an integral role in making suggestions on how to increase the functionality of the new system to be rolled out in July/August 2015.

Communications Drills 

TCHD conducts communications and radios drills with Emergency Support Function (ESF) #8 partners throughout Adams, Arapahoe and Douglas Counties, as well as Elbert County, at minimum of once a quarter. These drills help to ensure that TCHD is able to communicate with external partners using multiple redundant systems in the event that traditional means are overwhelmed or no longer available. 16

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In 2014, TCHD conducted:  4 email communication and 4 800MHz radio drills with 18 hospitals, 12 Offices of Emergency Management and 8 other community partners including behavioral health, school districts and one military installation.  4 communication drills with our Local Transfer Point (LTP) custodians.

Social media 

Utilizing social media, TCHD provides information to our communities on public health threats, emergency preparedness and response information as well as notification on national campaigns and local events such as our annual Household Chemical RoundUps, health and produce fairs and back-to-school immunization clinics. TCHD established a more active Social Media Presence with Twitter, Pinterest and Facebook in 2014. Over the course of the year, @TCHDEmergency grew from 16 to 121 followers as we engaged with both response partners and the community. Additionally, the overall agency Twitter account, @TCHDHealth was created and grew to 604 followers. This account incorporates tweets from divisions across TCHD covering a wide breadth of public health topics. These Twitter accounts allow us to engage with and provide valuable public health information to the public and our external partners. TCHD also utilizes Pinterest (www.pinterest.com/pintchd) to promote healthy eating, breastfeeding, environmental health issues, and emergency preparedness information. All of the TCHD Social Media accounts can be found at: http://www.tchd.org/79/Social-Media.

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Syndromic Surveillance/Meaningful Use TCHD was awarded the BioSense 2.0 grant from the Centers for Disease Control and Prevention (CDC) in 2012 through a joint application with Denver Public Health (DPH). The BioSense program is a public health surveillance system (syndromic surveillance) that increases the ability of health officials at local, state, and national levels to efficiently, rapidly and collaboratively monitor and respond to harmful health effects of exposure to disease or hazardous conditions. In Adams, Arapahoe, Denver and Douglas counties, we asked eligible hospitals to submit syndromic surveillance data, which is a core objective of Meaningful Use (MU) Stage2 and will add to hospitals’ readiness for MU incentive funds. Updated information is posted on the TCHD website (http://www.tchd.org/264/Syndromic-SurveillanceMeaningful-Use-Dec). TCHD works closely with hospitals and the Colorado Regional Health Information Organization (CORHIO) vendor to transmit messages to allow for syndromic surveillance data sharing. As of September 2014, TCHD is receiving on-going submission data from the hospitals in the TCHD jurisdiction (10 hospitals) and Denver County (5 hospitals). As BioSense 2.0 moves forward, we will work towards developing plans for early outbreak detection, routine analysis of syndromic surveillance data, and monitoring of special events/incidents. TCHD also installed an analytical tool, ESSENCE (the Electronic Surveillance System for the Early Notification of Community-Based Epidemics), to better monitor anomalies and clusters. Electronic syndromic surveillance data is used to improve population health by supporting timely and effective outbreak prevention and response at TCHD. ESSENCE is a prototype syndromic surveillance system for capturing and analyzing public health indicators for early detection of outbreaks. We used this system to assist monitoring outbreak alerts and events, such as a synthetic marijuana event and entrovirus-D68-Like syndromes (see Figure1). Figure1. ESSENCE, Analytical tool for outbreak detection at TCHD

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As syndromic surveillance provides timely information, public health decision makers can use this information to better monitor and mitigate public health threats. The future use of near-real-time syndromic surveillance also enables public health authorities to provide timely assessments of population health and improve situational awareness.

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THANK YOU! One of the reasons our community has been so successful in building and maintaining the Emergency Preparedness and Response network is that we are able to leverage the expertise from our partners and disciplines across our 3 counties. Thank you to all of those individuals and organizations who have contributed their time and expertise to our committees and projects. Your involvement has had a direct impact on our collective success.

OUR TEAM Emergency Preparedness and Response Staff Michele Askenazi, MPH, CHES Director Sara Garrington, MA, MSW Coordinator Veronica Moody Planner Jason Atencio Planner Clinton Andersen, MA, PhDc Planner (Vacated position in November, 2014)

Michael Perret-Gentil, MPA, MPH Planner (Assumed position in January 2015)

Julie Ross Program Support Yushiuan Chen, MS Syndromic Surveillance Epidemiologist Jennifer Chase, MPH Regional Epidemiologist1

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Note: EPR fully funds the Regional Epidemiologist position placed in the TCHD Division of Epidemiology, Planning and Communication

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