Champlain Port of Entry (POE) Communicable Disease Functional Exercise at Champlain, NY Pacific North West Border Health Alliance (PNWBHA) Victoria, BC May 24-26, 2011
Learning Objectives Outline the key components of International Border Communicable Disease Response Plan. Describe key objectives for the Champlain POE Exercise. Describe the major expected /unexpected outcomes of the Exercise. Identify the lessons learned from the Exercise. 2
Background Early Warning Infectious Disease Surveillance (EWIDS) Created in 2003 by the US Department of Health and Human Services (DHHS)-Assistant Secretary for Preparedness and Response (ASPR) Centers for Disease Control and Prevention (CDC) Funding Goals To enhance disease surveillance, information sharing, laboratory analysis, and health alert notification capability along the northern US border by establishing collaboration among US states and Canadian provinces. 3
EWIDS was a primary catalyst in the creation of several cross-border public health alliances along the northern US border/southern Canadian border. 4 NYS participates in both the Great Lakes and Eastern Border Health Initiatives
International Border Communicable Disease Response Plan Guides the Local Health Department / EMS State Health Department Federal (CBP/CDC) response to an infectious disease emergency at the international border. 5
Key Features of the Response Plan: Immediate Contact Numbers Immediate Contact Numbers Clinton County US Customs and Border Protection (CBP) CBP Port of Entry: Champlain 518-298-8346 24 Hours/Day CBP Press Office, Buffalo 716-626-0400 X 204 Centers for Disease Control and Prevention (CDC) CDC JFK Airport Quarantine Station / 24-hour service 718-553-1685 CDC Public Affairs Office (Press Officer) 404-639-3286 County and State Department of Health Clinton County Department of Health 518-565-4848 Business Hours 518-565-3270 After Hours Clinton County EMS 911(Local) Champlain Valley Physician s Hospital 518-561-2000 NYS DOH Capitol District Regional Office Albany NYS DOH Bureau of Communicable Disease Control (BCDC) Albany NYS DOH After Hours Duty Officer Albany 518-408-5396 Business Hours 518-473-4439 Business Hours 1-866-881-2809 After Hours Regional Public Health Units, Canada (Ontario or Quebec) depends on location of initiating county Monteregie Region Public Health Unit 450-928-6777 Business /After Hours Montreal Region Public Health Unit Quebec Ministry of Health and Social Services, QC Neighboring US State: Vermont Health Department 514-528-2400 Business /After Hours 418-266-6723 Business Hours 800-363-3781 # 32245 After Hours 802-863-7240 Business /After Hours 6
Key Features of the Plan: Roles and Responsibilities The Plan outlines the roles and responsibilities of the primary responders to a communicable disease at a land border port of entry. Roles and Responsibilities of the Various Agencies Involved AGENCY ROLE FUNCTION CBP Recognition Notification / Command and Control EMS/Hospital Response Medical Care LHD Response / Evaluation Operations / Legal Authority State DOH Awareness Notification and Support CDC Quarantine Guidance / Notification Notification / Legal Authority 7
Key Features of the Plan: Communication Pathways Notification / Communication Pathways What are some challenges to Isolation and Quarantine? Illness observed in passenger aboard conveyance Parallel notification from CBP to CDC Q Station and EMS / LHD Separation of ill and non-ill Release Passengers / Conveyance Public Health Agency of Canada CBP POE Field Office CDC Quarantine Station EMS LHD Response and Medical / Public Health Assessment Hospital + LHD + CDC Possible Quarantine? No Yes Quarantine CDC Response and medical assessment is a collaborative effort between responding public health nurses, hospital, CDC (via phone) Isolate ill passengers Consult CDC Quarantine Duty Office Consult Health Department ISSUE FEDERAL QUARANTINE ORDER Or ISSUE LHD QUARANTINE ORDER 8
Isolation and Quarantine: Challenges Logistics of managing medical evaluation, separation of ill/non-ill, confining people for extending lengths of time. What if a case confirmation takes hours or days? Managing the media? Who pays for care and transport if individuals have to be hospitalized? 9
Exercise at the Champlain Port of Entry September 2010 Primary Partnering Agencies: US Customs and Border Protection (CBP), Champlain POE CDC, Division of Global Migration and Quarantine, JFK Airport, NY Clinton County Health Department, Plattsburgh, NY Champlain Valley Physicians Hospital NYSDOH 10
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Exercise at the Champlain Port of Entry September 2010: OBJECTIVES Recognition: Epidemiology & Surveillance - Detection of illness at border crossing Initiate protocols for assessment and identification of biological illness Communication Notification protocols Response: Emergency Operations Center (EOC) Management Activation of Command Center / Unified Command Response: Isolation & Quarantine Protocols Medical assessment, isolation of exposed and quarantine of ill Quarantine Order County and Federal 12
Exercise at the Champlain Port of Entry September 2010: PREPARATION 13 17 volunteers from the University Nursing Program participated. Scripts were provided to each volunteer to provide a back story and assist with medical assessment questions. Moulage was applied to two volunteers to simulate the pustules associated with monkey pox.
Exercise at the Champlain Port of Entry September 2010: SCENARIO 17 students and one Advisor from Plattsburgh State University are returning home from a three-week school trip to Sierra Leone. They traveled by air to Montreal Canada and spent the night there before returning for the US by bus. 14 At the Champlain POE their bus is stopped for routine customs interviews and the CBP agent detects illness aboard the bus at the Port of Entry into the US.
Exercise at the Champlain Port of Entry September 2010 - IMMPLEMENTATION EXPECTED OUTCOMES SERIES OF EVENTS UNEXPECTED OUTCOMES CBP agent asks passengers to depart bus for standard central processing. Upon detection of illness, passengers return to bus and moved out of line into secondary holding area. Arrival of the students via bus into the conveyance line at the Champlain POE. Long lines at the port delayed start of play. CBP agent boarded the bus before it entered the station for a pre-assessment. He immediately detected a situation and requested supervisor assistance. Resulted in the bus being moved immediately and CBP agent becoming isolated onboard bus with passengers. 15
Exercise at the Champlain Port of Entry September 2010 - IMMPLEMENTATION 16 EXPECTED OUTCOMES SERIES OF EVENTS UNEXPECTED OUTCOMES It was expected that CPB would simultaneously notify CDC Q Station and EMS. Both would respond and participate in medical assessment PH Nurses from CCHD, EMS, CDC Q Station would communicate and deliberate. PH Nurses from CCHD would use CDC forms to gather information. CBP called 911 as their first call, causing EMS to be the first responders. Q Station was notified as was Clinton County DOH. Clinton County DOH arrived onsite Medical Assessment Clinton Co EOC Activated EMS established incident command for medical assessment. CBP s incident command was not fully established due to other priotities. Clinton County PH Nurses were delayed because they simply did not know how to navigate the POE. CDC had difficulty in assisting with medical assessment because key details were delayed. Technical difficulties made communication outside garage difficult, coordination between onsite responders and Clinton Co EOC was a challenge, communication between agencies was sporadic. CDC forms were cumbersome.
Exercise at the Champlain Port of Entry September 2010 - IMMPLEMENTATION EXPECTED OUTCOMES SERIES OF EVENTS UNEXPECTED OUTCOMES 17 Passengers would be given medical assessment, ill and non-ill would be separated, passengers are not allowed to leave until a suspect diagnosis was identified and a course of action determined Expected that notifications would flow from county to state That BCDC would be involved in the exercise to assist in a specimen transport protocol. That notifications would go from LHD to VT and QC Assessment of passengers by EMS and LHD took place. Non-ill and ill passengers were managed by EMS / LHD while medical assessment was taking place. Notifications: NYSDOH -Regional Office and Bureau of Communicable Disease Control (BCDC) VT / Quebec Non-ill passengers started to question the CBP agents about their rights and how long they would be held. Passengers began to exhibit anxiety about length of time being held and what may be going on for them. Communications through NYS channels did not occur as expected due to time constraints. Notification to QC was completed.
Exercise at the Champlain Port of Entry September 2010 LESSONS LEARNED The simplest details can derail a good plan know your directions! Develop a simple check off list to prepare for the type of questions CDC Q Station will ask. CDC s Medical Assessment Form is cumbersome and could be reduced to a simple line list. Passengers (ill and non-ill) need to be kept informed, and provided mental health support if needed. 18
The single biggest problem in communication is the illusion that it has taken place George Bernard Shaw 19
Thank you! Richard Buck, Border Health Manager/Tribal Liaison Associate Director, Office of Health Emergency Preparedness New York State Department of Health Riverview Center 150 Broadway Suite 355 West Menands NY 12204 518-474-2893 Office 518-402-6228 Fax rjb06@health.state.ny.us 20