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Airport Response during Communicable Disease Outbreaks
Tuesday, December 11, 20182:00-3:30 PM ET
TRANSPORTATION RESEARCH BOARD
Purpose Discuss research from the Airport Cooperative Research Program (ACRP) Insight Event: Airport Roles in Reducing Transmission of Communicable Diseases and Legal Research Digest 34: Airport Public Health Preparedness and Response: Legal Rights, Powers, and Duties.
Learning ObjectivesAt the end of this webinar, you will be able to:
• Discuss the relationships within the public health community that must be made and maintained during an outbreak event
• Describe a response plan and all aspects of emergency management operations during an outbreak event
• Describe applicable sources of law that address responsibilities of airports in communicable disease outbreaks and identify the unique legal challenges
• Understand how to use checklists for legal considerations preparedness plans
ACRP Webinar
Airport Response During Communicable Disease OutbreaksDecember 11, 2018
ACRP is an Industry–Driven Program
Managed by TRB and sponsored by the Federal Aviation Administration (FAA).Seeks out the latest issues facing the airport industry.Conducts research to find solutions.Publishes and disseminates research results through free publications and webinars.
Other Ways to Participate
December 12Understanding Airport Air Quality Management and Public Health
Stay Tuned for ACRP’s 2019 Webinar Series
Upcoming ACRP Webinars
Synthesis 83: Preparing Airports for Communicable Diseases on Arriving Flights
Report 91: Infectious Disease Mitigation in Airports and on Aircraft
Insight Event Presentations From: Airport Roles in Reducing Transmission of Communicable Diseases
Visit us online:
Additional ACRP Publications Available on Today’s Topic
Leila Barraza and Elizabeth Hall-LipsyUniversity of Arizona
Presenting Legal Research Digest 34: Airport Public Health, and Preparedness and Response:
Legal Rights, Powers and Duties___________________________________________________________________________________________
Deborah Helton and Randal RhodesDallas/Fort Worth International Airport
Insight Event Presentation: Airport Roles in Reducing Transmission
of Communicable Diseases
Today’s Speakers
Airport Roles in Reducing Transmission of Communicable Diseases
Deb Helton and Randal Rhodes
Dallas / Fort Worth International Airport
Department of Public Safety
• DFW Airport – 2.5 years• EOC Operations and Innovation• B.S. Social Psychology • Master of Social Work
▪ Focus on Systems Theory ▪ Recovery and resilience of
impacted communities• 22 years Emergency Management
Deb HeltonDFW Airport Emergency Management Administrator
• DFW Airport – 24.5 years• Emergency Medical Services Div.• Career Development Div.• Fire Training Research Center• B.S. Biology / Biological Research
▪ Genetic analysis of disease and abnormailities
• 20 years military aviation experience
Randal RhodesDFW Airport Public Safety – Assistant Fire Chief
Airport Roles in Reducing Transmission of Communicable Diseases
https://www.youtube.com/watch?v=Xxf_fCg51lc
Dallas / Fort Worth International Airport
Statistics:
• 18,000 acres of property• 28 sq miles in size• Larger than the city of Manhattan, New York• 3rd busiest airport in the United States• Global International Entry Airport• 5 Terminals• 69 million passengers per year• 200,000+ passengers per day• 7 Runways• 6 Fire Stations covering EMS, structural, and ARFF responses• 184 fire fighters/ EMT-Basic / EMT-Paramedics• 36 fire fighters per shift• 7 paramedics per shift• HazMat and Special Operations Specialties• World-renowned Fire Training and Research Center
Dallas / Fort Worth International Airport
Statistics:
• Comprehensive Emergency Management Program• 6 full-time staff members• Fully Integrated with all Airport functions• Available to respond / ramp up at any given moment – on call rotation• Airport Support Function EOC structure – 118 trained EOC responders• Flexible response process tailored to the need• Close partnerships with government, air carriers, and intelligence
communities for situational awareness• Fully trained airport leadership for crisis leadership and decision making
Dallas / Fort Worth International Airport
Emergency ManagementEmergency Management
Comprehensive Emergency Management Includes:
Airport Emergency Planning
Continuity of Operations Planning and Training
Crisis Decision Making and Leadership
Helping All Victims of Emergencies in Need (HAVEN) Program
Emergency Operations Center leadership and sustainment
Pandemic and Contagious Disease Response
Protective Actions Plans and Training
Data Utilization Project
Enterprise wide emergency response and recovery training
Drills and Exercises – Annual LifeSaver Exercise Series
Intelligence Monitoring for Public Health, Weather, and Terrorism activity
Dallas / Fort Worth International Airport
Dallas / Fort Worth International Airport
EMS Division (2017)• Full, Self-sufficient services• 3 – 24hr ALS Staffed MICU units• 1 – 24hr Paramedic Supervisor• 4,321 medical calls• 1,574 ER transports
A. Intelligence
1. Centers for Disease Control (CDC) and Preventiona) Enrollment in email outbreak reports or noted trendsb) Enrollment in email – Morbidity and Mortality Weekly Reportc) Close working relationship with CDC staff / medical epidemiologists – Houston and
Atlanta
2. World Health Organization (WHO)a) Website review for outbreak reports or noted trends
3. State / Local Health Agenciesa) Tarrant and Dallas County Public Health - Epidemiologistsb) Health Intelligence reports – local hospital systems
4. National and International News Media5. Social Media postings
a) Facebookb) Twitter
DFW - Preparing for The PH Emergency
B. Standard Operating Procedures
1. Established response procedures and protocolsa) International Flightsb) Domestic Flightsc) Original International Passengers on Domestic Flights (New Process)d) EOC SOPs for all Airport Support Functions – enterprise wide
2. Medical Director Patient Care Protocols
1. Receiving Hospital ER Communications Procedures
1. Mutual Aid Agreements to support transport
DFW - Preparing for The PH Emergency
DFW - Preparing for The PH Emergency
C. Tactical Training
1. Disease Characteristics2. Signs and Symptoms Identification
a) Feverb) Rashc) Unusual bleeding / bruisingd) Swollen glands
3. Patient Medical Assessment 4. Patient Travel Assessment
a) Destinations Visitedb) Urban or Countryside c) Animals Present – Domestic / Wild
5. Isolation Procedures6. The Dreaded “Q-Word”
DFW - Preparing for The PH Emergency
D. Training – Major Disease Considerations
A. Plague (Bubonic or pneumonic)B. CholeraC. Infectious TuberculosisD. DiphtheriaE. SmallpoxF. Yellow FeverG. Viral Hemorrhagic FeverH. SARS / MERS / Respiratory ConditionsI. Any Influenza that can cause a pandemic
A. Avian FluB. Swine FluC. Season Flu
J. Ebola
DFW - Preparing for The PH Emergency
E. EOC TrainingASF #1 – Transportation /Led by TBU
ASF #2 - Communications Systems /Led by ITS
ASF #3 – Infrastructure /Led by ETAM
ASF #4 - Safety and Documentation /Led by RM
ASF #5 - Emergency Management /Led by EM
ASF #6 - Customer Care and Services /Led by CX
ASF #7 - Resource Management /Led by Procurement
ASF #8 - EMS and Fire /Led by Fire Services (Supported)
ASF #9 - Spiritual and Mental Health /Led by Airport Chaplaincy
ASF #10 - HazMat and Environmental Protection /Led by EAD
ASF #11 – AirOPS /Led by Operations
ASF #12 – Utilities /Led by ETAM
ASF #13 - Law Enforcement and Security /Led by Police
ASF #14 - Recovery Planning /Led by Airport Planning
ASF #15 - Crisis Communication /Led by Corp Comm
DFW - Preparing for The PH Emergency
F. Practice, Practice, Practice
1. Begins with Field Traininga. Recognitionb. Treatment optionsc. Isolationd. Notification Protocols
2. Response Traininga. Classroom trainingb. Shift trainingc. Include affected departmentsd. CDC Representative presentations
3. Exercisesa. Tabletop exercisesb. Full Scale exercises with specialized equipment
4. Anniston – Center for Domestic Preparedness
DFW - Preparing for The PH Emergency
G. Authority to Act
1. USC 42, section 201-300: Public Health Act2. 42 CRF part 70 & 71: Interstate and Foreign Quarantine3. Texas Communicable Disease Prevention & Control Act – Texas
Health & Safety Code
DFW – Responding to a PH Emergency
Response ProtocolInitial Notification Routes
a. 9-1-1b. Airline Operations Staffc. FAA Control Tower d. CDC Notificatione. EOCf. Everbridge – automatic response notification system
EOC is activateda. ASF #8 EMS and Fire is supportedb. All others are supportingc. Activation Priorities:
a. Support for isolation and/or quarantine operationsb. Manage public messaging/media in partnership with public health and airlinec. Ensure normal operations resume/continued during response
d. Briefing tempo and reports
DFW – Responding to a PH Emergency
Response ProtocolDomestic Flight with Domestic Passenger(s)
a. EMS responseb. Law Enforcement Responsec. Passengers / crew remain onboard the planed. May require additional PPE geare. 1 Paramedic to make patient(s) contactf. Assessment is passed along to partner paramedic g. Phone call made to local County Health Dept CDC representativeh. Action coordination between EMS, County Health, and receiving Hospitali. Limited contact with civilians and other emergency respondersj. Documentation of passengers surrounding the patientk. Treat symptoms per standard of care
DFW – Responding to a PH Emergency
Response ProtocolDomestic flights with International Passenger(s)
a. EMS responseb. Law Enforcement Responsec. Passengers / crew remain onboard the planed. May require additional PPE geare. 1 Paramedic to make patient(s) contactf. Assessment is passed along to partner paramedic g. Travel history documentedh. Phone call made to local County Health Dept CDC representativei. Additional phone call made to CDC Representative (Houston or Atlanta)j. Action coordination between EMS, County Health, and receiving Hospitalk. Limited contact with civilians and other emergency respondersl. Documentation of passengers seated around the patientm. Treat symptoms per standard of care based on CDC recommendations
DFW – Responding to a PH Emergency
Response ProtocolInternational Flight
a. EMS responseb. Customs/Border Patrol will secure the aircraftc. Passengers / crew remain onboard the aircraftd. May require additional PPE geare. 1 Paramedic to make patient(s) contactf. Assessment is passed along to partner paramedic g. Travel history documentedh. Phone call made to local County Health Dept CDC representativei. Additional phone call made to CDC Representative (Houston or Atlanta)j. Action coordination between EMS, CDC, and receiving Hospitalk. Limited contact with civilians and other emergency respondersl. Treat symptoms per standard of care based on CDC recommendationsm. Possible full isolation / quarantine of some or all passengers / crewn. County Health and CDC personnel response to the isolation area
DFW – Responding to a PH Emergency
QUESTIONS
Airport Roles in Reducing Transmission of Communicable Diseases
ACRP Legal Research Digest 34
Airport Public Health Preparedness and Response: Legal Rights, Powers, and
DutiesLeila Barraza, JD, MPH
Elizabeth Hall-Lipsy, JD, MPH
Leila Barraza, Principal Investigator
Leila Barraza Assistant Professor-The University of Arizona Mel and Enid Zuckerman College of Public Health
Elizabeth Hall-LipsyAssistant Professor-The University of Arizona College of Pharmacy
David Y. Bannard, Project Chairman
Rod C. Borden
Jay Hinkel
Clyde Otis
Daniel S. Reimer
Elizabeth Smithers
Daphne A. Fuller
Tom Devine
Robert J. Shea
Marci Greenberger, Responsible Senior Program Officer
ACRP LRD 35 Project Committee 11-01
BackgroundResearch and ProcessReport HighlightsTools Developed and Recommendations for UseConclusion
ACRP LRD 34: Presentation Outline
Current Context
In-depth research and report preparationUse of subscription legal databases Search terms: communicable diseases, disease
surveillance, decontamination, privacy, quarantine, isolation, contract tracing, and screening Cross-check using research team composed of
law fellows and two authorsReview of draft report by project consultants and CDC representatives
Research Process
Identification and reporting of ill passengersWhen: departures, inflight, arrivalsWhat: pilots are required to report deaths or illnesses that occur during inbound international and domestic interstate flights; specific list of symptomsTo whom: CDC
Report Highlights: Legal Considerations for Communicable Disease Response Planning
Report Highlights
Measures to detect communicable diseasesSurveillanceNon-invasive proceduresInvasive procedures (with consent)Contact tracing
Report Highlights: Legal Considerations for Communicable Disease Response Planning
Federal laws- apply to travelers crossing state lines or arriving from foreign country/territory Quarantine- separates people exposed but not
yet confirmed to be infected or contagious Isolation- separates confirmed, infected cases
from non-infected personsLimited to specific diseases: cholera, diphtheria, infectious TB, plague, smallpox, yellow fever, viral hemorrhagic fevers, severe acute respiratory syndromes, and influenzas
Report Highlights: Isolation and Quarantine
Report HighlightsAuthority: DHHS can enact rules for inspection, fumigation, disinfection, sanitation, pest extermination, and destruction of infected animals or contaminated thingsCDC and FDA can implement measures to prevent transmission, if local authorities are unableDisinsection of Aircraft: CDC and EPA no recommended routine disinsection of commercial airplanes
WHO and ICAO permit and describe methods, and some countries require
This Photo by Unknown Author is licensed
Report Highlights: Decontamination
OSHA sets standards for safe working conditions State and local government employees may not be
covered by OSHA, but may be covered by an OSHA approved state plan
Employers requirements Training programs- exposures to hazardous substances
including infectious agentsNo cost to employees
Written safety and health plans (org plan, work plan, surveillance, etc.)
Necessary equipment
Report Highlights: Safety of Airport Employees
Communications Internal- rapid sharing of information among
stakeholders Responsibilities for notifications and communications
Internal – airport administration, management and operations, airlinesExternal communications- public health authorities, other airports, media, travelers (consider even international communication)
Coordination with federal, state, or local public health authorities and airlines for consistent and cohesive messaging
Report Highlights: Legal Authorities for Roles and Responsibilities
HIPAA Privacy RuleExceptions: Public Health Law Enforcement Serious and Imminent Threat
Report Highlights: Ensuring Privacy and Confidentiality
Unreasonable searches and seizuresZone of privacyPrivacy Act of 1974Common law claims False light
Due Process Protections Fifth and Fourteenth Amendments Civil Actions for Depravation of Rights (§1983) False Imprisonment
Report Highlights: Protection of Privacy Interests
Emergencies can be declared by an expanding array of officials at various levels of government at the federal, state, tribal, and local levels.Declared emergencies instantly change the legal environment to facilitate effective response efforts by giving officials flexible powers, releasing needed resources and personnel, and waiving or modifying certain legal requirements.Overlapping powers and simultaneous declarations for the public health event require coordination and communication between responding agencies and parties.
Report Highlights: Changing Legal Environment During Emergencies
Report Highlights: Changing Legal Environment During Emergencies
Public Readiness and Emergency Preparedness ActVolunteer Protection ActUniform Emergency Volunteer Health Practitioners ActModel State Emergency Health Powers ActOther State Volunteer ProtectionsEquipment, Planning, and Training
Report Highlights: Potential Liability and Protections
Tools- Stakeholders
Tools- State and Local Quarantine and Isolation Laws (10 busiest airports)
Tools- Checklist of Legal Issues to Consider in Developing Airport Communicable Disease Preparedness Plans
Conclusion
Questions?
Today’s Participants• John Wilhelmi, Eastern Research Group, Inc.,
[email protected]• Deborah Helton, Dallas/Fort Worth International Airport,
[email protected]• Randal Rhodes, Dallas/Fort Worth International Airport,
[email protected]• Leila Barraza, University of Arizona,
[email protected]• Elizabeth Hall-Lipsy, University of Arizona,
Panelists Presentations
http://onlinepubs.trb.org/onlinepubs/webinars/181211.pdf
After the webinar, you will receive a follow-up email containing a link to the recording
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