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Biosurveillance Used At Bush Inauguration (Mar. 13)



Americans and visitors from around the world converged on Washington, D.C., in January to witness the swearing in of the 43rd U.S. President. In the background, a new medical epidemiology software program developed by the Defense Advanced Research Projects Agency (DARPA) gathered real-time data in order to provide an alert in the event of a covert release of a biological warfare agent.

DARPA's Enhanced Consequence Management Planning And Support System (ENCOMPASS) software demonstrated its worth as an early signal detector system for public health safety. The system was used to share relevant clinical information at military treatment facilities, Veterans Administration medical clinics and participating civilian hospitals and aid stations in the Washington, D.C., metropolitan area.

For the demonstration of ENCOMPASS during the recent Inauguration, DARPA worked with the Washington, D.C., Emergency Management Agency and Washington, D.C., Maryland and Virginia Departments of Health to provide ENCOMPASS software for syndromic surveillance. Medical aid stations along the Inaugural parade route and at the Inaugural balls collected anonymous symptoms and signs data. At civilian hospitals in Maryland and Virginia, health care personnel filled out brief forms when first seeing patients.

The form noted whether the patient had any of seven particular complaints such as fever and rash, cough, or sore throat that matched a warning list developed in cooperation with the Centers for Disease Control and Prevention. The forms from the participating hospitals were aggregated into an ENCOMPASS database. Other ENCOMPASS software looked for disproportionate increases in any complaint category in order to alert medical officials. The three local Departments of Health held daily conference calls to discuss trends in the anonymously collected data.

Lcdr. Kurt Henry, USN, M.D., DARPA's ENCOMPASS program manager, noted, ENCOMPASS picked out a sudden spike in fevers at some military clinics. We immediately issued a public health alert to participating civilian medical centers to see whether there was a larger pattern. With the ENCOMPASS software, an epidemiology team was able to determine that the sudden increase in fevers was found only in the military facilities and that the increase was consistent with regular seasonal flu patterns."

The ENCOMPASS biosurveillance system includes software components that can function together as a unit or independently based on the needs of users. The system is capable of tracking patient symptoms to alert epidemiologists of new syndromic trends that could indicate the possible release of a biological warfare agent. These software components include the Incident Repository, Patient Encounter Module, Medview and Biological Agency Symptomatology Information System.

The Incident Repository contains the database that drives the management system. The Patient Encounter Module is a handheld software program that interfaces with ENCOMPASS to facilitate data collection in the field. The Biological Agency Symptomatology Information System (BASIS) provides medical surveillance during the quiescent phase of a covert bioagent release. BASIS actively monitors signs and symptoms collected during the patient encounter and correlates those events with time to show any disturbances.

Medview is a medical surveillance visualization tool that assists medical planners, epidemiologists, and responders to identify the geographic origin of covert biological warfare agent releases. It provides a dynamic view of medical syndromic data in a geographical context in conjunction with the location of medical treatment facilities. The progression of syndromic data over time can be viewed in a VCR-like playback/play forward format.

Lcdr Henry added, ""We are extremely pleased with how the system helped the public health community. It was interesting for me as a medical professional to be able to see so quickly, for example, that the Washington area was not experiencing the usual region-wide winter increase in cold and flu symptoms.""

The biosurveillance component of ENCOMPASS used during the Inauguration has also been successful demonstrated in military exercises and at other special civilian events. The U.S. military plans to use ENCOMPASS as a medical surveillance system for deployed forces in support of the Department of Defense Force Protection strategy. The commercial products derived from ENCOMPASS research are available for transition to local and state emergency agencies and public health departments.

Contractors for the ENCOMPASS Inaugural demonstration include: Oracle, Reston, Va. (Incident Repository and Patient Encounter Module); ScenPro, Dallas, Texas (Medview); Veridian, Rosslyn, Va. (BASIS); Mitre, McLean, Va. (Inaugural Management Information Portal); Unconventional Concepts Inc., Fort Walton Beach, Fla. (integration of ENCOMPASS with public health community systems).

Note:
Local and state emergency agencies and public health departments interested in information about commercial variants of the ENCOMPASS technology should contact commercial vendors Oracle and Science Applications International Inc.

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" DARPA Epidemiology Software Used During Presidential Inauguration