PDPH Advisory – July, 2013


Health Notification
Fourth of July Special Events – Public Health Preparedness Recommendations
July 1, 2013

The City of Philadelphia is preparing to host several large events as part of the Wawa Welcome America Festival occurring this week in celebration of the upcoming July 4th holiday. While the City of Philadelphia has received no information regarding any threats specific to these events, healthcare facilities should be prepared for both naturally occurring events that might result in increased illness, as well as the possibility of terrorism resulting in civilian casualties. The Philadelphia Department of Public Health Division of Disease Control (DDC) recommends that healthcare facilities review their emergency response and disaster preparedness plans before the upcoming holiday period with the possibly heightened potential for terrorism and disease transmission. Specific recommendations include:

 -Evaluate facilities and personnel to ensure the safety and security of both
 -Ensure that appropriate staff understand their roles in an emergency and communications protocols
 -Update clinical providers on biological, chemical, and radiological agents.  (Information on these threats is attached and additionally may be found at www.bt.cdc.gov, and www.atsdr.cdc.gov, and www.health.state.pa.us)
 -Review procedures that address medical treatment of mass casualties, including decontamination protocols, the use of personal protective equipment and triage protocols
 -Review procedures that address medical treatment of blast and bombing injuries. (Information can be found at http://emergency.cdc.gov/masscasualties/blastinjuryfacts.asp)
 -Prepare to treat individuals suffering from heat related illnesses
DDC reviews data daily from multiple sources to facilitate the recognition of disease outbreaks. However, DDC always relies on clinicians to report by telephone conditions that require immediate notification, as well as any outbreak or unusual presentation or cluster of disease. Indicators of naturally occurring outbreaks or possible biological terrorism are:
 -An unusual temporal or geographic clustering of illness (e.g., persons who attended the same public event or gathering)
 -Increase in serious lower respiratory illness with negative tests for common bacteria and viruses
 -Patients presenting with clinical signs and symptoms that suggest an infectious disease outbreak (e.g., >2 persons presenting with an unexplained febrile illness associated with sepsis, pneumonia, respiratory failure, or rash or a botulism-like syndrome with flaccid muscle paralysis, especially if occurring in otherwise healthy persons)
 -An unusual age distribution for common diseases (e.g., an increase in chickenpox-like illness in adult patients)
 -Single cases of disease due to uncommon, non-indigenous agents (e.g., anthrax, plague, tularemia) in patients with no history suggesting an explanation for illness
 -Large number of cases of acute flaccid paralysis with prominent bulbar palsies, suggestive of a release of botulinum toxin

Please contact the Division of Disease Control (DDC) to report conditions requiring immediate notification, or to obtain public health consultation.  DDC will also facilitate diagnostic testing requiring public health laboratory services.  During normal business hours, call 215-685-6740; after business hours, contact the Division of Disease Control on-call personnel at 215-686-4514 through Philadelphia City Hall.

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