ECADS
- Early CBRN Attack Detection by Computerized Medical Record Surveillance

Public Safety and Security Mitigation and Detection Solution:

In April 2004, the Chemical, Biological, Radiological and Nuclear Research and Technology Initiative (CRTI) accepted AMITA’s syndromic surveillance proposal entitled ECADS. CRTI is a joint interdepartmental initiative led by Defence R&D Canada. Its primary focus is to strengthen the nation’s preparedness for, prevention of and response to a CBRN terrorist attack by fostering new investments in research and technology that will generate knowledge and technology, and support their application, while harnessing existing capabilities.

The goal of the ECADS project is to make possible the early detection of a covert terrorist attack in progress via real time surveillance of medical records.

The ECADS project lead is the University of Ottawa Heart Institute. Other project partners include AMITA Corporation, National Research Council - Institute for Marine Biosciences (lead federal government partner), National Research Council - Institute for Information Technology, Public Health Agency of Canada (Foodborne, Waterborne and Zoonotic Infections Division, Centre for Infectious Disease Prevention and Control), Michigan State University (National Food Safety and Toxicology Center), Carnegie Mellon University (School of Computer Science, Auton Lab), e-Privacy Management Systems Inc., Performance Support Services Inc., CAM Emergency Preparedness, Grey Bruce Health Unit, South Bruce Grey Health Centre, Grey Bruce Health Services, Hanover and District Hospital.

Scientific studies have shown that routinely monitoring specific indicator variables can prove accurate as early indicators of a disease outbreak. Syndromic surveillance (SS) systems are designed to detect time- and geography-dependent abnormal occurrences, i.e., frequency or total numbers of these indicator variables. Syndromic surveillance can be used to alert responders that an outbreak / terrorist attack may be in progress, and to track the growth of an outbreak after it has been detected.

The University of Pittsburgh is contributing a syndromic surveillance system as the basis, known as RODS.

Objectives:

• As the first objective, the ECADS team will adapt RODS (Real time Outbreak Detection and Surveillance) to a Canadian setting and with the help of Grey Bruce Health Unit, deploy it successfully as a technology demonstration.
• The second objective is to improve the specificity of syndromic surveillance. The objective is comprised of three tasks: the team will add the capability of storing free text portions of the emergency room record (anonymized) to RODS so they can be read by responders, giving them the information they need to characterize better a potential event; the team will then work with the NRC Institute for Information Technology to improve the computerized analysis of those free text portions of the medical record; and finally, the Carnagie Mellon Auton Laboratories will help optimize detection algorithms for syndromic surveillance data.
• The third objective of the project is to integrate a RODS-based syndromic surveillance system with existing and planned disease surveillance and information management systems in Canada and the US.
• The fourth objective is to develop a roadmap for implementing syndromic surveillance in Canada. The roadmap will consist of a detailed implementation plan addressing technical and non-technical issues that affect future development and deployment of such a surveillance system.

When combined with emerging electronic health records technology, ECADS will provide unique disease surveillance and early detection capabilities that directly address four of the seven highest risk scenarios identified by the CRTI. This will be critical for the success of containment, decontamination and consequence mitigation efforts by first responder organizations.

By advancing Canadian expertise in syndromic surveillance and demonstrating a system that can be readily deployed across the country ECADS will provide Canada with a unique disease surveillance/early detection capability to detect and identify the following:

Chemical:

• A chemical attack against people in enclosed spaces (e.g., subways, large buildings) – covert aerosol attack with a volatile toxic agent, e.g., sarin.
• A chemical attack against people by contamination of food or water supply.

Biological:

• A covert attack on a large urban area using an agent such as anthrax. This type of attack is expected to result in a large number of casualties.
• A biological attack against critical infrastructure, food or water supply – contamination of a localized supply (e.g. reservoir, hospital, stadium) with an infectious agent or toxin.

Radiological:

• A covert attack on a large urban area using a non-explosive radiological dispersal device.

In the absence of a terrorist attack, syndromic surveillance systems will also provide public health institutions with the ability to detect and manage naturally occurring outbreaks.