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J Urban Health. Mar 2003; 80(Suppl 1): i50–i56.
PMCID: PMC3456558

Clinical evaluation of the Emergency Medical Services (EMS) ambulance dispatch-based syndromic surveillance system, New York City


Since 1998, the New York City Department of Health has used New York City Emergency Medical Services (EMS) ambulance dispatch data to monitor for a communitywide rise in influenzalike illness (ILI) as an early detection system for bioterrorism. A clinical validation study was conducted during peak influenza season at six New York City emergency deparments (EDs) to compare patients with ILI brought in by ambulance with other patients to examine potential biases associated with ambulance dispatch-based surveillance. We also examined the utility of 4 EMS call types (selected from 52) for case detection of ILI. Clinical ILI was defined as fever (temperature higher than 100°F) on history or exam, along with either cough or sore throat. Of the 2,294 ED visits reviewed, 522 patients (23%) met the case definition for ILI, 64 (12%) of whom arrived by ambulance. Patients with ILI brought in by ambulance were older, complained of more severe symptoms, and were more likely to undergo diagnostic testing, be diagnosed with pneumonia, and be admitted to the hospital than patients who arrived by other means. The median duration of symptoms prior to presenting to the ED, however, was the same for both groups (48 hours). The selected call types had a sensitivity of 58% for clinical ILI, and a predictive value positive of 22%. Individuals with symptoms consistent with the prodrome of inhalational anthrax were likely to utilize the EMS system and usually did so early in the course of illness. While EMS-based surveillance is more sensitive for severe illness and for illness affecting older individuals, there is not necessarily a loss of timeliness associated with EMS-based (versus ED-based) surveillance.

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Selected References

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1. Meltzer M, Damon I, Duc J, Millar J. Modeling potential responses to smallpox as a bioterrorist weapon. Emerg Infect Dis. 2001;7:959–969. [PMC free article] [PubMed]
2. Kaufmann A, Meltzer M, Schmid G. The economic impact of a bioterrorist attack: are prevention and postattack interventions justifiable. Emerg Infect Dis. 1997;3:83–94. [PMC free article] [PubMed]
3. Centers for Disease Control and Prevention Recognition of illness associated with the intentional release of a biologic agent. MMWR Morb Mortal Wkly Rep. 2001;50:893–897. [PubMed]
4. Rotz L, Khan A, Lillibridge S, Ostroff S, Hughes J. Public health assessment of biological terrorism agents. Emerg Infect Dis. 2002;8:225–230. [PMC free article] [PubMed]
5. Cieslak T, Eitzen E. Clinical and epidemiologic principles of anthrax. Emerg Infect Dis. 1999;5:552–555. [PMC free article] [PubMed]
6. Franz D, Jahrling P, Friedlander A, et al. Clinical recognition and management of patients exposed to biological warfare agents. JAMA. 1997;278:399–411. doi: 10.1001/jama.278.5.399. [PubMed] [Cross Ref]
7. Pavlin JA, Kelley PW, Mostashari F, Institute of Medicine (United States) et al. Biological Threats and Terrorism: Assessing the Science and Response Capabilities. Washington, DC: National Academy of Sciences; 2002. Innovative surveillance methods for monitoring dangerous pathogens; pp. 185–196.
8. Lober WB, Karras BT, Wagner MM, et al. Roundtable on bioterrorism detection: information system-based surveillance. J Am Med Inform Assoc. 2002;9:105–115. doi: 10.1197/jamia.M1052. [PMC free article] [PubMed] [Cross Ref]
9. Centers for Disease Control and Prevention Syndromic surveillance for bioterrorism following the attacks on the World Trade Center—New York City, 2001. MMWR Morb Mortal Wkly Rep. 2002;51:13–15. [PubMed]
10. Barthell EN, Cordell WH, Moorhead JC, et al. The Frontlines of Medicine Project: a proposal for the standardized communication of emergency department data for public health uses including syndromic surveillance for biological and chemical terrorism. J Urban Health. 2003;80(2):i26–i27. [PubMed]
11. Townes JM, Kohn MA, Southwick KL, et al. Use of an electronic emergency department information system as a data source for respiratory syndrome surveillance. J Urban Health. 2003;80(2):i117–i118.
12. Foldy S, Biedrzycki P, Barthell E, et al. Milwaukee Biosurveillance Project: real-time syndromic surveillance using secure regional Internet. J Urban Health. 2003;80(2):i126–i126.
13. Peterson D, Perencevich E, Harris A, Novak C, Davis S. Using existing electronic hospital data for syndromic surveillance. J Urban Health. 2003;80(2):i122–i123.
14. Miller S, Fallon K, Anderson L. New Hampshire emergency department syndromic surveillance system. J Urban Health. 2003;80(2):i118–i119.
15. Davidson AJ, McClung MW, Cantrill SV. Syndromic surveillance: an applied tool for monitoring health effects of Colorado wildfires, summer 2002. J Urban Health. 2003;80(2):i125–i126.
16. Cochrane D, Allegra J, Rothman J. Real-time biosurveillance using an existing emergency department electronic medical record database. J Urban Health. 2003;80(2):i120–i121.
17. Espino JU, Wagner MM. Accuracy ofICD-9-coded chief complaints and diagnoses for the detection of acute respiratory illness.Proc AMIA Symp. 2001:164–168. [PMC free article] [PubMed]
18. Mostashari F, Fine A, Das D, Adams J, Layton M. Use of ambulance dispatch data as an early warning system for communitywide influenzalike illness, New York City. J Urban Health. 2003;80(2):i43–i49. [PMC free article] [PubMed]
19. Brammer T, Murray E, Fukuda K, Hall H, Klimov A, Cox N. Surveillance for influenza-United States, 1997–98, 1998–99, and 1999–00 seasons. MMWR Morb Mortal Wkly Rep. 2002;51(SS07):1–10.
20. Centers for Disease Control and Prevention Notice to readers: considerations for distinguishing influenza-like illness from inhalational anthrax. MMWR Morb Mortal Wkly Rep. 2001;50:984–986. [PubMed]
21. Sosin DM. Draft framework for evaluating syndromic surveillance systems. J Urban Health. 2003;80(2):i8–i13. [PMC free article] [PubMed]

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