Preparing Airports for Communicable Diseases on Arriving Flights (2017)

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76 Appendix d Survey Questions and Responses D-1: Survey Questions and Responses for Airports 1. Name of person completing this section______________________________________________ 2. Title of person completing this section _______________________________________________ 3. Phone ________________________________________________________________________ 4. E-mail ________________________________________________________________________ 5. Airport name __________________________________________________________________ 6. Airport 3-letter code _____________________________________________________________ 7. Is your airport a Joint Use facility with the military? (Y/N) 8. Do you have flights arriving nonstop to your airport from outside the U.S. or Canada? (Y/N) Of the 49 airports submitting surveys, 40 (81.6%) have flights arriving nonstop from outside the U.S. or Canada. Table 25 shows the types of such flights arriving at the 40 airports. Type of Flight n Percent Scheduled commercial passenger flights 28 71.8 Charter flights 31 79.5 Cargo/freight flights 29 74.4 Industrial aviation flights (e.g., aircraft) 13 33.3 Humanitarian support flights 17 43.6 Emergency repatriation flights 16 41.0 Corporate general aviation flights 34 87.2 Private (non-corporate) general aviation flights 29 74.4 Smith and Greenberg data (2016) TAblE 25 TYPES Of flIghTS ArrIvINg frOm OUTSIDE U.S. AND CANADA 9. how many monthly international arrivals do you have (rough estimate)? 60.50% 1001 or more 2.60% 501 to 1000 5.30% 151 to 500 18.40% 31 to 150 13.20% 30 or fewer 10. Is your airport a port of entry with CbP or CbSA? 11. how big is the CbP or CbSA staff at your airport? 12. how large (square feet) is the CbP or CbSA facility at your airport?

77 13. What types of communicable disease issues has your airport been involved in responding to? 14. how does your airport expect to learn that it has a potential issue with a communicable disease on an incoming flight? [See Table 3 in chapter three for aggregated data for question 14.] 15. Do you have a written communicable disease or quarantine plan for your airport? (Y/N) 16. What form does your communicable disease or quarantine plan take? TAblE 26 rElATIONShIP Of COmmUNICAblE DISEASE PlANS TO OThEr mAJOr PlANS Title N Percent Stand-alone communicable disease/quarantine plan maintained by the airport 24 49.0 Communicable disease/quarantine plan is part of the airport emergency plan (AEP) 18 36.7 Stand-alone or community communicable disease/quarantine plan maintained by a health department 9 18.4 Communicable disease/quarantine plan is part of the airport business continuity plan (BCP), also sometimes called the continuity of business plan (COB). 5 10.2 Not applicable—we have no written plan and don’t share in health department’s plan. 3 6.1 Airport Standard Operating Procedures 1 2.0 Communicable disease/quarantine plan is maintained by CDC Quarantine Station representatives. 1 2.0 Communicable disease/quarantine plan is maintained as part of county Fire Rescue Response Plan. 1 2.0 Communicable disease/quarantine plan is part of public safety standard operating procedure 1 2.0 Plan under development 1 2.0 Note: The total percentage exceeds 100% as some airports have their communicable disease response plans attached to more than one other plan. Smith and Greenberg data. 17. how do you communicate your communicable disease plan to other stakeholders? 18. Does CbP or CbSA at your airport have a communicable disease/quarantine plan? 19. Is any part of your communicable disease plan Sensitive Security Information (SSI)? 20. Is your communicable disease plan reflected in your crisis communications plan/emergency communications plan? 21. Who are the stakeholders in your communicable disease planning process? TAblE 27 STAkEhOlDErS TO INvOlvE IN COmmUNICAblE DISEASE rESPONSE PlANNINg Stakeholder Airport Health Dept. n % n % Airport operations 43 87.8 23 62.2 Airport senior management 41 83.7 22 59.5 Airport ARFF and EMS 40 81.6 25 67.6 Local health department 38 77.6 Hospitals and clinics 38 78.6 1 2.7 Airport law enforcement 36 73.5 15 40.5 Airport emergency management 35 71.4 28 75.7 Airport media/public relations 35 71.4 21 56.8 (continued on next page)

78 TAblE 27 (continued) Caterers 2 4.1 1 2.7 HAZMAT—local fire department 1 2.0 17 45.9 City emergency management Not asked in survey 14 37.8 County emergency management 23 62.2 State emergency management 11 29.7 Smith and Greenberg data. CBP/CBSA 32 65.3 17 45.9 CDC/PHAC—Quarantine office 31 63.3 30 81.1 Airlines, air cargo companies, charter operators, and air taxi operators 28 57.1 12 32.4 Local agencies 27 55.1 18 48.6 State health department 25 51.0 27 73.0 Ambulances/medical transport services 22 44.9 28 75.7 TSA/CATSA 22 44.9 13 35.1 FAA/Transport Canada/Nav Canada 21 42.9 3 8.1 Airport human resources 20 40.8 2 5.4 Airport maintenance 20 40.8 5 13.5 American Red Cross/Red Cross of Canada 16 32.7 3 8.1 Airport planning 15 30.6 17 45.9 State agencies 15 30.6 11 29.7 Medical institutions 14 28.6 16 43.2 Sponsor/certificate holder (This is the owner of the airport; e.g., city, county, state, country, or authority.) 13 26.5 8 21.6 Concessionaires 11 22.4 1 2.7 Other public officials (elected officials, etc.) 11 22.4 9 24.3 National agencies 10 20.4 4 10.8 Airport training 9 18.4 3 8.1 Airport finance 8 16.3 1 2.7 Military (if joint use) 7 14.3 1 2.7 Non-airport law enforcement 7 14.3 9 24.3 General aviation aircraft owners and pilots 6 12.2 2 5.4 Healthcare coalition 6 12.2 21 56.8 Airport IT 5 10.2 1 2.7 HAZMAT contractors 5 10.2 1 2.7 Medical and nursing associations and societies 4 8.2 1 2.7 Fuel services 3 6.1 0 0.0 Mobility services (wheelchairs, carts) 3 6.1 1 2.7 Public media 3 6.1 4 10.8 Stakeholder Airport Health Dept. n % n % 22. Does your plan differentiate how to handle passengers from how to handle flight crews? 23. Does your plan incorporate National Incident management System (NImS) principles and practices? 24. Does your plan incorporate Incident Command Systems (ICS) principles and practices?

79 26. how do you train on your communicable disease/quarantine plan? 27. When was your most recent drill or exercise of your airport/arriving flight communicable disease preparedness plan? 25. Do you review your communicable disease response plan periodically? [CATEGORY NAME] 31 airports, [PERCENTAGE] [CATEGORY NAME], 4 airports, [PERCENTAGE] N/A, 3 airports, [PERCENTAGE] [CATEGORY NAME] 11 airports, [PERCENTAGE] Not applicable 6% 2016 21% 2015 31% 2014 18% 2013 4% 2012 2% 2010 2% 2009 or before 4% Never 12% 28. What is the role of outbound social media (push social media) regarding communicable disease at your airport? 29. Does your plan take into account the possibility of social media posts by a passenger about disease on an inbound flight while the flight is still in progress?

80 30. What protective measures (training, personal protective equipment, other clothing, equipment, vaccines, countermeasures, medical checks, etc.) do you provide for airport employees? 31. Does your communicable disease/quarantine plan involve diverting inbound flights to other airports? 32. Can you identify a case at your airport or another airport where the plan or protocol was notably successful or notably unsatisfactory? (Y/N—this will help identify a potential case example.) 33. What are the top three lessons (positive and/or negative) that you learned concerning communi- cable diseases on arriving flights? See Appendix E for responses. 34. Overall, how prepared do you consider your organization to be in the event of an airport/arrival flight communicable disease event? 35. If you answered (b) or (c) to the previous question, what is the one thing you feel your organization should or could do to enhance its airport/arrival flight communicable disease preparedness? D-2: Survey Questions and Responses for Local Public Health Preparedness Coordinators 1. Name of person completing this section______________________________________________ 2. Title of person completing this section ______________________________________________ 3. Phone ________________________________________________________________________ 4. E-mail _______________________________________________________________________ 5. Agency name __________________________________________________________________ 6. 3-letter code of nearest airport (e.g., OmA, ATl, YYZ, vNY, ASE, Yvr, etc.) ______________ 7. Do you have a written communicable disease or quarantine plan for your airport? (Y/N) 8. What form does your communicable disease or quarantine plan take? Communicable disease/quarantine plans is part of the airport emergency plan. Stand-alone communicable disease/quarantine plans maintained by the airport. Stand-alone or community communicable disease/quarantine plans maintained by a health department Other (Please specify): Not applicable—we have no written plan. 9. Who are the stakeholders in your communicable disease planning process? See Table 27. 10. have you trained on your airport/arriving flight communicable disease preparedness plan? (Y/N) 11. Is your agency expected to provide services at the airport? [CATEGORY NAME], 21 airports, [PERCENTAGE] [CATEGORY NAME], 3 airports [PERCENTAGE] [CATEGORY NAME], 25 airports, [PERCENTAGE]

81 12. how does your agency meet requirements to surge for an airport communicable disease response? (Please mark all that apply.) Surge staff available request surge staff re-prioritize existing programs/staff Temporarily suspend programs/divert staff Other (Please specify): 13. When was your most recent drill or exercise of your airport/arriving flight communicable disease preparedness plan? 14. Overall, how prepared do you consider your organization to be in the event of an airport/arrival flight communicable disease event? very prepared Somewhat prepared Not prepared 15. If you answered (b) or (c) to the previous question, what is the one thing you feel your organization should or could do to enhance its airport/arrival flight communicable disease preparedness? D-3: Template for Expert Validity Interviews The senior officials from five health organizations were asked to comment on preliminary conclusions and further research needs after the completion of data collection and late in the analytical process: Conclusion 1: health departments and airports benefit from pre-established relationships and joint planning efforts for communicable disease response. Conclusion 2: miscommunication is a huge risk, so message discipline and use of all forms of com- munication are essential. A Joint Information Center is very helpful. Conclusion 3: A unified command with a public health, law enforcement, fire/EmS and airport presence is the most effective way to manage a communicable disease incident. Conclusion 4: An airport needs to have quick access to a health department SmE. Conclusion 5: Airports and health departments broadly agree on the importance of including stake- holders in planning and on who those stakeholders are. Conclusion 6: The larger the airport, the more likely it and its hD partner are to say it’s very Prepared. [65% for large hubs, 22% for medium hubs, 17% for small hubs, 0% for non-hubs, but 56% for relievers (really big gA airports) and 50% for small gA airports]. Conclusion 7: looking at the 37 matched pairs of airports and hDs, 24 (about 2/3) agree on level of preparedness. Overall, the biggest category of agreement is somewhat prepared (16 of 37 airports). further research Topic 1: Information about a sick passenger on an international flight flows, but similar information is not available for passengers on domestic flights. further research Topic 2: Uniform procedures for getting flight manifests when hD asks airport for help after a disease is detected. further research Topic 3: Are requirements for screening outgoing passengers coming? What other areas of further research would you like to see? TAblE 28 YEAr hEAlTh DEPArTmENT mOST rECENTlY DrIllED WITh AIrPOrT Year n % 2016 12 35.3% 2015 6 17.6% 2014 6 17.6% 2013 1 2.9% 2010 1 2.9% 2009 or before 2 5.4% Never 4 11.8% N/A 2 5.4% n = 34. Smith and Greenberg data.