By Jeff Eggert

It is another beautiful Denver morning. The sun is shining, and Canadian geese are honking in 40 degree weather. A large crowd has begun to gather in the center of a park, huddled around hot coffee and warm bagels while yellow-vested volunteers quickly triage individuals in the crowd towards the appropriate registration line. The Incident Commander holds a last minute briefing with Denver Police Department, Denver Health Paramedic Division and Denver Parks and Recreation covering everything from “securing the perimeter” to “ensuring client and volunteer safety.”

Casual observers may get the impression this is a public health response to an infectious disease outbreak, but it is not. The scenario is an annual 5 K run to raise funds to assist patients battling a tuberculosis infection. Denver’s annual TB Trot is an example of how Denver Public Health uses the incident command system in creative ways to protecting the community’s health. The Denver Metro TB Clinic has organized this event since 2008, and in 2010, they began using the Incident Command System (ICS) to get and stay organized during a crisis…or annual event. Denver’s Center for Public Health Preparedness provided trainings and information on how to organize staff/volunteers, appoint an Incident Commander for the event, and staff all the key ICS positions. Each individual was trained on the roles and responsibilities for their assigned position and gained valuable experience in their assigned role. Little did they know, their ICS training would soon come in handy for a true public health emergency.

Fast forward one calendar year. On January 20^th Denver Metro TB Clinic received a report of a high school student with active tuberculosis and started a routine investigation into the case. When the test results came up positive in 10 of 11 immediate family members, investigators quickly realized this was not a typical investigation and testing needed to be done for the student’s teachers and some classmates. After 10 of the 19 (53% ) teachers and students who shared more than one classroom with the case patient were positive for latent TB infection, an investigation plan was developed. Testing was expanded to over 130 students who shared any class with the case patient, and the possibility to test the entire school of over 1200 students was considered. Investigators called upon the Incident Command skills acquired during the TB Trot event to organize this effort. During the investigation, all of the command staff positions were filled by the Denver Metro TB Clinic, Boulder County Public Health and Denver Public Health Epidemiology/Preparedness. This team quickly developed a response plan and began activating resources to test 1,255 students and staff members for latent TB infection over the course of two weeks.

Fifty individuals assisted in the response to this multi-jurisdictional event. All planning and response activities were coordinated through unified command (Denver Public Health and Boulder County Public Health) as the infected student attended school in Boulder County. When the dust settled, this team had coordinated the largest TB investigation in Colorado history. Approximately 14% of all students were positive for latent TB and nearly all were provided with the appropriate regiment of anti-tuberculosis medication. In the end, the student with the index case was the only person with infectious TB. 

ICS is the real success story here. What seemed like a helpful way to organize a charity run turned out to be an invaluable tool in responding to a major public health event. Everyone involved was able to quickly step into a role and complete the mission of protecting the public’s health from an infectious disease. Denver Metro TB clinic will continue to use Incident Command to organize their charity run knowing now that practicing it helps them prepare for the worst case scenario.