Injury; surveillance; heat illness; NEISS; RIO TM Introduction Syndromic surveillance uses syndrome (a specific collection of clinical symptoms) data that are monitored as indicators of a potential disease outbreak. Advanced surveillance systems have been implemented globally for early detection of infectious disease outbreaks and bioterrorist attacks. However, such systems are often confronted with the challenges such as (i) incorporate situation specific characteristics such as covariate information for certain diseases; (ii) accommodate the spatial and temporal dynamics of the disease; and (iii) provide analysis and visualization tools to help detect unexpected patterns. New methods that improve the overall detection capabilities of these systems while also minimizing the number of false positives can have a broad social impact.