A consensus-based educational framework and competency set for the discipline of disaster medicine and public health preparedness.

BACKGROUND: Various organizations and universities have developed competencies for health professionals and other emergency responders. Little effort has been devoted to the integration of these competencies across health specialties and professions. The American Medical Association Center for Public Health Preparedness and Disaster Response convened an expert working group (EWG) to review extant competencies and achieve consensus on an educational framework and competency set from which educators could devise learning objectives and curricula tailored to fit the needs of all health professionals in a disaster. METHODS: The EWG conducted a systematic review of peer-reviewed and non-peer reviewed published literature. In addition, after-action reports from Hurricane Katrina and relevant publications recommended by EWG members and other subject matter experts were reviewed for congruencies and gaps. Consensus was ensured through a 3-stage Delphi process. RESULTS: The EWG process developed a new educational framework for disaster medicine and public health preparedness based on consensus identification of 7 core learning domains, 19 core competencies, and 73 specific competencies targeted at 3 broad health personnel categories. CONCLUSIONS: The competencies can be applied to a wide range of health professionals who are expected to perform at different levels (informed worker/student, practitioner, leader) according to experience, professional role, level of education, or job function. Although these competencies strongly reflect lessons learned following the health system response to Hurricane Katrina, it must be understood that preparedness is a process, and that these competencies must be reviewed continually and refined over time.

Houston biosecurity: building a national model.

On September 11, 2001, Al Qaeda terrorists committed an atrocity when they used domestic jetliners to crash into buildings in New York City and Washington, DC, killing thousands of people. In October 2001, another act of savagery occurred, this time using anthrax, not airplanes, to take innocent lives. Each incident demonstrates the vulnerability of an open society, and Americans are left to wonder how such acts can be prevented. Two years later, Al Qaeda operatives are reportedly regrouping, recruiting, and changing their tactics to distribute money and messages to operatives around the world. Many experts believe that terrorist attacks are inevitable. Every city is vulnerable to an attack, and none are fully prepared to handle the residual impact of a biological or chemical attack. A survey conducted by the Cable News Network (CNN) in January 2002, studied 30 major US cities, ranking them based on 6 statistical indices of vulnerability. Thirteen cities were deemed better prepared than Houston, 10 were in a similar state of preparedness, and only 6 were less prepared than Houston. We will discuss the protective measures that have been put in place in Houston, and future steps to take. Other cities can model Houston's experience to develop similar plans nation-wide.

New developments in health and medical preparedness related to the threat of terrorism.

Since 1999, and particularly the tragic events of September 11, 2001, the federal government has sought to prepare against the threat of bioterrorism by developing a comprehensive national "preparedness and response" program that encompasses state and local health agencies. In fiscal year 1999, approximately $150 million was made available through the Department of Health and Human Services (DHHS) to develop bioterrorism preparedness and response infrastructure in public health departments. Emergency medical services (EMS) funding was not specifically considered in this DHHS program, primarily because EMS is usually funded through traditional first-responder programs in other departments of the U.S. government. This approach may be effective in addressing some EMS needs, but it is insufficient for enhancing the emergency medical infrastructure throughout this country or for linking emergency public health and emergency medical prehospital initiatives. The role of EMS is shifting. As EMS in the future will be expected to be more comprehensive and encompass the urgent aspects of public health preparedness and response, more resources must be applied to the medical control units of EMS systems so that they may provide the most benefit to the public health and medical system. Emergency medical systems and their leadership are poised to play a critical role in national preparedness against bioterrorism. Preparedness funding within the health sector will continue to expand markedly in the near future. However, a well-developed strategy will be necessary to sustain the best linkage between EMS, hospital preparedness, and public health preparedness at the local, state, and federal levels.

Cybercare NDMs: an improved strategy for biodefense using information technologies.

The National Disaster Medical System (NDMS) was created in the early 1980's, and it was designed to meet the threats of the time. Today the threats are much less discreet and predictable. They are distributed; they move and spread quickly; and they walk silently among us. Specifically, biological agents are an enemy unlike any we have had to deal with before. They offer unique challenges that fly in the face of current doctrine. We must redesign the NDMS in order to contain and eliminate this new threat. Tools exist today capable of effectively coordinating distributed resources--even through containment borders. We need to strengthen our public health system, create a net-centric disaster management system, and blur the boundaries between local and federal resources. Ultimately we must move from an incremental, echelon-based response to an immediate, continuous response. This can be accomplished by adding inexpensive, well-established information technologies to the existing response system.

Hemorrhagic fever viruses as biological weapons: medical and public health management.

OBJECTIVE: To develop consensus-based recommendations for measures to be taken by medical and public health professionals if hemorrhagic fever viruses (HFVs) are used as biological weapons against a civilian population. PARTICIPANTS: The Working Group on Civilian Biodefense included 26 representatives from academic medical centers, public health, military services, governmental agencies, and other emergency management institutions. EVIDENCE: MEDLINE was searched from January 1966 to January 2002. Retrieved references, relevant material published prior to 1966, and additional sources identified by participants were reviewed. CONSENSUS PROCESS: Three formal drafts of the statement that synthesized information obtained in the evidence-gathering process were reviewed by the working group. Each draft incorporated comments and judgments of the members. All members approved the final draft. CONCLUSIONS: Weapons disseminating a number of HFVs could cause an outbreak of an undifferentiated febrile illness 2 to 21 days later, associated with clinical manifestations that could include rash, hemorrhagic diathesis, and shock. The mode of transmission and clinical course would vary depending on the specific pathogen. Diagnosis may be delayed given clinicians' unfamiliarity with these diseases, heterogeneous clinical presentation within an infected cohort, and lack of widely available diagnostic tests. Initiation of ribavirin therapy in the early phases of illness may be useful in treatment of some of these viruses, although extensive experience is lacking. There are no licensed vaccines to treat the diseases caused by HFVs.

Complex, humanitarian emergencies : III. Measures of effectiveness

Complex, humanitrian emergencie, lack a mechanism to coordinate, communicate, assess and evaluate response and outcome for the major participant (United Nations, International Committee of the Red Cross, nongovernmental organizations and military force). Success in these emergecies will depend on the ability to accomplish agreed upon measures of effectiveness (MOEs). A recent civil-military humanitarian exercive demostrated the ability of participants to develop consensus-driven MOEs. Measures of effectiveness have the potential to be a unifying disaster management tool and a partial solution to the communication and coordination problems inherent in these complex emergencies (AU)

Complex, humanitarian emergencies : III. Measures of effectiveness

Complex humanitarian emergencies lack a mechanism to coordinate, communicate, assess, and evaluate response and outcome for the major participants (United Nations, International Committee of the Red Cross, nobgovernmental organization and military forces). Success in these emergencies will depend on the ability to accomplish agreed upon measures of effectiveness (MOEs). A recent civil-military humanitarian exercise demonstrated the ability of participants to develop consensus-driven MOEs.(AU)

The rapid implementation of a statewide emergency health information system during the 1993 Iowa flood

In the face of disastrous flooding, the Iowa department of public health established the statewide emergency computer communications network to establish rapid electronic reporting of disaster related health data, provide e-mail communications among all country health departments, monitor the long - range public health effects of the disaster, and institute a general purpose public health information system in Iowa, Based on software (CDC wonder/PC) Provided by the centers for Disease control and prevention and using standard personal computers and modems, this system has resulted in a 10 - to 20 fold increase in surveillance efficiency at the health department, not including time saved by country network participants. It provides acritical disaster assessment capability to the health department but also facilitates the general practice of public health (AU)