Promoting Clinician Readiness

Leslie Beitsch, M.D., J.D.Commissioner and State Health OfficerOklahoma State Department of Health

Efforts by Health Departments

Over the past 3 years, many State health departments were recipients of CDC sponsored bioterrorism (BT) grants

Grantees made concerted outreach efforts to clinical practitioners

Strengthening the Health Alert Network (HAN) included coordination with local and State medical societies

Establishing ties with Metropolitan Medical Response System (MMRS)

Clinician Needs after 9/11

Definitive information on BT Diagnostic criteria Surveillance and reporting primer State and local medical societies wanted

greater participation in the BT planning and advisory processes

Engaging Clinicians

Have a BT event… it creates the teachable moment Clinicians without further prodding will seek to

enhance their competency in diagnosing BT related illnesses

Modest educational efforts will pay immediate dividends by raising the clinical index of suspicion

Reminding medical societies and individual physicians of legal duty to report diseases (e.g., anthrax, etc.)

Reducing barriers to simplified reporting (e.g., electronic disease reporting)

Steps for State and Local Health Departments

Build a systemic response to BT events Provide education and training to the

entire public health workforce, not only staff with day-to-day BT responsibilities

Enhance epidemiology, biostatistics, microbiology, and communication skills through core courses, seminars, and distance learning technologies

Offer graduate education for selected staff who demonstrate potential for future leadership roles

Role for Clinicians

Physicians are now engaged New BT grant requires planning and advisory

committees Coordination with local and State medical

societies requires further strengthening Recruitment/involvement with MMRS

Testing the System

April 12 and 13, the Oklahoma State Department of Health (OSDH) staged largest BT exercise ever

Blueprint and lessons will be available for others to use across the country

Planning activities and exercises are the best methods to test systems responsiveness

Employ hackers to test security IT system redundancy test

Preparing for Bioterrorism

State and local task forces in virtually every health jurisdiction

Involvement with Gubernatorial and Legislative task forces

ASTHO and NACCHO have provided tools, recommendations, and enhanced Web sites

CDC BT grants Enhanced surveillance

Public Health and Clinical Medicine

Renewed appreciation of the importance the public health system plays in protecting our communities

Better understanding of the need for disease surveillance and reporting systems

Willing participant now in BT and other related advisory groups

Model Emergency Health Powers Act

Act is attempt to codify the various powers and authorities needed to respond to the most catastrophic public health events (BT)

Private sector may be called upon to assist governmental public health

Hospitals and other facilities may be “statecized”

Conceivably clinicians could be asked to practice in adjacent jurisdictions

Coordination with Tribal Governments

Coordination required under the terms of the new CDC grant

Oklahoma example: 39 federally recognized tribes

Short-term approach: include Bureau of Indian Health (BIH) in advisory group

Expand to all interested participants in the long-term planning process

Available Tools

All States recently completed a Department of Justice (DOJ) survey, with results now available

National Public Health Performance Standards look at broad public health systems capabilities

Reconcile laws in jurisdiction with Model Emergency Health Powers Act

Lessons Learned

Build close working relationships with clinical colleagues before threatened BT events

Use HAN resources to tie clinicians into public health network

Examine disease reporting and surveillance systems from perspective of the “user” and lower barriers to easy accessibility

Improve web sites so that clinicians seeking information can obtain it rapidly

Anticipate ongoing educational needs, and use CME as a carrot