Engaging Health Care Professionals in Bioterrorism Preparedness

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning

• Jeffrey S. Duchin, M.D.
• Chief, Communicable Disease Control, Epidemiology
  Immunization Section, Public Health - Seattle
  King County
• Division of Allergy and Infectious Diseases
• University of Washington

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning

• Why do health care professionals reject
  participation in BT preparedness planning?

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning

• Why do health care professionals reject
  participation in BT preparedness planning?
• Competing Priorities

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Competing priorities

• Economic crisis for practicing physicians and
  hospitals
• changes in health care economics
• managed care
• typical patient encounter is 10-15 minutes for 30
  or more patients/day
• no time/compensation for training, conferences,
  meetings

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Competing priorities

• Perception of planning for a low probability
  event
• not a priority for hospital administrators for
  allocation of internal funds and resources
• dont see the relevance to more common situations

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Competing priorities

• Health care professionals prioritize management
  of individual patients, not populations
• not trained to manage populations
• may not want to do this
• no expectations to do this
• not paid to do this

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Competing priorities

• Information overload/avalanche for subjects
  directly relevant to clinical practice
• new diseases
• new treatments and drugs
• new tests
• new technologies
• new management strategies
• changing administrative procedures, rules and
  regulations

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Competing priorities

• Lack of funding to support participation of
  medical professionals despite allocations for
  public health, fire, law enforcement,
  pharmaceutical stockpile, research

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Competing priorities

• The bottom line bioterrorism, and public health
  in general, are not priorities in either the
  academic or private health care sectors

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Competing priorities

• The challenge how can we change this?

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Competing priorities

• Emphasis by state and local health departments
  may impact
• the physicians and public health officials who
  work for them,
• but it is unlikely to have an important impact on
  most
• practicing physicians and most in academic
  medicine
• John Bartlett, MD
• Director, Division of Infectious Diseases
• Johns Hopkins School of Medicine and Center for
  Civilian Biodefense Strategies

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
The role of health care professionals

• First stepdefine the role of the clinician in
  the public health response
• Use examples from actual outbreaks to educate
  clinicians
• 2001 anthrax outbreak
• West Nile Virus
• hantavirus pulmonary syndrome
• JAMA and New England Journal editorials
  describing role of clinicians in bioterrorism
  response
• Set expectations

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
The role of health care professionals

• What is the role of the clinician in bioterrorism
  response?

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
The role of health care professionals

• Detection of a possible event
• clinicians must be familiar with the clinical
  signs and symptoms and epidemiological clues of
  disease due to biological terrorism
• know how and when to engage appropriate clinical
  and public health resources
• Medical management of sick patients
• treatment
• post-exposure prophylaxis with antibiotics or
  vaccine
• monitoring for adverse effects of treatments
• Evaluation of the worried well

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Methods to engage health care providers - key
principles

• Relevance
• Credibility
• Value
• Efficiency

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Relevance

• Emphasize concept of biological disaster
  planning relevance of BT planning to other
  common, naturally-occurring diseases, outbreaks
  and disasters
• Use actual local examples when possible
• Demonstrate the logic and necessity of
  community-wide response planning (table top
  exercises help)
• Keep the issue alive

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Relevance

• Emphasize concept of biological disaster
  planning relevance of BT planning to other
  common, naturally-occurring diseases, outbreaks
  and disasters
• Use actual local examples when possible
• Demonstrate the logic and necessity of
  community-wide response planning (table top
  exercises help)
• Keep the issue alive
• establish communication channels to provide
  ongoing information reinforcing the importance of
  planning and preparedness
• use the media

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Relevance

• Naturally-occurring clinical conditions
• meningitis/encephalitis syndrome meningococcal
  disease, West Nile virus, rabies, enteroviruses
• cough illness pertussis, TB
• rash with fever measles, varicella, rubella
• botulism

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Relevance

• Naturally-occurring outbreaks
• Food- and water borne outbreaks E. coli 0157H7,
  salmonella, shigella, cryptosporidium, etc.
• hepatitis A
• nosocomial outbreaks
• hantavirus pulmonary syndrome
• West Nile virus infection
• 2001 anthrax outbreak
• pandemic influenza

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Relevance
The influenza pandemic of 1918-19 killed more
humans than any other disease in a period of
similar duration in the history of the
world. Alfred W. Crosby Americas Forgotten
Pandemic - The Influenza of 1918 Cambridge
University Press, 1989
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Deaths By Week due to Pneumonia
InfluenzaOctober, 1918 through March, 1919 -
Philadelphia, PA
Population 1,761,371 Total deaths 15,785
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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
RelevancePandemic Influenza, 1918

• Approximately 675,000 Americans died, 10 times as
  many as in WW I
• The effect of the epidemic was so severe that the
  average life span in the U.S. was depressed by 10
  years
• Death rate 25 times higher than previous
  epidemics
• The epidemic preferentially affected and killed
  younger, healthy persons
• Epidemic suspected to be biological warfare

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Influenza H5N1 Bird Flu - Hong Kong,
1997Slaughter of the InnocentsTime Magazine
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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Credibility

• Peer driven process
• develop partnerships (champions) in the
  clinical sector
• physicians must be convinced before they will
  engage in training
• train the trainer model
• identify and promote training opportunities by
  quality organizations respected by clinicians
• Ensure technical expertise, appropriate
  credentials and relevant experience

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Credibility

• Endorsements by relevant and respected
  authorities, organizations, and professional
  societies
• Understand and address the needs and concerns of
  the clinical community
• Establish personal contacts with key constituents
• Work with local leadership to set expectations

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
King County Outbreak Response Work Group (ORWG)

• Meeting of King County hospital leadership
  convened by local health officer
• Made case for preparedness planning
• CEOs designated representatives to attend ORWG
• Group co-chaired by Public Health and respected
  local physician-leader
• Addressing communicable disease response and
  preparedness planning with an focus on smallpox

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Value

• Provide practical resources that allow clinicians
  to fulfill role defined for them

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Value

• Preparedness and planning

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Value

• Preparedness and planning
• authoritative resources and references
• training and tabletops
• tools for improving recognition and management of
  biological terrorism
• communication methods

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Value

• Outbreak response
• demonstrate how public health can help clinicians
  
• provision of timely local epidemiological and
  surveillance data
• real time health advisories
• facilitate diagnostic testing
• provision of drugs and vaccine
• links for authoritative BT information and
  updates CDC and IDSA sites
• communication

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Value

• Integrate with routine disease control issues
• management and infection control guidelines for
  communicable diseases
• Control of Communicable Diseases Manual, AAP Red
  Book
• ACIP statements/immunization issues
• Take advantage of opportunities related to
  quality assurance activities and JCAHO guidelines
  and accreditation requirements

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Value

• Public health must be visible in the clinical
  community
• Regular, ongoing presence at
• medical grand rounds
• teaching conferences
• preparedness planning meetings
• hospital BT response exercises
• Training materials
• provide useful, authoritative materials
• CME accreditation when possible
• Be available and responsive

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Preparing and Responding to Bioterrorism
Information for Primary Care Clinicians
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http//www.anesoft.com/demo/bio/bio.html
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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Efficiency

• Dont waste their time
• Use proven learning strategies when possible
• Integrate BT planning with delivery of other
  existing, valuable resources and services
• Tabletop exercises
• help clinicians understand the issues they will
  be confronted with
• conceptualize response needs
• appreciate role of public health

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Methods to engage health care providers

• Advocate for additional resources for hospitals
  and health care providers for training and
  preparedness and planning activities
• identify and advertise funding opportunities
• Incorporate training on the clinicians roles and
  responsibilities in the public health system and
  in biological disaster response into professional
  and post-graduate education

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Engaging Health Care Professionals in
Bioterrorism Preparedness Response Planning
Summary

• Understand your audience and their priorities
• Define the role of the clinician in BT and
  outbreak response
• Help the clinicians meet the expectations for
  that role
• Stress relevance use examples
• Have high credibility partner with respected
  clinical authorities and organizations
• Provide value deliver something useful now
• Efficiency make it worth their time and effort

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Communicable Disease SectionPublic Health -
Seattle King County

• Contact us for additional information and to
  report suspected cases.
• 24-hour communicable disease line
• 206-296-4774
• Public Health - Seattle King County Web Site
  http//www.metrokc.gov/health/bioterrorism