Bioterrorism and Health System Preparedness, Issue Brief No. 6
The Agency for Healthcare Research and Quality is holding a series of Web-assisted conferences on bioterrorism and the health care system.
Archived online, each Web conference on bioterrorism is also distilled into an issue brief. This brief examines the role of community providers in bioterrorism preparedness and resources for them.
Select for the downloadable print version (PDF file 126 KB). PDF Help.
Contents
Introduction
The Role of Community Providers in Bioterrorism Preparedness
CDC Resources for Community Providers
Resources for Pediatric Terrorism Preparedness
Surveillance Tool Launched by Pediatric Practice-Based Research Network
For More Information
Introduction
At the core of any public health
emergency response plan is an
indispensable group of professionals:
community providers. These providers—whether local clinicians, emergency
responders, or the staff of public health
clinics—play a critical role in planning
for, detecting, and responding to acts of
bioterrorism and other public health
emergencies.
In the event of an
emergency, these providers must be able
to send and receive critical information to
and from the public health system in a
timely, efficient, and effective manner.
A Web-assisted audioconference sponsored
by the Agency for Healthcare Research and
Quality (AHRQ) in December 2003
examined the role of community providers
in detecting and responding to a potential
bioterrorist event or other public health
emergency. The conference highlighted
resources available to community providers
from AHRQ, the Centers for Disease
Control and Prevention (CDC), and the
American Academy of Pediatrics. The
conference also examined the efforts of a
pediatric practice-based research network
to enable community-based providers to
share information on emerging public
health threats.
Presentations were made by the following
researchers and practitioners:
- Helen Burstin, M.D., M.P.H., Director, Center for Primary Care, Prevention, and Clinical Partnerships, Agency for Healthcare Research and Quality, Rockville, Maryland.
- Dan Baden, M.D., Clinician, Communication Team Lead, Emergency Communication System, Centers for Disease Control and Prevention, Atlanta, Georgia.
- Molly Hicks, M.P.A., Associate Director, Department of Federal Affairs, American Academy of Pediatrics, Washington, D.C.
- Jeralyn Bernier, M.D., M.P.H., Research Director, Cincinnati Pediatric Research Group, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
A question and answer session
followed the presentations.
Return to Contents
The Role of Community Providers in Bioterrorism
Preparedness
Local providers are not only essential
to detecting the first signs of
bioterrorist activity, they are key
resources for responding to a potential
bioterrorist event.
These providers
need better links to the public health
infrastructure, including local health
departments, State laboratories, and
emergency departments. Strengthening
these links is especially important now
because of the increased threat of a
bioterrorist incident.
A survey in the
Journal of Family Practice found that,
before the anthrax attacks, two-thirds
of family physicians said they felt
unprepared to respond to a bioterrorist
event.1
Community providers serve as critical
sentinels in detecting the first signs of
a public health threat, whether a
bioterrorist attack or other disaster.
These providers face challenges,
however, in identifying symptoms
associated with bioterrorist activity.
Patients often come to their providers
with vague symptoms that may be
confused with flu. Training and point-of-care information could better
prepare community providers to
diagnose and manage patients
appropriately.
| Community providers serve
as critical sentinels in
detecting the first signs of a
public health threat. |
Providers need to interact with public
health departments or emergency
responders to develop ongoing
relationships with the public health
infrastructure (such as health
departments and emergency medical
services), develop community-based
data sharing systems for ongoing
surveillance for bioterrorism and other
public health emergencies (such as the
flu), and develop a role for community
and volunteer providers to respond to
public health emergencies.
AHRQ has several initiatives to help
community providers prepare to detect
and respond to potential bioterrorist
activity. Under a contract from AHRQ,
Vanderbilt University and the
University of Alabama at Birmingham
are developing training and
information tools to meet the needs of
clinicians in the community in the
event of a bioterrorist attack. AHRQ
also supports several practice-based
research networks of community-based
providers in their efforts to
address important questions related to
bioterrorism preparedness.
According
to Dr. Helen Burstin, AHRQ is
enhancing and reinforcing linkages
and information technology
connectivity between the health
care system and the public health
infrastructure. Further information
on these and other AHRQ
bioterrorism planning and response
initiatives can be found at http://www.ahrq.gov/prep/.
1 Chen FM, Hickner J, Fink KS, Galliher JM, Burstin H. On the front lines: family physicians'
preparedness for bioterrorism. Journal of Family
Practice 2002 Sept; 51(9):745-50.
Return to Contents
CDC Resources for
Community Providers
With the emergence of multiple public
health threats ranging from the threat
of chemical weapons to flu outbreaks,
it is more important than ever for
community providers to receive up-to-date
public health information.
To
meet this need, Dr. Dan Baden
explained that the CDC leads several
outreach efforts designed to
communicate with clinicians across
the country.
- Clinician Outreach and
Communication Activity
(COCA).
The CDC offers regular
conference calls on emerging
topics—such as updated
information on Severe Acute
Respiratory Syndrome (SARS)—to a network of more than 84
clinician and professional
organizations, including the
American Medical Association,
American Nurses Association, and
the American Academy of
Pediatrics. Go to http://www.bt.cdc.gov/coca/
- Clinician Registry.
The CDC's
free registry provides clinicians
with real-time information to help
prepare for and respond to
bioterrorism and other emergency
events. More than 40,000 members
have received more than 800,000
E-mail updates on terrorism,
emerging diseases, and relevant training opportunities. Clinicians
may sign up at http://www.bt.cdc.gov/clinregistry/index.asp
- Clinician-Specific Web Pages.
The CDC offers several Web pages
with information on the avian flu,
smallpox, SARS, West Nile virus,
and other potential public health
threats. Go to the CDC site at http://www.cdc.gov/az.do
- Clinician Information Line
(CIL).
The CDC's information
line at (877) 554-4625 responds to
questions from clinicians on
emerging health concerns ranging
from the flu to smallpox. Staffed
by clinicians, the CIL is accessible
24 hours a day, 7 days a week.
Return to Contents
Resources for
Pediatric Terrorism
Preparedness
When it comes to the threat of
terrorism, community providers need
extra resources to respond to the
special needs of children.
Children
have unique health and mental health
needs that really distinguish them
from adults and make them more
vulnerable than adults to bioterrorism
and other catastrophic events,
according to Molly Hicks of the
American Academy of Pediatrics. For
example, children will not understand
the complexity of an evacuation plan
that is broadcast over radio or
television.
| A chemical
weapon may cause greater harm to
children because they breathe more
rapidly than adults and will absorb
more of any chemical agent that is
released. |
While the pediatric workforce is
familiar with children's special needs,
providers outside the pediatric
community would benefit from
continuing education to better respond
to children in the event of a possible
terrorist attack.
The American
Academy of Pediatrics, a national
membership organization of 57,000
pediatricians and pediatric specialists,
provides several resources that can
help community providers prepare for
a possible terrorism threat. Foremost
among these is the Academy's
"Children, Terrorism & Disasters"
Web site, which is located at
http://www.aap.org/terrorism. The site
provides information on biological
agents as well as extensive resources
and links for providers, community
planners, and families.
The Academy also provides a
"Children, Terrorism & Disasters"
toolkit, which offers important tips for
parents and caregivers. The toolkit can
be downloaded from the Academy's
Web site free of charge (http://www.aap.org/terrorism/topics/parents.pdf) PDF Help.
Through funding from AHRQ, the
Academy is developing the Pediatric
Terrorism Preparedness Resource.
The resource guide will serve as a
comprehensive clinical and policy
reference on the needs of children
following a terrorist attack or other
disaster. This resource will improve
the ability of all health care
professionals to undertake pediatric
preparation and planning, and will
provide activities for hospitals,
schools, emergency medical systems,
and communities. The resource guide
will have an accompanying Web site
where the Academy will post updates.
The Academy plans to publish a
comprehensive resource for providers
working with children on crisis-related
mental health problems. Until then,
the Academy has on its "Children,
Terrorism & Disasters" Web site a
section devoted to children's mental
health needs during times of crisis
(entitled "Psychosocial Aspects"). In
this section, the Academy provides
guidance on the role of pediatricians
in responding to children's emotional
needs and advice on talking to
children about disasters.
Return to Contents
Surveillance Tool Launched by Pediatric
Practice-Based Research Network
Another group working to address the
special needs of children in the event
of a public health emergency is the
Cincinnati Pediatric Research Group
(CPRG), a Midwestern regional
practice-based research network
spanning 8 counties in 3 States. The
CPRG comprises 45 community child
health care providers in 22 practices.
With support from AHRQ, this
regional network of pediatricians is
working on strategies that allow
community-based provider networks
to share critically important
information to help them identify and
respond to bioterrorist events and
other health threats.
The CPRG recently launched the
Symptom Surveillance Project, a Web-based
surveillance system with a
pediatric focus, which facilitates
communication between community
providers and government agencies
charged with monitoring symptoms
associated with transmissible diseases
or bioterrorism.
According to Dr.
Jeralyn Bernier of the CPRG, the
Symptom Surveillance Project involves
providers in the detection of
bioterrorism and outbreaks that are both
naturally occurring and intentional, and
establishes regular two-way
communication between providers and
health departments.
CPRG members enter data about
prevalent symptoms and unusual cases
in their outpatient pediatric office
settings. Symptoms entered into the
password-protected database include
those associated with transmissible
diseases and bioterrorism-linked
illnesses. Interactive computer graphs
enable physicians to view customized
snapshots of symptoms prevalent in
their region. While the system does not
replace required reporting of diseases,
the local health department reviews the
data regularly, allowing for more timely
detection of disease outbreaks.
With many providers occupied with
busy practices, CPRG strives to keep
data collection simple. Weekly data
collection takes about 10 minutes for
participating physicians to review and
enter. The network is studying different
incentives to motivate providers to
participate, including offering modest
financial remuneration and
complimentary staff lunches for active
participants.
In the future, the CPRG plans to
expand its activities by linking with
other provider networks. CPRG also
hopes to improve threat detection by
adding automated analyses of claims
data and telephone triage information.
Information on CPRG and updates on
the network's research projects can be
found at http://www.cincinnatichildrens.org/research/project/cprg/default.htm.
Return to Contents
For More Information
The audioconference on which this
Issue Brief is based, Bioterrorism and
Other Public Health Emergencies:
Linkages with Community Providers,
is available on the AHRQ Web site at http://www.ahrq.gov/prep/.
Information on the tools discussed in
this Issue Brief, and other tools and
publications related to health system
preparedness for bioterrorism, will be
posted on the AHRQ Web site as it
becomes available.
Return to Contents
| This issue brief was prepared for AHRQ by AcademyHealth under
contract No. 290-98-0003. |
AHRQ Publication No. 05-0032
Current as of January 2005
Internet Citation:
Bioterrorism and Other Public Health Emergencies: Linkages with Community Providers. Bioterrorism and Health System Preparedness, Issue Brief No. 6. AHRQ Publication No. 05-0032, January 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/btbriefs/btbrief6.htm
540 Gaither Road Rockville, MD 20850