Engaging Health Care Professionals in Bioterrorism Preparedness & Response Planning

1. 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

2. Engaging Health Care Professionals in Bioterrorism Preparedness & Response Planning Why do health care professionals reject participation in BT preparedness planning?

3. Engaging Health Care Professionals in Bioterrorism Preparedness & Response Planning Why do health care professionals reject participation in BT preparedness planning? Competing Priorities

4. 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

5. 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 • don’t see the relevance to more common situations

6. 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

7. 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

8. 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

9. 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

10. Engaging Health Care Professionals in Bioterrorism Preparedness & Response Planning Competing priorities • The challenge: how can we change this?

11. 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

12. Engaging Health Care Professionals in Bioterrorism Preparedness & Response Planning The role of health care professionals • First step:define 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

13. 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?

14. 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”

15. Engaging Health Care Professionals in Bioterrorism Preparedness & Response Planning Methods to engage health care providers - key principles • Relevance • Credibility • Value • Efficiency

16. 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

17. 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

18. 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

19. Engaging Health Care Professionals in Bioterrorism Preparedness & Response Planning Relevance • Naturally-occurring outbreaks • Food- and water borne outbreaks: E. coli 0157:H7, salmonella, shigella, cryptosporidium, etc. • hepatitis A • nosocomial outbreaks • hantavirus pulmonary syndrome • West Nile virus infection • 2001 anthrax outbreak • pandemic influenza

20. 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 America’s Forgotten Pandemic - The Influenza of 1918 Cambridge University Press, 1989

21. Deaths By Week due to Pneumonia & InfluenzaOctober, 1918 through March, 1919 - Philadelphia, PA Population: 1,761,371 Total deaths: 15,785

22. 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

23. Influenza H5N1 “Bird Flu” - Hong Kong, 1997“Slaughter of the Innocents”Time Magazine

24. 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

25. 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

26. 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

27. Engaging Health Care Professionals in Bioterrorism Preparedness & Response Planning Value • Provide practical resources that allow clinicians to fulfill role defined for them

28. Engaging Health Care Professionals in Bioterrorism Preparedness & Response Planning Value • Preparedness and planning

29. 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

30. 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

31. 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

32. 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

33. Preparing and Responding to Bioterrorism: Information for Primary Care Clinicians

34. http://www.anesoft.com/demo/bio/bio.html

35. Engaging Health Care Professionals in Bioterrorism Preparedness & Response Planning Efficiency • Don’t 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

36. 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 clinician’s roles and responsibilities in the public health system and in biological disaster response into professional and post-graduate education

37. 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

38. 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