Promoting Clinician Readiness Leslie Beitsch, M.D., J.D. Commissioner and State Health Officer Oklahoma 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