SESSION 3:  Clinical Medicine

Discussion leader:  Martha N. Hill (Johns Hopkins University)
Reporters:  Janet Corrigan and Nicole Amado (IOM)
Attendance:  About 55 participants

The group identified four major areas of activity in which the IOM might contribute to public health preparedness:

1. Emergency Preparedness Coordination
2. Key Competencies and “Best Practices”
3. Communication with the Public and Health Care Professionals
4. Ethical Considerations for Health Care Professionals

Emergency Preparedness Coordination

All communities/regions need some form of coordinating structure to respond to major public health threats.  An effective response requires public and private sector input, and generally involves many people and organizations.  It would be helpful for the IOM to identify different models for establishing public/private sector coordinating structures.  Since 9/11, some communities have established coordinating structures and these should be looked at as potential models.

Strategic Plan and Core Competencies

The country as a whole, separate geographic communities, and various stakeholders (e.g., the hospital sector) need strategic plans that address certain core competencies that might be needed by clinical providers (e.g., evacuation, inoculation, triage, the ability to rapidly form multi-disciplinary teams, command and control center, etc).  The IOM might convene leaders to identify core competencies and “best practices”.  Approaches taken for handling emergency situations in other countries, such as Israel, should be studied.  Leading national groups (e.g., CDC, AHA, AAFP, ACP/ABIM, AMA) might collaborate on the development of a web site (or linked set of sites) that would make core competencies and “best practices” available to those working on strategic plans.  The plan should be interdisciplinary and cover all stakeholders (e.g., not just focusing on hospitals—small practice settings, schools, etc. may be the front line of the response).   The strategic plan should be pro-active in surveillance (e.g., use all opportunities and information to identify threats at the earliest possible time).

Communication with the Public and Health Care Professionals

One of the greatest challenges in responding to a major public health threat is managing the public’s reaction.  The IOM might help in this area by assembling experts to develop a communication plan and identify the necessary infrastructure (both people and technology) to carry out the plan.  There need to be communication structures in place globally, nationally, and locally.  The CDC would certainly play an important role at all levels.  The United Way and other groups might be important contributors at the local level.

The communication structure might be implemented by forming coalitions of existing groups.  It should be capable of providing both routine and emergency information to the public and health care professionals.  For example, information on global travel in the event of another SARS outbreak and information on evacuation routes in the event of a major biochemical outbreak.  The communication plan should provide for the development of “key messages”.  The communication plan should consider the needs of special groups, such as, children, pregnant women, non-English speaking people, and the frail and disabled.  The communication sites should provide detailed, up-to-the minute information to clinicians (who are often the front line communicators with the public) and to the public, in general.

Ethical Considerations for Health Care Professionals

The IOM might work with various professional groups (e.g., state medical societies, specialty societies) to develop a code of ethics for professional behavior during a major public health disaster.  For example, what are the responsibilities of health care professionals during a smallpox outbreak?  Do they have an ethical obligation to remain and treat the sick? 

The code of ethics will also need to be communicated to health care professionals (well in advance of an emergency).  Efforts should be made to assist health care professionals in personally preparing for possible emergencies, so they will be better able to meet their professional obligations.  For example, each health care professional (who will be involved in responding to an emergency) should have a family emergency response plan to make sure that the needs of their children and spouse are met (while they are attending to the needs of the sick).  IOM members might be able to contribute examples of such plans that have been developed by their own institutions.

Concluding Thought

In addition to these four areas of activity, the group embraced the overarching principle that the public health and personal health care delivery systems should view emergency preparedness as a “design constraint” when redesigning the system.  This state of readiness must last for decades and it is a very expensive undertaking.  Energy and resources going into “redesigning the system for readiness” should also be serving other purposes (e.g., providing high quality care to people).  Systems should be designed to serve multiple purposes  (e.g., if going to have better communication systems, these should serve both emergency and non-emergency needs).