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Organized Medicine's Role in the National Response to Terrorism--Update NOTE: This report represents information on this subject as of June 2000. Full Text Report 4 of the Council on Scientific Affairs, Organized Medicine's Role in the National Response to Terrorism (A-99 ), recommended: "That the AMA and the Federation of Medicine develop a plan that identifies the specific needs, roles, contributions, and participation of organized medicine and individual physicians in disaster planning, and in responding to terrorist attacks in their states or communities." This report reviews actions undertaken by the Council on Scientific Affairs (CSA) to implement this recommendation. Background The United States continues to prepare for possible terrorist acts involving the use of military chemical weapons, toxic industrial chemicals, infectious agents (biological weapons), and nuclear or radioactive materials. The CSA prepared Report 4 (A-99) because physicians and organized medicine had been largely excluded from planning efforts. This is problematic because physicians will play essential roles in responses to terrorist acts, such as providing acute care for victims (eg, symptoms caused by exposure to chemical weapons or trauma caused by conventional explosive). Physicians may be even more important if biological weapons are used. Early detection and control of biological (or chemical) attacks depends on an efficient public health response at the local, state, and federal level. Physicians throughout the United States must remain vigilant and promptly report unusual symptoms or illnesses to the local health department. Delays caused by misdiagnosis or lack of prompt reporting will retard the activation of plans designed to control a possible epidemic and the implementation of appropriate care for those already exposed. Although biological and chemical terrorist acts may affect a community, natural disasters such as tornadoes, hurricanes, floods, and earthquakes, as well as industrial accidents, also can severely stress community and state response capabilities. This was evident in the experience of physicians in Oklahoma City, who responded to a terrorist bombing in 1995 and a tornado disaster the following year. An "all-hazards" approach to local disaster planning is advisable. Therefore, the CSA attempted to identify critical areas of need for involving physicians in general disaster planning, and considered the specific needs to help medical societies and their members prepare for acts of terrorism. These areas included: Community disaster planning. How should local and state medical societies, as well as individual physicians, be involved in community plans for disaster response? Physician education. What do physicians of different specialties need to know about the medical consequences of terrorism, and what are the most effective ways to convey the information? Interaction with public health infrastructure. What are the unique issues that terrorism poses for the relationship between the practicing physician and the local health department? How should physicians report possible bioterrorism-related illness to the health department, and how should the health department prepare in order to make that reporting as easy and rewarding as possible? Treatment issues. What are the implications for practicing physicians of national response plans that include the use of medications for off-label or Investigational New Drug uses? Medic WMD 2000 The Council concluded that these and other issues could best be explored by convening a series of "town meetings" involving medical and public health stakeholders during which the issues would be discussed, setting the stage for the development of consensus recommendations to be offered to county, state, and specialty medical societies. These recommendations would be expected to provide guidance on how the societies and their members can become involved in preparedness planning, and what steps should be taken to more effectively engage physicians at the local level. In Fall 1999, several military physicians who are members of the Section Council on Federal and Military Medicine informed the CSA that the Office of the Surgeon General of the US Army was planning a conference for April 2000. Entitled "Medic WMD 2000," the conference would educate attendees about weapons of terrorism and present the military assets that could respond to terrorist acts on domestic soil. Army Surgeon General Ronald Blanck, MD, generously invited the CSA to participate in Medic WMD 2000, thereby relieving the AMA of the obligation to stage an independent conference. The Council accepted this offer and participated in Medic WMD 2000 on April 3-6, 2000. During the opening plenary session, Council member Scott Deitchman, MD, MPH, introduced the issues and needs in organized medicine s preparation for acts of terrorism. The town meetings were held on the afternoons of April 3, 4, and 5. Participants represented state, county, and national medical societies, public health organizations, military health services, and the federal health agencies. Attendance for several AMA stakeholders was made possible by a generous grant from the National Medical Veterans Society, which donated $40,000 to help defray the travel expenses of medical society participants. More than 80 individuals participated in each town meeting. Each day the town meeting began with presentations by speakers with experience in one of the topic areas to be discussed. The presentations stimulated the ensuing discussion, which was moderated by Dr. Deitchman. Monday April 3--Physician Involvement in Local Response Planning. Jay Gregory, MD, of the Oklahoma State Medical Society described the Oklahoma City medical community's experiences with the bombing of the Alfred P. Murrah building in 1995 and the tornadoes of 1996. This stimulated discussions of how medical societies and their members can help their communities prepare for disasters. Among the lessons learned from Oklahoma City were that communication (radio) and efficient interagency responses are critical. Because the volunteer response was phenomenal, plans need to be in place to efficiently use those who come forward to help. Subsequently, county and state subcommittees on terrorism were formed to increase awareness of medical needs, increase communication among members, and open lines of communication with governmental agencies. The multidisciplinary planning panels include community physicians. The town meeting focused on physician training, how to engage local physicians in disaster planning, identifying obstacles to physician involvement, identifying partners in disaster planning, discussing communication trees and media relations, and discussing civilian/military coordination. Tuesday April 4--Teaching the Practicing Physician About Terrorism. Colonel Edward Eitzen, MC, Chief, Operational Medicine Division of the US Army Medical Research Institute for Infectious Diseases, described medical education materials and programs the Army has developed to teach physicians about chemical and biological terrorism. Admiral (retired) James Zimble, MD, president of the Uniformed Services University of the Health Sciences, described portions of its Contingency Medicine curriculum devoted to issues involving biological and chemical weapons. It is the only such medical school curriculum in the country. Salley Faith Dorfman, MD, of the Medical Society of New York discussed how state medical societies can educate their members about terrorism. The town meeting focused on how bioterrorism-related education and training for physicians can be enhanced, what the core knowledge base and clinical competencies are, and how to disseminate materials and pay for development of educational initiatives. Wednesday April 5--Medical Care, Drug Issues, and Audience-Contributed Topics. Jonathan Weisbuch, MD, MPH, Director, Maricopa County Public Health Department, described the needs and solutions for close collaboration between health departments and physicians. Gary K. Chikami, Director, Division of Anti-Infective Drug Products, Food and Drug Administration, provided an overview of the regulatory status of products, explained the applicable regulations, and broached liability issues. Steven Bice of the Centers for Disease Control and Prevention (CDC) explained the CDC s role in overseeing and mobilizing the National Pharmaceutical Stockpile. The town meeting reviewed what physicians can do to help prevent public health disasters and identified barriers to reporting. Ideas to facilitate reporting also were presented. Because the initial detection of a covert biological or chemical attack will probably occur at the local level, disease surveillance systems must be capable of detecting unusual patterns of illness. Public health officials must have the expertise and resources for responding to reports of clusters of rare, unusual, or unexplained illnesses. The legal/ethical issues will vary somewhat depending on treatment priority (ie, mandatory versus voluntary) and potential adverse reactions. The town meeting concluded with a global discussion of various planning issues. Next Steps The CSA is currently reviewing the information obtained from Medic WMD 2000 and is also reaching out to other agencies and organizations that either have already begun efforts to involve physicians in preparation for acts of terrorism, or have expressed interest in working with the CSA on new efforts. These include the Office of Emergency Preparedness (an office in the Department of Health and Human Services that supports programs to develop community medical preparedness for disasters), the CDC, and the Department of Defense. The CSA plans to develop recommendations and present them to the House at I-2000. It is our hope that these recommendations will help focus medical society efforts, as well as provide a basis for further discussion and refinement. The CSA also plans to work with the organizations and agencies listed above to identify ways that the Federation of Medicine can help disseminate physician-specific educational materials to the members of component societies. The CSA will continue to inform the House of its activities and plans. Individual delegates and their societies who wish to assist in these efforts or share suggestions or experiences are welcomed and encouraged to contact the CSA through its office at AMA Headquarters. RECOMMENDATIONS The following statements, recommended by the Council on Scientific Affairs, were adopted by the AMA House of Delegates at the 2000 AMA Annual Meeting.
Acknowledgements: The CSA wishes to thank the Section Council on Federal and Military Medicine, the National Medical Veterans Society, and the Office of the Surgeon General of the US Army. None of our efforts would have been as successful without the help of all these parties. Related CSA report: Medical Preparedness for Terrorism and Other Disasters (I-00) Full Text Also see AMA's Center for Public Health Preparedness and Disaster Response |
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