Report 1 of the Council on Scientific Affairs (I-03)

AMA National Disaster Life Support Program
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Summary

The American Medical Association (AMA), through its Center for Public Health Preparedness and Disaster Response, will work collaboratively with the Federation* and others to develop and disseminate a comprehensive disaster management education and training program for physicians and other health professionals. The National Disaster Life Support (NDLS) program will enable physicians, medical students, other health professionals, and other first responders to acquire a fundamental understanding and working knowledge of their effective contributions to disaster management at the clinical and public health response levels and become knowledgeable of their integrated professional roles and responsibilities inherent in a community, state, or regional response. This will be accomplished through three stand-alone courses that can be incorporated into various training curricula. The courses, Basic Disaster Life Support (BDLS), Advanced Disaster Life Support (ADLS), and Core Disaster Life Support (CDLS), are targeted to physicians, nurses, pharmacists, dentists, and public health and allied health professionals, as well as public safety and emergency medical services workers. Upon successful completion of the ADLS and BDLS classes, participants receive "certificates of training" and course completion cards, and are eligible for continuing medical education credit.

The overarching purpose of the NDLS program is to provide the basic knowledge and skills set that all health and safety workers need to competently respond to an intended or naturally occurring public health emergency. Such training will help create and sustain a seamless and integrated disaster life support system at the national, state, and community levels. The NDLS courses provide the working knowledge and skills to enable emergency responders to:

Recognize the potential for a mass casualty incident and identify quickly when a dangerous incident has occurred;
Rapidly alert the public health and emergency response systems;
Participate in a multidisciplinary, coordinated response;
Cope with the unusual search, rescue, triage, and treatment challenges that occur in disaster situations;
Protect themselves and others from harm;
Recognize their roles and limitations in disaster response efforts;
Communicate confidently with the public and the media about the response plans and capabilities; and
Seek additional information and resources.

Through the NDLS program, the AMA can be recognized as an important national resource for enhancing disaster preparedness and response capabilities of both civilian and military providers. By institutionalizing training throughout the health system, the AMA can better ensure that readiness remains high even during periods of seeming safety and stability. Building a well-trained and well-prepared health workforce through an all-hazards approach provides the dual benefit of bolstering medical and public health systems to respond to terrorism and other public health emergencies, which will truly strengthen the public health infrastructure.

Recommendations

The following statements, recommended by the Council on Scientific Affairs, were adopted by the AMA House of Delegates as AMA policy at the 2003 AMA Interim Meeting:

The AMA:

Condemns terrorism in all its forms and will provide leadership in coordinating efforts to improve the medical and public health response to terrorism and other disasters.
Will work collaboratively with the Federation* in the development, dissemination, and evaluation of a national education and training initiative, called the National Disaster Life Support Program, to provide physicians, medical students, other health professionals, and other emergency responders with a fundamental understanding and working knowledge of their integrated roles and responsibilities in disaster management and response efforts.
Will join in working with the Department of Homeland Security, the Department of Health and Human Services, the Department of Defense, the Federal Emergency Management Agency, and other appropriate federal agencies; state, local, and medical specialty societies; other health care associations; and private foundations to (a) ensure adequate resources, supplies, and training to enhance the medical and public health response to terrorism and other disasters; (b) develop a comprehensive strategy to assure surge capacity to address mass casualty care; (c) implement communications strategies to inform health care professionals and the public about a terrorist attack or other major disaster, including local information on available medical and mental health services; (d) convene local and regional workshops to share "best practices" and "lessons learned" from disaster planning and response activities; (e) organize annual symposia to share new scientific knowledge and information for enhancing the medical and public health response to terrorism and other disasters; and (f) develop joint educational programs to enhance clinical collaboration and increase physician knowledge of the diagnosis and treatment of depression, anxiety, and post traumatic stress disorders associated with exposure to disaster, tragedy, and trauma.
Believes all physicians should (a) be alert to the occurrence of unexplained illness and death in the community; (b) be knowledgeable of disease surveillance and control capabilities for responding to unusual clusters of diseases, symptoms, or presentations; (c) be knowledgeable of procedures used to collect patient information for surveillance as well as the rationale and procedures for reporting patients and patient information; (d) be familiar with the clinical manifestations, diagnostic techniques, isolation precautions, decontamination protocols, and chemotherapy/prophylaxis of chemical, biological, and radioactive agents likely to be used in a terrorist attack; (e) utilize appropriate procedures to prevent exposure to themselves and others; (f) prescribe treatment plans that may include management of psychological and physical trauma; (g) understand the essentials of risk communication so that they can communicate clearly and nonthreateningly with patients, their families, and the media about issues such as exposure risks and potential preventive measures (eg, smallpox vaccination); and (h) understand the role of the public health, emergency medical services, emergency management, and incident management systems in disaster response and the individual health professional’s role in these systems.
Believes that physicians and other health professionals who have direct involvement in a mass casualty event should be knowledgeable of public health interventions that must be considered following the onset of a disaster including: (a) quarantine and other movement restriction options; (b) mass immunization/chemoprophylaxis; (c) mass triage; (d) public education about preventing or reducing exposures; (e) environmental decontamination and sanitation; (f) public health laws; and (g) state and federal resources that contribute to emergency management and response at the local level.
Believes that physicians and other health professionals should be knowledgeable of ethical and legal issues and disaster response. These include: (a) their professional responsibility to treat victims (including those with potentially contagious conditions); (b) their rights and responsibilities to protect themselves from harm; (c) issues surrounding their responsibilities and rights as volunteers, and (d) associated liability issues.
Believes physicians and medical societies should participate directly with state, local, and national public health, law enforcement, and emergency management authorities in developing and implementing disaster preparedness and response protocols in their communities, hospitals, and practices in preparation for terrorism and other disasters.
Urges Congress to appropriate funds to support research and development (a) to improve understanding of the epidemiology, pathogenesis, and treatment of diseases caused by potential bioweapon agents and the immune response to such agents; (b) for new and more effective vaccines, pharmaceuticals, and antidotes against biological and chemical weapons; (c) for enhancing the shelf life of existing vaccines, pharmaceuticals, and antidotes; and (d) for improving biological, chemical, and radioactive agent detection and defense capabilities.

*EDITOR'S NOTE: The term "Federation" is used to describe the state, county, and specialty medical societies represented in the AMA House of Delegates that work together to advance the agenda of physicians and their patients.