Report 4 of the Council on Scientific Affairs (A-01)
Full Text

Update: Medical Preparedness for Terrorism and Other Disasters

At the 2000 Interim Meeting, the House of Delegates adopted the recommendations contained in Council on Scientific Affairs (CSA) Report 11, Medical Preparedness for Terrorism and Other Disasters (Full Text). These recommendations directed the AMA to: 

1. Call for the creation of a public-private entity (including federal, military, and public health content experts) that, collaborating with medical educators and medical specialty societies, would: develop medical education curricula on disaster medicine and the medical response to terrorism; develop information resources for civilian physicians and other health care workers on disaster medicine and the medical response to terrorism; develop model plans for community medical response to disasters, including terrorism; and address community physician reporting of dangerous diseases to public health authorities;     
2. Encourage the Federation of Medicine to become involved in planning for the medical component of responses to disasters, including terrorism, at levels appropriate to the Federation component; and     
3. Encourage the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and state licensing authorities to include the evaluation of hospital plans for terrorism and other disasters as part of their periodic accreditation and licensure.

Since the CSA presented Report 11 (I-00) to the House, several expert panels also have commented on the need for better involvement of the medical community in the response to terrorism. These expert panels, some chartered and funded by Congress, released their reports in late 2000.^1-3 In 2001, several congressional committees have explored the issue, often seeking testimony from these expert panels. Among the most prominent of these is the Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction, also known as the "Gilmore Commission" for its Chair, Virginia Governor (and Republican National Committee Chairman) James S. Gilmore III. 

In its second report, released in December 2000, the Gilmore Commission stated that its third and final report would address health and medical preparations for terrorism. The AMA provided a copy of Report 11 (I-00) to the Commission. At the Commission’s invitation, a CSA member and an AMA staff representative presented the report to the Commission and discussed it with them during the Commission’s meeting on March 30, 2001. The Commission members received the report and AMA policy enthusiastically. The AMA has offered to work with the Commission as it prepares its final report, and hopes the report will reflect the AMA’s policies in this area. The Gilmore Commission’s prominence in Washington has the potential to significantly promote the AMA’s participation in national and local medical preparedness efforts.

Also speaking at the March meeting were representatives from the Centers for Disease Control and Prevention and the JCAHO. The JCAHO has taken a significant step toward addressing the AMA’s concern that disaster preparedness should be evaluated in hospital accreditation. In January 2001, the JCAHO released a new standard, EC.1.4, which revised the accreditation standard for emergency management.⁴ The standard requires the health care organization to have an emergency management plan describing an effective response to disasters, with provisions for integrating with the surrounding community’s disaster response organization. The standard lists essential elements of a plan, including an annual evaluation of its effectiveness. The standard does not include recommended or mandatory strategies for disaster response planning, leaving these specifics to the health care organization. It also does not explicitly describe a role for medical staff to participate in developing the emergency management plan. However, the JCAHO representative to the March Gilmore Commission meeting stated that JCAHO would be willing to participate in the "public-private entity" described in the AMA recommendation.

In summary, the AMA’s policies on medical preparedness for terrorism and other disasters anticipated the needs identified by national expert panels, and have drawn the attention of one of the most prominent. One of the unique aspects of the AMA recommendations is the proposed use of the Federation of Medicine. As explained in CSA Report 11 (I-00), the Federation provides a ready vehicle for drawing expertise from component societies and for disseminating model curricula and plans. Given the interest in the AMA’s recommendations, the CSA believes the AMA should work with and through the Federation to develop a mechanism for coordinating disaster/terrorism planning and response activities that involve more than one component society. These mechanisms can be employed as national planning and preparedness progress.

RECOMMENDATIONS

The following statements, recommended by the Council on Scientific Affairs, were adopted by the AMA House of Delegates as AMA Directives at the 2001 AMA Annual Meeting: 

1. The AMA will work with the Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction, the Joint Commission on the Accreditation of Healthcare Organizations, and other appropriate parties to promote our policies and recommendations for medical preparedness for terrorism and other disasters.     
2. The AMA will work with and through the Federation of Medicine to develop a mechanism for coordinating disaster/terrorism planning and response activities that involve more than one component medical society. 

Also see the AMA's  Center for Public Health Preparedness and Disaster Response Web site

References

1. Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction. Second Annual Report to The President and The Congress. Washington DC: RAND, 2000:32-35.    
2. U.S. Commission on National Security/21st Century. Road Map for National Security: Imperative for Change: Phase III Report of the U.S. Commission on National Security/21st Century . Washington DC, 2001:26.    
3. Cilluffo FJ, Cardash SL. Combating Chemical, Biological, Radiological and Nuclear Terrorism: A Comprehensive Strategy. Washington DC: Gordon N. Center for Strategic and International Studies, 2000:61-71.     
4. Standard EC.1.4. Emergency Management. Chicago: Joint Commission on Accreditation of Healthcare Organizations, 2001. 

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