Report 1 of the Council on Scientific Affairs (I-03)
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AMA National Disaster Life Support Program

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In December 2002, in response to policy recommendations advanced by the Council on Scientific Affairs (CSA), the American Medical Association (AMA) established the Center for Disaster Preparedness and Emergency Response* to develop and disseminate a comprehensive disaster management education and training program for physicians and other health professionals. This report describes the AMA’s involvement in developing a National Disaster Life Support (NDLS) program through which all health professionals can acquire a fundamental understanding and working knowledge of their potential contributions to disaster management at the clinical and public health response levels and become aware of their integrated professional roles and responsibilities inherent in a community, state, or regional response. This new initiative builds on and advances years of work by the CSA and others to enhance physicians’ awareness of their important role in responding to terrorism and other public health emergencies. Recommendations in the report underscore this important role as well as support critical learning objectives and competencies identified recently by the Association of American Medical Colleges (AAMC).

[*Editor's Note:  In the spring of 2005,  the name of the disaster preparedness center was changed to Center for Public Health Preparedness and Disaster Response.]

Introduction

The increasing likelihood of the use of weapons of mass destruction (WMD) on large civilian populations has been described in many venues, from professional journals to Congressional hearings to media documentaries. Concern continues about the security of the enormous worldwide arsenal of nuclear, chemical, and biological agents, as well as the recruitment of people capable of manufacturing or deploying them. While the likelihood of a successful chemical, biological, or nuclear attack may seem remote compared to other known health risks, the catastrophic nature of such events demands that health professionals and their communities be prepared. Natural disasters such as tornadoes, hurricanes, floods, and earthquakes, as well as industrial and transportation-related catastrophes, are far more common and also have the potential to severely stress existing medical, public health, and emergency response systems. The emergence of the West Nile virus and SARS, as well as the recent arrival of monkeypox in the Western hemisphere, reinforce to health care professionals that they also must be prepared to respond to novel and unexpected public health emergencies.

A critical component in dealing with disasters is a strong public health infrastructure. Investment in public health systems will enhance capacity to detect and contain rare or unusual disease outbreaks, whether deliberately induced or naturally occurring. Establishing more effective strategies against bioterrorism, for example, will have the benefit of improving response to natural epidemics and new or emerging diseases. Capacities needed to cope effectively with the consequences of an act of bioterrorism could therefore build on the systems used to respond to natural disease outbreaks. This allows for a dual-use response infrastructure that improves the capacity of physicians and public health agencies to respond to multiple hazards while taking into account the unique and complex challenges presented by a WMD event.

Filling the Gaps in Emergency Preparedness and Response Training

The events of the past two years have made clear that the nation’s public health and health care systems are underprepared to address the full scope of health, safety, and security consequences that can result from catastrophic events.¹ Findings of a study by the American College of Emergency Physicians (ACEP) Task Force are typical of others that have attempted to assess the emergency response capabilities of the health workforce.^2-7 In an extensive review of the readiness of emergency physicians, emergency nurses, and emergency medical technicians to respond to the health consequences of the use of WMD (which was performed prior to the terrorist events of September 2001), ACEP found that "little or no WMD-based expertise existed among the three audiences…"² Even among emergency physicians – specialists whom the public most expects to be well-trained to respond to WMD-related events – WMD training was lacking. Such training was not part of the core content of medical schools and is only a small part of training in residency programs. This finding is echoed by the Liaison Committee on Medical Education’s annual survey of medical schools, which found that while 88 of 126 medical schools required students to take course work in biological and chemical terrorism, most of them required less than 6 hours of course work over the four-year curriculum.⁸

Among hospitals, a 2001 survey suggests that 100% of hospitals surveyed were inadequately prepared for a biologic incident and 73% were inadequately prepared for a chemical or nuclear event.⁹ A different survey of more than 180 emergency departments found that fewer than 20% of hospitals had plans for biological or chemical weapons events.¹⁰ This lack of preparedness further suggests a lack of training.

Recognizing that much needs to be done to improve the public health and health care capacity of the nation to respond to acts of terrorism and other catastrophic disasters, the US Congress is providing unprecedented financial support to states to train the nation’s health workforce and strengthen public health and emergency response systems. With federal support, state and local public health agencies are improving disaster response programs and services, and hospitals are in the process of upgrading their ability to respond to acts of bioterrorism and outbreaks of infectious disease, as well as natural disasters and other public health emergencies.

Through the Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services has moved aggressively to fill important infrastructure and education gaps. HRSA is supporting education and preparedness training and addressing regional surge capacity, emergency medical services, and hospital linkages to public health agencies. The CDC is funding efforts to improve surveillance and epidemiology, laboratory capacity for biological and chemical agents, health communications and information technology, and health information dissemination. In 2000, the CDC established a national system of Centers of Public Health Preparedness (http://www.phppo.cdc.gov/owpp) to improve the capacity of front-line public health and health care workers to respond to terrorism and other public health threats and emergencies. Published data are not yet available to assess the accomplishments and effectiveness of this training network.

Since the September 11 attacks, associations representing health professionals of all disciplines have responded quickly and impressively to provide health care workers with skills and competencies to respond to acts of terrorism.^2,11-15 Specialties of family practice, preventive medicine, pediatrics, emergency medicine, internal medicine, psychiatry, and radiology, to name but a few, have developed excellent training materials to educate their respective constituencies. Training programs have been created in various formats, such as didactic lectures, Web-based tutorials, video and lecture tape series, workshops, and conferences. Many programs are more narrowly targeted (eg, to infectious disease specialists, emergency physicians, pediatricians, psychiatrists, radiologists) and do not necessarily reach a broad spectrum of health care students and professionals. To date, most efforts focus almost entirely on clinical and technical material, while not adequately addressing public health and emergency management system response requirements. Few national programs have been developed to address the important skills and educational needs in disaster management and response, in an "all-hazards" approach, that are common to multiple disciplines.

The Web site of the Public Health Foundation (http://www.trainingfinder.org) reveals a plethora of educational opportunities for practicing health care professionals. A search for "bioterrorism/emergency preparedness" training materials revealed 96 unique resources, most of which are Web-based or available on video tape. Few of these are targeted at students in health professions schools. For medical school students, the AAMC has compiled a list of model training programs across the country.

The CDC has assembled perhaps the widest assortment of readily available training materials and modules, nearly all of which are available through its Web site (http://www.bt.cdc.gov). This is a valuable resource on public health emergencies and includes fact sheets on a variety of biological, chemical, and radioactive agents, clinical and infection control guidelines, the types of injuries resulting from mass trauma, and pharmaceutical stockpile information. These materials generally focus on responding to a specific type of terrorism, often targeting a specific hazard. The educational materials and modules are often not suitable for introductory education about the health worker’s role in the public health system, public health surveillance and reporting, the organization of incident command centers, overarching information about major categories of WMD agents, fundamental clinical concepts for managing WMD-related events, and strategies for dealing with mass casualties.

The Need for Standardized, Multidisciplinary Training

Since the terrorist attacks in 2001, interest has increased for a nationally recognized course in "all-hazards" training to better prepare health and safety professionals for mass casualty incidents. While each discipline brings a unique and valuable knowledge base and skill set that contributes importantly to the nation’s readiness, the multitude of responders including emergency medical technicians, paramedics, fire fighters, law enforcement personnel, physicians, nurses, administrators, military personnel, and others who arrive at a disaster scene typically have very different definitions of terms, standards, operation methods, and classifications, as well as experiences and training.

Through recent grant programs, federal agencies such as HRSA and the CDC recognize the need to teach the important skills, competencies, and knowledge bases that cut across individual health professions and are important for all health workers to acquire. The multidisciplinary response that communities and the nation as a whole must implement in a public health emergency makes it critical that health professionals be trained in multidisciplinary settings.

A key finding of the ACEP Task Force was the lack of any "approved" standard content literature on which to base a WMD course.² The Task Force identified discipline-specific core content for a national training program to detect and respond to chemical, biologic, and radioactive agents. This includes core objectives and principles for preparing emergency physicians, nurses, paramedics, and students in these disciplines to respond to terrorism involving WMD. The ACEP task force addressed barriers to professional training and curricula enhancement, and acknowledged the difficulty in implementing new course material into the already crowded core content of undergraduate and graduate medical and nursing education programs. Recently, the AAMC published guidance on the content and teaching methods that would be most appropriate for incorporating this content into medical school curricula.¹¹

Some of the disaster management skills needed by health care providers are clinical in nature; others relate to their role in the larger public health system. When encountering disaster victims, physicians must be able take medical histories and conduct physical examinations to rule out signs and symptoms characteristic of exposure to various chemical, biological, and radioactive agents. They must also be able to order appropriate procedures and laboratory studies to confirm or refute possible diagnoses. Health care providers also must employ appropriate procedures to prevent exposure to themselves and others. Clinicians must be able to prescribe treatment plans that may include management of psychological as well as physical trauma. Finally, they must understand the basics of risk communication so that they can communicate clearly and nonthreateningly with patients, their families, and the media about such things as exposure risks and potential preventive measures (eg, smallpox vaccination).

An integral component of any WMD-based curriculum should be focused on physicians’ interaction with the public health system in order to facilitate effective and coordinated medical and public health responses to WMD, as well as to more common health threats, including chronic and infectious diseases, injuries, and substance abuse.¹¹ Most health professions curricula do not address either the role of the public health, emergency medical services, and emergency management systems or the individual health professional’s role in these systems. Interventions that must be considered following the onset of a disaster (terrorism-related or not) include quarantine, mass immunization, mass triage, public education about preventing exposures, environmental decontamination and sanitation, and epidemiological surveillance and investigation. Health professionals who have direct involvement in a disaster event may need to understand procedures used to collect patient information for surveillance as well as the rationale and procedures for reporting cases and patient information. Furthermore, clinicians will need to understand the incident command structure and their role within that structure.

Another important set of issues involves professional ethics and disaster response.¹¹ This encompasses responders’ responsibility to treat patients (including those with potentially contagious conditions), responders’ rights and responsibilities to protect themselves, issues surrounding their responsibilities and rights as volunteers, and associated liability issues.

While there is no nationally recognized, standardized, multidisciplinary curriculum for training health professionals about the medical and safety implications of disasters and other public health emergencies, considerable interest and activity exist nationally in this regard. As described below, the AMA is actively involved in the development and fielding of three standardized disaster life support courses aimed at medical and nonmedical responders. In September 2003, HRSA awarded $26.6 million in 23 states to support continuing education programs for health professionals and curriculum development in health professions schools.¹⁶ Comprehensive training manuals and textbooks are being published on which to base course development.^17-20 In April 2003, Columbia University created a National Center for Disaster Preparedness in the Mailman School of Public Health. A stated goal of the Center is to develop curricula for health professionals and to "serve as a national resource and training ground for community and public health emergency preparedness."²¹ A National Health Professions Preparedness Consortium, founded by Louisiana State University, the University of Alabama, and the Vanderbilt School Nursing, has been formed to facilitate the development of curricula and training programs to address preparedness of physicians and other health care workers to respond to WMD-incidents.²²

Perhaps the best examples of standardized training programs targeted at multiple health professions focus on cardiac arrest and trauma support. Over the past three decades, nationally recognized and validated programs for advanced cardiac life support (ACLS, sponsored by the American Heart Association) and advanced trauma life support (ATLS, sponsored by the American College of Surgeons) have become a standard part of civilian and US military medical curricula and continuing medical education (CME).

Even before the terrorist attacks in 2001, experts in emergency and disaster medicine saw the need for a nationally recognized course similar to ACLS and ATLS but directed at the recognition and management of "all-hazards" threats (ie, nuclear, biological, chemical, explosive, and natural disasters). With CDC support, the National Disaster Life Support Education Consortium (NDLSEC) was established to better prepare health care professionals and emergency response personnel for mass casualty incidents by assimilating pre-existing disaster educational programs into a cohesive all-hazards manual and continuing education program (the Appendix lists current NDLSEC members). Like ACLS and ATLS, these courses were offered in a didactic and skills lab format, in a schedule that could be accomplished in a weekend. Courses targeted resident physicians, critical care/emergency nurses, paramedics, primary care physicians, and medical students.

The National Disaster Life Support (NDLS) Program

At the 2001 AMA Interim Meeting, the House of Delegates mandated that the AMA develop a major national initiative to rebuild the nation's public health infrastructure and ensure that physicians, in partnership with public health agencies, have the capacity to respond to future medical disasters. It was through this action that the Center for Disaster Preparedness and Emergency Response (CDPER) was created to manage a comprehensive disaster management education and training program. Directed by James James, MD, DrPH, MHA, the CDPER resides within the Group on Science, Quality, and Public Health.

In 2003, the AMA signed a memorandum of understanding with the four NDLSEC founding institutions (the Medical College of Georgia, University of Georgia, University of Texas Southwestern Medical Center at Dallas, and University of Texas at Houston School of Public Health) and established a steering committee to coordinate efforts and resources of the AMA and the NDLSEC to enhance the education and training of health care professionals and others in disaster preparedness and emergency response.

The overarching purpose of NDLS program is to provide the basic information and skill set that all health and safety workers need to competently respond to an intended or naturally occurring public health emergency. This will be accomplished through the development and dissemination of three stand-alone courses, Basic Disaster Life Support (BDLS), Advanced Disaster Life Support (ADLS), and Core Disaster Life Support (CDLS), which can be incorporated into various training curricula, including but not limited to medicine, nursing, pharmacy, dentistry, public health, and the allied health sciences. It should be noted at the outset that these courses are not intended to displace existing curricula or training programs but to complement them (see the AMA's Center for Disaster Preparedness and Emergency Response for course descriptions). Course participants are expected to gain a fundamental understanding and the working knowledge needed for effective contributions to medical disaster management at the clinical and public health response levels and become knowledgeable of their integrated professional roles and responsibilities in emergency response efforts.

Strategic goals of the NDLS program are:

• To provide a comprehensive and consistent overview of disaster management topics relevant to all health and safety professionals regardless of discipline or specialty.
• To be recognized nationally as the definitive basic training resource for disaster preparedness and response for both civilian and military providers.
• To promote AMA leadership in protecting public health, safety, and security.

When fully developed, courses will be "packaged" to include a basic text; an "Instructor’s Manual" containing the course syllabus; accompanying audiovisuals; and an examination, evaluation, and verification process to allow the stand-alone course to be offered throughout the country. Course participants are eligible for CME credit. The packaged product includes access to a faculty development program to prepare course directors to offer the courses at their institution. Key features of the NDLS program are provided in the Table.

An additional benefit will be the establishment of a central database or registry to allow rapid identification by discipline and specialty of individuals who have successfully completed the courses. This central database or registry could be used for an expanded Medical Reserve Corps of volunteer health care providers who might be willing to contribute expertise beyond their local community.

AMA Leadership in Action

Much more still needs to be done to fully integrate the public health community, physicians, pharmacists, nurses, police, firefighters, emergency medical service providers, and hospitals into a cohesive emergency response system. This will require coordinated and sustained efforts from many groups across many disciplines. Implementing a national education and training program requires a strong advocate for the importance of including content integration as a priority into existing medical and public health education. As the umbrella for organized medicine and the nation’s leading voice for individual physicians, the AMA is ideally positioned to provide leadership and advocacy in this regard. This important role of the AMA was underscored by the National Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction (also known as the "Gilmore Commission"),²³ which has advised Congress to fully implement the recommendations in CSA Report 11 (I-00), "Medical Preparedness for Terrorism and Other Disasters."

Recognizing that various potentially competitive programs have been developed or are under development, it is imperative that the AMA move forward expeditiously with this program. Currently, the AMA is working with the American College of Preventive Medicine to identify important public health-related elements in the NDLS courses and procure funding for the further development and fielding of the courses. Through its convening capacity, the AMA and the Center for Disaster Preparedness and Emergency Response must reach out immediately to other potential partners including:

• Medical specialty societies
• State and local medical societies
• Public health agencies, emergency management agencies, and emergency medical services organizations
• Federal agencies (eg, Department of Homeland Security, Department of Health and Human Services, Department of Defense, Veterans Administration)
• Other medical and public health organizations (eg, Association of American Medical Colleges, American Hospital Association, National Association of EMS Physicians, American Public Health Association, American Nurses Association, American Osteopathic Association, National Medical Association, Association of Schools of Allied Health Professions, Joint Commission on Accreditation of Healthcare Organizations, National Association of County and City Health Officials)
• Academic institutions (eg, CDC- and HRSA-funded Centers for Bioterroism/Public Health Preparedness, Uniformed Services University for the Health Sciences)
• P>rivate foundations and voluntary organizations

Developing comprehensive curricula to train health care professionals for a disaster event presents a daunting challenge. That is because disasters can occur in multiple scenarios, with diverse clinical and public health outcomes, many of which are not addressed in current health professional student education. Current knowledge gaps cut across the continuum of emergency events and point to the important need to train all health care workers 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.

All health care personnel have an obligation to their patients, their profession, and to the health, safety, and security of their communities. Health professionals, regardless of specialty or area of concentration, must understand the roles of each segment of the response system and must be trained to detect and respond to all types of potential disasters in a coordinated and integrated way. To support these obligations, the AMA has a duty to ensure that physicians and other health care professionals have the requisite knowledge and skills to function effectively in a disaster or other public health emergency. 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 in emergency preparedness and response 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 (Adopted AMA Policy)

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:

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.

  References

1. Institute of Medicine. Biological Threats and Terrorism: Assessing the Science and Response Capabilities: Workshop Summary. Washington, DC: National Academy Press; 2002.
2. NBC Taskforce. Developing Objectives, Content, and Competencies for the Training of Emergency Medical Technicians, Emergency Physicians, and Emergency Nurses to Care for Casualties Resulting From Nuclear, Biological or Chemical Incidents. Dallas, Texas: American College of Emergency Physicians; 2001. Available at: http://www.acep.org/library/pdf/NBCreport2.pdf. Accessed October 2003.
3. Institute of Medicine. Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21^st Century. Washington, DC: National Academy Press; 2002.
4. Council on Scientific Affairs, American Medical Association. Medical Preparedness for Terrorism and Other Disasters. CSA Report 11 (I-00). Chicago, IL: AMA; 2001. Available at: http://www.ama-assn.org/ama/pub/category/14313.html. Accessed October 2003.
5. Alexander GC, Wynia MK. Ready and willing? physicians’ sense of preparedness for bioterrorism. Health Affairs. 2003;22:189-197.
6. Chen FM, Hickner J, Fink KS, Galliher JM, Burstin H. On the front lines: family physicians’ preparedness for bioterrorism. J Fam Pract. 2002;51:745-750.
7. Ghilarducci DP, Pirrallo RG, Hegman KT. Hazardous materials readiness of United States Level I trauma centers. J Occupat Environ Med. 2000;42:683-692.
8. Liaison Committee on Medical Education. 2002-2003 Annual Medical School Questionnaire. Chicago, IL: American Medical Association, 2003.
9. Treat KN. Hospital preparedness for weapons of mass destruction: and initial assessment. Ann Emerg Med. 2001;38:562-565.
10. Wetter DC, Daniel WE, Treser CD. Hospital preparedness for victims of chemical or biological terrorism. Am J Public Health. 2001;91:710-716.
11. Association of American Medical Colleges. Training Future Physicians About Weapons of Mass Destruction: Report of the Expert Panel on Bioterrorism Education for Medical Students. Washington, DC: AAMC;2003.
12. Association of Departments of Family Medicine, Association of Family Practice Residency Directors. Disaster Medicine: Recommended Curriculum Guidelines for Family Practice Residents. Available at: http://www.aafp.org/x16647.xml?printxml. Accessed October 2003.
13. International Nursing Coalition for Mass Casualty Education Competency Committee. Educational Competencies for Registered Nurses Responding to Mass Casualty Incidents. Available at: http://www.aacn.nche.edu/Education/INCMCECompetencies.pdf. Accessed October 2003.
14. American College of Radiology, American Association of Physicists in Medicine, American Society of Therapeutic Radiology and Oncology. Disaster Preparedness for Radiology Professionals: Response to Radiological Terrorism. Available at: http://www.acr.org/publications/mnp/mnp_primer.html. Accessed October 2003.
15. Center of Health Policy, Columbia University School of Nursing. Bioterrorism and Emergency Preparedness: Competencies for all Public Health Workers. Available at: http://cpmcnet.columbia.edu/dept/nursing/institute-centers/chphsr/btcomps.pdf. Accessed October 2003.
16. HHS Awards $26.6 Million in New Program to Provide Bioterrorism Training and Curriculum. News Release September 12, 2003. Available at: http://www.hhs.gov/news/press/2003pres/20030912d.html. Accessed September 2003.
17 Landesman LY. Public Health Management of Disasters: The Practice Guide. Washington, DC: American Public Health Association; 2001.
18. Hogan DE, Burstein JL. Disaster Medicine. Philadelphia: Lippincott Williams & Wilkins; 2002.
19. Briggs SM, ed. Advanced Disaster Medical Response: Manual for Providers. Boston: Harvard Medical International, Inc; 2003.
20. Veenema TG, ed. Disaster Nursing and Emergency Preparedness for Chemical, Biological, Radiological Terrorism and Other Hazards. New York: Springer Publishing; 2003.
21. Columbia University’s Mailman School of Public Health Creates National Center for Disaster Preparedness: Names Irwin Redlener, MD, to Head New Center. Press Release. April 28, 2003. Available at: http://www.mailman.hs.columbia.edu/news/redlener.html. Accessed October 2003.
22. The National Health Professions Consortium. Available at http://www.mc.vanderbilt.edu/nursing/coalitions/INCMCE/nhppcoverview.pdf. Accessed October 2003.
23. National Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction. Third Annual Report to the President and the Congress of the Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction, III. Arlington, VA: RAND; 2001.

Robert R. Bass, MD, FACEP
Executive Director, Maryland Institute for Emergency Medical Services Systems, Baltimore, Maryland. Dr. Bass represents the National Association of EMS Physicians, National Association of State EMS Directors, and the American Public Health Association.

Phillip L. Coule, MD, FACEP
Associate Director, Center for Operational Medicine, Medical Director MCG LifeNet, Department of Emergency Medicine, Medical College of Georgia

Cham Dallas, PhD
Director, Interdisciplinary Toxicology Program, Department of Pharmaceutics and Biomedical Sciences, College of Pharmacy, University of Georgia; Director, CDC Center for Leadership in Education and Applied Research in Mass Destruction Defense (CLEARMADD).

Scott Lillibridge, MD
Professor of Epidemiology and Director, Center for Biosecurity and Public Health Preparedness, School of Public Health, University of Texas Health Science Center at Houston

Paul E. Pepe, MD, MPH, FACEP, FACP, FCCM
Professor of Medicine, Surgery, Public Health and Riggs Family Chair in Emergency Medicine
University of Texas Southwestern Medical Center and the Parkland Health and Hospital System

Richard B. Schwartz, MD, FACEP, FAAEM
Interim Chair, Department of Emergency Medicine and Director, Center of Operational Medicine, Medical College of Georgia

Raymond E. Swienton, MD, FACEP
Assistant Professor of Surgery and Emergency Medicine and Director, Practice Management Group, The University of Texas Southwestern Medical Center and the Parkland Health and Hospital System, Dallas, Texas

Participating Agencies and Organizations

American College of Emergency Physicians, Dallas, Texas

Center for Disaster and Humanitarian Assistance Medicine (CDHAM), Department of Military and Emergency Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland (Specifically, the Medical Director of CDHAM is a collaborating representative to the NDLSEC from the Uniformed Services Health Sciences University)

Centers for Disease Control and Prevention, Atlanta, Georgia (Original sponsoring agency for BDLS/ADLS development)

Center for Leadership in Education and Applied Research in Mass Destruction Defense (CLEARMADD). A collaborative center of the University of Georgia and the Medical College of Georgia, which has been designated by the CDC as a Specialty Center for Public Health Preparedness and funded under a directed congressional appropriation in 2002 to develop medical education programs in mass casualty management for emergency care personnel.

Academic Centers

Johns Hopkins University
Medical College of Georgia
Parkland Health and Hospital System, Dallas
Uniformed Services University Health Sciences University
University of Georgia
University of Massachusetts Medical School
University of Texas School of Public Health, Houston
University of Texas Southwestern Medical Center

Participating Individuals

Richard Aghababian, MD Professor and Chair, Emergency Medicine, University of Massachusetts Medical Center, Worcester, MA; Past-President, American College of Emergency Physicians; developer of the Pediatric Disaster Life Support course

Erik Auf der Heide, MD, MPH Disaster planning and training specialist, Agency for Toxic Substances and Disease Registry, US Department of Health and Human Services

Ronald Blanck, DO Past Surgeon General of the US Army and President of the University of North Texas Health Sciences Center, Special Consultant on Homeland Defense to the Bush Administration

Raymond A. Fowler, MD Assistant Professor, Division of Emergency Medicine, University of Texas Southwestern Medical Center at Dallas; Past-President National Association of EMS Physicians; founding Program Director for Basic Trauma Life Support

Chris Keyes, MD, MPH Associate Professor and Chief, Section of Toxicology, University of Texas Southwestern Medical Center at Dallas

Robert Suter, DO Attending Physician, Parkland Memorial Hospital, Dallas, TX; Associate Professor, Department Emergency Medicine, Medical College of Georgia; national Secretary-Treasurer, American College of Emergency Physicians

Nelson Tang, MD Medical Director, US Secret Service; Assistant Professor, Johns Hopkins University Department of Emergency Medicine

John M. Wightman, EMT-P, MD Chair, Disaster Medicine Interest Group, Society for Academic Emergency Medicine; Associate Professor and Medical Director, Center for Disaster and Humanitarian Assistance Medicine, Department of Military and Emergency Medicine, Uniformed Services University of Health Sciences

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