Cannon, Ellen

Herskovic, Arnold

English

Calhoun, Institutional Archive of the Naval Postgraduate School

Calhoun: The NPS Institutional ArchiveDSpace RepositoryCenter for Homeland Defense and Security (CHDS) Center for Homeland Security and Defense Publications2010-02-24Physician Preparedness: Role of Medical SocietiesHerskovic, Arnold; Cannon, EllenMonterey, California: Naval Postgraduate Schoolhttp://hdl.handle.net/10945/69232This publication is a work of the U.S. Government as defined in Title 17, UnitedStates Code, Section 101. Copyright protection is not available for this work in theUnited States.Downloaded from NPS Archive: CalhounPh i i P dys c an repare ness: role of Medical Societies   Ellen Cannon PhDProfessor Northeastern Illinois University Political ScienceArnold Herskovic MDRush University Medical Center Radiation OncologyRole of SMS in Preparing a P d C l f Ph i irepare ness u ture or ys c ansFocus of research: Scholarly research     continues to underscore that Culture of Preparedness does not exist among     American Physicians to disaster/terrorist incidentsWe examined role SMS are currently playing and potentially can play in rectifying this       situationContext: and Value of this R hesearcDisaster/Terrorist material incorrectly   assumes that physicians are prepared as first responders in local/state disaster incidenceLatest Findings AMA argues contrary stating American physicians including ER physicians are not trained or prepared for 21 t t N l Ch i l Bi l i ls cen ury uc ear, em ca , o og ca   or a local WMD incidentRecent studies AMA find current medical school curriculum continues to be deficient in preparing       interns and residents for active responsiveness to disaster/terrorist incidentsThesis of graduate students Naval Post Graduate School written between 2006 &2010 underscore the lack of culture of Preparedness of Physicians, hospitals, nurses, EMT, h i t t t N l Ch i l Wp armac s  e c. o uc ear em ca  eapons and WMD situations (DR Joan McInererney MD 2009 AnnMarie Conroy 2008 Paula Bloom    ,   2007 Leading physicians Public Health experts and Political Scientist concur that a Culture of Preparedness among physicians do not exist as of 2010;hospital surge plans are inadequate.  A new decision making medical expert position with required training in Disaster Medicine must be developed and operationalized (Cannon,Herskovic 2007,8,9) Daniel Barnett MD 2010, Ralph Shealay MD 2010 Shumel Shapira MD 2010 and Jonah Burstein MD 2007,2010)Oct 18,2007 DHS Presidential Directive 21 underscores physician preparedness limitations and calls for a new leadership role of physicians in disaster decision making during all state local and federal issues-Medical Technician expertise in Disaster MedicinePresidential Directive #21 R i l f N i l Di M di i iecogn zes ro e o  at ona  saster e c ne n preparedness planning and state and local role in disaster response   created new position of Medical Technical specialist (s) as decision makers in incident       command Differs in that current disaster planning by       hospital administrator changed to Dr who is trained in ethics, pediatrics, security mass casualty, biologic, chemical, radiation weapons, infectious dz , admin staff decision making, legal i k t l i ti thr s  managemen , og s cs among o er disciplinesPresidential Directive 21 –(2)   AMA if committed to Directive 21     AMA in forefront of new Medical SpecialistD i i M ki d Di t L d hiec s on a ng an  sas er ea ers p Training now imperative and obligatory for Di t M di isas er e c neState Medical SocietiesSome states are at forefront often acting as conduit linking Dr to Critical Information which is keyMany (20%) have potential but need better       clarity and directionMany have extensive information but it is       embeddedM j it h i l i l ti l bb ia or y emp as ze eg s a on o y ng, financial concerns, advertising and jobsMany are Disengaged and disconnected from potential disaster threatsWhy are SMS Important 2Culture of Preparedness not in place among Drs.-(most citizens)Drs role becomes more importantHospitals maybe unable to sustain a surge; maybe at physical riskAs Federal local resources are being      reducedAll disasters are ultimately local    SMS reflect American Federalism ( ti l t l t i d d tna ona  o vo un ary n epen en  organization is statesSMS’s are an underutilized resource The content of their website currently has       little or no concern with physician responsiveness to disaster or terrorist     incidentsCurrently majority of SMS website focus      on State and Federal legal issuesP liti l L bb io ca  o y ngMedicare/and other reimbursementElectronic Billing and Coding SystemsJob Placement and opportunities   Advertisement  SMS websites could be a cost effective shovel ready tool that could be utilized to develop a Culture of Preparedness among physicians  without undermining other legitimate concernsMethodologyContent Analysis of 51 SMS websites re:7       variablesNewsletter & Journal including electronic     newsletterAvailable directory medical volunteer info ,   Mission statement whether mentions disaster threatRelated Educational resource and linksLinks to State and Federal Public Health and        helpful response websites Specific reference on first page re:disasterExamination of SMS websites Based on the content analysis of these 7 variables all websites  were placed into one of 4 categories:1 Weak-website.2 Moderate3 E b dd d m e e4 CompleteWeak SMS Web Sites   1.Limited or no communication to existing      and developed governmental resources2 No connection to preparedness/disaster     training, education, or Disaster Medicine fellowships3.No link to national regional or State Dept of Health preparedness training4. Mission Statement limited5. No access to Real Time Information      Weak SMS web sites (28)    56% of state medical societies web sites were found to b k ( Al C Ct D Fl GA HA IL I KN ME MA MAe wea   , a, , e, , , , , owa, , , , ,MT,NJ,NM,NC,ND,OH,OK,RI,SC,TN,VT,WV,WI,WY2. 7 of above states are among the largest populations and OK had which has a very weak website experienced a terrorist attack in 19953 All of the weak web sites had little or no communication with governmental emergency resources4 All weak SMS had no mention of preparedness disaster training or related CME courses5 All weak SMS had no connection or mention of State Medical Reserve Corps6. most devoted extensive space to history of SMSModerately Informative SMS b i ( )we s tes 7Alaska,Ark,ID,SD,VA,DC,NH (14%)Newsletter, State Medical Journal availableAvailable Directory for potentially mobilizing Medical Reserve CorpsMission Statement has no reference disaster/terrorist threatFew Links to State, Federal Dept of Health available Few Links to national preparedness websitesLimited front page reference to disaster/terrorismMentioning of Reserve Medical corps &/or potential tool kitEmbedded SMS websites 10Md M M M N N O P T Ut (20%)   , n, s, o, e, v, r, a, x,  Information available regarding all 8 variablesInformation embedded in website most often in strange or implausable locationsE.g.all 8 variable in 3  SMS websites found under “Patient Care”  Takes a great deal of time to find pertinent informationSlight refinement needed to transform an Embedded site to “Complete” highly cost      effective Complete SMS websites (5)   AZ,CO,LA,MI,NY (10%)  2 states had major disasters;3 taking leadership roles thru SMS without experience a disasterClear Statement with bold visuals for Disaster/Terrorist Preparedness as a primary concernCross border SMS co operation: Statewide Summit on Preparedness (CO)Extensive listing of critical links to all levels of government and Dept of Public Health, interactive videos, CME, multilingual, fellowship information on Disaster MedicineLessons Recommendations 1   1 30% of SMS websites are on their way.         to serving a major function in physician responsiveness2.No need to reconstruct the wheel- cost effective changes to existing websites are      feasible  3 M h d l d k t lif. ass. as eve ope  a poc e  esaver guide that can be duplicatedLesson/recommendation 2 4 Several sites focused on children and       schools focusing attention to needs of school physicians and nurses   5 Bold or colored symbols were effective 6 NY St t d Cit d l d iti.  a e an  y eve ope  a c zen, doctor alert system which can be d li t d b thup ca e  y o ers7.Membership not required to access disaster information especially important for RN’s,PA’s, DDS’s etcLessons Recommendations 3  9 recruitment for Reserve Medical Corps is worthwhile and should be highlighted    10 Some states featured summits which ld b d li t d b ll t tcou  e up ca e  y a  s a es11 Critical Information should be on the front page and urgent information to be available via a ACTION BUTTONFuture Research Based on our study: Doctors as Linchpins       using model of practicing physiciansOther sites ASTRO: disaster preparedness not on     front page however if one puts in “Public Policy” in the search one can eventually       access Homeland Security  information despite the organization responding to the      potential need EMBEDDED NOT INTUITIVEAmerican College of Chest Physicians-remarkable information Ideal Web SiteACTION BUTTOM: quick access to critical i f tin orma on Emphasis on local concerns in disasterNo restrictions to membership, even DrsMultitude of linkages  Educational opportunities perhaps certifications cme etc,   Development of Interactive motivating d ti l t i l b bl i l die uca ona  ma er a  pro a y nc u ng virtual disastersConclusion:Web sites of state medical societies are a        potential source of good informationEmergency information must be easily available and formatted for use in a stressful situationInformation should be available to all “qualified” individuals without restriction by membership or degreeWe do not have to invent the wheel-most information is available by linksTherefore: we inquired Are physicians willing to participate?What is the physicians knowledge base?Are there differences  per practice areas/specialties?Have our institutions, societies included physicians in training ongoing education?  ,  Have governmental institutions, specialty b d t i i di l h l doar s, ra n ng, me ca  sc oo s an  other agencies been involved?What are critical issues to be addressed?Reliable Information Concl:  Only the emergency room doctors had a       level of comfort as to receiving reliable information 10 of 26 internist were.       second.  In a small sample the ER doctors were trained in disaster preparations and      CME.  Internist mostly from CME.Have You received Reliable,Usable Information from where?Y/N CME intertMedS hDis ER Lic Bd Jornl MedSne c prep prep oc? 8/14 2 6 2 3 4 1 4 4 3I 10/7 10 4 3 3 - - - 2 3S 2/11 2 5 1 4 - 1 2 2 -RO 1/3 - - - - - - - - -ER 5/- 2 1 1 2 3 1 1 2 1XR -/4 - - - - - - - - -Path ½ 1 1 - - - - - 2 -gyn 1/3 1 1 - - - - - - -misc ¼ - 1 2 2 - - - - -T   Y 29/4818 19 9 14 7 3 7 12 729/48Comments Q44-48 (7)  Learning and receiving preparedness    knowledge from local &regional medical associations hospitals and governmental, ,   agencies has been disappointing Table 744. To what extent has local, regional medical association contributed to your preparedness knowledge and preparation? ____(1-5)45. To what extent has local hospital prepared you with information and sources? ___(1-5)46. Have you been involved in a drill? ___ how often?___ how has it prepared you ?___(1-5)47. To what extent has local government and local officials made preparedness and disaster training an issue___ to what extent has this increased your knowledge____ (1-5)48 To what extent has the local media impacted your knowledge of disaster preparedness.              ____(1-5) Survey 44-48Prep: 44 Med Soc 45 Hospital 46 drills prep 47 govt issue prepared 48media                              0/1/2/3/4     0/1/2/3/4       y/n     0/1/2/3/4    0/1/2/3/4   0/1/2/3/4      0/1/2/3/4  NOS 22/7/1/ /4 23/4/ / / 11/13 10/4/2/ /1 19/1/3/4/ 11/4/3/ / 17/6/9/ /             -      - - -   -    - - - - -Intern            16/3/2/-/- 14/4/4/-/- 7/14     6/-/2/-/- 16/2/1/-/2   15/4/-/-/2   9/3/7/2/2       Surg              10/-/-/-/4       5/9/-/-/- 7/4     4/3/3/-/- 3/1/-/-/- 1/1/1/-/- -/2/-/3/1      Rad Onc       4/-/-/-/- 1/------- -/3         ------- -/-/3/-/- 2/-/-/-/- 3/-/-/-/-ER 1/2/1/ / 2/1/2/ / 3/ 1/2/ / / /3/ / / 2/3/ / / 2/2/ /1/                 - - - - - - - - - - - - - - - - -Rad                4/-/-/-/- 4/-/-/-/- -/3       2/-/-/-/- 2              4/-/-/-/- 3/-/-/-/-Path               1/1/-/-/- 1/1/-/-/- 2/1     --------- 1/-/-/-/- 2/-/-/-/- -/-/2/-/-Obgyn            3/1/-/-/- 4/-/-/-/- ½       2/-/-/-/- 2/-/1/-/- 1/2/-/-/- 2/2/-/-/-Miscell 4/3/-/-/- ---------- 2/3 -/1/-/-/- 3/1/-/-/- 1/1/1/-/- -/2/-/3/1                Total 65/17/14/0/8   54/19/6/0/0   38/43  25/10/7/0/1    43/8/8/4/2 39/15/5/0/236/17/18/9/4Q20  Are you willing to be a  responderQ 30 How Much would you be involved in a disaster if family tended t                  1.no change 2.moderate increase3.more directly involved in a sustained basis20           30y/n           1/2/3NOS (31) 14/5 3/15/9                    Intern(26)         10/9          5/10/7Surg (15)         11/1          1/8/5R O (4) 2/2 1/ /2a nc                     -ER(5)                2/1          -/5/-Rad(4)              1/3        -/2/1Path(3)              2/1         1/1/-Gy(4)              4/- 1/1/1     Miscell (8) 7/0 1/7/-                   .   totals           53/22     13/49/2516 Do you feel prepared to deal with a local disaster (y/n)?mass disaster (y/n)?  18 H i d t i i fi t d ( / ) ? ave you rece ve  any ra n ng as a rs  respon er y n  or patient motivator (y/n)?16                   18         Y/N Local Mass y/n y/n                          NOS (31)                13/17    2/24   4/22   1/5    Intern(26)                 6/14     4/17              5/17    7/8     Surg (15)                  6/6       3/7                5/9     -/11    RaOnc(4)                 -/4         -/4                -/4       -/4       ER(5) 4/1 3/2 4/1 3/2                                                        Rad(4)                      1/3        -/4                1/3      -/4       Path(3)                      ½          ½                 -/3      -/2     ObGyn(4) 1/3 1/3 2/2 1/3                                                            Miscell (8)                 1/6        -/7               1/5     -/5   TOTALS33/56  14/70               22/66  12/44   Ideal Web SitePANIC BUTTOM: quick access to critical i f tin orma onEmphasis on local concerns in disasterNo restrictions to membership, even DrsMultitude of linkages  Educational opportunities perhaps certifications cme etc,  Development of Interactive motivating d ti l t i l b bl i l die uca ona  ma er a  pro a y nc u ng virtual disastersConclusion:Web sites of state medical societies are a        potential source of good informationEmergency information must be easily available and formatted for use in a stressful situationInformation should be available to all “qualified” individuals without restriction by membership or degreeWe do not have to invent the wheel-most information is available by linksWhy physicians:Di i t li it d t D b t it bscuss on no  m e  o rs, u   may e easier to trackOthers such as EMT, RN, corpsmen  PA, DDS, Therapist etc may be qualifiedSuggest-in a disaster a hierarchy based on experience and trainingOther sites ASTRO: disaster preparedness not on     front page however if one puts in “Public Policy” in the search one can eventually       access Homeland Security  information despite the organization responding to the      potential need EMBEDDED NOT INTUITIVEAmerican College of Chest Physicians-remarkable information Weak SMS Web sites 28     Al Ca Ct De Fl Ga Ha Il In Iowa Ka Me Ma, , , , , , , , , , , , ,Mass,Mt,NJ,NM,NC,ND,OH,OK,RI,SC,TN,Vt WV WI WY (56%), , ,      Limited intercommunication with governmental emergency resources  No connection to preparedness/disaster d ti li it d i t i tie uca on- m e  n ercommun ca on No national/regional or educational  linksEG little information Mission statement refers to license and career    Methodology 51 SMS b it i d i C t t  we s es were exam ne  us ng on en  Analysis of 7 potential variablesSMS magazine,and newsletter (hard copy or      electronic) SMS membership directory SMS i i t t t bj ti d l m ss on s a emen , o ec ves, an  goa s Clear statement of SMS role in disaster/ emergency preparedness if any   Direct links to State Dept of HealthDirect links to national preparedness websites i l di CDC HSS HSD DOD AMA finc u ng , , , ,  on rst pageBased on the content analysis the websites were        categorized as (I) Weak, (II) Moderate,           (III) Embedded or (IV) Complete  Other sites ASTRO: disaster preparedness not on     front page however if one puts in “Public Policy” in the search one can eventually       access Homeland Security  information despite the organization responding to the      potential need EMBEDDED NOT INTUITIVEAmerican College of Chest Physicians-remarkable information Why are SMS important in rectifying this problem ?All disasters are ultimately local with Dr response critical to all phases of a disaster       Role of Dr more important and essential medically and as a decision maker in       incident commandH it l b bl t t iosp a s may e una e o sus a n a surge-maybe at physical riskPhysicians must respond during this environmentWhy Are SMS ImportantCulture of Preparedness not in place among Drs.-(most citizens)Drs role becomes more important & essential in all phases of disasterHospitals maybe unable to sustain a surge; maybe at physical risk    Federal local resources are being reducedAll di t lti t l l l sas ers are u ma e y ocaSMS reflect American Federalism (national to voluntary independent organization in statesMethodology 51 SMS b it i d i C t t  we s es were exam ne  us ng on en  Analysis of 8 potential variablesSMS magazine,and newsletter (hard copy or      electronic) SMS membership directory SMS i i t t t bj ti d l m ss on s a emen , o ec ves, an  goa s Clear statement of SMS role in disaster/ emergency preparedness if any   Direct links to State Dept of HealthDirect links to national preparedness websites i l di CDC HSS HSD DOD AMA finc u ng , , , ,  on rst pageBased on the content analysis the websites were        categorized as (I) Weak, (II) Moderate,           (III) Embedded or (IV) Complete  Examination of SMS websites 2Based on the content analysis of these   8 variables all websites  were placed into one of 4 categories1 Weak-website.2 Moderate3 E b dd d m e e4 Clear and Ready

Physician Preparedness: Role of Medical Societies

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Physician Preparedness: Role of Medical Societies

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Calhoun, Institutional Archive of the Naval Postgraduate School