Role of Allied Health Professionals in Disaster Response


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  • Dentistry has been exploring its role since 2002. Discussion is always good. (Forensic dentistry example?) Reality: The nation has moved well beyond the exploratory phase. Systems are in place. Roles have been defined. Competencies have been established. Dentistry has been AWOL. Bottom line: If dentistry doesn’t set its course, someone else will. Right now it’s your medical colleagues and the government (whether Fed, State, local). SPECIALTY RECOGNITION Illinois: Amended Dental Practice Act to include reference to a "Dental emergency responder," defined as: "a dentist or dental hygienist who is appropriately certified in emergency medical response, as defined by the Department of Public Health." (Where was the state dental society? Where was the ADA? Did ADA furnish the state society any guidance? Was the ADA authorized by Board, HOD to furnish any guidance?) LICENSURE, CE REQUIREMENTS Nevada: Requires dentists to complete 4 hours of CE, within two years of initial licensure, on medical consequences of an act of terrorism. (Where was the state dental society? Where was the ADA? Did ADA furnish the state society any guidance? Was the ADA authorized by Board, HOD to furnish any guidance?) FEDERAL GOVERNMENT NIMS: Core competencies, training curricula, certification guidelines ESAR-VHP: Credentialing system (registration, verification, badge)
  • Activation Depending upon the scale of the event, DERs/IDENT may be activated by LHD’s or by the State. In both instances, activated oral health professionals will be indemnified under the Dental Practice Act.
  • 9/11 (2001), Gulf Coast Hurricanes (2005) Casualties produced, structural damages that resulted… Simply overwhelmed the basic medical infrastructure in both cities. The number of victims Resulted in a number of preventable deaths. Congress, Administration Attention to enhancing the nation’s medical surge capacity. Substantially reorganized the Federal response infrastructure. And in so doing, made fundamental changes to the mission(-s), powers, duties of FEMA, HHS. Medical Surge Capacity The nation’s medical surge capacity, of course, is the ability to treat large numbers of casualties when a community’s basic medical/public health infrastructure is overwhelmed. In trying to strengthen it, policymakers have sought to capitalize on (and in some cases expand) the traditional roles of health professionals… INCLUDING DENTISTS, who have most often been relied on to help identify disaster victims and perform minimally invasive (and often non-clinical) procedures. Most policymakers, planners are not aware 9/11 WTC: Not allowed to take medical histories. Directed patients to nurses for that. New Opportunity When it comes to a mass casualty event, most dentists would agree that the profession’s role is to support, not supplant, the work of their medical colleagues. At the same time, dentists possess a wealth of medical knowledge and clinical training that if leveraged properly, could substantially expand their supportive role. Some have given this role a formal name: the dental emergency responder. Though while the ADA does not recognize the dental emergency responder as a specialty, the concept behind it has been a subject of much discussion.
  • We’re definitely LATE to the game. But are we TOO LATE? I don’t think so (e.g., PHS interest, AMA dialogue). But to have a place at the table - to chart our own course - we must catch up… and we must do so quickly.
  • Amends the following: Public Health Service Act Homeland Security Act of 2002 Post-Katrina Emergency Management Reform Act of 2006 Committee assignment(s) may or may not affect strategy. HOUSE Rep. Bart Stupak (D-1 st Mich.) has committed to sponsor. Currently sits on House Energy and Commerce Committee. Prefer sponsor's) on House E&C and/or Homeland Security. SENATE Sponsor not yet identified. Prefer sponsor(s) on Senate HELP and/or Homeland Security.
  • Role of Allied Health Professionals in Disaster Response

    1. 1. Role of Allied Health Professionals in Disaster Response Michael D. Colvard, Member in Oral Medicine Royal College of Surgeons Edinburgh, UK. Director, Disaster Emergency Medicine Readiness Training Center University of Illinois at Chicago [email_address]
    3. 3. Who’s directing the Disaster Response Plans and Programs within the USA? <ul><li>Individual State Legislatures Control: </li></ul><ul><ul><li>physician and dentist practice acts, specialty recognitions, state licensure, CE requirements, who can do what… </li></ul></ul><ul><li>Federal Emergency Management Agency (FEMA): </li></ul><ul><ul><li>Federal Core disaster response competencies: (NIMS) </li></ul></ul><ul><ul><li>Steers national training curricula, certification guidelines </li></ul></ul><ul><ul><li>AMA’s NDLS curriculum reciprocity….. </li></ul></ul><ul><li>US Depart of Health & Human Services (HHS): </li></ul><ul><ul><li>Single National Credentialing system, mobilization infrastructure </li></ul></ul><ul><ul><li>Education, training, outreach, identification badges…. </li></ul></ul><ul><li>KEY Providers selected: Physicians, Dentists, Nurses, Pharmacists, Clergy, & Veterinarians. </li></ul>
    4. 4. Illinois Dental Emergency Responder Illinois Dental Practice act expanded: Public Act 94-409, 2006 Local Health Department Other LHD’s Illinois Department of Public Health Statewide volunteer or funded DDS provider Database Activate local DERs Activate expanded DER CERT MRC IMERT VMAT NNRT NPRT DMORT DMAT : National Liberation Front of Corsica Colvard, The dental emergency responder: expanding the scope of dental practice. 2006, JADA , 137:468-473 All Hazard and CBRNE
    5. 5. DDS / DMD / MD DEMRT Center at University of Illinois at Chicago Illinois State Dental Society Chapter based Disaster Coordinator's COMMUNITY RESPONSE TEAMS IDPH MD Director DDS Director <ul><li>Receive advanced training </li></ul><ul><li>Organize/Conduct training </li></ul><ul><li>Strengthen relationship with Local Health Departments </li></ul><ul><li>Constituent Society meetings </li></ul><ul><li>CDS and ISDS Published Papers </li></ul><ul><li>Garner needed constituent political support </li></ul><ul><li>ISDS Government Relations Office works with State </li></ul><ul><li>Voice of the Profession </li></ul><ul><li>FED Requirements: NIMS </li></ul><ul><li>Additional DDS/DMD Training with AMA NDLS </li></ul><ul><li>Serves as pipeline to and for DDS/DMD seeking teams, </li></ul><ul><li>Pipeline to CDS, ISDS, ADA </li></ul><ul><li>Support to IDPH, I-FLOSS </li></ul><ul><li>Holds Provider database </li></ul><ul><li>Public Health Research </li></ul><ul><li>Public Health Policy </li></ul><ul><li>Needs grants and to publish </li></ul><ul><li>Funding: sources and steers </li></ul><ul><li>Defines Policy and State Mission </li></ul><ul><li>Defines Operational Guidelines </li></ul><ul><li>Seeks political support with other Health Care Professionals </li></ul>Oral Health Responder
    6. 6. “ Dentist Emergency Responder” TRAIN in WHAT SKILLS? <ul><li>Medical Surge Capacity (“Licensed DDS/DMD”) </li></ul><ul><ul><li>Inoculation/prophylaxis </li></ul></ul><ul><ul><li>Walking wounded including minor triage care </li></ul></ul><ul><ul><li>ABC: Airway, Bleeding, and CPR, </li></ul></ul><ul><ul><li>With appropriate training, advanced triage care. </li></ul></ul><ul><li>Local INFRA-STRUCTURE & Supply Capacity </li></ul><ul><ul><li>Alternative treatment site (chairs = beds) </li></ul></ul><ul><ul><li>Medical Supplies (through MOU w / LHD) </li></ul></ul><ul><ul><li>OXYGEN, </li></ul></ul><ul><ul><li>STAFF </li></ul></ul>
    7. 7. DEMRT received AMA NDLS Regional Training Centers Outstanding Support and Collaboration with AMA NDLS Leadership
    8. 8. Disaster Emergency Medicine Readiness Training Center Advise Illinois Department Public Health and Disaster Response leaders Provide a Roster of Providers for Surge and Recovery. Problem Benefits to the State of Illinois Implementation <ul><li>MCIs entail large numbers of healthcare workers in surge capacity/recovery roles </li></ul><ul><li>Many healthcare DDS, PharmD, DVM, RN, RDH curricula do not teach disaster medicine </li></ul><ul><li>Most civilian medical professionals are not acquainted with CBRNE event recognition or Incident Command </li></ul><ul><li>Competent volunteer medical workforce for surge/recovery efforts for local communities under expanded scope operations </li></ul><ul><li>Healthcare professionals (MD, DDS, RN, PharmD, RT, MPH, Medical IT, etc.) conducting constant, informal surveillance of patient population. </li></ul>Continue training Illinois Providers in NIMS and AMA National Disaster Life Support (NDLS) Curricula Teach, Track, and Credential Illinois DDS/RDH healthcare professionals in Disaster Response Competencies. <ul><li>Illinois Terrorism Task Force (ITTF) </li></ul><ul><li>IDPH Pandemic Influenza Workgroup </li></ul><ul><li>IDPH Bioterrorism Task Force </li></ul>DEMRT Staff ILLINOIS Taskforce Memberships <ul><li>IL Public Act 94-409: “DER” </li></ul><ul><li>IL Public Act 94-733 (SB 2921): Volunteers become state employees during declared disaster response </li></ul>ACTIVE LOCAL Collaborations ACTIVE Legislative Collaborations ACTIVE Congressionals <ul><li>Over 3000 healthcare professionals from All Licensures for 2003-2008. </li></ul><ul><li>Conducting CDLS and BDLS courses for all UIC COD students </li></ul><ul><li>Expand to support IDPH state-wide </li></ul>“ ILLINOIS RESPONSE” NIMS, NDLS, HAZMAT with IL National Guard
    9. 9. DEMRT Fy03-FY08 Total NDLS Certified: 1200+ Total Contact: 3500 + 2006: NDLS TRAINING IS Required Certification Training for all D-1 through D-4 Students at UIC College of Dentistry PUBLICATIONS: Dentistry's Role in Disaster Response . Ed: Colvard MD, 2007, Dental Clinics of North America. Elsevier, St Louis MO, 51:767-898 Colvard MD, Naiman MI, Mata D, Cordell GA, Lampiris L. Disaster medicine training survey results for dental health care providers in Illinois. J Am Dent Assoc . 2007 Apr;138(4):519-24. Colvard MD, Lampiris LN, Cordell GA, James J, Guay A, Lee M, Stokes CM, Scott G. The dental emergency responder: Expanding the scope of dental practice J Am Dent Assoc . 2006 Apr;137(4):468-73. “ MILESTONES”
    10. 10. Elevating Dentistry’s Role in the Federal Disaster Response Framework Robert J. Burns Manager, Legislative and Regulatory Policy American Dental Association 202-898-2400 | [email_address]
    11. 11. ADA HOD Resolution 19H-2007 November 2007 Resolved, that the ADA advocate for national emergency preparedness solutions through research, public policy, and legislation. Resolved, that the ADA promote multidisciplinary disaster education and training programs such as core, basic and advanced disaster life support courses, or other courses that train dentists and dental staff in the handling of declared emergencies, and be it further Resolved, that the American Dental Association provide leadership in national, state and community disaster planning and response efforts by increasing participation in coalitions and programs that put “disaster preparedness into practice,” and be it further Resolved, that because dentists have the clinical skills and medical knowledge that are invaluable assets in a mass casualty event, dentists be given the opportunity with additional targeted training to become more effective responders to natural disasters and other catastrophic events, and be it further
    12. 12. California Bill AB 64 Uniform Emergency Volunteer Health Practitioners Act 2008 <ul><li>Licensee is authorized to provide emergency care consistent with his or her dental education and emergency training for the duration of a declared state of emergency. </li></ul><ul><li>Dental Board is authorized to waive a licensee's violation of any provision of the Dental Practice Act that adversely affects that person’s ability to provide emergency services for the duration of a declared state of emergency. </li></ul><ul><li>Passed Nov 2008 </li></ul>
    13. 13. Expanding Nationally “Train for any Disaster” <ul><li>USPHS Workgroup: Chair: United States Public Health Service, Chief Dental Surgeon, Rear Admiral Chris Halliday : </li></ul><ul><ul><li>Government and Academic dental leaders </li></ul></ul><ul><ul><li>Assist ADA policy update </li></ul></ul><ul><ul><li>Advocate inclusion of “dentist” by name in FEMA Documents </li></ul></ul><ul><ul><li>Add DDS/DMD disaster response to the CDC Oral Health Mission Statement </li></ul></ul><ul><li>HHS Policy: USPHS Captain Lee Shackelford : </li></ul><ul><ul><li>Incorporate “disaster” terminology, rather than “bioterrorism” </li></ul></ul><ul><ul><li>Increase DDS/RDH clarity, “emergency” and “public health provider” keeps DDS/RDH potential “outside the box”. </li></ul></ul>
    14. 14. Shaping the outcome <ul><li>Advance a Federal solution </li></ul><ul><ul><li>Define “dental emergency responder” into US Law, </li></ul></ul><ul><ul><li>Core competencies, training requirements </li></ul></ul><ul><li>Shape Federal policy </li></ul><ul><ul><li>FEMA guidance </li></ul></ul><ul><ul><li>CDC Oral Health Mission Statement </li></ul></ul><ul><ul><li>NDMS Dental Emergency Response Team </li></ul></ul><ul><ul><li>CDC’s Centers for Public Health Preparedness (CPHP) Program* </li></ul></ul><ul><ul><li>Educate Federal, state, local emergency managers. </li></ul></ul><ul><li>Funded the nation’s only emergency responder training center for dentists (based at the University of Illinois at Chicago’s School of Dentistry). </li></ul>
    15. 15. Dental Emergency Responder Bill Before US CONGRESS <ul><li>Draft authored, advanced by ADA </li></ul><ul><li>Incorporates dentistry by name into existing federal disaster response framework </li></ul><ul><li>Requires no new federal money </li></ul><ul><li>Adds no new constraints on existing programs </li></ul><ul><li>Will be introduced in 2009 </li></ul><ul><li> </li></ul>
    16. 16. (Anglican) CLERGY ROLE <ul><li>The Right Reverend +Peter Beckwith, DD, </li></ul><ul><li>Episcopal Bishop of the Diocese of Springfield, Springfield, Illinois, </li></ul><ul><li>Vice President of the American Anglican Council, North American Anglican Province, </li></ul><ul><li>(Retired) Rear Admiral, US Navy Reserve, </li></ul><ul><li>Former Chief of Chaplains, US Navy Reserve and United States Marines. </li></ul>
    17. 17. ROLE OF (ANGLICAN) Clergy <ul><li>“Care for the care provider”. </li></ul><ul><li>On scene physical, psychological, and spiritual care and counseling for disaster wounded, deceased and providers, </li></ul><ul><li>Grieving, death, and post traumatic stress disorder (PTSD) counseling, </li></ul><ul><li>Extended family grieving & counseling care, </li></ul><ul><li>Documentation & “reach-back” to parishes. </li></ul>
    18. 18. Role of Allied Health Professionals in Disaster Response QUESTIONS?