Forum on Medical and Public Health Preparedness for Catastrophic Events – författare

On March 3-4, 2008, the Institute of Medicine (IOM) Forum on Medical and Public Health Preparedness for Catastrophic Events hosted a workshop titled "Medical Countermeasures Dispensing." The overall objective was to discuss a range of solutions to rapidly provide medical countermeasures to protect large numbers of people prior to or during a public health emergency, such as a bioterrorist attack or infectious disease outbreak. The United States is currently unprepared to confront the range of threats it is facing, such as an intentional anthrax release, severe acute respiratory syndrome (SARS), or pandemic influenza, and it must plan aggressively to counteract the threat of these and other future public health emergencies.

Countermeasure dispensing must harness all types of imaginative partnerships between public and private institutions, working together in ways tailored to meet individual community needs. This workshop summary highlights the presentations and subsequent discussion that occurred at the workshop.

During a wide-reaching catastrophic public health emergency or disaster, existing surge capacity plans may not be sufficient to enable health care providers to continue to adhere to normal treatment procedures and follow usual standards of care. This is a particular concern for emergencies that may severely strain resources across a large geographic area, such as a pandemic influenza or the detonation of a nuclear device. Under these circumstances, it may be impossible to provide care according to the standards of care used in non-disaster situations, and, under the most extreme circumstances, it may not even be possible to provide basic life sustaining interventions to all patients who need them. Although recent efforts to address these concerns have accomplished a tremendous amount in just a few years, a great deal remains to be done in even the most advanced plan. This workshop summary highlights the extensive work that is already occurring across the nation. Specifically, the book draws attention to existing federal, state, and local policies and protocols for crisis standards of care; discusses current barriers to increased provider and community engagement; relays examples of existing interstate collaborations; and presents workshop participants'' ideas, comments, concerns, and potential solutions to some of the most difficult challenges.

During natural disasters, disease pandemics, terrorist attacks, and other public health emergencies, the health system must be prepared to accommodate a surge in the number of individuals seeking medical help. For the health community, a primary concern is how to provide care to individuals during such high demand, when the health system''s resources are exhausted and there are more patients than the system can accommodate.

The IOM''s Forum on Medical and Public Health Preparedness for Catastrophic Events held a workshop June 10-11, 2009, to assess the capability of and tools available to federal, state, and local governments to respond to a medical surge. In addition, participants discussed strategies for the public and private sectors to improve preparedness for such a surge. The workshop brought together leaders in the medical and public health preparedness fields, including policy makers from federal agencies and state and local public health departments; providers from the health care community; and health care and hospital administrators. This document summarizes the workshop.

During public health emergencies such as pandemic influenza outbreaks or terrorist attacks, effective vaccines, drugs, diagnostics, and other medical countermeasures are essential to protecting national security and the public''s well-being. The Public Health Emergency Medical Countermeasures Enterprise (PHEMCE)—a partnership among federal, state, and local governments; industry; and academia—is at the forefront of the effort to develop and manufacture these countermeasures. However, despite the PHEMCE''s many successes, there are still serious challenges to overcome. Government-funded medical research is not always focused on countermeasures for the most serious potential threats, and it is difficult to engage pharmaceutical and biotechnology companies to develop and manufacture medical countermeasures that have a limited commercial market. At the request of the Secretary of the U.S. Department of Health and Human Services and the Assistant Secretary for Preparedness and Response, the IOM held a workshop February 22-24, 2010, to address challenges facing the PHEMCE. Workshop participants discussed federal policies and procedures affecting the research, development, and approval of medical countermeasures and explored opportunities to improve the process and protect Americans'' safety and health.

During a wide-reaching catastrophic public health emergency or disaster, existing surge capacity plans may not be sufficient to enable health care providers to continue to adhere to normal treatment procedures and follow usual standards of care. This is a particular concern for emergencies that may severely strain resources across a large geographic area, such as a pandemic influenza or the detonation of a nuclear device. Under these circumstances, it may be impossible to provide care according to the standards of care used in non-disaster situations, and, under the most extreme circumstances, it may not even be possible to provide basic life sustaining interventions to all patients who need them. Although recent efforts to address these concerns have accomplished a tremendous amount in just a few years, a great deal remains to be done in even the most advanced plan. This workshop summary highlights the extensive work that is already occurring across the nation. Specifically, the book draws attention to existing federal, state, and local policies and protocols for crisis standards of care; discusses current barriers to increased provider and community engagement; relays examples of existing interstate collaborations; and presents workshop participants'' ideas, comments, concerns, and potential solutions to some of the most difficult challenges.

During natural disasters, disease pandemics, terrorist attacks, and other public health emergencies, the health system must be prepared to accommodate a surge in the number of individuals seeking medical help. For the health community, a primary concern is how to provide care to individuals during such high demand, when the health system''s resources are exhausted and there are more patients than the system can accommodate.

The IOM''s Forum on Medical and Public Health Preparedness for Catastrophic Events held a workshop June 10-11, 2009, to assess the capability of and tools available to federal, state, and local governments to respond to a medical surge. In addition, participants discussed strategies for the public and private sectors to improve preparedness for such a surge. The workshop brought together leaders in the medical and public health preparedness fields, including policy makers from federal agencies and state and local public health departments; providers from the health care community; and health care and hospital administrators. This document summarizes the workshop.

During public health emergencies such as pandemic influenza outbreaks or terrorist attacks, effective vaccines, drugs, diagnostics, and other medical countermeasures are essential to protecting national security and the public''s well-being. The Public Health Emergency Medical Countermeasures Enterprise (PHEMCE)—a partnership among federal, state, and local governments; industry; and academia—is at the forefront of the effort to develop and manufacture these countermeasures. However, despite the PHEMCE''s many successes, there are still serious challenges to overcome. Government-funded medical research is not always focused on countermeasures for the most serious potential threats, and it is difficult to engage pharmaceutical and biotechnology companies to develop and manufacture medical countermeasures that have a limited commercial market. At the request of the Secretary of the U.S. Department of Health and Human Services and the Assistant Secretary for Preparedness and Response, the IOM held a workshop February 22-24, 2010, to address challenges facing the PHEMCE. Workshop participants discussed federal policies and procedures affecting the research, development, and approval of medical countermeasures and explored opportunities to improve the process and protect Americans'' safety and health.

During public health emergencies such as terrorist attacks or influenza outbreaks, the public health system''s ability to save lives could depend on dispensing medical countermeasures such as antibiotics, antiviral medications, and vaccines to a large number of people in a short amount of time. The IOM''s Forum on Medical and Public Health Preparedness for Catastrophic Events held a workshop on November 18, 2009, to provide an overview of current threats, recent progress made in the public health system for distributing and dispensing countermeasures, and remaining vulnerabilities.

The 2009 H1N1 vaccination campaign was one of the largest public health campaigns in U.S. history, vaccinating one-quarter of the population in the first three months. The Institute of Medicine held three workshops in Raleigh, NC; Austin, TX; and Seattle, WA to learn from participants'' experiences during the campaign and improve future emergency vaccination programs.

Problems contacting emergency services and delayed assistance are not unusual when incidents occur in rural areas, and the consequences can be devastating, particularly with mass casualty incidents. The IOM''s Forum on Medical and Public Health Preparedness for Catastrophic Events held a workshop to examine the current capabilities of emergency response systems and the future opportunities to improve mass casualty response in rural communities.

On March 3-4, 2008, the Institute of Medicine (IOM) Forum on Medical and Public Health Preparedness for Catastrophic Events hosted a workshop titled "Medical Countermeasures Dispensing." The overall objective was to discuss a range of solutions to rapidly provide medical countermeasures to protect large numbers of people prior to or during a public health emergency, such as a bioterrorist attack or infectious disease outbreak. The United States is currently unprepared to confront the range of threats it is facing, such as an intentional anthrax release, severe acute respiratory syndrome (SARS), or pandemic influenza, and it must plan aggressively to counteract the threat of these and other future public health emergencies.

Countermeasure dispensing must harness all types of imaginative partnerships between public and private institutions, working together in ways tailored to meet individual community needs. This workshop summary highlights the presentations and subsequent discussion that occurred at the workshop.

During public health emergencies such as terrorist attacks or influenza outbreaks, the public health system''s ability to save lives could depend on dispensing medical countermeasures such as antibiotics, antiviral medications, and vaccines to a large number of people in a short amount of time. The IOM''s Forum on Medical and Public Health Preparedness for Catastrophic Events held a workshop on November 18, 2009, to provide an overview of current threats, recent progress made in the public health system for distributing and dispensing countermeasures, and remaining vulnerabilities.

The 2009 H1N1 vaccination campaign was one of the largest public health campaigns in U.S. history, vaccinating one-quarter of the population in the first three months. The Institute of Medicine held three workshops in Raleigh, NC; Austin, TX; and Seattle, WA to learn from participants'' experiences during the campaign and improve future emergency vaccination programs.

Problems contacting emergency services and delayed assistance are not unusual when incidents occur in rural areas, and the consequences can be devastating, particularly with mass casualty incidents. The IOM''s Forum on Medical and Public Health Preparedness for Catastrophic Events held a workshop to examine the current capabilities of emergency response systems and the future opportunities to improve mass casualty response in rural communities.

Whether or not the United States has safe and effective medical countermeasures—such as vaccines, drugs, and diagnostic tools—available for use during a disaster can mean the difference between life and death for many Americans. The Food and Drug Administration (FDA) and the scientific community at large could benefit from improved scientific tools and analytic techniques to undertake the complex scientific evaluation and decision making needed to make essential medical countermeasures available. At the request of FDA, the Institute of Medicine (IOM) held a workshop to examine methods to improve the development, evaluation, approval, and regulation of medical countermeasures.

During public health emergencies such as influenza or chemical, biological, radiological/nuclear (CBRN) attacks, safe and effective vaccines, treatments, and other medical countermeasures are essential to protecting national security and the well being of the public. Advancing Regulatory Science for Medical Countermeasure Development examines current medical countermeasures, and investigates the future of research and development in this area. Convened on March 29-30, 2011, this workshop identified regulatory science tools and methods that are available or under development, as well as major gaps in currently available regulatory science tools.

Advancing Regulatory Science for Medical Countermeasure Development is a valuable resource for federal agencies including the Food and Drug Administration (FDA), the Department of Health and Human Services (HHS), the Department of Defense (DoD), as well as health professionals, and public and private health organizations.

Whether or not the United States has safe and effective medical countermeasures—such as vaccines, drugs, and diagnostic tools—available for use during a disaster can mean the difference between life and death for many Americans. The Food and Drug Administration (FDA) and the scientific community at large could benefit from improved scientific tools and analytic techniques to undertake the complex scientific evaluation and decision making needed to make essential medical countermeasures available. At the request of FDA, the Institute of Medicine (IOM) held a workshop to examine methods to improve the development, evaluation, approval, and regulation of medical countermeasures.

During public health emergencies such as influenza or chemical, biological, radiological/nuclear (CBRN) attacks, safe and effective vaccines, treatments, and other medical countermeasures are essential to protecting national security and the well being of the public. Advancing Regulatory Science for Medical Countermeasure Development examines current medical countermeasures, and investigates the future of research and development in this area. Convened on March 29-30, 2011, this workshop identified regulatory science tools and methods that are available or under development, as well as major gaps in currently available regulatory science tools.

Advancing Regulatory Science for Medical Countermeasure Development is a valuable resource for federal agencies including the Food and Drug Administration (FDA), the Department of Health and Human Services (HHS), the Department of Defense (DoD), as well as health professionals, and public and private health organizations.

When a nation or region prepares for public health emergencies such as a pandemic influenza, a large-scale earthquake, or any major disaster scenario in which the health system may be destroyed or stressed to its limits, it is important to describe how standards of care would change due to shortages of critical resources. At the 17th World Congress on Disaster and Emergency Medicine, the IOM Forum on Medical and Public Health Preparedness sponsored a session that focused on the promise of and challenges to integrating crisis standards of care principles into international disaster response plans.

Influenza pandemics overwhelm health care systems with thousands or hundreds of thousands of sick patients, as well as those worried they may be sick. In order to ensure a successful response to the patient swell caused by a pandemic, robust planning is essential to prepare for challenges public health officials may face. This includes the need to quickly distribute and dispense antiviral medications that can reduce the severity and duration of disease to large numbers of people.

In response to a request from the Centers for Disease Control, the Institute of Medicine''s Forum on Medical and Public Health Preparedness for Catastrophic Events held a series of workshops that explored the public''s perception of how to facilitate access to antiviral medications and treatment during an influenza pandemic. To help inform potential strategies still in the development stages at the CDC, workshops were held in Fort Benton, Montana; Chattanooga, Tennessee; and Los Angeles, California during February and March 2012 to consider the usefulness of several alternative strategies of delivering antiviral medication to the public. Participants considered how the normal systems for prescribing and dispensing antiviral medications could be adjusted to ensure that the public has quick, safe, and equitable access to both potentially life-saving drugs and information about the pandemic and treatment options. This document summarizes the workshops.

Health systems and assets are a large part of the critical infrastructure of any community and are vital not only for the safety and well-being of its citizens, but also for the economic vitality, quality of life, and livelihood of the entire community. As part of its ongoing mission to foster dialogue among stakeholders and to confront the challenges inherent in ensuring the nation''s health security, the Institute of Medicine (IOM) Forum on Medical and Public Health Preparedness for Catastrophic Events sponsored a town hall session at the 2012 Public Health Preparedness Summit. This event took place February 21-24 in Anaheim, California.

In this session sponsored by the IOM, the focus of discussion was sustaining health care delivery beyond the initial response to a disaster and facilitating the full long-term recovery of the local health care delivery systems. Many elements required for recovery are also fundamental to the day-to-day operations of these systems. Investing in improved health care delivery systems, both financially and through collaborative capacity building, can enhance economic development and growth before a disaster, and also prove instrumental in sustaining services and recovering after a disaster.

Post-Incident Recovery Considerations of the Health Care Service Delivery Infrastructure serves as a summary of the session and explains the value of regional capacity building; the importance of interagency, intergovernmental, and public-private collaboration; and the significant role that health care coalitions can play in ensuring resilient communities and national health security.

Our nation faces the distinct possibility of a catastrophic terrorist attack using an improvised nuclear device (IND), according to international and U.S. intelligence. Detonation of an IND in a major U.S. city would result in tens of thousands to hundreds of thousands of victims and would overwhelm public health, emergency response, and health care systems, not to mention creating unprecedented social and economic challenges. While preparing for an IND may seem futile at first glance, thousands of lives can be saved by informed planning and decision making prior to and following an attack.

In 2009, the Institute of Medicine published the proceedings of a workshop assessing the health and medical preparedness for responding to an IND detonation. Since that time, multiple federal and other publications have added layers of detail to this conceptual framework, resulting in a significant body of literature and guidance. However, there has been only limited planning effort at the local level as much of the federal guidance has not been translated into action for states, cities and counties. According to an informal survey of community preparedness by the National Association of City and County Health Officials (NACCHO), planning for a radiation incident ranked lowest in priority among other hazards by 2,800 local health departments.

The focus of Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary is on key response requirements faced by public health and health care systems in response to an IND detonation, especially those planning needs of outlying state and local jurisdictions from the detonation site. The specific meeting objectives were as follows:

- Understand the differences between types of radiation incidents and implications of an IND attack on outlying communities.

-Highlight current planning efforts at the federal, state, and local level as well as challenges to the implementation of operational plans.

-Examine gaps in planning efforts and possible challenges and solutions.

-Identify considerations for public health reception centers: how public health and health care interface with functions and staffing and how radiological assessments and triage be handled.

-Discuss the possibilities and benefits of integration of disaster transport systems.

-Explore roles of regional health care coalitions in coordination of health care response.

Engaging the Public in Critical Disaster Planning and Decision Making is the summary of a workshop held in March 2013 to discuss the key principles of public engagement during the development of disaster plans, the response phase, and during the dissemination phase when interested community partners and the general public are informed of the policies that have been adopted. Presenters provided specific examples of resources to assist jurisdictions in planning public engagement activities as well as challenges experienced and potential solutions. This report introduces key principles of public engagement, provides practical guidance on how to plan and implement a public engagement activity, and presents tools to facilitate planning.

Preparedness, Response and Recovery Considerations for Children and Families is the summary of a workshop convened in June, 2013 by the Institute of Medicine Forum on Medical and Public Health Preparedness for Catastrophic Events to discuss disaster preparedness, response, and resilience relative to the needs of children and families, including children with special health care needs. Traditional and non-traditional medical and public health stakeholders from across federal, state, and local government health care coalitions, community organizations, school districts, child care providers, hospitals, private health care providers, insurers, academia, and other partners in municipal planning met to review existing tools and frameworks that can be modified to include children''s needs; identify child-serving partners and organizations that can be leveraged in planning to improve outcomes for children; highlight best practices in resilience and recovery strategies for children; and raise awareness of the need to integrate children''s considerations throughout local and state emergency plans.

Communities across the United States face the threat of emergencies and disasters almost every day, natural and man-made, urban and rural, large and small. Although children represent nearly 25 percent of the U.S. population, current state and local disaster preparedness plans often do not include specific considerations for children and families. The preparedness and resilience of communities related to children will require a systems framework for disaster preparedness across traditional and non-traditional medical and public health stakeholders, including community organizations, schools, and other partners in municipal planning. This report examines resilience strategies that lead to successful recovery in children after a disaster and discusses current approaches and interventions to improverecovery in children.

Many of the elements of the Affordable Care Act (ACA) went into effect in 2014, and with the establishment of many new rules and regulations, there will continue to be significant changes to the United States health care system. It is not clear what impact these changes will have on medical and public health preparedness programs around the country. Although there has been tremendous progress since 2005 and Hurricane Katrina, there is still a long way to go to ensure the health security of the Country. There is a commonly held notion that preparedness is separate and distinct from everyday operations, and that it only affects emergency departments. But time and time again, catastrophic events challenge the entire health care system, from acute care and emergency medical services down to the public health and community clinic level, and the lack of preparedness of one part of the system places preventable stress on other components. The implementation of the ACA provides the opportunity to consider how to incorporate preparedness into all aspects of the health care system.

The Impacts of the Affordable Care Act on Preparedness Resources and Programs is the summary of a workshop convened by the Institute of Medicine''s Forum on Medical and Public Health Preparedness for Catastrophic Events in November 2013 to discuss how changes to the health system as a result of the ACA might impact medical and public health preparedness programs across the nation. This report discusses challenges and benefits of the Affordable Care Act to disaster preparedness and response efforts around the country and considers how changes to payment and reimbursement models will present opportunities and challenges to strengthen disaster preparedness and response capacities.

Over the past decade, preparedness and response capacities of government agencies, hospitals and clinics, public health agencies, and academic researchers in the United States and abroad have been challenged by a succession of public health emergencies, ranging from radiological threats to pandemics to earthquakes. Through After Action Reports, each of these emergencies has yielded important information and lessons learned that can inform future disaster response and recovery efforts. However, important information that needs to be collected during and immediately following these emergencies is often missed because of barriers and obstacles to gathering such data, such as varying institutional review board restrictions in different states, no sustainable funding network for this type of work, uncertainty on who should be involved in research response, and a lack of knowledge around how best to integrate research into response and recovery frameworks.

Taking action to enable medical and public health research during disasters was the focus of a workshop held on June 12 and 13, 2014, coordinated and supported jointly by the Institute of Medicine Forum on Medical and Public Health Preparedness for Catastrophic Events, National Institute of Environmental Health Sciences, the National Library of Medicine, the U.S. Department of Health and Human Services'' Office of the Assistant Secretary for Preparedness and Response, and the Centers for Disease Control and Prevention. Invited speakers and participants from federal, state, and local government, academia, and community and worker organizations came together to discuss how to integrate research into existing response structures; identify critical research needs and priorities; identify obstacles and barriers to research; discuss structures and strategies needed for deployment of a research study; share ideas, innovations, and technologies to support research; and explore data collection tools and data-sharing mechanisms for both rapid and longitudinal research. Enabling Rapid and Sustainable Public Health Research During Disasters summarizes the presentations and discussion of the workshop.

When disaster strikes, it rarely impacts just one jurisdiction. Many catastrophic disaster plans include support from neighboring jurisdictions that likely will not be available in a regional disaster. Bringing multiple stakeholders together from sectors that do not routinely work with each other can augment a response to a disaster, but can also be extremely difficult because of the multi-disciplinary communication and coordination needed to ensure effective medical and public health response. As many communities within a region will have similar vulnerabilities, a logical step in planning is to establish responsibilities and capacities, and be able to work toward common goals to address all-hazards when the entire region is affected. To explore these considerations, the Institute of Medicine''s Forum on Medical and Public Health Preparedness for Catastrophic Events organized a series of three regional workshops in 2014 to explore opportunities to strengthen the regional coordination required in response to a large scale multijurisdictional disaster. The purpose of each regional workshop was to discuss ways to strengthen coordination among multiple jurisdictions in various regions to ensure fair and equitable treatment of communities from all impacted areas. Regional Disaster Response Coordination to Support Health Outcomes summarizes the presentation and discussion of these workshops.

Emerging infectious disease threats that may not have available treatments or vaccines can directly affect the security of the world''s health since these diseases also know no boundaries and will easily cross borders. Sustaining public and private investment in the development of medical countermeasures (MCMs) before an emerging infectious disease becomes a public health emergency in the United States has been extremely challenging. Interest and momentum peak during a crisis and wane between events, and there is little interest in disease threats outside the United States until they impact people stateside.

On March 26 and 27, 2015, the Institute of Medicine convened a workshop in Washington, DC to discuss how to achieve rapid and nimble MCM capability for new and emerging threats. Public- and private-sector stakeholders examined recent efforts to prepare for and respond to outbreaks of Ebola Virus Disease, pandemic influenza, and coronaviruses from policy, budget, and operational standpoints. Participants discussed the need for rapid access to MCM to ensure national security and considered strategies and business models that could enhance stakeholder interest and investment in sustainable response capabilities. This report summarizes the presentations and discussions from this workshop.