# Presentation: 087298

## Promoting Clinician Readiness

**Leslie Beitsch, M.D., J.D.**
- Commissioner and State Health Officer
- Oklahoma State Department of Health

## Efforts by Health Departments

**Over the past 3 years, many State health departments were recipients of CDC sponsored bioterrorism (BT) grants**
**Grantees made concerted outreach efforts to clinical practitioners**
**Strengthening the Health Alert Network (HAN) included coordination with local and State medical societies **
**Establishing ties with Metropolitan Medical Response System (MMRS)**

## Clinician Needs after 9/11

**Definitive information on BT**
**Diagnostic criteria**
**Surveillance and reporting primer**
**State and local medical societies wanted greater participation in the BT planning and advisory processes**

## Engaging Clinicians

**Have a BT event... it creates the teachable moment**
**Clinicians without further prodding will seek to enhance their competency in diagnosing BT related illnesses**
**Modest educational efforts will pay immediate dividends by raising the clinical  index of suspicion**
**Reminding medical societies and individual physicians of legal duty to report diseases (e.g., anthrax, etc.)**
**Reducing barriers to simplified reporting (e.g., electronic disease reporting) **

## Steps for State and Local Health Departments

**Build a systemic response to BT events**
**Provide education and training to the entire public health workforce, not only staff with day-to-day BT responsibilities**
**Enhance epidemiology, biostatistics, microbiology, and communication skills through core courses, seminars, and distance learning technologies**
**Offer graduate education for selected staff who demonstrate potential for future leadership roles**

## Role for Clinicians

- Physicians are now engaged
- New BT grant requires planning and advisory committees
- Coordination with local and State medical societies requires further strengthening
- Recruitment/involvement with MMRS

## Testing the System

- April 12 and 13, the Oklahoma State Department of Health (OSDH) staged largest BT exercise ever
- Blueprint and lessons will be available for others to use across the country
- Planning activities and exercises are the best methods to test systems responsiveness
- Employ hackers to test security
- IT system redundancy test

## Preparing for Bioterrorism

**State and local task forces in virtually every health jurisdiction**
**Involvement with Gubernatorial and Legislative task forces**
**ASTHO and NACCHO have provided tools, recommendations, and enhanced Web sites**
**CDC BT grants**
**Enhanced surveillance**

## Public Health and Clinical Medicine

**Renewed appreciation of the importance the public health system plays in protecting our communities**
**Better understanding of the need for disease surveillance and reporting systems**
**Willing participant now in BT and other related advisory groups**

## Model Emergency Health Powers Act

- Act is attempt to codify the various powers and authorities needed to respond to the most catastrophic public health events (BT)
- Private sector may  be called upon to assist governmental public health
- Hospitals and other facilities may be “statecized”
- Conceivably clinicians could be asked to practice in adjacent jurisdictions

## Coordination with Tribal Governments

- Coordination required under the terms of the new CDC grant
- Oklahoma example: 39 federally recognized tribes
- Short-term approach:  include Bureau of Indian Health (BIH) in advisory group
- Expand to all interested participants in the long-term planning process

## Available Tools

- All States recently completed a Department of Justice (DOJ) survey, with results now available
- National Public Health Performance Standards look at broad public health systems capabilities
- Reconcile laws in jurisdiction with Model Emergency Health Powers Act

## Lessons Learned

- Build close working relationships with clinical colleagues before threatened BT events
- Use HAN resources to tie clinicians into public health network
- Examine disease reporting and surveillance systems from perspective of the “user” and lower barriers to easy accessibility
- Improve web sites so that clinicians seeking information can obtain it rapidly
- Anticipate ongoing educational needs, and use CME as a carrot