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Meeting the Challenges of the 21st Century: The Federal Education and Training Interagency Group for Public Health and Medical Disaster Preparedness and Response D.W. Chen, MD, MPH, and Clare Helminiak, MD, MPH

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etween January 2001 and August 2005, disaster response agencies and organizations responded to nearly 250 declared disasters, including the terrorist attacks of September 11, 2001. Many responders from the United States also gained valuable experience in other disasters, including the December 2004 Indian Ocean tsunami and many smaller, local events. Thus, in late August 2005, when the hurricanes from the Atlantic Ocean traversed Florida to the Gulf Coast, federal, state, local, and private sector emergency responders had reason to believe that their previous training and experience would be successfully used during these storms as well. However, response leaders had not fully appreciated that no well-established emergency preparedness doctrine, knowledge, skill sets, or abilities of disaster response personnel had ever been standardized, either nationally, across regions, or in individual localities. Previously, responses had succeeded in large part because the disasters had been localized events, requiring mostly local response personnel who used locally accepted and practiced standards. When hurricanes Katrina and Rita reached the Gulf Coast, the paradigms governing previous responses proved woefully insufficient to meet the demands of a truly regional and national disaster. The aftermath of the hurricanes testifies to how unprepared the nation’s response capabilities actually are in a major, large-scale domestic disaster. Although catastrophic events on the scale or complexity of the 2004 Sumatran tsunami and the 2005 Gulf Coast hurricanes are relatively rare, the predominant lesson learned by response agencies and organizations is the untoward effect on teamwork and unity of effort whenever knowledge, skills, and abilities of disaster response personnel vary by organization, locality, profession, or occupation. Preparedness and response to large-scale, catastrophic domestic disasters will always be less effective until training and educational standards exist among our nation’s public health and medical first-responder and receiver communities.

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THE PANDEMIC AND ALL-HAZARDS PREPAREDNESS ACT To address this gap in preparedness and to improve the overall US emergency health care system, Congress passed the Pandemic and All-Hazards Preparedness Act (PAHPA) in December 2006 ‘‘to improve the Nation’s public health and medical preparedness and response capabilities for emergencies.’’ In general, PAHPA charged the US Department of Health and Human Services (HHS) with responsibility for federal public health and medical emergency response functions under the National Response Plan (now called the National Response Framework). Section 304 of the statute specifically addresses training, and the Secretary of HHS, in collaboration with the Secretary of Defense and in consultation with relevant public and private entities, is tasked to develop core health and medical response curricula and trainings by adapting applicable existing curricula and training programs to improve responses to public health emergencies.

HOMELAND SECURITY PRESIDENTIAL DIRECTIVE 21 In October 2007, Homeland Security Presidential Directive (HSPD) 21, ‘‘Public Health and Medical Preparedness,’’ was signed by the President. Consistent with PAHPA legislation, the directive contains specific education and training deliverables. Paragraph 37 calls on the Secretary of HHS, in coordination with the secretaries of the Department of Defense (DoD), Department of Transportation (DOT), Department of Veterans Affairs (VA), and Department of Homeland Security (DHS), to develop a mechanism to coordinate public health and medical disaster preparedness and response core curricula and training across executive departments and agencies. Paragraph 38 tasks the secretaries of HHS and DoD, in coordination with the secretaries of the VA and DHS, to establish a new National Center for Disaster Medicine and Public Health (NCDMPH) at the Uniformed Services University of the Health Sciences (USUHS) and to VOL. 7/NO. 1

Copyright & 2013 Society for Disaster Medicine and Public Health, Inc. DOI: 10.1017/dmp.2013.27

Meeting the Challenges of the 21st Century

lead efforts to develop and propagate core curricula, training, and research related to medicine and public health in disasters.

Department of Veterans Affairs > >

FEDERAL EDUCATION AND TRAINING INTERAGENCY GROUP In November 2008, the Office of the Secretaries of HHS, DoD, DHS, VA, and DOT signed a charter establishing the Federal Education and Training Interagency Group (FETIG). The departments agreed to create this group to coordinate myriad medical and public health disaster preparedness and response education/training activities across federal executive departments; work with all relevant stakeholders, both public and private, in developing core competencies and education and training standards; and translate research findings into practice. In addition, FETIG would serve as sponsor and advisory body to the new NCDMPH. Membership in FETIG from all other federal departments and agencies with equity was also secured. The following lists the federal departments, independent agencies, and their respective offices, components, and subordinate agencies that are FETIG members.

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Employee Education System Emergency Management Strategic Healthcare Group Office of Academic Affairs

Department of Transportation >

National Highway Traffic Safety Administration

Department of Agriculture > >

Animal Plant and Health Inspection Service Food Safety and Inspection Service

Department of Education >

Office of Safe and Drug-Free Schools

Department of Labor >

Occupational Safety and Health Administration

Department of Health and Human Services Environmental Protection Agency >

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Office of the Assistant Secretary of Preparedness and Response Agency for Healthcare Research and Quality Centers for Disease Control and Prevention Food and Drug Administration Health Resources and Service Administration Indian Health Service National Institutes of Health Office of Public Health and Science Office of the Surgeon General Substance Abuse and Mental Health Services Administration

Department of Defense >

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Office of the Assistant Secretary of Defense for Health Affairs Office of the Assistant Secretary of Defense for Homeland Defense and America’s Security Affairs Office of the Assistant Secretary of Defense for Nuclear, Chemical, and Biological Defense Programs Defense Medical Readiness Training Institute US Northern Command Uniformed Services University of the Health Sciences– National Center for Disaster Medicine and Public Health

Department of Homeland Security > >

Office of Health Affairs Federal Emergency Management Agency

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Office of Health Services

White House National Security Staff THE NATIONAL CENTER FOR DISASTER MEDICINE AND PUBLIC HEALTH The NCDMPH was established within USUHS in October 2008 to serve as the new focal point to lead and coordinate national efforts to develop and propagate core curricula, education, training, and research in all-hazards disaster health across multiple disciplines and professions. The mission of the new national center colocates education and research within the university and addresses the related specialties of domestic medical preparedness and response, international health, and international humanitarian assistance and disaster relief. The center’s work necessarily calls for engagement with state, local, territorial, and tribal governments, as well as academia, industry, nongovernmental and private voluntary organizations, and specialty societies and professional associations.

PROGRESS TO DATE Consistent with the strategic plan its members initially developed, FETIG continues to aspire toward a vision of ‘‘a nation educated and trained effectively to respond to medical and public health emergencies.’’ To achieve this vision, FETIG provides ongoing advice ‘‘on public health and medical training and education standards across government, Disaster Medicine and Public Health Preparedness

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academia, and private entities so that disaster medicine and public health core curricula contribute to an effective national response to all-hazards.’’

significant array of organizations and initiatives that are involved in disaster education and training including: >

As part of its early efforts, FETIG and NCDMPH collaborated with the US Northern Command (USNORTHCOM) and Yale New Haven (YNH) Health Systems (under contract to USNORTHCOM) to field a series of 6 workshops to develop an initial framework for establishing competencies for the disaster response and preparedness workforce. These workshops were 1-day intensive consultative meetings that convened representatives of the 20 health care professions participating in the Federal Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP). The findings and presentations of the workshops are available on the NCDMPH website (http://ncdmph.usuhs.edu/JointProgram/JP_ Workshops.htm). In addition to these workshops, FETIG has supported 3 conferences sponsored by the NCDMPH. In September 2009, NCDMPH supported the first federal stakeholder conference for 100 federal managers under the theme ‘‘A Nation Prepared: Education and Training Needs for Disaster Medicine and Public Health.’’ This conference aimed to identify available federal education and training programs, recognize gaps in these programs, and clarify where further competencies could be developed. The NCDMPH then convened a pediatric disaster preparedness curriculum development conference in March 2011, in Bethesda, Maryland, fulfilling a central recommendation of the president’s National Commission on Children and Disasters regarding training. This conference initiated early and important work in addressing the unmet education and training needs of medical responders who care for children during disasters. The products of this workshop will be used as first steps in the development of a role-specific, competency-based training program for pediatric disaster preparedness. In September 2011, the NCDMPH hosted a natural disaster health workforce conference. The purpose of this meeting was to: >

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Describe selected aspects of the health professions workforce that would respond to a catastrophic domestic natural disaster; Analyze programs from federal departments and agencies supporting the National Response Framework, Emergency Support Function No. 8: Public Health and Medical Services; and Examine 3 key responder subgroups: emergency and critical care physicians, emergency and critical care nurses, and paramedics.

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THE WAY AHEAD With support of its 5 signatory federal departments and its full membership, FETIG continues to advance public health and medical disaster education and training, building on its current progress, and, most importantly, seeking outreach, partnership, and contributions from all stakeholders. Between FY2013 and FY2015, FETIG will: >

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Work in coordination with the NCDMPH to identify and integrate both federal and national disaster health core competencies, curricula, education and training standards; Work in coordination with the NCDMPH to identify gaps between learning outcomes and both individual and team performance; Work in coordination with the NCDMPH to develop an analytic framework to identify gaps among core competencies, curricula, and response requirements; Work in coordination with the NCDMPH on official engagement with Disaster Medicine and Public Health Preparedness to encourage scholarly work in disaster medicine and public health, and support the NCDMPH’s academic mission; Identify evidence-based evaluation strategies to assess operational outcomes of competencies; Communicate information about the NCDMPH and its efforts within federal, state, local, tribal, and territorial communities; Support federally-sponsored disaster health task forces; and Develop and implement a strategy to achieve coordination of education and training requirements of federal grant programs relating to public health and medical preparedness.

The long-term goals of FETIG, set between FY2016 and FY2018, are to: >

To date, both FETIG and NCDMPH have collaborated and established important partnerships with a preliminary and

The National Disaster Life Support Education Consortium Yale New Haven Health System’s Center for Emergency Preparedness and Disaster Response (CEPDR) The Association of Schools of Public Health (ASPH) The National Association of County and City Health Officials (NACCHO). The Association of State and Territorial Health Officials (ASTHO). Bioterrorism Curriculum Development Program (BTCDP) The Institute of Medicine (IOM) Forum on Medical and Public Health Preparedness for Catastrophic Events. The National Commission on Children and Disasters (NCCD)

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Oversee the establishment of a disaster medicine and public health education and training research program; Sustain and maintain FETIG and NCDMPH VOL. 7/NO. 1

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Evaluate the effectiveness of outreach by FETIG and NCDMPH to all nonfederal partners; and Oversee and review an external evaluation of NCDMPH.

Success of FETIG, NCDMPH, and the entire national community of interest is vital for the preparation of everchanging locations threatened by disaster. Since the original PAHPA legislation and release of HSPD-21, these have included the 2009 H1N1 influenza pandemic; the earthquake in Haiti; the earthquake, tsunami, and nuclear power plant incident in Japan; and recent severe weather activities including tornadoes and wildfires in the US South, Midwest, and West. By working together, we can collectively develop core competencies and education and training standards for our entire public health and medical first-responder and

receiver communities, which, in turn, will advance the safety and health of our nation in the decades to come.

About the Authors Office the Assistant Secretary of Defense for Health Affairs, US Department of Defense, Falls Church, Virginia (Dr Chen), and Office of the Assistant Secretary of Preparedness and Response, US Department of Health and Human Services, Washington, DC (Dr Helminiak). The discussion and conclusions in this article are those of the authors and do not necessarily represent the views of the Department of Defense, Department of Health and Human Services, or any of their components.

Address correspondence and reprint requests to: CAPT D.W. Chen, MD, MPH, Director, Civil-Military Medicine, Force Health Protection & Readiness Programs, Office of the Assistant Secretary of Defense for Health Affairs, Department of Defense, Pentagon 3E1073/DHHQ-7700 Arlington Blvd, Suite 5101, Falls Church, VA 22042-5101 (e-mail: [email protected])

Disaster Medicine and Public Health Preparedness

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Meeting the challenges of the 21st century: the federal education and training interagency group for public health and medical disaster preparedness and response.

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