James M. Lyznicki

A consensus-based educational framework and competency set for the discipline of disaster medicine and public health preparedness.

BACKGROUND Various organizations and universities have developed competencies for health professionals and other emergency responders. Little effort has been devoted to the integration of these competencies across health specialties and professions. The American Medical Association Center for Public Health Preparedness and Disaster Response convened an expert working group (EWG) to review extant competencies and achieve consensus on an educational framework and competency set from which educators could devise learning objectives and curricula tailored to fit the needs of all health professionals in a disaster. METHODS The EWG conducted a systematic review of peer-reviewed and non-peer reviewed published literature. In addition, after-action reports from Hurricane Katrina and relevant publications recommended by EWG members and other subject matter experts were reviewed for congruencies and gaps. Consensus was ensured through a 3-stage Delphi process. RESULTS The EWG process developed a new educational framework for disaster medicine and public health preparedness based on consensus identification of 7 core learning domains, 19 core competencies, and 73 specific competencies targeted at 3 broad health personnel categories. CONCLUSIONS The competencies can be applied to a wide range of health professionals who are expected to perform at different levels (informed worker/student, practitioner, leader) according to experience, professional role, level of education, or job function. Although these competencies strongly reflect lessons learned following the health system response to Hurricane Katrina, it must be understood that preparedness is a process, and that these competencies must be reviewed continually and refined over time.

Manganese in gasoline

This report responds to a resolution that asked the American Medical Association (AMA) to take action to reduce potential health risks from the use of methylcyclopentadienyl manganese tricarbonyl (MMT) in gasoline. Information for this report was derived from a search of the MEDLINE database and references listed in pertinent articles, as well as through communications with medical and public health experts. Based on this information, the AMA Council on Scientific Affairs determined that there is insufficient scientific evidence to assess the public health impact of MMT use. While limited evidence indicates that general-population exposures to manganese from the use of MMT in gasoline are low, more research is needed to determine possible health effects from long-term, low-dose exposures to MMT and its combustion products. Until such data are available, educational and informational strategies should be developed to improve public awareness of the health and environmental issues surrounding MMT use.

Report of the Council on Scientific Affairs American Medical Association: Immunization of Healthcare Workers With Varicella Vaccine

OBJECTIVE In June 1996, a resolution was introduced to the House of Delegates of the American Medical Association (AMA) asking the AMA to advocate that healthcare workers be given the informed option of receiving the varicella vaccine. The AMA Council on Scientific Affairs studied this issue and presented this report to the House of Delegates in June 1997. METHODS Information for the report was derived from published literature and from personal communications with medical and public health experts and the vaccine manufacturer. FINDINGS Nosocomial outbreaks of varicella-zoster virus (VZV) can result in serious morbidity and mortality. Serological testing of healthcare workers and immunization of nonimmune individuals is recommended by infection control and infectious disease experts to prevent nosocomial transmission of VZV. While current data indicate that the vaccine is safe and poses minimal risks to both adults and children, ongoing research should address various concerns about the long-term safety, efficacy, and epidemiological impact of more widespread use of the vaccine. CONCLUSION Unless contraindicated, all susceptible healthcare workers should receive the varicella vaccine. Whereas individuals with a definite history of VZV infection can be considered immune, those with a negative or uncertain history should undergo serological testing and, if seronegative, should be immunized.

Developing a consensus framework for an effective and efficient disaster response health system: a national call to action.

Eighteen national organizations, representing medicine, dentistry, nursing, hospital systems, public health, and emergency medical services, have worked together to create a framework for a national and regional disaster response health system that is scalable, multidisciplinary, and seamless, and based on an all-hazards approach. In July 2005 and June 2006 the American Medical Association (AMA) and the American Public Health Association (APHA) convened the AMA/APHA Linkages Leadership Summit, with funding from the Centers for Disease Control and Prevention under the Terrorism Injuries: Information Dissemination and Exchange (TIIDE) program. As cofacilitators, James J. James, MD, DrPH, MHA, director of the AMA Center for Public Health Preparedness and Disaster Response, and Georges Benjamin, MD, FACP, FACEP(E), APHA executive director, met with leaders from 16 national medical, dental, hospital, nursing, hospital systems, public health, and emergency medical services organizations in Chicago (2005) and New Orleans (2006) to deliberate the deficiencies in the medical and public health disaster response system and the lack of necessary linkages between key components of this system: the health care, emergency medical services, and public health sectors. The goal was to reach consensus on a set of overarching recommendations to improve and sustain health system preparedness and to combine each organizations advocacy expertise and experience to promote a shared policy agenda. The full summit report contains 53 consensus-based recommendations, which will serve as the framework for a coordinated national agenda for strengthening health system preparedness for terrorism and other disasters. The 9 most overarching critical recommendations from the report are highlighted here. Although the summit report presents important perspectives on the subject of preparedness for public health emergencies, we must understand that preparedness is a process and that these recommendations must be reviewed and refined continually over time.

Special Report: Report of the Council on Scientific Affairs American Medical Association: Immunization of Healthcare Workers with Varicella Vaccine

OBJECTIVE: In June 1996, a resolution was introduced to the House of Delegates of the American Medical Association (AMA) asking the AMA to advocate that healthcare workers be given the informed option of receiving the varicella vaccine. The AMA Council on Scientific Affairs studied this issue and presented this report to the House of Delegates in June 1997. METHODS: Information for the report was derived from published literature and from personal communications with medical and public health experts and the vaccine manufacturer. FINDINGS: Nosocomial outbreaks of varicella-zoster virus (VZV) can result in serious morbidity and mortality. Serological testing of healthcare workers and immunization of nonimmune individuals is recommended by infection control and infectious disease exp rts to prevent nosocomial transmission of VZV. While current data ndicate that the vaccine is safe and poses minimal risks to both adults and children, ongoing research should address various concerns about the long-term safety, efficacy, and epidemiological impact of more widespread use of the vaccine. CONCLUSION: Unless contraindicated, all susceptible healthcare workers should receive the varicella vaccine. Whereas individuals with a definite history of VZV infection can be considered immune, those with a negative or uncertain history should undergo serological testing and, if seronegative, should be immunized (Infect Control Hosp Epidemiol 1998;19:348-353). Varicella-zoster virus (VZV) is a highly contagious herpes virus responsible for two common diseases: varicella (chickenpox) and herpes zoster (shingles).1 Varicella results from primary VZV infection and is a common childhood illness associated with fever and a generalized pruritic rash. Following primary infection, VZV establishes itself in cells of the dorsal root ganglia where it remains latent for years. Reactivation results in herpes zoster, a localized, painful, vesicular rash involving one or adjacent dermatomes. The incidence of herpes zoster increases with age and immunosuppression. Every year in the United States, thousands are hospitalized, and dozens die due to complications of VZV infection. Groups such as infants under 1 year of age, adults, the immunocompromised, and pregnant women are at increased risk for developing complications. It is important for healthcare workers, especially those working with high-risk groups, to know their VZV immune status. If susceptible personnel are exposed, they are considered potentially infectious for up to 21 days.1,2 Because the disease is communicable 1 to 2 days before symptoms begin, exposed employees may need to be reassigned temporarily or furloughed to prevent transmission to susceptible coworkers, patients, and visitors. In 1995, a varicella virus vaccine was approved for use in the United States. Administration of the vaccine to healthcare workers could reduce nosocomial transmission of VZV. Furthermore, considerable cost and labor savings could be realized by avoiding expensive and potentially disruptive infection control measures.