The National Emergency Responder Credentialing System was recently published by the U.S. Department of Homeland Security and FEMA. The document establishes a baseline for 43 different medical and public health job titles most likely to be requested in the event of a major disaster response. The baseline criteria was developed by the Public Health/Medical Working group looking to identify relevant education, training, certification, etc. for medical and public health professionals to participate Incident Management System. The baseline lists the necessary Incident Command System (ICS) and FEMA courses required.
It should come as no surprise that professionals under the credentialing systems will be required to have ICS-100 (Introduction to ICS), ICS-200 (Basic ICS) and IS-700 (Introduction to National Incident Management System). In addition, individuals are to have training in basic HAZMAT Awareness Training. The baseline also goes on to identify, by job title, the necessary experience, certification and licensing required. The standards are to allow professionals to respond under mutual aid compacts which may take them into different states. Some positions have very extensive training requirements beyond the basics but no at least health care workers have some national standard to use for disaster preparedness training. The one omission that jumps out is the lack of a language requirement. Going into a neighborhood or an area primarily inhabited by non-English speaking residents adds another challenge to mitigating a disaster particularly when trying to administer medical treatment. It is still rare to find American born health care providers with proficiency in another language. In the
The baseline follows the early publication of the National Preparedness Guidelines. In Section 4.7, Strengthen Medical Surge and Mass Prophylaxis Capabilities, these capabilities are identified as the first line of defense against bioterrorism, pandemic flu, and other health emergencies. Surge capacity in these terms means individuals with the highest levels of training and equipment. However, as these individuals tend to little depth to their ranks, they often are depleted after the first 48-72 hours of a disaster. Hospitals likewise are ill-equipped to handle large number of patients requiring immediate hospitalization following any type of incident. The increased possibility of a terrorist attack using some type of chemical or biological agent, or the increased possibility of a pandemic illness striking, increases the possibility that a hospital may be quickly overwhelmed by casualties. Hospital and other medical treatment facilities must be able to collectively handle different types of injuries, including physical and psychological trauma. While some hospitals specialize in treating burns, the number of cases facing their staffs at any one time is usually low. Imagine the flood of burn victims in the event of a refinery explosion. Surprising few facilities train for and are equipped to deal with any kind of injury due to exposure of radiation. Treating patients injured due to chemical or radiological exposure requires additional decontamination procedures for operating rooms and medical personnel that are not normally practiced (due to time and costs).
In anticipation of a mass casualty event that exceeds the capability of local hospitals, medical and public health professionals should conduct regular table top exercises to identify gaps in their capabilities. Hospital staffs s need to have practiced working with an influx of medical health care providers arriving from other facilities or even other parts of the country. Everything from familiarization with local procedures to room and food services needs to be planned out in advance. Such exercises take time and depending on the complexity of the exercise can be costly. A mass prophylaxis campaign, especially one in response to a biological agent or rapidly spreading pandemic illness, could quickly overwhelm local public health professionals. In order to bridge such a shortfall in staffing, it will become necessary to bring in additional personnel from first responders, non-governmental organizations and volunteer organizations. The sheer magnitude of such an effort cannot be conducted on the fly, these needs to be planned and coordinated well in advance of the outbreak.
Working in a collaborative environment is something that is almost alien to many medical professionals. Specialization requires years of training and concentration on one particular task or function. To start talking about a surge capability is to almost go back in time and have individuals focus on basic medical tasks (such as inoculations, taking blood samples, administering IVs) which many don’t practice in their daily routines. Medical professionals are also not immune to institutional biases that may prevent them from wanting to work in a collaborative environment. Hospital administrators may question such exercises or strategies sessions since it doesn’t produce any immediate return on investment. Of course in the event of a major disaster it is revealed the institution was NOT prepared, the financial liability could be huge.
The baseline contained in the National Emergency Responder Credentialing System is an important step in overcoming some of these challenges. It is still rare to see ICS or NIMS taught in the typical healthcare curriculum (and to be sure, adding courses on this material may increase time and expense that the students don’t have). Therefore it would seem to expose healthcare workers early in their academic careers to these topics and require refresher training as part of their continuing education. Most of the courses are available on-line through the FEMA Emergency Management Institute (EMI) or local community colleges. Many county emergency management agencies conduct ICS and NIMS training for first responders. They may be another resource for hospitals to insure their staff has the necessary training to respond to major disasters.
Proposed National Emergency Responder Credentialing System
http://www.fema.gov/library/viewRecord.do?id=3078
National Preparedness Guidelines:
www.fema.gov/pdf/government/npg.pdf
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