New emergency and disaster preparedness course work for physicians and other health care professionals.

The American Medical Association (AMA), in cooperation with four major medical centers, has established training courses to better prepare health care professionals and emergency response personnel for mass-casualty events. The courses aim to standardize emergency response nationwide.

"Currently, there is a tremendous amount of information out there on emergency response," said Dr. James James, M.D., Dr. PH., M.H.A., director of the newly-established AMA Center for Disaster Preparedness and Emergency Response. "But while there is a lot of material, there is not much consistency. We need to be thinking of standardization and what is required in terms of basic skills and knowledge to make our health care providers and physicians more ready."

Issues covered in the initial curriculum include

* natural and manmade disasters;

* traumatic and explosive events;

* nuclear- and radiological-weapon attacks;

* biological events:

* chemical events;

* medical decontamination;

* mitigating stress on health care workers:

* legal issues of disaster response;

* health care facility and disaster planning: and

* mass-fatality incidents.

Although the terrorist attacks of September 11 increased the demand for a nationally recognized course in all-hazards training, several academic medical centers were already developing disaster education programs to meet a perceived lack of medical disaster preparedness. Following the 2001 attacks, a National Disaster Life Support Education Consortium (NDLSEC), comprising national and international experts in disaster management, was formed under a federal grant managed by CDC.

"In large-scale events with mass casualties, there are a number of new areas of medical-training emphasis needed, such as efficient integration with emergency federal and state response, decontamination, and addressing the unique psychological impacts and related social chaos in medical settings," said Dr. Cham Dallas, professor and director of the CDC Center for Public Health Preparedness at the University of Georgia.

The four medical centers cooperating with AMA on the courses are the Medical College of Georgia, the University of Georgia, the University of Texas Southwestern Medical Center at Dallas, and the University of Texas at Houston School of Public Health. All four institutions are members of NDLSEC and, along with AMA, established the AMA Committee on Disaster Preparedness and Emergency Response.

The Basic Disaster Life Support (BDLS) course teaches an all-hazards recognition and management approach to disaster response. It contains several chapters under the acronym D-I-S-A-S-T-E-R (D-detect, I-incident command, S-scene security and safety, A-assess hazards, S-support, T-triage/treatment, E-evacuation, R-recovery). Mass triage and disaster casualty zones are emphasized according to military categories to triage large numbers of victims quickly.

Advance Disaster Life Support (ADLS) training is the next level. This curriculum consists of interactive scenarios and drills, focusing on hands-on skills drawn from the BDLS course work. Exercises include high-fidelity mannequins and address topics such as decontamination and use of protective equipment, subjects not covered in 1he medical education of most health care professionals. AMA will validate and provide continuing medical education (CME) credit for both courses, and is developing a distance-learning module.

"Disaster medicine has not been a traditional part of medical education, so there is a tremendous need for a train-up for the country," said Dr. Richard B. Schwartz, director, Center of Operational Medicine, Department of Emergency Medicine at the Medical College of Georgia in Augusta. "Our first phase will be to do that initial tram-up for the health care providers who are out there. To sustain that training is the next piece, where we have ongoing training within medical schools and nursing schools for students coining through so that this becomes an integrated part of our mission."

"I think physicians' current level of readiness is decent," Dr. James commented. "A lot has been done in terms of technical knowledge and specialty-specific information in public health systems overall since September 11. These courses aim to improve the individual practitioner's role in the larger system and broaden his or her understanding of that role in a particular scenario."

Future course work will include a National Disaster Life Support Course (NDLS), which will focus less on medicine and more on systems logistics, and a Community Disaster Life Support Course (CDLS), which will target the general public and basic first responders.

For more information, contact Lise Stevens by phone at [phone].