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PubMed2006

On pandemics and the duty to care: whose duty? who cares?

BACKGROUND: As a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs - both in clinical care and in public health - were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk. DISCUSSION: In the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics. SUMMARY: An honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue.

Codes of Ethics↗
PubMed2003

Meeting the challenge of bioterrorism: lessons learned from West Nile virus and anthrax.

Hospital emergency departments (EDs) and ambulatory clinics may be the first to recognize illness related to a bioterrorist event. Every health-care institution must develop a weapons-of-mass- destruction (WMD) preparedness plan as part of its all-hazards disaster planning. As part of an all-hazards disaster plan, WMD preparedness should use the incident-command model to insure the required chain of command for effectively coordinating activities between hospital departments and external agencies. Preparedness for bioterrorism poses unique challenges. In the event of a biological attack, the hospital infection control staff and administration must already have in place the means to communicate with local and state public health agencies, the Centers for Disease Control and Prevention (CDC), local law-enforcement agencies, and the Federal Bureau of Investigation (FBI). Local and regional planners must consider how to coordinate the responses of emergency medical services (EMS), police, and fire departments with healthcare providers and the news media. Most hospitals are ill equipped to deal with a catastrophic event caused by WMD. The burden of responding to such events will fall initially on ED physicians and staff members. The severity of such an incident might be mitigated with careful planning, training and education. The responses of one hospital network to the outbreak of West Nile virus and, more recently, to the threat of anthrax, are presented as guides for bioterrorism preparedness.

Anthrax↗
PubMed2006

Pandemic preparedness: pigs, poultry, and people versus plans, products, and practice.

Influenza pandemic preparedness planning is critical for reducing human suffering and negative effects on the economy and society. The Centers for Disease Control and Prevention (CDC) is working to ensure a rapid, efficient, and successful response to an outbreak if, when, and where it appears. The CDC's context for strategic planning is based on experiences with seasonal influenza and what is known about past influenza pandemics. From a public health perspective, pandemic preparedness can be achieved with a plan that builds a network of shared responsibility from the local to the global level, with a focus on saving lives with vaccines, antiviral drugs, medical supplies, containment, and communication.

Animals↗
PubMed2006

An analysis of an early-warning system to reduce abortions in dairy cattle in Denmark incorporating both financial and epidemiologic aspects.

Emergency preparedness relies on the ability to detect patterns in rare incidents in an early stage of an outbreak in order to implement relevant actions. Early warning of an abortion storm as a result of infection with a notifiable disease, e.g. brucellosis, bovine viral diarrhea (BVD) or infectious bovine rhinotracheitis (IBR), is a significant surveillance tool. This study used data from 507 large Danish dairy herds. A modified two-stage method for detecting an unusual increase in the abortion incidence was applied to the data. An alarm was considered true if an abortion were detected in the month following the alarm month, otherwise false. The total number of abortions that could potentially be avoided if effective action were taken ranged from 769 (22.9%) to 10 (0.3%), as the number of abortions required to set the alarm increased from 1 to 6. The vast majority of abortions could, however, not be predicted, much less prevented, given this early-warning system. The false to true alarm ratio was reduced when the number of abortions that set the alarm increased. The financial scenarios evaluated demonstrated that the value of an abortion, the cost of responding to an alarm and the efficiency of the actions are important for decision making when reporting an alarm. The presented model can readily be extended to other disease problems and multiple-time periods.

Abortion, Veterinary↗
PubMed2006

Anticipating demand for emergency health services due to medication-related adverse events after rapid mass prophylaxis campaigns.

OBJECTIVES: Mass prophylaxis against infectious disease outbreaks carries the risk of medication-related adverse events (MRAEs). The authors sought to define the relationship between the rapidity of mass prophylaxis dispensing and the subsequent demand for emergency health services due to predictable MRAEs. METHODS: The authors created a spreadsheet-based computer model that calculates scenario-specific predicted daily MRAE rates from user inputs by applying a probability distribution to the reported timing of MRAEs. A hypothetical two- to ten-day prophylaxis campaign for one million people using recent data from both smallpox vaccination and anthrax chemoprophylaxis campaigns was modeled. RESULTS: The length of a mass prophylaxis campaign plays an important role in determining the subsequent intensity in emergency services utilization due to real or suspected adverse events. A two-day smallpox vaccination scenario would produce an estimated 32,000 medical encounters and 1,960 hospitalizations, peaking at 5,246 health care encounters six days after the start of the campaign; in contrast, a ten-day campaign would lead to 41% lower peak surge, with a maximum of 3,106 encounters on the busiest day, ten days after initiation of the campaign. MRAEs with longer lead times, such as those associated with anthrax chemoprophylaxis, exhibit less variability based on campaign length (e.g., 124 out of an estimated 1,400 hospitalizations on day 20 after a two-day campaign versus 103 on day 24 after a ten-day campaign). CONCLUSIONS: The duration of a mass prophylaxis campaign may have a substantial impact on the timing and peak number of clinically significant MRAEs, with very short campaigns overwhelming existing emergency department (ED) capacity to treat real or suspected medication-related injuries. While better reporting of both incidence and timing of MRAEs in future prophylaxis campaigns should improve the application of this model to community-based emergency preparedness planning, these results highlight the need for coordination between public health and emergency medicine planning for infectious disease outbreaks to avoid preventable surges in ED utilization.

Anthrax↗
PubMed2005

Anthrax in New Jersey: a health education experience in bioterrorism response and preparedness.

The anthrax attack in 2001 created new challenges to health educators working on the response effort in New Jersey. Never before had there been a need for educating a group of people who had been exposed to a biological weapon. Coming on the heels of the catastrophic World Trade Center collapse on September 11, 2001, the New Jersey Department of Health and Senior Services was entrenched in the response to, and management of, the anthrax attack that placed a heavy emphasis on educating the postal workers of the United States Postal Service Trenton Processing and Distribution Center. This article provides an account of the preparation and delivery of educational materials and activities in the midst of a biological emergency, emphasizes the role health educators play in responding to bioterrorism events, and encourages health educators to become involved in bioterrorism preparedness efforts.

Anthrax↗