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January 2002 Reporter

"First Contact, First Response" The AAMC Responds to the Threat of Terrorism

Paying the Price to Become a Doctor: The Impact of Medical School Debt

AAMC Releases Guidelines: Financial Conflicts of Interest in Human Subjects Research

Viewpoint: CDC and "First Contact, First Response"

A Word from the President

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Viewpoint

CDC and "First Contact, First Response"


	Edward L. Baker, Jr., M.D., M.P.H.; Director, Public Health Practice Program Office; U.S. Centers for Disease Control and Prevention

The horrific events and aftermath of Sept. 11 have impacted all of us in so many different ways. Those of us in public health, and in academic medicine, now face a host of new challenges; fortunately, we've formed a partnership that will serve the country well as we work to meet them.

AAMC's "First Contact, First Response" meeting, held Nov. 28 in Washington, D.C., convened medical, public health, and nursing educators, professional societies, and government agencies, representing the expertise needed to prepare for and respond to bioterrorism effectively. We discussed the need to educate practicing and student clinicians regarding the diagnosis and treatment of unfamiliar illnesses like anthrax and smallpox; the emergency medical response system; the interface between the clinical and public health systems; and the psycho-social aspects of terrorism. The participants responded to these educational needs through e-mail and print bulletins, Web sites, and continuing education programs.

The cooperative agreement between the Centers for Disease Control and Prevention (CDC) and AAMC provides a mechanism to operationalize "First Contact, First Response." CDC responded to the events of Sept. 11 and the anthrax outbreaks by providing epidemiologic investigators, disaster relief, laboratory support, and updated training and information for the public health and clinical front lines. CDC activities may serve as models and resources for three aspects of AAMC's initiative: regional educational and resource centers, technology-mediated educational resources, and a rapid health professions communications system.

Strengthening the relationship between academic and practice communities is critical for an effective preparedness strategy. In 2000, CDC established Centers for Public Health Preparedness to support public health work force training. There are currently 14 funded centers:11 academic centers in schools of public health and three local health department exemplars.

The Columbia University, Mailman School of Public Health Center for Public Health Preparedness provided a "Basic Emergency Preparedness for Public Health Nurses" course to over 800 New York City Department of Health staff 11 days before the World Trade Center disaster, preparing them to be among the first to respond to victims' needs. The St. Louis University School of Public Health, Center for Bioterrorism and Emerging Infections distributed over 6,000 CD-ROM Bioterorrism Toolkits to agencies and health practitioners and provided training via the Internet on bioterrorism agents.

The Regional Education Centers (RECs) proposed by the AAMC through its cooperative agreement with the CDC provide similar regional resources to the academic medical community. RECs were proposed to identify and develop public health rotation sites and curricula, initially for medical students, and in the future, for resident and practicing physicians. Although physicians should understand how public health systems work and their role in them, medical students receive variable exposure to public health. We envision that RECs, partnerships between academic medical centers and public health agencies, can contribute to the general public health education of medical students and help ensure that all physicians are prepared to respond to bioterrorism.

Timely learning opportunities promote an effective medical and public health response to bioterrorism. Since the anthrax outbreaks were first identified, the CDC's Public Health Training Network has produced a series of broadcasts, "CDC Responds," in collaboration with medical and public health colleagues, including AAMC. Topics range from "Anthrax: What Every Clinician Should Know" to "Risk Communication and Bioterrorism" and have reached hundreds of thousands in health departments, hospitals, National Guard units, and academic medical and public health centers. The CDC Public Health Preparedness and Response Web site provides updated information on anthrax investigations and diagnosis and treatment protocols. These CDC resources may provide useful technology-mediated curricular materials in the education of student and practicing health professionals.

A rapid health communications system is crucial for a national preparedness strategy. CDC's Health Alert Network (HAN), such a national system, enables high-speed, continuous, secure connection to the Internet and access to public health information, staff skilled in information/communication technology, and a distance learning infrastructure. HAN was activated within four hours of the World Trade Center event. Forty-two states have extended HAN to private providers. HAN may be a model for the "just-in-time" clinical information needed by practicing clinicians.

At no other time in recent history have so many in the medical and public health communities, the media, and the general public witnessed the importance of a strong public health infrastructure working in concert with the clinical community. Vigilant clinicians in Florida, New York, and the Washington area saved their patients' lives and alerted their public health colleagues. Their recognition of anthrax and a responsive public health system helped to identify and safeguard exposed populations. CDC will be an enthusiastic partner in "First Contact, First Response," to help ensure that all communities benefit from informed and coordinated clinicians and public health systems.