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The incident command system provides an organizational structure at the agency, discipline, or jurisdiction level for effectively coordinating response and recovery efforts during most conventional disasters. This structure does not have the capacity or capability to manage the complexities of a large-scale health-related disaster, especially a pandemic, in which unprecedented decisions at every level (eg, surveillance, triage protocols, surge capacity, isolation, quarantine, health care staffing, deployment) are necessary to investigate, control, and prevent transmission of disease. Emerging concepts supporting a unified decision-making, coordination, and resource management system through a health-specific emergency operations center are addressed and the potential structure, function, roles, and responsibilities are described, including comparisons across countries with similar incident command systems.

Hypothesis: The public health system has a specialized body of knowledge and expertise in bioterrorism and public health emergency management that can assist in the development and delivery of continuing medical education programs to meet the needs of emergency medical service providers., Methods: A nationally representative sample of the basic and paramedic emergency medical service providers in the United States was surveyed to assess whether they had received training in weapons of mass destruction, bioterrorism, chemical terrorism, radiological terrorism, and/or public health emergencies, and how the training was provided., Results: Local health departments provided little in the way of training in biologic, chemical, or radiological terrorism to responders (7.4%-14.9%). State health departments provided even less training (6.3%-17.3%) on all topics to emergency medical services providers. Training that was provided by the health department in bioterrorism and public health emergency response was associated with responder comfort in responding to a bioterrorism event (OR = 2.74, 95% CI = 2.68, 2.81)., Conclusions: Local and state public health agencies should work with the emergency medical services systems to develop and deliver training with an all-hazards approach to disasters and other public health emergencies.

Health care providers must understand the following regarding pathogens linked to bioterrorism: (1) the classification and qualities of possible biologic agents; (2) the natural history and management of biologic, chemical and radiologic injuries and exposures; (3) chemical agents that may be used and their properties; (4) different types of radiologic terrorism; (5) decontamination procedures; and (6) availability of antidotes and other therapeutics.

The recent increased threat of terrorism, coupled with the ever-present dangers posed by natural disasters and public health emergencies, clearly support the need to incorporate bioterrorism preparedness and emergency response material into the curricula of every health professions school in the nation. A main barrier to health care preparedness in this country is a lack of coordination across the spectrum of public health and health care communities and disciplines. Ensuring a unified and coordinated approach to preparedness requires that benchmarks and standards be consistent across health care disciplines and public health, with the most basic level being education of health professions students. Educational competencies establish the foundation that enables graduates to meet occupational competencies. However, educational needs for students differ from the needs of practitioners. In addition, there must be a clear connection between departments of public health and all other health care entities to ensure proper preparedness. The authors describe both a process and a list of core competencies for teaching emergency preparedness to students in the health care professions, developed in 2003 and 2004 by a team of experts from the four health professions schools of Columbia University in New York City. These competencies are directly applicable to medical, dental, nursing, and public health students. They can also easily be adapted to other health care disciplines, so long as differences in levels of proficiency and the need for clinical competency are taken into consideration.