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Training of Clinicians for Public Health Events Relevant to Bioterrorism Preparedness
Evidence Reports/Technology Assessments, No. 51
Christina Catlett, MD, Trish Perl, MD, MSc, Mollie W Jenckes, MHSc, Karen A Robinson, MSc, Derrick Mitchell, BA, John Hage, MD, Carolyn J Feuerstein, Simon Chuang, and Eric B Bass, MD, MPH.
Structured Abstract
Objectives:
Recent terrorist attacks have increased concerns about the Nation's vulnerability to terrorism, including the potential use of biological weapons. The purpose of this evidence report is to identify and review data on the most effective ways to train clinicians to respond to a bioterrorist attack or other public health events that may pose similar threats to the health care system, including infectious disease outbreaks, toxidromes or mass poisonings, catastrophic events that incite public fear, and events that call for use of hospital disaster plans.
Search strategy:
The Johns Hopkins University Evidence-based Practice Center (EPC) searched electronic literature databases, including MEDLINE® and the Educational Research Information Clearinghouse (ERIC®), using separate strategies for each database. The EPC also searched Internet Web sites and conducted a hand search of references and selected journals. The search covered articles published through May 2001. Search terms included biological warfare, bioterrorism, communicable disease, disease outbreaks, epidemic, disaster planning, catastrophe, toxins, toxidromes, poison, disease notification, surveillance, education, and evaluation.
Selection criteria:
Paired investigators independently reviewed the titles and abstracts of citations identified by the search to exclude articles that were not written in English, did not include human data, had no original data, had only a meeting abstract, did not include health care professionals, did not address bioterrorism or a relevant public health model, did not include training or education, or did not include evaluation data.
Data collection and analysis:
The paired reviewers evaluated study quality in terms of representativeness of study population, methodologic bias, description of the educational intervention, outcomes, and statistical analysis. The reviewers also extracted information on learning objectives, targeted learners, educational methods, results, and conclusions. The EPC team synthesized information qualitatively because the studies were too heterogenous to support quantitative synthesis.
Main results:
The search identified 1,942 unique citations, of which 60 were eligible for complete review. Of these, 53 evaluated the training of clinicians for detection and management of an infectious disease outbreak, 1 evaluated training of clinicians in how to detect and manage toxidromes or mass poisonings, 5 addressed training in how to respond to events that call for the use of hospital disaster plans, and 1 evaluated training of clinicians to report infectious diseases to a central agency. None of the studies evaluated the training of clinicians in how to use Web- or telephone-based central information resources or to communicate with other health professionals during a public health event. Many of the studies had low study quality scores. However, several pertinent findings emerged from some of the studies: 1) use of standardized patients was an acceptable and effective way to train physicians in detection and management of infectious disease outbreaks; 2) satellite broadcasting was an effective way to train large numbers of clinicians and to standardize training across geographically separated groups; 3) a tabletop exercise may be useful for training health care professionals about management of a bioterrorist attack; 4) disaster drill training improved clinicians' knowledge of hospital disaster plans and allowed identification of problems; and 5) a didactic program can help train infection control nurses to report certain infectious disease symptom complexes to a central agency.
Conclusions:
Modest evidence exists about effective ways to train clinicians to detect and manage an infectious disease outbreak. Very little evidence exists about how to effectively train clinicians to respond to other types of public health events deemed relevant to bioterrorism preparedness. Almost no evidence exists on training clinicians in aspects of response such as using central information resources, communicating with other professionals, and reporting events to a central agency. This gap in evidence warrants an increased commitment to developing and evaluating educational programs relevant to bioterrorism preparedness, infectious disease outbreaks, and other public health events.
Contents
- Acknowledgments
- Preface
- Summary
- 1. Introduction
- 2. Methodology
- Recruitment of Experts
- Target Population
- Identifying the Specific Questions
- Public Health Models for Training Clinicians
- Key Questions
- Causal Pathway
- Literature Search Methods
- Web Site Search Methods
- Qualitative and Quantitative Data Abstraction
- Article Review Process
- Evidence Grading
- Construction of Evidence Tables
- Peer Review Process
- 3. Results
- 4. Conclusions
- 5. Future Research
- Evidence Tables
- Appendixes
- Appendix A. Core Technical Experts and Peer Reviewers
- Appendix B. Priority Journals for Handsearching
- Appendix C. Literature Search Strategy
- Appendix D. Literature Abstract Review Form
- Appendix E. Search Terms and Details of Web Site Search
- Appendix F. Web Site Eligibility Form
- Appendix G. Quality Assessment Form
- Appendix H. Content Review and Abstraction Form
- Appendix I. Literature Search Summary
- Appendix J. Web Sites Reviewed and Reasons for Exclusion
- Appendix K. U.S. Army Medical Research Institute of Infectious Diseases Bioterrorism Training Courses
- References
- Bibliography
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-97-006. Prepared by: Johns Hopkins Evidence-based Practice Center.
Suggested citation:
Catlett C, Perl T, Jenckes M, et al. Training of Clinicians for Public Health Events Relevant to Bioterrorism Preparedness (Evidence Report/Technology Assessment No. 51 (Prepared by Johns Hopkins Evidence-based Practice Center under Contract No. 290-97-006). AHRQ Pub. No. 02-E011. Rockville, MD: Agency for Healthcare Research and Quality. January 2002.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers -- patients and clinicians, health system leaders, and policymakers -- make more informed decisions and improve the quality of health care services.
The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.
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2101 East Jefferson Street, Rockville, MD 20852. www
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- Review Preparedness for biological terrorism in the United States: Project BioShield and Beyond.[J Am Osteopath Assoc. 2005]Review Preparedness for biological terrorism in the United States: Project BioShield and Beyond.Dudley G, McFee RB. J Am Osteopath Assoc. 2005 Sep; 105(9):417-24.
- South Carolina Area Health Education Consortium Disaster Preparedness and Response Training Network: an emerging partner in preparedness training.[J Public Health Manag Pract. 2...]South Carolina Area Health Education Consortium Disaster Preparedness and Response Training Network: an emerging partner in preparedness training.Kennedy B, Carson DS, Garr D. J Public Health Manag Pract. 2009 Mar; 15(2 Suppl):S13-9.
- Review Water and bioterrorism: preparing for the potential threat to U.S. water supplies and public health.[Annu Rev Public Health. 2005]Review Water and bioterrorism: preparing for the potential threat to U.S. water supplies and public health.Meinhardt PL. Annu Rev Public Health. 2005; 26:213-37.
- Building a system for preparedness: the NYCEPCE NEST experience.[J Public Health Manag Pract. 2...]Building a system for preparedness: the NYCEPCE NEST experience.Gebbie KM, Horn L, McCollum M, O'Hara K. J Public Health Manag Pract. 2009 Mar; 15(2 Suppl):S3-7.
- Bioterrorism threat makes preparation essential.[WMJ. 2002]Bioterrorism threat makes preparation essential.Parvin K. WMJ. 2002; 101(2):14-6.
- Training of Clinicians for Public Health Events Relevant to Bioterrorism Prepare...Training of Clinicians for Public Health Events Relevant to Bioterrorism Preparedness
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