CALL TO ACTION | Obtaining and Maintaining Local Interoperability

In the aftermath of the terrorist attacks on 9/11, the American College of Emergency Physicians (ACEP) issued a press release on December 11, 2001, announcing the formation of a new coalition to strengthen community readiness for biological, chemical, and nuclear terrorism and other disasters. Entitled “Partnership for Community Safety: Strengthening America’s Readiness,” the announcement calls on the federal government to support and sustain comprehensive readiness efforts in the nation’s public health departments, hospitals, emergency departments, medical education institutions, nursing profession, and first-responder agencies. To work toward these goals, the partnership has brought together the ACEP, the American Ambulance Association, the American Hospital Association (AHA), the American Organization of Nurse Executives, the American Public Health Association, the Association of American Medical Colleges, the National Association of County and City Health Officers, the International Association of Fire Chiefs, and the National Association of State EMS Directors.

Member organizations agree that weaknesses exist in U.S. medical preparedness and response systems and that additional resources are needed to address the following issues (ACEP 2001):

• Improving the communications infrastructure

• Improving community-based planning

• Increasing community capacity to deal with disasters

• Improving disease surveillance, disease reporting, and field laboratory identification

• Protecting responders from the effects of nuclear, biological, or chemical (NBC) agents

• Increasing and enhancing training programs, continuing education, and community drills for mass-casualty incidents

Two of these recommendations are discussed in the following paragraphs.

Improving the communications infrastructure addresses the heart of building interoperability. In most American cities, response organizations, hospitals, and public health agencies are not linked by alternative communications means other than telephones or e- mail. This problem was stated in testimony by the AHA to the DHHS National Committee on Vital and Health Statistics Panel on National Preparedness and a National Health Information Infrastructure (U.S. DHHS, National Committee on Vital and Health Statistics 2002):

In disasters, particularly those involving a large numbers of casualties, it is critical that hospitals have pre-established communications linkages with other frontline responders that are reliable and interoperable. However, in disasters, most organizations experience problems with interoperability. Communications often degrade as a result of saturated cellular and wireless communications systems that interfere with public safety communications. Public health services must be linked using secure connections to the Internet. High speed, dedicated Internet access should be available for all public and private healthcare facilities and related organizations. There is a critical need for funding to upgrade, modernize and link frontline responder communications systems and to address interoperability problems.

The recommendation to increase and enhance training programs is especially important because the new threats posed by terrorists can include NBC agents that are unfamiliar to most medical providers. In addition, the handling of mass casualties has not been studied in U.S. healthcare curricula, nor have the various aspects of community systems and interoperability that must be built for an effective community response to disaster.