Florida, the third most populated state in the U.S., has a history of events of bioterrorism, natural disasters, and other public health emergencies, including the nation’s first man-made anthrax outbreak and death in 2001. The state has also suffered from devastating hurricanes and is susceptible to floods, massive fires, agricultural terrorism and tornadoes.

Damage resulting from Hurricane Katrina on the Mississippi Coast.

Healthcare organizations have been asked to become active partners in preparing a health care workforce and first responders to be able to act rapidly and appropriately to treat, recognize, participate and alert the public in the event of an all-hazards catastrophic event.

Although healthcare agencies, primarily hospitals, have been conducting bioterrorism/all-hazards training, there are major deficiencies and gaps in providing standardized and ongoing training. These continue to exist in both the health care system and in communications systems. Additionally, training is necessary to meet the needs of special populations such as persons with mental and physical disabilities, children, elderly, pregnant women, homeless, non-English speaking, and in Florida the visitor or part-time resident.

Trailer damaged by Hurricane Wilma in South Florida.

The Center for Bioterrorism and All-hazards Preparedness (CBAP) at Nova Southeastern University College of Osteopathic Medicine has accepted this challenge with the support of a 3-year HRSA-funded continuing education grant. Partnering with Broward Community College, the project is developing appropriate and timely training for Florida’s healthcare workforce, including first responders, healthcare administrators, as well as volunteers who may not have a medical or scientific background. Training and resource topics include terrorism due to chemicals, biological agents, radiation, nuclear energy, and explosion, natural disasters related to the weather and the environment, man-made accidental disasters, and pandemics such as the potential avian influenza.

According to Sally Bragg, RN, MSN, Health Professions Education Coordinator for CBAP, “In September 2004 a study for the Florida Department of Health, Drs. Leonard Levy and Jean Malecki identified the ‘hard-to-reach population’ as a major target for public health to improve communication and services during a major disaster. This report identified the need for health professionals in the time of a public health emergency to be able to properly recognize and treat specials needs groups working within a team and alerting the system for appropriate assistance. ”

Bragg continued, “Did you know that Florida has the nation’s largest proportion of people over 65 years (18.3%) compared to the national average of 12.0%. By 2025, 25% of the state’s population will be 65 years of age and over. In addition, of Florida’s over 65 population, 19.3% of them have two or more disabilities and 18.6% are unable to go outside of the home in which they live. Within the group of 65 years of age and older, 14.3% have Alzheimer’s disease. Helping these and other segments of the population which have disabilities in a public health emergency requires special preparation and training. This is a focus for CBAP.”

CBAP content committee members discussing education modules. From left to right, Jeff Larson, PhD; Judith Farrar, PhD; Sharon Cohen, RN, MSN; David Thomas, MD, JD; Steve Bowen, MD, MPH; Leonard Levy, MD, MPH; and Sally Bragg, RN, MSN.

“Other unique groups which will require special assistance include tourists. Tourists, visitors and part-time residents, from both the U.S. and abroad, make up over 30% of Florida’s population at any one time. Although this group can be impacted by a terrorist attack or public health emergency in any part of the world, the hurricane vulnerability of Florida makes this group one that professionals would have to deal with in different ways because of their relative lack of preparedness compared to full-time residents.”

In December 2004, the Florida Interdisciplinary All Hazards Training Consortium Advisory Committee was established to identify the current training activities and the strengths and weaknesses of current all hazards continuing education programs and to plan programs to improve them. The Committee’s research has identified the following gaps:

• Not all healthcare employees and volunteers are receiving awareness training.
• Competency standards and training gaps exist for specific health care disciplines such as medicine, dentistry, optometry, podiatric medicine, pharmacy, nursing, medical office personnel, occupational therapy, physical therapy, rehabilitation counseling, and geriatric psychology at the basic, mid, and advanced levels.
• Health care agencies are using face-to-face and home study as the primary method of instructional delivery at the awareness level that requires dedicated trainers at larger institutions and large numbers of highly committed trainers.
• A need to have training in Spanish at the awareness level to address the significant number (20%) of South Florida’s health care employees with limited English language skills.
• No adequate evaluation process to assess the employees/participants current knowledge and competency.
• No executive level training for top-level administrators who may have to assume a significant role in the event of an incident.
• No awareness level training to address the needs of special populations which includes the homebound and frail elderly, children, pregnant women, persons with mental and physical disabilities, non-English speakers, visitors and homeless, others who may be difficult to reach.

Recent events also emphasize the need for an All-Hazards Program in Florida.

Besides the fact that at least some of the perpetrators of 9/11 received flight training in South Florida and that the first criminal incident of anthrax including the first death occurred in Palm Beach County, other realities make Florida an at risk area for major hazardous events. In the last two years Florida has been viciously pelted by major hurricanes that have caused loss of life and devastation to residences, business, health care and other institutions. Sally Bragg commented, “While Florida is considered better prepared than other states, a large percentage of its residents do not have a personal preparedness plan including health care providers, some of whom lost precious medical records. The hurricane season that just began in Florida has resulted in considerable concern by the Governor and others. In addition, in June 2006, in Liberty City, Florida the FBI arrested several men who were alleged to have plotted to bomb the Justice Department Building in Miami and the Sears Tower in Chicago.”

Currently, The Center for Bioterrorism and All-hazards Preparedness has introduced an on line course which can be accessed through on their web site at www.nova.edu/allhazards.com. This course offers free CEU and CE credits to those that complete the course requirements.

The Basic Awareness Course is the first in a series presenting information on Bioterrorism and All-hazards Preparedness and Response appropriate for a variety of healthcare professionals and healthcare workers. This includes:

• Awareness of the history of terrorism and bioterrorism
• Basic understanding of emergency operations
• Basic knowledge of the emergency structure in the community, region, state, including local, state, and federal agencies
• Ability to identify public health disasters – including man-made and natural
• Recognition of the need for an emergency response
• Knowledge base of a potential pandemic influenza
• Knowledge of personal and workplace emergency plans
• The health provider’s role in preparing for and responding to an all-hazards emergency situation at home and at work
• Awareness of the general requirements of special needs populations in an all-hazards emergency situation

A variety of training and resources are provided including online courses, speaker programs, and educational materials.

Suggesting how others can become involved, Bragg states, “We are currently in the process of seeking members for the 2006-2007 Advisory Committee. If you are interested in serving please contact Sally Bragg for more information at bragg@nova.edu.”