The Pandemic and All-Hazards Preparedness Act

To address this gap in preparedness and to improve the overall US emergency health care system, Congress passed the Pandemic and All-Hazards Preparedness Act (PAHPA) in December 2006 “to improve the Nation's public health and medical preparedness and response capabilities for emergencies.” In general, PAHPA charged the US Department of Health and Human Services (HHS) with responsibility for federal public health and medical emergency response functions under the National Response Plan (now called the National Response Framework). Section 304 of the statute specifically addresses training, and the Secretary of HHS, in collaboration with the Secretary of Defense and in consultation with relevant public and private entities, is tasked to develop core health and medical response curricula and trainings by adapting applicable existing curricula and training programs to improve responses to public health emergencies.

Homeland Security Presidential Directive 21

In October 2007, Homeland Security Presidential Directive (HSPD) 21, “Public Health and Medical Preparedness,” was signed by the President. Consistent with PAHPA legislation, the directive contains specific education and training deliverables. Paragraph 37 calls on the Secretary of HHS, in coordination with the secretaries of the Department of Defense (DoD), Department of Transportation (DOT), Department of Veterans Affairs (VA), and Department of Homeland Security (DHS), to develop a mechanism to coordinate public health and medical disaster preparedness and response core curricula and training across executive departments and agencies. Paragraph 38 tasks the secretaries of HHS and DoD, in coordination with the secretaries of the VA and DHS, to establish a new National Center for Disaster Medicine and Public Health (NCDMPH) at the Uniformed Services University of the Health Sciences (USUHS) and to lead efforts to develop and propagate core curricula, training, and research related to medicine and public health in disasters.

Federal Education and Training Interagency Group

In November 2008, the Office of the Secretaries of HHS, DoD, DHS, VA, and DOT signed a charter establishing the Federal Education and Training Interagency Group (FETIG). The departments agreed to create this group to coordinate myriad medical and public health disaster preparedness and response education/training activities across federal executive departments; work with all relevant stakeholders, both public and private, in developing core competencies and education and training standards; and translate research findings into practice. In addition, FETIG would serve as sponsor and advisory body to the new NCDMPH. Membership in FETIG from all other federal departments and agencies with equity was also secured. The following lists the federal departments, independent agencies, and their respective offices, components, and subordinate agencies that are FETIG members.

The National Center for Disaster Medicine and Public Health

The NCDMPH was established within USUHS in October 2008 to serve as the new focal point to lead and coordinate national efforts to develop and propagate core curricula, education, training, and research in all-hazards disaster health across multiple disciplines and professions. The mission of the new national center colocates education and research within the university and addresses the related specialties of domestic medical preparedness and response, international health, and international humanitarian assistance and disaster relief. The center's work necessarily calls for engagement with state, local, territorial, and tribal governments, as well as academia, industry, nongovernmental and private voluntary organizations, and specialty societies and professional associations.

Progress to Date

Consistent with the strategic plan its members initially developed, FETIG continues to aspire toward a vision of “a nation educated and trained effectively to respond to medical and public health emergencies.” To achieve this vision, FETIG provides ongoing advice “on public health and medical training and education standards across government, academia, and private entities so that disaster medicine and public health core curricula contribute to an effective national response to all-hazards.”

As part of its early efforts, FETIG and NCDMPH collaborated with the US Northern Command (USNORTHCOM) and Yale New Haven (YNH) Health Systems (under contract to USNORTHCOM) to field a series of 6 workshops to develop an initial framework for establishing competencies for the disaster response and preparedness workforce. These workshops were 1-day intensive consultative meetings that convened representatives of the 20 health care professions participating in the Federal Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP). The findings and presentations of the workshops are available on the NCDMPH website (http://ncdmph.usuhs.edu/JointProgram/JP_Workshops.htm).

In addition to these workshops, FETIG has supported 3 conferences sponsored by the NCDMPH. In September 2009, NCDMPH supported the first federal stakeholder conference for 100 federal managers under the theme “A Nation Prepared: Education and Training Needs for Disaster Medicine and Public Health.” This conference aimed to identify available federal education and training programs, recognize gaps in these programs, and clarify where further competencies could be developed.

The NCDMPH then convened a pediatric disaster preparedness curriculum development conference in March 2011, in Bethesda, Maryland, fulfilling a central recommendation of the president's National Commission on Children and Disasters regarding training. This conference initiated early and important work in addressing the unmet education and training needs of medical responders who care for children during disasters. The products of this workshop will be used as first steps in the development of a role-specific, competency-based training program for pediatric disaster preparedness.

In September 2011, the NCDMPH hosted a natural disaster health workforce conference. The purpose of this meeting was to:

• • Describe selected aspects of the health professions workforce that would respond to a catastrophic domestic natural disaster;

• • Analyze programs from federal departments and agencies supporting the National Response Framework, Emergency Support Function No. 8: Public Health and Medical Services; and

• • Examine 3 key responder subgroups: emergency and critical care physicians, emergency and critical care nurses, and paramedics.

To date, both FETIG and NCDMPH have collaborated and established important partnerships with a preliminary and significant array of organizations and initiatives that are involved in disaster education and training including:

• • The National Disaster Life Support Education Consortium

• • Yale New Haven Health System's Center for Emergency Preparedness and Disaster Response (CEPDR)

• • The Association of Schools of Public Health (ASPH)

• • The National Association of County and City Health Officials (NACCHO).

• • The Association of State and Territorial Health Officials (ASTHO).

• • Bioterrorism Curriculum Development Program (BTCDP)

• • The Institute of Medicine (IOM) Forum on Medical and Public Health Preparedness for Catastrophic Events.

• • The National Commission on Children and Disasters (NCCD)

The Way Ahead

With support of its 5 signatory federal departments and its full membership, FETIG continues to advance public health and medical disaster education and training, building on its current progress, and, most importantly, seeking outreach, partnership, and contributions from all stakeholders.

Between FY2013 and FY2015, FETIG will:

• • Work in coordination with the NCDMPH to identify and integrate both federal and national disaster health core competencies, curricula, education and training standards;

• • Work in coordination with the NCDMPH to identify gaps between learning outcomes and both individual and team performance;

• • Work in coordination with the NCDMPH to develop an analytic framework to identify gaps among core competencies, curricula, and response requirements;

• • Work in coordination with the NCDMPH on official engagement with Disaster Medicine and Public Health Preparedness to encourage scholarly work in disaster medicine and public health, and support the NCDMPH's academic mission;

• • Identify evidence-based evaluation strategies to assess operational outcomes of competencies;

• • Communicate information about the NCDMPH and its efforts within federal, state, local, tribal, and territorial communities;

• • Support federally-sponsored disaster health task forces; and

• • Develop and implement a strategy to achieve coordination of education and training requirements of federal grant programs relating to public health and medical preparedness.

The long-term goals of FETIG, set between FY2016 and FY2018, are to:

• • Oversee the establishment of a disaster medicine and public health education and training research program;

• • Sustain and maintain FETIG and NCDMPH

• • Evaluate the effectiveness of outreach by FETIG and NCDMPH to all nonfederal partners; and

• • Oversee and review an external evaluation of NCDMPH.

Success of FETIG, NCDMPH, and the entire national community of interest is vital for the preparation of ever-changing locations threatened by disaster. Since the original PAHPA legislation and release of HSPD-21, these have included the 2009 H1N1 influenza pandemic; the earthquake in Haiti; the earthquake, tsunami, and nuclear power plant incident in Japan; and recent severe weather activities including tornadoes and wildfires in the US South, Midwest, and West. By working together, we can collectively develop core competencies and education and training standards for our entire public health and medical first-responder and receiver communities, which, in turn, will advance the safety and health of our nation in the decades to come.