Pandemic influenza. Smallpox. Anthrax. Ebola. Radiation poisoning from a “dirty bomb.” These and other 21st century threats to public health and safety are potentially devastating and require innovative and extensive preemptive planning to counter such risks. Both the School of Medicine and the University of Pittsburgh Medical Center (UPMC) are actively engaged in extensive and often collaborative efforts to anticipate and prepare for how they as institutions—and how the people who comprise those institutions—would respond.
Even more fundamentally, the approach adopted here to teaching medical students about the public health threats—whether from biological attacks, disease epidemics, or natural disasters—that they might face someday as physicians is inclusive: “Almost anything is a potential threat, the thinking goes, so prepare for all possibilities,” says John F. Mahoney, MD, associate dean for medical education and associate professor of emergency medicine.
While this approach might seem inordinate, the logic is clear. Modern threats to society are so pervasive that preparing intensively to deal with any single one of them is unlikely to pay off. “Twenty hours of anthrax training won’t counter an ebola outbreak,” Mahoney notes. “Instead, the all-hazards approach to preparedness provides a basic understanding and awareness of specific threats but emphasizes fundamental principles that can be followed regardless of what the specific threat turns out to be.”
UPMC echoes this emphasis on all-hazards disaster planning. “UPMC’s innovative approach to preparedness must extend beyond expected types of emergencies. It must address potential threats about which there are limited scientific facts and multiple variables,” says Loren H. Roth, MD, MPH, the health system’s chief medical officer.
At the School of Medicine, various aspects of preparedness are woven throughout the curriculum rather than addressed in a single course. Topics like bioterrorism agents and pandemic influenza, for instance, are covered in the first-year medical microbiology course, while pharmacologic aspects of chemical weapons agents are integrated into second- and fourth-year pharmacology courses. Every eight weeks during the third-year medicine clerkship, a lecture on emerging infectious diseases is presented. Such initiatives are ongoing and subject to constant review to keep them current. Likewise, specific, hands-on training is being developed and implemented. All students are taught how to select and fit-test an appropriate breathing apparatus; still to come are lessons on personal protective equipment and decontamination. An annual exercise for third-year students simulates the drama of a pandemic influenza outbreak that inundates a hospital with infected patients. This role-playing drill is designed to teach students not only how to care for patients in a crisis as supplies run short, hospital workers themselves fall ill, and the mortality rate climbs, but also the importance of leadership, cooperation, and teamwork.
In the early planning stages is an initiative to prepare students to assist UPMC in the event of a major disaster, if needed, in providing patient care on a massive scale to the extent that their level of training would allow. First-year medical students, for example, could take vital signs and help move patients, whereas third-year students could variously assist a patient care team. Students would be trained each year to anticipate—regardless of what the crisis might be—what types of tasks they could be expected to perform, whereas UPMC personnel would be briefed regularly to know what each level of student is capable of doing and, therefore, what kind of help to expect from them.
The logistics of this initiative, which could encompass other health sciences students beyond the School of Medicine, are being developed in synchrony with UPMC’s comprehensive planning efforts, which entail the anticipation of quarantine, protection, and vaccination issues in the event of an outbreak of a contagious disease like smallpox or avian flu as well as the vast range of other considerations in preparing for natural or man-made disasters or other emergencies. “UPMC makes emergency preparedness a top priority,” Roth says.
Underlying all of these efforts on the parts of both UPMC and the School of Medicine is not only anticipation of the leadership that would be expected of them in the event of a cataclysmic event but also the realization that the best time to grapple with one is before it occurs.