President's Page
By Frank Randolph, M.D.

Disaster Preparedness

The SBCMS would like to take steps to examine our local response and assist in developing a crisis plan that would support the Public Health Department and the law enforcement response in the event of a catastrophe. The plan would identify treatment facilities outside the hospitals that would be prepared to handle emergency room overflow. It would also address the need for additional staffing and medical equipment.

The readiness of our local health care system to deal with the increased number of respiratory illnesses in late fall and winter each year has been a topic of discussion at SBCMS board meetings for several years. During the past year, the more recent threat of bioterrorism sparked further discussion leading to a board decision to examine our local response to disasters and/or bioterrorism. Public Health Officer Dr. Thomas Prendergast has assisted us in initial planning.

We sought information from various sources (other medical societies, CMA, CDC). We have posted such information on our web site at www.sbcms.org for physicians and the public as well as links to other related websites. We sponsored conferences, developed educational materials, began attending the local Terrorism Early Warning Group meetings (local law enforcement, public health), and initiated an ad hoc committee (participants included leadership from Public Health, Inland County Emergency Medical Agency, Southern California Hospital Association) to study local preparedness.

At a recent SBCMS Disaster Preparedness Ad Hoc Committee meeting, Dr. Prendergast and Dr. Eric Frykman, Division Chief, Preventive Medical Services (both members of the SBCMS board) informed us of their progress in preparing a proposal for local system improvements (proposal due to the state in mid-September 2002) for federal government bioterrorism funding. Part of the plan includes the designation of a local advisory committee to assist in strategic direction, coordination and assessment, upon which our medical society has been invited to serve. In December 2001, Governor Davis announced a plan to release statewide $5 million in one time funds to County Health Departments to detect, fight, and respond to biological and/or chemical events targeting the residents of California. Our County has been preparing for participation in a multi-county pilot of the Rapid Health Electronic Alert, Communications, and Training System (RHEACTS) which is a secure, integrated web-based communications alert system developed by the state Department of Health Services under grant from the CDC. A regular electronic communication system exists between Public Health Emergency Medical Services and emergency departments in over half of the hospitals in San Bernardino County. This system (ReddiNet) has been in place for over a year. Among other things, ReddiNet is designed to provide early notification to Public Health of observed increases in respiratory illnesses, gastrointestinal disease and other disease clusters. These increases may indicate predictable seasonal variations in illness, possible outbreaks of diseases normally tracked by Public Health, or increases in illnesses caused by intentional release of an organism as a form of terrorism. Dr. Prendergast reported that the RHEACTS system has been worked on for nearly four years. It has not been completed and does not do what it is suppose to do. State funding for the RHEACTS alert system is currently on hold.

Help from CMA-the Community Health Alert Information Network (CHAIN)

On May 22, 2002, Sam Roth, CMA VP, presented a live (on-line) demonstration on the Community Health Alert Information Network (CHAIN) to the Disaster Response Ad Hoc Committee. This collaboration between the SBCMS, CMA and Invizeon could provide physicians with a Desktop "portal" to the Internet. No software or additional hardware or servers are required - the application is web-based, contained within the Desktop application. It permits the CDC, the California Department of Health Services and individual county local health officers to post urgent health alerts, warnings and advisories as well as other public health information that might be necessitated by a bioterrorist or emergency situation. Authenticated, secure communications are possible. It can be enhanced to facilitate continuing medical education and a variety of distance learning options. The technology can permit surveillance, specimen and laboratory results, security of possible cases with manual entry by authorized users, and directories of users can be maintained and modified. The Desktop (and CHAIN) can be used by hospitals, emergency departments and other first-responders. Urgent public health information posted electronically can be assessed by all relevant health care sectors. CDC, DHS and local health officers alone control the postings, alerts, advisories and other information. The network would allow physicians to organize information and communicate with all health care sectors, taking advantage of the long-standing relationship between local county health care leadership and county medical societies. This partnership with medicine -- to wire together all physicians and in turn, the first responders the counties are tasked with connecting to is a chance for the public health community to appropriately utilize the bioterrorism preparedness and response mandate to completely rebuild and reconnect to the private healthcare community. The CHAIN platform will link to other platforms such as the RHEACTS and ReddiNet. Following discussion, the general consensus of the committee was to support further investigation of the CHAIN project.

Our Public Health Department's proposal for local system improvements for federal government bioterrorism funding will be pre-reviewed at the SBCMS August Executive Committee meeting with subsequent board discussion to determine how our medical society can support our local response. What can we do? Our participation may be crucial in providing insight to local health system capacity, not just to combat bioterrorism, but to prepared for nature's own surprises (remember the influenza virus?). As well, our willingness to volunteer our time to prepare or to serve in the event of a catastrophe is a vital part of our public system response. It is also a clear message to the public of our commitment to our patients and to our community.