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The U.S. approach to dental emergency preparedness and disaster response
C L I N I C A L P R A C T I C E BRIEF REPORT
The U.S. approach to dental emergency preparedness and disaster response American Dental Association Council on Dental Practice; American Dental Association Council on Government Affairs
ince the terrorist attacks of Sept. 11, 2001, and the Gulf Coast hurricanes of 2005, federal, state and local officials have given considerable attention to the public health and medical response to major disasters. These efforts have stemmed from concerns about the nation’s ability to care for large numbers of patients in the wake of a major disaster, when considerable casualties can severely challenge or exceed the normal limits of a community’s basic medical infrastructure. Dentistry, too, has focused efforts on answering these concerns. The American Dental Association (ADA), on its own and in conjunction with other organizations and professions, has worked to determine dentistry’s place in disaster response, joined a national coalition providing disaster-response training and made strides in legislating the profession’s role on a national level.
S
DENTISTRY’S ROLE IN DISASTER RESPONSE
Dentistry’s role in disaster response is relatively new and still evolving. After the events of Sept. 11, 2001, the ADA developed a consensus report outlining the various roles dentistry might play in response to public health emergencies.1 In 2007, the ADA’s House of Delegates passed a resolution to help guide the Association’s response to emergency preparedness and
injuries during the Sichuan earthquake and in the 14 days immediately afterward. Although most facial injuries are not lifethreatening, they often require intensive care. Facial fractures, especially bilateral or comminuted mandible fractures, can cause gross posterior displacement of bones and soft tissue, such as the tongue’s interfering with a patient’s 546
JADA, Vol. 140
http://jada.ada.org
disaster-response issues.2 The resolution was the result of a May 2007 mega-issue discussion by the ADA’s Council on Dental Practice. It called on the Association to dhelp dentists become more effective responders to natural disasters and other catastrophic events; dprovide leadership in national, state and community disaster planning and response by increasing efforts that put disaster preparedness into practice; dpromote multidisciplinary disaster courses and education that train dentists and dental staff members in the handling of declared emergencies; dadvocate for national emergencypreparedness solutions through research, public policy and legislation. With dentistry’s role defined and Association policy firmly established, the ADA has moved forward with a series of steps to promote dentistry’s role in responding to disasters and other public health emergencies. These steps have been built around the following priorities: dcredentialing systems affecting dentists, dental assistants, dental hygienists and other health professionals interested in supporting the medical and public health response to a major disaster; deducation and training to help dental volunteers establish and plan for their roles in caring for large numbers of patients during public
airway. Therefore, it is vital to monitor and maintain patients’ airways in such cases. In addition to simply repositioning the bone or soft tissue in an anterior position or performing endotracheal intubation, a clinician may need to perform a tracheostomy to maintain an adequate airway.8-11 A blow to the face resulting in fractures also may cause intracranial hematoma, which is a life-
May 2009
Copyright © 2009 American Dental Association. All rights reserved. Reprinted by permission.
C L I N I C A L P R A C T I C E BRIEF REPORT
health emergencies; dcivil liability protection and licensure accommodation for in-state dentists and those traveling across state lines for the good-faith treatment of casualties during public health emergencies. NATIONAL DISASTER LIFE SUPPORT EDUCATION CONSORTIUM
In addition to its internal activities in this area, the ADA serves as a voting member of the National Disaster Life Support Education Consortium (NDLSEC), a coalition of academic institutions, corporations, government partners, medical centers and professional organizations that provide disaster-response training courses. The consortium is jointly sponsored by the American Medical Association (AMA) and the National Disaster Life Support Foundation. NDLSEC supplies expertise and knowledge for the periodic critique and review of the National Disaster Life Support (NDLS) disaster training courses. The goal of these courses is to establish nationally recognized, standardized and multidisciplinary curricula to train health professionals to respond to disasters and other public health emergencies in an effective and coordinated manner by using an all-hazards approach. The ADA has made one of the NDLS courses, the electronic Core Disaster Life Support (eCDLS) course, available at no charge for dentists interested in learning the core concepts of disaster management. The nationally recognized eCDLS course consists of nine training modules that prepare dentists to be more effective in disaster recognition and response. The course is offered through a cooperative educational venture between the ADA and the AMA, and dentists who successfully complete a posttest receive four hours of continuing education
threatening injury. However, facial fractures often distract attention from such critical injuries. Therefore, early identification of an intracranial hematoma in a neurologically healthy patient with a facial injury is crucial and may lead to improved outcomes of treatment for patients with facial injuries.12 Disaster response. Medical disasterresponse models. To reduce earthquake-
credit. A link to the eCDLS online course is available at “www.ada.org/prof/prac/disaster”. ENSURING DENTISTRY’S PLACE IN FEDERAL DISASTER RESPONSE
The ADA also has been urging lawmakers to elevate dentistry’s role in the federal disaster response framework. In early 2009, Reps. Bart Stupak (D-Mich. 1st) and Candice Miller (RMich. 10th) introduced H.R. 903, the Dental Emergency Responder Act of 2009. The legislation would elevate dentistry’s role in federal disaster planning by definition and clarify that dental schools are eligible to apply for publichealth and medical-response training grants. It also would strengthen America’s medical surge capacity by taking advantage of the extensive education, training and professionalism of dentists. The act requires no new federal money, poses no new restrictions on monies now being spent and places no new mandates on dentists. The ADA is working hard to secure congressional cosponsors for H.R. 903. In March, the Association sent—with a coalition of 44 state dental societies and 13 national dental organizations that endorsed the legislation—a letter urging members of Congress to support the bill. Outside support is continuing to build, and it is hoped that a Senate version will be introduced sometime in 2009. Interested dentists can review background materials, letters of support and the current status of H.R. 903 at “www.ada.org/goto/ disasterresponse”. 1. Guay AH. Dentistry’s response to bioterrorism: a report of a consensus workshop. JADA 2002;133(9):1181-1187. “http://jada.ada. org/cgi/content/full/133/9/1181”. Accessed March 30, 2009. 2. Furlong A. ADA House defines dentistry’s role in disaster response. ADA News Nov. 20, 2007. “www.ada.org/prof/ resources/pubs/adanews/adanewsarticle.asp?articleid=2783”. Accessed March 30, 2009.
associated mortality and morbidity, various medical disaster-response systems have been designed.6 Unfortunately, local hospitals in China and many other countries, which usually are used in cases of mass casualties, often are vulnerable in a catastrophic earthquake, and outside medical assistance usually arrives rather late to meet needs for immediate care. Therefore, there is a need for stable and qualified local responders who JADA, Vol. 140
http://jada.ada.org
Copyright © 2009 American Dental Association. All rights reserved. Reprinted by permission.
May 2009
547
The U.S. approach to dental emergency preparedness and disaster response American Dental Association Council on Dental Practice; American Dental Association Council on Government Affairs
ince the terrorist attacks of Sept. 11, 2001, and the Gulf Coast hurricanes of 2005, federal, state and local officials have given considerable attention to the public health and medical response to major disasters. These efforts have stemmed from concerns about the nation’s ability to care for large numbers of patients in the wake of a major disaster, when considerable casualties can severely challenge or exceed the normal limits of a community’s basic medical infrastructure. Dentistry, too, has focused efforts on answering these concerns. The American Dental Association (ADA), on its own and in conjunction with other organizations and professions, has worked to determine dentistry’s place in disaster response, joined a national coalition providing disaster-response training and made strides in legislating the profession’s role on a national level.
S
DENTISTRY’S ROLE IN DISASTER RESPONSE
Dentistry’s role in disaster response is relatively new and still evolving. After the events of Sept. 11, 2001, the ADA developed a consensus report outlining the various roles dentistry might play in response to public health emergencies.1 In 2007, the ADA’s House of Delegates passed a resolution to help guide the Association’s response to emergency preparedness and
injuries during the Sichuan earthquake and in the 14 days immediately afterward. Although most facial injuries are not lifethreatening, they often require intensive care. Facial fractures, especially bilateral or comminuted mandible fractures, can cause gross posterior displacement of bones and soft tissue, such as the tongue’s interfering with a patient’s 546
JADA, Vol. 140
http://jada.ada.org
disaster-response issues.2 The resolution was the result of a May 2007 mega-issue discussion by the ADA’s Council on Dental Practice. It called on the Association to dhelp dentists become more effective responders to natural disasters and other catastrophic events; dprovide leadership in national, state and community disaster planning and response by increasing efforts that put disaster preparedness into practice; dpromote multidisciplinary disaster courses and education that train dentists and dental staff members in the handling of declared emergencies; dadvocate for national emergencypreparedness solutions through research, public policy and legislation. With dentistry’s role defined and Association policy firmly established, the ADA has moved forward with a series of steps to promote dentistry’s role in responding to disasters and other public health emergencies. These steps have been built around the following priorities: dcredentialing systems affecting dentists, dental assistants, dental hygienists and other health professionals interested in supporting the medical and public health response to a major disaster; deducation and training to help dental volunteers establish and plan for their roles in caring for large numbers of patients during public
airway. Therefore, it is vital to monitor and maintain patients’ airways in such cases. In addition to simply repositioning the bone or soft tissue in an anterior position or performing endotracheal intubation, a clinician may need to perform a tracheostomy to maintain an adequate airway.8-11 A blow to the face resulting in fractures also may cause intracranial hematoma, which is a life-
May 2009
Copyright © 2009 American Dental Association. All rights reserved. Reprinted by permission.
C L I N I C A L P R A C T I C E BRIEF REPORT
health emergencies; dcivil liability protection and licensure accommodation for in-state dentists and those traveling across state lines for the good-faith treatment of casualties during public health emergencies. NATIONAL DISASTER LIFE SUPPORT EDUCATION CONSORTIUM
In addition to its internal activities in this area, the ADA serves as a voting member of the National Disaster Life Support Education Consortium (NDLSEC), a coalition of academic institutions, corporations, government partners, medical centers and professional organizations that provide disaster-response training courses. The consortium is jointly sponsored by the American Medical Association (AMA) and the National Disaster Life Support Foundation. NDLSEC supplies expertise and knowledge for the periodic critique and review of the National Disaster Life Support (NDLS) disaster training courses. The goal of these courses is to establish nationally recognized, standardized and multidisciplinary curricula to train health professionals to respond to disasters and other public health emergencies in an effective and coordinated manner by using an all-hazards approach. The ADA has made one of the NDLS courses, the electronic Core Disaster Life Support (eCDLS) course, available at no charge for dentists interested in learning the core concepts of disaster management. The nationally recognized eCDLS course consists of nine training modules that prepare dentists to be more effective in disaster recognition and response. The course is offered through a cooperative educational venture between the ADA and the AMA, and dentists who successfully complete a posttest receive four hours of continuing education
threatening injury. However, facial fractures often distract attention from such critical injuries. Therefore, early identification of an intracranial hematoma in a neurologically healthy patient with a facial injury is crucial and may lead to improved outcomes of treatment for patients with facial injuries.12 Disaster response. Medical disasterresponse models. To reduce earthquake-
credit. A link to the eCDLS online course is available at “www.ada.org/prof/prac/disaster”. ENSURING DENTISTRY’S PLACE IN FEDERAL DISASTER RESPONSE
The ADA also has been urging lawmakers to elevate dentistry’s role in the federal disaster response framework. In early 2009, Reps. Bart Stupak (D-Mich. 1st) and Candice Miller (RMich. 10th) introduced H.R. 903, the Dental Emergency Responder Act of 2009. The legislation would elevate dentistry’s role in federal disaster planning by definition and clarify that dental schools are eligible to apply for publichealth and medical-response training grants. It also would strengthen America’s medical surge capacity by taking advantage of the extensive education, training and professionalism of dentists. The act requires no new federal money, poses no new restrictions on monies now being spent and places no new mandates on dentists. The ADA is working hard to secure congressional cosponsors for H.R. 903. In March, the Association sent—with a coalition of 44 state dental societies and 13 national dental organizations that endorsed the legislation—a letter urging members of Congress to support the bill. Outside support is continuing to build, and it is hoped that a Senate version will be introduced sometime in 2009. Interested dentists can review background materials, letters of support and the current status of H.R. 903 at “www.ada.org/goto/ disasterresponse”. 1. Guay AH. Dentistry’s response to bioterrorism: a report of a consensus workshop. JADA 2002;133(9):1181-1187. “http://jada.ada. org/cgi/content/full/133/9/1181”. Accessed March 30, 2009. 2. Furlong A. ADA House defines dentistry’s role in disaster response. ADA News Nov. 20, 2007. “www.ada.org/prof/ resources/pubs/adanews/adanewsarticle.asp?articleid=2783”. Accessed March 30, 2009.
associated mortality and morbidity, various medical disaster-response systems have been designed.6 Unfortunately, local hospitals in China and many other countries, which usually are used in cases of mass casualties, often are vulnerable in a catastrophic earthquake, and outside medical assistance usually arrives rather late to meet needs for immediate care. Therefore, there is a need for stable and qualified local responders who JADA, Vol. 140
http://jada.ada.org
Copyright © 2009 American Dental Association. All rights reserved. Reprinted by permission.
May 2009
547