The role of physician in healthcare are many; this include diagnosing and working collaboratively with other members of the healthcare team to provide ultimate care for their patients. Physician also perform educational role to their patients and significant other, and other members of the healthcare team. Physician conduct medical researches, and sometimes participate in transferring the research findings from the bench to the bedside. Physician also perform advocacy for their patients.
The threat of bioterrorism in today’s world is real and enormous. The events of 9/11 showed that the United States is not protected from the turbulent world of terrorism by the surrounding oceans. It’s estimated that over 60 nations and terrorist organizations have stockpiles of different biological weapons (Dudley et al, 2005). Al Qaeda and relatively new Islamic state of Iraq and Levant (ISIL) have publicly displayed interest in acquiring and using biological weapons against the United States and other western interests.
Biodefense are measures taken by an individual or state to prevent bioterrorism, or to ensure early detection of the threat of biological weapon attack, and to ensure prompt response and management when there is an attack from biological weapon. Physicians play a pivotal role in this regard. Physicians, Nurses, and Public health specialists are usually the first responders to an epidemic emanating from bioterrorism (O’Toole, 2000). Main purpose of biodefense is to establish biosecurity to the population.
This protection against bioterrorism agents are extended to water and food supply chain in broader term, but the focus for this paper will on the population biodefense and physician role. Preparedness against bioterrorism in the United States has been bolstered following 9/11 terrorist attack. One of the effort undertaken to improve preparedness was to significantly increase the strategic national stockpile (SNS) of antibiotic, vaccine and other essentials medical supplies against commonly weaponized biological agents (Dudley et al, 2005).
CDC’s plan for biodefense preparedness mainly focuses on; enhancing the capacity for prompt detection, diagnosis, and management of disease outbreak, improving identification of the causative agents, and strengthening the information infrastructures for effective communication during emergencies. The role of physician in biodefense can therefore be discussed under the following theme; evidence-based risk assessment, leadership and decision making, organization structure and training, communication and management, application of public health principle to biodefense, and critical evaluation using relevant public health theories and frameworks.
Evidence-Based Risk Assessment. An enduring biodefense requires a robust public health system that is responsive to the health needs of the populace. Evidence-based risk assessment of public health infrastructure is an effort to ascertain the capacity and strength of existing public health infrastructure to cope with a potential bioterrorist attack in the United States. Public health work force in the United States is about 500,000 in strength and most of them don’t have formal training in public health emergency response.
These workforce need to be well trained in response to bioterrorism emergency. Hospitals are far from being prepared to handle potential mass casualties that can result from bioterrorism (Knobler et al, 2002). A mathematical method of bioterrorist attack risk assessment (BTRA) has been proposed and tested on the United States Anthrax attack of 2001. BTRA consist of three steps. The first step involve vulnerability analysis, the second step involve feasibility analysis of bioterrorist attack components; perpetrator, agent and medium of delivery, and the third step involve general risk assessment nalysis of all the earlier highlighted bioterrorist attack components, including the target (Vladen et al, 2012).
All these constitute 32 parameters altogether; with 22 qualitative parameters and 10 quantitative parameters. These parameters does not constitute a threat of bioterrorism by itself, but are collectively interpreted to determine if additional investigation is needed. Each parameters are scored between 0 and 1; with 1 signifying high probability of bioterrorism. Components of protection parameters involve physical, chemical and immunological protections.
Physical protection encompasses staying away from the sources of attack, the chemical protection involve the use of antibiotics, and immunological protection include mass immunization (Vladen et al, 2012). Chemical and immunological protection present a serious logistic challenge; especially during pandemonium following bioterrorism. Physician as a member of public health response team can help in overcoming this logistic challenges by providing real time evidence-based assessment of the risk-benefit of the use antibiotics and employing immunization in large scale as a response to bioterrorism.
Physician can also play a role in using evidence-base assessment of hospital needs to be able to effectively respond to potential mass casualties from bioterrorism. As a leader in the health sector, physician can use their wealth of knowledge to help improve and strengthen the capacity of hospitals in the United States to effectively respond to bioterrorism. Leadership and Decision Making. Leadership is the act of being a leader. A leader is an individual that guide or direct a group, organization or a state. Decision making is the process of making an important decision(s).
Good leadership and decision making capability are vital for an effective public health response to bioterrorism. Physicians, being an important stakeholder in the public health; are equally expected to possess the traits of good leadership and decision maker. Personal qualities of a successful leaders include practicing accountability, taking calculated risks, and value orientation that is consistent in all decision making. Physician leadership has been missing at the local level in the government bioterrorism preparedness plan. This scenario will hampered effective management of disease outbreak following bioterrorism (Kahn, 2003).
This isn’t a surprising revelation that probably still remain valid up till today. Most county’s health departments don’t have adequate physicians on their staff. Situations in country side counties are worse. Random survey conducted among emergency physicians and primary care physicians in the fall of 2003 showed that most physicians in public service believed they were not well prepare for bioterrorist attack (Alexander, 2006). Physicians require adequate but robust training and continuous preparation in order to be able to fill the expected leadership role in both federal and local biodefense plan.
Physicians needs up to date essential public health information to be able to make the right decision as a public health teacher during a bioterrorism attack. It’s also important to put a mechanism in place that will continue to define, measure, and expand bioterrorism response preparedness, and continue to expand public health infrastructure (Alexander, 2006). This will create a continuous check and balance system that can continue to bring the best out of the biodefense system.
Organization Structure and Training Organization structure in this context highlight how task of biodefense are allocated among various groups, coordinated and supervised by the leadership towards achieving organizational goals of biodefense. Training is the process of teaching public health personnel including physicians on how to prevent, respond and manage bioterrorism, and its aftermath. Biodefense is a multi-disciplinary, multi-sectoral, and multispecialist effort that requires an integrated health system which permit harmonious working relationship between these various groups that constitute the core of biodefense.
An important principle of integrated health system is its comprehensiveness in planning for, providing and coordinating all core health response required for biodefense along the continuum of response to the health emergencies resulting from bioterrorism. The extent of integration is determined to a larger extent by the assimilation of the various groups, in to the larger system of biodefense (Suter et al, 2009). Leadership with an organizational culture and vision is required to operate and implement an integrated health response system of biodefense (Suter et al, 2009).
Physicians with their background in health care deliv including knowledge of drugs and immunization, fits perfectly well in to this role. Multiprovider health care system within the biodefense are usually the first to respond to either a confirmed or suspected case of bioterrorism, and it’s their responsibility to report this. It’s this initial report that will alert and activate the emergency response system within the biodefense (Blair et al, 2004).
Adequate ‘surge capacity’ of the hospitals within the system, and availability of specialize medical manpower within the system is very essential to a successful response to medical emergencies emanating from bioterrorism. Hospitals must be supported to be able to afford appropriate training for its personnel, and to acquire necessary equipment by the government. Health care system success in responding to bioterrorism depends on an effective leadership, strong organizational structure, appropriate staffing, and adequate training (Blair et al, 2004). Physicians can provide this strong leadership.
Continuous training public health personnel is vital to maintaining robust preparedness as a component of biodefense, and physician can serve as a valuable resources for this activity; while they equally continue to update their knowledge of bioterrorism and biodefense. Communication and Management. Communication entails the exchange of information between the various groups within the biodefense system. Management is essentially the organization and coordination of this information exchange with other responses towards achieving the defined goal of biodefense.
Quality information system is needed for utmost communication capacity (Suter et al, 2009). The United States health system has made a giant stride in this direction over the years. There is also a specific provision within the Affordable care act to encourage hospitals across the United States to wholly adopt this integrated electronic health information system. Physicians as a provider in the health care system can, and should play a complementary role; this they can do both as a leader and a provider. There is also the need to incorporate crisis risk communication training in to the emergency public health preparedness of the biodefense.
This involve training public health workers in the art of environmental risk communication, health promotion, and effective prompt dissemination of information to the media (Glik, 2007). This is very important to the success of any biodefense operation because majority of the public get their information from the media. An open, transparent, and up to date communication with the media by the biodefense team will eliminate any potential rumors and speculations that can hamper success as was with some previous public health emergency interventions.
