CDC urges physicians to become more involved in disaster preparedness planning

Federal health officials said being armed with a kit and a plan is important no matter the threat — whether it is infectious diseases or zombies.

When the CDC announced a “zombie preparedness plan” on its website in May, officials with the agency said they were looking for an innovative — and highly viral — way to inform the public about a subject some could consider uncomfortable: disaster preparedness.

The plan was released in the form of a blog written by Ali S. Khan, MD, MPH, who works with the CDC’s Office of Public Health and Preparedness and Response. In his blog, Khan wrote, “The rise of zombies in pop culture has given credence to the idea that a zombie apocalypse could happen. In such a scenario, zombies would take over entire countries, roaming city streets eating anything living that got in their way. The proliferation of this idea has led many people to wonder: ‘How do I prepare for a zombie apocalypse?’ Well, we’re here to answer that question for you, and hopefully share a few tips about preparing for real emergencies, too.”

Khan urged the public to maintain emergency kits with several days’ worth of food, water, tools and supplies such as duct tape and battery-powered radios, besides sanitation supplies such as towels, clothing, bedding, first aid supplies and medications.

Effect of the blog

Within hours of release, the “zombie blog” went viral (pun intended). Khan told Infectious Diseases in Children that the Public Health Matters blog usually receives about 3,000 visitors a month but crashed the morning after it was posted, after 30,000 readers rushed to see what all the commotion was about. Five days after launch, the blog post had received more than 2 million page views, and traffic spiked from fewer than 80 page views per hour to more than 30,000 views per hour after a social media push and heavy attention from news media. The blog also increased traffic to emergency preparedness pages by 3,147% during the same time period in the previous year when there was no campaign.

The data indicate that 50% of readers of the blog planned to implement some type of preparedness plan.

The blog is just part of an increasing effort by federal health officials to get the word out about disaster preparedness. Several of these efforts have focused on physicians, as well, because response to disasters has been a topic at several physician meetings this year, including the Pediatric Academic Societies, the American Academy of Allergy, Asthma and Immunology and the National Association of Pediatric Nurse Practitioners (NAPNAP).

Richard Ricciardi, PhD, NP, who worked with the military’s Incident Command System for 30 years as a triage first-responder, was the guest lecturer on disaster preparedness at the NAPNAP meeting last spring. He told Infectious Diseases in Children that disaster planning is on the mind of more people in the wake of numerous high-profile incidents in the past decade, including Hurricane Katrina, the earthquakes in Haiti and Japan, and the fact that North America is currently in the peak of hurricane and tornado seasons.

Multiple responsibilities during a disaster

Ricciardi, who is currently a health scientist with the Agency for Healthcare Research and Quality, said emphasizing disaster preparedness to health care providers in particular is key because they have three compelling and competing responsibilities during an emergency — themselves, their families and the community members whom they treat.

“Particularly for health care personnel who are involved in infectious diseases, they may be called in cases of bioterror or infectious disease outbreaks. So they need to have a support system in place for themselves, as well as a plan for what they would do if they were called in to help,” he said.

Health care providers should have a support system in place in case they must have family members or household responsibilities taken care of while they are helping the community during a disaster, Ricciardi said, adding that health care providers are encouraged to keep preparation kits similar to those mentioned in Khan’s blog that the CDC recommends.

“Physicians have many responsibilities, so it is important that they have a plan for the family and friends so they can then be prepared to take care of their patients,” Khan said.

Ricciardi said disaster response is multipronged. During the “immediate” phase of disaster response, emotions are high, anxieties are common, and depending upon the situation, health risks can abound. The key for health care providers at this stage is assessing immediate health dangers and assuring those affected that although they have been through a trauma, “they are now safe and not in any immediate danger,” he said.

Physicians who work in a community should try to respond to disasters because just the simple act of having a familiar face can be a calming experience for those who have been through a trauma, according to Ricciardi. This is particularly important for children because they react to disasters differently than adults, and pediatricians and nurse practitioners are in a key position to help this vulnerable population.

Health care responders responding to scenes of disasters are encouraged to:

• Calm and orient those who are emotionally overwhelmed or distraught.
• Gather information and address survivors’ immediate needs.
• Offer practical assistance and information to address immediate needs of those affected by disaster.
• Become knowledgeable on medical and support services that are available to those affected by disaster.

Thorough follow-up

The second phase of the response is follow-up. Ricciardi said most people, particularly children, who have been through a trauma may have intrusive recollections, persistent autonomic arousal, multiple somnatic symptoms, anger and/or apathy. Health care providers’ roles after the initial traumatic event is to assess children for behaviors that are outside of the normal or expected response and may warrant further attention.

Clinicians should remain vigilant for stress-related illnesses, such as cardiovascular problems, gastrointestinal distress, memory impairment, systemic infections, acute stress disorder and post-traumatic stress disorder.

“It is important to emphasize to parents that they should expect some erratic behavior following a disaster,” Ricciardi said. “What the health care provider must do is assess whether that erratic behavior warrants further therapeutic or mental help.”

During follow-up, he said, health care providers can play an integral role in helping patients affected by tragedy to set achievable goals, thus reversing feelings of failure and an inability to cope and restore hope and optimism.

“Most children, adolescents and adults exposed to trauma do recover without the need for behavioral therapies and do not develop psychological pathology,” Ricciardi said.

Advocating preparedness

Clinicians also play a key role before a disaster occurs, according to Ricciardi. He encouraged pediatricians and nurse practitioners to become advocates for children and get involved in community disaster planning so that children are represented in these plans.

Besides helping formulate a plan, Khan urged physicians to also familiarize themselves with skills they may need during a disaster.

“Targeted brochures that demonstrate how to be prepared are always a good idea,” he said, offering the example of pamphlets that outline preparation for hurricanes can be helpful for both physicians and patients who live along the Gulf Coast.

Ricciardi agreed and said performing triage, disease surveillance and stabilizing patients for transportation may be unfamiliar roles to some clinicians; so understanding these before a disaster occurs can be helpful.

CDC officials said they hope that readers of the blog will take steps to plan for real-life emergencies. CDC is planning to follow-up with the public to find out in coming months. There are talks of zombie-themed graphic novels on preparedness and even a video contest for readers to show what they learned about preparedness.

Khan said physicians should consider enrolling in The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) program, or their state equivalent, to establish and implement guidelines and standards for the registration, credentialing and deployment of medical professionals in the event of a large-scale national emergency. – by Colleen Zacharyczuk

To read the full blog, visit http://www.bt.cdc.gov/socialmedia/zombies_blog.asp.

Disclosure: Drs. Khan and Ricciardi report no relevant financial disclosures.

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