Open Access Open Access  Restricted Access Subscription or Fee Access

The Transitional Medical Model: An innovative methodology for a community’s disease outbreak and pandemic preparedness and response plan

Paul Rega, MD, FACEP, Christopher Bork, PT, PhD, EMT-B, FASAHP, Michael Bisesi, PhD, CIH, Jeffrey Gold, MD, Kelly Burkholder-Allen, RN, MSEd

Abstract


Infectious disease outbreaks, epidemics, and subsequent pandemics are not typical disasters in the sense that they often lack clearly delineated phases. As in any event that is biological in nature, its onset may be gradual with signs and symptoms that are so subtle that they go unrecognized, thus missing opportunities to invoke an early response and implement containment strategies. An infectious disease outbreak—whether caused by a novel virus, a particularly virulent influenza strain, or newly emerging or resistant bacteria with the capability of human-to-human transmission—can quickly degrade a community’s healthcare infrastructure in advance of coordinated mitigation, preparation, and response activities. The Transitional Medical Model (TMM) was developed to aid communities with these crucial phases of disaster response as well as to assist with the initial steps within the recovery phase. The TMM is a methodology that provides a crosswalk between the routine operations and activities of a community’s public health infrastructure with action steps associated with the mitigation, preparedness, response, and recovery phases of an infectious disease outbreak.

Keywords


infectious disease outbreak, disease outbreak, epidemic, pandemic, influenza, novel virus, emerging disease

Full Text:

PDF

References


CDC Pandemic Operation Plan: Available at http://www.cdc.gov/flu/pandemic/OPLAN/BaseOPLAN.pdf. Accessed December 13, 2008.

Department of Homeland Security: National Incident Management System.Washington, DC: Department of Homeland Security, 2008.

Coppola DP: Introduction to International Disaster Management. Burlington, MA: Butterworth-Heinemann, 2006.

Markel H, Lipman HB, Navarro JA, et al.: Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic. JAMA. 2007; 298(6): 644-654.

Hatchett R, Mecher CE, Lisitch M: Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proc Natl Acad Sci USA. 2007: 104(18): 7582-7587.

US House of Representatives, Committee on Homeland Security, Rep. Bennie B. Thompson, Chairman: Getting beyond getting ready for pandemic influenza, 2009.

ACEP: National Strategic Plan for Emergency Department Management of Outbreaks of Novel H1N1 Influenza. Available at http://www.acep.org/WorkArea/DownloadAsset.aspx?id=45781. Accessed October 6, 2009.

Veenema TG, Toke J: When standards of care change in mass casualty events. Am J Nurs. 2007; 107(9): 72A-78A.

Vawter DE, Garrett JE, Gervais KB, et al.: For the good of us all: Ethically rationing health resources in Minnesota in a severe influenza pandemic. Minnesota Pandemic Ethics Project Preliminary Report, 2009.

Cinti SK,Wilerson W, Holmes HG, et al.: Pandemic influenza and acute care centers: Taking care of sick patients in a nonhospital setting. Biosecur Bioterror. 2008; 6(4): 334-347.

HRSA Bioterrorism and Hospital Preparedness: Community outreach mass prophylaxis: A mass casualty strategy for biological terrorism incidents. Available at http://www.hrsa.gov/bioterrorism/ resources/COMP_PurpleBookhtm. Accessed September 2, 2005.

Taberry J, Mackett CW: The University of Pittsburgh Medical Center Pandemic Influenza Task Force’s Triage Review Board: Ethics of triage in the event of an influenza pandemic. Disaster Med Public Health Prep. 2008; 2: 114-118.

Powell T, Christ KC, Birkhead GS: Allocation of ventilators in a public health disaster. Disaster Med Public Health Prep. 2008; 2: 20-26.

Kass NE, Otto J, O’Brien D, et al.: Ethics and severe pandemic influenza: Maintaining essential functions through a fair and considered response. Biosecur Bioterror. 2008; 6(3): 227-236.

Bartlett JG, Borio L: The current status of planning for pandemic influenza and implications for health care planning in the United States. Clin Infect Dis. 2008; 46: 919-925.

White DB, Katz MH, Luce JM, et al.: Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions. Ann Intern Med. 2009; 150: 132-138.

Ceriani R, Mazzoni M, Bortone F, et al.: Application of the sequential organ failure assessment score to cardiac surgical patients. Chest. 2003; 123: 1229-1239.

Arts DG, de Keizer NF, Vroom MB, et al.: Reliability and accuracy of sequential organ failure assessment (SOFA). Crit Care Med. 2005; 33(9): 1988-1993.

Maim H, May T, Francis LP, et al.: Ethics, pandemics, and the duty to treat. Am J Bioeth. 2008; 8(8): 4-19.

Devereaux A, Christian MD, Dichter JR, et al.: Summary of suggestions from the Task Force for Mass Critical Care Summitt, January 26-27, 2007. Chest. 2008; 133: 1S-7S.

Rubinson L, Hick L, Hanfling DG, et al.: Definitive care for the critically ill during a disaster: A framework for optimizing critical care surge capacity. Chest. 2008; 133: 18S-31S.

Christian MD, Devereaux AV, Dichter JR, et al.: Definitive care for the critically ill during a disaster: Current capabilities and limitations. Chest. 2008; 133: 8S-17S.

Devereaux AV, Dichter JR, Christian MD, et al.: Definitive care for the critically ill during a disaster: A framework for allocation of scarce resources in mass critical care. Chest. 2008; 133: 51S-66S.

Kinlaw K, Levine R, the Ethics Subcommittee of the Advisory Committee to the Director, Centers for Disease Control and Prevention: Ethical Guidelines in Pandemic Influenza. Available at http://www.cdc.gov/od/science/phethics/panFlu_Ethic_Guidelines.pdf. Accessed May 18, 2009.

Rubinson L, Hick JL, Curtis JL, et al.: Definitive care for the critically ill during a disaster: Medical resources for surge capacity. Chest. 2008; 133: 32S-50S.

Christian MD, Hawryluck L,Wax RS, et al.: Development of a triage protocol for critical care during an influenza pandemic. CMAJ. 2006; 175(11): 1377-1381.

Gebbie KM, Peterson CA, Subbarao I, et al.: Adapting standards of care under extreme circumstances. Disaster Med Public Health Prep. 2009; 3(2): S111-S116.

Botsick NA, Subbarao I, Burkle FM, et al.: Disaster triage systems for large-scale catastrophic events. Disaster Med Public Health Prep. 2008; 2 (Suppl 1): S35-S39.

Melnychuk RM, Kenny NP: Pandemic triage: The ethical challenge. CMAJ. 2006; 175(11): 1393-1394.

University of Toronto Centre for Bioethics Pandemic Influenza Working Group. Stand on Guard for Thee: Ethical considerations in preparedness planning for pandemic influenza. University of Toronto Centre for Bioethics, November, 2005.Available at http://www. jointcentreforbioethics.ca/people/documents/upshur_stand_guard.pdf. Accessed October 5, 2009.

Coleman CHH, Reis A: Potential penalties for health care professionals who refuse to work during a pandemic. JAMA. 2008; 299(12): 1471-1473.

Iserson KV, Heine CE, Larkin GL, et al.: Fight or flight: The ethics of emergency physician disaster response. Ann Emerg Med. 2008; 51(4): 345-353.

Hoffman S, Goodman RA, Stier DD: Law, liability, and public health emergencies. Disaster Med Public Health Prep. 2008; 3(1): 1-9.

Wineman NV, Braun BI, Barbera JA, et al.: Assessing the integration of health center and community emergency preparedness and response planning. Disaster Med Public Health Prep. 2007; 1: 96-105.

Morton ME, Kirsch TD, Rothman RE, et al.: Pandemic influenza and major disease outbreak preparedness in US emergency departments: A survey of medical directors and department chairs. Am J Disaster Med. 2009; 4(4): 199-206.

Ciottone GR: Introduction to disaster medicine. In Ciottone G, Anderson P, Auf Der Heide E, et al. (eds.): Disaster Medicine, 3rd edition. Philadelphia: Elsevier, Mosby, 2006: 3-6.

Lurie N, Dausey DJ, Knighton T, et al.: Community planning for pandemic influenza: Lessons from the VA health care system. Disaster Med Public Health Prep. 2008; 2(4): 251-257.

Dorian A, Rottman S, Shoaf K, et al.: Special Report: The Novel Influenza a H1N1 Epidemic of Spring 2009. PDM 2009.Available at http://pdm.medicine.wisc.edu. Accessed January 2, 2010.

Lerner E, Cronin B, Schwartz M, et al.: Linking public health and the emergency care community: Seven model communities. Disaster Med Public Health Prep. 2007; 1: 142-145.




DOI: https://doi.org/10.5055/ajdm.2010.0010

Refbacks

  • There are currently no refbacks.