What If ‘Contagion’ Really Happened?

Wednesday, January 25, 2012 - 8:00am
EVENT:        Simulated pandemic flu exercise provides health professions students with real experience tackling ethical and logistical problems that could be encountered during a disease outbreak in Arizona.
 
Participants include more than 360 students and nearly 30 faculty and staff from the UA Colleges of Medicine, Nursing and Pharmacy; UA Mel and Enid Zuckerman College of Public Health; UA James E. Rogers College of Law; and Arizona State University School of Social Work.
 
DATE/TIME:            WEDNESDAY, JAN. 25, 8-10:50A.M.
8:10 a.m. CDC Pandemic Influenza “mock” video, welcome and introduction
8:25-8:40 a.m. Keynote, “All-Hazards Emergency Preparedness, Mitigation and Response,” Richard Carmona, MD, MPH, FACS, 17th Surgeon General of the United States
8:45-9:35 a.m. Exercise 1: Limited Resources and Mass Care
9:35-10 a.m. Exercise 2: Health and Safety of Health-Care Workers
10-10:30 a.m. Hotwash: Panel of experts and health-care leaders
10:30-10:50 a.m. Student Q & A with health-care experts
 
LOCATIONS:           UA College of Medicine, Room 3230 (Emergency Operations Center, EOC)
                                    UA College of Medicine, MDL (Multi-Discipline Labs) Rooms:
                                                3113 (representing Douglas)
                                                3114 (representing Flagstaff)
                                                3115 (representing Ganado)
                                                3116 (representing Phoenix)
                                    UA College of Nursing, Room 117 (representing Tucson)
                                    Arizona Health Sciences Library, Room 4150 (representing Bisbee)
                                    1501 N. Campbell Ave., Tucson
                                   
Disease outbreaks are popular movie plots, but what if the real thing happened? How would limited supplies of respirators be distributed when there is an overwhelming need for them during a flu pandemic? What about the safety of health-care workers and their duty to treat patients when their own health is at risk?
 
These and other tough ethical and logistical problems that Arizona could face in a flu pandemic will be tackled during a simulated pandemic flu emergency – using real-time electronic communication – by more than 360 students and nearly 30 faculty and staff faculty from the University of Arizona Colleges of Medicine, Nursing and Pharmacy; UA Mel and Enid Zuckerman College of Public Health; UA James E. Rogers College of Law; and Arizona State University School of Social Work on Wednesday, Jan. 25, 8 to 10:50 a.m., at the University of Arizona Health Sciences Center (AHSC), 1501 N. Campbell Ave., Tucson.
 
The interprofessional exercise will help prepare future health professionals to understand the threats and consequences of a pandemic flu outbreak, and will underscore the importance of collaboration across professional lines. It is designed to teach and reinforce teamwork, quality, safety and effectiveness through joint learning integrated into the students’ respective curricula. The exercise consists of a set of scenarios to which students must respond and justify their actions.
 
 “There’s no ‘right’ answer to some of these questions; we want students to see the complexity of these issues and the role and perspectives of other professions,” says Hal Strich, MPH, associate director of the MD-MPH Dual Degree Program offered jointly by the UA College of Medicine and UA Mel and Enid Zuckerman College of Public Health, and one of the event organizers.
 
Decisions will depend on the inherent values, interests and perspectives of the different professions and individuals. The intent is not to identify a correct or best answer, but to make explicit the diversity of values and explore ways to accommodate disparate and often conflicting interests in an infectious disease emergency, Strich notes.
 
The exercise will begin at 8 a.m. with a pandemic flu mock newscast, followed by remarks – delivered via real-time streaming video to teams of students stationed in rooms throughout the AHSC campus – from 8:20 to 8:40 a.m. by Andreas Theodorou, MD, chief medical officer, The University of Arizona Medical Center-University Campus; UA professor of pediatrics; chief, pediatric critical care medicine and associate head, UA Department of Pediatrics; and Richard Carmona, MD, MPH, FACS, 17th Surgeon General of the United States; distinguished professor, UA Mel and Enid Zuckerman College of Public Health; and vice chairman, Canyon Ranch.
 
Dr. Theodorou will address the role of the emergency operations center (EOC), resource allocation and workforce needs in a public health emergency and the uses of new communication technologies. Dr. Carmona will discuss “All-Hazards Emergency Preparedness, Mitigation and Response,” the concept of disaster preparedness and the local, state and national infrastructure in place to respond to a public health emergency.
 
Small groups of approximately six students each will be assigned to work as interprofessional teams on problems in rooms representing six Arizona communities: Bisbee, Douglas, Flagstaff, Ganado, Phoenix and Tucson. The students will discuss various disaster scenarios relating to a worldwide influenza epidemic striking Arizona – for example, how to distribute limited supplies of respirators and health-care workers’ duty to treat when their own health is at risk.
 
Student teams also will be paired with experts who will staff a live emergency operations center (EOC) in UA College of Medicine Room 3230 (third floor teleconference room). The experts are UA, hospital, state and national health-care leaders with expertise in public health and infectious disease, including:
 
Ÿ Moderator/Chief Medical Officer: Andreas Theodorou, MD, chief medical officer, The University of Arizona Medical Center-University Campus
 
Ÿ Incident Commander: Richard Carmona, MD, MPH, FACS, 17th Surgeon General of the United States
 
Ÿ Public Health Official: Sherry Daniels, MS, MPH, RN, director, Pima County Health Department
 
Ÿ Consultant in Infectious Diseases: Vincent A. Fulginiti, MD, The University of Arizona Health Network; member, Governor’s Task Force on Emergency Preparedness; UA professor and department head emeritus (pediatrics); chancellor emeritus, University of Colorado Health Sciences Center; dean emeritus, Tulane University School of Medicine; professor emeritus, University of Colorado
 
Ÿ EOC Controller: Kathryn Knak, MBA, CHSP, CHEP, emergency preparedness officer, The University of Arizona Health Network
 
Ÿ Legal Counsel: Christopher Robertson, JD, PhD, associate professor, UA James E. Rogers College of Law; officer for emergency preparedness, The University of Arizona Health Network
 
Ÿ Director, Metropolitan Response System: Theodore Tong, PharmD, director, Pharmacy Task Force, Metropolitan Medical Response System; advisor, pharmacy preparedness for biological and chemical terrorism, The University of Arizona Health Network
 
Ÿ Pandemic Disease Emergency Planning: The Campus and Community: Harry McDermott, MD, MPH, director, campus health and emergency preparedness; executive director, campus health-wellness services, UA Campus Health Service
 
Real-time, two-way streaming video will be used to transmit verbal and visual communication between the EOC to the student teams.
 
The exercise will conclude with a “hotwash” debriefing session moderated by Dr. Carmona and featuring EOC officials addressing many of the issues that came up and responding to students’ questions.
 
Background
 
The University of Arizona’s pandemic flu IPE exercise has been conducted five times since 2008. It was developed in response to a 2003 Institute of Medicine report, “Health Professions Education: A Bridge to Quality,” that delineated core areas in which students should develop and maintain proficiency around the organizing principle that “all health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics.” Since the report, interprofessional education (IPE) has been implemented for health professions students in a number of academic programs across the nation.
 
The UA’s pandemic flu IPE exercise is designed to help students explore and understand the complex social, psychological, legal and public health issues they will face as health care professionals during an infectious disease pandemic. Student learning objectives are three-fold: to identify and explore social, psychological, ethical, legal and public health issues that arise during an infectious disease pandemic; to articulate the roles and functions of different health and human service professionals; and to explain how cooperation among federal, state and local jurisdictions and public-private agencies and organizations can improve effective disease control measures.
 
Among the issues addressed during the exercise are:
 
Mass care, limited resources and patient triage. Resources are limited and mechanical ventilators may not be available for everyone; a decision must be made as to priorities for who will receive mechanical breathing assistance. Students must decide how to make allocation decisions, prioritize and justify their decisions.
 
Health and safety of health-care workers. Students explore issues related to their duty as health-care workers to provide care when their own health and safety are at risk. Students must decide if they would care for patients at the risk of exposure to a potentially lethal pathogen.
 
Last year’s exercise was documented by AHSC BioCommunications for use in the largest-ever international conference on interprofessional health education, “Collaborating Across Borders III, An American-Canadian Dialogue on Interprofessional Health Education & Practice,” held Nov. 19-21 in Tucson and attended by more than 750 national and international government leaders, policy makers, health-care professionals, educators and students.
 
More information about the UA Interprofessional Education and Practice Program (IPEP) is on the website www.ipep.arizona.edu
 
A video with an overview and history of interprofessional education at the UA is available on the UA IPEP Facebook page, www.facebook.com/video/video.php?v=128679453913273