"One of the enduring characteristics that people have is the ability not only to survive catastrophe but to prevail. In times like these, our best human qualities emerge and amidst confusion and uncertainty we apply our skills and goodwill[horizontal ellipsis]" - -Gregory L. Eastwood, MD, to the people of Upstate Medical University, September 12, 2001
THE 140 ACADEMIC health centers in the United States, collectively and severally, are uniquely positioned to play key leadership and contributory roles in homeland defense and the war on terrorism.
What Are Academic Health Centers and What Do They Do?
Academic health centers are defined by the partnership between a college of medicine (allopathic or osteopathic) and a major teaching hospital. In addition, usually one or more other health professional colleges, such as nursing, allied health, pharmacy, public health, and dentistry, are included in an academic health center.
The essential, interdependent missions of academic health centers are education, research, and health care. The education of nearly all the physicians in the United States and the large majority of other health professionals-nurses, dentists, pharmacists, medical technicians, physical therapists, public health professionals, etc.-occurs within the various colleges of academic health centers. Also, most of the biomedical research that is generated in this country takes place in academic health centers. Many of the biomedical scientists who conduct that research receive their training in those institutions.
Academic health centers provide a vast array of vital clinical services to the communities in which they are located. These services range from routine, accepted practices to leading edge treatments and technologies. Typically, academic health centers are the referral centers for their locale or region and the place where complex, extraordinary medical problems are addressed. The emergency and trauma rooms at these centers usually are busy. When there is a catastrophic event, such as a natural disaster or an incident in which many people are injured, the academic health center becomes the hub of the emergency response. Consequently, academic health centers are leaders in education of health professionals and in generating the science that fuels new approaches to health care.
Although academic health centers are uniquely qualified and situated to contribute substantially to emergency preparedness and the war on terrorism, they do it in collaboration with many partners. These partners include public health agencies, other hospitals, local medical societies, elected officials, and emergency responders (e.g., emergency medical technicians, police, and fire fighters).
The partnership of the academic health center with the local or regional public health departments is important. Public health departments are charged with preparing the community for disasters and acts of terrorism, including identifying surge capacity, training first responders, and implementing national directives, such as the smallpox vaccination program. Beyond the community, partners include other academic health centers, schools of public health, state departments of health, state police, and federal agencies and elected officials.
Involvement of the Association of Academic Health Centers
The Association of Academic Health Centers (AHC) is a national organization composed of the chief executive officers (chancellor, president, vice president for health affairs, and similar titles) from over 100 academic health centers. The mission of the AHC is "to improve the health of the people by advancing the leadership of academic health centers in health professions education, biomedical and health services research, and health care delivery." Thus, the mission of the AHC is aligned closely with the missions of education, research, and health services that are expressed at all the individual academic health centers.
Within days after September 11, 2001, the leadership of AHC recognized that this country and the world had entered a new era. We understood the relevance and importance of academic health centers to the war on terrorism and homeland defense. We perceived that academic health centers everywhere would be involved in some manner and that the involvement would be both explicit and implied.
Some actions were obvious, such as dealing with casualties and immediate effects, lending personnel and other resources, and working with local and regional partners to develop plans for emergency preparedness. Other actions were implicit: developing educational programs for our students, faculty, staff, practitioners, area first responders, and citizens of the community and focusing our research on the detection, prevention, and treatment of the anticipated instruments of terrorism, including biological and chemical agents, nuclear devices, and conventional methods, as well as studying the psychological aspects of terrorism.
But the involvement of academic health centers does not end there. Our institutions are the home of experts in biomedical science, social science, and psychology who are called on by governmental and other agencies for advice. Also, academic health centers must maintain the security and safety of their employees, students, patients, and visitors. Some, even, have had to deal with xenophobic words and actions.
In November 2001, AHC assembled a group of officers, members, and experts in biodefense to advise the association in defining its role in the war on terrorism and this matter became a permanent item on the agenda of the Board of Directors. Consequently, the 2002 AHC spring meeting was focused on the role of academic health centers in emergency preparedness, resulting in the publication, Emergency Preparedness: Bioterrorism and Beyond.1
In November, 2002, the first meeting of the AHC Biodefense Council was convened. The Council is composed of current and former leaders of academic health centers, some who have served as Surgeon General of their branch of the armed services before assuming their present positions. All have experience in dealing with the issues related to the war on terrorism.
Under the advice and guidance of the Biodefense Council, the AHC has developed several initiatives. A survey of academic health centers reveals, not surprisingly, that nearly all are intensely involved in emergency preparedness in some manner. Most already are working with local and state officials on related matters, have incorporated emergency preparedness and biodefense into their educational curricula and offer educational offerings to practicing health professionals, and have augmented or developed relevant research programs. Many have formed centers or institutes of emergency preparedness. The AHC plans to identify best practices in education, research, and clinical services in emergency preparedness. Also, the AHC seeks to develop effective communications among academic health centers on these matters and disseminate information through conferences and publications.
Involvement of SUNY Upstate Medical University
Upstate Medical University (Upstate) is a component of the State University of New York (SUNY), a system of over 60 higher education institutions distributed throughout the state. It is located in Syracuse, a midsize city, near the geographic center of New York State. Upstate comprises a university hospital, four professional colleges (medicine, nursing, health professions, and graduate studies), and a clinical campus 75 miles south in Binghamton, NY.
Upstate serves a vast, largely rural area that stretches north to the St. Lawrence River, south to the Pennsylvania border, and east and west to indistinct boundaries that meet the service areas of Albany and Rochester. Although numerous small hospitals populate this area and several larger ones are within Syracuse, Upstate is regarded as the regional academic health center and serves as the major site for emergency services. The locally infamous Labor Day Storm of 1998 and an AmTrak train crash near Syracuse in 2001 that injured 62 people are remembered vividly by emergency personnel as recent examples of how Upstate's Emergency Department was called upon to meet the needs of an extraordinary emergency.
Within hours of the horrific events on the morning of September 11, 2001, Upstate was prepared to receive several hundred casualties from New York City, as were numerous other medical facilities throughout the northeast. The next day, Upstate's Department of Emergency Medicine convened regional representatives from hospitals, police and fire departments, emergency medical services, public health departments, the military, and other agencies to assess and plan. This subsequently evolved to regular communications with local, regional, and state agencies in a collaborative development of plans to protect the region in event of terrorist acts. In particular, we have worked closely with Dr. Lloyd Novick, Commissioner of Health for the County of Onondaga, who also is a member of the faculty in our College of Medicine.
Upstate Medical University Center for Emergency Preparedness
Out of these collaborative activities and building on a rich history of research, education, and emergency services appropriate to a regional center, has come Upstate's Center for Emergency Preparedness, under the leadership of Dr. Richard Hunt, Chair of the Department of Emergency Medicine.
The activities of the Center are varied and consist of education, research, and service programs, many in collaboration with multiple partners. The appendix lists many of the entities with which the Center has, or is establishing, collaborative relationships. Center activities include Life Support and other certification courses; four annual Contemporary Issues conferences; disaster/terrorism preparedness and response education; Strategic Management Simulations evaluation and training; event staffing (including emergency physician services at the Carrier Dome and other locations); a project with the New York State Fairgrounds to establish an alternative emergency department site and surge capacity facility; and collaborations with the Welch-Allyn Company to reduce medical errors. Other Center initiatives are geared towards providing preparedness for both everyday and extraordinary emergency circumstances.
Concluding Comment
The expressed missions of academic health centers-the education of health professionals and biomedical scientists, the generation of new information through research ranging from basic science to clinical applications, and the provision of health care services-not only qualify academic health centers but obligate them to participate in the war on terrorism and the emergency preparedness that accompanies that war.
The need for emergency preparedness is shared by every community in the United States. Most academic health centers have declared publicly their commitment to serve their communities. For example, at Upstate Medical University our mission is stated simply: "to improve the health of the communities we serve through education, biomedical research, and health care." Thus, the inherent capabilities of academic health centers linked with their acknowledged commitment to serve their communities will be a major determinant in prevailing in the war on terrorism and providing security and reassurance for our citizens.
REFERENCE