Events in the United States, such as the September 11, 2001 incident and the anthrax breakout lead the government of the United States to respond at an unprecedented pace to better prepare and manage terrorist events. Informatics could contribute to increasing the efficiency in disaster response as well as providing a telepresence for remote medical caregivers.

The purpose of this chapter is to explore current and future roles of informatics in emergency preparedness and response.

Changes in the Federal System Affecting Emergency Preparedness and Response

A New Definition of Community

Community health is the provision of healthcare outside the hospital infrastructure. As such, the public health departments have been viewed as the major delivery system of healthcare.

Federal funds were channeled through the Centers for Disease Control and Prevention (CDC) to the states in order to strengthen the public health infrastructure. At the same time, federal funds were directed to hospitals through the Health Resources and Services Administration (HRSA). Both funding agencies encouraged the development of systems that would intersect one another, and for the first time a concerted effort was made to promote a collaborative system that would best meet the needs of the nation’s health.

Even the reporting of victims during a mass casualty event created challenges. There was no central place for the family members of the victims to access the information. Healthcare members in St. Louis wanted to make certain this did not happen to their community. As a result, they developed a bar code system to log and track their victims. In addition, PDAs were used by medics to log patients and belongings as well as notebook computers with wireless technology and networked desktop machines in command centers.

Federal Responsibilities for Healthcare Providers

The U.S. Department of Health and Human Services (DHHS) is responsible for the education of healthcare professionals in preparedness for emergencies, including potential terrorism. Three of the units focus on emergency planning and response: the CDC the Agency for Healthcare Research and Quality (AHRQ), and HRSA. Each of these agencies play a critical role in emergency planning and response.

The organization of the new Department of Homeland Security (DHS) caused some confusion about whether education for emergency planning and response of healthcare professionals would remain within DHHS or move to other first responder training activities already instituted by the Federal Emergency Management Agency (FEMA).Typically, first responders are: firemen, policemen, and emergency technicians who arrive first on the scene of an event but now healthcare providers are included. This allows for the healthcare community to be eligible for funding from the DHS.

New Visibility of CDC Promotes Informatics Solutions

The CDC is recognized as the lead federal agency for protecting the health and safety of people – at home and abroad, providing credible information to enhance health decisions and promoting health through strong partnerships. CDC serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and education activities designed to improve the health of the people of the United States. CDC also compiles statistical information to guide actions and policies to improve the health of the nation.

Several of the CDC initiatives require informatics support. The National Electronic Disease Surveillance System (NEDSS) is an initiative that promotes the use of data and information system standards to advance the development of efficient, intergrated, and interoperable surveillance systems at federal, state and local levels. It is a major component of the Public Health Information Network (PHIN).

The purposes of the NEDSS include: to detect outbreaks rapidly and to monitor the health of the nation; facilitate the electronic transfer of appropriate information for clinical information systems in the healthcare system to public health departments; reduce provider burden in the provision of information; and enhance both the timeliness and quality of information provided.

The Health Alert Network (HAN) was funded to develop capacity at the state and local levels for continuous, high-speed access to public health information, and to broadcast information in support of emergency communications.

The CDC established the Laboratory and Response Network (LRN) which outlined national antiterrorism policies and assigned specific missions to federal departments and agencies. Its objective was to ensure an effective laboratory response to bioterrorism by helping to improve the nation’s public health laboratory infrastructure, which had limited ability to respond to bioterrorism. Today, it is charged with the task of maintaining an intergrated network of the state and local public health, federal, military and international laboratories that can respond to both bioterrorism and chemical terrorism.

Division of Public Health Surveillance and Informatics is an informatics component of the CDC. Its purpose is to provide and improve access to and use of public health information.

Roles of AHRQ in Stimulating New Informatics Solutions

AHRQ’S involvement in bioterrorism comes for the recognition that clinicians, hospitals, and healthcare systems have essential roles in public health infrastructure.


AHRQ’s Intergrated Delivery System Research Network (IDSRN) is to develop a computer simulation model for citywide response planning for mass prophylaxis and vaccination during bioterrorist attacks and other public health emergencies.

Researchers at the Children’s Hospital of Boston are building decision support models for information systems of linked healthcare data, which would speed up reporting and enhance rapid dissemination of relevant information.

Boston Children’s Hospital and Harvard University seeks to develop a prototype database and Web site to facilitate clinician reporting of trends that will be used to diagnose possible bioterrorist attacks.


It is a detection of a disease outbreak before the actual disease or mechanism of transmission is identified. Real-time outbreak and disease Surveillance (RODS) system is a system that provides early warning of possible infectious disease outbreaks caused by bioterrorism or other public health emergencies.


Provider training and education are also critical elements of a comprehensive plan for bioterrorism and public health preparedness in general.

Researcher at the University of Alabama at Birmingham have developed continuing medical education training modules to each healthcare professionals to identify various biologic agents, as many pathogens and conditions (such as smallpox) are rarely seen in the United States, which limits clinicians from being familiar with related infection. The 6 biologic agents covered on the Website are anthraz, smallpox, botulinum toxin, tularemia, viral hemorrhagic fever, and the plague. There are specialized modules specifically for emergency room practitioners, radiologists, pathologists and infection control specialists.

Roles of Health Resource & Services Administration (HRSA) in Promoting Informatics Educational Solutions

The Hospital Bioterrorism Preparedness Program and the Bioterrorism Training and Curriculum Development Program (BTCD) are 2 grant management programs that exist under the management of the HRSA.

The purpose of the National Bioterrorism Hospital Preparedness Program is to aid state, territory, and care system, including hospitals, emergency departments, outpatient facilities, emergency medical services systems, and poison control centers, to respond to incidents requiring mass immunization, isolation, decontamination, diagnosis, and treatment, in the aftermath of terrorism or other public health emergencies.

The BTCD program provides practicing healthcare providers and current students. The developed materials are designed to equip a healthcare workforce to recognize indications of a terrorist event or other public health emergency, meet the acute care needs of patients, including pediatrics and other vulnerable populations in a safe and appropriate manner, rapidly and effectively alert the public health system of such an event at the community, state, and national level, and participate in a coordinated, multidisciplinary response to terrorist events.

Other Changes Affecting Emergency Preparedness and Response

Competency – Based Learning and Informatics Needs

The American College of Emergency Physicians (ACEP) formed a nuclear, biologic, and chemical task force to evaluate the status of bioterrorism training in the United States, identify barriers to this training, and offer recommendations for effective education. Specific methods were used to adequately describe the targeted audiences including group interactions, interviews, review of materials, and agreement by task force. The content was organized into three proficiency categories – awareness, performance, and planning.

Informatics and the Emergency Operations Center

The Incident management system (IMS) was first used by firefighters to control disaster scenes in a multijurisdictional and interdepartmental manner. The IMS calls for a hierarchical chain of command led by the incident manager or commander. Each job assignment is consistently followed by assigned personnel who refer to a specific job action sheet. The IMS has been adapted for hospital use and is called the Hospital Emergency Incident Command System (HEICS)