WorkshopMaterialsBooklet (1)

Competencies to Curriculum in the Context of Preparedness

Friday, September 22, 2006 Research Park Center 10000 Innovation Drive

Facilitators: Kristine Gebbie, DrPH, RN

William W. Greaves, MD, MSPH Nancy Healy-Haney, PsyD, MPH, RN

Jason Liu, MD Donna Page, MPH

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Competencies to Curriculum in the Context of Preparedness Table of Contents

I. About this Workshop ……………………………………………………..……………… 3 II. Agenda………………………………………………………………………………………… 4 III. Clinician Competencies…………………………………………………………..………… 5 IV. Slides…………………………………………………………………………………………. 7 V. Group Activity …………………………………………………………………………….…. 38 VI. Competencies to Curriculum Examples…………………………………………………. 42

Example 1.1 Medicine Example 1.2 Nursing Example 1.3 Dentistry

VII. Incorporating Competencies and Content into Existing Course Curricula ……… 58

Example 2.1 Medicine Example 2.2 Nursing Example 2.3 Dentistry

VIII. Sample Syllabi………………………………………………………………………………. 67 Syllabus 1.1 Medicine Syllabus 1.2 Nursing Syllabus 1.3 Dentistry IX. Resources………………………………………………………………………………………… 87

Columbia University Common Competencies in Emergency Preparedness for the Health Sciences Sample Lesson Plan Format Bibliography

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I. ABOUT THIS WORKSHOP Target audience: Persons with responsibility for, or interest in, finding ways to enhance community emergency response capacity through development and implementation of innovative training programs and materials. Goal: The goal of this workshop is to share ways in which emergency preparedness competency training can be included in curricula and training programs for health and public health professionals. Materials are based on Columbia University’s experience in developing emergency preparedness competencies and training programs in health departments, hospitals and health professional schools. The “Competencies to Curriculum Toolkit” provides the framework for the workshop. (http://www.cumc.columbia.edu/dept/nursing/research/ResCenters/chphsr/pdf/toolkit.pdf) Principal learning objective: Participants will be able to incorporate emergency preparedness principles and content into curricula through the use of the Competency-to-Curriculum Toolkit and Clinician Competencies for Emergency Preparedness. Learning activities: Presentation, small group exercises, discussion. Competency-based examples of integrated presentation using the format from the Competency-to-Curriculum Toolkit for presentations, handouts, slides and resources will be provided during this workshop. Workshop Partners: Medical College of Wisconsin, Association for Prevention, Teaching, and Research (APTR), and Center for Health Policy Columbia University School of Nursing,

http://www.cumc.columbia.edu/dept/nursing/research/ResCenters/chphsr/pdf/toolkit.pdf

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II. WORKSHOP AGENDA

9:30a.m. Sign in, Coffee

10:00 a.m. Detailed presentation on walking from BT competencies to course curriculum and innovative teaching methods

11:00 a.m. Small group exercise for developing courses and training modules for selected topics and audiences

12:00 p.m. Lunch break (lunch provided)

12:30 p.m. Small group exercises resumes

1:00 p.m. Putting it all together

3:00 p.m. Adjourn

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IV. SLIDES Slide 1

Teaching Emergency Preparedness

From Competencies to Curriculum

Association for Prevention Teaching and ResearchAnd

Center for Health PolicyColumbia University School of Nursing

September 22, 2006

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Slide 2

Sept. 22, 2006

Goals for this workshopReview the relationship of competencies and curriculum Review the core emergency preparedness competencies for cliniciansDiscuss the steps in moving from any competency set to a curriculumPractice the process of planning an educational experience that includes an emergency exercise as a learning opportunity

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Slide 3

Sept. 22, 2006

A well-built curriculum

Does not have to be complexIs worth thinking through before presentationIs definitely more than a one-time content presentationCan make the difference in having a well-prepared workforce!

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Slide 4

Sept. 22, 2006

Competency

an individual measure of applied skills and knowledge that enable people to perform work. consists of

action verb (observable or measurable performance of a worker) content (subject matter, type of performance, specific task) context (limitations or conditions of work environment).

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Slide 5

Sept. 22, 2006

Plenty of emergency preparedness competencies

Public health workersHospital workersCliniciansNurses (INCMCE)Basic and advanced disaster Life support (AMA)

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Slide 6

Sept. 22, 2006

These vary on several dimensions

Focus on education or workplaceFocus on level of attainmentFocus on various workers

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Slide 7

Sept. 22, 2006

Education or the workplace?

Workplace statementscomplex performance within the workplace, akin to KSAs of job classifications.a series of embedded tasks that are either sequential or parallel.demonstrated over long periods of time. require contextual measurement.allow for a range of indicators to measure competence.

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Slide 8

Sept. 22, 2006

Example of a workplace competency

A clinician is able to respond to an emergency event within the emergency management system of his/her practice, institution and community.

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Slide 9

Sept. 22, 2006

Education or the workplace?

Instructional Competenciesthe building blocks of learning experiences.structured learning activities.require higher levels of performance to be built upon lower level ones.determine the measurement indicators.require measurement in the short term.

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Slide 10

Sept. 22, 2006

Example of an instructional competency

The medical student will be able to conduct a physical exam that is guided by information about exposure or potential exposure to CBRNE

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Slide 11

Sept. 22, 2006

Levels? Or different competencies?

Aware: Basic level of mastery of the competency. Individuals may be able to identify the concept or skill but have limited ability to perform the skill.Knowledgeable: Intermediate level of mastery of the competency. Individuals are able to apply and describe the skill.Proficient: Advanced level of mastery of the competency. Individuals are able to synthesize, critique or teach the skill.

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Slide 12

Sept. 22, 2006

Level of worker expertise

Novice: new to a skill or attributeentry-level seasoned professional with limited exposure to the area.

Intermediate: detailed knowledge in area Often mid-level and has supervisory responsibilities.

Expert: mastery of a skillOften this person the highest ranking person in the skill area.

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Slide 13

Sept. 22, 2006

How do competencies fit in?

Workforce competencies

InstructionalCompetencies& Curriculum

Organizational performance

Individual worker performance

Interveningvariables

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Slide 14

Sept. 22, 2006

Bloom’s Taxonomy

KNOWLEDGE

COMPREHENSION

APPLICATION

ANALYSIS

SYNTHESIS

EVALUATIONIncreasing independence

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Slide 15

Sept. 22, 2006

Sample Skills by Bloom’s Taxonomy

Knowledge: name, list, arrange, relate, specify, enumerate, define, recall, label, cite, repeat, copy, order, record

Comprehension: describe, iterate, recognize, summarize, explain, discuss, locate, input, translate, paraphrase, itemize

Application: practice, calculate, compute, sketch, illustrate, interview, operate, simulate, demonstrate, apply, schedule, utilize, relate, diversify

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Slide 16

Sept. 22, 2006

Sample Skills by Bloom’s Taxonomy

Analysis: interpret, test, differentiate, scrutinize, investigate, interpret, compare, contrast, discriminate, distinguish, question, manipulate, dissect, estimate, measure

Synthesis: compose, construct, predict, reason, hypothesize, design, formulate, manage, develop, assemble, propose, theorize, invent, attribute, simplify

Evaluation: judge, assess, recommend, determine, criticize, argue, defend, estimate, appraise, justify, feedback, review

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Slide 17

Sept. 22, 2006

The clinician competencies

Licensed healthcare providers (e.g., MD, DO, DDS, RN, Advanced Practice Nurse, Physician Assistant, Clinical Psychologist, Clinical Social Worker, Optometrist) who see and triage patients or communicate with patients and are in a position to recognize initial cases and manage the initial care and referral of patients. In all cases, the competencies are understood to be defined or limited by the legal scope of practice of the specific clinician.

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Slide 18

Sept. 22, 2006

The clinician in an initial assessment and decision-making role is able to

describe his/her expected role in emergency response in the specific practice setting as a part of the institution or community response. respond to an emergency event within the emergency management system of his/her practice, institution and community.

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Slide 19

Sept. 22, 2006

and

recognize an illness or injury as potentially resulting from exposure to a biologic, chemical or radiologic agent possibly associated with a terrorist event.

recognize uncommon presentations of common diseases and distinguish these from common presentations of uncommon diseases that may be related to a terrorist event or emerging infectious disease.recognize emerging patterns or clusters of unusual presentations

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Slide 20

Sept. 22, 2006

andinstitute appropriate steps to limit spread, including infection control measures, decontamination techniques and use of appropriate personal protective equipment.report identified cases or events to the public health system to facilitate surveillance and investigation using the established institutional or local communication protocol.initiate patient care within your professional scope of practice and arrange for prompt referral appropriate to the identified condition(s).

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Slide 21

Sept. 22, 2006

and

use reliable information sources for current referral and management guidelines.provide reliable information to others (e.g., institutional administration, other patients) as relevant to the specific practice site and emergency response protocol.communicate risks and actions taken clearly and accurately to patients and concerned others.

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Slide 22

Sept. 22, 2006

and finally

identify and manage the expected stress/anxiety associated with emergency events, making referrals for mental health services if needed.participate in post-event feedback and assessment of response with the local public health system and take needed steps to improve future response.

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Slide 23

Sept. 22, 2006

Steps to a curriculumSelect competency(ies)Define key words or phrases within the competencyDescribe the target audienceSequentially separate all required sub-competencies

Develop objectives for each sub-competencyRelate an evaluation procedure to learning objectivesProvide relevant content (theory and practice) for each sub-competencyPlan specific learning experiences for all identified objectives

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Slide 24

Sept. 22, 2006

Example: Emergency Preparedness Continuing Ed

Assumption: you have been asked to plan a program for the staff of a local community clinicGoal: assure that all of the clinical staff are prepared to follow the community emergency plan in which the clinic becomes a site for minor triage and supportive care.

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Slide 25

Sept. 22, 2006

Step 1. Competency selected

This may be based on organizational or individual needs assessment

Your contact person has said that a key problem is adherence to emergency chain of command

Selection from the emergency preparedness competencies for clinicians

respond to an emergency event within the emergency management system of his/her practice, institution and community.

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Sept. 22, 2006

Step 2. Definition of key terms

Emergency management system: The Incident Command System (ICS) linking clinics to the health sector within the unified command structure of the county, consistent with the principles of the National Incident Management System (NIMS).

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Slide 27

Sept. 22, 2006

Step 3. Define target audience:

All clinical staff of the community clinic, including MD, PA, NP, DDS, RN. Some of these individuals work part-time, and several are new to the practiceAdditional needs assessment may be conducted

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Sept. 22, 2006

Step 4. Separate the sub-competencies

Describe the principles of ICSDescribe the XYZ county emergency management systemDiscuss the chain of command that links the clinic to the health sector in the ICS planIdentify the chain of command that will exist within the clinic during an emergencyFollow the chain of command during an exercise or real emergency

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Slide 29

Sept. 22, 2006

Step 5. Develop learning objectives 1:

Describe the principles of ICSPredictable chain of commandModular organization, flexible organization chartAccountability and clearly defined rolesCommon terminologyUse of action plans with a defined operational period

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Sept. 22, 2006

Learning objectives 2

Describe the XYZ county emergency management system

Modify standard ICS chart to be consistent with XYZ countyFill in names of all key agency players

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Slide 31

Sept. 22, 2006


Discuss the chain of command that links the clinic to the health sector in the ICS plan

Describe all components of the health sector in the ICS plan

Health departmentHospitalsLong term care facilitiesCommunity clinicsMedical Reserve Corps unit

Discuss the activation and functioning of the chain of command

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Sept. 22, 2006


Identify the chain of command that will exist within the clinic during an emergency

How is an emergency identifiedWho assumes commandWhat does the individual clinician do

If at work when the emergency beginsIf at home when the emergency beginsIf he/she has responsibilities within another institution

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Slide 33

Sept. 22, 2006

Step 6: Select evaluation procedures*

Objective testObjective self reportEssayOral reportPlanned observationProductPerformance

Chosen in this case because of the 4th objective

* in order of efficiency

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Sept. 22, 2006

Step 7. Identify relevant key content

Expert consultationPublicationsPolicy and procedure manual for clinic

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Slide 35

Sept. 22, 2006

Step 8. Plan the learning experiences

Map out a sequence of classroom, self-guided or experiential learning experiences that can take the learner to the desired level of competency. If there are multiple competencies to learn, the individual experiences may combine severalThe curriculum may occur in a compressed period, or be spread over many months.

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Slide 36

Sept. 22, 2006

Plan the learning experiences A one-hour classroom lecture/discussion can cover all key content areas identifiedThe evaluation exercise will require an additional hour, and may follow the classroom experience immediately, or at a later dateBoth should be repeated a sufficient number of times that ALL clinicians can participate

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Slide 37

Sept. 22, 2006

Step 9 Present and evaluate

This is the fun part!!Make sure that audience is attentive and engaged.Make sure any observers are acquainted with the goals and remain unobtrusive.

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Slide 38

Sept. 22, 2006

Small group task one:

Assume you are the curriculum or CE planning committee for an emergency preparedness learning event that will include an emergency drill or exercise

Who is your audience?Profession(s)?Previous exposure/experience?

What is the setting?Single workplace?Professional school?Other?

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Slide 39

Sept. 22, 2006

Drills and exercises

These are both experiential learning and an opportunity to evaluateOnce you move beyond workshops, they are easier to work with as system-level evaluation rather than individual assessment

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Slide 40

Sept. 22, 2006

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Slide 41

Sept. 22, 2006

Defining any drill

ORIENTATION Or SEMINAR

TABLETOP EXERCISE

FUNCTIONAL DRILL

FULL SCALE

DEFINITION PURPOSE/ OBJECTIVES

SETTING MATERIALS PARTICIPANTS CONDUCT EVALUATION

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Slide 42

Sept. 22, 2006

Exercise investment

Exercises don’t just “happen”Costs

Time Advance trainingMaterials/resources

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Slide 43

Sept. 22, 2006

Planning an exercise

Define the Purpose of the ExerciseIdentify Goals & Measurable ObjectivesDefine the Scope of the Exercise Define the Scale of the ExerciseSelect the Exercise ScenarioSelect the Exercise FormatDefine the Evaluation MethodDevelop the Exercise Work Plan and Schedule

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Slide 44

Sept. 22, 2006

Examples

Design risk communication and methods to disseminate public education information on exposure hazards and effective public response. Practice clinician behavior associated with transition into emergency role assigned by local health agency

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Slide 45

Sept. 22, 2006

Example

Test a POD operational model:introduce students to POD management and Job Action Sheet (JAS) responsibilities. provide students with an opportunity to practice ICS & functional staff roles to expeditiously receive and dispense appropriate medications.

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Slide 46

Sept. 22, 2006

Draft goal: activate POD clinic

Is the goal realistic? Has the organization opened a POD before?Does the organization have the resources and support to open a POD?

Is the goal achievable? Is there a time limit on how quickly the POD needs to be set up?Is the target number of patient through-put too high or too low?

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Slide 47

Sept. 22, 2006

Discussion-Based ExercisesTabletops (TTX)

Purpose is trainingA controller orients participants to objectives, ground rules and communication and simulation procedures. The scenario describes an event or emergency incident and brings participants up to a simulated present time. May use an imaginary jurisdiction or use participants knowledge of actual local resources. The controller sets the pace.

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Slide 48

Sept. 22, 2006

Operation-Based Exercise Drills

Purpose is to instruct thoroughly by repetition. Used to test personnel training, response time, interagency cooperation and resources, manpower and equipment capabilities. Staff should have an understanding of the function being tested and be given an opportunity to ask questions.A briefing by the drill designer sets the scene and reviews it’s purpose and objectives.Operational procedures to be tested and safety precautions are reviewed before the drill begins.

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Slide 49

Sept. 22, 2006

Example of options Practice clinician behavior associated with transition into emergency role assigned by local health agency

TabletopVignettes about clinic activity & specific patients challenging clinicians to change from usual care to emergency planScenario requires a clinician to assume command function

Functional drillAnnounce change to emergency plan, manage ‘patients’already in clinic and convert clinic to fit emergency planChallenge process by activating some clinicians to roles elsewhere in community

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Slide 50

Sept. 22, 2006

Using the National Planning Scenarios

Scenario 1: Nuclear Detonation Scenario 2: Biological Attack –Aerosol Anthrax Scenario 3: Biological Disease Outbreak – Pandemic InfluenzaScenario 4: Biological Attack –PlagueScenario 5: Chemical Attack –Blister Agent Scenario 6: Chemical Attack –Toxic Industrial ChemicalsScenario 7: Chemical Attack –Nerve AgentScenario 8: Chemical Attack –Chlorine Tank Explosion

Scenario 9: Natural Disaster –Major Earthquake Scenario 10: Natural Disaster –Major HurricaneScenario 11: Radiological Attack – Radiological Dispersal DevicesScenario 12: Explosives Attack –Bombing Using Improvised Explosive DevicesScenario 13: Biological Attack –Food Contamination Scenario 14: Biological Attack –Foreign Animal Disease (Foot and Mouth Disease) Scenario 15: Cyber Attack

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Slide 51

Sept. 22, 2006

Small group task two:

Working from the audience and setting you have identified

Select the competency(ies) that will be the focus of learning through an exerciseState the specific objective of the exercisePlan the exercise scenario

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Slide 52

Sept. 22, 2006

Evaluation questions

Did you reach the point you wanted?Did you reach that point when you wanted to?Were all students appropriately involved?Were you pleased with the manner in which you got to the end point?

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Slide 53

Sept. 22, 2006

Be clear on what you are evaluating, such as

The exercise processAn organization’s emergency planThe ability of the organization to fulfill the planThe speed with which some portion of the plan is put in to placeThe efficiency with which some portion of the plan can be carried outThe competency of individuals in some specific functional roles

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Slide 54

Sept. 22, 2006

Individual competency in functional roles

Identify in advance the functional roles that need to be assessedCompetency statements and applicable JAS must be incorporated into the assessment

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Slide 55

Sept. 22, 2006

Ways to evaluate

‘Hot wash’comments

Narrative of observations

Subjective

Post-event checklist

Checklist with stated objectives

Objective

ParticipantExternal evaluator

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Slide 56

Sept. 22, 2006

Sample for recording

Exercise Objective Number (1___): Objective: Demonstrate ability to develop and adapt Section Action Plan during an emergency

Anticipated Actions:

Met Not Met

Not Observed

1. Identify expectations from IAP

2. Prepare initial SAP for time frame

3. Communicate SAP to team members with JAS

4. Develop revised SAP with new data or new IAP

5. Communicate new SAP to team members

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Slide 57

Sept. 22, 2006

Pre-drill

Identify all functional roles to be activatedInclude those functional roles likely to be identified if initial participants perform as desiredExample:

Planning unit activatedPlanning calls for extensive field epidemiology

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Slide 58

Sept. 22, 2006

Pre-drill

Prepare observer documentsCriteria to be observedJAS to be observed

Prepared participant feedback formOne form for those carrying out assigned JASOne form for any individual playing parts of community members or patients during the drill.

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Slide 59

Sept. 22, 2006

Small group task 3

Identify all materials you will need for the exercise you have selectedOutline all components of the evaluation that will allow you to assess student learning

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Slide 60

Sept. 22, 2006

Small group summaries

Biggest challenges?Easiest problems to solve?What next?

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Slide 61

Sept. 22, 2006

Thank you for your participation!

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Slide 62

Sept. 22, 2006

http://www.nursing.hs.columbia.edu

Association for PreventionTeaching andResearch

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V. Group Activity: Worksheet Steps to Competencies Curriculum

(Intentionally left blank - may also be used as a Template) Step 1. Competency selected The competency selected for the example is from the emergency preparedness competencies for: Step 2. Definition of key terms

In this example, the key term is: Step 3. Define target audience: The target audience for this training will include: Step 4. Separate the sub-competencies. If these students are to be able to (list competency here) hen they must be able to:

• list • list • list • list

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V. Group Activity: Worksheet, cont. Step 5. Develop learning objectives: Complete the following table that illustrates the statement of learning objectives that can fulfill the desired competencies. Competency Sub-competency Learning objective

Step 6: Select evaluation procedures

Complete the table below to represent a wide array of evaluation approaches matched to the specific learning objectives identified for a hypothetical program. The choice of methods will depend upon the length of time and resources available, and the capacities of both the organization and the teaching team. The evaluation decision should be made about each objective prior to planning the learning experiences.

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Step 6: Chart - Select evaluation procedures

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V. Group Activity: Worksheet, cont. Step 7: Identify relevant key content

For this example, the following relevant literature from theory and practice have been identified as contributing to the needed content: (list) Step 8. Plan the learning experiences

It is only at this point that the planner is ready to map out a sequence of classroom, self-guided or experiential learning experiences that can take the learner to the desired level of competency. If time allows the faculty might schedule one or more expert guest lecturers, distribute pertinent materials, and expect the students, by the end of the semester to have critiqued the current level of achievement of an agency and developed a work plan for subsequent improvement. If time is limited, the number of competencies might have to be narrowed, along with a different combination of group discussion, reading assignments and homework assignments related to specific areas of concentration. If a good high-speed internet connectivity is available, the learners might be asked to download relevant materials from the CDC and other national web sites and apply them to an agency, with group discussion and expert advice available to support the learning.

Step 9. Deliver Training Step 10. Evaluate

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VI. Competencies to Curriculum – Example 1.1: Medical Curriculum

EMERGENCY PREPAREDNESS Step 1. Competency selected

The competency selected for the example is from the emergency preparedness competencies for graduate medical students: Initiate patient care within your professional scope of practice and arrange for prompt referral appropriate to the identified conditions(s).


In this example, the key term is patient care, which is defined as: impairment of normal physiological function affecting part or all of an organism/an accident that results in physical damage or hurt


The target audience for this training will include students who are enrolled in a medical education program where the curriculum includes course work such as clinical clerkship.

Step 4. Separate the sub-competencies.

If these student are to be able to Initiate patient care within their professional scope of practice and arrange for prompt referral appropriate to the identified conditions(s), that is required for bioterrorism response then they must be able to:

• Initiate patient care • Conduct physical exams • Identify patterns of signs and symptoms likely to be associated with occult exposure to CBRNE • Interpret results of the medical history, physical exam, and diagnostic workup to determine an accurate diagnosis of

CBRNE exposure. • Incorporate evidence-based diagnostic procedures and laboratory studies to confirm the diagnoses and/or causative

agents.

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VI. Competencies to Curriculum - Example 1.1: Medical Curriculum cont. Step 4. Separate the sub-competencies, cont.

• Knowledge of signs and symptoms of acute or delayed critical incident stress reaction among community members or responders.

• Pharmaceutics and pharmaceuticals used to combat CBRNE e.g., burn therapies, biochemical antidotes, antibiotics, vaccines.

• Consider critical aspects of treatment plans for patients who may have been affected physically and/or psychologically by CBRNE including:

• Recognize the need for, and collect and preserve forensic evidence from patients who may be victims of a CBRNE event

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VI. Competencies to Curriculum - Example 1.1: Medical Curriculum cont. Step 5. Develop learning objectives: The following table illustrates the statement of learning objectives that can fulfill the desired competencies. Competency Sub-competency Learning objective

1. Take medical histories

a. Determine the absence or presence of symptoms that are characteristics of exposure to CBRNE b. Identify patients who may have psychological trauma following a CBRNE event c. Identify occupational and psychosocial risks for exposure to potential CBRNE d. Characterize exposures to potential CBRNE, including type of agent, timing, and length of exposure

Initiate patient care within your professional scope of practice and arrange for prompt referral appropriate to the identified conditions(s).

2. Ability to conduct physical exams

a. Conduct physical exams that are guided by exposure or potential exposure to CBRNE. b. Determine the absence or presence of physical signs that are characteristics of exposure to CBRNE


Table 1.1 presents a wide array of evaluation approaches matched to the specific learning objectives identified for this hypothetical program. The choice of methods will depend upon the length of time and resources available, and the capacities of both the organization and the teaching team. The evaluation decision should be made about each objective prior to planning the learning experiences.

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VI. Competencies to Curriculum - Example 1.1: Medical Curriculum cont. Step 6: Table 1.1- Evaluation Procedures

O

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1. Determine the absence or presence of symptoms that are characteristics of exposure to CBRNE X X X 2. Identify patients who may have psychological trauma following a CBRNE event X X X 3. Identify occupational and psychosocial risks for exposure to potential CBRNE X X X 4.. Characterize exposures to potential CBRNE, including type of agent, timing, and length of exposure X X X 5. Conduct physical exams that are guided by exposure or potential exposure to CBRN. X 6. Determine the absence or presence of physical signs that are characteristics of exposure to CBRNE X X

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VI. Competencies to Curriculum - Example 1.1: Medical Curriculum cont. Step 7: Identify relevant key content

For this example, the following relevant literature from theory and practice have been identified as contributing to the needed content:

• Hospital Provider Course- Defense against WMD - Office for Domestic Preparedness

• Compendium of acute food borne and waterborne diseases - CDC, Epidemiology Program Office; 2003

• Second Edition Medical Management of Radiological Casualties Handbook - Military Medical Operations Armed Forces Radiobiology Research Institute Bethesda, Maryland 20889– 5603; Accessed April, 2003; http://www.afrri.usuhs.mil

• Dept of Homeland Security Working Group on Radiological Dispersal Device (RDD) • Preparedness Medical Preparedness & response Sub-Group - Dept. Of Veteran Affairs, Dept.

• An Epidemic of Thyrotoxicosis- Instructor’s Guide - CDC and Prevention Epidemiology Program office, case studies

in applied Epidemiology No. 873-703-Dept. of Health and Human Services/EIS 2003.

• Smallpox Clinical Poster - Dept. of Health and Human Services, Center for Disease Control and Prevention.

• Oswego –An Outbreak of Gastrointestinal Illness Following a Church Supper, Students Guide -CDC and Prevention- Epidemiology program office case studies in applied Epidemiology No. 401-303.

• Suspected Legionnaires ’ disease in Bogalusa- Instructor’s Guide, Student’s Guide - CDC- Epidemiology Program

Office- Case studies in applied Epidemiology No. 912-303- Dept of Health and Human Services/EIS 2003

http://www.afrri.usuhs.mil/

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VI. Competencies to Curriculum - Example 1.1: Medical Curriculum cont. Step 8. Plan the learning experiences It is only at this point that the planner is ready to map out a sequence of classroom, self-guided or experiential learning experiences that can take the learner to the desired level of competency. If possible the trainer might schedule one or more expert guest lecturers. If only a portion of the course were available, the number of competencies might have to be narrowed, along with a different combination of group discussion, reading assignments and homework assignments related to specific work units. If the school has good high-speed internet connectivity, the learners might be asked to download relevant documents from the CDC or DHS web site and apply them to his or her clinical site, with group discussion and expert advice available to support the learning.

SUBSECTION COLOR PAGE PLACEHOLDER

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VI. Competencies to Curriculum - Example 1.2: Nursing Curriculum EMERGENCY PREPAREDNESS Step 1. Competency selected

The competency selected for the example is from the emergency preparedness competencies for accelerated program nursing students: describe your expected role in emergency response in the specific practice setting as part of the institution or community response.


In this example, the key term is emergency response, which is defined as: the complete range of activities included in an agency plan that allow for management of a possible terroristic event or disaster.


The target audience for this training will include students who are enrolled in a nursing education program where the curriculum includes course work such as professional issues, Pathophysiology, pharmacology epidemiology.


If these student are to be able to define modifications to the agency’s internal command notification and coordination structure that are required for bioterrorism response then they must be able to:

• Describe the agency’s basic notification structure • Describe the differences between bioterrorism response and other emergency response • Analyze application of bioterrorism response to the usual notification structure • Define a modified command structure

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VI. Competencies to Curriculum - Example 1.2: Nursing Curriculum, cont. Step 5. Develop learning objectives: The following table illustrates the statement of learning objectives that can fulfill the desired competencies. Competency Sub-competency Learning objective

Describe the agency’s basic notification structure

Describes the uses of a notification structure Define the difference between an organizational chart and a notification structure Define the role of command in emergency response

Describe the differences between bioterrorism response and other emergency response

• Articulate the principles of emergency response • Describe the variation in response needed for a bioterrorist event

• List the participants in community emergency response • Define the role of nurse in emergency response

Analyze application of bioterrorism response to the usual notification structure

• Identify the potential risks in using the ordinary notification structure in a bioterrorism event

• Describe the partners in bioterrorism response at a community level

• Specify the key junctures at which a different notification or command response could be useful

Describe your expected role in emergency response in the specific practice setting as part of the institution or community response.

Define a modified command structure

• Specify the changes in notification needed for bioterrorism response

• Define the command structure for a hospital • Present an agency-specific emergency notification and command structure sufficient for a bioterrorism event



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VI. Competencies to Curriculum - Example 1.2: Nursing Curriculum, cont. Table 1.2 Evaluation Procedures


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1.a. Describes the uses of a notification structure X X X 1.b. Define the difference between an organizational chart and a notification structure X 1.c. Define the role of command in emergency response X 2.a. Articulate the principles of emergency response X X X 2.b. Describe the variation in response needed for a bioterrorist event X 2.b. List the participants in community emergency response X 2.c. Define the role of nursing in emergency response X 3.a. Identify the potential risks in using the ordinary notification structure in a bioterrorism event X 3.b. Describe the partners in bioterrorism response at a community level X 3.c. Specify the key junctures at which a different notification or command response could be useful X 4.a. Specify the changes in notification needed for bioterrorism response X 4.b. Define the command structure for a hospital X 4.c. Present an agency-specific emergency notification and command structure sufficient for a bioterrorism event X X

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VI. Competencies to Curriculum - Example 1.2: Nursing Curriculum, cont. Step 7: Identify relevant key content

For this example, the following relevant literature from theory and practice have been identified as contributing to the needed content:

• FEMA Independent Study Program: IS-100 Introduction to Incident Command System, I-100. Available at: http://training.fema.gov/EMIWeb/IS/is100.asp

• FEMA Independent Study Program: IS-700 National Incident Management System (NIMS), An Introduction. Available at: http://training.fema.gov/EMIWeb/IS/is700.asp

• National Incident ManHospital Provider Course- Defense against WMD(52)- Office for Domestic Preparedness • Management System(37)

• DHS WMD Awareness Course (50)- U.S. Dept. of Homeland Security, Office for Domestic Preparedness, Center for

Domestic Preparedness

• Arnold JL. Dembry LM. Tsai MC. Dainiak N. Rodoplu U. Schonfeld DJ. Paturas J. Cannon C. Selig S. Recommended modifications and applications of the Hospital Emergency Incident Command System for hospital emergency management. [Journal Article] Prehospital & Disaster Medicine. 20(5):290-300, 2005 Sep-Oct.

• Jacoby IJ. SARS and the Hospital Emergency Incident Command System (HEICS): outbreak management as the

mother of invention. [Editorial] Journal of Emergency Medicine. 28(2):225-6, 2005 Feb.

• Zane RD. Prestipino AL. Implementing the Hospital Emergency Incident Command System: an integrated delivery system's experience. [Journal Article] Prehospital & Disaster Medicine. 19(4):311-7, 2004 Oct-Dec.

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VI. Competencies to Curriculum - Example 1.2: Nursing Curriculum, cont. Step 8. Plan the learning experiences It is only at this point that the planner is ready to map out a sequence of classroom, self-guided or experiential learning experiences that can take the learner to the desired level of competency. If possible the trainer might schedule one or more expert guest lecturers. If only a portion of the course were available, the number of competencies might have to be narrowed, along with a different combination of group discussion, reading assignments and homework assignments related to specific work units. If the school has good high-speed internet connectivity, the learners might be asked to download relevant documents from the CDC or DHS web site and apply them to his or her clinical site, with group discussion and expert advice available to support the learning.


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VI. Competencies to Curriculum - Example 1.3: Dental Curriculum EMERGENCY PREPAREDNESS Step 1. Competency selected

The competency selected for the example is from the emergency preparedness competencies for graduate dental students: Recognize an illness or injury as potentially resulting from exposure to a chemical, biological, or radiological/nuclear (CBRN) agent possibly associated with a terrorist event.


In this example, the key term is illness/injury, which is defined as: impairment of normal physiological function affecting part or all of an organism/an accident that results in physical damage or hurt


The target audience for this training will include students who are enrolled in a medical education program where the curriculum includes course work such as pathophysiology, pharmacology epidemiology (dental).


If these student are to be able to recognize an illness or injury as potentially resulting from exposure to a chemical, biological, or radiological/nuclear (CBRN) agent possibly associated with a terrorist event, that is required for bioterrorism response then they must be able to:

• Describe the major classes of chemical, biologic, radiological, nuclear and explosive agents that can be used as terrorist

weapons. • Describe the basic principles of selection and use of personal protective equipment appropriate to a range of situations typical of

one's profession.

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VI. Competencies to Curriculum - Example 1.3: Dental Curriculum, cont. Step 5. Develop learning objectives: The following table illustrates the statement of learning objectives that can fulfill the desired competencies. Competency Sub-competency Learning objective

Describe the major classes of chemical, biologic, radiological, nuclear and explosive agents that can be used as terrorist weapons.

a. Describe Category A biologic agents, including epidemiology, routes of exposure, treatments and infection control principles. b. Describe general classes of potential chemical weapons, including mechanisms of exposure, decontamination and treatment principles and concepts of personal protection. c. Describe types of radiation associated with potential terrorist devices, including mechanisms of distribution, effects of exposure, treatment and personal protection.

Recognize an illness or injury as potentially resulting from exposure to a chemical, biological, or radiological/nuclear (CBRN) agent possibly associated with a terrorist event, that is required for bioterrorism response

Describe the basic principles of selection and use of personal protective equipment appropriate to a range of situations typical of one's profession.

Demonstrate use of personal protective equipment appropriate to a range of situations typical of one's profession.



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VI. Competencies to Curriculum - Example 1.3: Dental Curriculum, cont.

Table 1.3 Evaluation Procedures


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1. Describe Category A biologic agents, including epidemiology, routes of exposure, treatments and infection control principles. X X X 2. Describe general classes of potential chemical weapons, including mechanisms of exposure, decontamination and treatment principles and concepts of personal protection. X 3. Describe types of radiation associated with potential terrorist devices, including mechanisms of distribution, effects of exposure, treatment and personal protection. X 4. Demonstrate use of personal protective equipment appropriate to a range of situations typical of one's profession. X

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VI. Competencies to Curriculum - Example 1.3: Dental Curriculum, cont. Step 7: Identify relevant key content

For this example, the following relevant literature from theory and practice have been identified as contributing to the needed content: • Terrorist CBRN Materials & Effects - Central Intelligence Agency- May 2003

• Criminal and Epidemiological Investigation Handbook - 1. U.S. Dept. of Justice, 2. Federal

• Second Edition Medical Management of Radiological Casualties Handbook - Military Medical Operations Armed

Forces Radiobiology Research Institute Bethesda, Maryland 20889– 5603; Accessed April, 2003; http://www.afrri.usuhs.mil

• Managing Hazardous Materials Incidents- A Planning Guide for the Management of Contaminated Patients - A three

volume series, Agency for Toxic Substances and Disease Registry; March 2001

• Hospital Provider Course- Defense against WMD - Office for Domestic Preparedness

• Bioterrorism Readiness Plan: A Template for Healthcare Facilities, APIC Bioterrorism Task

• Aid for Decontamination of Fire and Rescue Service Protective Clothing and Equipment After Chemical, Biological, and Radiological Exposures - Lawson, J. Randall, Jarboe, Theodore L. National Institutes of Standards and Technology(NIST) Special Publication 981, US Dept of Commerce, May 2002

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VI. Competencies to Curriculum - Example 1.3: Dental Curriculum, cont. Step 8. Plan the learning experiences It is only at this point that the planner is ready to map out a sequence of classroom, self-guided or experiential learning experiences that can take the learner to the desired level of competency. If possible the trainer might schedule one or more expert guest lecturers. If only a portion of the course were available, the number of competencies might have to be narrowed, along with a different combination of group discussion, reading assignments and homework assignments related to specific work units. If the school has good high-speed internet connectivity, the learners might be asked to download relevant documents from the CDC or DHS web site and apply them to his or her clinical site, with group discussion and expert advice available to support the learning.

SECTION TAB

PLACEHOLDER

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VII. Incorporating Competencies and Content into Existing Course Curricula

Example 2.1: Medicine Competency Content

Curriculum/Course

II. Terrorism and Public Health Emergency Preparedness

1. Chemical biologic, radiological, and explosive agents.

1a. Describe the major classes of chemical, biologic, radiological, nuclear and explosive agents that can be used as terrorist weapons.

Biologic: bacterial, viral, rickettsial, intoxictions; Chemical: nerve agents, blister agents, blood agents, choking agents, irritants; Nuclear/Radiological: alpha, beta, gamma, electro-magnetic pulses, dispersal devices; Explosive: trauma patterns

2. Biologic agents

2a. Describe Category A biologic agents, including epidemiology, routes of exposure, treatments and infection control

anthrax, tularemia, cholera, plague, botulism, encephalitis

Pathophys I (microbiology): anthrax, cholera, botulism, smallpox; viral hemorrhagic fevers may be added next year

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principles.

2b. Describe knowledge of Category B biologic agents.

brucellosis, clostridium, salmonella, Q fever, typhus, staph

Pathophys I (microbiology): C. perfringens, salmonella/GI, typhus, staph

3. Chemical agents

3a. Describe the general classes of potential chemical weapons, including mechanisms of exposure, decontamination and treatment principles and concepts of personal protection.

organophosphates (sarin, soman, tabun, v-agent); mustard agents / corrosives; blistering agents; blood agents (hydrogen cyanide, cyanogen chloride) choking agents (chlorine, phosgene); irritants (chloropicrin, mace, tear gas, capsicum/pepper spray, dibenzoxazepine)

Pharmacology: organophosphates, mustard agents (only for oncology Rx)

4. Radiological agents

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4a. Describe types of radiation associated with potential terrorist devices, including mechanisms of distribution, effects of exposure, treatment and personal protection.

alpha (inhalation, ingestion, injection); beta (dermatologic), gamma (greatest danger), electromagnetic pulses (damage to electrical systems)

Pathophys II (oncology): brief overview of radiation oncology but only as therapeutics

5. Personal Protective Equipment and Decontamination

5a. Demonstrate basic principles of selection and use of personal protective equipment appropriate to a range of situations typical of one's profession.

definitions, levels A-D, need for training and fitting, respiratory devices (SCBA, supplied-air respirators, air-purifying respirators, HEPA filters, surgical masks); chemical protective clothing, surgical gowns, latex gloves, M40 Mask, battle-dress over garments, chemical protective gloves


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VII. Incorporating Competencies and Content into Existing Course Curricula–

Example 2.2: Nursing

Competency Content Curriculum/Course



1a. List the major classes of chemical, biologic, radiological, nuclear and explosive agents that can be used as terrorist weapons.


2. Biologic agents

2a. Demonstrate knowledge of Category A biologic agents, including epidemiology, routes of exposure,

anthrax, tularemia, cholera, plague, botulism, encephalitis, viral hemorrhagic fevers

Microbiology or Med Surg

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treatments and infection control principles. 2b. List Category B biologic agents.


Microbiology or Med Surg

3. Chemical agents 3a. Demonstrate knowledge of general classes of potential chemical weapons, including mechanisms of exposure, decontamination and treatment principles and concepts of personal protection.


Pharmacology




Med Surg

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definitions, levels A-D, need for training and fitting, respiratory devices (SCBA, supplied-air respirators, air-purifying respirators, HEPA filters, surgical masks); chemical protective clothing, surgical gowns, latex gloves, M40 Mask, battle-dress over-garments, chemical protective gloves

Clinical Skills Lab Professional Development

5b. Describe principles and application of decontamination

5:1 ratio unaffected to affected; need for immediate decontamination; disrobing as decontamination (head to toe, more better); water flushing best mass decontamination method; need to decontaminate emergency responders; reservation of decontaminant as evidence


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VII. Incorporating Competencies and Content into Existing Course Curricula

Example 2.3: Dentisrty Competency Content Curriculum/Course



1a. Describe the major classes of chemical, biologic, radiological, nuclear and explosive agents that can be used as terrorist weapons.


2. Biologic agents

2a. Describe Category A biologic agents, including epidemiology, routes of exposure, treatments and infection control principles.

anthrax, tularemia, cholera, plague, botulism, encephalitis, viral hemorrhagic fevers

Pathophysiology

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2b. Describe Category B biologic agents.


Pathophysiology

3. Chemical agents 3a. Describe general classes of potential chemical weapons, including mechanisms of exposure, decontamination and treatment principles and concepts of personal protection.


Pharmacology




Pathophysiology


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definitions, levels A-D, need for training and fitting, respiratory devices (SCBA, supplied-air respirators, air-purifying respirators, HEPA filters, surgical masks); chemical protective clothing, surgical gowns, latex gloves, M40 Mask, battle-dress over-garments, chemical protective gloves

Clinical Skills Lab Professional Development

SECTION TAB

PLACEHOLDER

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VIII. Sample Syllabus 1.1: Medicine Consider where to incorporate Emergency Preparedness Competencies within this sample

Introduction General Course Information: MEDI M7201.083 CLINICAL CLERKSHIP IN MEDICINE Instructor Information: XXXXX E-mail: XXXXX Overview The clinical clerkship in Medicine is an intensive ten week introduction to internal medicine. You will spend five weeks at XUMC and five weeks at one of the affiliated hospitals. At each site, in addition to your team of house officers and attendings you will have a preceptor who will be responsible for didactic sessions, feedback, the observed history and physical, and reading your write-ups. The in-patient experience will allow you to see a wide variety of patients—not only your own, whom you will know in depth, but the others on your team, and those of the other students in your preceptor group. This will help you broaden your fund of knowledge even in these brief ten weeks. Even more importantly, every day will provide multiple opportunities to practice your interviewing and physical diagnosis skills, animate your knowledge of basic and clinical science, and experience your emerging identity as a physician as you apply yourself to the task of caring for sick patients. To fully integrate the knowledge, skills, and professional attitudes will take time, hard work and practice. Work with each of your patients closely. Let the patient teach you about the person and about the disease. Watch everyone -- medical staff, nursing staff, social workers, ward clerks, etc. Watch their interactions with patients and with each other. Select those approaches and presentations that you find most effective, appropriate and helpful in caring for your patients. It is normal to feel overwhelmed at first, but call for help, if you are having difficulty understanding your role and your priorities.

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The clerkship is, in part, an apprenticeship. It is an opportunity to work with the patients and to learn from them with the luxury of not having direct, final responsibility for their management. It will not always be so, so take full advantage of the fact that you are still a student and take time to read, prepare your write-ups, and prepare for your preceptor group. You will need to balance two demands on your time and two sources of learning, your ward team and your preceptor. If you have problems, concerns, questions, or if anything seems "WRONG", or even not as good as it should be, please contact Dr. XXXX. Expectations and Requirements: 1. Each student should actively participate in the care of at least 10 patients during each of the five weeks. ---/////You will work closely with an intern and resident and will be "on call" admitting and working up new patients /////approximately every fourth day. You should work up one patient per call (prepare to present the patient on /////attending rounds the following day, and do a formal write-up for your preceptor) and if possible pick up another /////patient to follow (this will be easier as the rotation progresses). 2. Each student should be following 2-4 patients at any given time 3. Each student is responsible for handing in six full write-ups to their preceptor for each of the five weeks of /////the clerkship. These are due no later than 48 hours after the day "on call" and must all be handed in by the last /////day of the five weeks. (see assignments for sample write ups) 4. Each student will be responsible for entering the data on their patients into the Patient Encounter system. /////Over the course of the clerkship at a minimum you should be exposed to patients and learn in depth about the /////following diagnostic categories and differentials:

• / Constitutional signs and symptoms (fever, wt loss, fatigue) • //Chest Pain • //Shortness of Breath • //Abdominal Pain • //Gastrointestinal Bleeding • /Liver disease • Renal insufficiency/failure • Electrolyte and acid-base disorders • Anemia

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• Clotting disorders • Diabetes • Dizziness and syncope • HIV • Malignancy

You should have opportunities to observe, perform, and practice the following: • EKG interpretation • CXR interpretation • Blood drawing • IV placement • Skin testing (e.g. PPD) • Counseling re health behaviors: smoking cessation, alcohol and other substance abuse, diet • Breaking bad news • End of life issues • Educating patients and families about diagnosis and/or chronic disease

5. Each student will discuss midpoint feedback with their Preceptor and the form (see assignments) will be ///submitted by the Preceptor. 6. Each student will do an observed history and physical examination with their Preceptor who will complete the ///form. (see assignments). 7. The last day of the 10-week clerkship the shelf examination in Internal Medicine will be given. This will ///contribute approximately 10% toward the final grade. Goal: The goal of the clerkship is to develop competencies in the basic knowledge, skills and attitudes of an effective clinician in evaluating and caring for hospitalized adult patients

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At the end of this clerkship, students will be able to demonstrate competencies in the basic knowledge, skills and attitudes of an effective clinician in evaluating and caring for hospitalized adult patients. Objectives

Methods/Opportunities/Evaluators

Medical Knowledge

Medical Knowledge

Develop and expand core medical knowledge: Presentation, mechanisms, natural history, and treatment of common diseases in the inpatient setting (Competency 3) Develop and expand knowledge of differential diagnosis of presenting signs, symptoms and laboratory abnormalities in inpatient setting (Competency 5)

Major resources: Textbook of Medicine: Harrison’s is on-line Pathophysiology syllabus and other material from Pre clinical curriculum Pub med is on line for researching specific topics Identify areas of incomplete core knowledge based on one’s own patients, those of the team and other students in preceptor group. Total patient exposure at least 20 direct patient care, >50 indirect (discussed in preceptor group, on rounds, etc) Read, focusing on presentation, mechanisms of disease, natural history, and treatment and Differential diagnosis and approach to the patient with a presenting complaint Weekly CPC’s at XUMC: preparation with course director; presentation of student’s formulation at Departmental conference is an exercise in diagnostic reasoning and differential diagnosis Review and learn interpretation of most frequent diagnostic tests: laboratory studies, echocardiography, pulmonary function studies in preceptor group EKG interpretation-- 5 sessions/ five weeks Radiology--5 sessions/ five weeks (varies by site)

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Develop and expand knowledge of diagnostic testing and skills in clinical reasoning that lead to differentiating among diagnoses for complaints in the in patient setting Depth of knowledge: Demonstrate and share understanding of basic pathophysiologic and/or pharmacologic mechanisms Demonstrate motivation and skills in life long learning Actively formulate questions—on rounds, in preceptor group, and pursue answers

Review and present pathophysiology and pharmacologic basic mechanisms on attending rounds and in preceptor group After reading the foundations: ask questions always, of everyone: house officers, attendings, consultants, preceptors. If no one is sure of the answer, look up what you can and educate the group Evaluators: House officers, attendings, preceptors

Patient care: Data gathering, synthesizing and reporting (Competency 7)

Patient Care: Data gathering, synthesizing and reporting

Be able to obtain a complete and accurate admission history Be able to obtain a focused interval history on a daily basis Perform an accurate, complete physical examination Perform a focused physical examination appropriately guided by

Perform a complete history and physical examination on all admitted patients (minimum 20 in the 10 weeks) this includes all components of the history as listed on the “Atchley” form, and in addition gathering any additional information from records and outside sources –e.g. physicians, and other hospitals Perform a focused interval history on a daily basis for all admitted patients (average two per day).

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the patient’s diagnosis and evolving illness Be able to summarize the case and the main findings of each case in a succinct sentence Develop an appropriate, and prioritized differential diagnosis for the presenting and other significant problems of the patient Create a problem list Formulate a prioritized diagnostic strategy Formulate a treatment strategy (Competency 6) Clinical skills: Practice basic skills with appropriate supervision from house staff: blood drawing, starting IV's, skin testing (PPD)

Perform an observed history and physical examination with your preceptor Present/review findings with resident and prepare the formulation and differential diagnosis for formal presentation on attending rounds. These presentations are to be made at the bedside from memory. Complete write-ups (at least six per five weeks) to be turned in to Preceptor and returned with feedback in 48 hours. Present patients in preceptor group in both complete and abbreviated formats. Present/review findings with house staff and present on attending rounds Write daily notes, review with house staff. Feed back and Evaluation: House officers, attendings, and preceptors all see different stages of the process and provide feedback and evaluation on each aspect of the student’s progress

Interpersonal and communication skills (Competencies 8, 9)

Interpersonal and communication skills

Be able to establish a therapeutic relationship: some of the specific skills include: Always think about the multiple perspectives model:

Observe others and practice the multiple perspectives model yourself; all clinical encounters offer opportunities Practice communicating with patients and families

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-Identify the patient’s perspective, as well as those of family members -Identify your own perspective -Identify barriers to successful communication -Choose to put the patient’s needs first -Create a comfortable environment -Sit down when possible -Ask open ended questions -Be dependable and help set realistic expectations -Communicate effectively with patients and families -Be able to summarize and explain to each patient their illness, diagnostic tests, treatments and the anticipated risks and benefits. Be able to identify key issues to address at the end of life and acquire basic skills in talking to patients about end of life issues and choices. Be able to address patients’ health behaviors: identify teachable moments, and reinforce skills in behavior change (Competency 10) Communicate effectively and work

Clinical Practice (XUMC) and Psychiatry sessions (away sites) focus on end of life, difficult patients, effecting behavior change, ethics and professional development Evaluators: House officers, attendings, preceptors, clinical practice and psychiatry preceptors

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with other members of the team Identify your role with house officers, attendings, preceptors Communicate effectively with social workers, nurses and others Be collegial and helpful to fellow students Communicate effectively with other consulting services Professionalism

Professionalism

Demonstrate altruism and motivation to provide effective patient care Continuously reflect on, discuss, and expand your model of the doctor-patient relationship Steadily advance in level of responsibility towards patients: third year clerks should be interpreters and managers, and prove themselves capable of closely supervised independence (Competency 11) Observer: watches what happens Reporter: describes what happens, gathers information accurately Interpreter: synthesizes data from multiple sources and formulates a differential diagnosis

Clinical Practice3: assignment is to consider the doctor-patient relationship and how a specific patient or encounter challenged or expanded your concept of that role. With the Clerkship Director and the Clinical Practice 3 Course Director we will discuss the themes that each student’s case raises Evaluators: House officers, attendings, preceptors, course director

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Manager: based on the interpretation, can predict and anticipate the possible course of illness and act accordingly Practice-based learning Practice-based learning Read effectively, be curious, and ask questions about all aspects of the care rendered to their patients: medical knowledge, clinical reasoning, and doctor-patient relationships Observe and reflect on all members of the team, their, knowledge, professionalism, and relationships with patients

See Medical Knowledge above. Learn from everyone: not just knowledge but skills and attitudes Evaluators: house officers, attendings, preceptors

Systems-based practice

Systems-based practice

Work effectively with all other health care professionals (Competency 5) Observe and reflect on the systems issues that impact in patient care Communicate about near misses or errors to others (chief resident, attendings, preceptors) so that human errors and system errors can be reviewed in appropriate context.

Observe others and develop one’s own effective skills in team work Evaluators: house officers, attendings, preceptors

Source available at: http://www.columbia.edu/itc/hs/medical/curriculum/course_online/


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VIII. Sample Syllabus 1.2: Nursing Consider where to incorporate Emergency Preparedness Competencies within this sample

NXXX - THE SCIENCE OF NURSING PRACTICE IN THE COMMUNITY

CREDITS: 3.0 FALL 2005 HOURS & LOCATION: Monday 8:00 – 11:00 a.m. & 12:00 – 3:00 p.m. Medical Science Pavilion Tuesday 8:00 – 11:00 a.m. XXXX Cancer Research Center 115 COURSE DIRECTOR: xxx

xxx xxx xxx

PREREQUISITE: Successful completion of the first semester of the program CO REQUISITE: NXXX Nursing Practice in the Community DESCRIPTION: This course focuses on the role of the nurse in community health: caring for aggregate

populations at risk and the community as a whole. Nursing science and epidemiology provide the base for examining the spectrum of community health. Tools for community assessment and diagnosis as well as concepts of health promotion, disease prevention, risk reduction and rehabilitation and evidence-based practice for the health of groups are presented.

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VIII. Sample Syllabus 1.2: Nursing, cont. OBJECTIVES: At the completion of the course, the student will be able to:

1. Identify health status indicators involved in community or population group assessment upon which to determine working diagnoses for community nursing interventions

2. Formulate evidence-based plans for care of families and groups in diverse community settings,

integrating concepts of bio-behavioral and epidemiologic sciences in the plan 3. Examine the impact of acculturation and cultural heritage on the community health care needs of

specific aggregate groups 4. Analyze research findings relevant to needs of specific community groups at high risk for illness,

disability or poor recovery 5. Evaluate efficacy of health promotion and education modalities used in community settings with

diverse populations 6. Discuss the relationship of public health and community health nursing sciences on the practice of

community health 7. Discuss the legal and ethical challenges of community health nursing practice

METHODOLOGY: Lecture, case studies, assignments EVALUATION: Community Assessment Presentation 40%

Midterm 25% Final Exam 35%

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VIII. Sample Syllabus 1.2: Nursing, cont. REQUIRED TEXT(S): McKenzie, J. F., Pinger, R. R., Kotecki, J. E. (2004). An

introduction to community health (5th ed.). Sudbury, MA: Jones and Bartlett Publishers.

RECOMMENDED TEXT(S):

Kidder, Tracy (2004). Mountains beyond mountain, the quest of Dr. Paul Farmer, A Man Who Would Cure The World. New York, NY: Random House Publishers. ISBN: 0812973011 Kozol, Jonathan (1996). Amazing grace: lives of children and the conscience of a nation. New York, NY: Harper Perennial. ISBN: 0060976977

LeBlanc, Adrian (2003). Random family: love, drugs, trouble and coming of age in the Bronx. New York, NY: Scribner Publishers.

ISBN: 0743254430 SUGGESTED TEXT(S): Clark, M.J. (2002). Community health nursing: caring for populations (4th ed.). Prentice Hall. ISBN: 0130941492

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VIII. Sample Syllabus 1.2: Nursing, cont. COURSE POLICY: 1. Class attendance and participation are required.

2. Any student who will miss an exam must notify faculty ////before the exam. Failure to do so will result in a grade of 0 on the exam.

3. You must pass the clinical co-requisite in order to progress

////in the program. 4. All papers must be written using APA format.

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VIII. Sample Syllabus 1.2: Nursing, cont. CONTENT OUTLINE: Week 1

• Brief history of community health and public health (Competencies 8, 9) • Organizations in community health • Introduction to Epidemiology in Community Health • Community Assessment & intervention principles • Health Education in the community • Emergency preparedness and disaster preparedness at the community level (Competencies 1, 2)

Week 2

• School Health • Asthma in the community: applying principles of surveillance, health education & public health in the community. • Environmental health and Occupational health: applying principles of surveillance, health education & public health in the

community. (Competency 5) • Contraception in the community: applying principles of surveillance, health education & public health in the community. • Sexually transmitted diseases: applying principles of surveillance, health education & public health in the

community.

Week 3 • International comparative healthcare systems, International infectious disease • Communicable disease & Immunization: applying principles of surveillance, health education & public health in the

community. Focus on Tuberculosis. • Hepatitis: applying principles of surveillance, health education & public health in the community. (Competency 3) • Vector born illness: applying principles of surveillance, health education & public health in the community. (Competency 4) • Malnutrition & GI parasitology: applying principles of surveillance, health education & public health in the community.

Week 4

• Violence in the community • Domestic Violence • Drug and Alcohol Abuse • Caring for correctional communities • Foster care

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VIII. Sample Syllabus 1.2: Nursing, cont. Week 5

• Domestic HIV/AIDS, HIV counseling and testing • Health insurance/ Medicaid & Medicare • Final Exam review • Final Exam

Guidelines for Community Assessment and Intervention Project: Please submit topics on the second Tuesday of class via email for written approval by Professor XXXXX. The due date for each group’s presentation will be assigned on the first day of class.

Part 1: Community Assessment Objective

• To introduce the class to the community for which you have designed your intervention. Method

• Lecture format with Power Point • Not to exceed fifteen (15) slides and not to exceed ten minutes presentation time.

Directions • Assess a community that one or more of the students in the group is exposed to in community clinical rotation. You may do

an assessment of the health care provider community or the patient/health care recipient community. You may request approval to assess a community outside the scope of your group members’ community placements. An example of this would be an international or historical community.

• At least two (2) students should present the power point portion of this assignment • The power point presentation should include the following:

• References: please choose current sources, specific to your community. Data obtained via a community assessment interview process is ideal (minimum n=10). Data obtained from reliable community resources (ie. Providers on site) is highly appropriate, but should be reviewed for accuracy by the group.

• Epidemiological overview of community (4 relevant statistics) • Factors affecting health of the community

o Physical and environmental factors (2) o Social and Cultural Factors (2)

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• Needs and strengths of community (2 to 4 of each) • Summary slide of developmental, psychosocial, and socioeconomic status of the community. Include literacy level

here. • Define the “gatekeepers” of the community (2) • How can this community be organized for change? Please discuss a potential grassroots initiative. (1) • Define the roles of the community health nurse within the community. (2 to 3) • Give examples of evaluation methods for community health nurse interventions. (2 to 3) • Please prepare a printed version of the power point (6 slide to a page format) for submission to Professor XXXX at the

time of your presentation. • Resources: Please refer to chapters 1,3 and 5 in the required text.

Part 2: Community Intervention Objectives

• To design, implement and evaluate a ‘real life’ community intervention based on the health education concepts discussed in class.

• To gain proficiency in your current role as student nurse educator and potential future role as community health nurse and nurse educator.

• To have the class gain insight, understanding and cultural awareness regarding unique and potentially high risk populations or target groups.

Method

• General class instruction (Non-traditional instruction formats may be appropriate) • Not to exceed twenty (20) minutes presentation time

Directions

• Present a health education intervention to the class, as though the class is the community you assessed in Part 1 of this project.

• At least two students (different than those students who presented in part 1) should present the intervention portion of this assignment.

• Group participants who are not presenting as student nurse educators may be dispersed throughout the audience and ask questions or voice opinions and concerns that may represent the community being addressed. All group members should be culturally competent and maintain a high level of cultural sensitivity during this process.

• Group participants who are not presenting as student nurse educators may represent educators of other disciplines.

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• Dissemination of large amounts of health information should be followed up with a written document. Please create an original document at the appropriate literacy level for this community and be prepared with 35 copies for class distribution. If your target group can’t read, it may be feasible to use a picture document.

• Conclude the intervention with an appropriate evaluation tool. • This intervention must indicate that an appropriate developmental, psychosocial and socioeconomic assessment

has been performed. ***** • Creativity is welcome!

In total your group presentation should not exceed 30 minutes! The trick to the power point component is simplicity! NO MORE THAN 15 SLIDES PLEASE.


84

VIII. Sample Syllabus 1.3: Dentistry

Consider where to incorporate Emergency Preparedness Competencies within this sample

Oral Public Health and Community Service Program, Summer 2005

This course addresses the following questions:

• What are Public Health, Civic Engagement, and Community Service, and how do they relate to general health and well-being?

• What are the fundamentals of epidemiology and biostatistics and what are their practical applications in general health and healthcare?

• Why are oral health and oral healthcare access major public health issues world-wide? • How do the oral public health issues of water fluoridation, mercury disposal, HIV/AIDS, cancer, and tobacco use

impact general health and well-being? • How can the strategies and methods of community-based healthcare systems development make a positive impact

on oral health and oral healthcare access?

Course Description

This program examines the impact of society, disparate cultures, attitudes, health beliefs and risk behaviors on oral public health. The fundamental principles and practices of public health, epidemiology, civic engagement, and community service are presented from a practical and applied perspective. The significance of oral diseases and disorders as a “silent epidemic” and their grave impact on general health and well-being is emphasized, including specific examples of current issues and “hot topics” in oral public health. Strategies and methods to overcome existing substantial impediments to oral healthcare access for the most needy, vulnerable and underserved populations, is discussed from the perspective of community-based healthcare systems development. The course is principally a lecture/seminar format, with readings, case studies, assigned learning experience project and final paper. Students are expected to participate actively in class discussion.

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VIII. Sample Syllabus 1.3: Dentistry, cont. Please note that the course as presented here does not contain the full content of the course as taught at Tufts. The included content is based on material the Tufts faculty and instructors choose to include, as well as factors such as content preparation, software compatibility, and intellectual property and copyright restrictions. Objectives

• Demonstrate a broad understanding of the underlying factors influencing public health and oral public health, including social, cultural, behavioral, economical and political determinants of health.

• Apply the principles and practices of epidemiology, statistics and the behavioral sciences to oral public health and to critical review of the scientific literature.

• Describe the types of research designs used for descriptive, analytic, and experimental inquiry. • Describe evidence-based clinical practice and reis assessment and their application to clinical dentistry. • Describe the major issues and obstacles in oral public health, and their possible resolutions. • Demonstrate an understanding of the principles and practices of planning, developing, implementing and

evaluating oral health care delivery systems. • To develop the student's civic engagement, social and cultural awareness and knowledge and skills needed to

provide quality oral health care services to underserved populations. • To develop the students' professional and ethical growth by providing compassionate quality oral health care to

disparate, underserved, and disadvantaged patient populations.

1. Grading and Assessment • Three case studies periodically assigned during the academic term 25% • ALE Final Paper25% • Final written exam50%

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VIII. Sample Syllabus 1.3: Dentistry, cont. Lectures 1. Overview 2. The Science of Public Health: Epidemiology and Biostatistics Competencies 2, 6) 3. Issues and Hot Topics in Oral Public Health (Competencies 1, 2, 11) 4. Oral Public Health Strategies and Methods (Competencies 4, 5, 7) Oral Public Health - Stand-Alone Assignments Author: XXXX

1. Applied Learning Experience (ALE) Final Paper

Students will submit a final paper documenting a public health/community service (PH/CS) research project, a practical PH/CS experience or project they are or have recently been involved in, or a literature review on a relevant current PH/CS issue. Further details, guidelines and suggestions for the final paper will be provided to students under separate cover.

The ALE final paper will count toward 25% of the grade.

Original syllabus found at http://ocw.tufts.edu/Course/11/Coursehome

SECTION TAB

PLACEHOLDER

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IX. Resources:

Columbia University - Common Competencies in Emergency Preparedness for the Health Sciences

Competency School Specific Language

School of Public Health School of Nursing School of Dental and Oral Surgery

College of Physicians and Surgeons

I. Emergency Management Principles

1. Phases of disaster management Explain Describe Describe Describe

2. Hazards risk assessment a. Concept Explain Explain Describe Describe b. Methods Explain Describe Describe Describe c. Uses Explain Describe Describe Describe

3. Response Functional Roles

a. Role of the citizen , community, volunteers, and various health sectors and agencies in disaster planning and response.

Explain Describe Describe Describe

b. Concept of disaster response functional role, and the disaster response functional role for one's profession.

Explain Explain Demonstrate Describe

c. Ability to perform basic disaster response functional roles that are commonly used in one's profession.

Apply (depending on department and what is meant

by roles) Demonstrate Demonstrate Demonstrate

d. Importance of maintaining expertise and knowledge in this area of practice, and participating in emergency response drills.

Explain Discuss Describe Describe

88




e. Ability to apply knowledge and experience to new situations that are posed by the emergency without exceeding authority or capabilities.

Explain Demonstrate Demonstrate Demonstrate

f. Importance of personal and family preparedness and the need to incorporate one's functional role into the context of family and personal concerns.

Explain Explain List Describe

4. Incident Command System (ICS)

a. Concept of incident command and incident management, and how it is applied at the federal, state, local, agency and institutional level.


b. Concept and function of an emergency operations center. Explain Describe Describe Describe

5. Integration with Emergency Management

a. Processes and lines of communication in coordinated multi-agency emergency response at the local, state and national level.

Explain Describe Describe List

89




b. Concepts of and contributions to emergency response evaluation activities, exercises and scenario-based events.

Apply quantitive or qualitative analysis (needs some

rewording and depends by department)

Describe Describe Describe

c. Social, moral and ethical challenges that emanate from disaster planning and response.

Apply quantitive or qualitative analysis (needs some

rewording and depends by department)

Describe Describe Describe

6. Communication a. Risk communication principles and their application during disasters.

Explain Describe List Describe

b. Sources to obtain accurate information during all phases of a disaster or other emergency event.

Explain Describe List List

7. Governmental Resources and Authority

a. State and federal resources that contribute to emergency management and response at the local level e.g. SNS, DMAT, MMRS


b. Basic legal and regulatory issues related to emergency preparedness including those pertaining to healthcare.

Explain Explain Describe Describe

8. Preparedness Evaluation

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Contribution of one's profession to regular emergency response drills and evaluations as a means of maintaining expertise and knowledge.

Explain Explain N/A (No response)

Terrorism II. Terrorism and Public Health Emergency Preparedness

1. Chemical biologic, radiological and explosive agents.

a. Knowledge of the major classes of chemical, biologic, radiological, nuclear and explosive agents that can be used as terrorist weapons.

List List Describe Describe

2. Biologic Agents

a. Knowledge of Category A biologic agents, including epidemiology, routes of exposure, treatments and infection control principles.

Explain Demonstrate Describe Describe

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School of

Public Health

School of Nursing School of Dental and Oral Surgery


b. Knowledge of Category B biologic agents. Explain List Describe Describe

3. Chemical agents

a. Knowledge of general classes of potential chemical weapons, including mechanisms of exposure, decontamination and treatment principles and concepts of personal protection.

Explain Demonstrate Describe Describe

4. Radiological Agents

a. Types of radiation associated with potential terrorist devices, including mechanisms of distribution, effects of exposure, treatment and personal protection.



a. Basic principles of selection and use of personal protective equipment appropriate to a range of situations typical of one's profession.

Explain Demonstrate Demonstrate Demonstrate

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School of

Public Health

School of Nursing School of Dental and Oral Surgery


b. Principles and application of decontamination

(No Response) Describe (No Response)

III. Public Health Surveillance and Response

1. Principles and Practice of Surveillance

a. Principles of surveillance and individual reporting of potential or actual emergencies that could affect the health of a community.

Apply Describe List Describe

b. Procedures used to collect patient data for surveillance or tracking. Apply Demonstrate Describe List

c. Unusual clinical scenarios that may represent sentinel cases of victims of an unannounced use of CBRNE.

Identify Demonstrate Knowledge Demonstrate Describe

2. Interventions

a. Public health interventions that are part of the response to public health emergencies such as the use of CBRNE.


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School of Public Health School of Nursing School of

Dental and Oral Surgery


IV. Patent Care for Disasters, Terrorism and Public Heath Emergencies

1. Take medical histories that: a. determine the absence or presence of symptoms that are characteristic of exposure to CBRNE.

Demonstrate

Demonstrate

Demonstrate

b. identify patients who may have psychological trauma following a CBRNE event

Demonstrate

Demonstrate

Demonstrate

c. Identify occupational and psychosocial risks for exposure to potential CBRNE.

Demonstrate

Describe

Describe

d. characterize exposures to potential CBRNE, including type of agent, timing, and length of exposure.

Demonstrate

Describe

List

2. Ability to conduct physical exams that: a. are guided by exposure or potential exposure to CBRNE.

Demonstrate

Demonstrate

Demonstrate

b. determine the absence or presence of physical signs that are characteristic of exposure to CBRNE.

Demonstrate

Demonstrate

Demonstrate

3. Identify patterns of signs and symptoms likely to be associated with occult exposure to CBRNE.

Demonstrate

Describe

Demonstrate

4. Interpret results of the medical history, physical exam, and diagnostic workup to determine an accurate diagnosis of CBRNE exposure.

N

OT A

PP

LICA

BLE

Demonstrate

Demonstrate

Demonstrate

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School of Public Health School of Nursing

School of Dental and

Oral Surgery College of Physicians and

Surgeons

5. Incorporate evidence-based diagnostic procedures and laboratory studies to confirm the diagnoses and/or causative agents.

Demonstrate

Demonstrate

Demonstrate

6. Knowledge of signs and symptoms of acute or delayed critical incident stress reaction among community members or responders.

N/A

Describe

Demonstrate

7. Pharmaceutics and pharmaceuticals used to combat CBRNE e.g., burn therapies, biochemical antidotes, antibiotics, vaccines.

Identify (and describe range of

resources to address)

Describe

Describe

8. Consider critical aspects of treatment plans for patients who may have been affected physically and/or psychologically by CBRNE including:

Describe and provide care as appropriate to

specific position/role

Demonstrate

a. Acute care management See 8 Demonstrate Demonstrate

b. Long-term management See 8 N/A Describe c. Secondary and tertiary prevention See 8 N/A List d. Attention to mental health concerns See 8 N/A Demonstrate

e. Referrals See 8 Demonstrate Demonstrate f. Awareness of concomitant psychosocial issues

See 8

Describe

Demonstrate

g. Consultation with public health authorities

N

OT A

PP

LICA

LBE

See 8 N/A Describe

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School of Public Health School of Nursing

School of Dental and

Oral Surgery College of Physicians and

Surgeons

h. The ability to use appropriate precautions to prevent CBRNE exposure to other patients, care providers, and themselves (e.g., isolation, decontamination, personal protective equipment, appropriate waste disposal)

See 8

Demonstrate

Demonstrate

9. Recognize the need for, and to collect and preserve, forensic evidence from patients who may be victims of a CBRNE event.

N

OT A

PP

LICA

BLE

Describe

Demonstrate

Describe


96

IX. Resources:

Sample Lesson Plan Format

Epidemiology

COMPETENCY: Institute appropriate steps to limit spread, including infection control measures, decontamination techniques and use of appropriate person protective equipment SUBCOMPETENCY: Activate infection control measures specific to agent EPIDEMIOLOGY COURSE OBJECTIVES:

• Describe the infectious disease process. • Describe prevention and control interventions to prevent transmission. • Identify infectious diseases, and associated pathogens • Describe their diagnosis, transmission, clinical presentation, prevention and control

METHOD

• Lecture • Audio Visual • Computer Assisted • Web-Based Module • Demonstration • Hands-On Learning

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IX. Resources:

Sample Lesson Plan Format , cont. CONTENT Epidemiology of infectious disease process 1. Epidemiologic triangle

• Agent • Host • Environment

2. Infectious disease process • Natural history • Exposure • Incubation period • Onset of symptoms/ clinical disease • Recovery, disability, or death • Clinical spectrum of disease

• sub clinical • clinical • carriers

3. Characteristics of Microbes • Invasiveness • Pathogenicity • Virulence • Infectious dose

4. Chain of Infection • Agent

• bacteria • viruses • fungi (yeasts & molds) • parasites

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IX. Resources:

Sample Lesson Plan Format, cont. • Reservoir

• people • fomites • water

• Exit • excretions & secretions • body fluids • respiratory tract

• Modes of Transmission • Direct

• direct contact • droplet

• Indirect • airborne • vehicle • vector

• Portal of entry • GI tract • skin • mucous membranes • respiratory tract

• Susceptible host • nonspecific defense mechanisms • specific defense mechanisms

99

IX. Resources:

Sample Lesson Plan Format, cont. 5. Infection prevention and control methods

• Hand hygiene- just review • Isolation precautions • HICPAC

• isolation guidelines • How to read it Recommendations • PPE (INTRODUCE LEVELS OF BT SPECIFIC PROTECTION)

• Cleaning/ disinfection/ sterilization • Immunization • Safe work practices

6. Infectious Diseases (Specific to include WMD)

• AGENT • Organism • Transmission • Clinical presentation • Diagnosis • Prevention & control • Post exposure management

EVALUATION

• Written Exam • Pre-Test • Post-Test • Verbalization • Return- Demonstration


100

IX. Resources:

BIBLIOGRAPHY

1. Public Health Emergency Response Guide for state, local, & tribal public health directors- Dept. of Health and Human Services- CDC and Prevention; available at: http://www.bt.cdc.gov/planning/responseguide.asp Accessed June 2006.

2. BT & Emergency Readiness Competencies for all PH workers- Public Health Ready, Columbia and NACCHO,

Columbia University School of Nursing Center for Health Policy, CDC and Prevention/Association of Teachers and Preventive Medicine Agreement #TS0740- November 2002; available at: http://www.nursing.hs.columbia.edu/institutes-centers/chphsr/btcomps.html Accessed June 2006.

3. Instructions for use of Emergency Preparedness core competencies for all public health workers training program -

Columbia University-Center for Public Health Preparedness(CPHP); available at: http://www.ncdp.mailman.columbia.edu/program_cphp.htm Accessed June 2006.

4. Generic: Basic Emergency Preparedness Competency Training Program -Sample pre and post test questions for

measuring achievement of emergency preparedness learning objectives- CPHP, available at: http://www.ncdp.mailman.columbia.edu/program_cphp.htm Accessed June 2006.

5. Core Public Health Worker Competencies for Emergency Preparedness and Response -Local Public Health

Competency for Emergency Response- Columbia University- School of Nursing Center for Health Policy, April 2001; available at: http://www.cumc.columbia.edu/dept/nursing/research/ResCenters/chphsr/index.html Accessed June 2006.

6. Oswego –An Outbreak of Gastrointestinal Illness Following a Church Supper, Instructor’s Guide - CDC and

Prevention- Epidemiology program office case studies in applied Epidemiology No. 401-403.

7. Compendium of acute food borne and waterborne diseases - CDC, Epidemiology Program Office; 2003.

101

IX. Resources:

BIBLIOGRAPHY, cont.

8. Suspected Legionnaires ’ disease in Bogalusa- Instructor’s Guide, Student’s Guide - CDC- Epidemiology Program Office- Case studies in applied Epidemiology No. 912-303- Dept of Health and Human Services/EIS 2003.

9. Texarkana -Epidemic Measles in a Divided City-Instructor's Guide - CDC and Prevention, Epidemiology program

office, Case studies in applied Epidemiology No. 711-903- US Dept of Health and Human Services/EIS, 2003. 10. Paralytic Illness in Ababo- Instructor’s Guide -CDC and Prevention Epidemiology Program office, case studies in

applied Epidemiology- No. 891-903- Dept. of Health and Human Services/EIS 2003.

11. An Epidemic of Thyrotoxicosis- Instructor’s Guide - CDC and Prevention Epidemiology Program office, case studies in applied Epidemiology No. 873-903-Dept. of Health and Human Services/EIS 2003.

12. Homeland Insecurity: Building expertise to Defend America from Bioterrorism - Partnership for public service;

available at http://www.ourpublicservice.org Accessed June 2006. 13. Principles of Epidemiology Second Edition An Introduction to Applied Epidemiology & Biostatistics - US Dept of

Health and Human Services, CDC and Prevention, December 1992. 14. Terrorist CBRN Materials & Effects - Central Intelligence Agency- May 2003. 15. Compendium of Federal Terrorism Training For State & Local Audiences - Central Intelligence Agency, June 10,

2004. 16. Criminal and Epidemiological Investigation Handbook - 1. U.S. Dept. of Justice, 2. Federal Bureau of Investigation, 3. U.S. Army Soldier Biological chemical command; 2003. 17. Office For Domestic Preparedness Guidelines For Homeland Security: Prevention & Deterrence - U.S. Dept of //////Homeland Security June 2003.

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IX. Resources:

BIBLIOGRAPHY, cont. 18. Homeland Security Exercise & Evaluation Program Vol I: Overview & Doctrine - U.S. Dept. of Homeland Security,

Office for Domestic Preparedness, May 2004. 19. Homeland Security Exercise & Evaluation Program Vol II: Exercise Evaluation & Improvement - U.S. Dept. of

Homeland Security, Office for Domestic Preparedness; October 2003. 20. Homeland Security Exercise and Evaluation Program Volume III: Exercise Program Management and Exercise

Planning Process - U.S. Dept of Homeland Security, Office for Domestic Preparedness; July 2004. 21 ODP WMD Training Program Enhancing State and Local Capabilities to Respond to Incidents of Terrorism - Dept.

of Homeland Security, Office for Preparedness; October 2004. 22. Fire and Emergency Services Preparedness Guide for the Homeland Security Advisory System First Edition –

Federal Emergency Management Association (FEMA); January 2004. 23. Vulnerability Assessment Methodologies Report - U.S. Dept. of Homeland Security, Phase I Final Report, Office for

Preparedness; July 2003. 24. Guidance for Water Utility Response, Recovery and Remediation actions for man-made and/or technological

emergencies - Environmental Protection Agency, Office of Water April 2002. Available at: www.epa.gov/safewater Accessed June 2006.

25. Emergency Responder Guidelines(29)- Office of Justice Programs Office for Domestic Preparedness; August

2002, available at: http://www.ojp.usdoj.gov/odp Accessed June 2006.

26. National Response Plan - U.S. Dept. of Homeland Security; December 2004. 27. GIS for Homeland Security - ESRI 2001.

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IX. Resources:

BIBLIOGRAPHY, cont. 28. Bioterrorism Readiness Plan: A Template for Healthcare Facilities, APIC Bioterrorism Task Force - CDC Hospital Infections Program Bioterrorism Working Group; April 13, 1999.

29. Second Edition Medical Management of Radiological Casualties Handbook - Military Medical Operations Armed //////Forces Radiobiology Research Institute Bethesda, Maryland 20889–5603; April, 2003; available at: //////http://www.afrri.usuhs.mil.

30. Dept of Homeland Security Working Group on Radiological Dispersal Device (RDD) /Preparedness Medical Preparedness & response Sub-Group - Dept. Of Veteran Affairs, Dept. /Of Health and Human Services; May 1, 2003. 31. Managing Hazardous Materials Incidents- A Planning Guide for the Management of Contaminated Patients - A three volume series, Agency for Toxic Substances and Disease Registry; March 2001.

32. National Strategy for Combating Terrorism - U.S. Dept. of Homeland Security; February 2003. 33. National Incident Management System - U.S. Dept. of Homeland Security, available at: http://www.nimsonline.com ////// /Accessed June 2006. 34. Aid for Decontamination of Fire and Rescue Service Protective Clothing and Equipment After Chemical, Biological, ////////and Radiological Exposures - Lawson, J. Randall, Jarboe, Theodore L. National Institutes of Standards and ///////Technology(NIST) Special Publication 981, US Dept of Commerce, May 2002. 35. Homeland Security Preparedness Technical Assistance Program (HSPTAP) - Technical Assistance Catalog- U.S. ///////Dept. of Homeland Security. 36. Terrorism with Ionizing Radiation General Guidance Pocket Guide - Produced by the Employee Education System ////////or the Office of Public Health and Environmental Hazards, Department of Veterans Affairs; August 2003.

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IX. Resources:

BIBLIOGRAPHY, cont. 37. Interim Recommendations for Firefighters and Other First Responders for the Selection & Use of Protective ///////////Clothing and Respirators against Biological Agents(43)- U.S. Dept. of Health and Human Services, CDC. 38. What Every Public Safety Officer Should Know About –Radiation & Radioactive Materials National Law ///////Enforcement and Corrective Technology Center, National Institute of Justice; available at http://www.justnet.org.

39. Radiological Emergency Management - Independent Study Course – FEMA.

40. Smallpox Clinical Poster - Dept. of Health and Human Services, Center for Disease Control and Prevention.

41. Terrorist Organization Reference Guide - U.S. Dept. of Homeland Security, U.S. Customs and Border Protection, /////////Office of Border Patrol.

42. WHO Building Capacities for Risk Reduction - Disaster Management Training Programme,1997.

43. DHS WMD Awareness Course - U.S. Dept. of Homeland Security, Office for Domestic Preparedness, Center for /////////Domestic Preparedness.

44. Hospital Provider Course- Defense against WMD)- Office for Domestic Preparedness.

45. Nat’l Incident Management System Overview - U.S. Dept. of Homeland Security, National Incident /////////Management System, Integration Center.

46. CDC Anthrax - Center for Disease Control and Prevention; available at: http://www.bt.gov Accessed June 2006.

Documents

WorkshopMaterialsBooklet (1)