2002
Primary Health Care Policy Fellows

First Alert Network

Leonard Bauer, MD
Indian Health Service
Lame Deer, Montana

Stephen Bogdewic, PhD
Society of Teachers of Family Medicine
Indianapolis, Indiana

Laura Dean, MD
American College of Obstetricians & Gynecologists
Stillwater, Minnesota

Deborah S. McPherson, MD
American Academy of Family Physicians
Leawood, Kansas

Christine Moranetz, PhD
Association of Teachers of Preventive Medicine
Prairie Village, Kansas

Dennis Richling, MD
Washington Business Group on Health
Omaha, Nebraska

Proposal

The Centers for Disease Control and Prevention (CDC) will establish an inbound help telephone service, 1-800-DOCS911, for primary care providers to obtain clinical decision-making assistance at the point of care. Experts in management of biological, chemical, and nuclear threats will be available to provide assistance in diagnosing suspicious cases, make treatment and prophylaxis recommendations, and assist in the appropriate recommendations for the isolation of the patient. This service will integrate into the developing state Health Alert Network infrastructures, either individually or in regional coalitions, with assistance from the CDC.
A CDC Command Center working with regional Health Alert Networks (HAN) can collect and analyze data from reported incidents and disseminate alerts to providers through an outbound toll-free telephone line.
Development of Internet-based professional assistance for the primary care provider will complement the 800-telephone line. As Internet technology proliferates within the provider community, the 800 line will remain for those providers that will not or cannot adopt the technology.

Background & Rationale

The rapid proliferation of infrastructure to address bioterrorism threats has been most impressive. However, these efforts have been largely designed to provide links between federal agencies and public health departments. The final link needed to maximize the system's effectiveness is a mechanism to:

Provide immediate assistance to primary care providers in their efforts to manage patients in an environment of increasing threats
Provide individual primary care providers with a practical method for obtaining needed clinical decision-making assistance at the point of care
Provide individual primary care providers with a method for communicating potential threats to appropriate federal and state agencies when a suspicious case is encountered

The foot soldiers in the war on bioterrorism are primary care providers. The challenge is one of how to best arm and mobilize this national resource. Elegant attempts to educate primary care providers regarding the identification, response, and treatment of disease risks that are seldom seen or expected through customary venues have been ineffective in changing behavior and will continue to be both impractical and unsuccessful because:

Primary care providers are taught to treat common things commonly and minimize "zebras" during routine patient care. The adage is, "When you hear hoofbeats, think horses, not zebras."
The scientific knowledge base related to bioterrorism is changing rapidly. As we learned from the anthrax cases, biological agents used as weapons may act differently than experts currently believe.
If emerging knowledge is not used frequently it is lost. Studies have demonstrated limited retention of knowledge that is seldom used.

As a result, citizens will continue to be at risk if primary care providers cannot access real time assistance and support for clinical decision making related to bioterrorism. Additionally, research has shown that primary care providers feel they cannot adequately manage a serious infectious disease outbreak and would welcome the help.

The citizens of the US will use their primary care provider, as they do today, to seek care or information about an early medical illness. Thus it may be possible to detect or treat a case before a massive outbreak has begun. It may also be possible to limit the spread of an infectious agent by better management of a suspicious case. The First Alert Network is not designed to manage a major outbreak of an act of bioterrorism. Substantial initiatives to address these overwhelming situations are being developed by the Department of Health and Human Services. In addition, new systems for surveillance and early detection are being advanced (e.g. NEDSS, DEEDS, Lab Alert Network). However, the First Alert Network is designed to provide a large front-line force with critical technology for detecting the suspicious first-case, a situation for which no existing system can account.

Process

A primary care provider places a call to 1-800-DOCS911 for clinical decision-making assistance. The call is automatically routed to the appropriate Health Alert Network (HAN). It is possible that several Health Alert Networks will form coalitions to provide this service. The CDC will receive a simultaneous electronic alert.
HAN provides just-in-time clinical education/consultation to primary care providers with assistance as needed from the CDC.
Incidence data from each primary care provider contact would then be communicated from the HAN to the CDC Command Center.

Benefits

Authoritative information available to every primary care provider in the US
More rapid sentinel detection of nuclear, biological and chemical threats
The ability to recognize and control the magnitude of exposure, particularly across state lines
Higher quality care delivered to individual patients
Mobilized front-line primary care providers
Simple concept that can be implemented quickly based upon existing models (e.g. Poison Control Centers)

Current initiatives to strengthen the public health system will significantly improve the potential for people to survive a bioterrorism attack. However, what remains is the need for a final link in the chain of events between a suspicious first case and the activation of an appropriate public health response. The First Alert Network can close this gap. This system will enable a national network of primary care providers to appropriately recognize and react to an act of bioterrorism. The CDC can act immediately to provide a viable method of linking the primary care provider into the expertise of the public health system by the establishment of the First Alert Network.