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JADA Continuing Education

	ABSTRACT

TOP ABSTRACT DISASTER RESPONSE MATERIALS AND METHODS DISCUSSION CONCLUSIONS REFERENCES

 
Background. Ongoing vigilance by governments, public health agencies and health care professionals monitoring potential epidemic and pandemic outbreaks, terrorist threats and ever-present natural disasters requires the continuous evolution of comprehensive disaster response plans and teams, which include the integration of oral health care professionals.

Methods. The authors conducted a study in which oral health care professionals assessed their training in the American Medical Association’s (AMA’s) National Disaster Life Support (NDLS) courses. At the conclusion of each instructional session, the authors asked participants to complete an anonymous course evaluation form to report their impressions of the training activity. The authors included in the analysis those evaluations associated with sessions attended almost exclusively by dentists and hygienists.

Results. The authors derived descriptive statistics from the selected course evaluations. Overall, oral health care professionals believed that the Core Disaster Life Support (CDLS) and Basic Disaster Life Support (BDLS) courses were of great educational value, rating course impact at 9.50 and 9.29, respectively, on a scale from 1 to 10.

Conclusions. Statistical evaluation instruments reveal satisfaction with the all-hazards awareness training received through the AMA’s NDLS disaster medicine training curriculum. Licensed oral health care professionals in Illinois accepted the utility and merits of, and benefited from, the four-hour CDLS and eight-hour BDLS certification programs.

Practice Implications. Dental professionals in Illinois require minimal additional training for dental emergency responder duties. The AMA’s NDLS curriculum provides effective preparation for dental professionals.

Key Words: Dental emergency responder; pandemic training; disaster medicine training; Core Disaster Life Support; Basic Disaster Life Support

Abbreviations: AMA: American Medical Association • BDLS: Basic Disaster Life Support • CDLS: Core Disaster Life Support • DEMRT: Disaster Emergency Medicine Readiness Training • DER: Dental emergency responder • IDFPR: Illinois Department of Financial and Professional Regulations • IDPH: Illinois Department of Public Health • IEMA: Illinois Emergency Management Agency • NDLS: National Disaster Life Support • NIMS: National Incident Management System • UIC: University of Illinois at Chicago

Discussion of the role of the oral health care provider functioning within the disaster and emergency medicine paradigm began in 1996, with a report by Morlang¹ describing the role of the dentist in the military.

	DISASTER RESPONSE

TOP ABSTRACT DISASTER RESPONSE MATERIALS AND METHODS DISCUSSION CONCLUSIONS REFERENCES

 
After Sept. 11, 2001, many members of the oral health care community began to identify potential roles that they can play in detecting and responding to bioterrorism.^2–13 Federal, medical and dental policy experts, academics and researchers have defined the educational and training requirements needed by oral health care professionals to be considered appropriately trained for disaster response.^2,14 Academic institutions are responding by striving to include disaster response in the professional dental curriculum,^15–19 while practicing professionals seek appropriate, professionally sanctioned and credentialed continuing education opportunities for disaster medicine.

Disasters demand the integrated response of health care professionals and the expansion of "scopes of practice" leading to collaborations among professionals that extend traditional and historical professional boundaries.²⁰ Delicate and sensitive collaborations, consensus building and education (including outreach to the public) among elected officials, government agencies, professional organizations and the public must be accomplished; local or state governments will not sanction such collaborations without a full understanding of the benefits to the public.²¹ Public acceptance with respect to such collaborative efforts is manifested through legislation and professional recognition.

Regardless of origin, all disasters are managed primarily at the local level and reflect the unique environments, needs and risks within a given community, jurisdiction and state. The efficacy of the response effort is linked directly to the ability of community members to recognize an event, activate appropriate response plans and integrate seamlessly with support agencies within the federal and state hierarchies.

Legislation. Two important pieces of legislation in Illinois that affect health care professionals—and oral health care professionals in particular—are Public Acts 94–409 and 94–733. Public Act 94–409, effective Jan. 1, 2006, defines, for the first time nationally, the dental emergency responder (DER) within the Illinois Dental Practice Act. A DER is a dentist or dental hygienist certified by the State of Illinois in emergency medicine who is acting within the scope of practice when administering total-body care during a declared local, state or federal emergency as part of a recognized response organization. Colvard and colleagues²¹ discussed the details of this act and the specific roles of the DER.

Public Act 94–733 (originally Senate Bill 2921) amends the Department of Professional Regulation Law of the Civil Administrative Code of Illinois and allows the secretary of the Illinois Department of Financial and Professional Regulations (IDFPR) to have flexibility during emergencies when acting in conjunction with the Illinois Department of Public Health (IDPH) and the Illinois Emergency Management Agency (IEMA). During declared emergencies and disasters, the IDFPR may suspend temporary and permanent licensure requirements and may expand the scope of practice for professionals licensed in Illinois if they are working under the direction of IDPH and IEMA. This amendment took effect in the state on April 27, 2006.

As a result of these provisions in Illinois, the possibility of a DER’s working as a member of a disaster response team alongside a pharmacist working in an expanded scope and an emergency department nurse from another state, all supervised by a paramedic, becomes a realistic scenario. Mass casualty incidents require an "all hands on deck" approach. However, blending people from such diverse professional backgrounds will not occur without planning and training. The greater the respect and prior rapport between responders, the more functional the multidisciplinary team will be under the duress of a disaster response.

In addition to the guidelines issued by professional organizations and state agencies, the National Incident Management System (NIMS) provides a set of guidelines and recommendations for disaster response plans and recommends that training programs involve standard classes (that is, they provide consistent curricula across training sessions), as well as multidisciplinary and multijurisdictional events, to improve professional interoperability during a disaster.²²

National Disaster Life Support Foundation. In response to the national need for all-hazards training, the American Medical Association’s (AMA’s) National Disaster Life Support (NDLS) Foundation designed and developed several levels of disaster medicine curricula for health care providers. These courses provide an increasingly advanced set of disaster medicine training standards that are adaptable to each health care provider’s background. The AMA’s NDLS program is analogous to the American Heart Association’s cardiopulmonary resuscitation curriculum, offering a common national standard for all providers, regardless of medical specialization or system of practice (visit "www.bdls.com" for more information).

Disaster Emergency Medicine Readiness Training Center. The Disaster Emergency Medicine Readiness Training (DEMRT) Center ("www.demrt.org") at the University of Illinois at Chicago (UIC) was established in 2003 to serve as a disaster medicine training facility for volunteer responders, with a special focus on the needs of the oral health care community. In spring 2005, the AMA approved the UIC DEMRT Center as one of seven fully accredited NDLS regional training centers in the United States. The UIC DEMRT Center has trained and provided AMA certification to more than 375 oral health care professionals nationally in the AMA’s Core Disaster Life Support (CDLS) and Basic Disaster Life Support (BDLS) programs. However, to date, no analyses have been performed to determine the educational impact of, or participants’ satisfaction with, these courses.

Our goal was to document the experience of the oral health care community in Illinois with the AMA NDLS curricula and to validate the utility of the curricula as a nationally regarded training program available for all oral health care professionals.

	MATERIALS AND METHODS

TOP ABSTRACT DISASTER RESPONSE MATERIALS AND METHODS DISCUSSION CONCLUSIONS REFERENCES

 
Methodology. This study was approved by the UIC Institutional Review Board under research protocol number 2006–0245. From Feb. 25, 2005, to March 13, 2006, DEMRT Center staff members trained and certified more than 260 oral health care professionals in the AMA’s CDLS and BDLS programs. At the conclusion of each CDLS and BDLS course, staff members requested that participants complete an anonymous course evaluation form provided by the AMA, which asked them to assess and rate their experience. We analyzed these evaluations using statistical software (SPSS version 13.0, SPSS, Chicago) to determine the overall perceptions and experiences of oral health care professionals regarding the BDLS and CDLS courses, which were designed originally for traditional medical providers (such as physicians, nurses, emergency medicine technicians). We used for the analyses those surveys (all anonymous) from courses in which almost all of the participants were oral health care professionals. Table 1 provides a complete breakdown of the reported professions.

 
Instructor’s background. Course instructors varied by staff availability; teaching experience of the instructors ranged from two to 25 years. The staff of the DEMRT Center varies in educational and professional backgrounds. All instructors hold a minimum of a bachelor’s degree; their backgrounds include dentistry, public health, chemistry, forensic science and emergency medical services (emergency medical technician-basic and emergency medical technician-paramedic).

One of us (D.M.) performed analyses on 93 course evaluations from CDLS participants and 171 course evaluations from BDLS participants to determine attitudes toward this training program. The first section of the survey instrument focused on the curriculum and the ability of the instructors to convey this information effectively. Participants were asked to rank—on a scale from 1 to 5 (with 5 corresponding to "strongly agree" and 1 corresponding to "strongly disagree")—each section of the course regarding the knowledge of the instructor and whether the presentation facilitated learning.

Instructor’s knowledge. In the first section of the survey, participants were asked to rank how strongly they agreed with the statement that the instructors displayed knowledge of the subject matter they presented. The mean rating for CDLS participants was 4.85, with a range from 4.82 to 4.89. The mean rating for BDLS participants was 4.78, with a range from 4.70 to 4.86. A mean of 97.75 percent of CDLS participants and 97.06 percent of BDLS participants chose a 4 ("agree") or 5 ("strongly agree") for each category, indicating that the instructors appeared to be highly knowledgeable in each subject presented. Tables 2 and 3 provide a complete breakdown of these findings.

View this table: [in this window] [in a new window]   TABLE 2 Core Disaster Life Support program evaluation.

 

View this table: [in this window] [in a new window]   TABLE 3 Basic Disaster Life Support program evaluation.

 
Facilitated learning. The second statement in the first section of the survey prompted participants to indicate how strongly they agreed that the subject matter was presented in a manner that facilitated learning. The mean rating for CDLS participants was 4.73, with a range from 4.68 to 4.82. The mean rating for BDLS participants was 4.66, with a range from 4.52 to 4.72. A mean of 97.12 percent of CDLS participants and 94.77 percent of BDLS participants chose a 4 or 5 for each category. Tables 2 and 3 provide a complete breakdown of participants’ responses.

The second section of the survey instrument focused on the impact of the course on the participant. The survey asked participants to indicate how much educational impact the course had on them, whether the knowledge gained would be used in their practice, and how they felt their knowledge had changed as a result of the CDLS or BDLS training.

Educational value/impact on practice. The survey asked participants to assess—on a scale from 1 to 10 (10 corresponding to "strongly agree")—whether the information they received had educational value, and whether the information gained would affect the way they practiced. On average, participants believed there was great educational value in both courses; the mean rating was 9.50 for the CDLS and 9.29 for the BDLS. When asked whether the course would have an impact on their patients and change the way they practiced, CDLS participants indicated that there would be a significant impact; their mean responses to the two questions were 9.13 and 8.93, respectively. When the BDLS participants were asked to rank how strongly they agreed that the content of the course would have a positive impact on their patients and change the way they practiced, they also indicated that there would be a significant impact; their mean responses to the two questions were 8.26 and 7.97, respectively. Table 4 provides a complete breakdown of the results.

View this table: [in this window] [in a new window]   TABLE 4 Participants’ assessment of educational value and impact on patients.

 
Knowledge gained. The final section of the survey asked participants to assess their knowledge of preparedness before and after the course. Only 24.09 percent of CDLS participants and 13.76 percent of BDLS participants considered themselves to be very knowledgeable about disaster preparedness before the course; 57.83 percent of CDLS participants and 56.88 percent of BDLS participants believed they had little to no knowledge of disaster preparedness at the initiation of the course.

At the conclusion of the CDLS course, 81.71 percent of participants believed they were very knowledgeable about disaster preparedness; 57.32 percent of these participants believed they had experienced improvement by two or more levels (on a scale from 1 to 5) in their knowledge of disaster preparedness. At the conclusion of the BDLS course, 85.90 percent of participants believed they were very knowledgeable about disaster preparedness; 63.46 percent of participants believed they had experienced two or more levels of improvement in their knowledge of disaster preparedness.

	DISCUSSION

TOP ABSTRACT DISASTER RESPONSE MATERIALS AND METHODS DISCUSSION CONCLUSIONS REFERENCES

 
Overall, oral health care professionals in Illinois responded positively to the AMA’s NDLS curricula. When asked to rate their satisfaction with these courses on a scale from 1 to 10, participants reported a mean rating of 9.25 for the CDLS course and 9.06 for the BDLS course. Our analysis of the 264 surveys completed by participants in NDLS courses showed that oral health care professionals are capable of completing these courses and using the knowledge they gained in their practices. Approximately 57 percent of CDLS participants and 63 percent of BDLS participants reported that they experienced significant improvement in their knowledge of disaster preparedness; 82 percent of CDLS participants and 85 percent of BDLS participants believed they had a high level of knowledge after completing the course.

Receiving training that is identical to that received by other health care professionals will encourage rapport between responders and enhance their overall ability to communicate, thereby fulfilling an important NIMS requirement. Including oral health care professionals will not require any new curriculum development and, therefore, will not create an additional burden on training budgets. In addition, this analysis shows that oral health care professionals are willing to receive instruction from people with varied backgrounds and feel strongly that they benefit from it. This implies that future training will not require organizations to augment their training staff to accommodate the needs of the DER.

	CONCLUSIONS

TOP ABSTRACT DISASTER RESPONSE MATERIALS AND METHODS DISCUSSION CONCLUSIONS REFERENCES

 
The results of this survey should have important implications for disaster planners and emergency response teams. Oral health care professionals do not require awareness-level training different from that of other health care providers. The fact that participants believed that the educational experience offered by the CDLS and BDLS programs will affect the way they practice and care for patients should be of significance to coordinators of dental and hygiene programs. Providing students with standardized disaster training that meets the requirements of the American Dental Association and the American Dental Education Association, developed by leaders in disaster medicine, as well as providing recognized training for those from multiple professional backgrounds, will lead to more fully aware practitioners in the field who are capable of interacting with a variety of health care professionals during a disaster.

	FOOTNOTES

Ms. Naiman is a research specialist and co-director, Disaster Emergency Medicine Readiness Training Center, Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois at Chicago, 801 S. Paulina, Chicago, Ill. 60612, e-mail "mnaima1{at}uic.edu". Address reprint requests to Ms. Naiman.

Ms. Mata is a graduate assistant, Disaster Emergency Medicine Readiness Training Center, Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois at Chicago.

Dr. Cordell is a professor emeritus, Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois at Chicago.

At the time this report was written, Dr. Lampiris was the chief, Division of Oral Health, Illinois Department of Public Health, Springfield. He currently is director, Council on Access, Prevention and Interprofessional Relations, American Dental Association, Chicago.

This study was funded by the Illinois Department of Public Health and the National Institutes of Health, National Center for Complementary and Alternative Medicine (NIH/NCCAM grant K08-AT000987).

The authors thank everyone who contributed to this effort. In particular, they recognize the Illinois Department of Public Health for its tireless endorsement of the Illinois dental emergency responder concept and the behind-the-scenes efforts of staff members. They also thank James James, MD, DrPH, MHA, and Ruth-Anne Steinbrecher, MPH, of the American Medical Association’s National Disaster Life Support (NDLS) program office for their continued support of training efforts and provision of the evaluation instrument created for the NDLS program.

	REFERENCES

TOP ABSTRACT DISASTER RESPONSE MATERIALS AND METHODS DISCUSSION CONCLUSIONS REFERENCES

 

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