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Human Resources at U.S. Ports of Entry to Protect the Public’s Health: Interim Letter Report Human Resources at U.S. Ports of Entry to Protect the Public’s Health Interim Letter Report Committee on Measures to Enhance the Effectiveness of CDC Quarantine Station Expansion Plan for U.S. Ports of Entry Board on Global Health Board on Health Promotion and Disease Prevention INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu
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Human Resources at U.S. Ports of Entry to Protect the Public’s Health: Interim Letter Report THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. 200-2000-00629, Task Order No. 31 between the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Additional copies of this report are available from the Institute of Medicine, 500 Fifth Street, N.W., Washington, DC 20001; Internet, http://www.iom.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2005 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
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Human Resources at U.S. Ports of Entry to Protect the Public’s Health: Interim Letter Report “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Adviser to the Nation to Improve Health
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Human Resources at U.S. Ports of Entry to Protect the Public’s Health: Interim Letter Report THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org
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Human Resources at U.S. Ports of Entry to Protect the Public’s Health: Interim Letter Report COMMITTEE ON MEASURES TO ENHANCE THE EFFECTIVENESS OF CDC QUARANTINE STATION EXPANSION PLAN FOR U.S. PORTS OF ENTRY GEORGES C. BENJAMIN, M.D. (Chair), Executive Director, American Public Health Association JOAN M. ARNOLDI, D.V.M. 1, Retired, Animal and Plant Health Inspection Service, U.S. Department of Agriculture BARBARA A. BLAKENEY, M.S., R.N., President, American Nurses Association LAWRENCE O. GOSTIN, J.D., Professor of Law, Georgetown University Law Center MARGARET A. HAMBURG, M.D., Vice President for Biological Programs, Nuclear Threat Initiative FARZAD MOSTASHARI, M.D., M.S.P.H., Assistant Commissioner, Bureau of Epidemiological Services, New York City Department of Health WILLIAM A. PETRI, Jr., M.D., Ph.D., Chief, Division of International Health and Infectious Diseases, University of Virginia Health System ARTHUR L. REINGOLD, M.D., Professor of Epidemiology, School of Public Health, University of California at Berkeley RONALD K. ST. JOHN, M.D., M.P.H., Director General, Centre for Emergency Preparedness and Response, Public Health Agency of Canada KATHLEEN E. TOOMEY, M.D., M.P.H., Director2, Division of Public Health, Georgia State Health Department MARY E. WILSON, M.D., Associate Professor of Medicine, Harvard Medical School Study Staff KATHLEEN STRATTON, Ph.D., Study Director LAURA B. SIVITZ, M.S.J., Research Associate DAVID W. GILES, Research Assistant SHEYI LAWOYIN, Senior Program Assistant PATRICK KELLEY, M.D., Ph.D., Director, Board on Global Health ROSE MARIE MARTINEZ, Sc.D., Director, Board on Health Promotion and Disease Prevention 1 Dr. Arnoldi resigned from the committee on December 21, 2004. 2 Dr. Toomey resigned from the Georgia State Health Department effective January 15, 2005.
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Human Resources at U.S. Ports of Entry to Protect the Public’s Health: Interim Letter Report Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Ruth L. Berkelman, M.D., M.P.H., Rollins School of Public Health, Emory University Donald S. Burke, M.D. Johns Hopkins Bloomberg School of Public Health Kathleen F. Gensheimer, M.D., M.P.H., Maine Department of Health and Human Services Ann Marie Kimball, M.D., School of Public Health, University of Washington Bonnie Kostelecky, R.N., M.S., M.P.A., Multnomah County Health Department, Portland Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final report before its release. The review of this report was overseen by Hugh H. Tilson, M.D., Dr.P.H., School of Public Health, University of North Carolina. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
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Human Resources at U.S. Ports of Entry to Protect the Public’s Health: Interim Letter Report Contents HISTORIC CONTEXT 1 Dismantling of Quarantine Station System, 1 Emergence of Infectious Diseases and the Threat of Bioterrorism, 3 U.S. Government Invests in Biosecurity, 5 VISION FOR THE EXPANDED QUARANTINE STATION SYSTEM 5 Guidance Sought from IOM, 7 FUNCTIONS AND COMPETENCIES 7 Guiding Framework, 7 I. Conduct Historic Functions, 8 II. Plan for Public Health Threats, 10 III. Conduct Surveillance for Public Health Threats, 11 IV. Assess and Respond to Public Health Threats, 12 V. Communicate the Nature of Diseases, Risks, and Responses, 13 VI. Create Linkages across Sectors and Jurisdictions, 16 TYPES OF HEALTH PROFESSIONALS 16 CONCLUDING REMARKS 17 REFERENCES 19
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Human Resources at U.S. Ports of Entry to Protect the Public’s Health: Interim Letter Report Tables, Figures, and Boxes TABLES 1-1 Number of Employees and Contractors at Each CDC Quarantine Station at U.S. Ports of Entry, Mid-2004, 2 1-2 Types of Workers Who Could Conduct the Priority Functions Necessary for the Surveillance for, Detection of, and Response to Microbial Threats at U.S. Ports of Entry, 18 FIGURES 1-1 DGMQ’s proposed geographic distribution of the 25 quarantine stations, 6 BOXES 1-1 Statement of Task, 2 1-2 Quarantinable Communicable Diseases, 3 1-3 Class A and Class B Conditions, 4 1-4 Priority Functions, 7