On Wednesday, January 22 from 1 – 2:30pm EST, NACCHO hosted a webinar on behalf of several partner organizations to provide an update on public health law research and initiatives related to the Nurse Triage Line Project. More than 60 members from the public health law workgroups of NACCHO, the Association of State and Territorial Health Officials (ASTHO), and the Council of State and Territorial Epidemiologists (CSTE) participated.
The purpose of this webinar was to (1) explain how a coordinated network of telephone triage lines may be useful during a severe pandemic or other public health emergency; (2) identify legal issues and concerns that may be associated with using a coordinated network of telephone triage lines during a severe pandemic or other public health emergency; and (3) discuss possible solutions for resolving issues and concerns.
Dr. Lisa Koonin of the Centers for Disease Control and Prevention (CDC) provided an overview of the project and the need for such a system. The impact of a severe influenza pandemic could be overwhelming to hospital emergency departments, clinics, and medical offices if large numbers of ill people simultaneously seek care. Based on lessons from the 2009 H1N1 pandemic, CDC launched a project that has resulted in collaboration with NACCHO, ASTHO, the American Association of Poison Control Centers, and United Way Worldwide/2-1-1, among other partners, to explore the acceptability and feasibility of using a national, coordinated network of triage telephone lines during a pandemic. These lines will assess the health status of callers, help callers determine the most appropriate site for care (e.g., hospital emergency department, outpatient, home), provide clinical advice, and provide access to antiviral medications for ill people, if appropriate.
To offer context for the discussion, Dr. Aaron DeVries of the Minnesota Department of Health shared lessons learned from the Minnesota’s FluLine during the 2009 H1N1 pandemic. The existing Minnesota legal framework allowed for a licensed practitioner to prescribe without reference to specific patient via a protocol administered by a nurse (other clinicians also allowed by law). All partner nurse triage lines in Minnesota had a medical director who already approved their protocols. The Nurse Triage Line Project in many ways builds upon the successes of Minnesota’s Flu Line and seeks to expand upon this model and scale it to use at a national level.
Ms. Jamie Ware of the Public Health Management Corporation (PHMC) provided an overview of her study that examined laws impacting the feasibility for utilization of registered nurses for triage and access to prescriptions during an influenza pandemic. The 50-state review analyzed state statutory and regulatory law, state attorney general opinions, and state pandemic flu plans. PHMC is in the process of developing a template for state government officials to use in order to increase the scope of services provided by nurses during a pandemic emergency.
Lastly, Mr. Michael Loehr of Public Health – Seattle and King County provided an overview of how Washington state has successfully implemented collaborative practice agreements during public health emergencies to improve access to needed medications. Washington state developed such agreements for antiviral medications for treatment or prophylaxis during an influenza outbreak, which specifically authorizes pharmacists to prescribe antiviral medications and is only effective when authorized by public health officials. In 2010 as part of NACCHO’s Advanced Practice Center program, Seattle developed this toolkit to help other local health departments implement collaborative practice agreements prior to disasters.
Whether you participated in this webinar, or are simply interested in this summary, we want to hear from you!
•What issues have you explored at your health department that can inform this work?
•Would the development of additional templates that public health officials can use during an emergency be useful?
•What other areas should be explored to develop a path forward?