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| SPECIAL REPORT |
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| Year : 2019 | Volume
: 2
| Issue : 1 | Page : 4-9 |
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Ten years of experience with a veterinary credential responder course
Dianne Dunning1, Barrett Slenning2, Jimmy Tickel3, David C Dorman4
1 Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
2 Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
3 North Carolina Department of Agriculture and Consumer Services, Emergency Programs Division, Raleigh, NC, USA
4 Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| Date of Web Publication | 30-May-2019 |
Correspondence Address:
Dr. Dianne Dunning
College of Veterinary Medicine, North Carolina State University, Raleigh, NC
USA
 Source of Support: None, Conflict of Interest: None  | 2 |
DOI: 10.4103/EHP.EHP_28_18
Training of veterinary students to improve their ability to respond to disaster events that affect livestock and companion animals is an important facet of veterinary education. Just over 10 years ago, the North Carolina (NC) State University College of Veterinary Medicine worked collaboratively with the NC Department of Agriculture and Consumer Service's Emergency Management Program and the University of North Carolina at Chapel Hill Gillings School of Global Public Health, to develop a competency-based Veterinary Credential Responder (VCR) course. This special report reflects on this experience and provides a detailed description of the current VCR course. The 2-week VCR course combines lecture, online, experiential, and group exercises to meet entry-level federal credentialing requirements. Students gain a working knowledge of emergency management, emergency operation plans, and emergency support functions. Over 1000 veterinary students have received the VCR credential making them eligible to participate as deployable members of NC Veterinary Response Corps.
Keywords: Curriculum, disaster, training, veterinary medicine
How to cite this article:
Dunning D, Slenning B, Tickel J, Dorman DC. Ten years of experience with a veterinary credential responder course. Educ Health Prof 2019;2:4-9 |
How to cite this URL:
Dunning D, Slenning B, Tickel J, Dorman DC. Ten years of experience with a veterinary credential responder course. Educ Health Prof [serial online] 2019 [cited 2023 Mar 27];2:4-9. Available from: https://www.ehpjournal.com/text.asp?2019/2/1/4/259384 |
| Introduction | |  |
Hurricane Michael, Florence, Katrina, Sandy, and California wildfires, among other recent calamities, have dramatically illustrated the need for veterinary support during small- and large-scale emergencies and disasters that occur naturally, accidentally, or intentionally.[1],[2],[3] For the purposes of this article, an emergency is defined as an unanticipated event that could threaten humans, animals, or the environment and that requires immediate action. A disaster is defined as an escalating emergency resulting in significant loss, damage, or destruction. An emergency can become a disaster if immediate action is not taken.[4]
Emergencies and disasters can adversely impact human and animal health in many ways. For example, many animal owners will risk personal injury during a disaster to protect their animals.[5],[6] This can result in delayed evacuation and interference with rescue operations. Emergency preparedness groups and legislators have responded to this dilemma in several ways. As early as the mid-1960s, there was recognition on the part of the United States (US) Government that veterinarians were needed to respond to disasters.[7] Veterinarians play a critical role during disasters by serving at-risk animal populations and protecting human health.[2],[3] More recently, shortly after Hurricane Katrina, the US Congress passed the Pets Evacuation and Transportation Standards Act of 2006 (PETS Act). In response to the PETS Act, State and local emergency preparedness operational plans consider the needs of individuals with household pets and service animals following a major disaster or emergency.[8],[9]
The frequency and severity of large-scale disasters, especially weather-related events, appear to be on the increase.[10],[11] This has led to increased demand on both emergency services and the veterinary profession.[1] This reality has prompted, in part, several veterinary schools to incorporate disaster preparedness into their veterinary curriculum. These courses have resulted in the creation of a growing cadre of veterinary professionals trained in disaster preparedness to help meet this growing societal need.[12]
A key element in developing disaster preparedness coursework for future veterinarians is to critically assess what type of “disaster training” is needed in today's veterinary curriculum. Similar efforts that have occurred in other health profession training programs have helped inform veterinary emergency preparedness curriculum development.[13],[14] Veterinary educators looking to develop emergency preparedness training programs can also glean best practices from existing training programs. This article discusses North Carolina (NC) State University College of Veterinary Medicine (NCSU-CVM) experience in providing a Veterinary Credential Responder (VCR) training program to our students for the past 10 years.
| Overview of the Veterinary Credential Responder Training Program | | |
NC has a long history of leadership and excellence related to disaster preparedness and animal response. In 1999, flooding from Hurricane Floyd devastated eastern NC, killing more than three million poultry and pigs.[15],[16] In response, NC formed the State Animal Response Team (SART), a public–private partnership, to more effectively deal with animals in disasters.[15] The NC SART has emerged as a national model for systematically dealing with animals in disasters.[17] Despite these successes, NC and other states and municipalities often have difficulty mobilizing veterinarians trained in emergency preparedness.
The NCSU-CVM VCR training program has helped NC meet these workforce shortfalls by training over 1000 veterinary students. The NCSU-CVM VCR training program evolved out of a partnership between the CVM, University of North Carolina at Chapel Hill (UNC), and the NC Department of Agriculture and Consumer Services (NCDACS).[4] This credential program was launched at the CVM in 2007. Completion of this credential allows a veterinary student or graduate veterinarian to officially assist emergency responders in the event of a disaster. This training program was incorporated into the 3rd-year curriculum for its first few years and currently is incorporated into the 2nd-year curriculum.
At its inception, the VCR program assimilated best practices identified from a review of the educational literature that existed in the 2000s [4] and the real-world experiences of CVM faculty and partnering agencies. The program has subsequently evolved into an approximately 2-week long program that is currently embedded in two 2nd-year core CVM courses: A and B. Faculty from the CVM's three departments and UNC, as well as veterinarians from NCDACS participate in the course. Students are required to complete 7 h of classroom training, 6 h of online training, and two 4-h scenario-based disaster and community response laboratories at the NCSU-CVM [Table 1]. Some lecture and laboratory procedures are given to one-half of the class at a time requiring faculty to provide this content twice during a semester. Successful completion of the VCR program currently accounts for 35% of the overall grade in the two-unit course A. | Table 1: Estimated time commitment of students enrolled in the veterinary responder course
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The overarching goal of the VCR training program is to provide the training necessary for NCSU veterinary students to surpass entry-level federal credentials in emergency response. Technically, Federal Emergency Management Agency (FEMA) considers our students to be “First Line, Single Resource, Field Supervisors.” Achieving this goal requires students to complete seven broad activities, thereby gaining a number of core competencies at a certain level of proficiency [Table 2] and [Table 3]. Each of these activities is considered in more detail below. | Table 2: Learning objectives associated with each training activity in the Veterinary Credential Responder course
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 | Table 3: Core competencies and level of proficiency addressed by the Veterinary Credential Responder course
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| Veterinary Credential Responder Activity 1: United States Federal Emergency Management Agency Incident Command System | | |
The VCR program recognizes that a core competency is the ability of veterinarians to effectively function within the emergency management structure related to emergency planning, detection, response, and/or mitigation. In the US, the Incident Command System (ICS) provides this management structure. The ICS is a nationally standardized, on-scene, all-hazard incident management concept that is based on a flexible, scalable response organization, providing a common framework within which people can work together effectively.[18] The National Incident Management System is used in the US to coordinate emergency preparedness and incident management among various federal, state, and local agencies.[18] The National Response Framework (NRF) is the US national plan for response to emergencies such as terrorist attacks or natural disasters.[7] These foundational parts of response training are offered through FEMA's Emergency Management Institute online as IS100.c (Introduction to ICS), IS200.b (ICS for Single Resources and Initial Action Incidents), and IS800.c (NRF, an introduction).
Completion of the three ICS modules is self-directed and self-paced. Although formal surveys have not been completed, most students indicate that they can complete each online module in 1–2 h. Certificates of completion for each module are provided to students by FEMA on successful completion of the online training and are used by the course leaders to assure student accomplishment. Three modules are completed before the start of the VCR program [Table 4]. Completion of the ICS 100 and 700 training programs is the minimal ICS training necessary for an individual to be a federally credentialed responder at the entry level; whereas, successful completion of the three FEMA modules allows participants to operate at a higher level within response and/or command structures. | Table 4: Incident Command System modules incorporated in the Veterinary Credential Responder program
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There is also a 2-h lecture and discussion that occurs at the start of the VCR program. This lecture reinforces key concepts that are addressed in the three FEMA training modules and offers examples from animal health and public health disaster activities. In particular, students are exposed to concepts common natural disasters that occur throughout the US and the key differences between emergency management and human health infrastructures versus those available to respond to animal needs. Students are reminded that individual veterinary clinics are often the cornerstone for local veterinary responses during an emergency. For veterinarians to serve in this capacity, they need to develop robust response plans and to identify colleagues and other veterinary clinics that could assist them in an emergency. Finally, this introductory lecture is used to describe the different types of temporary animal facilities (e.g., shelter, evacuation, rescue, and collection/transfer evaluation site otherwise known as a “lily-pad”) that may be needed during an emergency and the roles of veterinarians in supporting these facilities. A second 1-h lecture period is used to discuss in more detail recent experiences in NC and elsewhere that relate to human- and animal-health situations for hurricane and related flooding events (e.g., Hurricane Florence, Maria, and Matthew).
| Veterinary Credential Responder Activity 2: All-Hazard Training: first Responder Awareness Training | | |
During a hazardous material (HazMat) emergency, there are five levels of response, each of which requires increasingly specialized training first responder awareness level; first responder operational level; HazMats' technician; HazMats' specialist; and HazMats' incident commander. During the VCR program, veterinary students receive a 1-h lecture that addresses the lowest level of HazMats' response (i.e., awareness training for the first responders). Awareness HazMat training is required to allow students to actively participate in state-level response programs.
A key concept in this HazMat training is for students to learn about HazMats and be able to identify and accurately report where they may be encountered during an emergency. Students receive training in recognizing HazMats (e.g., use of placards, transport container size and shapes, and facility design), with a focus on examples from farms and veterinary clinics. Awareness training during this lecture is strictly defensive and centers on recognition, isolation, protection, and notification.
| Veterinary Credential Responder Activity 3: Psychological first Aid, Crisis Communication, and Compassion Fatigue Training | | |
Psychological first aid for health professionals can be considered as psychological support that is both used to improve one's own resilience and is provided by nonmental health professionals to family, friends, neighbors, coworkers, and students.[19] Psychological first aid is an essential veterinary skill with relevance across species and disciplines and carries significant emotional and psychological benefits within a community.[9],[20] Within the VCR training, psychological first aid is defined as the acute intervention of choice for supporting people who are having normally expected, at times overwhelming, reactions to an abnormal event. This lecture and discussion cover the impact of disasters on animal owners wherein enforced abandonment of animals significantly increases the likelihood of postdisaster stress syndromes.[21],[22] The negative impact of livestock loss on farmers [23],[24] is also discussed during this session. Students receive information regarding cognitive, behavioral, emotional, spiritual, and physical markers of distress and an overview of the proactive steps they can take to identify and counteract these effects.[25]
| Veterinary Credential Responder Activity 4: Principles of Euthanasia | | |
Students are expected to read and understand the current edition of the AVMA's Guidelines for the Euthanasia of Animals.[26] By the end of the session, students are expected to understand how these guidelines classify euthanasia methods as acceptable, acceptable with conditions, unacceptable, or as adjunctive methods. A 2-h lecture and discussion session are used to familiarize students with common methods of companion animal, livestock, avian, and selected nonmammalian, nonavian species' (i.e., fish) euthanasia. This session includes information concerning the pharmacologic or physical modes of action of different euthanasia methods and advantages and disadvantages of each in a routine clinical setting or a disaster. Depopulation methods and controversies for livestock are also discussed.
| Veterinary Credential Responder Activity 5: Management of an Infectious Disease Outbreak | | |
A 2-h zoonotic avian influenza tabletop exercise is also used during the VCR training. Animal and human health issues associated with a growing influenza pandemic are discussed, and various roles that veterinarians might play during an avian influenza or another pandemic event are considered. A second-related activity held in an inactive poultry facility requires students to learn proper methods used to don and doff personal protective equipment (PPE) appropriately in a farm setting. All students enter into the poultry house with full PPE in the form of an impervious hooded coverall, a surgical bouffant cap, double examination gloves, double plastic boots, and surgical masks and are assigned to a rubber chicken coated in fluorescent powder in groups of two and three. Each student was required to simulate an examination of the bird utilizing appropriate handling and sampling techniques. After doffing their PPE, a Germ City tent is utilized to highlight individual breaks in biosecurity. This particular exercise drives home the potential weaknesses of PPE and the absolute necessity of showering and mechanical decontamination to prevent the dissemination of infectious disease. Costs for PPE associated with this exercise are approximately $12 per student.
| Veterinary Credential Responder Activity 6: Personal or Business Emergency Plan | | |
For this activity, students are required to develop either a personal or business emergency plan. They are given templates available from the Red Cross and other groups to use as an initial plan. The students' individual emergency plans are expected to go beyond checklists and include more details regarding identifying individuals' roles in accomplishing the plan and resources that may be needed. This exercise also prepares future veterinarians to assist livestock producers and others to develop continuity of operations or emergency plans that are needed for floods or other disasters.[27] This activity currently accounts for 15% of the course grade and is considered one of the most important components of the course due to its everyday life personal and professional applications.
| Veterinary Credential Responder Activity 7: Emergency Shelter Exercise | | |
This activity involves the students simulating the setup and operation of both a colocated and rescue animal emergency shelter utilizing the equipment available within a Companion Animal Mobile Equipment Trailer (CAMET). The purchase price of the CAMET unit is approximately $20,000 for those programs that do not have access to this county or state resource. The emergency shelter exercise requires students to work in teams to problem solve how the CAMET resources and equipment can be used. Students also become familiar with the steps needed to procure additional resources from the local, state, and federal government and nongovernmental organizations. The CAMET used for this exercise is provided by the state of NC and meets the requirements of the PETS Act of 2006. The CAMET can provide 45 large cages/crates and 15 medium cages/crates.
| Discussion | | |
There is growing recognition of an urgent need to build capacity in emergency management and disaster preparedness in all health professions. Shortcomings in veterinary and medical school curricula in this regard have been identified for nearly two decades. For example, the Association of American Medical Colleges and the Institute of Medicine published a landmark 2003 report that encouraged the introduction of bioterrorism topics in medical school curricula.[27] In response, by 2004, a large percentage (83%) of US medical schools included the topic of biological or chemical terrorism in their required medical school courses.[28] Despite these changes in curricula, US medical student knowledge and confidence in their ability to respond to disasters remains limited.[29] For example, a 2009 study of US medical students suggested that approximately half of the surveyed respondents felt prepared to respond to a natural disaster or pandemic influenza outbreak.[30] This same survey found that nearly all surveyed medical students expressed a willingness to respond to natural and other disasters despite their lack of knowledge or skills.[30]
Courses developed for medical students often share many of the elements found in our VCR course including the use of PPE, all-hazard training, local- and regional-level disaster preparedness, disaster response, and organizational structures.[29],[30],[31],[32],[33],[34] These curricula differ from the VCR training provided to our veterinary students with respect to medical aspects of different forms of disasters and the intensity of the training.[29],[32],[34] Other states have also developed shorter training programs for other health professionals that are qualitatively similar to our VCR course; however, to the best of our knowledge, none of the other veterinary-based courses are part of the required core curriculum, as is the VCR program.[33]
The recent Hurricane Maria, Florence, and Michael have highlighted the need of this kind of core competency-based program within veterinary health professions. During Florence, our faculty, staff, and students responded at rescue and colocated shelter settings in addition to deploying to the most affected areas along the NC coast and providing care to severely injured animals in our specialty animal hospital. Furthermore, we were still engaged in supplying feed and veterinary supplies to shelters and equine and small animal practices for many months after the storms.
The current program at NCSU-CVM is administered over the course of the 2nd year of our professional veterinary curriculum. The placement of the content in the 2nd year is ideal for our students because they have received the bulk of their didactic material and are preparing to enter the clinical phase of the program. There is also an additional benefit to having the lectures, tabletop activities, and simulations in a concentrated time frame so as to help students retain the continuity of the information being presented. We believe that the importance of disaster and emergency preparedness and response training in veterinary medicine cannot be overstated. Veterinarians are fundamental to response and recovery efforts during and after disasters at all levels as they engage an important role in promoting and aiding preparedness efforts, to limit the impact of disasters on both animals and people. This program can be used a model by colleges and schools seeking to incorporate disaster training into their Doctor of Veterinary Medicine (DVM) professional programs.
Acknowledgments
The authors thank Dr. Michael P. Martin, Mr. William Gentry, Dr. Lysa Posner, Dr. Brenda J. Stevens, Dr. Bruce Akers, Dr. Anna Allen, Dr. Mandy Tolson, Dr. Betsy Taylor, and Ms. Jeannine Moga for their contributions to the creation and delivery of the VCR course.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]
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