A dignitary medicine curriculum developed using a modified Delphi methodology

BACKGROUND

Dignitary medicine is an emerging field of training that involves the specialized care of diplomats, heads of state, and other high-ranking officials. In an effort to provide guidance on training in this nascent field, we convened a panel of experts in dignitary medicine and using the Delphi methodology, created a consensus curriculum for training in dignitary medicine.

METHODS

A three-round Delphi consensus process was performed with 42 experts in the field of dignitary medicine. Predetermined scores were required for an aspect of the curriculum to advance to the next round. The scores on the final round were used to determine the components of the curriculum. Scores below the threshold to advance were dropped in the subsequent round.

RESULTS

Our panel had a high degree of agreement on the required skills needed to practice dignitary medicine, with active practice in a provider's baseline specialty, current board certification, and skills in emergency care and resuscitation being the highest rated skills dignitary medicine physicians need. Skills related to vascular and emergency ultrasound and quality improvement were rated the lowest in the Delphi analysis. No skills were dropped from consideration.

CONCLUSIONS

The results of our work can form the basis of formal fellowship training, continuing medical education, and publications in the field of dignitary medicine. It is clear that active medical practice and knowledge of resuscitation and emergency care are critical skills in this field, making emergency medicine physicians well suited to practicing dignitary medicine.

Dignitary Medicine: A Novel Area of Medical Training

Dignitary medicine (DM) involves the provision of healthcare to government leaders and other high-profile individuals collectively referred to as "dignitaries." Due to the unique circumstances around their lifestyle, dignitaries often receive suboptimal healthcare. We define the requisite skills needed to practice DM based on the available literature and provide a framework for training providers in these skills. A review of the English language medical literature focussing on adult subjects was performed, searching for terms such as "dignitary medicine," "VIP medicine," and "protective medicine." Literature was gathered from CINAHL, Google Scholar, PubMed, EBSCOHost, and San Bernardino County Library databases and then analyzed by experienced DM providers. A total of 23 relevant articles were eligible for review. No meta-analyses on the subject exist. We found that existing studies highlight skills in wellness, executive health, and protective medicine, which form the backbone of DM. The burgeoning field of DM encompasses several disciplines and skills. We strongly recommend a structured curriculum for the field of DM, focused on dignitary wellness, executive health, and protective medicine.

Threats in bioterrorism. I: CDC category A agents

Although once considered unlikely, bioterrorism is now a reality in the United States since the anthrax cases began appearing in the fall of 2001. Intelligence sources indicate there are many countries and terrorist organizations that either possess biological weapons or are attempting to procure them. In the future it is likely that we will experience additional acts of bioterrorism. The CDC category A agents represent our greatest challenge because they have the potential to cause grave harm to the medical and public health systems of a given population. Thus, it is imperative that plans be developed now to deal with the consequences of an intentional release of any one or more of these pathogens.

The history and threat of biological warfare and terrorism

The inevitable conclusion is that the availability of biological warfare agents and supporting technologic infrastructure, coupled with the fact that there are many people motivated to do harm to the United States, means that America must be prepared to defend her homeland against biological agents. Some have argued to the contrary, that the threat and risks from a biological weapon attack are not to be considered serious, because [39]: They've not been used yet on a large scale so they probably won't be in the near future. Their use is so morally repugnant that they probably won't be used at all. The technologic hurdles associated with isolating, growing, purifying, weaponizing, and disseminating adequate quantities of pathologic agents are so high that only the most advanced laboratories could attempt the process. Similar to a 'nuclear winter,' the aftermath of a biological attack is so unthinkable that none would attempt it. Unfortunately, the trends associated with biotechnology globalization, terrorist group dynamics, and global/regional politics render these beliefs untenable and inappropriate, as recent events have underscored. To that end, the United States has accelerated its program of defense against biological weapons, as it must. Biological weapons are such dreadful weapons of uniqueness and complexity that a specific defense strategy is paramount. Elements of this program include pharmaceutical stockpiles, heightened surveillance systems, energized vaccine development programs, and comprehensive training initiatives. Although the depth and breadth of these efforts are unprecedented, above all these efforts is the absolute necessity for medical and public health care professionals to be educated and actively involved. These professionals are the sine qua non of future defensive readiness. This is just the start; unfortunately, there is no end yet in sight.