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Disaster Medicine

Leadership and Advocacy May 2004 Report: Terrorism Preparedness Funding, “Grant Center”

By Andrew I. Bern, MD, FACEP
Vol. 13, Issue 4, September 2004

Board Facilitator: Linda Lawrence, MD, FACEP. Staff Facilitator: Rick Murray. Panel Members: Andrew I. Bern, MD, FACEP; Andrew M. Milsten, MD, MS, FACEP; Brad Younggren; Sonia Callejas; Eric S. Weinstein, MD, FACEP; Kristi Koenig; Stephen Hartsell; Jon Krohmer; Rob DeLorenzo; Evangeline Sokol; Beth Brunner.

There was a lively discussion amongst the group members who discussed purpose, structure, operation, and funding issues.  Objective 5 of the State Legislative/Regulatory Committee has been looking at a concept known as the "Grant Center" as a way of accessing these funds. The panel focused its attention to the pros and cons of this issue.

There is money available that has been allocated through bioterrorism and homeland security. We should go after it. Should the College be doing this?
Start up costs could be tempered and kept to a minimum through outsourcing to experienced companies. This would not be dissimilar to when the College outsourced the executive search firm to assist in the executive director search. It would allow us to have a fast start.  Through indirect costs, there may be a significant non-dues revenue generation. Large start up costs? Would we have any success?  Would it be budget neutral?
There may be monies received that permit the development of a national curriculum for bioterrorism. This course development could be done in the usual way in which the College does course development. Are there ACEP members that would come forward to participate in the implementation of monies and grants received?
The College could be more involved in advocacy—especially in setting up National recommendations to assist the current programs that are disorganized and implemented in a non-standardized way. This might take energies away from current priority objectives (or might support priority objective 3 and with non-dues revenue support other objectives).
Anything the College does to help the members would be good.
This would be in support of an all-hazards approach and surge capacity. Questions were raised as to how to set up?  Will this be able to support all-hazard planning approach and surge capacity issues?
Importance of the College to set standards and benchmarks for standardization of grants and their implementation. It was a positive meeting that the College set up with the chapter executives and the Health Resources and Services Administration (HRSA). The College does not have representation or interaction at the level of DHS, DOJ, HRSA, CDC (initial interaction at the Chapter Executive Committee during this conference was an initial first contact for most of the chapter executives.
The College could be in a position of "broker" getting grants and distributing monies to the states and local areas. Example, if HRSA money was obtained and used to fund the Hospital Emergency Assessment Tool (H.E.A.T.) for emergency preparedness as part of an accreditation of a hospital’s emergency preparedness. Would the grant center place the College in an ethical dilemma of helping some cities, states, or chapters and not others?
What if the College served as a broker of funds? Are there liability issues in assisting in getting or administrating grants? If the College was funding in this business model—what about the profit and loss?
The College might become a player in template development. For example, Florida has three HRSA grants that set up a speaker’s bureau, a best practices educational project, and developed an alliance of Universities. Could these identified chapter successes be shared with other chapters in the form of a template or completed applications for similar money that comes down as a block grant to all states? How would we determine who would develop the benchmarks or templates?  Who would administer the service?  How would the benchmarks be developed?
A clearinghouse of information would help all of our members if posted on the Web site. (An example would be the educational meetings Web page where meeting offerings could be searched by type, date, and location.) The clearinghouse could identify grant opportunities by type, state or local, and date of application. Information may be obtained from out sourcing. Would information technology (IT) be able to support this activity? Who initially gathers the information to be placed on the Web?
If the grant center was implemented, it would be helpful to use the EMF model of an advisory group of members to assist in template, benchmark, and other issues. Current mechanism not in place.
Advocacy for EMS—some attempts by the American Hospital Association (AHA) to push emergency medical services (EMS) out of the current HRSA preparedness funding sources.  Might upset AHA if we were supporting EMS in these issues in direct opposition to their position.
The grant center could be a line of business with a variety of services available. We could address this issue by doing demonstration projects in selected chapters until the concept is demonstrated. Difficult undertaking and should start small.
Start with bioterrorism funding first. Should the grant center only be limited to bioterrorism grants or should it be opened for all potential grants such as the 100 million for implementing electronic methods that enhance safety?
We should go after national HRSA funding for projects like phase II and III of the NBC grant. Would we be successful?

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