33 J.L. Med. & Ethics 53 (2005)
Scope of Practice for Public Health Professionals and Volunteers

handle is hein.journals/medeth33 and id is 925 raw text is: Scope of Practice for Public Health
Professionals and Volunteers
James G. Hodge, Jr., Jeanine K. Mount, Joy F Reed, and
Mary P. Couig (Moderator)

Mary P. Couig
Public health workers face a variety of challenges
including preparing for and responding to emerging
infectious diseases, large scale industrial accidents,
bioterrorism, and natural disasters. In the aftermath
of Florida's triple hurricane damage, there was an
urgent need for health professionals, especially nurses,
to supplement healthcare personnel already respond-
ing to the hurricanes. Although states such as Georgia,
Texas, and Colorado have developed large databases
of nurses, there are legal challenges in the terms of the
scope of practice, licensure, credentialing, and liability.
Federal employees and those hired as temporary
federal employees, working under their scope of
employment, are covered under the Federal Tort
Claims Act (FTCA) of 20001 for liability and also are
covered for workman's compensation if injured.
Health professionals want to know that they will be
protected if they volunteer to respond. This session
highlights new initiatives to protect health volunteers
and specific issues related to pharmacists and nurses.
James G. Hodge, Jr.
Any emergency involving mass casualties or injuries
inevitably will stretch existing health care and public
health resources. Meeting surge capacity during
emergencies is one of the most significant challenges
for public health planners. Many rely on the efforts of
volunteer health professionals to treat patients during
emergencies. However, the legal environment impli-
cates the ability of these volunteers to effectively par-
ticipate, as well as raises multiple issues of concern for
the volunteers themselves.

Prior to September 11, 2001, state and local govern-
ments depended on general emergency declarations
for authority to respond to emergencies, because
existing legal infrastructure typically focused on gen-
eral emergency responses and not on specific public
health events.
After September 11, 2001, federal, state, and local
governments systematically reformed their emer-
gency response laws, especially in the areas of licens-
ing, credentialing, and privileging to address public
health emergencies. Credentialing evaluates a health
professional's general skills and competencies while
privileging authorizes a health professional's scope of
practice within a specific facility.
Some states, recognizing potential hurdles in emer-
gency management, relax licensing requirements
during emergency situations. Although professional
licensing is part of a state's regulatory process for
health professionals, emergency laws typically waive
licensure requirements or allow license reciprocity
during declared emergencies.
To address an imminent shortage of volunteer
health care professionals needed to meet surge capac-
ity during emergencies, the Health Resources and
Services Administration (HRSA) is overseeing state
and territorial creation of volunteer registration sys-
tems known as the Emergency System for the
Advance Registration of Volunteer Health Pro-
fessionals (ESAR-VHP). The ESAR-VHP functions as
a state-based and state-run system to register and vet
in advance health professionals who may be called
upon during an emergency. State Emergency Man-
agement Assistance Compacts (EMAC) formalize
emergency requests among states to provide immuni-
ty for responders as agents of a requesting state.


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