HHS Delivers the Nation's First Health Security Strategy

HHS Secretary Kathleen Sebelius today released The National Health Security Strategy, the nation's first comprehensive strategy focused on protecting people's health during a large-scale emergency. The strategy sets priorities for government and non-government activities over the next four years.

"As we've learned in the response to the 2009 H1N1 pandemic, responsibility for improving our nation's ability to address existing and emerging health threats must be broadly shared by everyone - governments, communities, families, and individuals," Secretary Sebelius said. "The National Health Security Strategy is a call to action for each of us so that every community becomes fully prepared and ready to recover quickly after an emergency."

National health security means that the nation and its people are prepared for, protected from, and resilient in the face of health threats or incidents with potentially negative health consequences such as bioterrorism and natural disasters. The strategy provides a framework for actions that will build community resilience, strengthen and sustain health emergency response systems, and fill current gaps.

"Events which threaten the health of the people of this nation could very easily compromise our national security. Whether it's a pandemic or a premeditated chemical attack, our public health system must be prepared to respond to protect the interests of the American people. In order to be prepared to both respond to an incident and to recover, we need a strong national health system with individuals and families ready to handle the health effects of a disaster," Secretary Sebelius said.

The National Health Security Strategy and the accompanying interim implementation guide outline 10 objectives to achieve health security:

1. Foster informed, empowered individuals and communities
2. Develop and maintain the workforce needed for national health security
3. Ensure that situational awareness so responders are aware of changes in an emergency situation
4. Foster integrated, health care delivery systems that can respond to a disaster of any size
5. Ensure timely and effective communications
6. Promote an effective countermeasures enterprise, which is a process to develop, buy and distribute medical countermeasures
7. Ensure prevention or mitigation of environmental and other emerging threats to health
8. Incorporate post-incident health recovery into planning and response
9. Work with cross-border and global partners to enhance national, continental, and global health security
10. Ensure that all systems that support national health security are based upon the best available science, evaluation, and quality improvement methods

The National Health Security Strategy also highlights specific actions that the nation - including individuals, communities, non-government organizations, and government agencies - should take to prevent, protect against, respond to, and recover from health threats.

Among the initial actions for the federal government are conducting a review to improve the system for developing and delivering countermeasures - medications, vaccines, supplies and equipment for health emergencies; coordinating across government and with communities to identify and prioritize the capabilities, research, and investments needed to achieve national health security; and evaluating the impact of these investments.

Federal, state, local, tribal, and territorial government agencies, as well as medical, public health and community-based organizations, collaborated to develop the strategy and interim implementation guide. To determine any additional issues and themes the strategy should address, the HHS solicited direct input from non-federal participants during six regional workshops. HHS also worked with the Institute of Medicine to engage the medical community.

The Pandemic and All Hazards Preparedness Act directed the HHS Secretary to develop the National Health Security Strategy with an accompanying implementation plan by 2009 and to revise the documents every four years. HHS, however, will update the implementation plan every two years to reflect advances in public health and medicine.

Because of the close relationship between health and national security, the National Health Security Strategy that complements and supports other U.S. strategies and guidelines related to security preparedness, response, and recovery.

To obtain a copy of the strategy and implementation guide, visit www.hhs.gov/disasters.

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FDA Alerts Public about Danger of Skin Numbing Products

The U.S. Food and Drug Administration today issued a Public Health Advisory to alert consumers, patients, health care professionals, and caregivers about potentially serious and life-threatening side effects from the improper use of skin numbing products. The products, also known as topical anesthetics, are available in over-the-counter (OTC) and prescription forms.

Skin numbing products are used to desensitize nerve endings that lie near the surface of the skin, causing a numbness of the skin. These topical anesthetics contain anesthetic drugs such as lidocaine, tetracaine, benzocaine, and prilocaine in a cream, ointment, or gel. When applied to the skin surface, they can be absorbed into the blood stream and, if used improperly, may cause life-threatening side effects, such as irregular heartbeat, seizures, breathing difficulties, coma, or even death. FDA has received reports of adverse events and deaths of two women who used topical anesthetics before laser hair removal. In February 2007, the FDA issued a Public Health Advisory - “Life-Threatening Side Effects with the Use of Skin Products containing Numbing Ingredients for Cosmetic Procedures,” to warn consumers about these products.

Patients for whom an over-the-counter or prescription topical anesthetic is recommended should consider using a topical anesthetic that contains the lowest amount possible of medication that will relieve your pain. Also, health care professionals should determine whether adequate pain relief can be safely achieved with a topical anesthetic, or whether a different treatment would be more appropriate.

The FDA strongly advises consumers not to:

* make heavy application of topical anesthetic products over large areas of skin;
* use formulations that are stronger or more concentrated than necessary;
* apply these products to irritated or broken skin;
* wrap the treated skin with plastic wrap or other dressings; and
* apply heat from a heating pad to skin treated with these products.

When skin temperature increases, the amount of anesthetic reaching the blood stream is unpredictable and the risk of life-threatening side effects increases with greater amounts of lidocaine in the blood.

A recently published study in Radiology looked at women taking acetaminophen and ibuprofen by mouth versus applying lidocaine gel, a topical anesthetic, to the skin to decrease discomfort during mammography. The lidocaine gel was applied to a wide skin surface area and then covered with plastic wrap. There were no serious or life-threatening side effects reported in the study, nor were any reported when FDA discussed the results with the doctor who performed the study. The study results favored the use of lidocaine as there was significantly less discomfort than with the plain gel or oral acetaminophen or ibuprofen. However, given the life-threatening side effects associated with the use of topical anesthetics during laser hair removal, FDA is concerned that similar side effects could occur when topical anesthetics are used during mammography. Further, the study was small and it is possible that a larger study might show different findings.
Patients should talk with their health care professional if they are considering using a topical anesthetic before a mammogram. The following summarizes advice for patients if a topical anesthetic is recommended for their use:

* use a topical anesthetic that contains the lowest strength, and amount, of medication that will relieve the pain;
* apply the topical anesthetic sparingly and only to the area where pain exists or is expected to occur;
* do not apply the topical anesthetic to broken or irritated skin;
* ask their healthcare professional what side effects are possible and how to lower their chance of having life-threatening side effects from anesthetic drugs; and
* be aware that wrapping or covering the skin treated with topical anesthetics with any type of material or dressing can increase the chance of serious side effects, as can applying heat to the treated area while the medication is still present.

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