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Wednesday, March 12, 2014

NYC Explosion/Collapse - Terrorism, Gas Leak, or Souvenir Ordnance?

"Terrorism, Gas Leak, or Souvenir Ordnance?" was the first question asked when an explosion destroyed an apartment building in Harlem, New York City, 1992.

In 1992 a natural gas leak originating in an eleventh floor apartment caused an explosion that killed three and injured 34. Nineteen police officers and six firefighters were among the injured.

More than twenty years later, as the Vulcan Blizzard dominates media coverage, emergency management and traditional responders are asking that same question as five-alarms respond to a deadly explosion and building collapse in East Harlem.

The 1992 Harlem event was publicized in the U.S Fire Administration Technical Report Series (see Fire, Police, and EMS Coordination at Apartment Building Explosion). In an era before September 11 and before the National Incident Management System, the traditional responders of the City of New York are noted by this report to have effected a remarkable response to the situation.

According to the USFA report:
"The efforts of the three lead response agencies, fire, police, and emergency medical services (EMS), were coordinated within the structure of an Incident Command System (ICS). Integrated and coop- erative command, linked with the implementation of a Collapse Rescue Plan; prudent triage and effective use of available resources for medical treatment; and rapid perimeter control to prevent fur- ther injuries demonstrated that seemingly overwhelming emergencies can be managed by applying good standard operating procedures. The lessons learned/reinforced by each agency at this incident can serve as a model to assist other emergency responders in planning for similar situations."
 I encourage everyone to review this report from 1992 with special attention to the Lessons Learned and Reinforced. The recommendations made and findings of this report are as important today as they were back in 1992. Solid emergency management and response does not mean re-inventing tactics and policy. Rather, better to remember your experiences and build on them. 

Friday, February 28, 2014

The Week in Preparedness February 28, 2014

A brief of emergency preparedness from social media.





Tuesday, February 25, 2014

2013/2014 Flu Update #6


Update #6 for February 25, 2014

A long, slow march into the sunset 

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week #7 for the period ending February 15, 2014.

In the News

CDC: Flu Vaccine 61% Effective
The CDC issued a report on February 20, 2014 claiming the current influenza vaccine to be sixty-one percent effective so far this season. The report notes those vaccinated have a lowered need to be seen by their doctor. CDC also notes that the 2014 influenza season has been, as in years past, particularly difficult for some age groups. We typically focus on extremes of age and those with comorbid conditions as being at risk for influenza related illness (ILI) or death. The trend over several years indicates hospitalizations and deaths attributed to ILI is growing in the "young and middle-age populations. The vaccination rate for these age groups has been estimated at 34%.

California Influenza ICU Admissions and Deaths
California is reporting the highest number of severe and fatal cases of seasonal influenza since the 2009 H1N1 pandemic, according to Morbidity and Mortality Weekly Report (MMWR). The report states that there have been 94 deaths and 311 ICU admissions due to flu from September, 2013 to January, 2014.

WHO: No Changes to Vaccine for 2014-2015 Flu Season
The World Health Organization (WHO) announced in a press release that it is keeping essentially the same vaccine profile for next year. The current vaccine is touted by CDC as being 61% effective and will keep the same influenza virus strains for next season. These strains include  - A/California/7/2009 (H1H1) pdm09, A/Texas/50/2012 (H3N2), and B/Massachusetts/2/2012 in the trivalent vaccine. 

Social Media

 Flu by the CDC numbers

According to the CDC Flu View site:
During week 7 (February 9-15, 2014), influenza activity decreased, but remained elevated in the United States.
  • Viral Surveillance: Of 6,887 specimens tested and reported during week 7 by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories, 958 (13.9%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: Two influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A season-cumulative rate of 26.1 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 2.5%, above the national baseline of 2.0%. Nine of 10 regions reported ILI at or above region-specific baseline levels. Seven states experienced moderate ILI activity; 16 states and New York City experienced low ILI activity; 27 states experienced minimal ILI activity, and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 17 states was reported as widespread; 22 states reported regional influenza activity; the District of Columbia, Guam, and nine states reported local influenza activity; Puerto Rico and two states reported sporadic influenza activity, and the U.S. Virgin Islands reported no influenza activity.

Timeline Comparison

Below are CDC FluView maps that compare ILI Activity between corresponding weeks of 2012/2013 influenza season against the 2013/2014 season. The 2014 week 4 CDC map demonstrates considerably lower level of activity as compared to 2012/2013 map at this time.

2013/2014 CDC Flu Interactive Map for week 7, 2014


2012/2013 CDC Flu Interactive Map for week 7, 2013


Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data. According to Google Flu Trends ILI activity has progressed from moderate to high  overall with plateaus noted in other areas.

Monday, February 03, 2014

2013/2014 Flu Update #5


Update #5 for February 3, 2014

ILI activity continues, progressing 

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week #5 for the period ending January 25, 2014.

In the News

WHO issues A(H7N9) Global Alert and Response Update
January 31, 2014. The World Health Organization (WHO) issued a Global Alert and Response (GAR) Update based on reports from the National Health and Family Planning Commission of China and the Center for Health Protection (CHP) of China regarding six more cases of human infection with H7N9 avian influenza.

Numerous commonalities exist among the cases, according to the report.
All of the six cases are males. The age range is 2 to 63 years old. The cases are reported from Fujian (1), Guangdong (1), Hong Kong SAR (1), and Zhejiang (3). Four of the cases are currently in critical or serious condition. Four of the cases are reported to have had exposure to poultry or a live poultry market. Source: WHO/GAR
Follow up story from Center for Infectious Disease Research and Policy (CIDRAP)
"...new cases lift the number reported in the second wave to 137, topping the 136 cases reported during the first wave last spring." CIDRAP

Social Media

A nice approach by NBC#3 in Syracuse, NY. Key message: 
  • Not too  late to get flu vaccine
  • Have symptoms, call you doctor (that's call your doctor...NOT go to the ED)
  • If your sick, stay home...appropriate social distancing
  • Flu cases (in this area) are lower
And then there's this short, self-limiting flu going around:

Biologic event "serious" threat in London, 2012...not so much in Sochi, 2014

 Flu by the CDC numbers

According to the CDC Flu View site:
During week 4 (January 19 - 25, 2014), shows a high rate of influenza activity in the United States.
  • Viral Surveillance: Of 9,514 specimens tested and reported during week 4 by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories, 2,006 (21.1%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: Nine influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A season-cumulative rate of 20.3 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 3.3%, above the national baseline of 2.0%. All 10 regions reported ILI above region-specific baseline levels. Ten states experienced high ILI activity; 12 states and New York City experienced moderate ILI activity; 14 states experienced low ILI activity; 14 states experienced minimal ILI activity, and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 38 states was reported as widespread; 10 states reported regional influenza activity; the District of Columbia and one state reported local influenza activity; Guam, Puerto Rico, and one state reported sporadic influenza activity, and the U.S. Virgin Islands did not report.

Timeline Comparison

Below are CDC FluView maps that compare ILI Activity between corresponding weeks of 2012/2013 influenza season against the 2013/2014 season. The 2014 week 4 CDC map demonstrates considerably lower level of activity as compared to 2012/2013 map at this time.

2013/2014 CDC Flu Interactive Map for week 4, 2014

2012/2013 CDC Flu Interactive Map for week 4, 2013



Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data. According to Google Flu Trends ILI activity has progressed from moderate to high  overall with plateaus noted in other areas.

Tuesday, January 28, 2014

This Week in Preparedness 1.24.14

TWiP: Top trending preparedness topics of the week


Hospital preparedness for natural disasters has come into question more than ever since Hurricane Katrina. Despite preparedness efforts on the part of healthcare institutions they remain vulnerable to natural disasters because much of the preparedness and training that's going on in healthcare has failed to touch on the real issues.

Should you have to dial a"9" to get an outside line when you're staying in a hotel? That's the question being asked after a series of events highlighting the fact that you just can't pick up the phone in a hotel or some businesses and dial 911. The need to dial an extra digit to obtain an outside line has been questioned by many fire and emergency service personnel over the years. With modern technology that includes the ability to text message many 911 systems are adding enhanced features that allow them to receive emergency calls via text messaging. It seems intuitive that the need to dial a "9" to get an outside line has certainly outgrown its usefulness… if it ever served a purpose.

An article I wrote back in 2010 highlighting the details in planning that went into the failed Times Square bombing event has received a  fair amount of attention this week. This article highlights the fact that explosive events are real threat it's civilian soft targets in at those who would carry out such an event have the ability to plan and conduct surveillance on their intended targets.

Saturday, January 18, 2014

This Week in Preparedness

Topping the Twitter Feeder  - A week in review

We continue to expect that hospitals Will be prepared to handle anything that we bring to them. Unfortunately the level of preparedness for most hospitals and emergency departments in United States is lacking. If hospitals are truly part of critical infrastructure and emergency departments part of the initial response to disaster they must be prepared, protected, trained, and supported. In 2014 Will have to answer the question" hospitals: are they public-health for public safety?"

This was an interesting piece that caught my eye because it encouraged us to shelter in place in event of a nuclear blast. It was also interesting because the peace encouraged us to calculate how long or how far would take us to get to the next place of shelter from where we currently are. The interesting bias in the story was the assumption that you would know where to go for shelter, have an idea of how to get there, and what the road conditions and travel time would be like during times of crisis. Most interestingly you'd make these decisions after a new player detonation…
The story boasts about the precautions taken to prevent and Deter active shooter an explosive events that mass gatherings. High profile event such as the Olympics, The World Series, and the Super Bowl, have all undergone tremendous scrutiny for their security efforts. But when it comes to truly being prepared training for explosive events and active shooters is child's play compared to planning and preventing a biologic event.

Monday, January 13, 2014

2013/2014 Flu Update #4


Update #4 for January 13, 2014

ILI activity continues, increased in some areas plateaus in others

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week #1for the period ending January 4, 2014.

In the News

CIDRAP is reporting on the first Canadian death from H5N1. Death of an Alberta resident with travel history to Beijing is the first fatal case of H5N1 in North America.
PhillyDOTcom: bioterror limits efforts needed to fight viruses. 

Rochester media beginning to notice flu season

According to the CDC Flu View site:
During week 1 (December 29, 2013-January 4, 2014), shows continued increase of influenza activity in the United States.
  • Viral Surveillance: Of 9,482 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 1, 2,486 (26.2%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: Four influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 9.7 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 4.4%, above the national baseline of 2.0%. All 10 regions reported ILI above region-specific baseline levels. Twenty states experienced high ILI activity; seven states and New York City experienced moderate ILI activity; 11 states experienced low ILI activity; 12 states experienced minimal ILI activity, and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: : The geographic spread of influenza in 35 states was reported as widespread; 12 states and Guam reported regional influenza activity; the District of Columbia, Puerto Rico, and two states reported local influenza activity; and one state reported sporadic influenza activity, and the U.S. Virgin Islands did not report.
Timeline Comparison
Below are CDC FluView maps that compare the prior two reporting periods against the corresponding weeks of 2012/2013 influenza season. The 2014 week 1 CDC map demonstrates a clustered geographical impact of High ILI activity compared to 2012/2013 map at this time.

2013/2014 CDC Flu Interactive Map for week 1, 2014


2012/2013 CDC Flu Interactive Map for week 1, 2013


Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data. According to Google Flu Trends ILI activity has progressed from moderate to high  overall with plateaus noted in other areas.

Top MJ Podcasts of 2013 + One More

2013 Top of the Charts includes a podcast from 2012!











Friday, January 10, 2014

Top MJ Reads of 2013

MJ readers select Top Blog Topics of 2013

Mitigation Journal blog readers have voted and the results are in on the top topics of 2013. The top 3 blog pieces were selected based on site statistics, number of article views, and reader interaction, we've come up with our best articles of 2013.

#3 From May, 2013. Biological effects of radiation are dependent upon the type of exposure a person has with the duration of the exposure and intensity of the material playing a key role. We also have to include the role of personal protection such as time, distance and shielding. In this piece, we discussed, Hematopoietic Syndrome, Gastrointestinal syndrome, Cardiovascular syndrome, and central nervous system syndrome


#2 JAMA Flu Myth Busters appeared on MJ in March, 2013 creating substantial debate on social media about the flu vaccine. We also enjoyed an unprecedented volume of email conversations behind the scenes. The big vaccine debate was at the heart of most of our conversations. We also noted a substantial increase in request for biologic planning, plan writing and plan review. Our most popular live talk during this period (Understanding Flu and Biological Events) was presented seven times in and around New York. Fueling the fire on this topic was the political climate surrounding flu related public health emergencies, mandated vaccination for health care workers, and an intense flu season.
 #1 Our top rated posting comes from January, 2013. No Shelter for You was a unique post because it tied together the Tenent Health Care ruling with subtle emergency management changes that were brought to our attention by MJ readers. We had the good fortune of first-hand reporting by Michael Ehrman, a retired emergency manager and long time MJ follower.  Mr. Ehrman continued his reporting on the changes in shelters by joining us on the podcast as well. 

Sunday, December 29, 2013

2013/2014 Flu Update #3


Update #3 for December 28, 2013

ILI activity climbing fast, HAN Alert Issued

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week 51 for the period ending December 21, 2013. In this period flu cases are described as "widespread" and Health Alert Network advisory published.

The  CDC's Heath Alert Network (HAN) has published an official CDC Health Advisory alerting clinicians to reports of severe respiratory illness/infection with influenza A (H1N1). According to the HAN Advisory, the H1N1 pdm09 virus has resulted in numbers pH1N1 hospitalizations and ICU admissions. Some fatalities have bee reported. The alert also notes "While it is not possible to predict which influenza viruses will predominate during the entire 2013-14 influenza season, pH1N1 has been the predominant circulating virus so far.

According to the CDC Flu View site:
During week 51 (December 15-21, 2013), shows continued increase of influenza activity in the United States.
  • Viral Surveillance: Of 6,813 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 51, 1,639 (24.1%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: One influenza-associated pediatric death that occurred during the 2012-2013 season was reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 4.3 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 3.0%, above the national baseline of 2.0%. Eight regions reported ILI at or above region-specific baseline levels. Six states experienced high ILI activity; eight states experienced moderate ILI activity; six states experienced low ILI activity; 28 states experienced minimal ILI activity, and the District of Columbia, New York City, and two states had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 10 states was reported as widespread; Guam and 23 states reported regional influenza activity; 12 states reported local influenza activity; the District of Columbia, Puerto Rico, and four states reported sporadic influenza activity, and the U.S. Virgin Islands and one state did not report.
Timeline Comparison
Below are CDC FluView maps that compare the prior two reporting periods against the corresponding weeks of 2012/2013 influenza season. They indicate ILI activity increasing steadily through weeks 48 to week 51, 2013. There is a noticeable difference in ILI activity between week 51 2013 when compared to week 51 2012. The 2013 CDC map demonstrates a much lower geographical impact of High ILI activity compared to the current year at this time.

2013/2014 CDC Flu Interactive Map for week 51 2013


2013/2014 CDC Flu Interactive Map for week 50 2013


Comparison: 2012/2014 CDC Interactive Map for week 51, 2012 

Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data. According to Google Flu Trends ILI activity has progressed from moderate to high between December 15 to December 22, 2013. 

Monday, December 16, 2013

Scheduling Your Mandated Vaccines

 When is voluntary compliance not enough?

Joint Policy Statement endorses mandated vaccine schedule.

The Infectious Disease Society of America, the Society of Heatlhcare Epidemiology of America, and the Pediatric Infectious Diseases Society have collectively endorsed recommendations made by the Advisory Committee on Immunization Practices (ACIP) concerning universal immunization of health care workers.

The joint statement issued December, 2013, called for voluntary immunization programs to be discontinued in favor of mandates when compliance falls below 90%. ACIP further recommends that healthcare workers provide "documentation of receipt of ACIP-recomended vaccinations as a condition of employment, unpaid service, or receipt of professional privileges." Full text of the joint statement can be found with the link below.

Mandated vaccine against seasonal influenza has been hotly debated for several years (see Mandate the Shot or Not). While this debate continues to grind on there has been little attention given to the non-pharmacologic strategies that go hand-in-hand with vaccinations.

Pharmaceutical shortages have occurred and are certain to play a role in vaccine production in the future. Requirement or not, if vaccine is not available, you won't get it. What about when no vaccine has been created to fight a given pathogen? To both situations healthcare workers should turn to personal protective equipment to help prevent the spread of disease (see Best Disease Prevention is Action).

Saturday, December 14, 2013

2013/2014 Flu Update #2


Update #2 for December 14, 2013

Modest increases in ILI activity 

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week 49 for the period ending December 7, 2013. In this reporting period flu cases are continuing to increase but remain behind last year at this time.

According to the CDC Flu View site:
During week 49 (December 1-7, 2013), shows continued increase of influenza activity in the United States.
  • Viral Surveillance: Of 6,219 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 49, 830 (13.3%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: No influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 2.0 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 2.1%, above the national baseline of 2.0%. Three regions reported ILI above region-specific baseline levels. Four states experienced high ILI activity, five states and New York City experienced low ILI activity, 41 states experienced minimal ILI activity and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 14 states was reported as regional; 18 states reported local influenza activity; the District of Columbia, Guam, Puerto Rico, and 16 states reported sporadic influenza activity; the U.S. Virgin Islands and two states reported no influenza activity.

Timeline Comparison

Below are CDC FluView maps that compare the last two reporting weeks and 2012/2013 week 49 to this year at week 49. They indicate a modest increase in ILI activity from the week 48 to week 49, 2013. There is a noticeable difference in ILI activity between week 49 this year versus week 49 2012.

2013/2014 CDC Flu Interactive Map for week 49 2013

2013/2014 CDC Flu Interactive Map for week 48 2013

Comparison: 2012/2014 CDC Interactive Map for week 49, 2012 

Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data.

Monday, December 09, 2013

2013/2014 Flu Update #1


Update #1 for the week ending December 9, 2013

Flu activity increases slightly, but will we follow the 2012/13 pattern?

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week 48 for the period ending November 30, 2013. In this reporting period flu cases are starting to increase most notably in the south and south east.

According to the CDC Flu View site:

During week 48 (November 24-30, 2013), influenza activity increased slightly in the United States.
  • Viral Surveillance: Of 5,306 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 48, 536 (10.1%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: One influenza-associated pediatric death was reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 1.2 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 1.9%, below the national baseline of 2.0%. Two regions reported ILI above region-specific baseline levels. Two states experienced high ILI activity, two states experienced moderate ILI activity, two states and New York City experienced low ILI activity, 44 states experienced minimal ILI activity and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in nine states was reported as regional; 13 states reported local influenza activity; the District of Columbia, Guam, Puerto Rico, and 27 states reported sporadic influenza activity, and the U.S. Virgin Islands and one state reported no influenza activity.

Comparison to last year at this time.

In the 2012/2014 flu season public health emergencies were not declared in New York and Boston until well after high numbers of ILI cases and intensity had been experienced. By looking at the  trends displayed between these two maps, can we predict and prepare for increased flu numbers in the coming weeks? The following images compare the Influenza Like Illness (ILI) activity for week 48 of 2012 and 2014. Both maps indicate ILI concentrations in the South and Southeastern United States. By reviewing last years data we know that with in four-weeks high ILI activity had progressed to the Northeast. Can we predict the same for 2013?  

2013/2014 CDC Flu Interactive Map for week 48 2013




Comparison: 2012/2014 CDC Interactive Map for week 48, 2012 


Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data.

Friday, November 29, 2013

This Week in Preparedness 11.29.13

Mitigation Journal TWiP week ending 11.29.13

CDC buys into Social Media to Predict Flu - sponsors "Predict the Influenza Season Challenge" Enter for a chance to will $75,000 and CDC recognition. (CDC.gov)

Department of Health and Human Services balk at H7N9 Vaccine. Is HHS holding back on a vaccine that could dampen the threat of pandemic from H7N9? If so, why? Read Politix Why Won't HHS Approve Crucial Flu Vaccine? (politic.topix.com)

Always worth following - Google Flu Trends indicates low level of seasonal flu activity in the United States as of this posting. Current numbers reflect flu cases on par with average for this time of year.  (google.org)

New Guidelines on Managing Obesity Crisis - The American College of Cardiology and the American Heart Association along with The Obesity Society and National Heart Lung and Blood Institute have issued a updated set of guidelines to battle what is believed to be one of the largest threats to national security and public health...Obesity. (medscape.com)

H7N9 Has Virulence and Transmissibility - It's stupid and contagious! But then, these are the qualities of most viruses. Novel Flu Virulence and Transmissibility. (thealmagest.com)

Nurses have a role in creating new IT? Really, what the heck for? Read: Why nurses must be involved in developing new health IT (fiercehealthit.com)

Preventing Opimism Bias is cornerstone of MJ's Culture of Preparedness. We've talked about preventing the "it can't happen to me" mentality since day one. Mainstream media is starting to listen according to this piece from The Journal Gazette (Fort Wayne IN) Be Wary of 'it can't happen here' attitude. (journal gazette.net)

The Many Faces of H7N9. Indications are that H7N9 has as many as six different clinical presentations according to data gathered and presented in the Avian Flu Diary. Bookmark and check Avian Flu Diary often. (afludiary.blogspot.com)

Monday, November 25, 2013

Preparedness by Popular Demand

MJ Readers Suggest Topics for 2014


What preparedness topics are important to you as we move dangerously close to 2014? I asked that question on my Facebook page (rickrussotti) and was impressed by the depth of topics our readers and listeners came back with.

Steve Erb (Rochester, NY) suggested crowd/spectator control planning for events at malls, schools, sports ensues and outdoor events (civilian soft targets). Steve writes "we might learn some things regarding planning, communication and response from the Aurora, Colorado theater shooting as a case study." 

The Aurora situation is another tragic milestone with enduring lessons.  The rescue efforts have been questioned during that event and we've seen how politics can bog down readiness. In the end, what have we learned since Columbine? 

Michael Coffin (California) suggested a continued look at active shooter events along with a session on Zombie Apocalypse. Both are right up our alley. The zombie theme was mentioned by Lisamarie Pocza (Massachusetts), too. 

John Spaulding (Rochester, NY)suggested credentialing for volunteer fire officers, pre incident planning, and  social media in public safety. Johns topic about social media is exemplified by this post - all this subject matter came from one Facebook post!

Micheal F. Staley (Georgia) brought up an often overlooked topic - the importance of taking care of our family. 

Jim O'Kelly (Rochester) hit on another under-addressed topic - life in the post antibiotic world. 

You can follow me on Facebook and Twitter (@rickrussotti)

Saturday, November 23, 2013

Welcome to Year Nine

Mitigation Journal Begins Ninth Year

For a variety of reasons I've struggled to find the time and energy to get back to the keyboard. I've questioned the relevance and importance of what we've been doing with Mitigation Journal blog and podcast over these past eight years. Social media has exploded and resource sites such as the CDC and UPMC have grown exponentially since MJ started in November, 2005, leaving me to wonder if this project is relevant any longer. 

The answer to the self-imposed question of relevancy came while I was speaking at large conference on the East coast. A line of attendees formed at the conclusion of each of my talks; not so much to ask questions, but to tell me how much they appreciated Mitigation Journal. Some preferred the blog content while others relied on the podcast of information. More than fifty people stopped me to introduce themselves and say they had read or listened to Mitigation Journal. Fifty people - I know the number because thats how many business cards were given out. Not too bad considering my original goal for this project was to reach 100 readers/listeners in Rochester, New York. 

With my misgivings abated we will move on. Mitigation Journal has turned eight. We're proud to say the blog receives 300 hits per day (even during hiatus) and the podcast reaches thousands of listeners world wide. As I say in classes "this is audience participation" and your voice is important to our conversation. Please follow me on Facebook (rickrussotti) and Twitter (@rickrussotti) to carry on that conversation. 

On behalf of Matt, our podcast co-host, thank you for your support and welcome to year nine!

Wednesday, June 12, 2013

MJ 252: A Unique Perspective on Secret Spying




A Unique Perspective on Secret Spying on Mitigation Journal - keeping the use of tin foil to a minimum. 
This edition is all about the revelation that the United States Government has been collecting data from various sources on each and every one of us. The situation is breaking news and unnerving but should we be surprised? 
In this edition we discuss how the changes in technology have made it possible for secret spying on the American pubic to take place. In the name of “stoping terrorism” we’re collecting cellular, internet, and email data on everyone...just in case we find something worth investigating. 
WIll this type of surveillance work? No. It didn’t work during the Civil War and World War Two and it won’t work now. 
At the end of it all, we have to ask it now is the time to unplug? 

Check out this episode!

Monday, June 03, 2013

MJ 251: Tornadoes - first hand with Mike Ehrman



We have a special guest this week, Mr. Mike Ehrman is joining us by phone to bring a first-hand account of the tornadoe situation in Oklahoma. Mike has been posting updates to his Facebook page outlining the situation as well as rescue and recovery operations. Today we'll talk about the disaster backpack program, pet supplies for special needs populations, damage assessments, and shelters.
We'd like to thank Mike for taking the time to join us on todays podcast and we extend our thoughts and prayers to those impacted by the storms.

Check out this episode!

Tuesday, May 21, 2013

When Can We Stop Training for Terrorism?

Time to focus on what we're the threats we're seeing today

This posting was originally written in 2005 and reflected my views on how expenditures of time and money were being wasted in the name of terrorism training. Not much has changed over the eight years since I originally published this article' except for a decrease in preparedness funding, of course. We've seen several assaults on civilian soft targets resulting in mass casualties during this time as well. Some have been labeled "terrorism" some have not. While we can debate the usefulness of terrorism as a descriptor of what we face, we can't ignore the fact that our responses to these events are not much improved from the pre-9/11 days.

From 2005...
Our language reflects how we think and act. When we place a term on an issue, that term becomes face or imprint in our mind for that given issue. Terrorism and weapons of mass destruction (WMD) are two terms arisen out of the September 11, 2001 attacks that have been imprinted on us. Although not entirely new terms for many in the traditional response group of emergency medical service (EMS), fire service, and law enforcement; terrorism and WMD became the language defining events of National crisis. These and several other terms have taken on a center stage appearance since 9-1-1. Highly paid “experts” have become obligatory content in any number of trade journals and conferences. Emergency service organizations have received millions of grant dollars to purchase training/education, equipment, and supply all to be brought to defend against terrorism/WMD. 

Most of the training that has been conducted is next to meaningless. A majority of the training conducted lacks context to what is encountered and managed every day. That is to say; we need to take the all-hazards approach to training and relate the material to the bread-and-butter jobs paramedics, EMT’s and firefighters respond to. Doing so will keep the skills and knowledge fresh and usable. If we continue to wrap this material up and say “don’t open ‘till terrorist attack” we will not be able to use it properly. We must take the message given by intentional event training and project it across routine, every day events. I believe the terms terrorism and WMD should be replaced with intentional events.

A good example would be to apply the all-hazards approach to triage. Ask any group of emergency medical technicians or firefighters, veterans or rookies, if they’ve ever worked an event that they’ve needed to do triage. You might get one or two that have, but the majority will claim to have never needed their triage skills. In reality we all have. The fact is that we do triage on each and every call we’re on. Triage means to sort and prioritize. We do that with every patient, looking at injuries and complaints, making decisions about what to treat first and how. Firefighters triage the situation, the building and the fire…only it’s called size-up, and we’ve been doing it for years. Educators who can describe intentional event preparedness in this format will be giving the student the tools to truly be prepared.

"If we continue to wrap this material up and say “don’t open ‘till terrorist attack” we will not be able to use it properly."

I’ve found numerous training officers who would come to me after a lecture and buoyantly declare “this WMD stuff is all well and good, but my guys need to get back to basics”. I usually ask those officers if they believe the “basics” include training on poisons and toxics like organophosphate materials. Or, might we be able to find time in our zealous training schedule to include basics of mass casualty management. Oh, the irony of it all! For these same training officers do not hesitate to defend the need for hazardous materials or mass casualty training yet miss the more than obvious relationship between intentional events and the hazardous materials event or bus crash. I guess if we call it haz-mat they’re OK with it, but; terrorism…hell, terrorism can’t happen here, right? Not to mention the probability of a natural event impacting any community.

The point here is this; we have to blend what we’ve come to know as terrorism/WMD training into the “basics” of EMS and fire service. To do so is simple because of the similarities between the intentional (terrorist/WMD) event and haz-mat accidents, mass casualty events, and natural disasters.

What do accidents, man-made events (human initiated to be politically correct), and natural disasters (ice storms, hurricanes, earth quakes, floods) have in common? The short list of examples include:

  • Little or no warning
  • potential for large numbers of civilians needing assistance
  • multiple casualties and fatalities
  • protracted operations
  • limited resources


The all-hazards approach looks at preparing us for a multitude of potentials. Not everyone has to be ready for a blizzard or a wildland fire, but we should all be cognizant of the need for self-protection, working within the incident management systems, triage and the like. We also must take advantage of our existing knowledge and skill base by putting them to use in the context of terrorism/WMD events.

The labels of terrorism and WMD may have been a great disservice to our responders and citizens. Those terms imply an event that most people don’t believe will ever happen to them. However, the principles, tactics, and added knowledge that training for intentional events advocate can traverse a multitude of disciplines and events.

Let’s try to change our thinking...when will it happen here?

Wednesday, May 15, 2013

Rescue efforts questioned after Aurora

EMS NOW - a weekly highlight of emergency medical services

Paramedics cited as unprepared but system preparedness should be in question.
By Rick Russotti, RN, EMTP
This article made possible with the support of KMS Medical

"When a shooter sprayed a movie audience...paramedics were not prepared for the extent of the carnage and arrived with too few ambulances..."  - CNN.com Ben Brumfield and Cristy Lenz, CNN
The above quote occupies the opening lines of a recent CNN article outlining the Aurora Fire Department Preliminary Incident Analysis of the July, 2012, theater shootings (link provided by Denver Post).  The incident took place on July 20, 2012 at 0040 hours, according to the report. A chaotic scene was described by initial responders who were met by nearly 1400 movie goers. Also, according to the report, responders were swarmed response vehicles and access/egress points.
"The number of critically injured patients encountered prior to reaching the theater slowed the process of apparatus reaching specific locations. Responding units were stopped by frantic moviegoers covered in blood and carrying critically injured patients." - AFD report
The report also notes that communications between traditional response agencies was lacking, resulting in delay in notification and deployment of EMS resources. Communications improvement and responder interoperability were major areas of improvement described by the McKinsey report after 9/11. The National Incident Management System (NIMS) also held interagency coordination at major events as a bedrock goal.

A gunman opening fire in a crowed multiplex theater is one of the most terrible situations conceivable perhaps trumped only by the release of a chemical agent. Preplanning and training for civilian soft target locations cannot be overstated. As I've said in past postings "skip the airport disaster drill and train for todays emerging threats."

While the AFD incident analysis reads with striking similarity to the after action report from Columbine High School in1999; we have to wonder how well have we remembered the lessons from Columbine?  How ready are we for an active shooter situation in a civilian soft target?

The threat of attacks on soft targets (movie theaters) continues. Why was EMS taking the headline fault for issues during this event? Faulting EMS for large-scale, multi jurisdictional failures seems to be a trend. It would be rare for an EMS agency, including one attached to a fire or police department, to take the incident command role in an active shooter event and more likely be operating as a division within the NIMS/ICS framework. So, why then do we continue to see headlines describing EMS as the weak link in a system-wide response? Natural events in Pittsburgh, Washington D.C., and NYC have all cited EMS as the poor performer and contributor to deaths.

The traditional response groups to fire, EMS and law enforcement must work together in training for scenarios such as a movie complex shooting. An understanding of each services response objectives and standard operating procedure must be reviewed and drilled on. Tabletop exercises and functional exercises can make this a reality.

EMS NOW sponsored by KMS Medical