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Review of HHS Pandemic Flu Plan

I've wallowed in the 394 pages of the HHS Pandemic Influenza Plan for the last day or so.

I've wasted my time.

The goal was to review the plan, come up with workable solutions and methods to put the plan into practice...everyday use. You know, that "All-Hazards" stuff I keep talking about.

A number of healthcare and allied healthcare groups have come out swinging against the Plan. Although I will not take such an extreme view, I would describe the plan as non-workable. The little voice keeps asking me "after the Anthrax attacks of 2001 and all the WMD training we've done; why don't we have this plan workable and ready to go now?" Another reason why all the "terrorism" and "WMD" training has been a waste...the EXACT same actions, materials, and protective measures employed against a biological intentional event could be used in the setting of a natural event...The flu. See the posting Its Time To Stop Training for Terrorist and WMD Events for my full rant on this.

Here is the problem(s): HHS estimates that the H5N1 avian flu could kill 1.9 million Americans and hospitalize another 10 million. This is based on the potential of the virus to spread rapidly world-wide, people being infectious and asymptomatic, simultaneous outbreaks, and demands on the health care system. Of similar concern is the potenial disruption of infrastructure including public safety due to widespread illness and death among workers and concern about on-going exposure to the virus. Yet, the Plan fails to identify any actionable precautions outside of standard body substance isolation and respiratory etiquette. The Plan also makes note of the Strategic National Stockpile (SNS), yet today, long after 9-1-1, few cities have the abilities or even the plans in place to receive and distribute the SNS. The Plan also calls on non-traditional and traditional responders, emergency and domestic support groups to all work together under the Federal Response Plan and the National Incident Management System (NIMS). The fact, again, is that..well let me ask you; do you know your role in NIMS or duties under the FRP? Chances are you don't. See the problem?

The good news is that we've been doing BSI/PPE and respiratory etiquette for a long, long time. The bad news is that we've failed to learn from the hysteria of "white powder" events and the SARS epidemic.

The bottom line:
  1. Wear a mask-N95 if you've got it, but wear a mask
  2. Put a mask on the patient- over the cannula or non-rebreather
  3. Cover your mouth when you cough or sneeze
  4. Wash your hands...and do it often
  5. Put all the Bio-Terror training into play in the event of any natural flu outbreak
  6. Don't bother reading the Pandemic Influenza Plan...It's a colossal waste of paper


Stop training for terrorist and WMD events!

Its time to stop training for terrorism and weapons of mass destruction!

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. That is the good news.

The bad news is that most of the training that has been conducted is next to meaningless. Before anyone starts typing a response – four letters at a time – let me explain. A majority of the training conducted is next to meaningless because it 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.

I’ve found numerous training officers (you know, those supposedly setting the example) 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.

Here’s a quiz: What do accidents, man-made events (human initiated to be politically correct), and natural disasters (ice storms, hurricanes, earth quakes, floods) have in common? Here is short list of examples:
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.

In the following posts we’ll begin to address the all-hazards approach in greater detail. Look for EMS case studies and situational reviews as well.


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Key Words: Fire Department, Emergency Medical Service, EMS, Disaster, Terrorism, WMD