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Thursday

Predictions from 2010

2010 Predictions...How well did I do? Well, lets take a look...

Here is the list of my 2010 Mitigation Journal predictions. I've listed my self-assessment of accuracy in these predictions. You can feel free to agree or not. Either way, I'd love to hear from you.

 2010 Prediction: Budget Declines in municipal public services agencies: shortfalls in tax revenue and increased pressure to justify/cut personnel, facilities, and equipment. Public tax based services will be forced to refocus their mission.
Accuracy: 70%. The topic of public service budgets continues to circulate with various intensity and emotion.  Much discussion and mainstream media attention tuned towards pay and benefits throughout the year. Here in last few months of 2010, more attention has been directed to responses and the number of employees. Budget scrutiny seems to be hit or miss.

 2010 Prediction: Reduction in health care reimbursement, scrutiny of public service budget (fire and EMS) and justification of services - evidence based fee for services (I might predict a decline in fire service EMS...don't know if I want to mention that at this time)
Accuracy: 50%. Not as much of an issue as I would have thought this year. But as noted above, this issue is not going away. 

 2010 Prediction: EMS role in community health:
 EMS responders will take more work doing community-based health - for homeless and home confined populations. EMS will also have an increased interaction with at-risk or special needs populations.
Accuracy: 0% Totally ignored. Nothing happened with this at all...but, I wish it would! Should we keep this on the list for 2011?

 2010 Prediction: An increased number of walk-in care centers, urgent care centers, and retail health care clinics will impact health care delivery in general and EMS. Taking patients to them and picking people up from them.
 Accuracy: 80% I think I hit this one pretty close. Events and requests for service at walk in centers has increased as have the number of these centers. Both factors point to the fact that people are willing to forgo a trip to the family doc in favor of a walk-in/urgent care center.


Wednesday

Three Problems for Planning in 2011

Three Problems for Planning...that will follow us into 2011

Hospitals as Soft Targets
#1. The threat of intentional attacks on civilian soft targets continues.
Locations of critical infrastructure such as hospitals, will need to be protected from attack as will other civilian locations. Hotels, coffee shops, and shopping centers lack the deterrents necessary to prevent attacks. The psychological impact of an attack on any of these soft targets will nearly as devastating as the loss of life.



#2. The threat of intentional attacks on critical infrastructure continues.
Critical Infrastructure
As noted above, hospitals may be the most visible civilian soft target of critical infrastructure. Several other locations meet this definition, however. Fire departments, ambulance services, law enforcement locations, and public works facilities should all be considered targets of critical infrastructure. While health care locations may be the most visible, it is the locations power grid/power supply that may be the most vulnerable. Several references have indicated that the Nations power grid is the most "at risk" target we have. It stands to reason that the power generation and distribution network in any community would also be at risk. 



#3. Naturally occurring environmental and biological events will continue.
Biological Events
Not only will these events continue to occur, their scope and severity will increase. The population "at risk" to given biological events increases as the number of people with chronic diseases (increasing in severity) increases. At one point, we were mainly concerned with those of extremes of age when discussing naturally occurring biologic events. Existing disease states among all members of the population along with growing numbers of people with a weakened or compromised immune system will make for a large population that will be prone to more severe disease or prolonged recovery.

Tuesday

Hospitals...Public Health or Public Safety?

Hospitals...Public Health or Public Safety?
For years EMS personnel have found themselves torn between being part of public health or public safety. This identity tug-of-war has led to a certain lack of identity on the part of emergency medical services. The same problem is now being faced by hospitals and health care organizations.

Are hospitals part of public safety or public health? The answer is, both...based on public expectation. As much as traditional response groups train and prepare for disasters, they do so as part of their mission. The interesting fact is that hospitals are expected to manage the day-to-day events as well as the large scale event. The public expectation is that hospitals will be able to manage any crisis or disaster situation.

Monday

MJ Podcast 202: CO again, See Something at Wal-Mart, Patriot App

MJ Podcast 202: CO again, See Something at Wal-Mart, and the Patriot App
Click for edition 202
Today we'll celebrate the end of 2010 by looking back at my 2010 predictions and ask..."how well did I do"? First off in this weeks podcast; a review of the predictions. I'll be posting my self assessment later this week. In the meantime, I invite you to listen to my list of 2010 prediticions and let me know what you think...drop me a line on the voice mail line 585-672-7844 or email me mitigationjournal@gmail.com. We'll be posting the 2011 predictions early in the new year.

It's not all good news this week...we have hate mail to discuss. That's it, hate mail. In response to a Facebook posting; promoting Insights in Nursing, a podcast by the producer of the Medic Cast, an EMS podcast, I've been accused of "selling out' to the nursing profession. You'll have to listen to the podcast for all the details, but in short, Mitigation Journal is designed to bridge the gaps between responders...traditional and non-traditional. Fire, EMS, Public Health, and yes, nursing. Its about all hazards preparedness and getting that cross discipline information to a point where we appreciate the common ground we have and be better prepared. Tune in for all the details.

So Long, 2010
Our topics this week: Key point of CO events, See Something/Say Something at Wal-Mart, and the Patriot Act App. We'll also have a visit from Lori VanScoter of Instinctively Healthy giving us some tips on remaining healthy while working this holiday season.

Get the podcast at iTunes or click on the Podcast Player in right side-bar. 

Donate Today! Support mitigation journal by making a donation of $1.00.  Click the "donate" button on the right sidebar. Mitigation Journal is a listener supported independent podcast and blog… and any little bit will help.

 Get Mitigation Journal on your e-mail… subscribe to our free e-mail edition of the blog by typing your e-mail address in the e-mail subscription box.
 Subscribe to the podcast...FREE! visit us on iTunes and subscribe to get all the podcast information delivered to you each week.


Get the MJ app and support the blog and podcast! Visit the app store at iTunes  and for $1.99 purchase the MJ app...its the best way to get the podcast.

Friday

Responding with Awareness

Responding with Awareness...What's this all about?

What are you thinking about when you respond to an event? Location, construction type, occupancy, road and weather conditions, perhaps. How about awareness?

What's this awareness stuff all about? Its about waking up in a different world. That wake up might be in the middle of an event; such as when you hear the "mayday" being called on what you thought was a simple bread and butter operation. That wake up may come when you least expect it...

Responding with Awareness means waking up before the alarm goes off.

Talking with many responders during a recent delivery of my program Maintaining a Culture of Preparedness, it became clear to me that we haven't done a good job of teaching awareness or preparedness. We have learned to hit the snooze alarm pretty well.

Wednesday

Consumer Level HazMat Situational Awareness

Situational Awareness for Consumer Level HazMat Situations

You've heard me talk about this thing called Situational Awareness plenty of times. But, what's it mean and how do we apply it to Consumer-Level Hazardous Materials situations?

Let's start with a reminder of what Consumer Level HazMat situations are. Simply put, these are conditions created, either intentional or accidental, when chemicals available to the general public via retail purchase are used, combined, or discarded, that create a hazardous chemical environment or immediately dangerous to life and health (IDLH) situation. In other words, Consumer Level HazMat situations are derived out a creative use of everyday materials.

Situational awareness in these events is not only key to successful mitigation, but paramount in accomplishing the our response strategy of life safety, incident stabilization, and property conservation.

We can break Situational Awareness for Consumer Level Hazmat down into three easy to remember points:

One: Avoid Optimism Bias...the belief that "it can't happen to me, us, or here" is key to keeping yourself safe in any situation. We are often lulled into a false sense of security when events involve materials we can buy at any store. Make no mistake, household chemicals and product available at retail centers can and do pack the same potential as toxic industrial chemicals. It is this false belief that causes many civilians  and responders to fall victim to these products. Responders have the added scourge of complacency to deal with...that's another story.

Two: Its NOT "terrorism"...and it doesn't have to be! After several years of meaningless terrorism training, the traditional response community of fire and EMS have been led to believe that only intentional events require us to deploy our "terrorism" training. The fact is that many materials that fall into the consumer category can be used for illicit purposes. The fact is that we do not have to wait for an intentional act in order to use the knowledge, skills, and materials learned in "terrorism" training. We can and should be using this information (and finding ways to use it) every day. The result will be better preparedness and response to accidents as well as intentional events.

Three: Think Rule of Outcomes. Rule of Outcomes thinking requires us to think past the cause of the event and understand the common outcomes to a variety of events. We should be thinking the these types of events are going to need some level of decontamination, protective clothing, specialty care and transport, management of multiple patients, working in hostile environments or protracted times, and a coordinated multi-jurisdictional response...just to name a few. Rule of Outcomes thinking also tells us that the every-day calls for service will continue to come in and they'll do so when your resources are taxed.

Monday

MJ Podcast 201 Maintaining a Culture of Preparedness Live

Click for MJ Podcast 201
MJ Podcast 201 Maintaining a Culture of Preparedness Live...and Updated All-Hazards introduction to my most popular talk.

If you've been waiting for the perfect overview of preparedness, this is it! I've been working on the update Maintaining a Culture of Preparedness for a few months. Current events have driven me to get it done with a new introduction to the all-hazards approach to preparedness. In this all new segment, I'll discuss the Rule of Outcomes, Optimism Bias, natural and man made events, as well as intentional and accidental situations. We'll also discus the important difference between hard targets and soft targets.

You can click the icon in this posting for direct download or click the podcast player in the right side bar.

Donate Today! Support mitigation journal by making a donation of $1.00.  Click the "donate" button on the right sidebar. Mitigation Journal is a listener supported independent podcast and blog… and any little bit will help.

 Get Mitigation Journal on your e-mail… subscribe to our free e-mail edition of the blog by typing your e-mail address in the e-mail subscription box.

 Subscribe to the podcast...FREE! visit us on iTunes and subscribe to get all the podcast information delivered to you each week.


Get the MJ app and support the blog and podcast! Visit the app store at iTunes  and for $1.99 purchase the MJ app...its the best way to get the podcast.

Friday

America the Anxious to America the Prepared

America the Anxious to America the Prepared...
                            Updated document calls for civilian preparedness. 

Someone from DHS must have been in one of my Maintaining a Culture of Preparedness talks.

We talk quite a bit about the differences in today's response culture compared to the response culture of years ago. In brief, we used to have fallout shelters, civil defense shelters...and what I call the "Civil Preparedness Mindset"...Mr. and Mrs. America stocked up of food and materials and perhaps had a shelter of some type in the basement or back yard. While in today our society practices the "Just in Time" approach to preparedness...instead of stock shelf-stable supplies, we'll run to the supermarket daily, rather than take any responsibility for our own safety and readiness we'll assume someone will be there to rescue us. Our society has traded in the preparedness mindset for Optimism Bias...the "it can't happen to me" crowd.

Having been vocal about the need to prepare our civilian populations in much the same fassion as we did during the Cold War era, I am pleased to see this updated version of Planning Guidance to Response to a Nuclear Detonation. This guide updates the January 2009 version and makes a compelling assertion that the civilian population should: a) be informed, b) prepared, and c) shelter in place during a nuclear event. See the video below. A movement from America the Anxious to America the Prepared. 

All good points and topics we should continue to preach to the populations we serve. Furthermore, good things to remember for all-hazards preparedness...universal preparedness, if you will, not just nuclear events.

We've discussed various levels of readiness and planning most recently in our post on Survival Basics; taking simple preparations to survive being standed in your car.  We've also taken on the large preparedness view; What if it did happen here? We've even been a bit catastrophic while In Search of Preparedness in America.

Get the original guidance document here.



Wednesday

Biological Events Series: Smallpox

Smallpox...5 points to remember

Read the Demon
#1 Smallpox does not exist outside of a lab. Smallpox is highly contagious virus that no longer exists in nature. Seriously, the World Health Organization along with Dr. D.A. Henderson, wiped the Smallpox virus off the face of the earth back in the 1970's. Yet, people often tell me that the virus is alive and well in "third world" countries.

#2 Smallpox, even one case anywhere on Planet Earth, will be a global health emergency. We stopped routine vaccination against smallpox back in the '70's here in the United States. If you were born after 1979 there is a good chance you were not vaccinated. If you were born prior to that, chances are equally good that you no longer have full immunity to the virus. Many experts believe that a majority of the population is susceptible to Smallpox infection. Since we stopped vaccination, you guessed it, we stopped vaccine production...meaning no vaccine available if the virus were to be released intentionally or reemerge naturally. No immunity, no vaccine. Big problem.

#3 Several types of Smallpox. Specifically, smallpox is a variola virus and there are two types; variola minor and variola major. Variola major is the most severe (and was) the most common type, causing extremely high fever and extensive rash. Variola major comes in four flavors - ordinary (most common, about 90% of historical cases), modified - more common for people with prior vaccination, flat and hemorrhagic round out the category - both are noted in history to be rarely seen, but deadly.

#4 Smallpox is really contagious. Historical data suggests that one person with Smallpox can infect over twenty other people. While this may not sound like much, think about how many people you come in contact with everyday. These number are also based on the assumption that exposure would be accidental. Consider the potential of dissemination of Smallpox, or any other biological agent for that matter, was conducted intentionally. Smallpox is spread by droplet transmission, by direct contact with the sores or eruptions on an infected persons, and by contact with clothing or other items of an infected person. The potential for infection lingers until all the scabs have healed.

#5 Smallpox, like many biologic agents, presents like influenza. The incubation period is generally thought to be 7 to 14 days (some sources say 10 -12 days). A person with Smallpox can spread the virus even before they develop the associated rash. Initial signs and symptoms include; general illness, fever, nausea, vomiting, headache...similar to flu. The rash sprouts in about 3 days, going quickly from lesions to vesicles. This rash develops in a centrifugal pattern...meaning it appears on the face, the palms of hands and the soles of the feet first. In contrast to other rashes like chickenpox (varicella) that concentrates on the trunk of the body.

Tuesday

The Home Emergency Pocket Guide - Preparedness for all seasons

Home Emergency Pocket Guide
Consider giving the gift of preparedness this year with the Home Emergency Pocket Guide from Informed Publishing

One of the most frequent questions I get when it comes to disaster preparedness is "where do I start!?" The problem is that those who actually take personal and family readiness seriously can be easily overwhelmed by the amount of material available...even the most motivated of people can find themselves spinning without clear direction. The Home Emergency Pocket Guide from Informed Publishing provides that clear direction in a easy-to-understand format that allows for reference and repetition as well as planning.

If you're like me,  you've been using Informed field guides for EMS for years. I reviewed the Home Emergency Pocket Guide and of all the guides and documents I've reviewed in the last few years, this one takes first place.

The Home Emergency Pocket Guide is easy to use and written so anyone quickly quickly find life saving information on everything from planning to first aid. Covering natural disasters, hazardous materials, terrorism and recovery, this guide takes the All-Hazards approach.

I was hooked by page 4: "...preparedness experts have cautioned civilians for decades to take the necessary precautions to help themselves in times of catastrophe. And yet, many of us do not. " We believe it will happen to someone else: we suffer from Optimism Bias - In fact recent data suggests that only 6-7% of the public has done any planning or preparation for disaster or crisis. The Home Emergency Pocket Guide walks you through in a logical direction, the path to being aware and prepared for numerous situations.

The section on first aid is formatted for quick reference and easy recall. ABC'S, CPR, medical emergencies and trauma situations are all covered. Some not-so-common situations are included as you may need to be self reliant in disaster or survival situations. There is even guides for biological agents such as smallpox, botulism, cholera, and anthrax.

The first rule in any emergency is to stop and think. The Home Emergency Pocket Guide provides the foundation for your preparedness efforts. The more prepared the public is...the better the responders can help! Even the most experienced responder can benefit from this guide, giving piece of mind that your family knows what to do while you're responding to crisis.

Donate Today! Support mitigation journal by making a donation of $1.00.  Click the "donate" button on the right sidebar. Mitigation Journal is a listener supported independent podcast and blog… and any little bit will help.

 Get Mitigation Journal on your e-mail… subscribe to our free e-mail edition of the blog by typing your e-mail address in the e-mail subscription box.

 Subscribe to the podcast...FREE! visit us on iTunes and subscribe to get all the podcast information delivered to you each week.


Get the MJ app and support the blog and podcast! Visit the app store at iTunes  and for $1.99 purchase the MJ app...its the best way to get the podcast.
 

Monday

Consumer Level Hazardous Materials Events

Consumer Level Hazardous Materials Events...A New Way of Thinking.

When you hear "hazardous materials" what comes to mind? Toxic materials housed in some giant factory? A tanker truck overturned on a busy highway? Level 'A' protection and special response teams? If so, you're not alone. The scenes mentioned are what most people think of in terms of hazmat or toxic chemicals.

Its time to change the way we think.

I'd like to introduce you to the concept of Consumer Level Hazardous Materials (CLHM )situations. These are situations where there is a creative use or misuse of chemicals that can be found in any grocery store, do-it-yourself center, or your local drug store. CLHM's can be accidental or intentional. Accidental events, as the title implies, is the unintentional use or misuse of chemical products. Examples of unintentional CLHM events can range from simply mixing two different cleaning products; bleach and an acid of some type, to produce chlorine gas. CLHM's can also be used to carry out an intentional act such as Homemade Chemical Bombs or Chemical Assisted Suicide.

To illustrate the CLHM situations, lets look at this case study -

A homeowner is attempting to clear a clogged drain in his kitchen sink. Over the course of three days, he uses several consumer level products from his local grocery store. None of the products work. Indesparation the homeowner now visits the local builders labyrinth (big box do-it-yourself store) for something stronger...still, no results.

Finally, he pours the remainder of all the drain cleaning products into the drain at the same time. In this case, he used Liquid Plumr, Rooto Professional Drain Opener, Comet, liquid bleach, and some sulphuric acid for good measure.  The mixture reacts resulting in a severe inhalation hazard and the homeowner dies. His wife and son are overcome. Responder were called for trouble breathing and entered the structure as anyone might. They are also exposed to the fumes.

This situation actually took place.

Lets take a look at the CLHM involved and get a picture of how bad this is:
  • Liquid Plumr = Sodium Hypoclorite and Lye
  • Bleach and Acid (from comet) = chlorine gas
  • Bleach and Ammonia = Chloramines
  • Lye, an oxydizer = caustic burns, defatting/soapification injury
  • Take a deep breath
All this from products bought in any grocery or department store.  Until next week, just imagine what we could do if we wanted to really hurt somebody...

Sunday

MJ Podcast Edition 200

Mitigation Journal 5 years blogging, 4 years podcasting and MJ Edition #200

Podcast #200
Well, here we are! Edition 200 of Mitigation Journal podcast coinciding with the anniversary of this adventure. We're marking not only our 200th edition and four years of podcasting, but five years blogging in the emergency community.

This is also the week I'd like to say 'thank you' to everyone who has supported this project. Like so many other projects, Mitigation Journal has become more than the sum of its parts...with all the listeners, readers, and supporters being those "parts".

This week, Matt, Bob, Dan, Jamie, and I revisit some memorable moments marking the development of Mitigation Journal.  We run a bit longer than normal this week...so, sit back, get a fresh coffee, and tune in.

Biological Events Scenario One

Situation: EMS and fire first-response crews are dispatched to a local hotel. There is a high school basketball tournament in town with teams from all over the state. Today, you're called there for the third time...this time for a "male with general illness".  You encounter the patient who is complaining of flu-like symptoms and a non-productive cough for several days. He also notes a fever of 102F and general aches and pains. Self medicating with with over the counter cold preparations for over a week, they are no longer helping. He appears ill, tiered, but hemodynamically stable.

Questions:
Would you recognize this situation as a potential biological exposure?

In addition to your standard body substance isolation, what (if any) protective measures would you deploy?

What additional information would help you identify the possibility of exposure and raise your situational awareness?

Discussion:
While it is unlikely that the initial responders would identify an intentional biological event based on one patient contact, they should be aware of the potentials of a naturally occurring biological event. Since most of biological agents (naturally occurring or intentionally released) have an incubation period of 7-14 days, a biologic event can be talking hold of an area prior to signs/symptoms developing. Responders have to be on the lookout for patterns or clusters of illnesses. Situational awareness of outbreaks of "cold and flu" symptoms or unusually large number of calls for people with similar illness patterns, should clue the responder to the potential of an evolving biological event.

Give the questions above some thought.

Saturday

CO events...When are you going to take notice?

Embrace the practice of monitoring for CO...in patients and responders

I talk about carbon monoxide and cyanide quite a bit in this blog and on the podcast. I also get several emails after each CO and cyanide post telling me how boring the topic is, telling me that the CO thing has been "done.." and we don't need to keep going over it. I also get some flack from those who don't want to hear about non-invasive monitoring (ie monitoring for CO levels in patients). In fact, the most often (over)used comment is: "using a CO monitoring device on a patient is a waste...we're going to take them to the hospital anyway..."

Ignorance.

There have been four significant carbon monoxide events within the last three months here in Rochester, NY. Two deaths, numerous serious illnesses, and an evacuation of a nursing home. I wonder how many low-level chronic exposures are going undetected? Chronic exposure to CO has been linked to cardiovascular events and often misdiagnosed as cold or flu. Responders are also at risk...not just at fire events...but working in any environment. Why do responders and administrators continue to ignore the technology and the practice that may allow for rapid screening and detection of occult CO exposure?

Ignorance.

After all, we're going to take the person with headache, nausea, or vomiting (signs of exposure) to the hospital anyway...so why bother? Good point.

Lets look at it this way:

Why bother doing an ECG or 12-lead on a patient with chest pressure and shortness of breath (signs of a cardiac event)?...after all, we're going to take them to the hospital anyway...

12/10/2010 http://www.13wham.com/news/local/story/Woman-Dies-of-CO-Poisoning-Boyfriend-Released/A0CArnFpSkqmrMv-pDLUqg.cspx

11/10/2010  http://www.13wham.com/news/local/story/Penfield-Man-Dies-of-Carbon-Monoxide-Poisoning-in/UwgwR8FNPUCveJM52CdjaA.cspx

11/25/2010  http://www.13wham.com/news/local/story/Carbon-Monoxide-Leak-at-Nursing-Home/u4BTCSTpgk6SBS2_1BAV7w.cspx

10/22/2010   http://www.13wham.com/news/local/story/Carbon-Monoxide-Scare-Lands-Brighton-Family-in/YH8Osg2xSkOO57x_Fz-mfA.cspx

Not your average fire safety video

Not your average fire safety video...but maybe more realistic.

Here is some fire safety information on another level...that we're not used to. This video was created by a friend of my kids for a school project and I thought you'd get a kick out of it.

I want to thank Thomas for his creativity and realism on the subject.


Friday

Holiday Fire Safety Reminders


Holiday Fire Safety Reminders...because responders need to hear it, too.

I know we're all in the emergency service business and are used to being the ones delivering this message. It's just as important to remind each other of the importance fire safety during the holidays as it is to remind the public. The holiday season brings additional risks and requires vigilance to prevent tragedy related to fires. According the the National Fire Protection Association (NFPA) and the U.S. Fire Administration (USFA), there are about 250 residential structure fires involving Christmas trees and another 170 fires attributed to holiday lights and decorations each year. The results are numerous deaths and injuries.

Join Mitigation Journal and the NFPA/USFA in an attempt to decrease the holiday tragedies related to fires. Remember, as responders we are not immune to fires in our own homes. We have a duty to serve the public and ourselves by keeping a few important from the USFA/NFPA points in mind:

Care for your tree:
Do not place your tree close to a heat source, including a fireplace or heat vent. The heat will dry out the tree, causing it to be more easily ignited by heat, flame or sparks. Be careful not to drop or flick cigarette ashes near a tree. Do not put your live tree up too early or leave it up for longer than two weeks. Keep the tree stand filled with water at all times.
Maintain your lights:
Inspect holiday lights each year for frayed wires, bare spots, gaps in the insulation, broken or cracked sockets, and excessive kinking or wear before putting them up. Use only lighting listed by an approved testing laboratory. And do not leave holiday lights unattended!
Avoid using real candles:
If you do use lit candles, make sure they are in stable holders and place them where they cannot be easily knocked down. Never leave the house with candles burning.
Keep two ways out:
Ensure that trees and other holiday decorations do not block an exit way. In the event of a fire, time is of the essence. A blocked entry/exit way puts you and your family at risk.


Thursday

Three Things the new Homeland Security Advisory System Must Do

Color Code Homeland Security Advisory System to Retire...Well, maybe. 

The Department of Homeland Security is considering a retirement of that ridiculous color-coded threat assessment system. According to a number of mainstream media reports, this system which has been in place since 2002, is now out dated. You may recall that this threat level color code system was instituted by a Homeland Security Presidential Directive 3 (HSPD three) and has come under scrutiny and criticism ever since. So with this system gone, we have to ask; what will replace it.

My opinion is that we should take the entire color code style assessment system and replace it with the old “test pattern” that used to see when a TV station went off the air… for those of you that remember the days when television stations actually stopped broadcasting at night.

Why do I say that? Simply because no one paid attention to the color code system since its inception. Worse than that, often times the system was misleading and failed to provide any type of useful information to the public. But while we are bashing the terrorism threat color code system lets not forget that there are other systems that are equally ignored by the public like fire alarms and public alerting sirens. These other systems have a few things in common with the color code threat level system… that common thread is: irrelevance.

 And here is why I think the Homeland security advisory system is irrelevant: it does not do what it was designed to do… it never did. And worse, those other types of alerting systems suffer the same level of "ignore it and it will go away" attitude from the public.

 While we don't know what type of system (if any) will replace this color code terrorism threat thing, I do have an opinion as to what the next generation of threat alerting system should do:

First, any warning system should engage the public with meaningful intelligence and data.  The information the system provides has to make sense to the public and provide some type of concrete information.

Second, a warning system has to define an action. It has to underscore the level of preparedness that should be taken for each level of warning… it has to call us to action. Think about the last time you were in a public place in the fire alarm went off. Perhaps you've been in a restaurant when the fire alarm system activated. When in public, how often do you see people actually leave the location when the fire alarm goes off? Often times you'll see people continue about their business while the fire alarm rings. To be effective a warning system has to change behavior.

Third, an alerting system or warning system has to inform the public when to de-escalate or stand down from a threat. Unsubstantiated and prolonged periods of increased vigilance lead to sensory burn out and decrease the efficiency and effectiveness of future warnings. A warning system has to have a defined end point–just the opposite of telling people what to do when the threat level increases or the alarm goes off, we have to tell them what we want them to do when the threat has been relieved.

Wednesday

MJ Podcast #199: DHS Threat System Changes, WikiLeaks and You, Survive in your car for a day?

Click for MJ Podcast #199
Get instant free access to Mitigation Journal podcast - click on the podcast player in the sidebar or below.

Matt and I churn up a few good topics this week on the podcast. First, we discuss that ridiculous color-code threat system the Department of Homeland Security has been using. The color code system has never been meaningful to the public or those in emergency management...other than for jokes, that is. Its due to be replaced (but we don't know when or with what). In this segment, we discuss the top three things a a warning system should do. We'll also have a separate blog posting out on this topic scheduled for December 9. This post will have additional information, history and links. Click here for a sneak preview or check back at Mitigation Journal blog for more details.  

Next up, we tackle the WikiLeak situation from a different point of view...yours. What would life be like if your public service had a WikiLeak of its very own? Would you be able to defend your budget secrets, your spending, or your billing practices? Would you want the public to know the deep-dark secrets of your quality assurance process? What if the general public (including those who what to do you harm with an intentional event) got a hold of you pre-incident plans or other response plans? Would your personnel be at risk? Consider the impact to you public support if your agency secrets became public...

Finally, this week, we discuss a situation from Western New York (South of Buffalo) where over 100 people were stranded on a 10-mile stretch of I-90. Could you survive in your car for a day...during a snow storm? We've got a post up about this and add to the suggestions for keeping yourself prepared when traveling.





Donate Today! You can help support mitigation journal by making a donation of $1.00.  Click the "donate" button on the right sidebar. Mitigation Journal is a listener supported independent podcast and blog… and any little bit will help.

 Get Mitigation Journal on your e-mail… subscribe to our free e-mail edition of the blog by typing your e-mail address in the e-mail subscription box.

 Subscribe to the podcast...FREE! Visit us on iTunes and subscribe to get all the podcast information delivered to you each week.

Get the MJ app and support the blog and podcast! Visit the app store at iTunes  and for $1.99 purchase the MJ app...its the best way to get the podcast.

Survival Basics

Survival basics for your car will keep you going and improve response.

Hundreds of motorists were stranded on the New York State  Thruway this week when a tractor-trailer jackknifed blocking the road during a snowstorm. The storm eventually dumped over 2 feet of snow in the region south of Buffalo, New York. Hundreds of occupants of personal vehicles and commercial vehicles were stranded without any means of escape during the storm. Many were stranded for over 24 hours. Eventually, local fire department and police crews were able to make their way down the miles long lanes of stranded motorists to deliver extra fuel, food, and to assess the situation.

Criticism of the New York State Thruway authority has been building since the event on December 1, 2010. One of the criticisms was that the authority allowed traffic to enter the block area of roadway during the storm even though they were aware of the traffic jam. Another shortcoming has been described as the lack of a plan to deal with such emergencies and allowing the area to go on monitored and not being able to remove the truck blocking the lanes of travel.

This event has important emergency management and preparedness implications for us. First, we have to remember that no response will be successful if the public involved has not done at least some preparedness. In this case, it appears that few if any of the motorists in either private or commercial vehicles had any emergency supplies. Most complained of being cold yet did not have any spare clothing with them… some did not even appear to be dressed appropriately for the environment found in western New York this time of year. Another important thing to consider is the length of time it took traditional responders (police and local fire apartment) to get to those trapped in the snow. Most accounts indicate that it was over 12 hours before rescuers were able to make their way into the traffic jam to deliver supplies and assess the situation. One source was quoted as saying the reason for this delay was because this area of roadway is not routinely monitored by any jurisdiction.

Another frustration expressed by stranded motorists was that the responders were not able to give them any information on the situation. While this may be difficult to do, we should make every attempt to craft a generic statement that will give the civilians some information. That statement could be as simple as which radio station to tune into to get information and updates. A common misconception is that if we inform the public of the actual situation they will panic. This is clearly a false belief. Information helps keep people calm and promotes compliance with instruction. Disaster research shows that when people are poorly informed, feel trapped, and hopeless that they begin to panic and make poor decisions.

Once again we have a local example of Optimism Bias in action. That is, it won't happen to me… if it happens to me, someone will be there to rescue me. We have to take measures to protect ourselves and be able to be self-sufficient (even rudimentary effort would help) in cases where rescue or assistance may be delayed.

Here are my tips for survival when stranded:
 
First, be sure to keep your car's fuel tank greater than half-full. Keeping your vehicles fuel tank  above half full or better will help make sure you can navigate detours if you're route is blocked. Keeping that much fuel in your vehicle will also allow you to run the engine for much longer in order to stay warm. It's important to keep in mind also that you should run the vehicle's motor only intermittently when stranded… just enough to warm up the interior every 30 to 45 minutes. On this point we should also mention the need for good ventilation in your vehicle… keeping a window cracked open to allow for fresh air and periodically checking the exhaust pipe to ensure it has not become blocked with snow or debris. Failing to do either of those could result in exposure to automobile exhaust and carbon monoxide poisoning.

Second keep a survival kit in your car. It does not have to be elaborate put should contain a few simple items. A hat, gloves, extra socks, and a pair of boots would be helpful as well as a warm blanket. It's best also to have some shelf stable snacks available. Candy bars, energy bars, and those little crackers and cheese combination will work just fine. Along with something to eat you should try to keep something to drink in your vehicle as well.

Third, communications is key. Although we all have cellular phones these days it won't do us much good if the battery runs out. Therefore, keeping your cell phone charger (the car adapter type) in the vehicle will go a long way to letting people know where you are and getting information… especially if you were stranded for a prolonged period of time. Another important part of communications is your communications plan. Although we take traveling for granted it's important to let people know when were leaving and when we plan to arrive at our next destination. This is especially helpful when traveling during inclement weather seasons or in unfamiliar areas.

And finally, don't forget the shovel and salt. Keeping a small shovel in your vehicle may mean the difference between being stranded and effecting a self rescue. Also keeping a small bag of sand, gravel, or rock salt may be able to provide the needed traction to get yourself unstuck.

Although I recommend a shelter in place approach to surviving these situations, there may come a time where you have to decide to attempt self evacuation. The decision to leave safe shelter and walk out into a storm is not one to make lightly. You must consider your level of fitness, your clothing, your hydration and nutrition status, and the environment before attempting self rescue.



Planning and preparedness.
For those of us responsible for responding to such events there are several keys to successful operations. The first, of course, is pre-incident planning. If you have stretches of highway in your area you can find yourself dealing with hundreds, perhaps thousands, of stranded motorists in any season… from any cause. There is no excuse for not pre-planning your response with various size highway incidents involving multiple patients. Your threat assessment is a major part of the pre-planning process and should include natural as well as man-made events.

As a traditional responder you'll need to consider additional points:
First, what personnel and resources will I be able to bring to this situation and how long  will deployment take. In these large-scale events deployment of resources is often best done only after sufficient personnel, supplies, and equipment have been staged to support the effort. Although rapid triage crews may be effective, the main thrust of the response should only take place when all the pieces are together.

Secondly, you must make provisions early on for emergency incident rehabilitation. Your responders will be providing assessment and care in very difficult environmental conditions. Appropriate rehab and rotation of responders will go a long way to maximizing efficiency and extending crew viability.

Third, you'll have to make some difficult decisions as to shelter in place versus attempt evacuation. As noted above there are several conditions that have to be taken into account before people are moved from an area of relative safety into a hazard area.


This post will also appear in ProResponder

Tuesday

What if your agency had a Wiki-Leak?

Food for thought...when your internal secrets become public.

 Would you try to stop it? Would you try to prevent your deep, dark, agency secrets from becoming public? We're all familiar with the current wiki leak situation that's causing a stir around the globe. But what if this Internet distribution of sensitive information came home to roost in your emergency service?

 How confident are you that your service is properly collecting Medicaid or Medicare dollars, tax dollars, or is correctly billing for services? How would a wiki week on your billing practices or other revenue-generating activities be seen by your community?

How about your policies and procedures? Would they stand up to public scrutiny if to be suddenly made available to your general public? What about your quality assurance practices? It would be very interesting for the public to find out about some of the well-kept secrets and emergency service surrounding the quality and delivery of that service.

So, while the world is focused on the wiki leak induced hysteria over secret documents, take a few minutes to examine your internal structure… from billing to quality assurance… and ask yourself how would we measure up if all this got out?

Would you shine, or get a shiner?

Friday

Sara Russotti December 3, 2005

Dear Sara,

It's been five-years. Time has sailed by without you here. So many changes and so many gifts we'd like to share. None of our gifts could match the joy you've gave in your short time with us. Your brother and sisters have grown so much...but they have not out-grown you. You have a baby sister now...that makes you the big sister! I wonder how you'd like that?

I often think about what we'd do if we were together. Would we color or play catch? Build a snowman or go sledding? Or, would we just sit with the sun and look at the leaves? Oh, what I would give for the summers we didn't have or the pictures we didn't color...for the daughter I can not hold.

You remain in our hearts and we see you in every sunbeam and snowflake. We wait for the day we can hold you again...

Monday

MJ Podcast #198: Ultrasound in Pre Hospital Care


We have a special guest joining Matt and I on the podcast this week talking about the potentials for ultrasound in pre-hospital care. In this edition, we're joined by Peter Bonadonna, CI/C, EMTP and  director of the Monroe Community College Paramedic Program.

Is there a role for ultrasound in EMS? You decide as we discuss everything from the how-to's and educational expanse needed. We also go over the technology and the situations it might be useful in. Peter gives us a review from A to Z on the uses of ultrasound and talks us though a series of ultrasound images delivered over the internet.

You can view a sampling of the live ultrasound images and hear Peters narration on our latest video "EMS Ultrasound" posted on our Video page. We'll also host the story and video on our newest emergency service blog; ProResponder.

Donate Today! You can help support mitigation journal by making a donation of $1.00.  Click the "donate" button on the right sidebar. Mitigation Journal is a listener supported independent podcast and blog… and any little bit will help.

 Get Mitigation Journal on your e-mail… subscribe to our free e-mail edition of the blog by typing your e-mail address in the e-mail subscription box.

 Subscribe to the podcast...FREE! Visit us on iTunes and subscribe to get all the podcast information delivered to you each week.

Get the MJ app and support the blog and podcast! Visit the app store at iTunes  and for $1.99 purchase the MJ app...its the best way to get the podcast.

Saturday

Trauma Assessment Tips

Five assessment tips to better trauma assessments

Tip #1: It’s okay to be distracted by traumatic injuries. It’s not okay to be fooled by them.
Traumatic injuries to the face, to the head, or open injuries to the chest, abdomen and to the extremities can certainly be distracting to your assessment. Being distracted by The devastating injury or injury pattern is a natural, human response. The paramedic cannot be fooled, no matter how devastating these injuries may appear, that they are the only injuries or the most serious injuries the patient has. The point is that no matter what is ripped open, sticking out of, or impaled into the patient, the paramedic must fully assess the patient, mechanism of injury, and the surroundings. Bottom Line - You can be distracted...just don’t be fooled: as long as momentary distraction does not lead to being fooled by a nasty looking, less serious injury

Tip #2: What lies beneath? Anatomy!
Understanding of anatomy in relation to injuries, injury patterns and mechanism of injury. It’s not enough to simply observe and injury from the surface. The paramedic must understand the implication of that injury on the tissues, structures and, organs that lay beneath. What appears to be a superficial soft tissue injury on the outside can have substantial structural/organ injury underneath. Only by possessing a solid foundational understanding of anatomy will the paramedic be able to relate exterior body damage to where the true injury is… that is to the structure, organ, or system that’s impacted by the trauma. Bottom Line: Think about what lies beneath...Anatomy lies beneath and your understanding of anatomy will lead to better treatment.

Tip #3: Assess all critical areas...even if they're not injured.
No matter what the injury, injury pattern or MOI is, always assess the head, neck, chest, abdomen, pelvis, and long bones. These areas often go unchecked when we focus on a single area of the body or isolated injury. The point here is, that no matter where the injury is all of these areas have to be assessed… even if they appear on injured. Note on the neck...we spend a lot of time worrying about c-spine injuries and trauma to the posterior neck...thats good thing. But, we cant ignore the injuries to the lateral and anterior neck...vessels and airway. Bottom Line: Always assess the critical areas...head, neck, chest, abdomen, pelvis, and long bones...even if they’re seemingly uninjured.

Tip #4: Change you view...you'll get a better look!
We too often assess trauma patients while they’re supine starring straight down on them. After all, that's how you were doing it in practice in EMT class...To be effective, change your point of view. Get down on the patients level and examine from the side, survey the patient from a short distance, observe a few breaths while kneeling at the patients feet or head. Bottom Line: Change your view...move around and look at the patient from various views and from a distance...get as much of the picture as you can before you leave...you're the only one who is going to be able to do this!

Tip #5: Assess any trauma patient for hypothermia and any hypothermic patient for trauma. Think: Trauma=hypothermia, hypothermia=trauma. Trauma patients may loose the ability to thermoregulate and have a difficult time keeping warm...especially if there is uncontrolled internal or external hemorrhage. Hypothermic patients may not be able to feel the pain of an injury or have the mental ability to comprehend the injury and report it. Bottom Line: Trauma and hypothermia...they go hand in hand. Any trauma patient should be assessed for hypothermia and any hypothermia patient should be assessed for trauma.

EMS uses of Ultrasound

EMS uses of Ultrasound...an introduction. This is a quick video created with the help of my friend Peter Bonadonna. Pete is the Paramedic Program Director at Monroe Community College and leader in EMS education. In this clip, we look at uses, training, and other issues surrounding the use of Ultrasound in the pre hospital environment. We recorded the ultrasound images live (Peter was scanning himself) via internet.  This video will also appear on our "Videos" page (see top row of tabs) and on ProResponder.  Join me, Matt and Peter as we discuss EMS and Ultrasound on Mitigation Journal podcast edition #198...available 11/29/2010...click the Podcast Player in the right sidebar to listen.

Friday

In Our Boots

This PSA comes from FireRescue1.com.
It's worth a minute to watch...trouble is, were not the ones that need to see it...


FlashoverTV is powered by FireRescue1.com
 
 
 
 
Donate Today! You can help support mitigation journal by making a donation of $1.00.  Click the "donate" button on the right sidebar. Mitigation Journal is a listener supported independent podcast and blog… and any little bit will help.

 Get Mitigation Journal on your e-mail… subscribe to our free e-mail edition of the blog by typing your e-mail address in the e-mail subscription box.

 Subscribe to the podcast...FREE! Visit us on iTunes and subscribe to get all the podcast information delivered to you each week.


Get the MJ app and support the blog and podcast! Visit the app store at iTunes  and for $1.99 purchase the MJ app...its the best way to get the podcast.
 

Wednesday

Cooking Safety

Cooking Safety...Don't let fire or injury put your holiday to a bad end.

We could all use a good reminder about fire safety in the kitchen. Especially us responders. The United States Fire Administration has a few good tips for use to keep in mind...at home and away.

According to the U.S. Fire Administration:


Watch What You Heat

  • The leading cause of fires in the kitchen is unattended cooking.
  • Stay in the kitchen when you are frying, grilling, or broiling food. If you leave the kitchen for even a short period of time, turn off the stove.
  • If you are simmering, baking, roasting, or boiling food, check it regularly, remain in the home while food is cooking, and use a timer to remind you that you're cooking.
  • Stay alert! To prevent cooking fires, you have to be alert. You won't be if you are sleepy, have been drinking alcohol, or have taken medicine that makes you drowsy.
  • Plug microwave ovens and other cooking appliances directly into an outlet. Never use an extension cord for a cooking appliance, as it can overload the circuit and cause a fire.

Keep Things That Can Catch Fire and Heat Sources Apart
  • Keep anything that can catch fire - potholders, oven mitts, wooden utensils, paper or plastic bags, food packaging, towels, or curtains - away from your stovetop.
  • Keep the stovetop, burners, and oven clean.
  • Keep pets off cooking surfaces and nearby countertops to prevent them from knocking things onto the burner.
  • Wear short, close-fitting or tightly rolled sleeves when cooking. Loose clothing can dangle onto stove burners and catch fire if it comes into contact with a gas flame or electric burner.

Tuesday

Action Items for Disease Prevention

Thinking about your PPE actions ahead of time will pay off

Mandated or not, personal protection equipment (PPE) can protect us from a variety of hazards; in EMS the standard body substance isolation PPE can protect us from everything from anthrax to hepatitis. Often times the value of body substance isolation or personal protective equipment is under realized… as is the value of a good infection control program.  Most responders think of personal protective equipment as masks, gloves, eye wear, and gowns. But our personal protection is more than  a “thing” we put on… our best personal protection is our action. Far too often responders don't think about their personal protective equipment until they have to use it so we decided to include a few tips in today's post.

Action number one: get vaccinated.
No matter which side of the mandated vaccine debate you happen to be on, vaccine is a top preventative measure. Vaccines are proven to be safe and effective. Not only do they provide the individual with protection from specific diseases, vaccination also provides herd immunity to a given population. That is,  a community that is vaccinated and protected against disease also protects those who have not developed immunity. Herd immunity is vital to those with compromised immune systems and even to some healthy groups such as schoolchildren.

Action number two: it's not all about vaccine
Okay, this was really not an action is a mindset… so pay attention anyway. Pharmacological measures such as vaccine are fantastic at preventing disease. However, the downfall is that they are not always readily available. As we saw with the swine flu situation 2009, vaccine production is time-consuming and with most vaccine production occurring overseas, delivery of vaccine is susceptible to breaks in the logistical chain. Additionally, deployment of pharmacological measures (oral medications as well as vaccine) can be challenging. Because of the shortcomings, it's important for everyone to understand the role of non-pharmaceutical interventions in disease spread control. The non- pharmaceutical interventions include; hand washing, respiratory etiquette, appropriate social isolation.

Action number three: hand hygiene.
Above all medications and science; hand hygiene (the simple act of washing your hands) is rated as the number one means for preventing the spread of disease. The use of warm water and soap for washing hands for between 15 and 30 seconds is a major component in effectively stopping disease spread in any population.

Action number four: respiratory etiquette.
Respiratory etiquette means covering your cough and your sneeze and any other secretions you discharge from your mouth or nose. Covering your cough and sneeze is a mainstay of respiratory etiquette and helps prevent droplet transmission of disease. Droplet transmission is a major mode of transmission for Type A influenza. And don't be afraid to wear a mask. That is, don't be afraid to put a mask on yourself or on the patient if they have a cough or sneeze. Placing a mask on the patient goes a long way to containing the source of the droplets and respiratory secretions at the source… placing a mask on you significantly decreases your intake potential of those droplets and respiratory secretions. And yes, you can place a standard surgical mask over an oxygen delivery device such as a nasal cannula or non-rebreather mask. And no, it does not have to be an N. 95 mask. The centers for disease control and prevention noted that standard surgical masks were sufficient to prevent droplet transmission in the setting of many respiratory illnesses including Type A influenza.

Action number five: appropriate social distancing.
Simply stated, appropriate social distancing means staying home when you're sick. That's not just staying home from work; this also includes staying out of public areas when you're ill. It does us no good to have someone stay home from work and/or school only to go to the local shopping mall or otherwise be out in public. I realize this is not a popular topic with many employers (emergency service or civilian employers) but the fact remains that people who are ill with gastrointestinal problems or respiratory illness should not be in a position to spread that disease whenever possible.

And finally, action number six: clean your work environment. Simply wiping down flat surfaces in your work environment will go a long way to preventing your exposure to disease and the spread of many illnesses. Cleaning your work environment means wiping down flat surfaces and other areas of your response vehicle. Many commercially available cleaning materials will do the trick… you don't have to get too fancy. Wiping down the dashboard, the steering wheel, and the microphone will go a long way to preventing illness amongst your crew and your patient. Don't forget your office environment either. A quick wipe on telephones and computer keyboards as well as other surfaces will prevent disease spread as well.

Monday

MJ Podcast 197: EMS staffing reduced, FF raises given and Casual talk on MCI/Triage

Note: We've got some phantom sound problems this week...so if it sounds like we're talking in a coffee can, you'll know why. 

This week we're joined on Mitigation Journal by Matt Comer and Tom Sullivan and we pick up from where we left off last week. Our first topic is on a situation of EMS staff reductions...yet, included wage increases for firefighters...in the same department.

In the second half, we talk about mass casualty events and triage. We're unscripted (as we are for most of the podcasts) so, sit back and enjoy.

Also this week,  a new video released Sunday on the topic of natural disasters. I originally recorded this in response to the situation in Haiti back in April, 2010. You can find it on the main page at www.mitigaitonjournal.org and under the "videos" tab.


Donate Today! You can help support mitigation journal by making a donation of $1.00.  Click the "donate" button on the right sidebar. Mitigation Journal is a listener supported independent podcast and blog… and any little bit will help.

 Get Mitigation Journal on your e-mail… subscribe to our free e-mail edition of the blog by typing your e-mail address in the e-mail subscription box.

 Subscribe to the podcast...FREE! Visit us on iTunes and subscribe to get all the podcast information delivered to you each week.


Get the MJ app and support the blog and podcast! Visit the app store at iTunes  and for $1.99 purchase the MJ app...its the best way to get the podcast.

Sunday

Video: It Can Happen Here

This topic has come up again...how well prepared we are...or, are not. This video will be available under the "videos" tab at www.mitigationjournal.org

Wednesday

Carbon Monoxide Background

 Carbon monoxide exposure is one of the most common poisonings in the United States.  Although we often think of CO is a “winter time” problem, carbon monoxide exposure and poisonings can take place at any time of the year. Carbon monoxide exposure incidents tend to increase during the winter months we can also see an increase in these events at any time when a population uses auxiliary heating or power generating equipment; such as seen during major power failures or other natural events.

Carbon monoxide is known as the “Great Imitator” and can mimic a variety of other medical problems such as cold and flu. In fact a study done in 2006 indicated that one in four patients presenting to a hospital with cold and flu symptoms actually had carbon monoxide exposure. Carbon monoxide has also been linked to cardiac events after chronic exposure. Failure to recognize the potential of carbon monoxide exposure can lead to a deadly missed diagnosis. In some cases, carbon monoxide exposure and poisoning has been mistaken for substance abuse.

Common signs and symptoms of carbon monoxide exposure include headache, drowsiness, confusion, tachycardia. Continued exposure to carbon monoxide also lead to impaired thinking and sensory perception.  These effects of carbon monoxide reduce the ability of a person to recognize a hazard or self rescue from an environment.

Symptoms of carbon monoxide differ from person to person and level of exposure. Mild exposures (15 to 20% COHb) symptoms may include headache, nausea, vomiting, dizziness, and blurred vision. Moderate exposure is defined as 21 to 40% COHb and may present as confusion, syncope, chest pain, dyspnea, and general weakness. The severe exposure (41 to 59% COHb) may result in myocardial ischemia, rhythm disturbances seizures, and respiratory as well as cardiac arrest. Exposures to levels of carbon monoxide greater than 60% are usually considered fatal. It's important to note that CO exposure and COHb  levels do not have the same symptoms with all patients.

 Carbon monoxide alarm technology is reliable and found in many residential and commercial structures. In general, there are two types of carbon monoxide detection equipment. The first type is known is a biomimetic style detector. This type of detector uses a synthetic hemoglobin that reacts to acute and chronic carbon monoxide. Biomimetic style detectors are very common and usually resemble smoke alarms or are manufactured in combination with a smoke alarm.  These units typically have a module sensor built-in the battery compartment. Some of the most common manufacturers estimate a module life of two years and a total unit life of 10 years. This type of carbon monoxide detector can be influenced greatly by exposure to cooking products.
Another style of carbon monoxide alarm is the semiconductor style. this style of alarm uses an electronic sensor to measure carbon monoxide  and is typically plugged into a power outlet or other power supply. The general recommendation is that the unit be replaced every 5 to 10 years. Most carbon monoxide alarms activate at an estimated 10% of carboxylhemoglobin or 100 ppm of carbon monoxide.

Tuesday

3 things to know about seasonal flu

In this post will explore several areas of seasonal influenza. We'll take a look at what influenza is and is not, what causes it, and the various types. We'll also discuss the normal impact of influenza and the potential extraordinary impact of influenza.

1. Terminology.
The first thing in the need to know about influenza is the terminology… and we've come to recognize quite a bit of terminology surrounding the flu. Seasonal flu (sometimes called the common flu) is exactly what it sounds like; that strain of flu that circulates a given area every year. Avian flu (highly pathologic avian influenza) is the name given to a strain of flu that mainly circulates in Asia impacting various bird species with limited transmission to humans. Swine flu on the other hand, is the name given to a strain of influenza that emerged from South America–Mexico–in late 2008. This strain of influenza was particularly troublesome because it seemed to impact otherwise healthy people in a very dramatic way. And lastly, the term pandemic. A pandemic has been seen by the media as a term that indicates large numbers of deaths from disease. Although throughout history this is often the case, a pandemic is not an automatic term for mass fatalities. The term pandemic simply means the disease has spread around the globe and impacted many areas of population.

2. Types of Influenza.
There are several types of influenza viruses… so more concerned about, others, not so much. Influenza virus belongs to the category of diseases known as Orthomyxoviruses.   The three types of flu are Type  A, Type B,  and Type C. Type A influenza is known as a multi-host pathogen infecting both humans, swine, and birds. This is the most virulent  group and is classified by its surface antigens into subtypes. It is these subtypes that make up the H and N that we hear so much about on the news. H stands for hemagglutinin and N indicates neurominidase.  Both of these are surface proteins on the virus that allow the virus to get into a host cell, reproduce, and then escape. Remember, viruses are parasites and need to have a host to survive. There are 15 different types of H's and nine types of N's giving us a total of 135 potential combinations of type A influenza. Type B influenza is seen mostly in humans and although it's very common it is much less severe than Type A influenza. Epidemics involving type B influenza occur much less often than those involving Type A. It's important to note here that human seasonal flu vaccine includes two strains of Type a and one strain of Type B protection. Given that there are 135 potential type a influenza combinations and only two are included in the seasonal flu vaccine, indicates why we have years when the seasonal flu vaccine is less effective than others… that is, scientists have to guess which two strains of influenza should be included in the vaccine. Type C influenza infects humans and swine and has a completely different pattern of surface proteins. Normally Type C presents with rare occurrences and has mild or no symptoms. In fact, by age 15 most people have antibodies against Type C influenza.

3. Impact.
During an average flu season in the United States there are 35,000 to 45,000 deaths attributed to seasonal flu. The hardest hit by seasonal flu include those with severe medical conditions,  impaired immune systems, or extremes of age… young or old. Epidemics tend to occur in the winter months with peaks of hospitalization and death related influenza during this time.



Further Consideration.
Prevention of transmission of flu sometimes takes on a life of its own. We need to remember that the flu virus is one of the most infectious pathogens we know of and that type a influenza is prone to subtle changes in its structure that make it a challenge to our immune systems year after year. It's also important to remember that droplets aerosols and direct contact can spread influenza.  The flu virus can remain active on a contaminated surface or item for up to 48 hours.

We'll discuss prevention strategies, P. P. E., and pharmacology versus non-pharmacology strategies in our Medical/Biological posting next week.