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Tuesday

Dutch Good Example of Anti-Terror Efforts

I can not  believe what I'm reading today. According to MSNBC.com  and CNN.com Dutch authorities are holding two men on allegations of conspiracy to commit a terrorist act and the U.S. authorities...well, not so much. With the same set of facts at their disposal; the Dutch (who have not had a terrorist attack) suspect terrorist attempt while the U.S. (in the midst of tense Ground Zero mosque situation and home to 9/11/01) says that terrorism "is unlikely"...

Here are the circumstances as outlined in several mainstream media outlets...read it, then you decide.

1- cell phones attached to a bottle containing liquid, multiple cell phones and watches taped together, and a knife and box cutter
2- man and his luggage were headed to separate international destinations
3- TSA screeners determined that the items did not pose a threat. No explosives were found.
4- arriving in Chicago from Birmingham, one suspect then checked his luggage on a flight to Washington Dulles airport and then on to Dubai, but did not board the flight himself. Instead, he joined the other suspect for the flight to Amsterdam while his luggage went on to Virginia.

For more details, see the MSNBC. com and the CNN.com articles.

I don't know who is asleep at the switch here...CIA, TSA, DHS, FBI...but they are asleep and they aim to keep the American public asleep, too. By taking the "nothing to see here" approach, they are attempting to lull the public into the false scene of security. Rather then taking the stance that this threat is real, this threat exists, we have to remain vigilant to this real threat opportunity to inform the public, we brush it aside. Nothing to see here.

We have a couple of guys who tape cell phones to bottles, watches taped to cell phones, pack knives and box cutters...and then...and then...send their luggage on a different flight to a different location. All at a time when our nation is polarized in debate over the Ground Zero mosque.

How is this NOT concerning?!  No, the items in question are not dangerous in checked luggage. It is the intent that is the problem. We're so concerned about being anti-this or anti-that, afraid of being seen as "profiling" that we have become ineffective in our domestic preparedness efforts.

How can this be seen as anything other then a surveillance dry run?

Monday

Tipping on the Point

Tipping on the Point...A case for preparation for domestic terrorism.

I just wrote about my feelings and concerns in Mitigation Journal blog and talked on edition #186 of the podcast  regarding the Mosque situation in NYC, near Ground Zero.  Here is an outtake from my August 28 posting:
"From the polarization of opinion, the demonstrations, to the time when construction on the NYC Ground Zero Mosque begins and to its completion...indeed, for the duration the Islamic Center stands, it will be a target of political and public debate"...and..."I am concerned about the "actions" we may see. Gunfire at a anti-NYC Mosque protest...an explosive event at a pro-Islamic Center political speech...or a major event O.K. City style, after the NYC Mosque is built. Nobody is talking about the ability, more likely inability, to protect this Islamic Center from domestic terrorism. We're not talking about it because we can't..."
My number one concern in this mosque issue is that it will become the spark that ignites domestic terrorism or the perpetration of an act of terrorism that is constructed to look like an attack on the American Muslim. I firmly believe that this issue has grown to the point of volatility and any attack or event will lead to localized (if not wide spread) civil unrest and retaliation.

On August 30, 2010, CNN U.S. is reporting on a fire at the site of a proposed mosque located in Murfeesboro, Tennessee.  Calling it suspected arson, the article goes on to describe how the fire destroyed construction equipment at the site of this future Islamic Center. According to CNN officials are saying that arson...is a reasonable assumption. Despite vigils held in honor of religious freedom, the fear factor has been increased, one source mentioned in the article says "it really put fear into the community".

Yet, in another story by CNN U.S. highlights the actions of Muslims who have launched an internet advertising campaign to reinforce the point that they're Americans. The movement under the name of Park51 (www.park51.org) is intended to fight back against "the rising tide of fear-mongering". There is also a YouTube video "My Faith, My Voice" that delivers a simple, yet compelling message..."I am a Muslim...I don't want to take over this country...and I don't support terrorism". There are a number of other PSA located on the My Faith My Voice website that are worth the minute or so to view.

I am sure the Muslim community in the United States is not out "take over the country" and equally confident that the majority of Americans don't participate in fear-mongering. There are two issues here...the mosque at Ground Zero and the polarization of public opinion...that is, radicalization on both sides. There is the real danger.

Sunday

MJ Podcast #186: Hydrogen Explosion, The Mosque, Power Failure, and Acid

There is a ton of stuff packed into Mitigation Journal Podcast #186! Yes, its a long podcast, but after two weeks of reruns; what did you expect? This week we talk about a major event here in Rochester, NY, that is the hydrogen tank explosion at the refueling center on Scottsville Road. This explosion was felt for miles and caused two minor injuries, resulted in the airport being closed, major highway (route 390) and surrounding roadways being closed...and, yes, limiting if not crippling any operation at the County Emergency Operation Center. We'll discuss the need for continuing threat assessment and not letting high hazards grow around critical infrastructure.

A short talk about the controversial Mosque near Ground Zero in NYC...my opinion is that it is like adding any other high hazard into an area...and it is a high hazard...as I believe that there will be an increased risk for domestic terrorism related to the construction of the Islamic Center. I hope I am wrong.

And turning to darker thoughts, blackouts and power grid failures (no pun intended) Nobody wants to talk about this or address planning for widespread and prolonged loss of electricity, except me, of course. What would we do without electricity for weeks, months or years? I think this could be at the top of disaster scenarios in the Nation.

Finally on this addition, we talk about unexpected hazards at "routine" events. Six emergency medical technicians were exposed to hydrochloric acid while treating the victim of a motor vehicle collision. While the conditions and situation remains unclear, the EMTs were treated and transported to a local hospital. This type of incident further indicates the need for situational awareness an all events...not just those we think were intentional. I did get a number of emails on the topic eluding to the opinion that "we cannot expect EMS to deal" with chemical events. I posted a reply on the blog and give my commentary at the end of the podcast...so be sure to listen to the end.

Saturday

Of Power Grids and Blackouts

I'm often chided by coworkers for my standings on domestic preparedness. Sometimes called "too apocalyptic" to be taken seriously. In fact, my questioning of established "because we've always done it that way" policy has cost me professionally on more than one occasion. And that's okay...

There is another area that has come up again and again. One potential threat that I cannot get anyone to talk about. Even the thought of me bringing it up in conversation gets me strange looks. The topic is that of a prolonged power outage/black out and or collapse of the power grid. I believe the loss of electricity related to a power grid failure is one of the most likely and most devastating threats we face. And nobody wants to talk about it or plan for it...

Our power grid is a series of power plants interconnected by wires that distribute the electricity from one area to another. If a power plant has to be taken off the grid for repair or maintenance, the other plants in the grid spin-up in order to make-up the capacity and meet demand. The issue is that when the "grid" is functioning at capacity and one power plant fails, the other plants may not be able to meet demand...they may be overwhelmed and kick themselves off-line to prevent burning out. Thus the cascade of failures travels through the grid and results in power outages. Keep in mind that there is no capacity for storage of electricity any place in the power grid...when the plants shut down, we go dark. In nearly every major blackout situation the commonalities are clear; one piece of the system fails, other plants cannot spin-up to meet demand or they in fact, fail and the failures cascade through the system.

What can cause a failure? Simple maintenance problems, storms/lightening, fires, or other natural disasters. What about this 'EMP' thing? Certainly. An EMP or electromagnetic pulse such as caused by a nuclear blast or other man-made variety could knock out a given area of the power grid. A solar storm and the electromagnetic disturbance that ensues could actually devastate the electrical system for years.

Whatever the cause, the sudden loss of electricity is an unnerving thought. There will be impact on infrastructure and civil response; including fire, EMS, and law enforcement. The longer the outage continues,  the greater the impact will be on everyone. Elevators will stop working, the ability to purify and pump water will slow to a drip, natural gas distribution may cease. Even those places with backup power supplies will eventually run short. The impact on health care facilities will be catastrophic and in many cases, evacuation will be impossible. Sheltering in place will work scantly better. In either case, power to ventilators and other medical machinery will fail. Communications will eventually fail with transportation systems halting long before that.

The impact on society caused by a prolonged power grid failure is almost too difficult to imagine. What would you do (personally and professionally) without electricity for one month? Six months?  A year?  It could be a long winter, couldn't it.

Mosque

Mosque...The Mosque...Victory Mosque...NYC Mosque...Ground Zero Mosque. Many names, many issues, many polarized points of view. It's not all about the Mosque. We must think deeper.

Before I give you another way to look at the situation, remember this; I do everything possible to keep my political views out of Mitigation Journal. With that in mind, let me clearly state:
Building a Islamic Cultural Center/Mosque near the NYC Ground Zero site is beyond building code and religious freedom. It is legal and supported by the United States Constitution, but is it appropriate...
Legislation to support health care for Ground Zero responders and workers now afflicted and suffering from pulmonary disease has failed. Almost without a whimper. There has been minimal support for those who are dying today from their work at Ground Zero...how much support will be there for you or I after the next attack?
On to the point of this post. From the polarization of opinion, the demonstrations, to the time when construction on the NYC Ground Zero Mosque begins and to its completion...indeed, for the duration the Islamic Center stands, it will be a target of political and public debate.

Nobody is talking about the unfortunate truth that some mosque locations have been used to recruit, raise money, and plan terrorist activity. There are over 100 other mosques in NYC and their may or may not be illicit activity taking place now. Here. In NYC.

The problem now is that forcing the issue of building this Mosque will draw attention to these facts and foster discontent and perhaps, action. I am concerned about the "actions" we may see. Gunfire at a anti-NYC Mosque protest...an explosive event at a pro-Islamic Center political speech...or a major event O.K. City style, after the NYC Mosque is built. Nobody is talking about the ability, more likely inability, to protect this Islamic Center from domestic terrorism. We're not talking about it because we can't.

The Mosque will be built, the debate and demonstrations will continue, and you heard it here first, somebody is going to ignite the spark and we'll have a domestic terrorist event on our hands. There will be retaliation...and another event. And so on and so forth.

You and I will be in the middle...those in emergency response, in our hospitals, in public safety. We'll again be at the center of keeping people alive, keeping hospitals working, and infrastructure intact. And when it's over...if its ever over...who will be there to support us?

Friday

Hydrogen Explodes at Rochester Airport

Two hydrogen tanks exploded near the Greater Rochester International Airport this afternoon. The tanks are part of an alternative/green fuel re-fueling center that includes refueling for hydrogen cars. The cause of the explosion is not known as of yet. Two injuries were reported and the airport was closed for a short period of time. News coverage from WHAM 13, YNN Rochester, WHAM 1180, and WHEC 10 all covered the event. The video from most stations showed dark black smoke from behind a truck, no fire was visible. The event was over in about two hours and the airport was reopened without further incident.

What is not being talked about is the fact that directly across the street is the Public Safety Training Facility (PSTF). As the name implies, this is the main training hub for police and fire departments in the region as well as home to the local paramedic training program. Interestingly, the Monroe County Emergency Operations Center (EOC) is located on the second floor of this building as well.

Before I go on, you should know that the airport was there long before the PSTF was created out of the old City of Rochester Fire Department building and training center that was in place since the 1950's. The EOC was added along with the PSTF sometime in the late 1980's. Way back then I knew little about emergency management (nor did I care to) but remember wondering why would you put a training facility and the EOC so close to the airport?

Since the PSTF and EOC moved onto the site, the airport and surrounding property has grown, too. The most recent improvements (over past 5 years) included the addition of the refueling center where the explosion took place today...about 100 yards from the PSTF/EOC.

So, today I question even more than ever why the EOC and training center are located there...or why were the hazards allowed to be build so close to this building of critical infrastructure? There were two injuries related to this explosion along with all major roads surrounding the airport being closed.

Lets think this over...all the roads to the airport closed...EOC located near airport...explosion near airport...EOC near airport...Get the picture? This one event crippled the ability of Monroe County to utilize their state-of-the-art EOC. It could have been destroyed. At any given time there are dozens, perhaps hundreds of responders in and around the PSTF. They could have been killed.

So, again, my question is why have the hazards been allowed to grow within sight of the EOC? Could nobody else see the threat changing and hazards increasing! A threat assessment and hazards assessment is an on-going process.

Thursday

Elizabethtown - Lewis Rescue Squad

video
Elizabethtown - Lewis Rescue Squad - I was recently invited by my friends Larry and Patty Bashaw to visit the E'Town-Lewis Rescue Squad. They took delivery of a new ambulance this summer...it is one of the best configured vehicles I've seen. So, enjoy this little video tour or the E'Town-Lewis Rescue Squad.

Wednesday

MJ Podcast edition #184 Notes from an Elevator Rescue

This week on Mitigation Journal Podcast edition #184

This week we'll revisit one of the most challenging rescues this region has ever encountered. Almost three years ago I had the opportunity to speak with one the command officers involved in this event. The event and its management...from response to rescue, to recovery still gets high marks today. I originally posted this interview on Mitigation Journal way back in December, 2007...and still get emails on it today. Because of a recent email (content remaining anonymous at the request of the listener) we're going to reply this interview.

On November 29, 2007, EMS and fire agencies from the 3rd Battalion of Monroe County, NY responded to one of the most challenging rescue situations one can imagine. This situation has it all...multiple victims entrapped in an elevator shaft, extreme cold, confined space, and technical rescue.
Five EMS agencies, Five Fire/Rescue agencies, Air-Medical and on-scene medical command came together under a unified command structure to effect a most amazing rescue.

I recently had the pleasure of traveling to the opposite side of my county to speak with Mr. Steve Waters about this elevator rescue. Steve is an emergency medical technician with several years of experience (decades, actually). He is the President of Perinton Volunteer Ambulance (http://www.pvac.org/) and was among the Command Staff during this event.

While you're listening, keep the Rule of Outcomes in mind...we don't have to wait for a large disaster or terrorist attack to use the planning and skills we've been training on!

Tuesday

Elizabethtown - Lewis Rescue Squad Gets New Ambulance

This is going to be a long post, so hang on.

Its the kind of vehicle you'd expect to see in a large city. All the sophistication and technology to support any patient care needs...from emergency to transport. But not this ambulance. This vehicle shown below is the latest edition to the Elizabethtown - Lewis Emergency Squad. I was treated to a grand tour by my friends Larry and Patty Bashaw and wanted to share this with the readers. Yes, there is a story behind the color choice...but you'll have to ask Larry to tell the story.
Look below:

Larry Bashaw (left) giving me a tour of the "brown" ambulance
Ricky, Jyl, Michelle in 5 point harness 
Me behind the wheel...don't see that everyday

Restraints to fit us Full-Figured Paramedics

Monday

Yes, I Do Expect Situational Awareness Every Time

Yes, I do expect situational awareness every time...and you should, too!

Perhaps you read my August 22 post in Mitigation Journal blog. It was about six EMT's who were taken to a local hospital after being exposed to acid while treating a victim of a motor vehicle crash. I saw this event (not too far from home) as yet another wake-up call for responders...with the message: "You don't have to wait for a terrorist attack to use your WMD training..."I've been spouting that message for years in the hopes that someone will listen...not to cast dispersions or point fingers...Simply making my point that a majority of WMD training has been useless because it is not applied in every-day situations (for the record, I hate the term WMD, but that's another story.

Shortly after the August 22 posting was published I received several emails from local and not-so-local readers. Here are some choice excerpts from those emails:
"EMS is not trained to look for hazardous materials...that is the job for the FD..." Blog reader New York
"You can't expect [responders] to be thinking about toxic stuff on routine calls like a MVC (motor vehicle collision)..." Blog reader Florida

"EMS has to be focused on patient care, triage and transport..." Blog reader Colorado

"It's not our [EMS] job to do that (chemical)...FD and police should..." Blog reader Washington
I'd like to thank all who wrote in on this topic for providing me the proof that most WMD training has been a waste of time and for providing me with a ton of editorial material for future blog posts and podcasts.

Lets debunk each of these comments, shall we?
"EMS is not trained to look for hazardous materials...that is the job for the FD..."
Not trained to look for hazardous materials?! Yes you are! EMS personnel are (at least in NY) required to undergo hazardous materials awareness training with annual updates meeting OSHA 1910.120. The problem is that this hazmat training is usually delivered by someone who is not familar with the material, the impact on EMS, or the potential danger of failure. How long will it take before EMS realizes it cannot stand on the sideline in well-pressed uniforms waiting for someone else to deal with a situation. Although I give this some credence due to the "second-class citizen" mindset of EMS, we have to wake up and understand that EMS (indeed, all responders) have an obligation to look for hazards on every incident.
"You can't expect [responders] to be thinking about toxic stuff on routine calls like a MVC (motor vehicle collision)..." 
Uh, duh...yes I can...or I wouldn't have written this post. After all the time and money spent on preparedness and awareness we are still not thinking about hazardous situations because...why? Isn't there enough in the news? Or, is it because it can't happen here? And that is the problem with most WMD and terrorism training...they get you to thinking about it only when you are told the situation is intentional or an attack of some sort. 
"EMS has to be focused on patient care, triage and transport..."  
I thought EMS got out of the "you call, we haul, that's all..." mentality a decade ago. I can't argue this point...if you're still thinking that way, good luck. 

Stay tuned for more on this...

Sunday

Six EMTs Exposed to Acid Fumes

As reported in the Rochester Democrat and Chronicle, six emergency medical technicians from the Ontario Ambulance were transported to an area hospital after exposure to acid fumes. As of this report, the exposure took place while providing patient care at the scene of a motor vehicle collision. The vehicle containing an injured driver also contained a quantity of muriatic acid. Muriatic acid is the same as hydrochloric acid (H3O+Cl-). The container of acid may have spilled in the cab of the pick-up truck as a result of the crash. The intended use of the acid remains unknown as well. The concentration and quality of the acid are not known, but were enough to cause symptoms and necessitate hospitalization.

Hydrochloric acid is one of the popular ingredients in the construction of homemade chemical bombs.

The good news (if there is any in this case) is this exposure took place outside with presumably good movment of ambient air. Exposure to most acids results in irritation of mucous membranes and respiratory difficulty at low concentrations. Exposure at higher concentrations (such as when a person cannot self-evacuate) can result in non-cardiogenic pulmonary edema and hypoxia.

Look for containers as clues to danger
This case is another reminder that the term "routine" has yet to be scrubbed from our vocabulary. Also, despite the warnings about bottle bombs, homemade chemical bombs, acid attacks, and of course, the ever popular WMD training, we're still not looking for these hazards when we respond to every-day events.  This exposure was not a result of a chemical attack or terrorist event...but lack of situational awareness and Optimism Bias could have cost responder lives.

Points to ponder:
What, if any, clues were there? Containers, odors, unidentified liquids in the vehicle?
Did the victim of the crash present with signs or symptoms that lead you to think something other than what the situation looked like? Could exposure to the acid fumes caused or contributed to the crash?
What PPE should EMS don for such an event? Let me answer...none. EMS typically is not equiped with the PPE needed for a chemical exposure.
Decon...decon...decon. Prior to leaving the scene...with early notification of area hospitals.

Wednesday

MJ Podcast #183: Childhood Obesity

MJ Podcast #183: Childhood Obesity 

This week on Mitigation Journal Podcast edition 183


Obesity. Maybe you're tiered of hearing about the growing health problem and the impact on our health care system. Maybe you've heard all you'd like on how diseases like diabetes, cardiovascular failure and stroke are causing our health care system to crumble. And perhaps, you're now wondering what childhood obesity has to do with domestic preparedness and why I'm devoting so much podcast time and blog space to the topic. That answer is short...and in Mitigation Journal Podcast #183 we'll discuss this issue with Dr. Marji Nasin. This interview first appeared on MJ way back in 2007. As we move on to explore this topic, this interview still has meaning...maybe more so...today; some three years later. Simply put, childhood obesity is a National Security/Domestic Preparedness issue. I'm not alone in my thinking on this. This posting on the No Quarter blog pokes at the situation and mainstream media are giving the topic some attention.

As our Nation continues to struggle with these diseases...all linked to childhood obesity...our population becomes more unhealthy at an alarming rate. To the point of emergency management and traditional responders, consider the impact of  childhood obesity on traditional and non-traditional responders;
  • Dealing with a sicker, more fragile population increases the risk of communicable disease and impact of biological events such as flu
  • A sicker, unstable population is more likely to require additional resources and special needs planning during disaster events
  • The ever increasing special needs population will continue to be at increased risk (if) evacuation is needed. Special needs groups may lack the ability to self-evacuate. 
  • In the future, a sicker, medically fragile society may lack qualified candidates to fill the role of responders...think about that. Fewer people medically/physically able to do the job of Paramedic or firefighter.

Tuesday

A Nuke in the Future

Is there a Nuke attack in our future? According to a recent poll, when it comes to a terrorist use of nuclear devices, 17 percent think it unlikely they'll detonate a nuclear weapon and just two percent  believe it’s not going to happen...at all...ever. This is in contrast to fifty-eight percent of adults who believe it is at least somewhat likely that there will be a major war involving nuclear weapons in next century...with twenty-six percent who say nuclear war is very likely.

There are also divisions among party lines...but few other demographics are given in this posting from NewsMax.

So, is there a nuke in our domestic future? Who knows. The point is that preparedness for such an event is not constrained to nuke attacks. This type of preparedness, with basic ideas, can be used in a variety of situations.

Monday

There's no escape chutes in ambulances

There's no escape chutes in ambulances...and even if there was, EMS providers wouldn't use 'em.

Mainstream media and the web are abuzz with the story or JetBlue flight attendant Steven Slater. By now you've heard about his exchange with passengers, grabbing a beer or two, and jumping ship via the aircraft escape chute. Who many of us in EMS have wanted to escape our ambulance from time to time?

I read a recent article that expounded how unhappy people were when the board aircraft; becoming rude and obnoxious. The passengers "expected" to be treated better (by what standard, I don't know) and the flight attendants were there to serve every need. On the other hand, the article tells us about how hard and stressful the job is and that flight attendants take the brunt of these difficult passengers and it is they who deserve to be treated better.

Lets compare this situation to emergency medical service. I've dealt with difficult patients, family members, and bystanders (like every other EMS provider). Not unlike an aircraft, the back of an ambulance strips people of their feeling of self-control and sprinkles in a bit of helplessness. Add to that the stress of a major (or minor) illness/trauma and you've got all the makings of a quite stressful environment. How many times have I wanted to pull the ambulance to the side of the road and get out...simply get out and walk away...to another line of work? How many times have you felt this way? The numbers might be hard to count and in hindsight, maybe it wasn't all that bad. But at the end of the day what counts is that you (and I) didn't pull over and get out.

Ambulances don't have escape chutes...

Sunday

The Problem with PODs

Points of Distribution, or PODs, are the hub of pandemic planning in some communities. PODs are set up at certain locations and used to distribute oral or injected medication. Despite urging from the emergency response community, many jurisdictions have hung onto the POD plan as the only distribution method for pharmaceuticals in the setting of pandemic. Although not entirely a bad idea, the POD system has a number of faults that should be addressed and considered in the planning and contingency process.
What is a POD? As mentioned, a POD is a site designated for the distribution of medications or supplies in the event of a crisis or emergency. The pubic gathers at a give location or locations and materials are handed out.

Why was the POD system developed? In short, the current points of distribution model is based on an earlier process used to receive, break down, repackage, and distribute materials/supplies from the National Pharmaceutical Stockpile (NPS). The idea was further refined for the use in the setting of SARS and later, H5N1 Highly Pathological Avian Flu.

So, whats the problem? The first problem is in the planning assumptions made with POD Establishment. The assumption has been made that "we'll know" when a given pathogen is threatening and have time to medicate/vaccinate our public. That assumption was based on experience with SARS and predictions of H5N1 and is totally dysfunctional. To assume there will be a "lead-time" when we know a pathogen is coming is a terrible mistake. As we have seen with H1N1 in 2009, the disease was present in various states with little or no lead-in. In that situation, we have to plan for the disease spreading beyond any given boundary...simply by virtue of our modes of modern travel. So, to bring otherwise healthy people together into a central location(s) may actually increase exposure.

The next assumption we have to deal with is that a vaccine or medication may not be available in the amount we need...we could run out of medication. Running out of medication leaves us with people standing in line and not getting protected, perhaps being exposed. And speaking of standing in line...managing the que and providing sanitation services, shelter from the environment, food, and medical care at POD locations can be an event in itself. These continence's are not often included in POD plans. As one pubic health emergency managed told me; "the people in line are not our problem..."
That brings me to the problem of civil unrest and disobedience. Dealing with uncooperative persons, people with special needs, and those intent on causing problems is often beyond the scope of those working in a POD. Understand that the unrest can turn into a riot and become violent quickly...especially if you run out of medication.

In recent experiences, some PODs were overwhelmed with people and had delays of several hours while other locations remained nearly silent. Why? Because people did not know where to go, under what conditions to go, or did not understand direction. We cannot plan on people following direction. We can expect that once the media announces that site "A" is running with a ten-hour delay, many people will flood site "B".

Want another snapshot view...see Mitigation Journal Of Chicken and Expectations from May, 2009 to see what I'm talking about. Points of Distribution sites are difficult to manage and plan for...they are a part of pandemic planning, but only a part. Putting all our eggs in the POD basket puts us at risk of failure to meet the expectations of the public. Not meeting expectations will be disastrous.

Saturday

MJ Podcast #182: The Problem with PODs, Flu Season Preparation, and Prescription Medication Abuse.


I received a number of emails this week about a comment made on edition 181 of Mitigation Journal podcast...I was talking about my support for the United States Postal Service pharmaceutical delivery program the lack of functionality and failure potential of points of distribution. Leading off edition 182 is a discussion A few listeners/readers wanted to know why...nobody disagreed with me...just wanted more information on my opinion. One podcast listener actually wants me to write an opinion for their superiors and deliver some training on the topic of comprehensive biological event planning.

Matt and I also discuss the need to revisit flu season planning. Who knows what we're in for this flu season, but this is a good time to develop (or encourage) those good non-pharm infection control practices; respiratory etiquette, hand hygiene, and appropriate social distancing. Its also a good time to revisit your services infection control plan...review, update, train on it.  This segment of the podcast expands on several recent blog postings. For more on these topics check out these postings in Mitigation Journal blog CDC: Vaccine not a requirement, Forward Thinking for Flu  , and CDC Drops N95 Requirement

And finally this week, we talk about the importance of a medication profile and history in the pre-hospital environment. Medications and medication history are important but never so important as they are today. Prescription medication abuse is increasing faster than meth use and the rate of emergency calls due to abuse is rising. EMS responders must add medications and medication history to the list of things-to-do. I also encourage everyone to have a field guide that lists medications, indications, and side effects. I recommend the EMS Field Guide and Field Guide app for iPod/iPhoneTouch from Informed Publishing.

Thursday

CDC: Vaccine not a requirement

The Centers for Disease Control and Prevention have announced that it would not endorse mandated flu vaccine for health care workers. The CDC states:
"In 2009, CDC posted on its Web site Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel. At the time it was posted, uncertainties existed regarding the novel H1N1 influenza strain, and the vaccine was not yet widely available. As stated in that document, CDC planned to update the guidance when new information became available. Since then, circumstances have changed. A safe and effective vaccine has become widely available, and is being included in the 2010-2011 seasonal influenza vaccine. Further, we now have information about the number of cases of disease, hospitalizations, and deaths caused by 2009 H1N1, which can be compared to historical seasonal influenza data. At this point, an update of the guidance to address current circumstances is warranted..." Click here for the full text of the statement from CDC...pay close attention to the definition of healthcare settings and healthcare personnel...
Although it sounded like a common sense thing to do, mandating flu vaccine for all health care workers caused quite a bit of debate. In fact, the NYS Nurses Association came out hard against the requirement while many health care facilities threatened discipline or termination of any provider who refused to be vaccinated.  See my post NYS Nurses Association Opposes Mandates for Vaccine for more on this topic. EMS and other traditional responder groups were left in limbo, at the whim of the situation...do EMS personnel who are in and out of various hospitals meet the requirement for mandated vaccine? Nobody knew for sure. Despite it all there was not enough vaccine to go around.  

Wednesday

Forward Thinking for Flu

 It's that time of year again. Time to be forward thinking for flu.

As we approach another flu season it remains unclear what, if any, role H1N1 Swine Flu will play. Will there be another Type A influenza strain that will impact us? Will we see Swine Flu back as a seasonal visitor? Or, will we simply continue to have the various seasonal flu wax and wain throughout the season? I'm safe to say I don't know, nor will predict. Equally safe is the bet that nobody knows for sure.

Despite the less-than-glamorous remarks I get from some planners and responders, I continue to hold the position that flu; seasonal or novel strain, is a naturally occurring biological event. Look at the situation in that frame for just a second or two...If you knew there was going to be a biological event occurring in your community in the next few months, would you begin preparing for it now? I certainly hope so.

We know that seasonal influenza kills 30-35 thousand people in the United States every year. And we also know (now) that vaccine production and distribution in the event of a novel (or, perhaps intentional) biological event will be slow and sparse. So why wait until flu season (with or with a novel strain or variant) to begin preparing to meet the demands this naturally occurring event will place on your public and your service? I'd like to offer my list of things to consider when reviewing/planning for the 2010 flu season:

First, start or renew your infection control practices now. Get in (or back in) the habit of disinfecting your apparatus at the beginning of each tour, after each patient, and at the end of each tour. This includes wiping down all surfaces in the patient care compartment of ambulances, equipment that comes in contact with patients, and the cab of the vehicle. Don't neglect the place were you ride! Wipe down or disinfect the cab...with special attention to door handles, radio microphones, and the steering wheel.

 Second, although vaccination is still a great way to protect yourself from getting the flu, non pharmacutical interventions go a long way in stopping the spread of any disease. Remember to follow good hand hygiene practices by washing your hands as often as possible and using waterless sanitizers when soap and water are not available. Practice respiratory ettiquette - cover your cough and sneeze. Do so by coughing or sneezing into your elbow reduces the spray of material that comes out of you and into society. Also, wear a mask and don't be afraid to put a mask on your patient. The Centers for Disease Prevention and Control has recently dropped their requierment for N95 masks in the setting of flu in favor of surgical masks (See my previous Mitigation Journal post CDC Drops N95 Requirement) Also, consider appropriate social distancing...that is, stay home if you're sick. Many employers don't like to hear about this one. It is irresponsible to go to work (especially if you have contact with the public) if you are ill. Those involved in planning must account for the possibility that the workforce will be decreased, perhaps significantly, by members not reporting due to illness. You must also consider the absentee rate to increase due to employees remaining home to care for significant others who are ill or children when schools/daycare centers are closed. 

I encourage everyone to review the Mitigation Journal posting Bio-Event Ready or Die! 3 Thing to do, Today. originally posted August, 2009, for more on this topic.


For a summary of Mitigation Journal blog postings and podcast episodes on flu and flu-related topics, click here

Tuesday

MJ Podcast #181: Acid, Bombing Changes, Flu season on the way

MJ Podcast #181: Acid, Bombing Changes, Flu season on the way...with CoHost Matt and special guest Tom Sullivan, is now available.

This week we tackle a number of important topics as always. Join us as we discuss the not-so-obvious operational concerns in the wake of an assault involving acid here in Rochester. The key point being that decontamination must be accomplished prior to any victims being transported and this and any type of incident involving multiple patients or intentional acts involving hazardous materials must be communicated to all area hospitals in order for them to prepare for the potential of self-referring, contaminated patients. For more on this, see Acid used in Rochester, NY attack in Mitigation Journal August 2010.

Although the mainstream media would have you believe different, would-be bombers can and do test their bombs. On this edition of the podcast, we discuss how the stifled Times Square Bomber did, in fact, test his bombs, change his materials, and conduct pre-incident surveillance. See Times Square bombing details indicate planning, testing posted August, 2010.

Make sure you listen to the podcast, better yet, go to iTunes or click the and subscribe!

Saturday

Times Square bombing details indicate planning, testing

Bomber had planning and surveillance

"...the bomber decided to substitute higher grade explosives for items that were "more readily available" on the consumer market..."
A recently released article by CNN.com provides some frightening details surrounding the attempted Times Square bombing. According to this report, Faisal Shahzad, who pleaded guilty to the attempted attack on Times Square, also admitted that he had altered the composition of the bomb, its materials and structure to avoid detection. After what seems to be comprehensive surveillance on his part, Shahzad decided to substitute higher grade explosives for items that were "more readily available" on the consumer market. This action indicates surveillance, planning, contingency planning, and testing on the part of this would-be bomber. Interestingly, these steps, now obvious, are the same steps mainstream media outlets have stated would allow an attempt to be detected by officials...making it nearly impossible to carry out an attack.

The most disturbing facts here are that the targeting of a major hotel in a densely populated area on a Saturday night...the intent clearly to maximize casualties.

They only have to work once...
We were lucky. This bomb didn't detonate. It was discovered (noticed...by a civilian who had the wherewithal to say something) before anything could happen. Fortunately the skills of the bomb maker were lacking, but the planning and intel gathering/surveillance work were not; this is exactly why this type of attack got as far as it did ad why they will be successful in the future.We also have to admit to ourselves that this type of individual effort is almost impossible to detect. Not part of a know cell, nobody tunes into their actions, purchases, emails, or cell phone conversations. So, when someone buys guns, propane tanks, fireworks, and fertilizer...they don't raise any red flags. They may be detected, maybe not...but it only has to work once.

Friday

MJ Podcast 180: Invisible Bracelet - Great Start for National Preparedness Month

Workable communication is key to managing any crisis...individual emergencies, local events, and large-scale disasters, all need an efficient means of communication. National Preparedness Month is September, 2010 and encourages everyone to be better prepared - Get a Kit, Make a Plan, and Be Informed. A great way to start your personal and professional National Preparedness Month activities is to enhance communication.

Visit Invisible Bracelet
How about a means of improving communications for every-day emergencies and large-scale events? I found an answer with Invisible Bracelet (iB)...an online tool that allows targeted medical information to be available to emergency responders and others involved in health care delivery. iB is not a comprehensive Electronic Medical Record or EMR, its a snapshot of vital information (that you control) available for responders to act on in case of emergency.

Th iB system also tackles communication with family members - simple to program In Case of Emergency (ICE) contact information allows the iB system to send a text message to emergency contacts letting them know you or your loved one has been taken to a hospital.

This week on Mitigation Journal Podcast, I had the opportunity to speak with Mr. Mark Tornstrom, the Executive Director of the National Medic Network for iB (listen to MJ#180). In our conversation, Mark details the functionality of this vital service. Tune in to the podcast as we discuss the role for this technology in every-day and disaster events as well as the benefits to traditional and non-traditional responders. 

Functional, with just the basic information needed to save a life...Invisible Bracelet is a great fit for National Preparedness Month. For more on National Preparedness Month, go to www.ready.gov and for all the details of iB got www.invisiblebracelet.org...and, of course, keep checking Mitigation Journal Podcast/Blog for the latest in emergency response.

CDC Drops N95 Requirement

CDC Drops N95 Requirement...and boy, do I feel good about it! 

N95 - Surgical Mask Just as Good
I've been arguing that the Centers for Disease Control and Prevention (CDC) requirement for N95's was not only expensive but, cumbersome, and difficult to ensure compliance. Pushing my  thoughts on the use of surgical masks over N95's has caused me significant headache...from the 2003 SARS epidemic to 2009 Swine Flu. I've written my opinion of surgical masks over N95 and stood by it for years.  See Bio-Event Ready or Die! 3 Thing to do, Today. originally published August, 2009 and On The Topic of N95s originally published May, 2009.
 .
But now, the CDC has issued opinion that surgical masks can be used in place of the N95.

I've been outspoken in classes; and now, it seems that the CDC agrees with me! The recent document from the CDC Interim Guidance for the Use of Masks to Control Influenza Transmission states the following:

About time they listened to me
"The use of surgical or procedure masks by infectious patients may help contain their respiratory secretions and limit exposure to others. Likewise, when a patient is not wearing a mask, as when in an isolation room, having health-care personnel mask for close contact with the patient may prevent nose and mouth contact with respiratory droplets. However, no studies have definitively shown that mask use by either infectious patients or health-care personnel prevents influenza transmission. In the United States, disposable surgical and procedure masks have been used widely in health-care settings to prevent exposure to respiratory infections, but they have not been used commonly in community settings (e.g., schools, businesses, public gatherings)."
 and further states -
"A surgical or procedure mask should be worn by health-care personnel who are in close contact (i.e., within 3 feet) with a patient who has symptoms of a respiratory infection, particularly if fever is present, as recommended for standard and droplet precautions. "

Monday

Non-Pharm Interventions: Only Half the Battle

Non-Pharm Interventions: Only Half the Battle...the other half is doing them correctly!

A recent study from New Zealand doesn't give us much hope the public will practice good hand hygiene or respiratory etiquette; two actions that are vital to prevention of disease spread. The researchers studied the habits of general public over two weeks in late August; a time when H1N1 Swine Flu was a concern and the work "pandemic" was all over the news.
Full article as found at MSNBC.com here.

What they found was 3 out of 4 people at least made an attempt to cover their cough. But, they didn't do a very good job as most people coughed or sneezed into their hands. Contaminating the hands is a great way to spread disease to surfaces or items. They also found that people were in the habit spitting on floors. You'll recall that spitting on streets and public places was implicated in the spread of SARS.

All this should come as little surprise following that a 2007 study noted that one in four adults still do not wash their hands after using the bathroom.

This study leaves me wondering about the impact of public information campaigns and disease prevention strategies. Were public information programs ineffective? Was the message poorly received or not understood? Or, do we still suffer from Optimism Bias...it can't happen to me! In either case, we have to stress that the non-pharmacological interventions; hand hygiene, respiratory etiquette, and social distancing are keys to preventing spread of any biologic agent. These interventions become even more vital when vaccine is not readily available.