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MJ 220: Consumer-Level HazMat and Chemical Suicide

Consumer-Level HazMat and Chemical Suicide...

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A number of readers have written in with renewed interest on the threat of chemical assisted suicide asking that I re-release the popular Mitigation Journal entries on this topic.

I'm truly impressed by the level of interest shown by MJ followers. I'm also grateful to you for letting me help get this and other preparedness information out to responders, hospital staff, and emergency management folks. 

This weeks podcast is a mixed compilation from the popular Consumer Level Hazmat talks taken from various epidodes.
Consumer-Level Hazmat and Chemical Assisted Suicide are covered in editions 59, 64, and 72. Full versions of the original Mitigation Journal podcasts are available from the Mitigation Journal archives with the links provided.

Click player below to listen to Consumer Level Hazmat and Chemical Assisted Suicide.


Seismologists warning not "aggressive enough"

Last month we talked about something I called the biggest decision in healthcare that nobody was paying attention to. I was referring to the July, 2011 court decision requiring Tenet Health to pay $25 million to those patients and civilians who took shelter at Memorial Health Center and died or suffered injury during Hurricane Katrina. The court ruled that Tenet failed to establish an evacuation plan and that by poor design, the backup power system was vulnerable to flooding. See Mitigation Journal "Message from Katrina" part one and part two to hear me, Jamie Davis (MedicCast) and Matt discuss this on the podcast.

This month I want to tell you about a similar situation, this time from Italy.

Six Italian seismologists are being brought up on manslaughter charges for failing to predict a deadly earthquake. Yes, your read that correctly...for failing to predict an earthquake. According to MSNBC, the Italian seismologists are specifically accused of failing to warn the public "aggressively enough" ahead of the 2009 earthquake that killed 300 people.

This will be an interesting situation that should may have implications for disaster and emergency management here in the United States. This Italian case combined with the recent Tenet Health decision is ought to be enough to give anyone working in emergency preparedness a moment of pause.

How far can the legal ramifications of prediction (or failing to predict) a situation go?

If the situation were reversed; a prediction with "aggressive warning" that resulted in evacuations (and injury/deaths from that evacuation) that turned out to be a false alarm - would that also be grounds for indictment?

What level of warning is appropriate or "aggressive enough" and how do we gauge the severity of a predicted situation to warn appropriately?

What are the implications for those who study and predict natural phenomena? To break this down even further, will epidemiologists be held accountable when the flu vaccine is poorly matched to the flu strain that actually shows up?

This could be another influential decision in domestic preparedness that nobody is paying attention to.  Nobody but us anyway.


MJ 219: Understanding Flu and Biological Events

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 If I told you that there was a biological event coming this winter that would kill 36,000 to 40,000 people, would you be concerned? What if I told you that this biological event would target the old, the young, and those with chronic medical conditions; what would you say?

If I told you that flu season is around the corner, how concerned would you be?

This post is an introduction to our popular classroom session Understanding Flu and Biological Events. In this program we tackle these issues and compare seasonal flu (a predicable, natural event) and intentional events involving biological material.

This weeks posting is a primer as we enter flu season.

Click the player below to view the movie:

Click the player below for the podcast audio only version:

9.11.01 The Headlines Tell the History

9.11.01 The Headlines Tell the History...its our history...

All of us can recall where we were around 9:00 AM on Tuesday September 11, 2001. I've been collecting headlines and magazine covers for ten years now. Each one has a memory attached to it.
Click the player below for the video:

Looking at the images on T.V. I commented what we, safe in our station, knew: nobody at or above that fire was getting out alive. 

The T.V. voice said the obvious "I think we're under attack...its pretty clear that impact was intentional..."

I called my wife: "get Sammy from" I was concerned that more attacks might cause police to restrict movement...we lived near a target in the form of one of the largest chemical/industrial facilities in the Nation; the Eastman Kodak Company.

Moments later another commentator broke in with news about an explosion at the Pentagon.

Several years of my career had been dedicated to thinking, planning, dreaming up doomsday situations to prepare responders for mass casualty events and natural disasters.

Response to such events had been an important part of my professional life since the 1989 Loma Prieta earthquake. I was captivated by the response to that earthquake. Amazed at the scale of devastation. I was inspired to learn something about urban search and rescue, about crush injury syndrome...
This was an area of expertise that let firefighting, paramedicine, hazardous materials and planning merge...

The media was still sorting out what had happened to cause such a huge smokey fire from the upper floors of the tower.

I remember being in the day room of our headquarters fire station with the smell of that perpetual pot of coffee in the background that morning.

This was different. How many targets could there be?

I'd been at my desk in the special operations/training office...someone called and said something about the World Trade Center being on fire. Shortly thereafter everything changed.

Then in a wide-angle, slow motion approach, another aircraft entered the frame. What is this guy doing?! Then it hit. Then it erupted. It began to sink in...

Waking up in a Different World

Its not the time of day you get out of bed.

Today, September 12, 2011, we are waking up in a different world.

We awoke to September 12, 2001 to the images of the day before ingrained in reality. Ingrained forever in history. The world woke up a different place. It wasn't the first time, either.

In 1993 the World Trade Center was the target of an attack. Albeit far less devastating, the '93 WTC event showed us a glimpse of what could be. We were in a different world.

We again woke to a different world on April 19, 1995. A day when we woke up to the reality of Domestic Terrorism when the Murrah Federal Building was destroyed. Ammonium nitrate/fuel oil and a truck. 163 dead...including the kids in a day care.

On April 20, 1999 our alarm clock went off again. This time in a high school. Semi-automatic weapons and secondary devices. Random Domestic Terrorism.

A few years after September 11, 2001 Mother Nature voiced her opinion. And she did so over and over in the past few years. In 2003 we woke up to the reality that a naturally occurring biological event could make a terrorist attack look like a cake walk. Hurricane Katrina forced the evacuation of a major metropolitan area...for the fist time. Katrina also showed us the gaps in our response ability. We were in a different world. Not to be outdone, biological events made a comeback in 2009 with the sudden appearance of H1N1. And we realized that we couldn't make vaccine as quickly as we need...and misinformation information on how to handle a predictable event was not readily available.

Today, September 12, 2011, we are waking up in a different world.What will it look like? Will it be explosions and gunfire? If it is, what will you do?

I think the next event will be a bit more subtle. We'll wake up in a different world when we flip the little switch on the wall and no lights come on. What will we do?


9.11 More than terrorism

September 11, 2001 taught responders and emergency planners many lessons. There are many more to learn. Its important for us to look at all hazards; natural, man made, and technological as if they have the same potential as an intentional terrorist attack. This video underscores that importance.

I hope that in the wake of ten years in the post 9-11 era we will realize that public health, emergency medical service, and other traditional response agencies deserve our support. I also hope that we'll realize that mother nature can cause devastation on a scale that dwarfs terrorism.

Its time to stop living in the post 9-11 era and start training in the Pre-insert next event here-era.


9.11 a decade later "what have you done for me lately?"

Newsweek cover
September 11 will be filled with remembrance ceremonies, flags, pictures and exhibits commemorating the September 11, 2001 terrorist attack on the United States. People will recount where they were when the heard the news, saw the second plane hit the second Tower, and express anguish when the World Trade Center towers collapsed.

Many will use the phrase "Never Forget" in their speeches. Perhaps the news clips of the plane hitting the tower, the explosions and eventual collapse of the towers will be shown on television again. Perhaps not. Many have decided the video images of the Pentagon and WTC are too graphic, too upsetting. We certainly won't see the clips of civilians, trapped in the inferno of the towers jumping to their deaths. Too graphic? Maybe. A reminder of intensity and brutality of the attacks and suffering inflicted on a civilian location...absolutely.

In our race to "Never Forget" we wouldn't want to insult any group or label anyone as extremist. Maybe we don't really want to remember how we felt in the days directly following the attacks. Maybe we'd rather pretend the aftermath of September 11, 2001 is not as bad as we remember and get back to work being a cog in the one global nation farce.

The flag will seem a bit empty without EMS and Fire
Maybe we'll see the clips of New York City streets lined with civilians holding signs that read "hero" and "thank you" as emergency services roll into the World Trade Center site; a reminder of attitude towards emergency medical service and the fire department on September 12, 2001. A period before public safety budgets, salaries, and retirements became the target of municipal shortfalls and pubic outcry. Never Forget  is an interesting concept as today we look to eliminate responders, cut benefits, dismantle public health services in the name of balancing budgets.

Never Forget is an interesting concept as ten-years later, first responders will not be welcome at the 9/11 memorial service in NYC.

Ten-years later "Never Forget" reads more like "what have you done for me lately?"


It's national preparedness month

September has been designated national preparedness month by FEMA… so what

Nobody knows (possibly nobody cares) that National Preparedness Month even exists.

The heart of the national preparedness month effort is an offshoot of FEMA/Department of Homeland Security using the website The website encourages us to prepare, plan, and stay informed. We're told to do this all we need to do is to get a kit, make a plan, and be informed. Throughout the website, again, at the heart of the national preparedness month effort is a sprinkling of information tips for the public and for responders. Albeit a little oversimplified, FEMA presents a fairly decent message for the public. The information for responders is minimal at best.

Despite the urging to prepare, plan, stay informed; and to get a kit, make a plan, and be informed, the efforts of national preparedness month initiative to little to entice members of the public to do any of that. I believe one of the key reasons that the general public remains unaware of initiatives like this is because the focus on Homeland Security… security equating to badges and guns. As of said before,   Homeland Security is a  failing model for preparedness. We have to shift the focus back to a more neutral preparedness ground. That is, to be able to look at and prepare for natural, man-made, technological, and intentional events.

 A recent earthquake that impacted a majority of the East Coast and was quickly followed by hurricane Irene was a stark reminder of our vulnerability to natural events. Carbon monoxide deaths (which are described by many as completely avoidable) continue to climb in the United States.   Consumer-Level hazardous materials events and acts involving use of consumer level hazardous materials with intent to harm self and others is seen as a growing threat. Although these events may have gotten some media attention  they don't typically appear in one's mind when we think about homeland security. Yet, these events are quite capable of causing harm to people and infrastructure on par with any terrorist intentional event. The challenge is to bring our Preparedness Pendulum back from the extreme edge were we look only at terrorist events… and I think that is what National Preparedness Month is trying to do.

Just like the other specialty areas that have their own special “day” or “month”  the general public outside of that specialty area remains unaware of the national preparedness month effort. Further, what useful information is on the website goes unnoticed by most. Bottom line is, the National Preparedness Month initiative remains stagnant and has little if any impact on improving civilian readiness.

 FEMA could learn a lot from successful initiatives such as fire prevention week. Fire prevention week has historically involved a reasonable media campaign as well as some type of open house affair at a local fire station.  Key to success is that some officials and the local community are engaged in spreading the word and promoting action among individuals, families, and communities. The combination of a marketable media campaign along with their open house ability brings the community together and puts the information provided into a tangible format. National Preparedness Month efforts lack that tangible format and community leadership effort.

Despite being around since 2002, and National Preparedness Months have done little more than provide information on a website. While they do provide decent public service announcements in the form of videos and audio clips, there is little effort  to get the general public to turn this information into action.

So, I guess it now becomes our responsibility (perhaps it always has been) to get the message out to the public about the national preparedness month initiative. It will also be our responsibility to turn that information into action.

I recommend that everyone visit and explore the content there. Become familiar with what the site in the initiative has to offer. Then take that information and turn it into something useful… that is, explore ways it can benefit your community. Maybe coupling national preparedness month activities with existing awareness topics such as fire prevention week, EMS week, or any other specialty area that has  their own “holiday” would be a good place to start. That might be a good place for the folks at FEMA to start marketing National Preparedness Month as well.


A Message from Katrina Reader Comments

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Long time supporter of Mitigation Journal, Michael Ehrman sends in his commentary on our recent podcast A Message from Katrina: Hospitals be Ready. Part One and Part Two are available on the Mitigation Journal homepage.

You can contact Michael directly via Twitter @MichaelEhrman

Michael writes:
First point.  When I went to National Red Cross training and National Fire Academy training in the middle 1970's with some of the Public Safety Officers of New Orleans, the levies were a disaster waiting to happen and they knew it in the 1960's for sure so with 50 years to prepare for what I call their worst nightmare and not have gotten their public prepared and themselves is NO excuse.  When I worked in California, almost every public organization, most businesses to varying degrees and most residents prepare for that big 9+ earthquake they know is coming.  May not be prepared for San Onofre, the nuclear power plant to explode but their worst nightmare they prepare for and practice.

As for NIMS and Jamie's comments.  NIMS is simply a way to organize and help control a bad situation in an orderly fashion.  Not a resource to mitigate the situation.  Just an orderly set of step to follow to help the responders mitigate the situation and to play well with each other.

As for Matt, FYI, regardless, there will be lawsuits-for any reason.  Hey, you had one less stored supply for one more person that you had.  Hey, you should have built your ATM to work perfectly while being under 10-feet of water.  Get real here.  If one attorney lives, there will be at least one lawsuit.

Improvements since 9-11?  Look at communications, one of my pet peeves.  We are still bantering about allocating a portion the 700 MHz frequency for first responders.  Every major disaster has had communications as the base shortfall in that disaster.  Read the reports, books, etc.  And we still have not resolved that one.  And we expect the population to be prepared for X days and we, ourselves, are not prepared?  Let us totally fix our house first before we complain about the neighbors.

Hey, don't bitch about the bus.  I have preached long before Katrina that every community should make a contract with their school district or buy a school bus, whether used or new but used is cheaper by a mile if maintained.  Every bus can mass move in first responders.  Every bus can mass move out casualties and every school bus comes with its own set of red lights.  Just paint it fire engine red or police blue.

More PSA's is right.  Jamie hit the nail on the head.

As for Dr. Pou, she did what she had to do when her world was ending for her patients.  If we were there and faced with the limited information available at that time versus the type of death your patients would suffer during this world ending crisis (for you), what would you do?  I know I would not want to give up and would try to find a solution until it was too late, but that's me and my patients would have most likely suffered.  It is a shame the situation got to that point.  And she was not alone in making he decision to euthanize some patients.  Remember that.

Jamie was right, Katrina was a lesson of the worst, and the best and that we need to prepare.  Bigger question now is, will we.  Or will we be stating, like a broken record, the same solutions are needed that we said for the last XXX disasters and still do nothing to fix the problem except to spend money to say let's fix it...again.

Got me on a rant on this one.  Good job!