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7 Health Care Preparedness things you need to know

7  things you need to know...and why you need to know them

#1. Understand the broad scope of threats and trends in your community. Know what your local responders and emergency planners working on and what your community plans call for.

Why? Best reason why is to be a better prepared citizen, parent, [nurse] [medic]. You’ll be able to carry out your duties (at any level) during times of crisis and add to the success of the response.

#2. Know your internal emergency plans. Know your role within the plan and how crisis situations  change the way you do what you do every day. Know what triggers your emergency plans to be put into action and when to shift from your standard of care to sufficiency of care. Consider what will change when you have to shelter in place or evacuate.
Why? There may not be time to look things up during a crisis situation and the event will most likely change quickly. Being familiar with your plans ahead of time cuts down on reaction time and contributes to good outcomes. That is, lives saved...yours and your [patients] [citizens] If you’re

#3 Have a basic understanding of the Hospital Incident Command System.

Why? You will have to work within the HICS system during any crisis and you might be put into a lead role at some point. A basic awareness of the HICS and how to carry out the various functional positions within it will go a long way to success in the small scale and large scale of the event.

#4. Know the special resources of your institution and those around you.

Why? Knowing what specialties services are available gives you an idea of how certain cases will be triage into your system. You may also get an idea of the type of patients you can expect when a specialty hospital (burn unit, trauma or cardiac center) is over-run or has to evacuate. conversely, you can get a head of the decision making for sending your patients out to other appropriate facilities if you know their capabilities.

#5. Know how to prepare yourself and your family for community emergencies...and do it.

 Why? The best way to prepare a community for disasters is to prepare the citizens. Well prepared citizens  and communities lead to improved outcomes in disaster situations. On the professional side, having a prepared family means that we can continue to go to work and do our jobs better. Keeping staff coming back to work in times of crisis is a major concern. The best way to improve the numbers of people coming back to work is to help them prepare their families to shelter or evacuate as needed during crisis.

#6. Recognize incident indicators, signs/symptoms and heralding events that foretell a problem. In other words, pay attention to what's going on around you...even when you're off duty.

Why? You situational awareness may be all that stands between you and harm. Someone has to be the first to recognize danger signs...don't wait for someone else to tell you there's a problem...

#7. Get better accuainted with your Personal Protective Equipment. Even the stuff you use every day

Why? Some research has suggested that personal protective equipment may not be utilized properly and that annual training is not enough. Without regular and on-going practice, the PPE we have may not be used, or worse, used improperly.


MJ: 224 Emergency Alert System test -Part two

Click for direct download
FEMA conducted a never before attempted Nation wide test of the Emergency Alert System on November 9, 2011. The test included television, radio, cable, and satellite carriers. Despite the effort on the part of FEMA, there are many who suggest this was more like a pop quiz than a test.

This week we complete our discussion with Matt and Jamie talking about the success of the test, role of social media, and the continued need for the Emergency Alert System. We even get into the CDC's Zombie Apocalypse preparedness program. 

    Click the player below to listen now


Three reasons this cyber-attack is cause for concern

First foreign cyber attack destroys pump in Illinois 

Cyber attack - rather than causing physical destruction from direct force or assault, a cyber attack infiltrates a technology and turns the technology against the systems it's designed to control. For the first time we've had a foreign cyber attack in the United States. For more, read Technological Disasters, they're going to get worse.
An internet provider address traced to Russia is being described as the origin of a cyber attack that destroyed a pump at a water pumping station in Illinois. The pump was destroyed when access was gained to operational control software that allowed the pump to be repeatedly turned on and off causing it to burn out. The pumping station is reported to serve a population of over 2000 people. Mainstream media is reporting that there were no interruptions in service because redundant systems were in place and sufficient.

The November 8 attack, described as the first foreign cyber-attack on the United States, has been acknowledged by the Department of Homeland Security (DHS) and Federal Bureau of Investigation (FBI). Both DHS and FBI claim there is no immanent threat.  The breach is connected with compromised passwords and security information from civilan a software vendor. 

The media is also reporting that whoever hacked this system actually had access to Supervisory Control and Data Acquisition (SCADA) systems for three months. SCADA systems are widely used software that controls engineering systems for critical infrastructure. Nuclear power plants, power grid systems, waste treatment facilities, and some rail transportation systems, use SCADA software. Read more on why you can't ignore your critical infrastructure.

Three reasons this cyber-attack is cause for concern -
  1. No early warning systems in place to detect an attempted or actual cyber-attack. This attack was discovered only after the damage had been done. There was no detection mechanism in place to alert of an attack or attack attempt. Without early warning/detection systems, there could be additional attacks on more critical systems at any point...or in progress. 
  2. This could have been a probing evaluate vulnerability and assess reaction/response. A probing attack could indicate a larger cyber attack is on the horizon.
  3. Critical infrastructure lacks resiliency. Impact in this case was limited because redundant systems were in place and functional. Our power grid, by comparison, lacks functional redundancies. Had this attack shut down an electric generator or destroyed a vital component of the power grid, the outcomes could have been much more dramatic. More MJ posts on the power grid; Of Power Grids and Black Outs
"... [a] power grid/power supply that may be the most vulnerable (critical infrastructure). 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..."      Three Planning Problems for 2011 (MJ 12/2010) 



Mitigation Journal - 6 years later

Thank You for six years of support.

We're celebrating six years of Mitigation Journal blogging and podcasting. When I clicked "publish" for the first time back in November, 2005, I couldn't have predicted how important this blog would become to so many readers and listeners. Our growth has been tremendous.

From blog to podcast to video to of material has grown. We've published over 600 blog posts and dozens of videos. More than 6000 people visit Mitigation Journal DOT ORG every month. I've met so many people through Mitigation Journal and I've lost count of how many places I've been asked to visit - to give a talk or consult on a project. I've met so many emergency service professionals through the use of social media. I've had the opportunity to review plans, provide opinions, and teach.

What's next? I can't begin to predict. The only thing I can say for sure is that Mitigation Journal will continue to provide unique perspectives on civil preparedness and emergency response. I don't like the mainstream way of emergency management thinking and would rather stay off the beaten(down) path.

Through blogging, podcasting, social media, and independent reporting, we'll continue to examine the limitless topics of preparedness and response for civilians, traditional rescuers and non-traditional responders.

We'll be reporting on current events, conducting case study, providing original material sprinkled with commentary. Mitigation Journal will cover everything from routine incidents to local disaster and national crisis. Professional responders and concerned citizens will gain valuable insight into preparedness and emergency response.

With real world experience and insight, Mitigation Journal will be there helping you prepare for whatever challenges your role in preparedness care, emergency medical service, fire department, public health preparedness...Mitigation Journal will cover it all.

With your help. With your continued support.


Reaction to Cold

Reaction to Cold: How the body responds


They are the major effects of cold that are the root of all other problems. These five body changes are the building blocks of system failure caused by cold environmental conditions. They all stress the healthy body.

Cold conditions do not have to be extreme to cause problems. Even mild decreases in temperature are enough to trigger those five major effects of cold can cause increased heat losses through radiation and conduction. Heat losses can increase 25 to 30 times when a body is in contact with a cold or wet surface.

Any condition or disease that involves vasoconstriction, respiratory or neurological impairment places a person at increased risk during exposure to cold. In general, increased cold exposure risk increases with:
  • age < 1
  • Circulatory, vascular or neurological disease
  • Raynaud's Phenomenon
  • Alcohol, tobacco, caffeine, or energy drink use
  • Trauma or Hypoglycemia
  • Prior cold injury
Better health means better performance in cold environments. Exposure to cold decreases mental capacity with increased risk of injury, accidents and errors

While often considered during the hot summer month, dehydration is a major threat during cold periods. Evaporation, sometimes referred to as insensible losses, increases with cold atmospheric conditions. Respiration moisture losses account results in large amount of fluid loss through evaporation. These respiratory/evaporation losses  increases dramatically in cold environments as the moisture in exhaled breath increases. Dehydration is more prevalent with excessive use of caffeine or alcohol. Prolonged exposure to cold and dehydration are important variables to evaluate as both increase risk for hypothermia.

Environmental exposure to cold is also linked to decreased mental capacity. Reduced mental endurance has been shown to increase the risk of errors and accidents. Responders should be taking this into account when operating in cold environmental conditions for any period of time.  Further, the physical discomfort associated with exposure to cold, even for brief periods, may contribute to decreased mental alertness.

Additionally, there is an increased risk of physical injury while operating in a cold environment. Joints and muscles become stiff and strength decreases. These factors lead to sprains and strains and muscular micro-trauma as well as acute injury. These effects can be seen in the well-conditioned person just as easily as in those who are not in good physical condition.

Factors in remaining warm include maintaining good food/nutrition status, adequate fluid and hydration and maintaining reasonable physical fitness.


MJ: 223 Emergency Alert System Test

Click for direct download
FEMA conducted a never before attempted Nation wide test of the Emergency Alert System on November 9, 2011. The test included television, radio, cable, and satellite carriers. Despite the effort on the part of FEMA, there are many who suggest this was more like a pop quiz than a test.

This week on Mitigaiton Journal Podcast, Matt, Jamie and I discuss several important topics related to this test and the status of the Emergency Alert System. In this two part discussion we'll ask:
  • was the test a success?
  • what is the impact of omitting social media from the test?
  • what should the role of social media be in emergency alerting?
  • do we need the emergency alert System anymore?
    Click the player below to listen now


Zombies, the Public Health Mascot?

Zombies, the Public Health Mascot?

The Centers for Disease Control and Prevention (CDC) began a Zombie Preparedness initiative with the goal of engaging the public on preparedness. Obviously not just for a "Zombie Apocalypse", the information projected by the CDC's Office of Public Health Preparedness is useful in real-world disaster situations. Reaching a diverse audience is what this campaign is all about. According to the CDC website:
"If you are generally well equipped to deal with a zombie apocalypse you will be prepared for a hurricane, pandemic, earthquake, or terrorist attack." Dr. Ali Khan, Director
Are Zombies the enduring icon public health wants to be remembered by?
I appreciate the efforts of the CDC and believe they've reached a major milestone in pubic health awareness. Will the Zombie Apocalypses continue to be effective? What the CDC has done is to copy  what traditional responders have been doing for years: public education through an iconic mascot. The fire service has Sparky the fire dog and law enforcement has McGruff, the Crime Dog...and the CDC/Public Health has Zombies. Sparky has his own site as does McGruff. The CDC Zombies have an enhanced web presence with a graphic novel, apps, YouTube and webpage widgets. Each embrace popular culture with an appropriate message.

Is the Zombie audience going to get the message?
The fire service and law enforcement continue to put uniformed responders into the schools and at public events to reinforce the messages of Sparky and McGruff. Real world people teaching age-appropriate information. The Zombie Apocalypse initiative is web and social media savvy but it is also static. You have go out and look for it. Traditional public safety puts educators in contact with at-risk populations to deliver and reinforce the message.

Will the Zombie image be a motivating factor in getting a kit, making a plan, and being informed?

Putting an icon to a message is a good idea. I'm not sure that the Zombie image is exactly what the CDC and public health want their enduring icon to be. A large issue is the identity of public health. Is it time to consider public health part of emergency preparedness or public safety? I think so. With that in mind, is the public health preparedness message better delivered via a partnership with traditional response groups? Should police and fire educators take on public health awareness task?

One solution may be a partnership between the CDC and the National Fire Protection Association to deliver a joint public health preparedness message. That message (including the Zombies) could be delivered by local uniformed responders, personnel from the local hospital or health department during fire prevention week. I advocate for public health preparedness to become part of Fire Prevention Week activities (maybe Fire Protection Week needs a name change?)


Get Bio-Event Ready or Die

     ...or at least get sick. 3 Things to do today to prevent even that!

 Three things to do to Be Ready for a natural or intentional biological event:
  1. Train your people on infection control and personal protective equipment (PPE) more than once a year. This is the time to develop good habits for regular cleaning and disinfection of our vehicles and workplaces. Several studies have pointed out that practice with masks...getting proper fit and knowing how to put them on as important as annual fit-testing.
  2. Promote the safety and health of responders and their families. That means getting appropriate vaccine or other medications available for your personnel and at-risk family. Identify those who can't get vaccinated or take medications and take steps to isolate them from infection. Numerous self-report surveys have concluded that one key to keeping your personnel coming to work in a biological event is provide for the safely of the family.
  3. Prepare a Can't Go Home Plan. Stock you stations and facilities with food, water, hygiene products and ready additional bunk areas to keep personnel in-house during extended operational periods.


Report claims North Korea has Smallpox

Smallpox may be in the biologic hands of North Korea

A recent posting by the Global Security Newswire caught my eye. The headline reads something about North Korea and expanded WMD production. Normally this would get a "so what else is new" response from me but, a quick scan of the piece kept my mouse from clicking away. According to the October 27 article, South Korea claims...
"The military authorities understand that among the 13 types of fungus body of biological agents that North Korea currently has, five types -- including anthrax bacterium, botulinum, and smallpox -- can actually be used as weapons."
 Excuse me, did you say smallpox? I was led to believe that smallpox samples resided in only to repositories on Earth. The World Health Organization (WHO) believes this to be the case as well and since 1986 the has been arguing about the destruction of these stockpiles of Smallpox. Destruction of these virus reserves would mean the removal of the treat of this virus on our planet. Smallpox virus samples were due for destruction but received a stay of execution over the summer of 2011. (learn more on Smallpox stay of execution click here)

Does North Korea (or any other nation) actually has smallpox virus? Can it be or has it been weaponized? South Korea seems to think so and has undertaken an unprecedented bio-preparedness initiative. Good for them. The bad news is that, once Smallpox is let out of the freezer, it will not stay in Korea. One case of Smallpox any place on Earth will ignite a global health crisis. A crisis we are not ready to face. As we saw during the H1N1/Swine Flu episode, our health care system may not be "there" yet when it comes to being ready for a major biologic event.

In the United States we stopped routine vaccination against Smallpox in the 1970's and immunity of those vaccinated prior to that is unclear. There have been some promising data suggesting those vaccinated will still have protection but nothing conclusive. Those born after we stopped vaccination would have no immunity. (click here for more on Smallpox vaccine) Despite the vaccine and the virus, there are steps you can take to protect yourself and your workforce. (Be bio-event ready click here)

There are several things to remember about Smallpox as a bio weapon, chief among them is the estimate that one person with the disease can infect about 20 others. To that we should mention that Smallpox has an approximate fatality rate of 30% and is spread by aerosol transmission. (read my 5 points to remember click here)

A good place to start your refresher class on Smallpox is with a review of biologic tabletop exercises such as Dark Winter and Atlantic Storm. (Click here for more on DW/AS)


Biologic Worst Case: Smallpox Terrorism

 Exercise Highlights Biologic Devastation - Comparing Dark Winter and Atlantic Storm
Terrorist attacks using biological agents are potentially deadly beyond imagination. How would we respond to a devastating Smallpox attack?

That is the exactly the scenario tested by the Dark Winter exercise (2001) and Atlantic Storm (2005).

Exercise similarities, important differences

Both Dark Winter and Atlantic Storm focused on government leadership and their ability to manage issues in public health, medical capabilities, diplomacy, domestic response, and critical infrastructure. Both exercises were well developed and planned...they did, however, reach different results. Despite commonalities in scenario and biological agent there are striking differences between the two exercises.

In order to compare the two exercises I studied the documents, video and layout of the scenarios themselves. Of course, some study of the Smallpox virus itself was helpful.

Comparison of Assumptions

Dark Winter focused on the United States as the only target in a “worst-case” scenario while Atlantic Storm targeted the international community with “best-case” circumstances. 

Although both scenarios simulated the use of smallpox as the agent with similar methods of dissemination, there were concerning differences in the projected infection rates, death rates, and person-to-person transmission potential. Smallpox deaths in the Dark Winter scenario were projected at thirty percent while Atlantic Storm used a twenty-five percent. Atlantic Storm also assumed that there was residual immunity among the affected population with 300 million doses of vaccine available. Dark Winter was somewhat less optimistic, assuming a stockpile of 15.4 million doses of vaccine would be available from the Centers for Disease Control and Prevention. Reality is present with vaccine assumptions as the scenario accounted for up to twenty percent of stockpile loss due to contamination or improper use.

Dark Winter hypothesized that 1gram of Smallpox could generate 100 infections when aerosolized resulting in 3000 first generation cases from 30 grams of virus. There is no mention of virus quantity in Atlantic Storm, however, both scenarios disseminate the virus via an aerosolizing device under similar conditions. Dark Winter used 1:10 transmission rate (every one person with smallpox could infect ten others) as compared to Atlantic Storms rate of only a 1:3 ratio. Atlantic Storm also anticipated 1: 0.25 for second to third generation while no mention was made in the Dark Winter scenario of second to third generation transmission. Dark Winter planners integrated herd immunity of twenty percent into the scenario which was not accounted for in Atlantic Storm. The lack of herd immunity in the later exercise may be reflect doubt that any immunity exists among the currently vaccinated population.

I found the following excerpt from the Dark Winter scenario an interesting commentary on person-to-person transmission rate.
“…Given the low level of herd immunity to smallpox and the high likelihood of delayed diagnosis and public health intervention, the authors of this exercise used a 1:10 transmission rate for Dark Winter and judged that an exercise that used a lower rate of transmission would be unreasonably optimistic, might result in false planning assumptions, and, therefore, would be irresponsible. The authors of this exercise believe that a 1:10 transmission rate for a smallpox outbreak prior to public-health intervention may, in fact, be a conservative estimate, given that factors that continue to precipitate the emergence and reemergence of naturally occurring infectious diseases (e.g., the globalization of travel and trade, urban crowding, and deteriorating public health infrastructure) [26, 27] can be expected to exacerbate the transmission rate for smallpox in a bioterrorism event…”
Atlantic Storm best-case scenario planned for adequate disease control, compliance with public health “social distancing” (quarantine/isolation), available vaccine, higher herd immunity, residual protection granted by prior vaccination, and lower transmission rates. The wide range of transmission rates between the two exercises may account for the differences in total number of smallpox cases and deaths. Dark Winters worst-case predicted 1,000,000 deaths with 3,000,000 infections while the Atlantic Storm exercise predicted 660,000 cases and approximately 495,000 deaths.

Learn more about Smallpox from the CDC- click here