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Saturday

Evil hunted our Brothers

 On the eve of the most joyous event known to man, evil hunted our Brothers.

He set the trap with bait of fire and smoke. The trap was ignited and he waited. He waited and they came as they always do. As he expected. They came to fight the fire, save lives. They expected fire; bread and butter. They expected flame and heat not bullet and gunpowder. They found an evil more sinister than fire, a devil in human form who waited to ambush...and he did.

Nomex and vapor barrier could offer no protection. The air on their backs could supply not one more breath. Irons and hose and nozzle would provide no offense in this fight.

There was no opportunity to read this smoke...it did not foretell danger of backdraft or flash. This was a different smoke. The smoke that comes from the muzzle of the assassin's weapon.

Today families will grieve, the fire service will mourn. Not in numbers so grand as 9/11, but for wounds equal in depth.

Today we have rewritten the meaning of insanity, redefined tragedy. It’s been done in our own words. In our own hearts. In our own home.

The politics will soon fade. The media will leave. Those who answer the next alarm will stay. What will not fade is the commitment to duty. They will come again when called. Our memory of this unimaginable tragedy will not leave.

Forever there are two empty bunks in the house. Two empty seats at the table.

We will not be afraid. Those who are not in the bunks or at the table will be with us...there are two more Angels on the Back Step of the engine.

May God bless those lost and wounded in West Webster, Monroe County, NY on December 24, 2012.

Thirteen years after Columbine, what have we learned about school shootings?

 Are we any further ahead at preventing school shootings today than we were in 1999?
Our prayers are with the victims, survivors, and rescuers...

Newtown CT joined the ranks of the those communities devistated by a school shooting event  on December 14, 2012 when a 20-year-old carries out shooting event at an elementary school. The lone attacker is reportedly to have fatally shot his mother as she slept, stealing two pistols and one rifle, prior to going to the Sandy Hook Elementary School.


According to media reports, he forced entry, easily defeating school security systems, by shooting out a window and proceeded to shoot two school administrative staff and children in a first grade class. All the children were between six and seven-years-old. Authorities are reporting a total of 20 children and 7 adults murdered.

It’s sad to say it and hard to hear it. It's even harder to understand. Sadly, it is a topic we've visited many times in this blog and podcast. We've discussed active shooter events and civilian soft targets as much as we've talked about chemical and biological weapons.

We most recently spoke on this topic after the Aurora Colorado movie theater shootings. Our opinions are the same today as they were after that tragedy. The liberal left and conservative right have it all wrong when it comes to finding causes and preventing similar active shooter events. (listen to MJ 238 Aurora CO Movie Shootings - Why we’ve got it all wrong) Stricter gun control will not solve this issue. More people with guns will not prevent future attacks.

Commonalities in active shooter events
  • Civilian soft target remain the location of choice. Hospitals also remain at risk with once such active shooter event taking place almost simultaneously at a hospital in Birmingham, Alabama. The Sandy Hook School did have some level of security but it was circumvented. Why was it so easy to breach?
  • Gunshot wounds inflicted at close range. The rate of fire and physical confines produce a rapid attack with high fatality rate. There is little opportunity for protective action because of the speed of the event (possibly also because of the age of majority of the victims and the situation they are in).
  • Ancillary event - some other related occurrence, prior to main event, that would herald the main attack - shooting his mother, in this case. Use of explosives in other situations to draw attention away form the intended target or as a secondary event to create further casualties.
  • History - in many of the cases the alleged perpetrator has had a mental illness diagnosis
Shooting events at high profile soft targets are difficult to prevent and have significant, long-lasting effects. They also have numerous commonalities that can be used to aid planning efforts.

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

How ready are we for active shooter events? A question asked too many times over the last seven years.

Active shooter situation may be the most difficult to domestic terrorism situation to deal with. Many of the active shooter situations take place in a work environment or in a public venue with little or no warning. Firearms of all varieties have been noted in active shooter case studies from the United States. According to the Department of Homeland Security:
"An Active Shooter is an individual actively engaged in killing or attempting to kill people in a confined and populated area; in most cases, active shooters use firearms(s) and there is no pattern or method to their selection of victims..."
These events are unpredictable in nature and timing, but the outcomes and be generically predicted.  If we follow the basic principles of Life Safety, Incident Stabilization, and Property Conservation, we'll be able to keep personnel safety and response priorities in balance.

Key to remember that soft targets continue to be chosen by active shooters and present significant threats. Preplanning and inter-agency cooperation is paramount to reducing the loss of life.

Active shooter situations in a soft target location - a mall, school, hospital/health care environment, or sporting events are disastrous. The answer may be someplace between the left and right...

Wednesday

2012/2013 Flu Update #3

Update #3 for the week of  December 12
This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends, and other media sources.

Preliminary data reported for week 48/ending December 1, 2012 (latest period reported by CDC as of this post) indicates continued increases in influenza activity in the United States. The CDC reports 5,511 specimens were tested with 20.7% of those positive for influenza with the proportion of deaths from pneumonia and influenza (P&I) remaining below epidemic threshold.  Week 47/ending November 24, 2012 reported 15.2% positive of 5,342 specimens tested.

The CDC also reports three pediatric influenza related deaths for week 48/ending December 1.  Two deaths attributed to influenza A, one from influenza B. There were no pediatric deaths related to influenza in the week 47 period.

Neuraminidase inhibitor resistance testing continues to show circulating influenza virus samples of Influenza A/H3N2, 2009 H1N1, and Influenza B are susceptible to oseltamivir and zanamivir. Sporadic cases of neuraminidase inhibitor resistance has been identified outside the United States.

Video compilation of flu maps from Centers for Disease Control and Prevention as reported for week 48/ending December 1, 2012.



Google Flu Trends data reports "high" flu activity in the United States as of December 11, 2012.



In the news.
Flu forecasting model may become as common weather forecasts in the future.
The Columbia University Mailman School of Public Heath is reporting on a computer model that may predict regional outbreaks in influenza. The new forecasting model, published in the Proceeding of the National Academy of Sciences, uses data from Google Flu Trends and climactic data to predict influenza. The model combines data from these sources and is adjusted for regional geography to minimize error.

Flu forecasting has numerous benefits and, if used correctly, will have a positive impact on preparedness. Just as a weather forecast that predicts rain causes people to carry an umbrella, a flu forecast may prompt people to take a parallel protective action such as getting a vaccine or remaining home if they're ill. Flu forecasting could eventually lead to larger scale forecasting during a biologic event and  help public health officals and responders prepare for and respond to these situations.

Links:
Flu Forecasts Could Soon Join Weathercasts. Voice of America, Science World
Scientists develop flu-forecasting model. Vaccine News Daily


Tuesday

From suitcase nuke to gym bag EMP, could microwave weapons be the next arms race?

Boeing/USAF First Non-kinetic/Microwave EMP Missile 

 

Boeing and the United States Air Force have produced a missile capable of delivering a targeted electromagnetic pulse (EMP). The Counter-electronics High power Advanced Missile Project (CHAMP) was tested late in September of 2012; receiving little, if any, media attention. The CHAMP missile produces an electromagnetic pulse (EMP) from a high power microwave (HPM) device that capable of incapacitating electronic equipment, connections, communication lines, and antenna systems. High power microwave systems have been tested for a variety of weapons applications. The test proved that CHAMP could effectively strike selected targets and destroy entire electrical systems, including an unprotected power grid. Detonation of a nuclear device can also create an EMP but on a much larger, non specific scale. The CHAMP missile is certainly more subtle than a nuclear detonation but is equally destructive and potentially deadly.

How bad could it be?
Systems that could be targeted by an EMP delivered by CHAMP include civilian targets; banking, power grid infrastructure, communications, and the internet. The United States military has known the potentials of EMP since the early 1960’s. In today’s techno-driven society the impact could be disastrous. Unlike a nuclear detonation, effect from an EMP would be far more discrete and deaths would most likely result from disruption in electrical systems over a wide area. We’ve seen what natural disasters such as Hurricane Katrina and Sandy can do to major modern cities and we’ve seen what happens when the power goes out for extended periods. Considering the impact of an EMP; we could be talking about loss of electricity over entire regions of the U.S. for months or years.

Wednesday

2012/2013 Flu Update #2

 Update #2 as of December 5, 2012

This weeks MJ F2012/2013 Flu update is being released several days early due to the increased flu activity and change in reported data. Citations and information based on available data as of Dec 5, 2012.

National influenza vaccine week December 2-8.
The Centers for Disease Control and Prevention reminds us that getting the flu shot is the best way to prevent serious illness from influenza. The CDC established National Influenza Vaccination Week to promote vaccine and help provide factual information about seasonal influenza vaccine. CDC and other sources indicate that the 2012-2013 vaccine is well matched to the circulating strains of influenza A: 2009 H1N1 and H3N2 as well as influenza B strain.

It’s not too late to get vaccinated.
The typical flu season reaches its peak around February, but flu cases are climbing quickly indicating an early start to season. The current CDC FluView indicates considerable increase in flu activity since our last report. The CDC recommends  annual influenza vaccine for everyone 6 months and older. Pregnant women, children, people greater than 65, and those with chronic medical conditions are considered to be at increased risk of serious illness from seasonal influenza. Despite controversy, the CDC recommends that healthcare workers be vaccinated against flu.

Boise, Idaho and Rochester, New York, are reporting deaths from flu. The recently reported deaths all involve people over 50 years of age. The baseline medical condition and flu vaccination status of the victims has not been publicly reported. The latest data from CDC (thru Nov 28, 2012) indicates no pediatric deaths attributed to flu. Other sources cite two pediatric deaths in the early start of the 2012-2013 flu season (see About.com Pediatrics for details).

A similar trend is reflected by Google Flu Trends this week. As of December 2, 2012, Flu Trends reflect a sharper rate of increase and higher case numbers early in this season than many previous years.
Google.org Flu Trends Graphic


Influenza is not the only virus out there.
Severe Acute Respiratory Syndrome or SARS became headline material when it emerged as a Novel Coronavirus in 2003. Lacking a vaccine for the virus, emphasis was placed on non-pharmacological interventions to prevent spread of SARS.

In September 2012, another Novel Coronavirus began causing illness. Coronaviruses can cause a spectrum of illness ranging in severity from the common cold to SARS. According to the WHO Novel Coronavirus Infection update (30 Nov 2012) there has been a total of nine lab confirmed cases of infection with the novel coronavirus. Five of the cases and three deaths are in Saudi Arabia. Two cases reported in Qatar, two fatal cases reported in Jordan.

Tuesday

Screen savers and call bells offer hand hygiene reminders

Two studies look at infection control prompts


Non-pharmaceutical interventions for preventing and controlling infection often take a back seat to vaccination programs. This is especially true during flu season. While vaccination is a vital cornerstone of preventing disease spread, limited access to vaccine and reluctance of staff to get vaccinated can cripple your vaccination program. Non-pharmaceutical interventions are easily taught and integrated within your daily routine. The typical non-pharmaceutical interventions include hand hygiene, respiratory etiquette, and appropriate social distancing, and should be readily available at all times. Hand hygiene is historically considered the most important of these interventions for controlling the spread of disease.

How do we increase voluntary compliance with such an important intervention?

Two studies published in the American Journal of Infection Control looked specifically at ways to improve hand hygiene compliance.

Sample screen saver message
Computer screen saver hand hygiene information curbs a negative trend in hand hygiene behavior.
Can your screen saver change hand hygiene habits? Apparently so, according to the authors of this study. They concluded that by placing gain-framed messages highlighting the benefits of hand hygiene on computer screen savers that compliance was increased.

Evidenced based or not, this seems like a good idea. Screen savers are a venue for delivering a message to your target audience. Rather than displaying some random graphic or blank screen, use the screen saver to reinforce important information on relevant topics.

Positive deviance: Using a nurse call system to evaluate hand hygiene practices evaluated the use of staff alerting system (referred to in the study as a nurse call system) to improve compliance with hand hygiene when entering and leaving a patient care area.
This study monitored the use of alcohol based hand sanitizers using electronic counters. They found that the use of hand sanitizer increased after linking the call system and sanitizer use data - using the call system as a reminder to use hand sanitizer - with higher utilization rates remaining for 2 years. They also noted a trend toward lower device-related infections, including urinary catheter-associated infections.

The study concluded: “The PD [positive deviance] approach to hand hygiene produced increased compliance, as measured by increased consumption of alcohol hand sanitizer, an improved ratio of alcohol hand rub uses to nurse visits, and a reduced rate of device-related infections, with results sustained over 2 years.”

Monday

Federal Medical Stations

Providing special needs care in less than 48 hours


What do you get when you add 24 hours and 40,000 square feet of
 medical equipment? You get a Federal Medical Station or FMS.

The FMS is part of the Centers for Disease Control and Preventions Strategic National Stockpile program and is designed to fill a gap that exists between disaster shelters and temporary hospitals. According to the CDC Works For You 24/7 Blog, Federal Medical Stations are non-emergency medical installations used during disaster situations to care for people with special medical needs and  chronic health conditions. They also include services for those with mental health issues. The CDC notes that FMS can be operational within 48 hours and their operational period is open-ended.

 It’s vitally important that basic medical needs are met during disaster situations and meeting those needs becomes an extraordinary challenge when hospitals are compromised or destroyed. While the FMS’s are not hospitals, they provide an invaluable resource and example for the disaster and emergency management community. Federal Medical Stations become a force multiplier by providing routine medical care for those with routine medical conditions, including the provision of routine medications, by sheltering those people, and keeping them out of an already stressed healthcare system during disaster. The FMS has the extra dimension of meeting mental health needs.

The FMS system relies on the asset management and logistics of the Strategic National Stockpile (SNS) for deployment. The SNS is a combination of warehoused supplies and vendor managed inventories of critical medications and equipment that can be shipped in bulk to areas in need. Each city or jurisdiction should have a plan in place (and tested) to receive assets from the SNS.

Photo Credit: CDC - Federal Medical Station
Creation of civilian, locally-based medical stations (in addition to disaster shelters) would be a major improvement to local and regional preparedness. Systems like the FMS should be reproduced by local jurisdictions to meet the expected needs of a community during crisis. We’re not suggesting reinvention of the entire system or duplication of existing programs. A smaller scale version of the FMS that is readily available to local governments with minimal lag-time would improve local response to crisis and disaster situations.

Thursday

2012/2013 Flu Update

Situational Update #1 Week of Nov 21 to Dec 1, 2012

Our coverage of influenza and influenza like illness begins this week. We'll continue weekly updates throughout the season season.

Influenza season starts about this time of year with a peak usually seen in early February. During an average flu season in the United States there are 35,000 to 45,000 deaths attributed to seasonal flu. Those most at risk of serious illness or death from seasonal influenza include people with severe medical conditions, impaired immune systems, or extremes of age young or old. Although vaccine remains the mainstay of flu prevention, proper use of personal protective equipment (PPE) and other non-pharmacological interventions can’t be ignored.

Review: Types of influenza
Influenza virus belongs to the category of diseases known as Orthomyxoviruses and is divided into three types(Type A, B,  and C). Type A influenza is the variety that causes us the most concern for mutation and has the largest possibility for creating a pandemic situation. Type A influenza is also the one we hear described by a combination of letters and numbers; H1N1, H5N1 for example. The “H”, more precisely HA, stands for hemagglutinin and “N” (NA) indicates neurominidase. Hemagglutinin and Neurominidase are proteins that allow the flu virus to enter a host cell, reproduce, and get out of the host cell. Some of the most promising medications used to fight influenza are Neurominidase inhibitors (NI). Tamiflu is a NI that has been widely used to treat flu and has recently come under concern as flu becomes resistant. There are 15 different types of HA and nine types of NA giving us a total of 135 potential combinations of type A influenza. The seasonal flu vaccine contains only two of those combinations. Hopefully they are the two most prevalent circulating strains.

Type B influenza is seen mostly in humans and although it's very common it is much less severe than Type A influenza. Type C influenza infects humans and swine and has a completely different pattern of surface proteins. Normally Type C presents with rare occurrences and has mild or no symptoms. In fact, by age 15 most people have antibodies against Type C influenza.

Vaccine
Mandate or not? There has been a lot of discussion on the topic of mandated flu vaccine with many opinions and views, but few conclusions. Many healthcare institutions have adopted a mixed program that requires vaccine or signing a declination form. There may be increased PPE use requirements for those who choose not to take the vaccine.  Unprecedented reports have begun to question the validity of seasonal flu vaccine. A CIDRAP report  suggested that vaccine actually had limited protection for young/middle age and only modest protection > 65. Tamiflu concerns have also been in the news with some accusing Roche Pharmaceuticals of withholding data relating to increased flu resistance with Tamiflu  use.

Terminology
The media and public may not fully understand the terms used in biologic/pandemic situations. Simple working definitions can be easily explained to the public, increase understanding and decrease anxiety.
Isolation - People who are sick are kept away from those who are not.
Quarantine - People who are not sick, but may have been exposed, are kept apart from others until the incubation period passes.
Social Distancing - A term that can mean anything from not shaking hands or hugging, maintaining a distance of 3 to 6 feet away from others, up to staying home when you’re sick. Social distancing can be used to describe extreme recommendations that include school closure. “Snow day” is a term that is sometimes used to describe a period when everybody stays home to decrease the spread of disease.
Pandemic refers to a disease that has spread to a large number of people over a large (national or global) geographical area. Pandemic is not synonymous with large numbers of fatalities.

Non Pharmacological Interventions
NonPharm practices can save the day. If used properly they can be vital in curbing the spread of disease. The non pharmacological interventions of hand hygiene, respiratory etiquette, and appropriate social distancing should be used in any actual or suspected case of Influenza Like Illness (ILI). The key to personal protective equipment or PPE - is using it correctly. Routine practice makes perfect when it comes to PPE and may be more important than annual testing.

On the Web
Flu.gov
Centers for Disease Control Flu CDC Flu
CDC weekly flu report
Center for Infectious Disease Researsh and Policy CIDRAP
American Journal of Infection Control AJIC
Google Flu Trends Google.org/flutrends

Monday

Influenza Vaccine Overrated?

Study reignites vaccine, antiviral controversy

Debate to mandate the (flu) shot or not for healthcare workers in the United States continues as additional data suggests seasonal influenza vaccine may not be all its cracked up to be.

Canadian healthcare workers are getting two differing opinions on mandated flu vaccine according to a report published by Public Health Ontario/Canadian Medical Association. Some Canadian researches continue to endorse the mandated flu vaccine policy for healthcare workers citing an 86% effectiveness when the vaccine is well matched to circulating virus. Researchers also claim that flu vaccination of healthcare workers in long-term care facilities (LTCF) may decrease resident flu mortality by 5-20%. The Canadian report, published in CIDRAP, the Public Health Ontario editorial indicates that flu strains that may produce Guillian-Barre Syndrome (GBS) are avoided in vaccine production. Its not clear how, exactly, GBS causing strains of influenza are kept out of vaccine production.

In the United States many healthcare systems and some sates are mandating participation in a flu vaccination program, according to the Centers for Disease Control and Prevention (CDC). “Participation” may include mandated vaccine, vaccine or singing a declination form, or mandated to don a mask.

Adding to the vaccine mandate controversy is a report from the Center for Infectious Disease Research and Policy at the University of Minnesota. This report proposes that seasonal influenza vaccine offers little protection to otherwise healthy young and middle-age individuals. They also believe that the benefit may be even less for those greater than 65 years of age. The New York Times recently printed an editorial on this topic.

While the vaccine debate continues, use of the antiviral drug Tamiflu is drawing concern. You may recall that Tamiflu (oseltamivir), and a class of medications known as Neuraminidase (NA) inhibitors, has been used to treat influenza. These medications are also on the CDC list for the treatment of seasonal influenza. However, reports have suggested that influenza has become (or is becoming) resistant to Tamiflu. One report from the CDC (9 Jan 09) states early data from a limited number of states indicating that a high proportion of influenza A (H1N1) viruses are resistant to the influenza antiviral medication oseltamivir (Tamiflu®). An article in Medscape highlights Tamiflu concerns brought on by researchers in the British Medical Journal. If you'd like to read in scientific detail about Tamiflu resistance, check out this post from the Virology Blog.

What’s the answer?
We have to remember that season influenza A continues to change every year. Some years the vaccine is well matched to the circulating strain, while other years it may not be. Its important to have an understanding of the terminology, types and impact of influenza (see 3 things to know about seasonal flu MJ 11/10). You should also brush up on the non-pharmaceutical interventions of hand hygiene, respiratory etiquette, and (appropriate) social distancing.

Wednesday

Proposals fall short of correcting critical infrastructure problem

NY problems are valid but proposals miss the real issue

NY Gov. Cuomo and Sen. Schumer make proposals to harden NY critical infrastructure. Governor Cuomo is recommending that all gas stations be required to have a backup power source; solar panels or a gas generator. Similarly, Senator Schumer is pushing the Federal Communications Commission to require emergency power options for cellular communications networks.

Both proposals are important. Neither address the real problem of vulnerable infrastructure.

There is no doubt that the loss of power from any cause results in cascading infrastructure failures.  Communication and fuel availability are among those failures. Reports have indicated that 40% of gas stations in areas hardest hit by Hurricane Sandy had fuel in their tanks but couldn’t pump for lack of electricity. Its been estimated that 1 in 4 cell towers failed during the storm due to lack of power or inadequate backup systems.

But disruptions in the fuel supply and cellular communication are not the only problems created when the power goes out. People may not be able to pay for groceries at the local supermarket when power and communication to the “cash” registers is disrupted while others may not be able to breathe (for too long) at the local hospital if power to our ventilator is cut.
Ordering individual systems such as gas stations and cellular installations to establish auxiliary power corrects the problem for those pieces only and continues to leave other systems vulnerable.
At issue here is a failure to harden the bigger target: the Nations power grid as well as correcting individual facility preparedness shortfalls.

The recommendations by Gov. Cuomo and Sen. Schumer are not bad ideas, they just ignore the larger problem of a weak and vulnerable electrical infrastructure. If we’re going to consider mandating gas stations and cellular companies to install backup generators, why not mandate New York hospitals to improve their backup systems? After all, going without fuel and your phone is inconvenient, going without your ventilator is fatal. Ultimately, vulnerabilities that were either undetected or ignored in the backup power systems caused hospitals to be evacuated.
This also raises the issue of civilian businesses being considered part of critical infrastructure.
The U.S. power grid remains the most vulnerable of our critical systems. We’ve seen routine seasonal storms disrupt power for days, sometimes weeks. We’ve seen natural disasters disrupt services for months and Mother Nature is not the only threat to keeping the lights on.

Our Nations power grid is strikingly vulnerable to the threat of electromagnetic pulse (EMP), obsolescence and decay. Having discussion of power grids and blackouts is a difficult subject for many leaders and elected officials to talk about.

Focusing on cell service and gas stations is a lot like telling people how much drinking water they should have on hand. Its only half the story. You can have plenty of water to drink, but if you don't have enough to flush the toilet you’re going to have problems.

Why not harden the whole puzzle rather than little pieces of it?

Monday

Selling the Preparedness Mindset

A recent comment got my attention; it should get yours, too. 

 

Aaron Marks posted a comment in response to No surprises in Sandy's wake that will hit home for many in emergency management as we struggle to make a successful pitch for preparedness. Although his comment specific to business and commercial preparedness, I think the spirit of the post can be applied to the public/civilian.

Aaron Marks writes:

For most of the people who follow MJ you're preaching to the choir here. The million dollar question is how do we fix it? 

I spend most of my time these days trying to convince business owners to invest in preparedness - with extremely limited success. Most of the decision-makers and so-called leaders out there just don't want to acknowledge that there is an issue because once they acknowledge it there may be liability associated with failing to do something about it. How do we convince 'the massess' that preparedness is an INVESTMENT and not a cost?

Why is preparedness such a hard topic to sell?

We should put the word sell in parenthesis. We can be selling the idea of preparedness or selling a product or service related to preparedness, or both. In there may be the problem. We’re trying to convince people in the community, business owners, public officials, or civilians that a certain action needs to be taken when most of those we’re selling to haven’t ever experienced any kind of serious event. And they don’t think they ever will. Many individuals and business owners have used phrases like “that’s what I have insurance for” when rationalizing their lack of preparedness.

What we’re “selling” is the preparedness mindset.

Persuading anyone to buy or do something they don’t think they need is an extraordinary uphill trek. After terrorist attacks and natural disasters woke us from the slumber of complacency, we’re eager to hit the snooze alarm and get back to business as usual. Or at least back to business of the new normal...whatever that may be.

The sad and unrelenting fact is that in the face terrorism, pandemics, and devastating natural disasters, many continue to believe that “its not going to happen to me.” In June, 2008, we wrote about this in the posting In search of preparedness in America. That post generated considerable discussion. As I wrote then “governments seem to have lacked the stamina to keep up with preparedness...” and I continue to believe that today. The response to and recovery from Hurricane Sandy continue to make my point here in 2012. You’d think that with Sandy fresh in our minds that preparedness would sell itself.

The liability of acknowledgment.

We also described an interesting, yet disturbing trend in October, 2010 (see Cassandra Paradox)  - We’ll call it the Theory of Successful Blame.
“Emergency planners, managers, and responders are responsible for actions taken (or not) before, during, and after disaster situations. While emergency planners, managers and responder should be held accountable for their performance during crisis or the performance of their planning or training preparedness, it seems that the need to have a scapegoat overpowers the reality that many of the disaster situations are fluid and may not evolve as predicted. Unreasonable expectations need to hold someone accountable when an unpredictable situation goes astray.”
The point is that acknowledged or not, someone is going to be held accountable. The preparedness liability exists and will remain on someones shoulders. A review of of the Hurricane Katrina/Tenent Health decision is a good reminder of this.

How do we convince the masses?

What we should be doing is informing and keeping it simple. Informing that preparedness is a cost effective in financial and life safety terms. We can provide information and rationale that may be helpful in bringing awareness to the forefront.

E. L. Quarantelli (University of Delaware Disaster Research Center) is my most cherished resource on emergency management teaching. In his paper More and Worse Disasters in the Future (1991); Quarantelli provides us with decent talking points, if not ammunition, to get people thinking about their need to embrace preparedness (click here for PDF).

For example, Quarantelli suggests that:
  • Natural disasters will increasingly generate technological disasters
  • Old kinds of natural disaster agents will simply have more hit and along some lines more vulnerable populations to impact
  • There are technological advances that add complexity to old threats
  • Many of the future threats or risks have high catastrophic potentials by way of the casualties or kinds of injuries they may generate
  • Some of the future disasters while occasioning relatively few casualties or physical damage will be very economically costly or socially disruptive
Perhaps the most poignant statement in his paper is this:
Better disaster planning can mitigate the impact of these future kinds of disaster but will not prevent their occurrence.
 On a more individual note, you might consider advocating a preparedness program that focuses on the home and the family. Doing as much as possible towards making individuals and family groups will go a long way in making communities as a whole more resilient in times of crisis.

Wednesday

Healthcare realities you can't ignore...anymore

Healthcare facilities: part domestic preparedness and part public safety.

Simply meeting building and fire codes do not equate to resiliency and checking off the Joint Commission preparedness requirements does not mean you're prepared.

Healthcare facilities will need to function before, during and after an event. The goal is to maintain operation as independently as possible for any foreseeable threat in your hazard vulnerability assessment. Those that can’t do that will need to evacuate or move their operations to another facility. Sheltering in place or evacuation are clearly realities each facility must face. They’re big decisions. Both options require substantial pre-planning and functionality between facilities.

Sheltering in place.

Deciding to remain in your facility during an event (sheltering in place) is not an easy choice. On the surface it may appear that staying put is a simple thing to do but, sheltering in place (making the decision not to evacuate ahead of a threat) comes with its own set of risks. Hopefully you have a robust 96-hour plan that you’ve trained on and tested. Hopefully it’ll see you through the situation. Even with solid planing, we have to has how long can you remain in your facility without outside support? Of course you have memorandums of understanding (MOU) with a variety of vendors as required by the Joint Commission. So, you're set. Right? The interesting thing about MOU's is that your vendor has an MOU with  all their clients, not just you. Will they be able to deliver their goods or services when demand is maxed out by all clients? Consider that infrastructure damage, such as damage to roads and bridges, will prevent shipments from making it to your supplier and further, prevent them from making delivery to you.

Part of sheltering in place is having a series of decision points or triggers that will tell you when its time to change tactics. Trigger events are situations that cause you reconsider your current position and may indicate the need for evacuation.

If you haven’t got a functional 96-hour plan or if your plans are questionable, you may want to consider evacuation ahead of a threat if possible.

Evacuation.

Evacuation of a healthcare facility is a major event. There are risks to go along with the benefits. Before you give the order to begin the evacuation process you need to consider the following:
  • Will this be a full or partial evacuation?
  • What is the available capacity of receiving facilities? Can they absorb the number of patients we wish to send?
  • Have the receiving facilities damaged by the current event or are they in danger of being evacuated themselves?
  • What resources are available to move people and equipment?
  • What are the risks of going out into the environment?

Keep in mind that surge capacity may exist before an event, but not during or after. Evacuations must be done early or pre-event whenever possible. Ideally, your evacuation plans and triggers have been shared and tested with other facilities.

Monday

No surprises in Sandy's wake

Foreseeable issues plague response, recovery 


We're all focused on the aftermath of hurricane Sandy and the level of destruction she delivered. Once again the bullseye of this natural event is a major metropolitan coastal area. Some have referred to Sandy as the Katrina of the Northeast.

They may be right in more ways than one.

We see the devastation and the agonizingly slow road to recovery unfold with a familiar, yet eerie, similarity to other natural disasters. We were hopeful that the pre landfall actions ahead of Sandy were a setup for success. What we're seeing is foreseeable, almost expected, issues that plague the response and recovery as if planners have forgotten the major lessons of past events.

As I write this post some two-weeks after Sandy's landfall, hundreds of thousands are without electricity. Fuel supply is short and access to gas stations is limited, punctuated by long lines and short tempers. Some major hospitals remain closed, patients evacuated to already over crowded facilities in area less impacted by the storm. Even FEMA withdrew assets for a short time.

Patience is at a premium as the public struggles to accept the fact that there is no timeline for recovery. No one knows when the lights will come back on or when the toilets will flush again. Anger is begging to surge as high as the flood waters.

All this is happening in an area with arguably the most resources and experience dealing with disaster.

All of this has happened before and it will happen again. The power goes out for along time, food runs short, fuel is in short supply, and the recovery efforts falls short of our expectations. This is not to say that NYC or New Jersey were not prepared. Rather a series of beliefs and issues make it possible for a Katrina or Sandy to cause the same situation in your city and mine.

The over emphasis on terrorism has caused us to forget about the power of natural events. Despite the ridiculous amount of money spent on fantasy homeland security efforts we remain woefully unprepared to mobilize for or recover from natural disasters.

Our power grid is the most vulnerable piece of critical infrastructure in the United States. Decay and obsolescence alone are enough to fuel the concern that our power grid is not up to the challenge of day-to-day use, note to mention the impact of a outside event on local service. No power means no heating or cooling. No financial access. No ability to pump fuel or water. Prolonged power outage and failure of the power grid are issues few want to acknowledge.

The healthcare community continues to be shacked by standards that don't equate to patient safety in disaster situations. Lack of funding for preparedness results in a halfhearted effort and "check the box" mentality that simply meets a vague requirement for bureaucratic satisfaction. Similarly, the inability to move beyond the insanity of Optimism Bias keeps some healthcare preppers from acknowledging their vulnerability to natural disasters.

The public suffers from a similar complacency. Even after seeing less-than-encouraging examples of our national response to disasters and a new definition of disaster, the civilian population seems to hang onto the fallacy that someone will come to the rescue, put food in the pantry, and turn the lights back on.  

Saturday

Vermont EMS Conference

Vermont EMS Conference, Burlington VT

I'd like to extend a special thanks to conference attendees and organizers, especially All Clear Emergency Management, for inviting me to present at the Vermont EMS Con!

I truly enjoy public speaking and presenting at emergency service conferences and in 2012 I've been invited to conferences from Alaska to Vermont and many places in between. Speaking at conferences and meeting other emergency management and EMS professionals always excites me. I often return home energized from meeting proactive people and with a head full of new ideas.  The sessions on Special Needs in Crisis and School Bus Rescue were very well attended with a considerable amount of audience participation. Just the way I like it.

Travel to the Vermont conference had an added, albeit challenging, twist...hurricane Sandy. When I left home in the afternoon of October 28 predictions for Sandy's landfall were being confirmed. I figured I'd bump into this category 1 storm at some point.

On the NYS Thruway Eastbound



It wasn't long before I was driving along side convoys of utility trucks with license plates from the Great Lakes area to the Gulf Coast.

The road conditions pictured at left are actually from a local weather system and not from Sandy...I'd meet up with her later.






Welcome to VT



The approach to Vermont. Leaving New York and entering Vermont is punctuated by crossing Lake Champlain via this massive bridge.

Note that, while overcast, the weather is nothing less than cooperative at this point. From here its another hour into Burlington. A six-hour drive from Rochester, NY.












Sums up my feeling toward air travel in general

After getting checked in and settled I took a recon walk to check out the conference area and rooms.

Along the way I found a pumpkin carving display in the hotel lobby. The carvings had a obvious EMS theme.

The Scare Care pumpkin...precisely summarizes my feelings on air travel.






A bit less inventive but obligatory Star of Life pumpkin.










As I said, an EMS theme. When I checked back the next morning there was something missing.








Take note of the topic listed just below mine. I was impressed with the number of emergency management/preparedness topics at this conference. Rory Putnam is the EMS Clinical coordinator at Northern Essex Community College. He hit a home run with his talk on EMS preparedness. Rory and I had a few minutes to talk during lunch. I appreciated his insights on EMS and disaster situations and hope to have him on Mitigation Journal podcast soon.




No laptop for me.  This was the second conference I worked entirely from my iPad and controlled with the iPhone. I use Keynote (Mac version of PPT) on my iPad and Keynote Remote for iPhone. Connected via Bluetooth I can see current slide, preview next slide and view speaker notes on the phone.

The iPad/iPhone-Keynote setup is simple to use and user-friendly at the podium or walking around the room. 



The Special Needs topics have been growing in popularity. This session focused on preparedness, including a how-to on conducting a hazard vulnerability assessment.

As with all my presentations, I customized the content with Vermont-specific statistics to add relevance to the message. 







A not-so-ominous to the South approaching the Vermont/NY state line at 5pm October 29, 2012. 






Welcome to NY...just ahead of Sandy. I did feel a sense of accomplishment knowing I'd filled my gas tank in Vermont and paid a buck-fifty less per gallon than I would in NY.

This is also the point in the trip when the weather started to change. My drive through the Southeastern Adirondacks was a zig-zag of downed trees and wind-driven rain. It was also darker than I've ever known it to be. No pictures...but made it home safe.

Thanks, again to the organizers of the VT EMS Con. I had a wonderful, albeit short, visit. See you next year.

Friday

Evacuation: Should I Stay or Should I Go?

Not an easy decision but its not a trick question

When to order an evacuation is no easy decision. It never has been. Its also not a trick question and you have plenty of time to study for the test.

Controversy surrounding evacuation of civilian populations and healthcare facilities has bubbled for many years without clear resolution. And for good reason - there is no "one size fits all" approach to the problem.

The hard taught lessons from Katrina, Joplin, and Tokyo showed up on another disaster test. The final grade isn't in, but its not looking good. In the aftermath of hurricane Sandy, as the public and public health struggle to regain a foot hold on normalcy, we're wondering why problems of power, evacuation, sheltering, and fuel are persisting.

Here's a review of evacuation considerations from Mitigation Journal edition #41 - Should I Stay or Should I Go? Points to consider when deciding to shelter in place or Evacuate - overviews issues for individuals, families, and healthcare facilities to consider when making this critical decision.


MJ Podcast #41published October, 2007*
 
*Note: original audio from 2007 and has not been edited. It may contain outdated material.

Wednesday

Decontamination at health care facilities




Hurricane Sandy a setup for success

Pre landfall actions minimize loss of life


A major storm known as hurricane Sandy barrels up East Coast and is predicted to collide with two other storm systems to form “a perfect storm”. As Sandy reaches the conversion point with these two other storms, it becomes clear that it will make landfall in the most populated areas of the nation. Coastal areas of the Northeast including Philadelphia, New York City and New Jersey are in the direct path of the predicted landfall.

The aftermath of the storm is nothing short of devastation. The damage done in New York City alone rivals that of September 11, 2001. Yet the loss of life remains minimal because of actions taken by local government officials prior to the storm making landfall.

Good decisions and actions were made possible in the pre-storm phase because of solid predictive evidence and what I’ll call “techno-intel” - the ability to rely on multiple pieces of technology to provide situational awareness. Local government officials including Mayor Bloomberg from New York City and Mayor Christie from New Jersey were on the same page and delivered a consistent message to the public. Unlike other natural disaster situations, these officials listened to the predictions and took appropriate, measured action in the pre-landfall phase that included emergency declarations and realistic public information. These pre-landfall declarations allowed access to resources to be pre-positioned ahead of the storm, activation of response teams, and access to funding streams. These actions will be proven to have saved lives.

Perhaps one of the most important pre-landfall actions of the hurricane Sandy event was a consistent nature of the warnings given by the local government officials. I believe that because these messages were consistent, clear (blunt), and described the actions to be taken by the population, the loss of life has been kept to minimum.

Another key factor in the storm response is the protection of infrastructure. Mayor Bloomberg ordered mass transit shutdown well ahead of the landfall hurricane Sandy. This action reinforced to the public evacuation orders must be followed within a given period of time and allowed for vehicles such as buses and subway trains to be sheltered and serviced. Getting mass transportation vehicles to shelters where they could be prepared for a return to service after the storm would allow them to be used in the recovery phase.

As I write this the recovery from hurricane Sandy is just beginning. There has been loss of life and the physical damage has yet to be fully assessed.

Local government officials have listened to the experts and taken an all hazards approach to preparedness with good planning and execution. As of today it seems the residual impact from this “super storm” will be contained to an absolute minimum.

Saturday

MJ 240: Why do we have to pay for CPR training? Should flu vaccine be mandated for health care providers?



Edition 240 October 21, 2012
This week on Mitigation Journal:
Why do we have to pay for citizen CPR training?
Mandate the shot or not?

Hosted by Rick Russotti, RN, Paramedic
Co Host Matt Comer, Paramedic
Please visit Mitigation Journal at www.mitigationjournal.org

Check out this episode!

Tuesday

Mandate the shot or not?

Debate over mandated vaccination continues
Voice your opinion, take our informal poll located in the right sidebar. 

What rights do I forfeit to work in health care?

Do health care workers have a "duty" to be vaccinated against seasonal flu? 
The answer to that question is "yes" ccording to the New York Times  who published an article suggesting that health care workers "should know better and anyone". The article cites a recent survey conducted by the CDC and claims that while doctors and nurses are "getting the message" about flu vaccination, mid-level providers and other health staff are not. They goe on to state that "Vaccinations of health care personnel should be required, either by state laws or by employers" and further notes that compliance is 95% when flu vaccination is mandated by an employer.

Should health care employers "mandate" workers to be vaccinated?
According to an opinion published in Medscape, Why Hospital Workers Should Be Forced To Get Flu Shots, by Arthur L. Caplan, PhD, the answer to the question of mandated flu vaccine is clearly affirmative. Correctly noting that seasonal influenza impacts high risk groups such as extremes of age, immune-compromised, and those living in long term care facilities, he states -
"Ethically, your first obligation is to do no harm. If you are there to do no harm and that is your primary obligation, then you cannot put your personal choice or your personal reluctance to get that shot above doing harm. And you are likely to do harm to others if you do not get that shot."
He goes on to say -
"...every code of ethics that I have seen -- medical, nursing, and others -- says that we put patient interests first. It is not in the patient's interest for you to not get a flu shot. If we are putting patient interests first, if that rhetoric is what we believe in our codes of ethics, what we teach in our medical and nursing schools, there is no excuse for not getting a flu shot."
Can a seasonal influenza vaccine be mandated as a "condition of employment" be enforced?
New York State attempted to mandate vaccine during the 2009 H1N1pandemic for all health care workers. The vaccine mandate was made by then Governor David Patterson despite a lack of vaccine, a sustainable mass vaccination program or a declaration of public health emergency. There was also considerable debate as to who, exactly, was considered health care workers. Most studies overlook non staff health care professionals such as EMS providers, firefigters and other public safety responders who contact the public in and out of the hospital setting.

Should we include environmental/support service staff or provide for blanket inclusion of anyone who would walk into a hospital?

Not everyone agrees with vaccine mandates.
New York State Nurses Association vigorously opposed the vaccine mandate in 2009. (See NYS Nurses Opposes Mandates for Vaccine) In June, 2010, the Centers for Disease Control and Prevention issued a statement saying they would not endorse mandated flu vaccines for health care workers for that year. The announcement by the CDC was a reversal from their controversial stance in 2009 that anyone working in a hospital must be vaccinated against the H1N1 Swine Flu. The full text of the CDC's statement can be found here.

Can vaccination be mandated without a formal declaration of a public health emergency?
You may recall that the United States Army (2003) had to resort to disciplinary action against soldiers who refused mandated Anthrax vaccine in preparation for deployment to a area with a credible Anthrax threat. The Army Anthrax vaccination program was eventually halted by federal court in 2006.  
If the Army cannot mandate vaccine soldiers in the presence of a credible threat, can anyone mandate civilian health care workers to be vaccinated in the absence of public health emergency?

If health care providers are mandated to be vaccinated today, what will be mandated tomorrow? 
What do the experts say? The opinion of the CDC is echoed by other infectious disease. The Society for Health care Epidemiology of America (SHEA) has released a position paper endorsing mandated vaccination with endorsement from the Infectious Disease Society of America. According to the SHEA media release:
"...influenza vaccination of health care personnel [is] a core patient safety practice that should be a condition of both initial and continued employment in health care facilities."
More than one controversy in this situation.
There is no doubt that flu vaccination will prevent the spread of flu, seasonal or otherwise. Public health history reminds us that viruses like Smallpox can be eradicated by a staunch vaccination effort. But can we expect to vanquish Type A influenza by mandating seasonal flu vaccination?

Saturday

Power Failure and Situational Awareness

Follow up on EMP/Power Grid Collapse

Critical infrastructure and failure of the electrical power grid continue are among the most popular topics on Mitigation Journal. Last week we posted a piece on electromagnetic pulse, power grid failure and the end of electricity (see And the lights go out...Fun with EMP).

In response to the number of requests for additional information, we're posting this video excerpt from MJ Podcast #186 (August 2010) discussing situations and potential outcomes of prolonged loss of electrical power and critical infrastructure failure. Other topics in MJ Podcast #186 include Hydorgen explosion in Rochester, Mosque Opinions, and Six responders exposed to acid at "routine" event.

Free podcast subscription link via iTunes.



Thursday

And the lights go out...Fun with EMP

National EMP Awareness Day and the end of electricity

Protection of critical infrastructure continues to be ignored. Of all the critical infrastructure to be considered, few hold the significance of our power grid. And still, few people are willing to discuss protecting it from natural or intentional threats.

The power grid is a series of electrical generating plants connected to form a distribution network or a grid. There is no capacity for storage of electrical power and if one plan is removed from the grid others must pick up the load. When that demand for power cannot be met by the grid the situation gets dim. Literally. (see Power Grids and Blackouts)

We've all experienced the occasional loss of power for one reason or another. Usually the lights go back on in a few hours and life returns to normal. The furnace or air conditioner starts modifying our indoor climate, our refrigerators and freezers keep our food supply safe, and the internet connection works. Life returns to normal.

The the thought the power going out and not coming back on can be frightening. Over half a billion people in India found out what happens when a national power grid fails in July 2012. Not only were people without electricity, but transportation systems were crippled, people were trapped in buildings and mines. In essence, time stopped and started to run backwards.

Our power grid continues to be vulnerable to natural disasters and mechanical failures as a result of neglect and obsolescence. But there is a growing threat looming on the horizon that could turn our civilization back a hundred years. That threat is electromagnetic pulse or EMP.

An EMP can be produced by a device designed to create the pulse or as the by product of a nuclear burst. Some have speculated that one of Irans goals is to be able to strike with an EMP. While awareness to the EMP potential continues to grow as fast as our dependance on technology, most of use remain unable to fully grasp the scope of the problem.

Friday

Don't listen to me! Recording without consent in healthcare

Is recording without consent a real concern?

 Are you being recorded without consent? Imagine your reaction when you discover a patient or family member has been secretly recording your interactions with them. A MJ follower recently had such a discovery and was (not surprisingly) concerned...

T.U. is an RN from Central New York and writes:
"...I was appalled to find that a patient had coordinated with family to record interactions with their health providers. A family member recorded (our voices) on a smartphone by simply leaving it on the table while another filmed encounters on another phone. All this without the nurses knowing about it. We found out about it only when a recording was accidentally played while a housekeeper was cleaning the room."

 Discovering you've been recorded without your knowledge or permission stirs emotion and puts us on the defensive. Why would a patient or family want to record our actions? Are they upset about our care or waiting to catch proof of a mistake? Perhaps the family just wants to have a record of the conversation to remind themselves of our instructions. Those who provide care outside the hospital environment may be more aware of the potential for being recorded. EMS providers and firefighters frequently provide care in public locations and are always in a position to be recorded by bystanders. Radio transmissions are also recorded and often are played on various websites.
Recording devices have come along way

While there are many reasons why someone would record (audio/video) we often jump to the negative conclusion...a reasonable defense mechanism when were recorded without our permission or knowledge. If nothing else, finding out you've been recorded without your knowledge or permission, taints the environment of care.

The ever increasing popularity of smartphones and other portable devices makes covert recording an almost certain eventuality.  And here in New York, its perfectly legal to do. Okay, disclaimer time - I'm not a lawyer, I have no background in legal matters and Mitigation Journal is not (emphasis not) a blog for legal opinion or recommendation.With that in mind, lets move on...

Recording your healthcare providers conversation without consent is perfectly legal in New York and many other states. There are only 12 states with "all-party" legislation that requires consent for recording. That being said, I think its important to take a calm approach to the situation.
 
Upsetting as the situation may be, recordings made covertly (or overtly, for that matter) may not be of benefit during legal proceedings. While medical records are seldom questioned for authenticity, recordings made by patients and families may be. They can be edited, tampered with and it may be difficult to prove exactly who is talking on the recording.

Here are a few articles that I found helpful:

Be Careful Who and What You Are Recording

When Patients Audio Record Without Your Consent

Family may use secret recording in medical negligence suit

Secretly recording conversations with doctors... Is it legal?

 

Thursday

MJ Podcast 239 West Nile Virus

Special joint podcast episode with the MedicCast and This Week in Virology


What is it about West Nile virus that has everybody talking? Do the number of infections and deaths from WNV this year make sense? Is this hype or example of emerging infectious disease threats to come?


Join me, Jamie Davis (MedicCast/Nursing Show/Insights in Nursing), Dr. Vincent Racaniello and Dr. Dickson Despommier (This Week in Virology) for everything you wanted to know about West Nile virus and more!


In this episode:
  • Where did WNV come from? 
  • How did WNV get to the United States? 
  • What's driving the 2012 epidemic and is this really the worst ever? 
  • How can we apply current knowlege to other emerging infectious diseases?


Click player below to listen now or direct download here


Mitigation Journal is listener supported. Please consider making a donation or rating us in iTunes.

Tuesday

Schools fail bio preparednes 101

U.S. Schools receive a failing grade in pandemics

If a biological agent targeted schools and children would try to prevent it?

Despite the global awareness of biological terrorism, emerging infectious diseases and the impact of diseases such as influenza, a majority of schools in the United States remain unprepared for a biological event. Only 40 percent of schools have updated their infection control/pandemic preparedness according to a study published in the American Journal of Infection Control. The study, conducted by Saint Louis University suggests that many schools in the United States are not prepared for a biological event despite experiences from the 2009 H1N1 pandemic event. As the threat from naturally occurring infectious disease and intentional acts of bioterrorism grow, the importance of community preparedness will increased. We know that one of the keys to a successful outcome in disaster situations is the preparation of local response agencies. Traditional responders and non-traditional responders (public health, hospitals) are the primary responders in any community during times of crisis. Unfortunately, hospital and public health preparedness may still be lacking. Schools should be included in the non-traditional responder group, considered part of critical infrastructure and as such, should be given direction for biologic preparedness according to their role in a biologic event. Best media coverage from Science Daily (http://www.sciencedaily.com/releases/2012/08/120830105323.htm)
Could school preparedness be any worse? Yes.
These findings question the general preparedness of critical infrastructure. The Saint Louis study looked at responses from about 2000 school nurses encompassing only in 26 states. If the results truly represent the biological preparedness efforts (or lack thereof) the school preparedness situation could be much, much worse and equate to greater risks. Closing schools during a biologic or pandemic event will not replace preparedness as studies have shown that kids don't often stay home.

Traditional elementary and high schools draw students together from a variety of social, economic, and cultural background. Bringing a student population together to share ventilation systems, food, water and sanitation, in close quarters, provides opportunity for disease spread. With this in mind, school systems must be a leader in educating students on proper hygiene and infection control measures. Non-pharmacological  interventions are vital to prevent the spread of disease and include hand hygiene, respiratory etiquette and appropriate social distancing. These simple measures are important for everyday health promotion but could be even more important in preventing or limiting the spread of influenza.
By the numbers, per the Saint Louis study.
According to the Saint Louis study, less than one-third of the sample schools maintained a supply of personal protective equipment (PPE). Even more concerning is the over 20% of the staff in these schools have no members trained in the schools disaster plan. Infection control training for students was reported by only one third of schools and conducted usually once a year or less.

The study also asserts a positive note, finding that nearly 75% of school nurses have recieved seasonal flu vaccination.While this is good news, its only a drop in the bucket. One person (school nurse) vaccinated for seasonal influenza will do little to stop the spread of the disease. When it comes to emerging diseases and intentional biologic releases there may be no vaccine and we'll need to rely on those non-pharmacological interventions.


Friday

Test all Baby Boomers for Hepatitis C. Really?

CDC: Boomers need HVC testing

Baby Boomers make up about one-third of the United States population with a startling number of Hepatitis C (HCV) infections. In fact, the Centers for Disease Control and Prevention (CDC) believe that the Baby Boomers, those born between 1945 and 1965, should undergo one-time testing for HCV. Previously, CDC recommended testing only if risk factors such as IV drug use, blood transfusion, or organ transplant existed. Testing for those in healthcare or other high risk occupations (including EMS and nursing) should be tested.

Given that as many as 2 million baby boomers are infected with HCV and many of the 15,000 Americans who will die from the disease are boomers, risk-based screening is no longer enough. According to the CDC -
"...newly available therapies that can cure up to 75 percent of infections, expanded testing – along with linkage to appropriate care and treatment – would prevent the costly consequences of liver cancer and other chronic liver diseases and save more than 120,000 lives." 

  Why are baby boomers at such increased risk for HCV? One theory attributes the increased risk to past behavior, suggesting boomers participated in activities that placed them at risk for HCV. 

HCV can be contracted by occupational exposure. I wonder what the ramifications will be for those baby boomers, who by definition now have increased risk of having HCV, have an undocumented occupational exposure in their past? 


http://www.medscape.com/viewarticle/769361
http://www.cdc.gov/nchhstp/Newsroom/2012/HCV-Testing-Recs-PressRelease.html