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Tuesday

4 pitfalls to avoid in your biologic planning

Think you'll have access to everything you'll need? Think again. 
This plan is your plan, this plan is my plan. Not.
Emergency service agencies and healthcare systems have spent countless hours and dollars on the planning process yet, few if any of these plans integrate with each other. There is little if any continuity between traditional response groups and healthcare systems. Failure of any agency or service to adopt or even recognize the existence of the national incident management system or NIMS will be the cornerstone of failure during a large scale event. Scant few services, either public or private, address planning needs or participate in any level of joint training. This unfortunate situation is perhaps the least expensive and easiest to implement, yet remains ignored. 

Four things you shouldn't count on in a biologic crisis
1. Communications
Each plan assumes that there’s going to be the ability to communicate and that communications will be undisturbed throughout any given event regardless of the length or scope of that event.  Case studies of numerous large scale events indicate the communications will be among the first piece of infrastructure to be compromised. When communication systems have failed or are compromised alternate means of communication will spring up; and it is these alternate means of communications that will lend a false sense of communications security and ultimately yield unreliable and inaccurate information unless they are planned and tested.

2. Power and Transportation

The reliance on public energy and public transportation are critical weak link in the disaster and emergency planning process. Power and transportation are linked together in the disaster planning setting. If we have and reliable and hardened power infrastructure capable of producing climate control, light, and maintaining critical operations in a given facility we can reasonably assume that facility will remain habitable and functional during crisis. If the power supply is threatened or lost we will no longer be capable of sheltering in place throughout the crisis and the decision will have to be made concerning evacuation or alternative sheltering. Should the need arise to evacuate a given facility, especially a healthcare facility, there will be our reliance on emergency medical service (EMS) and public transportation to make it happen. EMS transportation vehicles may or may not be available in such a situation. One must understand that all traditional response groups, including emergency medical services, will have their resources stretched to capacity and beyond. Air and ground transportation units will be subject to the same problems of fuel, power, and communications disruptions as fixed facilities. Alternate means for power supplies and shelter in-place needs must be addressed by fixed facilities in addition to hospital evacuation contingency and 96 hour planning.

3. Personnel
Another fatal flaw in emergency planning is the assumption that personnel will in fact report to work. This consideration must be taken without regard to the status of roadways and transportation. A survey study conducted by Columbia University in September, 2005 demonstrates possibility of personnel, who are otherwise unaffected by crisis, refusing to report to work. In this study, health care workers were asked to indicate if they would be able to report for work or willing to report for work in the event of a mass casualty incident. 81% said that they would be able to go to work if there was an environmental disaster, yet only 69% said they would be able to go to work during a small pox epidemic. The study goes on to note that the willingness to report for work would only be 48% of health care workers during a SARS outbreak. Further, only 57% of health care workers would return to work in the setting of a radiological event. The fallacy in this stage of planning is to assume that Healthcare workers who have a perceived obligation to respond will, in fact report to work. Numerous sources have noted that the willingness to report for work in any situation may be impacted by concerns for the safety of the responders family. It is important for employers of public and private organizations to understand that the family care can be as vital as responder care. Workers fears will impact their willingness to work and administrators and company leaders must talk to their workers about these concerns regarding exposure and contamination and reassure them by planning to assure family and dependent safety. An example of such contingency planning would be the setting of highly pathogenic flu or other biologic event. It is estimated in such a situation that nearly 30 to 40% of the American workforce would become stricken or ill and unable to report for work of any kind. That percentage includes persons engaged in critical infrastructure such as traditional responder and healthcare providers. 

4. Surge Capacity
Another important point to consider is that of the lack of surge capacity in the concept of ripple effect deaths. Surge capacity is a specter of imagination as many Healthcare systems operate above capacity every-day. Just as the traditional response groups will continue to respond to the routine calls for service during a large scale event, routine medical emergencies will continue to arrive at local hospitals. Lacking surge capacity will almost certainly cause some of these otherwise routine patients to destabilize and become critical or fatal. This can add to the death toll of any large scale event and further destabilize community infrastructure.

Thursday

Its Summer. Do you know where your plans are?

Summer months are the time to exercise your pandemic plans

We’ve been looking down the barrel of a loaded “pandemic gun” for some time and you've been meaning to do something meaningful about biological preparedness for a while now. Lets face it, a mild winter and lack luster flu season has taken biologic preparedness off the radar.  Here it is Summer time and were guided ever so gently by the media away from flu (avian or otherwise) and pointed towards gas prices, immigration, and politics of all sorts. Although not without good reason and some value, we’ve forgotten about the “pandemic gun” or maybe just because the weather is warm here we figure that gun is no longer loaded.

Experts are warning of the biologic implications of the London Olympics. Now what?


Its Summertime, do you know where your plans are?
Just because we’re out of the typical flu season is no rationale whatsoever to put planning and training for such an event on the back burner. I’ve been asked a number of questions recently pertaining to planning, preparedness and response capabilities. The sad fact is that, despite effort and dollars, most pandemic and biologic event plans fall short of functionality. The overtone seems to be that the healthcare community and public health are going in one direction and traditional response groups are not going anywhere at all when it comes to planning for a biological event.

Each of the plans I’ve reviewed share a number of pitfalls by assuming:

1. The ability to communicate will remain intact and accurate/factual information will flow
2. Power and transportation will be readily available
3. Personnel will be healthy enough and willing to report to work
4. Civil obedience will be maintained both in the community and at healthcare facilities
5. Patients will be able to be evacuated to neighboring facilities or regions.

In addition, these plans do not mention the fact that every-day emergencies will continue to come to hospitals expecting treatment.

Tuesday

If you want resiliency, stop doing this one thing.

When we place a term on an issue, that term becomes imprint in our mind. 

Terrorism and weapons of mass destruction (WMD) are terms arisen out of the September 11, 2001 attacks that have been imprinted on us. Although not entirely new terms for many in the traditional response group of emergency medical service (EMS), fire service, and law enforcement; terrorism and WMD became the language defining events of national crisis. Highly paid “experts” have become obligatory content in any number of trade journals and conferences. Emergency service organizations have received millions of grant dollars to purchase training/education, equipment, and supply all to be brought to defend against terrorism/WMD.

The sad  reality is that much of the training conducted has been lacking context to what is encountered and managed every day. There is little, if any, ability to apply theory or skills from terrorism training to the real world. We need to take the all-hazards approach to training and relate the material to the daily events that  paramedics, firefighters and healthcare providers deal with.  are just a few examples of the threats outside of the traditional terrorism training we've been given. 

 Doing so will keep the skills and knowledge fresh and usable. If we continue to wrap this material up and say “don’t open ‘till terrorist attack” we will not be able to access it efficiently or use it properly.  Lets make terrorism training part of the greater Civil Preparedness/Resiliency that includes naturally biologic events, chemical suicide and technological failure.

Civil preparedness is much more than readiness for an intentional event - its not about being a Doomsday Prepper, either. Its a way of identifying through analysis and assessment the hazards we're likely to encounter and the potential impact of those threats. We have to blend what we’ve come to know as terrorism/WMD training into the “basics” of public emergency service and healthcare response. To do so is simple because of the similarities between the intentional events and haz-mat accidents, mass casualty events, and natural disasters.

What do accidents, man-made events, and natural disasters (ice storms, hurricanes, earth quakes, floods) have in common?

Here's the short list of commonalities:
    From the web. I do not own this.
  • little or no warning
  • large numbers of civilians needing assistance
  • multiple casualties and fatalities
  • protracted operations
  • limited resources

The Civil Preparedness Mindset looks at preparing us for a multitude of potentials. Not everyone has to be ready for a blizzard or a wildland fire, but we should all be aware of the hazards we're likely to face based on our Hazard Vulnerability Assessment. We all need self-protection, working knowledge of the incident management system, triage and casualty/fatality management, for example.

The labels of terrorism and WMD may have been a great disservice to emergency responders, healthcare providers and citizens. Those terms imply an event that most people don’t believe will ever happen to them. There is much more to preparedness than terrorism.

Let’s try to change our thinking.
Updated/edited. Original 11/05

Podcast 237 Doomsday Preppers: More harm than good?

National Geographic series diminishes civil preparedness

Thinking about getting yourself prepared for an emergency situation?  How about your family? Are you planning for their needs during a crisis? What are your neighbors doing? Will you be able to work together as a community during crisis?

 Those are common question that most of us think about...now and then.

 There's a National Geographic program that takes common sense preparedness and gives it a shake; like a seizure. We're talking about the Doomsday Preppers and rather than promoting citizen preparedness, the program may just be making a mockery resiliency efforts and turning people away from the very actions that could save their lives.

According to the National Geographic/Doomsday Preppers website:
"Doomsday Preppers explores the lives of otherwise ordinary Americans who are preparing for the end of the world as we know it. Unique in their beliefs, motivations, and strategies, preppers will go to whatever lengths they can to make sure they are prepared for any of life’s uncertainties. And with our expert’s assessment, they will find out their chances of survival if their worst fears become a reality."
 Otherwise ordinary American? After viewing several Preppers episodes, I had to read that again! Did they say "otherwise ordinary"? I didn't think there was too  much "ordinary" going on here. And I'm not alone.

Todd Jasper (toddjasper.com) is a fellow Emergency Management Blogger who shares this opinion. Todd recently wrote a popular posting on this topic entitled Social Fear and Loathing & Treat to Legitimate Preparedness and this week he joins me on the podcast to discuss the good, the bad, and the ugly...and the impact of such a program on your preparedness efforts.



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