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Wednesday

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.