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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 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...


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.

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


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.


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 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. 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.


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.”


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.