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Friday

Nurse Triage Line Project: Improving Service and Information During a Pandemic

Nurse Triage Lines provide information and reduce surge

Biologic and naturally occurring pandemic events share several commonalities. Whatever the cause of a large biologic event, like any other disaster, people need to know what to do and when to do it. In the case of a pandemic or similar biologic event, we also have to consider how we will manage getting appropriate medication to those who are sick. And no conversation on this topic would be complete without mention of surge capacity; a time when healthcare systems are overwhelmed with the flood of patients presenting with illness from the biologic or pandemic event.

Managing these situations and the many complexities within them requires a strong biologic event plan. There are numerous issues to consider when writing your biologic plan and it may seem like an impossible task. There are pitfalls to avoid in planning and you should consider having your plans reviewed to see if they include what every good plan should.  The bottom line: it all starts with information.

Getting information to the public and having them act on that information is key to successful operations during a pandemic event. Information is vital to getting people to the most appropriate level of care, medication, and in some cases, prophylaxis. The Nurse Triage Line (NTL) Project tackles these issues and more. The NTL Project goals inlcude:
  • Improving access to medications for the sick
  • Providing accurate and actionable information to the public
  • Promoting appropriate alternatives to medical care (to reduce surge)
Read the preliminary report on the role of NTL during 2009 H1N1 event here.

The public needs information they can rely on and take action on. The public needs to have access to this information in a timely manner, in a means that can be understood, and delivered by a medium that can be accessed. Key information points during a pandemic are when and where to seek medical care. Emergency departments, points of distribution (POD) sites, and clinics can quickly be overwhelmed by the surge of patients looking for information as well as those who are ill. The worried well or those looking for "what should I do" information clog the system and cause delays in seeing a medical provider and receiving medications.
From: Background, Purpose and Description of CDC NTL Project

The NTL Project seeks to mitigate these situations by building on existing systems such as 2-1-1 lines and Poison Control Centers (PCC). By implementing a NTL system into a PCC or other existing system, a caller could be triaged based on (a) need for information or (b) symptoms or need for care. The call would be screened based on need an then forwarded for medical advice, given information of where to seek face-to-face care, manage at home, or where to receive prophylaxis or antiviral care.

The systems of a NTL Project are considered for use only during a severe biologic event or pandemic. They mus also be able to meet the needs of at-risk populations including uninsured or underinsured. The benefits of NTL's are clear; improved access to medications, direction of appropriated people to face-to-face care (minimizing surge), and providing accurate and actionable information.

Wednesday

EMS NOW: Understanding the Trainee

EMS NOW - a weekly highlight of emergency medical services

EMS NOW: Understanding the Trainee
By Matt Comer, EMTP
 "...we have probably all been intimidated by one thing or another in the world of EMS..."
 We have all been trainees at one time or another in our EMS careers. We know firsthand the difficulties and hardships of having to be the new guy / girl. Everything is new and simply completing a rig check is a task requiring concentration. Likewise, we have probably all been intimidated by one thing or another in the world of EMS. Maybe it was learning CPR, suctioning an airway for the first time, or maybe it was just talking to a stranger about their medical history. As field training officers or FTOs and clinical educators we must be able to remember what it was like to be in that stage of our EMS career if we wish to be successful in training. We must be able to meet the trainee where they are in their EMS career in order to facilitate successful training. Identifying with the trainee and realizing they are not a veteran EMT like ourselves; is the first step in becoming a great FTO.

The next step is to understand how the trainee will learn so that we can teach them appropriately.  Learning styles have been well studied in many areas of instruction including EMS. There are three domains of learning: Cognitive, Affective, and Psychomotor. Over the next few months we will post articles that focus on understanding and applying teaching styles which encompass all three domains. So let me quickly define the three domains individually.

Cognitive
Involves knowledge and the development of intellectual skills. Includes the recognition of specific facts, patterns and concepts.
Affective
the manner in which we deal with things emotionally, such as feelings, values, appreciation, enthusiasms, motivations, and attitudes.
Psychomotor
physical movement, coordination, and use of the motor-skill areas. Development of these skills re-quires practice and is measured in terms of speed, precision, distance, procedures, or techniques in execution.
(Definitions according to Bloom)

Tuesday

MJ 248: Boston Marathon Bombing: First Thoughts



Mitigation Journal - the All Hazards Podcast #248

Visit www.mitigationjournal.org click the "voicemail" tab and leave us your comments.

Boston Marathon Bombing - Mitigation Journal first thoughts

This edition of Mitigation Journal Podcast was recorded on April 16, 2013. Due to technical issues the publication was delayed.

In this MJ Podcast we discuss our reaction to the Boston Marathon bombing. We outline the differences between hard and soft targets and implications of See Something, Say Something. Also included is information on situational awareness, incident indicators and a few explosive event tips.

Check out this episode!

Friday

Biologic Effects of Radiation

Radiation Exposure Phases and Syndromes

The biological effects of radiation are dependent upon the type of exposure a person actually has. Duration of the exposure as well as the intensity of the material play a role. Factors of personal protection such as time, distance, and shielding need to be included.

Biologic effects can be categorized generically as acute or chronic. Acute exposure may be for a very short period of time to a higher level radiation source while chronic exposure can either be in extended exposure to low-level source or repetitive exposures to a variety of sources of radiation.

 Individual biological differences must be considered. Each person is different and will respond differently to radiation exposure.  Extremely high-level radiation exposure is an exception.

In general, radiation causes three major problems in our bodies.
  • Radiation can damage DNA and other cellular structures
  • Radiation exposure results in cell death immediately or shortly after exposure
  • Radiation exposure results in incorrect cellular repair and mutations that can cause cancer and other disease
The effects of radiation on each person differs in their biologic response to any given dose of radiation. The factors that influence radiological impact on the body include:
  • age- Younger patients and those with a higher metabolism and cell turnover rate are more susceptible.
  • sex
  • diet
  • body temperature and overall health
Acute radiation sickness can occur when an individual is exposed to a large amount of radiation in a short period of time (acute exposure). This level of exposure may be defined that radiation doses greater than 100 REM which is equivalent to 100 RAD for gamma ray exposure. The signs and symptoms of acute radiation sickness vary by the dose received and by the unique biologic factors of each individual. Symptoms can be as subtle as “flu-like” symptoms or as dramatic as rapid changes in blood cells. In general acute radiation sickness generates the following:
  • nonspecific (flu-like symptoms)
  • hair loss
  • fever
  • skin irritation
  • vascular changes
  • blood cell changes
While the initial symptoms may seem minor such as with G.I. upset, the sooner a person vomits or loses consciousness after cute exposure indicates severe exposure. Severity and course of treatment depend on how much total doses been received as well as how much of the body has been exposed taking into account individual susceptibility as a variable. Acute radiation sickness is not an all-or-nothing situation. The symptoms may appear shortly after exposure only to disappear after a few days. Symptoms may also reappear in a much more severe illness later on.

Acute radiation sickness has four phases and may manifest with four separate syndromes.
The four phases of acute radiation sickness are:
  • prodromal phase
  • latent phase
  • manifest phase (sometimes called the period of illness)
  • and recovery or death
The four syndromes of acute radiation sickness  are:
  • Hematopoietic Syndrome
  • gastrointestinal syndrome
  • cardiovascular syndrome
  • and central nervous system syndrome

Wednesday

EMS NOW: Clinical Education Strategies for Success

EMS NOW - a weekly highlight of emergency medical services

EMS NOW: Clinical Education Strategies for Success
By Matt Comer, EMTP

"...in order for the trainee to learn they must have timely positive and negative constructive feedback..."
The clinical educator faces many challenges day to day.  Let’s take a look at some of the big ones and some strategies for successful outcomes.  First and most obvious principle is that you must be able to teach during non protected clinical time.  Most of the time when you think of an educator you think of a classroom right?  Teaching during clinical time requires you to balance teaching with being the clinician who is responsible for your patient.  Effective clinical teaching also requires that the trainee have patient contact and make or be involved in making actual patient care decisions.  In addition, in order for the trainee to learn they must have timely positive and negative constructive feedback.  As we all know this may be challenging when the pagers are beeping and dispatch is calling.  Being an effective clinical educator can be a daunting task.  In order to succeed as clinical educators we must take a strategic approach.  Below are some effective and proven strategies for being an effective clinical educator.

  • Orientation:  You must orient the trainee to the process in which the shift / call will flow.  The trainee must know where they fit in to the process.  This will give them the freedom to learn without being worried about the logistics of the shift / call.
  • Expectations:  You must set clear expectations for the shift / call.  Expectations allow the trainee to know how they will be evaluated.   Expectations should be discussed at the beginning of the shift in order to set the tone and create a positive learning environment.  
  • Feedback:  Both positive reinforcement of correct behavior / skills & constructive feedback correcting incorrect / inappropriate behavior / skills.  Feedback should be given as soon as possible and be as specific as possible.  
  • Demonstration:  You must role model and even demonstrate the desired outcome.  Whether it be patient rapport / communication or the skill of immobilizing a patient you must show the trainee the correct / appropriate way.  Role modeling gives the trainee a clear picture of what they should do, how they should act, and what cleared EMT / Paramedic / Nurse looks like.
     

Friday

Radiation Basics Demystified

Making Sense of Radiation

The threat or potential of harmful radiation can be expected from a variety of sources.
  • Nuclear weapon
  • Nuclear power plan accidents
  • Transportation and waste storage accidents
  • Military accidents
  • Vandalism
  • Terrorism

Rules for Radiosensitivity...made easy

“The sensitivity of cells to irradiation is in direct proportion to their reproductive activity and inversely proportional to their degree of differentiation.”                                          (Bergonie and Trubondeau)
What this means is:
  • The faster turnover rate (reproduction rate) a cell has the greater radiation exposure will effect it.
  • Unborn children and young children are affected more.
  • Effects can be terotgenic or mutagenic
Dose Rate Effects

From: REMM
Dose RATE is a significant factor. As the dose rate is decreased and the exposure time is increased, the biological effect for a given dose is decreased.

What this means is:

At lower dose rates more subleathal damage to the cell can repair and cell populations have time to reproduce and repopulate.




Units of radioactivity measurements

The three units of activity that are of concern to patient care are:
  • Units of activity.
  • Units of radiation dose or deposited energy
  • Units of biological dose equivalent.
  • Units of activity
From: REMM
Radioactive materials are classified by activity or rate of decay. Knowing radiation unit conversion is also helpful. The units of radioactive decay are:
  • The Becquerel (Bq) or disintegrations per second:
    • 1Bq = 1 disintegration per second
  • The Curie (Ci)
    • 1 Ci = 3.7 x 1010 Bq

Units of radiation dose

Units of radiation that is absorbed by the body is the dose.  The units of absorbed dose are:
  • The radiation absorbed dose (rad)
    • 1 rad = 0.01 Gy
    • 1 Gray (Gy) = 100 rad

Wednesday

EMS NOW: Future of EMS

EMS NOW - a weekly highlight of emergency medical services

EMS NOW: The Future of EMS
By Matt Comer, EMTP

"... if we hope to have a cutting edge provider as the future of EMS we need cutting edge clinical educators now..."
How does your agency/department select, train, and maintain its field training officers (FTOs)?  If your agency is anything like the ones I have worked for over the years, the process probably goes something like; “Hey you’re a good EMT or Paramedic , you’re going to be an FTO.”  FTOs are typically then sent out with little to no direction or continued education.  Unfortunately, this has been the model for FTO programs throughout EMS over the years.  In order to produce better EMTs and paramedics in the future we have to shift our model to view FTOs as educators.

As mentioned, typically the selection process for choosing FTOs has been picking our best    EMTs / Paramedics.  This selection process is based on the quality of the provider’s clinical care and perhaps whether or not they are a friendly person.  The selection process often does not take into account the future FTOs teaching style, personality type, or perhaps most importantly their passion to teach.  As EMS leaders looking to further our profession we must create a more comprehensive FTO selection process.  EMS leaders should place a strong emphasis on a provider’s passion to teach and become a FTO.  The future FTO will have to balance being a solid provider, a constant learner, as well as a passionate and skilled clinical educator.  The future FTO will become more than a trainer, they must become educators.

What is an educator?  According to Merriam-Webster it is:  one trained in teaching, a specialist in the theory and practice of education. “One trained in teaching”, that assumes some type of training specific to the science / art of teaching.  Rarely do FTOs receive any training on how to teach and may not ever receive any such training.  EMS training departments must develop and implement a comprehensive FTO training program in which the EMT/Paramedic can make the transition from clinician to clinical educator.  Our future FTOs are already experts in their field we must make them specialists in the theory and practice of education.  An additional challenge faces the FTO and that is being an effective clinical educator.  Over and above being an educator the clinical educator must teach their students in the clinical environment which offers many challenges.  The primary challenge we must prepare the new FTO for is how to balance appropriately treating their patients while allowing for a rich learning environment for the student.

So what does this new FTO program look like?  It begins with recruiting, seeking out, and selecting solid providers who are passionate about teaching.  Providers must be solid in their own practice as much of the additional training they receive will be on the theory and practice of clinical education.  The provider should be passionate about teaching as they now have to commit much of their time to teaching, guiding and mentoring students.  An FTO program must now offer initial and ongoing training on how to become and improve as a clinical instructor.  The program must place a strong emphasis on the education of the FTOs.  FTOs should be offered consistent and regular educational opportunities which give them a greater knowledge base not only as providers, but as educators.

The logic is fairly simple; if we hope to have a cutting edge provider as the future of EMS we need cutting edge clinical educators now. 

Monday

2012/2013 Flu Update #14


Update #14 for the week ending April 6, 2013

Influenza B Dominates Declining Flu Season

Publication Notice: Update #14 will be the final seasonal Flu Update for the 2013/2014 flu season. Weekly updates will continue under the post title of Biologic Update and will include information on Dengue, novel Avian Influenza, novel Corona Virus, seasonal flu and other emerging diseases. Specific Flu Updates will return with for the 2013/2014 flu season in the United States.

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2012/2013 Influenza season week 13 for the period ending March 30, 2013. In this reporting period (March 24-30, 2013) pockets of influenza persist throughout the United States with Influenza B accounting for 75% (up from 72% in previous report) of all influenza cases.

The number of hospitalizations reported this period was 42.3 per 100,000 and up slightly from last weeks number of  41.8  per 100,000  population. Those greater than 65 years of age account for 50% of those hospitalized. Influenza and pneumonia related deaths are now reported to be below the epidemic threshold.

 All 50 states report low or minimal ILI activity. No regions report high or moderate activity.  

Viral surveillance results for week 13, 2013 showed 11.3% of 4,909 samples (down from 13.2% of 702 samples last week) testing positive for influenza. Influenza A accounted for 25.2% (down from 26.5%) of results with 2009 H1N1 11.4%, H3 25.7%, and Influenza B 74.8% (up from 73.5%) of circulating flu.

Outpatient ILI surveillance (those seen at clinics and doctors offices for ILI complaints) remains at 1.8% and is below the national base line of 2.2%.

Antiviral resistance is a non-issue at this point. None of the circulating strains (H1N1, H3N2 or Influenza B) are resistant to Oseltamivir or Zanamivir.



CDC Flu Interactive Map

Influenza-like Illness, ILI, activity indicator map application screenshot.
Click for Week 13 interactive map from CDC



Google Flu Trends

Friday

Where has our little SARS gone?

A decade later is SARS ready to come home?


2003: Severe Acute Respiratory Syndrome (SARS) rips around the globe causing serious illness and death. In many ways, we’re still dealing with the preparedness aftermath of the SARS situation as we struggle to maintain some level of sustainable preparedness for biological events.

SARS was contained in the summer of 2003 after it mysteriously vanished from the environment. Few cases of SARS-like infections were seen in late 2003/early 2004, but it seems that SARS, in an uncharacteristic move for a virus, had died off. Or did it?

According to an article in Canada.com, we can’t be sure SARS wont come back despite evidence that the previous novel corona virus that causes SARS is indeed dead.

The reason, according the those quoted in the Canada.com article, is that animals can still transmit a SARS-type virus to humans. The Civet has been long believed to be the vector between bats and humans, allowing SARS to make the leap between species.

According to the Canada.com article:

“While the precise sequence of events that resulted in the 2003 SARS virus can never be traced, it's clear that the factors that led to its emergence still exist. Bats still carry SARS-like viruses. Small carnivores still eat dead bats. People in some parts of the world still trap small carnivores and sell them as food in markets crowded with other mammals...”

Meanwhile, Saudi Arabia has confirmed cases of infection with a novel corona virus (nCoV) according a World Health Organization (WHO) update. Of the 15 reported cases of infection with this nCoV, 9 of those have died.

World Health Organization defines cases of nCoV infection as confirmed or probable. Confirmed cases are those with laboratory confirmation of infection. According to the WHO Revised Interim Case Definition nCoV, a probable case is defined as:
"A person with an acute respiratory infection with clinical, radiological, or histopathological evidence of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress Syndrome, (ARDS); AND no possibility of laboratory confirmation for novel corona virus either because the patient or samples are not available for testing; AND close contact with a laboratory-confirmed case."

Close contact is defined by WHO as:
"...anyone who provided care for the patient, including a health care worker or family member, or who had other similarly close physical contact;
anyone who stayed at the same place (e.g. lived with, visited) as a probable or confirmed case while the case was symptomatic."


Are we seeing the start of SARS, the next generation? If so, planning for biologic events is more important than ever.

Thursday

National Public Health Week: Protecting You While Your're on the Move

Public Health: Something to Take With You

The theme for NPHW 2013 is "Public Health is ROI: Save Lives, Save Money...the focus of day four  is Protecting You While You're on the Move




According to the NPHW 2013 site: 
"Public health is in every corner of our homes. It's in the safe food in the fridge, the carbon monoxide and smoke detectors affixed to the ceiling, and the child-proof latches that keep dangerous chemicals out of little hands. Home is also where we learn healthy behaviors, such as eating right and exercising. Good prevention starts at home."

Public health is also something we should take with us. According to the NPHW Protecting You While You're on the Move page:
"...the simple act of using a seat belt may be one of the most recognizable public health victories: From 1981 to 2010, seat belt use rose from 11 percent to about 85 percent, saving hundreds of thousands of lives..."
Protecting You While You're on the Move points out that public health efforts have helped reduce deaths related to automobile accidents. NPHW states that more than half of drivers and passengers killed in car crashes in 2009 were not wearing restraints. In 2010, more than 4,200 pedestrians died in traffic crashes and more than 600 bicyclists died in collisions with vehicles in 2010 and 52,000 were injured.

As a sign of the times, motor vehicle crashes kill 15 people every day. 1200 are injured in crashes caused by distracted driving.

For more information and to get involved with National Public Health Week, go to www.NPHW.org and come back to Mitigation Journal coverage of NPHW for synopsis and additional information. 

Wednesday

National Public Health Week: Creating a Healthy Workplace

NPHW2013: Creating a Healthy Workplace

 

National Public Health Week (NPHW) has been bringing communities together since 1995 to address critical issues in public health. April 1-7, 2013, has been designated for this years events and will highlight two major ares of importance: public health and prevention.

NPHW 2013  encourages us to show support for public health by taking one small step each day for a healthier life and by joining with your community to celebrate NPHW. 

The theme for NPHW 2013 is "Public Health is ROI: Save Lives, Save Money...and today we join NPHW for Day Three with the theme: Creating a Healthy Workplace.

Todays NPHW theme reminds us that:
"Thanks to workers' rights and public health movements, workplaces have become dramatically safer places during the last century: According to the National Safety Council, deaths from unintentional work injuries declined 90 percent from 1933 to 1997. However, workers still get hurt and injured on the job and oftentimes such injuries — and deaths — are completely preventable. No one should have to unnecessarily risk his or her life or health to make a living."                -from NPHW Creating a Healthy Workplace

NPW Creating a Healthy Workplace encourages us to Start small and Think big by taking simple steps like:
  • Understand and follow all workplace safety regulations and best practices.
  • Educate employees about workplace safety regulations  
  • Create a work environment in which workers feel comfortable reporting unsafe work conditions or workplace abuse.
For more information and to get involved with National Public Health Week, go to www.NPHW.org and come back to Mitigation Journal coverage of NPHW for synopsis and additional information.

Tuesday

National Public Health Week: Safe at School

NPHW2013: Providing a Safe Environment for Children at School

 

National Public Health Week (NPHW) has been bringing communities together since 1995 to address critical issues in public health. April 1-7, 2013, has been designated for this years events and will highlight two major ares of importance: public health and prevention.

NPHW 2013  encourages us to show support for public health by taking one small step each day for a healthier life and by joining with your community to celebrate NPHW. 

The theme for NPHW 2013 is "Public Health is ROI: Save Lives, Save Money...and today we join NPHW for Day Two with the theme: Providing a Safe Environment for Children at School.

Todays NPHW theme reminds us of the many issues that impact grades, attendance, behavior, and graduation. Education can be tracked as an influence over health throughout ones lifespan.

According to the NPW  Providing a Safe Environment for Children at School page obesity prevalence among children and teens has nearly tripled since 1980 with 17 percent, or 12.5 million, of children and teens ages 2 to 19 are obese. We know that obesity is linked with early onset of diabetes, heart disease and metabolic syndrome.

NPW Providing a Safe Environment for Children at School encourages us to Start small and Think big by taking simple steps like being vocal in support of physical education in school, advocating for smoke and tobacco free environments at school and involving your community in recognizing bullying and developing community-wide responses to bullying.

For more information and to get involved with National Public Health Week, go to www.NPHW.org and come back to Mitigation Journal coverage of NPHW for synopsis and additional information.

Monday

2012/2013 Flu Update #13


Update #13 for the week ending March 23, 2013

Influenza B Dominates Declining Flu Season

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2012/2013 Influenza season week 12 for the period ending March 23, 2013. In this reporting period (March 17-23, 2013) influenza continues a lingering goodbye as the season begins to change.

Accounting for 72% of all influenza cases reported during this period, influenza B virus is now the most prevalent strain according to the CDC.

The number of hospitalizations reported this period was 41.8 and up slightly from last weeks number of  40.6  per 100,000  population. Those greater than 65 years of age account for 50% of those hospitalized. Influenza and pneumonia related deaths are now reported to be at the epidemic threshold.

 Michigan is the only state to report high ILI activity (down from nine states in previous report) with five other states reporting moderate activity. Six states and NYC report low ILI activity while thirty-eight states now report minimal activity. 

Viral surveillance results for week 13, 2013 showed 13.2% of 702 samples samples testing positive for influenza as compared to last week when 16.3% of 5,526 samples were positive. Influenza A accounted for 26.5% of results with 2009 H1N1 5.9%, H3 32.8%, and Influenza B 73.5% of circulating flu.

Outpatient ILI surveillance (those seen at clinics and doctors offices for ILI complaints) remains at  the national base line of 2.2% for the second week in a row. The CDC adds:
Three of 10 regions reported ILI at or above region-specific baseline levels. One state experienced moderate activity; 3 states and New York City experienced low activity; 46 states experienced minimal activity, and the District of Columbia had insufficient data.
Antiviral resistance is a non-issue at this point. None of the circulating strains (H1N1, H3N2 or Influenza B) are resistant to Oseltamivir or Zanamivir.

National Public Health Week Day One

Ensuring a Safe, Healthy Home for Your Family kicks off NPH Week

National Public Health Week (NPHW) has been bringing communities together since 1995 to address critical issues in public health. April 1-7, 2013, has been designated for this years events and will highlight two major ares of importance: public health and prevention.

The NPHW 2013 program encourages us to show support for public health by taking one small step each day for a healthier life and by joining with your community to celebrate NPHW. 

The theme for NPHW 2013 is "Public Health is ROI: Save Lives, Save Money...and we're starting at Ensuring a Safe, Healthy Home for Your Family; addressing how to make health and prevention a fun family tradition.
home.

According to the NPHW 2013 site: 
"Public health is in every corner of our homes. It's in the safe food in the fridge, the carbon monoxide and smoke detectors affixed to the ceiling, and the child-proof latches that keep dangerous chemicals out of little hands. Home is also where we learn healthy behaviors, such as eating right and exercising. Good prevention starts at home."
Its common sense and good advice, too. Mitigation Journal remains a strong proponent of individual and family preparedness and safety. Simply maintaining your smoke detectors or learning CPR and first aid will help you be better prepared for any crisis. When individuals and families are prepared, communities are more resilient...and emergency response crews are better able to help.

To support NPHW 2013, Mitigation Journal will highlight each of the daily themes listed below.
  • Monday, April 1: Ensuring a Safe, Healthy Home for Your Family: Health and safety begin at home. Make prevention a fun family tradition.
  • Tuesday, April 2: Providing a Safe Environment for Children at School: Schools are the perfect setting for improving child health. Plus, children's health is a rallying point few can ignore.
  • Wednesday, April 3: Creating a Healthy Workplace: Wellness and safety in the workplace are good for health and for business. Let's make prevention work for us.
  • Thursday, April 4: Protecting You While You're on the Move: Safety on the go is often in our own hands, but it's also tied to community design. Together, we can turn our streets into roads to better health.
  • Friday, April 5: Empowering a Healthy Community: Support public health efforts that create healthy opportunities for all. Good health is a community affair.