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Wednesday

NYC Explosion/Collapse - Terrorism, Gas Leak, or Souvenir Ordnance?

"Terrorism, Gas Leak, or Souvenir Ordnance?" was the first question asked when an explosion destroyed an apartment building in Harlem, New York City, 1992.

In 1992 a natural gas leak originating in an eleventh floor apartment caused an explosion that killed three and injured 34. Nineteen police officers and six firefighters were among the injured.

More than twenty years later, as the Vulcan Blizzard dominates media coverage, emergency management and traditional responders are asking that same question as five-alarms respond to a deadly explosion and building collapse in East Harlem.

The 1992 Harlem event was publicized in the U.S Fire Administration Technical Report Series (see Fire, Police, and EMS Coordination at Apartment Building Explosion). In an era before September 11 and before the National Incident Management System, the traditional responders of the City of New York are noted by this report to have effected a remarkable response to the situation.

According to the USFA report:
"The efforts of the three lead response agencies, fire, police, and emergency medical services (EMS), were coordinated within the structure of an Incident Command System (ICS). Integrated and coop- erative command, linked with the implementation of a Collapse Rescue Plan; prudent triage and effective use of available resources for medical treatment; and rapid perimeter control to prevent fur- ther injuries demonstrated that seemingly overwhelming emergencies can be managed by applying good standard operating procedures. The lessons learned/reinforced by each agency at this incident can serve as a model to assist other emergency responders in planning for similar situations."
 I encourage everyone to review this report from 1992 with special attention to the Lessons Learned and Reinforced. The recommendations made and findings of this report are as important today as they were back in 1992. Solid emergency management and response does not mean re-inventing tactics and policy. Rather, better to remember your experiences and build on them. 

Friday

The Week in Preparedness February 28, 2014

A brief of emergency preparedness from social media.





Tuesday

2013/2014 Flu Update #6


Update #6 for February 25, 2014

A long, slow march into the sunset 

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 2013/2014 Influenza season for week #7 for the period ending February 15, 2014.

In the News

CDC: Flu Vaccine 61% Effective
The CDC issued a report on February 20, 2014 claiming the current influenza vaccine to be sixty-one percent effective so far this season. The report notes those vaccinated have a lowered need to be seen by their doctor. CDC also notes that the 2014 influenza season has been, as in years past, particularly difficult for some age groups. We typically focus on extremes of age and those with comorbid conditions as being at risk for influenza related illness (ILI) or death. The trend over several years indicates hospitalizations and deaths attributed to ILI is growing in the "young and middle-age populations. The vaccination rate for these age groups has been estimated at 34%.

California Influenza ICU Admissions and Deaths
California is reporting the highest number of severe and fatal cases of seasonal influenza since the 2009 H1N1 pandemic, according to Morbidity and Mortality Weekly Report (MMWR). The report states that there have been 94 deaths and 311 ICU admissions due to flu from September, 2013 to January, 2014.

WHO: No Changes to Vaccine for 2014-2015 Flu Season
The World Health Organization (WHO) announced in a press release that it is keeping essentially the same vaccine profile for next year. The current vaccine is touted by CDC as being 61% effective and will keep the same influenza virus strains for next season. These strains include  - A/California/7/2009 (H1H1) pdm09, A/Texas/50/2012 (H3N2), and B/Massachusetts/2/2012 in the trivalent vaccine. 

Social Media

 Flu by the CDC numbers

According to the CDC Flu View site:
During week 7 (February 9-15, 2014), influenza activity decreased, but remained elevated in the United States.
  • Viral Surveillance: Of 6,887 specimens tested and reported during week 7 by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories, 958 (13.9%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: Two influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A season-cumulative rate of 26.1 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 2.5%, above the national baseline of 2.0%. Nine of 10 regions reported ILI at or above region-specific baseline levels. Seven states experienced moderate ILI activity; 16 states and New York City experienced low ILI activity; 27 states experienced minimal ILI activity, and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 17 states was reported as widespread; 22 states reported regional influenza activity; the District of Columbia, Guam, and nine states reported local influenza activity; Puerto Rico and two states reported sporadic influenza activity, and the U.S. Virgin Islands reported no influenza activity.

Timeline Comparison

Below are CDC FluView maps that compare ILI Activity between corresponding weeks of 2012/2013 influenza season against the 2013/2014 season. The 2014 week 4 CDC map demonstrates considerably lower level of activity as compared to 2012/2013 map at this time.

2013/2014 CDC Flu Interactive Map for week 7, 2014


2012/2013 CDC Flu Interactive Map for week 7, 2013


Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data. According to Google Flu Trends ILI activity has progressed from moderate to high  overall with plateaus noted in other areas.

Monday

2013/2014 Flu Update #5


Update #5 for February 3, 2014

ILI activity continues, progressing 

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 2013/2014 Influenza season for week #5 for the period ending January 25, 2014.

In the News

WHO issues A(H7N9) Global Alert and Response Update
January 31, 2014. The World Health Organization (WHO) issued a Global Alert and Response (GAR) Update based on reports from the National Health and Family Planning Commission of China and the Center for Health Protection (CHP) of China regarding six more cases of human infection with H7N9 avian influenza.

Numerous commonalities exist among the cases, according to the report.
All of the six cases are males. The age range is 2 to 63 years old. The cases are reported from Fujian (1), Guangdong (1), Hong Kong SAR (1), and Zhejiang (3). Four of the cases are currently in critical or serious condition. Four of the cases are reported to have had exposure to poultry or a live poultry market. Source: WHO/GAR
Follow up story from Center for Infectious Disease Research and Policy (CIDRAP)
"...new cases lift the number reported in the second wave to 137, topping the 136 cases reported during the first wave last spring." CIDRAP

Social Media

A nice approach by NBC#3 in Syracuse, NY. Key message: 
  • Not too  late to get flu vaccine
  • Have symptoms, call you doctor (that's call your doctor...NOT go to the ED)
  • If your sick, stay home...appropriate social distancing
  • Flu cases (in this area) are lower
And then there's this short, self-limiting flu going around:

Biologic event "serious" threat in London, 2012...not so much in Sochi, 2014

 Flu by the CDC numbers

According to the CDC Flu View site:
During week 4 (January 19 - 25, 2014), shows a high rate of influenza activity in the United States.
  • Viral Surveillance: Of 9,514 specimens tested and reported during week 4 by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories, 2,006 (21.1%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: Nine influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A season-cumulative rate of 20.3 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 3.3%, above the national baseline of 2.0%. All 10 regions reported ILI above region-specific baseline levels. Ten states experienced high ILI activity; 12 states and New York City experienced moderate ILI activity; 14 states experienced low ILI activity; 14 states experienced minimal ILI activity, and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 38 states was reported as widespread; 10 states reported regional influenza activity; the District of Columbia and one state reported local influenza activity; Guam, Puerto Rico, and one state reported sporadic influenza activity, and the U.S. Virgin Islands did not report.

Timeline Comparison

Below are CDC FluView maps that compare ILI Activity between corresponding weeks of 2012/2013 influenza season against the 2013/2014 season. The 2014 week 4 CDC map demonstrates considerably lower level of activity as compared to 2012/2013 map at this time.

2013/2014 CDC Flu Interactive Map for week 4, 2014

2012/2013 CDC Flu Interactive Map for week 4, 2013



Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data. According to Google Flu Trends ILI activity has progressed from moderate to high  overall with plateaus noted in other areas.

Tuesday

This Week in Preparedness 1.24.14

TWiP: Top trending preparedness topics of the week


Hospital preparedness for natural disasters has come into question more than ever since Hurricane Katrina. Despite preparedness efforts on the part of healthcare institutions they remain vulnerable to natural disasters because much of the preparedness and training that's going on in healthcare has failed to touch on the real issues.

Should you have to dial a"9" to get an outside line when you're staying in a hotel? That's the question being asked after a series of events highlighting the fact that you just can't pick up the phone in a hotel or some businesses and dial 911. The need to dial an extra digit to obtain an outside line has been questioned by many fire and emergency service personnel over the years. With modern technology that includes the ability to text message many 911 systems are adding enhanced features that allow them to receive emergency calls via text messaging. It seems intuitive that the need to dial a "9" to get an outside line has certainly outgrown its usefulness… if it ever served a purpose.

An article I wrote back in 2010 highlighting the details in planning that went into the failed Times Square bombing event has received a  fair amount of attention this week. This article highlights the fact that explosive events are real threat it's civilian soft targets in at those who would carry out such an event have the ability to plan and conduct surveillance on their intended targets.

Saturday

This Week in Preparedness

Topping the Twitter Feeder  - A week in review

We continue to expect that hospitals Will be prepared to handle anything that we bring to them. Unfortunately the level of preparedness for most hospitals and emergency departments in United States is lacking. If hospitals are truly part of critical infrastructure and emergency departments part of the initial response to disaster they must be prepared, protected, trained, and supported. In 2014 Will have to answer the question" hospitals: are they public-health for public safety?"

This was an interesting piece that caught my eye because it encouraged us to shelter in place in event of a nuclear blast. It was also interesting because the peace encouraged us to calculate how long or how far would take us to get to the next place of shelter from where we currently are. The interesting bias in the story was the assumption that you would know where to go for shelter, have an idea of how to get there, and what the road conditions and travel time would be like during times of crisis. Most interestingly you'd make these decisions after a new player detonation…
The story boasts about the precautions taken to prevent and Deter active shooter an explosive events that mass gatherings. High profile event such as the Olympics, The World Series, and the Super Bowl, have all undergone tremendous scrutiny for their security efforts. But when it comes to truly being prepared training for explosive events and active shooters is child's play compared to planning and preventing a biologic event.

Monday

2013/2014 Flu Update #4


Update #4 for January 13, 2014

ILI activity continues, increased in some areas plateaus in others

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 2013/2014 Influenza season for week #1for the period ending January 4, 2014.

In the News

CIDRAP is reporting on the first Canadian death from H5N1. Death of an Alberta resident with travel history to Beijing is the first fatal case of H5N1 in North America.
PhillyDOTcom: bioterror limits efforts needed to fight viruses. 

Rochester media beginning to notice flu season

According to the CDC Flu View site:
During week 1 (December 29, 2013-January 4, 2014), shows continued increase of influenza activity in the United States.
  • Viral Surveillance: Of 9,482 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 1, 2,486 (26.2%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: Four influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 9.7 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 4.4%, above the national baseline of 2.0%. All 10 regions reported ILI above region-specific baseline levels. Twenty states experienced high ILI activity; seven states and New York City experienced moderate ILI activity; 11 states experienced low ILI activity; 12 states experienced minimal ILI activity, and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: : The geographic spread of influenza in 35 states was reported as widespread; 12 states and Guam reported regional influenza activity; the District of Columbia, Puerto Rico, and two states reported local influenza activity; and one state reported sporadic influenza activity, and the U.S. Virgin Islands did not report.
Timeline Comparison
Below are CDC FluView maps that compare the prior two reporting periods against the corresponding weeks of 2012/2013 influenza season. The 2014 week 1 CDC map demonstrates a clustered geographical impact of High ILI activity compared to 2012/2013 map at this time.

2013/2014 CDC Flu Interactive Map for week 1, 2014


2012/2013 CDC Flu Interactive Map for week 1, 2013


Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data. According to Google Flu Trends ILI activity has progressed from moderate to high  overall with plateaus noted in other areas.

Top MJ Podcasts of 2013 + One More

2013 Top of the Charts includes a podcast from 2012!











Friday

Top MJ Reads of 2013

MJ readers select Top Blog Topics of 2013

Mitigation Journal blog readers have voted and the results are in on the top topics of 2013. The top 3 blog pieces were selected based on site statistics, number of article views, and reader interaction, we've come up with our best articles of 2013.

#3 From May, 2013. Biological effects of radiation are dependent upon the type of exposure a person has with the duration of the exposure and intensity of the material playing a key role. We also have to include the role of personal protection such as time, distance and shielding. In this piece, we discussed, Hematopoietic Syndrome, Gastrointestinal syndrome, Cardiovascular syndrome, and central nervous system syndrome


#2 JAMA Flu Myth Busters appeared on MJ in March, 2013 creating substantial debate on social media about the flu vaccine. We also enjoyed an unprecedented volume of email conversations behind the scenes. The big vaccine debate was at the heart of most of our conversations. We also noted a substantial increase in request for biologic planning, plan writing and plan review. Our most popular live talk during this period (Understanding Flu and Biological Events) was presented seven times in and around New York. Fueling the fire on this topic was the political climate surrounding flu related public health emergencies, mandated vaccination for health care workers, and an intense flu season.
 #1 Our top rated posting comes from January, 2013. No Shelter for You was a unique post because it tied together the Tenent Health Care ruling with subtle emergency management changes that were brought to our attention by MJ readers. We had the good fortune of first-hand reporting by Michael Ehrman, a retired emergency manager and long time MJ follower.  Mr. Ehrman continued his reporting on the changes in shelters by joining us on the podcast as well.