Yes, but what if it DID happen here?

Yes, but what if it DID happen here? For years I've based training and teaching on this simple question. The idea has always been to overcome complacency and Optimism Bias. When we think "...it can't happen here" or that it "won't be as bad as they say it will be". Were 'IT' becomes the last or worst crisis we've encountered and we don't believe 'IT' could ever happen again...we're victim to Optimism Bias. The challenge is to not only believe that we're vulnerable but also to acknowledge the need for pre-incident planning and training.

With that, there are still a large number who believe that it can't happen here. And until recently, this issue has seen limited attention from mainstream media. Until recently. The earthquake in Haiti and results of relief efforts have spurred an uptick in the number of those asking "what if it DID happen here"? In my opinion this is an important indicator of change. Perhaps swinging our preparedness pendulum back to center from way over on the terrorism end of the scale.

A snapshot of this is illustrated by numerous articles and one such example can be read in Newsvine and coming from MSNBC.com. So, lets take a look at a few quotes from that article and relate comment:

"The White House and the Capitol have been destroyed. Congress and critical government agencies overseeing finance, health and other domestic services have been critically impaired. Many of the government employees who used to work in those offices are dead."

This is an important point and underscores the need for local government self-sufficiency. States will be in competition for  Federal resources. Those resources will have to be triaged...if they would be available at all...States, cities, towns, communities, and individual families will be on their own. Probably for months.

"The U.S. Interstate highway system has been destroyed (there never was one in Haiti), and travel by road is arduous."

The ability to get aid into the areas effected may not be possible. Travel in and around those areas may not be possible. Refugees may not be able to get out. Local responders will not be able to provide relief.

"There is no FEMA. The well-financed network of local “first responders” that Americans take for granted is gone. "

Well, no FEMA might not be a big deal. Loss of the first responder networks...another story. 

"The entire air traffic control system has been destroyed. "

Air travel may be the only way to bring relief materials to states in need or provide evacuation...and in the scope of impact seen in Haiti...where would you evac to?

"The infrastructure to handle marine cargo has been destroyed at the major seaports — New York, Los Angeles, Houston."

OK, we won't get supplies that way either.

"As much as one third of the population (in the U.S., roughly 100 million people) are without food, water or shelter and limited means of acquiring it."

Knowing that a majority of Americans do not have supplies of food or water on hand and that there will be no supermarket to run to magnifies this problem. The loss of water and sanitation will exponentially compound this problem. And no shelter? The lack of Civil Defence style preparedness will force entire communities into the elements. The ripple effect will be huge.

"Millions of survivors are in need of urgent medical attention; many simply won’t receive it — even if relief efforts proceed flawlessly. Most local hospitals have been destroyed. The ones that remain have no supplies. Doctors have resorted to using hacksaws and vodka in place of surgical instruments and alcohol."

When will it be it be time to change from a standard of care to a sufficiency of care? How will we make triage decisions? Who will get care and who will not? Forget surge capacity...no hospitals. Everyone should take a First-Aid class.

Two Chemical Events, Two Deaths. Many Lessons

Two recent chemical events have claimed two lives and provided some valuable lessons to be learned or reinforced. First, an man in his 30's died hours after ingesting some type of hazardous substance. As if that is not bad enough...twenty-four people at the clinic where he had gone for treatment were either deconed or quarantined.  Buest guess at this point is that the man ingested selenomthionine in the industrial environment he worked in. It is not known if the ingestion was an accident or not. The article interchanges ingestion and inhalation...we know the route of absorption is important...but is unclear in the new article.  The victim came home from work, changed clothes, and went to an InstaCare clinic (walk-in health care/urgent care). As a result, the clinic was shut down for twenty-four hours with eight people undergoing decontamination on site...none complained of illness. In this case decon seems to have been more pro-active.

In another, unrelated event, a fire department in Iowa responded to a "person not breathing" call at Mercy Medical Center to find that what seemed to be a routine event was actually a hazardous materials event. Sodium Hydroxide...a laundry additive...was leaking. Responders began working on the victim then noticed the leak. Four other civilians who were in the area and several firefighters were evaluated in the emergency department as a result. It is not clear if the leak caused the victims death.

Lessons Learned and Reinforced:

1. Response to medical facilities, including walk-in or urgent care centers, can not be taken lightly or considered to be routine. The additional hazards associated with these locations have to be considered in preincident planning and responders must size-up with a high level of suspicion. 
2. The need for decon may exist wherever people go for help. Many emergency departments have some form of decontamination equipment or facility...few, if any walk-in care/urgent care centers have decon equipment or the trained people to carry out the activity. Expect this type of situation to occur more frequently. 
3. Understand the logistics behind the confinement or "quarantine" of otherwise well civilians...those who do not have any symptoms, yet give you reason to believe they may have exposure. This group to can be difficult to manage as compared to those who actually have symptoms.

Cyanide Suicide

I've been using the term "consumer-level" hazardous materials events to describe everything from mixing household cleaning products to creating hydrogen sulfide and homemade chemical bombs. Noting that these situations are developed out of ordinary, off the products...the kind you find in almost any store...to raise awareness to the severity and potential impact to responders.

A recent story from the Kansas City Star underscores what I've been talking about for years. A man decided to kill himself in his car by opening canisters of cyanide. No warning signs on the windows this time. Responders open the door...instant exposure.

For more on cyanide, check out prior Mitigation Journal Blog posting and be sure to tune in to Mitigation Journal Podcast (edition #143 for 1/3/2010) for the latest on this topic.