Sometimes what you read scares the crap out of you.

Sometimes you should believe what you read. Sometimes what you read scares the crap out of you.

I published a blog post way back in August, 2006, entitled Homemade Chemical Bombs: A Legitimate Threat to Responders. I've gotten numerous notes of praise for writing and talking (on the podcast) about chemical bombs. The topic has evolved into one of my most requested talks; Consumer-Level HazMat Events.

I recently received this anonymous comment in reply to Homemade Chemical Bombs: A Legitimate Threat to Responders that I think you should read. Below is the text of that comment. Tune in to Mitigation Journal Podcast to hear more discussion on this.

"This article is obviously biased against homemade explosive devices! People view the explosives with suspicion and fear, but the truth is that they are actually much less of a threat than guns. Why is it that it is acceptable to have "fun" with guns at a target range or rural area, but anyone making an explosive device is assumed to be up to no good.
Do not condemn what you are not knowledgeable about! Most of the "chemical" bombs described in the article, despite having the potential for substancial injury, and not really extremely dangerous, and are certainly NOT capable of blasting a hole in anything. As for fire danger, a bottle of gasoline is much more dangerous than any of the "explosives" in the article.
Terrorists are very ignorant about explosives. The only thing they have been able to make so far (that is small enough to be carried by an individual) are organic peroxides.

The police and fire departments overreact when dealing with a potential bomb threat. Much time and money gets wasted in treating dry ice bombs as if they were some chemical warfare timebomb.

When someone finds a stick of dynamite or plastic explosives, do they really need to call the bomb squad? Is it not a wast of time for police cars and a team of explosives experts to show up to deal with something that could probably just be dropped off at a hazardous material dumpsite? This all is no different than children getting expelled from their school when a teacher finds a knife that the mother packed in the childs lunch to slice an apple. Overreaction, ignorance, unwarranted fear.
Supposed bomb scares make headlines on states that are on the other side of the country, but what about the FREQUENT drive by shootings that happen in inner city school districts in many parts of the country. We never hear about those."

Fire Safety and Seniors.

Fire Safety and Seniors.

This is a short video put together by our local EMS system on the topic of fire safety and seniors - awareness for EMS. The URMC actually secured a grant. Of course, being a big medical center, they get the grants to do their podcasting...I have to have a baked food sale to keep Mitigation Journal going. (sarcasm)

I remember recording this well over a year ago, but never knew the completed it until today. The info is good and worth the time to view. Just remember, this video was done prior to my retirement...that means no beard and about twenty extra pounds. Click here to view the Fire Safety video http://www.mlrems.org/page.php?99

Feel free to check out the other offerings at http://www.mlrems.org/page.php?55 or click here.

These are not products of Mitigation Journal and I am not responsible for their content.

Leaving the Oxygen Tank in the (EMS) Garage

Leaving the Oxygen Tank in the (EMS) Garage...EMS Garage Podcast leaves oxygen and outdated thinking in the dust.

I don't recommend products, services, or other podcast and blogs lightly. This week I'm going to ask that every Mitigation Journal Blog reader and Podcast listener, and every EMS responder in the world tune into EMS Garage Podcast episode 101.

Why? This episode begins with the typical panel discussion...this time on the topic of oxygen and the (over)use thereof. But the real meat of this EMS Garage episode comes about halfway into the talk. The panel dives into opinion and controversy concerning EMS education standards, folk lore, and legend...and how that outdated thinking and training has led EMS.

OK, I'll say no more...tune in and hear for yourself. You can find EMS Garage at www.emsgarage.com or at www.promednetwork.com. They're also on Stitcher.

Canadian Cessna Visits Rochester, NY

Canadian Cessna Visits Rochester, NY...by way of nuclear power plant.

A Cessna 152 piloted by two men flew into United States airspace and landed at the Greater Rochester International Airport. The two men were allegedly flying from Toronto to Kingston and apparently took a wrong turn. For some reason, rather then flying east from Toronto to Kingston (or west going back), they flew south for nearly 100 miles over the open water of Lake Ontario.  The trip included a detour through the airspace surrounding the Ginna Nuclear Power plant.

There was no radio communication between the plane and air traffic control. The two men in the plane, described as Canadians of Indian decent, were questioned and released. Click here for an article on this from the Rochester Democrat and Chronicle.

I'm not going to buy into the proposal that this was simply an accident or mistake. Could this be another dry run testing our response to events? We've seen other events that looked like dry run probing in the recent past. See Dutch Good Example of Anti Terrorism (August 31, 2010 Mitigation Journal).

I don't know why I'm surprised by this event. After all, NORAD decided not to intercept Russian bomber flights into U.S./Canadian airspace because they were "just training missions"...see NORAD v. Cessna (July 12, 2010 Mitigation Journal). But, then again, how bad can a Cessna be? After all, it's just a Cessna. Although I seriously doubt that a Cessna could damage a nuclear power plant, we should remember the situation of not too long ago where a disturbed person flew his Cessna into a building that housed a regional IRS office. See An Attack by Any Other Name (February 18, 2010 Mitigation Journal).

Did I mention September is National Preparedness Month?

What am I looking for? See Something, Say Something

See Something, Say Something. Sure. Tell me again, what am I looking for?

"Report anything out the ordinary is simply not enough."

The phrase "see something, say something" has taken on a whole new meaning since the attempted Times Square Bombing plot was discovered by a NYC street vendor. The latest cover of this phrase is by our very own Department of Homeland Security.

The See Something, Say Something campaign  was developed by NYC Transit back in 2002 with the plan to get people to report "things". What things? Well, anything...out of the ordinary...an unattended backpack, an open can of sarin, or the powdered sugar in the bottom of the doughnut box.

The See Something, Say Something campaign had the potential for being a tremendous public awareness tool and a way to integrate the public as everyday forward observers.

The Department of Homeland Security paid $13 million on the See Something, Say Something campaign  out of a total $44 million spent since 2006 on preparedness efforts. Over fifty other locations outside of NYC have begun using the slogan, but it's not clear if they had to pay to do so.  NYC Transit secured the trademark for See Something, Say Something in 2007.

Problems. The campaign uses an 800 number rather than 9-1-1 for reporting. Thant builds in a level of delay and risk for poor communications to responders.

The biggest problem is that people simply don't know what they are looking for. "Report anything out the ordinary" is simply not enough information for people to take action on.  The result is failure for this See Something, Say Something campaign. Without an idea of what to look for, we'll get little if any useful information.

Vaccine. Mandate or Not?

Vaccine. Mandate or Not? CDC says no. Other infectious disease experts say yes.

As you may recall, New York State attempted to mandate H1N1vaccine for all health care workers despite a lack of vaccine or a declared public health emergency. Yes, there was a pandemic declared, but no public health emergency. There was considerable debate as to who, exactly, was considered health care workers...did it include EMS? Firefighters? Or simply, anyone who would walk into a hospital? The New York State Nurses Association came out swinging hard against the vaccine mandate. We posted on this way back on July 31, 2009. See NYS Nurses Opposes Mandates for Vaccine in Mitigation Journal.

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 this 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 details of this CDC decision were posed in the Mitigation Journal Blog (CDC: Vaccine Not a Requirement. 12 Aug 2010) The full text of the CDC's June 22 statement can be found here.

What will it be for the 2010-2011 flu season? Mandated vaccine or not? Well, the CDC has their opinion and other infectious disease experts have another view. 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."

There is more than one controversy in this situation.

Should flu vaccine be mandated? I think a better question is: "what rights do I forfeit to work in health care?" We already require health care workers to undergo TB testing. Hepatitis vaccine is offered, but can be declined. The SHEA position paper states "a condition of employment" in regards to flu vaccination...but who will enforce it? You may recall that the United States Army had to resort to disciplinary action against soldiers who refused mandated Anthrax vaccine. That 2003 mandate for Anthrax vaccine was in preparation for soldiers who were deploying to a area with a credible Anthrax threat and was eventually halted by federal court in 2006 (note: the Army is planning to restart the program 2010-2011). If the Army cannot mandate vaccine soldiers in the presence of a credible threat, how can anyone mandate civilian health care workers to be vaccinated in the absence of public health emergency or credible threat?

Are we following the CDC, WHO or other groups such as SHEA? What are policy makers to do when these expert groups disagree? Last years NY mandate covered anyone who had patient contact in a health care facility. That included some EMS personnel...and here is the lunacy...only commercial (private) ambulances were included in the mandate. The rationale was that commercial or private ambulance services had a higher call volume and, therefore, higher risk. There was no consideration for the numerous EMS providers who work/volunteer for multiple agencies (and hence, have a higher exposure). Also, the 2009-2010 H1N1 vaccination plan had EMS near the bottom of the list to receive vaccine. The point is, if health care workers are going to be mandated to receive vaccine, EMS should fall under that...if EMS responders refuse, if hospital health care workers refuse...what will the system impacts be? I would predict a near-crippling effect on our ability to manage daily volumes.

There is no doubt in my mind that flu vaccination will prevent the spread of flu...seasonal or otherwise. Public health history reminds us that viruses like Smallpox can be eradicated from nature by a staunch vaccination effort. But can we expect to vanquish Type A influenza by mandating seasonal flu vaccination? That answer is no. I'm also concerned about the "what's next" factor. If we mandated to be vaccinated for flu or loose jobs today, what will be mandated (under pain of unemployment) tomorrow? 

More to follow. Feel free to comment (constructively) or email for discussion.

MJ# 188: Chemical Accident at Hotel, Assignment Terror, ED wait times posted on billboards

This week on Mitigation Journal Podcast - First things first; oops. I posted this episode (#188) early. Matt and I had a small window to get the recording done so we pre-recorded a bit earlier then normal with the intent of posting on 9/12/10. Well, as went to post the file to the rss feed I forgot to change the availability date. Bottom line is that edition #188 was available early.

Okay, on to this week...Matt and I discuss how a simple accident caused phosgene to be created in one hotel. Certainly, this was a situation that could have been much worse. It's not a terrorist attack...its an accident. But phosgene is phosgene...no matter who made it or let it out. Tune in to hear the details.

How long would you wait to be seen in an emergency department? A number health care systems have begun posting wait times on highway billboards. The hope is that people will go to an emergency department (one within the same health system, of course) that is less busy. These billboards are aimed at the non-urgent or less acute medical need. My question is, why not just stay out of the ED altogether and just go to a walk-in care center?

Assignment terror...that's right. How about a school assignment that has kids (high school) thinking like a terrorist. An Australian teacher gets bounced because he encourages students to find vulnerabilities in their communities.

September 11, 2010

September 11, 2010...

There will be hundreds, perhaps thousands, of blog postings and podcast discussions today. Many will have titles like "Always Remember" or "Never Forget". While even more will talk about the details of time and events from 9-11-01. There will also be ceremonies and services featuring memorials and testimonials. Where were you when...will be a popular conversation.

I, however, will take a slightly different path behind the keyboard and mic of Mitigation Journal on September 11, 2010.

With the greatest of reverence and everlasting memory of those who died in the attacks of 9-11-01, I will ask those responders who remain to reflect on where we are now and what we'll be doing tomorrow.

Are we better prepared in 2010 than 2001? Prepared to do what, you ask...as well you should.

Can you remember the public enthusiasm that greeted the responders who flooded into New York City in the days following 9-11-01? Can you picture the signs that read "Thank You"? The ones the read "Our Heroes" as lines of ambulances and fire apparatus drove by? Can you still picture the crowds welcoming responders of every color uniform and vehicle?

Can you remember the stream of funding in the months that followed as we suddenly realized that weapons of mass destruction training was needed? And the awakening that one spore could kill?

The American Fire Service could seemingly have anything needed as our nation realized the need for its First Responders. And we got it. There was money for training classes and protective clothing. There were funds for apparatus and buildings.

Is the fire service better prepared in 2010? Prepared to do what, you ask...as well you should.

How much as been spent and squandered on dysfunctional apparatus and worthless "WMD" and terrorism training?  How much of that training and apparatus was never put to use because it did not fill any real firefighting function outside of terrorism? Nearly everyday we're reading about firefighter line of duty deaths from cardiac disease or from entrapment, collapse, or apparatus crash.  How much "preparedness" have these topics gotten? What can the fire service point to as a measure of preparedness in the wake of all this terrorism and WMD training? Protection of infrastructure in our communities? No. In a level of audacity never before heard, the American Fire Service told hospitals that, in case of chemical or biological attack, your local fire department is going to be too busy...better get ready to deal with those contaminated self-referrals on your own. For the first time in our history, the fire service is telling someone "we're not coming".

Recently, legislation aimed at aiding those responders and rescuers who worked at Ground Zero and are now dying from pulmonary diseases...failed. Almost without a whimper. No crowds, no signs, no aid. Cities in every state are faced with demands to cut fire department budgets, reduce staffing, cleave benefits. On September 12, 2001, the American Firefighter was still a hero. In 2010 the fire service is another taxation anchor wincing under the public scrutiny and shouts for tax cuts.

Is our emergency medical services system better prepared in 2010? Prepared to do what, you ask...as well you should.

EMS as a whole received a scant amount of preparedness dollars in the wake of 9-11-01. When asked why, one legislator remarked "aren't the ambulance drivers part of the fire department"? Despite changes to the National Response Plan, now the National Response Framework, EMS remains on the fringes, fragmented and without any nationally recognized leadership. Despite increases in training and education paramedics, who are allowed to give injections to a variety of sick people in the back of an ambulance, have been barred from assisting a flu vaccination clinics during the Swine Flu pandemic of 2009...adding to the nauseatingly slow vaccine distribution at some public vaccine clinics. EMS is the service that should be best able to identify an unfolding biological event. In 2010 we still ask "aren't the ambulance drivers part of the fire department"?

Is our public health system better prepared in 2010? Prepared to do what, you ask...as well you should.

Hospital preparedness, surge capacity, resource triage, and sufficiency of care were all buzzwords after 9-11-01. The buzz has faded into annoying tinnitus as many hospitals and public health organizations go through the motions of checking the boxes on the Joint Commission list...functionality optional...check mark required.  Decontamination precautions remain unworkable at many health care facilities. Issues of surge capacity continue to dog hospitals as over crowding forces patients into the halls waiting hours to be seen by a doctor. Discussions on the triage of limited medical therapy (ventilators, for instance) is hotly debated and unsettled. Oh, and that pesky flu...even after 9-11-01, SARS and the Avian Flu threat; we fall short of vaccine production and distribution capability...even when given months warning as in the case of Swine Flu.

As I've written and said many times before...It is time to stop training for WMD terrorism events. It is also time to stop living in the "post 9/11 era" and start living in the pre (insert next event here) era.We must recognize the need for all-hazards training. This training must be delivered in a way that puts the material into context, so the skills and knowledge can be used every day. Our readiness for natural disasters must also improve.

Never forget. Always remember. Are we better prepared in 2010? Prepared to do what, you ask...as well you should.

Wrong, Wrong, Wrong...

Wrong, Wrong, Wrong...Not only wrong, but endangering to troops and domestic responders.

That's what I have to say to the Dove World Outreach Church on their plans to burn copies of the Quran on September 11, 2010. They have a top-ten list of reasons why they should partake in this act, too. I've read the list and find each one of the reasons given by this church...well, less than impressive. Click here for a link to their blog/top-ten list.

The Dove World Outreach Church, self-described as nondenominational, plans to burn copies of the Quran as part of its "international burn a Quran day"in honor of September 11. This group invites all Christians to participate, calling Islam "the work of the devil", according to this article from CNN.com

Think what you want, I don't care. But burning a holy book (even if its not reflective of your beliefs) is flat out wrong.

My message to the Dove World Outreach Church is; please reconsider your planned action. Your intent on burning copies of the Quran will only incite deeper polarization between extremist groups. Your actions may well be the catalyst that tips the balance and results in retaliation, cries of bigotry, and escalation of violence.  Read more of my comments previously posted (Mosque) and Tipping on the Point in Mitigation Journal. These may well be the actions that spark domestic terrorism in this country.

The responders and public will be in the middle. As will our troops around the world. CNN.com notes that this type of activity will "jeopardize the safety of our men and women that are serving over here in the country..."

Burning copies of the Quran is akin to Nazis marching on Main Street U.S.A and waving a swastika flag. Nothing good will come from this...it will not stop the Ground Zero Mosque from being built. 

The Bible, the Torha, the Quran...just a few of the Holy books people on this earth hold sacred. They all deserve respect.

(note: the Dove World Outreach spelled Quran with a K -Kuran, other references all use Quran)

This Weeks Reading List

A list of topics that might find their way to the blog or podcast.

Do you have insight, opinion, or comment on any of these topics? If so, email me mitigationjournal@gmail.com or call the voice mail line at 585-672-7844

 Healthcare groups need to share emergency plans...link

Violence Against ER workers...link

FDA attempts to slow Robo-tripping...link

Is there a doctor in the motor-house?...link

Forget the ED wait...just go to an urgent care center

This story from MSNBC.com discusses the latest in tactics by emergency departments to cut down wait times. The strategy is to post ED wait times (as near real time as possible) on billboards in various areas. The idea is that people, when they need to go to the ED, will look for the location with the shortest wait time...even if it means driving to a distant hospital.

This move and others like it, are in preparation for a new Medicare regulation that requires hospitals to report how fast people are moved through the ED. The MSNBC.com story notes that these moves are directed for less urgent patients and not actual emergencies. According to the article, the longer a person remains in the ED, the greater the risk of poor outcomes (like infection) or death. There is also increased complaints in relation to long wait times in the ED.

So, will posting wait times on billboards make a difference on ED wait times? I doubt it. I think people won't bother reading the billboards...you'd have to be on the road already anyway...I think they'll continue to call 9-1-1. What's also interesting here is the fact that we're targeting less urgent or non-emergency cases. Perhaps a better solution would be to point these folks away from the hospital ED completely. Sending them to an urgent care/walk-in care center for the ear aches, stitches, and sprains may be an even better solution.

All threats are not equal

Not all objects are designed to go boom...some are designed to spread disease.

Last week we reported on a situation involving two guys with "suspicious" devices (cell phones tapped to empty bottles, watches tapped together, knives, box cutters...over thirty items by some reports) who each missed flights, changed travel plans in mid-stream, and whose luggage continued to different destinations than they did as they're on the way to Yemin. The Dutch hold them on suspicion of plotting to commit terrorism, the U.S., not wanting to jump to conclusions, believes the situation to be a matter of coincidence. See my post Diligence or Paranoia, Profiling or Protection September 1, in Mitigation Journal.

Today, CNN.com is reporting that the Miami airport...all of the Miami airport...was closed because of a suspicious item in a travelers luggage. The man in question, arriving in Miami from Brazil, is said to have an item the looked like a pipe bomb in his suitcase. According to CNN.com, the 70-year-old man was detained (not arrested) while the bomb squad evaluated the item. The article goes on to state that nothing hazardous was found, there were no traces of explosives. This story might sound like a bit of over kill. That is until  you find out that the 70 year-old man in question has a history of imprisonment for transporting (illegally) biological agents...including plague.

With good reason we've focused on explosive devices recently. This story being reported by CNN.com is a reminder that another potential exists. The treat of biological terrorism has not been front page lately, but we have to keep in mind that biological events could kill thousands more that any given improvised explosive device. While bombs detonate (or, defligrate, for the purists) they give us a call to action...a heralding event that alerts us to the fact that something is going on. We put our guard up. We take appropriate actions and precautions.

Biological event lack that "big bang" or that heralding event. Biological agents can be spread by a variety of delivery methods and devices. Perfume bottles, aerosol spray cans...even the automatic air fresheners in the men's room at the mall. There wont be a call to action. We wont know to put up our defenses. And since most of the CDC A List biological materials will present with signs and symptoms similar to cold and flu, we probably wont know anything is going on till it's well underway.

The explosive bang is nothing compared to the biological whisper.

Pakistani Military Delegation Removed From Flight

Pakistani Military Delegation Removed From Flight, Tampa - Florida

According to WTSP.com the group of nine foreign-born men were taken off a flight after one off them made inappropriate comments to a flight attendant. Those comments were not defined in this article. Whatever the situation or comment (we don't know how loud the comments were) 15 other passengers declined to fly on that flight and were re-booked. Read the full article from WTSP.com here. Be sure to scroll down and read the comments at the bottom of the story - a must read!

Following a link posted in the comments on the above article, took me to this story from DAWN.COM. (I've never heard of DAWN.COM or the DAWN Media Group and have no idea about their credibility). According to the DAWN.COM article, the men removed from the flight in question were members of a Pakistani military delegation who were in the U.S. for a military meeting. DAWN.COM writes that the men were:

"offended by this treatment, decided to cancel an important meeting at the headquarters of the US Central Command in Tampa, Florida, on Tuesday, and return home."

Also, according to investigation by DAWN one of the men (presumably a military officer  had "misbehaved" in some way (not defined) with a stewardess and told her that “this would be her last mission”.

Where do you draw the line between bad behavior and credible threat? Perhaps these men were no aware of the current tensions in the United States centered around the Ground Zero mosque and perhaps they have not heard about the airline event involving two men traveling to Yemen. You'd think that members of a visiting military delegation would do everything in their power to police themselves and remain above reproach.

So, what would you do having someone tell you "this would be your last mission"? If someone said that to me in the back of the ambulance...I'd stop the truck and get out. 

Diligence or Paranoia, Profiling or Protection

Diligence or Paranoia, Profiling or Protection - A note about semantics

Since posting Mosque, Tipping on the Point, Dutch Good Example of Anti-Terror Efforts, and Local Example of Dangerous Tension I've received a (nearly) unpreceidented amount of email from blog readers and podcast listeners. Most are tossing in their two-cents on the Ground Zero mosque and the recent event on an airline flight to Yemen. A few (as expected) believe that I have crossed the line into paranoia..."seeing terrorist cell activity in every piece of media" (mostly from the It Can't Happen Here crowd).  Some, however, have decided that I must be a racist and have been "poisoned by right wing hate".  See MSNBC.com and CNN.com as the articles I've sited in blog postings listed above.

Are you kidding me? Right-wing hate, really? I blog and podcast about domestic preparedness not politics. The impact of natural, accidental, man-made, and intentional events on traditional and non-traditional responders as well as the community and family is the focus of my work here. I've been critical about extremist on any side of the line (see Never mind Osama, Here's the Right Wing Extremists, April, 2009).

I have made a career out of taking care of complete strangers...whoever calls...whenever they call. No self-respecting racist would take care of people the way I do!

Too many people want to remain in the comfort zone and ignore the warning signs flashing around them. Some because they lack the mental or emotional capacity to decode those signs. Some deny the treats out of desire to be "hip" and accepted and accepting, to be seen as not racist.

To look up seeing storm clouds and say "it looks like rain" is not paranoia. To carry your umbrella in the morning because it might rain this afternoon is preparedness.

To carry a snow shovel in July because it might snow, however is paranoia (that is, unless it has snowed in July were you are).

To stand in the middle of the thunder storm screaming "its not going to rain! Why do you hate?" is ignorance.