MJ Podcast #194: Mail Bomb Threat & Soft Targets, Traditional v. Retail Health Care, and Biological Preparedness Introduction

This week on Mitigation Journal Podcast we'll take a quick look at the Air Freight Bombing attempts. This developing story is another example of the probing attacks on soft targets. Yes, I said probing. And as this situation continues to evolve and more information becomes available, we're seeing that the bombs were not only on board cargo aircraft. Passenger aircraft were targeted as well. Although the going theory is that the planes were to be blown up in flight, I reserve the possibility that they were to be detonated at airports or after the packages had gotten inside the airport. More to follow.

Next we discuss the growing discontent between traditional health care delivery (doctors offices) and non-traditional delivery of care by retail and walk-in health centers. In this case, some physician offices are claiming that are not getting flu vaccine to keep up with the vaccine being delivered to the non-traditional venues.

In the second half of the podcast this week, we introduce another series for November. We'll run a multi-part series on the topic of biological preparedness...with at twist. How about comparing naturally occurring biological events (colds/Flu) with our preparedness for large-scale or intentional biological events?

Check our EVENTS tab for our blog and podcast publication schedule and class listing!

Five tips that will enhance your Exercise Design program

 Do you want to improve the quality of your exercise design program? We all want to get the most out of the time we spend planning, training, and preparing. The one of the basic properties of good  organizational preparedness is a solid exercise design program.

Follow these tips to get the most out of your exercise design program and keep your personnel engaged in the process:




1. Know your hazards and threats. 
Every organization should be conducting a hazard vulnerability assessment and a threat assessment. Ask yourself what you're likely to be facing and keep it realistic. After you've made your list, prioritize it according to actual threats. Again keep it real! Planning an exercise around the hazard that is so remote for your organization or location will whittle away at your credibility. When planning a first-time exercise, choose a threat or a hazard that everyone is familiar with… don't be afraid to build a scenario around a routine storm situation or other event that you could reasonably face.

2. Know your facility your department and your people. 
Apply the results from your assessment to your mission. How could these threats or hazards impact your mission in the delivery of your service? How will these threats and hazards impact your people in their ability to do their jobs? This next part can be uncomfortable… but you have to do a realistic skill level evaluation of your personnel. Knowing exactly what they are capable of (or not capable of) is vital to establishing your exercise design program. Designing exercises or drills that are too complex for the skill level of your personnel and you risk losing credibility and participation in your program. And once that's lost its almost impossible to get it back.
3. Lay the groundwork. 
Preparation is the key from buy-in to actual delivery of your exercise program. Let the information you gather from your hazard vulnerability and threat assessment out to the public make your findings part of everyday life for your personnel, agency or your department. As mentioned previously, base your exercise design program on realistic threats… but, don't be afraid to add a hint of acting in dramatic license.
4. Start small. 
Follow the exercise design progression: orientations and seminars, then drills, then tabletop exercises, and only then when you've mastered these exercises move on to full scale functional exercises. Skipping steps in this progression put you on the path to failure. You risk wasting time, wasting resources, and losing the support of your peers.

5. Write your scenario well. 
Spend some time on your scenario to make it as realistic as possible… again with a hint of acting and dramatic license… you can bring your scenario to life. Make sure your scenarios are plausible (even if exaggerated) and are based on reality and the information you've gathered in your assessment process. Do not come up with scenarios that are so catastrophic as to create a no-win situation. No-win situations are discouraging and you'll have a hard time getting people to come back for follow-up exercise.

Biological Preparedness Testing

Draw your own conclusions about these two videos. While viewing consider the potentials in todays environment of preparedness ....

Cold, Flu, and Personal Responsibility

Preventing contamination is up to your behavior....

I gave a presentation entitled Understanding Flu and Biological Events at Integrated Safety and Response Solutions to an enthusiastic crowd.  After the program, Captain Tim Mahar, EMTP, mentioned the Myth Busters clip below.

This clip is all about spreading contamination...in this case from a typical runny nose/cold scenario. The Myth Busters do a fantastic job displaying the potential for one person with a respiratory illness to spread that illness to others. You've read my postings and heard me talk on the podcast about the need to improve our non-pharmacological interventions to prevent disease spread...this clip proves my point! (For more on this, listen to Mitigation Journal podcast #179 and read the related postings on the blog)

The second half of the clip displays how just a little bit of personal responsibility when you're sick and prevent the spread of disease. This says a lot for non-pharmacological interventions...hand washing and respiratory etiquette are the real stars.

In this demonstration the disease was cold or flu. What if it were something worse?

If a person with respiratory illness can spread disease easily without trying...how much disease could be spread it were done intentionally?

This Myth Busters clip is about eleven minutes long. So, sit back and enjoy!
Special thanks to Captain TIm Mahar (Monroe Ambulance) for sending this to Mitigation Journal.

Aircraft did not buzz Golden Gate Bridge

Camera angle aids in hysteria

Compare the videos below. In the first, it looks as if the Golden Gate Bridge is about to become history as a United Airlines 747 bears down on it. This video has already circulated the internet raising concerns for airline safety. Even a few mainstream media sites have posted this first video...without explanation as to what is really happening...raising concerns to the potential of another "9/11 - like" attack .



As this second video explains, the camera angle makes the story. The 747 was not near the bridge and was part of an airshow.

MJ Podcast #193: Duty to Act and Move Over Laws

The latest edition of Mitigation Journal is sure to get you thinking. This week on edition #193, Matt and I discuss the implications of the Duty to Act (or failure thereof) on the part of two NYC EMT/Dispatchers and Move Over Laws.

We've added a podcast player to the upper right side-bar of the blog page...now you can get the podcast directly from the blog page and listen while you read! You can subscribe to Mitigation Journal Podcast (free) at iTunes and subscribe to the blog post feed here.

The NYC EMT/dispatcher who walked out of a coffee shop after being told about a woman having a seizure is now facing misconduct charges. The other EMT involved in this case was fatally shot outside of a NYC nightclub this past summer. I've already posted about this several times and discussed it on the podcast in edition #142. As this situation comes back into the media, it bears discussion again. Tune in to hear the details as Matt and I take a few spins and 'what ifs' of the potential ramifications of this case along with a few other side-issues; public perception, duty to act, and on/off duty image.

In the second half this week, we'll review the Move Over Laws. These are the laws intended to protect responders by getting motorists to move into a lane away from an emergency vehicle or slow to 20 miles per hour when approaching. The idea here is to prevent collisions while emergency vehicles are parked on the side of the highway. You'll want to hear the discussion as Matt describes the law and I ask a few questions.

Support Mitigation Journal - Donate Today! Even a donation of $1.00 a week will help keep this blog and podcast a free service.

Support our supporters:

www.medexbilling.com





Integrated Safety and Response Solutions www.isrstraining.com

NYC EMT faces misconduct charge

Remember the two New York City EMT/public safety dispatchers made headlines back in December, 2009 when they refused to help a woman having a seizure? One of them is back in the news and facing misconduct charges. One of the EMTs was fatally shot outside of a New York City nightclub this summer.

The defense at the time was that these actions, or rather, in actions were defensible because these two people were dispatchers and not “field personnel”.

The situation made headlines and was  written about here  (Duty to Act in NY and Are they EMT's or not? Get off the fence! December 22, 2009). you can also go back and listen to my comments on Mitigation Journal podcast edition 142

The Associated Press is running a story telling us that the other EMT is now facing charges of official misconduct. The penalty for which could be up to a year in jail. I found this article  on EMS1.com http://www.ems1.com/ems-news/893526-ny-emt-faces-charge-in-pregnant-womans-death/

 I'd like to open up the duty to act debate again as the story progresses. Please leave comments here or e-mail mitigationjournal@gmail.com you can also call the voicemail line at 585-672-7844.

A note on poor performance

The following is a rant about poor performance and bad leadership… read on with caution.
Why do we accept poor performance? 

Are we afraid of change? Are we afraid people won't work and/or volunteer at our service anymore? Does our leadership lack the fortitude to correct unacceptable behaviors and poor performance?
Every one of us can cite examples of poor performance that is allowed to continue each and every day. Sometimes this poor performance is a result of bad behavior, bad behavior that is allowed to continue without correction, or less often, behavior out of ignorance.

Quite often the phrase “because we've always done it that way” is attached to one of these situations.  Sometimes I'll hear people say “because that's the way they want us to do it”. But more often than not poor performance and dangerous behavior is linked to equally poor supervision and leadership in something called error creep.

When I hear “that's what they want us to do it”  I'll challenge someone to tell me who exactly they are. Typically when I hear the “they” come out of somebody's mouth it's a result of some misinterpretation of a rumor and not fact. The term “they” often refers to some governing body or person. Used in this context, I have to wonder why we let other people or governing bodies make decisions for us. In some cases it is clearly unavoidable when it comes to governing bodies and their decisions on how we do business. We have to accept that. But when instructions don't make sense or don't fit common sense in a situation we should be questioning the authority… respectfully and professionally.

No blind obedience.  Take a stand...and don't just do something...especially when that action may endanger ourselves or others.

Error creep is a situation where people make small and insignificant mistakes over a longer time. And when those small and insignificant mistakes turn into habit we begin to see the problem that has been brewing sometimes for years. The point is that when error becomes commonplace and cannot be distinguished from proper practice, it often becomes accepted as the norm. Eventually these small and insignificant mistakes (that is, seemingly small and insignificant) will result in a critical failure and poor outcome.

Emergency service leadership, in all its forms, must have the backbone and fortitude to correct bad behavior and prevent poor performance. It's not comfortable to do so. It's not popular to do so. But it can be deadly not to do so.

MJ192: Uniforms/ID Complacency, 'Fun-Size' Terrorism, EMS Readiness, and No Pay, No Spray

This week on Mitigation Journal podcast we discuss a number of important emergency service related topics. We were a little late in getting the podcast episode posted this week due to illness, but we got it up and running and ready for you. As you read this post glance over to the right sidebar   and you'll notice that we have placed a podcast player there… now you can listen to Mitigation Journal podcast directly from our blog page.

Leading off the podcast this week is a short discussion about an incident that took place in the Philadelphia airport. It seems someone got a hold of a US air ground crew uniform and was able to get onto the airport property and actually assist other employees loading baggage on an aircraft. The aircraft was backed away from the gate and eventually evacuated after the two employees reported the stranger in uniform helping him load the baggage. This issue highlights the debate on what should be done to secure old uniforms and turnout gear.

Next we discussed this most unfortunate situation coming to us from Tennessee where a subscription fire service had a delayed response to a structure fire. Because the homeowner had not paid the $75 subscription fee the fire department would not extinguish the blaze in his house.  The house, their possessions, and their pets were all lost in the fire. This situation raises the issues as to whether or not subscription fire service would be able to manage large-scale events.

We'll also talk about first responder preparedness… we always talk about first responder preparedness. This time we'll take a look at a study done by Meridian Medical Technologies that notes an overwhelming majority of “first responders” don't feel the receiving the training they need for chemical biological and radiological events.

Special thanks to our sponsors this week:
The Mitigation Journal APP - Only $1.99 from the iTunes app Store
MedEx Billing
Integrated Safety and Response Solutions

FBI Caught Tracking Student

FBI trades black helicopters for GPS and gets caught by the trackee.

Imagine going in for an oil change and finding a GPS tracking device stuck to your engine. That's exactly what happened to a college student from Santa Clara, Calif. After finding the device, the student called the FBI...and the FBI had the nerve to actually ask him to give the device back! Offering no explanation for the tracking (the device or the action), the FBI simply hid behind the "on-going investigation" line.

The device was identified as Cobham Orion Guardian ST820 tracking system. Supposedly, this is a low-enforcement only device. According to MSNBC.com this kid had no idea the thing was there or why. The story was originally printed in Wired.com. Makes me want to look under my car.

What are the implications here? Food for thought and discussion. Your comments on this are welcome.

HHS to Support Community Health Centers

Over $727 million going to support community health centers.

The U.S. Department of Health and Human Services (HHS) has announced that over $727 million will be distributed to 143 community health centers for upgrades and new construction (text here). According to HHS, the money will come from the Affordable Care Act and go to community health centers serve nearly 19 million patients in the U.S., about 40 percent of whom have no health insurance.

This is a fantastic idea that will have a positive impact in each targeted community. I've long held the position that if more attention were paid to community health needs, we may not need sweeping health care reform.  Many of the under- or uninsured suffer from a variety of health problems and lack access to affordable, quality health care. Not only are the undeserved populations at increased risk of disease, they are at greater risk for complications related to lack of treatment and insufficient knowledge. The cost of diabetes and heart disease is staggering. The cost of complications and long-term care is staggering. This initiative will bring that care to the population. 

Want to run a good rehab operation? Start with this list.

Must do list for effective rehab… here's a few things you have to do in order to run an effective emergency incident rehabilitation. This is a good start, but just a start.

• Understand the requirements of the National Fire Protection Association standard 1984 on emergency incident rehabilitation. In order to provide emergency incident rehabilitation services, you must have an understanding of what the requirements are. NFPA 1984 outlines the requirements and actions that must be taken to effectively conduct rehabilitation functions. Every responder should be familiar with this document. Every EMS agency that provides rehab services must not only be familiar with the document but be able to apply the procedures on the scene of an incident.

• Operate autonomously at the scene of an incident. EMS responders must be able to operate without having their hands held while conducting rehab operations. The most effective rehab will operate within the established incident command system and will be able to carry out their assignment with little or no supervision.

• Make decisions based on assessment data.  The biggest hold-back to participating in rehabilitation functions is history. EMS has to go beyond the outdated vision of some EMT chasing a firefighter down the street with a blood pressure cuff. Firefighters have to recognize that they will be returned to duty as long as no abnormalities are found during assessment. Decisions to treat and transport can only be made after assessment. Your assessment has got to include an understanding of the environment the responder was working in as well as baseline vital signs. Noninvasive monitoring of end tidal carbon dioxide, carbon monoxide, impulse oximetry are vital… all EMS providers should understand what these values do and do not indicate.

• Understand the response priorities of the fire service you're working with. The best way to run an effective emergency incident rehabilitation station is to understand the needs of those who are serving. An understanding of standard operating procedure in general tactics and strategy will put you ahead of your colleagues when operating on the fire ground.

 Got a suggestion on how to implement Emergency Incident Rehabilitation? I'd love to hear from you send your thoughts to mitigationjournal@Gmail.com or call the voice mail line 585–672–7844. You can also leave your comments here on this blog.

American Heart Month

October is American Heart Month and is support of this effort, here are a few heart healthy tips from the American Heart Association:

• Combine physical activity and social fun by encouraging everyone in the household – kids and adults – to enjoy active-play video games together. 

• No time for exercise? Break up your activity into 10-15 minute bouts.

• If your favorite sports include seasonal activities such as tennis or skiing, you may spend months waiting for the right weather to arrive. Consider how active-play video games based on seasonal sports can provide a fun, physically active supplement to your activities all year round.

• Take the stairs instead of the elevator.

• Typical dinner parties can be nice, but isn’t it always more fun to surprise and entertain guests with something out of the ordinary? Next time you’re hosting a social gathering, turn it into an active-play video game night that gets your friends on their feet and having a blast.

• Choose a parking spot farther away than usual, and take some extra steps.

• If rain or snow prevents you from enjoying outdoor activities, host an active-play video game tournament in your living room. Challenge family members, neighbors or friends to step up and vie for the best scores. The friendly competition might inject some extra fun into your experience.

Evacuate This!

Evacuate this! So, you want to evacuate your hospital now?

It seems like evacuating hospitals has become all the rage in healthcare preparedness recently. While I think understanding how and when to evacuate your hospital is an important part of healthcare preparedness, evacuating a hospital should not be taken lightly. Among the many factors to consider the simplest is often the most overlooked… and that is, the traffic.

You see, any event that would be big enough to cause you to evacuate your hospital would probably have an impact on the surrounding community as well. What will you do when it's not only your hospital evacuated but the entire community or county or city that you live in trying to evacuate?

This traffic pattern concern became upfront and personal with me just the other day on my way home from school. One single traffic accident 10 miles away from where I was snarled traffic on the major expressways and alternate routes.  Again, this was one simple traffic accident… no hazardous materials, no terrorist attack, no helicopter crash. Just a simple multi-car pileup during rush hour. The injuries thankfully, were not severe either.

In just a few minutes every feeder to the expressway was congested with overflow traffic. The expressway itself Route 390 N. was bumper-to-bumper for almost 10 miles. Can you imagine trying to get vehicles in and out of your hospital during that type of traffic snarl?  What happens when you begin an evacuation only to find the roads are no longer clear? Moving patients from hospital to hospital without a designated clear route of evacuation is dangerous. There is substantial risk of having patients become caught in traffic tie ups or other situations that obstruct roadway travel.

These issues must be understood in the risks calculated before any evacuation of the healthcare facility takes place.

From here to there.

  From here to there… in one career.

You go from EMS to disaster and emergency management? That's become a question I have heard often. I received e-mails over the years asking me how I made the switch from being a paramedic to diving into disaster and emergency management. While I still practice as a paramedic, I enjoy the research and planning that goes into emergency preparedness and disaster management.

So, here's a short review on a few things that helped shape my career. Remember, you asked.

I was not influenced by the television show emergency. If there were any television influences in my career it was M*A*S*H and Planet of the Apes.
The TV series M*A*S*H always interested me. Here were group of people working under the most difficult conditions with limited supplies and seemingly no support… yet they got the job done despite the challenges. That television show showed me that it was okay to deal with stress and care about what you do. The series M*A*S*H also highlighted that the job was not always glamorous. The TV show emergency, while focused on the fire department, seemed to portray that the job of a firefighter or paramedic was challenging yet dramatic and glamorous. Even as a teenager that portrayal didn't sit well with me as being realistic. The rest of my EMS career hinged on training under some very good EMTs and paramedics who never stopped making a positive impact on how I did the job. The people who trained me had the fortitude to demand perfection and correct bad behavior. Sometimes it seems like that's a quality in short supply today.

As far as emergency and disaster management goes, that's another story. As a young firefighter and paramedic I noticed a lack of training preparing us for dealing with large-scale events. Doing some self study on the topic of mass casualty incident management and large-scale events but there was a lot of material available at that time. Then, on October 19, 1989 we were stunned to see the results of the Loma Prieta earthquake displayed in the mainstream media. Seen by many as the rebirth of urban search and rescue, this one event on the other side of the country changed the way I looked at large-scale events. The scenes coming out of California on the nightly news reminded me of the old TV series and movies called Planet of the Apes. You know the ones, that would show various scenes of a city in ruins after some type of holocaust. I was so taken by the efforts of the responders of all disciplines during that earthquake that I decided to dedicate a major portion of my career to improving response to large scale events and studying emergency management and disaster preparedness.

Mitigation Journal the dictator

 Mitigation Journal the dictator… speech recognition software improves my blogging!

Do ever get tired of typing on your blog? Sometimes I have so many ideas floating in my head it seems I can't type fast enough to get them out. So I often sit and make dozens of notes on various pieces of paper and sticky pads only to lose them or forget what they're about… cause the loss of so many good ideas rather than the creation of outstanding blog posts. All because I don't feel like sitting down to type.
What's changing now. I've gone out on a limb and decided to try a speech recognition software again. I had a speech recognition program on my old PC a few years ago and could never get it to work right, it was very frustrating it seemed like a waste of money and time.

Recently, after being fed up with typing, I decided to look into speech recognition software for my iMac. What I found was Mac speech dictate software. Albeit a bit skeptical, I decided to give it a try in a vice of the salesperson at the local Apple store purchased MacSpeech Dictate for my iMac. Within minutes of installing the software I was able to talk into the microphone and the software recognized my voice so accurately it was instantly a success. In fact I am “typing” this blog post now through the headset that came with my MacSpeech Dictate software.

So big tip of the helmet to the folks at the local Apple store here in Rochester New York and recommending this piece of software. Not only will it improve my blogging but my spelling as well!

MJ# 191: Smallpox Stay of Execution, Sharing Health Care EM Plans, Flu Vaccine, Mandate or Not?

First things first, we had a major problem with the Mitigation Journal podcast feed at the end of September. Because of the popularity of the podcast we exceeded our file size and were not able to update iTunes. All that's been corrected now and were back on track. You may notice that a number of old files in the feed have been removed or are no longer accessible via iTunes.

This week on Mitigation Journal edition #191 Matt and I discuss several important topics. First off, we'll talk about smallpox and the need or not to keep smallpox virus housed in laboratories for experiments.  Should smallpox get a stay of execution? This topic is generated quite a stir in the emergency management and public health community. Tune in to hear Matt and I have to say.

Also this week, we'll talk about the need to share emergency plans between healthcare organizations. It's unbelievable to me that hospitals and healthcare organizations would not be sharing their emergency plans. But that seems to be the case. No one organization will be able to manage a large-scale public health crisis or natural disaster without integrating their emergency management plans with other healthcare organizations and hospitals. In this segment, Matt and I overview why healthcare system emergency management planning is so important. We also throw in a little bit of commentary on the topic.

And finally this week, were back to the old debate “should seasonal flu vaccine be mandated”  for healthcare workers? We also dive into another controversy that's brewing and that is; who are we listening to… the CDC or other expert organizations?

Don't forget to check out the Mitigation Journal app for the iPhone and iPod touch. The Mitigation Journal app is only $1.99 with portions of the proceeds going to support the podcast and blog. If an “app” is not your thing, you can support Mitigation Journal by visiting the blog and making a donation there. Every little bit helps and we appreciate your support.

Why would hand foot and mouth disease stop air travel?

 Why would hand - foot and mouth disease stop air travel? Because it looks bad, like something else.

 I'm preempting a couple of other blog posts to talk about why and four in mouth disease in a child on board an aircraft caused a bit of a panic in Colorado. According to CNN, a plane arriving in Colorado from Mexico was held at the gate because there was a sick child on board. Travelers became concerned when they were asked to de-board the plane using stairs rather than the jetway ramp.

Hand, Foot and Mouth

The child appeared to have a rash on the hands the feet and around the mouth prompting health evaluation and eventual transport to a hospital by paramedics. So, why would a child with a simple viral infection of hand, foot and mouth disease caused such a stir? Hand - foot and mouth disease is a common viral illness among infants and children causing a fever and little blister like eruptions in the mouth, hands and feet… this pattern of eruption is known as a centrifugal pattern. Remember that, centrifugal pattern. Usually this disease is self-limiting although painful and uncomfortable. One of the worst side effects from this disease is viral meningitis. It is transmitted from person to person by direct contact with a person who has hand, foot and mouth disease.

So, again, why did this cause such a stir? Well I can only speculate that when the symptoms in the presentation of this 23 month old child were relayed to health officials someone recognized a centrifugal pattern of lesion development. Can you guess what other viral disease develops innocent critical pattern? If you answered smallpox, you would be correct. I suspect that when someone recognize the symptoms of fever, rash and blisters on the hands feet and mouth they also suspected smallpox.

Smallpox Eruptions on Hand

It's very important to understand how deadly smallpox is in is equally important to remember that there are other diseases that can mimic the presentation. The actions by the airline and by public health officials I believe in this case were justified and appropriate. If I'm correct in my assumptions, this would indicate someone in public health was awake and alert when this case came in.

Read the CNN story here

Smallpox gets stay of execution.

 Smallpox gets stay of execution. But should it?

Smallpox is been removed from the environment for almost 30 years now. Today however, smallpox is still making the headlines. This time it's all about the smallpox stores we keep as pets in our laboratories. Apparently since marking 30 years since smallpox was eradicated from nature the World Health Organization set deadlines for destruction of stores a smallpox virus around the world. June 30, 2010 was the latest deadline to come and go. The execution date for smallpox virus stores started way back in 2006. Another date was set in 2007 and ultimately 2010… and now has been due for until 2011.

At the center of the concern for smallpox that virus stores is security. Security not only in the United States at the Centers for Disease Control and Prevention but in the former Soviet Union as well.

Is it prudent to continue to keep smallpox virus stores on hand? So much research has already been done on this virus but one has to question what further use it could be. Is it solely to produce vaccine should smallpox reemerge in nature?

One concern I have is the lack of general knowledge about smallpox amongst emergency responders. Nearly every class I teach I asked the responders: “where do we see smallpox today?” Most of the time people answer they see smallpox cases and some Third World country when in fact smallpox as mentioned, has been removed from our environment completely. This lack of knowledge leads to increased concern about the virus continuing to live in labs. Smallpox is in fact one of the most dangerous diseases we could face in the event of a biological attack. We haven't vaccinated anyone in the United States against smallpox since 1980. And those who were vaccinated prior to that have questionable immunity to the virus.

These two factors alone underscore the need to destroy this virus.

Release the App - Mitigation Journal Podcast App Available

Release the App...the Mitigation Journal App, that is!

Mitigation Journal now has an app for iPod and iPhone that will allow users access to several content updates. As a Mitigation Journal app user you'll get the weekly Mitigation Journal episodes on an early release schedule...that is, before they hit the main feed. Also, as an app user, you'll get access to two new Mitigation Journal products available exclusively for the app.

You'll get the Lessons Learned segment - a weekly review of emergencies and disasters from around the world...past disasters and current events will be highlighted. You'll want to listen to Lessons Learned to keep pace with the challenges we face today.

As a Mitigation Journal app user, you'll also receive my weekly Situation Update; a weekly review of major events in the realm of fire, EMS, emergency management, and hospital preparedness.

One new app - three great podcasts - Mitigation Journal, Lessons Learned, and Situation Update - all for a one -time purchase of $1.99. Your purchase will supply you with a tremendous volume of relevant content for any responder - and you'll be supporting one of the most popular emergency service/domestic preparedness podcasts on the Internet.


Follow the link to the iTunes app store and get your Mitigation Journal app now for just $1.99.
Link to iTunes app store http://itunes.apple.com/us/app/mitigation-journal-podcast/id389383669?mt=8

Review of Informed Publishing RN pocket guide

Review of Informed Publishing RN pocket guide... a great guide for student and practitioner.

I was recently asked by my friends Informed Publishing to review their nursing pocket guide hard copy  and  mobile application.  I've been continually impressed by the publications from informed in the quality of their mobile applications. Having used a number of their guides and applications over the last few years I've come to expect a pretty high standard. So, while reviewing the RN pocket guide, informed had some pretty high standards to live up to.

As far as overall content is concerned, I found the RN pocket guide to be relevant for the student nurse. This guide met all my standards and needs as a concise reference. The cardiac section was the most useful I found that the cardiac section translated very well into electronic format. The respiratory section was also very useful and the expanded graphics allowed you to increase the size and to get a full page view. The graphics both in hard copy and the mobile application are a major bonus. The mobile application is searchable in several different ways with functions for “touch to expand” and “continue reading” making for a smooth user interface.

Again the graphics in the design of both the application in the hard copy are in pocket guide were superior to other products that look that and the fact that you could explode the graphics to full page size makes visual scanning much easier.

The mobile application for the RN pocket guide by informed publishing has a few extras as well. One in particular that I'd like to talk about is the note function. The note function allows you to type in your own notes related to a specific subject and save those notes. Another important extra of this application is the fact that it automatically updates without any need for registration or continual connection. The application continually updates itself whenever there is an Internet connection.

Find the RN pocket guide here or go to iTunes by clicking here for the mobile application.