Is the end of extrication near?

I originally posted this back in July, 2008. The topic came up again as it has several times. This recent thought on the topic of extrication comes from the latest edition of First Few Moments. Our discussion on extrication, To Cut or Not to Cut, has been one of the best talks on the topic in a while.


So, sit back and enjoy this reprint...from July, 2008.

How long will it be before the evolution of hybrid and alternate fuel vehicles changes the way we open vehicles and extricate trapped occupants? Will the cutting and tearing, muscle and sweat of hydralic tools become a thing of the past?

Interesting questions: no clear answers. The point, though, is that hybrid and alternate power vehicles have construction features and hidden hazards that will make traditional methods of disentanglement obsolete if not a potentaly harmful to the rescurer.

We shouldn't be suprised by this prediction...after all, we've seen changes in automobile construction that spured tactical changes before. You may remember at time when you could cut into a vehicle, gain a purchase point and move metal with some predictability. Perhaps those cars build prior the the 1980's fit here. After 1980, cars seemed to scale down and we saw less steel and more plastic. Frame construction changed as well as location of fuel lines. Plastic replaced steel in dashboards and crumple zones became an industy standard. Not long into the 80's traditional bumbers evolved (disapeared) and the airbag with its deployment system began to evolve.

From metal to plastic, frame to unibody, bumper to airgag, responders have adjusted thier extrication tactics and tecniques to fit the situation. Hybrind and alternate fuel vehicles represent the next generation of chage. The adjustment, however, will need to factor in hazards associated with the vehicle in evreyday conditions...not just in crash situations.

Perhaps the bigest concern is the use of high voltage electrical systems througout hybrind and alternalt fuel vehicles. These electrical systems are often hidden within the vehicle structure and rescures are advised not to cut into them. The charge and discharge time of an electrical system varries widly with vehicle manufacturer and the rescuer should consider the system "live" during extrication efforts. The location and potential hazard of high voltage cables have created "no cut zones" and limit the use of traditional operations such as roof removal and a dash roll-up. Even lifting a stearing colum may have to be avoided. Vehicle stabilization operations may also have to change as electrical system components become exposed during collision. The simple act of box cribbing under hybrind vehicles could expose rescures to damaged, live electrical conduting systems.

While we'll see less petrolium (gasoline) product, larger battery systems, high voltagae converters, additional acids, and fuels such as hydrogen will add another dynamic to controling hazards.

NIMS is dead

NIMS is dead...you still have to take the classes and jump through the hoops...but the practice is dead. Few if any local governments or response agencies are truly NIMS compliant and the NIMS CAST has become just another checklist - to "say" we've done it. In reality our practice of NIMS under the National Response Framework is no better off at improving on-scene coordination and interoperability than twenty years ago.

Example? Example, please, you ask? How about the Nations largest city encountering a total failure of responsse to a preditced snowstorm...and then fires the EMS Chief. Further, a lack of coordination continues between traditional response groups. No intel sharing, little if any interoperability. In some cases continual and intentional withholding of critical infrastructure data and assessments.

And perhaps worst of all is the absence change to the antiquated hierarchy...that is we allow certain groups of traditional responders to be treated as second-class citizens within the incident command structure. The so-called NIMS trained "command" personnel continue to ignore a unified command structure or even to allow for input from other traditional response disciplines...despite our collective (supposed) universal NIMS training.

More to come.

Post Retraction

 Post Retraction
The post of 1/20/11 has been removed by individual request.
We sincerely apologize for any impression of impropriety.

The Arizona shootings

The Arizona shootings… a failure of mental health care, not political.


The tragic shootings in Arizona are a representation of many things. None of them are political.

The accused perpetrator of this terrible event seems to have a well-known history of mental illness. Of course, we find out about all the people who had concerns and voiced those concerns after the fact. This shooting in Arizona is more about mental illness and civil rights than it is about politics or gun control.

The young man who stands accused of shooting innocent civilians (including a nine-year-old girl ) and the congresswoman seems to have gotten the attention of family, friends, and educators because of his unstable demeanor and assumed mental illness.

While many people are asking how this person could've gotten his hands on firearms, I'm asking “why did he not get treatment?”

I think this answer to that question is the fact that nobody wanted to violate his civil rights and force treatment on him. This despite him being violent or unstable enough to be barred from schools and other locations.

How many violent events will it take for us to recognize these problems and take them seriously?  It seems that after the Virginia Tech massacre, the assaults on Fort Hood, and this deadly rampage in Arizona, that we look back and recognize the warning signs. They might take the form of postings on Facebook… notes on a personal blog… or even videos posted publicly on YouTube. Regardless of the media, the warning signs are there… and they were there in all of these cases. But no one took action.

Again a matter of concern over violating someone else's civil rights. In the name of political correctness we could not (or would not) mandate someone to treatment or restrict their activities because of their intent. In intent that seems all too clear.

When will we recognize that mental illness has to be taken as seriously as any other medical problems. In fact, I believe that if we were to engage mental health, substance abuse, and substance addiction with the same vigor as we do heart disease, and traffic safety we may very well prevent  this type of event in the future.

MJ Podcast 205:Arizona Shooting, Reducing Health Care/Increasing Risk, Meth without Pseudoephedrine

MJ podcast 205: Arizona Shooting, Reducing Health Care/Increasing Risk, Meth without Pseudoephedrine 

Just a few notes on this weeks podcast. First, we're 'better late than never' this week due to starting a few teaching projects and getting ready to go back to school.

Lets start with my take on the Arizona Shootings. This tragety is not about politics and its not about gun control. It is about attention to mental health and getting people to the help they need. If we devoted the same resouces to mental health, substance abuse and substance addiction that we did to other medical issues, we may avert these types of events. Its amazing to me, that in this environment of "See Something, Say Something" that people recognized the unstable mental situation this shooter displayed...and nobody did anything about it...for fear of violating his civil rights.

Reductions in health care are coming. With these reductions will come shortages in specialized care and access to services for many with chronic conditions. This means that we'll see a sicker population and a widening of the group we call "special needs populations".

Pseudoephedrine has been linked to methamphetamine production. Over the last few years we've tried to stop or slow meth production by limiting access to over the counter cold preparations. According to recent reports...its been a failed effort. New methods for Meth production have sprouted with all the new hazards to go with them. Top on the list is the Shake-N-Bake methods of meth production.

Biologic Effects of Radiation #3: Acute Radiation Sickness

This multi-part  series of articles will focus on radiation and biological effects. We'll cover the basics of radiation as well as the phases and syndromes associated with radiation exposure. In part one of this series we provided an overview of radiation sources, measurement, and an introduction to the biologic effects.  In part two of Biologic Effects of Radiation, we looked at biological effects, acute radiation sickness and associated symptoms and syndromes.

Part Three: Biologic Effects of Radiation, Acute Radiation Sickness

As discussed in part one and part two, the biological effects of radiation are dependent upon the type of exposure a person actually has. Simply stated, the duration of the exposure as well as the intensity of the material play a role. We also have to include the role of personal protection such as Time, Distance, Shielding and its effectiveness.

In part three of our series, we'll discuss the details of Acute Radiation Sickness (ARS). Acute Radiation Sickness (sometimes called Acute Radiation Syndrome) or ARS, occurs when an individual is exposed to a large amount of radiation in a short period time… and acute exposure, or a total doses greater than 100 REM (100 RAD  for gamma radiation).  Acute radiation sickness has a variety of clinical manifestations which can be obvious with some symptoms yet, less than obvious with others. Generally speaking, the clinical manifestations of acute radiation sickness include the following:

• changes in blood cell count, specifically lymphocytes decrease
• vascular permeability changes
• gastrointestinal irritation; nausea, vomiting, and diarrhea
• fever
• hair loss, in uneven patterns
• skin rash, skin burns, in general skin irritation
• vague symptoms such as flu-like symptoms

The appearance of these symptoms may begin within minutes after exposure. In some cases symptoms may not appear for several days. Depending upon the total dose in the body surface area exposed to the radiation, symptoms may disappear after a few days only to resurface with severe illness. Remember, a variable that has to be accounted for is each individuals unique response to radiation and other factors such as age and pre-existing medical condition.

Acute radiation sickness has four phases and may manifest with four separate syndromes.
The four syndromes of acute radiation sickness  are:

• Hematopoietic Syndrome
• gastrointestinal syndrome
• cardiovascular syndrome
• and central nervous system syndrome

The four phases of acute radiation sickness are:

• prodromal phase
• latent phase
• manifest phase (sometimes called the period of illness)
• and recovery or death

 Hematopoietic Syndrome  effect the blood cells and platelet counts. Generally speaking the lymphocyte count begins to drop and is seen is the earliest marker or indicator of the degree of severity of exposure and subsequent acute radiation sickness.  There are a variety of complications associated with Hematopoietic Syndrome  including infection and internal hemorrhage. Changes in lymphocyte counts are detected or measured on a Andrews Curve. The Andrews curve graphs the lymphocyte count for the first 48 hours. In addition to being a marker for severity of exposure to radiation,  decreasing lymphocytes are also all marker for treatment and prognosis. In many cases red blood cells and red blood cell production remains fairly normal after radiation exposure. Neutrophils decline in a gradual rate, while platelets may decrease slightly over time. Again, lymphocytes and lymphocyte counts are critical for determining the degree of severity of acute radiation sickness.

Gastrointestinal syndrome is a condition in which the epithelial lining of the G.I. system is gradually destroyed. Epithelial cells decline in results in nausea, vomiting, diarrhea, and sepsis. Sepsis is a result  of the loss of protective barrier that separates normal bacteria from the bloodstream. Gastrointestinal syndrome may impact the lower G.I. or upper G.I. tract, or both. In the lower G.I. system bloody diarrhea (frank in nature) is most common.

Large doses of whole body radiation can cause Central Nervous System and Cardiovascular syndrome. Both are caused by a destruction of blood vessels and an increase in capillary permeability. Symptoms usually appear fairly rapidly and take the form of cerebral edema, pulmonary edema, cardiogenic shock, and death. Victims exposed to large amounts of whole body radiation may often die within 72 to 80 hours, often before the symptoms of G.I. syndrome or hematopoietic  develop.

Acute radiation sickness may present within four distinct stages. As mentioned earlier, prodromal, latent, manifest, recovery/death. In the prodromal phase (approximately 48 hours after exposure) victims may present with:

• nausea and vomiting, diarrhea
• fatigue and headache
• fluid shifts due to  increased permeability and electrolyte losses

 In the latent phase the victim may show signs of improvement. Depending upon the unique variables of the person and the dose/rate/body surface area of exposure, this improvement may be temporary. Symptoms may return in 24 hours to several days with greater severity.  The manifest illness stage produces compromise to the immune system and can present with symptoms of any one or all of the syndromes  (hematopooietic, GI, CV/CNS) discussed earlier. Symptoms may also be seen in major organ systems; particularly in the integument, neurovascular and G.I. systems of the body. The final stage of acute radiation sickness is the recovery or death stage. Unfortunately, treatment at this point is supportive in nature and the outcome is determined by the dose of radiation exposure and the body surface area along with the other variables we discussed. It should be noted that after a lethal dose of radiation, victims may progress through each of the four phases rapidly with a quick decline in status.

In part four of our series we will discuss contamination and exposure issues as well as decontamination and monitoring. Will also review the severity levels and associated symptoms/indicators for each level. Later, in our final installment (part five), will discuss issues of planning and preparedness for radiologic emergencies.

Links and References

You'll also find these links and references useful. I've used them, in part and along with references, to put this series together. Again, the complete bibliography will be posted along with the final installment of the series. 


Radiation Injury Treatment Network


Radiation Emergency Medical Treatment (from the U.S. Department of Health and Human Services)


Get the Mobile REMM app, FREE and worth the time!

Biologic Effects of Radiation #2

This multi-part  series of articles will focus on radiation and biological effects. We'll cover the basics of radiation as well as the phases and syndromes associated with radiation exposure. In part one of this series we provided an overview of radiation sources, measurement, and an introduction to the biologic effects.  In part two of Biologic Effects of Radiation, we'll look at biological effects, acute radiation sickness and associated symptoms and syndromes.

Part Two: The Biologic Effects of Radiation

The biological effects of radiation are dependent upon the type of exposure a person actually has. Simply stated, the duration of the exposure as well as the intensity of the material play a role. We also have to include the role of personal protection such as Time, Distance, Shielding and its effectiveness.

Biologic effects can be categorized generically as acute or chronic. Acute exposure may be for a very short period of time to a higher level radiation source while chronic exposure can either be in extended exposure to low-level source or repetitive exposures to a variety of sources of radiation.
One variable that we have to account for his individual biological differences. Each person is different and will respond differently to radiation exposure… unless it is an extremely high-level of exposure.

In general, radiation causes three major problems in our bodies.

• Radiation can damage DNA and other cellular structures
• Radiation exposure results in cell death… immediately or shortly after exposure
• Radiation exposure results in incorrect cellular repair and mutations that can cause cancer and other disease

 As I mentioned earlier, there are biologic factors that are unique to each individual. The effects of radiation on each person differs in their biologic response to any given dose of radiation. The factors that influence radiological impact on the body include:

• age- Younger patients and those with a higher metabolism and cell turnover rate are more susceptible.
• sex
• diet
• body temperature and overall health

Acute radiation sickness can occur when an individual is exposed to a large amount of radiation in a short period of time… that is, an acute exposure. This level of exposure may be defined that radiation doses greater than 100 REM which is equivalent to 100 RAD for gamma ray exposure. The signs and symptoms of acute radiation sickness vary by the dose received and by the unique biologic factors of each individual. Symptoms can be as subtle as “flu-like” symptoms or as dramatic as rapid changes in blood cells. In general acute radiation sickness generates the following:

• nonspecific (flu-like symptoms)
• hair loss
• fever
• skin irritation
• vascular changes
• blood cell changes

While the initial symptoms may seem minor such as with G.I. upset, it should be noted that the sooner a person vomits or loses consciousness after cute exposure, indicates severe exposure in the potential for poor outcome. Generally speaking the severity and course of treatment depend on how much total doses been received as well as how much of the body has been exposed. Again, individual susceptibility to radiation has to be taken into account as a variable. Acute radiation sickness is not an all-or-nothing proposition. The symptoms may appear shortly after exposure only to disappear after a few days. Symptoms may also reappear in a much more severe illness later on.

Acute radiation sickness has four phases and may manifest with four separate syndromes.
The four phases of acute radiation sickness are:

• prodromal phase
• latent phase
• manifest phase (sometimes called the period of illness)
• and recovery or death

The four syndromes of acute radiation sickness  are:

• Hematopoietic Syndrome
• gastrointestinal syndrome
• cardiovascular syndrome
• and central nervous system syndrome

 In part three of Biologic Effects of Radiation, we'll take a look in detail at the phases and syndromes of acute radiation sickness.

Links and References

You'll also find these links and references useful. I've used them, in part and along with references, to put this series together. Again, the complete bibliography will be posted along with the final installment of the series. 


Radiation Injury Treatment Network


Radiation Emergency Medical Treatment (from the U.S. Department of Health and Human Services)


Get the Mobile REMM app, FREE and worth the time!

MJ Podcast 204: Fire Departments and Homelessness, Transport in Crisis Situation, FDNY EMS Chief

Click for edition 204

MJ Podcast 204: Fire Departments and Homeless, Transport in Crisis, and FDNY EMS Chief.

Of Fire Departments, Vacants, and Homeless. Today's fire service participates in a variety of fire safety activities. Anything from traditional fire safety that's taught in schools to children, fire safety education for seniors and community living centers, and even how to install child safety seat in your vehicle has become part of the fire safety training initiative. So, my question is: why not get the fire service involved in special needs populations and serving the homeless? We've seen several fires that have occurred in vacant or abandoned structures where an aggressive interior attack has been carried out because “there might be homeless people” in there. Isn't it time the American fire service took an active role in assisting the underserved members of their community? Would it not make sense that by providing adequate shelter for the homeless, we would be less likely to initiate that aggressive interior attack in a vacant structure.

A number of situations have erupted out of the snowstorm that hit New York City in the East Coast last month. One of the lesser discussed topics has been that of transportation of EMS patients by a non-ambulance vehicle. There are reports of sick people being transported to a hospital  fire apparatus   during this snow event. These transports have seemed to have set some people on edge. We have to remember that during crisis situations (and this was a crisis situation in New York City) people will need to be transported, and indeed, will be transported by any means available. Remember, in crisis or disaster situations… it's no longer a standard of response is a sufficiency of response.

Also coming out of the snowstorm event in New York City is the demotion of the EMS chief for FDNY It's. For some reason, the EMS chief has been reassigned with the administration citing a need for change in leadership after the storm. While there are rumors and speculation of pre-existing problems with this EMS chief, the outward appearance is that he is being removed from his position because of the storm response. I've written about this frightening situation where EMS personnel are held accountable for failures of local government before. See the Mitigation Journal blog post EMS under the bus in Pittsburgh for more detail.

EMS takes fall for storm failure

CNN: NYC EMS chief replaced over storm response. 

 How many events does it take to start a trend?  One? Two?  More? Further, how do you know when that trend has been started? And when is it time to take an action against a “trend”?

I usually don't write a blog posting when I'm angry… with few exceptions.

This post will be one of those exceptions.

I just read an article posted on CNN.com informing us that the New York City emergency medical services chief has been replaced as a result of the recent snowstorm response. This will be the second time  in under one year that EMS personnel have been terminated or demoted because of their actions during a major community crisis. Both cases were predicted, natural events...a snowstorm in the winter.

You might remember back in February of 2010 when Pittsburgh, Pennsylvania was under a major snowstorm. (See EMS Under the Bus in Pittsburgh, Mitigation Journal, 2/28/10) It was reported that a woman called EMS repeatedly over 30 hours and did not receive an ambulance. Reports from that incident indicate ambulances could not get within several blocks of many patients because of a major snowstorm.  EMS personnel were chastised publicly by government officials because they didn't "get out and walk" to patients. Ultimately, at least one person died and many did not receive ambulance service for prolonged periods of time. The outcome? A number of Pittsburgh EMS paramedics relieved of duty or fired.

Several commonalities exist between Pittsburgh Pennsylvania in February, 2010 and New York City in December, 2010. In both Pittsburgh and NYC:

• we saw a predicted major snow event. 

• we saw a failure of local government and public works to be able to effectively manage the snowfall… that is, an inability to plow the roads.

•  there were reports of the 911 system being overwhelmed with calls and vehicles unable to respond because roads were not passable.

• we have seen reports of tragic deaths as a result of the situation.

• emergency responders have been blamed for the failed response.

This is a disturbing trend. A trend that can be traced to hurricane Katrina (Dr. Ana Pou)  and other disaster situations.

According to NYC Fire Commissioner Salvatore Cassano as reported by CNN

"Last week's blizzard presented tremendous challenges for the Department that are currently being addressed with an eye toward improving performance going forward,"..."Despite Chief Peruggia's dedicated service to this Department, I felt new leadership was needed at this time,"

 Are we to believe (or are we being led to believe) that this EMS chief is being held responsible in some way for the failed response to the snowstorm? The fact of the matter is, in both Pittsburgh and New York City, the local government failed in its mission to provide basic services during a time of crisis.

In both cases the storm was predicted well in advance. Yet, New York City (the largest city in our nation) was not able to plow the streets or even to make them passable for ambulances. Now in the wake of tragedy and scrutiny the EMS leadership is faulted and fired. This despite accusations of sabotage on the part of public Works.

 The bottom line is that New York City was not prepared for this natural, predicted, expected event. What are we to think when the nation's largest city with overwhelming resources is not able to handle a predicted natural event? How can we think (or even say) that we are prepared for anything?

And how long will we go on blaming those further down the food chain for the failures in preparedness of local government?

The EMS chief in New York City is no more responsible for the failed response than you or I.

If there is proof that employees of the sanitation Department of New York City participated in sabotage of the response to this snow emergency, then there should be criminal as well as civil liability. But, at the end of the day it is the city of New York that has failed.

 What will happen when the next event is not predicted?

You can read the full article here.

Biological Effects of Radiation #1

This multi-part  series of articles will focus on radiation and biological effects. We'll cover the basics of radiation as well as the phases and syndromes associated with radiation exposure. In this post we'll provide an overview of radiation sources, measurement, and an introduction to the biologic effects.

Biological Effects of Radiation Part 1 Radiation Basics

Potential Radiation Sources...the threat is not just from terrorism. The threat or potential of harmful radiation can be expected from a variety of sources. These sources include, but are not limited to:

• Nuclear weapon
• Nuclear power plan accidents
• Transportation and waste storage accidents
• Military accidents
• Vandalism
• Terrorism

Rules for Radiosensitivity...made easy

“The sensitivity of cells to irradiation is in direct proportion to their reproductive activity and inversely proportional to their degree of differentiation.” (Bergonie and Trubondeau)

What this means is:

• The faster turnover rate (reproduction rate) a cell has the greater radiation exposure will effect it.
• Unborn children and young children are affected more.
• Effects can be terotgenic or mutagenic. 

Dose Rate Effects

Dose RATE is a significant factor for the biological response to a given dose of radiation exposure. As the dose rate is decreased and the exposure time is increased, the biological effect for a given dose is decreased.

What this means is:

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

Units of radioactivity measurements

In order to understand the effects of radiation on a cell, tissue or organism three units of activity must be looked at. The three units of activity that are of concern to patient care are:

• Units of activity.
• Units of radiation dose or deposited energy
• Units of biological dose equivalent.
• Units of activity

A radioactive substance can be characterized by its activity or rate of decay. The units measuring radioactive decay are:

• The Becquerel (Bq) or disintegrations per second:
• 1Bq = 1 disintegration per second

• The Curie (Ci)
• 1 Ci = 3.7 x 1010 Bq

Units of radiation dose

Units of radiation that is absorbed (the dose) of any radiation type and in any material is defined as the amount of energy deposited or received. The units of absorbed dose are:

• The radiation absorbed dose (rad)
• 1 rad = 0.01 Gy
• 1 Gray (Gy) = 100 rad

Types of radiation injury

• Whole body radiation
• Partial body radiation
• External contamination
• Internal contamination
• Combined radiation and traditional injuries

Local radiation injury

1. Frequently involves the hands
2. Acute Radiation Syndrome (ARS) is rare
3. Traditional wound management is not effective

Links and References

You'll also find these links and references useful. I've used them, in part and along with references, to put this series together. Again, the complete bibliography will be posted along with the final installment of the series. 


Radiation Injury Treatment Network


Radiation Emergency Medical Treatment (from the U.S. Department of Health and Human Services)


Get the Mobile REMM app, FREE and worth the time!

Top Ten of 2010

Are you the resolution-making type? I'm more inclined to reflect back of the successes and areas of improvement from the past year. The intent is not to resolve, but to plan...a steady plan of improvement.

I'd like to share the...lets call it..."best of 2010" or "year in review" from Mitigation Journal.

Top blog postings in 2010

E. coli:A Cause of Renal Failure and Disseminated Intravascular Coagulation was the most-read post in 2010. This topic originally posted way back in September, 2007 and I was a bit surprised to see how popular it has remained. In fact, its been read over 3000 times in 2010. It was read under 100 times when it originally posted. Kind of interesting, isn't it?

Homemade Chemical Bombs: A Legitimate Threat to Responders, originally posted August, 2006 was read by 2500 readers in 2010. This is getting interesting from two directions. First, the most read posts on my blog in 2010 were written three or four years ago. Second, I took a fair bit of criticism about wiring both. In fact, after the Homemade Chemical Bombs post, I was accused of being "too alarmist" and that I was making something out of nothing. Unfortunately, these events continue to go under reported and their dangers under appreciated by fire, EMS, and law enforcement. Interest must be there, it was a popular topic in 2010.

Paramedic Future posted in July, 2009 and was intended to spark debate about what EMS technologies would be beneficial. We received quite a bit of feed back on this one...little on technology...most focused on evidence based treatment.

And now, the only post in the Top Ten that was actually written in 2010 comes in at number 4. Why would hand foot and mouth disease stop air travel? was posted in October after a plane load of people were quarantined as someone noticed a child with a centrifugal pattern rash and fever.

Duty to Act in New York was a post that surprises me even today. We blogged about the two NYC EMT/Dispatchers that walked out of a coffee shop after being told about a pregnant woman having a seizure. The woman and baby died. There was some "flash" national coverage, but the enduring debate centered on what we would do if we were there. In 2010 this post was read 1320 times and continued to be a topic on the Mitigation Journal podcast.

Chemical Assisted Suicide and Possible Chemical Suicide in Ontario both registered over 700 reads in 2010.  I was again accused of being too alarmist when originally posting about chemical suicide...mainly by the "it can't happen here" crowds around the country. Some uniformed responders locally actually thanked me for posting on the topic. Behind the scene, and quite unofficially, I was told my research and this posting generated a bit of embarrassment on some fire service leaders. Interestingly, a few documents from a certain fire service contained a nearly word-for-word recital of this post. A certain state publication came out with the same wording and references. Of course, there was no mention of Mitigation Journal.

CYANIDE: The Deadly Partner of Carbon Monoxide was a posting made in an attempt to bring attention to the all-hazards approach. This posting was read over 600 times in 2010 and referenced by several mainstream publications!

Meth Labs and Propane Cylinders warned of the dangers of anhydrous ammonia storage and meth labs. Originally posted in 2008 got 550 hits in 2010.

And finally, This app advances BLS! posted July, 2010 and is the second posting actually written in 2010 to make the list. I used this post to spur interest in medical/EMS apps. A special thanks to our friends at Informed Publishing for letting me review the apps.

MJ Podcast 203: Snowstorm uncovers poor planning, No refusal of breath tests for New Year

Click here for edition 203

And, we're off! Welcome to 2011...

This week Matt and I will try to shovel our way through the "blizzard" that hit the east coast last week. We'll focus on the events in NYC. Why was this such a major event? Where was the preparedness on the part of non-traditional responders? When non-tradition responders fail, infrastructure fails, and responders fail. The result; greater impact on the community.

We also go over our list of predictions for 2010 and how well we did. Join us for the full story.


Matt brings up a great topic from the mainstream media. According to Matt's research, there has been an injunction requiring all persons pulled over by police with suspicion for driving while intoxicated will no have the ability to refuse a breath test. The question is, why only this weekend? Why only on on New Years? Sounds like this tactic should be used everyday.


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