Immediate Actions at Bus Crashes ...there are quite a few to think about. Establishing command and control of the scene is paramount. Today I'll focus on some points for the responders working on operations and we'll save the C&C for another post.
So, from an operations perspective, especially for those arriving early in the situation. A few "quick tips" if you will:
Size up - don't get tunnel vision and focus only on the bus. There most likely is another vehicle involved. For more on this, see Mitigation Journal post First in? Think first! and tune into the First Few Moments podcast at firstfewmoments.com
The fatality/injury ratio is proportional to the size of the vehicle that hit the bus (or that the bus hit). Keep this in mind when you arrive.
Think about where kids like to sit. Prepare for entrapment or multiple casualties in the back of the bus.
Expect exits will be unusable. They'll be blocked by bodies or debris. Side exits are not usable if the bus is on its side. If you can use existing exits, I recommend doing so. If not, make the exits bigger and use them. As a last resort; make your own openings.
July 22, 2010
July 19, 2010
First in? Think First!
We just finished recording the First Few Moments podcast #3 the other night. The topic was So, you're first in...Now what? We had an All-Star cast including Wilma Vinton, Chris Montera, and Kyle David Bates.The discussion was lively...with viewpoints that as vast as the difference between Rochester, NY and Fairbanks, AK. If you haven't checked out First Few Moments, now is the time.
I was asked to chime in and, of course, had my own take on things.
I was asked to chime in and, of course, had my own take on things.
"So, you're first in...Now what?"
- First of all, know where you're going before you're first in. Pre-plan (FD is real good with this, EMS not so much) - do you have areas of your district that are notorious for bad thing happening? A place where the bad wreck always occurs...a high hazard area, lots of commercial traffic, hazardous materials, or a roadway location that could impact a target hazard building or site? Tunnels and bridges fall into this category as well, as do locations with poor visibility. Areas that change hazards with the changes in the environment should also be considered. Knowing where your going also means knowing how to get there and get out...alternate routes for both! Table talks on these locations make for great "quick drills" for new members and the seasoned veterans.
- Do something smart with your apparatus. Placement of first in apparatus can make or break the entire event. You can promote scene safety or put responders at risk. Know what other services are responding with you...fire department, EMS, law enforcement...and have an understanding of their operational priorities. No, you don't need to know everyone's standard operation procedures, just an awareness will do. Doing so may help prevent conflict and keep you from getting blocked in...or out. Also, when it comes to EMS appatus placement, begin with the end in mind. That is, think about how you're going to get out before you get in.
- And finally; don't just do something, stand there. Take the time to do a good size-up of the situation and report your findings back to the communication center and other responding units. Resist the urge to rush in - prevent tunnel vision - just take the few seconds needed to gain preliminary situational awareness. To be a little more detailed; use the Two x 360 method...a 360 big circle of the event on the ground and a big 360 that looks above and below the incident. Remember, size up is dynamic...and you have to report changes or your findings mean nothing.
July 12, 2010
NORAD v. Cessna
Dear NORAD,
I was reading last week about how many "incursions" Russian naval and aviation forces have made near or into the United States over the last several months. Russian nuclear subs in international waters off both coasts, and bombers flying through U.S./Canadian airspace. Real Cold War stuff. Now, when I think of Cold War "incursions" by the Russians, I hear horns and klaxons and imagine fighter pilots racing across the tarmac, jets scrambling...the kind of thing you'd see when Godzilla was sighted...and backyard bomb shelters; you get the idea.
But, not so in today's world. The North American Aerospace Defense Command, NORAD, commander Adm. James A. Winnefeld Jr. is quoted in a recent Washington Times article:
But this situation is not all that has me wound up. Another story posted by CNN tells us the NORAD actually scrambled two fighters because a CESSNA violated "Obama airspace" over Las Vagas, Nevada. Okay, I can see the point of that. We've seen what kind of damage a civilian single-engine Cessna can do to a building...remember the kook who flew his plane into the IRS building in Austin, TX back in February, 2010 in an act of Domestic Terrorism? Oh, wait..it wasn't terrorism. Just a criminal act. (so that means we scramble fighter jets for the "criminal act" of violating Obama airspace...?)
Dear NORAD,
The point of all this is:
Next week: Building your own bomb shelter.
This is a CESSNA:
This is a RUSSIAN STRATEGIC NUCLEAR BOMBER:
I was reading last week about how many "incursions" Russian naval and aviation forces have made near or into the United States over the last several months. Russian nuclear subs in international waters off both coasts, and bombers flying through U.S./Canadian airspace. Real Cold War stuff. Now, when I think of Cold War "incursions" by the Russians, I hear horns and klaxons and imagine fighter pilots racing across the tarmac, jets scrambling...the kind of thing you'd see when Godzilla was sighted...and backyard bomb shelters; you get the idea.
But, not so in today's world. The North American Aerospace Defense Command, NORAD, commander Adm. James A. Winnefeld Jr. is quoted in a recent Washington Times article:
"...beginning a couple of years ago, Russian strategic aviation forces began stepping up training flights of nuclear-capable Tu-95 Bear bombers near or through U.S. and Canadian airspace..."And that means...?
"They are trying to show the world that they are a powerful nation, and we're not giving them the satisfaction … ."So, do we do anything about it? Like in Top Gun; have a US fighter pilot flip 'em off or something?
"If we intercept every single flight that comes out in our direction, then we're really just feeding into their propaganda,"No, really. What do we do?
"So we intercept them when we feel like we ought to, and we have various criteria that we use for that, to include just rehearsing our own skills to be able to do that."Oh, OK. Is there anything else NORAD can do?
"we just leave them alone,"...[the Obama administration has] "done a good job of trying to hit the reset button with these guys, and sooner or later they've got to respond." Above quoted taken from the Washington Times on-line article.Sooner or later they've got to respond!? Respond with what!? Anyone else see the problem here? Can you immagine where we'd be if we took this stance during the Cuban Missile Crisis?
But this situation is not all that has me wound up. Another story posted by CNN tells us the NORAD actually scrambled two fighters because a CESSNA violated "Obama airspace" over Las Vagas, Nevada. Okay, I can see the point of that. We've seen what kind of damage a civilian single-engine Cessna can do to a building...remember the kook who flew his plane into the IRS building in Austin, TX back in February, 2010 in an act of Domestic Terrorism? Oh, wait..it wasn't terrorism. Just a criminal act. (so that means we scramble fighter jets for the "criminal act" of violating Obama airspace...?)
Dear NORAD,
The point of all this is:
This is what a CESSNA can do to a building:
And, this is what a RUSSIAN STRATEGIC BOMBER can do to the Nation:
Next week: Building your own bomb shelter.
July 10, 2010
EMS Points to Remember
Just a couple of points to remember...for anyone who delivers emergency medical service:- If the person is unconscious, lay them down and open the airway. Its called putting them supine and its the beginning, not the end of care. But don't hold them up because it looks more natural...they're unconscious for a reason and probably don't care how they look.
- If the person is having trouble breathing, don't let them lay down. Especially if they are tired. Sit them up. This is called Fowler's position and you have some choices; low- semi- or high-Fowler's. It will make it easier for them to breath and easier to assess.
July 9, 2010
The First Rule of Preparedness
The First Rule of Preparedness is: Make sure you love your God, your country and your family more than being popular...
Add this new First Rule of Preparedness to the growing list of Mitigation Journalisms...
- Rule of Outcomes
- Optimism Bias
- Know Your Job, Do It Well
July 7, 2010
Heat Ready
One of the best things we can do for the public we service is to keep ourselves ready to respond. That means we:
- Stay fit and healthy all the time, as best as possible. Remember, how you live off duty will effect your abilities on duty.
- Hydrate, and then hydrate some more. People ask me about the type of fluid to drink all the time. The best answer is...Water, the drink of champions! That's it...water, just water.
- Eat. Fruits and veggies...put them in the freezer or keep them cold.
- Review your rehabilitation program and equipment. Be familiar with your stuff before you have to use it...in hot weather I recommend early set-up of a rehab unit. Be proactive.
- Listen to a NOAA Weather Radio for critical updates from the National Weather Service (NWS).
- Never leave children or pets alone in enclosed vehicles.
- Stay hydrated by drinking plenty of fluids even if you do not feel thirsty. Avoid drinks with caffeine or alcohol.
- Eat small meals and eat more often.
- Wear loose-fitting, lightweight, light-colored clothing. Avoid dark colors because they absorb the sun’s rays.
- Slow down, stay indoors and avoid strenuous exercise during the hottest part of the day.
- Postpone outdoor games and activities.
July 6, 2010
Heat Wave
The weather man tells us that there is an Air Quality Alert and we're under attack by ozone. So, its not the heat, its not the humidity, its the ozone!
Below you'll find some of the research on ozone and your health...But lets make another point...air quality and ozone may also impact the responder. I think we'll include that in our PRE Habilitation plan and talk more about it in future posts and podcast episodes.
What does this all mean - well, here it is:
Air Quality Alert - as defined by News 10 in Ohio Issued during times (usually on hot, summer days) when ground-level ozone and/or fine particle concentrations unexpectedly reach, or are approaching, unhealthy levels in your area based on monitored values. Sensitive groups are urged to limit their exposure outdoors.
The following is from a great website; AIR INFO NOW Consider the following selections from Air Info Now and check there for more details.
The properties that make ozone a powerful cleaner, disinfectant, and bleaching agent also make ozone dangerous to living tissues.
When it comes in contact with living tissues, like our lungs, ozone attacks and damages cells lining the airways, this causes swelling and inflammation.
Some have compared ozone's effect to a sunburn ... inside your lungs.
Other health effects include: · Irritation of the airway: a cough, an irritated throat, or an uncomfortable feeling in your chest. · Reduced lung function: you may not be able to breath as deeply or vigorously as you normally would. · Worsened Asthma: ozone can aggravate the effects of asthma (see Asthma below). · Potential health effects: ozone may aggravate the effects of emphysema and bronchitis, and may reduce the body's ability to fight infections in the respiratory system. |
High ozone levels can affect anyone.
Some groups of people are particularly sensitive to ozone.
Sensitive Groups · Children They spend more time outdoors, are more active, and their airways are not fully developed. · Adults exercising outdoors Healthy persons engaged in physical activity breathe faster and more deeply. This increases the amount of ozone flowing into the lungs. · People with respiratory disease Ozone can further irritate the airways of persons who already have diseases of the lung or airways. |
Summertime can be ozone time.
First, there may be more ozone around. During the summer months high temperatures and bright sunshine lead to increased ozone formation. Second, people may spend more time outside engaged in physical activities.
Asthma and ozone.
Ozone can irritate the already sensitive airway of someone with asthma. When ozone levels are high, more asthmatics have asthma attacks that require a doctor's attention or the use of additional medication. One reason this happens is that ozone makes people more sensitive to allergens, which are the most common triggers for asthma attacks. (Allergens come from dust mites, cockroaches, pets, fungus, and pollen.) Also, asthmatics are more severely affected by the reduced lung function and irritation to the respiratory system caused by ozone.
Referenced sites:
http://forecast.weather.gov/wwamap/wwatxtget.php?cwa=usa&wwa=Air%20Quality%20Alert
lhttp://www.10tv.com/live/content/weather/stories/story_weather_meanings.html
http://www.airinfonow.com/html/ed_ozone.html
April 21, 2010
Don't Ignore your Infection Control Program!
Don't Ignore your Infection Control Program! This means you...
I hear it all the time - "why do we have to do this "OSHA" training?" Of course they're talking about what should be some of the most important training you'll get all year...infection control and disease prevention.
Far too often infection control training is passed off as a minor topic and not given the appropriate attention. I find this to be the case in many types of services among traditional responders. Well, take a look at this article stating that a hospital worker and police officer became ill after exposure to bacterial meningitis. Cal/OSHA fines to follow.
Don't overlook this important training.
I hear it all the time - "why do we have to do this "OSHA" training?" Of course they're talking about what should be some of the most important training you'll get all year...infection control and disease prevention.
Far too often infection control training is passed off as a minor topic and not given the appropriate attention. I find this to be the case in many types of services among traditional responders. Well, take a look at this article stating that a hospital worker and police officer became ill after exposure to bacterial meningitis. Cal/OSHA fines to follow.
Don't overlook this important training.
April 15, 2010
Its the end of the world as we know it
Well, maybe not. But looking at the video shocked me! Numerous media outlets are streaming video of a massive fireball streaking across the sky. Visible in several Midwestern states, the reason and cause of the fireball remains a mystery.
See the video and article from CNN.com
No terrorist, no zombies, no plague...just Mother Nature. But hey, it can't happen here.
See the video and article from CNN.com
No terrorist, no zombies, no plague...just Mother Nature. But hey, it can't happen here.
March 28, 2010
Hospital Preparedness Still Not "There"
Here is an interesting look at hospital preparedness from Trust for Americas Health and worth the time to read.
"...the H1N1 outbreak also underscored the "existing gaps in public health preparedness." Decades of chronic underfunding of public health meant that many of the core systems that would have been invaluable to have in place during an emergency were not at-the-ready when H1N1 emerged..."In short, after 9/11:
- $8 billion-in all hazards emergency preparedness
- ongoing appropriations of more than $300 million a year at the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), National Institutes of Health (NIH) and Department of Health & Human Services (HHS)
- approximately $15 billion in pandemic-specific investment
February 18, 2010
An attack by any other name...
An attack by any other name...
Small plane was intentionally flown into a building housing a Federal IRS institution. CNN and MSNBC both are reporting the same story. Both sites are featuring video with eerie resemblance to 9-11. Authorities are, once again, quick to note in staunch "nothing to see here fashion" - we have no reason to believe this is a terrorist act -
Perhaps its a matter of not connecting the dots...
Lets connect a few:
Small plane was intentionally flown into a building housing a Federal IRS institution. CNN and MSNBC both are reporting the same story. Both sites are featuring video with eerie resemblance to 9-11. Authorities are, once again, quick to note in staunch "nothing to see here fashion" - we have no reason to believe this is a terrorist act -
Perhaps its a matter of not connecting the dots...
Lets connect a few:
- Man writes suicide note on website
- Man proclaims anti-government rage and 'violence the only solution'
- Man sets own house on fire then flys private plane into building (IRS, CIA and FBI all have offices in the complex where the building that was struck is located)
- And the official speculation is...
"At this time, we have no reason to believe there is a nexus to terrorist activity."What? Maybe we have forgotten the term domestic terrorism, forgotten about government buildings as targets (soft ones). And maybe we've forgotten about places like Oklahoma City and the Murrah Federal Building.
February 17, 2010
Wanna see my mucous plug?
 |
| My Little Mucous Plug |
If you've been listening to the podcast or within the sound of my voice, you know I've been sick with a little chest cold...and annoying cough. Well the other day I coughed this mucous plug out of my (left) lung.
Note the retained shape of the bronchi and smaller airways (at the top left of the picture).
February 15, 2010
Close Schools, No Food
Close Schools, No Food?! What? MSNBC is running a story along with several other web and mainstream media talking about various fallout from the winter storms that have hit the Maryland/Virgina/D.C. area. Living in Western NY, it is somewhat difficult for me to understand how 2-3 inches of snow can close an area down. (I don't bother to shovel the driveway until we get 6 inches of snow!) With that said, this storm dropped more than 2-3 inches; it left 30-35 inches of snow on areas that are not geared to deal with it. That much snow is a show stopper no matter where you are. But the snow is not the point of today's post.
Among the various secondary impacts is the fact that schools are closed and therefore, kids are going hungry, leaving families without any food.
The article goes on:
So, lets ask a few questions...
I also wonder what will happen when the money dries up and the public assistance goes away? Where would this go if it were a prolonged (months, not weeks) worth of natural disaster...Haiti style. But that can't happen here. What all this leads me to is an in-your-face reminder about the population living on the edge here in the most prosperous nation in the world. It's also a reminder that the Ripple Effect of a situation can be just as bad, if not more devastating that the original catalyst event.
When it comes to domestic preparedness in this country, we should point to the map and say "lets pretend this is a country in need of our assistance..."
Among the various secondary impacts is the fact that schools are closed and therefore, kids are going hungry, leaving families without any food.
"The two snowstorms that pummeled the region, leaving more than 3 feet of snow in some areas, deprived tens of thousands of children from Virginia to Pennsylvania of the free or reduced-price school lunch that may be their only nutritious meal of the day...."I can understand the need for reduced price or free lunch programs and support the effort. However, I have to ask how this situation is possible...if you don't go to school, you don't eat?! This snowstorm was predicted well in advance and nobody took the time (knowing they need the supplemental food from schools) to act in advance? To be even a little pro-active...just a little?
The article goes on:
"...about 43,000 children are eligible for free or reduced-price lunches. Some also get breakfast, dinner and bags of staple foods to take home for the weekend."Okay, I can buy the fact that poverty in America is worse that most would like to admit. But to say that kids and by extension, families, will go hungry because the schools are closed is almost unbelievable...I said almost.
So, lets ask a few questions...
- What do you do when a kid is sick and stays home from school? No school, no eat. Right?
- There is no mention of routine absentee rates or drop out rates in the schools. A quick Google search indicates that, if you're not going to school you're not eating...there must be a lot of hungry kids. Even before the snow storm hit.
- How about this...What the heck do these kids do during school breaks and summer vacation!?
I also wonder what will happen when the money dries up and the public assistance goes away? Where would this go if it were a prolonged (months, not weeks) worth of natural disaster...Haiti style. But that can't happen here. What all this leads me to is an in-your-face reminder about the population living on the edge here in the most prosperous nation in the world. It's also a reminder that the Ripple Effect of a situation can be just as bad, if not more devastating that the original catalyst event.
When it comes to domestic preparedness in this country, we should point to the map and say "lets pretend this is a country in need of our assistance..."
February 13, 2010
Swine Flu Numbers
These numbers brought to you by the letters H and N
February 8, 2010
Doing Decon
There have been several instances in late 2009 and early 2010 that highlight the need for emergency decontamination at health care facilities. People contaminated with a hazardous material showing up at random to emergency departments or other health care location poses untold risks to the health care provider, the facility, other patients, and the community. A recent such event at a walk-in urgent care clinic underscored these risks. With the number of walk-in care, urgent care and retail health clinics growing, the issue of emergency decontamination needs to be revisited.
Lets start with the understanding that there is a difference between chemical, biological, and radiological contamination. Chemicals and radiological material is perhaps the most concerning as the longer the material remains in contact with the person, the greater the exposure and subsequent effects will be. Also, if externally contaminated the person may be able to "off gas" or spread the contamination. With chemical materials off-gassing can cause serious inhalation and mucous membrane irritation and secondary contamination in other people. The facility can likewise become contaminated. The spread of radiological contamination has a higher risk of secondary contamination...although the onset of effects will most likely be delayed...and the possibility for occult contamination and extended cleanup measures will be needed. Biological contamination can take the form of a person ill with a disease (flu) or the presence of disease containing solid material...like anthrax in a powder. We should point out here that a difference exists between exposure, contamination and reasonable risk. Exposure simply means you've come in contact with something and may or may not suffer from it. When we talk about exposure we usually are not overly concerned with decontamination unless visible product remains on the person or clothing. Contamination commonly indicates that a residue or material remains on the victim and that material is able to be spread. Contamination comes in two forms...external - able to be spread and internal - not able to be spread. A person who ingests a radiological source most likely would not be capable of spreading that contamination nor would a victim exposed to vapor or gases unless the vapors permiated the clothing. The point is that once a material is inside the body the risk of secondary contamination is much less as is the need for decontamination. Reasonable risk exists when a person has been in an area and, with or without symptoms, is anticipated to have been exposed or contaminated...prophylactic decontamination is warranted.
So, the big question is; who should do decon? At an emergency scene the issue is clear that the jurisdiction having authority in a chem/bio/rad event (most often the fire department) should provide or cause to provide decontamination. The use of low pressure, high volume water streams and improvised shelters may be used in emergency mass decontamination, while specially trained hazardous materials teams may provide a more refined and specific decontamination. The problems begin to arise when victims begin to self-refer to emergency departments or clinics... that is they leave the scene prior to the arrival of traditional responders. This poses a major issue as these victims will likely arrive a health care sites with no warning and no clue as to what they may have been exposed to or contaminated with. When this occurs and goes unrecognized, the health care facility, civilians, and health care providers are at risk. Immediate action will be needed to stave off secondary contamination and serious impact.
Now the question becomes; who should do decontamination at a health care facility? This argument has been going on for years and opinions are highly polarized. One opinion often held by health care organizations is that the local responders will not be able to provide decon services at a hospital during such a large event. This camp believes that hospitals must be able to provide decontamination on their own for a period of time. Still others believe that traditional responders will be able to provide protective services to health care sites by way of mutual-aid from surrounding departments. Both points have concerns. First, how do we expect health care providers, security staff, environmental staff, or others to provide decontamination at a health care site? This is often the pool of personnel that is called upon to take training and carry out the functions if needed. The concerns however, loom large. Who will carry out the duties of those assigned to decon? Will the people mentioned above be able to retain the training information and function in protective clothing, including self-contained breathing apparatus? These issues are just the tip of the iceberg.
Second, while many hospitals in the nation have added some type of decontamination shelter or system to meet requirements most, if not all walk-in care, urgent care and retail health care centers have not. As more and more people turn to these clinics rather than emergency departments for routine care, we must realize that the same level of preparedness must exist for these locations. In the non-hospital clinic setting the need for trained traditional responders doing decon operations is even more vital.
Another issue is the logistics of preparedness for decontamination. Tents and shelters must be trained on and practices with. They must be maintained and checked. Self contained breathing apparatus must also be maintained and personnel continually re-familiarized with its use. Other logistical items that are often forgotten are water supply, cleaning solution, lighting, towels, clothing and runoff management. It is simply not enough for a health care facility to purchase a tent and believe they are prepared.
To wrap this up, let me leave you with a few take-home points:
Lets start with the understanding that there is a difference between chemical, biological, and radiological contamination. Chemicals and radiological material is perhaps the most concerning as the longer the material remains in contact with the person, the greater the exposure and subsequent effects will be. Also, if externally contaminated the person may be able to "off gas" or spread the contamination. With chemical materials off-gassing can cause serious inhalation and mucous membrane irritation and secondary contamination in other people. The facility can likewise become contaminated. The spread of radiological contamination has a higher risk of secondary contamination...although the onset of effects will most likely be delayed...and the possibility for occult contamination and extended cleanup measures will be needed. Biological contamination can take the form of a person ill with a disease (flu) or the presence of disease containing solid material...like anthrax in a powder. We should point out here that a difference exists between exposure, contamination and reasonable risk. Exposure simply means you've come in contact with something and may or may not suffer from it. When we talk about exposure we usually are not overly concerned with decontamination unless visible product remains on the person or clothing. Contamination commonly indicates that a residue or material remains on the victim and that material is able to be spread. Contamination comes in two forms...external - able to be spread and internal - not able to be spread. A person who ingests a radiological source most likely would not be capable of spreading that contamination nor would a victim exposed to vapor or gases unless the vapors permiated the clothing. The point is that once a material is inside the body the risk of secondary contamination is much less as is the need for decontamination. Reasonable risk exists when a person has been in an area and, with or without symptoms, is anticipated to have been exposed or contaminated...prophylactic decontamination is warranted.
So, the big question is; who should do decon? At an emergency scene the issue is clear that the jurisdiction having authority in a chem/bio/rad event (most often the fire department) should provide or cause to provide decontamination. The use of low pressure, high volume water streams and improvised shelters may be used in emergency mass decontamination, while specially trained hazardous materials teams may provide a more refined and specific decontamination. The problems begin to arise when victims begin to self-refer to emergency departments or clinics... that is they leave the scene prior to the arrival of traditional responders. This poses a major issue as these victims will likely arrive a health care sites with no warning and no clue as to what they may have been exposed to or contaminated with. When this occurs and goes unrecognized, the health care facility, civilians, and health care providers are at risk. Immediate action will be needed to stave off secondary contamination and serious impact.
Now the question becomes; who should do decontamination at a health care facility? This argument has been going on for years and opinions are highly polarized. One opinion often held by health care organizations is that the local responders will not be able to provide decon services at a hospital during such a large event. This camp believes that hospitals must be able to provide decontamination on their own for a period of time. Still others believe that traditional responders will be able to provide protective services to health care sites by way of mutual-aid from surrounding departments. Both points have concerns. First, how do we expect health care providers, security staff, environmental staff, or others to provide decontamination at a health care site? This is often the pool of personnel that is called upon to take training and carry out the functions if needed. The concerns however, loom large. Who will carry out the duties of those assigned to decon? Will the people mentioned above be able to retain the training information and function in protective clothing, including self-contained breathing apparatus? These issues are just the tip of the iceberg.
Second, while many hospitals in the nation have added some type of decontamination shelter or system to meet requirements most, if not all walk-in care, urgent care and retail health care centers have not. As more and more people turn to these clinics rather than emergency departments for routine care, we must realize that the same level of preparedness must exist for these locations. In the non-hospital clinic setting the need for trained traditional responders doing decon operations is even more vital.
Another issue is the logistics of preparedness for decontamination. Tents and shelters must be trained on and practices with. They must be maintained and checked. Self contained breathing apparatus must also be maintained and personnel continually re-familiarized with its use. Other logistical items that are often forgotten are water supply, cleaning solution, lighting, towels, clothing and runoff management. It is simply not enough for a health care facility to purchase a tent and believe they are prepared.
To wrap this up, let me leave you with a few take-home points:
- Emergency mass decontamination should be done on site of the event whenever possible
- Hospitals need to be prepared for self-referrals who may be contaminated and that self-referrals can pose a serious risk
- Traditional and non-traditional responders must be able to recognize the incident indicators of chemical/biological/radiological exposure
- Keep in mind that simply removing a victims outer clothing can remove 85 to 95% of contamination
- All victims being transported by ambulance must be decontaminated prior to transport regardless of triage score or severity
February 5, 2010
BOTOX: The next bio terror agent
Several mainstream media outlets have been talking about BOTOX...the cosmetic version of Clostridium Botulinum or botulism as the next possible biological terrorist weapon. Also within the past few days, I've recieved dozens of emails looking for information on BOTOX...many asking if this cosmetic botox could be used as an actual biologic agent. So, I thought this would be a good time to review.
What is bioterrorism? Simply put, bioterrorism is the use of microbes or toxins to cause illness or death, or poison the environment. Microbes such as bacteria and viruses could be used as well as toxins. BOTOX is a toxin. Remember, bacteria and viruses cause an infection while toxins result in inTOXication. Bacterial examples include anthrax, plague, and Tularemia. Virus examples include Smallpox, and hemorrhagic fevers. While toxins include botulism and ricin.
What is Botulism? Botulism toxin has several forms; toxin A - G...they are all some variety of Clostridium Botulinum. The cosmetic BOTOX is the toxin A variety and its estimated that it would take a huge amount of cosmetic BOTOX to cause serious biological threat. With that in mind, we have to reinforce the fact that BOTOX is BOTOX...cosmetic grade or pure strength. The symptoms are the same and the lethality is always a potential. In fact, there have been several deaths related to cosmetic BOTOX in the United States. We should point out that there are other medical uses for this toxin. BOTOX can be used to treat muscular diseases. In fact, a tragic case in California has highlighted the dangers of medical botox as a seven-year-old girl who was undergoing botox treatments for her cerebral palsy has died, attributed to the toxin treatment.
Alright, what are the symptoms of botox intoxication? First, you've got to remember that botox is botox...medical, cosmetic or pure toxin. If used improperly, with an incorrect dose, poor injection/administration technique, or intentional exposure to the pure toxin...the symptoms are the same. The general incubation period is 24 to 36 hours after exposure. By the way, estimates are that a single gram pure botulinum is enough to kill one million people. Botox in general causes weakness, descending flaccid paralysis and eventually respiratory failure. Botox enters the nervous system via the bloodstream, binding to the receptors of peripheral synapses. Again, all forms of Botox act in the same way...making the point that all forms of Botox have the potential for intoxication and the same set of neurological symptoms. The binding to peripheral synapses stops the release of Ach and the production of AchE.
The specific symptoms are:
Care is mainly supportive...not good news. Ventiliatory support, feeding support and mechanical ventilation may be needed for as little as 6-8 weeks or as much as 7 months.
With all that in mind, Botulinum Toxin being the most deadly toxins known is certainly capable causing thousands, maybe even millions of deaths, with a very small amount. The question then becomes one of production, availability, and dissemination.
Read Fatal Botox Reaction on MSNBC.com
Read Botox as next bio terror weapon in the Washington Post
What is bioterrorism? Simply put, bioterrorism is the use of microbes or toxins to cause illness or death, or poison the environment. Microbes such as bacteria and viruses could be used as well as toxins. BOTOX is a toxin. Remember, bacteria and viruses cause an infection while toxins result in inTOXication. Bacterial examples include anthrax, plague, and Tularemia. Virus examples include Smallpox, and hemorrhagic fevers. While toxins include botulism and ricin.
What is Botulism? Botulism toxin has several forms; toxin A - G...they are all some variety of Clostridium Botulinum. The cosmetic BOTOX is the toxin A variety and its estimated that it would take a huge amount of cosmetic BOTOX to cause serious biological threat. With that in mind, we have to reinforce the fact that BOTOX is BOTOX...cosmetic grade or pure strength. The symptoms are the same and the lethality is always a potential. In fact, there have been several deaths related to cosmetic BOTOX in the United States. We should point out that there are other medical uses for this toxin. BOTOX can be used to treat muscular diseases. In fact, a tragic case in California has highlighted the dangers of medical botox as a seven-year-old girl who was undergoing botox treatments for her cerebral palsy has died, attributed to the toxin treatment.
Alright, what are the symptoms of botox intoxication? First, you've got to remember that botox is botox...medical, cosmetic or pure toxin. If used improperly, with an incorrect dose, poor injection/administration technique, or intentional exposure to the pure toxin...the symptoms are the same. The general incubation period is 24 to 36 hours after exposure. By the way, estimates are that a single gram pure botulinum is enough to kill one million people. Botox in general causes weakness, descending flaccid paralysis and eventually respiratory failure. Botox enters the nervous system via the bloodstream, binding to the receptors of peripheral synapses. Again, all forms of Botox act in the same way...making the point that all forms of Botox have the potential for intoxication and the same set of neurological symptoms. The binding to peripheral synapses stops the release of Ach and the production of AchE.
The specific symptoms are:
- Diplopia or double vision
- Dytharthia, difficulty walking secondary to descending paralysis of skeletal muscle
- Dysphonia or trouble speaking
Care is mainly supportive...not good news. Ventiliatory support, feeding support and mechanical ventilation may be needed for as little as 6-8 weeks or as much as 7 months.
With all that in mind, Botulinum Toxin being the most deadly toxins known is certainly capable causing thousands, maybe even millions of deaths, with a very small amount. The question then becomes one of production, availability, and dissemination.
Read Fatal Botox Reaction on MSNBC.com
Read Botox as next bio terror weapon in the Washington Post
'Fun-Size' Terrorism
'Fun-Size' Terrorism is not a term relating to an attitude toward terrorism. No, not at all...let me explain;
Have you ever been out on Halloween? Of course. You dress up in costume and go out expecting to get a variety of candy. Sometimes you get back and find out that the candy you got was not exactly what you expected. People dump those fun-size candy bars in your bag, not quite the event you expected but gets the point across.
Well, with that in mind, lets look at our expectations and preparations for acts of terrorism or intentional events. We've been told what it means to live in the "post 9/11" era and how we must be prepared for the next terror attack. Nobody will tell you what the next attack will look like and so we believe and plan for what we've seen in the past...another 9/11-style attack. In short we've fallen into the trap of believeing the biggest or last major event we've experienced is the worst we will ever see. Nothing could be further from the truth! In short, we're preparing (and have been) for the wrong type of event...that's my opinion anyway.
I think we're going to see another attack on the United States and many other sources believe it will be in the not too distant future. While I'm not willing to commit to a time frame, I am comfortable relating my opinions as to what the next terrorist attack will look like. No, I don't think we'll see another attack on the same size and scope of September 11, 2001, rather I think we'll see a "fun-size" smaller and coordinated multiple simultaneous attacks version. I would also predict that these smaller, coordinated intentional events will be aimed at soft targets...those locations of infrastructure that lack defensive protection or deterrence.
Specifically, I'm talking about locations such as shopping malls, ground transit hubs, health care facilities, sporting events, and hotels and coffee shops. The impact of bombings or other events on these locations...especially if they're coordinated in multiple locations across the country...will have a significant death toll as well as a devastating ripple effect. These smaller attacks will be harder to predict and intercede on. The impact on a community and economy will be huge. Consider the possibility of mass casualty events coupled with a lack of surge capacity or total loss of local hospitals.
The failed attempt to bomb an airliner on Christmas Day, 2009 is an indication that independent individual attackers are a potential threat. Often referred to as "Lone-Wolf" attackers, these individuals may have a loose affiliation and training with well-funded, established terror groups. They may also be individuals with no affiliation but share an ideology or sympathy with terrorist groups. Smaller than coordinated terrorist cells, these lone-wolf attackers could easily infiltrate soft target locations and carry out attacks with conventional explosives, chemicals or even biological materials. As an aside, while the impact of an explosive attack will be huge...the impact of a biological attack (biological bomber style) is almost unimaginable.
McVeigh, Rudolf, and Kaczynski are all names in our domestic terrorism history that we should keep in mind and even study as a means to appropriate pre-plan and train for what might be ahead. We should also keep in mind the ever-present threat posed by domestic groups; hate groups, supremest groups and Ecological groups. Keep in mind that multiple smaller attacks will be just as devastating as a focused single event.
Have you ever been out on Halloween? Of course. You dress up in costume and go out expecting to get a variety of candy. Sometimes you get back and find out that the candy you got was not exactly what you expected. People dump those fun-size candy bars in your bag, not quite the event you expected but gets the point across.
Well, with that in mind, lets look at our expectations and preparations for acts of terrorism or intentional events. We've been told what it means to live in the "post 9/11" era and how we must be prepared for the next terror attack. Nobody will tell you what the next attack will look like and so we believe and plan for what we've seen in the past...another 9/11-style attack. In short we've fallen into the trap of believeing the biggest or last major event we've experienced is the worst we will ever see. Nothing could be further from the truth! In short, we're preparing (and have been) for the wrong type of event...that's my opinion anyway.
I think we're going to see another attack on the United States and many other sources believe it will be in the not too distant future. While I'm not willing to commit to a time frame, I am comfortable relating my opinions as to what the next terrorist attack will look like. No, I don't think we'll see another attack on the same size and scope of September 11, 2001, rather I think we'll see a "fun-size" smaller and coordinated multiple simultaneous attacks version. I would also predict that these smaller, coordinated intentional events will be aimed at soft targets...those locations of infrastructure that lack defensive protection or deterrence.
Specifically, I'm talking about locations such as shopping malls, ground transit hubs, health care facilities, sporting events, and hotels and coffee shops. The impact of bombings or other events on these locations...especially if they're coordinated in multiple locations across the country...will have a significant death toll as well as a devastating ripple effect. These smaller attacks will be harder to predict and intercede on. The impact on a community and economy will be huge. Consider the possibility of mass casualty events coupled with a lack of surge capacity or total loss of local hospitals.
The failed attempt to bomb an airliner on Christmas Day, 2009 is an indication that independent individual attackers are a potential threat. Often referred to as "Lone-Wolf" attackers, these individuals may have a loose affiliation and training with well-funded, established terror groups. They may also be individuals with no affiliation but share an ideology or sympathy with terrorist groups. Smaller than coordinated terrorist cells, these lone-wolf attackers could easily infiltrate soft target locations and carry out attacks with conventional explosives, chemicals or even biological materials. As an aside, while the impact of an explosive attack will be huge...the impact of a biological attack (biological bomber style) is almost unimaginable.
McVeigh, Rudolf, and Kaczynski are all names in our domestic terrorism history that we should keep in mind and even study as a means to appropriate pre-plan and train for what might be ahead. We should also keep in mind the ever-present threat posed by domestic groups; hate groups, supremest groups and Ecological groups. Keep in mind that multiple smaller attacks will be just as devastating as a focused single event.
January 31, 2010
Yes, but what if it DID happen here?
Yes, but what if it DID happen here? For years I've based training and teaching on this simple question. The idea has always been to overcome complacency and Optimism Bias. When we think "...it can't happen here" or that it "won't be as bad as they say it will be". Were 'IT' becomes the last or worst crisis we've encountered and we don't believe 'IT' could ever happen again...we're victim to Optimism Bias. The challenge is to not only believe that we're vulnerable but also to acknowledge the need for pre-incident planning and training.
With that, there are still a large number who believe that it can't happen here. And until recently, this issue has seen limited attention from mainstream media. Until recently. The earthquake in Haiti and results of relief efforts have spurred an uptick in the number of those asking "what if it DID happen here"? In my opinion this is an important indicator of change. Perhaps swinging our preparedness pendulum back to center from way over on the terrorism end of the scale.
A snapshot of this is illustrated by numerous articles and one such example can be read in Newsvine and coming from MSNBC.com. So, lets take a look at a few quotes from that article and relate comment:
With that, there are still a large number who believe that it can't happen here. And until recently, this issue has seen limited attention from mainstream media. Until recently. The earthquake in Haiti and results of relief efforts have spurred an uptick in the number of those asking "what if it DID happen here"? In my opinion this is an important indicator of change. Perhaps swinging our preparedness pendulum back to center from way over on the terrorism end of the scale.
A snapshot of this is illustrated by numerous articles and one such example can be read in Newsvine and coming from MSNBC.com. So, lets take a look at a few quotes from that article and relate comment:
"The White House and the Capitol have been destroyed. Congress and critical government agencies overseeing finance, health and other domestic services have been critically impaired. Many of the government employees who used to work in those offices are dead."
This is an important point and underscores the need for local government self-sufficiency. States will be in competition for Federal resources. Those resources will have to be triaged...if they would be available at all...States, cities, towns, communities, and individual families will be on their own. Probably for months.
"The U.S. Interstate highway system has been destroyed (there never was one in Haiti), and travel by road is arduous."
The ability to get aid into the areas effected may not be possible. Travel in and around those areas may not be possible. Refugees may not be able to get out. Local responders will not be able to provide relief.
"There is no FEMA. The well-financed network of local “first responders” that Americans take for granted is gone. "
Well, no FEMA might not be a big deal. Loss of the first responder networks...another story.
"The entire air traffic control system has been destroyed. "
Air travel may be the only way to bring relief materials to states in need or provide evacuation...and in the scope of impact seen in Haiti...where would you evac to?
"The infrastructure to handle marine cargo has been destroyed at the major seaports — New York, Los Angeles, Houston."
OK, we won't get supplies that way either.
"As much as one third of the population (in the U.S., roughly 100 million people) are without food, water or shelter and limited means of acquiring it."
Knowing that a majority of Americans do not have supplies of food or water on hand and that there will be no supermarket to run to magnifies this problem. The loss of water and sanitation will exponentially compound this problem. And no shelter? The lack of Civil Defence style preparedness will force entire communities into the elements. The ripple effect will be huge.
"Millions of survivors are in need of urgent medical attention; many simply won’t receive it — even if relief efforts proceed flawlessly. Most local hospitals have been destroyed. The ones that remain have no supplies. Doctors have resorted to using hacksaws and vodka in place of surgical instruments and alcohol."
When will it be it be time to change from a standard of care to a sufficiency of care? How will we make triage decisions? Who will get care and who will not? Forget surge capacity...no hospitals. Everyone should take a First-Aid class.
January 29, 2010
Two Chemical Events, Two Deaths. Many Lessons
Two recent chemical events have claimed two lives and provided some valuable lessons to be learned or reinforced. First, an man in his 30's died hours after ingesting some type of hazardous substance. As if that is not bad enough...twenty-four people at the clinic where he had gone for treatment were either deconed or quarantined. Buest guess at this point is that the man ingested selenomthionine in the industrial environment he worked in. It is not known if the ingestion was an accident or not. The article interchanges ingestion and inhalation...we know the route of absorption is important...but is unclear in the new article. The victim came home from work, changed clothes, and went to an InstaCare clinic (walk-in health care/urgent care). As a result, the clinic was shut down for twenty-four hours with eight people undergoing decontamination on site...none complained of illness. In this case decon seems to have been more pro-active.
In another, unrelated event, a fire department in Iowa responded to a "person not breathing" call at Mercy Medical Center to find that what seemed to be a routine event was actually a hazardous materials event. Sodium Hydroxide...a laundry additive...was leaking. Responders began working on the victim then noticed the leak. Four other civilians who were in the area and several firefighters were evaluated in the emergency department as a result. It is not clear if the leak caused the victims death.
Lessons Learned and Reinforced:
In another, unrelated event, a fire department in Iowa responded to a "person not breathing" call at Mercy Medical Center to find that what seemed to be a routine event was actually a hazardous materials event. Sodium Hydroxide...a laundry additive...was leaking. Responders began working on the victim then noticed the leak. Four other civilians who were in the area and several firefighters were evaluated in the emergency department as a result. It is not clear if the leak caused the victims death.
Lessons Learned and Reinforced:
- Response to medical facilities, including walk-in or urgent care centers, can not be taken lightly or considered to be routine. The additional hazards associated with these locations have to be considered in preincident planning and responders must size-up with a high level of suspicion.
- The need for decon may exist wherever people go for help. Many emergency departments have some form of decontamination equipment or facility...few, if any walk-in care/urgent care centers have decon equipment or the trained people to carry out the activity. Expect this type of situation to occur more frequently.
- Understand the logistics behind the confinement or "quarantine" of otherwise well civilians...those who do not have any symptoms, yet give you reason to believe they may have exposure. This group to can be difficult to manage as compared to those who actually have symptoms.
January 4, 2010
Cyanide Suicide
I've been using the term "consumer-level" hazardous materials events to describe everything from mixing household cleaning products to creating hydrogen sulfide and homemade chemical bombs. Noting that these situations are developed out of ordinary, off the products...the kind you find in almost any store...to raise awareness to the severity and potential impact to responders.
A recent story from the Kansas City Star underscores what I've been talking about for years. A man decided to kill himself in his car by opening canisters of cyanide. No warning signs on the windows this time. Responders open the door...instant exposure.
For more on cyanide, check out prior Mitigation Journal Blog posting and be sure to tune in to Mitigation Journal Podcast (edition #143 for 1/3/2010) for the latest on this topic.
A recent story from the Kansas City Star underscores what I've been talking about for years. A man decided to kill himself in his car by opening canisters of cyanide. No warning signs on the windows this time. Responders open the door...instant exposure.
For more on cyanide, check out prior Mitigation Journal Blog posting and be sure to tune in to Mitigation Journal Podcast (edition #143 for 1/3/2010) for the latest on this topic.
December 28, 2009
Protecting At-Risk Populations
Protecting At-Risk Populations: Here is a great story...perhaps the best way to better hold off the spread of H1N1 or any other disease. CNN is reporting on a crew of volunteers going out to the streets to vaccinate homeless persons against H1N1. Taking the vaccine to the streets, along with any type of treatments, will almost certainly keep the infection rates down and may prevent spread of the disease.
Lets remember that the homeless population includes many who have issues with addiction or mental illness in addition to co-existing medical conditions. This situation clearly makes the homeless population at greater risk.
Lets remember that the homeless population includes many who have issues with addiction or mental illness in addition to co-existing medical conditions. This situation clearly makes the homeless population at greater risk.
December 25, 2009
Air Terror Attack
I've suspected something of this nature would be happening and have been following events the mainstream media has not been covering. Tonight, 12/25/09 we have striking developments from Detroit...
MSNBC is reporting that a Nigerian man attempted to detonate or ignite a powdery material on a Northwest airlines flight today.
At the same time, CNN is reporting that this incident took place at the end of the flight from the Netherlands to Detroit and involved fireworks or fire crackers of some type.
While the latest Reuters report out of Washington and being carried locally here in Rochester, NY, has the White House confirming a more serious event...calling it an act of terrorism.
Interestingly, we've been talking about several instances occurring on commercial airliners in the last few weeks. These events seemed to involve threatening or hostile-like actions on the part of passengers appearing of Middle-Eastern dissent. I've called them "probing" events - those events used to test our response to and actions during an event and just talked about them in MJ#140 on the podcast. They have received scant media coverage and what has been covered has received a glossy political correct finish. While supposed eye-witness accounts and the "official" airline accounts differ in degree of severity, its important to note that seemingly everything that can be done to discredit those concerned (civilians) who bring this issue up. The National Terror Alert is linking to an article published by the American Thinker that you should read. They do a nice job of piecing the commonalities together.
While all the details are yet to be known, we have to ask what type of explosive or device could get past TSA? We'll be increasing our security for sure. More to follow.
MSNBC is reporting that a Nigerian man attempted to detonate or ignite a powdery material on a Northwest airlines flight today.
At the same time, CNN is reporting that this incident took place at the end of the flight from the Netherlands to Detroit and involved fireworks or fire crackers of some type.
While the latest Reuters report out of Washington and being carried locally here in Rochester, NY, has the White House confirming a more serious event...calling it an act of terrorism.
Interestingly, we've been talking about several instances occurring on commercial airliners in the last few weeks. These events seemed to involve threatening or hostile-like actions on the part of passengers appearing of Middle-Eastern dissent. I've called them "probing" events - those events used to test our response to and actions during an event and just talked about them in MJ#140 on the podcast. They have received scant media coverage and what has been covered has received a glossy political correct finish. While supposed eye-witness accounts and the "official" airline accounts differ in degree of severity, its important to note that seemingly everything that can be done to discredit those concerned (civilians) who bring this issue up. The National Terror Alert is linking to an article published by the American Thinker that you should read. They do a nice job of piecing the commonalities together.
While all the details are yet to be known, we have to ask what type of explosive or device could get past TSA? We'll be increasing our security for sure. More to follow.
December 23, 2009
Cardiac Arrest Survival: Thirty Years of Change without any Changes
Cardiac Arrest Survival: Thirty Years of Change without any Changes...Yes, you guessed it. I going to take yet another shot at the American Heart Association. UPI is reporting on a study by the University of Michigan that states cardiac arrest survival rates have not changed in thirty-years. This despite all the CPR and ACLS cards issued to and paid for by emergency service responders. The study concluded the chance of surviving an out-of-hospital cardiac arrest has not improved since the 1950s. As quoted from the original UPI article:
"Increasing bystander CPR rates, increasing the awareness and use of devices to shock the heart and keeping paramedics on scene until they restore a person's pulse needs to occur if we are ever going to change our dismal survival rate," Dr. Comilla Sasson, the study's lead author, said in a statement.Now lets take a look back...how many CPR changes have we seen...all with a new book ($$) and another class (more $$)...and can someone tell me why we have to PAY for CPR training? How about all the "research" that causes us to change the procedures we do (advanced airway, for example) or the medication changes we have to endure. High dose Epi, Vasopressin, Amiodarone, Verapamil, bicarb or not, Lido or not...in what order...and don't forget...the research (sarcasm) will tell you that everything you know and have been doing will be totally wrong and deadly tomorrow! So run out and take another class and buy another book. Because you can see the results of all the cardiac arrests we saving.
Too many systems still gauge effectiveness based on cardiac resuscitation rates. Nothing could set us up for failure more than this unrealistic expectation. Why do we expect responders to show up and correct decades or a lifetime of disease that caused the cardiac arrest? We'll work on a cardiac arrest victim for a while with limited resources in the field and then turn them over to the ED. Yet, if they don't walk out of the hospital...we didn't "save" them. How can this make any sense? A majority of what Paramedics carry in terms of medications and equipment is aimed at the cardiac arrest patient.
And despite what we know and do, we're not making much of a difference.
December 21, 2009
Air Medical. At What Cost?
I have the deepest respect for my colleagues who work in the air medical arena. I also have little doubt that air medical transport with helicopter and fixed-wing aircraft have saved untold numbers of lives throughout the Country. In general I support air medical, albeit with some reservation on the use of helicopters.
I've written about the potentials of landing a helicopter at your emergency scene or on the roof of a hospital (a totally bad idea as far as I'm concerned) and you can read my comments in Mitigation Journal http://mitigationjournal.blogspot.com/2008/05/helicopters-and-hospitals.html one persons opinion may be that helicopters and operating with lights and siren are the two biggest contributors to EMS LODD...maybe they should be avoided...and at all costs, keep your helicopters off of and away from your hospitals!
Todays posting is going to look at another, less deadly impact of air medical transport...cost. MSNBC is running an article with focus on the cost of emergency helicopter transport and the health care system. According to MSNBC, the cost of this service can be anywhere from $12,000 to $25,000 and that cost may not be covered by insurance. Sure, we can't put a price on a life...and I would certainly pay that amount and more for any of my family...gladly. I think what is at issue here is the fact that these flights are not always deemed appropriate. Even in the setting of trauma other alternatives to air medical transport my have provided the same outcome at a fraction of the cost.
Another issue is choice. Victims of trauma who are in serious condition may not have the capacity to provide informed consent for air transport. The public is trusting the emergency responders to make the best choice for their care. Transport mode should be a decision, like any other, made carefully and with the patients best interest in mind. In these cases the "customer" has little choice. And on that note, please remember we treat patients...not customers. Read my comments on the word "customer".
So let this one sink in a while. When is air medical helicopter really needed? How can this service be put to best use...when should it be avoided? Patient condition, injury severity, distance to definitive care, and weather conditions are just some of the points to ponder. Now we have to add in cost...or better stated; cost effectiveness. Will air medical transport make a difference in relation to the non-covered cost in relation to ground transport alternatives. More to follow on this...and I welcome your opinion.
I've written about the potentials of landing a helicopter at your emergency scene or on the roof of a hospital (a totally bad idea as far as I'm concerned) and you can read my comments in Mitigation Journal http://mitigationjournal.blogspot.com/2008/05/helicopters-and-hospitals.html one persons opinion may be that helicopters and operating with lights and siren are the two biggest contributors to EMS LODD...maybe they should be avoided...and at all costs, keep your helicopters off of and away from your hospitals!
Todays posting is going to look at another, less deadly impact of air medical transport...cost. MSNBC is running an article with focus on the cost of emergency helicopter transport and the health care system. According to MSNBC, the cost of this service can be anywhere from $12,000 to $25,000 and that cost may not be covered by insurance. Sure, we can't put a price on a life...and I would certainly pay that amount and more for any of my family...gladly. I think what is at issue here is the fact that these flights are not always deemed appropriate. Even in the setting of trauma other alternatives to air medical transport my have provided the same outcome at a fraction of the cost.
Another issue is choice. Victims of trauma who are in serious condition may not have the capacity to provide informed consent for air transport. The public is trusting the emergency responders to make the best choice for their care. Transport mode should be a decision, like any other, made carefully and with the patients best interest in mind. In these cases the "customer" has little choice. And on that note, please remember we treat patients...not customers. Read my comments on the word "customer".
So let this one sink in a while. When is air medical helicopter really needed? How can this service be put to best use...when should it be avoided? Patient condition, injury severity, distance to definitive care, and weather conditions are just some of the points to ponder. Now we have to add in cost...or better stated; cost effectiveness. Will air medical transport make a difference in relation to the non-covered cost in relation to ground transport alternatives. More to follow on this...and I welcome your opinion.
September 5, 2009
Finding Radiation in the Parking Lot
I happened to go out for a cup of coffee with a friend of mine this morning and found something unexpected in the parking lot. In the space next to mine was a pickup truck owned by a construction company with two containers in the back...labeled RADIOACTIVE. Barely secured with an old chain and skimpy padlock, these containers were just sitting in the open bed of the truck with nobody around.
I'm certain they were legitimate. But in today's society, just leaving them out in the open was a bit odd. Certainly, these materials could be used for some untoward event, like a dirty bomb, but more concerning is the number of possibilities that are more likely to happen.
Suppose this truck were to be involved in a collision, a roll-over or rear-end collision for instance. You find the containers after you
approach, size-up and being patient care...or worse, you find the compromised containers only after patients have been taken to the hospital.
How about fire? You arrive to find this truck fully involved. Only after extinguishment you find the melted, compromised containers. Do you have radiation detection equipment available? Would you even think about getting it out?
Finally, what will the average citizen think of this? Two containers left out in the open and clearly marked radiation. Perhaps they'll call 9-1-1, how will you respond?
I'm certain they were legitimate. But in today's society, just leaving them out in the open was a bit odd. Certainly, these materials could be used for some untoward event, like a dirty bomb, but more concerning is the number of possibilities that are more likely to happen.Suppose this truck were to be involved in a collision, a roll-over or rear-end collision for instance. You find the containers after you
approach, size-up and being patient care...or worse, you find the compromised containers only after patients have been taken to the hospital.How about fire? You arrive to find this truck fully involved. Only after extinguishment you find the melted, compromised containers. Do you have radiation detection equipment available? Would you even think about getting it out?
Finally, what will the average citizen think of this? Two containers left out in the open and clearly marked radiation. Perhaps they'll call 9-1-1, how will you respond?
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