Canadian Cessna Visits Rochester, NY

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

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

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

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

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

Did I mention September is National Preparedness Month?

What am I looking for? See Something, Say Something

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

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

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

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

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

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

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

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

Vaccine. Mandate or Not?

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

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

In June, 2010, the Centers for Disease Control and Prevention issued a statement saying they would not endorse mandated flu vaccines for health care workers this year. The announcement by the CDC was a reversal from their controversial stance in 2009 that anyone working in a hospital must be vaccinated against the H1N1 Swine Flu. The details of this CDC decision were posed in the Mitigation Journal Blog (CDC: Vaccine Not a Requirement. 12 Aug 2010) The full text of the CDC's June 22 statement can be found here.

What will it be for the 2010-2011 flu season? Mandated vaccine or not? Well, the CDC has their opinion and other infectious disease experts have another view. The Society for Health care Epidemiology of America (SHEA) has released a position paper endorsing mandated vaccination with endorsement from the Infectious Disease Society of America. According to the SHEA media release:

"...influenza vaccination of health care personnel [is] a core patient safety practice that should be a condition of both initial and continued employment in health care facilities."

There is more than one controversy in this situation.

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

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

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

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

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

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

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

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

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

September 11, 2010

September 11, 2010...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wrong, Wrong, Wrong...

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

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

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

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

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

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

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

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

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

This Weeks Reading List

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

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

 Healthcare groups need to share emergency plans...link

Violence Against ER workers...link

FDA attempts to slow Robo-tripping...link

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

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

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

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

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

All threats are not equal

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

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

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

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

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

The explosive bang is nothing compared to the biological whisper.

Pakistani Military Delegation Removed From Flight

Pakistani Military Delegation Removed From Flight, Tampa - Florida

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

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

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

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

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

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

Diligence or Paranoia, Profiling or Protection

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

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

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

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

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

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

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

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

Dutch Good Example of Anti-Terror Efforts

I can not  believe what I'm reading today. According to MSNBC.com  and CNN.com Dutch authorities are holding two men on allegations of conspiracy to commit a terrorist act and the U.S. authorities...well, not so much. With the same set of facts at their disposal; the Dutch (who have not had a terrorist attack) suspect terrorist attempt while the U.S. (in the midst of tense Ground Zero mosque situation and home to 9/11/01) says that terrorism "is unlikely"...

Here are the circumstances as outlined in several mainstream media outlets...read it, then you decide.

1- cell phones attached to a bottle containing liquid, multiple cell phones and watches taped together, and a knife and box cutter
2- man and his luggage were headed to separate international destinations
3- TSA screeners determined that the items did not pose a threat. No explosives were found.
4- arriving in Chicago from Birmingham, one suspect then checked his luggage on a flight to Washington Dulles airport and then on to Dubai, but did not board the flight himself. Instead, he joined the other suspect for the flight to Amsterdam while his luggage went on to Virginia.

For more details, see the MSNBC. com and the CNN.com articles.

I don't know who is asleep at the switch here...CIA, TSA, DHS, FBI...but they are asleep and they aim to keep the American public asleep, too. By taking the "nothing to see here" approach, they are attempting to lull the public into the false scene of security. Rather then taking the stance that this threat is real, this threat exists, we have to remain vigilant to this real threat opportunity to inform the public, we brush it aside. Nothing to see here.

We have a couple of guys who tape cell phones to bottles, watches taped to cell phones, pack knives and box cutters...and then...and then...send their luggage on a different flight to a different location. All at a time when our nation is polarized in debate over the Ground Zero mosque.

How is this NOT concerning?!  No, the items in question are not dangerous in checked luggage. It is the intent that is the problem. We're so concerned about being anti-this or anti-that, afraid of being seen as "profiling" that we have become ineffective in our domestic preparedness efforts.

How can this be seen as anything other then a surveillance dry run?

Mosque

Mosque...The Mosque...Victory Mosque...NYC Mosque...Ground Zero Mosque. Many names, many issues, many polarized points of view. It's not all about the Mosque. We must think deeper.

Before I give you another way to look at the situation, remember this; I do everything possible to keep my political views out of Mitigation Journal. With that in mind, let me clearly state:

Building a Islamic Cultural Center/Mosque near the NYC Ground Zero site is beyond building code and religious freedom. It is legal and supported by the United States Constitution, but is it appropriate...

Legislation to support health care for Ground Zero responders and workers now afflicted and suffering from pulmonary disease has failed. Almost without a whimper. There has been minimal support for those who are dying today from their work at Ground Zero...how much support will be there for you or I after the next attack?

On to the point of this post. From the polarization of opinion, the demonstrations, to the time when construction on the NYC Ground Zero Mosque begins and to its completion...indeed, for the duration the Islamic Center stands, it will be a target of political and public debate.

Nobody is talking about the unfortunate truth that some mosque locations have been used to recruit, raise money, and plan terrorist activity. There are over 100 other mosques in NYC and their may or may not be illicit activity taking place now. Here. In NYC.

The problem now is that forcing the issue of building this Mosque will draw attention to these facts and foster discontent and perhaps, action. I am concerned about the "actions" we may see. Gunfire at a anti-NYC Mosque protest...an explosive event at a pro-Islamic Center political speech...or a major event O.K. City style, after the NYC Mosque is built. Nobody is talking about the ability, more likely inability, to protect this Islamic Center from domestic terrorism. We're not talking about it because we can't.

The Mosque will be built, the debate and demonstrations will continue, and you heard it here first, somebody is going to ignite the spark and we'll have a domestic terrorist event on our hands. There will be retaliation...and another event. And so on and so forth.

You and I will be in the middle...those in emergency response, in our hospitals, in public safety. We'll again be at the center of keeping people alive, keeping hospitals working, and infrastructure intact. And when it's over...if its ever over...who will be there to support us?

Hydrogen Explodes at Rochester Airport

Two hydrogen tanks exploded near the Greater Rochester International Airport this afternoon. The tanks are part of an alternative/green fuel re-fueling center that includes refueling for hydrogen cars. The cause of the explosion is not known as of yet. Two injuries were reported and the airport was closed for a short period of time. News coverage from WHAM 13, YNN Rochester, WHAM 1180, and WHEC 10 all covered the event. The video from most stations showed dark black smoke from behind a truck, no fire was visible. The event was over in about two hours and the airport was reopened without further incident.

What is not being talked about is the fact that directly across the street is the Public Safety Training Facility (PSTF). As the name implies, this is the main training hub for police and fire departments in the region as well as home to the local paramedic training program. Interestingly, the Monroe County Emergency Operations Center (EOC) is located on the second floor of this building as well.

Before I go on, you should know that the airport was there long before the PSTF was created out of the old City of Rochester Fire Department building and training center that was in place since the 1950's. The EOC was added along with the PSTF sometime in the late 1980's. Way back then I knew little about emergency management (nor did I care to) but remember wondering why would you put a training facility and the EOC so close to the airport?

Since the PSTF and EOC moved onto the site, the airport and surrounding property has grown, too. The most recent improvements (over past 5 years) included the addition of the refueling center where the explosion took place today...about 100 yards from the PSTF/EOC.

So, today I question even more than ever why the EOC and training center are located there...or why were the hazards allowed to be build so close to this building of critical infrastructure? There were two injuries related to this explosion along with all major roads surrounding the airport being closed.

Lets think this over...all the roads to the airport closed...EOC located near airport...explosion near airport...EOC near airport...Get the picture? This one event crippled the ability of Monroe County to utilize their state-of-the-art EOC. It could have been destroyed. At any given time there are dozens, perhaps hundreds of responders in and around the PSTF. They could have been killed.

So, again, my question is why have the hazards been allowed to grow within sight of the EOC? Could nobody else see the threat changing and hazards increasing! A threat assessment and hazards assessment is an on-going process.

Elizabethtown - Lewis Rescue Squad

Elizabethtown - Lewis Rescue Squad - I was recently invited by my friends Larry and Patty Bashaw to visit the E'Town-Lewis Rescue Squad. They took delivery of a new ambulance this summer...it is one of the best configured vehicles I've seen. So, enjoy this little video tour or the E'Town-Lewis Rescue Squad.

MJ Podcast edition #184 Notes from an Elevator Rescue

This week on Mitigation Journal Podcast edition #184

This week we'll revisit one of the most challenging rescues this region has ever encountered. Almost three years ago I had the opportunity to speak with one the command officers involved in this event. The event and its management...from response to rescue, to recovery still gets high marks today. I originally posted this interview on Mitigation Journal way back in December, 2007...and still get emails on it today. Because of a recent email (content remaining anonymous at the request of the listener) we're going to reply this interview.

On November 29, 2007, EMS and fire agencies from the 3rd Battalion of Monroe County, NY responded to one of the most challenging rescue situations one can imagine. This situation has it all...multiple victims entrapped in an elevator shaft, extreme cold, confined space, and technical rescue.
Five EMS agencies, Five Fire/Rescue agencies, Air-Medical and on-scene medical command came together under a unified command structure to effect a most amazing rescue.

I recently had the pleasure of traveling to the opposite side of my county to speak with Mr. Steve Waters about this elevator rescue. Steve is an emergency medical technician with several years of experience (decades, actually). He is the President of Perinton Volunteer Ambulance (http://www.pvac.org/) and was among the Command Staff during this event.

While you're listening, keep the Rule of Outcomes in mind...we don't have to wait for a large disaster or terrorist attack to use the planning and skills we've been training on!

Elizabethtown - Lewis Rescue Squad Gets New Ambulance

This is going to be a long post, so hang on.

Its the kind of vehicle you'd expect to see in a large city. All the sophistication and technology to support any patient care needs...from emergency to transport. But not this ambulance. This vehicle shown below is the latest edition to the Elizabethtown - Lewis Emergency Squad. I was treated to a grand tour by my friends Larry and Patty Bashaw and wanted to share this with the readers. Yes, there is a story behind the color choice...but you'll have to ask Larry to tell the story.
Look below:

Larry Bashaw (left) giving me a tour of the "brown" ambulance

Ricky, Jyl, Michelle in 5 point harness 

Me behind the wheel...don't see that everyday

Restraints to fit us Full-Figured Paramedics

Yes, I Do Expect Situational Awareness Every Time

Yes, I do expect situational awareness every time...and you should, too!

Perhaps you read my August 22 post in Mitigation Journal blog. It was about six EMT's who were taken to a local hospital after being exposed to acid while treating a victim of a motor vehicle crash. I saw this event (not too far from home) as yet another wake-up call for responders...with the message: "You don't have to wait for a terrorist attack to use your WMD training..."I've been spouting that message for years in the hopes that someone will listen...not to cast dispersions or point fingers...Simply making my point that a majority of WMD training has been useless because it is not applied in every-day situations (for the record, I hate the term WMD, but that's another story.

Shortly after the August 22 posting was published I received several emails from local and not-so-local readers. Here are some choice excerpts from those emails:

"EMS is not trained to look for hazardous materials...that is the job for the FD..." Blog reader New York
"You can't expect [responders] to be thinking about toxic stuff on routine calls like a MVC (motor vehicle collision)..." Blog reader Florida

"EMS has to be focused on patient care, triage and transport..." Blog reader Colorado

"It's not our [EMS] job to do that (chemical)...FD and police should..." Blog reader Washington

I'd like to thank all who wrote in on this topic for providing me the proof that most WMD training has been a waste of time and for providing me with a ton of editorial material for future blog posts and podcasts.

Lets debunk each of these comments, shall we?
"EMS is not trained to look for hazardous materials...that is the job for the FD..."

Not trained to look for hazardous materials?! Yes you are! EMS personnel are (at least in NY) required to undergo hazardous materials awareness training with annual updates meeting OSHA 1910.120. The problem is that this hazmat training is usually delivered by someone who is not familar with the material, the impact on EMS, or the potential danger of failure. How long will it take before EMS realizes it cannot stand on the sideline in well-pressed uniforms waiting for someone else to deal with a situation. Although I give this some credence due to the "second-class citizen" mindset of EMS, we have to wake up and understand that EMS (indeed, all responders) have an obligation to look for hazards on every incident.

"You can't expect [responders] to be thinking about toxic stuff on routine calls like a MVC (motor vehicle collision)..." 

Uh, duh...yes I can...or I wouldn't have written this post. After all the time and money spent on preparedness and awareness we are still not thinking about hazardous situations because...why? Isn't there enough in the news? Or, is it because it can't happen here? And that is the problem with most WMD and terrorism training...they get you to thinking about it only when you are told the situation is intentional or an attack of some sort. 

"EMS has to be focused on patient care, triage and transport..."  

I thought EMS got out of the "you call, we haul, that's all..." mentality a decade ago. I can't argue this point...if you're still thinking that way, good luck. 

Stay tuned for more on this...

Six EMTs Exposed to Acid Fumes

As reported in the Rochester Democrat and Chronicle, six emergency medical technicians from the Ontario Ambulance were transported to an area hospital after exposure to acid fumes. As of this report, the exposure took place while providing patient care at the scene of a motor vehicle collision. The vehicle containing an injured driver also contained a quantity of muriatic acid. Muriatic acid is the same as hydrochloric acid (H3O+Cl-). The container of acid may have spilled in the cab of the pick-up truck as a result of the crash. The intended use of the acid remains unknown as well. The concentration and quality of the acid are not known, but were enough to cause symptoms and necessitate hospitalization.

Hydrochloric acid is one of the popular ingredients in the construction of homemade chemical bombs.

The good news (if there is any in this case) is this exposure took place outside with presumably good movment of ambient air. Exposure to most acids results in irritation of mucous membranes and respiratory difficulty at low concentrations. Exposure at higher concentrations (such as when a person cannot self-evacuate) can result in non-cardiogenic pulmonary edema and hypoxia.

Look for containers as clues to danger

This case is another reminder that the term "routine" has yet to be scrubbed from our vocabulary. Also, despite the warnings about bottle bombs, homemade chemical bombs, acid attacks, and of course, the ever popular WMD training, we're still not looking for these hazards when we respond to every-day events.  This exposure was not a result of a chemical attack or terrorist event...but lack of situational awareness and Optimism Bias could have cost responder lives.

Points to ponder:
What, if any, clues were there? Containers, odors, unidentified liquids in the vehicle?
Did the victim of the crash present with signs or symptoms that lead you to think something other than what the situation looked like? Could exposure to the acid fumes caused or contributed to the crash?
What PPE should EMS don for such an event? Let me answer...none. EMS typically is not equiped with the PPE needed for a chemical exposure.
Decon...decon...decon. Prior to leaving the scene...with early notification of area hospitals.

MJ Podcast #183: Childhood Obesity

MJ Podcast #183: Childhood Obesity 

This week on Mitigation Journal Podcast edition 183

Obesity. Maybe you're tiered of hearing about the growing health problem and the impact on our health care system. Maybe you've heard all you'd like on how diseases like diabetes, cardiovascular failure and stroke are causing our health care system to crumble. And perhaps, you're now wondering what childhood obesity has to do with domestic preparedness and why I'm devoting so much podcast time and blog space to the topic. That answer is short...and in Mitigation Journal Podcast #183 we'll discuss this issue with Dr. Marji Nasin. This interview first appeared on MJ way back in 2007. As we move on to explore this topic, this interview still has meaning...maybe more so...today; some three years later. Simply put, childhood obesity is a National Security/Domestic Preparedness issue. I'm not alone in my thinking on this. This posting on the No Quarter blog pokes at the situation and mainstream media are giving the topic some attention.

As our Nation continues to struggle with these diseases...all linked to childhood obesity...our population becomes more unhealthy at an alarming rate. To the point of emergency management and traditional responders, consider the impact of  childhood obesity on traditional and non-traditional responders;

• Dealing with a sicker, more fragile population increases the risk of communicable disease and impact of biological events such as flu
• A sicker, unstable population is more likely to require additional resources and special needs planning during disaster events
• The ever increasing special needs population will continue to be at increased risk (if) evacuation is needed. Special needs groups may lack the ability to self-evacuate. 
• In the future, a sicker, medically fragile society may lack qualified candidates to fill the role of responders...think about that. Fewer people medically/physically able to do the job of Paramedic or firefighter.

A Nuke in the Future

Is there a Nuke attack in our future? According to a recent poll, when it comes to a terrorist use of nuclear devices, 17 percent think it unlikely they'll detonate a nuclear weapon and just two percent  believe it’s not going to happen...at all...ever. This is in contrast to fifty-eight percent of adults who believe it is at least somewhat likely that there will be a major war involving nuclear weapons in next century...with twenty-six percent who say nuclear war is very likely.

There are also divisions among party lines...but few other demographics are given in this posting from NewsMax.

So, is there a nuke in our domestic future? Who knows. The point is that preparedness for such an event is not constrained to nuke attacks. This type of preparedness, with basic ideas, can be used in a variety of situations.

There's no escape chutes in ambulances

There's no escape chutes in ambulances...and even if there was, EMS providers wouldn't use 'em.

Mainstream media and the web are abuzz with the story or JetBlue flight attendant Steven Slater. By now you've heard about his exchange with passengers, grabbing a beer or two, and jumping ship via the aircraft escape chute. Who many of us in EMS have wanted to escape our ambulance from time to time?

I read a recent article that expounded how unhappy people were when the board aircraft; becoming rude and obnoxious. The passengers "expected" to be treated better (by what standard, I don't know) and the flight attendants were there to serve every need. On the other hand, the article tells us about how hard and stressful the job is and that flight attendants take the brunt of these difficult passengers and it is they who deserve to be treated better.

Lets compare this situation to emergency medical service. I've dealt with difficult patients, family members, and bystanders (like every other EMS provider). Not unlike an aircraft, the back of an ambulance strips people of their feeling of self-control and sprinkles in a bit of helplessness. Add to that the stress of a major (or minor) illness/trauma and you've got all the makings of a quite stressful environment. How many times have I wanted to pull the ambulance to the side of the road and get out...simply get out and walk away...to another line of work? How many times have you felt this way? The numbers might be hard to count and in hindsight, maybe it wasn't all that bad. But at the end of the day what counts is that you (and I) didn't pull over and get out.

Ambulances don't have escape chutes...

The Problem with PODs

Points of Distribution, or PODs, are the hub of pandemic planning in some communities. PODs are set up at certain locations and used to distribute oral or injected medication. Despite urging from the emergency response community, many jurisdictions have hung onto the POD plan as the only distribution method for pharmaceuticals in the setting of pandemic. Although not entirely a bad idea, the POD system has a number of faults that should be addressed and considered in the planning and contingency process.
What is a POD? As mentioned, a POD is a site designated for the distribution of medications or supplies in the event of a crisis or emergency. The pubic gathers at a give location or locations and materials are handed out.

Why was the POD system developed? In short, the current points of distribution model is based on an earlier process used to receive, break down, repackage, and distribute materials/supplies from the National Pharmaceutical Stockpile (NPS). The idea was further refined for the use in the setting of SARS and later, H5N1 Highly Pathological Avian Flu.

So, whats the problem? The first problem is in the planning assumptions made with POD Establishment. The assumption has been made that "we'll know" when a given pathogen is threatening and have time to medicate/vaccinate our public. That assumption was based on experience with SARS and predictions of H5N1 and is totally dysfunctional. To assume there will be a "lead-time" when we know a pathogen is coming is a terrible mistake. As we have seen with H1N1 in 2009, the disease was present in various states with little or no lead-in. In that situation, we have to plan for the disease spreading beyond any given boundary...simply by virtue of our modes of modern travel. So, to bring otherwise healthy people together into a central location(s) may actually increase exposure.

The next assumption we have to deal with is that a vaccine or medication may not be available in the amount we need...we could run out of medication. Running out of medication leaves us with people standing in line and not getting protected, perhaps being exposed. And speaking of standing in line...managing the que and providing sanitation services, shelter from the environment, food, and medical care at POD locations can be an event in itself. These continence's are not often included in POD plans. As one pubic health emergency managed told me; "the people in line are not our problem..."
That brings me to the problem of civil unrest and disobedience. Dealing with uncooperative persons, people with special needs, and those intent on causing problems is often beyond the scope of those working in a POD. Understand that the unrest can turn into a riot and become violent quickly...especially if you run out of medication.

In recent experiences, some PODs were overwhelmed with people and had delays of several hours while other locations remained nearly silent. Why? Because people did not know where to go, under what conditions to go, or did not understand direction. We cannot plan on people following direction. We can expect that once the media announces that site "A" is running with a ten-hour delay, many people will flood site "B".

Want another snapshot view...see Mitigation Journal Of Chicken and Expectations from May, 2009 to see what I'm talking about. Points of Distribution sites are difficult to manage and plan for...they are a part of pandemic planning, but only a part. Putting all our eggs in the POD basket puts us at risk of failure to meet the expectations of the public. Not meeting expectations will be disastrous.

MJ Podcast #182: The Problem with PODs, Flu Season Preparation, and Prescription Medication Abuse.

This week on Mitigation Journal Podcast edition #182

I received a number of emails this week about a comment made on edition 181 of Mitigation Journal podcast...I was talking about my support for the United States Postal Service pharmaceutical delivery program the lack of functionality and failure potential of points of distribution. Leading off edition 182 is a discussion A few listeners/readers wanted to know why...nobody disagreed with me...just wanted more information on my opinion. One podcast listener actually wants me to write an opinion for their superiors and deliver some training on the topic of comprehensive biological event planning.

Matt and I also discuss the need to revisit flu season planning. Who knows what we're in for this flu season, but this is a good time to develop (or encourage) those good non-pharm infection control practices; respiratory etiquette, hand hygiene, and appropriate social distancing. Its also a good time to revisit your services infection control plan...review, update, train on it.  This segment of the podcast expands on several recent blog postings. For more on these topics check out these postings in Mitigation Journal blog CDC: Vaccine not a requirement, Forward Thinking for Flu  , and CDC Drops N95 Requirement

And finally this week, we talk about the importance of a medication profile and history in the pre-hospital environment. Medications and medication history are important but never so important as they are today. Prescription medication abuse is increasing faster than meth use and the rate of emergency calls due to abuse is rising. EMS responders must add medications and medication history to the list of things-to-do. I also encourage everyone to have a field guide that lists medications, indications, and side effects. I recommend the EMS Field Guide and Field Guide app for iPod/iPhoneTouch from Informed Publishing.

CDC: Vaccine not a requirement

The Centers for Disease Control and Prevention have announced that it would not endorse mandated flu vaccine for health care workers. The CDC states:

"In 2009, CDC posted on its Web site Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel. At the time it was posted, uncertainties existed regarding the novel H1N1 influenza strain, and the vaccine was not yet widely available. As stated in that document, CDC planned to update the guidance when new information became available. Since then, circumstances have changed. A safe and effective vaccine has become widely available, and is being included in the 2010-2011 seasonal influenza vaccine. Further, we now have information about the number of cases of disease, hospitalizations, and deaths caused by 2009 H1N1, which can be compared to historical seasonal influenza data. At this point, an update of the guidance to address current circumstances is warranted..." Click here for the full text of the statement from CDC...pay close attention to the definition of healthcare settings and healthcare personnel...

Although it sounded like a common sense thing to do, mandating flu vaccine for all health care workers caused quite a bit of debate. In fact, the NYS Nurses Association came out hard against the requirement while many health care facilities threatened discipline or termination of any provider who refused to be vaccinated.  See my post NYS Nurses Association Opposes Mandates for Vaccine for more on this topic. EMS and other traditional responder groups were left in limbo, at the whim of the situation...do EMS personnel who are in and out of various hospitals meet the requirement for mandated vaccine? Nobody knew for sure. Despite it all there was not enough vaccine to go around.