MJ 220: Consumer-Level HazMat and Chemical Suicide

Consumer-Level HazMat and Chemical Suicide...

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A number of readers have written in with renewed interest on the threat of chemical assisted suicide asking that I re-release the popular Mitigation Journal entries on this topic.

I'm truly impressed by the level of interest shown by MJ followers. I'm also grateful to you for letting me help get this and other preparedness information out to responders, hospital staff, and emergency management folks. 

This weeks podcast is a mixed compilation from the popular Consumer Level Hazmat talks taken from various epidodes.

Consumer-Level Hazmat and Chemical Assisted Suicide are covered in editions 59, 64, and 72. Full versions of the original Mitigation Journal podcasts are available from the Mitigation Journal archives with the links provided.

Click player below to listen to Consumer Level Hazmat and Chemical Assisted Suicide.

Seismologists warning not "aggressive enough"

Last month we talked about something I called the biggest decision in healthcare that nobody was paying attention to. I was referring to the July, 2011 court decision requiring Tenet Health to pay $25 million to those patients and civilians who took shelter at Memorial Health Center and died or suffered injury during Hurricane Katrina. The court ruled that Tenet failed to establish an evacuation plan and that by poor design, the backup power system was vulnerable to flooding. See Mitigation Journal "Message from Katrina" part one and part two to hear me, Jamie Davis (MedicCast) and Matt discuss this on the podcast.

This month I want to tell you about a similar situation, this time from Italy.

Six Italian seismologists are being brought up on manslaughter charges for failing to predict a deadly earthquake. Yes, your read that correctly...for failing to predict an earthquake. According to MSNBC, the Italian seismologists are specifically accused of failing to warn the public "aggressively enough" ahead of the 2009 earthquake that killed 300 people.

This will be an interesting situation that should may have implications for disaster and emergency management here in the United States. This Italian case combined with the recent Tenet Health decision is ought to be enough to give anyone working in emergency preparedness a moment of pause.

How far can the legal ramifications of prediction (or failing to predict) a situation go?

If the situation were reversed; a prediction with "aggressive warning" that resulted in evacuations (and injury/deaths from that evacuation) that turned out to be a false alarm - would that also be grounds for indictment?

What level of warning is appropriate or "aggressive enough" and how do we gauge the severity of a predicted situation to warn appropriately?

What are the implications for those who study and predict natural phenomena? To break this down even further, will epidemiologists be held accountable when the flu vaccine is poorly matched to the flu strain that actually shows up?

This could be another influential decision in domestic preparedness that nobody is paying attention to.  Nobody but us anyway.

MJ 219: Understanding Flu and Biological Events

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 If I told you that there was a biological event coming this winter that would kill 36,000 to 40,000 people, would you be concerned? What if I told you that this biological event would target the old, the young, and those with chronic medical conditions; what would you say?

If I told you that flu season is around the corner, how concerned would you be?

This post is an introduction to our popular classroom session Understanding Flu and Biological Events. In this program we tackle these issues and compare seasonal flu (a predicable, natural event) and intentional events involving biological material.

This weeks posting is a primer as we enter flu season.

Click the player below to view the movie:




Click the player below for the podcast audio only version:

9.11.01 The Headlines Tell the History

9.11.01 The Headlines Tell the History...its our history...

All of us can recall where we were around 9:00 AM on Tuesday September 11, 2001. I've been collecting headlines and magazine covers for ten years now. Each one has a memory attached to it.

Click the player below for the video:

Looking at the images on T.V. I commented what we, safe in our station, knew: nobody at or above that fire was getting out alive. 

 

The T.V. voice said the obvious "I think we're under attack...its pretty clear that impact was intentional..."

I called my wife: "get Sammy from school...now" I was concerned that more attacks might cause police to restrict movement...we lived near a target in the form of one of the largest chemical/industrial facilities in the Nation; the Eastman Kodak Company.

Moments later another commentator broke in with news about an explosion at the Pentagon.

Several years of my career had been dedicated to thinking, planning, dreaming up doomsday situations to prepare responders for mass casualty events and natural disasters.

Response to such events had been an important part of my professional life since the 1989 Loma Prieta earthquake. I was captivated by the response to that earthquake. Amazed at the scale of devastation. I was inspired to learn something about urban search and rescue, about crush injury syndrome...

This was an area of expertise that let firefighting, paramedicine, hazardous materials and planning merge...

The media was still sorting out what had happened to cause such a huge smokey fire from the upper floors of the tower.

I remember being in the day room of our headquarters fire station with the smell of that perpetual pot of coffee in the background that morning.

This was different. How many targets could there be?

I'd been at my desk in the special operations/training office...someone called and said something about the World Trade Center being on fire. Shortly thereafter everything changed.

Then in a wide-angle, slow motion approach, another aircraft entered the frame. What is this guy doing?! Then it hit. Then it erupted. It began to sink in...

Waking up in a Different World

Its not the time of day you get out of bed.

Today, September 12, 2011, we are waking up in a different world.

We awoke to September 12, 2001 to the images of the day before ingrained in reality. Ingrained forever in history. The world woke up a different place. It wasn't the first time, either.

In 1993 the World Trade Center was the target of an attack. Albeit far less devastating, the '93 WTC event showed us a glimpse of what could be. We were in a different world.

We again woke to a different world on April 19, 1995. A day when we woke up to the reality of Domestic Terrorism when the Murrah Federal Building was destroyed. Ammonium nitrate/fuel oil and a truck. 163 dead...including the kids in a day care.

On April 20, 1999 our alarm clock went off again. This time in a high school. Semi-automatic weapons and secondary devices. Random Domestic Terrorism.

A few years after September 11, 2001 Mother Nature voiced her opinion. And she did so over and over in the past few years. In 2003 we woke up to the reality that a naturally occurring biological event could make a terrorist attack look like a cake walk. Hurricane Katrina forced the evacuation of a major metropolitan area...for the fist time. Katrina also showed us the gaps in our response ability. We were in a different world. Not to be outdone, biological events made a comeback in 2009 with the sudden appearance of H1N1. And we realized that we couldn't make vaccine as quickly as we need...and misinformation information on how to handle a predictable event was not readily available.

Today, September 12, 2011, we are waking up in a different world.What will it look like? Will it be explosions and gunfire? If it is, what will you do?

I think the next event will be a bit more subtle. We'll wake up in a different world when we flip the little switch on the wall and no lights come on. What will we do?

9.11 More than terrorism

September 11, 2001 taught responders and emergency planners many lessons. There are many more to learn. Its important for us to look at all hazards; natural, man made, and technological as if they have the same potential as an intentional terrorist attack. This video underscores that importance.

I hope that in the wake of ten years in the post 9-11 era we will realize that public health, emergency medical service, and other traditional response agencies deserve our support. I also hope that we'll realize that mother nature can cause devastation on a scale that dwarfs terrorism.

Its time to stop living in the post 9-11 era and start training in the Pre-insert next event here-era.

9.11 a decade later "what have you done for me lately?"

Newsweek cover

September 11 will be filled with remembrance ceremonies, flags, pictures and exhibits commemorating the September 11, 2001 terrorist attack on the United States. People will recount where they were when the heard the news, saw the second plane hit the second Tower, and express anguish when the World Trade Center towers collapsed.

Many will use the phrase "Never Forget" in their speeches. Perhaps the news clips of the plane hitting the tower, the explosions and eventual collapse of the towers will be shown on television again. Perhaps not. Many have decided the video images of the Pentagon and WTC are too graphic, too upsetting. We certainly won't see the clips of civilians, trapped in the inferno of the towers jumping to their deaths. Too graphic? Maybe. A reminder of intensity and brutality of the attacks and suffering inflicted on a civilian location...absolutely.

In our race to "Never Forget" we wouldn't want to insult any group or label anyone as extremist. Maybe we don't really want to remember how we felt in the days directly following the attacks. Maybe we'd rather pretend the aftermath of September 11, 2001 is not as bad as we remember and get back to work being a cog in the one global nation farce.

The flag will seem a bit empty without EMS and Fire

Maybe we'll see the clips of New York City streets lined with civilians holding signs that read "hero" and "thank you" as emergency services roll into the World Trade Center site; a reminder of attitude towards emergency medical service and the fire department on September 12, 2001. A period before public safety budgets, salaries, and retirements became the target of municipal shortfalls and pubic outcry. Never Forget  is an interesting concept as today we look to eliminate responders, cut benefits, dismantle public health services in the name of balancing budgets.

Never Forget is an interesting concept as ten-years later, first responders will not be welcome at the 9/11 memorial service in NYC.

Ten-years later "Never Forget" reads more like "what have you done for me lately?"

It's national preparedness month

September has been designated national preparedness month by FEMA… so what

Nobody knows (possibly nobody cares) that National Preparedness Month even exists.

The heart of the national preparedness month effort is an offshoot of FEMA/Department of Homeland Security using the website ready.gov. The website encourages us to prepare, plan, and stay informed. We're told to do this all we need to do is to get a kit, make a plan, and be informed. Throughout the website, again, at the heart of the national preparedness month effort is a sprinkling of information tips for the public and for responders. Albeit a little oversimplified, FEMA presents a fairly decent message for the public. The information for responders is minimal at best.

Despite the urging to prepare, plan, stay informed; and to get a kit, make a plan, and be informed, the efforts of national preparedness month initiative to little to entice members of the public to do any of that. I believe one of the key reasons that the general public remains unaware of initiatives like this is because the focus on Homeland Security… security equating to badges and guns. As of said before,   Homeland Security is a  failing model for preparedness. We have to shift the focus back to a more neutral preparedness ground. That is, to be able to look at and prepare for natural, man-made, technological, and intentional events.

 A recent earthquake that impacted a majority of the East Coast and was quickly followed by hurricane Irene was a stark reminder of our vulnerability to natural events. Carbon monoxide deaths (which are described by many as completely avoidable) continue to climb in the United States.   Consumer-Level hazardous materials events and acts involving use of consumer level hazardous materials with intent to harm self and others is seen as a growing threat. Although these events may have gotten some media attention  they don't typically appear in one's mind when we think about homeland security. Yet, these events are quite capable of causing harm to people and infrastructure on par with any terrorist intentional event. The challenge is to bring our Preparedness Pendulum back from the extreme edge were we look only at terrorist events… and I think that is what National Preparedness Month is trying to do.

Just like the other specialty areas that have their own special “day” or “month”  the general public outside of that specialty area remains unaware of the national preparedness month effort. Further, what useful information is on the ready.gov website goes unnoticed by most. Bottom line is, the National Preparedness Month initiative remains stagnant and has little if any impact on improving civilian readiness.

 FEMA could learn a lot from successful initiatives such as fire prevention week. Fire prevention week has historically involved a reasonable media campaign as well as some type of open house affair at a local fire station.  Key to success is that some officials and the local community are engaged in spreading the word and promoting action among individuals, families, and communities. The combination of a marketable media campaign along with their open house ability brings the community together and puts the information provided into a tangible format. National Preparedness Month efforts lack that tangible format and community leadership effort.

Despite being around since 2002, ready.gov and National Preparedness Months have done little more than provide information on a website. While they do provide decent public service announcements in the form of videos and audio clips, there is little effort  to get the general public to turn this information into action.

So, I guess it now becomes our responsibility (perhaps it always has been) to get the message out to the public about the national preparedness month initiative. It will also be our responsibility to turn that information into action.

I recommend that everyone visit ready.gov and explore the content there. Become familiar with what the site in the initiative has to offer. Then take that information and turn it into something useful… that is, explore ways it can benefit your community. Maybe coupling national preparedness month activities with existing awareness topics such as fire prevention week, EMS week, or any other specialty area that has  their own “holiday” would be a good place to start. That might be a good place for the folks at FEMA to start marketing National Preparedness Month as well.

A Message from Katrina Reader Comments

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Long time supporter of Mitigation Journal, Michael Ehrman sends in his commentary on our recent podcast A Message from Katrina: Hospitals be Ready. Part One and Part Two are available on the Mitigation Journal homepage.

You can contact Michael directly via Twitter @MichaelEhrman

Michael writes:
First point.  When I went to National Red Cross training and National Fire Academy training in the middle 1970's with some of the Public Safety Officers of New Orleans, the levies were a disaster waiting to happen and they knew it in the 1960's for sure so with 50 years to prepare for what I call their worst nightmare and not have gotten their public prepared and themselves is NO excuse.  When I worked in California, almost every public organization, most businesses to varying degrees and most residents prepare for that big 9+ earthquake they know is coming.  May not be prepared for San Onofre, the nuclear power plant to explode but their worst nightmare they prepare for and practice.

As for NIMS and Jamie's comments.  NIMS is simply a way to organize and help control a bad situation in an orderly fashion.  Not a resource to mitigate the situation.  Just an orderly set of step to follow to help the responders mitigate the situation and to play well with each other.

As for Matt, FYI, regardless, there will be lawsuits-for any reason.  Hey, you had one less stored supply for one more person that you had.  Hey, you should have built your ATM to work perfectly while being under 10-feet of water.  Get real here.  If one attorney lives, there will be at least one lawsuit.

Improvements since 9-11?  Look at communications, one of my pet peeves.  We are still bantering about allocating a portion the 700 MHz frequency for first responders.  Every major disaster has had communications as the base shortfall in that disaster.  Read the reports, books, etc.  And we still have not resolved that one.  And we expect the population to be prepared for X days and we, ourselves, are not prepared?  Let us totally fix our house first before we complain about the neighbors.

Hey, don't bitch about the bus.  I have preached long before Katrina that every community should make a contract with their school district or buy a school bus, whether used or new but used is cheaper by a mile if maintained.  Every bus can mass move in first responders.  Every bus can mass move out casualties and every school bus comes with its own set of red lights.  Just paint it fire engine red or police blue.

More PSA's is right.  Jamie hit the nail on the head.

As for Dr. Pou, she did what she had to do when her world was ending for her patients.  If we were there and faced with the limited information available at that time versus the type of death your patients would suffer during this world ending crisis (for you), what would you do?  I know I would not want to give up and would try to find a solution until it was too late, but that's me and my patients would have most likely suffered.  It is a shame the situation got to that point.  And she was not alone in making he decision to euthanize some patients.  Remember that.

Jamie was right, Katrina was a lesson of the worst, and the best and that we need to prepare.  Bigger question now is, will we.  Or will we be stating, like a broken record, the same solutions are needed that we said for the last XXX disasters and still do nothing to fix the problem except to spend money to say let's fix it...again.

Got me on a rant on this one.  Good job!

NIMS Incident Types

NIMS info from DHS

Today's post come in the form of an email question and answer on NIMS incident typing. The question comes from Ben Hazlerig, a Paramedic who has transitioned into Emergency Management. The answer from Alan Bubel, Assistant Chief of the Gates (NY) Fire District, an authority on NIMS, and frequent contributor to Mitigation Journal blog and podcast. 

NIMS Field Guide from Informed Publishing

 I love NIMS job aids and memory helpers. The best guides I've found have come from Informed Publishing. Informed offers a wide variety of field guides for the traditional and non-traditional responder. The NIMS ICS Field Guide puts all the needed information in your pocket...for any NIMS/ICS position. Available in electronic and hard-copy, it's a tremendous aid for any experience level. You can also stay current by reading the Mitigation Journal and listening to our podcast. The Mitigation Journal podcast App is also available on iTunes! 

Note: I endorse Informed Publishing products. Neither Ben nor Alan have any involvement with Informed.




Ben writes:

I’ve been a listener of your podcasts for some time now, especially during my days of Paramedic school.  I’ve now transitioned from EMS into an office Emergency Management job.  One thing I’m having a hard time grasping is the NIMS Incident typing.  The company I’m with uses the Incident Type 1 to 5 scale to classify events in the beginning stages.  I haven’t been able to find anything within the FEMA online materials that clearly defines who officially determines Incident Types as it relates to National disasters.  We are essentially mimicking the NIMS system within our own organization and putting the job of Incident Typing on our Senior Level Executives who have limited Emergency Management experience.  It seems to me that this classification is better implemented after the fact as a way to summarize what resources were used.   Do you have any thoughts on this subject or know of any reference material online I could refer to.  Thanks for any information you can provide.

Alan responds:

Here are some thoughts on the topic of Incident Typing:

One of the responsibilities of the Incident Commander (IC) is to analyze the complexity of the incident. This helps to identify resource requirements and manipulate the incident management structure appropriately. Complexity analysis factors include such things as safety, resources, size of the incident and impacts to life, property and the economy. More information on this can be found in the ICS200 curriculum.

Categorizing an incident by type, then, is based on the incident's complexity. You're aware of the 5 to 1 scale (Type 1 incidents being the most complex) so we don't need to get into that discussion. However, your question pertained to who officially determines incident type relative to a national disaster. With that being said, there are only two incident levels where Federal resources come into play - Type 2 and Type 1; of those two, only a Type 1 incident is considered an "Incident of National Significance". A national disaster would fit the criteria for an "Incident of National Significance", activating the National Response Framework (former National Response Plan) and likely resulting in Stafford Act declarations. But, WHO determines the incident type?

The answer is the IC, based on the whole complexity analysis thing. In addition to analyzing incident complexity, the IC has the responsibility to call for resources. The level from which those resources are requested (local, state, or Federal) also speaks to the incident type. Type 5 and Type 4 incidents normally require local resources; Type 3 incidents local and state resources; and Type 2 and Type 1 incidents all three levels. So, if incident complexity is not enough for an IC to base an incident type decision on, the resource requests can serve as an added guide.

Although incident typing is very useful for summarizing the size, scope and complexity of an incident after the fact, the determination of the incident type needs to be made real-time during the incident by the IC. If your executives have IC responsibilities, they should be afforded the training and education required to identify incident type. (Training through the ICS400 level would be my recommendation). If they do not function as an IC, but support an incident as Emergency Management personnel, they should still be aware of the incident typing process and the role it plays relative to resources and geo-political impact.

My opinions on Hospital Emergency Preparedness are nothing new

Click to download podcast

I've receieved reader emails asking if all this talk about hospital preparedness, accountability during crisis, and the after-the-fact accusations is a new outcome from recent legal decisions.

The quick answer is, no.

In fact, I've been talking about these and other hospital emergency preparedness topics in Rule of Outcomes fashion for a long time. Its nice to be ahead of the curve...

In response to those emails, I recalled discussion on the topic of Dr. Anna Pou and the allegations against her and other staff from Memorial Medical Center in the wake of Hurricane Katrina.

In this talk, from Mitigation Journal podcast (originally recorded in 2007) I discussed the issues that are now foremost on the minds of many in healthcare emergency management.

In this re-issue, we'll consider the implication of crisis decision making, triaging of limited medical resources, incident action planning, and standard of response versus sufficiency of response.

This clip will reiterate many of the points in from the recent Tenet Health/Katrina decision. It will also serve as a primer to get you thinking about the possibilities and adverse outcomes in crisis decision making.

Click the player below to listen on-line

Interview with Ceciel County, MD County Emergency Services

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Welcome to a special interview with Mr. Richard Brooks, Director of Ceciel County Emergency Services, on the topic of winter storm activities. This is a re-issue of our podcast (#156). The planning and preparedness discussion in this segment remains one of the best on the web.

Although the topic is winter storms, the philosophy and actin-planning are universal to the current Hurricane Irene situation. This podcast episode is one of the most listened to and commented on by MJ followers.

For those of us thinking ahead to be ready for the next event, this podcast will be a great reminder of how to get things done.
 Click the player below to listen on-line:

Sitting on the edge of Irene: cautiously optimistic

Sitting here in Rochester, New York it's easy to be just a bit removed from the Hurricane Irene situation. Viewing the situation from a distance gives me the opportunity to reflect on the response of local governments, officials, and Federal agencies.

I'm cautiously optimistic that the actions taken by state and local government authorities will save lives. The forward thinking approach to evacuations and sheltering has been impressive up and down the East Coast. I am particularly pleased with the actions of New York City Mayor Bloomberg and the New York State office of emergency management. Although I have been critical of NYC in past storms; I'm encouraged to see that they are doing what I believe to be the best course of action possible.

Has the recent legal president from hurricane Katrina influenced emergency management decision making?

The decision to order a large-scale evacuation or shelter in place is never an easy one. Evacuations are not benign events and there are certainly risks associated with sheltering in place.  Major metropolitan areas such as those cities on the East Coast have to make this decision carefully and well in advance of a potential threat. I think they got it right this time.  Let's not forget that this is an area (the entire East Coast) that just suffered from one of the largest earthquakes in recent history.  A 5.8 magnitude earthquake struck the entire East Coast last week. There is untold and unseen damage to buildings and infrastructure. While this earthquake did not cause massive collapses and instruction, it certainly may have caused some buildings to be weakened. It certainly may have caused unseen damage to below ground utilities, sanitation, and transportation infrastructure. These same structures and pieces of infrastructure will now be impacted by hurricane Irene and thus raising the level of severity and the need for pro-activity on the part of local governments and responders.

There has been tough and honest talk from governmental leaders. The information has been blunt…  “if you don't evacuate we may not be able to rescue for several days…”. I think that's the reality of the situation and I think that demonstrates an understanding of when to switch from a standard of response to a sufficiency of response.

The physical damage to structures will be dependent upon the storm itself. The impact to life will be dependent upon the actions of local governments and local responders.

 So, what's going to happen next?

Well, if the storm turns out to be less severe than predicted there will certainly be accusations of overreaction. I've also anticipate that there will be those in the media who will accuse many in emergency management of crying wolf and scaring the public.

On the other hand, if hurricane Irene turns out to be as severe as predicted and to cause as much flooding and damage as predicted the ends will have justified the means. In either case I believe no other decisions could have been made by emergency managers the net to evacuate far in advance of the storm.   

 The only certain next step is recovery… and recovery is largely dependent upon preparation.

"I'm cautiously optimistic that the actions taken by state and local government authorities will save lives. Imagine the level of domestic preparedness that could be achieved with fully funded and staffed health departments and emergency management programs?"

Rick Russotti, Mitigation Journal

So far, the Irene has the flag barely moving...0900 8/28/11

North East Earthquake: The Real Hazards are Beneath Us

Top-5 list of issues responders and planners need to address

A magnitude 5.8 earthquake struck the East coast of the United States on August 24. The United States geological survey indicates that this quake was felt in 25 states reaching from the deep South to New England and possibly extending into Canada. Impacting more than 12 million people, this was the most powerful earthquake to be felt since 1944. It also happens to be the second earthquake felt in western New York in the last year. Its enough to make you ask: what if it did happen here?

NOAA photo

 E. L.Quarantelli (Disaster Research Center of the University of Delaware) warned us of the increasing impact of natural disasters. In his paper "Future Disasters in the United States: More and Worse" (1988),  he suggests that natural disasters will be more intense simply because they have more to impact in today's society. Again, this was written in 1988 and since that time we've seen our share of devastating natural events. We've also seen an increase in co-occurring natural events; earthquakes leading to tsunamis leaving to technological failures such as nuclear power plant failures. For more details, see Three Problems for Planning 2011. Related: They're going to get worse. (MJ July, 2010)
Critical Infrastructure:
the evidence of the quake was obvious in many buildings and while many monuments and tourist attractions were closed, the real concern is the impact the buildings of critical infrastructure… hospitals, for example.The recent decision from hurricane Katrina (Tenant Healthcare) has made us aware of the expectations for hospitals and healthcare facilities to be prepared for naturally occurring events. Furthermore, it seems the public has an expectation that hospitals will be in area refuge or shelter during crisis situations.

Co-occurring natural events:
Hurricane Irene is also projected to impact the East Coast of the United States within the next week. Changes in weather are often the most overlooked hazards in emergency response. With predicted sustained winds of over 85 miles an hour, hurricane Irene certainly has the potential for increased damage to structures weakened by the earthquake.

What lies beneath?
What we haven't seen (perhaps we haven't looked for yet) is what lies beneath…  under our feet, below ground is where we may find the true potential hazards from this earthquake. Quarantelli reminds us that natural disasters will simply be worse because they have more to impact. We have to keep in mind that there will be an increased impact on technology. Perhaps most importantly, is the impact to aging infrastructure. Natural gas lines,  power distribution systems, sanitation, bridges/tunnels and highway overpasses have all been cited as aging pieces of infrastructure. The impact of this earthquake may be harder to measure in this capacity as these items are mainly underground and problems may not be readily observable.

Communications:
Communications difficulties have to be considered a given in crisis situations. Even without widespread death and destruction cellular service was rapidly overwhelmed with the number of calls made  during and after the quake.  Social Media was also widely used to communicate and twitter was bombarded with “tweets” during and after the quake.

 Access to goods and services:
Many retail outlets including gas stations and supermarkets lost power making it impossible for people to purchase fuel and causing untold losses of frozen food and other consumables. While the inconvenience in this case appeared minor, consider the impact had a large scale evacuation been required… with limited availability of fuel for vehicles. Also consider the possibilities of prolonged sheltering without ready access to refrigeration.

Forward thinking: Bringing the Katrina decision home

Ken Beers writes in this week with tremendous insight. He's asking questions that focus our attention on what will happen when the fallout from the recent Katrina decision comes home to our communities.

Concerning the Katrina/Tenet health settlement, Ken writes:

Let’s extend the thinking in this case to rural America. Can a small one ambulance town have a class action suit brought successfully when the tour bus goes off the cliff and 48 of the 55 patients die since their nearest mutual aid is an hour away?

What an interesting dilemma. How do we prepare for every contingency? When have we planned enough? How much should we spend on being prepared for the “big one”. How does Mother Nature figure in?

It would appear that in this case, the hospital didn’t plan on the levy breaking and taking out all their ability to continue providing services. If this hospital’s evacuation plan was similar to many others I’ve seen, they were all set to depend on ambulances for evacuation of the sickest patients. This doesn’t work when it is a community wide disaster since the ambulances will be tied up on other tasks. So how do you plan for community wide destruction and continuity of service?

In a way this is both very scary and fascinating at the same time.

Thanks, Ken, for writing in on this!

When is 25% preparedness acceptable?

 ...apparently, nearly ten-years into the "post 9/11 era"

"I would say Tampa is probably about 25 percent ready for a terrorist event. That's based on the training I've done throughout the State of Florida for the last five years. I think that there needs to be more funding and more education,”

                                                   Eric Dotten, Emergency Med. Learning & Resource Center Read more on this story from ABC

The above quote and the basis for this post comes from a story found over at ABC Action News. Please see the video below.

9/11/10 commentary

It caught me off guard. I expected to read about how the EMS providers were polishing their skills for dealing with a high profile event; an event that represented a high hazard, an event that held potential for an terrorist intentional attack with chemical or biologic weapons.

In my ignorance, I expected Florida to be a highly prepared state. Hurricanes, tropical storms, high heat, large special needs populations, big cities...Florida seemed to be a state that has prepared and practiced. Some of the best emergency management conferences I've been at have been hosted and presented by Florida. A state with solid Domestic Preparedness.

I seem to be wrong.

Tampa is Florida's third largest city with a population of 335,709 and Florida is the fourth largest state in the U.S. I think the Buccaneers still pay football there. But despite the size of the state and city, Tampa seems to be only 25% ready for a terrorist event. This after ten-years in the "post 9/11 era".

I've held the opinion that the current Homeland Security approach to preparedness is a failed model. If accurate, does Mr. Dottens quote reflect that failing? I've also held that we should not be (specifically) training for terrorism...we must integrate readiness for intentional events into an overall domestic preparedness program.

What, then should we expect...after all we're ten-years into the "post 9/11 era". Read my opinion from 9/11/2010. As one reader wrote in saying "25% is better than nothing".

And that may be the theme as we get ready to embrace 9/11/2011.

Effect of the recent Katrina ruling

I wanted to share a brief email from Michael Ehrman. Michael has been a long-time friend of Mitigation Journal and encountered a situation that reflected the impact of a recent legal decision from Hurricane Katrina. You can listen to Message from Katrina: Hospitals be ready part one and part two now.

You can contact Michael directly via Twitter @MichaelEhrman

Michael writes:

Just saw an effect caused by this ruling.

Went to Midwest City Regional Hospital for my Kiwanis Club bi-monthly meeting.  New signage on the revolving door and other doors stated "This hospital is not a shelter".  I had not seen this before and I asked security when did that go on the door but he did not know.  Could not understand it as the 8-story building is strong enough for current history of tornados including those that destroyed parts of the city years ago.  Now I know why it was put on the door.  Thank you judge.

Thanks, Michael. Make us wonder what could be next...

Rochester, NY EMT has Stolen Trust

 While attempting to steal prescription medications, a Rochester, NY, EMT steals public trust.

“Shocked that somebody that is that close to helping people with medical conditions to be able to go in and invade your property."

                                                                   - Joseph Pula, 79 of Chili, NY

Sad but true. Here we are (once again) talking about a responder who defiles the public trust. Once again, we see that Rochester, NY is not immune from this behavior. Video below, full story here.

In this latest situation, Derek Carstairs (formerly an EMT with Monroe Ambulance) returned to the home of a respiratory patient and attempted burglarize the patients home for prescription medication. While the local media attention to this has been scant, it has rippled (but not shocked) the emergency response community here in Rochester.

Prescription medications are at the top of the list of abused drugs. Addictions drive otherwise good people to do terrible things; mostly impacting family and friends. In this case, the addiction/crime has cost many responders the trust of the public.

Its not the first time.

In November, 2005 I wrote about an EMS director who accused of using the internet to arrange sex from the girl who is actually an undercover Monroe County Sheriff's Deputy.

Also in November, 2005, we talked about California, not to be out done by NY, seems to have trouble with EMS providers and internet solicited, under-age sex crimes.


December, 2006 we found out about a forty-year-old volunteer firefighter has been arrested for sexual abuse of a minor.

More recently, in January, 2009, I got upset about six paid-on call firefighters have been setting fires to get work...at the rate of $10.00 an hour.

Its not just crimes that fail the public trust. January, 2006, a paramedic who has been fired as a result of her blogging activities, reminded us that public trust exists outside of the clinical arena. Just as the paramedics who responded to Jett Travolta defaulted on the public trust and gave the "inside scoop" about John Travolta's son to the media.

These are the cases I've written about...there have been many, many more. 

This is obviously not a problem unique to Rochester or to EMS. The damage to responders is also not limited to any one agency, service, or location.

Back to the Carstairs situation. The patient turned burglary victim makes a very poignant statement:

"I have to be very, very careful of the people that come and help me that they don't rob me."

Don't you forget that this statement will be going through the mind of each and every person you try to help. Think about this when your service lowers its standards because of a lack of personnel...just to get a warm body.

MJ 216 Message from Katrina: Hospitals be ready. Part Two

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Special Early Release by popular demand
 
This may be the most influential decision in domestic preparedness that nobody is paying attention to. 
Join me, Jamie Davis (The MedicCast/The Nursing Show), and MJ Co-Host Matt Comer on this two-part podcast. In part one we discuss the general situation and organizational implications. Part two will address individual actions and decision making in disaster situations.

In part one we opened discussion on the situation with an overview and potential outcomes. The financial and precedence setting are on the top of the list. Also, we take a look at the impact on future planning and preparedness for healthcare in disaster situations. What will the impact be to health care costs? Should a community expect to shelter in a hospital during crisis?
In part two: public preparedness, the post 9/11 failing, preparedness pendulum, optimism bias and more!

Click the player below to listen to Mitigation Journal podcast on-line

MJ 215 A Message from Katrina: Hospitals be ready. Part One

Click for direct download

This may be the most influential decision in domestic preparedness that nobody is paying attention to. 

Join me, Jamie Davis (The MedicCast/The Nursing Show), and MJ Co-Host Matt Comer on this two-part podcast. In part one we discuss the general situation and organizational implications. Part two will address individual actions and decision making in disaster situations.

This will be an extended series on Mitigation Journal Blog and Podcast. Will be evaluating the pro's and con's of this important legal decision, implications for health care and traditional response. This podcast is important for hospital as well as non-hospital personnel.


Tenet Health owned Memorial Medical Center during Hurricane Katrina in 2005. Over one thousand civilians and patients sheltered in the hospital in the aftermath of the storm. The backup power had failed, there was no air conditioning, no power for ventilators, no running water or sanitation, and temperatures rose above 100 degrees.

But that's not all. Dr. Pou was accused of euthanasia "hastening" the deaths of some patients. Reports of inadequate triage processes for evacuation and lack or leadership quickly followed. Eventually, forty-five bodies were found in the devastated health center during recovery efforts.

A July, 2011 court decision requires Tenet Health to pay $25 million to those patients and civilians who took shelter at Memorial Health Center and died or suffered injury. The court ruling is based on the belief that the medical center failed to establish an evacuation plan and that by poor design, the backup power system was vulnerable to flooding...that is, they failed to plan, prepare, and implement adequate preparedness operations.

Part-Two available now. 

Click on the player below to listen now!

See Something Say Something goes to Wal-Mart

More than 230 Walmart stores nationwide launched the "If You See Something, Say Something" campaign today, with a total of 588 Walmart stores in 27 states joining in the coming weeks. A short video message will play at select checkout locations to remind shoppers to contact local law enforcement to report suspicious activity.

DHS Secretary Napolitano encourages you to say something to local police or a Walmart manager if you notice anything unusual while at Walmart. This is a continuation of the larger "See Something, Say Something" campaign designed to help report suspicious activity.

Although not an entirely bad idea, the statistics have yet to prove it worth.

I'm also a bit sceptical that running to the local Walmart manager is the best practice for reporting potential terrorist activity. Further, the campaign has yet to be proven as anything effective...check out this New York Times report.

Here's a quote from MJ Blog "See Something, Say Something" posted in September, 2010:

"Another problem is that people simply don't know what they are looking for. We, as emergency managers and planners have not done a good job at educating the public...or, is it that we simply don't want to share information? 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."

Let me add to that: Each report, while it may or may not result in useful information, will require law enforcement to expend resources to investigate.

We also discussed this topic on the podcast edition #202.
Click on the player below to hear my comments:



DHS video shown at Wal-Mart can be seen on the DHS Press Release (http://www.dhs.gov/ynews/releases/pr_1291648380371.shtm)

MJ 214: Angelo's Podcast

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This week Mitigation Journal becomes Angelo's Podcast! Angelo is the son of our Co-Host, Matt Comer.

Angelo needs our help.

Angelo needs a live transplant...soon.

Angelo is only 5 years old.

Most of his life he has been in and out of hospitals in an effort to figure out what is wrong. After years of being misdiagnosed, the cause of his sickness has been found. Angelo has Progressive Familial Intrahepatic Cholestasis (PFIC) type 2. This is a rare genetic disorder of the liver in which the liver cannot effectively pump bile out of the liver cells leading to liver damage and ultimately, liver failure. He also has severe cirrhosis (scarring) of the liver and is tormented daily by intractable and mutilating pruritus (itching). The only course of action for Angelo, in order for him to live, is to receive a liver transplant.

Tune in this week as we turn over the podcast to Matt in order to tell Angelo's story. Its a story of frustration with the medical community.

Its the story nightmare of reality for moms and dads.

Click the player below to listen on line or the MJ graphic (above) for a download mp3.

You can help. Join us at the next event to support Angelo's liver transpant:

September 3rd, 2011

4:00pm to 10:00pm at the North Greece Firemans Pavilion click here for info and directions...

If you can't join us, visit Angelo's Fund homepage or on Facebook. You can also click the Angelo's Fund tab at the top of Mitigation Journal blog page.

Click the player below to listen to Angelo's Podcast:

U.S. Boarder Patrol to blame for recent bus crash

Why was Canadian tour bus driver allowed to drive in U.S. with suspended license?

It looks like the U.S. Boarder Patrol took a page from the TSA playbook. A Canadian tour bus driver was allowed to enter the United States and drive his bus with a suspended license. The tour bus, with 53 passengers on-board, was traveling to New York City from Hamilton, Ontario.

The tour bus had been traveling on the NYS Thruway when the driver had to pull to the side of the road to fix a mechanical problem around 0130 hours on Friday, July 22. It is believed that shortly after pulling back into the travel lane, the bus was struck from behind by a tractor-trailer truck. The bus and the truck burst into flames.

The truck driver was killed, 30 passengers were injured, two critically.

Why was this tour bus driver allowed to even enter the United States with a suspended license. According to media reports, his license has been suspended for almost five years due to multiple speeding violations in the U.S.

How is it that the U.S. Boarder Patrol, who monitors the U.S. - Canadian crossings, missed this little fact? It's not like the guy is riding a bike into the U.S. - he's behind the wheel of a tour bus!

The point is that this incident was preventable. It could have been avoided if the Boarder Patrol checked the drivers status in the U.S. They either didn't bother to check or didn't have access to the drivers U.S. license information...both options worry me.

The Department of Homeland Security is a failed model of preparedness.

If the Boarder Patrol can't get a tour bus driver off the U.S. highways, how are they going to find other threats crossing the boarder? Has the Boarder Patrol been reading the TSA manual on Domestic Stupidity?

MJ 213: Getting Healthy, Instinctively

Click to download MJ 213

I've been working on dropping a few pounds and getting into reasonable physical condition over the last few months. Back in March, 2011, my doctor used the word "obese"...I didn't like the sound of that. So, I changed. Changed diet and lifestyle. I bought (Joanne bought) a road bike and started biking in addition to running. Much of this change was brought on due to the sudden death of a friend and experiencing a little episode of SVT/PSVT.

The good news is that I'm well on the way to a level of fitness I've not had before. Even (years ago) as an amateur fighter did I have the level of endurance and cardiovascular health I have now...and I'm just getting going!

There has been a good bit of help along the way. The Mitigation Journal Health and Wellness Consultant (Lori VanScoter, RN) has been providing some Health Coaching from the sidelines! This week on the podcast, Lori joins me to discuss an individualized health history review. We discuss general lifestyle, cholesterol, nutrition, exercise, and supplementation. The discussion is candid.

We'll be posting the video segments here in the blog over the next few weeks, too. In the meantime, listen to this weeks Mitigation Journal podcast. You can find all of the services Lori provides by going to her website Instinctively Healthy (http://www.lorivanscoter.com/)

Note: We're co-posting this on The Occasional Vagabond blog

MJ 212: Paramedic Ultrasound part two

Don't object until you have all the facts!

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We're back on Mitigation Journal podcast with Peter Bonadonna, EMT-P, CI/C, for part-two of our series on Paramedic Ultrasound. In part-one (MJ podcast 211) we reviewed the goals of ultrasound use, diagnostic ultrasound, training programs, and changes to paramedic practice and delivery of care.


In part-two, Peter answers the question: Ultrasound, why now? You'll have to listen to the podcast to hear the answer. 

Lets leave you with a few points:

1. Don't object unless you have all the facts. How do I get the facts? Listen to Paramedic Ultrasound podcast part one and podcast part two view our brief ultrasound video on the Training Videos tab, then visit the Paramedic Ultrasound tab above to go directly to www.paramedicultrasound.com.  

2. Training might not be as hard as you think.  Again, view the Ultrasound Video...see for yourself.


3. Why not now? Paramedic Ultrasound is an assessment tool that might just change the way we assess and triage certain patients. It may just be the next best thing since the pre-hospital 12-lead ECG!