Bus Rescue: Interior

Front windows may not be an easy exit

For gaining access and ease of evacuation, remember three simple points: Use existing openings, enlarge existing openings, or make your own opening. The example used in this series is a full-size school bus has been turned on its passenger side. The side exits and passenger side windows have been rendered inaccessible leaving the front, rear, and roof as access points.

In Through the Roof we concentrated on gaining access and enlarging existing opening. Exit at the Back of the Bus demonstrated the need to open large areas for extrication. In this installment of Bus Rescue, we'll focus on interior operations that create space for extrication and disentanglement.

Side door access blocked by seats

Above: The side rescue door now sits at the top side of the bus. Access from the exterior can be difficult. Don't forget that access to this door may be difficult from the inside as well. Here we see two seats that will impeded the use of this exit door. These seats can be quickly and easily removed.

Hydraulic tools cut seat posts quickly

Above: Hydraulic cutting tools can be used to quickly remove seats by cutting the posts. Remember to cut the posts as low as possible, close to the floor. Gasoline power generators for hydraulic cutting tool systems must be positioned outside and away from the bus to prevent the introduction of carbon monoxide.

Below: A battery powered saw can accomplish the task of seat post removal. All tools must be well maintained with replacement blades readily available as well as batteries as needed. Hand tools and power hand tools are instrumental for arming additional work teams to speed the seat removal evolution.

hand tools are instrumental for arming additional work teams

Bigger is not always better, some cutting tools are too big for efficient interior operation

Above: Larger hydraulic cutting tools can be used but take more space to operate and may be too cumbersome inside a bus. It may be wise to monitor air quality inside the bus whenever gasoline powered hydraulic tools are used.

Reaching the interior door from the inside may be difficult

Above: Firefighter Lisa Coia-Bubel (City of Rochester Fire Department) demonstrates the difficulty of accessing the side interior door from inside a bus turned on its side. Note seats have been removed allowing for ladder placement into the bus. Roof or straight ladders can be placed into the bus via the side door for quick evacuation of minimally injured occupants.

Below: Further illustration of the side-to-side height created when a school bus it on its side. Note the seats are intact in this view demonstrating additional access limitation. Note also the proximity and size of the roof hatches (now side hatches). Intact seats will make placement of ladders difficult.

Height of side door and intact seats create difficult extrication

Above and below: Hand tools can be used to remove seats and some interior bus components when power/hydraulic tools are not appropriate.

Manage the "MCI in a can" with these five suggestions

Five tips for managing Passenger Transportation Accidents

1. Planning: Situational Awareness is important for all levels of the response community. Knowing your response area and the types of hazards therein is the first step. Pre-incident planning is also a necessity and must involve surrounding agencies. Don't forget to include the non-traditional responders and the health care system in your area in your pre-incident panning and training. Perhaps a best first step is to remember that it CAN happen here.

2. Responding: The actions of the first-in crews will dictate the outcome of the event. I recommend that everyone know where they're going, do something smart with your apparatus, and keep in mind there are events when it is better to not just do something...but stand there. LOCATE (Location, Obstacles, Conditions, Accessories, Treatment, Extra help) works for transpiration accidents as well as single patient response.

3. Managing the scene and incident command: The first suggestion...ask yourself how bad can this get? Then ask; Are we ready for this bus crash? Incident manages, rescue and triage branch leaders need to consider a few immediate actions when working at a passenger transportation accident: the injury/fatality ratio, understand where people (and kids) like to sit while riding buses, and that existing openings (doors and windows) may not be accessible.


4. Emergency Incident Rehabilitation: This may be the most important part of planning, responding and managing any event. Effective rehab helps to keep your personnel safe and working. We should be trying to run a good rehab at every incident. Use my  5 LEVEL Steps to Proper Incident Rehab and use these 4 points to make your Emergency Incident Rehab Functional.

5. Know general bus types and construction: You have to be able to get in and get out of the bus. A general working knowlege of school bus construction features is a tremendous benefit. Don't worry about getting too detailed...just understand the basics of construction and types of school buses.
Doing so will help improve planning, response and management.

EMS considerations for School Bus Rescue

A majority of passengers will be minimally injured after a school bus crash. Utilization of proper access/egress, triage and treatment procedures will improve the EMS response to these high stress events.

School Bus Rescue: Exit at the Rear of the Bus

When existing opening aren't enough...enlarge the opening for efficient extrication of victims.

Above: Firefighters assess access and begin dismantling rear door.

For gaining access and ease of evacuation, remember three simple points: Use existing openings, enlarge existing openings, or make your own opening.

In this installment we consider access and removal of the rear door. We'll focus on enlargement of existing openings and creating your own opening.

As seen in Through the Roof, this full-size school bus has been turned on its passenger side. The side exits and passenger side windows have been rendered inaccessible leaving the front, rear, and roof as access points. In Through the Roof, we looked at operations to enlarge roof hatch openings to improve access and rescue. This post will focus on access, opening, and enlargement of the rear door.  In our next installment, we'll focus on interior operations for disentanglement and access. 

Keep in mind that school bus accidents of this magnitude are rare, but when they do occur there is almost certainly going to be significant injuries, need for disentanglement, and protracted operational periods.  Successful management of incidents such as these require solid performance of the first in units. A significant knowledge of scene size up and vehicle construction are also vital. The 7 basic bus rescue points will aid any responder in the setting of a large vehicle/school bus event.

Below: Most rear doors are hinged to swing open towards the passenger side. In this situation the door does not hamper egress. Most doors lack a hold-open device, meaning if the bus were on the drivers side, the door would need to be supported in the open position or removed to keep it from obstructing operations. In either event, keep in mind there are seats directly forward of the door that do impede the use of this space as an exit. Those seats will need to be removed (as seen in following) in order to maximize extrication space.

Note height of door from road level.

Interior latch assembly can be removed with wrenches or socket set

Above: This view demonstrates the robust latching system and bolt throw (receiver removed). The entire latch assembly can be removed with hand tools (wrench/socket) from the inside; thus freeing the door.

Below: Traditional forcible entry tools and techniques may not be successful on the rear door of a school bus.  

Forcible entry tools and techniques may not be successful on rear doors

Use of a power saw to remove door hinge

Above: A battery powered saw can be used to cut away the door hinge and completely remove the door. The evolution can be completed fairly quickly with a well maintained saw and replacement blades.

Below: Once the door and glass from rear windows are removed, a cutting tool can be used to remove the door/widow frame and create and enlarged opening. Again, this can be accomplished quickly with well maintained equipment and skilled firefighters.

Hydraulic cutters remove frame between rear widows and door

Door/window frame removed. Note edge protection in place.

Above: Door/window frame removed providing greatly improved access. Note seat removal operation taking place adjacent to rear of bus. In combination, these two evolutions provide greater access/egress and facilitate removal of immobilized victims.

Below: Door removed and opening enlarged. Note the added space created by removal of rear seats. This creates an opening that allows for safe, efficient movement of immobilized patients.

Added space created by removal of door and rear seats. Note tape used to protect edges.

Bus Rescue: gaining access through the roof

Bus on the side is rare and challenging. Injuries are almost certain.

For gaining access and ease of evacuation, remember three simple points: Use existing openings, enlarge existing openings, or make your own opening.

Using existing openings will work well if patients can walk or have limited injuries and is the fastest and easiest to accomplish. In the pictured here, the bus is turned on the passenger side, rendering the passenger door, side and window exits unusable. In this scenario your best choice may be to use the rear door exit. Removal of the front windshield may also facilitate movement out via the front of the bus.

When existing opening aren't enough, enlarging existing openings is your next step. Enlarging openings such as roof hatches takes some time, personnel and equipment, but allows for rapid movement of rescuers and gear in and patients out. Once you start to cut on a bus be sure to reevaluate the need for structural stability and any effect on vehicle stabilization.

Firefighters use hand tools to augment power tools in this evolution

Above: Two properly protected firefighters use hand tools to cut the roof outer skin. Its important to rely on hand tools as a back up to hydraulic or battery powered cutting tools. Hand tools can also be affective for arming multiple teams when power tools are in short supply.

Below: The roof hatch opening enlarged (hatch removed) to facilitate movement of a backboard or rescue basket and personnel in and out of the bus. Note the jagged sheet metal. These hazards must be covered. Sharp edges will be present in the interior of the bus as well as a result of cutting the interior skin.

Note the inner and outer skin and the presence of structural hoops

Above: Marked by black arrow - Note the sharp edges on the outer skin (yellow) and the presence of the inner skin (red). Both will need to be removed and edges covered to prevent mechanical injury. FF John Harnischfeger (Ridge Road Fire District) points out a support hoop that has been cut to enlarge the opening. Hoop locations can be determined by the sequential line of rivets. Although these hoops can be cut, caution must be used as the structural integrity of the bus may be compromised. 

Below: A triangle cut made towards the rear of the bus facilitates interior extrication/disentanglement and removal. Caution must be taken to remove any victims from that area prior to beginning cutting operations.  Note the intact roof hatch to the right.

Gaining access no matter what side the roof is on.

Up Next: School Bus - Exit at the Rear of the Bus

School Bus Types

A general review of construction types and features of school buses

A news report posted by MSNBC.com about a "church" bus crash reminds us of the severity and hazards posed by incidents involving school buses. According to MSNBC, there were 29 people involved in this event, 23 were children. According to the report, the crash may have been caused by driver over correction causing the bus to overturn onto its side and resulted in nine injuries.

Lets do a quick overview of buses and some quick tips that you can use today.

Types of buses

Various Type A and B vehicle

Type A and B - described as van-style vehicles, are usually small van conversions with a gross weight around 10,000 pounds. Type A vehicles may carry 8-12 passengers with the main door behind the passenger side front tire. Type B vehicles may carry slightly more with a capacity of 16-24 passengers. The door is in the same configuration as the type A. In the setting of type A/B van-style vehicles, don't be complacent; these vehicles are a measure of quality versus quantity. The van-style buses are often used for transportation of special needs populations adding an entirely different medical, emotional, and evacuation element to the situation. These vehicles may also include special ramps, lifts and restraint devices...you'll need to be familiar with these items to be effective in your rescue efforts.

Wide range of type C/D buses

Type C and D vehicles are the larger buses that you normal see used as school buses or other transportation uses. Type C vehicles have a capacity of 30-70, also with the front door behind the front wheel. Type A/B/C buses have a rear exit door and may have a side exit as well. Type D buses are those with the flat front and the engine in the rear. They have a capacity of 40-120 passengers. The rear exit is an escape widow above the rear engine.

Use of Exits
Keep in mind that the bottom of rear and side exit doors are about four-feet above the ground. Side escape windows can be six feet off the ground and open upward...with no "hold open" device.

Command and Control
These events will be challenging. Multiple agencies and responders, media, traffic and the environment will all play a role in your bus event. Add to that the fact that many school-aged kids have cellular phones...you'll have frantic family members on scene with, or perhaps a head, of you. Don't ever forget the probability your actions will be recorded, too. 

Bus Rescue points you can use now

 7 take-home recommendations when dealing with any large passenger vehicle collision. 

• Knowing the construction and type of bus or large vehicle involved can be your first clue to the potential severity of the incident. Type A and B buses are the converted van style while Type C and D are the classic school bus types. Size-up must include the type of bus, number of occupants, and the position of the bus. Experience has shown that most collisions involving school buses result in little damage to the bus and the bus remaining upright. 

• Remaining on all four tires is not a guarantee of no injuries inside, while finding a school bus in any other position almost certainly predicts a variety of injury patterns. This is a good time to remind everyone that there may (most likely will) be injuries in any passenger vehicle that has collided with the bus. 

• Your size-up must include factors such as traffic conditions and environmental conditions. These contingencies will impact rescue efforts as well as treatment, triage and transport as well as longevity of responders.

• You should plan for distractions. Anticipate the media will have been contacted and will show up as well as parents. Plan for their arrival. Consider that patients may have walked off the scene prior to your arrival as well. 

• Control the hazards simultaneously with stabilizing the vehicle is a priority. Shutting off the electrical master switch and ignition as soon as possible may be your best bet. If you need to disconnect the battery, remember two things; there may be more than one battery and disconnect the negative cable. It is not uncommon for buses to have multiple batteries in different locations. Removing the negative cable and securing it to prevent contact with other parts of the bus is a good safety tip. 

• Solid stabilization has to be done at either end of the bus or under the center frame rails. Never attempt to crib a school bus under the skirting on the sides. Keep in mind that you'll need more cribbing than usual. Simply choking the wheels may be sufficient if the vehicle is upright; otherwise, the situation will dictate where best to crib and stabilize the bus. 

• For gaining access and creating evacuation , follow three simple steps points: Use existing opening, enlarge existing openings, or make your own opening. First, using existing openings will work well if patients can walk or have limited injuries and is the fastest and easiest to accomplish. Enlarging existing openings such as windows takes some time, personnel and equipment, but allows for rapid movement of rescuers and gear in and patients out. Once you start to cut on a bus be sure to reevaluate the need for structural stabilization and any effect on vehicle stabilization. You can make your own openings, too. I would leave this tactic as a last resort. Cutting into the side or top of a school bus is personnel intensive, time consuming and can add to the hazards. Cutting into the bottom of a bus is doable, but next to impossible.

Reading for Disaster

National Academies Press  introduces Emergency Preparedness/Disaster Management publications

The National Academies Press is offering a series of documents and eBooks focused on various aspects of preparedness. Many of them are free PDF downloads and make a quick read. The ones I'm reading are linked in the sidebar.

Topics include:

Facing Hazards and Disasters: Understanding Human Dimensions

Grand Challenges in Earthquake Engineering Research: A Community Workshop Report 

Preparedness and Response to a Rural Mass Casualty Incident:Workshop Summary

National Earthquake Resilience: Research, Implementation, and Outreach 

Building Community Disaster Resilience through Private-Public Collaboration  

Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response

Shootings, High- Profiles Soft Targets

The threat of intentional attacks on civilian soft targets continues.

"Locations of critical infrastructure such as hospitals, will need to be protected from attack as will other civilian locations. Hotels, coffee shops, and shopping centers lack the deterrents necessary to prevent attacks. The psychological impact of an attack on any of these soft targets will nearly as devastating as the loss of life."

I wrote that in a post quite some time ago and unfortunately, its proven accurate again.

In response to the recent shootings at a movie theater in Colorado -

Consider the following:

1. Soft target - lacking any deterrent or protection from an attack
2. Lone Wolf - individual acting alone with considerable planning, action intelligence,  resources, and motivation
3. Multiple threats - secondary devices, chemical hazards
4. Prior events show commonalities for preparedness (Olympic Park, Columbine H.S.) - lessons from case study improve response efficiency 

Lessons:

1. It can happen here
2. If you haven't conducted joint training, response will suffer
3. Include case study in your training program

Recommendations:

1. Plan for the realistic threats you face - maybe you should skip the airport/crash drill this year and replace it with an active shooter event at a soft target
2. Evaluate your plans
3. Evaluate your exercise design program and consider including tabletop exercises

How ready are you for an active shooter?

Co-posted on ProResponder
Ready or not, soft targets are at risk

Active shooter situation may be the most difficult to domestic terrorism situation to deal with. Many of the active shooter situations take place in a work environment and may have no warning. Firearms of all varieties have been noted in active shooter case studies from the United States. According to the Department of Homeland Security

"An Active Shooter is an individual actively engaged in killing or attempting to kill people in a confined and populated area; in most cases, active shooters use firearms(s) and there is no pattern or method to their selection of victims..."

These events are unpredictable in nature and timing, but the outcomes and be generically predicted.  If we follow the basic principles of Life Safety, Incident Stabilization, and Property Conservation, we'll be able to keep personnel safety and response priorities in balance.We'l focus on Life Safety and Incident Stabilization in this post.

Life Safety. In active shooter situations life safety means protection of responders, elimination of freelancing, and accountability. While the first step in life safety is pre-incident planning, the root of successful is understanding the response priorities of each responder discipline. In active shooter situations the rapid deployment of law enforcement is paramount to life safety and incident stabilization. The response priorities of law enforcement in active shooter situations is going to be different from those of fire and EMS responders. While fire and EMS responders may be focused on evacuation of live persons or treatment of wounded, law enforcement may have to delay action on the part of other responders to secure the scene and progress toward the actual suspect. The urge to rapidly gain access to wounded persons must be suppressed until law enforcement has deemed the situation safe. To help understand law enforcement perspectives on these situations, I recommend this article from PoliceOne.com

Incident stabilization. First arriving units may encounter persons leaving the scene or may be inundated with wounded. A slow approach with good positioning well away from building egress points will be the best first-in location. EMS should use the delay in patient contact to establish patient collection points and staging areas within the geographical confines of the situation. Keep in mind that wounded persons may have left the scene prior to your arrival and gone into nearby buildings or neighborhoods...you may receive calls to your dispatch center from multiple locations outside the shooter area. Deployment of resources on the perimeter will help speed response to these areas.

The Department of Homeland security has issued a list of good practices for persons in an active shooter situation:

• Be aware of your environment and any possible dangers
• Take note of the two nearest exits in any facility you visit
• If you are in an office, stay there and secure the door
• If you are in a hallway, get into a room and secure the door
• As a last resort, attempt to take the active shooter down. When the shooter is at close range and you cannot flee, your chance of survival is much greater if you try to incapacitate him/her.

Also, according to DHS, there are thee main steps people should take;
Evacuate if there is a clear path of egress
Hide Out if evacuation is not possible
Take action against the shooter only as a last resort when your life is directly in danger.

Rule of Outcomes thinking: Active Shooter events

The value of preparing generically

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We've posted several pieces discussing the active shooter situation in Ohio. This weeks Mitigation Journal podcast summarizes many of the issues discussed and introduces Rule of Outcomes thinking as applied to armed gunman/active shooter events.

Click the player below to listen

Soft Targets Attractive to Active Shooter Events

Co-Posted on ProResponder
Active shooters pose active threats

The topic of an active shooter event has tragically made headlines once again. Active shooter situations in a soft target location - a mall, school, hospital/health care environment, or sporting event would be disastrous. We have to acknowledge the fact that these locations are indeed soft targets - they lack the infrastructure to deter an attack and, as current events and case study reminds us, are attractive targets. Further, with all the attention and money spent on chem/bio/rad preparedness, I belive that the active shooter situation has been left behind.

Given this, I've decided to re-post Mitigation Journal podcast #187 (an interview with Net Talon) on active shooter situations, as well as excerpts from prior blog posts on the topic.

Click on the player below to listen to the Net Talon interview!


We're all about situational awareness. Numerous articles and sources have talked about the use of civilians as forward observers...that is, those who are engaged in a situation being part of the solution be providing first-hand data to responders. The best example of this is the cell phone videos that make it to mainstream media; those videos taken by civilians who are actually there and perhaps in harms way. Even more recently we've discussed how many 9-1-1 dispatch centers were now accepting emergency calls via text messaging. Suffice to say, those in the midst of a situation have technology available to get important data out to responders.

I had an opportunity to have Donald Jones, Director of Corporate Development, and Ronald DuBois, Director of Administration and Finance at Net Talon join me on Mitigation Journal Podcast edition 187 for an in-depth look at Net Talon and the Virtual Command technology. What you'll hear on Mitigation Journal Podcast this week is perhaps the most invigorating news on the topic of threat mitigation I've heard in a long time.

Please visit Net Talon on at www.nettalon.com. While you're there, be sure to watch their active shooter demonstration.

7 Surefire Tips for Emergency Plan Failure

Following these simple tips will bring your planning to a bitter end!

Tip #1. Use a template that you found on the internet to write your plan. Just Google for a plan template then use the Find/Replace feature in your word processing application to place your community or organizations name in the appropriate spot. The results will be stunning! You'll have your plan(s) written in no time and they'll be completely dysfunctional. Beware! You might run into a problem when someone else reads the plan or you actually have to put it into action. Don't worry, the following tips are designed to prevent that from happening.

Tip #2. Put the completed plan in a three-ring binder. The next action is to take your generic template from another organization, print it, and place it in a three-ring binder. Slap a label on the binder spine and place it on a shelf! This tip is almost guaranteed to keep anyone from reading your pirated plan! Even better, you'll never have to worry about updates or answering questions on the plan. What a time saver!

Tip #3. Don't have the plan reviewed. Don't even tell anyone about it. The last thing you want is someone reading your plan once its finished, especially someone from outside your agency. To best ensure failure, keep the plan to yourself and quote from it only when absolutely necessary.

Tip #4. Write your plan based on the last crisis you encountered. Remember the last "big one"? Think about what you did during that crisis and build your plan from there. After all, you've always done it that way. Heck, the last "big one" is as bad as it will ever get. Above all, keep in mind that it can't happen here.

Tip #5. Spend fifteen minutes with your Hazard Vulnerability Analysis. Or ignore it completely. You Hazard Vulnerability Analysis will only add work to your plate by making you focus on realistic threats in your community. Why waste the time? If you follow tips 1-4, there is no need to spend time with the HVA.

Tip #6. Write the plan specifically for your organization. Remember, nothing outside of your boundaries needs to be planned for. And any crisis in a neighboring jurisdiction will in no way bother you.

Tip #7. Do not, under any circumstances, test your plan. Save time and build morale with this tip! Skip the realistic training scenario. Table the tabletop exercise. Instead, gather the troops and order pizza! Talk about the good 'ole days and slap each other on the back over what a good job we did at the last drill. Your meaningless template of a plan can remain safe in its binder. No muss, no fuss.

Why you should read history

Learning lessons from historical case study

Click for podcast

I've been a fan of using historical case study in emergency response and domestic preparedness for many years, and until recently, thought I was the only one. Just the other day I read a post on another emergency management blog that noted the significance of the MGM Grand fire in fire code and code enforcement change (Thank you, Todd Jasper -if you haven't visited his blog, click here).

• What is a case study?
• What makes case study valuable today?
• How can we apply case studies to our current environment?
• Where can we find good case studies?

What is a case study?
According to Dictionary.com, a case study is

"...a study of an individual unit, as a person, family, or social group, usually emphasizing developmental issues and relationships with the environment, especially in order to compare a larger group to the individual unit."

While the above definition is fine for generic use, I'd rather think of a case study (as it pertains to emergency management as the following:

• an historical record of something the really happened - an after action report
• a synopsis of the situation
• a review of positive and negative outcomes from the event
• an honest review of the lessons learned from the response

A case study should include all of these elements to be useful. It's our job to apply them to today's situations. 

What makes case studies valuable today?
Wouldn't it be nice to learn an important lesson without having to pay the price of error to learn it? Of course it would. And that is the value of relevant case studies...you can learn the lesson without paying the price!

 Reading a case study is just like reading history. It's an event that really happened. People actually responded to the event and had to make decisions. Making a case study valuable to your situation is up to you and you'll have to do a bit of work to find a case study that's good for you. That work includes:

•  defining what your needs/threats are - is there a specific situation you're preparing for or are you looking to explore you Hazard Vulnerability Assessment?
• finding a case study or situation that is similar to those needs/threats - finding an event that is similar to what you're preparing for means you'll have to apply the outcomes and lessons to your situation.
• applying the lessons from that case to your situation - understand where and when the case took place, then compare the outcomes/lesson to today's world and your needs.

How can we apply case studies to our current environment?
Think about what happened in the case. Look at the end result and ask "what would we do?" Would we respond in the same way? Do we have a similar hazard with the same potential? How can we avoid the situation? These are all questions you need to ask yourself while reading a case study.

You'll also need to take into account any changes in operations, personnel, or threats that have been put into play since the case took place. Reading the lessons learned section of an after action report or case study can be the catalyst for training and thinking.

Where can you find emergency response case studies?
United States Fire Administration - Technical Report Series
FEMA - Keyword search Case Study
Centers for Disease Control and Prevention (includes NIOSH)- Keyword search Case Study

Just remember; it can’t happen here.

The time is just before noon on April 20, 1999 and the teachers and students of Columbine High School are going about their business as they would any other day. In fact, it is just that; any other day in Littleton, Colorado.

April 20, 1999 was not an ordinary day for two students Columbine High. Tragically this day would become one of the darkest days for domestic terrorism in our Nation. It would also become the day the parents of thirteen children dread…the day their children were killed.

Can anyone remember the act of domestic terrorism at Columbine High School way back in 1999? In case you’ve forgotten let me give you a review.

Two juvenile students of Columbine walk into the school that late morning after killing two students at the entrance. The offenders continue to fire-at-will killing another 11 people and wounding over 160. The semi-automatic guns were not the only weapons of the day. These juvenile home-grown terrorists deployed or possessed over 100 incendiary and explosive devices in an anti-personnel fashion.

Nobody saw it coming. Nobody was ready.

But, that can’t happen here. Dozens of firefighters and paramedics tell me so every month.

Fast forward to January 31, 2006 were we find the first two of three events that underscore our vulnerability to such events. A student of Webster Shcroeder High manages to get a small caliber handgun into the school with a population of 2000 students. He’s caught and peacefully disarmed of the gun and the knife he had hidden in his locker. On that same day at 7th grader at Geneseo Middle School is arrested for compiling a “hit list” from his 536 classmates and attempting to conceal a “fake” bomb.

Editors Note: Don’t let the term “fake” fool you. “Fake” bomb is just another name for one that will not go off. There is a fine line between a bomb that fails to detonate and one that is a “fake”.

February 2, 2006; the 840 student population of Franklin High School in Rochester, NY in lockdown mode, reportedly a student has a loaded gun.

January 31 and February 2, 2006. Two days just like any other.

Here we are nearly seven-years after the Columbine High School attack. Are we better prepared for such an eventuality here?

We’ve broken our collective arms patting each other on the back at various simulations of chemical attacks and aircraft crashes. We’ve written for grant dollars and purchased shinny trucks. So, we must be prepared. Aren’t we?

The sad fact is that we are not prepared. For all the hard work and planning that goes into planning a full-scale functional exercise, many of the lessons that should be taught and learned simply aren’t. We’ve failed to glean all we can from these training sessions because they are WMD or hazardous materials or airplane crash scenarios…not school shootings.

We have to shift our focus to training in the all-hazards mindset. The commonalities among these large-scale events; mass casualty, haz-mat and so on, can be translated to almost any situation.

Can anybody remember April 20, 1999 at Columbine High School? The lessons that should have been learned from that day at Columbine were lost just as the lessons from Y2K, SARS, and any number of natural disasters have been.

Our response community suffers from the worst preparedness shortfall; we still think that the worst thing that we’ve ever encountered in our career is the worst thing that will ever happen…

Just remember; it can’t happen here.

Links:
Franklin H.S. lockdown: http://www.13wham.com/news/local/story.aspx?content_id=52F7165B-88D2-4322-A360-F839E5F5F446

Geneseo student “hit list”: http://www.13wham.com/news/local/story.aspx?content_id=1DF9C978-6764-4009-B733-9CDC331ECC3A

Webster student brings gun: http://www.13wham.com/news/local/story.aspx?content_id=66946445-AD9E-45E7-9D2F-29DB9C59A915

Mas Shootings

Check out this article on Mass Shootings from Government Technology online magazine. Read the You might be interested to listen to my commentary on Mitigation Journal Podcast (see Mitigation Journal #90) as to why hospitals and shopping malls are soft targets and need their own MCI plan.

4 pitfalls to avoid in your biologic planning

Think you'll have access to everything you'll need? Think again. 

This plan is your plan, this plan is my plan. Not.
Emergency service agencies and healthcare systems have spent countless hours and dollars on the planning process yet, few if any of these plans integrate with each other. There is little if any continuity between traditional response groups and healthcare systems. Failure of any agency or service to adopt or even recognize the existence of the national incident management system or NIMS will be the cornerstone of failure during a large scale event. Scant few services, either public or private, address planning needs or participate in any level of joint training. This unfortunate situation is perhaps the least expensive and easiest to implement, yet remains ignored. 

Four things you shouldn't count on in a biologic crisis

1. Communications

Each plan assumes that there’s going to be the ability to communicate and that communications will be undisturbed throughout any given event regardless of the length or scope of that event.  Case studies of numerous large scale events indicate the communications will be among the first piece of infrastructure to be compromised. When communication systems have failed or are compromised alternate means of communication will spring up; and it is these alternate means of communications that will lend a false sense of communications security and ultimately yield unreliable and inaccurate information unless they are planned and tested.

2. Power and Transportation

The reliance on public energy and public transportation are critical weak link in the disaster and emergency planning process. Power and transportation are linked together in the disaster planning setting. If we have and reliable and hardened power infrastructure capable of producing climate control, light, and maintaining critical operations in a given facility we can reasonably assume that facility will remain habitable and functional during crisis. If the power supply is threatened or lost we will no longer be capable of sheltering in place throughout the crisis and the decision will have to be made concerning evacuation or alternative sheltering. Should the need arise to evacuate a given facility, especially a healthcare facility, there will be our reliance on emergency medical service (EMS) and public transportation to make it happen. EMS transportation vehicles may or may not be available in such a situation. One must understand that all traditional response groups, including emergency medical services, will have their resources stretched to capacity and beyond. Air and ground transportation units will be subject to the same problems of fuel, power, and communications disruptions as fixed facilities. Alternate means for power supplies and shelter in-place needs must be addressed by fixed facilities in addition to hospital evacuation contingency and 96 hour planning.

3. Personnel. 
Another fatal flaw in emergency planning is the assumption that personnel will in fact report to work. This consideration must be taken without regard to the status of roadways and transportation. A survey study conducted by Columbia University in September, 2005 demonstrates possibility of personnel, who are otherwise unaffected by crisis, refusing to report to work. In this study, health care workers were asked to indicate if they would be able to report for work or willing to report for work in the event of a mass casualty incident. 81% said that they would be able to go to work if there was an environmental disaster, yet only 69% said they would be able to go to work during a small pox epidemic. The study goes on to note that the willingness to report for work would only be 48% of health care workers during a SARS outbreak. Further, only 57% of health care workers would return to work in the setting of a radiological event. The fallacy in this stage of planning is to assume that Healthcare workers who have a perceived obligation to respond will, in fact report to work. Numerous sources have noted that the willingness to report for work in any situation may be impacted by concerns for the safety of the responders family. It is important for employers of public and private organizations to understand that the family care can be as vital as responder care. Workers fears will impact their willingness to work and administrators and company leaders must talk to their workers about these concerns regarding exposure and contamination and reassure them by planning to assure family and dependent safety. An example of such contingency planning would be the setting of highly pathogenic flu or other biologic event. It is estimated in such a situation that nearly 30 to 40% of the American workforce would become stricken or ill and unable to report for work of any kind. That percentage includes persons engaged in critical infrastructure such as traditional responder and healthcare providers. 

4. Surge Capacity
Another important point to consider is that of the lack of surge capacity in the concept of ripple effect deaths. Surge capacity is a specter of imagination as many Healthcare systems operate above capacity every-day. Just as the traditional response groups will continue to respond to the routine calls for service during a large scale event, routine medical emergencies will continue to arrive at local hospitals. Lacking surge capacity will almost certainly cause some of these otherwise routine patients to destabilize and become critical or fatal. This can add to the death toll of any large scale event and further destabilize community infrastructure.

Its Summer. Do you know where your plans are?

Summer months are the time to exercise your pandemic plans

We’ve been looking down the barrel of a loaded “pandemic gun” for some time and you've been meaning to do something meaningful about biological preparedness for a while now. Lets face it, a mild winter and lack luster flu season has taken biologic preparedness off the radar.  Here it is Summer time and were guided ever so gently by the media away from flu (avian or otherwise) and pointed towards gas prices, immigration, and politics of all sorts. Although not without good reason and some value, we’ve forgotten about the “pandemic gun” or maybe just because the weather is warm here we figure that gun is no longer loaded.

Experts are warning of the biologic implications of the London Olympics. Now what?


Its Summertime, do you know where your plans are?
Just because we’re out of the typical flu season is no rationale whatsoever to put planning and training for such an event on the back burner. I’ve been asked a number of questions recently pertaining to planning, preparedness and response capabilities. The sad fact is that, despite effort and dollars, most pandemic and biologic event plans fall short of functionality. The overtone seems to be that the healthcare community and public health are going in one direction and traditional response groups are not going anywhere at all when it comes to planning for a biological event.

Each of the plans I’ve reviewed share a number of pitfalls by assuming:

1. The ability to communicate will remain intact and accurate/factual information will flow
2. Power and transportation will be readily available
3. Personnel will be healthy enough and willing to report to work
4. Civil obedience will be maintained both in the community and at healthcare facilities
5. Patients will be able to be evacuated to neighboring facilities or regions.

In addition, these plans do not mention the fact that every-day emergencies will continue to come to hospitals expecting treatment.

If you want resiliency, stop doing this one thing.

When we place a term on an issue, that term becomes imprint in our mind. 

Terrorism and weapons of mass destruction (WMD) are terms arisen out of the September 11, 2001 attacks that have been imprinted on us. Although not entirely new terms for many in the traditional response group of emergency medical service (EMS), fire service, and law enforcement; terrorism and WMD became the language defining events of national crisis. Highly paid “experts” have become obligatory content in any number of trade journals and conferences. Emergency service organizations have received millions of grant dollars to purchase training/education, equipment, and supply all to be brought to defend against terrorism/WMD.

The sad  reality is that much of the training conducted has been lacking context to what is encountered and managed every day. There is little, if any, ability to apply theory or skills from terrorism training to the real world. We need to take the all-hazards approach to training and relate the material to the daily events that  paramedics, firefighters and healthcare providers deal with.  are just a few examples of the threats outside of the traditional terrorism training we've been given. 

 Doing so will keep the skills and knowledge fresh and usable. If we continue to wrap this material up and say “don’t open ‘till terrorist attack” we will not be able to access it efficiently or use it properly.  Lets make terrorism training part of the greater Civil Preparedness/Resiliency that includes naturally biologic events, chemical suicide and technological failure.

Civil preparedness is much more than readiness for an intentional event - its not about being a Doomsday Prepper, either. Its a way of identifying through analysis and assessment the hazards we're likely to encounter and the potential impact of those threats. We have to blend what we’ve come to know as terrorism/WMD training into the “basics” of public emergency service and healthcare response. To do so is simple because of the similarities between the intentional events and haz-mat accidents, mass casualty events, and natural disasters.

What do accidents, man-made events, and natural disasters (ice storms, hurricanes, earth quakes, floods) have in common?

Here's the short list of commonalities:

From the web. I do not own this.

• little or no warning
• large numbers of civilians needing assistance
• multiple casualties and fatalities
• protracted operations
• limited resources

The Civil Preparedness Mindset looks at preparing us for a multitude of potentials. Not everyone has to be ready for a blizzard or a wildland fire, but we should all be aware of the hazards we're likely to face based on our Hazard Vulnerability Assessment. We all need self-protection, working knowledge of the incident management system, triage and casualty/fatality management, for example.

The labels of terrorism and WMD may have been a great disservice to emergency responders, healthcare providers and citizens. Those terms imply an event that most people don’t believe will ever happen to them. There is much more to preparedness than terrorism.

Let’s try to change our thinking.

Updated/edited. Original 11/05

Nuclear KODAK Moment. So what?

Highly Enriched Uranium, yes. How much of a threat?

Mainstream media and blogs are alive with the discovery of a nuclear reactor at Eastman Kodak Company (EKC). Enchanting headlines lead us to believe that there is and was a conspiracy to keep the reactor and its contents, 3.5 pounds of enriched uranium, from public knowledge.

 Knowledge of the reactor, its contents, and location had been limited to a small group of employees until an ex-employee recently outed the reactors existence. Supposedly nobody in Rochester/Monroe County, NY government knew about it. The community at large was not informed.  Its interesting how just a few years ago I found two containers labeled "radioactive" sitting unsecured in the back of a truck and nobody seemed to care but, now we're supposed to get upset over a small amount of material that has been safely operating since 1975.

Background
The EKC reactor, a Californium Neutron Flux multiplier (CFX), and associated material had been kept quiet since the mid-seventies. Only two reactors of this type were ever produced and according to documentation, EKC was issued a Special Nuclear Material License by the Nuclear Regulatory Commission in 1975 for the use/operation of the CFX. The reactor was housed a concrete labyrinth outside the Northwest corner basement of EKC building 82. This building is well known as Kodaks research and development area. Researchers used the CFX reactor for chemical and radiological testing, manufacturing process studies, and investigation of new chemicals.

The reactor was shut down in 2006 with the fissile material/fuels, Uranium/Claifornium (Cf) 252, removed and shipped to the Department of Energy (DOE) Savannah River facility in Aiken, GA.

Kodak Building 82-a mixed industrial/residential area

What should we have known?
The CFX reactor is not a nuclear power plant. Its no Three Mile Island and its no Chernobyl. Should the public, emergency planners and responder shave been informed of the CFX reactor operation? Absolutely. Not because the CFX was dangerous, but because its one more threat that we should have been planning for...just in case. The Greater Rochester region has a robust nuclear response plan in place for the Ginna Nuclear Power Plant. The Ginna plant came on-line in 1969. In 1982 the plant leaked a small amount of radioactive steam. The 93 minute leak resulted in a disaster declaration. Nuclear and radioactive materials is nothing new for this area, and it is inconceivable that the local government did not know of the Kodak CFX reactor existence.

What is the Potential Threat?
If we'd turned on the news today and heard the Iran had obtained 3.5 pounds of highly enriched uranium (HER), I'd be concerned...the revelation of Kodak operating a nuclear reactor doesn't really bother me.

Kodak CFX Reactor

Despite headlines claiming Kodak could start a nuclear war or was sitting on a nuclear bomb, there is little threat to be found here...as long as everything goes as planned. 3.5 pounds of HER is roughly 1.5 Kg of material. The Little Boy dropped on Japan carried approximately 64Kg of HER. With today's nuclear weapons technology, it would take 15 to 25Kg of material to produce a true nuclear weapon.

A major potential for harm comes not from the Uranium but from the lack of knowledge that it exists. Most reports have indicated that local officials were unaware of the reactor. I find this hard to believe since, as noted above, EKC was issued a Special Nuclear Material License by the Nuclear Regulatory Commission. However, I’m certain that the responders who protected that area were not aware of the reactor...and there is the danger.  If planners and responders are not aware of a hazard, proper actions will most likely not be taken - the response outcomes will suffer.

Theft or sabotage are the larger threats. Even a small amount of HER or Cf 252 could created a significant dirty bomb threat.

You can check to see how many nukes you are within range of by going looking at the Nuke-O-Meter

Biologic Effects of Radiation
For more on the biologic effects of radiation that covers the basics of radiation as well as the phases and syndromes associated with radiation exposure. You can read the three-part series on Mitigation Journal. Part one is an overview of radiation sources, measurement, and an introduction to the biologic effects, part two covers biological effects, acute radiation sickness and associated symptoms and syndromes, while part three reviews the details of Acute Radiation Sickness (ARS)

School-Based Health Centers, not your average nurses office

HHS tags $75 million for school-based health centers

Image: Seattle School Based Heath

Funding for the school-based health centers capital (SBHCC) program is contained within the Affordable Care Act with an earmarked total of $200 million.  SBHCC will receive $75 million spread out over an estimated 150 grants in 2013. The purpose of SBHCC grants is to help create jobs and improve child health by either implementing a school-based health center or improving an existing school health center. Like retail health clinics and walk-in care/urgent care centers, school-based healthcare centers are (or can be) part of the public health safety net. Children and adolescents will have improved access to healthcare resources while attending school. Kids with special or chronic care needs will also benefit from increased access to care.

According to the Health Resources and Services (HRSA) website:

School-Based Health Center, in general, means a health clinic that

• is located in or near a school facility of a school district or board or of an Indian tribe or tribal organization;
• is organized through school, community, and health provider relationships;
• is administered by a sponsoring facility;
• provides through health professionals primary health services to children in accordance with State and local law, including laws relating to licensure and certification; and
• satisfies such other requirements as a State may establish for the operation of such a clinic.

These clinics will provide care and improve overall health and wellness through health screening, promotion and disease prevention.

Opinion
The "off label" benefit to a community will be increased disease surveillance and additional healthcare resources. These clinics will almost certainly meet the routine health needs of children and adolescents who may otherwise end up in an emergency department. In times of crisis, such as severe flu/pandemic, or other emergency, the school-based clinics could play an important auxiliary role (much like retail healthcare) in the distribution of pharmaceuticals and screening exams.