Representing over 37,000 nurses, the NYS Nurses Association (NYSNA) has spoken out against a new regulation making flu vaccine mandatory for all people who care for patients in health care...including nurses. Under the new regulations, nurses would be mandated to get a seasonal flu shot as a condition of employment. No shot, no work.
My first thought was: how could anyone be against this?! But, after reading the testimony, I can understand it...moreover, there are a number of Ripple Effect points to consider. After reading all the material, I think NYSNA has a number of valid points.
The first point is: Can this be mandated when no current public health emergency exists? The NYSNA is clear that they fully support and encourage nurses to get flu vaccine. Most would agree that getting a flu shot is good preventative action. When working in health care, what rights do you give up? Consider all the issues the military had mandating Anthrax vaccine not too long ago. Keep in mind you can still decline to get a HBV series and work...
I'll be talking about this in detail on the next Mitigation Journal Podcast (Edition 118 expected release 8/3/09). In the meantime - I've talked about the three best things you can do - now - to prepare for biologic events now, without vaccine...you can hear my recommendations on Mitigation Journal Podcast Edition 117.
Below are the links to the NYS Nurses Association press release and testimony.
Medical News Today story: http://www.blogger.com/post-create.g?blogID=18608016
NYS Nurses Association Press Release: http://www.nysna.org/news/press/072309.htm
NYS Nurses Association full text of testimony delivered by Eileen Avery, MS, RN, Associate Director, NYSNA Education, Practice and Research Program to the State Hospital Review and Planning Council, July 23, 2009, New York, NY.
July 21, 2009
Paramedic Future
What role will technology play in the future delivery of out-of-hospital care? I once believed that an increased use of technology would increase the scope and duties of paramedics. Today I'm not so sure.
I'm now starting to believe that implementing technology may actually decrease the need for paramedic treatment and, dare I say, speed critical patients treatment.
I learned to read 12-lead EKG's over twenty years ago. It was not common for EMS to "do" a 12-lead and the technology wasn't there to support us doing so. Years later the technology became readily available and is in wide use today. Many seasoned paramedics looked down on the computer interpretation and some, including me, would not read the interpretation until after reading all the leads and making a diagnosis.
Luckily, the technology has grown and become far more trusted. That is trusted to a point where we can question if the middle-man is needed. That middle-man, of course, being the paramedic. I don't know how I feel about this; on one side, any EMT could attach the leads and obtain and transmit the readings to the hospital making 12-lead EKG readily available, sooner. But on the other hand, technology can't consider the patient as a whole and put all the assessment pieces together like a skilled paramedic can.
Like any other technology, once we become accustomed to it, we become dependent on it...try going a without your email or word editor and hand-write a few letters...get the point. In the case of EKG's I'm afraid we'll eventually decide we don't need to teach reading them any longer...what will we do when technology fails?
Anyway - here is a cool article on the use of Blackberrys and EKGs
http://www.theglobeandmail.com/news/technology/heart-attack-help-the-blackberry-solution/article665450/
I'm now starting to believe that implementing technology may actually decrease the need for paramedic treatment and, dare I say, speed critical patients treatment.
I learned to read 12-lead EKG's over twenty years ago. It was not common for EMS to "do" a 12-lead and the technology wasn't there to support us doing so. Years later the technology became readily available and is in wide use today. Many seasoned paramedics looked down on the computer interpretation and some, including me, would not read the interpretation until after reading all the leads and making a diagnosis.
Luckily, the technology has grown and become far more trusted. That is trusted to a point where we can question if the middle-man is needed. That middle-man, of course, being the paramedic. I don't know how I feel about this; on one side, any EMT could attach the leads and obtain and transmit the readings to the hospital making 12-lead EKG readily available, sooner. But on the other hand, technology can't consider the patient as a whole and put all the assessment pieces together like a skilled paramedic can.
Like any other technology, once we become accustomed to it, we become dependent on it...try going a without your email or word editor and hand-write a few letters...get the point. In the case of EKG's I'm afraid we'll eventually decide we don't need to teach reading them any longer...what will we do when technology fails?
Anyway - here is a cool article on the use of Blackberrys and EKGs
http://www.theglobeandmail.com/news/technology/heart-attack-help-the-blackberry-solution/article665450/
July 6, 2009
Is there a Nuke in your neighborhood?
Is there a Nuke in your neighborhood? Check out Nukeometer at http://nukeometer.com/
Just enter your city and country to find out how many nukes are within range of your city! The breakdown is given by potentially offending country and by delivery...ICBM, submarines, short range missile...these guys thought of everything!
Here in Rochester, NY, we're in range of 6404 nuclear warheads...2347 from the USA and 3684 from Russia, 192 from UK, 121 from China. 2490 of those can be delivered from ICBM and 2771 by submarine with only 1143 available by bombers.
By contrast, Denver Colorado is within range of 8127 warheads and Washington DC 6404 warheads. Tune in and find out where your location stands...pleasant dreams.
Just enter your city and country to find out how many nukes are within range of your city! The breakdown is given by potentially offending country and by delivery...ICBM, submarines, short range missile...these guys thought of everything!
Here in Rochester, NY, we're in range of 6404 nuclear warheads...2347 from the USA and 3684 from Russia, 192 from UK, 121 from China. 2490 of those can be delivered from ICBM and 2771 by submarine with only 1143 available by bombers.
By contrast, Denver Colorado is within range of 8127 warheads and Washington DC 6404 warheads. Tune in and find out where your location stands...pleasant dreams.
June 1, 2009
May 31, 2009
More Chemical Suicide
I've been made aware of a case of chemical suicide in Toronto via a memo on Toronto EMS letterhead. Although I've not been able to confirm the validity of the memo or find associated material on the event, it seems as if Toronto has had a case of chemical suicide. The chemicals listed in the Toronto EMS memo are among those on the list of potential chemicals for other events in Japan and the U.S.
When certain chemicals are mixed, Hydrogen Sulfide gas can be created. In some cases the gas has been created in concentrations greater than 2000 parts per million. Hydrogen Sulfide is more potent than cyanide, has a quick "knock down" - causing unconsciousness/respiratory failure - withing one to two breaths.Chemical suicide events have taken place in hotel rooms, residential areas, and apartments. The latest trend is to mix the chemicals in a car parked in a parking lot. Both residential and vehicle borne events have the potential to cause responder deaths and mass casualty/multi-patient events.
In some cases, people have posted signs on the doors of apartments or windows of cars indicating their intent to commit suicide by chemical agent. Responders need to be aware of any unusual clues such as windows taped shut, open containers of liquids (chemicals have been mixed in small wash tubs), odors of any kind. We should also add a high index of suspicion for any "person over the wheel" calls - don't assume the person in that car is sleeping! If you think there has been chemicals involved in a situation - do not enter, do not open the car. Keep the area clear, create a parameter and keep yourself uphill and upwind - call for FD/hazmat.
Below is a list of links to prior Mitigation Journal posts from the podcast and blog...
Blog Postings:
Chemical Suicide in Cars
Suicide by Blood Agent
Podcasts:
Mitigation Journal Podcast #72
Mitigation Journal Podcast #64
Mitigation Journal Podcast #59
May 30, 2009
DHS/FEMA Announce Shelter System
I've been expounding this concept for years now...reminding us to get back to the Civil Defence mindset. My meaning has been simple: prepare the individual and the family, provide for save shelters in public areas (a.k.a. Fallout Shelters) to give people a place to go when out in daily life, and we'll greatly improve our ability to mitigate natural and intentional events.
Someone must have been listening...finally.
DHS and FEMA have announced the creation of a Disaster Shelter System to house civilians in the event of a natural disaster. Details are still drifting in, but we are moving in the right direction!
Check the source materials from Los Angeles Times and National Terror Alert.
Homeland Security Secretary Janet Napolitano and Craig Fugate mentioned that we will only be as successful to the level of preparedness of the family - and I agree. September is National Preparedness Month and we should all be making plans, keeping informed and getting involved as best we can to prepare ourselves, our families, and our communities for crisis. Remember - local efforts will save lives!
Now, onto some interesting statements:
Craig Fugate, the new director of the Federal Emergency Management Agency, further stated “We are only going to be as successful as the public is prepared,” and “There are a lot of folks who are going to need very specific help that should not have to compete with the rest of us.”
I agree with the first quote here - public preparedness make for an efficient and successful (as much as can be expected) response to emergencies and disasters. But what is FEMA Director Fugate talking about in the second quote? “There are a lot of folks who are going to need very specific help that should not have to compete with the rest of us.”
Who is competing with whom? Moving towards a shelter system is an excellent idea...but, yet again, we will overwhelm those resources if people are individually prepared! Even the best Nation-wide shelter system will fail under the strain of an uniformed, unprepared community.
Someone must have been listening...finally.
DHS and FEMA have announced the creation of a Disaster Shelter System to house civilians in the event of a natural disaster. Details are still drifting in, but we are moving in the right direction!
Check the source materials from Los Angeles Times and National Terror Alert.
Homeland Security Secretary Janet Napolitano and Craig Fugate mentioned that we will only be as successful to the level of preparedness of the family - and I agree. September is National Preparedness Month and we should all be making plans, keeping informed and getting involved as best we can to prepare ourselves, our families, and our communities for crisis. Remember - local efforts will save lives!
Now, onto some interesting statements:
Craig Fugate, the new director of the Federal Emergency Management Agency, further stated “We are only going to be as successful as the public is prepared,” and “There are a lot of folks who are going to need very specific help that should not have to compete with the rest of us.”
I agree with the first quote here - public preparedness make for an efficient and successful (as much as can be expected) response to emergencies and disasters. But what is FEMA Director Fugate talking about in the second quote? “There are a lot of folks who are going to need very specific help that should not have to compete with the rest of us.”
Who is competing with whom? Moving towards a shelter system is an excellent idea...but, yet again, we will overwhelm those resources if people are individually prepared! Even the best Nation-wide shelter system will fail under the strain of an uniformed, unprepared community.
May 23, 2009
Attacking Hemagglutinin and Neuraminidase
Hemagglutinin and Neuraminidase are the proteins of the Type A flu. Hemagglutinin allows the virus to enter a host cell (remember, virus is must have the cellular mechanics of a host) and Neuraminidase allows the virus to reproduce and exit...going on to infect another cell. To date, antiviral agents attack Neuraminidase (Neuraminidase inhibitors). New research outlined in Medical News Today, highlights the possibility of attacking both the H and the N. See the article here: In A New Way Of Treating The Flu, Both The H And N Portions Of The Virus Are Targeted
This would be good news for all of us as virus begin to become resistant to medications such as Tamiflu.
This would be good news for all of us as virus begin to become resistant to medications such as Tamiflu.
May 20, 2009
Common Sense PPE
This clip talks about the common sense actions to take during and after encountering any patient with fever and respiratory illness, including influenza like illnesses (ILI) such as seasonal flu or Swine Flu. Hats off to this RN, Paramedic from Paratech Ambulance in Milwaukee, WI, and to the reporter for a job well done.
For more on the topic of flu, type in keyword "flu" in the search box in the upper left header on the Mitigation Journal blog page or into the search box on the right side-bar on the Mitigation Journal podcast page.
For more on the topic of flu, type in keyword "flu" in the search box in the upper left header on the Mitigation Journal blog page or into the search box on the right side-bar on the Mitigation Journal podcast page.
May 13, 2009
Cassandra
Cassandra, in Greek mythology, was given the gift of correct prophecy of forthcoming mishaps and calamities. Apollo, a Greek deity, because of anger, made certain that no one would believe her. Thus, Cassandra has become known as the bearer of evil tidings that no one will believe.
E.L. Quarantelli, 1988
E.L. Quarantelli, 1988
May 11, 2009
Do it in your Sleeve
Here is a nice public education video on the topic of respiratory etiquette. Its lighthearted and factual. Check it out here: http://www.coughsafe.com/media.html
Thanks to Mitigation Journal reader/listener, Ted Lenze, for sending this in.
May 6, 2009
Of Chicken and Expectations
OK, you've got to see this video! When watching, do so from an emergency management standpoint...that is, substitute antiviral agents, antibiotics, masks...for the word "chicken".
Also, change the question "how do I feed my family?" to "how do I protect my family?". How about instead of Popeyes...we use [insert your organization/community name here] ? Are you prepared for the onslaught?
How does simply changing from "chicken" to medication/masks (or whatever) impact this situation? What will changing from "feed my family" to "protect my family" do to social unrest and public health?
Is this a snapshot of what we can expect when the community expectation is not met?! These people are not actors, they are actual citizens with actual expectations...reacting when those expectations are not met.
Imagine your point of distribution running out of medication...or the neighboring jurisdiction running out of medication and how that will impact your community. If people react in the manner displayed on this video over a chicken combo special, what do you think they will do when we run out of antivirals, antibiotics, masks...or whatever?
I can hear it now..."What do you mean you didn't order enough antiviral medication and masks?! You knew this flu was coming two months ago!"
Special thanks to our Director of Apocalyptic Thinking, Officer Sundquist, for sending me this video and bringing this potential to our attention.
I await debate and comment!
Also, change the question "how do I feed my family?" to "how do I protect my family?". How about instead of Popeyes...we use [insert your organization/community name here] ? Are you prepared for the onslaught?
How does simply changing from "chicken" to medication/masks (or whatever) impact this situation? What will changing from "feed my family" to "protect my family" do to social unrest and public health?
Is this a snapshot of what we can expect when the community expectation is not met?! These people are not actors, they are actual citizens with actual expectations...reacting when those expectations are not met.
Imagine your point of distribution running out of medication...or the neighboring jurisdiction running out of medication and how that will impact your community. If people react in the manner displayed on this video over a chicken combo special, what do you think they will do when we run out of antivirals, antibiotics, masks...or whatever?
I can hear it now..."What do you mean you didn't order enough antiviral medication and masks?! You knew this flu was coming two months ago!"
Special thanks to our Director of Apocalyptic Thinking, Officer Sundquist, for sending me this video and bringing this potential to our attention.
I await debate and comment!
May 5, 2009
Selected Reading on the Flu Situation
Here are a few of the many articles I've read in the last few days on the topic of Swine Flu and flu in general.
Avian Flu Research Sheds Light on Swine Flu
"...A new study by University of Maryland researchers suggests that the potential for an avian influenza virus to cause a human flu pandemic is greater than previously thought. Results also illustrate how the current swine flu outbreak likely came about..."
Is Swine Flu A Worldwide Threat?
Pandemic Flu Vaccine 6-Month Lag Time
"...the first wave of pandemic flu may be over before people are vaccinated..."
Avian Flu Research Sheds Light on Swine Flu
"...A new study by University of Maryland researchers suggests that the potential for an avian influenza virus to cause a human flu pandemic is greater than previously thought. Results also illustrate how the current swine flu outbreak likely came about..."
Is Swine Flu A Worldwide Threat?
Pandemic Flu Vaccine 6-Month Lag Time
"...the first wave of pandemic flu may be over before people are vaccinated..."
On the topic of N95's
Some questions about fit testing for N95 masks have come up.
Fit Testing...is it worth the time?
http://www.upmc-cbn.org/report_archive/2008/12_December_2008/cbnreport_12192008.html
and here is a joint NIOSH/OSHA/CDC study
http://www.cdc.gov/eid/content/13/5/700.htm
Don't Expect Too Much from N95
http://www.iom.edu/CMS/3740/32033.aspx
http://www.medicalnewstoday.com/articles/42502.php
OSHA comments on stockpile of masks
http://www.upmc-cbn.org/report_archive/2008/05_May_2008/cbnreport_05302008.html
...and http://www.medicalnewstoday.com/articles/69826.php
Flu virus is airborne...suspended in air - need for more stringent precautions?
http://www.upmc-cbn.org/report_archive/2009/01_January_2009/cbnreport_01222009.html
Don't expect much from facemasks
http://www.medicalnewstoday.com/articles/42502.php
Fit Testing...is it worth the time?
http://www.upmc-cbn.org/report_archive/2008/12_December_2008/cbnreport_12192008.html
and here is a joint NIOSH/OSHA/CDC study
http://www.cdc.gov/eid/content/13/5/700.htm
Don't Expect Too Much from N95
http://www.iom.edu/CMS/3740/32033.aspx
http://www.medicalnewstoday.com/articles/42502.php
OSHA comments on stockpile of masks
http://www.upmc-cbn.org/report_archive/2008/05_May_2008/cbnreport_05302008.html
...and http://www.medicalnewstoday.com/articles/69826.php
Flu virus is airborne...suspended in air - need for more stringent precautions?
http://www.upmc-cbn.org/report_archive/2009/01_January_2009/cbnreport_01222009.html
Don't expect much from facemasks
http://www.medicalnewstoday.com/articles/42502.php
May 3, 2009
What NOT to do for Flu
Here is some good info in the setting of flu from TIME/CNN: The top five things NOT to do in a pandemic situation -
- DONT go to the hospital
- DONT be afraid to eat pork (and yes, I think we should continue to call this SWINE FLU)
- DONT hoard anti-viral medications (lets add to this one...DONT take antibiotics...they wont work on flu - antibiotics are for bacterial infections, flu is viral. Taking any medication...antibiotic or antiviral...when you're not sick can lead to the development of resistance, too)
- DONT leave your home if you feel sick (lets add to that if you have fever and respiratory symptoms...or symptoms suggesting cold/flu of any kind)
- DONT panic (its Swine Flu...not an IRS audit)
- Call 9-1-1 only if you need to...remember, ambulance crews are limited and calling an ambulance will NOT guarantee you get a hospital bed any faster (if at all)
- Wash your hands...all the time
- cover you cough/sneeze
- practice appropriate social distancing
April 20, 2009
FEMA Preparedness Guide 101
The final version of the FEMA Comprehensive Preparedness Guide 101 is available. You can download the entire 176 page PDF here: http://www.fema.gov/about/divisions/cpg.shtm
I read the draft a while ago and used that as a template for the Planning Series on the Mitigation Journal Podcast. I think it is a solid document with many good features for civilian and responder alike. My biggest joy from this document comes from an apparent return to a civil defense approach...something I am a BIG fan of...throughout the document.
I just hope someone at FEMA or DHS reads it.
I read the draft a while ago and used that as a template for the Planning Series on the Mitigation Journal Podcast. I think it is a solid document with many good features for civilian and responder alike. My biggest joy from this document comes from an apparent return to a civil defense approach...something I am a BIG fan of...throughout the document.
I just hope someone at FEMA or DHS reads it.
April 12, 2009
Anthrax? Not. Lessons Learned? Not.
Check the story here...good video, too.
Envelopes containing the dreaded "white powder" have been found in numerous locations Sebring, Fl. Some of the envelopes were found on cars in the parking lot of a hospital, some at the town hall, others in various mailboxes throughout the area. In at least one instance, a person who found the item on their car, took it back into the hospital...a lock down and default quarantine followed...
Of course, responders in PPE and SCBA collected samples that later turned out to be "non-hazardous" to humans.
What strikes me about this situation is not the fact that someone did it...its how the public and media responded to it. We know that, of the three varieties of Anthrax, inhalational anthrax is not spread person-to-person, we also know that it is difficult to manufacture is quantity and distribute. Why, in today's culture, would you take a substance back into a hospital?
Yet, we don't seem to get the lessons from prior events. Emergency managers should be informing the media about the reality of inhalational anthrax and responders (with appropriate caution) need to be realistic about responses...not every white powder event is NIMS laden, large scale disaster event.
We knew this before 9-11-01, we knew this after 9-11-01, yet we keep reacting to white powder events as if we've never seen it before.
Envelopes containing the dreaded "white powder" have been found in numerous locations Sebring, Fl. Some of the envelopes were found on cars in the parking lot of a hospital, some at the town hall, others in various mailboxes throughout the area. In at least one instance, a person who found the item on their car, took it back into the hospital...a lock down and default quarantine followed...
Of course, responders in PPE and SCBA collected samples that later turned out to be "non-hazardous" to humans.
What strikes me about this situation is not the fact that someone did it...its how the public and media responded to it. We know that, of the three varieties of Anthrax, inhalational anthrax is not spread person-to-person, we also know that it is difficult to manufacture is quantity and distribute. Why, in today's culture, would you take a substance back into a hospital?
Yet, we don't seem to get the lessons from prior events. Emergency managers should be informing the media about the reality of inhalational anthrax and responders (with appropriate caution) need to be realistic about responses...not every white powder event is NIMS laden, large scale disaster event.
We knew this before 9-11-01, we knew this after 9-11-01, yet we keep reacting to white powder events as if we've never seen it before.
April 11, 2009
Sabotage: Back to the Stone Age
An act of sabotage in Santa Clara, Ca. has disrupted communications and left 52,000 without telephone, cellular phone, or internet communications. According to the National Terror Alert and MercuryNews.com someone got into (an unsecured)utility man-hole and cut four or five fiber optic lines. The disruption impacted not only "land line" service, but cellular service, ATM's, and emergency communications.
Although sabotage is the suspected (obvious) cause of this event, the MercuryNews.com report notes that the contract between AT&T and the Communications Workers of America (CWA) had expired at 11:59 (problem identified at 2am)...
According to both reports, the situation was noticed when an emergency communications center discovered they had lost phone service. Officials have given some interesting quotes published in both the National Terror Alert and MercuryNew.com...
"We've never to this extent in recent history had this kind of phone outage,''and It's kind of like an earthquake" are two that stand out.
According to MercuryNews.com:
"The Santa Clara County Emergency Operations Center has been activated; the Santa Clara County Fire Department has moved more firefighters to south county fire stations; the county sheriff has increasing staffing and patrols; and additional ambulances have been positioned in the area."
Overall this is a good tactic. However, you have to consider that loss of communications is a precursor to another event in another area. If you move resources into the effected area, make sure other areas are also well supported.
A couple of things to point out, and this is what I'd be thinking if I worked in this areas emergency management:
Although sabotage is the suspected (obvious) cause of this event, the MercuryNews.com report notes that the contract between AT&T and the Communications Workers of America (CWA) had expired at 11:59 (problem identified at 2am)...
According to both reports, the situation was noticed when an emergency communications center discovered they had lost phone service. Officials have given some interesting quotes published in both the National Terror Alert and MercuryNew.com...
"We've never to this extent in recent history had this kind of phone outage,''and It's kind of like an earthquake" are two that stand out.
According to MercuryNews.com:
"The Santa Clara County Emergency Operations Center has been activated; the Santa Clara County Fire Department has moved more firefighters to south county fire stations; the county sheriff has increasing staffing and patrols; and additional ambulances have been positioned in the area."
Overall this is a good tactic. However, you have to consider that loss of communications is a precursor to another event in another area. If you move resources into the effected area, make sure other areas are also well supported.
A couple of things to point out, and this is what I'd be thinking if I worked in this areas emergency management:
- Soft Target/Hard Target...communications service is part of critical infrastructure...protect it! Open utility vaults/man hole access are soft targets when they contain communication equipment, power supply access, water supply distribution and so on. They should not be soft targets...they need to be protected.
- Despite the almost obvious link between AT&T/CWA contract negotiations, don't jump to conclusion that this situation was perpetrated by a member of either party. Keep in mind that people that want to do us harm read the paper, too. The contract negotiations may be just the cover an individual(s) would want to try an act such as this...bottom line, think deeper. Also, it wont take a lot of imagination to figure out what to cut/destroy to cripple a system like fiber optic communications. I think anyone with motivation could do it.
- Consider that this act may be a probe, a test simply to see how a community responds to such an event. Although significant, this could be the tip of the sabotage iceberg.
- Consider also that destruction of communications ability may be the heralding event for something else...disruption of communication may be just the start, with the primary event taking place later. Crippling of the emergency service communication and the public ability to report an event would signal trouble for responders...and increase the scale/impact of a concurrent event.
March 11, 2009
National Infrastructure Protection Plan
I've just received this link for the new National Infrastructure Protection Plan. We'll be reading it over in the next few days and reporting back here and on the podcast.
Until then, give the Plan and associated documents a look. All documents are available in PDF.
The updated document replaces the 2006 document...I think that one was over 200 pages...the update is only 188 pages. Your thoughts and comments are important. If you take the time to review the NIPP and documents, please let me know what you think.
Until then, give the Plan and associated documents a look. All documents are available in PDF.
The updated document replaces the 2006 document...I think that one was over 200 pages...the update is only 188 pages. Your thoughts and comments are important. If you take the time to review the NIPP and documents, please let me know what you think.
March 3, 2009
Chemical Suicide in Cars
Information is circulating on the topic of chemical suicides. We've talked about them a number of times on Mitigation Journal and here, in the blog. I've added some links to the podcast and blog postings on the topic of chemical suicides...see the links below.
There have been numerous cases in Japan of people committing suicide by mixing various chemical products with the end result being Hydrogen Sulfide. The situations in Japan have occurred at an alarming rate, and due to the living conditions, created a number of MCIs and ripple effect casualties in apartment buildings.
Two cases are being talked about recently...both in the U.S and both involving people sitting in parked cars (sometimes sealed with tape on the inside) and mixing chemicals. By reports I've been reading, the chemicals are different from the types used in Japan and other places, but the end result is the same.
I have been aware of this type of activity for a while now and reported about it on the podcast and blog. I am aware of two events within the last 6 months or so (Georgia and California) where people have locked themselves inside their car and mixed chemicals. I am also aware of at least one other similar event in Portland, Ore, where a guy used chemicals heated by a hibachi in a hotel room to do the same thing. In many cases there is hydrogen sulfide (H2S) created. Chemical suicide has been a growing problem in Japan...these situations have caused MCI's in apartment buildings and numerous deaths. It would seem the trend is continuing and moving toward us.
Mitigation Journal Podcast #72
Mitigation Journal Podcast #64
Mitigation Journal Podcast #59
Mitigation Journal Blog
More to follow...If any readers have better intel on this, please write in or call the voicemail line 585-672-7844.
There have been numerous cases in Japan of people committing suicide by mixing various chemical products with the end result being Hydrogen Sulfide. The situations in Japan have occurred at an alarming rate, and due to the living conditions, created a number of MCIs and ripple effect casualties in apartment buildings.
Two cases are being talked about recently...both in the U.S and both involving people sitting in parked cars (sometimes sealed with tape on the inside) and mixing chemicals. By reports I've been reading, the chemicals are different from the types used in Japan and other places, but the end result is the same.
I have been aware of this type of activity for a while now and reported about it on the podcast and blog. I am aware of two events within the last 6 months or so (Georgia and California) where people have locked themselves inside their car and mixed chemicals. I am also aware of at least one other similar event in Portland, Ore, where a guy used chemicals heated by a hibachi in a hotel room to do the same thing. In many cases there is hydrogen sulfide (H2S) created. Chemical suicide has been a growing problem in Japan...these situations have caused MCI's in apartment buildings and numerous deaths. It would seem the trend is continuing and moving toward us.
Mitigation Journal Podcast #72
Mitigation Journal Podcast #64
Mitigation Journal Podcast #59
Mitigation Journal Blog
More to follow...If any readers have better intel on this, please write in or call the voicemail line 585-672-7844.
March 2, 2009
Stand by for the Ripple Effect
One out of every four people said they're (or someone in the family) is putting off getting medical attention due to cost. Another 50% admit to over-reliance on folk remedy and over the counter medications in lieu of seeking prescription drugs and doctors office visits.
EMS providers hang on to your EKG leads! The combination of prolonged reliance on over the counter medications will lead to increased medication interaction and more severe disease. Sprinkle in a bit of denial and delayed access to care, and we'll be seeing sicker patients with masked symptoms. The situation reported by MSNBC should also be a warning for use to look ahead for the Ripple Effect...in this case, the Ripple will be surge on hospitals and EMS with patients who have been under treated or have been non-compliant with treatment. Also, responders have to be ready for the prescription / OTC interaction and complication of history and exam.
Keep an eye on this one.
EMS providers hang on to your EKG leads! The combination of prolonged reliance on over the counter medications will lead to increased medication interaction and more severe disease. Sprinkle in a bit of denial and delayed access to care, and we'll be seeing sicker patients with masked symptoms. The situation reported by MSNBC should also be a warning for use to look ahead for the Ripple Effect...in this case, the Ripple will be surge on hospitals and EMS with patients who have been under treated or have been non-compliant with treatment. Also, responders have to be ready for the prescription / OTC interaction and complication of history and exam.
Keep an eye on this one.
February 26, 2009
Protecting Nuke Plants from Air Attack
Shouldn't we have done this already?
You and I may have thought that nuclear power plants have been evaluated and made safe from threats on the ground and in the air. We're wrong. A story being run on CNN.com states that new construction of nuclear power plants will have to be protected from dive-bombing aircraft.
Just think, it's only been seven years since the September 11, 2001 attacks on the WTC...and we're just getting to the protection of our nuke plants now!? To make matters worse, the requirement put forth in the article notes that "...require any future nuclear power plants to be designed to withstand strikes from commercial jetliners..." What about the current plants? Shouldn't we be doing something with them as well? I have to honest here, I thought that they were already protected to some degree from this scenario...guess not.
Once again we demonstrate the failure to learn from our emergency preparedness history. Billions of dollars have been spent and much of it wasted in the name of preparedness since 9-11-01. We've failed to make meaningful changes to our attitudes toward preparedness and been mediocre at best keeping up with man-made and biological threats.
You and I may have thought that nuclear power plants have been evaluated and made safe from threats on the ground and in the air. We're wrong. A story being run on CNN.com states that new construction of nuclear power plants will have to be protected from dive-bombing aircraft.
Just think, it's only been seven years since the September 11, 2001 attacks on the WTC...and we're just getting to the protection of our nuke plants now!? To make matters worse, the requirement put forth in the article notes that "...require any future nuclear power plants to be designed to withstand strikes from commercial jetliners..." What about the current plants? Shouldn't we be doing something with them as well? I have to honest here, I thought that they were already protected to some degree from this scenario...guess not.
Once again we demonstrate the failure to learn from our emergency preparedness history. Billions of dollars have been spent and much of it wasted in the name of preparedness since 9-11-01. We've failed to make meaningful changes to our attitudes toward preparedness and been mediocre at best keeping up with man-made and biological threats.
If IT CAN Happen Here, IT CAN Happen Anywhere
For those of you remaining in the "it can't happen here" crowd; let CNN serve up this story as a reminder. I actually read this a few days ago and forgot to post it. The scenario is that an improvised explosive device was detonated inside a prison during a search. Although no one was injured, it is another reminder of the relative ease of construction and obtaining materials for an improvised explosive device (IED) or homemade chemical bomb can be.
If some motivated inmate, presumably with limited access to materials and under salience, can construct an IED...what makes you think your community is going to remain free from this type of event.
If the term "Domestic Terrorism" is not in your vocabulary...put it there today.
See these Mitigation Journal blog postingsand listen to Mitigation Journal Podcast for more:
Homemade Chemical Bombs
Chemical Fumes Risk
Domestic Terrorism in Aspen
If some motivated inmate, presumably with limited access to materials and under salience, can construct an IED...what makes you think your community is going to remain free from this type of event.
If the term "Domestic Terrorism" is not in your vocabulary...put it there today.
See these Mitigation Journal blog postingsand listen to Mitigation Journal Podcast for more:
Homemade Chemical Bombs
Chemical Fumes Risk
Domestic Terrorism in Aspen
February 25, 2009
Point and Click Equals Sick?
I found this story in the Orlando Sentinel interesting. The story suggests that more people are turning to the Internet for medical information and becoming "Cyberchondriacs" as a result of diagnosing themselves with a worst-case disease scenario.
Any access to information has to be put into context. Without qualified medical opinion and assessment the medical information found on-line or sought in texts is next to impossible to use correctly. Should we limit public access to medical information? Absolutely not. While a person may over diagnose themselves with a condition they may be just a likely to seek evaluation and treatment earlier. We may actually see a decrease in denial!
In any event, I think we as responders have to recognize the fact that people who call 9-1-1 have access to a great deal of information...and that information may lead them to incorrect conclusions about their health condition or situation. That means a charge in expectation. Responders have to be able to speak intelligently and factually in the face of "Internet self-diagnosis". We have to be able to do this in order to maintain our credibility, elicit the proper information from the patients, make the correct decisions...the list goes on.
If you fail to acknowledge the fact that the public you serve is informed...you may fail to meet their expectations or elevate fears. Both are failures of service.
Any access to information has to be put into context. Without qualified medical opinion and assessment the medical information found on-line or sought in texts is next to impossible to use correctly. Should we limit public access to medical information? Absolutely not. While a person may over diagnose themselves with a condition they may be just a likely to seek evaluation and treatment earlier. We may actually see a decrease in denial!
In any event, I think we as responders have to recognize the fact that people who call 9-1-1 have access to a great deal of information...and that information may lead them to incorrect conclusions about their health condition or situation. That means a charge in expectation. Responders have to be able to speak intelligently and factually in the face of "Internet self-diagnosis". We have to be able to do this in order to maintain our credibility, elicit the proper information from the patients, make the correct decisions...the list goes on.
If you fail to acknowledge the fact that the public you serve is informed...you may fail to meet their expectations or elevate fears. Both are failures of service.
February 24, 2009
1 in 5 Quit
Another story being run by MSNBC states that 1 in 5 nurses quit within their first year of service. Once considered a product of the over-worked, under-paid emergency services field, it seems as if the longevity and retention of nurses is reaching alarming rates.
This article is worth the few minutes it will take to read. I think it will open your thoughts to the situation in the Nations emergency departments.
On a final note, things that make you go HHHMMM...
"Many novice nurses like O'Bryan are thrown into hospitals with little direct supervision, quickly forced to juggle multiple patients and make critical decisions for the first time in their careers."
This article is worth the few minutes it will take to read. I think it will open your thoughts to the situation in the Nations emergency departments.
On a final note, things that make you go HHHMMM...
"Many novice nurses like O'Bryan are thrown into hospitals with little direct supervision, quickly forced to juggle multiple patients and make critical decisions for the first time in their careers."
February 23, 2009
The Cost of Texting
For many, its not the cost of text messaging service that's a problem...it's the loss of communications skills. This recent MSNBC story highlights a concern many of us (especially parents of teens) have about the texting communication craze. The story highlights the possibility of loss of traditional communication skills, use of grammar, inability to use proper sentence structure and so on. Thinking about my own experiences I'm not sure that I fully agree. I know my own writing, spelling and desire to write increased dramatically when personal computers (read: spell check) came to the commonplace . In my case, the use of technology (personal computer...in my case a TANDY notebook) made it possible for me to overcome poor handwriting and spelling. When all is said and done, the personal computer became a way for me to overcome limits and eventually produce Mitigation Journal, one of the finest niche blogs available today.
Can we say the same thing for text messaging or "texting"? I don't know, its far too early to tell. I do think that texting allows us (teens and others) to communicate with others who we'd not normally contact and share immediate thoughts. We've talked about the value of social networking sites such as Twitter (follow Mitigation Journal on Twitter) and Facebook. These sites have value in emergency service and public safety communication as well as message delivery to the public.
To put a public safety spin on it; the question that remains is one of integration. How will the "text" generation communicate with others in an official situation. Let me define that as, for example, communications face to face between paramedic and physician or paramedic and triage nurse. Although we can become concerned with issues of miscommunication or loss of data with texting and the impact of patient care, I suggest that texting posses no more threat to communication between people than poor use of grammar or body language. In fact, texting a brief EMS patient care report or fire ground situation update may improve communication. Texts are usually short and focused and contain the only the needed words to get the point made. How will we integrate texting and other social media into emergency service remains to evolve...rest assured, it will continue to evolve.
Think about the use of texting the next time you're giving a verbal report on a noisy fire ground or at a crowded triage station. Texting may be a solution to the "THEY never told me that"...phenomenon that happens to so many EMS providers.
We'll be following this one for a while.
Can we say the same thing for text messaging or "texting"? I don't know, its far too early to tell. I do think that texting allows us (teens and others) to communicate with others who we'd not normally contact and share immediate thoughts. We've talked about the value of social networking sites such as Twitter (follow Mitigation Journal on Twitter) and Facebook. These sites have value in emergency service and public safety communication as well as message delivery to the public.
To put a public safety spin on it; the question that remains is one of integration. How will the "text" generation communicate with others in an official situation. Let me define that as, for example, communications face to face between paramedic and physician or paramedic and triage nurse. Although we can become concerned with issues of miscommunication or loss of data with texting and the impact of patient care, I suggest that texting posses no more threat to communication between people than poor use of grammar or body language. In fact, texting a brief EMS patient care report or fire ground situation update may improve communication. Texts are usually short and focused and contain the only the needed words to get the point made. How will we integrate texting and other social media into emergency service remains to evolve...rest assured, it will continue to evolve.
Think about the use of texting the next time you're giving a verbal report on a noisy fire ground or at a crowded triage station. Texting may be a solution to the "THEY never told me that"...phenomenon that happens to so many EMS providers.
We'll be following this one for a while.
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