Emergency Incident Rehabilitation or EIR, is a complex and life saving operation on any emergency scene. Successful EIR means integrating firefighting personnel and emergency medical services. By its nature, EIR is a multidisciplinary activity that is often dismissed by agency leaders and company officers alike. Just getting responders to participate in the rehab process can be difficult.
Starting your EIR and being prepared to function properly is key. In order to keep all the considerations for setting up EIR in mind, I had come up with a way to make the decision-making process more universal (that is, less specific to rehab) so that the same decision-making process for setting up rehab could be used for establishing just about any other days of operation.
Similar to the way we use LOCATE for situational assessment (here for audio, here for text) , try the acronym LEVEL (Location, Estimate number of responders, Vehicles, Environment, and Leadership). You can apply this decision-making model and Rule of Outcomes thinking to nearly any situation. LOCATE is another system to guide responders on assessing the patient, the scene, and as a decision making aid
Location. EIR (or any other base of operations) needs to be established an area that is free from fumes, smoke, or any other hazardous environment. I think the reasons for this are obvious…to put responders who are in need of incident rehabilitation in an area where they will continually be exposed to carbon monoxide or other products of combustion is counterproductive. Keep in mind that this includes exhaust from running vehicles and generators. Access and egress points are also important when choosing a location for emergency incident rehabilitation and maintaining accountability...one way in, one way out.
Estimate Number of Responders. Many emergency incidents of are mass casualty incidents waiting to happen. The successful rehabilitation operation will be able to flex and expand to include traditional as well as nontraditional responders. Remember, anyone on that scene may find themselves in need of rehabilitation and or medical care. That goes for nontraditional responders such as utilities and media personnel as well as fire and emergency services personnel. When you estimating the number of responders you should include the personnel needed for rehab, traditional responders (fire/EMS/police) from your agency and outside agencies, and nontraditional responders. Estimating the Number of Responders is an important factor in proper staffing for your EIR.
Vehicles. Every incident rehab operation will be impacted by vehicle placement. Your need to bring in additional vehicles (transporting ambulances, trailers) is also a consideration. You'll need to maneuver around these vehicles, hose, and various other obstacles to gain access to or move victims on a gurney. Likewise, you must estimate the number of transport vehicles you'll need on scene and those you'll stage away from the situation. You should also consider the need for special call vehicles such as mass casualty trailers and command posts vehicles.
Environment. This is perhapse the most overlooked component in any operation. The environment (and changes) will largley determine how and where you set up your EIR. The environment will also give you clues on how to best estimate secondary impact (heat or cold stress) on responders. Keep in mind the environment can change...better or worse. The functional EIR will institute its own Action Plan that accounts for changes in weather conditions and prepares accordingly.
Leadership. Leadership in EIR can be a tricky spot. You're expected to manage a multi-discipline group of EMT's and Paramedics, integrate EMS into the ICS and personnel accountability system, act on physical findings that may preclude valuable firefighting personnel from returning to work, manage any other casualties that come along, and do so while operating in the background or the ICS. Leading the EIR requiers appropriate knowledge of ICS and accountability systems. You must also have a basic understanding of fire ground tactics and standard operation practices.
I feel that Emergency Incident Rehabilitation (EIR) is one of
the most critical components of any emergency incident operation.
Unfortunately, EIR is also one of the most overlooked and under appreciated concepts on the emergency scene. Emergency Incident Rehabilitation is not to be reserved for fire scenes. EIR should be
considered at any prolonged event including technical rescue, MVC, or
even a routine event.
May 31, 2011
May 30, 2011
Podcast #209: Public Service Lay-Offs and Local Preparedness
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| Click for podcast #209 |
Lay-offs. Not a term we're used to talking about when it comes to emergency services and first responders. Not until recently, that is. The growing concern over state, city, and local government budgets as well as a Nation-wide fiscal crisis, have made the potential of public service lay-offs a reality.
Citizen groups and government officials are stammering about pay and benefits awarded to those who protect our lives and property and serve our communities.
"Why should firefighters get that retirement?"
"Why should police officers get that type of health care?"
Those are just a few of the battle cries we hear from citizens who are struggling under an increasing tax burden and who may have been downsized (and lost everything) from the corporations they served.
While these questions should be (easily) answered; I think I bigger problem(s) exist.
- Local traditional responders will be the ones who will be there (or not) to save lives when a crisis or disaster hits. Not just for terrorism folks. For the natural disasters we've read so much about and for the routine, incipient events that are controlled and managed...that are kept from becoming the "big one".
- The willingness to cut public service responders...to "make them suffer, too" as one media outlet put it, is concerning. Look around. Chances are you'll see someone with a sticker on their car that says something like: "9-11-01 Never Forget". On 9-12-01 the first responders of this Nation were held up as a national treasure. Today, just shy of 10 years later...we're wiling to cut away that treasure to balance a budget.
- Lastly...you wont know what you've got (had) until its gone.
May 26, 2011
NY Tornado Exercise Gets Little Attention
A recent health-care preparedness exercise has gone virtually unnoticed. FLurriccane 2011, a Finger Lakes Regional Exercise was designed to test preparedness for healthcare facilities in the face of an impending natural disaster. This exercise ran between May 16 in May 20, 2011 and was sponsored by the New York State Department of Health office of health emergency preparedness, finger Lakes regional resource Center and the New York State office of emergency management. Despite the commitment of hospitals, health departments, emergency management officials in a nine county area, this well-planned and well executed exercise remained unnoticed. It's hard to believe that that's the case knowing that this is one of the largest exercises in recent years.
At the heart of this exercise was a category five hurricane bearing down on Western New York. And while most people still believe that it can't happen here… this exercise showed us what might happen if in fact it did happen here. By all preliminary accounts of this exercise participants were well-prepared to carry out their emergency plans. While we wait for the after action reports, I can safely say this was one of the best exercises I've seen in some time. That is to say, I think it made a difference. I think it will save lives. I think lessons were learned.
I was tasked with running a tabletop exercise as a follow-up to the FLurricane exercise at a local community hospital. The focus of this particular tabletop was on evacuation of a hospital in senior living facility. Again, I think you made a difference. I think lives may be saved because of this training. I think lessons were learned.
The point is that we can no longer continue down the path of ignoring natural events. Our preparedness pendulum has swung so far towards the side of terrorism that we have continued to ignore the devastation of natural events… unless of course they occur in another country. I wonder if the outcomes of Hurricane Katrina would have been different if emergency managers and responders learned the lessons from Hurricane Pam?
Within the first six months of 2011 the United States has been victim to snowstorms crippling major cities, devastating floods, and most recently ferocious tornado activity. To illustrate the potentials take a look at the New York Times website… they have a fantastic aerial photograph series from Joplin, Missouri, that illustrates the impact to communities and infrastructure from natural events.
See (http://www.nytimes.com/interactive/2011/05/25/us/joplin-aerial.html?hp)
Yet much of the preparedness efforts and planning, training, and readiness go unnoticed and under reported. The value of this material appearing in the media is not to promote any hospital or health department. The true value of media coverage of these planning events and exercises is to illustrate to the public that there is a side of preparedness focused on community infrastructure rather than solely focused on terrorism. I believe that message is critical to maintaining confidence in our local governments during times of crisis.
Joplin Before and After the Tornado
At the heart of this exercise was a category five hurricane bearing down on Western New York. And while most people still believe that it can't happen here… this exercise showed us what might happen if in fact it did happen here. By all preliminary accounts of this exercise participants were well-prepared to carry out their emergency plans. While we wait for the after action reports, I can safely say this was one of the best exercises I've seen in some time. That is to say, I think it made a difference. I think it will save lives. I think lessons were learned.
I was tasked with running a tabletop exercise as a follow-up to the FLurricane exercise at a local community hospital. The focus of this particular tabletop was on evacuation of a hospital in senior living facility. Again, I think you made a difference. I think lives may be saved because of this training. I think lessons were learned.
The point is that we can no longer continue down the path of ignoring natural events. Our preparedness pendulum has swung so far towards the side of terrorism that we have continued to ignore the devastation of natural events… unless of course they occur in another country. I wonder if the outcomes of Hurricane Katrina would have been different if emergency managers and responders learned the lessons from Hurricane Pam?
Within the first six months of 2011 the United States has been victim to snowstorms crippling major cities, devastating floods, and most recently ferocious tornado activity. To illustrate the potentials take a look at the New York Times website… they have a fantastic aerial photograph series from Joplin, Missouri, that illustrates the impact to communities and infrastructure from natural events.
See (http://www.nytimes.com/interactive/2011/05/25/us/joplin-aerial.html?hp)
Yet much of the preparedness efforts and planning, training, and readiness go unnoticed and under reported. The value of this material appearing in the media is not to promote any hospital or health department. The true value of media coverage of these planning events and exercises is to illustrate to the public that there is a side of preparedness focused on community infrastructure rather than solely focused on terrorism. I believe that message is critical to maintaining confidence in our local governments during times of crisis.
Joplin Before and After the Tornado
May 18, 2011
School Security Goes in Wrong Direction part two
Follow up video from Mitigation Journal podcast #208: When School Security Goes in Wrong Direction part two.
May 16, 2011
MJ208: School Security Goes in Wrong Direction
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| click image for podcast |
Its important to note that our view of this situation is based on prior experiences, information available in mainstream media sources, and posted comments on those mainstream media sites.
The background story can be found here. Several years ago there was a movement to
We continue to support our position that schools, hospitals, shopping malls and similar locations are soft targets. These soft target locations can also be locations of critical infrastructure and need to be protected. The problem in this situation seems to be that the planning and delivery of the training scenario.
The video (segment 1 of 3) is from our recording of Mitigation Journal #208. We'll be posting remaining segments here.
April 20, 2011
Why I've not been blogging and podcasting
Why I've not been blogging and podcasting
...and a re-launch of Mitigation Journal.
Tune into this edition of Mitigation Journal podcast as I try to explain the twists and turns that have kept me from blogging and podasting. I'll do my best to explain the various situations and describe what we're going to do to get Mitigation Journal back on track...NOW.
Look for a new podcast edition in the first week of May, 2011...our topic will be How Public Safety Lay-offs will impact domestic preparedness.
...and a re-launch of Mitigation Journal.
Look for a new podcast edition in the first week of May, 2011...our topic will be How Public Safety Lay-offs will impact domestic preparedness.
March 31, 2011
Biological Effects of Radiation Summary
Biological Effects of Radiation Summary
...at the half-way pointIn response to the numerous requests for information on the topic of radiological injuries and situational management, we're posting a mid-point summary of our Biological Effects of Radiation series. This series has five segments scheduled. The first three are linked below...the remaining parts (including bibliography and source links) are being written now.
Biologic Effects of Radiation #1: Radiation Basics - A focus on the potential radiation sources, terminology, units of measure...an overview to get started or refreshed on the topic.
Biologic Effects of Radiation #2: Protective Actions and Variables - We try to put a little bit of common sense behind Time, Distance, and Shielding. This installment also looks at the general medical signs and symptoms of exposure/contamination.
Biologic Effects of Radiation #3: Effects of Radiation on the Body - look at biological effects, acute radiation sickness and associated symptoms and syndromes.
Links and References
You'll also find these links and references useful. I've used them, in part and along with references, to put this series together. Again, the complete bibliography will be posted along with the final installment of the series.
Radiation Injury Treatment Network
Radiation Emergency Medical Treatment (from the U.S. Department of Health and Human Services)
Get the Mobile REMM app, FREE and worth the time!
March 20, 2011
Redefining Disaster
Tragedy in Japan is redefining the term Disaster
Multiple natural disasters resulting in technological failure and further devastation...An earthquake of historical magnitude, a ferocious tsunami, and failure of at least three nuclear power plants. The only thing missing from the global tragedy unfolding in Japan is Godzilla.
Japan may well be suffering the type of event that only us cataclysmic/apocalyptic emergency management thinkers can dream up for our next training event. And having been accused of being “too apocalyptic” myself I can appreciate this line of thinking.
The earthquake, tsunami, and resultant damage to nuclear power pants in Japan have been compared to the earthquake that crushed Haiti, the tsunami that washed out Sri lanka, and the nuclear disaster in Chernobyl; with these comparisons many people are drawn conclusions of disease and radioactive fallout. With all this in mind I think it's important that we look at some differences between Japan in other areas of the globe before making any doomsday predictions.
Many sources have predicted and warned about emerging infectious disease and disease spread related to the situation in Japan. Many sources have also cited the disease spread and contamination concerns attributed to the natural disasters in Haiti and Sri Lanka. When it comes to evaluating the earthquake and tsunami in comparison to natural disasters in Haiti and Sri Lanka we have to remember some important differences between these areas and Japan. Japan has superior infrastructure. That is, Japan enjoys a good healthcare system, a culturally stable state of health among its population and excellent infrastructure which includes sanitation. I do not believe that long-term disease spread (as has been predicted) or new emerging diseases will come from Japan as a result of the devastation and death.
There have been a number of predictions regarding the radiation spread within the country of Japan itself and to other nations… most notably the United States West Coast. The historical references drawn to make these predictions have included nuclear detonations over Nagasaki and Hiroshima during World War II. Some sources have looked at more recent nuclear events such as Three Mile Island here in the United States and Chernobyl in this former Soviet Union. The first point to make on these nuclear fallout predictions is that the nuclear event in Japan is unprecedented. Never before have we seen multiple nuclear reactors with their fuel rods exposed, containment breached, and suffering such catastrophic failure. This alone should be cautionary to making any predictions. I believe that any comparison to the nuclear detonations during World War II to be inappropriate. Nuclear weapons detonate high above the ground and place radioactive material higher in the atmosphere… which allows that material to spread a greater distance. That does not seem to be the case in Japan now. Radioactive fallout from these reactors seems to be contained within 50 to 100 miles. In order to compare to the more recent nuclear power plant events we should review a little about each case.
March 28, 1979 at the 3 Mile Island nuclear power facility: a power failure and water pump failure resulted in loss of reactor cooling which spilled the Xeon 133 and iodine 131 onto the containment room floor. There was very little radiation detected outside the structure and no reports of injuries or long-term illness as a result. Despite that, the psychological impact was and remains high.
April 1986 Chernobyl: a power instability resulted in a steam explosion powerful enough to lift the reactors 90 ton cover. The explosion resulted in 31 deaths, 135,000 people evacuated, and a release of iodine 131, cesium 137 in Xeon. Perhaps the most important implication for Japan related to the Chernobyl event is the recovery and stabilization of the situation.
Multiple natural disasters resulting in technological failure and further devastation...An earthquake of historical magnitude, a ferocious tsunami, and failure of at least three nuclear power plants. The only thing missing from the global tragedy unfolding in Japan is Godzilla.
Japan may well be suffering the type of event that only us cataclysmic/apocalyptic emergency management thinkers can dream up for our next training event. And having been accused of being “too apocalyptic” myself I can appreciate this line of thinking.
The earthquake, tsunami, and resultant damage to nuclear power pants in Japan have been compared to the earthquake that crushed Haiti, the tsunami that washed out Sri lanka, and the nuclear disaster in Chernobyl; with these comparisons many people are drawn conclusions of disease and radioactive fallout. With all this in mind I think it's important that we look at some differences between Japan in other areas of the globe before making any doomsday predictions.
Many sources have predicted and warned about emerging infectious disease and disease spread related to the situation in Japan. Many sources have also cited the disease spread and contamination concerns attributed to the natural disasters in Haiti and Sri Lanka. When it comes to evaluating the earthquake and tsunami in comparison to natural disasters in Haiti and Sri Lanka we have to remember some important differences between these areas and Japan. Japan has superior infrastructure. That is, Japan enjoys a good healthcare system, a culturally stable state of health among its population and excellent infrastructure which includes sanitation. I do not believe that long-term disease spread (as has been predicted) or new emerging diseases will come from Japan as a result of the devastation and death.
There have been a number of predictions regarding the radiation spread within the country of Japan itself and to other nations… most notably the United States West Coast. The historical references drawn to make these predictions have included nuclear detonations over Nagasaki and Hiroshima during World War II. Some sources have looked at more recent nuclear events such as Three Mile Island here in the United States and Chernobyl in this former Soviet Union. The first point to make on these nuclear fallout predictions is that the nuclear event in Japan is unprecedented. Never before have we seen multiple nuclear reactors with their fuel rods exposed, containment breached, and suffering such catastrophic failure. This alone should be cautionary to making any predictions. I believe that any comparison to the nuclear detonations during World War II to be inappropriate. Nuclear weapons detonate high above the ground and place radioactive material higher in the atmosphere… which allows that material to spread a greater distance. That does not seem to be the case in Japan now. Radioactive fallout from these reactors seems to be contained within 50 to 100 miles. In order to compare to the more recent nuclear power plant events we should review a little about each case.
March 28, 1979 at the 3 Mile Island nuclear power facility: a power failure and water pump failure resulted in loss of reactor cooling which spilled the Xeon 133 and iodine 131 onto the containment room floor. There was very little radiation detected outside the structure and no reports of injuries or long-term illness as a result. Despite that, the psychological impact was and remains high.
April 1986 Chernobyl: a power instability resulted in a steam explosion powerful enough to lift the reactors 90 ton cover. The explosion resulted in 31 deaths, 135,000 people evacuated, and a release of iodine 131, cesium 137 in Xeon. Perhaps the most important implication for Japan related to the Chernobyl event is the recovery and stabilization of the situation.
March 15, 2011
Russell C. Hogue, Paramedic
The EMS community in Rochester, New York, is mourning the loss of Paramedic Russ Hogue.
Russ, like so many EMS professionals, worked numerous jobs. He was a paramedic with Rural/Metro Rochester and Spencerport (NY) Ambulance. He passed away while on duty at Spencerport, March 12, 2011. He was 45 years old.
I got to know Russ while he was a student in the Monroe Community College Paramedic Program. We had much in common...particularly, we both have large families. Russ was more than a caring provider who touched many lives. He was one of those paramedics that truly loved what he did. I respected him greatly for the way he conducted himself. He wanted to be a paramedic because it was an honorable thing to do...not for lights, not for sirens, not for glory...for others.
People gravitated towards Russ. Perhaps it was the calm demeanor. Perhaps his dedication. Maybe it was simply because Russ was just a down-to-earth good guy. And that is how I'll remember him.
Our prayers are with his family as a community mourns with them.
In addition to being a dedicated husband and father, Russ was President of the Scottsville Fire Corporation, a paramedic with Rural Metro and Spencerport Ambulance and a volunteer at Scottsville Ambulance. He committed his life to service of others, will remain in our hearts and deeply missed.
Family & friends may call at the Scottsville Fire Department, 385 Scottsville-Mumford Road, Scottsville on Wednesday from 4-8PM. Rite of Christian Burial will be held on Thursday at 10AM at St. Mary of the Assumption Church, Scottsville. In lieu of flowers, memorial contributions may be made to the family. To leave an online condolence, please visit: www.ScottsvilleFuneralHome.com
As printed in the Rochester Democrat and Chronicle
Russell C. Hogue
Scottsville: 3/12/2011 (formerly of Nova Scotia, Canada) Passed away suddenly at the age of 45. Survived by his loving wife Patricia; children, Stephanie (Nova Scotia), Paul, Patrick, Ian, Alex, Madison, Colin (at home); parents, Paul and Judy Hogue; mother and father-in-law, James and Louise Boyle; brother, Jeffrey (Leslie) Hogue; several nieces and nephews, sister and brother-in-laws (Nova Scotia) and many dear friends.In addition to being a dedicated husband and father, Russ was President of the Scottsville Fire Corporation, a paramedic with Rural Metro and Spencerport Ambulance and a volunteer at Scottsville Ambulance. He committed his life to service of others, will remain in our hearts and deeply missed.
Family & friends may call at the Scottsville Fire Department, 385 Scottsville-Mumford Road, Scottsville on Wednesday from 4-8PM. Rite of Christian Burial will be held on Thursday at 10AM at St. Mary of the Assumption Church, Scottsville. In lieu of flowers, memorial contributions may be made to the family. To leave an online condolence, please visit: www.ScottsvilleFuneralHome.com
March 13, 2011
Setbacks
I've had a few setbacks recently.
Enough to curtail my blogging and podcasting for a while. Enough to make me question what I'm doing and why I'm bothering to do it.
Just as I was about to hit the "delete this blog" button...literally had the mouse on the button...I received an email from a long-time supporter that provided a much needed moment of pause.
Thank you, Ted.
Enough to curtail my blogging and podcasting for a while. Enough to make me question what I'm doing and why I'm bothering to do it.
Just as I was about to hit the "delete this blog" button...literally had the mouse on the button...I received an email from a long-time supporter that provided a much needed moment of pause.
Thank you, Ted.
February 1, 2011
MJ 207: National EMS Bike Ride, Move Over...the NY Way
Matt and I catch up with Kevin Esparza from Canandaigua Emergency Squad on the topic of the National EMS Memorial Bike Ride. This is Kevin's second year doing the EMS Bike Ride. Kevin provides us with an inside look at training and participating in the National EMS Memorial Bike Ride.
Kevin is training and participating in the Ride with the support of his agency, Canadaigua Emergency Squad...but could use your help. If you'd like to support Kevin in his efforts, send him an email or contact him via Canandaigua Emergency Squad.
Never heard of the National EMS Memorial Bike Ride? Check out their page at http://www.muddyangels.com/
Excerpts from the National EMS Memorial Bike Ride site...
"The National EMS Memorial Bike Ride, Inc. honors Emergency Medical Services personnel by organizing and implementing long distance cycling events that memorialize and celebrate the lives of those who serve everyday, those who have become sick or injured while performing their duties, and those who have died in the line of duty."In some not-so-encouraging news...a Upstate NY fire chief was given a citation by a NYS Trooper for blocking an extra lane at a motor vehicle crash. We talked about NY adopting the Move Over Law (with tremendous support of the NYS Troopers) and hoped it would help get responders on the same page and understand safety on the highway...for all responders! We talked about this way back in October, 2010 on edition #193 of Mitigation Journal ...and my cynicism is confirmed by this recent action. And you wonder why I think NIMS is Dead? Anyway, check out the story on Fire Fighter Close Calls.
January 25, 2011
Is the end of extrication near?
I originally posted this back in July, 2008. The topic came up again as it has several times. This recent thought on the topic of extrication comes from the latest edition of First Few Moments. Our discussion on extrication, To Cut or Not to Cut, has been one of the best talks on the topic in a while. So, sit back and enjoy this reprint...from July, 2008.
How long will it be before the evolution of hybrid and alternate fuel vehicles changes the way we open vehicles and extricate trapped occupants? Will the cutting and tearing, muscle and sweat of hydralic tools become a thing of the past?
Interesting questions: no clear answers. The point, though, is that hybrid and alternate power vehicles have construction features and hidden hazards that will make traditional methods of disentanglement obsolete if not a potentaly harmful to the rescurer.
We shouldn't be suprised by this prediction...after all, we've seen changes in automobile construction that spured tactical changes before. You may remember at time when you could cut into a vehicle, gain a purchase point and move metal with some predictability. Perhaps those cars build prior the the 1980's fit here. After 1980, cars seemed to scale down and we saw less steel and more plastic. Frame construction changed as well as location of fuel lines. Plastic replaced steel in dashboards and crumple zones became an industy standard. Not long into the 80's traditional bumbers evolved (disapeared) and the airbag with its deployment system began to evolve.
From metal to plastic, frame to unibody, bumper to airgag, responders have adjusted thier extrication tactics and tecniques to fit the situation. Hybrind and alternate fuel vehicles represent the next generation of chage. The adjustment, however, will need to factor in hazards associated with the vehicle in evreyday conditions...not just in crash situations.
Perhaps the bigest concern is the use of high voltage electrical systems througout hybrind and alternalt fuel vehicles. These electrical systems are often hidden within the vehicle structure and rescures are advised not to cut into them. The charge and discharge time of an electrical system varries widly with vehicle manufacturer and the rescuer should consider the system "live" during extrication efforts. The location and potential hazard of high voltage cables have created "no cut zones" and limit the use of traditional operations such as roof removal and a dash roll-up. Even lifting a stearing colum may have to be avoided. Vehicle stabilization operations may also have to change as electrical system components become exposed during collision. The simple act of box cribbing under hybrind vehicles could expose rescures to damaged, live electrical conduting systems.
While we'll see less petrolium (gasoline) product, larger battery systems, high voltagae converters, additional acids, and fuels such as hydrogen will add another dynamic to controling hazards.
January 22, 2011
NIMS is dead
NIMS is dead...you still have to take the classes and jump through the hoops...but the practice is dead. Few if any local governments or response agencies are truly NIMS compliant and the NIMS CAST has become just another checklist - to "say" we've done it. In reality our practice of NIMS under the National Response Framework is no better off at improving on-scene coordination and interoperability than twenty years ago.
Example? Example, please, you ask? How about the Nations largest city encountering a total failure of responsse to a preditced snowstorm...and then fires the EMS Chief. Further, a lack of coordination continues between traditional response groups. No intel sharing, little if any interoperability. In some cases continual and intentional withholding of critical infrastructure data and assessments.
And perhaps worst of all is the absence change to the antiquated hierarchy...that is we allow certain groups of traditional responders to be treated as second-class citizens within the incident command structure. The so-called NIMS trained "command" personnel continue to ignore a unified command structure or even to allow for input from other traditional response disciplines...despite our collective (supposed) universal NIMS training.
More to come.
Example? Example, please, you ask? How about the Nations largest city encountering a total failure of responsse to a preditced snowstorm...and then fires the EMS Chief. Further, a lack of coordination continues between traditional response groups. No intel sharing, little if any interoperability. In some cases continual and intentional withholding of critical infrastructure data and assessments.
And perhaps worst of all is the absence change to the antiquated hierarchy...that is we allow certain groups of traditional responders to be treated as second-class citizens within the incident command structure. The so-called NIMS trained "command" personnel continue to ignore a unified command structure or even to allow for input from other traditional response disciplines...despite our collective (supposed) universal NIMS training.
More to come.
January 21, 2011
Post Retraction
Post Retraction
The post of 1/20/11 has been removed by individual request.
We sincerely apologize for any impression of impropriety.
The post of 1/20/11 has been removed by individual request.
We sincerely apologize for any impression of impropriety.
January 19, 2011
The Arizona shootings
The Arizona shootings… a failure of mental health care, not political.
The tragic shootings in Arizona are a representation of many things. None of them are political.
The accused perpetrator of this terrible event seems to have a well-known history of mental illness. Of course, we find out about all the people who had concerns and voiced those concerns after the fact. This shooting in Arizona is more about mental illness and civil rights than it is about politics or gun control.
The young man who stands accused of shooting innocent civilians (including a nine-year-old girl ) and the congresswoman seems to have gotten the attention of family, friends, and educators because of his unstable demeanor and assumed mental illness.
While many people are asking how this person could've gotten his hands on firearms, I'm asking “why did he not get treatment?”
I think this answer to that question is the fact that nobody wanted to violate his civil rights and force treatment on him. This despite him being violent or unstable enough to be barred from schools and other locations.
How many violent events will it take for us to recognize these problems and take them seriously? It seems that after the Virginia Tech massacre, the assaults on Fort Hood, and this deadly rampage in Arizona, that we look back and recognize the warning signs. They might take the form of postings on Facebook… notes on a personal blog… or even videos posted publicly on YouTube. Regardless of the media, the warning signs are there… and they were there in all of these cases. But no one took action.
Again a matter of concern over violating someone else's civil rights. In the name of political correctness we could not (or would not) mandate someone to treatment or restrict their activities because of their intent. In intent that seems all too clear.
When will we recognize that mental illness has to be taken as seriously as any other medical problems. In fact, I believe that if we were to engage mental health, substance abuse, and substance addiction with the same vigor as we do heart disease, and traffic safety we may very well prevent this type of event in the future.
The tragic shootings in Arizona are a representation of many things. None of them are political.
The accused perpetrator of this terrible event seems to have a well-known history of mental illness. Of course, we find out about all the people who had concerns and voiced those concerns after the fact. This shooting in Arizona is more about mental illness and civil rights than it is about politics or gun control.
The young man who stands accused of shooting innocent civilians (including a nine-year-old girl ) and the congresswoman seems to have gotten the attention of family, friends, and educators because of his unstable demeanor and assumed mental illness.
While many people are asking how this person could've gotten his hands on firearms, I'm asking “why did he not get treatment?”
I think this answer to that question is the fact that nobody wanted to violate his civil rights and force treatment on him. This despite him being violent or unstable enough to be barred from schools and other locations.
How many violent events will it take for us to recognize these problems and take them seriously? It seems that after the Virginia Tech massacre, the assaults on Fort Hood, and this deadly rampage in Arizona, that we look back and recognize the warning signs. They might take the form of postings on Facebook… notes on a personal blog… or even videos posted publicly on YouTube. Regardless of the media, the warning signs are there… and they were there in all of these cases. But no one took action.
Again a matter of concern over violating someone else's civil rights. In the name of political correctness we could not (or would not) mandate someone to treatment or restrict their activities because of their intent. In intent that seems all too clear.
When will we recognize that mental illness has to be taken as seriously as any other medical problems. In fact, I believe that if we were to engage mental health, substance abuse, and substance addiction with the same vigor as we do heart disease, and traffic safety we may very well prevent this type of event in the future.
January 18, 2011
MJ Podcast 205:Arizona Shooting, Reducing Health Care/Increasing Risk, Meth without Pseudoephedrine
Just a few notes on this weeks podcast. First, we're 'better late than never' this week due to starting a few teaching projects and getting ready to go back to school.
Lets start with my take on the Arizona Shootings. This tragety is not about politics and its not about gun control. It is about attention to mental health and getting people to the help they need. If we devoted the same resouces to mental health, substance abuse and substance addiction that we did to other medical issues, we may avert these types of events. Its amazing to me, that in this environment of "See Something, Say Something" that people recognized the unstable mental situation this shooter displayed...and nobody did anything about it...for fear of violating his civil rights.
Reductions in health care are coming. With these reductions will come shortages in specialized care and access to services for many with chronic conditions. This means that we'll see a sicker population and a widening of the group we call "special needs populations".
Pseudoephedrine has been linked to methamphetamine production. Over the last few years we've tried to stop or slow meth production by limiting access to over the counter cold preparations. According to recent reports...its been a failed effort. New methods for Meth production have sprouted with all the new hazards to go with them. Top on the list is the Shake-N-Bake methods of meth production.
Biologic Effects of Radiation #3: Acute Radiation Sickness
This multi-part series of articles will focus on radiation and biological effects. We'll cover the basics of radiation as well as the phases and syndromes associated with radiation exposure. In part one of this series we provided an overview of radiation sources, measurement, and an introduction to the biologic effects. In part two of Biologic Effects of Radiation, we looked at biological effects, acute radiation sickness and associated symptoms and syndromes.
Part Three: Biologic Effects of Radiation, Acute Radiation Sickness
As discussed in part one and part two, the biological effects of radiation are dependent upon the type of exposure a person actually has. Simply stated, the duration of the exposure as well as the intensity of the material play a role. We also have to include the role of personal protection such as Time, Distance, Shielding and its effectiveness.
In part three of our series, we'll discuss the details of Acute Radiation Sickness (ARS). Acute Radiation Sickness (sometimes called Acute Radiation Syndrome) or ARS, occurs when an individual is exposed to a large amount of radiation in a short period time… and acute exposure, or a total doses greater than 100 REM (100 RAD for gamma radiation). Acute radiation sickness has a variety of clinical manifestations which can be obvious with some symptoms yet, less than obvious with others. Generally speaking, the clinical manifestations of acute radiation sickness include the following:
Acute radiation sickness has four phases and may manifest with four separate syndromes.
The four syndromes of acute radiation sickness are:
Gastrointestinal syndrome is a condition in which the epithelial lining of the G.I. system is gradually destroyed. Epithelial cells decline in results in nausea, vomiting, diarrhea, and sepsis. Sepsis is a result of the loss of protective barrier that separates normal bacteria from the bloodstream. Gastrointestinal syndrome may impact the lower G.I. or upper G.I. tract, or both. In the lower G.I. system bloody diarrhea (frank in nature) is most common.
Large doses of whole body radiation can cause Central Nervous System and Cardiovascular syndrome. Both are caused by a destruction of blood vessels and an increase in capillary permeability. Symptoms usually appear fairly rapidly and take the form of cerebral edema, pulmonary edema, cardiogenic shock, and death. Victims exposed to large amounts of whole body radiation may often die within 72 to 80 hours, often before the symptoms of G.I. syndrome or hematopoietic develop.
Acute radiation sickness may present within four distinct stages. As mentioned earlier, prodromal, latent, manifest, recovery/death. In the prodromal phase (approximately 48 hours after exposure) victims may present with:
In part four of our series we will discuss contamination and exposure issues as well as decontamination and monitoring. Will also review the severity levels and associated symptoms/indicators for each level. Later, in our final installment (part five), will discuss issues of planning and preparedness for radiologic emergencies.
Links and References
You'll also find these links and references useful. I've used them, in part and along with references, to put this series together. Again, the complete bibliography will be posted along with the final installment of the series.
Radiation Injury Treatment Network
Radiation Emergency Medical Treatment (from the U.S. Department of Health and Human Services)
Get the Mobile REMM app, FREE and worth the time!
Part Three: Biologic Effects of Radiation, Acute Radiation Sickness
As discussed in part one and part two, the biological effects of radiation are dependent upon the type of exposure a person actually has. Simply stated, the duration of the exposure as well as the intensity of the material play a role. We also have to include the role of personal protection such as Time, Distance, Shielding and its effectiveness.
In part three of our series, we'll discuss the details of Acute Radiation Sickness (ARS). Acute Radiation Sickness (sometimes called Acute Radiation Syndrome) or ARS, occurs when an individual is exposed to a large amount of radiation in a short period time… and acute exposure, or a total doses greater than 100 REM (100 RAD for gamma radiation). Acute radiation sickness has a variety of clinical manifestations which can be obvious with some symptoms yet, less than obvious with others. Generally speaking, the clinical manifestations of acute radiation sickness include the following:
- changes in blood cell count, specifically lymphocytes decrease
- vascular permeability changes
- gastrointestinal irritation; nausea, vomiting, and diarrhea
- fever
- hair loss, in uneven patterns
- skin rash, skin burns, in general skin irritation
- vague symptoms such as flu-like symptoms
Acute radiation sickness has four phases and may manifest with four separate syndromes.
The four syndromes of acute radiation sickness are:
- Hematopoietic Syndrome
- gastrointestinal syndrome
- cardiovascular syndrome
- and central nervous system syndrome
- prodromal phase
- latent phase
- manifest phase (sometimes called the period of illness)
- and recovery or death
Gastrointestinal syndrome is a condition in which the epithelial lining of the G.I. system is gradually destroyed. Epithelial cells decline in results in nausea, vomiting, diarrhea, and sepsis. Sepsis is a result of the loss of protective barrier that separates normal bacteria from the bloodstream. Gastrointestinal syndrome may impact the lower G.I. or upper G.I. tract, or both. In the lower G.I. system bloody diarrhea (frank in nature) is most common.
Large doses of whole body radiation can cause Central Nervous System and Cardiovascular syndrome. Both are caused by a destruction of blood vessels and an increase in capillary permeability. Symptoms usually appear fairly rapidly and take the form of cerebral edema, pulmonary edema, cardiogenic shock, and death. Victims exposed to large amounts of whole body radiation may often die within 72 to 80 hours, often before the symptoms of G.I. syndrome or hematopoietic develop.
Acute radiation sickness may present within four distinct stages. As mentioned earlier, prodromal, latent, manifest, recovery/death. In the prodromal phase (approximately 48 hours after exposure) victims may present with:
- nausea and vomiting, diarrhea
- fatigue and headache
- fluid shifts due to increased permeability and electrolyte losses
In part four of our series we will discuss contamination and exposure issues as well as decontamination and monitoring. Will also review the severity levels and associated symptoms/indicators for each level. Later, in our final installment (part five), will discuss issues of planning and preparedness for radiologic emergencies.
Links and References
You'll also find these links and references useful. I've used them, in part and along with references, to put this series together. Again, the complete bibliography will be posted along with the final installment of the series.
Radiation Injury Treatment Network
Radiation Emergency Medical Treatment (from the U.S. Department of Health and Human Services)
Get the Mobile REMM app, FREE and worth the time!
January 11, 2011
Biologic Effects of Radiation #2
This multi-part series of articles will focus on radiation and biological effects. We'll cover the basics of radiation as well as the phases and syndromes associated with radiation exposure. In part one of this series we provided an overview of radiation sources, measurement, and an introduction to the biologic effects. In part two of Biologic Effects of Radiation, we'll look at biological effects, acute radiation sickness and associated symptoms and syndromes.
Part Two: The Biologic Effects of Radiation
The biological effects of radiation are dependent upon the type of exposure a person actually has. Simply stated, the duration of the exposure as well as the intensity of the material play a role. We also have to include the role of personal protection such as Time, Distance, Shielding and its effectiveness.
Biologic effects can be categorized generically as acute or chronic. Acute exposure may be for a very short period of time to a higher level radiation source while chronic exposure can either be in extended exposure to low-level source or repetitive exposures to a variety of sources of radiation.
One variable that we have to account for his individual biological differences. Each person is different and will respond differently to radiation exposure… unless it is an extremely high-level of exposure.
In general, radiation causes three major problems in our bodies.
Acute radiation sickness has four phases and may manifest with four separate syndromes.
The four phases of acute radiation sickness are:
Links and References
You'll also find these links and references useful. I've used them, in part and along with references, to put this series together. Again, the complete bibliography will be posted along with the final installment of the series.
Radiation Injury Treatment Network
Radiation Emergency Medical Treatment (from the U.S. Department of Health and Human Services)
Get the Mobile REMM app, FREE and worth the time!
Part Two: The Biologic Effects of Radiation
The biological effects of radiation are dependent upon the type of exposure a person actually has. Simply stated, the duration of the exposure as well as the intensity of the material play a role. We also have to include the role of personal protection such as Time, Distance, Shielding and its effectiveness.
Biologic effects can be categorized generically as acute or chronic. Acute exposure may be for a very short period of time to a higher level radiation source while chronic exposure can either be in extended exposure to low-level source or repetitive exposures to a variety of sources of radiation.
One variable that we have to account for his individual biological differences. Each person is different and will respond differently to radiation exposure… unless it is an extremely high-level of exposure.
In general, radiation causes three major problems in our bodies.
- Radiation can damage DNA and other cellular structures
- Radiation exposure results in cell death… immediately or shortly after exposure
- Radiation exposure results in incorrect cellular repair and mutations that can cause cancer and other disease
- age- Younger patients and those with a higher metabolism and cell turnover rate are more susceptible.
- sex
- diet
- body temperature and overall health
- nonspecific (flu-like symptoms)
- hair loss
- fever
- skin irritation
- vascular changes
- blood cell changes
Acute radiation sickness has four phases and may manifest with four separate syndromes.
The four phases of acute radiation sickness are:
- prodromal phase
- latent phase
- manifest phase (sometimes called the period of illness)
- and recovery or death
- Hematopoietic Syndrome
- gastrointestinal syndrome
- cardiovascular syndrome
- and central nervous system syndrome
Links and References
You'll also find these links and references useful. I've used them, in part and along with references, to put this series together. Again, the complete bibliography will be posted along with the final installment of the series.
Radiation Injury Treatment Network
Radiation Emergency Medical Treatment (from the U.S. Department of Health and Human Services)
Get the Mobile REMM app, FREE and worth the time!
January 10, 2011
MJ Podcast 204: Fire Departments and Homelessness, Transport in Crisis Situation, FDNY EMS Chief
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| Click for edition 204 |
Of Fire Departments, Vacants, and Homeless. Today's fire service participates in a variety of fire safety activities. Anything from traditional fire safety that's taught in schools to children, fire safety education for seniors and community living centers, and even how to install child safety seat in your vehicle has become part of the fire safety training initiative. So, my question is: why not get the fire service involved in special needs populations and serving the homeless? We've seen several fires that have occurred in vacant or abandoned structures where an aggressive interior attack has been carried out because “there might be homeless people” in there. Isn't it time the American fire service took an active role in assisting the underserved members of their community? Would it not make sense that by providing adequate shelter for the homeless, we would be less likely to initiate that aggressive interior attack in a vacant structure.
A number of situations have erupted out of the snowstorm that hit New York City in the East Coast last month. One of the lesser discussed topics has been that of transportation of EMS patients by a non-ambulance vehicle. There are reports of sick people being transported to a hospital fire apparatus during this snow event. These transports have seemed to have set some people on edge. We have to remember that during crisis situations (and this was a crisis situation in New York City) people will need to be transported, and indeed, will be transported by any means available. Remember, in crisis or disaster situations… it's no longer a standard of response is a sufficiency of response.
Also coming out of the snowstorm event in New York City is the demotion of the EMS chief for FDNY It's. For some reason, the EMS chief has been reassigned with the administration citing a need for change in leadership after the storm. While there are rumors and speculation of pre-existing problems with this EMS chief, the outward appearance is that he is being removed from his position because of the storm response. I've written about this frightening situation where EMS personnel are held accountable for failures of local government before. See the Mitigation Journal blog post EMS under the bus in Pittsburgh for more detail.
January 6, 2011
EMS takes fall for storm failure
CNN: NYC EMS chief replaced over storm response.
How many events does it take to start a trend? One? Two? More? Further, how do you know when that trend has been started? And when is it time to take an action against a “trend”?
I usually don't write a blog posting when I'm angry… with few exceptions.
This post will be one of those exceptions.
I just read an article posted on CNN.com informing us that the New York City emergency medical services chief has been replaced as a result of the recent snowstorm response. This will be the second time in under one year that EMS personnel have been terminated or demoted because of their actions during a major community crisis. Both cases were predicted, natural events...a snowstorm in the winter.
You might remember back in February of 2010 when Pittsburgh, Pennsylvania was under a major snowstorm. (See EMS Under the Bus in Pittsburgh, Mitigation Journal, 2/28/10) It was reported that a woman called EMS repeatedly over 30 hours and did not receive an ambulance. Reports from that incident indicate ambulances could not get within several blocks of many patients because of a major snowstorm. EMS personnel were chastised publicly by government officials because they didn't "get out and walk" to patients. Ultimately, at least one person died and many did not receive ambulance service for prolonged periods of time. The outcome? A number of Pittsburgh EMS paramedics relieved of duty or fired.
Several commonalities exist between Pittsburgh Pennsylvania in February, 2010 and New York City in December, 2010. In both Pittsburgh and NYC:
This is a disturbing trend. A trend that can be traced to hurricane Katrina (Dr. Ana Pou) and other disaster situations.
According to NYC Fire Commissioner Salvatore Cassano as reported by CNN
In both cases the storm was predicted well in advance. Yet, New York City (the largest city in our nation) was not able to plow the streets or even to make them passable for ambulances. Now in the wake of tragedy and scrutiny the EMS leadership is faulted and fired. This despite accusations of sabotage on the part of public Works.
The bottom line is that New York City was not prepared for this natural, predicted, expected event. What are we to think when the nation's largest city with overwhelming resources is not able to handle a predicted natural event? How can we think (or even say) that we are prepared for anything?
And how long will we go on blaming those further down the food chain for the failures in preparedness of local government?
The EMS chief in New York City is no more responsible for the failed response than you or I.
If there is proof that employees of the sanitation Department of New York City participated in sabotage of the response to this snow emergency, then there should be criminal as well as civil liability. But, at the end of the day it is the city of New York that has failed.
What will happen when the next event is not predicted?
You can read the full article here.
How many events does it take to start a trend? One? Two? More? Further, how do you know when that trend has been started? And when is it time to take an action against a “trend”?
I usually don't write a blog posting when I'm angry… with few exceptions.
This post will be one of those exceptions.
I just read an article posted on CNN.com informing us that the New York City emergency medical services chief has been replaced as a result of the recent snowstorm response. This will be the second time in under one year that EMS personnel have been terminated or demoted because of their actions during a major community crisis. Both cases were predicted, natural events...a snowstorm in the winter.
You might remember back in February of 2010 when Pittsburgh, Pennsylvania was under a major snowstorm. (See EMS Under the Bus in Pittsburgh, Mitigation Journal, 2/28/10) It was reported that a woman called EMS repeatedly over 30 hours and did not receive an ambulance. Reports from that incident indicate ambulances could not get within several blocks of many patients because of a major snowstorm. EMS personnel were chastised publicly by government officials because they didn't "get out and walk" to patients. Ultimately, at least one person died and many did not receive ambulance service for prolonged periods of time. The outcome? A number of Pittsburgh EMS paramedics relieved of duty or fired.
Several commonalities exist between Pittsburgh Pennsylvania in February, 2010 and New York City in December, 2010. In both Pittsburgh and NYC:
- we saw a predicted major snow event.
- we saw a failure of local government and public works to be able to effectively manage the snowfall… that is, an inability to plow the roads.
- there were reports of the 911 system being overwhelmed with calls and vehicles unable to respond because roads were not passable.
- we have seen reports of tragic deaths as a result of the situation.
- emergency responders have been blamed for the failed response.
This is a disturbing trend. A trend that can be traced to hurricane Katrina (Dr. Ana Pou) and other disaster situations.
According to NYC Fire Commissioner Salvatore Cassano as reported by CNN
"Last week's blizzard presented tremendous challenges for the Department that are currently being addressed with an eye toward improving performance going forward,"..."Despite Chief Peruggia's dedicated service to this Department, I felt new leadership was needed at this time,"Are we to believe (or are we being led to believe) that this EMS chief is being held responsible in some way for the failed response to the snowstorm? The fact of the matter is, in both Pittsburgh and New York City, the local government failed in its mission to provide basic services during a time of crisis.
In both cases the storm was predicted well in advance. Yet, New York City (the largest city in our nation) was not able to plow the streets or even to make them passable for ambulances. Now in the wake of tragedy and scrutiny the EMS leadership is faulted and fired. This despite accusations of sabotage on the part of public Works.
The bottom line is that New York City was not prepared for this natural, predicted, expected event. What are we to think when the nation's largest city with overwhelming resources is not able to handle a predicted natural event? How can we think (or even say) that we are prepared for anything?
And how long will we go on blaming those further down the food chain for the failures in preparedness of local government?
The EMS chief in New York City is no more responsible for the failed response than you or I.
If there is proof that employees of the sanitation Department of New York City participated in sabotage of the response to this snow emergency, then there should be criminal as well as civil liability. But, at the end of the day it is the city of New York that has failed.
What will happen when the next event is not predicted?
You can read the full article here.
January 4, 2011
Biological Effects of Radiation #1
This multi-part series of articles will focus on radiation and biological effects. We'll cover the basics of radiation as well as the phases and syndromes associated with radiation exposure. In this post we'll provide an overview of radiation sources, measurement, and an introduction to the biologic effects.
Biological Effects of Radiation Part 1 Radiation Basics
Potential Radiation Sources...the threat is not just from terrorism. The threat or potential of harmful radiation can be expected from a variety of sources. These sources include, but are not limited to:
“The sensitivity of cells to irradiation is in direct proportion to their reproductive activity and inversely proportional to their degree of differentiation.” (Bergonie and Trubondeau)
What this means is:
Dose RATE is a significant factor for the biological response to a given dose of radiation exposure. As the dose rate is decreased and the exposure time is increased, the biological effect for a given dose is decreased.
What this means is:
At lower dose rates more subleathal damage to the cell can repair and cell populations have time to reproduce and repopulate.
Units of radioactivity measurements
In order to understand the effects of radiation on a cell, tissue or organism three units of activity must be looked at. The three units of activity that are of concern to patient care are:
Units of radiation dose
Units of radiation that is absorbed (the dose) of any radiation type and in any material is defined as the amount of energy deposited or received. The units of absorbed dose are:
You'll also find these links and references useful. I've used them, in part and along with references, to put this series together. Again, the complete bibliography will be posted along with the final installment of the series.
Radiation Injury Treatment Network
Radiation Emergency Medical Treatment (from the U.S. Department of Health and Human Services)
Get the Mobile REMM app, FREE and worth the time!
Biological Effects of Radiation Part 1 Radiation Basics
Potential Radiation Sources...the threat is not just from terrorism. The threat or potential of harmful radiation can be expected from a variety of sources. These sources include, but are not limited to:
- Nuclear weapon
- Nuclear power plan accidents
- Transportation and waste storage accidents
- Military accidents
- Vandalism
- Terrorism
“The sensitivity of cells to irradiation is in direct proportion to their reproductive activity and inversely proportional to their degree of differentiation.” (Bergonie and Trubondeau)
What this means is:
- The faster turnover rate (reproduction rate) a cell has the greater radiation exposure will effect it.
- Unborn children and young children are affected more.
- Effects can be terotgenic or mutagenic.
Dose RATE is a significant factor for the biological response to a given dose of radiation exposure. As the dose rate is decreased and the exposure time is increased, the biological effect for a given dose is decreased.
What this means is:
At lower dose rates more subleathal damage to the cell can repair and cell populations have time to reproduce and repopulate.
Units of radioactivity measurements
In order to understand the effects of radiation on a cell, tissue or organism three units of activity must be looked at. The three units of activity that are of concern to patient care are:
- Units of activity.
- Units of radiation dose or deposited energy
- Units of biological dose equivalent.
- Units of activity
- The Becquerel (Bq) or disintegrations per second:
- 1Bq = 1 disintegration per second
- The Curie (Ci)
- 1 Ci = 3.7 x 1010 Bq
Units of radiation dose
Units of radiation that is absorbed (the dose) of any radiation type and in any material is defined as the amount of energy deposited or received. The units of absorbed dose are:
- The radiation absorbed dose (rad)
- 1 rad = 0.01 Gy
- 1 Gray (Gy) = 100 rad
- Whole body radiation
- Partial body radiation
- External contamination
- Internal contamination
- Combined radiation and traditional injuries
- Frequently involves the hands
- Acute Radiation Syndrome (ARS) is rare
- Traditional wound management is not effective
You'll also find these links and references useful. I've used them, in part and along with references, to put this series together. Again, the complete bibliography will be posted along with the final installment of the series.
Radiation Injury Treatment Network
Radiation Emergency Medical Treatment (from the U.S. Department of Health and Human Services)
Get the Mobile REMM app, FREE and worth the time!
January 3, 2011
Top Ten of 2010
I'd like to share the...lets call it..."best of 2010" or "year in review" from Mitigation Journal.
Top blog postings in 2010
E. coli:A Cause of Renal Failure and Disseminated Intravascular Coagulation was the most-read post in 2010. This topic originally posted way back in September, 2007 and I was a bit surprised to see how popular it has remained. In fact, its been read over 3000 times in 2010. It was read under 100 times when it originally posted. Kind of interesting, isn't it?
Homemade Chemical Bombs: A Legitimate Threat to Responders, originally posted August, 2006 was read by 2500 readers in 2010. This is getting interesting from two directions. First, the most read posts on my blog in 2010 were written three or four years ago. Second, I took a fair bit of criticism about wiring both. In fact, after the Homemade Chemical Bombs post, I was accused of being "too alarmist" and that I was making something out of nothing. Unfortunately, these events continue to go under reported and their dangers under appreciated by fire, EMS, and law enforcement. Interest must be there, it was a popular topic in 2010.
Paramedic Future posted in July, 2009 and was intended to spark debate about what EMS technologies would be beneficial. We received quite a bit of feed back on this one...little on technology...most focused on evidence based treatment.
And now, the only post in the Top Ten that was actually written in 2010 comes in at number 4. Why would hand foot and mouth disease stop air travel? was posted in October after a plane load of people were quarantined as someone noticed a child with a centrifugal pattern rash and fever.
Duty to Act in New York was a post that surprises me even today. We blogged about the two NYC EMT/Dispatchers that walked out of a coffee shop after being told about a pregnant woman having a seizure. The woman and baby died. There was some "flash" national coverage, but the enduring debate centered on what we would do if we were there. In 2010 this post was read 1320 times and continued to be a topic on the Mitigation Journal podcast.
Chemical Assisted Suicide and Possible Chemical Suicide in Ontario both registered over 700 reads in 2010. I was again accused of being too alarmist when originally posting about chemical suicide...mainly by the "it can't happen here" crowds around the country. Some uniformed responders locally actually thanked me for posting on the topic. Behind the scene, and quite unofficially, I was told my research and this posting generated a bit of embarrassment on some fire service leaders. Interestingly, a few documents from a certain fire service contained a nearly word-for-word recital of this post. A certain state publication came out with the same wording and references. Of course, there was no mention of Mitigation Journal.
CYANIDE: The Deadly Partner of Carbon Monoxide was a posting made in an attempt to bring attention to the all-hazards approach. This posting was read over 600 times in 2010 and referenced by several mainstream publications!
Meth Labs and Propane Cylinders warned of the dangers of anhydrous ammonia storage and meth labs. Originally posted in 2008 got 550 hits in 2010.
And finally, This app advances BLS! posted July, 2010 and is the second posting actually written in 2010 to make the list. I used this post to spur interest in medical/EMS apps. A special thanks to our friends at Informed Publishing for letting me review the apps.
January 2, 2011
MJ Podcast 203: Snowstorm uncovers poor planning, No refusal of breath tests for New Year
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| Click here for edition 203 |
This week Matt and I will try to shovel our way through the "blizzard" that hit the east coast last week. We'll focus on the events in NYC. Why was this such a major event? Where was the preparedness on the part of non-traditional responders? When non-tradition responders fail, infrastructure fails, and responders fail. The result; greater impact on the community.
We also go over our list of predictions for 2010 and how well we did. Join us for the full story.
Matt brings up a great topic from the mainstream media. According to Matt's research, there has been an injunction requiring all persons pulled over by police with suspicion for driving while intoxicated will no have the ability to refuse a breath test. The question is, why only this weekend? Why only on on New Years? Sounds like this tactic should be used everyday.
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December 30, 2010
Predictions from 2010
2010 Predictions...How well did I do? Well, lets take a look...
Here is the list of my 2010 Mitigation Journal predictions. I've listed my self-assessment of accuracy in these predictions. You can feel free to agree or not. Either way, I'd love to hear from you.
2010 Prediction: Budget Declines in municipal public services agencies: shortfalls in tax revenue and increased pressure to justify/cut personnel, facilities, and equipment. Public tax based services will be forced to refocus their mission.
Accuracy: 70%. The topic of public service budgets continues to circulate with various intensity and emotion. Much discussion and mainstream media attention tuned towards pay and benefits throughout the year. Here in last few months of 2010, more attention has been directed to responses and the number of employees. Budget scrutiny seems to be hit or miss.
2010 Prediction: Reduction in health care reimbursement, scrutiny of public service budget (fire and EMS) and justification of services - evidence based fee for services (I might predict a decline in fire service EMS...don't know if I want to mention that at this time)
Accuracy: 50%. Not as much of an issue as I would have thought this year. But as noted above, this issue is not going away.
2010 Prediction: EMS role in community health:
EMS responders will take more work doing community-based health - for homeless and home confined populations. EMS will also have an increased interaction with at-risk or special needs populations.
Accuracy: 0% Totally ignored. Nothing happened with this at all...but, I wish it would! Should we keep this on the list for 2011?
2010 Prediction: An increased number of walk-in care centers, urgent care centers, and retail health care clinics will impact health care delivery in general and EMS. Taking patients to them and picking people up from them.
Accuracy: 80% I think I hit this one pretty close. Events and requests for service at walk in centers has increased as have the number of these centers. Both factors point to the fact that people are willing to forgo a trip to the family doc in favor of a walk-in/urgent care center.
2010 Prediction: Budget Declines in municipal public services agencies: shortfalls in tax revenue and increased pressure to justify/cut personnel, facilities, and equipment. Public tax based services will be forced to refocus their mission.
Accuracy: 70%. The topic of public service budgets continues to circulate with various intensity and emotion. Much discussion and mainstream media attention tuned towards pay and benefits throughout the year. Here in last few months of 2010, more attention has been directed to responses and the number of employees. Budget scrutiny seems to be hit or miss.
2010 Prediction: Reduction in health care reimbursement, scrutiny of public service budget (fire and EMS) and justification of services - evidence based fee for services (I might predict a decline in fire service EMS...don't know if I want to mention that at this time)
Accuracy: 50%. Not as much of an issue as I would have thought this year. But as noted above, this issue is not going away.
2010 Prediction: EMS role in community health:
EMS responders will take more work doing community-based health - for homeless and home confined populations. EMS will also have an increased interaction with at-risk or special needs populations.
Accuracy: 0% Totally ignored. Nothing happened with this at all...but, I wish it would! Should we keep this on the list for 2011?
2010 Prediction: An increased number of walk-in care centers, urgent care centers, and retail health care clinics will impact health care delivery in general and EMS. Taking patients to them and picking people up from them.
Accuracy: 80% I think I hit this one pretty close. Events and requests for service at walk in centers has increased as have the number of these centers. Both factors point to the fact that people are willing to forgo a trip to the family doc in favor of a walk-in/urgent care center.
December 28, 2010
Hospitals...Public Health or Public Safety?
Hospitals...Public Health or Public Safety?
For years EMS personnel have found themselves torn between being part of public health or public safety. This identity tug-of-war has led to a certain lack of identity on the part of emergency medical services. The same problem is now being faced by hospitals and health care organizations.
Are hospitals part of public safety or public health? The answer is, both...based on public expectation. As much as traditional response groups train and prepare for disasters, they do so as part of their mission. The interesting fact is that hospitals are expected to manage the day-to-day events as well as the large scale event. The public expectation is that hospitals will be able to manage any crisis or disaster situation.
For years EMS personnel have found themselves torn between being part of public health or public safety. This identity tug-of-war has led to a certain lack of identity on the part of emergency medical services. The same problem is now being faced by hospitals and health care organizations.
Are hospitals part of public safety or public health? The answer is, both...based on public expectation. As much as traditional response groups train and prepare for disasters, they do so as part of their mission. The interesting fact is that hospitals are expected to manage the day-to-day events as well as the large scale event. The public expectation is that hospitals will be able to manage any crisis or disaster situation.
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