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

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.

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.

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.

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

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.

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!

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..."

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

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 -

1. DONT go to the hospital
2. DONT be afraid to eat pork (and yes, I think we should continue to call this SWINE FLU)
   
3. 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)
   
4. 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)
5. DONT panic (its Swine Flu...not an IRS audit)

And now for a few of my own...

• 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