Keeping pets safe from holiday hazards can become a full-time job. Given the possibilities that could cause serious illness or death of the family pet, heightened vigilance during the holiday season will be worth the effort.
CNN is reporting on the little know dangers to pets from everyday foods and provides a list of surprising items that can cause serious illness or death to domestic animals such as dogs and cats.
Don't miss my latest series "Pets in Disasters" on Mitigation Journal podcast for more information on protecting pets in crisis and evacuation situations. The series starts with edition number 89.
December 5, 2008
December 3, 2008
Holiday Food Safety
The Wisconsin Department of Health is offering tips for safe food handling during the holidays (http://dhs.wisconsin.gov/hometips/dhp/Holidays.htm). They site some common sense tips for keeping you and your family safe from foodborne disease...just good practice for all seasons.
The holiday recommendations and the Home Safety Tips both start off with...clean hands and clean surfaces!
This material would make a great health and safety topic for all personnel.
The holiday recommendations and the Home Safety Tips both start off with...clean hands and clean surfaces!
This material would make a great health and safety topic for all personnel.
December 2, 2008
Hospitals, Hotels, Malls - Soft Targets
We've been reading about the terrorist attacks in India and the relationship to soft targets. I talked about the need to identify and plan for attacks on soft targets in all communities on Mitigation Journal podcast this week. MSNBC has a nice article on the topic as well (http://www.msnbc.msn.com/id/27934097/)
A hard target is one that has some level of security protection that reduces the chances of an intentional event...in fire service terms; fire alarm systems "harden" a location against fire. Soft targets are locations that lack the deterrent from such events. Can you imagine if terrorist were to attack hospitals or hotels in the United States in the same fashion as in India?
It's important to understand that open structures with multiple access/egress points, isolated utility and services corridors and large crowds are potential target hazards for multi-patient, mass casualty events. Remember, we're not just talking terrorism here...gang activity can cause collateral damage as well as structural collapse, fires, panic situations, and of course, intentional events.
If you have MCI plans; do they reflect differences between an MCI occurring as a result of a bus crash on the highway and a multiple shooting at a movie theater? Everyone should take the time to review response plans and understand the needs of the location will necessitate alteration in your response plan.
A hard target is one that has some level of security protection that reduces the chances of an intentional event...in fire service terms; fire alarm systems "harden" a location against fire. Soft targets are locations that lack the deterrent from such events. Can you imagine if terrorist were to attack hospitals or hotels in the United States in the same fashion as in India?
It's important to understand that open structures with multiple access/egress points, isolated utility and services corridors and large crowds are potential target hazards for multi-patient, mass casualty events. Remember, we're not just talking terrorism here...gang activity can cause collateral damage as well as structural collapse, fires, panic situations, and of course, intentional events.
If you have MCI plans; do they reflect differences between an MCI occurring as a result of a bus crash on the highway and a multiple shooting at a movie theater? Everyone should take the time to review response plans and understand the needs of the location will necessitate alteration in your response plan.
Smallpox Vaccine Lasts Longer
According to a new study as reported in Medical News Today, (http://www.medicalnewstoday.com/articles/131290.php) the smallpox vaccine may last longer than we thought. Smallpox vaccine was thought to have little or no protective benefit after twenty or thirty years. According to this study, people vaccinated over 40 years ago have antibodies and may not even need a booster. You may recall that several trials of smallpox vaccination were stopped after adverse effects and deaths.
Keeping in mind that the last case of smallpox occurred in the late 1970's and routine vaccination stopped around the same time; anti-terrorism experts have been concerned that we humans lack any ability to protect ourselves and that vaccine stockpiles will not be adequate. Although this is only one study...it is still good news.
Keeping in mind that the last case of smallpox occurred in the late 1970's and routine vaccination stopped around the same time; anti-terrorism experts have been concerned that we humans lack any ability to protect ourselves and that vaccine stockpiles will not be adequate. Although this is only one study...it is still good news.
November 30, 2008
Sick? Stay Home!
If you're sick, stay home! Sounds like good advice, but how many of us actually do it? How many employers outwardly condone employees staying home if they are sick? This article from Medical News Today is specific with suggestions for Norovirus, but the lesson still makes sense...if you're sick, stay home. The point that has to be considered is that emergency responders may bring disease home with them, contribute to coworker illness, or even be unknowing partners in spreading community disease.
http://www.medicalnewstoday.com/articles/130661.php
http://www.medicalnewstoday.com/articles/130661.php
November 28, 2008
Generator Dangers
This story reminds us all of the dangers of carbon monoxide. In this situation, a generator was being used to heat and power a home and, due to improper use, created a situation of greater than 14,000 ppm of CO inside. The systemic effects of CO are underscored here as responders become overcome during the initial rescue operations.
Link to video:
http://www.clipsyndicate.com/publish/video/760452
View Video:
Link to video:
http://www.clipsyndicate.com/publish/video/760452
View Video:
November 26, 2008
Should Emergency Plans be open to the public?
I came upon this brief in Medical News Today (http://www.medicalnewstoday.com/articles/126767.php) talking about communicating emergency plans to the public. It seems that not all states have been able to make their plans available upon request. There also seems to be a disconnect in the communications area...few plans have a contingency communicating with the public.
This is an important topic for many reasons, two for sure; communication and public access. Communications are a vital part of any plan. We know that a solid community response can make or break the government response. That said, we have to ensure the public knows what to do, why they have to do it, and what we're going to do as emergency responders. On an entirely different point, we need to consider that the public may want to actually read our emergency plans. I don't think that anyone in the public will take action based on what they read in some plan...I think they are more likely to take action based upon the communication they receive from emergency personnel. However, we have to acknowledge that plans should be available in some form. Obviously there are parts of our plans that should be kept private.
I'd like to hear your thoughts to this.
This is an important topic for many reasons, two for sure; communication and public access. Communications are a vital part of any plan. We know that a solid community response can make or break the government response. That said, we have to ensure the public knows what to do, why they have to do it, and what we're going to do as emergency responders. On an entirely different point, we need to consider that the public may want to actually read our emergency plans. I don't think that anyone in the public will take action based on what they read in some plan...I think they are more likely to take action based upon the communication they receive from emergency personnel. However, we have to acknowledge that plans should be available in some form. Obviously there are parts of our plans that should be kept private.
I'd like to hear your thoughts to this.
November 24, 2008
Just in time for the holidays
Just in time for the holiday shopping season, gang-related shooting at a local Mall. MSNBC is reporting (http://www.msnbc.msn.com/id/27866465/) that a shooting in a Washington State Mall has resulted in at least two wounded.
Lets remember that this kind of attack can happen in any public venue and in any location. This is a good time to revisit (or create) your pre-incident plan to a multiple shooting or other MCI in public places such as malls and shopping centers.
Lets remember that this kind of attack can happen in any public venue and in any location. This is a good time to revisit (or create) your pre-incident plan to a multiple shooting or other MCI in public places such as malls and shopping centers.
Would you go to the Clinic at Wal Mart?
We've talked about in-store health care clinics on MJ in the recent past. These clinics are making the news again as some think these clinics, operated by Big Box stores, may be the next wave of health care solutions and relief of hospital over crowding.
MSNBC has done another story on them (http://www.msnbc.msn.com/id/26185769/). But the question is...would you go to one?
Check out the poll on the side-bar
MSNBC has done another story on them (http://www.msnbc.msn.com/id/26185769/). But the question is...would you go to one?
Check out the poll on the side-bar
July 23, 2008
Extrication: A Thing of the Past
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.
July 3, 2008
Graduation Time!
Lee (at left) is one of the most senior medics in our region...here he is talking with one of our regions seniors who just became a medic (Rick Roach). Rick is also a former ILS student of mine.
Dr. Shah (right) and I solving the world problems...
Honored to be the Emcee for the event, I'm getting ready to open the evening with one of my special one-liners...
At left, Amy Ruffo takes the stage and salutes her class
Members of the junior paramedic class, Kate and Nikki, attended the graduation. They now belong to the SENIOR paramedic class of 2009! Best of luck!
Boys will be boys...and we'll leave it at that.
Mr. B looks on as the festivities begin. Peter is the lead instructor for the Monroe Community College Paramedic Program.
Mr. B gives his address and salute to the sixteenth graduating class of paramedics from Monroe Community College.
Laurie King (a former ILS student) receives her Paramedic Diploma.
Bob Breese getting ready to deliver the Paramedic Oath to the Class of 2008. Known for his trauma lectures and "bob-a-cology", Bob is a leader in and out of the classroom.
On a more serious note...
Best Wishes to the MCC Paramedic Class of 2008!
June 14, 2008
Great Guide
The Home Emergency Pocket Guide from Informed: Perfect for Preparedness at all levels!I've been using Informed field guides for EMS for years and just recently received a copy of the Home Emergency Pocket Guide. Of all the guides and documents I've reviewed in the last few years, this one takes first place.
One of the most frequent questions I get when it comes to disaster preparedness is "where do I start!?" The problem is that those who actually take personal and family readiness seriously can be easily overwhelmed by the amount of material available...even the most motivated of people can find themselves spinning without clear direction. The Home Emergency Pocket Guide provides that clear direction in a easy-to-understand format that allows for reference and repetition as well as planning.
I read the guide cover to cover several times and found it easy to use and written so anyone, from citizen to CERT member to experienced responder can quickly get potential life saving information on everything from planning to first aid. Covering natural disasters, hazardous materials, terrorism and recovery, this guide takes the All-Hazards approach.
I was hooked by page 4: "...preparedness experts have cautioned civilians for decades to take the necessary precautions to help themselves in times of catastrophe. And yet, many of us do not. " We believe it will happen to someone else: we suffer from Optimism Bias - In fact recent data suggests that only 6-7% of the public has done any planning or preparation for disaster or crisis. The Home Emergency Pocket Guide walks you through in a logical direction, the path to being aware and prepared for numerous situations.
The section on first aid is formatted for quick reference and easy recall. ABC'S, CPR, medical emergencies and trauma situations are all covered. Some not-so-common situations are included as you may need to be self reliant in disaster or survival situations. There is even guides for biological agents such as smallpox, botulism, cholera, and anthrax.
The first rule in any emergency is to stop and think. The Home Emergency Pocket Guide provides the foundation for your preparedness efforts. The more prepared the public...the better the responders can help! Even the most experianced responder can benefit from this guide, giving piece of mind that your family knows what to do while you're responding to crisis
Check out my commentary on the Home Emergency Pocket Guide on the June 16, 2008 edition of Mitigation Journal: The All Hazards Podcast. Watch for a special offer from Informed and Mitigation Journal soon!
Thinking about Ambulance Safety
While at a recent emergency services exhibit, I noticed one of the most interesting ambulance designs...
This ambulance from the Premier Line was set up for a side loading gurney. Rather than the traditional rear load, this ambulance has two side doors and can load the gurney from each side. The patient rides across the width of the vehicle while the crew is seated in either front or rear facing seats. You can check out the full description on the North Eastern Rescue Vehicles site...click here.
Below are a few shots I took of this ambulance as well as a few video clips from the NHTSA. I don't have any proof or test data that shows this side load configuration is any safer than the tradition design, but after watching the videos...I'll try anything. I'd be interested to hear what you think.
This is the passenger side of the ambulance. Notice that the crew member is in a forward facing seat.
Again, from the passenger side; notice the sliding door on the drivers side and the gurney loading track in the middle.
These video clips are from YouTube...certainly something to think about!
This ambulance from the Premier Line was set up for a side loading gurney. Rather than the traditional rear load, this ambulance has two side doors and can load the gurney from each side. The patient rides across the width of the vehicle while the crew is seated in either front or rear facing seats. You can check out the full description on the North Eastern Rescue Vehicles site...click here.
Below are a few shots I took of this ambulance as well as a few video clips from the NHTSA. I don't have any proof or test data that shows this side load configuration is any safer than the tradition design, but after watching the videos...I'll try anything. I'd be interested to hear what you think.
This is the passenger side of the ambulance. Notice that the crew member is in a forward facing seat.
Again, from the passenger side; notice the sliding door on the drivers side and the gurney loading track in the middle.These video clips are from YouTube...certainly something to think about!
June 7, 2008
In Search of Preparedness in America
We've seen devastating examples of natural disasters all over the world. Here in the United States the number and severity of storms has seemed to increase along with the the death toll. In fact, the National Oceanic and Atmospheric Administration (NOAA) is reporting that 2008 is shaping up to be one of the worst years for severe weather. Given the combination of terrorist attacks and natural disasters like Hurricane Katrina as well as other storms around the world you'd think we (the public) would be paying attention. In fact, with all the dollars spent on domestic preparedness/homeland security, you'd think we would be ready for anything.
Don't believe everything you think.
A number of recent studies have indicated that the public is not prepared to provide self-help in times of crisis or natural disaster. In fact, the data suggests that much of our population is hanging onto the "it can't happen to me" mentality or, worse, is misinformed as to the potential life threatening situations that they may face.
From volcanoes in Hawaii to storms chewing up the mid-west, we've seen Mother Nature dish out some of the worst conditions since Katrina. Mainstream media has brought cataclysmic earthquakes in China into our living rooms and we watch with some disbelief...yet, it can't happen to us. The unfortunate fact is that "it" can happen to us and all the funding in the world can't buy a preparedness mindset.
Recent surveys indicate that our population is overwhelmingly complacent towards preparedness...lacking preparedness plans, survival food and water, or a basic awareness about the potential hazards in their region. Governments seem to have lacked the stamina to keep up with preparedness as well. Even those regions who have planed and practiced for disaster situations will find themselves fighting an uphill battle. One report cited 93% of Americans are not prepared to be self-sufficient for any crisis. How can any response community expect to assist a population where only 6-7% of a population has any capability to help themselves? Here's an everyday example: Your car is low on gas; what do you do? By looking at your cars gas gauge, you can estimate when and how much fuel you'll need. You simply drive to the gas station and fill up...that's taking care of yourself. What if we were to apply the "it won't happen to me" mindset or what I call Optimism Bias to the situation. Simply put, no need for a gas gauge...my car won't run out of fuel...and if it does, someone will come and fill it up for me.
The idea that "someone" will come to the rescue is a far cry from the Cold War mentality of bomb shelters and Civil Defense. Although rescue may come, it may not be for days. The idea is for every community to encourage residents to establish their own self sufficiency plan.
May 31, 2008
Helicopters and Hospitals
Landing helicopters on top of hospitals is not a good idea.
Landing a medical helicopter on a hospital landing pad can be a dangerous proposition under the best of conditions. Having a landing pad on top of your trauma center is flashy and exciting. All the TV shows do it! As we see in this story from the AP, when something goes wrong the outcome can be disastrous.
According to CNN, AP, and the local media coverage, Butterworth/Spectrum hospital in Grand Rapids, Michigan, endured a crash of a medical helicopter on the rooftop landing pad resulting in thick smoke and fire. According to the media reports several patient care floors had to be evacuated and power to the building had to be shut off. Surrounding roads and ground traffic were closed due to the threat of falling debris. According to available information at the time of this posting, there were no fatalities as a result of the helicopter crash. (Photo credit CNN.com)
Hospital trauma centers around the Nation utilize hundreds of air medical helicopter flights each day...safely...to bring trauma victims from emergency scenes to the trauma centers. There is little doubt that the appropriate use of air medical helicopters and trauma centers save lives that might otherwise be lost. Hospitals that have a need for air medical services can and should have designated landing pads (I think helispot is the correct term for those of you playing the NIMS home-game).
However, landing a helicopter ON TOP of a hospital is not a good idea...it never has been. This practice is flashy and dramatic, but not without risk. The crash at the Spectrum Hospital in Grand Rapids is a reminder of what can happen. As a result of this crash -several patient floors had to be evacuated -power to the hospital was disrupted -debris, smoke, and burning aviation fuel caused contamination and secondary hazard concerns, and roads were closed stopping surface traffic in the area. Beyond those issues, the "ripple effect" on a city or region include a drain on emergency response, surge issues on other hospitals as the Spectrum ED was closed (they are also the only level-one trauma center). Let's not forget that many major cities have hospitals in the in close proximity to other buildings and in the heart of the city.
Use air medical helicopters....yes, fly patients from rural areas to urban trauma centers...certainly, land the helicopter on the roof...no way. Landing in safe proximity to the hospital in a designated location is safer and can be nearly as efficient.
Consider the potential outcomes in the Grand Rapids crash and do a realistic risk/benefit analysis. The outcomes could have been much worse...and can be avoided.
Landing a medical helicopter on a hospital landing pad can be a dangerous proposition under the best of conditions. Having a landing pad on top of your trauma center is flashy and exciting. All the TV shows do it! As we see in this story from the AP, when something goes wrong the outcome can be disastrous.
According to CNN, AP, and the local media coverage, Butterworth/Spectrum hospital in Grand Rapids, Michigan, endured a crash of a medical helicopter on the rooftop landing pad resulting in thick smoke and fire. According to the media reports several patient care floors had to be evacuated and power to the building had to be shut off. Surrounding roads and ground traffic were closed due to the threat of falling debris. According to available information at the time of this posting, there were no fatalities as a result of the helicopter crash. (Photo credit CNN.com)Hospital trauma centers around the Nation utilize hundreds of air medical helicopter flights each day...safely...to bring trauma victims from emergency scenes to the trauma centers. There is little doubt that the appropriate use of air medical helicopters and trauma centers save lives that might otherwise be lost. Hospitals that have a need for air medical services can and should have designated landing pads (I think helispot is the correct term for those of you playing the NIMS home-game).
However, landing a helicopter ON TOP of a hospital is not a good idea...it never has been. This practice is flashy and dramatic, but not without risk. The crash at the Spectrum Hospital in Grand Rapids is a reminder of what can happen. As a result of this crash -several patient floors had to be evacuated -power to the hospital was disrupted -debris, smoke, and burning aviation fuel caused contamination and secondary hazard concerns, and roads were closed stopping surface traffic in the area. Beyond those issues, the "ripple effect" on a city or region include a drain on emergency response, surge issues on other hospitals as the Spectrum ED was closed (they are also the only level-one trauma center). Let's not forget that many major cities have hospitals in the in close proximity to other buildings and in the heart of the city.
Use air medical helicopters....yes, fly patients from rural areas to urban trauma centers...certainly, land the helicopter on the roof...no way. Landing in safe proximity to the hospital in a designated location is safer and can be nearly as efficient.
Consider the potential outcomes in the Grand Rapids crash and do a realistic risk/benefit analysis. The outcomes could have been much worse...and can be avoided.
May 14, 2008
To Live or Die in Disaster
The Associated Press is reporting on a panel of physicians who have made recommendations regarding who would and wouldn't get health care during times of disaster or catastrophe. The list is developed with the idea that health resources will be scarce or not readily available in times of crisis and the need for a more consistent method of triaging those resources. On the surface the idea has merit. The context and list-like approach are troubling.
The report recommends that each hospital have a team assigned in times of crisis to triage health care resources...note: resources is used synonymously with treatment. The triage team would have the sole responsibility of performing triage and utilizing the triage model...not a easy job when you consider those people meeting certain criteria (high risk of death) may not receive access to those resources. According to the list, you would not recieve treatment (ie: access to health care resources) if you have a high risk of death and a slim chance of long term survival. The following list is offered to define high risk of death and a slim chance of long term survival:
People greater than 85 yeas of age
severely burned patients greater than 60 years
Those with mental impairment...Alzheimers's disease
Those with chronic disease...heart failure, lung disease, or poorly controlled diabetes...
So, if you meet the above criteria or you have one of those conditions, there may be no care for you in a disaster. What do you think about that?
Although I totally agree that health care resources will be limited (if available at all) and a disaster situation will require health care rationing of some sort, I think this report is short sighted and not grounding in reality. Here's what I mean...
This scheme is not too distant from current triage modalities with one major exception...in triage we always base our decisions on the situation and a set of triage priorities. It is safe to say that those we choose not to work on in a triage situation are not conscious and those that are will be treated as expectant...note that I said treated here.
Was there any concern for facility safety when establishing this list? How do you expect to handle a situation when a family member is denied treatment based on this list while others are given treatment? Let's put it this way: if health care resources are going to be short, it is likely that law enforcement will be in short supply as well. It is reasonable to expect that families will show up at a hospital or treatment center as a unit...with expectations and conscious.
Lists such as the one suggested by this report may violate age discrimination or disability discrimination laws...I guess its one thing to make a decision on who gets what during a crisis...yet another thing to put groups of people on a list ahead of time.
Finally, when the public outcry and debate over this occurs (and I surprised it hasn't yet) emergency managers and medical personnel alike will be required to justify these actions and this list. That is not to say the the proposed triage model is wrong...just the way the list is presented seems to be a sticking point. The fact is that triage and health care rationing will occur by default as there is no way our current health care systems will continue to function during disaster or crisis situations. Hurricane Katrina taught us that lesson...and we haven't done much about it yet.
The best approach to the situation of health care in disaster situations is to prepare. Simple to say, far more difficult to do. In all reality, those groups mentioned on the list will receive some level of treatment in a disaster. A better plan may be to prepare community resources outside the hospital systems and place emphasis on dealing with special needs populations including shelter-in-place actions.
The report recommends that each hospital have a team assigned in times of crisis to triage health care resources...note: resources is used synonymously with treatment. The triage team would have the sole responsibility of performing triage and utilizing the triage model...not a easy job when you consider those people meeting certain criteria (high risk of death) may not receive access to those resources. According to the list, you would not recieve treatment (ie: access to health care resources) if you have a high risk of death and a slim chance of long term survival. The following list is offered to define high risk of death and a slim chance of long term survival:
People greater than 85 yeas of age
severely burned patients greater than 60 years
Those with mental impairment...Alzheimers's disease
Those with chronic disease...heart failure, lung disease, or poorly controlled diabetes...
So, if you meet the above criteria or you have one of those conditions, there may be no care for you in a disaster. What do you think about that?
Although I totally agree that health care resources will be limited (if available at all) and a disaster situation will require health care rationing of some sort, I think this report is short sighted and not grounding in reality. Here's what I mean...
This scheme is not too distant from current triage modalities with one major exception...in triage we always base our decisions on the situation and a set of triage priorities. It is safe to say that those we choose not to work on in a triage situation are not conscious and those that are will be treated as expectant...note that I said treated here.
Was there any concern for facility safety when establishing this list? How do you expect to handle a situation when a family member is denied treatment based on this list while others are given treatment? Let's put it this way: if health care resources are going to be short, it is likely that law enforcement will be in short supply as well. It is reasonable to expect that families will show up at a hospital or treatment center as a unit...with expectations and conscious.
Lists such as the one suggested by this report may violate age discrimination or disability discrimination laws...I guess its one thing to make a decision on who gets what during a crisis...yet another thing to put groups of people on a list ahead of time.
Finally, when the public outcry and debate over this occurs (and I surprised it hasn't yet) emergency managers and medical personnel alike will be required to justify these actions and this list. That is not to say the the proposed triage model is wrong...just the way the list is presented seems to be a sticking point. The fact is that triage and health care rationing will occur by default as there is no way our current health care systems will continue to function during disaster or crisis situations. Hurricane Katrina taught us that lesson...and we haven't done much about it yet.
The best approach to the situation of health care in disaster situations is to prepare. Simple to say, far more difficult to do. In all reality, those groups mentioned on the list will receive some level of treatment in a disaster. A better plan may be to prepare community resources outside the hospital systems and place emphasis on dealing with special needs populations including shelter-in-place actions.
May 13, 2008
Go Home, Everyone
I've recently had the pleasure of attending Courage to be Safe - So Everyone Goes Home. This program is offered by the National Fallen Firefighters Foundation and was delivered recently in my home town via the New York State Office of Fire Prevention and Control and was, simply put, one of the most meaningful presentations I've been at in the last twenty-four years.
This program, delivered by Mr. Paul Melfi, struck me at the core as a father, firefighter, and officer. I had the pleasure of interviewing Paul on the Courage to be Safe program while he was in Rochester. You can listen to the preview, my commentary and the interview with Paul on Mitigation Journal: The All-Hazards Podcast shows 60 and 61.Courage to be Safe - So everyone goes home is based on 16 Firefighter Life Safety Initiatives...everything from personal and organizational accountability for health and safety to apparatus design...are summed up in the 16 initiatives.
What are you prepared to do? Find your State Advocate here and request a class for your department...now, do it now. Not a fire-based organization? Courage to be Safe easily translates to emergency medical service.
Of course I have a few of the 16 Firefighter Life Safety Initiatives that stand out and have special meaning for me. Among my favorite initiatives are #4 All firefighters must be empowered to stop unsafe practices this means that the newest probie to the most senior officer have to have the guts to get out of the old mindset "because we've always done it that way" ...and that will take guts. This also means that we have to adjust our egos, actions and policy to reflect innovative safe thinking. When it comes to empowering your personnel to look for and stop unsafe practices, we have to think in the long term...a cultural change.
If your a chief officer or department offical - find your state advocate and request a class, if your a firefighter - forward this info to your chief and push this class to your brothers and sisters. It may be the best thing you can do to save a life.
May 12, 2008
Meth Labs and Propane Cylinders
A recent warning from the National Propane Gas Association highlights additional dangers from the production of methamphetamine.
Anhydrous ammonia is a common ingredient in the production of methamphetamine and adds to the growing list of hazards found at incidents involving meth labs. According to a release (no pun intended) by the National Propane Gas Association, anhydrous ammonia has been found to be stored and pressurized in consumer-grade propane tanks. The safety alert notes that anhydrous will corrode a
nd deteriorate the brass service valves of a propane tank. The brass turns to a blue-green stain after exposure to anhydrous ammonia. There is no mention of time frame to failure/or quantity/concentration of anhydrous ammonia that will cause deterioration or failure of the service valve. It is noted that if the valve shows evidence of exposure to anhydrous ammonia it can't be trusted and it may be dangerous to move the cylinder. Valve failure may result in a violent discharge of the valve...resulting in injuries.
Many responders have been made aware of the dangers of meth lab incidents. We know to consider the chemical hazards as well and physical hazards at
these locations and to be mindful that meth labs exist in nearly every jurisdiction, even on the highway. We also know to consider ammonia of various types in refrigeration and fertilizing operations, as well as in the residential setting as used for cleaning and disinfection in the commercial setting.
The issue of improper storage of anhydrous ammonia and the potential for service valve failure is just the tip of the iceberg. Propane tanks that have had anhydrous ammonia stored in them may be found in retail centers, craft stores, or any other location that offers a trade-in circulation for consumer-grade propane cylinders. This situation has to be added to your pre-planning and situational awareness.
Click here for the Safety Alerts page of the National Propane Gas Association. All photos courtesy of the National Propane Gas Association.
Anhydrous ammonia is a common ingredient in the production of methamphetamine and adds to the growing list of hazards found at incidents involving meth labs. According to a release (no pun intended) by the National Propane Gas Association, anhydrous ammonia has been found to be stored and pressurized in consumer-grade propane tanks. The safety alert notes that anhydrous will corrode a
nd deteriorate the brass service valves of a propane tank. The brass turns to a blue-green stain after exposure to anhydrous ammonia. There is no mention of time frame to failure/or quantity/concentration of anhydrous ammonia that will cause deterioration or failure of the service valve. It is noted that if the valve shows evidence of exposure to anhydrous ammonia it can't be trusted and it may be dangerous to move the cylinder. Valve failure may result in a violent discharge of the valve...resulting in injuries.Many responders have been made aware of the dangers of meth lab incidents. We know to consider the chemical hazards as well and physical hazards at
these locations and to be mindful that meth labs exist in nearly every jurisdiction, even on the highway. We also know to consider ammonia of various types in refrigeration and fertilizing operations, as well as in the residential setting as used for cleaning and disinfection in the commercial setting.The issue of improper storage of anhydrous ammonia and the potential for service valve failure is just the tip of the iceberg. Propane tanks that have had anhydrous ammonia stored in them may be found in retail centers, craft stores, or any other location that offers a trade-in circulation for consumer-grade propane cylinders. This situation has to be added to your pre-planning and situational awareness.
Click here for the Safety Alerts page of the National Propane Gas Association. All photos courtesy of the National Propane Gas Association.
April 28, 2008
Suicide by Blood Agent
A teen age girl in Japan committed suicide by creating deadly hydrogen sulphide gas in her apartment. The instructions for creating the chemical mixture was found on a computer in the apartment...apparently there have been a number of suicides/attempts since the internet information has been published. About 100 residents in the apartment building had to be evaluated following exposure. Other residents complained of respiratory distress and irritation.
This tragic story is yet another example of the Consumer-Level Hazardous Materials Incident. These events are created when routine chemical products are combined, intentionally or accidentally, to generate harmful chemical events. With all the focus on terrorism...we tend to forget about the common items we see everyday...and the impact they can have on our response.
In this case, Hydrogen Sulphide (H2S) was created by a mixture of readily available products (note: I am not listing the chemicals in attempt to keep people from doing this...if you're a responder and would like the information, please email me). H2S is a blood agent, meaning that it prevents the hemoglobin from functioning. Carbon Monoxide and Cyanide are other examples of blood agents. As an interesting note: cyanide is described as one of the least toxic blood agents. H2S poisoning follows the toxidrome of mucous membrane dryness, gasping, air hunger, respiratory failure, tachycardia and CV collapse.
In addition, H2S and a variety of other chemicals and acids can be produced by homemade chemical bombs. These types of events, intentional or accidental, can produce deadly outcomes. They can create the instant MCI and include worried well as well as actual exposure patients. Remember to consider decontamination of any patient exposed to a chemical liquid or gas.
More to follow.
Rick
This tragic story is yet another example of the Consumer-Level Hazardous Materials Incident. These events are created when routine chemical products are combined, intentionally or accidentally, to generate harmful chemical events. With all the focus on terrorism...we tend to forget about the common items we see everyday...and the impact they can have on our response.
In this case, Hydrogen Sulphide (H2S) was created by a mixture of readily available products (note: I am not listing the chemicals in attempt to keep people from doing this...if you're a responder and would like the information, please email me). H2S is a blood agent, meaning that it prevents the hemoglobin from functioning. Carbon Monoxide and Cyanide are other examples of blood agents. As an interesting note: cyanide is described as one of the least toxic blood agents. H2S poisoning follows the toxidrome of mucous membrane dryness, gasping, air hunger, respiratory failure, tachycardia and CV collapse.
In addition, H2S and a variety of other chemicals and acids can be produced by homemade chemical bombs. These types of events, intentional or accidental, can produce deadly outcomes. They can create the instant MCI and include worried well as well as actual exposure patients. Remember to consider decontamination of any patient exposed to a chemical liquid or gas.
More to follow.
Rick
February 10, 2008
Sudden Blizzard Causes MCI in Rochester, NY
Sudden blizzard-like conditions on Route 390 caused a forty-seven car pile up just outside of Rochester, NY. Details are still comming in, but at last count there were 27 patients transported, one surgical cardiac arrest.
All initial reports from those on scene indicate scene control and managment along with triage, treatment and transport were well done. The climate at the time of the event was 12 degrees F, with 20-30 mph winds.
Stay tunned to Mitigation Journal for more on this.
All initial reports from those on scene indicate scene control and managment along with triage, treatment and transport were well done. The climate at the time of the event was 12 degrees F, with 20-30 mph winds.
Stay tunned to Mitigation Journal for more on this.
January 13, 2008
White Paper fails to make justification for FD-EMS
A review of the White paper - Prehospital 9-1-1 Emergency Medical Response
The Role of the United States Fire Service in Delivery and Coordination shows shortsightedness on the part of some leaders.
This document points to the direction of emergency medical service in a fire service-based delivery model and highlights several benefits of that system. Although the document correctly notes the history and structure of the American Fire Service, it fails to achieve its self described mission; that “decision makers should recognize that the U.S. fire service is the most ideal prehospital 9-1-1 emergency response agency.” While this report makes several points many will find interesting, it lacks a comprehensive view of emergency medical service. Rather than accounting for the various aspects of EMS such as the provision of non-emergency and specialty care transport, the authors focus on only emergency response.
Emergency medical service is often considered as an ambulance only service. The public needs to understand the vital role of that first-response, non-transporting fire departments play in the total delivery of out-of-hospital care. Many fire departments provide both transport and first-response EMS with many of those being larger metropolitan areas staffed by career fire departments. However, with nearly 70% of fire departments being staffed by volunteer firefighters, the question is weather or not the fire service-based EMS transport model is sustainable. Numerous reports have indicated the need for more volunteers in any community.EMS has been cited as a drain on volunteer fire department resources and some departments only provide an emergency medical response to the most critical events.
The document also states that the fire service is the agency that first delivers on-scene health care services under the most true emergency situations and that “...it [EMS] has become almost universally, a principal duty of the fire service as well” and “fire service-based EMS systems are strategically positioned to deliver time critical response.” Its true that most if not all communities have a fire station strategically placed, usually near the center, of the population or a high-hazard area. While the traditional fire station may meet the needs of fire protection, I’m not sure the same structure is efficient for ambulance service. As population shifts occur at various times of day, the needs of a geographic area will also change. Ambulance services have practiced strategic staging of ambulances to meet changing needs of an area. Reliance on a fixed facility as a singe base of operation may not meet the daily changing needs of a community.
The report suggests that it is the fire service that provides the majority of medical services during emergencies that occur out of the hospital. What about the rest of the patient care cycle? Is the care and treatment provided during transport to be considered in a minority? These statements imply that once care is delivered on-scene (by fire department personnel), the patient needs only a ride. We know that this couldn’t be further from the truth. Patient conditions can change at any time...that’s why we continually reassess and examine.
The use of NIMS, the National Incident Management System, is also indicated as another reason for the fire service to have the lead role in the provision of EMS. However, NIMS compliance among fire departments is not universal. Although most, if not all, fire departments have adopted NIMS or utilize some form of incident command many are not fully NIMS compliant. NIMS is far more than an incident management system and encompasses an agency philosophy of management. Unfortunately, too few EMS ambulance services have taken the initiative to become NIMS compliant and embrace the concept in service delivery.
Ambulance sub-specialties are mentioned in the report and the reader is cautioned that these services “must not be confused with 9-1-1 emergency response.” I think this is one of the most disturbing comments I’ve ever heard. I we’re going to look at the global needs of EMS delivery, we have to included specialty care units like critical care transport. To exclude the specialty services is to fail to address the needs of not only the patient but the health care system as well. The emergency-only approach to pre hospital care is self-limiting and will not fulfill the mission of the fire service, the public, or the health care system.
Perhaps the most disturbing question asked in this report is “...what does a non-fire based EMS crew do on the scene of a motor vehicle accident when the care is engulfed in flames and occupants are trapped inside, and fire crews were not dispatched?” When did dispatch error become a justification for the fire service to provide ambulance service? Crashes with cars on fire a occupants trapped and similar situations are dangerous threats to civilian life and responder safety. The threat exists regardless of the availability of personal protective equipment. So, to answer the question of what non-fire based crew should do in these situations...let’s answer play your position and get the proper resources to the scene.
And what if we were to ask the question in another way? “What does a fire service based crew do with all the structural firefighting personal protective equipment and apparatus at the scene of a heart attack?” The fact is, that if we were to apply this line of thinking towards an overwhelming majority EMS response the fire department “emergency only” service would seem like a large expenditure with limited return.
My conclusion is that the report Prehospital 9-1-1 Emergency Medical Response: the Role of the United States Fire Service in Delivery and Coordination fails to make a valid claim that the fire service is universally the best provider of EMS. As I’ve attempted to point out in this summary, the delivery model that best serves a community is the best delivery system and that is certainly not a one-size fits all situation. The fact is that there are several delivery forms that will meet the needs and expectations of a community. The job is to evaluate, study and choose the best option for our individual area.
(a link to the original document can be found at www.mitigationjournal.com on the updates page)
The Role of the United States Fire Service in Delivery and Coordination shows shortsightedness on the part of some leaders.
This document points to the direction of emergency medical service in a fire service-based delivery model and highlights several benefits of that system. Although the document correctly notes the history and structure of the American Fire Service, it fails to achieve its self described mission; that “decision makers should recognize that the U.S. fire service is the most ideal prehospital 9-1-1 emergency response agency.” While this report makes several points many will find interesting, it lacks a comprehensive view of emergency medical service. Rather than accounting for the various aspects of EMS such as the provision of non-emergency and specialty care transport, the authors focus on only emergency response.
Emergency medical service is often considered as an ambulance only service. The public needs to understand the vital role of that first-response, non-transporting fire departments play in the total delivery of out-of-hospital care. Many fire departments provide both transport and first-response EMS with many of those being larger metropolitan areas staffed by career fire departments. However, with nearly 70% of fire departments being staffed by volunteer firefighters, the question is weather or not the fire service-based EMS transport model is sustainable. Numerous reports have indicated the need for more volunteers in any community.EMS has been cited as a drain on volunteer fire department resources and some departments only provide an emergency medical response to the most critical events.
The document also states that the fire service is the agency that first delivers on-scene health care services under the most true emergency situations and that “...it [EMS] has become almost universally, a principal duty of the fire service as well” and “fire service-based EMS systems are strategically positioned to deliver time critical response.” Its true that most if not all communities have a fire station strategically placed, usually near the center, of the population or a high-hazard area. While the traditional fire station may meet the needs of fire protection, I’m not sure the same structure is efficient for ambulance service. As population shifts occur at various times of day, the needs of a geographic area will also change. Ambulance services have practiced strategic staging of ambulances to meet changing needs of an area. Reliance on a fixed facility as a singe base of operation may not meet the daily changing needs of a community.
The report suggests that it is the fire service that provides the majority of medical services during emergencies that occur out of the hospital. What about the rest of the patient care cycle? Is the care and treatment provided during transport to be considered in a minority? These statements imply that once care is delivered on-scene (by fire department personnel), the patient needs only a ride. We know that this couldn’t be further from the truth. Patient conditions can change at any time...that’s why we continually reassess and examine.
The use of NIMS, the National Incident Management System, is also indicated as another reason for the fire service to have the lead role in the provision of EMS. However, NIMS compliance among fire departments is not universal. Although most, if not all, fire departments have adopted NIMS or utilize some form of incident command many are not fully NIMS compliant. NIMS is far more than an incident management system and encompasses an agency philosophy of management. Unfortunately, too few EMS ambulance services have taken the initiative to become NIMS compliant and embrace the concept in service delivery.
Ambulance sub-specialties are mentioned in the report and the reader is cautioned that these services “must not be confused with 9-1-1 emergency response.” I think this is one of the most disturbing comments I’ve ever heard. I we’re going to look at the global needs of EMS delivery, we have to included specialty care units like critical care transport. To exclude the specialty services is to fail to address the needs of not only the patient but the health care system as well. The emergency-only approach to pre hospital care is self-limiting and will not fulfill the mission of the fire service, the public, or the health care system.
Perhaps the most disturbing question asked in this report is “...what does a non-fire based EMS crew do on the scene of a motor vehicle accident when the care is engulfed in flames and occupants are trapped inside, and fire crews were not dispatched?” When did dispatch error become a justification for the fire service to provide ambulance service? Crashes with cars on fire a occupants trapped and similar situations are dangerous threats to civilian life and responder safety. The threat exists regardless of the availability of personal protective equipment. So, to answer the question of what non-fire based crew should do in these situations...let’s answer play your position and get the proper resources to the scene.
And what if we were to ask the question in another way? “What does a fire service based crew do with all the structural firefighting personal protective equipment and apparatus at the scene of a heart attack?” The fact is, that if we were to apply this line of thinking towards an overwhelming majority EMS response the fire department “emergency only” service would seem like a large expenditure with limited return.
My conclusion is that the report Prehospital 9-1-1 Emergency Medical Response: the Role of the United States Fire Service in Delivery and Coordination fails to make a valid claim that the fire service is universally the best provider of EMS. As I’ve attempted to point out in this summary, the delivery model that best serves a community is the best delivery system and that is certainly not a one-size fits all situation. The fact is that there are several delivery forms that will meet the needs and expectations of a community. The job is to evaluate, study and choose the best option for our individual area.
(a link to the original document can be found at www.mitigationjournal.com on the updates page)
January 5, 2008
Incident Safety Officers Crucial to Good Operations
Safety Officers Needed
Incident Safety Officers Crucial to Good Operations
Rick Russotti, CI/C, EMTP
rick@mitigationjournal.com
The role of the incident safety officer or ISO is about to expand. Although some refuse to acknowledge the importance of the incident safety officer’s position, a competent and proactive safety officer plays a crucial role in emergency scene management. All to often the assignment as incident safety officer is seen as a lack-luster job without the real importance of other positions within the command structure. Some departments continue to relegate the position of safety officer to personnel who are considered “exterior” or support personnel while others dedicate those members on light-duty to the role. Failing to understand how a incident safety officer fits into the command structure and what he or she represents on the emergency scene or fire ground can be that first domino in less then successful events.
Incident Safety Officers are more then safety or equipment Nazis. While it is true that the ISO should be helping to ensure the proper use of PPE and observe for potentially unsafe situations or acts, he or she must undertake an active role in ensuring other important duties are accomplished. All to often the ISO is seen as a nitpicky nag that keeps “real firemen” from doing their job. Unfortunately, when personnel are assigned to the position of incident safety officer as a matter of default (they’re the last one on-scene or they’re on light duty), the role diminishes in credibility as those personnel finding themselves in this role by default may lack the training and background to be effective. This highlights the need for the incident safety officer to have the background practical experience combined with a depth of knowledge of fire ground operations. This combination of knowledge and experience equates to credibility on the part of the incident safety officer.
Experienced firefighters and officers can and do operate as effective incident safety officers…usually in those departments who’ve embraced the position and added some level of acknowledgement within the command structure. Although every person on the fire ground have a responsibility to act in a safety officer capacity, those assigned to the role should have demonstrated comprehensive knowledge of department standard operating procedures as well as established firefighting strategies and tactics. In short, the practice of assigning an incident safety officer by default shortchanges the members working at an incident and deprives the incident commander of an invaluable resource.
As other functional areas such as personnel accountability and responder rehabilitation continue to expand, they should fall under the direction of the incident safety officer in the command structure. This is not to suggest that the incident safety officer should actually perform the duties, rather he or she should ensure that they occur according to department procedure. Consequently as the complexity and geographical scope of an incident expands, so will the need for additional personnel to be assigned to the safety group and deployed so as to manage the incident safety officer roles within the given areas. Additionally, rehabilitation and accountability group leaders should be reporting to the Incident Safety Officer. Rehabilitation and accountability are just two of the functional areas that should be under the direction of the incident safety officer.
Incident Safety Officers Crucial to Good Operations
Rick Russotti, CI/C, EMTP
rick@mitigationjournal.com
The role of the incident safety officer or ISO is about to expand. Although some refuse to acknowledge the importance of the incident safety officer’s position, a competent and proactive safety officer plays a crucial role in emergency scene management. All to often the assignment as incident safety officer is seen as a lack-luster job without the real importance of other positions within the command structure. Some departments continue to relegate the position of safety officer to personnel who are considered “exterior” or support personnel while others dedicate those members on light-duty to the role. Failing to understand how a incident safety officer fits into the command structure and what he or she represents on the emergency scene or fire ground can be that first domino in less then successful events.
Incident Safety Officers are more then safety or equipment Nazis. While it is true that the ISO should be helping to ensure the proper use of PPE and observe for potentially unsafe situations or acts, he or she must undertake an active role in ensuring other important duties are accomplished. All to often the ISO is seen as a nitpicky nag that keeps “real firemen” from doing their job. Unfortunately, when personnel are assigned to the position of incident safety officer as a matter of default (they’re the last one on-scene or they’re on light duty), the role diminishes in credibility as those personnel finding themselves in this role by default may lack the training and background to be effective. This highlights the need for the incident safety officer to have the background practical experience combined with a depth of knowledge of fire ground operations. This combination of knowledge and experience equates to credibility on the part of the incident safety officer.
Experienced firefighters and officers can and do operate as effective incident safety officers…usually in those departments who’ve embraced the position and added some level of acknowledgement within the command structure. Although every person on the fire ground have a responsibility to act in a safety officer capacity, those assigned to the role should have demonstrated comprehensive knowledge of department standard operating procedures as well as established firefighting strategies and tactics. In short, the practice of assigning an incident safety officer by default shortchanges the members working at an incident and deprives the incident commander of an invaluable resource.
As other functional areas such as personnel accountability and responder rehabilitation continue to expand, they should fall under the direction of the incident safety officer in the command structure. This is not to suggest that the incident safety officer should actually perform the duties, rather he or she should ensure that they occur according to department procedure. Consequently as the complexity and geographical scope of an incident expands, so will the need for additional personnel to be assigned to the safety group and deployed so as to manage the incident safety officer roles within the given areas. Additionally, rehabilitation and accountability group leaders should be reporting to the Incident Safety Officer. Rehabilitation and accountability are just two of the functional areas that should be under the direction of the incident safety officer.
December 2, 2007
Typhoid Mary: History for Today
Chances are that if you lived in the United States in early 1930’s you were concerned about numerous diseases that don’t have today’s media headlines. Typhoid Fever is one of those diseases which garnered much attention during that time in United Sates history, but today receives little or no attention. Although it lacks the marquee value of other diseases such as MRSA, smallpox, and anthrax, there are many lessons to be applied from the impact of Typhoid. One such lesson is that taught by Mary Mallon…better known as Typhoid Mary.
Mary Mallon (September 23, 1869 – November 11, 1938) has the dubious honor of being the first person in history to be a carrier of typhoid fever. Between 1901 and 1907 Mary Mallon held several positions with institutions and in private homes as cook. Many of the jobs were held here in New York State. During here working time she is alleged to have infected 22 people with typhoid fever and accused of the resulting single death. Typhoid illness and deaths spiked in her presence as she moved from city to city. The incidence of disease and deaths seemed to follow her from Mamaronek, NY to Manhattan to Long Island. It seems that within two weeks of Mary Mallon’s arrival, outbreaks of typhoid occurred.
Defending her innocence to the accusations of being a carrier of typhoid, Mallon refused to submit stool and urine samples in 1904, and in 1906 the possibility of a human carrier of typhoid was published in the June issue of the Journal of the American Medical Association. Later Mallon, now know by the popular Typhoid Mary name was taken into custody and held for three years. Her involuntary isolation came at her protests that the law was against her and claims of harassment because she was an Iris immigrant. She was eventually released on condition that not work with food, but took job as a hospital cook under an assumed name and infected twenty-five other people with typhoid. Two of those infected died. After this latest outbreak of typhoid, Mary “Brown” was discovered to actually be “Typhoid” Mary Mallon. She was arrested and re-admitted (involuntarily) for life-long isolation.
At the age of 69, on November 11, 1938, “Typhoid” Mary Mallon died of pneumonia. On postmortem exam, live typhoid bacteria was found in her gallbladder. Despite her overwhelming denial of her role in the typhoid cases and deaths, she in fact, produced the situations resulting in numerous cases and deaths from typhoid.
What relevance can we bring to today’s bio-security awareness society from Typhoid Mary? There are several historical points that should be considered. First, Mary’s situation was almost certainly unintentional. That is, Mary Mallon did not intend to harm anyone or spread disease. Would a change in the intent change the outcome or the circumstances of the situation? I think so. We have become accustomed to the “suicide bomber” scenarios played on the evening news. Consider the possibility of a “Biological Bomber”…a person who intentionally infects himself/herself with a disease in order to spread the disease and effect a bioterrorist event. Can you imagine the impact of one person infected with some disease walking into a hospital and contacting immunological suppressed patients, visitors, and health care workers?
And what if Mary was alive today and incarcerated on the suspicion of being a health carrier of a deadly disease; what would be said about her civil rights? Would public health authorities have the ability today to impose isolation? Think back to the media circus surrounding Mr. Speaker, the international traveler with extremely drug resistant tuberculosis. Can you imagine what would have happened had a fellow traveler contracted TB? Further, what will the effects be on society during an actual public health emergency? During a public health crisis I’m not convinced that the imposition of isolation or quarantine measures will be effective. During the Sever Acute Respiratory Syndrome (SARS) outbreak of 2003, the city of Toronto found that a majority of citizens voluntarily complied with social distancing. These high levels of compliance may be contributed to community education efforts and use of the modern media. With the SARS situation in mind, I am still skeptical that a similar outcome would be possible in the United States despite the Constitutional and legal ability to do so.
The Public Health Services Act (1944) provides for quarantine authority of the Federal government and authorizes “…apprehension, detention, and conditional release of individuals to prevent spread of communicable disease” This statute applies to persons infected with a communicable disease in a qualifying stage Title 42 U.S.C. Section 264 (Section 361 of the Public Health Service Act) gives the Secretary of Health and Human Services responsibility for preventing the introduction, transmission, and spread of communicable diseases from foreign countries into the U.S. and within the U.S. and its territories/possessions, and CDC has the authority to “detain, medically examine, or conditionally release individuals suspected of carrying a communicable disease” under regulations found at 42 C.F.R. Parts 70 and 71. Violation of a quarantine and isolation order is a federal criminal misdemeanor.
On April 4, 2003, at the request of the CDC, President Bush signed Executive Order 13295, adding SARS to the list of communicable diseases for which federal isolation and quarantine is authorized. And earlier in 2007, President Bush signed Homeland Security Presidential Directive 51 authorizing the Office of the President to declare and define “threats to continuity of government”.
The fact remains that during a public health crisis resources would be few and one has to wonder if quarantine would be possible at all.
References:
Preparing for Biological Terrorism: An Emergency Service Planning Guide. George Buck, Ph.D ISBN 1-4018-1094-2
Critical Care Study Guide. Criner/D’Alonzo ISBN 0-387-95164-4
Emergency Management: Principles and Practice for Local Government. ICMA ISBN 0-87326-082-1.
About.com:20th Century History. “Typhoid Mary” http://history1900s.about.com/od/1900s/a/typhoidmary.htm accessed Nov. 30, 2007
Typhoid Mary: Villain or Victim? Judith Walzer Leavitt http://www.pbs.org/wgbh/nova/typhoid/mary.html accessed Dec. 2, 2007
The Most Dangerous Woman in America. NOVA http://www.pbs.org/wgbh/nova/typhoid/ accessed Dec. 01, 2007
Women’s Health, Prevention works for women. Centers for Disease Control and Prevention http://www.cdc.gov/women/owh/wominspire/baker.htm accessed Dec. 1, 2007
Mary Mallon (September 23, 1869 – November 11, 1938) has the dubious honor of being the first person in history to be a carrier of typhoid fever. Between 1901 and 1907 Mary Mallon held several positions with institutions and in private homes as cook. Many of the jobs were held here in New York State. During here working time she is alleged to have infected 22 people with typhoid fever and accused of the resulting single death. Typhoid illness and deaths spiked in her presence as she moved from city to city. The incidence of disease and deaths seemed to follow her from Mamaronek, NY to Manhattan to Long Island. It seems that within two weeks of Mary Mallon’s arrival, outbreaks of typhoid occurred.
Defending her innocence to the accusations of being a carrier of typhoid, Mallon refused to submit stool and urine samples in 1904, and in 1906 the possibility of a human carrier of typhoid was published in the June issue of the Journal of the American Medical Association. Later Mallon, now know by the popular Typhoid Mary name was taken into custody and held for three years. Her involuntary isolation came at her protests that the law was against her and claims of harassment because she was an Iris immigrant. She was eventually released on condition that not work with food, but took job as a hospital cook under an assumed name and infected twenty-five other people with typhoid. Two of those infected died. After this latest outbreak of typhoid, Mary “Brown” was discovered to actually be “Typhoid” Mary Mallon. She was arrested and re-admitted (involuntarily) for life-long isolation.
At the age of 69, on November 11, 1938, “Typhoid” Mary Mallon died of pneumonia. On postmortem exam, live typhoid bacteria was found in her gallbladder. Despite her overwhelming denial of her role in the typhoid cases and deaths, she in fact, produced the situations resulting in numerous cases and deaths from typhoid.
What relevance can we bring to today’s bio-security awareness society from Typhoid Mary? There are several historical points that should be considered. First, Mary’s situation was almost certainly unintentional. That is, Mary Mallon did not intend to harm anyone or spread disease. Would a change in the intent change the outcome or the circumstances of the situation? I think so. We have become accustomed to the “suicide bomber” scenarios played on the evening news. Consider the possibility of a “Biological Bomber”…a person who intentionally infects himself/herself with a disease in order to spread the disease and effect a bioterrorist event. Can you imagine the impact of one person infected with some disease walking into a hospital and contacting immunological suppressed patients, visitors, and health care workers?
And what if Mary was alive today and incarcerated on the suspicion of being a health carrier of a deadly disease; what would be said about her civil rights? Would public health authorities have the ability today to impose isolation? Think back to the media circus surrounding Mr. Speaker, the international traveler with extremely drug resistant tuberculosis. Can you imagine what would have happened had a fellow traveler contracted TB? Further, what will the effects be on society during an actual public health emergency? During a public health crisis I’m not convinced that the imposition of isolation or quarantine measures will be effective. During the Sever Acute Respiratory Syndrome (SARS) outbreak of 2003, the city of Toronto found that a majority of citizens voluntarily complied with social distancing. These high levels of compliance may be contributed to community education efforts and use of the modern media. With the SARS situation in mind, I am still skeptical that a similar outcome would be possible in the United States despite the Constitutional and legal ability to do so.
The Public Health Services Act (1944) provides for quarantine authority of the Federal government and authorizes “…apprehension, detention, and conditional release of individuals to prevent spread of communicable disease” This statute applies to persons infected with a communicable disease in a qualifying stage Title 42 U.S.C. Section 264 (Section 361 of the Public Health Service Act) gives the Secretary of Health and Human Services responsibility for preventing the introduction, transmission, and spread of communicable diseases from foreign countries into the U.S. and within the U.S. and its territories/possessions, and CDC has the authority to “detain, medically examine, or conditionally release individuals suspected of carrying a communicable disease” under regulations found at 42 C.F.R. Parts 70 and 71. Violation of a quarantine and isolation order is a federal criminal misdemeanor.
On April 4, 2003, at the request of the CDC, President Bush signed Executive Order 13295, adding SARS to the list of communicable diseases for which federal isolation and quarantine is authorized. And earlier in 2007, President Bush signed Homeland Security Presidential Directive 51 authorizing the Office of the President to declare and define “threats to continuity of government”.
The fact remains that during a public health crisis resources would be few and one has to wonder if quarantine would be possible at all.
References:
Preparing for Biological Terrorism: An Emergency Service Planning Guide. George Buck, Ph.D ISBN 1-4018-1094-2
Critical Care Study Guide. Criner/D’Alonzo ISBN 0-387-95164-4
Emergency Management: Principles and Practice for Local Government. ICMA ISBN 0-87326-082-1.
About.com:20th Century History. “Typhoid Mary” http://history1900s.about.com/od/1900s/a/typhoidmary.htm accessed Nov. 30, 2007
Typhoid Mary: Villain or Victim? Judith Walzer Leavitt http://www.pbs.org/wgbh/nova/typhoid/mary.html accessed Dec. 2, 2007
The Most Dangerous Woman in America. NOVA http://www.pbs.org/wgbh/nova/typhoid/ accessed Dec. 01, 2007
Women’s Health, Prevention works for women. Centers for Disease Control and Prevention http://www.cdc.gov/women/owh/wominspire/baker.htm accessed Dec. 1, 2007
October 27, 2007
Emerging Diseases and the Hygiene Hypothesis
The media has been full of stories warning the public of a new “super bug” that is threatening the health of our communities. Despite the advances in cleaning products, antimicrobial agent soaps, and an emphasis public health, these infectious diseases continue to thrive and seek out new targets for disease. In the late 1990’s West Nile Virus gained concern as the never before pathogen, spread by mosquito bite and carried by wild birds, began showing up in wild birds across the United States. Our awareness to biological agents was thrust to the forefront of our culture as a result of the anthrax attacks following 9/11. Avian flu, or H5N1, has had our attention on and off for the last few years as the hotly debated question of mutation and the possibility of pandemic is discussed. Several incidents of illness and death have been cited due to pathologic Escherichia coli (E. coli) O157:H7, and most recently, the so-called super bug Methicillin Resistant Staphylococcus aureus or MRSA.
Methicillin Resistant Staphylococcus aureus or MRSA, along with its counterpart ORSA (Oxacillin Resistant Staphylococcus aureus) have been nosocomial, or hospital acquired infections of concern for quite some time infecting the patient who has undergone an invasive procedure or the long term care patient with a compromised immune system. Hospital and other health care workers can become infected with ORSA/MRSA as a result of the performance of their duties. Health care providers may become infected with ORSA/MRSA by 1) contact with colonized or infected patients, 2) colonized or infected sites of the personnel (clothing or unprotected areas) and, 3) exposure to contaminated surfaces or items such as medical devices, or environmental surfaces. The good news is that practicing standard body substance isolation and good personal hygiene (hand washing) can prevent many of these exposures.
The question remains, however, as to why these diseases continue to flourish in a society rich with countermeasures such as anti-microbial soaps and cleaners. Why do they continue to evolve to resist traditional treatment and migrate to infect otherwise healthy people in the community?
Certain theories propose that cleaner is not always better. One such theory is the Hygiene Hypothesis which began circulation as a theory on the relationship between exposure to viruses and bacteria and the development of a healthy immune system around 1989. The Hygiene Hypothesis proposes that exposure to environments that are less than germ-free as an infant or toddler builds a stronger immune system and reduces the risk of developing disease later in life.
How can this be possible? It seems counterintuitive to claim that a more microbe-free environment is not automatically equated to better health. We can, in fact, look to a simple analogy of the immune system for a better perspective. Let’s compare the immune system to voluntary muscle for a moment. When voluntary muscle is stressed, as in the case of exercise, the muscle becomes stronger; the hygiene hypothesis is merely suggesting the same principle applies to the immune system. The exposure a young, developing immune system to repeated small doses of various virus and bacteria endemic to a given environment can be considered as exercise for the immune system. “That which does not kill us makes us stronger” may be a better name for the hypothesis.
Although debated, several findings suggest that early infection with certain bacteria have reduced the severity of later immune response to allergens in mice.
The Hygiene Hypothesis has been implicated as a factor in the rise of asthma and some community acquired immunologic diseases. Research suggests that our society’s overuse of anti-microbial/anti-biotic materials, such as cleaners and soaps, has caused people to be exposed to fewer diseases during immune system development. Scientists point out that asthma and other diseases linked to the immune system have been on the rise for the last 30-40 years despite exposure to fewer infectious organisms. The thought is that these organisms are a key component in training and creating a healthy immune system. Without early exposure, the developing immune system fails to respond at an appropriate level and may actually overreact to irritants that would otherwise be inconsequential. The result is an increased overreaction of the immune system equating to conditions such as asthma. Other research has indicated that children who are exposed to high levels of the bacterial compound, endotoxin, found in house dust may actually be less likely to develop eczema during their first year of life3. Finding such as this support the hygiene hypothesis by indicating that early exposure to infectious or inflammatory agents cause changes in the immune systems and reducing the risk of developing allergy-related conditions later in life.
The hygiene hypothesis remains unproven but continues to be tested by a variety of researchers. I think my analogy comparing the immune system to the voluntary muscular system make a lot of sense. For an immune system to work property it must be trained and experienced, but if training and experience is lacking, the immune system defaults to “going to war” when all that may be needed is to fire a single shot. Our approach to develop items such as anti-bacterial soaps is not entirely bad…I think the marketing and media hold much of the responsibility for this situation.
References
1.Bacterial Infections Alter Allergic Response; Findings Support Hygiene Hypothesis. Science Daily/national Jewish Medical and Research Center http://www.sciencedaily.com/releases/2003/02030225065721.htm accessed 10 October 2007 accessed 10 October 07
2.Bacterial toxin may protect infants from asthma. National Institutes of Health; Medical News Today http://www.medicalnewstoday.com/articles/10416.php accessed 10 October 07
3.Infants who have fevers become children with fewer allergies. National Institute of Allergy and Infectious Diseases; Medical News Today http://www.medicalnewstoday.com/articles/5797.php accessed 12 October 07
4.S.B. Levy: Antibacterial Household Products: Cause for Concern. Emerging Infectious Diseases vol. 7, No. 3 Supplement, June 2001 accessed via PDF 12 October 07
5.Erwin W. Gelfand, MD. The Hygiene Hypothesis Revisited: Pros and Cons from Selected Coverage of the 60th Anniversary Meeting of the American Academy of Allergy, Asthma and Immunology accessed 13 October 07 via Medscape http://www.medscape.com/viewprogram/2318_pnt
6.Study dishes the dirt on hygiene’s role in disease. CBC News www.cbc.ca/health/story 2006/16/rats-hygiene.html accessed 12 October 07
7.The hygiene hypothesis: Are cleaner lifestyles causing more allergies for kids? Science Daily http://www.sciencedaily.com/releases/2007/09/070905174501.htm accessed 12 October 07
8.Edward Willett: The hygiene hypothesis. Online weblog http://www.edwardwillett.com/Columns/hygienehypothesis.htm accessed 12 October 07
9.MRSA in Healthcare Settings, Centers for Disease Control and Prevention www.cdc.gov/ncidod/dhqp/ar_MRSA_spotlight_2006.html accessed 15 October 07
10.Information About MRSA for Healthcare Personnel, Centers for Disease Control and Prevention www.cdc.gov/ncidod/dhqp/ar_mrsa_healthcareFS.html accessed 15 October 07
Methicillin Resistant Staphylococcus aureus or MRSA, along with its counterpart ORSA (Oxacillin Resistant Staphylococcus aureus) have been nosocomial, or hospital acquired infections of concern for quite some time infecting the patient who has undergone an invasive procedure or the long term care patient with a compromised immune system. Hospital and other health care workers can become infected with ORSA/MRSA as a result of the performance of their duties. Health care providers may become infected with ORSA/MRSA by 1) contact with colonized or infected patients, 2) colonized or infected sites of the personnel (clothing or unprotected areas) and, 3) exposure to contaminated surfaces or items such as medical devices, or environmental surfaces. The good news is that practicing standard body substance isolation and good personal hygiene (hand washing) can prevent many of these exposures.
The question remains, however, as to why these diseases continue to flourish in a society rich with countermeasures such as anti-microbial soaps and cleaners. Why do they continue to evolve to resist traditional treatment and migrate to infect otherwise healthy people in the community?
Certain theories propose that cleaner is not always better. One such theory is the Hygiene Hypothesis which began circulation as a theory on the relationship between exposure to viruses and bacteria and the development of a healthy immune system around 1989. The Hygiene Hypothesis proposes that exposure to environments that are less than germ-free as an infant or toddler builds a stronger immune system and reduces the risk of developing disease later in life.
How can this be possible? It seems counterintuitive to claim that a more microbe-free environment is not automatically equated to better health. We can, in fact, look to a simple analogy of the immune system for a better perspective. Let’s compare the immune system to voluntary muscle for a moment. When voluntary muscle is stressed, as in the case of exercise, the muscle becomes stronger; the hygiene hypothesis is merely suggesting the same principle applies to the immune system. The exposure a young, developing immune system to repeated small doses of various virus and bacteria endemic to a given environment can be considered as exercise for the immune system. “That which does not kill us makes us stronger” may be a better name for the hypothesis.
Although debated, several findings suggest that early infection with certain bacteria have reduced the severity of later immune response to allergens in mice.
The Hygiene Hypothesis has been implicated as a factor in the rise of asthma and some community acquired immunologic diseases. Research suggests that our society’s overuse of anti-microbial/anti-biotic materials, such as cleaners and soaps, has caused people to be exposed to fewer diseases during immune system development. Scientists point out that asthma and other diseases linked to the immune system have been on the rise for the last 30-40 years despite exposure to fewer infectious organisms. The thought is that these organisms are a key component in training and creating a healthy immune system. Without early exposure, the developing immune system fails to respond at an appropriate level and may actually overreact to irritants that would otherwise be inconsequential. The result is an increased overreaction of the immune system equating to conditions such as asthma. Other research has indicated that children who are exposed to high levels of the bacterial compound, endotoxin, found in house dust may actually be less likely to develop eczema during their first year of life3. Finding such as this support the hygiene hypothesis by indicating that early exposure to infectious or inflammatory agents cause changes in the immune systems and reducing the risk of developing allergy-related conditions later in life.
The hygiene hypothesis remains unproven but continues to be tested by a variety of researchers. I think my analogy comparing the immune system to the voluntary muscular system make a lot of sense. For an immune system to work property it must be trained and experienced, but if training and experience is lacking, the immune system defaults to “going to war” when all that may be needed is to fire a single shot. Our approach to develop items such as anti-bacterial soaps is not entirely bad…I think the marketing and media hold much of the responsibility for this situation.
References
1.Bacterial Infections Alter Allergic Response; Findings Support Hygiene Hypothesis. Science Daily/national Jewish Medical and Research Center http://www.sciencedaily.com/releases/2003/02030225065721.htm accessed 10 October 2007 accessed 10 October 07
2.Bacterial toxin may protect infants from asthma. National Institutes of Health; Medical News Today http://www.medicalnewstoday.com/articles/10416.php accessed 10 October 07
3.Infants who have fevers become children with fewer allergies. National Institute of Allergy and Infectious Diseases; Medical News Today http://www.medicalnewstoday.com/articles/5797.php accessed 12 October 07
4.S.B. Levy: Antibacterial Household Products: Cause for Concern. Emerging Infectious Diseases vol. 7, No. 3 Supplement, June 2001 accessed via PDF 12 October 07
5.Erwin W. Gelfand, MD. The Hygiene Hypothesis Revisited: Pros and Cons from Selected Coverage of the 60th Anniversary Meeting of the American Academy of Allergy, Asthma and Immunology accessed 13 October 07 via Medscape http://www.medscape.com/viewprogram/2318_pnt
6.Study dishes the dirt on hygiene’s role in disease. CBC News www.cbc.ca/health/story 2006/16/rats-hygiene.html accessed 12 October 07
7.The hygiene hypothesis: Are cleaner lifestyles causing more allergies for kids? Science Daily http://www.sciencedaily.com/releases/2007/09/070905174501.htm accessed 12 October 07
8.Edward Willett: The hygiene hypothesis. Online weblog http://www.edwardwillett.com/Columns/hygienehypothesis.htm accessed 12 October 07
9.MRSA in Healthcare Settings, Centers for Disease Control and Prevention www.cdc.gov/ncidod/dhqp/ar_MRSA_spotlight_2006.html accessed 15 October 07
10.Information About MRSA for Healthcare Personnel, Centers for Disease Control and Prevention www.cdc.gov/ncidod/dhqp/ar_mrsa_healthcareFS.html accessed 15 October 07
September 28, 2007
E. coli:A Cause of Renal Failure and Disseminated Intravascular Coagulation
Rick Russotti, CI/C, EMTP September 2007
rick@mitigationjournal.com
Another outbreak of pathologic Escherichia coli (E. coli) O157:H7 has emerged in the United States as a result of contaminated hamburger meat. Contaminated meat and meat products are the major cause of food-borne E. coli infection. Other routes of infection include contaminated water, non-pasteurized milk and juice, and some raw lettuce/vegetables. Although food- and water-borne vectors may account for many E. coli infections, transmission of the bacteria can occur by person-to-person contact.
E. coli O157:H7 was discovered in the human colon in 1885 by German bacteriologist Dr. Theodor Escherich and identified as a disease causing agent, or pathogen, as a result of an outbreak of gastrointestinal illness in 1982. E. coli is a bacterium that lives in the intestine of healthy cattle and has been found in the intestines of healthy chickens, deer, sheep, and pigs. Because these animals lack the specific protein receptors for the disease, they do not get sick but are reservoirs for the bacteria. The O157:H7 indicates the subspecies of the E. coli bacteria; the O157 designates the specific carbohydrate and the H7 identifies the flagella protein. Although hundreds of variations of E. coli exist, the O157:H7 strain is different and belongs to a class of pathologic E. coli known as enterohemorrhagic Escherichia coli or EHEC. This
strain of E. coli has the ability to produce a toxin; Verocytoxin E. coli (VTEC) or Shiga-like toxin (STEC). These toxins are known to cause severe complications from E. coli infection.
As previously noted, infection with E. coli can occur from eating undercooked contaminated meat, ingesting contaminated water or un-pasteurized beverages, contact with contaminated surfaces, or person to person contact. Contaminated meat looks and smells perfectly normal and the number of microbes needed to cause infection is very small. Transmission of the disease can occur from eating produce exposed to contaminated run-off or irrigation. Contamination of irrigation and soil can occur from infected manure being spread as fertilizer. As the bacteria can penetrate plant material; crops, even those not normally considered as a reservoir for E. coli, can harbor the bacteria and cause infection. Person-to-person contact among family members, close contact work environment, and child care centers can be difficult to manage. Bacteria found in the loose stool of a person infected with E. coli can be passed via the fecal/oral route if hygiene is lacking. Hand washing is of particular importance in the prevention of contamination and infection from the fecal/oral route.
Signs and symptoms of E. coli range from mild to severe and most often include brutal bloody diarrhea and abdominal cramps, with or without fever. Symptoms often resolve within ten-days and require little medical treatment. Oral and intravenous fluid replacement can be helpful, but antidiarrheal agents and antibiotics should be avoided. According to the Centers for Disease Control, antibiotics may actually precipitate renal complications. Deaths from E. coli occur annually in the United States and are caused by complications of the toxins (VTEC/STEC). These toxins are responsible for a condition known as Hemolytic Uremic Syndrome or HUS with approximately 2% to 7% of E. coli infections progressing with this complication. Hemolytic Uremic Syndrome (HUS) causes several life-threatening conditions including Acute Renal Failure (ARF) and Disseminated Intravascular Coagulation (DIC). Acute Renal Failure and Disseminated Intravascular Coagulation impact long-term health and recovery of E. coli patients. HUS causes 61 deaths annually (about 2-7% of E. coli patients) and another 8% go on to suffer complications of ARF such as high blood pressure, seizure, blindness and paralysis. ARF is diagnosed on the basis of increased blood urea nitrogen (BUN) and can be further classified as oliguric (urine output<400ml/24h)>
rick@mitigationjournal.com
Another outbreak of pathologic Escherichia coli (E. coli) O157:H7 has emerged in the United States as a result of contaminated hamburger meat. Contaminated meat and meat products are the major cause of food-borne E. coli infection. Other routes of infection include contaminated water, non-pasteurized milk and juice, and some raw lettuce/vegetables. Although food- and water-borne vectors may account for many E. coli infections, transmission of the bacteria can occur by person-to-person contact.
E. coli O157:H7 was discovered in the human colon in 1885 by German bacteriologist Dr. Theodor Escherich and identified as a disease causing agent, or pathogen, as a result of an outbreak of gastrointestinal illness in 1982. E. coli is a bacterium that lives in the intestine of healthy cattle and has been found in the intestines of healthy chickens, deer, sheep, and pigs. Because these animals lack the specific protein receptors for the disease, they do not get sick but are reservoirs for the bacteria. The O157:H7 indicates the subspecies of the E. coli bacteria; the O157 designates the specific carbohydrate and the H7 identifies the flagella protein. Although hundreds of variations of E. coli exist, the O157:H7 strain is different and belongs to a class of pathologic E. coli known as enterohemorrhagic Escherichia coli or EHEC. This
strain of E. coli has the ability to produce a toxin; Verocytoxin E. coli (VTEC) or Shiga-like toxin (STEC). These toxins are known to cause severe complications from E. coli infection.As previously noted, infection with E. coli can occur from eating undercooked contaminated meat, ingesting contaminated water or un-pasteurized beverages, contact with contaminated surfaces, or person to person contact. Contaminated meat looks and smells perfectly normal and the number of microbes needed to cause infection is very small. Transmission of the disease can occur from eating produce exposed to contaminated run-off or irrigation. Contamination of irrigation and soil can occur from infected manure being spread as fertilizer. As the bacteria can penetrate plant material; crops, even those not normally considered as a reservoir for E. coli, can harbor the bacteria and cause infection. Person-to-person contact among family members, close contact work environment, and child care centers can be difficult to manage. Bacteria found in the loose stool of a person infected with E. coli can be passed via the fecal/oral route if hygiene is lacking. Hand washing is of particular importance in the prevention of contamination and infection from the fecal/oral route.
Signs and symptoms of E. coli range from mild to severe and most often include brutal bloody diarrhea and abdominal cramps, with or without fever. Symptoms often resolve within ten-days and require little medical treatment. Oral and intravenous fluid replacement can be helpful, but antidiarrheal agents and antibiotics should be avoided. According to the Centers for Disease Control, antibiotics may actually precipitate renal complications. Deaths from E. coli occur annually in the United States and are caused by complications of the toxins (VTEC/STEC). These toxins are responsible for a condition known as Hemolytic Uremic Syndrome or HUS with approximately 2% to 7% of E. coli infections progressing with this complication. Hemolytic Uremic Syndrome (HUS) causes several life-threatening conditions including Acute Renal Failure (ARF) and Disseminated Intravascular Coagulation (DIC). Acute Renal Failure and Disseminated Intravascular Coagulation impact long-term health and recovery of E. coli patients. HUS causes 61 deaths annually (about 2-7% of E. coli patients) and another 8% go on to suffer complications of ARF such as high blood pressure, seizure, blindness and paralysis. ARF is diagnosed on the basis of increased blood urea nitrogen (BUN) and can be further classified as oliguric (urine output<400ml/24h)>
The development of DIC is more ominous. DIC is a condition of blood coagulation throughout the entire body. E. coli, sepsis, and viral hemorrhagic fevers are infectious causes of DIC. Other medical causes include amniotic emboli, eclampsia and Abrutio Plancentae; with burn trauma and profound decompensated shock states as traumatic causes. DIC can also be caused by some species of venomous snakes. Complications of renal failure and DIC are most often associated with patients in extremes of age; particularly children under five-years of age and the elderly. Increased potential of renal failure and DIC in the patient with a compromised immune system is not clear. Treatment for these conditions in the pre-hospital setting is to support the ABC’s and initiate intravenous fluid replacement per local protocol and medical direction.
There are a number of steps that can be taken to prevent E. coli infection. Since cattle intestine is the major source of the bacteria, strict adherence to regulations for the slaughter and processing of meat may decrease the contamination of meat products. Manure is another source of E. coli O157:H7 and can contaminate the environment, including ground and irrigation water. Containment and prevention of infection at the source, during processing and packaging, is key to abatement of outbreaks. There are numerous actions that can be taken to prevent infection and spread of E. coli; cooking all meat products thoroughly, proper storage of meat products, washing fruits and vegetables, consuming pasteurized milk, ciders, and juices, and by avoiding swallowing of pool water or lake water while swimming. For those engaged in patient care in the pre-hospital setting the most important preventative strategy is the easiest to employ: simple hand washing with soap and water and good hygiene practice coupled with body substance isolation and infection control practices. Each agency is required to have and implement an infection control plan. These plans are required to address agency-specific policy regarding body substance isolation and exposure incidents, reporting requirements, post exposure prophylaxis and treatment. The foundation of any infection control program and plan is based on training, management/employee buy-in, and prevention.
Situational awareness and education are the best defense against the spread of diseases like E. coli. Pre hospital care providers at all levels must arm themselves with the information needed to make good clinical decisions for their patients and good protective choices for themselves.
Recommended Reading:
Escherichia coli O157:H7; Wikipedia
http://en.wikipedia.org/Escheridhia_coli_O157:H7 accessed 27 September 2007
E. coli O157:H7 - Escherichia coli O157:H7; about.com
http://www.about-ecoli.com/ accessed 16 September 2007
Escherichia coli O157:H7, General Information; CDC Bacterial, Mycotic Diseases
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/escherichiacoli_g.htm accessed 16 September 2007
E. coli Questions and Answers; CDC
http://www.cdc.gov/ecoli/qa_ecoli_sickness.htm%20accessed%2020%20September%202007
E. coli Outbreak from Fresh Spinach, October 12, 2006; CDC
http://www.cdc.gov/ecoli/2006/september/qa.htm accessed 21 September 2007
For a copy of this and other articles, and the weekly All-Hazards podcast, visit Mitigation Journal website at http://www.mitigationjournal.com/.
Escherichia coli O157:H7; Wikipedia
http://en.wikipedia.org/Escheridhia_coli_O157:H7 accessed 27 September 2007
E. coli O157:H7 - Escherichia coli O157:H7; about.com
http://www.about-ecoli.com/ accessed 16 September 2007
Escherichia coli O157:H7, General Information; CDC Bacterial, Mycotic Diseases
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/escherichiacoli_g.htm accessed 16 September 2007
E. coli Questions and Answers; CDC
http://www.cdc.gov/ecoli/qa_ecoli_sickness.htm%20accessed%2020%20September%202007
E. coli Outbreak from Fresh Spinach, October 12, 2006; CDC
http://www.cdc.gov/ecoli/2006/september/qa.htm accessed 21 September 2007
For a copy of this and other articles, and the weekly All-Hazards podcast, visit Mitigation Journal website at http://www.mitigationjournal.com/.
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