Less Sleep, More Colds

A recent study has me thinking. One of my changes for 2009 (not resolution, mind you...just a change) is to add more sleep. That is more sleep each night and more each week. A number of studies have looked at the effects and the toll of lack of sleep. It seems that from cardiovascular to immunologic systems are among the two at most risk. See Sleep Habits and Susceptibility to the Common Cold as published in The Archives of Internal Medicine.

Here is a summary of findings...

• The less a person slept, the more likely he or she was to develop a cold (there was a graded association between infection rate and average sleep duration).


• Participants who slept fewer than 7 hours were 2.94 times more likely to develop a cold than those who had 8 hours or more sleep.


• The more efficiently a person slept (more of the time in bed actually spent asleep), the less likely he or she was to develop a cold (i.e. there was also a graded association between sleep efficiency and rate of infection).


• Participants whose sleep efficiency feel below 92 per cent were 5.50 times more likely to develop a cold than those whose efficiency was 98 per cent or more.


• Feeling rested was not linked to rate of infection.


• These relationships could not be explained by the potential counfounders such as levels of virus-specific antibodies beforehand, demographics, the season of the year, body mass index, socioeconomic status, health behaviours, and psychological variables.

Iron Safety a Hot Topic in Rochester

The University or Rochester and the Rochester Fire Department have teamed up to help prevent burn injuries. A recent article in the Rochester Democrat and Chronicle highlights the efforts between the two agencies to develop a safety campaign to prevent these burn injuries. They are working on two solutions; first an educational brochure to be given to new mothers at the U of R and, second, a physical device to hold the iron flat and protect the sides.

The need for this type of information and protective device are evident based on the stats given by the U of R:

"...Between 2003 and 2007, the Strong Memorial Hospital Regional Burn Center treated 212 children younger than 5 for contact burns. While wood-burning stoves were the most common source, hot clothing irons burned 29 patients."

"Toddlers suffer second- or third-degree burns when they touch a hot iron or knock it onto their hands or face. Some of those burns require skin grafts, a five-day hospital stay and a month of recovery."

Check it out here.

Thoughts on extreme cold weather

Random Thoughts on extreme cold weather...

"evaluate every trauma patient for hypothermia and every hypothermia patient for trauma"

"life safety, incident stabilization, property conservation"

"confine it to the Zip Code of origin and keep it off CNN"

Extreme low temps and brutal wind chill expected here in next 24 hours due to last through the weekend...high temps predicted to be between 2 and 5 above with sustained 25MPH winds. That means wind chills well below zero.

Even small events take more resources and protection of responders can be difficult. Don't forget Emergency Scene Rehab for cold situations (as important as during hot weather) and often forgotten.

Pumps can freeze, lines freeze turn into iron pipes, and the fire scene can turn into an MCI of responders.

"if there is snow on the roof...it can't be too hot inside"

MVC's on highways can become impossible blizzards...think rapid extrication...minor injuries and illnesses will deteriorate quickly.

Retail Health Clinics and Recession

We've talked quite a bit about the potentials of Retail Health Care Clinics on this blog and on the Mitigation Journal podcast. A retail health clinic is a clinic operated and located within a retail store such as Wal-Mart. These walk-in style clinics can be found in other areas like airports as well. Often, these privately operated clinics run within a profit margin and cater to those without health insurance.

Walk-in and retail health clinics are attractive because they are time and cost-effective. There have been questions of quality raised by medical associations in the last year, but no official complaints or awareness of errors have been noted. The trend throughout 2008 has been for these clinics to open and remain stable. That is stable until the shopping season tanked.

This article from Reuters talks about the possibilities of failure and impact on the economy when "big-box" stores decline due to economy and/or recession.

And Here We Are...2009

I've been anticipating this second, this day, this year for quite some time. There is a number of reasons, personal and professional for my focus on this year. If you don't know what I'm talking about; you will...as long as you continue to follow MJ podcast and blog.

Without any resolutions for the year; I've been deciding how to make a few changes in life and activity. How will I do business, how will I conduct myself, how will I simply do all that I do just a little different...all questions that I'll continue to review throughout the year.

I hope you'll similar steps in your life. That is, any steps you take in 2009, may they lead you to where you want to be!

Best wishes for a happy and safe 2009.
Rick

NY Website looks at Hospital Quality

You've got to see this website hosted by the NYS Department of Health. Interesting data on hospital quality and comparative data. Although there is no data pertaining to preparedness activity, the site explains the quality points that we as a community should be looking at.

Prevention Quality Indicators is a great site to consider.

NIMS: By any other name

Just when you thought it was safe to respond to an emergency, DHS has announced NIMS refit and updates in a recent press release. So, now that you've competed all those on-line annoying classes and taken all those ICS classes, you're ready to respond and manage disaster events! Maybe not. We'll have to wait and see, but I'll bet we'll all be sitting and/or tabbing through a series of "new and improved" NIMS classes. As if we don't have anything else to do.

Anyway, according to the press release...

"...NIMS expands on the original version released in March 2004 by clarifying existing NIMS concepts, better incorporating preparedness and planning and improving the overall readability of the document. The revised document also differentiates between the purposes of NIMS and the National Response Framework (NRF) by identifying how NIMS provides the action template for the management of incidents, while the NRF provides the policy structure and mechanisms for national-level policy for incident management."

and...

"...The basic tenets of NIMS remain the same. There have been several improvements to the revised NIMS document which will aid in readability and usefulness of preparing, preventing, and responding to incidents. For example, the revised document places greater emphasis on the role of preparedness and has reorganized its components to mirror the progression of an incident. Recognizing the importance of private sector partners and NGOs in incident response, FEMA has ensured that those entities have been more fully integrated throughout NIMS. The new document is consistent with the NRF, and together they provide a single, comprehensive approach to incident management."

Get the new NIMS document here and make sure you tune into Mitigation Journal: The All Hazards Podcast. We'll be reviewing this in detail on shows in the very near future.

Elders and Pharm - A Must Read

This article from CNN is a must read for every emergency responder. We've been talking about the dangerous combination of prescription medication and over-the-counter supplements in classes for quite some time. The growth of supplement use among all age ranges in the Untied States has been increasing steadily since the 1980's.

"...One in 25 people in the study, or about 2.2 million people, were taking a potentially risky combination of medications. That number jumped to one in 10 among men who were 75 to 85 years old."

With particular attention to the elder population, we have to be aware that; as the number of prescription medication rises, so will the chance of an adverse medication reaction. Adverse medication reactions account for thousands of hospital admissions and requests for emergency medical service. In many cases, traditional pre-hospital education is lacking in the area of medication awareness and getting a medication profile. Responders must take into account patient medication and potential interactions with OTC supplements as a contributing factor.

Tune in to my podcast, Mitigation Journal: The All-Hazards Podcast, we'll be talking more about this issue in the near future.

Need Triage Training...turn on the Wii

Check out this article in Government Technology - (http://www.govtech.com/gt/articles/565977?utm_source=rss&utm_medium=link) just in time for the holidays, too. You can hone your triage skills with a video game!

I'm not sure that this training will ever replace live, functional exercises, but it may help keep skills up between trainings and drills. Still, the best way to learn triage skills is with live, dynamic participants and role-play of victims in scenario based training. I know that is a lot to ask...but it is the best way to learn.

Anniversary and Goals

Goals are good things to review this time of year. And as this year of 2008 comes to an end I am reviewing the intent and goals of Mitigation Journal. Both the blog and the podcast have seen an explosion of readers/listeners. Mitigation Journal The All Hazards Podcast continues to be ranked in the top 3 on iTunes in the Local organizations and government category. I'm simply humbled by the response from the community and the number of people who I've come to rely on to get this stuff done.

I almost forgot to mention this topic, but as the calendar is down to just one page, I thought it would be nice. The blog has been going for three-years (since November 2005) with over 140 posts and several feature articles, and the podcast has just turned two-years old with 92 weekly editions, numerous in-service training sessions...and thousands of listeners.

So a simple "thank you" is in order to everyone who has helped make this effort worth it. We'll be moving in several new directions for 2009 and I'll be looking forward to your continued support!

Please contact me with your insight, thoughts and comments. If you have an idea about what you'd like to hear, read, or see us do in 2009, I'd love to hear from you! You can reach me at anytime by email mitigationjournal@gmail.com, calling our voice mail line at 585-672-7844.
I'll be posting our Year in Review segment here and on the podcast shortly after 1/1/2009. Please join us!

As It Happens - Plane Crash

I'd like to direct everyone over to Eric Holdemans blog; Disaster Zone. Besides the fact that I follow his blog closely, there is a wealth of insight posted there. Eric was kind enough to speak with me on Mitigation Journal a few weeks back on the topic of technology in disasters (see www.mitigationjournal.libsyn.com #86). One of the items we discussed was the use of social networking sites, YouTube, and services like Twitter; the ability to get real-time data from forward observers (those actually at the incident site).

A recent posting on Disaster Zone highlights this potential...and Eric puts the topic in focus.
(http://www.disaster-zone.com/2008/12/continental-passenger-twittering.html) A passenger on board the plane that skidded off the runway recently. Here is the direct link to the Twitter page from this passenger.

Holiday Gift Cards

They are better than a tie...a gift card for health care! Check out the story from a Rochester, NY news station

I think this is a great idea and may go hand-in-hand with the use of retail health care clinics. Keep an eye on this one.

I've also talked about this on Mitigation Journal podcast #92

Check out this link to Ready Illinois. They have a guide published "Emergency Preparedness Tips for those with Functional Needs".

I'll be reading it later this week and I've added it to my shared items under Emergency Service News in the sidebar. Let me know what you think.

Stretching Vaccine Supply

Stretching Vaccine Supply is an important issue for those involved with pandemic planning. The supply of anti-viral agents, both oral and injected, is a major issue among planners at all levels. In fact, the limits of anti-viral agents have pushed the need for non-pharmacological interventions such as face masks or other protective clothing.

Here is a story from MSNBC outlining the results of a recent study suggesting that flu vaccine given at half-strength can be effective.

Let's not get carried away...this is not an indication that we have all the vaccine we could need, nor should we abandon our non-pharm efforts. The fact still remains that, while this vaccine may be effective at half strengths levels, we still need to match the H's and N's of the circulating strain. Additionally, we will continue to contend with all the logistical issues of ineluctable and oral anti-viral agents.

Keeping pets safe from holiday hazards

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.

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.

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.

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.

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

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:

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.

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.

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

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.

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!