MJ192: Uniforms/ID Complacency, 'Fun-Size' Terrorism, EMS Readiness, and No Pay, No Spray

This week on Mitigation Journal podcast we discuss a number of important emergency service related topics. We were a little late in getting the podcast episode posted this week due to illness, but we got it up and running and ready for you. As you read this post glance over to the right sidebar   and you'll notice that we have placed a podcast player there… now you can listen to Mitigation Journal podcast directly from our blog page.

Leading off the podcast this week is a short discussion about an incident that took place in the Philadelphia airport. It seems someone got a hold of a US air ground crew uniform and was able to get onto the airport property and actually assist other employees loading baggage on an aircraft. The aircraft was backed away from the gate and eventually evacuated after the two employees reported the stranger in uniform helping him load the baggage. This issue highlights the debate on what should be done to secure old uniforms and turnout gear.

Next we discussed this most unfortunate situation coming to us from Tennessee where a subscription fire service had a delayed response to a structure fire. Because the homeowner had not paid the $75 subscription fee the fire department would not extinguish the blaze in his house.  The house, their possessions, and their pets were all lost in the fire. This situation raises the issues as to whether or not subscription fire service would be able to manage large-scale events.

We'll also talk about first responder preparedness… we always talk about first responder preparedness. This time we'll take a look at a study done by Meridian Medical Technologies that notes an overwhelming majority of “first responders” don't feel the receiving the training they need for chemical biological and radiological events.

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FBI Caught Tracking Student

FBI trades black helicopters for GPS and gets caught by the trackee.

Imagine going in for an oil change and finding a GPS tracking device stuck to your engine. That's exactly what happened to a college student from Santa Clara, Calif. After finding the device, the student called the FBI...and the FBI had the nerve to actually ask him to give the device back! Offering no explanation for the tracking (the device or the action), the FBI simply hid behind the "on-going investigation" line.

The device was identified as Cobham Orion Guardian ST820 tracking system. Supposedly, this is a low-enforcement only device. According to MSNBC.com this kid had no idea the thing was there or why. The story was originally printed in Wired.com. Makes me want to look under my car.

What are the implications here? Food for thought and discussion. Your comments on this are welcome.

HHS to Support Community Health Centers

Over $727 million going to support community health centers.

The U.S. Department of Health and Human Services (HHS) has announced that over $727 million will be distributed to 143 community health centers for upgrades and new construction (text here). According to HHS, the money will come from the Affordable Care Act and go to community health centers serve nearly 19 million patients in the U.S., about 40 percent of whom have no health insurance.

This is a fantastic idea that will have a positive impact in each targeted community. I've long held the position that if more attention were paid to community health needs, we may not need sweeping health care reform.  Many of the under- or uninsured suffer from a variety of health problems and lack access to affordable, quality health care. Not only are the undeserved populations at increased risk of disease, they are at greater risk for complications related to lack of treatment and insufficient knowledge. The cost of diabetes and heart disease is staggering. The cost of complications and long-term care is staggering. This initiative will bring that care to the population. 

Want to run a good rehab operation? Start with this list.

Must do list for effective rehab… here's a few things you have to do in order to run an effective emergency incident rehabilitation. This is a good start, but just a start.

• Understand the requirements of the National Fire Protection Association standard 1984 on emergency incident rehabilitation. In order to provide emergency incident rehabilitation services, you must have an understanding of what the requirements are. NFPA 1984 outlines the requirements and actions that must be taken to effectively conduct rehabilitation functions. Every responder should be familiar with this document. Every EMS agency that provides rehab services must not only be familiar with the document but be able to apply the procedures on the scene of an incident.

• Operate autonomously at the scene of an incident. EMS responders must be able to operate without having their hands held while conducting rehab operations. The most effective rehab will operate within the established incident command system and will be able to carry out their assignment with little or no supervision.

• Make decisions based on assessment data.  The biggest hold-back to participating in rehabilitation functions is history. EMS has to go beyond the outdated vision of some EMT chasing a firefighter down the street with a blood pressure cuff. Firefighters have to recognize that they will be returned to duty as long as no abnormalities are found during assessment. Decisions to treat and transport can only be made after assessment. Your assessment has got to include an understanding of the environment the responder was working in as well as baseline vital signs. Noninvasive monitoring of end tidal carbon dioxide, carbon monoxide, impulse oximetry are vital… all EMS providers should understand what these values do and do not indicate.

• Understand the response priorities of the fire service you're working with. The best way to run an effective emergency incident rehabilitation station is to understand the needs of those who are serving. An understanding of standard operating procedure in general tactics and strategy will put you ahead of your colleagues when operating on the fire ground.

 Got a suggestion on how to implement Emergency Incident Rehabilitation? I'd love to hear from you send your thoughts to mitigationjournal@Gmail.com or call the voice mail line 585–672–7844. You can also leave your comments here on this blog.

American Heart Month

October is American Heart Month and is support of this effort, here are a few heart healthy tips from the American Heart Association:

• Combine physical activity and social fun by encouraging everyone in the household – kids and adults – to enjoy active-play video games together. 

• No time for exercise? Break up your activity into 10-15 minute bouts.

• If your favorite sports include seasonal activities such as tennis or skiing, you may spend months waiting for the right weather to arrive. Consider how active-play video games based on seasonal sports can provide a fun, physically active supplement to your activities all year round.

• Take the stairs instead of the elevator.

• Typical dinner parties can be nice, but isn’t it always more fun to surprise and entertain guests with something out of the ordinary? Next time you’re hosting a social gathering, turn it into an active-play video game night that gets your friends on their feet and having a blast.

• Choose a parking spot farther away than usual, and take some extra steps.

• If rain or snow prevents you from enjoying outdoor activities, host an active-play video game tournament in your living room. Challenge family members, neighbors or friends to step up and vie for the best scores. The friendly competition might inject some extra fun into your experience.

Evacuate This!

Evacuate this! So, you want to evacuate your hospital now?

It seems like evacuating hospitals has become all the rage in healthcare preparedness recently. While I think understanding how and when to evacuate your hospital is an important part of healthcare preparedness, evacuating a hospital should not be taken lightly. Among the many factors to consider the simplest is often the most overlooked… and that is, the traffic.

You see, any event that would be big enough to cause you to evacuate your hospital would probably have an impact on the surrounding community as well. What will you do when it's not only your hospital evacuated but the entire community or county or city that you live in trying to evacuate?

This traffic pattern concern became upfront and personal with me just the other day on my way home from school. One single traffic accident 10 miles away from where I was snarled traffic on the major expressways and alternate routes.  Again, this was one simple traffic accident… no hazardous materials, no terrorist attack, no helicopter crash. Just a simple multi-car pileup during rush hour. The injuries thankfully, were not severe either.

In just a few minutes every feeder to the expressway was congested with overflow traffic. The expressway itself Route 390 N. was bumper-to-bumper for almost 10 miles. Can you imagine trying to get vehicles in and out of your hospital during that type of traffic snarl?  What happens when you begin an evacuation only to find the roads are no longer clear? Moving patients from hospital to hospital without a designated clear route of evacuation is dangerous. There is substantial risk of having patients become caught in traffic tie ups or other situations that obstruct roadway travel.

These issues must be understood in the risks calculated before any evacuation of the healthcare facility takes place.

From here to there.

  From here to there… in one career.

You go from EMS to disaster and emergency management? That's become a question I have heard often. I received e-mails over the years asking me how I made the switch from being a paramedic to diving into disaster and emergency management. While I still practice as a paramedic, I enjoy the research and planning that goes into emergency preparedness and disaster management.

So, here's a short review on a few things that helped shape my career. Remember, you asked.

I was not influenced by the television show emergency. If there were any television influences in my career it was M*A*S*H and Planet of the Apes.
The TV series M*A*S*H always interested me. Here were group of people working under the most difficult conditions with limited supplies and seemingly no support… yet they got the job done despite the challenges. That television show showed me that it was okay to deal with stress and care about what you do. The series M*A*S*H also highlighted that the job was not always glamorous. The TV show emergency, while focused on the fire department, seemed to portray that the job of a firefighter or paramedic was challenging yet dramatic and glamorous. Even as a teenager that portrayal didn't sit well with me as being realistic. The rest of my EMS career hinged on training under some very good EMTs and paramedics who never stopped making a positive impact on how I did the job. The people who trained me had the fortitude to demand perfection and correct bad behavior. Sometimes it seems like that's a quality in short supply today.

As far as emergency and disaster management goes, that's another story. As a young firefighter and paramedic I noticed a lack of training preparing us for dealing with large-scale events. Doing some self study on the topic of mass casualty incident management and large-scale events but there was a lot of material available at that time. Then, on October 19, 1989 we were stunned to see the results of the Loma Prieta earthquake displayed in the mainstream media. Seen by many as the rebirth of urban search and rescue, this one event on the other side of the country changed the way I looked at large-scale events. The scenes coming out of California on the nightly news reminded me of the old TV series and movies called Planet of the Apes. You know the ones, that would show various scenes of a city in ruins after some type of holocaust. I was so taken by the efforts of the responders of all disciplines during that earthquake that I decided to dedicate a major portion of my career to improving response to large scale events and studying emergency management and disaster preparedness.

Mitigation Journal the dictator

 Mitigation Journal the dictator… speech recognition software improves my blogging!

Do ever get tired of typing on your blog? Sometimes I have so many ideas floating in my head it seems I can't type fast enough to get them out. So I often sit and make dozens of notes on various pieces of paper and sticky pads only to lose them or forget what they're about… cause the loss of so many good ideas rather than the creation of outstanding blog posts. All because I don't feel like sitting down to type.
What's changing now. I've gone out on a limb and decided to try a speech recognition software again. I had a speech recognition program on my old PC a few years ago and could never get it to work right, it was very frustrating it seemed like a waste of money and time.

Recently, after being fed up with typing, I decided to look into speech recognition software for my iMac. What I found was Mac speech dictate software. Albeit a bit skeptical, I decided to give it a try in a vice of the salesperson at the local Apple store purchased MacSpeech Dictate for my iMac. Within minutes of installing the software I was able to talk into the microphone and the software recognized my voice so accurately it was instantly a success. In fact I am “typing” this blog post now through the headset that came with my MacSpeech Dictate software.

So big tip of the helmet to the folks at the local Apple store here in Rochester New York and recommending this piece of software. Not only will it improve my blogging but my spelling as well!

MJ# 191: Smallpox Stay of Execution, Sharing Health Care EM Plans, Flu Vaccine, Mandate or Not?

First things first, we had a major problem with the Mitigation Journal podcast feed at the end of September. Because of the popularity of the podcast we exceeded our file size and were not able to update iTunes. All that's been corrected now and were back on track. You may notice that a number of old files in the feed have been removed or are no longer accessible via iTunes.

This week on Mitigation Journal edition #191 Matt and I discuss several important topics. First off, we'll talk about smallpox and the need or not to keep smallpox virus housed in laboratories for experiments.  Should smallpox get a stay of execution? This topic is generated quite a stir in the emergency management and public health community. Tune in to hear Matt and I have to say.

Also this week, we'll talk about the need to share emergency plans between healthcare organizations. It's unbelievable to me that hospitals and healthcare organizations would not be sharing their emergency plans. But that seems to be the case. No one organization will be able to manage a large-scale public health crisis or natural disaster without integrating their emergency management plans with other healthcare organizations and hospitals. In this segment, Matt and I overview why healthcare system emergency management planning is so important. We also throw in a little bit of commentary on the topic.

And finally this week, were back to the old debate “should seasonal flu vaccine be mandated”  for healthcare workers? We also dive into another controversy that's brewing and that is; who are we listening to… the CDC or other expert organizations?

Don't forget to check out the Mitigation Journal app for the iPhone and iPod touch. The Mitigation Journal app is only $1.99 with portions of the proceeds going to support the podcast and blog. If an “app” is not your thing, you can support Mitigation Journal by visiting the blog and making a donation there. Every little bit helps and we appreciate your support.

Why would hand foot and mouth disease stop air travel?

 Why would hand - foot and mouth disease stop air travel? Because it looks bad, like something else.

 I'm preempting a couple of other blog posts to talk about why and four in mouth disease in a child on board an aircraft caused a bit of a panic in Colorado. According to CNN, a plane arriving in Colorado from Mexico was held at the gate because there was a sick child on board. Travelers became concerned when they were asked to de-board the plane using stairs rather than the jetway ramp.

Hand, Foot and Mouth

The child appeared to have a rash on the hands the feet and around the mouth prompting health evaluation and eventual transport to a hospital by paramedics. So, why would a child with a simple viral infection of hand, foot and mouth disease caused such a stir? Hand - foot and mouth disease is a common viral illness among infants and children causing a fever and little blister like eruptions in the mouth, hands and feet… this pattern of eruption is known as a centrifugal pattern. Remember that, centrifugal pattern. Usually this disease is self-limiting although painful and uncomfortable. One of the worst side effects from this disease is viral meningitis. It is transmitted from person to person by direct contact with a person who has hand, foot and mouth disease.

So, again, why did this cause such a stir? Well I can only speculate that when the symptoms in the presentation of this 23 month old child were relayed to health officials someone recognized a centrifugal pattern of lesion development. Can you guess what other viral disease develops innocent critical pattern? If you answered smallpox, you would be correct. I suspect that when someone recognize the symptoms of fever, rash and blisters on the hands feet and mouth they also suspected smallpox.

Smallpox Eruptions on Hand

It's very important to understand how deadly smallpox is in is equally important to remember that there are other diseases that can mimic the presentation. The actions by the airline and by public health officials I believe in this case were justified and appropriate. If I'm correct in my assumptions, this would indicate someone in public health was awake and alert when this case came in.

Read the CNN story here

Smallpox gets stay of execution.

 Smallpox gets stay of execution. But should it?

Smallpox is been removed from the environment for almost 30 years now. Today however, smallpox is still making the headlines. This time it's all about the smallpox stores we keep as pets in our laboratories. Apparently since marking 30 years since smallpox was eradicated from nature the World Health Organization set deadlines for destruction of stores a smallpox virus around the world. June 30, 2010 was the latest deadline to come and go. The execution date for smallpox virus stores started way back in 2006. Another date was set in 2007 and ultimately 2010… and now has been due for until 2011.

At the center of the concern for smallpox that virus stores is security. Security not only in the United States at the Centers for Disease Control and Prevention but in the former Soviet Union as well.

Is it prudent to continue to keep smallpox virus stores on hand? So much research has already been done on this virus but one has to question what further use it could be. Is it solely to produce vaccine should smallpox reemerge in nature?

One concern I have is the lack of general knowledge about smallpox amongst emergency responders. Nearly every class I teach I asked the responders: “where do we see smallpox today?” Most of the time people answer they see smallpox cases and some Third World country when in fact smallpox as mentioned, has been removed from our environment completely. This lack of knowledge leads to increased concern about the virus continuing to live in labs. Smallpox is in fact one of the most dangerous diseases we could face in the event of a biological attack. We haven't vaccinated anyone in the United States against smallpox since 1980. And those who were vaccinated prior to that have questionable immunity to the virus.

These two factors alone underscore the need to destroy this virus.

Release the App - Mitigation Journal Podcast App Available

Release the App...the Mitigation Journal App, that is!

Mitigation Journal now has an app for iPod and iPhone that will allow users access to several content updates. As a Mitigation Journal app user you'll get the weekly Mitigation Journal episodes on an early release schedule...that is, before they hit the main feed. Also, as an app user, you'll get access to two new Mitigation Journal products available exclusively for the app.

You'll get the Lessons Learned segment - a weekly review of emergencies and disasters from around the world...past disasters and current events will be highlighted. You'll want to listen to Lessons Learned to keep pace with the challenges we face today.

As a Mitigation Journal app user, you'll also receive my weekly Situation Update; a weekly review of major events in the realm of fire, EMS, emergency management, and hospital preparedness.

One new app - three great podcasts - Mitigation Journal, Lessons Learned, and Situation Update - all for a one -time purchase of $1.99. Your purchase will supply you with a tremendous volume of relevant content for any responder - and you'll be supporting one of the most popular emergency service/domestic preparedness podcasts on the Internet.


Follow the link to the iTunes app store and get your Mitigation Journal app now for just $1.99.
Link to iTunes app store http://itunes.apple.com/us/app/mitigation-journal-podcast/id389383669?mt=8

Review of Informed Publishing RN pocket guide

Review of Informed Publishing RN pocket guide... a great guide for student and practitioner.

I was recently asked by my friends Informed Publishing to review their nursing pocket guide hard copy  and  mobile application.  I've been continually impressed by the publications from informed in the quality of their mobile applications. Having used a number of their guides and applications over the last few years I've come to expect a pretty high standard. So, while reviewing the RN pocket guide, informed had some pretty high standards to live up to.

As far as overall content is concerned, I found the RN pocket guide to be relevant for the student nurse. This guide met all my standards and needs as a concise reference. The cardiac section was the most useful I found that the cardiac section translated very well into electronic format. The respiratory section was also very useful and the expanded graphics allowed you to increase the size and to get a full page view. The graphics both in hard copy and the mobile application are a major bonus. The mobile application is searchable in several different ways with functions for “touch to expand” and “continue reading” making for a smooth user interface.

Again the graphics in the design of both the application in the hard copy are in pocket guide were superior to other products that look that and the fact that you could explode the graphics to full page size makes visual scanning much easier.

The mobile application for the RN pocket guide by informed publishing has a few extras as well. One in particular that I'd like to talk about is the note function. The note function allows you to type in your own notes related to a specific subject and save those notes. Another important extra of this application is the fact that it automatically updates without any need for registration or continual connection. The application continually updates itself whenever there is an Internet connection.

Find the RN pocket guide here or go to iTunes by clicking here for the mobile application.

Sometimes what you read scares the crap out of you.

Sometimes you should believe what you read. Sometimes what you read scares the crap out of you.

I published a blog post way back in August, 2006, entitled Homemade Chemical Bombs: A Legitimate Threat to Responders. I've gotten numerous notes of praise for writing and talking (on the podcast) about chemical bombs. The topic has evolved into one of my most requested talks; Consumer-Level HazMat Events.

I recently received this anonymous comment in reply to Homemade Chemical Bombs: A Legitimate Threat to Responders that I think you should read. Below is the text of that comment. Tune in to Mitigation Journal Podcast to hear more discussion on this.

"This article is obviously biased against homemade explosive devices! People view the explosives with suspicion and fear, but the truth is that they are actually much less of a threat than guns. Why is it that it is acceptable to have "fun" with guns at a target range or rural area, but anyone making an explosive device is assumed to be up to no good.
Do not condemn what you are not knowledgeable about! Most of the "chemical" bombs described in the article, despite having the potential for substancial injury, and not really extremely dangerous, and are certainly NOT capable of blasting a hole in anything. As for fire danger, a bottle of gasoline is much more dangerous than any of the "explosives" in the article.
Terrorists are very ignorant about explosives. The only thing they have been able to make so far (that is small enough to be carried by an individual) are organic peroxides.

The police and fire departments overreact when dealing with a potential bomb threat. Much time and money gets wasted in treating dry ice bombs as if they were some chemical warfare timebomb.

When someone finds a stick of dynamite or plastic explosives, do they really need to call the bomb squad? Is it not a wast of time for police cars and a team of explosives experts to show up to deal with something that could probably just be dropped off at a hazardous material dumpsite? This all is no different than children getting expelled from their school when a teacher finds a knife that the mother packed in the childs lunch to slice an apple. Overreaction, ignorance, unwarranted fear.
Supposed bomb scares make headlines on states that are on the other side of the country, but what about the FREQUENT drive by shootings that happen in inner city school districts in many parts of the country. We never hear about those."

Fire Safety and Seniors.

Fire Safety and Seniors.

This is a short video put together by our local EMS system on the topic of fire safety and seniors - awareness for EMS. The URMC actually secured a grant. Of course, being a big medical center, they get the grants to do their podcasting...I have to have a baked food sale to keep Mitigation Journal going. (sarcasm)

I remember recording this well over a year ago, but never knew the completed it until today. The info is good and worth the time to view. Just remember, this video was done prior to my retirement...that means no beard and about twenty extra pounds. Click here to view the Fire Safety video http://www.mlrems.org/page.php?99

Feel free to check out the other offerings at http://www.mlrems.org/page.php?55 or click here.

These are not products of Mitigation Journal and I am not responsible for their content.

Leaving the Oxygen Tank in the (EMS) Garage

Leaving the Oxygen Tank in the (EMS) Garage...EMS Garage Podcast leaves oxygen and outdated thinking in the dust.

I don't recommend products, services, or other podcast and blogs lightly. This week I'm going to ask that every Mitigation Journal Blog reader and Podcast listener, and every EMS responder in the world tune into EMS Garage Podcast episode 101.

Why? This episode begins with the typical panel discussion...this time on the topic of oxygen and the (over)use thereof. But the real meat of this EMS Garage episode comes about halfway into the talk. The panel dives into opinion and controversy concerning EMS education standards, folk lore, and legend...and how that outdated thinking and training has led EMS.

OK, I'll say no more...tune in and hear for yourself. You can find EMS Garage at www.emsgarage.com or at www.promednetwork.com. They're also on Stitcher.

Canadian Cessna Visits Rochester, NY

Canadian Cessna Visits Rochester, NY...by way of nuclear power plant.

A Cessna 152 piloted by two men flew into United States airspace and landed at the Greater Rochester International Airport. The two men were allegedly flying from Toronto to Kingston and apparently took a wrong turn. For some reason, rather then flying east from Toronto to Kingston (or west going back), they flew south for nearly 100 miles over the open water of Lake Ontario.  The trip included a detour through the airspace surrounding the Ginna Nuclear Power plant.

There was no radio communication between the plane and air traffic control. The two men in the plane, described as Canadians of Indian decent, were questioned and released. Click here for an article on this from the Rochester Democrat and Chronicle.

I'm not going to buy into the proposal that this was simply an accident or mistake. Could this be another dry run testing our response to events? We've seen other events that looked like dry run probing in the recent past. See Dutch Good Example of Anti Terrorism (August 31, 2010 Mitigation Journal).

I don't know why I'm surprised by this event. After all, NORAD decided not to intercept Russian bomber flights into U.S./Canadian airspace because they were "just training missions"...see NORAD v. Cessna (July 12, 2010 Mitigation Journal). But, then again, how bad can a Cessna be? After all, it's just a Cessna. Although I seriously doubt that a Cessna could damage a nuclear power plant, we should remember the situation of not too long ago where a disturbed person flew his Cessna into a building that housed a regional IRS office. See An Attack by Any Other Name (February 18, 2010 Mitigation Journal).

Did I mention September is National Preparedness Month?

What am I looking for? See Something, Say Something

See Something, Say Something. Sure. Tell me again, what am I looking for?

"Report anything out the ordinary is simply not enough."

The phrase "see something, say something" has taken on a whole new meaning since the attempted Times Square Bombing plot was discovered by a NYC street vendor. The latest cover of this phrase is by our very own Department of Homeland Security.

The See Something, Say Something campaign  was developed by NYC Transit back in 2002 with the plan to get people to report "things". What things? Well, anything...out of the ordinary...an unattended backpack, an open can of sarin, or the powdered sugar in the bottom of the doughnut box.

The See Something, Say Something campaign had the potential for being a tremendous public awareness tool and a way to integrate the public as everyday forward observers.

The Department of Homeland Security paid $13 million on the See Something, Say Something campaign  out of a total $44 million spent since 2006 on preparedness efforts. Over fifty other locations outside of NYC have begun using the slogan, but it's not clear if they had to pay to do so.  NYC Transit secured the trademark for See Something, Say Something in 2007.

Problems. The campaign uses an 800 number rather than 9-1-1 for reporting. Thant builds in a level of delay and risk for poor communications to responders.

The biggest problem is that people simply don't know what they are looking for. "Report anything out the ordinary" is simply not enough information for people to take action on.  The result is failure for this See Something, Say Something campaign. Without an idea of what to look for, we'll get little if any useful information.

Vaccine. Mandate or Not?

Vaccine. Mandate or Not? CDC says no. Other infectious disease experts say yes.

As you may recall, New York State attempted to mandate H1N1vaccine for all health care workers despite a lack of vaccine or a declared public health emergency. Yes, there was a pandemic declared, but no public health emergency. There was considerable debate as to who, exactly, was considered health care workers...did it include EMS? Firefighters? Or simply, anyone who would walk into a hospital? The New York State Nurses Association came out swinging hard against the vaccine mandate. We posted on this way back on July 31, 2009. See NYS Nurses Opposes Mandates for Vaccine in Mitigation Journal.

In June, 2010, the Centers for Disease Control and Prevention issued a statement saying they would not endorse mandated flu vaccines for health care workers this year. The announcement by the CDC was a reversal from their controversial stance in 2009 that anyone working in a hospital must be vaccinated against the H1N1 Swine Flu. The details of this CDC decision were posed in the Mitigation Journal Blog (CDC: Vaccine Not a Requirement. 12 Aug 2010) The full text of the CDC's June 22 statement can be found here.

What will it be for the 2010-2011 flu season? Mandated vaccine or not? Well, the CDC has their opinion and other infectious disease experts have another view. The Society for Health care Epidemiology of America (SHEA) has released a position paper endorsing mandated vaccination with endorsement from the Infectious Disease Society of America. According to the SHEA media release:

"...influenza vaccination of health care personnel [is] a core patient safety practice that should be a condition of both initial and continued employment in health care facilities."

There is more than one controversy in this situation.

Should flu vaccine be mandated? I think a better question is: "what rights do I forfeit to work in health care?" We already require health care workers to undergo TB testing. Hepatitis vaccine is offered, but can be declined. The SHEA position paper states "a condition of employment" in regards to flu vaccination...but who will enforce it? You may recall that the United States Army had to resort to disciplinary action against soldiers who refused mandated Anthrax vaccine. That 2003 mandate for Anthrax vaccine was in preparation for soldiers who were deploying to a area with a credible Anthrax threat and was eventually halted by federal court in 2006 (note: the Army is planning to restart the program 2010-2011). If the Army cannot mandate vaccine soldiers in the presence of a credible threat, how can anyone mandate civilian health care workers to be vaccinated in the absence of public health emergency or credible threat?

Are we following the CDC, WHO or other groups such as SHEA? What are policy makers to do when these expert groups disagree? Last years NY mandate covered anyone who had patient contact in a health care facility. That included some EMS personnel...and here is the lunacy...only commercial (private) ambulances were included in the mandate. The rationale was that commercial or private ambulance services had a higher call volume and, therefore, higher risk. There was no consideration for the numerous EMS providers who work/volunteer for multiple agencies (and hence, have a higher exposure). Also, the 2009-2010 H1N1 vaccination plan had EMS near the bottom of the list to receive vaccine. The point is, if health care workers are going to be mandated to receive vaccine, EMS should fall under that...if EMS responders refuse, if hospital health care workers refuse...what will the system impacts be? I would predict a near-crippling effect on our ability to manage daily volumes.

There is no doubt in my mind that flu vaccination will prevent the spread of flu...seasonal or otherwise. Public health history reminds us that viruses like Smallpox can be eradicated from nature by a staunch vaccination effort. But can we expect to vanquish Type A influenza by mandating seasonal flu vaccination? That answer is no. I'm also concerned about the "what's next" factor. If we mandated to be vaccinated for flu or loose jobs today, what will be mandated (under pain of unemployment) tomorrow? 

More to follow. Feel free to comment (constructively) or email for discussion.

MJ# 188: Chemical Accident at Hotel, Assignment Terror, ED wait times posted on billboards

This week on Mitigation Journal Podcast - First things first; oops. I posted this episode (#188) early. Matt and I had a small window to get the recording done so we pre-recorded a bit earlier then normal with the intent of posting on 9/12/10. Well, as went to post the file to the rss feed I forgot to change the availability date. Bottom line is that edition #188 was available early.

Okay, on to this week...Matt and I discuss how a simple accident caused phosgene to be created in one hotel. Certainly, this was a situation that could have been much worse. It's not a terrorist attack...its an accident. But phosgene is phosgene...no matter who made it or let it out. Tune in to hear the details.

How long would you wait to be seen in an emergency department? A number health care systems have begun posting wait times on highway billboards. The hope is that people will go to an emergency department (one within the same health system, of course) that is less busy. These billboards are aimed at the non-urgent or less acute medical need. My question is, why not just stay out of the ED altogether and just go to a walk-in care center?

Assignment terror...that's right. How about a school assignment that has kids (high school) thinking like a terrorist. An Australian teacher gets bounced because he encourages students to find vulnerabilities in their communities.

September 11, 2010

September 11, 2010...

There will be hundreds, perhaps thousands, of blog postings and podcast discussions today. Many will have titles like "Always Remember" or "Never Forget". While even more will talk about the details of time and events from 9-11-01. There will also be ceremonies and services featuring memorials and testimonials. Where were you when...will be a popular conversation.

I, however, will take a slightly different path behind the keyboard and mic of Mitigation Journal on September 11, 2010.

With the greatest of reverence and everlasting memory of those who died in the attacks of 9-11-01, I will ask those responders who remain to reflect on where we are now and what we'll be doing tomorrow.

Are we better prepared in 2010 than 2001? Prepared to do what, you ask...as well you should.

Can you remember the public enthusiasm that greeted the responders who flooded into New York City in the days following 9-11-01? Can you picture the signs that read "Thank You"? The ones the read "Our Heroes" as lines of ambulances and fire apparatus drove by? Can you still picture the crowds welcoming responders of every color uniform and vehicle?

Can you remember the stream of funding in the months that followed as we suddenly realized that weapons of mass destruction training was needed? And the awakening that one spore could kill?

The American Fire Service could seemingly have anything needed as our nation realized the need for its First Responders. And we got it. There was money for training classes and protective clothing. There were funds for apparatus and buildings.

Is the fire service better prepared in 2010? Prepared to do what, you ask...as well you should.

How much as been spent and squandered on dysfunctional apparatus and worthless "WMD" and terrorism training?  How much of that training and apparatus was never put to use because it did not fill any real firefighting function outside of terrorism? Nearly everyday we're reading about firefighter line of duty deaths from cardiac disease or from entrapment, collapse, or apparatus crash.  How much "preparedness" have these topics gotten? What can the fire service point to as a measure of preparedness in the wake of all this terrorism and WMD training? Protection of infrastructure in our communities? No. In a level of audacity never before heard, the American Fire Service told hospitals that, in case of chemical or biological attack, your local fire department is going to be too busy...better get ready to deal with those contaminated self-referrals on your own. For the first time in our history, the fire service is telling someone "we're not coming".

Recently, legislation aimed at aiding those responders and rescuers who worked at Ground Zero and are now dying from pulmonary diseases...failed. Almost without a whimper. No crowds, no signs, no aid. Cities in every state are faced with demands to cut fire department budgets, reduce staffing, cleave benefits. On September 12, 2001, the American Firefighter was still a hero. In 2010 the fire service is another taxation anchor wincing under the public scrutiny and shouts for tax cuts.

Is our emergency medical services system better prepared in 2010? Prepared to do what, you ask...as well you should.

EMS as a whole received a scant amount of preparedness dollars in the wake of 9-11-01. When asked why, one legislator remarked "aren't the ambulance drivers part of the fire department"? Despite changes to the National Response Plan, now the National Response Framework, EMS remains on the fringes, fragmented and without any nationally recognized leadership. Despite increases in training and education paramedics, who are allowed to give injections to a variety of sick people in the back of an ambulance, have been barred from assisting a flu vaccination clinics during the Swine Flu pandemic of 2009...adding to the nauseatingly slow vaccine distribution at some public vaccine clinics. EMS is the service that should be best able to identify an unfolding biological event. In 2010 we still ask "aren't the ambulance drivers part of the fire department"?

Is our public health system better prepared in 2010? Prepared to do what, you ask...as well you should.

Hospital preparedness, surge capacity, resource triage, and sufficiency of care were all buzzwords after 9-11-01. The buzz has faded into annoying tinnitus as many hospitals and public health organizations go through the motions of checking the boxes on the Joint Commission list...functionality optional...check mark required.  Decontamination precautions remain unworkable at many health care facilities. Issues of surge capacity continue to dog hospitals as over crowding forces patients into the halls waiting hours to be seen by a doctor. Discussions on the triage of limited medical therapy (ventilators, for instance) is hotly debated and unsettled. Oh, and that pesky flu...even after 9-11-01, SARS and the Avian Flu threat; we fall short of vaccine production and distribution capability...even when given months warning as in the case of Swine Flu.

As I've written and said many times before...It is time to stop training for WMD terrorism events. It is also time to stop living in the "post 9/11 era" and start living in the pre (insert next event here) era.We must recognize the need for all-hazards training. This training must be delivered in a way that puts the material into context, so the skills and knowledge can be used every day. Our readiness for natural disasters must also improve.

Never forget. Always remember. Are we better prepared in 2010? Prepared to do what, you ask...as well you should.

Wrong, Wrong, Wrong...

Wrong, Wrong, Wrong...Not only wrong, but endangering to troops and domestic responders.

That's what I have to say to the Dove World Outreach Church on their plans to burn copies of the Quran on September 11, 2010. They have a top-ten list of reasons why they should partake in this act, too. I've read the list and find each one of the reasons given by this church...well, less than impressive. Click here for a link to their blog/top-ten list.

The Dove World Outreach Church, self-described as nondenominational, plans to burn copies of the Quran as part of its "international burn a Quran day"in honor of September 11. This group invites all Christians to participate, calling Islam "the work of the devil", according to this article from CNN.com

Think what you want, I don't care. But burning a holy book (even if its not reflective of your beliefs) is flat out wrong.

My message to the Dove World Outreach Church is; please reconsider your planned action. Your intent on burning copies of the Quran will only incite deeper polarization between extremist groups. Your actions may well be the catalyst that tips the balance and results in retaliation, cries of bigotry, and escalation of violence.  Read more of my comments previously posted (Mosque) and Tipping on the Point in Mitigation Journal. These may well be the actions that spark domestic terrorism in this country.

The responders and public will be in the middle. As will our troops around the world. CNN.com notes that this type of activity will "jeopardize the safety of our men and women that are serving over here in the country..."

Burning copies of the Quran is akin to Nazis marching on Main Street U.S.A and waving a swastika flag. Nothing good will come from this...it will not stop the Ground Zero Mosque from being built. 

The Bible, the Torha, the Quran...just a few of the Holy books people on this earth hold sacred. They all deserve respect.

(note: the Dove World Outreach spelled Quran with a K -Kuran, other references all use Quran)

This Weeks Reading List

A list of topics that might find their way to the blog or podcast.

Do you have insight, opinion, or comment on any of these topics? If so, email me mitigationjournal@gmail.com or call the voice mail line at 585-672-7844

 Healthcare groups need to share emergency plans...link

Violence Against ER workers...link

FDA attempts to slow Robo-tripping...link

Is there a doctor in the motor-house?...link

Forget the ED wait...just go to an urgent care center

This story from MSNBC.com discusses the latest in tactics by emergency departments to cut down wait times. The strategy is to post ED wait times (as near real time as possible) on billboards in various areas. The idea is that people, when they need to go to the ED, will look for the location with the shortest wait time...even if it means driving to a distant hospital.

This move and others like it, are in preparation for a new Medicare regulation that requires hospitals to report how fast people are moved through the ED. The MSNBC.com story notes that these moves are directed for less urgent patients and not actual emergencies. According to the article, the longer a person remains in the ED, the greater the risk of poor outcomes (like infection) or death. There is also increased complaints in relation to long wait times in the ED.

So, will posting wait times on billboards make a difference on ED wait times? I doubt it. I think people won't bother reading the billboards...you'd have to be on the road already anyway...I think they'll continue to call 9-1-1. What's also interesting here is the fact that we're targeting less urgent or non-emergency cases. Perhaps a better solution would be to point these folks away from the hospital ED completely. Sending them to an urgent care/walk-in care center for the ear aches, stitches, and sprains may be an even better solution.

All threats are not equal

Not all objects are designed to go boom...some are designed to spread disease.

Last week we reported on a situation involving two guys with "suspicious" devices (cell phones tapped to empty bottles, watches tapped together, knives, box cutters...over thirty items by some reports) who each missed flights, changed travel plans in mid-stream, and whose luggage continued to different destinations than they did as they're on the way to Yemin. The Dutch hold them on suspicion of plotting to commit terrorism, the U.S., not wanting to jump to conclusions, believes the situation to be a matter of coincidence. See my post Diligence or Paranoia, Profiling or Protection September 1, in Mitigation Journal.

Today, CNN.com is reporting that the Miami airport...all of the Miami airport...was closed because of a suspicious item in a travelers luggage. The man in question, arriving in Miami from Brazil, is said to have an item the looked like a pipe bomb in his suitcase. According to CNN.com, the 70-year-old man was detained (not arrested) while the bomb squad evaluated the item. The article goes on to state that nothing hazardous was found, there were no traces of explosives. This story might sound like a bit of over kill. That is until  you find out that the 70 year-old man in question has a history of imprisonment for transporting (illegally) biological agents...including plague.

With good reason we've focused on explosive devices recently. This story being reported by CNN.com is a reminder that another potential exists. The treat of biological terrorism has not been front page lately, but we have to keep in mind that biological events could kill thousands more that any given improvised explosive device. While bombs detonate (or, defligrate, for the purists) they give us a call to action...a heralding event that alerts us to the fact that something is going on. We put our guard up. We take appropriate actions and precautions.

Biological event lack that "big bang" or that heralding event. Biological agents can be spread by a variety of delivery methods and devices. Perfume bottles, aerosol spray cans...even the automatic air fresheners in the men's room at the mall. There wont be a call to action. We wont know to put up our defenses. And since most of the CDC A List biological materials will present with signs and symptoms similar to cold and flu, we probably wont know anything is going on till it's well underway.

The explosive bang is nothing compared to the biological whisper.