Jul 182015

I’m curious if readers would blindly follow a “mandatory” mass evacuation order?

A recent train derailment in East Tennessee resulted in a mass evacuation that the public was told could last from 24-48 hours.  I chose to stay. Using my own experience, as well as knowledge of the hazard, I obtained a second opinion of a subject matter expert I trusted and decided against evacuating my location.  Some of my neighbors made similar decisions, though many did leave.

I started to think about the factors behind my decision and wondered what others would do in similar conditions. Here are some of the questions that came to my mind.

Would you take the evacuation order at face value and leave without any questioning?

If you had the inside scoop from a subject matter expert who had previous experience with the same type of hazard would you stay or leave based on what they advised you?

If you thought it was politically driven more to cover a politician’s career (e.g. CYA) than address real public safety issues, would you stay or leave?  It’s easy to say everyone should evacuate out of harms way but there are a lot of factors that need to be in place to carry it out well.

Do you have to have trust in the source in order to follow the order?  For example do you have to believe the hazard (if airborne) is not at your location yet prior to leaving?  What if shelter-in-place might be a better option?

If you yourself were trained in the hazard would you trust your decision over someone else?

What if your neighbors looked to you knowing you have subject matter expertise? Would you advise them to follow the order or stay behind?  Would you then be responsible for their safety if conditions changed?

I have the benefit of years of experience and the Readers will have to trust that I understand all the nuances of evacuation and shelter-in-place as a protective action strategy. I’ve also helped clients develop policy, procedures, and standard operating guidance about evacuations.  I hope to keep this conversation more on the triggers and resources and critical thinking skills you would use to decide when or when not to follow a mandatory evacuation order.

Mass evacuation laws vary from state to state and seem to be more refined in those areas where natural disasters (fires and hurricanes) occur with some regularity.  People living in those areas gain experience and/or biases with historical events which probably influences their own decision.  Mass evacuation statutes typically give the governor the authority to declare a state of emergency/disaster and order a mandatory mass evacuation.  Many laws will indicate a delegation of that same authority to elected officials at lower levels of government.

Terminology in those laws include “compel” to mean to use force or coercion to bring about the desired result of evacuation.   Using coercion to get me to act against my free choice rubs me the wrong way. I think sets a dangerous precedent of government acting too paternalistic. Is it really reasonable to force people to leave their homes?  My parents often told me what was best for me as a young child.  As I grew older I often had a choice in the matter.  Of course my decisions had consequences.  I’m not convinced anymore that when politicians make a choice, there are consequences.

Coercion tactics such as being told to write your social security number on your arm with an indelible marker to make body identification “easier”; or knocking on doors wearing an SCBA only to be seen wandering up the street later yucking it up without wearing a mask don’t come off as professional or credible.  Apparently the strength of data, science, or reasonableness regarding the need to evacuate is not strong enough if these cheap tricks are deemed appropriate.

The recent surge in shark attacks along the eastern seaboard bring up a similar challenge of deciding if there should be a precautionary evacuation of going in the water.  If you don’t get in the water you won’t be bitten by a shark — that’s a fact.  What’s interesting is that evacuating the water as a public safety decision is diametrically opposite of supporting the tourism industry along coastal vacation communities.  As a result we see public officials pulling out the “probability” science of shark attacks as supporting the decision not to restrict going into the water.

The point I’m trying to make is that I am not comfortable letting government officials be responsible for making evacuation decisions on my behalf.  I’ve used the word trust more than once in this post and I think a great deal boils down to if I trust where the message is coming from.  Evacuation is a great CYA tool for politicians but I don’t think they always have my best interests at heart. I also believe reasonable people with key information can make good decisions on their own.

Help  me understand what factors you think would weigh in on your decision to evacuate or if being told to do so is sufficient for you.

Jul 092015

I like many of my readers enjoy when television gives us a whole week of nothing but sensationalized and awesome footage of sharks doing what sharks do.  I’m waiting for the week dedicated to bees, wasps and snakes since they are responsible for far more deaths each year in the U.S. than sharks.  I know, that is unlikely to happen.


What I have found interesting in watching the footage of shark attacks (few as they might be) is the typical cause of death, exsanguination.  Friends and bystanders risk their lives to bring the attack victim to shore but every minute more blood is being lost which can’t be replaced easily.  Any decent medic will tell you it’s much better to keep the blood in the body to circulate oxygen than plan on raising pressure with fluids which don’t carry oxygen.  Delayed death by organ failure due to poor field perfusion can’t really be called a win.  5574451_f520

I can’t advise people to tread water while putting on an improvised tourniquet but it may yield a better outcome than dragging a bled out corpse to the beach.   I know the shark could come back to attack again but that seems to be the exception in shark attacks not the rule.  Besides, not stopping the bleeding and allowing a limb to continue to bleed just leaves a scent trail for the shark to follow doesn’t it?


Traumatic injuries severe enough to cause loss of life by bleeding out was the most common cause of death in military combat.  Data from recent and continuing conflicts have reinforced the role of early application of tourniquets and hemorrhage control when it comes to life saving care and some military units have fantastic survival rates.  Non-combat causes of exsanguination include gunshot or stab wounds; motor vehicle crashes; suicide by severing arteries, typically those in the wrists; and partial or total limb amputation due to machinery or motorized cutting devices.


Visitors to my site know that I am a firm believer in giving the lay public more information to better position them to take proper action to save lives.  Some of my strategies may be a bit controversial such as my Active Shooter course but if I suffer an injury which is causing me to bleed out, I will gladly take the first trained person who shows up over waiting on the local emergency service providers.


Back to the connection to shark week.  In South Africa they have developed what is called a Shark Attack Pack which is designed to give the life guards everything they need to stop bleeding and infuse solutions.  I am not sold on the need for fluids in most cases and would be satisfied if first responders along our coastal waters had access to disposable arterial clamps, tourniquets and large trauma dressings.  The nice thing about this small list of supplies is that it will work for any cause of severe bleeding, not just a shark attack.


I’m pretty sure that in about two hours I can teach a member of the public what they need to know in order to use these supplies to stop lethal hemorrhaging.  I would also include a module on improvised replacements for each item which could probably be rapidly scrounged up.   The point is, we can build off of the public’s interest in sharks at this moment in time to educate them on how to manage bleeding regardless of cause.  I’m interested to hear what you think?



Apr 052015

Below I’ve listed the officially recognized Ebola Treatment Centers in the United States as of February 14th 2015.  If we have a case of Ebola, we know where to take the patient.  If the patient has Anthrax, Botulism, Plague, Small Pox, Tularemia or other highly virulent disease, the patient and care givers are still out of luck.

The reason I mention this is there are grant funds for Ebola preparedness are available through the Hospital Preparedness Program (HPP) Ebola Preparedness and Response Activities program. The cutoff date for application is April 22nd, 2015.

I can’t come up with a good reason why the program is one disease specific and not address all CDC Category A agents, or highly contagious and virulent organisms. Are we planning on waiting until after we get a significant outbreak of pneumonia plague to start getting ready just for plague?  I undoubtedly will benefit from this ignore the forest and focus on the tree approach with the PPE Course I offer, but even in my course I mention the critical need for universal application of proper PPE selection, donning and doffing and sanitizing.

We know that Hospital Acquired Infections (HAI) are a huge problem in the United States and obviously we are moving disease from one patient to another.  We also know Ebola is not a huge problem in the United States and I would argue if we dramatically decrease our efforts to decrease HAI we in turn make our staff and patients safer from all disease.

I’d love to hear your thoughts on this focused funding effort.


                        Ebola Treatment Centers, as of February 14, 2015

Jurisdiction City Hospital/Facility
AZ Phoenix Maricopa Integrated Health Systems
AZ Tucson University of Arizona Health Network
CA Oakland Oakland Medical Center
CA Sacramento South Sacramento Medical Center
CA Sacramento University of California Davis Medical Center
CA San Francisco University of California San Francisco Medical Center
CA Orange University of California Irvine Medical Center
CA San Diego University of California San Diego Medical Center
CHI Chicago Rush University Medical Center
CHI Chicago Ann & Robert H. Lurie Children’s Hospital of Chicago
CHI Chicago University of Chicago Medical Center
CHI Chicago Northwestern Memorial Hospital
CO Denver Denver Health Medical Center
CO Aurora Children’s Hospital Colorado
DC Washington, DC MedStar Washington Hospital Center
DC Washington, DC DC Children’s National Medical Center
DC Washington, DC George Washington University Hospital
GA Atlanta Emory University Hospital
GA Atlanta Grady Memorial Hospital
LAC Los Angeles University of California Los Angeles Medical Center
LAC Los Angeles Kaiser Los Angeles Medical Center
MA Boston Massachusetts General Hospital
MA Boston Boston Children’s Hospital
MA Springfield Baystate Medical Center
MA Worcester UMass Memorial Medical Center
MD Baltimore Johns Hopkins Hospital
MD Baltimore University of Maryland Medical Center
MN Fridley Allina Health’s Unity Hospital
MN St. Paul Children’s Hospitals and Clinics of Minnesota – Saint Paul Campus
MN Rochester Mayo Clinic Hospital – Rochester, Saint Mary’s Campus
MN Minneapolis University of Minnesota Medical Center, West Bank Campus
NE Omaha Nebraska Medicine – Nebraska Medical Center
NJ New Brunswick Robert Wood Johnson University Hospital
NY Glen Cove North Shore System LIJ/Glen Cove Hospital
NYC NYC New York-Presbyterian/Allen Hospital
NYC NYC The Mount Sinai Hospital
NYC NYC NYC Health and Hospitals Corporation/HHC Bellevue Hospital Center
NYC NYC Montefiore Health System
OH Cleveland MetroHealth
PA Philadelphia Hospital of the University of Pennsylvania
PA Philadelphia Children’s Hospital of Philadelphia
PA Hershey Penn State Milton S. Hershey Medical Center
PA Bethlehem Lehigh Valley Health Network – Muhlenberg Campus
TX Houston Texas Children’s Hospital
TX Galveston University of Texas Medical Branch at Galveston
VA Charlottesville University of Virginia Medical Center
VA Richmond Virginia Commonwealth University Medical Center
WA Seattle Harborview Medical Center
WA Seattle Seattle Children’s Hospital
WA Spokane Providence Sacred Heart Medical Center
WI Madison UW Health – University of Wisconsin Hospital, Madison,and the American Family Children’s Hospital, Madison
WI Milwaukee Froedtert & the Medical College of Wisconsin – FroedtertHospital, Milwaukee
WI Milwaukee Children’s Hospital of Wisconsin, Milwaukee
WV Morgantown West Virginia University Hospital