Feb 062016

I think it’s hard to argue that prevention of disease in the case of the Zika virus does beat a pound of cure. We are unlikely to have a vaccine in the near future and there is no specific treatment for the illness.   The mixed good/bad news is that roughly 80% of those infected are unlikely to even know they have the disease.  The bad news is if the patient happens to be a a female who is in any stage of pregnancy, it raises the potential for a serious birth defect of the brain called microcephaly.  We have the 2016 Olympics coming up in Rio de Janeiro in August.  More than one million visitors and athletes are expected for the games in Brazil.  If you’re in healthcare, what advice would you give to an individual?  If you’re in emergency management or public health what advice would you give in order to try and prevent the disease from returning to your community?zika

While the mosquito is the primary vector, there is concern now that the disease can spread via blood transfusions from an ill donor and also through sexual contact with an ill person.  Since November 2015, Brazil has seen 404 confirmed cases of microcephaly in newborns. Seventeen of those cases have a confirmed link to the Zika virus. Fifteen babies have died from the condition, with five linked to Zika. An additional 56 deaths are under investigation, and authorities are investigating 3,670 suspected cases.  CDC Director Dr. Tom Frieden recently said: “The priority is protecting pregnant women,” “If you’re pregnant, and you’re thinking about traveling to a place were Zika is spreading, please don’t.”  “Men who live in or travel to areas of active Zika infections and who have a pregnant sexual partner should use latex condoms correctly, or refrain from sex until the pregnancy has come to term.”

I think this raises some interesting questions regarding what information is being provided regarding the disease, prevention and potential complications of illness.  I expect that the majority of our athletes will be in the child bearing and/or child producing age bracket.  I accessed the Team USA Road to Rio website while writing this post and there is zero mention of Zika in Brazil.  Do you think there should at least be links to CDC and/or WHO information to help athletes make an informed decision?  Certainly bragging rights for medal counts does not trump the personal safety of athletes does it?

My personal opinion is that athletes will be more likely to be injured in a motor vehicle accident than contracting Zika if they take reasonable precautions to prevent mosquito bites.  I can’t speak to any issues of ingredients in bug spray that may show up as daughter products of a performance enhancing drug.  I understand there is a shortage of bug spray and mosquito netting in Brazil so visitors better pack their own. Remember only 3.4 ounces if you’re putting it in your carry on. I would hate to see TSA confiscate your bug spray and increase your risk of contracting disease and consequently importing it back into the country.

I’m curious what you would do if you were the athlete and/or planning on visiting during the games?

Jan 042016

It’s a challenge to know where to devote planning, training and exercise time with so many competing demands, agendas and requirements. Consider this – people will fall back on two things when under stress – training and experience.  If your staff don’t regularly get experience in these two subjects training becomes critical as life safety could be at stake.

Recommendation Number 1 – Gain Proficiency in Using the Incident Command System

National Incident Management System (NIMS) compliance requires more than just lip service. Ensure staff who will fill key roles on your Incident Management Team (IMT) have regular ongoing training in actually using the Incident Command System (ICS).  Identify staff for ICS positions based upon their existing job duties, shift assignments and personalities.  Find people well suited to the different positions and enable them to blossom in their roles through additional training, mentoring and practice.

ICS course recommendations are based off of an organization’s risk for varying level events (NIMS Event Types 1-5). Even small organizations at risk for a major event require higher level training since they will need to work with other agencies and government support.  training1If time is an issue for the full ICS 300 and ICS 400 courses, work with a consultant you trust to build a block of training you can support. This will help ensure staff have the key knowledge, skills and abilities necessary for incident management within your organization.

Conduct quarterly scenario-based (pulled from your HVA) drills on all shifts designed to ensure IMT activation.  Make sure your IMTs build realistic organizational structures designed to manage the event.

three business people talking about contractYour IMT should draft their Initial Incident Action Plan (IAP). Develop your own quick start IAP form. Make sure the IAP identifies the first operational period length, includes S.M.A.R.T. objectives and has an organizational chart.  IAPs can be reviewed by other teams from other shifts to help everyone learn from each other.

Stay out of the weeds and operational tactics. Your personnel know how to respond operationally. Practice establishing incident management not response. Drills like this can be short and take up no more than 30 minutes. If your management team can’t get their IAP developed within 30 minutes, operational staff will free-lance to address issues as best they can in the absence of leadership.  Good incident management during major events will ensure wise resource allocation, resulting in decreased morbidity and mortality.

Recommendation Number 2 –  Decrease Fear and Increase Respect for Unusual Threats

Seek jurisdiction specific education and training on the unconventional threats of chemical, biological, radiological, firearms and explosives.  Not only do each of these represent a unique threat to your staff and patients they have an added edge of fear associated with them.  Fear is a powerful motivator and for those in public safety and healthcare it can cause poor decisions.  If you disagree, sign up for one of my courses and ask for the “snake” addition. Once people understand the real risks from unusual threats, they are better prepared to survive the encounter and deal with the consequences in a safe and timely manner.

Unusual threats exist in some form or fashion in communities across the country.  When seeking training make sure your instructor makes the class content relevant to your jurisdiction.  GB and VX are interesting nerve agents to learn about, but don’t exist in most locations.  1aaca8Organophosphate pesticides are almost universally found and available over the counter. While they might behave similarly, there are differences in risk to your staff and emergency treatment.

Ebola does not need to be on everyone’s list of biologic agents to worry about. Norovirus on the other hand is a bad actor (contagious and harder to kill than the Ebola virus) everyone should be aware of.  Lots of phobia associated with radiation but knowledge and timely use of detection equipment makes it fairly simple to mount a safe response.

I am not too concerned about explosive devices although medical personnel do need to know how to assess the potential for blast injury and treat properly.  Firearms on the other hand represent what appears to be a growing indiscriminate threat.  rescue-workers-aid-wounded-woman

The 2011 attack in Norway by one person included a bomb which killed 8 and firearms which killed 69.  While the probability is low for any one organization, we know more events will happen somewhere. Perhaps at your organization while you read this post. Your preparedness can be broken down into two phases. The first is a reaction phase to the sound of gunfire or violent confrontation. Statistically 70% are over in 5 minutes or less and before police arrive. Your staff must immediately decide – run – hide- fight.  This represents life safety for them.

The second phase is your response to the aftermath.  How will you quickly triage and treat those with life threatening injuries.  One of the most important tools at this point is access to a good tourniquet and knowing how to apply it. During this second phase, your staff may very well save the life of someone they know.

We really can do emergency preparedness better.  I think these two areas should be the focus in 2016.  What are your ideas?




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.