Wednesday, October 31, 2007

Disaster Preparedness for Healthcare Workers

According to the Department of Labor, about 545,000 establishments make-up the healthcare industry (source, Bureau of Labor Statistics website). These establishments vary greatly in terms of size, staffing patterns and organizational structures. They exist in every population center, from major metropolitan areas to the smallest rural communities. The common denominator for all of these establishment is they employ a wide variety of workers with unique skill-sets which are invaluable during a response to a homeland security crisis.

Most healthcare workers in this day and age have to have at least an associate’s degree in order to be certified and hired. The training they receive is rigorous and subject to various state and national certifications. As healthcare worker’s technical proficiency increases in complexity, the one critical element that may be missing is an understanding of emergency response procedures during a large scale event (such as a terrorist attack).

Healthcare workers, as opposed to first-responders, often do not receive training in the Incident Command System (ICS) or the National Incident Management System (NIMS). Many would be at a loss if suddenly assigned to a medical strike team or may even wonder why their skills would be needed. The healthcare workers of today have dynamic technical skills that are applied at the individual level. What is needed to enhance their abilities is a basic understanding of how those skills are applied on a large-scale to a whole community facing a crisis.

Healthcare workers tend to focus on their primary skills without realizing the value of their ancillary skills. For example, during an emergency response the processing of hundreds or even thousands of casualties still requires the basics; taking patient histories, identifying allergies, identifying medication, or simply providing comfort and support to the injured. These are common skills shared across a wide spectrum of disciplines.

The healthcare worker who has had some initial training in ICS or NIMS is able to immediately function in a multi-agency response involving not only other healthcare providers but other responders as well. Healthcare workers unfamiliar with these incident response systems are not as immediately effective and may cause unnecessary delays. The training need not be overly arduous, the majority of those working towards a degree in healthcare already have full course loads. The intent here is encourage all healthcare workers to obtain at least a basic familiarization with ICS or NIMS, not to become subject matter experts.

A simple familiarization course of 1-3 credit hours for students enrolled in healthcare curriculums would be a good start. The course should cover the basics of the National Response Plan (NRP) and the 15 Emergency Support Functions (ESF) with emphasis on ESF #8 (Public Health and Medical Services). Healthcare workers need an early exposure to the concept of multi-agency response to a crisis situation. The individual needs to understand that they may have to respond as part of a larger effort versus their more individual centric responses. Their hospital or clinic may be only one of many dealing with mass casualties.

In order to better prepare these professionals, it is necessary to help them understand how they may have to help augment other healthcare professionals with whom they have not worked before. The healthcare worker responding during a major emergency may have to perform their duties at a different location than they are used to. The responding healthcare worker may have to pack up a kit and re-locate to another city or state and be able to still perform their jobs immediately upon arrival. This is a skill not taught in most healthcare curriculums. It may be an unnecessary skill for most making it too costly to add to all curriculums. However, the basic concept should be introduced to the student healthcare worker with follow-on training once they begin working in the field.

A healthcare worker leaving his or her home base should plan on being gone from anywhere from a week to 30 days. For major crisis response, these are not unusual timeframes. The responding healthcare worker needs to have already in advanced planned out their kit. While the basic equipment may seem obvious for their respective field, many other questions still need answering. Will there be additional equipment at their destination or will they have to pack everything before leaving? Will there be sufficient power or do they need to bring portable equipment and batteries? Will they need to pack their own food and water? If they do leave their home, what family care plans have they arranged? The time to start answering these questions is BEFORE the healthcare worker finds himself or herself heading out the door.

Why haven’t we seen more emphasis on emergency response training for healthcare workers? Large scale responses to emergencies involving large numbers of healthcare workers operating outside of their normal establishment aren’t the norm. In large metropolitan areas, healthcare workers tend to remain centered around their normal work locations. Responses to events with mass casualties can often be handled within existing healthcare systems negating the need to re-locate healthcare workers. Smaller communities normally don’t experience emergencies of large enough scale to require importing large numbers of healthcare workers from outside their region. Patients requiring specialized care can be flown to the nearest trauma center.

A pandemic illness, such as avian flu, could introduce the very set of circumstances that would cause the need for healthcare workers from one area being deployed to another area. Models of the effect of a pandemic illness on the workforce show something on the order of 40 percent of the workforce being out due to illness. Imagine the crisis that could happen should pandemic illness take out a large number of healthcare workers in a major city that simultaneously experiences a natural disaster (flood, hurricane, or earthquake). The need for large numbers of healthcare workers would be incredible. These workers won’t have much time to get ready to deploy and will need to focus on getting their gear together, not taking initial courses on incident management.

Healthcare workers that have been trained in the basics of incident management will more quickly grasp their role in a multi-agency response. Those who may have to work from a different location will be able to more quickly identify they equipment and supplies to take with them. The workers who have such preparation and training are able to quickly leave and report to their new work location. Fresh workers who are able to quickly start working in a multi-agency response environment are incredibly valuable. They can assist in treating casualties as well as providing much needed relief for healthcare workers already working crisis response.

Two years after Hurricane Katrina stuck land, we are still evaluating the response efforts and trying to determine how to improve responses to future events. Successful coordination of a wide range of resources is the key to achieve an effective response. Healthcare workers who have basic familiarization with incident management are just one more step to achieving that goal.

Tuesday, October 30, 2007

We Don't Need a National Emergency Response Corps!

National Emergency Response and Disaster Assistance Corps

The title is from an article appearing in the September 2007 Homeland Defense Journal by Robert McCreight. Dr. McCreight asserts the need for the corps based on National Guard personnel and equipment deployed overseas and unavailable to respond to state emergencies.

Dr. McCreight feels National Guard overseas deployments adversely impact disaster response missions in their home states. This argument was first heard when Kansas Governor Kathleen Sibelius said that half of the trucks of the Kansas National Guard were in Iraq creating shortfalls in responding to the tornados that struck the state last May. No one challenged the governor as to where her other state agencies where during this emergency response.

The National Guard has a dual-mission charter. The first mission is the federal mission where the Army and Air National Guard function as Reserve components to the United States Army and the United States Air Force respectively. The National Guard receives federal funding for the training necessary to meet these mission requirements. Since9/11, this has been the mission getting the most attention as units are mobilized to support the Global War on Terrorism.

The second mission is the state mission. Each state (including Guam, Puerto Rico, the US Virgin Islands and the District of Columbia) has an Army and Air National Guard. The National Guard of each state falls under the jurisdiction of the governor. (Washington D.C. is the one exception to this rule). The National Guard is the organized militia of the state articulated in the U.S. Constitution. The National Guard is the governor’s resource to deal with emergencies or insurrections once other state resources have been exhausted.

The National Guard is the last in and the first out during a state emergency. Other state agencies are called up first and if there is a shortfall the National Guard responds. Part of the reason for utilizing other agencies first is that the National Guard receives reimbursement by their state for all personnel and equipment used during the emergency. Other agencies do not receive state reimbursement as a rule.

Dr. McCreight advocates ‘a special cadre of emergency and disaster response specialists deployable from each state, and specially trained and equipped, to surge and assist localities in handling the toughest and most demanding tasks during the first days and weeks following a disaster’. The National Guard already has skill sets and equipment to fulfill this requirement. The National Guard is able to maintain their skills as part of their war-time skills training using federal dollars. The proposal from Dr. McCreight could strain already austere state budgets beyond the breaking point.

The system he advocates pre-supposes a large number of professionals that are available to join this cadre. Most are already employed either in the private or public sector and it is unlikely that they employers will allow them to augment another group (effectively reducing their own agency’s ability to respond). Many are also already members of the National Guard.

The other problem is standardization of training. If the intent is to create a deployable team, then the team members need to be able to seamlessly adapt to their new location. The National Guard is already established and funded to perform exactly as Dr. McCreight’s cadre. Furthermore, it does this as part of a federal mission so there are national standards to which National Guard members are trained and certified.

The author based his model on Russia’s EMERCOM (Ministry of Civil Defense) which provides many of the same disaster response capabilities as the National Guard and state emergency management agencies do here in the United States. Russia and many other nations have basically two types of military forces, active and reserves. The active duty troops perform military missions and the reserves act as a manpower pool to backfill any shortfalls the active duty forces may encounter. The United States is one of the only countries with a National Guard with the dual missions of federal military reserve and state emergency response. It is a model that other countries (such as Hungary and Serbia) are trying to model.

The National Guard is being utilized more heavily than ever in its federal mission but rather than invent another version of them, states need to take a more active role in monitoring how may Guard members are activated and which equipment is being tasked. All states have a Joint Force Headquarters (JFHQ) with and Joint Operations Center (JOC). The JOC can track all of the information and then the JFHQ can asses the impact of the deployments on state active duty missions. The assessments can then be briefed by the Adjutant General (commander of the state National Guard) to the governor. All of this infrastructure is already in place and states need not re-invent a whole new program (at tremendous cost and time).

The drain of the National Guard to support overseas deployments does need to be addressed, however creating a new corps isn't the right answer.

Chemical Spill

10 sickened in chemical spill


SPRINGDALE - A chlorine cloud at Maple Knoll Village, a retirement community in the 11000 block of Springfield Pike, sent 10 workers to area hospitals.
The employees were transported by ambulance to Bethesda North Hospital in Montgomery, Mercy Hospital in Fairfield and Jewish Hospital in Kenwood.

“Employees were mixing chemicals in the basement of the four-story building about 9:15 a.m. when an accident sent fumes through the building, said Becky Schulte, director of communications for Maple Knoll Village.”

It doesn’t take a terrorist attack to expose people to chemicals, sometimes all it takes is an accident. We need to keep this in mind at our workplace or school.

If you happen upon an individual that is down, our first inclination should be to run over and make sure they are okay. If they are not responsive, we want to check for vital signs. CPR may need to be administered.

However, if more than one individual is down, our response should be different. Heart attack, stroke and diabetes are not contagious so encountering a group of downed individuals indicates the presence of an agent or other danger in the area. This factor could be a chemical of some kind (either a gas or something that has been ingested such as a poison), perhaps a biological agent is present, or worse a sniper.

If you happen to see a group of individuals that have collapsed, immediately call 911 and report the situation. Do not enter further into the effected area as you risk becoming a casualty yourself. You need to report as much information to authorities possible. Take note of any signs of trauma (indicating an explosion or shooter), any chemicals spills, unusual odors or the presence of dead animals in the vicinity.

Mark the area to warn others behind you not to proceed.

While we are on this subject, be on the look out for suspicious packages. If you see powder or what looks like oil seeping through the wrapping, do not handle it! Get everyone out of the immediate area and call authorities. Mark the area to prevent others from entering the area until authorities area. Never smell, touch or taste any substances that may be on packages.

Monday, October 29, 2007

Who you gonna call?

Invoking the theme song from “Ghostbusters” seems appropriate this time of year. It wasn’t however nostalgia that cause be to think about this line, it was an op-ed piece written by David Brooks appearing in today’s Enquirer.

The ‘out-sourced’ brain covers Mr. Brooks sudden realization that his life is pretty much dictated by the information received through various electronic devices. From his GPS equipped car to his Blackberry, he feels as though he is inextricably linked to some external mind.

We’ve all seen people milling around downtown or in airports, head bent down squinting at their hand-held device feverishly typing away on a keyboard too small for a Hobbit. Who uses a map anymore when with a few key strokes on your laptop or handheld device you can Google your destination and get maps and directions?

I am no stranger to technology myself and in my previous line of work, my Blackberry was seemingly fused to my hands. As soon as someone sent a message, I was able to instantly read it and post a reply.

The ability to immediately access a wide variety of information creates expectancy, some may even say dependence, on it always being available whenever we want it. In the event of a disaster, digital information may not be available and a prudent safety or security professional needs to plan accordingly.

In responding to Katrina, military personnel and first responders quickly discovered cellular service was unavailable. A combination of power outages and damaged cellular towers prevented service from being available. Cellular devices were rendered useless and reliance on other means of retrieving and sending information had to be used.

Almost all communications now relies on digital technology and fiber optics. The broad band capability provided by this technology provides incredible speed for transmitting vast amounts of information. Despite its great capacity and speed, digital technology can only operate so long as power and the infrastructure are available. Technology works only if the necessary power and infrastructure are available. Granted not all services will necessarily be compromised (such as GPS), however imagine the increased workload for the remaining backbones as more and more users switch over to available networks for their information requirements.

The assumption is GPS will always available however depending on the nature of the disaster, for example something that generates an electro-magnetic pulse (EMP), the GPS satellites may be inoperable. Or your GPS device may get damaged during evacuation. You still have to be able to navigate regardless of your circumstances.

Hard copy maps should be a part of your emergency kit. Use the maps to plan out evacuation routes in advance for leaving the area (as they did in California or as some may have to do in Atlanta). Keeping hard copies maps though means keeping them up to date. Having a map or chart that is out of date is as bad as not having one at all. Different emergencies may dictate different evacuation points. Consider if you are evacuating towards an unaffected area or merely one that hasn’t been affected yet. Identify supplies you are going to need during your trip as well as those you will need once you get there. You may not be in a situation to evacuate under most circumstances due to medical issues with yourself or family members. However, things such as damaging storms, fire, or pandemic illness may not leave you with much choice.

A communication plan needs to be in place for your family and loved ones that assumes cellular service won’t be available. You need to know who is okay and who may be hurt or missing. Identify a pre-determined assembly point where everyone gathers in the event of an emergency. Each family member should understand the conditions that would cause you to assemble (loss of cellular phone service due to an emergency or impending storm for example), what they need to bring (if at work or school, they may not have time to gather emergency supplies). Agree on a no later time to have everyone gathered at this point (take into consideration factors such as gridlock, quarantines, accidents, damaged roads, etc). This is not you final evacuation destination, merely a point that everyone knows to go to when circumstances dictate. You will also need to come up with a secondary location in the event the first is unavailable. The point is to be able to communicate with family members despite the lack of cellular phones and other digital technology.

Make sure a family member or close friend outside of your home knows you plan in the event of an emergency. Establish a way of contacting this person once you arrive safely at your evacuation point.

Consider carefully the circumstances that may require you to evacuate from your home. Don’t try to take everything in your house. Focus on food, water, supplies, medical supplies, and emergency equipment that you will need during your trip and once you get to your final destination. You may have to travel for much longer and under more arduous conditions than when going on your vacation. You may have to evacuate by foot, especially if the disaster damages roads or destroys bridges. Don’t rely on emergency workers being there to get you out, during a major crisis they may be stretched to thin to get to you. Plan on the very least to get to a point where they can safely evacuate you.

Saturday, October 27, 2007

Media Relations during Crisis Response

Slightly two years after Hurricane Katrina, the Federal Emergency Management Agency (FEMA) is once again being criticized. The agency has received highly critical reviews of its response efforts during the 2005 hurricane response. The agency is widely viewed as having responded too late with too little. Two years later and many still blame FEMA for the lack of recovery in the New Orleans area.

The California wildfires are still burning as of this writing but by many accounts the response this time was much better. Citizens were evacuated in time and despite the massive property damage, many lives were spared. Inter-agency coordination worked much better this time with state, local and federal responders working with a synchronization seemingly unimaginable during 2005.

Perhaps this lack of friction caused complacency on the part of FEMA officials, regardless of the reason by now you will have heard of the “FEMA news conference”. Apparently a short-notice news conference was called giving reporters only 15 minutes notice. When no reporters showed up, FEMA personnel stood in as reporters and asked “softball” questions of Vice Admiral Harvey Johnson (FEMA deputy director). It is simply unbelievable that such an idea should have ever been conceived, much less attempted, by an organization with such a damaged reputation.

Media relations during a crisis response can either make an agency look like a hero or a fool. No matter how well the personnel execute the response effort, if the media gets the wrong message (or worse no message), the effects will be long lasting. The media must be viewed as an ally in getting the right message out. Your organization or agency must be seen as an honest broker of information and sincerity. If it isn’t, the effects can be devastating to the bottom line. The incident at Three Mile Island is a classic example of what I mean. Officials denied the facts, even in the face of overwhelming evidence to the contrary, and as a result nuclear energy to this day is still viewed with suspicion.

Gaming or ignoring the media is a recipe for disaster. Rather than avoid press conferences, agency leaders should actively schedule regular briefings to present an update. Avoid the short notice press conference (unless there really is something breaking), you will just be seen as trying to keep the media out. Work with your public information officer to develop a consistent theme to deliver in each and every update. Obviously as response efforts change, conflicting information can arise. It is imperative not to ignore these contradictions, explain them (or you may find that your explanations are provided for you by others!).

In physics you are taught that Mother Nature abhors a vacuum. In the media, lack of information is just as abhorrent. The tendency by industry or agency heads unfortunately is to answer questions on the fly or give glib answers. Both of the these tactics can lead to a public relations night mare. You goal should be to keep the story as a one night, local coverage event…not turn it into a national event.

Former Attorney Alberto Gonzales serves an example of turning a one night story into a national event. When he fired several judges (who were all Presidential appointees), he opted to give the answer they were being relieved for cause. Being appointed, the judges all served at the pleasure of the President and therefore Gonzales could have simply (and correctly) said the President would now like to make some changes. End of story but when Gonzales opened up the “relieved for cause” issue all of the judges could bring forward their performance appraisals (which all had excellent performance ratings). The more Gonzales attempted to explain his comments, the deeper he dug himself into a hole and the media attention increased.

Even small communities and companies need to be prepared to provide the right message. The steps you took to prevent or mitigate the crisis are articulated upfront. You need to convey the urgency with which you and other responding agencies are bringing the crisis to a successful conclusion. But most of all, you need to convey a sense of concern for all of the victims and what steps you are taking to help survivors with recovering from the disaster.

In my experience, the media has a sixth sense for finding the one employee that didn’t get the public information memo. You need to train ALL of your employees regularly on how to respond to media questions during a crisis response. “No comment” isn’t a response, it is a dodge. Have your media relations plan in place before you need it. If you are the head of your company or agency, it wouldn’t hurt to have you and your staff participate in a few mock interviews. You may think you are calm and collected speaking in front of a group but try it in front of a camera with a reporter asking several questions you never thought of. The practice could help you come off much better in front of the camera when it really counts.

The bottom line to remember is this an opportunity to let the public know how well you agency, community or company has prepared to respond during a crisis. Unfortunately for FEMA, they don’t quite seem to be there yet.

Friday, October 26, 2007

Cincinnati Bridges, our potential forest fire

The news for the last few days has been filled with images of the California forest fires. The devastation is almost unimaginable but also it seems people were evacuated in time saving countless lives. Sitting here in Cincinnati, with is wet clay soil and recent heavy rainfall, it hard to imagine what it must be like to see everything around you on fire. While a forest fire is very unlikely around here, we do have our own potential time-bomb just waiting to go off.

Cincinnati’s identity is inextricably linked with the Ohio River. It is because of the Ohio River that explorers first established settlements along the Ohio and Licking Rivers. The Ohio River allowed the economy of Cincinnati to first develop because of the commerce transported by first canal boats and later river boats. Many goods were shipped along the Ohio River but mainly pork. Before anyone ever heard of Chicago as the meat processing capital of the US, Cincinnati had the largest number of slaughter yards. You can’t live along the river and have a thriving economy without bridges. Cincinnati is no exception and has presently has six. In no particular order these are;

1. Roebling Suspension bridge (built in 1867)
2. I-75/71 Brent Spence bridge (built in 1963)
3. The Chesapeake & Ohio RR bridge (built in 1929) and Clay Wade Bailey bridge (built in 1974) stand immediately next to one another and share two piers in the middle of the river
4. I-471 Daniel Carter Beard bridge (built in 1981)
5. I-275 Combs Hehl bridge (built in 1979)
6. Taylor Southgate bridge (built in 1995 to replace the old Central Bridge)

Of these, the Brent Spence bridge has come to national attention after the I-35W bridge in Minneapolis collapsed back in August. The Brent Spence bridge merges two major interstates, I-75 and I-71, as traffic crosses between Ohio and Kentucky. The travel lanes are too narrow, and the merge lanes are too short. The signs are difficult to see, and the on- and off-ramps are spaced too closely together forcing sudden turns and braking by drivers unfamiliar with the exits. There's no room at all for emergency stops. Speeds vary within just several thousand feet. Daily use by cars and trucks long ago surpassed maximum design limits.

The Brent Spence bridge is primarily responsible for the urban development of Northern Kentucky (further increasing the traffic flow for this bridge). Some recent statistics about the Brent Spence Bridge that have come to light as a result of the tragedy in Minneapolis:

- The Brent Spence Bridge is one of only 15 major interstate bridges in the country labeled by the federal government as "functionally obsolete" for failure to meet safety or traffic flow standards.

- It ranks No. 7 among those bridges for highest crash rate, although deaths are few.
- Motorists are five times more likely to have a wreck on the bridge than on the interstate systems of Ohio, Kentucky or Indiana. About eight bridge accidents a month are bad enough to require police presence.

- Big trucks running side by side on the bridge have less than a yard of space between them. Remarkably, the big rigs account for just 11 percent of vehicles involved in reported accidents.

- Even minor mishaps can back up traffic for seven miles or more each way.

The bridge is not in danger of falling down, according to experts, however replacing the bridge would cost $750 million or more. It will take 12-15 years to build a new bridge and in the meantime traffic will continue to increase decreasing the life expectancy of this bridge. A failure of the bridge, especially at peak traffic times, could be devastating.

A response to the Brent Spence bridge disaster would be extremely complicated and slow. Both Ohio and Kentucky first responders and emergency management agencies would have to try and navigate the Ohio River to get survivors out (which becomes even more dire during the winter months with freezing water and ice flows complicating rescue operations). Traffic would be backed up for miles making it difficult, if not impossible, to get emergency vehicles in to evacuate casualties. Adjacent bridges would immediately be overwhelmed by the shift of traffic patterns and the flow of emergency response equipment. Downtown Cincinnati and Northern Kentucky would be put into gridlock. Many businesses would have to temporarily shut-down as workers and supplies could not get into town using the Interstate systems.

Unlike a forest fire or hurricane, if the bridge ever fails it will be without warning. We have about as much advance notice as we are ever going to get. All of us need to think about what such a cataclysmic event will mean to our families, our businesses and our community.

Thursday, October 25, 2007

Dirty Bombs

Fox News this morning had an item claiming that the United States is unprepared to respond to a dirty bomb. The item went on to say something on the order of 100,000 people could be affected in the event that a dirty bomb was detonated. I wasn’t able to locate the piece on their website to get the exact quote but believe I’ve captured the gist of the item.

The scenario of a dirty bomb arises every so often and yet there are some serious limitations to it that makes it a less likely scenario than you might think. A “dirty bomb” is not the same as a nuclear weapon. A dirty bomb uses a high explosive to disperse radioactive material. In that the first problem arises, namely assembling a bomb powerful enough to disperse the material over a large area and in a high enough concentration to effect people.

The bomb maker would have to steal enough high explosive, something like ammonium nitrate fuel oil (ANFO), which in and of itself would not be an easy task. Companies that have stockpiles of high explosives have tight security and accountability standards. In the event of a theft, authorities would be immediately alerted. Hiding a large amount of high explosives would not be easy.

Assuming however a group either stole or manufactured enough high explosive material, the next problem is procuring the radioactive material. Yes, there are many stories about weapons grade uranium missing from the former Soviet Union, however smuggling weapons grade uranium isn’t easy due to its telltale radioactive signature. The other problem is the danger posed to the bomb makers in simply handling such highly radioactive material. The slightest accident will result in the individuals receiving lethal doses of radiation. (This is also why attacks with biological or chemical agents are still rare. One misstep and the would-be bomb maker becomes a fatality).

Early detection of weapons grade uranium makes its use unlikely by a small group. Sure a nation-state could sponsor the manufacture of such a device but why not just build a nuclear weapon which is more powerful, accurate and reliable? The small group would probably resort to stealing radioactive material and the most likely candidate is Cesium-137 which is used in irradiators. These machines are used in hospitals, research facilities and food processing plants. Cesium-137 is highly radioactive and has a long half-life. The machines are relatively unprotected and some experts believe the radioactive material could be harvested and used in making a dirty bomb. The problem would be to seize enough material in a coordinated way before authorities would be alerted. The likelihood of being able to do that successfully seems unlikely.

A bomb powerful enough to spread the Cesium-137 would also reduce the concentration of the material and making it less harmful. Depending on the amount of Cesium-137, the explosion itself would cause more harm then the radiation. Weather conditions would also mitigate the effects of a Cesium-137 by winds blowing it away from populated areas.

The real effect of a dirty bomb then becomes the fear and panic its threatened use would incite in the populace. During the first Gulf War, Iraq threatened the use of chemical weapons. The threat would always forces service members into their chemical protective suits. Wearing charcoal lined suits in the desert is unbearably hot and the bulk of the material greatly restricts movement. By causing service members to don their protective gear, the effectiveness of the individuals was drastically reduced without the weapon ever needing to be actually fired or detonated.

The dirty bomb scenario seizes on the same principal; a threat is as good if not better than an actual attack. Citizens and employers will be forced to react to the threat. Disruption of services and the economy would quickly follow. Which brings up an important point, if a dirty bomb was the easy to build and detonate someone would have tried to use one by now. The difficulty in obtaining the necessary materials, the danger in manufacturing it and the unknown factors of weather make this a high-risk proposition for the terrorist with little chance of success. The preferred weapon still is high explosives. High explosives are safe to handle, powerful, and reliable.

While I believe a dirty bomb attack is unlikely based on the above reasons, I do believe Cesium-137 could still be used as a weapon of terror for another reason. As stated before, this material exists in irradiators scattered throughout the country. It only takes a small amount of Cesium-137 to effectively poison someone. Cesium-137 is highly radioactive and a small amount could be used with devastating results. It could be introduced into an office water cooler or food being served at a banquet. Radiation exposure is not something EMS and emergency room personnel routinely train for. Emergency rooms face more traumas as a result of violent crime or accidents. Treating a patient (or more likely patients) who have been exposed to radiation or poisoned with radiation would require very unique treatment protocols. The cost and likelihood of actually needing these protocols (over other ER treatments) may prevent ER personnel from being trained on them.

While the dirty bomb may not be a likely scenario, we do need to insure our radiological instruments are properly secured and accounted for. We already have seen what happens when our food supplies are contaminated by E. Coli, introduction of a radioactive material (which has no smell or taste) could be devastating.

Wednesday, October 24, 2007

Cincinnati Schools Report a 'Superbug'

Districts Report a ‘Superbug’
Drug-resistant form of staph found in some area schools

According to this morning’s Cincinnati Enquirer, at least four school districts are reporting cases of staph infection. These seem to be the drug resistant variant, methicillin-resistant Staphylococcus aureus (MRSA). School officials stated that this is not indicative of an outbreak. The district disinfected 124 schools to reduce the spread of infection.

MRSA is a bacterium most commonly colonizing around the nostrils and open wounds on the skin. MRSA was first discovered in the United Kingdom in 1961 but has now spread worldwide. It is termed a ‘superbug’ because it has mutated to the point where it can survive treatment with antibiotics to include penicillin and methnicillin.

It is most prevalent in hospitals and schools were there is the greatest incidence of human to human contact. Sanitation is a key in preventing further spread of the disease.

The outbreak here in Cincinnati provides us with an opportunity to evaluate our response to an epidemic and the eventual pandemic outbreak predicted once avian flu (H5N1) mutates into a sustainable, human to human virus. Yes, I know staph is a bacterium while the flu is a virus but the response by the community will involve some of the same factors.

Too often homeland security experts base their analysis on an intentional introduction of a pathogen by a terrorist organization (for example, anthrax). While important, such scenarios miss that Mother Nature is far more successful at introducing contagious diseases than anything think a group of humans can conjure up. The method of introduction gets more attention sometimes that what is being introduced. Infection, whether introduced artificially or naturally, creates the same response challenges for the infected community. For instance, the current MRSA outbreak has caused school officials to send kids home. Good, excellent, remove the vector and reduce the chance of the infection spreading. However, an important question we should be asking is what impact do sending sick kids home have on our economy? Tending to a sick child may require a parent to miss work if other family care arrangements cannot be made. This becomes problematic for those households where both parents work or for single parent households. Right now, the outbreak of MRSA is small enough that the economic impact will be negligible. What if though it continues to spread? More adults will be required to stay at home and also face becoming infected themselves. Work will begin to get disrupted. Services will begin to become impacted. Now adults with kids won’t be the only ones required to stay home, many families have elderly parents at home or other family members that my have compromised immune systems. Those adults may not want to come into work and risk infecting their family members.

Employers are going to have to insure that their workplace is clean and infection free (at least to the degree possible). The challenge will be for those businesses that have customers coming into the workplace, each of these people could potential bring in the infection or take it out of the workplace. Think about the next time you are driving on I-75 or I-71 and see all of the different license plates on the vehicles. You regularly see Michigan, Kentucky, Pennsylvania, Indiana even plates from Canada. All of those vehicles carry people who could potentially either introduce a disease or spread the outbreak to beyond the Cincinnati area. Employers will have to figure ways to minimize the spread of infection without compromising customer service. In addition, some employers may have to accomplish all of this with a reduced workforce.

Granted some business, particularly information technology based industries, will be able to utilize telecommuting and other technologies to allow employees to work from home. But the increased workload on the Internet backbones could cause slower speeds or even failure depending on the magnitude of the crisis. Even in high-tech businesses, some things still have to be accomplished on site. Insuring the safety on their employees will be a major part of successfully navigating the outbreak of a epidemic or pandemic illness.

Hospitals right now can meet the medical needs without any concerns. However, this could change should MRSA (or some other infection) begin to spread. Hospitals could become overrun with ill patients and will have to start sending patients to other hospitals creating a surge at neighboring facilities. Patients already admitted to the hospital for other conditions will now be at risk of exposure to the disease (and most likely these patients will have compromised immune systems). Hospital staff will be challenged with extended shifts and family care issues of their own. Staffing shortages will begin to happen as healthcare workers become sick, tired or just unable to come into work because of family care challenges.

This all assumes an actual outbreak of some kind, however we need to remember that even the threat of an outbreak can create similar challenges. Imagine even people believed avian flu was spreading or that someone had started to send anthrax laced mail again? People would stay away from areas they feel are high-risk (think of the recent flap created when Congressional staffers were advised to get a litany of vaccinations before attending a NASCAR race). Regardless the sanity of the guidance given to the staffers, it does remain valid that a large sporting event such as a NASCAR race could be a terrorist target. The methods that don’t need to involve an actual agent, a simple threat to use such an agent could create the same effect (panic and mass hysteria).

Now is the time to evaluate your procedures at work. We can’t ever stop someone (including Mother Nature) from introducing some type of pathogen into our community, but we can prepare now to reduce the impact to our business and families.

Tuesday, October 23, 2007

Where in the world is Losantiville?

Hopefully if you are reading this, it means that you have either heard of Losantiville or come from the Tri-state area. However in the event you don't, Losantiville is the original name for Cincinnati. In 1788, Israel Ludlow, Matthias Denman, and Robert Patterson purchased eight hundred acres from John Cleves Symmes along the Ohio River at the Licking River's mouth. They called this area "Losantiville" the name being a convoluted contraction of the idea that this was a "city across from the mouth of the Licking River."

I've always thought this to be a more elegant name for the Queen City rather than its later name, "Porkopolis" or even its current Cincinnati. I don't know, perhaps if we had kept Losantiville our city would have a different identity today. We may have become a more quaint city such as Ashville in North Carolina. Or we may have become more hip destination like Lexington. Instead, we are known as the city featured in WKRP in Cincinnati (which is one of my favorite sitcoms from the past). Or the home of the Bungles (sorry, Bengals), or the Big Red Machine (which was 30 years ago), or that funky chili made with cinnamon. Trust me, having lived around the country that's pretty much our pedigree.

It seems like everyone has a blog now and like others, I feel I've got something to say. Losantiville will be primarily focused on my observations of current events based on being from Cincinnati and having spent my formative years here (I went to St Xavier high school and the University of Cincinnati). I can still tell the difference between Skyline, Gold Star, Chili Time and Empress chili. I am not proud of but have consumed Burger, Hudepohl 14K, Hudy Delight, Little Kings Cream Ale, Schoenling and Sir Edward Stout (with a little Wiedeman and Cost Cutter thrown in for good measure). For those not from the area, those were all local beers with the exception of Cost Cutter which was a generic beer sold by Kroger's.

I spent over 2o years in the military (a combination of time in the US Air Force and Air National Guard). I now teach at Cincinnati State Tech and Community College which has really gotten me back into all things Cincinnati.

Right now the radio and TV news are sharing equal time between the super bug (multiple-resistant Staphylococcus aureus) and whether Chad Johnson will be traded later this year. I just don't get it, from all indications this super bug is very difficult to treat. The best bet is to never get it in the first place however thorough hand washing and following good sanitary practices will greatly reduce the risk of spreading infection. Unfortunately the track record for people doing these simple steps is not good. Just look at what has happened with out food supply recently. A number of produce items have been contaminated with E. Coli and recently a beef supplier went out of business for processing contaminated food.

My initial research into the superbug shows that the biggest risk for exposure is at hospitals (not schools as it would seem to be the case according to a flyer sent home with my kids). Why? Because Staphylococcus aureus normally enters through cuts and abrasions. Nothing like an incision to provide the type of exposure for this bug. But aren't hospitals the epitome of cleanliness and sanitation? Not necessarily so, other microbes (such as flesh-eating bacteria) run around hospital wards and operating rooms. All it takes is for someone to miss a disinfecting a bed rail and these germs have a ready made petri dish. Think of all of those human hosts with depleted immune systems.

But instead of providing us further information on this we get the latest soap opera courtesy of professional sports. Hey, don't get me wrong. I like watching football as much as the next guy but why do we allow ourselves to get so distracted by the antics of grown men (or women) who play games for a living?

Or what about the Bearcats? We haven't had a nationally ranked football team since 1954 so what happens? We lose two in a row and now people want to put Brian Kelly's head on a pike. Give me a break, this is his first year. Let's give the guy a chance to turn things around before we throw him under the bus.

But again more effort goes into discussing college sports than the proposed street cars. I may be in the minority but I actually like the street car concept, except the question becomes where exactly are they going to take us? Street cars may help commuters get to work but after quitting time, where are you going to go? Most of the destinations are either in Mt Adams or across the river in Kentucky. A real vision needs to be created for our city BEFORE we go about creating (and paying for!) the infrastructure to support it. Otherwise, we will just end up with a pink elephant on our hands (and another tax levy)