Is there a Nuke in your neighborhood?

Is there a Nuke in your neighborhood? Check out Nukeometer at http://nukeometer.com/

Just enter your city and country to find out how many nukes are within range of your city! The breakdown is given by potentially offending country and by delivery...ICBM, submarines, short range missile...these guys thought of everything!

Here in Rochester, NY, we're in range of 6404 nuclear warheads...2347 from the USA and 3684 from Russia, 192 from UK, 121 from China. 2490 of those can be delivered from ICBM and 2771 by submarine with only 1143 available by bombers.

By contrast, Denver Colorado is within range of 8127 warheads and Washington DC 6404 warheads. Tune in and find out where your location stands...pleasant dreams.

And Welcome to Part Two

As many of you know, I've made the difficult decision to retire from the fire department. Simply put, it is just time to move on. Amidst the change in pace, legal and financial council there has been little room for bogging or podcasting. My hope is that you'll all understand the rationale for my priorities over the last several weeks. When I announced my intent to retire to my superiors, I also requested a return to a staff position. I had been working on the line in various positions for the last two years, most recently as a battalion chief. Prior to that I had served as EMS/Health & Safety/Pandemic Planning Officer for about 9 years. In order to facilitate a meaningful hand-off to the next offer to take those rolls, it was my assessment (my boss agreed) that I should return to staff and prepare a transition.

My last uniformed day "on-the-job" was June 30, 2009 with offical retirement on September 21.

With that part of my life behind me, it is time for part two. What will follow is a mix of work, school, and of most importance...family. You see, my wife and four kids have taken the beating of my work schedule...ever changing...ever demanding...ever at the will of other people. I'm fortunate enough to have a job with several other offers, that allow flexibility and for me to do what I need to do and when I need to do it. I will also start nursing school this Fall...a change I'm sure from teaching the introductory sciences of anatomy, physiology, pathophysiology, and micro to being a student again.

Mitigation Journal will become a part-time job rather than a hobie. Stay tuned for the updates and changes!

Failure

When we fail to train together and understand the same goals and priorities...


ParamedicTV is powered by EMS1.com


ParamedicTV is powered by EMS1.com

Thanks, Mike for sending these in...

More Chemical Suicide

I've been made aware of a case of chemical suicide in Toronto via a memo on Toronto EMS letterhead. Although I've not been able to confirm the validity of the memo or find associated material on the event, it seems as if Toronto has had a case of chemical suicide. The chemicals listed in the Toronto EMS memo are among those on the list of potential chemicals for other events in Japan and the U.S.

When certain chemicals are mixed, Hydrogen Sulfide gas can be created. In some cases the gas has been created in concentrations greater than 2000 parts per million. Hydrogen Sulfide is more potent than cyanide, has a quick "knock down" - causing unconsciousness/respiratory failure - withing one to two breaths.

Chemical suicide events have taken place in hotel rooms, residential areas, and apartments. The latest trend is to mix the chemicals in a car parked in a parking lot. Both residential and vehicle borne events have the potential to cause responder deaths and mass casualty/multi-patient events.

In some cases, people have posted signs on the doors of apartments or windows of cars indicating their intent to commit suicide by chemical agent. Responders need to be aware of any unusual clues such as windows taped shut, open containers of liquids (chemicals have been mixed in small wash tubs), odors of any kind. We should also add a high index of suspicion for any "person over the wheel" calls - don't assume the person in that car is sleeping! If you think there has been chemicals involved in a situation - do not enter, do not open the car. Keep the area clear, create a parameter and keep yourself uphill and upwind - call for FD/hazmat.

Below is a list of links to prior Mitigation Journal posts from the podcast and blog...

Blog Postings:

Chemical Suicide in Cars

Suicide by Blood Agent

Podcasts:
Mitigation Journal Podcast #72
Mitigation Journal Podcast #64
Mitigation Journal Podcast #59

Mixed Messages on Flu Future

WHO recently reported there are over 11,000 cases of Swine Flu with 85 deaths spread over 41 counties. Mainstream media continues to report, albeit with less vigor, the spread of flu in NYC and an increasing number of school closures. The CDC continues to issue preemptive warnings about the possibility of flu strain mutation (a.k.a. antigenic drift). Indeed, many believe that this version of the Swine Flu may have a vengeance comeback in in the Fall of '09.

Yet, we as a culture have already forgotten the impact this flu event (or, non-event, if you prefer) had on the Planet Earth. There are mixed messages from all sorts of "experts" and media outlets. I've recently read that this strain of H1N1 lacks the bacterial pneumonia super-infection that marked the 1918 N1N1. Further, as this clinical picture continues to come into focus, we see a more seasonal flu-like mosaic; those who get the flu recover with little or no treatment, some require antiviral medication, and fewer still needing hospitalization. With the death toll at 85/11,000+ cases, the case fatality rate is running about 0.6%...far less than many thought it would be back at the end of April 2009. Although there is some debate, each flu fatality seems to be connected to "underlying medical problems."

In the 1976 Swine Flu epidemic, one person died of the flu and another 25 died of the vaccine. The point is that we still do not know why this flu emerged with fury in Mexico. And despite the travel-borne spread of the illness, it seems to lack the ability to rapidly and sustainably spread from person to person. Will this be the exclamation mark on the 2008-2009 flu season or is Swine Flu '09 the next major flu event waiting for '09-'10?

In any event we can not be lulled into false security thinking this flu event is over. Too many people are down-playing the roll of pandemic planning and accusing WHO, CDC, and local health departments of overreacting. How short sighted. It would also be a mistake to become so focused on flu that we forget the other threats and conditions we face. Recent media attention to domestic terrorism and North Korea nuclear weapons top the list.

The absolute worst thing we can do is forget about the situation...until we wake up in a different world one morning and find we've not learned anything...or prepared.

DHS/FEMA Announce Shelter System

I've been expounding this concept for years now...reminding us to get back to the Civil Defence mindset. My meaning has been simple: prepare the individual and the family, provide for save shelters in public areas (a.k.a. Fallout Shelters) to give people a place to go when out in daily life, and we'll greatly improve our ability to mitigate natural and intentional events.

Someone must have been listening...finally.

DHS and FEMA have announced the creation of a Disaster Shelter System to house civilians in the event of a natural disaster. Details are still drifting in, but we are moving in the right direction!
Check the source materials from Los Angeles Times and National Terror Alert.

Homeland Security Secretary Janet Napolitano and Craig Fugate mentioned that we will only be as successful to the level of preparedness of the family - and I agree. September is National Preparedness Month and we should all be making plans, keeping informed and getting involved as best we can to prepare ourselves, our families, and our communities for crisis. Remember - local efforts will save lives!

Now, onto some interesting statements:

Craig Fugate, the new director of the Federal Emergency Management Agency, further stated “We are only going to be as successful as the public is prepared,” and “There are a lot of folks who are going to need very specific help that should not have to compete with the rest of us.”

I agree with the first quote here - public preparedness make for an efficient and successful (as much as can be expected) response to emergencies and disasters. But what is FEMA Director Fugate talking about in the second quote? “There are a lot of folks who are going to need very specific help that should not have to compete with the rest of us.”

Who is competing with whom? Moving towards a shelter system is an excellent idea...but, yet again, we will overwhelm those resources if people are individually prepared! Even the best Nation-wide shelter system will fail under the strain of an uniformed, unprepared community.

Bomb Materials found in Home

A delivery company alerted emergency officials of a shipment of potential "bomb-making" materials and sparked an evacuation of the surround neighborhood. 40-homes were evacuated and a 300 ft. perimeter was established around a residence in Santa Cruz, CA. according to KION news. Again, another example of the potential for domestic terrorism. While we're all counting Swine Flu cases, groups and individuals from coast to coast have the ability to devastate.
Source and video link here. See also National Terror Alert.

There are a few interesting points in this situation. The challenge of evacuation of residential areas is difficult...this situation unfolded during the evening hours, contributing to an even greater challenge. Additionally, the neighbors of this suspect were not surprised he had bomb-making material and noted he has been making fireworks for "years." I think this level of familiarity with the situation may have complicated the evacuation request. But, we have to wonder why people didn't react (given their knowledge) to the change from fireworks to "bomb-making" threat.
Also at issue is decision to re-occupy. Police allowed residents to re-occupy later that night, only to come back the next day and find more material causing a second evacuation request. People were kept out of their homes for about 24-hours...but some admit to sneaking back in during the removal of the material. We need to be absolutely sure on our course of action when we initiate an evacuation and even more confident when we allow re-occupation. Getting people out and then letting them back in, only to evacuate a second time is dangerous. This misstep prompts people to second guess your action and leads to loss of credibility of your order. As in this case, people will find their way back in and potentially into harms way.
The implications are, of course, huge. Consider that if residence defy your evacuation or isolation (because of ignorance on their part or lack of confidence in your agency) you'll be in the position to have to commit resources to search and rescue that should be dedicated elsewhere. Bottom line: if you make the choice to evacuate...do it and initiate measures to keep people out until you are certain, without doubt, it is safe to let them back. (source: KION News and Terror Alert)
Evacuation - you only get one try

Flu Update as of May 22, 2009

The Centers for Disease Control and Prevention have posted numbers indicating 6,552 cases of Swine Flu in the United States. My estimate was we'd have over 5,000 cases in the US by next flu season...shot a bit low, I guess.The CDC is still guarded on the topic of person-to-person spread and possibility of increased cases and increased severity of illness. One thing remains certain, proper hand hygiene, respiratory etiquette, and when appropriate, social distancing, are effective countermeasures against the spread of flu.

"It’s thought that novel influenza A (H1N1) flu spreads in the same way that regular seasonal influenza viruses spread; mainly through the coughs and sneezes of people who are sick with the virus." (CDC)

Mitigation Journal Flu Planning Available

I opened the Mitigation Journal "Members Only" site to all blog readers and podcast listeners a few weeks ago. The idea was to help get factual information on general planning and details on flu out to as many as wanted it. The materials compiled here are open consumption, so feel free. I'll continue to add to and update as possible and this site will remain open until further notice...please let me know what you think

Go to the Mitigation Journal site here and navigate to the Training File page...look under the disease and flu file.

Info will be updated and added frequently...check for updates often or subscribe to the RSS feed. Also see the List of Flu-Related Posts from Mitigation Journal for more information.

Direct link: https://sites.google.com/site/mitigationjournal/Home/training-file

Japan Over Action - Set Up for Failure?

Talking about over-reaction!? The New York Times is reporting how Swine Flu is impacting Japan and apparently causing tremendous concern...

"Like many other countries, Japan has reported mild flu cases and no deaths. Still, it is in crisis mode: more than 4,800 schools have been closed in the region, medical services are swamped, and testing laboratories are working around the clock."
This quote should illustrate the difference between destruction and effect. No deaths but still considerable impact on the systems of infrastructure. Consider the Ripple Effect of the situation as routine calls for service and routine visits to hospitals continue to come in. I'm suprised at this situation and wondering what was learned from SARS.

"The outbreak has come as a particular shock for hygiene-obsessed Japan, where hand-washing is religiously taught in schools, children play in sanitized sandboxes, and everything from underwear to ballpoint pens comes with supposed antibacterial properties." Has hygiene gone too far? An earlier posting (see Emerging Diseases and the Hygiene Hypothesis October, 2007) discusses the impact of removing stimuli from a immune system. Cleaner is not always better.

Reminds me of the UniBomber

This story reminds me of the UniBomber cases...
CNN is reporting two low-order improvised explosive devices were detonated outside a Starbucks Coffee in Manhattan. There were no reports of injury and investigators are looking at similarities between this event and other bombings in NYC. Click here for the direct link to CNN.

Before we blow this off as another non-event, consider the possibility of such an attack. Soft target and explosive devices mean instant mass casualty event. Think about how someone could use this type of event to test or probe our response. Now consider the possibility of a coordinated multi-location attack...get the picture. Small events like this one should give us a glimpse of what we need to be prepared for in the future.

Take all explosive events seriously...IED and homemade...look for the clues and consider soft targets and responders as areas in need of pre-incident planning.

Flu Closes More NYC Schools

CNNHealth is reporting that an additional 31 schools in NYC have been closed due to outbreaks of influenza like illness or ILI. This is in addition to the 11 schools closed last week. CNN also notes that most of the schools will re-open shortly. Read the story HERE.

Is closing schools the best way to deal with an infectious disease? My answer is; not by itself, closure of schools will not stop the spread of disease. In order for this theory to work we have to close other public venues...shopping centers, recreation centers, and make sure people stay away from each other. In other words, closure of schools is only part of a reasonable social distancing plan. Social distancing is the practice of keeping people out of public groups and avoiding close contact. Social distancing is not synonymous with isolation or quarantine. Both of those words are charged with negative connotation.

The point is that closing schools creates several logistical issues and may not provide any benefit. Consider the impact on single parent or double-income households and the problems caused by keeping kids out of school. If you're going to close the schools, do as much as possible to keep those students apart.

If we're not able to keep students apart when schools are closed due to spread of disease, what will we do when the time comes that we actually need to impose social distancing, isolation or quarantine?

Will the Flu Continue this Summer?

Will the Flu Continue this Summer?
Check this out, from Medical News Today: Swine Flu Has Struck 41 Countries, 11,034 Cases, Including 85 Deaths

It will be interesting to see if this trend continues throughout the summer months. In any event, get your flu shot this year!
For those of you in emergency service, traditional responders (including Law Enforcement) and non-traditional responders (read: hospital staff)...this is a good time to get your infection control procedures up-to-date, and you might have about 4-6 months to get a community plan for flu together.

Attacking Hemagglutinin and Neuraminidase

Hemagglutinin and Neuraminidase are the proteins of the Type A flu. Hemagglutinin allows the virus to enter a host cell (remember, virus is must have the cellular mechanics of a host) and Neuraminidase allows the virus to reproduce and exit...going on to infect another cell. To date, antiviral agents attack Neuraminidase (Neuraminidase inhibitors). New research outlined in Medical News Today, highlights the possibility of attacking both the H and the N. See the article here: In A New Way Of Treating The Flu, Both The H And N Portions Of The Virus Are Targeted

This would be good news for all of us as virus begin to become resistant to medications such as Tamiflu.

More posts in 2009

Here we are, entering the last week of May 2009. With half the year behind us (almost) we're recording record visits to the blog and podcast! As of last week I've posted more blog entries than ever in the nearly four-year history of Mitigation Journal. The podcast audience is booming...I know because of the stat numbers, subscribers, and bandwidth costs.

The first half of '09 has been busy for sure. Some of our biggest topics so far this year -

• Use of flu tracking apps for iPhone and PDA's
• Coverage of cyanide poisoning in firefighters
• Info on Emergency Incident Rehab
• Seasonal and Swine Flu

The really impressive thing to me is the number of times we would either discuss a topic on the podcast or post about it on the blog only to find traditional media outlets covering the material weeks or months later. Mitigation Journal is ahead of the curve! I guess all the show-prep and editing time is worth it.

So as we get ready to celebrate four-years of blogging and three-years of podcasting...let me say thanks for reading and listening!
Rick