Showing posts with label Public Education. Show all posts
Showing posts with label Public Education. Show all posts

Sunday

West Nile Virus 2012. Hype or Threat?

 Is West Nile virus 2012 a serious public health concern or matter of media hype? 

The Centers for Disease Control and Prevention (CDC) tell CNN that the recent 2012 West Nile Virus outbreak is the largest ever seen in the United States.  Read CNN: West Nile outbreak largest ever.

Really? Worse by geographical distribution? By total number of cases? Fatalities? Not according to the CDC's Statistics, Surveillance, and Control Archive its not...at least not yet.

West Nile Virus (WNV) has hit the mainstream media in a big way over the last weeks of August, 2012. The virus is being dramatically portrayed as spreading, seemingly out of control, from state to state. As of this publication date, the Centers for Disease Control and Prevention (CDC) is reporting 1,118 human cases of WNV with 41 deaths attributed to the mosquito-borne disease. Going by these (most recent as of posting) numbers, the 2012 WNV situation is actually fairly average when guaged against previous years.  See How does 2012 WNV measure up to past years below.

Is the CDC intentionally contributing to the hype or are we missing something?

CDC categorizes WNV into broad groups; neuroinvasive and non-neuroinvasive disease. In other words, a severe form (neuroinvasive) that produces meningitis or encephalopathy and a less severe form. The 2012 data-to-date demonstrate that 56% of WNV cases are neuroinvasive, with 44% non-neuroinvasive or less severe.

Signs and Symptoms
As many as 80% of people infected with WNV will have no symptoms at all. Few may have mild symptoms resembling other viral illness such as influenza. One out of every 150 people infected with WNV go on to develop severe disease  - high fever, various neurological abnormalities, and weakness that may last several weeks. Neurological effects may be permanent.

How does 2012 measure up to past years? 
2012. An average year for WNV?
Looking back at the CDC data from 2011 to 2006 we find some interesting (albeit less dramatic) numbers. For that six-year period there were a total of 11,708 cases of WNV and 477 fatalities. That's an average of 1,951.3 cases/yr and 79.5 fatalities/yr. making 2012 look like an average year (of the last 6 years) for WNV.

Interestingly, the CDCs archived statistics 2003 would reign supreme as the worst outbreak ever. In 2003 there were 9862 reported cases of WNV and 264 deaths spanning 46 states.


According to the CDC West Nile Virus homepage:
  • People over 50 at higher risk to get severe illness. People over the age of 50 are more likely to develop serious symptoms of WNV if they do get sick and should take special care to avoid mosquito bites. 
  • Being outside means you're at risk. The more time you're outdoors, the more time you could be bitten by an infected mosquito. Pay attention to avoiding mosquito bites if you spend a lot of time outside, either working or playing. 
  • Risk through medical procedures is very low. All donated blood is checked for WNV before being used. The risk of getting WNV through blood transfusions and organ transplants is very small, and should not prevent people who need surgery from having it. If you have concerns, talk to your doctor. 
Vector control. Key to prevention or hazard trade-off?
The main countermeasure against WNV is to kill the mosquito that carries the virus by way of pesticide use. Substances such as malathion and parathion have been used. Both are organophosphate-based chemicals that can produce illness and cause reactions similar to chemical weapon nerve agents at toxic doses. More recently, the pesticide Zenivex has been used. Zenivex E4 is a skin and eye irritant that contains petroleum distillates and poses an aspiration pneumonia hazard. The NFPA rating is Health: 2 Fire: 2 Reactivity: 0. Zenivex has an oral toxicity LD50>5,000 mg/kg and an inhalational toxicity of LC50>2mg/L (4-hour).

Has public alerting technology made warning sirens obsolete?

Is hanging on to your siren warning system worth it? Many of the alerting siren systems are aging and becoming difficult if not impossible to maintain and operate. Siren systems have limited ability to do anything more than make noise. They can't tell the public what they need to know in order to take meaningful actions. In other words, for a siren-based alerting system to truly be functional, the public must know ahead of time what the activation means. Is there an storm coming or is there a meltdown at the local nuclear power plant? Is this simply a test activation? The cause may not be that easy to define but the fact remains that the public needs to know the message prior to the activation because the activation will not be able to give that message. We also like to convey  to the public what actions we'd like them to take based on our warnings. Do we want them to shelter in place or evacuate? We'd ideally like to be able to tell them or have them know ahead of time. Not only do communities need to know their role in advance of crisis, they need to pay attention and react to the situation - and the alert or warning.

So far, we've outlined some of the shortcomings of a siren system that a web-based or cellular messaging system might be able to fix.

Back to basics
A warning system has to be able to be get the job done in time of need. It has to be maintained and tested. The public has to be educated on what the alert or warning actually means. These things are universal regardless of the system used. Awareness and alert meaning are usually the result of emergency management public education public education efforts. Engaging the public is key.  A warning system must be able to do a minimum of three things:
  1. Tell the public why its been activated or what hazard is expected
  2. Tell the public what to do and why
  3. Tell the public how long they have to do it
These three simple items are asking a lot for even the best of siren-based systems. Should siren-based alerting systems be discarded in favor of web-based or cellular text alerting systems? Some people would argue that they should. New technology, social media, SMS/cellular messaging systems can solve the problems of awareness, notification, and meaning. New technology can produce real-time alerts, provide updated information on expected actions and hazards. Technology can even help educate the public. 

History lesson
The Control of Electromagnetic Radiation system or CONELRAD was developed in the cold war era and used from 1951 to 1963. As a radio-based system, it focused on key AM radio stations to deliver messages. AM 640 and 1240 were the designated stations. This system  worked because the AM radio was nearly a universal household item. Most automobiles were equipped with an AM radio, too. People were accustomed to getting their news, information, and entertainment from a radio during that time period.

The next generation of CONELRAD came into use around 1963 and functioned as the familiar Emergency Broadcast System or EBS. The familiar tone alert followed by the statement "this is a test - if this had been an actual emergency..." became well known to many in my generation. The EBS was upgraded for peacetime use to include FM radio and television as well as AM frequency.

In 1997 changes in technology made possible the Emergency Alert System. This system was maintained and tested by the FCC, FEMA, and the National Weather Service. One of the cornerstones of this system was that it claimed to be able to deliver a Presidential address to the nation within 10 minutes.

The Integrated Public Alert System (IPAWS) was designated in 2006. FEMA leads this project along with DHS, FCC, and NOAA. Later, in 2007, FEMA established the IPAWS program management office. With IPAWS, FEMA acknowledged new media as a method of message delivery. This system is estimated to be able to reach about 40% of the United States population during the day. Including new media and technology, the IPAWS system could reach the ever-expanding population that recieves a a majority of information from internet based technology.

An interesting note
Nation-wide emergency alerting systems were not used during September 11, 2001. When siren based systems were activated for more recent natural events, they were largely ignored by the public. Although newer technology was tested on a nation-wide basis in November, 2011, it is not clear exactly how successful those tests were.

Tuesday

Survival Basics for Civilians and Responders

Survival basics for your car will keep you going and improve response.

Hundreds of motorists were stranded on the New York State  Thruway this week when a tractor-trailer jackknifed blocking the road during a snowstorm. The storm eventually dumped over 2 feet of snow in the region south of Buffalo, New York. Hundreds of occupants of personal vehicles and commercial vehicles were stranded without any means of escape during the storm. Many were stranded for over 24 hours. Eventually, local fire department and police crews were able to make their way down the miles long lanes of stranded motorists to deliver extra fuel, food, and to assess the situation.

Criticism of the New York State Thruway authority has been building since the event on December 1, 2010. One of the criticisms was that the authority allowed traffic to enter the block area of roadway during the storm even though they were aware of the traffic jam. Another shortcoming has been described as the lack of a plan to deal with such emergencies and allowing the area to go on monitored and not being able to remove the truck blocking the lanes of travel.

This event has important emergency management and preparedness implications for us. First, we have to remember that no response will be successful if the public involved has not done at least some preparedness. In this case, it appears that few if any of the motorists in either private or commercial vehicles had any emergency supplies. Most complained of being cold yet did not have any spare clothing with them… some did not even appear to be dressed appropriately for the environment found in western New York this time of year. Another important thing to consider is the length of time it took traditional responders (police and local fire apartment) to get to those trapped in the snow. Most accounts indicate that it was over 12 hours before rescuers were able to make their way into the traffic jam to deliver supplies and assess the situation. One source was quoted as saying the reason for this delay was because this area of roadway is not routinely monitored by any jurisdiction.

Another frustration expressed by stranded motorists was that the responders were not able to give them any information on the situation. While this may be difficult to do, we should make every attempt to craft a generic statement that will give the civilians some information. That statement could be as simple as which radio station to tune into to get information and updates. A common misconseption is that if we inform the public of the actual situation they will panic. This is clearly a false belief. Information helps keep people calm and promotes compliance with instruction. Disaster research shows that when people are poorly informed, feel trapped, and hopeless that they begin to panic and make poor decisions.

Once again we have a local example of Optimism Bias in action. That is, it won't happen to me… if it happens to me, someone will be there to rescue me. We have to take measures to protect ourselves and be able to be self-sufficient (even rudimentary effort would help) in cases where rescue or assistance may be delayed.

Here are my tips for survival when stranded:
 
First, be sure to keep your car's fuel tank greater than half-full. Keeping your vehicles fuel tank  above half full or better will help make sure you can navigate detours if you're route is blocked. Keeping that much fuel in your vehicle will also allow you to run the engine for much longer in order to stay warm. It's important to keep in mind also that you should run the vehicle's motor only intermittently when stranded… just enough to warm up the interior every 30 to 45 minutes. On this point we should also mention the need for good ventilation in your vehicle… keeping a window cracked open to allow for fresh air and periodically checking the exhaust pipe to ensure it has not become blocked with snow or debris. Failing to do either of those could result in exposure to automobile exhaust and carbon monoxide poisoning.

Second keep a survival kit in your car. It does not have to be elaborate put should contain a few simple items. A hat, gloves, extra socks, and a pair of boots would be helpful as well as a warm blanket. It's best also to have some shelf stable snacks available. Candy bars, energy bars, and those little crackers and cheese combinations will work just fine. Along with something to eat you should try to keep something to drink in your vehicle as well.

Third, communications is key. Although we all have cellular phones these days it won't do us much good if the battery runs out. Therefore, keeping your cell phone charger (the car adapter type) in the vehicle will go a long way to letting people know where you are and getting information… especially if you were stranded for a prolonged period of time. Another important part of communications is your communications plan. Although we take traveling for granted it's important to let people know when were leaving and when we plan to arrive at our next destination. This is especially helpful when traveling during inclement weather seasons or in unfamiliar areas.

And finally, don't forget the shovel and salt. Keeping a small shovel in your vehicle may mean the difference between being stranded and effecting a self rescue. Also keeping a small bag of sand, gravel, or rock salt may be able to provide the needed traction to get yourself unstuck.

Although I recommend a shelter in place approach to surviving these situations, there may come a time where you have to decide to attempt self evacuation. The decision to leave safe shelter and walk out into a storm is not one to make lightly. You must consider your level of fitness, your clothing, your hydration and nutrition status, and the environment before attempting self rescue.



Planning and preparedness.
For those of us responsible for responding to such events there are several keys to successful operations. The first, of course, is pre-incident planning. If you have stretches of highway in your area you can find yourself dealing with hundreds, perhaps thousands, of stranded motorists in any season… from any cause. There is no excuse for not pre-planning your response with various size highway incidents involving multiple patients. Your threat assessment is a major part of the pre-planning process and should include natural as well as man-made events.

As a traditional responder you'll need to consider additional points:
First, what personnel and resources will I be able to bring to this situation and how long  will deployment take. In these large-scale events deployment of resources is often best done only after sufficient personnel, supplies, and equipment have been staged to support the effort. Although rapid triage crews may be effective, the main thrust of the response should only take place when all the pieces are together.

Secondly, you must make provisions early on for emergency incident rehabilitation. Your responders will be providing assessment and care in very difficult environmental conditions. Appropriate rehab and rotation of responders will go a long way to maximizing efficiency and extending crew viability.

Third, you'll have to make some difficult decisions as to shelter in place versus attempt evacuation. As noted above there are several conditions that have to be taken into account before people are moved from an area of relative safety into a hazard area.


This post will also appear in Mitigation Journal at www.mitigationjournal.org

Sunday

What if your department had a Wikileak?

Food for thought...when your internal secrets become public.

 Would you try to stop it? Would you try to prevent your deep, dark, agency secrets from becoming public? We're all familiar with the current wiki leak situation that's causing a stir around the globe. But what if this Internet distribution of sensitive information came home to roost in your emergency service?

 How confident are you that your service is properly collecting Medicaid or Medicare dollars, tax dollars, or is correctly billing for services? How would a wiki week on your billing practices or other revenue-generating activities be seen by your community?

How about your policies and procedures? Would they stand up to public scrutiny if to be suddenly made available to your general public? What about your quality assurance practices? It would be very interesting for the public to find out about some of the well-kept secrets and emergency service surrounding the quality and delivery of that service.

So, while the world is focused on the wiki leak induced hysteria over secret documents, take a few minutes to examine your internal structure… from billing to quality assurance… and ask yourself how would we measure up if all this got out?

Would you shine, or get a shiner?

Saturday

In Our Boots

This PSA comes from FireRescue1.com.
It's worth a minute to watch...trouble is, were not the ones that need to see it...



FlashoverTV is powered by FireRescue1.com
 
 
 
 


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