A place for the latest news, information and discussion regarding disasters, terrorism, emerging infectious diseases, disaster response, mitigation and preparedness!
In the April issue of the journal, CHEST, there was a study about the increased use of cigarette smoking among NY Firefighters. It’s entitled: The New York City Fire Department World Trade Center Tobacco Cessation Study and the authors are: Matthew P. Bars, MS, CTTS; Gisela I. Banauch, MD, MSCR; David Appel, MD; Michael Andreachi, HS; Philippe Mouren, BA; Kerry J. Kelly, MD and David J. Prezant, MD, FCCP
In the Introduction the authors stated that after 9/11, 15% of the rescue workers from FDNY considered themselves to be current cigarette smokers. After the collapse of the Towers, 98% reported acute respiratory symptoms and 81% reported health concerns.
Nevertheless, 29% of the current smokers increased tobacco use and 23% of ex-smokers resumed smoking.
Comment: It’s amazing how terrorism continues to act upon us even after the acute phase fades.
The effects of modern day terrorism on mental health are not well understood. Described here is a 51-year-old male with no pre-existing mental illness who developed paranoid delusions related to the September 11, 2001, terrorist attacks shortly after they occurred. After about two years of treatment with quetiapine the patient was no longer delusional about terrorism but experienced extensive paranoid delusions about commonly encountered persons, requiring treatment which continues to the current time. Clinicians should be aware of the possible impact of terrorist activities on the mental health of vulnerable individuals.
Introduction
The terrorist attacks of September 11, 2001, shocked the world and had a devastating effect on many people, including individuals with and without mental illness. As would be expected, many of those directly exposed to the traumatic events had increased rates of post traumatic stress disorder (PTSD) symptomatology and anxiety[1,2] and those who lost friends or family experienced increased rates of depression.[3] Brief psychotic episodes occurred in rare instances[4] and at least one patient with a pre-existing mental illness was temporarily worsened by the attacks.[5] Presented here is a patient with no prior mental illness who developed persistent paranoid delusions secondary to the September 11 terrorist attacks.
Case Report
Our patient, a 51-year-old male, was brought by his wife for evaluation on October 22, 2001, because of increasing paranoia for about a month. He related that several days after the September 11 terrorist attacks he began thinking that his small rural town was the intended site of the next attack. His sleep decreased to about three hours per night and he became hypervigilant. He worked for a trucking firm and started thinking that the trucks were carrying hidden weapons or explosives. When a new trainee was hired, the patient believed that he was part of an attack plot. Occasionally he complained of smelling strange odors which he believed were poisonous gases or toxic substances produced by terrorists.
The patient’s medical history was unremarkable and he was on no medications. He had no history of any psychiatric problems. He denied use of drugs or alcohol except for occasionally drinking beer at social events. He had no family history of mental illness. He had grown up in a rural area and described his childhood as happy. After completing high school he spent two years in the Army with an honorable discharge. He had been married to his wife for over 20 years and both of them described the marriage as satisfactory. He had been employed by the same employer for over 12 years preceding his presentation.
Treatment was started with quetiapine 25 mg b.i.d. with gradual increases in dosage. However he became increasingly paranoid. He climbed trees to use binoculars to monitor suspicious vehicles in his town and talked about buying guns and ammunition. He was eventually unable to continue working and had to be hospitalized.
He expressed great relief when admitted to a psychiatric unit because he felt the hospital was relatively safe. Examination revealed him to be cooperative and polite. He was anxious. Mood was euthymic or mildly depressed. His thought processes were coherent and cognitive functioning was within normal limits. He was paranoid and preoccupied with paranoid delusions of his town being the site of a terrorist attack as noted above. He believed that a number of individuals were involved in plots, that he was a specific target, and that a variety of everyday events were somehow related to the activities of terrorists. Physical and neurologic examinations were within normal limits. Laboratory studies, EEG, and MRI of the brain with gadolinium were unremarkable. Psychological testing included a Mini Mental State Examination[6] score of 30/30. His score on the Hamilton Rating Scale for Depression[7] was 13, not suggestive of a primary depressive process. On the Positive and Negative Syndrome Scale for Schizophrenia (PANSS)[8] he scored 22 (of a possible 49) in the positive scale, 13 (of a possible 49) on the negative scale, and 26 (of a possible 112) on the general psychopathology scale. Although he was anxious, he did not have any other symptoms of post traumatic stress disorder (PTSD). He met criteria for an initial diagnosis of psychotic disorder not otherwise specified.[9]
The dosage of quetiapine was gradually increased and titrated to control his paranoia. Improvement was slow and ultimately 300 mg b.i.d. was required. After a few weeks in the hospital he expressed discouragement about his life and the future in general and was thought to be having some depressive symptoms and sertraline 50 mg daily was started. A month after admission he was discharged on these medications.
Although he had concerns about his symptoms of insomnia and anxiety, the patient was unaware of having any kind of psychotic or delusional disorder, even after this was discussed with him. He did not consider his beliefs about terrorist attacks as delusions but actual facts and could not be convinced to attribute his unusual thoughts to a mental disorder. He was unaware of potential social consequences of his mental disorder, although it had already impaired his relationship with his employer and coworkers. The patient perceived quetiapine as being prescribed for anxiety, not for delusional thoughts, and was unaware of its effects on those thoughts.
With time his paranoia began to gradually lessen and after about two years, attempts were made to wean the quetiapine. He tolerated initial decreases, but dosages of less than 100 mg b.i.d. resulted in recurrence of paranoia and he had to remain on the medication. However his delusions had shifted from ideas related to the terrorist attacks to other generalized persecutory thoughts about different individuals (such as his neighbors and the local police) wanting to harm him, spying on him, and telling harmful lies about him. Although his paranoia was significant, at this point none of his delusions were bizarre and he fulfilled DSM-IV-TR criteria for a diagnosis of delusional disorder, persecutory type.[9] His mood was moderately improved and he also remained on sertraline. As of August 2005 he continued to require treatment.
Discussion
Our patient’s lack of insight about his mental disorder undoubtedly interfered with his improvement. Many reports indicate that a majority of patients with psychotic disorders have poor insight. Such patients appear to deny, fail to acknowledge, or in essence, lack awareness of having a mental disorder or symptoms of a mental disorder.[10,11] A body of literature has developed which suggests that poor insight may play an important role in the course of psychotic disorders. Such would appear to be the case with our patient. Why such a phenomenon occurs is unclear. Parallels have been drawn between lack of insight in psychosis and the loss of self awareness that often accompanies frontal lobe dysfunction or anosognosia related to lesions of the right parietal lobe. Alternatively, lack of insight early in the course of illness may be a psychological defense.[12]
Not enough is known about the mental health effects of modern day terrorism. Patients with elevated rates of PTSD symptomatology following the September 11 attacks have not been followed longitudinally and the long-term psychological consequences for these individuals are unknown. It was anticipated that veterans with pre-existing PTSD would have exacerbations of symptoms by the attacks. However, analysis of symptom levels and service utilization data in samples of veterans with PTSD have failed to demonstrate exacerbations of PTSD symptoms or increases in service utilization after September 11 and have even documented the opposite effect in some samples.[13-15] On the other hand, one sample of veterans demonstrated a significant increase in PTSD symptom severity directly after the terrorist attacks, followed by a return to baseline functioning.[16] Thus, what clinicians might anticipate in terms of chronic PTSD symptomatology related to terrorist attacks on the United States is not yet clear.
Similarly, only limited reports are available concerning the relationship of the terrorist attacks and other mental illnesses. Residents who lived in the neighborhood of the World Trade Center were surveyed immediately after September 11 and five months later; prevalent anxiety was found in general community residents and additional depression in those who lost family or friends.[3] Clinicians also identified individuals who developed psychotic symptoms after heavy exposure to the media coverage of the attacks. Their symptoms resolved with time.[4] A patient with a pre-existing mental illness with psychotic symptoms who had to be evacuated from the World Trade Center did not receive any specialized treatment during the ensuing months as his mental state deteriorated, and he eventually required psychiatric hospitalization for a full blown psychotic episode. He had not needed hospitalization previously and the trauma of the terrorist attack was felt to have precipitated the psychotic episode leading to his first admission. He improved after 42 days in the hospital.[5]
Our patient appears to have developed a persistent mental disorder other than PTSD secondary to the stress of the September 11 attack, or at least to have experienced precipitation of a latent, previously unrecognized condition. This case demonstrates that certain individuals may be particularly vulnerable to the effects of events of this nature. Acts of terrorism are particularly stressful because they lead to continuing uncertainty of future terrorist acts. Literature on disaster mental health has frequently described important differences between natural and man-made disasters.[17] Natural disasters typically have an identifiable low point, after which the worst is over and the process of recovery can begin.[18] In contrast, a man-made disaster typically poses continuing uncertainty about when it began, when it will end, and what continuing effects victims may yet encounter.[19] The fact that Americans are unaccustomed to such a manifest threat on their own soil and the possibility that global terrorism may be entering a dangerous escalating phase creates an environment which may have a significant impact on vulnerable individuals. Cases such as that of our patient and the others mentioned above suggest that clinicians should be aware of the possible impact of terrorism on certain people, with possible worsening of some patients who already have mental illness and precipitation of symptoms in certain individuals who have no history of pre-existing mental illness.
References
Galea S, Ahearn J, Resnick H, et al. Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med 2002;346:982-987.
Schlenger WE, Caddell JM, Ebert L, et al. Psychological reactions to terrorist attacks: findings from the national study of Americans’ reactions to September 11. JAMA 2002;288:581-588.
Chen H, Chung H, Chen T, et al. The emotional distress in a community after the terrorist attack on the World Trade Center. Community Ment Health J 2003;39:157-165.
Rushing SE, Jean-Baptiste M. Two cases of brief psychotic disorder related to media coverage of the September 11, 2001 events. J Psychiatr Pract 2003;9:87-90.
Ellick JD, Paradis CM. The effects of the September 11 World Trade Center attack on a man with preexisting mental illness. Psychiatr Serv 2004;55:1313-1314.
Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
Hamilton A. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62.
Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261-276.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
Amador XF, Strauss DH, Yale SA, et al. Awareness of illness in schizophrenia. Schizophr Bull 1991;17:113-132.
Amador XF, Strauss DH, Yale SA. Assessment of insight in psychosis. Am J Psychiatry 1993;150:873-879.
Thompson KN, McGorry PD, Harrigan SM. Reduced awareness of illness in first-episode psychosis. Compr Psychiatry 2001;42:498-503.
Reeves RR, Liberto V. Reactions of Veterans Administration psychiatric patients to the September 2001 terrorist attacks (letter). South Med J 2001;94:1139.
Rosenheck R, Fontana A. Use of mental health services by veterans with PTSD after the terrorist attacks of September 11. Am J Psychiatry 2003;160:1684-1690.
Rosenheck RA, Fontana A. Post-September 11 admission symptoms and treatment response among veterans with posttraumatic stress disorder. Psychiatr Serv 2003;54:1610-1617.
Niles BL, Wolf EJ, Kutter CJ. Posttraumatic stress disorder symptomatology in Vietnam veterans before and after September 11. J Nerv Ment Dis 2003;191:682-684.
Ofman PS, Mastria MA, Steinberg J. Mental health response to terrorism: the World Trade Center bombing. J Ment Health Counseling 1995;17:312-320.
Baum A, Davidson LM. A suggested framework for studying factors that contribute to trauma in a disaster. In Sowder BJ (ed): Disasters and Mental Health: Selected Contemporary Perspectives. Washington, DC, US Department of Health and Human Services, 1985, pp 29-30.
Bollin R. Disaster characteristics and psychosocial impacts. In Sowder BJ (ed): Disasters and Mental Health: Selected Contemporary Perspectives. Washington, DC, US Department of Health and Human Services, 1985, pp 2-27.
Sidebar: Key Points
Acts of terrorism are particularly stressful because they lead to continuing uncertainty about when they will end and what continuing effects victims may yet encounter.
The potential effects of modern day terrorist activities on mental health are poorly understood.
Clinicians should be aware of the possible impact of terrorism on the mental health of vulnerable individuals.
Reprint Address
Reprint requests to Roy R. Reeves, DO, PhD, Chief of Mental Health (11M), VA Medical Center, 1500 E. Woodrow Wilson Drive, Jackson, MS 39216. Email: roy.reeves@med.va.gov
Roy R. Reeves, DO, PHD, John J. Beddingfield, MD, G.V. (Sonny) Montgomery VA Medical Center and the University of Mississippi School of Medicine, Jackson, MS.
Apr 28, 2006 (CIDRAP News) – There is no practical way to clean disposable medical masks and N95 respirators to allow them to safely be reused if supplies run short in an influenza pandemic, a panel of experts at the Institute of Medicine (IOM) has concluded.
However, that doesn’t mean a mask or respirator can’t be used more than once by the same person, provided it’s still in reasonable condition, the committee said. At the same time, the panel cautioned that little is known about the effectiveness of the devices or about how flu viruses spread.
On the assumption that supplies may run short in a flu pandemic, the US Department of Health and Human Services (HHS) asked the IOM in January to assess the possibility of reuse of disposable masks and N95 respirators.
Medical masks fit loosely over the nose and mouth and are mainly meant for use by healthcare workers and patients to prevent them from spreading pathogens by sneezing and coughing, the IOM noted in a news release about the report.
N95 respirators, in contrast, are used in both medical and industrial settings to protect wearers from inhaling harmful microscopic particles, the IOM said. They are designed to fit snugly around the mouth and nose. When properly fitted, they should filter out 95% of aerosol particles.
The committee stressed that neither type of device has been tested for its ability to protect people from flu viruses.
The IOM said the committee found disposable masks and respirators “do not lend themselves to reuse because they work by trapping harmful particles inside the mesh of fibers of which they are made. This hazardous buildup cannot be cleaned out or disinfected without damaging the fibers or other components of the device such as the straps or nose clip.”
Further, the panel couldn’t identify any simple changes in the devices that would permit reuse, or any changes that would eliminate the need to test the fit of respirators to ensure that they work, the IOM said.
But that doesn’t necessarily rule out reuse of a respirator or mask by the same person, the report says.
A person who wants to reuse an N95 respirator should wear a medical mask or a clear plastic face shield over it to protect it from surface contamination, the committee said. The user should store the respirator carefully between uses and should wash his or her hands before and after handling it and the device used to shield it.
As for masks, manufacturers told the committee that several models can be used repeatedly by the same person until they become damaged, moist, dirty, or hard to breathe through, the report says. It says this is acceptable for infected patients in particular, since reuse is unlikely to increase their risk of contamination.
The report also notes that there are respirators with replaceable filter cartridges, and these can be reused by one or more wearers. Though they cost more than disposable respirators, they are worth considering as an alternative, in the panel’s judgment.
The IOM says that little is known about the effectiveness of masks and respirators or even about how flu viruses spread.
“Even the best respirator or surgical mask will do little to protect a person who uses it incorrectly, and we know relatively little about how effective these devices will be against flu even when they are used correctly,” said Donald S. Burke, professor of international health and epidemiology at Johns Hopkins University in Baltimore and co-chair of the IOM committee.
The IOM release says it is not known whether flu viruses “disperse as aerosolized particles released in the breath of infected people, spread on larger droplets projected through coughing and sneezing, or are contracted through physical contact with contaminated people and surfaces.”
The committee calls for HHS to sponsor research on how well masks, respirators, and other filtering materials protect against flu viruses. In addition, methods should be developed to decontaminate masks and respirators without damaging them, the IOM says.
Comment: Keep in mind that when Toronto medical personnel wore surgical masks taking care of patients, some contracted SARS. That really didn’t happen when they wore N-95 respirators.
There are some officials who believe surgical masks are sufficient. Poppy-cock! When advanced airway management becomes a necessity (e.g. intubations, aerosol therapy, etc.), the minimum standard should be N-95 respirators. I am even wondering whether personnel should be wearing PAPRs in those instances. Rega
Exercise by the World Economic Forum and Booz Allen finds potential strains on healthcare and telecommunications infrastructure.
Advance planning and public-private partnerships needed for effective response
NEW YORK, April 27, 2006 – A simulated influenza pandemic conducted by the World Economic Forum and Booz Allen Hamilton found that a widespread outbreak of avian flu would severely challenge governments and the private sector to manage essential services, limit the spread of the pandemic and communicate essential information.
More than 30 CEOs and senior executives from leading corporations, private and public sector institutions and governments gathered on January 26, 2006 at the World Economic Forum Annual Meeting in Davos, Switzerland to explore the implications of an influenza pandemic.
A flu pandemic conjures up images of streets and buses full of people going about their business with masks covering the lower half of their faces. But how useful would those devices actually be? A 12-person panel of experts, convened by the government, answered part of that question yesterday. It said that form-fitting molded “respirators” would be better than clothlike surgical masks, and surgical masks would be better than handkerchiefs and scarves. But how much protection any would provide is largely unknown — as is the question whether they could be safely washed and reused if there were not enough new ones in a pandemic…
In the weeks after Hurricane Katrina struck the U.S. Gulf Coast on August 29, 2005, reports of increased injuries and symptoms of physical illness and psychological strain among New Orleans police officers and firefighters prompted CDC to conduct a health hazard evaluation of these two groups. Questionnaires were distributed to members of the New Orleans Police Department (NOPD) and New Orleans Fire Department (NOFD) 7–13 weeks after the hurricane. This report summarizes the results of that evaluation, which determined that upper respiratory and skin rash symptoms were the most common physical symptoms reported by police officers and firefighters and lacerations and sprains were the most common injuries. In addition, approximately one third of the respondents reported either depressive symptoms or symptoms of posttraumatic stress disorder (PTSD), or both. These results underscore the need to incorporate the safety and health of emergency responders into existing disaster preparedness plans and to provide periodic responder training and education in tasks unique to disaster situations. Clinical follow-up of the physical and psychological health of emergency responders should be conducted to better understand, monitor, and treat their health conditions.
Investigators distributed survey questionnaires to NOPD members during October 17–28 and to NOFD members during November 30–December 5. The survey included questions about exposures to floodwater or floodwater sediment, work duties, housing status, physical and mental health symptoms, injuries, and whether medical care was sought. Respiratory and gastrointestinal symptoms were considered hurricane related if the respondent reported having the symptom every day or almost every day during the preceding 4 weeks and reported not having the symptom before Hurricane Katrina. A score of greater than 22 on the Center for Epidemiologic Studies Depression Scale was used to define major depressive symptoms and the Veterans Administration checklist was used to define symptoms consistent with PTSD
NOPD officials estimated that 1,650 police officers were employed by the department before Hurricane Katrina, and 1,200–1,400 police officers were on duty at the time of the interviews; 912 police officers completed the questionnaire, resulting in an estimated overall participation rate of 65%–76%. NOFD officials reported 683 firefighters on its most recent (prehurricane) roster; 525 (77%) completed the questionnaire. Median age of participants was 37 years (range: 19–78 years) for police officers and 42 years (range: 20–64 years) for firefighters. Eighty percent of police officers and 96% of firefighters were male. Police officers had a median job tenure of 8 years (range: <1--41 years); median tenure for firefighters was 13 years (range: <1--40 years). Not all participants responded to all questions; the number of responses per question ranged from 845 to 912 for police officers and from 487 to 525 for firefighters.
Floodwater contact with the nose, mouth, or eye was reported by 51% of firefighters (254 of 500) and 30% of police officers (258 of 864); 52% of police officers (473 of 910) and 63% of firefighters (330 of 524) reported rescuing citizens from flooded areas. Sixty-nine percent of police officers (618 of 899) and 59% of firefighters (288 of 490) reported that they were not living with their families at the time of the survey.
Police officers and firefighters reported similar prevalences of physical health symptoms.
Approximately 28% of police officers (236 of 848) and 31% of firefighters (162 of 525) reported upper respiratory symptoms (i.e., head/sinus congestion or nose/throat irritation).
Cough was reported by 21% of police officers (176 of 845) and 23% of firefighters (124 of 525).
Skin rash was reported by 54% of police officers (493 of 909) and 49% of firefighters (258 of 525)
Injuries most commonly reported by police officers and firefighters were lacerations (police officers: 20% [184 of 912] and firefighters: 24% [127 of 525]), sprains/strains (13% [120 of 912] and 25% [130 of 525]), falls (9% [84 of 912] and 10% [54 of 525]) and animal bites/stings (11% [104 of 911] and 8% [41 of 525].
Of 525 firefighters, 114 (22%) reported symptoms consistent with PTSD, and 133 of 494 (27) reported major depressive symptoms. Of 912 police officers, 19% (170) reported PTSD symptoms and 26% (227 of 888) reported major depressive symptoms. Among all police officers, 31% (279) reported seeing a health-care provider for post-hurricane illnesses and injuries; health-care utilization among firefighters was not assessed.
Editorial Note:
The findings from these surveys indicate that, 7–13 weeks after Hurricane Katrina, a substantial proportion of police officers and firefighters in New Orleans had injuries and symptoms of physical and mental illness. The prevalences of reported respiratory symptoms, skin rashes, and injuries were similar to those reported by Katrina relief workers through active CDC surveillance in the greater New Orleans area 3). The high prevalence of symptoms for PTSD and major depressive symptoms among police and firefighters is consistent with reports of increased risk for PTSD and depression after natural disasters (4,5). Police officers and firefighters also experienced stressors such as extended working hours, sleep deprivation, hostile communities, separation from their families, and destruction of their homes (6).
The relation between floodwater exposure and reported symptoms of illness is not clear. Hazards in floodwaters vary but can include varying amounts of sewage, household and industrial chemicals, petroleum products, pesticides, and flammable liquids. Floodwaters also can obscure physical hazards (e.g., storm debris or drainage openings); other threats are posed by displaced domestic animals (7,8).
The inherent dangers of the work of police officers and firefighters likely were compounded by the environmental hazards and personal stressors after Hurricane Katrina. In addition, certain police officers and firefighters were assigned to atypical activities (e.g., narcotic control officers who performed search and rescue operations) for which they might not have been adequately prepared. Full clinical diagnostic assessment of physical and psychological health is necessary to determine the breadth and scope of illness in persons with persistent symptoms. The National Institute for Occupational Safety and Health has prepared guidance for medical screening to assess the fitness of persons for deployment as recovery workers after a hurricane (9). These guidelines also can be used as a part of periodic medical evaluations to assess whether emergency responders meet minimal physical requirements to perform work duties.
The findings in this report are subject to at least three limitations. First, only police officers and firefighters working at the time of the surveys were included, introducing the possibility of participation bias. Second, responses to traumatic events can provoke a range of reactions, including intensifying preexisting symptoms; therefore, new symptoms alone are not adequate to fully document physical or mental illness. Finally, even psychological symptoms persisting for 1 month might be normal and reversible acute stress and grief reactions; responses to the questionnaire alone are not sufficient to diagnose PTSD or major depression (10).
Reducing risks for illness and injury to police officers, firefighters, and other emergency responders requires combining the capabilities of multiple government and private response agencies. Safety and health guidelines for emergency responders should be incorporated into existing disaster preparedness plans. These should include periodic disaster response training and education in tasks unique to disaster situations. Additional information regarding safety management strategies and guidance for emergency workers is available at http://www.cdc.gov/niosh/docs/2004-144, and comprehensive information regarding prevention of worker illness and injury after hurricanes and other natural disasters is available at http://www.cdc.gov/niosh/topics/flood.
References:
Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol 1977;106:203–14.
Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA. Psychometric properties of the PTSD checklist (PCL). Behav Res Ther 1996;34:669–73.
Fullerton CS, Ursano RJ, Wang L. Acute stress disorder, posttraumatic stress disorder, and depression in disaster or rescue workers. Am J Psychiatry 2004;161:1370–6.
Ginexi EM, Weihs K, Simmens SJ, Hoyt DR. Natural disaster and depression: a prospective investigation of reactions to the 1993 midwest floods. Am J Community Psychol 2000;28:495–518.
International Association of Fire Fighters. Reports from the hurricane frontlines: Katrina 2005. Washington, DC: International Association of Fire Fighters; 2005. Available athttp://daily.iaff.org/katrina/katrina.htm?c=report.
US Environmental Protection Agency. Environmental assessment summary for areas of Jefferson, Orleans, St. Bernard, and Plaquemines parishes flooded as a result of Hurricane Katrina. Washington, DC: US Environmental Protection Agency; 2005.
National Institute of Environmental Health Sciences. Safety awareness for responders to Hurricane Katrina: protecting yourself while helping others. Washington, DC: US Department of Health and Human Services, National Institutes of Health, National Institute of Environmental Health Sciences; 2005.
CDC. Interim guidance for pre-exposure medical screening of workers deployed for hurricane disaster work. Washington, DC: US Department of Health and Human Services, CDC, National Institute for Occupational Safety and Health; 2005. Available at http://www.cdc.gov/niosh/topics/flood/preexposure.html.
American Psychiatric Association. Diagnostic and statistical manual—text revision (DSM-IV-TR™, 2000). Arlington, VA: American Psychiatric Association; 2000.
This comes out of the Infection Control Monitor: The feds once again raise debate about fit-tests.
Fit-testing is one of the most controversial issues embedded in the CDC’s revised tuberculosis guidelines. In not recommending annual respirator fit-testing for tuberculosis (TB) exposures, the CDC is at odds with OSHA’s general respiratory standard, which mandates annual fit-tests.
Congress entered the debate by once again barring OSHA from enforcing its annual fit-test requirements for TB. The prohibition lasts for fiscal year 2006, which ends on September 30.
Comment: Let’s have a controlled study on this. Annual fit-testing for 1/2 of the country and no such requirement for the other half (preferably, the eastern half where CDC and Congress exist). Then see in 2-3 years, how many health care professionals develop hemoptysis. Rega
One brand of alcohol-based products and many homemade sanitizer recipes on the Web do not contain enough alcohol to kill most viruses and bacteria, the Des Moines Register reports.
The Food and Drug Administration (FDA) recommends a concentration of 60 to 95% ethanol or isopropanol for alcohol-based sanitizers. Consumers should read the active ingredients listed on the product before buying to make sure it meets FDA standards.
From The Atlanta Business Chronicle – April 21, 2006:
If an avian flu pandemic occurs, BellSouth has a certified team of employees who would go to work in Hazmat suits to keep critical operations going, while the company would communicate with employees through a special Web site and use software to monitor employee absences. (Comment: Sounds like over-kill to me, but their hearts are in the right place!)
In fact, a group of more than 35 local businesses has been quietly working together for months through a new group called the Business Operations Center. The group is laying out strategies on how to keep their businesses running during a crisis, how to communicate with their employees and how to best protect their work force from the deadly virus.
Comment: High praise should be given to these businesses for their proactivity. However, do they know what they are doing? Are they getting sufficient expert advice? Why Hazmat suits for an infectious disease? We have all these RMRS’ running around and public health officials sitting in their ivory towers. Are they getting together with businesses to assist? Probably not. At least, that’s the case in my neck of the woods! CDC, on its website, has information for businesses. Check it out. REGA
— By Ed Brock (edited for efficient reading)
ebrock@news-daily.com
There was something amiss on BWA Flight 1388, bound from Europe to Hartsfield-Jackson Atlanta International Airport.
That’s what the scenario was for the “Big Bird 2006” safety drill at the airport on Thursday, according to Hartsfield-Jackson Deputy Fire Chief Harold Miller.
“An hour and a half before the flight was to land they notified their company that they had a sick passenger on board,” Miller said.
It was a 41-year-old male passenger who had recently been to Vietnam with his family. Now he was showing flu-like symptoms, the kind also exhibited by victims of the avian flu.
“The only thing that’s a little odd is he has an extremely high temperature,” Miller said. “He has a temperature of 103.”
Thursday’s exercise was intended to test a quarantine procedure that airport officials began to develop in 2002 when there was concern about the use of smallpox in a terrorist attack.
“Now we have a procedure that will work for any communicable disease,” Miller said.
That procedure has been “table-top tested,” but Thursday was the first time all of the players were brought together to implement the plan in a real-world situation.
The scenario plays out from the point that the fictional Flight 1388 (actually a working Delta Air Lines jet) has landed and been parked by the old Northwest Airlines hangar. The hangar is one of three locations that would actually be used in a real quarantine situation, Miller said. All of the “passengers” remained onboard while a variety of responding agencies tried to analyze the situation.
Along with the airport’s fire fighting unit, which is part of the City of Atlanta Fire Department, participating agencies included the Centers for Disease Control and Prevention, U.S. Customs and Border Protection, the American Red Cross and more.
The CDC has a quarantine station in the airport.
Customs and Border Protection was there to secure the scene and maintain a sterile environment.
“If they had to quarantine these people or hold them for any length of time we would be involved in sheltering them (the shelter would have to be established by the Clayton County Department of Family and Children Services).”
Then a fire!: More than two hours after the drill began a fictional fire broke out on the plane, causing the passengers to finally be evacuated into the hangar.
Comment: In real life, once passengers knew that they were being held, at least one of them would have contacted a lawyer, the media, the ACLU, and family. A writ of habeas corpus would have been obtained and all the passengers would have been liberated to the applause of civil libertarians, Alec Baldwin, and Rev. Al Sharpton. Three days later, one-half of Atlanta’s citizens would be coming down with fever, chills, and purple splotches. REGA
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