A place for the latest news, information and discussion regarding disasters, terrorism, emerging infectious diseases, disaster response, mitigation and preparedness!
New regulations implemented by the U.S. Transportation Security Agency require airline passengers to toss bottles of water before boarding a plane. The rules, adopted in response to a British terror threat involving liquid explosives, have had an unintended consequence for travelers: dehydration.
With the relative humidity in an airplane cabin between 10 and 20 percent, dehydration can cause problems for travelers, especially those with health problems. According to Dr. Marc Siegel, of the New York University School of Medicine, “You’re actually more prone to infection because the low humidity dries mucous membranes.” The ban on liquids “puts more responsibility and pressure on the airlines to make sure beverage service is early in the flight and includes an option for water,” he said.
Representatives for some major U.S. airlines say that they are taking precautions by stocking extra water and other beverages. An American Airlines spokesman said, “This beverage provisioning is not a big deal for us at all,” but noted that American has slightly increased supplies of sodas, juices, and water on its flights. While airlines say it is rare for a plane to run out of bottled water, flight attendants say it is not that uncommon. If that happens, tap water from the airplane is used.
But, in 2004, random sampling by the U.S. Environmental Protection Agency revealed that 15 percent of aircraft water tested positive for total coliform bacteria — an indicator of disease-causing organisms in the water.
Comment: I’m not sure that dehydration is a bad thing on planes. If we can dehydrate travelers, then there is no need for on-board bathrooms which is the haven for would-be bombers and nicotine addicts.
Background: When you link the following story from Reuters, 8/31/06 with all the dark happenings on commercial jetliners lately, it makes you wonder why bother flying at all!
The pilot of a Canadian airliner who went to the washroom during a flight found himself locked out of the cockpit, forcing the crew to remove the door from its hinges to let him back in, the airline said on Wednesday.
The incident occurred aboard a flight from Ottawa to Winnipeg on Saturday. The regional jet, capable of carrying 50 people, was operated by Air Canada’s Jazz subsidiary.
Jazz spokeswoman Manon Stewart said that with 30 minutes of the flight to go, the pilot went to the washroom, leaving the first officer in charge. But when he tried to get back into the cockpit, the door would not open.
“The door malfunctioned … this is a very rare occurrence,” Stewart said, adding that the crew’s decision to remove the door had been in line with company policy.
A report in the Ottawa Citizen newspaper said that for about 10 minutes “passengers described seeing the pilot bang on the door and communicating with the cockpit through an internal telephone, but being unable to open the door.”
Stewart said the paper’s report was “a bit dramatic” and stressed that at no time had the plane or passengers been in danger. She did not say how many people had been on board.
Physicians in the Serbian province of Kosovo have registered 553 cases of meningitis since an epidemic began on 1 Jul 2006.
The Kosovo National Health Institute in Pristina said 123 new cases of meningitis were registered over the past week, raising the number of people infected with the disease to 553, Belgrade’s Beta news agency reported on Wed 30 Aug 2006.
Drinking water contaminated with waste is the main cause of meningitis
outbreaks in the predominantly ethnic-Albanian province of Kosovo. Ilir
Begolli, Director of the Health Institute, said the number of new cases has been decreasing but not at a satisfactory pace, the agency said. He said
about 90 patients stricken with meningitis are in Pristina’s clinical center.
The epidemic, which is spreading mainly among children, is under control, and hospitals in Kosovo are well-equipped with doctors, equipment, and medicine, Begolli said.
Background: While this blog is devoted to matters associated with disasters and terrorism, this report from MMWR, September 1, 2006 / 55(34);933-935 highlights an infectious disease that needs to be included in the differential diagnosis of acute flaccid paralysis. Part of that differential is botulism and this report will help in cementing an accurate diagnosis. In addition, this report will assist clinicians who are on disaster deployments where this malady is endemic.
Tick paralysis is a rare disease characterized by acute, ascending, flaccid paralysis that is often confused with other acute neurologic disorders or diseases (e.g., Guillain-Barré syndrome or botulism). Tick paralysis is thought to be caused by a toxin in tick saliva; the paralysis usually resolves within 24 hours after tick removal. During May 26–31, 2006, the Colorado Department of Public Health and Environment received reports of four recent cases of tick paralysis. The four patients lived (or had visited someone) within 20 miles of each other in the mountains of north central Colorado. This report summarizes the four cases and emphasizes the need to increase awareness of tick paralysis among health-care providers and persons in tick-infested areas.
Case 1. On May 15, a girl aged 6 years from Weld County awoke with symptoms of bilateral lower extremity weakness. She attended school as usual but needed assistance from a friend to walk outside for recess, where she fell down and was unable to get up. Her mother took her to an outpatient clinic, and a neurology appointment was arranged for the next day. She awoke the next day with a tingling sensation in her hands and feet, an inability to sit or stand on her own, and difficulty swallowing. She was taken to a local emergency department (ED) and transferred to a regional children’s hospital. A physical examination revealed ophthalmoplegia (i.e., paralysis of muscles controlling eye movement), dysarthria (i.e., slurred or abnormal speech), and areflexia (i.e., absence of neurologic reflexes); nerve conduction studies indicated decreased velocities. The girl was admitted to the intensive-care unit on May 16 with a presumed diagnosis of Guillain-Barré syndrome and subsequently required intubation. On the evening of May 17, a nurse who was bathing the girl found a tick along her hairline. Investigators later learned that the tick had been visible on magnetic resonance imaging of the girl’s head earlier that day. The tick was removed immediately, and the girl’s symptoms improved; she was discharged home 1 week later. The tick was identified as a female Dermacentor andersoni. The girl often had visited her grandmother in the mountains in Larimer County and frequently hiked in the area. Seven days before symptom onset, the girl had visited her grandmother and played outside in the yard.
Case 2. On May 22, a man aged 86 years from the mountains in Larimer County began to have increased difficulty standing and transferring to and from his motorized scooter. The man was homebound as a result of chronic polyneuropathy and weakness from spinal stenosis. The next morning, his weakness worsened, and he was unable to walk or grasp objects. He called for emergency services and was admitted to the local hospital with a diagnosis of progressive worsening of his chronic neuropathy. Physical examination revealed normal cranial nerve function but generalized weakness; deep-tendon reflexes were absent. On the evening of May 23, a nurse who was changing the man’s gown noticed a tick on his back. After tick removal, his symptoms improved during the next 4 days, and he was discharged home on May 27, although 2 weeks later he did not feel he had yet recovered to his baseline condition. The man did not report any recent travel or spending any time outdoors, with the exception of daily visits to his mailbox using his scooter. He owned a dog that was often outside, and he believed this was the likely source of the tick; the dog had no signs of tick paralysis.
Case 3. On May 22, a woman aged 78 years from the mountains in Grand County had generalized weakness and difficulty walking. During the next few days, her signs and symptoms progressed to facial weakness, slurred speech, decreased taste, and confusion. While the woman was preparing to go to the ED on May 25, her roommate noticed a tick on the back of the woman’s neck below the hairline. Physical examination in the ED revealed normal cranial nerve function and no appreciable weakness, but the patient did have decreased deep-tendon reflexes. The ED physician removed the tick by cutting the surrounding tissue with a scalpel. The patient was discharged home to recover. The patient subsequently reported that within 24 hours her weakness, alteration in taste, and confusion were resolved; however, 3 weeks after discharge, she still became tired easily. The woman reported that she hiked or walked outside daily.
Case 4. A man aged 58 years from Larimer County with a history of chronic renal failure traveled to southern Texas on April 20. On April 24, he had a tingling sensation in his hands and perioral numbness. Three days later, he collapsed while trying to stand and was unable to get up. While helping him off the floor, his wife discovered a tick on the man’s back. She removed the tick before transporting him to a local ED. He was transferred and admitted to an intensive-care unit but did not require intubation. Several hours later, he began to regain feeling in his hands and was able to walk with assistance. He was discharged home on May 5, but 6 weeks later he still reported residual subjective weakness. The patient reported that he frequently performed yard work and various outdoor recreational activities.
MMWR Editorial Note:
The four cases described in this report illustrate the importance of considering tick paralysis in the differential diagnosis of persons with ascending paralysis who live in or visit tick-endemic regions. Diagnosis is confirmed by finding a tick embedded in the skin and observing for signs of improvement after tick removal; no other test exists for confirming tick paralysis. Although rare, cases of tick paralysis have been identified worldwide; most cases in North America occur in the western regions of Canada and the United States. The species most often associated with tick paralysis in the United States and Canada are the Rocky Mountain wood tick (D. andersoni) and the American dog tick (Dermacentor variabilis); however, 43 tick species have been implicated in human disease around the world (1). Most North American cases of tick paralysis occur during April–June, when adult Dermacentor ticks emergefrom hibernation and actively seek hosts (2).
Tick paralysis is thought to be caused by a toxin secreted in tick saliva during feeding that reduces motor neuron action potentials and the action of acetylcholine, depending on the species of tick (1,3). Symptom onset usually occurs after 4–7 days of tick feeding. Ascending flaccid paralysis progresses over several hours or days; sensory loss does not usually occur, and pain is absent (4,5). Resolution of symptoms usually occurs within 24 hours of tick removal. When the tick is not removed, the mortality rate resulting from respiratory paralysis is approximately 10% (6,7).
Although tick paralysis is not a reportable disease in the state, the Colorado Department of Public Health and Environment receives, on average, a report of one case per year. The geographic and temporal clustering of cases described in this report is unusual. No explanation exists to account for this clustering; the risk for acquiring tick paralysis has been widespread in the western United States and Canada.
The cases described in this report also differ in other respects from previous reports. For example, the majority of patients have been children, particularly girls (2,7). However, in this cluster, only one patient was a child, and two patients were aged >70 years. The ticks removed from all four patients were on the neck or back; in previously reported tick paralysis cases, ticks were predominantly on the head and neck (7). Although outdoor exposure, such as hiking or camping in wooded areas, is usually associated with tick paralysis, one of the four patients was homebound with limited outdoor exposure.
Health-care workers discovered the ticks incidentally on two of the patients whose conditions had received alternative diagnoses. Health-care providers should consider a diagnosis of tick paralysis in any patient living in or visiting a tick-endemic area who has acute, symmetric paralysis and should perform a complete examination for ticks, particularly on the head, neck, and back. Ticks should be removed by grasping the tick close to the patient’s skin with forceps and pulling with a steady, even pressure (8). Persons in tick-endemic areas should be educated regarding tick-borne diseases and should perform routine checks for ticks after possible exposures. Insect repellents should be applied to skin, and permethrin-containing acaricides should be sprayed on clothing to help prevent tick bites. Additional information regarding prevention of tick-borne diseases is available at http://www.cdc.gov/ncidod/ticktips2005.
References
Gothe R, Kunze K, Hoogstraal H. The mechanisms of pathogenicity in the tick paralyses. J Med Entomol 1979;16:357–69.
Dworkin MS, Shoemaker PC, Anderson D. Tick paralysis: 33 human cases in Washington state, 1946–1996. Clin Infect Dis 1999;29:1435–9.
Felz MW, Smith CD, Swift TR. A six-year-old girl with tick paralysis. N Engl J Med 2000;342:90–4.
Spach DH, Liles WC, Campbell GL, Quick RE, Anderson DE Jr, Fritsche TR. Tick-borne diseases in the United States. N Engl J Med 1993;329:936–47.
McCue CM, Stone JB, Sutton LE. Tick paralysis: three cases of tick (Dermacentor variabilis Say) paralysis in Virginia: with a summary of all the cases reported in the Eastern United States. Pediatrics 1948;1:174–80.
Officials last week were playing the blame game after four people died and 300 were injured when a devastating storm hit the centre of Budapest on August 20 during the annual fireworks display to mark St Stephen’s Day. Gale force winds of up to 123 km/h uprooted trees, tore away huge branches, blew out windows and swept roofs away. Last Friday at noon a minute’s silence was held to remember the victims. Budapest Transport Company (BKV) vehicles stopped for one minute and the regional trains of State Hungarian Railway MÁV gave a ten second blast on their horns. Black flags were hoisted outside Parliament and the Mayor’s Office. The search for those responsible for failing to call off the fireworks display in time has resulted in conflict: an investigatory commission, lead by the head of the Prime Minister’s Office, György Szilvásy found the Meteorological Office and the National Disaster Management Authority to be responsible. Accusations have been made, however, that the work of the commission was inadequate.
The storm struck just a few minutes after the start of the fireworks, causing mass panic in some parts of the city among the almost one million people who had gathered along the banks of the Danube and on its bridges. The roof of the Sándor Palace – the President’s residence – was damaged and parts of it collapsed. Shards of glass from broken windows injured spectators near the Marriott Hotel and the Hotel Intercontinental. On the Buda side of the Chain Bridge a huge tree fell on top of two people killing them, one a 12-year-old girl. In the panic children were separated from their parents and most people fled for cover in restaurants and subways. An elderly woman died of a heart attack, believed to have been caused by the panic. The bodies of a Romanian married couple who were reported missing after the storm were found in the Danube last week. The woman’s body was hauled out of the river last Tuesday at Ercsi. Her husband’s body was found in a capsized speed boat that had become entangled in the anchor of the A38 ship, a cultural venue on the Buda side of the river.
“The Palace of Arts let a lot of people in. The BKV made sure there were more busses and trains and the security forces took care of people in a professional manner, calming them down and making sure that a panic didn’t break out,” Zita Anna Apáti, a pedestrian, told The Budapest Times and Budapester Zeitung. However not everyone was able to keep a cool head. “We tried to flee from the storm into the Sofitel on Roosevelt tér, but they wouldn’t let us in, or the 20 other people who were waiting. We were only allowed to take shelter in the garage of the hotel,” Oliver Pahnecke complained to The Budapest Times and Budapester Zeitung. The hotel has denied the accusation, producing a photograph on which dozens of people with towels can be seen in the hotel lobby. One reader of daily paper Magyar Nemzet claimed that the Gresham Four Seasons Hotel had let only around 50 people in, despite having the capacity for several thousand. The Gresham denied the claim: “We let people in and distributed towels so they could dry themselves,” explained marketing director Sherryn Bates. The Budapest Marriott Hotel also says that it opened its doors to a fleeing crowd of people: “Around 700 to 800 people took shelter with us, including several injured people, who were taken care of straight away by volunteer doctors,” Éva Trembácz, the hotel’s PR manager said. A witness claimed that the Inter-Continental closed its doors to those seeking cover, however the hotel said it had taken care of hundreds of people. The show goes on
Despite it barely being possible to see anything due to the torrential rain, the fireworks were not stopped, only discontinued for a few minutes. The Prime Minister called for an official investigation into the Budapest storm tragedy and appointed head of the Prime Minister’s Office, Szilvásy to lead the probe. However Fidesz’s parliamentary group chairman Tibor Navracsics said on state television last Tuesday morning that Szilvásy could be among those responsible and was completely inappropriate to lead the investigation. News agency MTI said that Szilvásy last Monday conceded that he was among those who had the authority to cancel the fireworks. Mayor Gábor Demszky, head of the city’s municipal defence committee, senior PMO officials and Szilvásy, could be held legally responsible, said Navracsics.
What is known “The National Meteorological Institute (OMSZ) informed the National Disaster Management Authority of the approaching storm on Sunday by email at 7:39 pm. The email, however, was only read at 11:30 pm,” Szilvásy, explained at a press conference last Monday after being given his charge.
According to news website index.hu, the event organiser Nexus Kft. had already learnt of the approaching storm that afternoon: between 4 and 5 pm. Nexus, an advertising agency, warned its VIP guests, at least by SMS, of the fierce weather conditions expected, index.hu reported last Monday. An explanation was only given by Nexus, which has organised numerous state events over the last three years, last Tuesday evening, as the company was asked not to comment until that time by the Prime Minister’s Office. Gábor Simon, the head of the advertising agency denied any responsibility for the catastrophe. In his opinion, Nexus had made no error in failing to call off or stop the fireworks. Simon insisted that doing so would only have increased the panic. “We consulted meteorologists several times, on the last occasion at 6 pm, but we knew nothing about a gale force storm,” he said last Tuesday evening. He described it as only natural that the company had warned its own guests to bring a raincoat with them.
Police only found out about the approaching gale a few minutes before the fireworks began from colleagues at Lake Balaton. That was too late according to spokesman László Garamvölgyi. Instead of causing a panic, the police prepared for rescue activities, Garamvölgyi said. Witnesses said lightning started flashing about 20 minutes before the storm hit. Mayor Gábor Demszky, who could have stopped the fireworks from going ahead, said he was not informed prior to the event and said the city’s only responsibility in the affair was to act as “janitor” and clean up the mess afterwards. András Kupper, the head of the Budapest Fidesz-faction accused Demszky of failing to prevent the disaster. In an open letter he referred to the fact that the mayor of Székesfehérvár had been in the position to cancel a fireworks display there and did so.
Search for those responsible Thus far, the investigation has laid the greatest blame with OMSZ, and Nexus was cleared of liability. According to the commission, the National Meteorological Office should have given better, more concrete and precise information to the National Disaster Management Authority. OMSZ was too passive, Szilvásy said last Tuesday. The OMSZ service duty officer faces disciplinary hearings and the duty officer at the National Disaster Management Authority who forgot to read the email was fired. He also proposed that the responsibility of the heads of both organisations be investigated: Zoltán Dunkel from OMSZ and Attila Tatár from the National Disaster Management Authority.
In addition the division chief at the PMO who signed the contract with Nexus was demoted, on the grounds that it did not contain a clause concerning a possible bad weather catastrophe. In reality, however, the contract which was made public last Monday, was found to contain such a clause. According to the contract, in the instance of force majeure, unless given written instructions to the contrary by the Prime Minister’s Office, Nexus was obliged to fulfil its contractual obligations “within the bounds of reasonable and practical considerations.” The contract also states that Nexus was obliged to ensure the safety of the event according to an attached safety plan, however this largely only extends to the fact that ambulances must be available and bans on parking and road closures, index.hu reported. There was also public resentment that Prime Minister Ferenc Gyurcsány did not comment on the catastrophe early enough. Gyurcsány only addressed the public on Monday afternoon, during a press conference. President László Sólyom said last Thursday that he was dissatisfied with the results so far of the investigatory commission, and called for those really responsible to face the consequences. Opposition party Fidesz raised accusations of bias, since the investigation was lead by the same government organ that was directly involved in organising the fireworks display
Since we are all sitting here and waiting and waiting for bird flu to hit, we have some extra time to look at what has happened during the Spanish flu between 1918-1920. Military docs from the Bureau of Medicine and Surgery, U.S. Navy and Uniformed Services University of the Health Sciences have published a meta-analysis study of research published in those dark days of the early 20th century. Their paper, in the latest Annals of Internal Medicine, shows that using influenza-convalescent human blood products (i.e. human plasma containing H5N1 antibodies from survivors) might possibly save lives. From an accompanying editorial:
In a thorough review and analysis of the historical literature, Luke and colleagues document the effects of passive immunotherapy. They found 8 studies that evaluated the effects of therapy with serum or plasma from convalescent patients on the course of clinically diagnosed influenza pneumonia during the 1918 Spanish influenza pandemic. Although the quality of these studies was relatively poor by modern standards, they all reached similar conclusions. In 6 of these studies, treatment was compared with a control group that received standard care, and in each of these reports, the mortality rate was lower in treated patients, although the decrease was statistically significant in only 3 reports. Two of the studies also compared the outcomes in those who received early treatment and those who received late treatment. An additional 2 reports compared early and late therapy but did not have an untreated control group. These studies demonstrated that only those who received early intervention experienced a beneficial effect of serum therapy, which is consistent with reports of serotherapy for other human infectious diseases. Luke and colleagues discarded multiple other reports that did not meet the methodologic criteria for inclusion in their meta-analysis. These weaker studies also supported the hypothesis that passive serotherapy was useful in treating Spanish influenza.
Would a similar approach be effective and feasible in the event of a pandemic of H5N1 influenza? Passive immunotherapy to treat infection with influenza viruses, including H5N1, has been effective in a mouse model. Other viral diseases offer ample precedent: Passive antibody prevents many human viral diseases, including varicella, rabies, hepatitis A and B, and respiratory syncytial virus (RSV). However, the distinction between prevention of disease and treatment of active disease is important. Few recent data support the use of passive antibody therapeutically after disease manifestations have already begun. For example, although passive antibody is highly effective at prevention of RSV infection in high-risk infants, systemic administration of antibody with high levels of RSV neutralizing activity is not useful therapeutically in infants with RSV disease.
Nevertheless, the concept is important and it should be explored further…
Pictured is a DMAT area set up in a hanger for a previous WIISARD disaster drill
Last week two separate mass casualty exercises were held in San Diego county. At UC San Diego, police, firefighters, paramedics, SWAT teams and others were called to a simulated terrorist attack at an academic building. There were numerous injuries, a chemical spill and a struggle to retake the building. Near Lindbergh Field, a simulated global pandemic was overtaking San Diego and a cyber-attack had knocked out cell phone and Internet communications across the United States.
This week’s event, called Strong Angel III, is being hosted by San Diego State University and includes a broad range of corporate sponsors, humanitarian and relief agencies, government groups and universities.
The office of the U.S. Secretary of Defense contributed $200,000 to the event, but equipment and in-kind donations, such as computers and wireless communications technology, are expected to be valued between $30 million and $35 million, Rasmussen said.
Companies participating in Strong Angel III include Microsoft, Bell Canada, Cisco Systems, Sprint, Nextel and Google, among others. Other participants include the Naval Postgraduate School, the U.S. Department of Defense and the humanitarian group Save the Children.
The drills focused on proving communications and information to coordinate logistics and deliver care to victims. The communications technology tested was integrated in a program called WIISARD, the Wireless Internet Information System for Medical Response in Disasters (here’s a link to the WIISARD Wiki. The system was developed as a collaboration between UCSD, police, firefighters, and paramedics in San Diego.
Electronic tags on patients in the disaster zone that recorded their vital signs and continually broadcast their conditions to paramedics in the disaster area, a command post nearby, and area hospitals.
Hand-held computers that paramedics used in the field to enter information about the conditions of patients and track medications they received.
Tablet personal computers used by supervisors in the field who acted as links between paramedics and officials at the command center.
A computerized command center that tracked the locations of all patients and emergency workers, steered first responders away from hazardous sites in the disaster zone and directed the transport of victims to area hospitals.
I’m disappointed (but not really surprised) that medical device vendors weren’t more involved with WIISARD. According to the caption of a photo accompanying the story, wireless medical devices were used and integrated into WIISARD. In the photo firefighters check the monitor on a “patient” during an exercise last Tuesday. The monitors record vital signs and continually broadcast patients’ conditions to paramedics in the disaster area and a command post nearby.
In two separate exercises in the county yesterday, emergency crews faced grim and very different crises.
NANCEE E. LEWIS / Union-Tribune
San Diego firefighters Collen Buona (center) and Avel Flores (right) check the monitor on a “patient” during an exercise Tuesday. The monitors record vital signs and continually broadcast patients’ conditions to paramedics in the disaster area and a command post nearby.
At UC San Diego, police, firefighters, paramedics, SWAT teams and others were called to a simulated terrorist attack at an academic building. There were numerous injuries, a chemical spill and a struggle to retake the building.
Near Lindbergh Field, a simulated humanitarian crisis was unfolding as a global pandemic was overtaking San Diego and a cyber-attack had knocked out cell phone and Internet communications across the United States.
Two emergencies, different in scope and severity, had created a shortage in one invaluable commodity: information.
But not for long.
New wireless communication technologies and other innovations had people quickly on line – talking with each other, managing the emergencies and caring for patients.
Five years after 9/11, one year after Hurricane Katrina, and in the midst of continued crises in Iraq, Afghanistan, Darfur and elsewhere, first responders and humanitarian workers rely heavily on their ability to communicate on the ground – frequently in harsh, dangerous and isolated terrain.
In New York City on Sept. 11, 2001, spotty radio communication among emergency workers proved deadly when the twin towers of the World Trade Center collapsed. In Banda Aceh and elsewhere in Southeast Asia after the Sumatra earthquake and tsunami, relief workers were overwhelmed by hundreds of thousands of dispossessed, injured and dead people.
Robert Kirkpatrick, a Microsoft employee who specializes in developing computer software used by humanitarian workers, summed up the need for communications in disaster zones.
“Even if you have all the right people, and all the right equipment and all the right supplies and all the good will in the world, we don’t do as good a job as we might because information does not get disseminated to all of the organizations working,” Kirkpatrick said.
“Organizations stream in, they don’t know who is doing what where, you have lots of redundancy, you have lots of inefficiency, you have lots of misinformation, (and) time passes when time shouldn’t be passing.”
The exercise at Lindbergh Field, which began Monday and ends Saturday, is less an exercise than a demonstration of how new computer technologies can work better in a humanitarian crisis, said SDSU professor Eric Rasmussen, director of this week’s event and a Navy physician who has worked around the world to improve military and civilian responses to humanitarian crises.
This week’s event, called Strong Angel III, is being hosted by San Diego State University and includes a broad range of corporate sponsors, humanitarian and relief agencies, government groups and universities.
The office of the U.S. Secretary of Defense contributed $200,000 to the event, but equipment and in-kind donations, such as computers and wireless communications technology, are expected to be valued between $30 million and $35 million, Rasmussen said.
Companies participating in Strong Angel III include Microsoft, Bell Canada, Cisco Systems, Sprint, Nextel and Google, among others. Other participants include the Naval Postgraduate School, the U.S. Department of Defense and the humanitarian group Save the Children.
Participants began the week faced with a brief scenario of a pandemic complicated by a nationwide crash of wireless communications.
By yesterday, they had established a command post in an abandoned building at the San Diego Fire-Rescue Department training facility, at the west end of the airport. The operation was running on its own power, lighting and cell phone and computer networks.
Sitting at tables with row after row of laptop computers, groups of workers tackled a variety of tasks to establish communications and improve links between groups that would respond in a real event.
At one point in the day, communications began to crash but technicians isolated the problem and the system was restored, Rasmussen said. The problem was typical of real-life events, and solving it will prove to be one of many valuable lessons learned this week.
At UCSD, the simulated terrorist attack required a much more focused approach to managing a crisis. The goal at the university was to test several new high-tech tools designed specifically to better manage emergency medical care in a disaster zone.
About 200 people, including emergency room physicians, nurses and technicians from UCSD Medical Center, participated in yesterday’s exercise.
Ramesh Rao, an engineer at UCSD and a lead investigator on the project, said the high-tech tools the university developed are critically needed.
“The most important part of the story is just how far behind first responders are relative to the military in terms of absorbing technology,” Rao said.
“They use methods that are 30 to 40 years old. They hardly use anything that’s based on the developments that have taken place in the last 10 to 15 years – in (computer) processing, display and storage.”
The $4 million project, called Wireless Internet Information System for Medical Response in Disasters, or WIISARD, marked the culmination of three years of collaboration between university engineers and police, firefighters and paramedics.
“It could revolutionize the way an incident like this would run,” San Diego Fire Department Capt. Kyle Passini said of the new high-tech tools. “It eliminates radio traffic, which is always a good thing.”
The National Library of Medicine, part of the National Institutes of Health, funded the WIISARD project. It is one of a handful of similar projects around the country. The WIISARD technologies were developed at the California Institute for Telecommunications and Information Technology, located at UCSD, in partnership with UCSD’s School of Medicine.
Some of the high-tech tools they used included:
Electronic tags on patients in the disaster zone that recorded their vital signs and continually broadcast their conditions to paramedics in the disaster area, a command post nearby, and area hospitals.
Hand-held computers that paramedics used in the field to enter information about the conditions of patients and track medications they received.
Tablet personal computers used by supervisors in the field who acted as links between paramedics and officials at the command center.
A computerized command center that tracked the locations of all patients and emergency workers, steered first responders away from hazardous sites in the disaster zone and directed the transport of victims to area hospitals.
University engineers collaborated with firefighters, paramedics and police officers to develop the new tools, Rao said.
“From the very beginning it was clear that we couldn’t design new systems in a vacuum,” he said.
The report from the Inspector General for the Department of Health and Human Services is based on site visits and interviews with administrators and staff members at 20 nursing homes in Alabama, Florida, Louisiana, Mississippi and Texas, all with emergency plans that meet the requirements of federal and state law. But it found that the plans had rampant deficiencies, especially in ensuring the safe and comfortable evacuation of residents with complex needs.
All 20 nursing home administrators agreed “that an evacuation can cause physical and mental stress on nursing home residents and consequently is not necessarily the best course of action,” according to the report, which was requested by Senator Herb Kohl, Democrat of Wisconsin, the ranking member of the Special Committee on Aging.
Of the 20 nursing homes examined, of 2,526 nursing homes in the Gulf States, 13 evacuated residents before the storms reached landfall, and 7 did not move their residents. All struggled during the storms, and two of the seven were eventually forced to evacuate because of uncertain water and power supplies and inadequate police protection. The homes that evacuated ahead of the storms had the most serious problems, mostly related to transportation.
Buses that the nursing homes had contracted for were not available, so residents had to travel in borrowed vehicles that often lacked air-conditioning or broke down along the way. Food and water had to be rationed on trips that took hours longer than expected. Medications, oxygen canisters and incontinence supplies were left behind. Staffing for the arduous trip was often inadequate. Some residents were dehydrated and suffered pressure sores or urinary tract infections from the travel conditions.
The report is the first federal effort to examine in detail the effectiveness of federally mandated emergency preparedness plans in nursing homes. The plans were tested under the most harrowing of circumstances: four deadly hurricanes in less than a year. The report was not intended to focus on the life-and-death decision on whether to evacuate residents, and it did not examine the health records of the patients.
But, its primary finding — that perfectly legal emergency plans, which 94 percent of nursing homes have, are silent or vague on scores of pressing issues — highlighted flaws in evacuation plans. Most of the gaps in the plans were in this area.
Of the nursing homes surveyed, some had no guidelines on deciding whether to evacuate, no instructions about how much food and water to bring, no method for assigning staff members to make the trip, no procedures for transporting medications, no suggestions on alternate evacuation routes if highways were clogged, no arrangements with a host facility and no plans for how and when to return. The report also found that the nursing homes could not get the help they needed from local officials because there were no formal partnerships.
“The entire evacuation process is problematical,” said Ruth Ann Dorrill, one of the analysts who worked on the report. “They are left in the dark to feel their way or they rely on impromptu thinking.”
The report recommends that 25 “core elements” of emergency preparedness be included in plans for the nation’s 16,125 nursing homes that receive Medicare or Medicaid money. The list was cobbled together from various sources before the site visits. Investigators studied nursing home guidelines for several states, including Florida, considered state-of-the-art in hurricane response. They consulted professional associations with expertise in long-term care, interviewed professors of emergency management and gerontology and reviewed scholarly articles on related subjects.
In addition to requiring that plans include certain elements, the inspector general, Daniel R. Levinson, has also asked that the Centers for Medicare and Medicaid Services, which regulates nursing homes, encourage more collaboration with state and local emergency officials.
Administrators at many of the 20 homes that were visited complained about not getting the help they needed from those officials. The help they got, the nursing home administrators said, came from sister facilities, family members and churches or schools.
Many academics and advocates for nursing home residents say the federal government must be more explicit about the components of an acceptable plan, not merely mandate that there be one.
“It is absolutely essential that a system be put in place up front, and the government must take the leadership role in that,” said Alice H. Hedt, executive director of the National Citizens Coalition for Nursing Home Reform. “It is too much to expect that nursing home operators can make all these difficult decisions in a very short time and with a lot of stressors.”
In a written response to the report, Dr. Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services, said he concurred with the findings, and was already exploring how the regulations could be strengthened.
Aug 29, 2006 (CIDRAP News) – The World Health Organization (WHO) today released a list of case definitions for human H5N1 avian influenza infection to improve reporting and tracking of the disease.
Officials listed several caveats about using the terminology. The case definitions apply only to the current phase of pandemic alert (phase 3, no or very limited human-to-human transmission) and may change as new information emerges about the disease or its epidemiology. National authorities should notify the WHO only about probable or confirmed H5N1 cases. The definitions are not intended to provide complete case descriptions, but to standardize case reporting.
Clinical decisions about the care of patients who may have H5N1 infection should be based on clinical judgment and epidemiologic reasoning, not on the case definitions, the WHO said. The agency said that although most patients with H5N1 infection have had fever and lower respiratory symptoms, the clinical spectrum is broad.
The case definitions include:
Person under investigation: A person whom public health authorities are investigating for possible H5N1 infection.
Suspected H5N1 case: A patient who has unexplained acute lower respiratory illness with a fever greater than 38°C (100.4°F) and cough, shortness of breath, breathing difficulty, and one or more of the following exposures 7 days before symptom onset:
Close contact within 1 meter (eg, caring for, speaking with, or touching) with a person who is a suspected, probable, or confirmed H5N1 case
Exposure to (eg, handling, slaughtering, defeathering, butchering, or preparing for consumption) poultry or wild birds, their remains, or their feces where H5N1 infections in animals or humans have been suspected or confirmed in the last month
Consumption of raw or undercooked poultry where H5N1 infections in animals or humans have been suspected or confirmed in the last month
Close contact with a confirmed H5N1-infected animal other than poultry or wild birds (eg, cat or pig)
Handling human or animal samples suspected of containing the H5N1 virus in a laboratory or other setting.
Probable H5N1 case (notify WHO):
Definition 1: A person who meets the criteria for a suspected case and has either (1) evidence of acute pneumonia on a chest radiograph plus respiratory failure (hypoxemia, severe tachypnea) or (2) laboratory confirmation of influenza A but insufficient laboratory evidence for H5N1
Definition 2: A person dying of an unexplained respiratory illness who is epidemiologically linked by time, place, and exposure to a probable or confirmed H5N1 case.
Confirmed H5N1 case (notify WHO): A patient who meets the criteria for a suspected or probable case and has had one of the following test results from a national, regional, or international influenza laboratory whose H5N1 test results are accepted by the WHO:
Isolation of an H5N1 virus
Positive H5 polymerase chain reaction (PCR) results from tests using two different PCR targets (eg, primers specific for influenza A and H5 hemagglutinin)
A fourfold or greater rise in neutralization antibody titer for H5N1 based on testing of an acute serum specimen (collected 7 days or less after symptom onset) and a convalescent serum specimen. The convalescent neutralizing antibody titer must be 1:80 or higher
A microneutralization antibody titer for H5N1 of 1:80 or greater in a single serum specimen collected at day 14 or later after symptom onset and a positive result using a different serologic assay, such as a horse red blood cell hemagglutination inhibition titer of 1:160 or more or an H5-specific Western blot positive result.
Email This Post
care to comment ? »