Disaster/Pandemic preparedness

[LMonty911]

I was looking the the other Disaster/Pandemic thread that Florida1 started. She mentioned that after the hurricanes, that they had problems getting basic supplies and food stores were often closed for weeks after the storm.

That concerns me. I wonder in case of disasters like hurricanes, earthquakes and pandemics if the nurses who work in the area have problems like that. I'd be worried about leaving my family if there was no heat or electric. After loosing electric in the ice storms in the Carolinas a few years back, my husband bought us a generator. I try to keep enough gas stored so that I could run that and maybe have an extra tank of gas for getting back and forth to work, if things were shut down. I never want to wait in the cold on those gas lines again; or have to risk driving around to find necessities!

What disasters have you been through? What lessons did you learn about what things would make life easier if it happens again to you? What can we learn from your experience, and how can we prepare for so we dont have to go through th esame problems you did?

Where there any sepcial tricks or issues that came up that helped you at work? Any special problems that nurses in disasters face?

I have a confession- my home first aid kit is pretty anemic right now :) DH burned his hand prety badly at work last week. I hadnt checked my kit in awhile, and was shocked to see how low I was on some stuff. I only had one roll banfage and had to make a run to WallyWorld the next day! If the stores were shut or the roads iced in or otherwise impassible that would have been an issue. Maybe not life threatening- but its a small example of how not being well prepared can be a problem.

I'd have been so embarrased to admit to hubby I couldnt take care of it, or come thru when he needed me to.

What do you do to prepare? I'm going to restock my kit, and get some more OTC stuff to keep on hand too. What else should I be thinking about?

Laura

[indigo girl]

Don't Rely on Drugs to Delay Pandemic - a message from the U.S. Government Accountability Office

http://afludiary.blogspot.com/2008/01/report-drugs-won-stop-pandemic.html

This information may be surprising to some, but this is how it really is. Once

people understand this, it is hoped that they will begin preparing their families.

No one can do this for you. You have to know that this threat is not science

fiction and act accordingly.

[quote name=http://www.reuters.com/article/governmentFilingsNews/

idUSN2236848820080122?rpc=401&]

Vaccines and drugs will not be enough to slow or prevent a pandemic of influenza, according to a U.S. government report released on Tuesday.

The report from the U.S. Government Accountability Office confirms what most experts have been stressing for years -- that the pharmaceutical industry cannot be relied on alone to protect the world from bird flu.

"The use of antivirals and vaccines to forestall the onset of a pandemic would likely be constrained by their uncertain effectiveness and limited availability," the GAO report reads.

Health experts almost universally agree that a global epidemic -- a pandemic -- of influenza is inevitable and even overdue. Flu is always circulating but, every few decades, a completely new strain emerges and makes millions sicker than usual.

One prime suspect is the H5N1 strain of avian influenza. It is entrenched in poultry across much of Asia, the Middle East and Africa, pops up regularly in Europe and has forced the slaughter of hundreds of millions of birds.

"Current antiviral production capacity is inadequate to reach the number of antivirals WHO (World Health Organization) estimates will be needed to contain a pandemic," it added.

"Increasing global production capacity of vaccines and antivirals will take several years as new production facilities are built, materials necessary for production are acquired, and the necessary approval is received to market these medical products in various countries."

[indigo girl]

Get Pandemic Ready: First Aid

What if you were the only person available to help your family and your

neighbors? Could you do it? Would you have some basic supplies on

hand? Think about it. There may be no medical care available. Hard to

imagine that situation, but this could happen. I am not suggesting that

you get a medical degree, just that maybe it would be useful to you to

have some basic first aide equipment around.

I am keeping in mind that this is a nursing forum and that we do not offer

medical advice, but it might be helpful for you to look at this information:

http://afludiary.blogspot.com/2008/01/get-pandemic-ready-first-aid.html

In a pandemic, health care services may be overwhelmed, or you may not wish to leave home and risk exposure to the flu virus. You may be required to administer more advanced medical care to yourself or others than you have in the past. If communications with a healthcare provider is available, you will need supplies and knowledge to be able to follow their directions. If no medical care is available, you might find yourself the sole provider of care for those around you. You will need supplies and skills.

[indigo girl]

With the permission of Effect Measure:

Marketing preparedness, Effect Measure style

Predictable as clockwork, no sooner does the Director General of the World Organization for Animal Health (OIE), M. Bernard Vallat tell us that things are looking up for bird flu then we have a massive outbreak threatening to devastate the poultry industry of India. So the poultry problem is neither stable nor under control, whatever M. Vallat says (and I daresay he probably regrets saying it). The Indian problem is a big deal, with reports of villagers eating birds that died of the virus and violent resistance to culling efforts. Clearly India was unprepared for this poultry outbreak, despite ample warning and plenty of examples elsewhere.

Nor is their health care system -- even their best hospitals -- prepared. Last year India dumped its plans to train health professionals midway through last year:

There are three vital training aspects -- clinical, preventive-medicine and microbiology -- to handle avian influenza outbreak. The team, last year, held clinical training sessions for health professionals. However, it could not complete its work, as it was 'abandoned' apparently for no good reason.

Effectively, the health professionals, including paramedics, lab technicians, professors and assistant professors do not have any idea about preventive and microbiology aspects, in case there is an outbreak. Three experts from clinical, microbiology and preventive medicine from city teaching hospitals were appointed for the rapid response team. The three members were sent to National Institute of Communicable Diseases (NICD), New Delhi, to get trained by avian influenza researchers. The members of the team were given a mandate to set-up a response team in the State, which could be deployed at a short notice in the event of an outbreak. (The Hindu)

So the only rapid response in India is panic.

Meanwhile, yet another conference of bird flu scientists is taking place, this time in Bangkok, Thailand. Meetings where scientists come face to face are still a major means of disseminating scientific information. The usual scientific sessions may provide the news but the work gets done in the corridors, lunch tables and other informal venues. No Power Point presentations there. Just scientists discussing their problems and often disagreeing and arguing about them.

And make no mistake. There is much to discuss and argue about. One school of thought says H5N1 is poised to become a pandemic strain, where and when no one knows. Robert Webster from St. Jude's in Memphis, the dean of flu virologists is in that camp. He is matched on the other side by Peter Palese, an equally eminent flu virus scientist from Mt. Sinai. Palese is by no means complacent about H5N1, but has wondered for a long time if there is some biological barrier to this subtype assuming pandemic features:

"I'm not convinced H5 really has the ability to jump into humans and cause the next pandemic," Peter Palese, a professor at the Mount Sinai School of Medicine in New York, told Reuters.

"Most of the human cases are the result of a large dose infection," he said, such as victims who come into close contact with sick birds.

"If you are a chicken it's a serious problem, but I'm not so sure it's the next pandemic strain," he said. (Reuters)

I don't know if Peter is right about this or not (and neither does he). It's not impossible. But I do believe we should act as if Rob Webster is right. There's too much we don't know, including the essential elements:

"We don't really know what it takes to be transmissible and we don't know where it's coming from. Where is it hiding out?" Webster told Reuters.

But how we act as if H5N1 could become a pandemic agent is also a matter that requires thought. My view, often expressed here, is that we are best served by investing in strengthening the public health and social service infrastructures of our communities (something we are not doing; on the contrary, we are weakening them with budget cuts). That way it doesn't matter who is right, Webster or Palese, because we will be acting in a way that covers them both.

I've said that before. Often. Just following the old adage, "The secret to marketing is repetition. The secret to marketing is repetition. The secret to marketing is repetition . . . "

The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.

[indigo girl]

Authors Defend Study of Nondrug Measures in 1918

http://www.cidrap.umn.edu//cidrap/content/influenza/panflu/news

/jan2508nyc-jw.html

If you read Barry's book, in the few places that did use measures such as isolation and quarantine, it appeared to help reduce morbidity and mortality. Too bad that New York was not one of those places.

[quote name=www.cidrap.umn.edu//cidrap/content/influenza/panflu/news

/jan2508nyc-jw.html]

The authors of a 2007 study of nonpharmaceutical measures used in the 1918 influenza pandemic, responding to a critique from historian John M. Barry, argued last week that there is strong evidence that New York City used isolation and quarantine to battle the Spanish flu.

In a study published in August, Dr. Howard Markel and colleagues said their analysis of historical records from 43 US cities indicated that the early use of nonpharmaceutical interventions (NPIs), such as isolating the sick and banning public gatherings, saved lives in the 1918-19 pandemic.

Their study, which appeared in the Aug 8 Journal of the American Medical Association, had a major influence on the Centers for Disease Control and Prevention's (CDC's) recommendations early in 2007 for the early, targeted use of NPIs in a flu pandemic. Two of the authors, including senior author Dr. Martin Cetron, work at the CDC Division of Global Migration and Quarantine.

[indigo girl]

No Magic Bullets to Fight Panflu

http://www.scottmcpherson.net/journal/2008/1/30/no-magic-bullets-to-fight-panflu.html

H1N1 is a seasonal flu. As you know, it's the kind of flu that some people

get an annual vaccination to prevent each flu season. It is a type A

influenza, as is H5N1, the notorious bird flu.

[quote name=www.scottmcpherson.net/journal/2008/1/30/no-magic-

bullets-to-fight-panflu.html]

We have known for years that H5N1 was slowly gaining Tamiflu resistance in some areas, most notably Egypt. We have also known that about 3% of Japanese seasonal Influenza B had shown some Tamiflu resistance.

What I don't think we knew was that H1N1 was showing a markedly increased resistance to Tamiflu, and we did not know the CDC was actually tracking and cataloguing those resistance markers...

[indigo girl]

Hospitals Not Ready for Pandemic

You already knew this, right?

http://afludiary.blogspot.com/2008/02/hospitals-not-ready-for-pandemic.html

The federal government's voluminous plans for dealing with pandemic flu do not adequately account for the overwhelming strain an outbreak would place on hospitals and public health systems trying to cope with millions of seriously ill Americans, some public health experts and local health officials say.

The Bush administration's plans, which run more than 1,000 pages, contemplate the nightmare medical scenarios that many experts fear, but critics say federal officials have left too much of the responsibility and the cost of preparing to a health-care system that even in normal times is stretched to the breaking point and leaves millions of people without adequate access to care.

[indigo girl]

Rescinding Community Mitigation Strategies in an Influenza Pandemic

http://www.cdc.gov/eid/content/14/3/pdfs/07-0673.pdf

(hat tip fluwiki)

An earlier study of this computational model demonstrated that closing schools and

curtailing contacts of children and teenagers for the duration of a mild 1957-like epidemic in a stylized community reduced the number of infected persons by >90% (10). The model was constructed with assumptions that children and teenagers are responsible for influenza transmission in a community because of the frequency and nature of their person-to-person contacts (11). However, sensitivity analyses showed that permutations of mitigation strategies that included adults were effective at reducing infections in the model population, even for more highly infective 1918-like viral strains or with removal of enhanced children/teenagers' role in transmission...

[indigo girl]

A Reminder from the UK

http://afludiary.blogspot.com/2008/02/reminder-from-uk.html

This blurb in Nursing in Practice about a Q&A session in the House of Lords about a possible pandemic reminds us that a pandemic is likely to be a long-term event.

It won't be over in a week, or a month, or perhaps, not even in a year.

Pandemic Video: Business Not As Usual

http://afludiary.blogspot.com/2008/02/pandemic-video-business-not-as-usual.html

[Laidback Al]

During a pandemic, or any kind of major emergency, lines of communication will be disrupted. FLA_MEDIC reviews the utility of hand held, battery operated FRS radios for family and neighborhood communication.

In my continuing look at simple solutions that could be applied during a pandemic, or other crisis, today we turn to emergency communications using FRS radios.

http://afludiary.blogspot.com/2008/02/neighborhood-communications.html

[indigo girl]

Pandemic Challenges For Hospitals

http://www.dailykos.com/storyonly/2008/2/10/83415/3883

(hat tip croftsblog)

Problems like pandemics, surge capacity and disaster preparation do not go away by ignoring them. Hopefully, by putting some of these issues in perspective, we can better appreciate the time, dollars and energy spent on mitigating that which cannot be stopped. At the same time, we can appreciate the efforts being made by your public health people which, if invisible, are still none the less remarkable. And finally, we can appreciate how strained the current health system is... it would not take much these days to push things over the edge, despite the remarkable resilience the health system has shown.

The ability to flex up in something this large is severely limited, which is why the emphasis has to be on home care rather than hospital care, wherever possible (something the Feds have been slow to explain and teach)...

[indigo girl]

The Rise Of Grassroots Preparedness Organizations

http://afludiary.blogspot.com/2008/02/rise-of-grassroots-preparedness.html

Last summer the HHS (Department of Health and Human Services), led by Secretary Michael Leavitt, embarked on a plan to encourage citizen's groups around the nation to help their communities prepare for a pandemic.

Recognizing that the job was simply too big for government to handle, they called in community leaders from all across the nation to a Pandemic Leadership Summit in Washington D.C.

[indigo girl]

Grassroot Preparedness Group Showing the Way

http://afludiary.blogspot.com/2008/02/readymom-alliance-rides-again.html

Don't know how to prepare your family? This group can help.