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]

Hong Kong experiments with anti-H5N1 cocktails

http://crofsblogs.typepad.com/h5n1/2008/06/hong-kong-exper.html

They used Relenza, Celebrex, and NSAIDs. It improved the survival rate, at

least in mice. Treatment was not started until after 48 hours. At this time,

survival in humans indicates that treatment with Tamiflu must occur during the

first 48 hours. Also, Relenza is an inhalent drug unless they have found some

new way to deliver it. I wonder how they gave it to the mice...

This is an interesting article and the treatment looks promising. There has

not been much to offer victims of H5N1 except Tamiflu, and already, there

have been some cases of Tamiflu resistance. Research into alternative drugs

is desperately needed.

Some experts believe H5N1 triggers a "cytokine storm" -- a reaction in the

immune system so severe it ends up killing the patient. The H5N1 is associated

with a mortality rate of between 60 and 80 percent in people.

Professor Yuen Kwokyung, a leading microbiologist at the University of Hong

Kong, said the team used the antiviral drug zanamivir and two non-steroidal

anti-inflammatory agents.

Commenting on the latter, Yuen said: "They suppress the cytokine storm

without suppressing the good protective response, which steroids do. Steroids

suppress everything."

"So the patient has the chance of mounting ... an antibody response,"

he told Reuters.

[indigo girl]

Where do the presidential candidates stand on pandemic preparation?

http://www.dailykos.com/storyonly/2008/6/1/01420/75347

At least some of them have thought about it...

A reminder from Barack Obama:

If we're lucky, we'll have at least a year, or perhaps several years, to prepare for a flu pandemic. But we might not be so lucky. And regardless of whether it is this particular strain of avian flu, H5N1, or another deadly strain, the time to act is long overdue if we want to prevent unprecedented human suffering, death, and economic devastation.

[indigo girl]

HHS Seeking Public Comment On Pandemic Guidance Documents

http://afludiary.blogspot.com/2008/06/hhs-seeking-public-comment-on-pandemic.html

The HHS has just published 3 interim guidance documents on pandemic influenza and is asking for public comment on them between now and July 3rd, 2008.

SUMMARY: The Department of Health and Human Services (HHS) is seeking public comment on three draft guidances:

Interim Guidance on the Use and Purchase of Facemasks and Respirators by Individuals and Families for Pandemic Influenza Preparedness;

Proposed Guidance on Antiviral Drug Use during an Influenza Pandemic

Proposed Considerations for Antiviral Drug Stockpiling by Employers In Preparation for an Influenza Pandemic.

[indigo girl]

Hawaii to screen international travelers for flu-like illnesses

http://www.flutrackers.com/forum/showpost.php?p=161651&postcount=1

The Hawaii Department of Health announced Wednesday that the state will implement a voluntary checkpoint screening process for international visitors to detect flu-like illness at Honolulu International Airport.

The program will span a one-year period and was made possible through a cooperative agreement between the Hawaii Department of Health and the Centers for Disease Control and Prevention in the amount of $289,000, the department said.

The Department of Health will collaborate with U.S. Customs and Border Protection, CDC, the Hawaii Department of Transportation and Hawaiian Airlines, the health department said.

[indigo girl]

Prophylactic Antivirals For Health Care Workers

Commentary on two documents released by HHS last week follow.

Can you believe that they are recommending 12 weeks worth of

antivirals for us? Would our employers really do this?

It is the right thing to do, but seriously, there isn't enough Tamiflu

available. Read the link to see where most of the Tamiflu is going to be

used.

http://afludiary.blogspot.com/2008/06/prophylactic-antivirals-for-health-care.html

...the most striking change is the recommendation that private sector

employers consider stockpiling prophylactic antiviral medications, particularly

if their employees will be at high risk of exposure.

That means Hospitals, EMS units, Fire Departments, and Law Enforcement

Agencies, among others.

Outbreak prophylaxis of front-line healthcare and emergency services

workers (fire, law enforcement, and emergency medical services [EMS])

is recommended because of their important role in providing critical

healthcare services, preserving health and safety in communities, the lack of

surge capacity in these sectors and the importance of reducing absenteeism

when demands for services are likely to be increased.

A strong recommendation that hospitals and emergency services provide

12 weeks of prophylactic antivirals to all employees who will have

direct exposure to infected patients.

[indigo girl]

PROPHYLACTIC USE OF TAMIFLU BAD IDEA, LEADING VIROLOGIST SAYS

Forget the prophylactic Tamiflu seems to be the message from this article

in Homeland Security Today. It's better to take Tamiflu 6 hours or

so after symptom onset, and hope it works.

http://hstoday.us/content/view/3741/150/

The US government's new proposal to use drugs like Tamiflu and Relenza as

a prophylaxis to prevent infection by a pandemic strain of influenza is

wrongheaded, says Dr. Graeme Laver, a former professor of biochemistry

and molecular biology at the John Curtin School of Medical Research at the

Australian National University in Canberra.

Laver, who played a key role in the development of both drugs, has been

studying influenza viruses for nearly 40 years. He and Dr. Robert Webster

(another world-renowned virologist at St. Jude Children's Research Hospital)

are credited with having first found the link between human flu and bird flu.

... it is "much better to use Tamiflu only for early treatment. If people

with flu symptoms take Tamiflu immediately, say within six or so hours after

symptom onset, the infection should be rapidly terminated, the person

should recover, and then, and this is important, should then be immune to

reinfection for the rest of the pandemic. Much better than any vaccine.

This has been called 'Aborted-infection Immunization,' and to use Tamiflu in

this way would allow many health care workers and so on to go about their

business without fear of reinfection."

(hat tip croftsblog)

[indigo girl]

http://afludiary.blogspot.com/2008/06/virologist-disagrees-with-hhs-proposed.html

Insightful commentary, as always from Avian Flu Diary on prophylactic use

of Tamiflu. He is right, of course about very few early recoveries. Most

of those that have survived infection with H5N1 were in the hospital for quite

some time. They were the lucky ones. Do you feel lucky? I don't...

I don't feel very trusting either when it comes to believing that the govt

can get that antiviral into our hands within 6 to 8 hours of symptom

onset.

...we haven't seen very many `quick recoveries' thus far.

One could argue that up until now most bird flu patients haven't received

the drug early enough - and that might well be true - but we don't have a

lot of evidence that Tamiflu administered early will be a panacea for

pandemic influenza.

Health Care workers, particularly those with families, are going to have a

difficult choice deciding whether to work during a pandemic.

[indigo girl]

Baxter's Cell Cultured Vaccine

http://afludiary.blogspot.com/2008/06/nejm-baxter-cell-cultured-vaccine.html

It appears that the future of vaccine technology is in using cell based

cultured vaccines rather than egg based. I am glad for the research

but feel uncomfortable with the use of monkey cells for this vaccine.

Let's hope that we do not need these vaccines soon because we

are not going to have them quickly, and there still will not be enough

for the global population.

Commentary from Avian Flu Diary on the two New England Journal of

Medicine articles on Baxter International's cell-cultured vaccine:

...a targeted vaccine cannot be produced until a pandemic strain is

identified, and using our current egg-based technology, it can take

another 20-28 weeks to produce the first batches of vaccine.

Second, our global capacity for creating vaccines using this egg-based

technology is limited. No one knows exactly how much we could produce

in a year, but estimates are that only enough vaccine could be produced

to inoculate 10%-15% of the world's population.

[indigo girl]

Public Health Planners Continue to See Problems With Fed Pandemic Plans

http://www.flutrackers.com/forum/showpost.php?p=164382&postcount=1

Flutrackers.com has posted this original article from Homeland Security

Today. In the event that the original article at HST is no longer available,

the information will be preserved at flutrackers.

There are tremendous problems addressed here. I can not imagine how

they can plan for all of these but I am thankful that they are acknowledging

that these critical issues must be tackled.

Public health planners who work on seeing the big picture of preparedness

for a catastrophic event like a global pandemic say the government still

hasn’t gotten a handle on things like coping with continuity and security for

multiple critical resources supply chains and quarantine issues.

One seasoned public health planner said, “I think the reasoning may be

flawed in certain areas, particularly the lack of attention to critical

infrastructure, and lack of notation that poor/ethnic minorities may need

particular support from law enforcement, as their communities may be

most vulnerable to social disorder."

This authority also believes, as do others HSToday.us has heard from, that

the matter of quarantining hasn’t been adequately debated.

But “the largest issue,” the veteran planner said, “is we have yet to describe

the common operating picture we need during a global catastrophic event.

Death and illness will not themselves describe the impact. [We haven’t

adequately addressed] the ability to keep oil flowing from the North Slope [to]

ensure the west coast has gas, potassium from Guam ensures we have

fertilizers, commercial flights from Asia ensure there are critical parts for

Internet servers.The complexity of supply chains is far beyond the

imagination of the public health planners, we almost need a futures market

for information.”

[jstbreathe]

New here but thought i would put my 2 cents in. I am not only in hurricane ally i was in katrina's path. I worked during katrina. I was not worried about my family. (they evacuted up north) I was not worried about my safety.

I spoke with my husband that morning. My house was flooded. Once the stoem hit, power went out, (generators died on day 2), WE had 7 vented adults, and 7 vented nicu pts. and 7 RTs on duty!!! The windows started to blow. pts were stranded in their rooms. the pressure from wind blew doors shut. we couldnt open them. it was awful! Then when the winds slowed, the locals started walking in. barefooted, naked. They were swept out of their houses and clothes. covered in mud and debri. Each person had a story. A sad, scarey story. It was one of the most horrible things I have ever been through. The whole time knowing my own house was destroyed.

things I wish could have happened:::

*hosp keeping us informed

*hosp not being full of pts

*evacuate pts from rooms with windows before storm starts.

*large O2 cylinders being placed on each floor before elevators stop working!! 5 stories of stairs!!!!!!

*Our dept head finding us a place to shower before storm

As far as being prepared. My suggestion is what ever you get ready put it in the top of the closet!! In a water proof container!! And, just incase your house gets washed away...write your name and address on container!! LOL! I always thought I was prepared. boy was I wrong!

Water, baby wipes, hand sanitizer, bleach,extra clothes, shoes (not crocs)zip loc bags, dog food,

the list is so long. I dont think you can ever be prepared enough.

[indigo girl]

AMA Now Supports Personal Rx Stockpiling For Disasters

http://afludiary.blogspot.com/2008/06/ama-now-supports-personal-rx.html

Personal medication supply in times of disaster: Earthquakes, hurricanes

and floods have headlined recent news reports. This new policy supports

allowing all patients with chronic medical conditions to maintain an

emergency reserve of prescription medications. It also encourages patients

to carry a list of current medications and the prescribing physician's contact

information with them to ensure continuity of care in the event of a disaster

or other emergency.

"There are more than 125 million Americans living with chronic illnesses who

rely on medication," said AMA Board Member Steven Stack, MD. "Disasters

can happen at any time, and ensuring that patients with chronic conditions

have access to needed medications may help minimize the uncertainty,

confusion and health risks following a disaster."

[indigo girl]

Example of Citizen Education for Disaster/Pandemic Preparation

http://afludiary.blogspot.com/2008/06/net-gain-for-your-community.html

Nez Perce County in Idaho has developed the type of program that is

urgently needed across the country. Using citizen volunteers from the

community to check on neighbors and offer education and assistance in

advance of any disaster makes sense. Everyone gets educated as to

what the risks are and how to minimize them with regards to a pandemic

situation as well. This is an excellent all hazards approach that any

community could use with success.

Produced by the Lewiston - Nez Perce County Office of Emergency

Management, and the Idaho North Central District Health Department -

this 34 page PDF file provides an excellent template for any community to

begin creating their own neighborhood disaster response.

NET, or Neighborhood Emergency Teams, are designed for an `all threats'

response. Prime among those, however, is the threat of a pandemic or

other communicable disease.

The ability of every community to mount a daily, door-to-door check of its

citizens during a prolonged disaster such as a pandemic will be paramount

if the maximum number of lives are to be saved. For most communities,

volunteers will be needed.