CDC guidance for call typing and patient assesment

This is a good one to pass along to your calltakers and study in the morning at shift change.

The issue with this flu is not death...

the issue is continuity of operations and the economy. This is not the 1918-19 influenza; it's (apparently, knocking on wood) not going to kill a whole lot of people. But it will make a lot of people in the work force's primary age groups sick, and people with the flu get very sick.

That is what the hype and the scare tactics miss. People probably aren't going to die, but they are going to miss work and school. Offices and schools are already closing in American cities. What do you do with your kids when they can't go to school? What happens to the economy when even a few business start shutting down? John Robb says it better than I ever could.

How big is your department? What would happen if just 10 percent of your workforce had a highly infectious illness that takes its victims completely out of commission for a week or two?

That is why this is (potentially) a big deal. And if it peters out, then it's a great dress rehearsal for The Big One.

Reflexive anti-hype as bad as reflexive media hype

"Remain calm, all is well."

We're at Phase 5 on the World Health Organization's pandemic alert level. What does that mean? "Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short." Things are quickening around the world and especially the United States. Schools around the country are starting to shut down and it won't be long before we start seeing some commercial enterprises lose functionality.

All over the news, newspapers, and news websites we're treated to a constant barrage of images of people in masks and alarming headlines about panics and runs on stores. The press gets a bad rap in situations like this, and often deserves it. Many people have become so inured to the alarmist infotainment thrown out by the 24-hour cable channels that they reflexively and vociferously disbelieve whatever the media says about whatever is going to kill everybody this week.

That has been amply demonstrated in my own city this week as the emergency management coordinator, who is not part of the fire department, has been sending out the official City emails about the swine flu to the employees. Yesterday afternoon he said, among other things, that there was no epidemic and that no one should be alarmed because this was the same as any other flu. I believe that all his emails/memoranda to this point have specifically said the media is just trying to scare people and that we and our families should ignore them.

This is neither helpful nor factually correct. We are now to the point the WHO defines as "pandemic imminent" and schools in our immediate area are closing. We think we may have made the first swine flu-related EMS call in our jurisdiction yesterday and the City's memorandum-of-record, from last night, says essentially "move along, nothing to see here."

Sober and context-rich analysis is lacking in the media, but it is also lacking in these emails. Just because the media implies a bunch of people are going to die does not mean that quite a few people won't die. Antipathy toward the press has in this case turned preparedness on its head and, perversely, actively discourages people from planning and preparing for things to get worse. It was obvious then (this was last night) and is more obvious now that things are getting worse and will continue to do so for some time.

Most of the people who received those emails/memoranda are not firefighters or cops or paramedics, they are just regular people. Discouraging them from preparing is bad enough, but authoritatively telling police, fire, and EMS supervisors that the the threat is inflated and minimal is downright reckless.

It is always appropriate to strike a calm and reasoned tone, but it is also always appropriate to be honest and not allow our biases to unduly affect our conclusions. That includes biases against the media and the urge to show people your head is even more level than theirs.

Ramping Up or Ramping Down?

Things look like they are heating up, with the number of laboratory-confirmed cases in America more than doubling today and Russia and England suspending consular services in Mexico City, and a whole bunch of countries issuing travel alerts on Mexico. Mexican authorities have shut down all schools across the country and Texas authorities are shutting down more schools around San Antonio.

The strongest impression on me has been the seriousness and urgency of the leading public health agencies. The World Health Organization raised the pandemic alert level to Phase 4, that last stop before a full-blown pandemic. The CDC and its Mexican and Canadian counterparts have been all over the news giving interviews and sharing information, showing everyone they're out in front of things. That is a good thing!

On the other hand, Mexican public health people said in a press conference tonight that the number of new cases has been declining each of the last three days. But like everything, it's all in how you manipulate the numbers. The official WHO tally for Mexico stands now at 26 confirmed with seven deaths, but that number appears to be coming from the CDC and differs from the tally the Mexican health minister has out there (110 reported today and overall death toll over 150). Both of those numbers seem quite low for a country that has closed the capitol city and every school from coast to coast; suffice it to say that I do not put much stock in the accuracy of those numbers. Actions speak louder than words, and the actions of the Mexican government and the Mexican people (Mexico City looks about as dead as Terlingua, TX on TV) paint a far less optimistic picture. Nevertheless, maybe this thing is not catching fire, despite the earnestness coming out of the CDC and WHO and the extraordinary actions in Mexico.

There are no reported or confirmed American deaths that I have been able to find, but the acting director of the CDC, Dr. Richard Besser, says, "I wouldn't be overly reassured by that. There are many reasons that could explain that...I expect that the spectrum of the disease (in the U.S.) will expand."

The media, of course, are overhyping this and working everyone into a frenzy. If you get a few confirmed or even suspected cases in your metro area you can expect the deluge to follow. Three very basic, very easy, things to remember to keep you and your crew healthy: wash your hands compulsively (soap or alcohol-based sanitizer), don't get within six feet of anyone if you don't have to (ESPECIALLY dyspnea patients), and don't be shy with the masks (N95 for you, surgical mask for the patient, even if he's on O2).

The Texas Department of State Health Services has some good personal protection guidelines specific to first responders.

More Web 2.0 Swine Flu stuff

In addition to the Twitter sites I mentioned in the last post, this new Google map of suspected and confirmed cases is interesting to follow. We should remember that user-generated content is often (usually?) unreliable, but the more widely it is disseminated the quicker inaccuracies are debunked and salient points reinforced. Firegeezer has written several times about having an Internet Intelligence Officer at the command post for very large, very public incidents. Twitter and RSS readers can keep you updated very quickly from a tremendous amount of sources and go a long way toward maintaining situational awareness using a resilient and durable platform.



View H1N1 Swine Flu in a larger map

Swine Flu in New York, Kansas

New York public health officials are confirming around 200 cases in Queens* centered around a school and CNN has reported cases in Kansas. Texas Department of State Health Services is closing certain schools around San Antonio and recommending people avoid public gatherings in those areas.

This is a great case for Twitter. Go sign up and follow @BreakingNews, @Veratect, and @CDCEmergency for some really bleeding-edge coverage.

I sent a memo up my chain of command this morning recommending a few actions.

1. Locate and inspect our previously issued N95 HEPA masks
2. Consider writing a standing order, to be issued later, ordering company officers and battalion chiefs to relieve from duty any members reporting sick (our guys hate using sick leave for actual sickness!)
3. Send someone to the store to stock up on Purell now (the City buys this, but they probably don't have a lot of reserves in the warehouse)
4. Issue a standing order directing members to wear their N95's when treating dyspnea patients and to wash hands after every EMS call, regardless of actual patient contact
5. Issue a standing order banning members from lingering in public places until further notice
6. Suspend all public ed and PR events until further notice

Don't hang out close to a patient if you don't have to, wash your hands frequently and thoroughly (or use alcohol-based sanitizer), and, if your patient is not on a NRB and has a respiratory problem then put a surgical or dust mask on his/her face.

This is the sort of thing that can push this teetering economy into a depression as business' continuity of operations begin to strain. That will definitely include fire departments, since this appears to be something that disproportionately affects healthy adults (vice kids and the elderly and infirm).

Oh, one other thing. When you sneeze, sneeze in the crook of your arm and not your hands (that actually is a CDC recommendation!). Sneezing on your hands just transfers that crap to doorknobs, keyboards, mice, and light switches

* (UPDATE at 15:20 on 4/26): That number has come down significantly, with under 20 being confirmed but others suspected.

Ad astra per porci?

Has the long-awaited influenza pandemic begun in the tinderbox of Mexico? Yesterday the Canadian equivalent of the CDC issued a BOLO to Canadian customs people for travellers returning from Mexico. This morning the World Health Organization announced that upwards of 900 people have become infected in Mexico City and surrounding areas and later in the morning Mexico City shut down its schools. Cases of swine flu in San Diego and San Antonio may be related, but no one is sure yet. Please note that "swine" flu, like "avian" flu and "Spanish" flu, can infect humans without any contact with pigs, birds, or Spaniards. They're just named after their natural reservoirs or wherever they were first noticed in people.

The unusual (read: scary) thing about this strain is that, like the 1918-19 near-apocalypse, it affects primarily people in the prime of life. If SARS and its attendant hysteria was any indication, this could turn into a nightmare for fire departments and EMS agencies around the country and especially in the border regions.

Things to think about:

1. Lots of dyspnea calls, many of which will require ventillatory support
2. Our own workforces may be hard hit and you may have to make do with holding people over on shift
   
3. The economy runs on Just In Time inventory systems; a pandemic that hits healthy adults the hardest could cripple the JIT system, possibly delaying or making unavailable things like food in the grocery store, HEPA masks at the pharmacy, Lysol and Clorox, and parts for your vehicles
4. In 1918-19 things collapsed, and that was with more local resilience (local food and dairy, local craftsmen, and inventory) and fewer people dependent on the fire department for their healthcare

If this thing takes off it could be a real adventure for the fire service.

Or it may fizzle out, but even if it does you should use it as a teaching moment about preparedness.


CDC's running swine flu updates here.