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.

Still around

Obviously I haven't posted much lately; given the small audience here I suspect it doesn't matter. I've been busy with school and work, but will return in May. Until then, be careful and take it easy.

Are the cops our friends? Are we our friends?

In the homeland security world we are all in the race for the big pie, the federal dollars. That's why it's especially disconcerting to see a national LE figure say something like this: “All my community policing grants turned into fire trucks, and homeland security became the monster that ate law enforcement.” Really? Really?

For starters, I don't believe that is true. Predictably, I believe the fire service doesn't get enough (or the right kind of) attention from the feds when it comes to homeland security. I also believe the cops get too much and want more. They want more money and more control, from street cops who want to tell the fire department when they can disregard a scene to the police chiefs who want to tell the fire chief what is and is not a hazmat incident. Federal grants have only accelerated the power grabs, with LE agencies all over the country moving into fields for which they are not qualified, trained, or experienced. From patrol cars with Level B CPC they don't know how to maintain or put on to police department rescue squads competing with fire department rescue squads, there is a disturbing trend of mission creep for them and marginilization for us.

Budgets are zero-sum games where each agency has to make a convincing argument that it deserves as much or more money as the next. When it comes to fire vs. police we start out at a disadvantage. Few people are scared of fire, but everyone is scared of being mugged (broad generalization). Your agency has to develop a strategic communications plan that combines smart leadership with clear illustrations of public worth. There are a lot of reasons the cops beat us at budget time (they bring in ticket revenue, the public is scared of crime, they market themselves better, etc.), but I think one of the biggest is a fire service-wide strategic problem. Namely, fire chiefs aren't as professional as police chiefs, as a group. We don't have dozens of undergraduate and graduate degree programs at legitimate universities and we don't have numerous truly peer-reviewed journals producing quality research. The fire service needs to stop thinking of itself as a great alternative to college for people "who just don't like school." A fire chief with a technical certificate from a community college or bachelor's from an internet-only school is at a significant disadvantage next to a police chief with a master's degree in CJ from a brick-and-mortar university.

I realize this is an unpopular and maybe inflammatory opinion. Let me be clear: firemen are smart. We all know that, but firefighters aren't always studious or intellectual. I've heard a lot of firefighters complain about being treated like garbage men. To that I'll ask a question: what do you have on your resume that sets you apart from the garbage men? And a hint: weekend NFA extension schools don't matter.

Disorder on the Doorstep*

* I stole this title from a chapter of John Robb's intriguing book on the future of terrorism and globalization.


So the Department of Defense is worried about Mexico and the news has finally trickled down to the AP. In short, a report that hopes to foresee looming and emerging strategic threats states "In terms of worst-case scenarios for the Joint Force and indeed the world, two large and important states bear consideration for a rapid and sudden collapse: Pakistan and Mexico," (36).

IF this were to happen what would be the fallout for the fire service in the border states? Affected Mexican states are burdened with mass killings on almost a daily basis, the police and military are under direct assault, and the legitimacy of local governments is in question. I doubt we'll see a challenge to legitimacy out of all this, but we could see the mass killings and direct combat with LE and the military.

For the fire service, I'd be more concerned by the flow of refugees coming across the border in case things get worse. The American fire service has never been on the front lines of a humanitarian crisis so I am not sure what it would look like. Along the border and the corridors leading from the border to places like Phoenix, LA, and Houston, you could have an influx of thousands (tens of thousands?) of people in a matter of days. This happened in the Houston and Beaumont areas during Katrina when people from NOLA packed hotels, four, six, ten to a room. EMS calls will go through the roof as you have poor people packed tight in unfamiliar surroundings under high stress. They won't have their meds, there will be assaults and other criminal activity, and multi-dwelling fires will take on added urgency.

Just something to think about an emerging potential threat for the fire service, and the report itself is interesting as general background.