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Predicting disaster.

Are we really prepared for emergencies and/or disasters--natural or man-made? Released on Dec. 16, 2009, the 7th annual Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism report says, basically, that we are not. The report cites the nation's ability to respond to public-health emergencies has serious underlying gaps--gaps brought to light during the H1N1 flu outbreak. The report also points to the ongoing economic crisis as straining "an already fragile" public-health system. (1)

The Ready or Not? report says a "Band-Aid" approach to public health is inadequate. Key infrastructure concerns highlighted by the study were lack of real-time coordinated disease surveillance and laboratory testing, outdated vaccine-production capabilities, limited hospital surge capacity, and a shrinking public-health workforce:

* More than half of the states had experienced public-health funding cuts and a 27% cut in federal preparedness funds since FY2005, which "puts improvements that have been made since the Sept. 11, 2001, tragedies at risk";

* Not one state received points on all 10 indicators;

* Eight states tied for the highest score of nine out of 10: Arkansas, Delaware, New York, North Carolina, Oklahoma, Texas, Vermont, and North Dakota;

* With three out of 10, Montana scored lowest;

* 14 states do not have the capacity in place to assure the timely pick-up and delivery of laboratory samples on a 24/7 basis to the Laboratory Response Network, or LRN;

* 11 states and Washington, DC, report not having enough laboratory staffing capacity to work five 12-hour days for six to eight weeks in response to an infectious-disease outbreak, such as H1N1; and

* among a series of recommendations for improving preparedness is a suggestion for public-health systems to reach out quickly and effectively to high-risk populations, including strengthening culturally competent communications around the safety of vaccines. Health disparities among low-income and racial/ethnic minorities, who are often at higher risk during emergencies, must also be addressed. (1)

Another disaster preparedness expert speaks out

At the National Center for Disaster Preparedness at Columbia University's Mailman School of Public Health--which offers resources to the nation's system of hospitals, public-health agencies, clinics, law enforcement, and emergency services--Irwin Redlener, MD, its director, speaks and writes extensively on national disaster-preparedness policies, pandemic influenza, the threat of terrorism in the United States, and other related issues, some of which echo the recent Ready or Not? report--main among his relevant points is that we have paid no attention to vulnerable populations like the disabled and children. (2) In fact, Redlener goes so far as to point out that we have not yet defined what a "prepared America" is. (2) And he strongly suggests that we have a failure of imagination in disaster planning: "No one is asking how far the consequences of disasters go." (2)

Dr. Redlener's lectures include material from his book, "Americans at Risk: Why We Are Not Prepared for Megadisasters and What We Can Do Now," authored in 2006, which lists several major points regarding disaster/emergency preparedness. He mentions "communications" as a major necessity for disaster/ emergency preparedness. His example emanates from the terrorist attacks on Sept. 11, 2001, during which police officers on the ground could not communicate with the firefighters who were in the higher floors of the World Trade Center in order to warn them to evacuate the buildings. Redlener laments the loss of 343 firefighters on Sept. 11 due to the simple fact that police and firefighters did not have interoperable communications devices. Yet, five years later, Redlener says the situation had not been resolved. In the interim, he discovered that Hurricane Katrina's first responders had the identical communications problem. (2) Now, a little more than eight years after Sept. 11, have we achieved any better measure of communication among first responders?

Redlener points to the slow, steady degradation in our governmental agencies such as the Federal Emergency Management Agency (FEMA) which was, in the 1990s, the "government's crown jewel." (2) During and after Hurricane Katrina, Redlener claims FEMA's leaders had little or no experience. The handling of Katrina, he says, was the "ultimate reality show, 'Bureaucracy Gone Wild'" and "the level of incompetency and functionality demonstrated by the United States to the entire world in New Orleans was without precedent." (FEMA is now housed under Homeland Security.) (2) Redlener claims "Achilles' heel" of American disaster planning is its transportation and communications infrastructures--and weak infrastructures complicate disaster preparations, "making us vulnerable."

Pandemic influenza

What about our preparations for a healthcare surge during a flu pandemic? Redlener's commentary on preparedness during the H1N1 flu season and potential pandemic, include his example of hospitals full to overflowing. In New York City alone, a flu pandemic could see 2 million of its 8.2 million citizens suffer from the H1N1 flu, with 200,000 of those needing hospitalization. He asks whether or not anyone has thought through the consequences of this type of need in surge capacity. (3)

Disaster-preparedness expert, John M. Barry, a prize-winning and New York Times best-selling author of five books including "The Great Influenza," answered that query in a September 2006 MLO article: "Our penchant for just-in-time operations would have a crippling effect on all institutions, but particularly upon those charged with taking care of large patient populations suffering from influenza. Supply-chain interruptions would wreak havoc, and few, if any, industries have any 'surge capacity.'" (4)

Debating the flu

Throughout the latter part of 2009, citizens nationwide debated the wisdom of getting H1N1 vaccinations; at the same time, vaccine producers--for a variety of reasons--failed to meet established deadlines. In fact, an almost laissez-faire philosophy about H1N1 permeated many communities. The one item that seemed to rouse popular interest was a government announcement for employers: The Centers for Disease Control and Prevention suggested that they develop "flexible leave policies" so that employees with flu-like symptoms or with family members with symptoms could use those without fear of losing their jobs. Statistics from that 1918 flu epidemic did not seem to make much of an impact on today's potential victims:

* The 1918 flu pandemic killed about 675,000 Americans. (5)

* The 1918 flu's high death rate hit 15- to 34-year-olds. (5)

* The influenza epidemic came in three waves. The first wave, in the spring 1918, took far fewer victims than the second. (5)

* People's indifference to the 1918 flu epidemic, both at the time and like today, led directly to the rapid and deadly spread of the disease. Many believed lethal epidemics were a common factor in their lives; at first, the flu seemed no different. (5)

* Most people had already lived through at least one smaller-scale epidemic (e.g., cholera, yellow fever, malaria), so another incurable disease had little effect on those who had already survived one. Flu news paled in comparison to the news from the European Front during World War I. (5)

Terrorism threats

In the past year alone, we have had a sampling of different situations that either threatened to or actually put first responders, public-health professionals, and healthcare workers on the front lines and/or at risk, and created potential problems and disasters for others down the disaster-/emergency-containment line. When it comes to terrorists, Redlener admits that America has some "tasty targets for terrorists." (2) He pointed out in 2006 that in a national disaster or emergency concerning disease spread or terrorist activity, we had no plans for closing our borders. We still do not. Redlener recognizes Israel as a good example of a country that is prepared because its citizens actively practice their preparations for such eventualities.

Fire and flooding threats

Outside Los Angeles in September 2009, several wildfires tore through the Angeles National Forest. The largest, the Station Fire, burned more than 140,000 acres, destroyed nearly 100 structures, and claimed the lives of two firefighters whose vehicle fell from a road into a steep canyon. Evacuation orders affected thousands in and around the city. (6) A year ago in January, river waters spread over highways, farms, towns, and parks in Washington, shutting down traffic on a 20-mile stretch of heavily traveled Interstate 5 between Seattle and Oregon and threatening the federal roadway north of Seattle. The risk of landslides also was high, leading to closure of all passes across the Cascades. (7)

Shooting threats

The Fort Hood shooting incident in late 2009 came as a shock to most people. Maj. Nidal Malik Hasan faces 13 counts of premeditated murder and 32 counts of attempted premeditated murder stemming from the Nov. 5 shootings at a processing center at the Fort Hood Army Post. (8) For lab personnel, however, Nov. 10, 2009, may have been an even more shocking incident.

As reported by The Dark Daily, in a suburb near Portland, OR, a gunman entered a laboratory facility owned by Legacy MetroLab, shot his estranged wife, then killed himself. Two other individuals in the laboratory were injured, including a man admitted to the hospital with multiple gunshot wounds. (9)

One other example of a shooting attack within a clinical laboratory or pathology group practice took place on June 28, 2000, when Rogert Haggitt, MD, professor of Pathology and director of Hospital Pathology at the University of Washington was shot and killed in his office by a pathology resident, Jian Chen, MD, who then turned the gun on himself and died. Chen's contract had not been renewed. Chen had spoken to colleagues at least 60 days earlier about purchasing a gun, and had been offered but refused counseling. (9)

Because attacks like these are such a rarity, it is difficult for clinical lab managers and pathologists to develop specific contingency plans for such an event. On the other hand, these events are a reminder that the unexpected can always happen. Thus, establishing a clear emergency-response chain of command and protocols for all types of events can prove invaluable when the need arises. (9)

Earthquake threats

A minor earthquake rattled southeast Nebraska on December 17th but caused little damage and no injuries. The U.S. Geological Survey (USGS) reported the 3.5 magnitude quake struck two miles north-northwest of Auburn. Though not known for its earthquakes, Nebraska has experienced several notable ones since its founding in 186, the most serious a magnitude 5.1 quake in 1877 in the east-central part of the state. (10) The National Earthquake Information Center reports from 12,000 to 14,000 earthquakes yearly or an average of about 35 earthquakes every day. (11)

Conclusion

Not only have we heard the results of a notable annual report and read the arguments of disaster/emergency experts, throughout this section, Drs. Poutanen and Williams and Mr. Sharar share the outcomes of their varied real-life disaster/emergency situations, each of which resulted in lessons learned and incorporated into their institution's preparedness plans. This is a new year, and new years typically begin with some mighty resolutions. Perhaps 2010 is the year for a thorough evaluation and upgrade of your laboratory's disaster/emergency plan(s), taking into consideration the types of disasters discussed here. We predict that by year's end we will all be better prepared, beginning now.

References (more detailed listing online)

(1.) http://healthyamericans.org/reports/bioterror09/. Accessed 12/23/09.

(2.) http://fora.tv/2006/09/15/lrwin_Redlener#comments_section. Accessed 12/23/09.

(3.) www.youtube.com/watch?v=saM7iG_aKDg.) Accessed 12/23/09.

(4.) www.mlo-online.com/articles/0906/0906clinical_issues.pdf Accessed 12/23/09.

(5.) www.haverford.edu/biology/edwards/disease/viral_essays/redicanuirus.htm Accessed 12/23/09.

(6.) www.cnn.com/2009/US/weather/01/08/washington.floods/index.html.Accessed 12/23/09.

(7.) www.cnn.com/2009/US/weather/01/08/washington.floods/index.html.Accessed 12/23/09.

(8.) http://www.foxnews.com/story/0,2933,578945,00.html. Accessed 12/23/09.

(9.) www.darkdaily.com/gunman-enters-clinical-laboratory-in-oregon-yesterday-two-dead-two-injured-111. Accessed 12/23/09.

(10.) www.1011now.com/home/headlines/79467002.html. Accessed 12/23/09.

(11.) www.crew.org/home/eqfacts.html.Accessed 12/23/09.

BY Carren Bersch, Editor

CE

CONTINUING EDUCATION

To earn CEUs, see current test on pp. 16-17 or at www.mlo-online.com under the CE Tests tab.

The CE test covers all material in the Cover Story section.

LEARNING OBJECTIVES

Upon completion of this article, the reader will be able to:

At the completion of this article the reader will:

1. Identify characteristics of various types of disasters.

2. Describe planning information to improve preparedness.

3. Identify types of power supplies and how they are used.
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Author:Bersch, Carren
Publication:Medical Laboratory Observer
Article Type:Cover story
Geographic Code:1USA
Date:Jan 1, 2010
Words:2078
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