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The swine flu buzz is causing information overload. There are three things pertinent to the fire service that must be implemented immediately to protect your members, provide excellent patient care, and be a good public health partner. Here's the list:

Fire Service Leaders
  1. Immediately notify all members and staff of the emerging problem.
  2. Review your plans using the CDC EMS Pandemic Preparedness checklist.
  3. Set up an email list and web site to provide continual updates and info for your members.
  4. Monitor news reports and government resources. Communicate with your local public health officials. Use the CDC minute-to-minute swine flu update site.

Communications Center/Dispatch Leaders

  1. Implement severe respiratory infection (SRI) screening for all callers with chest pain, difficulty breathing, headache, or general illness (sick person). If using the Medical Priority Dispatch System (MPDS), activate the SRI drop down on ProQA or add the following questions to paper card numbers 6, 10, 18, and 26 for further interrogation: (a) has the patient recently been in Mexico (or other outbreak location) or exposed to anyone who has (paying particular attention to those who stayed for 7 days or longer)? (b) are they febrile or have a fever and, if so, is it higher than 101 F (38 C) and (c) do they have a cough or other respiratory illness symptoms?
  2. Relay responses to these questions to EMS units before they arrive on scene.

Firefighters and EMS Providers

  1. Request additional information from dispatch when sent to respiratory, sick person and fever related calls if limited initial dispatch information is provided.
  2. Perform initial interview of all patients from at least 2 meters (6.5 feet) away to determine if personal protective equipment precautions are necessary.
  3. Place a mask on all patients with suspected influenza symptoms before approach. Use a surgical mask or non-rebreather mask (when oxygen is required).
  4. Avoid droplet producing procedures whenever possible including nebulizers, bag-valve-mask, suctioning or intubation. If bag-valve-masks are needed, use BVMs with HEPA filters whenever possible.
  5. Recommended PPE for taking care of ill/potentially infected patients includes: gloves and N95 or better respirators. PPE should be donned and doffed according to published guidelines to prevent cross contamination, including faceshield/eye and gown protection when splash or airborne contamination is possible.
  6. Alert receiving hospital personnel of the possibility of an infectious patient as soon as possible and hold suspected infectious patients in the ambulance until their destination in the hospital is known, rather than immediately moving them into the emergency department.
  7. Perform a thorough cleaning of the stretcher and all equipment that has come in contact with or been within 2 meters (6.5 feet) with an approved disinfectant, upon completion of the call following CDC interim guidelines for cleaning EMS transport vehicles.

Remember that this is a continually evolving situation. The most severe flu cases so far have been mostly adults from ages 25 to 45, but patients of all ages have been infected, so the same precautions should be used for all patients. We need to stay on heightened alert until this threat has been controlled. As with all infectious diseases, always remember that hand washing is the number one way to decrease transmission!

Mike McEvoy - EMS Editor - Fire Engineering

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posted by Mike McEvoy
4/27/2009 09:32:00 AM

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Blogger badge1 said...

If the swine flu turns into a pandemic there are some other considerations that command staff should consider now. In a pandemic, you can count on 1/3 of the workforce being affected. Man power problems being what they are will be strained even worse. Make some contingencies now.

Wed Apr 29, 09:20:00 AM EDT  
Blogger MusicKat said...

Just one little, though important addition to prevent cross infection - if you want to be really careful: when washing hands turn on faucet with a paper towel which you throw away before soaping up, wash well, scrubbing cuticles and under nails,between each finger, around wrist - and rinsing well with moderately hot water is equally important.If you are washing hands in a public rest facility,THEN DRY YOUR HANDS WELL WITHOUT TURNING THE FAUCET OFF. WHEN THEY ARE DRY, THEN TURN OFF THE FAUCETS WITH NEW TRIPLE LAYERED PAPER TOWEL AND THE SAME WHEN LEAVING ON THE DOORKNOBS. Otherwise, whatever was on the doorknobs is now back on your hands when leaving and all that washing you did was pointless. This is important regardless of pandemics, epidemics or if you simply don't want to catch a common cold or touch other people's heiny germs (believe it or not, not everyone washes after going to the bathroom). Oh, and if you have to crank to get paper towels out of the dispenser, make sure you crank and leave it hanging BEFORE you wash hands so as not to touch the crank handle after you've washed.

Wed Apr 29, 10:03:00 AM EDT  
Blogger raym54 said...

If we are to transport patient exhibiting H1N1 or similar pandemic symptoms we better ISOLATE those patients in the ambulance in order to protect ALL our assets ,1st Responders , ambulance and the hospital.95 masks etc are stopgap devices.PPE must be employed for personnel and equipment.

Wed Jun 24, 11:20:00 AM EDT  

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Uh oh. By now, you've probably read our breaking news reporting a swine flu outbreak in Southern California and Texas. Is this novel virus with confirmed human-to-human transmission the start of a pandemic? Maybe, maybe not. The CDC released a MMWR report with full details of the US cases investigated as of Friday afternoon, April 24th, 2009. The World Health Organization (WHO) is concerned.

The formula for a pandemic requires 3 things: a novel virus to which all or most people are susceptible, transmissability from person to person, and wide geographic spread. So far, we have a novel virus that appears most people are susceptible to. There has been person-to-person transmission. Wide geographic spread has yet to happen. Essentially, we are (overnight, no less) one step closer to a pandemic than the bird flu. Preliminary CDC incubation period estimates are 1 to 7 days. This is expected to be narrowed to 2 to 5 days with further data. That means we will likely see a pandemic or not within a very short time.

What to do? First, don't panic. Second, wash your hands. Often. Third, take an inventory of where you and your department stand. The CDC Pandemic Influenza EMS Planning Checklist has been available for over 3 years. Review the checklist and make sure you have adequate stockpiles of PPE including N-95 masks and hand hygiene gels. You will not be able to purchase or order them during a pandemic. Check availability of antivirals for your members. Review your sick leave and staffing contingency plans. Assure you have current contacts with public health, government, and hospital officials. Be certain your 911 center can handle calls when no EMS services or hospital beds are available. By now, all these matters should be in place. Make certain they are.

Watch the CDC (www.cdc.gov) and the WHO (www.who.int) for updates and notices. Hopefully, this outbreak remains simply an outbreak.

Mike McEvoy
Fire Engineering EMS Editor

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posted by Mike McEvoy
4/24/2009 10:17:00 PM

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In small town news worthy of national laughter, the City of Albany, New York treasurer refused to release copies of forgiven parking tickets to an investigating committee citing HIPAA privacy rules. The Health Insurance Portability and Accountability Act of 1996, for those with momentary lapse of memory, provided protections against unauthorized and unnecessary disclosure of medical records. Fire/EMS services made numerous business modifications to comply with HIPAA. Some 13 years after implementation, HIPAA remains poorly understood and is often incorrectly cited by folks unwilling or uninterested in sharing information.

I've heard nurses not want to update family members about a loved one's condition, hospitals refuse to provide patient information to an EMS crew who had treated and transported the patient, firefighters refuse to tell a family member or friend where a patient had been transported - all wrongly in the name of HIPAA.

HIPAA was designed to prevent medical information from falling into the wrong hands. Parking tickets are not medical information. Anyone a patient wants to know about their medical condition is entitled to have that information. Any health care provider who treats a patient is entitled to medical information about that patient. EMS services are required to post HIPAA information on their web sites and provide education on HIPAA to their members and employees. This parking ticket fiasco serves as an outright silly example of how convoluted HIPAA misinterpretations have become. It's probably time to check the HIPAA knowledge in your department.

Mike McEvoy
EMS Editor
Fire Engineering

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posted by Mike McEvoy
4/23/2009 11:32:00 AM

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Blogger Peter said...

We have run into occasional "HIPAA Roadblocks" in transffering care. We have seen HIPPA invoked as crutch to avoid work and as a shield to prevent or inhibit staff gaining useful knowledge about potential patient care issues. It has been addressed HIPAA officer to HIPAA officer with suggestions about retraining. Generally common sense has prevailed and with a little prodding our staff has received the pertinent information. We never miss an opportunity to educate, share, and learn.

Wed Apr 29, 09:39:00 AM EDT  

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For the first time ever, the FDIC Opening Ceremonies will be broadcast live over the Web on the Fire Engineering homepage. Next week Wednesday, April 22, head to www.fireengineering.com at 8:30 a.m. EST to watch the proceedings at home or at the fire station.You will hear the opening ceremonies, LODD tribute, renowned inspirational Chaplin Father Ed Byrne, the IFD Bagpipers, the voices of the IFD Keynoters Chief Dave McGrail and Ray McCormack, IAFF General President Harold A. Schaitberger, Chief Denny Compton, Chief John Norman and NIST Fire researcher Dan Madrzykowski. We know not everyone can make and the room only hold 5000, so the other 25000 or so attendees now can see the show online as well.

We will also have video and updates throughout the week from the show on www.fdic.com, and if you're using Twitter, follow Fire Engineering Editor in Chief Bobby Halton at twitter.com/BobbyHalton for constant updates on FDIC all week long.

It looks like great weather and another super turnout for America's largest training and social networking conference ever. If you are coming remember FOOLS BASH Wednesday, STOP DROP ROCK AND ROLL Thursday AND THE UNION PARTY Friday and the COURAGE AND VALOR FUN RUN Saturday!

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posted by Bobby Halton
4/19/2009 02:07:00 PM

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In reading news reports and watching the videos available online from the various news links I'm beginning to believe that there is a high probability that perhaps a sudden or sustained wind gust may have been a contributing factor in this most recent Houston tragedy. Click here to read more

By all accounts this was a well conducted proactive fire fight the type of firefighting America expects and quite frankly Huston expects from its professional firefighters. The subject of wind driven flames fronts is currently under much study by NIST, underwriters laboratory, and other scientific institutions who have an interest in our profession.

We must always remember that tactically wind and topography are critical pieces of our Fireground decision making. One of the most effective uses of an exterior Fireground command position is to observe weather and wind direction.

Although this is not yet confirmed reading the reports by citizens and video claiming embers had traveled 3 to 4 blocks leads me to believe we may be looking at a wind driven flame front which claimed the lives of Capt. James Harlow, 50, and rookie firefighter Damion Hobbs, 30. Our deepest sympathies and regrets go out to the family and friends of these two brave men and we honor firefighter Hobbs service to our country at this time as well.

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posted by Bobby Halton
4/13/2009 04:01:00 PM

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MIDWEST CITY, Ok
Only Fire Engineering traveled to Midwest City Oklahoma to report firsthand on the incredible fires which challenged Fire Departments across Oklahoma and Texas. Hundreds of families are now homeless and whole communities have been charred by deadly, wind-driven wildfires.

See FETV-On Scene report and read how these communities fared when faced by a perfect fire storm. The event sadly drives home several key issues, the interface is everywhere, staffing is critical to success, more study is desperately needed on wind driven flame fronts, codes are critical and money is need to equip and train every department in America now. I think pig stink can wait; public safety is suffering from a pathetic lack of attention. We read the stimulus bill we read the budget, and the fire service has to be screaming Wheres the Beef?

To see the On-Scene Reports under Fire Engineering First Report click here
http://www.fireengineering.com/videos/index.html

To read more click here

http://www.fireengineering.com/display_news/176600/25/none/OK,_TX_communities_ravaged_by_wildfires

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posted by Bobby Halton
4/11/2009 11:07:00 AM

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One year ago, two highly regarded firefighters in a well managed and well respected organization lost their lives in a residential structure fire. The fire which originated in the basement caused a floor collapse which claimed the two firefighters. What follows is a shorten version of the official description of the event. It provides many topics for discussion and review.

I would strongly suggest you place yourself in the role of Captain Broxterman or the any other positions to first try to understand what goals they were trying to achieve and what was occupying their thoughts as this event unfolded. Then read the entire report and see what you can learn that you can do or suggest to help your organization to better help those who are faced with making decisions on the fireground more effective and safer.

There is every possibility you will face a similar fire in your department, how can we support one another better, how can we work more effectively together. See what your crew thinks, see if they are willing to accept that we all are vulnerable any time at every fire.


On Friday, April 4, 2008, Captain Robin Broxterman, 37-years-old, a 17-year veteran
career firefighter and paramedic, and Firefighter Brian Schira, 29-years-old, a six-month
probationary, part-time firefighter and Emergency Medical Technician with Colerain Fire &EMS; died after the floor they were operating on collapsed at a residential structure fire. Dispatched at 06:11:23, two engine companies (Engines 102 & 109), one ladder company (Ladder 25),and the Battalion Chief (District 25) were dispatched to investigate at 06:12:45. At 06:13:43, following a second notification reporting a fire in the basement of the structure the initial response was upgraded to a structure fire response to include one additional engine company (Engine 25), one rescue company(Rescue 26), and one squad unit (Squad 25).

Captain Robin Broxterman commanding Engine 102 with four personnel, herself and three firefighters arrived on the scene at approximately 06:23:45 reporting moderate smoke showing and established Squirrelsnest Command. Verification was made through face-to-face communication with the male homeowner that all occupants were out of the structure, which was then relayed to Captain Broxterman.

District 25 arrived at the scene at 06:26:18, and assumed Command from Capt. Broxterman. At 06:26:29, Capt. Broxterman, Firefighter Schira deployed an inch and three quarter pre-connected hose line through the front main entrance toward the rear of the structure. The fire was determined to be located in the basement of the structure.

At06:27:35, Capt. Broxterman reported, E102 making entry into the basement, heavy smoke. At06:34:20 Engine 25 was the designated Rapid Assistance Team (RAT), having just completed their 360-degree size-up around the structure encountered E102 second firefighter in the front yard of the structure, whom reported that he had lost contact with his crew.

At 06:35:10, the Incident Commander identified a potential Mayday operation, which indicates a life threatening situation to a firefighter. RAT25 was deployed at 06:36:30. An official Mayday operation was declared at 06:37:23, and an immediate request was made at06:37:30 for a second alarm.

At 06:41:43,RAT25 entered the basement from the rear of the structure. At 07:00:12, E26 entered through the front main entrance of the structure and into the basement by means of the interior stairway. It was noted that during the search efforts, no audible signals from either victims Personal Alert Safety System devices were heard.

Both firefighters were located in the basement. Capt. Broxterman was located at 07:08:05, and Ffr. Schira was located at 07:29:28.Both firefighters were buried under collapsed structural components and contents. Capt.Broxterman and Firefighter Schira were declared deceased at the scene as a result of their injuries.

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posted by Bobby Halton
4/05/2009 04:13:00 PM

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