July 17, 2018

Volume 7, Issue 14

Visit HAPonline.com


Emergency Preparedness Hot Topics

UPDATE: Source of Nerve Agent Contamination Identified (Metropolitan Police, London) On July 11, a small bottle was recovered during searches of Charlie Rowley's house in Amesbury. It was taken to the Defence, Science and Technology Laboratory at Porton Down, Wiltshire, for tests. Following those tests, scientists now have confirmed that the substance contained within the bottle is Novichok. Further scientific tests will be carried out to try and establish whether it is from the same batch that contaminated Sergei and Yulia Skripal during March—this remains a main line of enquiry for police. Article

Drone in Superman Garb Crashes into French Nuclear Plant (U.S. News & World Report) Greenpeace activists say they have crashed a drone into a French nuclear plant to highlight the lack of security around the facility. The drone, which was decked out to resemble a tiny Superman, slammed into the tower in Bugey, 30 kilometers (20 miles) from the eastern city of Lyon, according to a video released by Greenpeace. Article

New Health Alerts and Advisories

Pennsylvania Health Alert Network (PA-HAN) Health professionals: Sign up for the PA-HAN. 2018 Health Alerts, Advisories and Updates

PA Statewide Knowledge Center (HIMS) Training Available

Pennsylvania health care facilities are requested to contact their HAP Regional Manager to schedule training.

Regional News

HAP regional manager contact info and the latest regional news and reminders are available at HAP's Emergency Preparedness page.

Coalition News

2017-2022 ASPR HPP Health Care Coalition Capabilites Document

CMS Emergency Preparedness Rule Home Page Source for official information about the rule and implementation.

National Preparedness News and Updates

FEMA Was Sorely Unprepared for Puerto Rico Hurricane, Report Says (New York Times) The Federal Emergency Management Agency's (FEMA) plans for a crisis in Puerto Rico were based on a focused disaster like a tsunami, not a major hurricane devastating the whole island. The agency vastly underestimated how much food and fresh water it would need, and how hard it would be to get additional supplies to the island. Article

INFECTIOUS DISEASES
Ebola

An Ebola Outbreak Has Just Been Stopped. Here's What It Tells Us About Containing Epidemics. (Harvard Business Review) After a month with no new cases, the Ebola outbreak in the Democratic Republic of Congo appears to be under control and weeks away from officially ending. Less than three months since it was declared, and after only about 50 cases, this outbreak's efficient containment is a remarkable achievement that stands in stark contrast to the West African epidemic that spiraled into a two-year global crisis with more than 28,000 cases. Article

MERS

MERS Situation Update, June 2018 (WHO Eastern Mediterranean) At the end of June 2018, a total of 2,229 laboratory-confirmed cases of Middle East respiratory syndrome, including 791 associated deaths (case-fatality rate: 35.5%) were reported globally; the majority of these cases were reported from Saudi Arabia (1,853 cases, including 717 related deaths with a case-fatality rate of 38.7%). Article

WHO Guidance: Home Care for Patients with Mild or Asymptomatic MERS-CoV Infection (Avian Flu Diary) Like with nearly all viral infections, patients infected with MERS-CoV can experience a wide range of symptoms—from asymptomatic carriage (roughly 20%), to mild flu-like symptoms, to severe pneumonia and/or death. While host co-morbidities (including age) appear to be important contributing factors, we have even seen some young—apparently healthy—individuals develop severe disease. Article

Influenza

Changes in Influenza Vaccination Requirements for Health Care Personnel in U.S. Hospitals (JAMA Network Open) Annual influenza vaccinations currently are recommended for all health care personnel to limit the spread of influenza to those at high risk of developing serious complications from the virus. Vaccination coverage has been shown to be significantly greater among employers requiring and encouraging health care personnel to receive the annual influenza vaccination. Article

BMC Infect Dis.: Key Amino Acid Substitutions in Egyptian H5N1 Isolates (Avian Flu Diary) Despite ambitious International Health Regulations adopted by World Health Organization (WHO) member states during 2005—which required all nations to develop mandated surveillance and testing systems, and to report certain disease outbreaks and public health events to WHO—there remain large swaths of the globe where surveillance and reporting are either weak, suppressed, or virtually nonexistent. Article

Indiana: First Human Case of H3N2 Variant Influenza Reported Since 2013 (Outbreak News Today) The Indiana State Department of Health and Indiana Board of Animal Health are urging Hoosiers to take steps to prevent illness while visiting events where pigs are exhibited following confirmation of a case of influenza in a resident with exposure to pigs. This is the first human case of H3N2 variant influenza reported in Indiana since 2013, and the first human case in the U.S. this year, according to the Centers for Disease Control and Prevention, which confirmed the test results. Article

Other Emerging Diseases

Alarming Polio Outbreak Spreads in Congo, Threatening Global Eradication Efforts (Science) Overshadowed by the Ebola outbreak in the Democratic Republic of the Congo (DRC), another frightening virus is on the loose in that vast, chaotic country: polio. Public health experts have worked for months to stamp out the virus, but it keeps spreading. It has already paralyzed 29 children and, on June 21, a case was reported on the border with Uganda, far outside the known outbreak zone, heightening fears that the virus will sweep across Africa. This is "absolutely" the most worrisome polio outbreak today. Article

Crimean-Congo Hemorrhagic Fever—Iraq: (Arbil) Confirmed, MOH, Request for Information (ProMED Mail) The spokesman of the Directorate of Health of Erbil (Arbil) announced that the results of the laboratory tests of the patient that was referred June 30 from Soran district to Erbil hospital for treatment revealed infection with Crimean-Congo hemorrhagic fever. This is the first case of this disease in the (Iraqi Kurdistan) region. The patient now is in a special room under monitoring. Article

HEALTH SYSTEM PREPAREDNESS

Johns Hopkins Hospital in Baltimore Evacuated Due to Possible Tuberculosis Exposure (Reuters) Two buildings at the Johns Hopkins Hospital in Baltimore, Maryland, were evacuated because people may have been exposed to tuberculosis. A small amount of the tuberculosis bacteria may have been released while being transported between two of the hospital's cancer research buildings. Article

Development and Implementation of the World Health Organization Emergency Medical Teams: Minimum Technical Standards and Recommendations for Rehabilitation (PLOS: Currents Disasters) Emergency medical teams provide urgent medical and surgical care in emergencies characterized by a surge in trauma or disease. Rehabilitation has historically not been included in the acute phase of care, as teams have either not perceived it as their responsibility or have relied on external providers, including local services and international organizations, to provide services. Article

Emergency Rooms Run Out of Vital Drugs, and Patients Are Feeling It (New York Times) At Norwegian American Hospital and other emergency departments around the country, doctors and nurses have been struggling for months without crucial drugs like morphine, which is used to ease the pain of injuries like broken bones, or diltiazem, a heart drug. Norwegian has been out of morphine since March, and the shortages are part of a nagging problem that has intensified this year as a rash of decades-old staples became scarce. Article

Items of Interest

The ASPR TRACIE Blood and Blood Products Topic Collection highlights lessons learned from recent mass casualty incidents; relevant plans, tools, and templates; resources on supply chain modeling; and additional resources. Please see the accompanying Blood and Blood Products FAQ document.

The National Center for Disaster Medicine and Public Health (NCDMPH) now is offering a Core Curriculum for Disaster Medicine and Public Health. This is a modular, online course covering the 11 core competencies in disaster medicine and public health. Online Course

The Department of Homeland Security has released four new resources that provide the critical infrastructure community with information regarding attack vectors used by terrorists and other extremist actors as well as corresponding suggested protective measures. These action guides align with the dynamic threat environment, and include:

An additional action guide, “Mass Gatherings: Take Charge of Your Personal Safety,” also is provided to support the general public’s understanding of the immediate actions that can be taken to increase the probability of survival. This action guide also can serve as a poster for the critical infrastructure community to use during events. These resources will be posted at the Department of Homeland Security Active Shooter website.

Ongoing Training Opportunities

The U.S. Centers for Disease Control and Prevention is offering a new online course for health professionals concerning reproductive health and emergency preparedness: Center for Domestic Preparedness Resident Training

 

The Disaster Resistant Communities Group has more than 100 online just-in-time "training videos" to enhance emergency preparedness. Many are related to health care.

Suspicious Activity Reporting (SAR) Training for Health Care Workers

 

The Nationwide SAR Initiative's (NSI) online training module, Public Health and Health Care Partners, was developed to teach workers to recognize suspicious behavior associated with pre-incident terrorist activities. The training also discusses civil rights, privacy, and how and when to report suspicious activity. NSI also offers a two-page resource: Suspicious Activity Reporting (SAR) for Public Health and Healthcare Partners. This training module could easily be added to any in-house training for new employees or yearly refresher training for established personnel.

Federal and CDC COCA Partner conference and training information for the next six months.

 

FEMA Emergency Management Institute Training Opportunities Independent Study Courses

Psychological First Aid for Leaders (PFA-L) Training—This interactive, online training has broad utility for response and health care partners as well as those in existing leadership roles. The training takes about 90 minutes to complete.

Public Health Nursing Disaster Surge Course is based upon the 25 Public Health Nursing (PHN) Competencies for disaster surge, and is intended to provide participants with a comprehensive view of PHN surge from preparedness to response to recovery. There is no cost for this course.

TRAIN PA—The Department of Health and the Pennsylvania Emergency Management Agency have established TRAIN PA, the Pennsylvania affiliate for the Public Health Foundation’s learning management system and network. TRAIN PA is a free, collaborative resource for public health organizations and academic institutions across the state to assist in their educational and workforce development efforts. Signing up for TRAIN PA allows access to thousands of trainings provided by public health agencies at all levels of government, schools of public health and other academic institutions, and other related organizations. If you already have a TRAIN account through TRAIN National, MRC TRAIN, or CDC TRAIN, you can log in to TRAIN PA using the username and password you use at these other sites. If you have any questions or would like to explore how you could use TRAIN PA as a training provider or administrator, please feel free to contact the TRAIN PA administrator team.

Training Trigger: Tourniquet Use Under Medical Protocols

This one-page document from the Interagency Board for Equipment Standardization and Interoperability provides information about the use of tourniquets in emergency medical services. Lessons learned in recent mass casualty incidents and combat casualty care have shown that a properly applied tourniquet can save the patient's life in cases where severe (critical) blood loss endangers the survival of the patient.

Reference Resources

New From ASPR TRACIE—EMTALA and Disasters (Updated) This fact sheet addresses several frequently asked questions regarding the Emergency Medical Treatment and Labor Act (EMTALA) and disasters, and provides links to more resources. Updated information includes actions that can be taken to address patient surge without an EMTALA waiver. Note: This document is not intended to be used as regulatory guidance or in place of communications with or guidance from the Centers for Medicare & Medicaid Services (CMS) who oversees EMTALA compliance. Updated Fact Sheet

Standard for an Active Shooter/Hostile Event Response (ASHER) Program This standard for active shooter and/or hostile events addresses all aspects of the preparedness, response, and recovery process, from identifying hazards and assessing vulnerability, to planning, resource management, incident management at a command level, competencies for first responders, and recovery. It was developed in concert by experts from a wide range of specialties and sets forth requirements for communities to establish a unified planning response and recovery program, long before an active shooter/hostile event occurs. Document

Illnesses on the Rise from Mosquito, Tick, and Flea Bites (CDC) Provides information about bites from mosquitoes, ticks, and fleas, which can spread pathogens and vector-borne disease, discusses what state and local public health agencies can do, and provides a video and sections about Overview, Problem, Infographic, What Can Be Done, and Issue Details. Webpage

Clinician Outreach and Communication Activity (COCA) provides timely, accurate, and credible information related to emergency preparedness and response and emerging public health threats. COCA fosters partnerships with national clinician organizations to strengthen information-sharing networks before, during, and after a public health emergency. COCA invites all clinicians to sign-up for COCA email updates and reminders.

Bioterrorism App (CDC) The Centers for Disease Control and Prevention’s (CDC) new Field Facts application provides crucial information to use in the first few moments and hours of a response to a potential bioterrorism incident. Designed for first responders, FBI agents who work with weapons of mass destruction, and any other person who might encounter biological agents, the app describes how to recognize signs and symptoms of disease associated with eight biological agents. The app also provides information to obtain expert help quickly with the contact details for the CDC's Emergency Operations Center, FBI Field Offices, and state public health laboratories.









July 17, 2018

Volume 7, Issue 14

Emergency Preparedness Hot Topics

UPDATE: Source of Nerve Agent Contamination Identified (Metropolitan Police, London) On July 11, a small bottle was recovered during searches of Charlie Rowley's house in Amesbury. It was taken to the Defence, Science and Technology Laboratory at Porton Down, Wiltshire, for tests. Following those tests, scientists now have confirmed that the substance contained within the bottle is Novichok. Further scientific tests will be carried out to try and establish whether it is from the same batch that contaminated Sergei and Yulia Skripal during March—this remains a main line of enquiry for police. Article

Drone in Superman Garb Crashes into French Nuclear Plant (U.S. News & World Report) Greenpeace activists say they have crashed a drone into a French nuclear plant to highlight the lack of security around the facility. The drone, which was decked out to resemble a tiny Superman, slammed into the tower in Bugey, 30 kilometers (20 miles) from the eastern city of Lyon, according to a video released by Greenpeace. Article

New Health Alerts and Advisories

Pennsylvania Health Alert Network (PA-HAN) Health professionals: Sign up for the PA-HAN. 2018 Health Alerts, Advisories and Updates

PA Statewide Knowledge Center (HIMS) Training Available

Pennsylvania health care facilities are requested to contact their HAP Regional Manager to schedule training.

Regional News

HAP regional manager contact info and the latest regional news and reminders are available at HAP's Emergency Preparedness page.

Coalition News

2017-2022 ASPR HPP Health Care Coalition Capabilites Document

CMS Emergency Preparedness Rule Home Page Source for official information about the rule and implementation.

National Preparedness News and Updates

FEMA Was Sorely Unprepared for Puerto Rico Hurricane, Report Says (New York Times) The Federal Emergency Management Agency's (FEMA) plans for a crisis in Puerto Rico were based on a focused disaster like a tsunami, not a major hurricane devastating the whole island. The agency vastly underestimated how much food and fresh water it would need, and how hard it would be to get additional supplies to the island. Article

INFECTIOUS DISEASES
Ebola

An Ebola Outbreak Has Just Been Stopped. Here's What It Tells Us About Containing Epidemics. (Harvard Business Review) After a month with no new cases, the Ebola outbreak in the Democratic Republic of Congo appears to be under control and weeks away from officially ending. Less than three months since it was declared, and after only about 50 cases, this outbreak's efficient containment is a remarkable achievement that stands in stark contrast to the West African epidemic that spiraled into a two-year global crisis with more than 28,000 cases. Article

MERS

MERS Situation Update, June 2018 (WHO Eastern Mediterranean) At the end of June 2018, a total of 2,229 laboratory-confirmed cases of Middle East respiratory syndrome, including 791 associated deaths (case-fatality rate: 35.5%) were reported globally; the majority of these cases were reported from Saudi Arabia (1,853 cases, including 717 related deaths with a case-fatality rate of 38.7%). Article

WHO Guidance: Home Care for Patients with Mild or Asymptomatic MERS-CoV Infection (Avian Flu Diary) Like with nearly all viral infections, patients infected with MERS-CoV can experience a wide range of symptoms—from asymptomatic carriage (roughly 20%), to mild flu-like symptoms, to severe pneumonia and/or death. While host co-morbidities (including age) appear to be important contributing factors, we have even seen some young—apparently healthy—individuals develop severe disease. Article

Influenza

Changes in Influenza Vaccination Requirements for Health Care Personnel in U.S. Hospitals (JAMA Network Open) Annual influenza vaccinations currently are recommended for all health care personnel to limit the spread of influenza to those at high risk of developing serious complications from the virus. Vaccination coverage has been shown to be significantly greater among employers requiring and encouraging health care personnel to receive the annual influenza vaccination. Article

BMC Infect Dis.: Key Amino Acid Substitutions in Egyptian H5N1 Isolates (Avian Flu Diary) Despite ambitious International Health Regulations adopted by World Health Organization (WHO) member states during 2005—which required all nations to develop mandated surveillance and testing systems, and to report certain disease outbreaks and public health events to WHO—there remain large swaths of the globe where surveillance and reporting are either weak, suppressed, or virtually nonexistent. Article

Indiana: First Human Case of H3N2 Variant Influenza Reported Since 2013 (Outbreak News Today) The Indiana State Department of Health and Indiana Board of Animal Health are urging Hoosiers to take steps to prevent illness while visiting events where pigs are exhibited following confirmation of a case of influenza in a resident with exposure to pigs. This is the first human case of H3N2 variant influenza reported in Indiana since 2013, and the first human case in the U.S. this year, according to the Centers for Disease Control and Prevention, which confirmed the test results. Article

Other Emerging Diseases

Alarming Polio Outbreak Spreads in Congo, Threatening Global Eradication Efforts (Science) Overshadowed by the Ebola outbreak in the Democratic Republic of the Congo (DRC), another frightening virus is on the loose in that vast, chaotic country: polio. Public health experts have worked for months to stamp out the virus, but it keeps spreading. It has already paralyzed 29 children and, on June 21, a case was reported on the border with Uganda, far outside the known outbreak zone, heightening fears that the virus will sweep across Africa. This is "absolutely" the most worrisome polio outbreak today. Article

Crimean-Congo Hemorrhagic Fever—Iraq: (Arbil) Confirmed, MOH, Request for Information (ProMED Mail) The spokesman of the Directorate of Health of Erbil (Arbil) announced that the results of the laboratory tests of the patient that was referred June 30 from Soran district to Erbil hospital for treatment revealed infection with Crimean-Congo hemorrhagic fever. This is the first case of this disease in the (Iraqi Kurdistan) region. The patient now is in a special room under monitoring. Article

HEALTH SYSTEM PREPAREDNESS

Johns Hopkins Hospital in Baltimore Evacuated Due to Possible Tuberculosis Exposure (Reuters) Two buildings at the Johns Hopkins Hospital in Baltimore, Maryland, were evacuated because people may have been exposed to tuberculosis. A small amount of the tuberculosis bacteria may have been released while being transported between two of the hospital's cancer research buildings. Article

Development and Implementation of the World Health Organization Emergency Medical Teams: Minimum Technical Standards and Recommendations for Rehabilitation (PLOS: Currents Disasters) Emergency medical teams provide urgent medical and surgical care in emergencies characterized by a surge in trauma or disease. Rehabilitation has historically not been included in the acute phase of care, as teams have either not perceived it as their responsibility or have relied on external providers, including local services and international organizations, to provide services. Article

Emergency Rooms Run Out of Vital Drugs, and Patients Are Feeling It (New York Times) At Norwegian American Hospital and other emergency departments around the country, doctors and nurses have been struggling for months without crucial drugs like morphine, which is used to ease the pain of injuries like broken bones, or diltiazem, a heart drug. Norwegian has been out of morphine since March, and the shortages are part of a nagging problem that has intensified this year as a rash of decades-old staples became scarce. Article

Items of Interest

The ASPR TRACIE Blood and Blood Products Topic Collection highlights lessons learned from recent mass casualty incidents; relevant plans, tools, and templates; resources on supply chain modeling; and additional resources. Please see the accompanying Blood and Blood Products FAQ document.

The National Center for Disaster Medicine and Public Health (NCDMPH) now is offering a Core Curriculum for Disaster Medicine and Public Health. This is a modular, online course covering the 11 core competencies in disaster medicine and public health. Online Course

The Department of Homeland Security has released four new resources that provide the critical infrastructure community with information regarding attack vectors used by terrorists and other extremist actors as well as corresponding suggested protective measures. These action guides align with the dynamic threat environment, and include:

An additional action guide, “Mass Gatherings: Take Charge of Your Personal Safety,” also is provided to support the general public’s understanding of the immediate actions that can be taken to increase the probability of survival. This action guide also can serve as a poster for the critical infrastructure community to use during events. These resources will be posted at the Department of Homeland Security Active Shooter website.

Ongoing Training Opportunities

The U.S. Centers for Disease Control and Prevention is offering a new online course for health professionals concerning reproductive health and emergency preparedness: Center for Domestic Preparedness Resident Training

 

The Disaster Resistant Communities Group has more than 100 online just-in-time "training videos" to enhance emergency preparedness. Many are related to health care.

Suspicious Activity Reporting (SAR) Training for Health Care Workers

 

The Nationwide SAR Initiative's (NSI) online training module, Public Health and Health Care Partners, was developed to teach workers to recognize suspicious behavior associated with pre-incident terrorist activities. The training also discusses civil rights, privacy, and how and when to report suspicious activity. NSI also offers a two-page resource: Suspicious Activity Reporting (SAR) for Public Health and Healthcare Partners. This training module could easily be added to any in-house training for new employees or yearly refresher training for established personnel.

Federal and CDC COCA Partner conference and training information for the next six months.

 

FEMA Emergency Management Institute Training Opportunities Independent Study Courses

Psychological First Aid for Leaders (PFA-L) Training—This interactive, online training has broad utility for response and health care partners as well as those in existing leadership roles. The training takes about 90 minutes to complete.

Public Health Nursing Disaster Surge Course is based upon the 25 Public Health Nursing (PHN) Competencies for disaster surge, and is intended to provide participants with a comprehensive view of PHN surge from preparedness to response to recovery. There is no cost for this course.

TRAIN PA—The Department of Health and the Pennsylvania Emergency Management Agency have established TRAIN PA, the Pennsylvania affiliate for the Public Health Foundation’s learning management system and network. TRAIN PA is a free, collaborative resource for public health organizations and academic institutions across the state to assist in their educational and workforce development efforts. Signing up for TRAIN PA allows access to thousands of trainings provided by public health agencies at all levels of government, schools of public health and other academic institutions, and other related organizations. If you already have a TRAIN account through TRAIN National, MRC TRAIN, or CDC TRAIN, you can log in to TRAIN PA using the username and password you use at these other sites. If you have any questions or would like to explore how you could use TRAIN PA as a training provider or administrator, please feel free to contact the TRAIN PA administrator team.

Training Trigger: Tourniquet Use Under Medical Protocols

This one-page document from the Interagency Board for Equipment Standardization and Interoperability provides information about the use of tourniquets in emergency medical services. Lessons learned in recent mass casualty incidents and combat casualty care have shown that a properly applied tourniquet can save the patient's life in cases where severe (critical) blood loss endangers the survival of the patient.

Reference Resources

New From ASPR TRACIE—EMTALA and Disasters (Updated) This fact sheet addresses several frequently asked questions regarding the Emergency Medical Treatment and Labor Act (EMTALA) and disasters, and provides links to more resources. Updated information includes actions that can be taken to address patient surge without an EMTALA waiver. Note: This document is not intended to be used as regulatory guidance or in place of communications with or guidance from the Centers for Medicare & Medicaid Services (CMS) who oversees EMTALA compliance. Updated Fact Sheet

Standard for an Active Shooter/Hostile Event Response (ASHER) Program This standard for active shooter and/or hostile events addresses all aspects of the preparedness, response, and recovery process, from identifying hazards and assessing vulnerability, to planning, resource management, incident management at a command level, competencies for first responders, and recovery. It was developed in concert by experts from a wide range of specialties and sets forth requirements for communities to establish a unified planning response and recovery program, long before an active shooter/hostile event occurs. Document

Illnesses on the Rise from Mosquito, Tick, and Flea Bites (CDC) Provides information about bites from mosquitoes, ticks, and fleas, which can spread pathogens and vector-borne disease, discusses what state and local public health agencies can do, and provides a video and sections about Overview, Problem, Infographic, What Can Be Done, and Issue Details. Webpage

Clinician Outreach and Communication Activity (COCA) provides timely, accurate, and credible information related to emergency preparedness and response and emerging public health threats. COCA fosters partnerships with national clinician organizations to strengthen information-sharing networks before, during, and after a public health emergency. COCA invites all clinicians to sign-up for COCA email updates and reminders.

Bioterrorism App (CDC) The Centers for Disease Control and Prevention’s (CDC) new Field Facts application provides crucial information to use in the first few moments and hours of a response to a potential bioterrorism incident. Designed for first responders, FBI agents who work with weapons of mass destruction, and any other person who might encounter biological agents, the app describes how to recognize signs and symptoms of disease associated with eight biological agents. The app also provides information to obtain expert help quickly with the contact details for the CDC's Emergency Operations Center, FBI Field Offices, and state public health laboratories.




July 17, 2018

Volume 7, Issue 14

Emergency Preparedness Hot Topics

UPDATE: Source of Nerve Agent Contamination Identified (Metropolitan Police, London) On July 11, a small bottle was recovered during searches of Charlie Rowley's house in Amesbury. It was taken to the Defence, Science and Technology Laboratory at Porton Down, Wiltshire, for tests. Following those tests, scientists now have confirmed that the substance contained within the bottle is Novichok. Further scientific tests will be carried out to try and establish whether it is from the same batch that contaminated Sergei and Yulia Skripal during March—this remains a main line of enquiry for police. Article

Drone in Superman Garb Crashes into French Nuclear Plant (U.S. News & World Report) Greenpeace activists say they have crashed a drone into a French nuclear plant to highlight the lack of security around the facility. The drone, which was decked out to resemble a tiny Superman, slammed into the tower in Bugey, 30 kilometers (20 miles) from the eastern city of Lyon, according to a video released by Greenpeace. Article

New Health Alerts and Advisories

Pennsylvania Health Alert Network (PA-HAN) Health professionals: Sign up for the PA-HAN. 2018 Health Alerts, Advisories and Updates

PA Statewide Knowledge Center (HIMS) Training Available

Pennsylvania health care facilities are requested to contact their HAP Regional Manager to schedule training.

Regional News

HAP regional manager contact info and the latest regional news and reminders are available at HAP's Emergency Preparedness page.

Coalition News

2017-2022 ASPR HPP Health Care Coalition Capabilites Document

CMS Emergency Preparedness Rule Home Page Source for official information about the rule and implementation.

National Preparedness News and Updates

FEMA Was Sorely Unprepared for Puerto Rico Hurricane, Report Says (New York Times) The Federal Emergency Management Agency's (FEMA) plans for a crisis in Puerto Rico were based on a focused disaster like a tsunami, not a major hurricane devastating the whole island. The agency vastly underestimated how much food and fresh water it would need, and how hard it would be to get additional supplies to the island. Article

INFECTIOUS DISEASES
Ebola

An Ebola Outbreak Has Just Been Stopped. Here's What It Tells Us About Containing Epidemics. (Harvard Business Review) After a month with no new cases, the Ebola outbreak in the Democratic Republic of Congo appears to be under control and weeks away from officially ending. Less than three months since it was declared, and after only about 50 cases, this outbreak's efficient containment is a remarkable achievement that stands in stark contrast to the West African epidemic that spiraled into a two-year global crisis with more than 28,000 cases. Article

MERS

MERS Situation Update, June 2018 (WHO Eastern Mediterranean) At the end of June 2018, a total of 2,229 laboratory-confirmed cases of Middle East respiratory syndrome, including 791 associated deaths (case-fatality rate: 35.5%) were reported globally; the majority of these cases were reported from Saudi Arabia (1,853 cases, including 717 related deaths with a case-fatality rate of 38.7%). Article

WHO Guidance: Home Care for Patients with Mild or Asymptomatic MERS-CoV Infection (Avian Flu Diary) Like with nearly all viral infections, patients infected with MERS-CoV can experience a wide range of symptoms—from asymptomatic carriage (roughly 20%), to mild flu-like symptoms, to severe pneumonia and/or death. While host co-morbidities (including age) appear to be important contributing factors, we have even seen some young—apparently healthy—individuals develop severe disease. Article

Influenza

Changes in Influenza Vaccination Requirements for Health Care Personnel in U.S. Hospitals (JAMA Network Open) Annual influenza vaccinations currently are recommended for all health care personnel to limit the spread of influenza to those at high risk of developing serious complications from the virus. Vaccination coverage has been shown to be significantly greater among employers requiring and encouraging health care personnel to receive the annual influenza vaccination. Article

BMC Infect Dis.: Key Amino Acid Substitutions in Egyptian H5N1 Isolates (Avian Flu Diary) Despite ambitious International Health Regulations adopted by World Health Organization (WHO) member states during 2005—which required all nations to develop mandated surveillance and testing systems, and to report certain disease outbreaks and public health events to WHO—there remain large swaths of the globe where surveillance and reporting are either weak, suppressed, or virtually nonexistent. Article

Indiana: First Human Case of H3N2 Variant Influenza Reported Since 2013 (Outbreak News Today) The Indiana State Department of Health and Indiana Board of Animal Health are urging Hoosiers to take steps to prevent illness while visiting events where pigs are exhibited following confirmation of a case of influenza in a resident with exposure to pigs. This is the first human case of H3N2 variant influenza reported in Indiana since 2013, and the first human case in the U.S. this year, according to the Centers for Disease Control and Prevention, which confirmed the test results. Article

Other Emerging Diseases

Alarming Polio Outbreak Spreads in Congo, Threatening Global Eradication Efforts (Science) Overshadowed by the Ebola outbreak in the Democratic Republic of the Congo (DRC), another frightening virus is on the loose in that vast, chaotic country: polio. Public health experts have worked for months to stamp out the virus, but it keeps spreading. It has already paralyzed 29 children and, on June 21, a case was reported on the border with Uganda, far outside the known outbreak zone, heightening fears that the virus will sweep across Africa. This is "absolutely" the most worrisome polio outbreak today. Article

Crimean-Congo Hemorrhagic Fever—Iraq: (Arbil) Confirmed, MOH, Request for Information (ProMED Mail) The spokesman of the Directorate of Health of Erbil (Arbil) announced that the results of the laboratory tests of the patient that was referred June 30 from Soran district to Erbil hospital for treatment revealed infection with Crimean-Congo hemorrhagic fever. This is the first case of this disease in the (Iraqi Kurdistan) region. The patient now is in a special room under monitoring. Article

HEALTH SYSTEM PREPAREDNESS

Johns Hopkins Hospital in Baltimore Evacuated Due to Possible Tuberculosis Exposure (Reuters) Two buildings at the Johns Hopkins Hospital in Baltimore, Maryland, were evacuated because people may have been exposed to tuberculosis. A small amount of the tuberculosis bacteria may have been released while being transported between two of the hospital's cancer research buildings. Article

Development and Implementation of the World Health Organization Emergency Medical Teams: Minimum Technical Standards and Recommendations for Rehabilitation (PLOS: Currents Disasters) Emergency medical teams provide urgent medical and surgical care in emergencies characterized by a surge in trauma or disease. Rehabilitation has historically not been included in the acute phase of care, as teams have either not perceived it as their responsibility or have relied on external providers, including local services and international organizations, to provide services. Article

Emergency Rooms Run Out of Vital Drugs, and Patients Are Feeling It (New York Times) At Norwegian American Hospital and other emergency departments around the country, doctors and nurses have been struggling for months without crucial drugs like morphine, which is used to ease the pain of injuries like broken bones, or diltiazem, a heart drug. Norwegian has been out of morphine since March, and the shortages are part of a nagging problem that has intensified this year as a rash of decades-old staples became scarce. Article

Items of Interest

The ASPR TRACIE Blood and Blood Products Topic Collection highlights lessons learned from recent mass casualty incidents; relevant plans, tools, and templates; resources on supply chain modeling; and additional resources. Please see the accompanying Blood and Blood Products FAQ document.

The National Center for Disaster Medicine and Public Health (NCDMPH) now is offering a Core Curriculum for Disaster Medicine and Public Health. This is a modular, online course covering the 11 core competencies in disaster medicine and public health. Online Course

The Department of Homeland Security has released four new resources that provide the critical infrastructure community with information regarding attack vectors used by terrorists and other extremist actors as well as corresponding suggested protective measures. These action guides align with the dynamic threat environment, and include:

An additional action guide, “Mass Gatherings: Take Charge of Your Personal Safety,” also is provided to support the general public’s understanding of the immediate actions that can be taken to increase the probability of survival. This action guide also can serve as a poster for the critical infrastructure community to use during events. These resources will be posted at the Department of Homeland Security Active Shooter website.

Ongoing Training Opportunities

The U.S. Centers for Disease Control and Prevention is offering a new online course for health professionals concerning reproductive health and emergency preparedness: Center for Domestic Preparedness Resident Training

 

The Disaster Resistant Communities Group has more than 100 online just-in-time "training videos" to enhance emergency preparedness. Many are related to health care.

Suspicious Activity Reporting (SAR) Training for Health Care Workers

 

The Nationwide SAR Initiative's (NSI) online training module, Public Health and Health Care Partners, was developed to teach workers to recognize suspicious behavior associated with pre-incident terrorist activities. The training also discusses civil rights, privacy, and how and when to report suspicious activity. NSI also offers a two-page resource: Suspicious Activity Reporting (SAR) for Public Health and Healthcare Partners. This training module could easily be added to any in-house training for new employees or yearly refresher training for established personnel.

Federal and CDC COCA Partner conference and training information for the next six months.

 

FEMA Emergency Management Institute Training Opportunities Independent Study Courses

Psychological First Aid for Leaders (PFA-L) Training—This interactive, online training has broad utility for response and health care partners as well as those in existing leadership roles. The training takes about 90 minutes to complete.

Public Health Nursing Disaster Surge Course is based upon the 25 Public Health Nursing (PHN) Competencies for disaster surge, and is intended to provide participants with a comprehensive view of PHN surge from preparedness to response to recovery. There is no cost for this course.

TRAIN PA—The Department of Health and the Pennsylvania Emergency Management Agency have established TRAIN PA, the Pennsylvania affiliate for the Public Health Foundation’s learning management system and network. TRAIN PA is a free, collaborative resource for public health organizations and academic institutions across the state to assist in their educational and workforce development efforts. Signing up for TRAIN PA allows access to thousands of trainings provided by public health agencies at all levels of government, schools of public health and other academic institutions, and other related organizations. If you already have a TRAIN account through TRAIN National, MRC TRAIN, or CDC TRAIN, you can log in to TRAIN PA using the username and password you use at these other sites. If you have any questions or would like to explore how you could use TRAIN PA as a training provider or administrator, please feel free to contact the TRAIN PA administrator team.

Training Trigger: Tourniquet Use Under Medical Protocols

This one-page document from the Interagency Board for Equipment Standardization and Interoperability provides information about the use of tourniquets in emergency medical services. Lessons learned in recent mass casualty incidents and combat casualty care have shown that a properly applied tourniquet can save the patient's life in cases where severe (critical) blood loss endangers the survival of the patient.

Reference Resources

New From ASPR TRACIE—EMTALA and Disasters (Updated) This fact sheet addresses several frequently asked questions regarding the Emergency Medical Treatment and Labor Act (EMTALA) and disasters, and provides links to more resources. Updated information includes actions that can be taken to address patient surge without an EMTALA waiver. Note: This document is not intended to be used as regulatory guidance or in place of communications with or guidance from the Centers for Medicare & Medicaid Services (CMS) who oversees EMTALA compliance. Updated Fact Sheet

Standard for an Active Shooter/Hostile Event Response (ASHER) Program This standard for active shooter and/or hostile events addresses all aspects of the preparedness, response, and recovery process, from identifying hazards and assessing vulnerability, to planning, resource management, incident management at a command level, competencies for first responders, and recovery. It was developed in concert by experts from a wide range of specialties and sets forth requirements for communities to establish a unified planning response and recovery program, long before an active shooter/hostile event occurs. Document

Illnesses on the Rise from Mosquito, Tick, and Flea Bites (CDC) Provides information about bites from mosquitoes, ticks, and fleas, which can spread pathogens and vector-borne disease, discusses what state and local public health agencies can do, and provides a video and sections about Overview, Problem, Infographic, What Can Be Done, and Issue Details. Webpage

Clinician Outreach and Communication Activity (COCA) provides timely, accurate, and credible information related to emergency preparedness and response and emerging public health threats. COCA fosters partnerships with national clinician organizations to strengthen information-sharing networks before, during, and after a public health emergency. COCA invites all clinicians to sign-up for COCA email updates and reminders.

Bioterrorism App (CDC) The Centers for Disease Control and Prevention’s (CDC) new Field Facts application provides crucial information to use in the first few moments and hours of a response to a potential bioterrorism incident. Designed for first responders, FBI agents who work with weapons of mass destruction, and any other person who might encounter biological agents, the app describes how to recognize signs and symptoms of disease associated with eight biological agents. The app also provides information to obtain expert help quickly with the contact details for the CDC's Emergency Operations Center, FBI Field Offices, and state public health laboratories.

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