February 3, 2019

Volume 8, Issue 3
Emergency Preparedness Hot Topics

U.S. Midwest Freezes, Australia Burns: This is the Age of Weather Extremes (New York Times) In Chicago, officials warned about the risk of almost instant frostbite on what could be the city's coldest day ever. Warming centers opened around the Midwest. And schools and universities closed throughout the region as rare polar winds streamed down from the Arctic. Article

Statement for the Record: Worldwide Threat Assessment of the U.S. Intelligence Community (Senate Select Committee on Intelligence) Threats to the U.S. national security will expand and diversify during the coming year, driven in part by China and Russia as they respectively compete more intensely with the U.S. and its traditional allies and partners. Report (pdf)

UPDATED Resources for Emergency Response Community. New resources from the U.S. government are now available to help emergency responders and health care workers develop specific guidance and training to protect themselves and save lives during incidents involving fourth-generation nerve agents, also known as Novichoks or A-series nerve agents. These resources can be found at the Chemical Hazards Emergency Medical Management (CHEMM) website.
New Health Alerts and Advisories

Pennsylvania Health Alert Network (PA-HAN) Health professionals: Sign up for the PA-HAN. 2019 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 contacts 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 Official information about the rule and implementation.
National Preparedness News and Updates

Ebola Infects 9 More in DRC as Ill Traveler Sparks Response Measure (CIDRAP) The number of people infected in the Democratic Republic of the Congo (DRC) Ebola outbreak grew by nine today, as health officials in the neighboring Haut Uele province took steps to prevent the spread of a disease from a resident who was exposed to the virus in Katwa. Article

Six Months On, Ebola Outbreak in Eastern Democratic Republic of the Congo (DRC) Now Second Largest in History (UNICEF) Since the latest Ebola outbreak in the DRC was declared six months ago on August 1, 2018, more than 740 people—30 percent of whom are children—have been infected with the disease, including more than 460 who have died, and 258 that have survived Ebola. Alongside the government and partners, UNICEF is scaling up its response to assist victims, control the spread of the disease, and ultimately end the deadly outbreak. Article

Monoclonal Antibody Ebola Treatment Shown Safe in Adults (CIDRAP) As the Ebola outbreak in the Democratic Republic of the Congo continues to grow, early data show that mAB114, a monoclonal antibody treatment for the disease, is safe and well-tolerated in adults, according to the results from the first human trial of the drug published today in The Lancet. Article

WHO Expert: Ebola Outbreak to Continue at Least 6 More Months (CIDRAP) In an interview, Peter Salama, MD, the World Health Organization's (WHO) deputy director-general for emergency preparedness and response, said the current Ebola outbreak in the Democratic Republic of the Congo (DRC) is likely to continue for at least another six months, as DRC officials confirmed five new cases. Article


Saudi MOH: Riyadh Reports 3rd MERS Case for Epi Week 4 (Avian Flu Diary) The Saudi Ministry of Health (MOH) announced two more community-acquired MERS cases in Riyadh, making four such cases in the capital city during the past six days. Article

Flu Widespread Across Most of U.S., with 3 New Kids' Deaths (CIDRAP) The U.S. flu season gained more steam last week, with most states reporting widespread activity and three more pediatric flu deaths, the U.S. Centers for Disease Control and Prevention said in its weekly update. Article

Nearly A Third of Hong Kong Preschools Hit By Flu Outbreaks, Forcing Seven-Day Closures (One News Page) Nearly a third of all preschool centers in Hong Kong recently reported a flu outbreak and suspended classes for a week. Article
Other Emerging Diseases

Measles Cases Confirmed in 3 New States Amid Washington Outbreak (ABC News) Health officials in Georgia, Hawaii, and Oregon have now reported that there has been at least one—if not multiple—confirmed cases of measles in their state. This comes amid an outbreak in Clark County, Washington, where there have been 38 confirmed cases of measles and 13 suspected cases. Article

Public Health Emergency Declared Over Measles in Anti-vax Hotspot near Portland, Oregon (CBS) A public health emergency has been declared in Clark County, Washington, as a result of an ongoing measles outbreak. According to the latest update from the county's Department of Health, 23 cases of measles have been confirmed and health officials are investigating two more suspected cases. Article

In Indore, Unknown Virus Claims 64 Lives in Four Months (The Times of India) An unknown virus showing identical symptoms of swine flu has claimed 64 lives in the city and nearby districts during the last four months. Officials said that, of the total suspected samples sent to the virology lab, 39 were found swine flu positive including 13 deaths, and 350 were dengue positive including one death. Article

AFM Investigation (CDC) Acute flaccid myelitis (AFM) is a rare but serious condition. It affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak. The U.S. Centers for Disease Control and Prevention (CDC) has been thoroughly investigating the AFM cases that have occurred since 2014, when a large number of cases were reported. Article

National Health Security Strategy 2019–2022 (U.S. Department of Health & Human Services Assistant Secretary for Preparedness and Response) Our nation faces diverse and evolving health security threats that have the potential to disrupt our public health and health care systems and inflict injury and loss of life on our people. Significant progress has been made in improving capabilities to address the immediate public health and medical consequences of anticipated and actual public health threats, such as extreme weather and infectious disease outbreaks. However, to save lives and protect the nation from other 21st century risks, we—the collective group of stakeholders with responsibilities for national health security—must advance our preparedness and response capabilities to address the realities of our immediate and future threat landscape. Report (pdf)
Training Opportunities NEW

FEMA Professional COOP Training—Courses at PEMA during Mid-April

    Course ID: L548 Continuity of Operations Managers Training Course (COOP)
    Course ID: L550 Continuity of Operations Planning (COOP)

Training Opportunities—Ongoing

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 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.
Items of Interest

New Drug Strikes Nerve Agent (Defense Visual Information Distribution Service) Used in many attacks such as the 1995 Tokyo subway incident, multiple Syrian chemical strikes and several assassinations, horrifying nerve agent assaults are becoming more common for both civilians and warfighters. Although medical countermeasures exist to sustain life after organophosphate nerve agent exposure, the risk of brain damage, and behavioral, and neurological disorders due to prolonged seizures persist. The Defense Threat Reduction Agency's Chemical and Biological Technologies Department has handed over development of Tezampanel, a new drug to counteract the long-term impacts of nerve agent poisoning to the Biomedical Advanced Research and Development Authority, enabling warfighters to recover. Article

Mapping Far-Right Chemical, Biological, Radiological, and Nuclear (CBRN) Terrorism Efforts in the West: Characteristics of Plots and Perpetrators for Future Threat Assessment (Terrorism and Political Violence) The threat of chemical, biological, radiological and nuclear (CBRN) terrorism is widely attributed to collective actors based on a religious ideology, e.g. globally operating Salafi-jihadist groups like al-Qaeda or ISIL. Only limited attention has been given to the CBRN threat of violent domestic extremists in general or far-right terrorists specifically. Article
Reference Resources

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:

    “Active Shooter Attacks: Security Awareness for Soft Targets and Crowded Places”
    “Chemical Attacks: Security Awareness for Soft Targets and Crowded Places”
    “Vehicle Ramming: Security Awareness for Soft Targets and Crowded Places”
    “Mass Gatherings: Security Awareness for Soft Targets and Crowded Places”

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.

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.

    Active Shooter Planning and Response in Healthcare Setting. An updated guidance document, produced by the Healthcare and Public Health Sector Coordinating Council, has been approved. This may be a helpful teaching adjunct to the guidance document. OSHA resources include guidelines, successful case studies, and a road map to building a culture of safety in health care.
    The California Emergency Medical Services Authority: Fifth Edition of the Hospital Incident Command System
    The Pennsylvania Department of Health Bureau of Public Health Preparedness has launched a new website to provide information about and support for Pennsylvania's health care coalitions.
    CDC Ebola: CDC Algorithm for Management of Possible Ebola
    CDC MERS: Interim Guidance for Healthcare Professionals; Healthcare Infection Control; Healthcare Preparedness Checklists for Providers; Healthcare Preparedness Checklists for Facilities

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