When I explain that I’ve been cycling for eighteen months, have altered the way I consume food, and carefully ensure I put in 90 minutes of exercise every day rain or shine, they want to know if I’m on a cookie diet.

It seems much easier for some people to accept that eating a package of diet cookies each and every day would somehow lead to lasting overall physical fitness.

It’s a funny thing.

I hear the same thing from corporate and government leaders who want to know how another entity achieved a meaningful level of emergency preparedness.

Was it a special plan? How can we do the same thing? How quickly can we make it happen? Can we be ready for that storm whose clouds are currently gathering on the horizon?

It always seems to be somewhat of an epiphany when I explain that a true culture of preparedness can be achieved by each and every community on a grassroots level simply by mapping out where you want to go and then figuring out what you need to change to get there.

A friend of mine, Jim Stephens, wrote these words to me as we discussed our respective efforts to achieve and maintain the delicate balance that comes with mind-body fitness:

“Change is for those who Want it, not for those who Need it. It is a miracle that sometimes occurs. If you could figure out how to put it in a bottle you could retire tomorrow.”

It is a process. It is not rocket science or neurosurgery.

You need to want to make the change and then you need to surround yourself with a scaffolding that will provide support, guidance, education, encouragement, and political will as each is required.

Or you could eat a special cookie or two or three and see how that works out for you in the long run.

Be well. Practice big medicine.

Rather than acknowledge and embrace your environment for what it is, it’s so much easier to ignore the overt risk factors and hope the current will help you skirt any life-threatening collisions with fixed objects, any sucking hydraulics that will drown you in place, or prevent you from falling from the boat into water moving so quickly you’ll never reach the safety of the river banks.

I know because I am a veteran of a serious whitewater rafting trip on the River Denial.

While busy providing guidance for others on emergency preparedness, response and recovery, I had deferred maintenance on my own body for the worse part of a decade. I had experienced an unpleasant brush with the health system before our children were born and had somehow convinced myself that I was better off going it alone – that nothing would really threaten my own existence. Not that I was living life particularly well, mind you.

I was a fat vegetarian. I grazed constantly. I had a love of fruit drinks and sugar-enhanced performance beverages. I didn’t engage in any real sustained exercise. I was a two- and three-helpings eater. There wasn’t a veggie chili recipe that I couldn’t polish off on my own. I could easily inhale a liter of orange juice a day.

I was a proverbial ticking time bomb. A high-stress hyper-involved human being just waiting for my human expiration date to come up on my wrapper. I was thoroughly enjoying the whitewater rafting trip on the River Denial.

I was well over 300 pounds when I discovered cycling. Accidentally. I had a consulting gig several kilometres from our home and so I bought a Trek hybrid bike to ride back and forth from work. It was only about 14 km each day and the bulk of the ride took me through a continuous industrial park wherein a fall at an inopportune moment would have literally pitched me under a passing truck.

And yet I was hooked. I began riding on weekends. I loved the feeling that came with pushing my own weight through the air – the accomplishment that came with achieving the personal goals I set for myself: 15 km, 20km, 25km. The consulting gig ended and I was still riding.

Don’t be mistaken. I was still quite content to be a part of grand adventure on the River Denial. I was a somewhat fitter fat man who rode a bicycle occasionally. That expiration date was still chasing me. It’s just that I had managed to finally put some distance between the hunter and the prey.

Two summers ago I rode the bike every other day on a 20km route that took me through the lakeshore area on the Western end of Montreal. Last summer I rode every single day on routes that ranged from 20-35km. I began to get serious about my biking and studied proper technique and posture. For the first time in my adult life, my weight began moving downwards.

I began blogging about my experiences as the Fat Man On Trek [FMOT] and was surprised when readers began sharing their own stories or telling me they were inspired by my stories.

I started a training program so I could take part in The Ride to Conquer Cancer* – a two-day 200-mile ride from Montreal to Quebec City.

I became an adopted member of the Synergy Cycle family which provided serious reinforcement in the form of technical expertise, education and a place to warm up on particularly cold days.

I bought a Blackburn trainer so I could ride my bike indoors during the cold winter months. And I stuck to it. I trained every single day.

Last December, after hauling the snow tires and wheels out to the car, I was awakened in the middle of the night by a screaming pain in my flank. I knew instinctively something was seriously wrong. I had a feeling the expiration light was flashing. I did something I hadn’t done in more than a decade. I called an internist and set up an appointment on an urgent basis.

Clearly, the karma police were circling the building when my test results came back. The exquisite pain was muscular – related to my straining myself to swing the heavy mag wheels out of the back of the car and into the shed. However, the internist wanted to know how long I had been a diabetic.

Damn.

It was finally time to get out of the River Denial.

One of the very few benefits of having spent a good chunk of my life as a paramedic was knowing an incredible med team at the Jewish General Hospital in Montreal who were willing to adopt me as a patient. Bloods were taken and analyzed, meds prescribed, counselling sessions with dietitians took place, a brilliant nurse assigned to walk me through my new reality and I was introduced to the first of two endocrinologists who have become an integral part of my continued existence.

The endocrinologist’s words have stuck with me. “You know what you’re doing wrong. Stop it. Let’s get on with the process of managing this disease.”

He pulled no punches. Stay on the river and die. Get out of the raft and take your best shot. No guarantees however your chances are a helluva lot better with you attempting to gain control.

That was just after the beginning of the New Year. I weighed 290 pounds.

Since then, I’ve upped my exercise routine to a minimum of 60 minutes a day, changed my diet to reduce portion creep, added nutritious snacks [I'll write about 'kindling' another time], have switched from fruit drinks to water, and am consuming enough protein and carbs to happily sustain a healthy 250-pound human being.

I have surrounded myself with people who believe and encourage and who together form an incredible support/scaffolding system that has helped me ride the ride on this adventure.

I have also given up my seat in the raft.

My blood gluc has dropped significantly although it’s not quite where my team would like to see it so I expect there will be adjustments made here and there along the way. It’s a long haul from here on in. Really, it’s the rest of my life.

Yesterday, I saw some very sweet numbers after my morning’s cycle training session. 245 pounds. Last time those numbers graced my scale was more than 35 years ago. Far out! The FMOT odyssey continues.

*Please visit the Fat Man On Trek to Conquer Cancer website and consider making a donation. http://www.conquercancer.ca/goto/FMOT

by Hal Newman

Last evening I exchanged notes with a well-regarded television journalist who seemed to be actively refusing to acknowledge the importance of news-on-the-net via social media as a real-world alternative to the nightly newscast.

The discussion was surreal at best. She truly believes ‘we’ need her and her colleagues to be our filter because we can’t understand the facts on our own. ‘We’ need journalists to decipher the code for us.

When I mentioned that near-real-time situational awareness already exists via the net her reaction was almost comical were it not so damned tragic: She warned me about the dangers of too many fragmented views.

My friend Andrew Fielden [follow him on Twitter @AndrewTF] reminds me on a regular basis that no one service provider can have a monopoly on the sources of the data.

He attended last week’s Media140 gathering in London and among the many comments he made afterwards was that “Twitter itself is seen as the latest threat to the media in that it appears to allow people to go direct to the source in real time and create an instant news thread which require only the presence of the microblogs and linking through to blogs and other supporting digital elements.”

So what happens when the ‘great unwashed’ are unleashed and able to generate news of their own making? Are there any guarantees that what they produce will be any less important than that which is professionally produced in a multi-million dollar studio?

I think not. Often, I am struck by the incredibly poor job the ‘professionals’ do at communicating a story. Last week, I read an op-ed in the Washington Examiner wherein the name of a man who was sent to Syria and tortured because he was mistakenly suspected of being a terrorist was replaced by the name of a man awaiting trial for allegedly killing an American medic in Afghanistan. Do not disturb with the facts. Professionals at work.

In emergency management, we talk about situational awareness as if it were the holy grail and in many ways it is. That ability to sift through multiple streams to pull the essential nuggets out on an ongoing basis is at least as important as the ability to craft a compelling narrative to ensure the information can be shared effectively.

However, the key to gaining that type of perspective is knowing what kind of nuggets you need to be fishing for at that moment in time – or more importantly, for the next several moments in the future.

Retired Canadian Forces Col. Richard Moreau [now a VP with Ottawa-based Prolity] teaches a serious ‘leadership in crisis program’ that emphasizes the need for intelligent awareness. According to Richard, if you don’t provide guidance on what you’re looking for, don’t be surprised when your intel crews come back excitedly proclaiming, “We’ve got cod! We’ve got cod!”

At some point, you’re going to have to explain to them that you were looking for swordfish.

Which brings me back to my exchange with the television journalist. I’m not sure what she’s fishing for, because of course, there’s no way for the collective ‘us’ to provide her with guidance on what we believe is important. It was clear in the course of our brief conversation that she thinks she knows what we need to learn and that we would be lost without these self-anointed guides. She mentioned words like ‘trust’ and ‘credibility’ however left out key terms like ‘depth of understanding’ and ‘real-world expertise.’

So, I go fishing on my own, looking for a spectacular mix of views, opinions and facts from which I will draw down my own intelligent situational awareness.

I don’t need a nanny journalist to ‘sort it all out’ for me every evening.

Good Morning: After recently reading and watching the urgent stories about the Swine Flu, I couldn’t help but wonder how long it would take before we reverted to complacency. For years now, I have been advocating for a calm, resolute culture of preparedness. Instead, I have been seeing what I refer to as the PowerGlide of Public sentiment. For those of you too young to remember, many Chevrolet automobiles in the 60′s had a PowerGlide transmission. Low gear and high gear…that’s all there was….. two gears. In the last 8 years, we as a society, have had only two collective mental gears….complacency and hysteria.

Prior to 9-11 we were in the complacent gear, and afterward, we were scared to death we would be attacked again and transitioned immediately into the hysteria gear. Although we all know we are going to be attacked again, soon after 9-11 we reverted to our complacent gear. As such, we have done little to significantly improve our overall state of Readiness to manage another 3,000 casualty event, let alone a 100,000-300,000 casualty event such as a 10 Kiloton detonation on a population center or a Pandemic . We just don’t want to think about it.

in 2005, we all saw thousands of people suffering and death during hurricane Katrina. Folks with disabilities were slumped down dead in wheelchairs outside storefronts, nurses crying on hospital rooftops while manually ventilating patients while they waited for a medical evacuation helicopter. We saw the dead floating down streets in New Orleans-an American city, with corpses in the water. We are now trying to recover from hurricane Ike in Galveston and other Texas Coastal towns,,,,and where are we? We are without healthcare for hundreds of thousands of people, that’s where we are.

We have been told by the CDC for years now that it was a matter of “When” and not “If” we would have a Pandemic. We have a few thousand ill people around the World who are ill and have experienced far fewer deaths than we experienced in a normal flu season and yet we are about to dust off our living wills.

The fact is, it is too late to worry if the current Influenza strain goes full bloom into a Worldwide Pandemic. I had some really good feedback on my latest article on the 2010 Pandemic (that has yet to happen).

What I hope we will do is develop a third gear…an overdrive if you will, that will take us into the future. Reinvigorate the National Disaster Medical System…and some big time reinvigorating it will take. Lets develop REAL plans to take care of REAL casualties. Lets do the hard work to develop supply and equipment lists of all classes of materials, including packaged disaster hospitals, needed for real people needing professional medical care and sheltering and lets ask HHS or DHS to purchase and manage these critical assets as Federal reserve Inventories.

Lets look at the 15 Federal Planning Scenarios and plan for the scenarios which will most likely occur for our jurisdictions. Lets build packaged disaster hospitals which are supplied and equipped with 60 days of supply (DOS) without resupply. Lets really enhance our Medical Reserve Corps by contacting every retired nurse and every certified nursing assistant, physician, laboratory and radiology technicians, respiratory and physical therapists and lets not forget the retired support staff. Lets also recruit Psychiatrics, Psychologists and independent practice nurses. Lets link-up to our communities and develop a real disaster-ready community response. Lets ask the Federal Government do build Federal Reserve Inventories of food, water, medical supplies, equipment and pharmaceuticals..to name just a few (FRIs). After all, we already have the model in the Strategic Petroleum Reserve.

If we can muster the “Will,” “Good Stewardship” and the funding to increase our Readiness posture, we can take the first few steps that lead us to “Full Readiness.” We can begin saving hundreds of thousands of lives during the next man-made or natural disaster.
Lets all insert that extra gear into our two speed culture. Let’ see how it feels to know that we did all that could have been done in preparing our Country for the really big next one. That gear is known as the Readiness gear. Start shifting!

When confronted with unfamiliar territory and a survival situation, many people follow a line of cascading decisions that lead to the unthinkable – they run away from rescue.

I understand how the average Jack/Jill can end up rejecting the omnipresent dangers inherent in a survival situation and do everything in their power to hold on to the familiar instead of embracing their new environment. I understand how those decisions can lead to someone sticking to what they believe is the trail and walking over the edge of a cliff.

What I don’t understand is how a supposedly seasoned emergency manager can make the same type of conscious decisions on behalf of his/her constituents and do everything in their power to prevent new ideas from circulating in their fiefdoms in the midst of a disaster. By refusing to embrace the new environment, they are, in effect, leading the move to run away from rescue.

Yesterday, I found myself having to explain that someone reaching out for assistance in the midst of a disaster probably wasn’t looking for a political leg-up. It was a surreal conversation due in part to the fact that the folks doing the reaching out were just trying to help the citizens who rely on them for help in a crisis. You might have guessed that wasn’t the surreal part.

You’re right. The surreal part was trying to convince a senior emergency management advisor that maybe it was just help these people were seeking and not a threat to the political status quo.

I went with the following line:

“So, what would be the ulterior motive of someone calling from a church in the midst of a disaster zone to my office in Montreal asking for help getting extra supplies to his congregants. All the while, he knows he’s reaching out to someone in a different country – except he doesn’t see it that way – he just knows maybe there’s a chance he can get find some hope from another network of caring people. Maybe he’s worked out that going outside the normal system will mean getting lifesaving help quicker. What’s the political motive there?”

There was a long pause at the other end of the line. I thought maybe I’d made the point.

Not so lucky.

Clearly calling from the bottom of a hermetically-sealed box, the voice on the phone said, “Maybe he’s just trying to embarrass us politically by taking his request to another country.”

Or maybe he’s just trying to find a source for crates of Ensure to feed the elderly residents who decided to weather the storm in their home, or maybe he’s trying to arrange for a couple of hundred of extra blankets to be sent his way because the power might not get fixed for two more cold weeks, or maybe it’s the family with a special needs child who need extra medical supplies…

Maybe he has embraced his new environment and determined he needs to take bold decisive action to survive. Perhaps he has decided to run towards the rescuers.

Newsflash: Your constituents will, no doubt, take notice when you make a big deal of attempting to halt the flow of help, new ideas, the exchange of lessons learned, or the swapping of stories. It has been my experience that there is no more powerful endorsement of someone offering to help than trying to prevent them from doing so.

This is an interim “After Action” report on a disaster. What separates it from other reports is that this Lessons Learned report can be studied before the event actually takes place. There may be time for Congressional Commissions to not only assign blame for a lack of Readiness after the fact (as they tend to do), but perhaps appoint personnel to the appropriate agencies capable of learning these lessons and putting real systems in place before the Pandemic. It is the hope of this writer that instead of simply assigning blame and writing reports (as most After Action review committees do), the Congress might actually proactively write language into laws that demands operational systems and not just the kind of information papers that currently serve as “readiness.”

Public Health Preparedness was very poor. The Department of Health and Human Services (HHS) underestimated the Pandemic’s impact on the American People in its initial estimate that approximately 92 Million Americans would become ill and that approximately 45 Million Americans would require some level of definitive healthcare, such as in a hospital. While this Lessons Learned report only covers the first wave of the Pandemic, it is clear that even more Americans will be impacted before the last wave of the Pandemic travels across America. HHS was proactive in funding a number of Public Health and Healthcare grant programs targeting syndromic surveillance and Public Health laboratory capabilities. The syndromic surveillance systems, while not perfect, provided advance detection of the novel strain of Influenza almost immediately. However, the American people already knew from news coverage, that the Pandemic was underway before the first cases were detected in the United States. Some lessons learned from a Public Health Preparedness prospective follow. Importantly however, most States did not share Pandemic Preparedness grant funds with hospitals and the “health care” infrastructure, opting to keep the Pandemic funds in the Public Health sector. At the same time, States did not bolster the hands-on care capabilities of the Public Health function, believing hands-on care was the “responsibility” of the Private Sector Healthcare System.

Early detection was not enough. While early detection and timely information to the public was laudable, there were virtually no actions taken to treat the projected 92 million sick Americans. The Public Health position was that public information, primers, and brochures fulfilled their responsibility to alert Americans about a coming Public Health catastrophe. Since no leaders in HHS, CDC or for that matter anywhere in the Public Health Community were alive during the 1918 Pandemic, there was no way for Public Health personnel to know how to care for the sick and dying. There had also been no inclination on the part of Public Health officials to learn how Public Health could expand healthcare services to augment the Healthcare Industry. Thus, there was no “Plan B” in the Public Health system to actually provide healthcare services to persons requiring definitive care if the healthcare industry was unable to care for influenza patients. There was no perceived need to provide additional resources for Private Sector healthcare, since the American Healthcare Industry has the total responsibility for providing actual healthcare services. In other words Pandemic-related healthcare was a Private Sector matter, with Public Health providing guidance only.

The CDC issued a timely Public Health Alert that a novel strain of Bird Flu had mutated to the point of human to human transmission, at about the time where the Pandemic was confirmed in Southeast Asia. Almost immediately, Americans began checking their stocks of prescription medications as well over-the-counter cold and flu products. As a result, before the first case of the new Influenza was diagnosed in America, there was a Nationwide shortage of virtually all prescription medications as well as over-the-counter medications. What was not predicted by HHS or CDC was the societal impact brought on by announcing the pending first wave of the Pandemic. The unintentional consequence of the Public Health alert announcement was an almost immediate failure of the pharmaceutical, medical, food, fuel and retail supply chains. Since raw materials for many American manufactured items are imported from outside the USA, all of these critical supply chains will remain sporadic for approximately 3 years post-Pandemic. In the meantime, those supplies which can be purchased will be in very short supply. Federal officials warn that sporadic violence will continue occurring as limited supplies arrive at retail outlets such as supermarkets, drug stores, gas stations, and retailers everywhere.

The American Healthcare Industry was unprepared. The American Healthcare Industry was totally unprepared to manage even a small percentage of the affected population. The HHS, the American Medical Association, the American Nurses Association, the American Hospital Association and virtually every other known Healthcare Membership Association in America had warned that the American Healthcare Industry was already in a crisis even without any additional stress on the system. However, no Federal agency, organization or association was empowered to do anything about the normal operating crisis, let alone resourcing the Healthcare Industry to effectively manage a major terrorist attack or the Public Health catastrophe which is fully underway now. As a result most of the Healthcare Industry has collapsed under the strain of this first Influenza wave. Since there were no serious plans to drastically expand the Public Health Service to provide “hands-on” health care, most Americans were left to care for themselves and their loved ones. A simultaneous exhaustion of healthcare staff, the healthcare supply chain and overcrowded hospitals, caused a collapse of the entire American Healthcare Infrastructure.

The American Healthcare Industry collapse was due to a lack of elasticity to expand for spikes in demand for a surge in admissions. While numerous studies had confirmed that all study parameters were accurate and that all models were valid, not all external factors were taken into consideration. It seems no Federal agency had predicted a collapse of the American Healthcare Industry under the stress of an Influenza Pandemic. Thus, due to extreme shortages in facilities, healthcare providers, beds, medical equipment, supplies and financial resources, American Healthcare collapsed almost immediately during the early days of the Pandemic. It is anticipated that the American Healthcare Industry will be rebuilt as a National Healthcare System with some Private Healthcare entities providing elective procedures. In any event, it will likely take between 10 to 15 years for American Healthcare to achieve Pre-Pandemic operational capabilities. During this time, religious organizations and charitable non-governmental organizations will provide the bulk of the healthcare available in America.

Factors bearing on the American Healthcare Industry collapse.

1. Lack of Healthcare facilities: During the 1960’s the Federal Government had approximately 1900 Packaged Disaster Hospitals. Each of these hospitals had 250 beds, an X-Ray room and three operating rooms. Thus, as far back as the 1960s, America had a total of 475,000 beds, 1900 radiology suites and 5,700 operating rooms. All of these assets came totally outfitted with equipment and sufficient supplies to remain self sufficient for 30 days. While there were a number of States that used Federal grant dollars to purchase tent hospitals and other smaller care centers on rolling stock, such as 18-wheelers, none of these care solutions were logistically supportable or staffed for continuous operation.

2. Lack of healthcare beds. The Strategic National Stockpile had stockpiled approximately 20,000 cots instead of beds. These cots were unsuited to providing patient care in any facility and thus, were used only for comfort care in patients’ last hours. These cots could not be reused, since there were no decontamination instructions or equipment capable of decontamination. These cots became single-use assets and were used up almost immediately.

3. Lack of caregivers: While there were predictions of an extreme shortage of caregivers, due to the shear numbers of sick Americans, no Federal planning agency placed an actual number on how many skilled and semi-skilled healthcare providers would be needed. As the first wave of the 2010 Pandemic swept across America, the requirement for additional registered nurses (RNs), respiratory therapists, licensed practice nurses (LPN), physicians, medical helpers and support staff rose to 10 million. While the Medical reserve Corps had approximately 200,000 volunteers, many could not respond due to obligations caring for their families or caring for themselves. The end result was that religious congregations, the Red Cross, Salvation Army and other voluntary organizations were and are currently the only entities providing any meaningful care in the United States today.

4. Lack of Healthcare financial assets: Financial pressures on the American Health Industry have been immense since the mid-80s. Government reimbursements for Medicare and Medicaid have been tightening consistently since at least 1985. Simultaneously, “Managed Care”, by way of the healthcare insurance industry, had concentrated on driving healthcare costs out of the system. Thus, both the Federal government and the healthcare insurance industry drove down operational healthcare capabilities to a point where a single, albeit catastrophic insult to the Healthcare Industry was sufficient to cause its collapse.

5. Federal infusion of dollars made little difference. Similar to America’s Financial System near collapse in the fall of 2008, by the time that Congress recognized the American Healthcare Infrastructure was as shallow as it was, it was too late to turn things around. In the Financial System crisis, huge injections of Federal dollars propped up most major financial institutions.

Unlike the Financial Crisis, injections of federal dollars made no difference at all, since there was little product available worldwide. Once the Pandemic was recognized, countries like China, America’s largest cotton trading partner for surgical masks, surgical gowns, and patient apparel, had stopped the flow of raw materials outside of their country. Similarly, other countries that previously were our major trading partners for both raw materials or for manufactured medical products, had shut down exports to America in order to sustain their own populations.

While DHS, HHS and private organizations all understood that America was operating in a “Just in Time” supply and equipment environment, Federal agencies took no actions to build National Medical Reserves, as they had with the Strategic National Petroleum Reserve in preparation for interruptions in the oil markets. The global nature of supply chains for food, medical supplies and equipment, and raw materials acquisition, while the ultimate in efficiency, turned out to be useless in any unexpected surge in demand. While Federal agencies well understood the “Just-In-Time” supply paradigm, nothing substantial was done to eliminate or mitigate the impact on America’s multiple critical supply chains, or the catastrophic unemployment consequences the manufacturing, processing and distribution industries faced when raw materials from overseas dried up.

6. Law Enforcement and Societal Norms. During the first several weeks of the crisis, there was widespread looting and vandalizing of supermarkets, drug stores, farmers markets and virtually any marketplace where food, pharmaceuticals, baby formula and other items deemed necessary to provide sustenance or treat the symptoms of Influenza were thought to exist. There were widespread home invasions where gangs in search of food and medicine took whatever goods they found, and then took other items of value in hopes of trading these items for food later. The Law Enforcement and Public Safety communities were themselves degraded in the area of law enforcement, and were essentially out manned and out gunned to protect the population. As expected, persons with disabilities, and the young and old subsets of the population were especially vulnerable to attack (already being more vulnerable to the ravages of the Pandemic and lack of needed food, medicine and shelter).

As larger and larger numbers of Americans were too sick or too weak to defend themselves, society lapsed into a more stoic norm, where religious congregations and other charitable organizations provided the only meaningful comfort for the sick and dying. Federal and State agencies were staffed with employees who either recovered or seemed to have a natural immunity to the novel Influenza strain. The services of these agencies were well intentioned but almost totally ineffective. Sanitation across all affected segments of society was deplorable. Municipal services including waste collection essentially halted. The mortuary affairs departments of State and local governments were overwhelmed with the dead.

Once again, religious congregations and charitable organizations represented the only real remaining societal structure, picking up bodies much the same as they did during the 1918 Pandemic and placing the bodies in communal graves. Grave registries were mainly paper documents, but efforts were taken to achieve a rudimentary accounting for those buried by gravesite.

7. Impact on the financial system. The financial system in the United States has been decimated by the 2010 Influenza Pandemic. Officials are advising Americans to retain all financial instruments, pending a recovery after the third wave of the Influenza Pandemic. It is felt that any idea of retirement based on a 401K or other stock market based instruments are lost for a generation or longer. Still, the United States is expected to make a more rapid recovery at least in comparison to many other countries around the World.

8. Conclusion: It appears that a cascade of failures of America’s critical industries and societal infrastructure began with Healthcare and Public Health functions and have expanded out to municipal services and finally to the fabric of society throughout the United States during this first wave of the 2010 Influenza Pandemic. The results are and will likely continue to remain characterized as “catastrophic” throughout the coming waves. Many of these failings could have been and were anticipated. Better preparedness in advance may have mitigated much suffering now.

9. Lessons Learned.

A. Develop a serious and sober listing of all Federal, State and Local products, services and utilities that will be degraded or destroyed in a Pandemic and fortify those areas immediately.

B. Build Federal Inventories of life sustaining goods such as food, pharmaceuticals, over-the-counter medicines, clothes, shoes, and special needs products for persons with disabilities, the old and the very young.

C. Pay manufacturers and distributors to manage federal inventories in order that the taxpayer’s investments in these commodities can be preserved through stock-rotation and quality control measures.

D. Enhance all critical infrastructure including items not normally associated with Infrastructure:

(1) Religious and charitable organizations that will do much to bring America back to normalcy.

(2) Bandwidth for the increase in communication requirements for any disaster

(3) Healthcare. Private Sector or not, these are the bastions of America’s health in a disaster or Public Health catastrophe. Build a Public-Private enduring relationship with every American hospital, nursing home, medical center, specialty center, community center etc., because in a disaster, they are all we have….and federally fund disaster-related hospital expansion programs.

(4) Purchase a minimum 1,000 portable rigid or semi-rigid walled healthcare structures, 200 beds each, with radiology and operating capability for long term use during any disaster that destroys American communities healthcare infrastructure.

(5) Build a logistical support system with civilian and military transportation assets sufficient to re-supply every healthcare entity in America during disasters.

(6) Assign Public Health Agencies a “hands-on care mission” for relieving the enormous stress hospitals, nursing homes and medical centers will experience during a pandemic. Provide funding not influenced by the “partisan dabbling” we have seen in our past.
(7) Insist on a Good Steward mentality for Government agencies and federal, state and local leaders at all levels of government. Rid ourselves of Government power brokers and castle builders and replace those shallow souls with Americans who seek the good of the People, well above any petty self-interest.
Please let the process begin today!

The Convergence of Emergency Management and Special Needs Issues

——————————————-

As previously mentioned, I want to thank you for your clear and strong commitment to the important issues briefly touched on during the January 2 meeting convened in DC.  These are very exciting and busy days and with so many issues to focus on, I am please the new administration values the human impact so highly.  Thank you also for the opportunity to provide a few thoughts.

As requested, I have listed the issues mentioned that required a follow up reference.  Each listing is an abbreviate outline only.  These are provided with an eye to the most immediate 30-, 60-, 90-day action items.

• Safe Centers:  Currently up and running in the states of Florida and Alabama several newly constructed senior centers were designed specifically for a dual purpose.  These could be shovel-ready very quickly.
o When necessary, the by-day senior center transforms into the community safe shelter for the seniors and others in need of refuge.
o  The design and construction took into account the hazards (in these locations hurricanes) and include hardened features such as uninterrupted power supplies, food, durable medical equipment, etc.
o The staff members are also trained to become shelter staff during operations.
o This concept is replicable and with minor design changes based on local hazard analysis and thus useful in most areas of the US.
o The concept is not limited to senior centers but could be a parks department facility, a day care center, etc.
o Points of contact:

- Michael Weston – who originally outlined the concept    westcots@aol.com;
- Irene Collins, Executive Director of Alabama’s Department of Senior Services who also chairs the FEMA NAC Special Needs Committee Irene.collins@adss.alabama.gov;
- Georgianne Cherry, a public health preparedness planner for the Florida Department of Health Georgianne_Cherry@doh.state.fl.us .

• Tax Relief and Credits:  Recognizing that especially in these difficult financial times, we have priced many Americans out of preparedness, replicating one of several existing or proposed tax reliefs encouraging ordinary people to take actions for themselves, their families, and their communities will increase capacity to self-sustain during a disaster.
o Exempting prefabricated go-bags and individual preparedness items at set times.
- Example can be found in New York State for a proposed bill http://assembly.state.ny.us/leg/?bn=A11206 .
o Providing a tax credit for specific forms of emergency volunteerism.
- Example can be found from Pennsylvania http://www.pasenategop.com/reform/emergency.htm
o Tax credit for those victims of disaster who receive certain aid.
- Example found in Georgia http://wwww.legis.state.ga.us/legis/1999_00/leg/fulltext/hb1327.htm

• Appropriate Staffing and Parallel Structures: Post Katrina Legislation (HR 5441) established a position in DHS of the National Disability Coordinator (NDC) and the post was placed in FEMA with the Equal Rights Office.
o The responsibilities envisioned by the legislation far exceed the capabilities of a single individual as is now the case.  o On December 5, 2008, FEMA Director Paulison in a letter accepted the recommendation of his National Advisory Council (NAC; also established in the same legislation) to establish additional support within all ten FEMA regions in the form of a Regional Disability Coordinator (RDC).  However these positions will not be funded until FY 2011. A new administration could identify immediate funding to support this structure.
o A new administration could also encourage or mandate that each of the FEMA Region Administrators establish a Regional Advisory Council (RAC) as many have done and ensure a Special Needs Subcommittee as Region II Administrator Steve Kempf, Jr. recently announced.
o Similarly, looking to states such as California, Florida, and Virginia, a new administration could encourage or mandate that the Governors of all states appoint a State Disability/Special Needs Coordinator.
o And with at least the NDC and the RDC a new administration could ensure the most qualified individuals are selected for these posts by setting a qualification standard with the assistance of both representatives of professional emergency management as well as the special needs community.  These posts must be administrative with the real-world experience to be deployed to the field
• Executive Order:  Executive Order 13347 signed by President Bush on July 22, 2004 is a good start at ensuring people with disabilities in particular (however by implication other special needs groups as well) are taken into account in all aspects of emergency planning.
o It also established the Interagency Coordinating Council (ICC) chaired by the Secretary of DHS to oversee federal agency coordination.
o A new administration could acknowledge the goals of this EO and then improve upon it so as to continue the momentum and set measure marks to reach.
o Current contact is the designated chair of the ICC, Daniel Sutherland the DHS Officer for Civil Rights and Civil Liberties Daniel.sutherland@dhs.gov .

• Functional and Medical Support Shelter (FMSS):  The Target Capabilities List describes the capabilities related to the four homeland security mission areas: Prevent, Protect, Respond, and Recover. The current version of the TCL contains 37 core capabilities.
o A key component required but not currently included is the Functional and Medical Support Shelter.
o Nearly two years of work by a vast group of practitioners and advocates working together produced a core concept and working document.
o A new administration could champion the need to put forth very aggressive and progressive guidance on shelter standardization for special needs populations and reexamine the FMSS document [see attached file for additional information].
• Promising Models of Agencies Planning for Special Needs Populations:  During the meeting, a few specific agencies were highlighted for their extemporary efforts.
o Within HHS, the Administration on Aging has spent years working to increase the resilience capabilities of its entire network of senior services down to the very local department for the aging.  Point of contact is Edwin Walker Edwin.walker@aoa.gov .
o Always set apart from its federal counterparts is USDA for its progressive commitment to the employees and guests in agency building who have special needs during disaster.  Over the years this has included an impressive list of physical planning tools, computer notification software, redundant plans, and most notably the assignment of a Special Needs Advisor as a direct report to the Incident Commander during an activation.  Best resource person: Bruce McFarlane – who held this position for almost 15 years before his very recent retirement from public service – bamconsulting@verizon.net

The above bullets represent the points from the meeting dialog that required further reference as requested.  They are also actionable in a short period of time.  Obviously there are many more issues, policies, solutions, collaborations around the core topic that can be taken on by the new administration.  If you feel I can provide further assistance I am more than willing to make myself available (as has been the case during this past administration).  I can offer to direct you to those within the government sector and/or private sector who can most meaningfully assist, and to facilitate other helpful networking efforts, i.e., in my role as Chair of the IAEM Special Needs Committee I interact with a wide spectrum of emergency managers on an ongoing basis.

My focus has always been on providing the best possible emergency management services for the people who can benefit most. Thank you for this extraordinary opportunity to share my insight with the people who will lead our nation.

Respectfully submitted.

Elizabeth Davis

EAD & Associates, LLC

Emergency Management & Special Needs Consultants

by Jim Rush

I have been involved in community preparedness all of my adult life and have had the good fortune to work with some of the best folks in the Emergency Management field. When I read some of the conversations on this IAEM List, I thought I’d comment on the types of personal qualities that promote and foster a “Culture of Preparedness” in jurisdictions and communities. For readers who like the bottom line up front, I’ll provide it here.

If you are working for an elected official who is not committed, do whatever you can to help this person become a real Community Preparedness leader. It will not be easy to foster this change, but try to exhaust all possible strategies within your scope.

If you can’t help the elected official, it may be time to find a community whose elected official wants to be prepared and elected leaders who will support you.  If you remain in a community and just go with the flow so to speak, you are truly a part of the problem.

Listed below are some traits that are absolutely necessary in Emergency Management leaders at all levels of government.

A Visionary: I think it was Walt Disney who said “If you can dream it, you can do it.”   In our context, if the Emergency Manager does not have a clear vision of how his/her community must plan, train, test, learn and manage future disasters, he or she cannot lead their communities toward a Culture of Preparedness.  The old mentality “we can all reach consensus and come together as involved stakeholders” sounds great and utopian but is a bunch of bunk. Someone needs to see the Big Picture, and have the requisite zeal for achieving the results of that Big Picture… and that person is the Emergency Manager at the local, state and federal level. True, the Emergency Manager can only be effective if the elected officials are truly committed to Preparedness, but the Emergency Manager is definitely the right person to articulate the vision of real community Preparedness.

A Leader: The National Response Framework (NRF) is useful in that it outlines very important concepts such as NIMS, an integrated Incident Command System where all stakeholders are a part of the total response. What the NRF is no good at providing is a no-nonsense “who does what for whom…and when” delineation of responsibilities.  It seems that in America today, we don’t want to be demanding of others and we absolutely hate failure, so we engineer systems that can’t fail. Of course these “wiggle plans” can’t succeed either as we saw in recent disasters including hurricanes Katrina and Ike.  New Orleans and Galveston Island are still living with limited or no Healthcare and Public Health infrastructure.

The Leader at the city and state levels of government needs to publish a clear and concise list of “measurable responsibilities” for the individual, local organizations (for-profit and non-profit), Non-Governmental Organizations, local governments and state governments. The plan needs to be clearly articulated using every possible media format and it must be signed by every stakeholder organization.  We have seen all of the advertising on what we need to do to become “Digital TV Ready” on terrestrial, cable and satellite TV channels.  Where are the 30 second spots on “what I need to do to become prepared” for the types of disasters listed in the jurisdiction’s Hazard Vulnerability Assessment (HVA)?  Are we more concerned with getting “American Idol” than we are at getting prepared?…..apparently so.

When I start seeing public service announcements (or paid spots) on TV informing me of the types of events for which I need to prepare and what I need to do and have available in my home, I’ll know we are headed down the right path to Preparedness. Public Information is a mandatory part of developing a Culture of Preparedness.”

If you need to pay Risk Communicators to effectively send the message, pay them. If you need to pay radio and TV stations to run the ads, pay for them. If your elected officials  will not support Community Preparedness, no matter your efforts to advance this, perhaps it is time to dust off your resume. There are many communities that with committed leadership truly want to become prepared…. find them.

A Good Steward: Every Emergency Manager in the United States is a “steward” of our tax dollars in the area of Emergency Management and Preparedness. I shudder when I hear Federal officials say the words “Use or it lose it” when applied to appropriated monies.  If ever there was a verbal mandate for waste, fraud and abuse, this is it.  No activities, projects or programs should be funded without clear plans, desired outcomes and measurements.  Measure fearlessly! If you aren’t failing in some areas, your community is not discovering ways to do things better and recover sooner.

All available funding should support the Preparedness vision mentioned above and not personal wishes. The “Good Steward” buys Preparedness and not preference. There is no “what’s in this for me?” question in Good Stewardship. I happened upon the test for stewardship when I was in charge of medical war reserves in Europe. For just one item, (nerve gas antidote) I could either spend $10 Million on Mark1 Autoinjectors which were expiring (there is no normal use for Mark1 Autoinjectors and thus no stock rotation opportunity), or hope that the FDA would extend the shelf life on over a million units of expiring Autoinjectors. If I purchased new product and the FDA approved the shelf life extension, I’d have $10 Million in excess Mark1 kits…a very bad place to be when the General Accountability Office visits …and it will. On the other hand, if a war broke out and I elected not to replace the expiring Autoinjectors, hoping for that shelf life extension, I’d be in the position of issuing expired antidote Autoinjectors.  I decided I’d rather explain to the GAO and to Congress my rational for replacing the antidote, than I would try to justify to parents and loved ones of Servicemen and woman why their loved ones had to use expired antidotes. I did the right thing and was prepared to defend my stewardship of taxpayer’s money.  As it turned out, the 1991 Gulf War broke out. We had the required on hand assets of serviceable Mark1 kits and we had made the right decision.

A Teacher. As every teacher knows, helping others learn is a real challenge, but it definitely has its rewards. The Emergency Manager is the expert in all aspects of Emergency Management and that knowledge should be shared with all stakeholders and the next generation of emergency managers in the agency. It is hard work meeting with groups of elected officials, other agencies, elected officials, healthcare executives, public health officers, non-governmental organizations and civic groups. The fact is, we need the entire community’s participation and commitment in developing a Culture of Preparedness. On top of that, it takes stamina to keep the commitment to Preparedness alive and vibrant in the community. We all want to get “comfortable” in our daily lives and in our normal jobs. It is the Emergency Manager, who as the teacher and mentor keeps the Culture of Preparedness alive and young in our communities.

It’s a tough job and at times a thankless one. In that 1991Gulf War, I certainly was concerned that there would be casualties and fatalities on both sides. The one thing that I did not worry about was our ability to medically support our troops. I can’t even imagine the horror, shame and sadness I would have felt if I had made decisions based on the safe thing to do for me in the months and years leading up to the war. Emergency Managers will never feel good about a disaster that befalls their community. What can happen though is that each Emergency Manager as a visionary, a leader, a good steward and a teacher can attack future disasters knowing that he or she did the right thing and pulled out all the stops to assist their community achieve a real Culture of Preparedness

Everyone talks about ‘creating a culture of emergency preparedness’ but no one talks about what the key elements are when creating any culture. How do we design a culture of preparedness to be used as a safety anchor for people to grasp onto when threatened?

If we’re trying to get people to understand that the ‘cavalry’ is not going to come riding over the crest of the hill to save them from most disasters – what are the visible attributes of culture – do we use artifacts [a rooftop with SOS spelled out on it perhaps], stories [Katrina, Ike, Greensburg KS, 9/11], rituals [the annual packing and unpacking of the ‘Go Bag’], symbols, beliefs, attitudes, rules and heroes?

In an age of fragmented views and diametrically opposed priorities – even among professional associations, advocacy groups, and govt agencies in the same space – who is setting the agenda for creating this culture of emergency preparedness?

Please don’t diss the query with a reply of ‘That’s the million dollar question, isn’t it?’ or something along those lines. How do we take this concept forward – without playing the blame game and talking about past failures.

So what’s your ‘wish list’ – your priorities, your plan, your roadmap? What are you reaching for – is there a list of tangible ‘things’ that will make this work? What are the things – the three things that I can do – that will really make a difference?

What was it that RFK said about the danger of expediency – “of those who say that hopes and beliefs must bend before immediate necessities. Of course if we must act effectively we must deal with the world as it is. We must get things done.”

I’ve been looking at medical surge as a series of ever-larger waves crashing ashore in that they continue picking up more and more debris and carrying that further inland until finally they begin to ebb.

All the surge plans I’ve seen are based on the notion that the emergency healthcare system will need to handle more and more patients until finally the peak flow is reached.

There is a fair bit of ‘resurrection medicine’ built into these plans – the need to reach into death’s door and pull the victims back into the land of the living.

Shouldn’t we be looking at creating critical care field triage levels that would prevent the surge waves from carrying patients requiring resurrection-medicine from reaching the ERs? Isn’t it about time we took a hard look at plans that would include field-based palliative care units?

Any idea on the total number of mechanical ventilators and respiratory techs there are in any given major jurisdiction in the United States or Canada? Anyone have a breakdown on that number per hospital – just the major centers?

The estimates I’ve heard sure don’t give me any peace of mind – and the fact that the actual numbers seem to be so closely guarded also gives me pause. Certainly don’t get the vibe there are overwhelming numbers of either ventilators or the human beings required to make them effective lifesaving tools.

“Disaster preparedness typically includes plans that address the need for surge capacity to manage mass-casualty events. A major concern of disaster preparedness in respiratory therapy focuses on responding to a sudden increase in the volume of patients who require mechanical ventilation.” – Mechanical ventilation in mass casualty scenarios. Augmenting staff: project XTREME, Hanley ME, Bogdan GM. 1: Respir Care. 2008 Feb;53(2):176-88; discussion 189

While I recognize the wonderful work done by major trauma centers that kick themselves into overdrive to deal with 20-30 seriously injured patients from a single incident, I believe it’s time to take a real-world look at what happens when there are 100 or 200 or 300 or maybe 1,000 people who are sick or injured?

And perhaps it’s not a one-time event, i.e., pandemic flu.

I live in Montreal where the EMS system runs on a Basic Life Support platform and where firefighter-first responders have been limited to a SSU [sticky side down] approach when it comes to providing care for patients prior to an ambulance crew’s arrival.

The idea that somehow the combined Fire/EMS system would be able to successfully triage, then transport more than 100 critically ill patients from a single incident without completely outstripping available resources is pretty well pure science fiction.

The EMS system is constantly short of ambulances and crews. There are a finite number of firefighter first responders. And that’s when the going is relatively good. Throw in an icy night and a few multi-patient car crashes and maybe simultaneous multi-alarm fires [definitely not unheard of in a major metropolitan area].

My educated guess would be that roughly 85 percent of the available mechanical ventilators in Montreal hospitals are currently in use. Combine that with an average ER occupancy rate in the 90-something percent range and we’re not talking surge – we’re talking about a damned near bankruptcy of the emergency healthcare system.

And we don’t need to be talking pandemics or terrorism. We could be talking about an ethyl-methyl-bad-stuff incident at one of the multiple chemical facilities that are smack dab in the middle of a heavily populated center. All that’s required to tip the balance between feasible and outright chaos is a higher percentage of critically ill patients.

If the walking wounded aren’t – then we’ve got a serious problem on our hands. It’s not as if we’re going to tell the populace to get a pick-up truck and an air mattress and take their neighbors to the ER on their own. One major incident doesn’t come with permission to suspend operations for the rest of the population. Just standing with Serge watching the waves crash on Tundra Beach.