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The Pandemic Flu Drive-Thru Clinic Exercise

by: DemFromCT

Thu Apr 03, 2008 at 20:52:30 PM EDT


UPDATE: Tabletop with state and regional health care emergency managers yesterday, field exercise today (Saturday)

Ottilie W. Lundgren was 94 years old when she died of inhalational anthrax in 2001, the only Connecticut resident affected by the anthrax incidents of that year. How she got it and why she died remain a mystery to this day. In her memory, the state's newly acquired mobile field hospital (MFH) is now officially known as the Ottilie W. Lundgren Memorial Field Hospital.

DemFromCT :: The Pandemic Flu Drive-Thru Clinic Exercise
Set up fully, it can house 100 beds. It can also be set up in four 25 bed sections for separate use, and we've deployed one of those sections to an area near to Danbury Hospital, adjacent to Bethel Health Care, a nursing home in the town of Bethel, CT.  This local storage, use and deployment is the first time in the state the MFH has been set up this way.

Knowing that we had access to this facility, local health and community leaders had an idea. Having been educated over the past year about the possibility of a severe pandemic, and the inevitability of some sort of event, area hospitals, nursing homes, businesses and health care groups decided to band together and try something.

In the event of a pandemic, the hospital would be overflowing with patients. To alleviate some of the bed crunch, the area nursing homes and extended care facilities would pool their available beds, accept transfers from the hospital to free up bed space, and utilize empty beds remaining to act as a 23 hour alternate care facility for flu patients. The Ottilie W. Lundgren Memorial Field Hospital would be set up adjacent to an area nursing home (not the hospital), and the parking garage would be used as a drive-by (stay in your car) flu clinic (see lugon's 'austere' care post.)

Area residents would be told to stay home, and care instructions via www.getpandemicready.org and American Red Cross (and other home care sites - see Into The Woods' excellent resource list) would be offered on line. If people felt ill, had fever >103, or lower fever for >5 days, had respiratory difficulty such as cough or shortness of breath, or were not urinating for 12 hours or more, or felt they could no longer stay home and they wanted to get checked out, they could drive over to the drive-by flu clinic. Area residents would be encouraged to do this, rather than go to the overwhelmed hospitals.

Staffing would be on a volunteer basis from area health care organizations, including nursing homes and hospitals.

Those that were well (green) would be given a home care packet (American Red Cross and getpandemicready.org). Those that were well but scared or in need would be moved to the social service tent, same info, more resources including psych counseling (blue, for this exercise). Those that needed hydration (IV, nasogastric or by mouth) would move to the MFH for a few hours (yellow), and sent home with home care instructions. Those that were not ready to go home would go into the nursing home for 23 hour observation (amber). Those with respiratory difficulty would be transported to the hospital (red). Those that died would be processed (black).

As a first step in implementing the testing of this scheme, we wrote and implemented an overarching scenario:

What day/week are we?
Day  11 of H5N1 outbreak in the US. There are 100 suspected cases  (and half of those are confirmed cases) of  H5N1 in CT and 1100 confirmed cases overall in the US.  Other states are harder hit, some not yet hit at all. It's also seasonal flu season.

What do we know about the virus?

It's influenza A, H5N1 and susceptible to tamiflu/oseltamivir, resistant to adamantanes. It's a clade 2.1 variant  from Indonesia, and the pre-pandemic vaccine we have does not match.

What's the WHO phase?
We are now at WHO Phase 6 (early USG stage 5). This is efficient and sustained human to human transmission, but we are early in the acceleration phase.

What's the case fatality rate or other info that lets us know if it's a category 1,2,3,4 or 5 pandemic?
The case fatality rate is 7%, suggesting a category 5 pandemic

In fact, the above is an actual exercise, and it started yesterday with the  deployment and standing up of the MFH. Today was the press conference informing local media about the event (more about that tomorrow, with a news link), with state officials in attendance.  Tomorrow will be a tabletop exercise with area health care leaders and the state DPH, including the state regional epi team. Saturday will be a run-through using volunteers as patients, volunteers as staff, and volunteers as evaluators of the exercise.

Our purpose in putting this together is to utilize the MFH, practice its local deployment, use its facilities to triage and plan surge in a pandemic, and coordinate with area organizations and the state for communication, triage and health care.

This is the first time such a panflu exercise has been done locally or on this scale as a live exercise and MFH deployment, in the state. For all we know, it's the first time it's been exercised in the country (although we must acknowledge the superb work done by Pierce County, WA in writing the Alternate facility triage guidelines that we used and adapted).

More tomorrow and through the weekend as we see how well or how poorly such an idea would work. The exercise, however, is already a success; diverse area organizations that have never worked together are now working as one in order to brainstorm about how to deal with a severe influenza pandemic, one with a worse CFR than 1918. It also gives us a chance to practice surge but emphasize home care. And that is an idea whose time has come.

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the pic is a Sim Man
that i took today as the MFH was being made useable.

btw, if things go as planned
project xtreme will be tested in field conditions. It's just in time teaching of non-respiratory therapy hcw how to use a vent and do rudimentary respiratory care.

most excellent!
thank you, Dem!  Looking forward to your updates.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


very exciting Dem & re. Susan, me too!
Thank you Dem and Susan and lugon and pogge and Bronco Bill and the foreign news trackers, etc. for all your hard work.    
I want to say this every day. Just so you know. Thanks.  

[ Parent ]
you're welcome ;-) n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
thanks all
I share the "I want to say this every day" feeling too.  Thanks for phrasing it.

What we're all doing is kind of interesting, isn't it? :-)

/me goes back to reading Dem's report.

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


[ Parent ]
Bethel drill will test area emergency flu response
Sooner or later a virus spreading quickly around the world will make millions of people very sick in a short period of time.

It might be the bird flu percolating in Asia right now. It might be something unknown.

But given the adaptability of flu bugs, and the ease of world travel, something will catch fire.

"We're not talking about what if," said Norma Gyle, of New Fairfield, the state's deputy commissioner of public health. "We're talking about when."

When it happens, every hospital, every pharmacy, every pool of doctors and nurses will suddenly find there is not enough of anything to go around -- not enough beds, not enough drugs, not enough bandages and not enough people.

"I say it's the three S's," said Dr. Gregory Dworkin, chief of pediatric pulmonology at Danbury Hospital. "Staff, space and stuff."

On Saturday, the region will have a chance to see how it responds to a pandemic flu in real time, with a mock flu pandemic drill at Bethel Health Care Center. It may be the first community-wide drill held in the United States to deal with pandemic flu, Dworkin said.

http://www.newstimes.com/local...


this is excellent Dem
and a great write up in the paper.

I am looking forward to hearing more -- good luck on Saturday!

I am especially interested in hearing any reactions to the GetPandemicReady.org website materials.  Sounds like they will be used in front of a LOT of different groups of people:  general public, area health care workers, nursing students, public health officials and state epidemiologists....

I'm curious to hear if they have any comments or reactions as to the content or format of the website.


GetPandemicReady.org - non commerical website with practical ways for families to prepare.


I'll let you know...
...off to today's tabletop now.

[ Parent ]
Amazizng Drill,
Dem! Good luck on today's event. I hope that this can be a precedent set for other communities who are ready for 'the next step'. I know those communities are few and far between, but there are some. Thank you for all your hard work!-k

www.EmergencyHomePreparation.org -- A 'card-catalog' style of prepping information.   -

Exercise design
begins with solid objectives and then seeks a critical balance.  The scenario needs to be 'just right' for learning/skills enhancement - not easy (and frankly boring) and not impossible (defeating any educational outcome not to mention future participation).  The 'just right' scenario motivates participants to apply the lessons to other areas in their organization, and encourages wider scope and participation in the next exercise.

It's an art, and from my experience your exercise design team has mastered it.  Best wishes for continued success.


[ Parent ]
thanks! today's tabletop was about
logistics, communication and process. As it should have been. Plenty of state-level participation, plenty of lessons learned.

[ Parent ]
People should drive over?
People with a greater than 103F temp are to be encouraged to drive over to a clinic to get checked out?  How many people have ever tried to drive with a fever that high, and all the concurrently happening other symptoms?  Last time I had a fever that high, the one thing I did have enough sense to know was that I should not be driving anywhere - I'd be a hazard to myself, and to everyone else on the highway.

I'm glad some people are starting to think, but I do think they need to be a little more grounded in reality in their thinking.


guesses
I guess other family members would do the driving.

People who live "alone" (small children who can't phone don't count) need phone-calls from their phone-tree, to check for their well being.

Children above whatever age could be trained to use the phone or other means for communicating that their parents are ill.

In short, my guess is these units are one more element in an ecosystem of care, so to speak.  One that maybe wasn't present before.

And as Dem wrote (paraphrased), it sure can be improved on.

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


[ Parent ]
Keep it easy for kids -
If communications goes out for any length of time, kiddos are not going to be able to get a call out or in. Maybe some type of visible communication card, etc. can be used to hang on a door. Give the kids instructions that if Mommy or Daddy are sick and you need help, put this on the door.

If communications are out in a neighborhood/community, it can be arranged for a pre-designated group make 'rounds' checking doors for the signs.

Or neighbor watching neighbor, sees sign and gets help.

I know in my files, I downloaded signs for the front door. I should share the files. They are colorful and range from everything is oke, to a death in the house.

But, we do need to have a very simple mode of communications for the kids. Even the small frys can dial 911, so, it shouldn't be too hard. -k

www.EmergencyHomePreparation.org -- A 'card-catalog' style of prepping information.   -


[ Parent ]
of course, if catching it from a neighbor is an issue,
and it is, then transport is another element that can and should be "designed".

Maybe people who feel ill could just about make it to the door, or strong folks could get inside wearing proper gear, or not so strong folks with a wheelchair or similar device.

If people are too ill then the community-care unit won't do much good anyway - possibly.

All of that is worthy of consideration.

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


[ Parent ]
probably should be changed to
People with fever over 103 should come by car, as opposed to calling the ambulance, which should be reserved for other types of emergencies (heart attacks, etc.)   and/or people who have no other transportation options (no family/friends/community helpers willing to drive them).


GetPandemicReady.org - non commerical website with practical ways for families to prepare.

[ Parent ]
yep, it's a drive by clinic
if someone cannot drive you, or you cannot drive, you will need to stay home or use EMS. The clinic is designed for the not so sick who can drive. It's not designed for every possible ill flu patient.

You stay in your car and get triaged as you drive on the site. We were able to triage 100 volunteers in 12 minutes. They were directed to go home (not so sick) with teaching instructions for home care, go into the mobile filed hospital for 2 hours of hydratioon, or get transported to area hospitals. if you were too sick to go home but not in need of hosipital, you'd get admitted to the adjacent short term care facility (i.e. nursing home or SNF) for 23 hours of care. From there, home or hospital the next day.

In 2.5 hours, we handled 134 patient volunteers not including the 'blast through' 100 mentioned earlier and we could have handled twice that number, by our medical team estimates. We also (in theory) freed up 60 beds in the adjacent SNF and another 90 in area SNF, so we'd have 150 beds to add to the 300 bed community hospital that serves the region. That's not enough, but a good step in maximizing what we have.

We had security, good communications, and wonderful turnout (over 200 volunteers)  and cooperation from community groups and area hospitals, as well as a prominent role played by the state, who were observers.

Definitely a successful exercise. Also, we had project xtreme simultaneously run, and I had the opportunity for mnedia interviews to emphasize home care.

There were things we could do better (like streamline the paperwork), but all in all, a good day. This doesn't make us pandemic ready, but it's a good first step.


[ Parent ]
but aren't people who can drive
by definition people who are well enough to look after themselves at home, who shouldn't be taking up the clinic's time? And conversely, aren't cognitive functions like those involved in driving among the first to be affected by dehydration? I can understand the "maybe another family member can drive you" angle, but I have a really hard time imagining someone who needs rehydration or hospitalisation but can still safely drive. I know people do - stories of women in advanced labour driving themselves to hospital, etc. - but in a pandemic, the last thing you want is to be encouraging people onto the road who are not safe there; that's a really poor use of ambulances! Wouldn't it be better if the instructions for a drive by clinic were "if you think you have influenza, DO NOT drive yourself: if noone else can drive you, call EMS"?

[ Parent ]
there will not be enough EMTs
and you really have to step back and imagine how current medical care is delivered, where many patients ill enough to admit actually get to hospitals on their own or with a driver.

The rest of the ambulance service is as it is now, but with triage phone lines to sort out what instructions to give patients (run by local health departments and poison control centers). This is not a stand alone. So, if you have fever, drive over. The idea that if you have fever you can't drive ain't so. But if you are dizzy, stay where you are, we will come get you... similar triage happens every day.

The question then is whether enough patients are served this way to free up other area resources to cover the ones who are not. We think so, but we still have to evaluate that more rigorously.


[ Parent ]
Volunteers -
So, Dem, you were also handing out the teaching materials to your community volunteers today, correct? Not only were they participating in a voluntary exercise, they were leaving with materials in their hands, to keep. Great Idea!
--Of course, I'm saying that 'cause one of those items was from Get Pandemic Ready! ;) -- -k

www.EmergencyHomePreparation.org -- A 'card-catalog' style of prepping information.   -

no
four of those items were from getpandemicready.org   ;-)

Community Protection
Home Treatment Resources
Isolation and Infection Control
First Aid


[ Parent ]
Even Better! :) n/t


www.EmergencyHomePreparation.org -- A 'card-catalog' style of prepping information.   -

[ Parent ]
I attended the exercise today, and went through
the line as a patient volunteer three times, each time as a different patient with a distinctly different patient profile.  As soon as I finish writing up my notes, I'll post them.  

Dem, it was a successful exercise and one that was well planned and well organized.  


please do!
also your comments about the tabletop the day before.

I also invited Goju (another CT flu poster) but he couldn't make it.  


[ Parent ]
to clarify
I was delighted to see that Pixie was a three time patient, but I didn't mean to imply anything else. She heard about it thorough local media, and we chatted about it on PFI yesterday and today.

There's also a PFI thread here that Pixie started.

http://www.singtomeohmuse.com/...


[ Parent ]
Actually,
I learned about the exercise from local officials.  

Dem, it would be great if you could alert those in the local area to any future exercises or panflu-related activities. There are any number of very interested CT members of flublogia who've contributed enormously to the effort and I'm sure they'd like to be more involved in any local processes, now that there are some.  ;-)

Btw, I circulated the request for volunteers for the exercise on the CT homeschooler web list and believe that a good number of them showed up.  They found it interesting.  


[ Parent ]
great, and much appreciated
hope you give us feedback from them as well.

The project was run under the incident command system, with roles assigned by the planning committee as per ICS guidelines. This wasn't really a flublogia project, although if and when we move to communications exercises, and expansions of this beyond a medical/public health drill, that's a totally different story. Nor was this 'my' personal project where it's up to me to decide who is in and who is out. I was a part of a vast conspiracy of players, mostly local, who wanted this to happen and made it so.  ;-)

If I am a stickler for protocol here, no offense intended. The use of the state mobile field hospital, and that this was a first exercise, meant by the book.



[ Parent ]
No, I am just referring to
giving people a heads up about the fact that an exercise is going on at all so that if they wish to attend as observers or participate as volunteers, they can. That's separate from the formal planning process/chain of command issues.

Citizens can, of course, observe any panflu tabletops or meetings apart from any specific portion of those meetings that might be exempt under FOI laws. But in this case, I was referring to the more general heads-up that the exercise was taking place and that they, as members of the public, could (in this particular case) participate in the simulation.  

I think some of our CT flublogia members in the local area (some very local to this exercise) haven't signed onto the boards since you first mentioned it on Thurs. night, and the first media stories were not published  until Friday, the day before the exercise.  That's a shame as they may have had an interest in what was really a very important drill.  If they spend time on the panflu boards, I just assume they might have that interest.  


[ Parent ]
I was delighted with the
over 300 citizens who did attend. We'll have to do it again and give you more notice.

[ Parent ]
Outrageous
Dem said:

great, and much appreciated
hope you give us feedback from them as well.
The project was run under the incident command system, with roles assigned by the planning committee as per ICS guidelines. This wasn't really a flublogia project, although if and when we move to communications exercises, and expansions of this beyond a medical/public health drill, that's a totally different story. Nor was this 'my' personal project where it's up to me to decide who is in and who is out. I was a part of a vast conspiracy of players, mostly local, who wanted this to happen and made it so.  ;-)

If I am a stickler for protocol here, no offense intended. The use of the state mobile field hospital, and that this was a first exercise, meant by the book.

Sorry Dem, I just don't get it. I'm not trying to pick a fight but most of the folks running the show have not a clue about the reality of what a severe Pandemic will be like. We in Flublogia do. And to be excluded by a major member of Flublogia by way of withholding information about the drill prior to it when there was enough time to gather the forces to really make a difference is outrageous.


Tell the truth


[ Parent ]
Hi Goju ;-)
read your post on pfi, and thought I should clarify.

I just don't get it. I am sure Susan C was aware of this event. Why didn't the RM participate? Are they not PC enough to pass the BS test of TPTB for Panflu drills?

Actually, the first time I knew about this was 3 days before, in an email as a btw sort of comment.  I don't know when Dem first wrote about this on FW but I'm pretty sure he wrote about it maybe a day or 2 before this diary.  I just can't find the post when he mentioned it the first time.  So yes, I was aware, but just maybe marginally ahead of everyone else.  ;-)

I think you over-estimate to extent to which

  1. we tell each other what we are doing, cos both of us are chronically overwhelmed with work, Dem especially because he has a day-job, but me also because I have complex domestic commitments and health challenges.

  2. we tell the world (or flublogia) what we are doing, for the same reasons

I read that you were involved in an all day event "an all day event in the city".  What was that event?  Was it panflu related?  It wasn't clear from your comment whether that all-day event was the same as the "pandemic drill in your town that was a complete joke".  I'm sure you must have announced it somewhere on flublogia; I must have missed it.  Pray tell?  I'm sure others living in your area would have been interested to attend, to play the victim or whatever.

It's not always possible to a) invite or b) inform others to attend events, but when there is an Opportunity to Attend, especially for significant events like the Seasonal and Pandemic Flu 2008 meeting, you're right, it's a good idea to tell others well ahead of time so they can make efforts to become invited, as SophiaZoe, LMWatBullRun, Readymom, ACM, Kobie and others have done.  

btw, I wonder, may I ask you whether you sent in a petition to attend for that meeting?  If not, why not?  I'm sorry, I don't normally pry but I'm just following your lead, in checking all motivations of all parties on all their activities or non-activities.  

Do you also know of others who petitioned?  Again to follow your logic, I'm sure Pixie for example would have petitioned.  If not, why not?  Is the meeting too PC to pass whatever test you guys have about, I don't know, whatever?  I'm sorry, I don't play this part well, so I apologize for my lack of coherence.  ;-D



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
pfi link
http://www.singtomeohmuse.com/...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Divided we fall
Susan C said:

Actually, the first time I knew about this was 3 days before, in an email as a btw sort of comment.  I don't know when Dem first wrote about this on FW but I'm pretty sure he wrote about it maybe a day or 2 before this diary.  I just can't find the post when he mentioned it the first time.  So yes, I was aware, but just maybe marginally ahead of everyone else.  ;-)

Yes shocking to find out he was involved in the planning and didn't alert "us"

I think you over-estimate to extent to which

we tell each other what we are doing, cos both of us are chronically overwhelmed with work, Dem especially because he has a day-job, but me also because I have complex domestic commitments and health challenges.

You wanna meet a busy guy? say hello to Goju. ask Pixie - she knows whats happening n my life yet I remain committed to the sharing of knowledge daily.... even when I dont "have time".

I read that you were involved in an all day event "an all day event in the city".  What was that event?  Was it panflu related?  It wasn't clear from your comment whether that all-day event was the same as the "pandemic drill in your town that was a complete joke".  I'm sure you must have announced it somewhere on flublogia; I must have missed it.  Pray tell?  I'm sure others living in your area would have been interested to attend, to play the victim or whatever.

I was refering to a Panflu Vax drill held in my town. It was a seasonal vax clinic where they tested their Pandemic Vax response. They used real people coming in for their seasonal flu shots. No PPE. No crowd control. Nada. It was a joke. But they said it was sucessful cause they got so many people through in 12 minutes.A great place to become infected. I have attended all day high level meetings one of which I met Dr. Nabarro... remember "God Given Time"?

It's not always possible to a) invite or b) inform others to attend events, but when there is an Opportunity to Attend, especially for significant events like the Seasonal and Pandemic Flu 2008 meeting, you're right, it's a good idea to tell others well ahead of time so they can make efforts to become invited, as SophiaZoe, LMWatBullRun, Readymom, ACM, Kobie and others have done.  

Thank you for agreeing.

btw, I wonder, may I ask you whether you sent in a petition to attend for that meeting?  If not, why not?  I'm sorry, I don't normally pry but I'm just following your lead, in checking all motivations of all parties on all their activities or non-activities.  

Which meeting? the town drill? it was posted in the newspaper weeks ahead of schedule - I just showed up ... and it was well publicized in Flublogia as was my reaction to the drill. The big one in NYC I paid to get into and I was the most informed person there... shocking. Read my notes from that meeting Susan.

Do you also know of others who petitioned?  Again to follow your logic, I'm sure Pixie for example would have petitioned.  If not, why not?  Is the meeting too PC to pass whatever test you guys have about, I don't know, whatever?  I'm sorry, I don't play this part well, so I apologize for my lack of coherence.  ;-D

what do you mean by this?

 Is the meeting too PC to pass whatever test you guys have about, I don't know, whatever?  I'm sorry, I don't play this part well, so I apologize for my lack of coherence.  ;-


Tell the truth

[ Parent ]
sorry can you post a link?
Read my notes from that meeting Susan.

to help refresh my memory.  Thanks?

what do you mean by this?

I don't know, I'm just trying to follow the logic of your complaint.  Obviously, since I'm not you and I don't think like you, it's impossible for me to imitate what you do well enough.  My best suggestion is to apply your own logic as best you can.  

Also obviously, since I was just trying to imitate your approach and not follow my own, it's not my 'real' voice.  ie I don't particularly care who has or has not done something or why, unless they choose to share.  In that sense, it wasn't a real question, so feel free to ignore it.  Thanks!  ;-D



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
oh wait
I know about the NYC meeting with Nabarro.

I meant, did you tell flublogia about the town drill?  And if so, can you post a link please?  thanks!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
ps, just to clarify again
I don't actually mind whether you did or did not inform others of your town drill.  We are all volunteers, and I respect everyone's right to decide how far or how much they want to participate or to share.  Even though I think it's a good idea if others are informed where possible, I don't think there is any obligation to do so.  In that sense, it doesn't bother me if you did or did not tell flublogia ahead of time.  It's you prerogative to decide what information you choose to share.  After all, it's your town and your life.

Unless someone is an official paid by taxpayers, my POV is nobody in flublogia has any obligation to do things a certain way as prescribed by others.  Suggestions and feedback are always good, improvements are always welcome, and everyone is entitled to opinions, but at least here on FW, no one is expected to answer to anyone except to follow the forum rules.
 



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
link?
I'm not going hunting this morning. It was reported the the local papers and was picked up by Monotreme i believe at PFI and posted at FW and FT. This was at least a week before it occurred.

I have no complaints Susan... I only wished that Dem, or any other member of Flublogia, lets us all know what is going on so we can actually participate. Was this supposed to be kept a secret? If so, why?

Dem holds a very high, perhaps the highest, place in TPTB' perception of a Flublogian leader and I feel he let us down by not posting about this sooner.

Tell the truth


[ Parent ]
I guess the key word is perception
I don't know if Dem thinks of himself as a 'Flublogian leader'.  I'll leave him to muse on that if he chooses.

Was this supposed to be kept a secret? If so, why?

I believe you mentioned on pfi that Dem had told you a month before, am I correct?  I'm sure he is well capable of keeping things secret if they were supposed to be secret.  So my guess is, the answer is probably no.  But again, I'll let Dem comment if he so chooses.

I'm not going hunting this morning. It was reported the the local papers and was picked up by Monotreme i believe at PFI and posted at FW and FT.

Yes, please don't waste your time link-hunting.  We all have long lists of things to do, and everyday we prioritize.  I don't know about you but I don't have anywhere close to 100% success rate of remembering to do everything that I intend to do.  I forgot my children's birthdays more than a couple of times, and I thank the Lord that they still love me, in spite of my shortcomings.  LOL.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
this might answer your previous question
I have no complaints Susan... I only wished that Dem, or any other member of Flublogia, lets us all know what is going on so we can actually participate.

of what I meant, about informing everyone about the opportunity to attend the Seasonal and Pandemic Flu 2008 meeting.  The hope is more people like you or Pixie can participate.  And I hope y'all will write about it. Thanks and hope to see you in DC.  ;-)



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
if i recall correctly, Dem
wrote it was not a flublogian event.

Which would means one perfectly good thing: others would leading, not Dem.  That's exactly what each of us wants, no?

The "price" may well be that when others lead, those others decide important and non important things.  One of those things (I don't know if important or not) is when to tell the press.  They decide that ... unless they are just too busy or focused or whatever.

Not that I know any details, just trying to look at things under a different light.

Personally, I try never to feel let down before considering different interpretations of any past event.  But then I'm personally not very energetic, and feeling let down drains me even more, and I don't like it so I try not to feel like that.

That said, you may be perfectly right and there are "secrets" and less than pure motivations, of course. ;-?

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


[ Parent ]
I am not obligated
to report every detail on every project I am involved in. Some come to fruition and some do not. When I am completely in charge (here is just about the only place one can make a case for that and even then... ;-)  I have more leeway than when I am a member of a team. That's reality.

Your complaint about not being involved in planning could not be helped. I am sorry that your busy life (I'll match mine against yours or anyone else's who is not in the military) and mine did not allow more dialogue, but there's nothing else to apologize for.

If you need a better explanation, see lugon:

Which would means one perfectly good thing: others would leading, not Dem.  That's exactly what each of us wants, no?

The "price" may well be that when others lead, those others decide important and non important things.  One of those things (I don't know if important or not) is when to tell the press.  They decide that ... unless they are just too busy or focused or whatever.



[ Parent ]
You dont understand me
You think I am upset that I wasnt included? You couldnt be further from the truth.

I am upset that WE werent told about this earlier.

You knew about it and kept it from us. Don't matter who was in charge. We are not playing a game here... No simulation Dem.

10 case just yesterday. Deaths too. This is FOR REAL AND YOU ARE PLAYING GAMES.

I would be happy if the RMs had a booth nearby. I would be happy if 10 of us were "victims" and REALLY played the part throwing wrenches in their nice and tidy exercise.

I read Pixie's report.. very good coverage - that is what Flublogia does well. You had the opportunity to give us all advanced warning so WE could go into battle prepared and well armed.

This is a war... humans against the flu

Do not hold hands with the enemy or those who conspire unknowingly with it.

Tell the truth


[ Parent ]
about RM booths
I can't speak for anyone who uses RMA material for exhibit booths, and we are happy for anyone to use them in whatever way that is consistent with the licenses of the site that they downloaded it from, but as far as ReadyMoms Alliance is concerned, we only do exhibits in events where exhibits are planned by the organizers and open for registration.  

Unless I missed something, I don't believe this is the case here.

In any case, there are always more events than we have the resources including time and money, to take part in.  We always choose very carefully and strategically where to put our efforts.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
my point
My point Susan is that you weren't given the CHOICE to be there.

Tell the truth

[ Parent ]
huh?
No vendors were there. It was neither the appropriate venue nor was it the kind of location (rain, outdoors, mud) conducive to it.



[ Parent ]
Goju
A drill run under the auspices of NIMS isn't the kind of event where you set up booths.  It's not an awareness event or a rally; it's a drill.  

[ Parent ]
I make my own choices
and I make my own judgments.  Thanks for your concern, but I'm perfectly capable of knowing when I should get upset about someone not telling me something, and this is NOT one of them.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
frankly
I haven't a clue as to what you are talking about. Your point is what, again, exactly? That people are dying in Indonesia?

And... ???

It's not the exercise YOU wanted. It was not directed by flublogia. RMs were not there. The governor did not get on CT tv and tell people to prep for 3 months or more.

And, so, that's my fault?? Please. I don't have a magic wand to compel everyone to listen to me. If I did, I promise you, you'd be among the first to feel the magic.   ;-P

 


[ Parent ]
My Point
Dem, You know i respect you and the position you hold both professionally and board wise. My point is that when I find out about something I deem important in the world of Panflu, I post it and alert everyone who cares to allow discussions to begin and if an event, time to put their ducks in order IF they want to, and can attend.

I feel this was not done in this case and a teachable moment was lost.

Perhaps in the future, when you have advanced warning about something important, (and this goes for anyone in a position of confidence) log on with a different screen name and post the info... keeping vital info out if you think necessary to keep your cover.

Indo does the news blackout thang... we shouldn't.

Tell the truth


[ Parent ]
why would I post something until I was sure
it was going to happen? Weather nearly canceled the event entirely. as it was, high winds prevented the erection of half the field hospital.

As it happens, the above explanation is besides the point.

Perhaps in the future, when you have advanced warning about something important, (and this goes for anyone in a position of confidence) log on with a different screen name and post the info... keeping vital info out if you think necessary to keep your cover.
This is an absurd expectation, and one that will be ignored.

[ Parent ]
"Weather nearly canceled the event entirely."
Heh, that was one other reason I thought organisers would not want to tell the press too soon (that they themselves weren't completely sure the event would take place on the planned date until the very end).

See, that was something I learned long ago: when something specific happens, there's a first explanation that comes to mind, and then there are other explanations.  Sometimes the first explanation that comes to mind is right, sometimes it isn't.  (After all, I only have one mind, and explanations pop up one by one, not simultaneously and tidily sorted by realisticity (if that's a word).)  That's why I look for the other explanations before feeling upset or anything.

In general, I've found that looking for alternate explanations (and I've become quick at that, with time, though I'm still biased in favor of good intentions) brings up what turns up to be a better (more valid, more conducive to constructive action) map of situations.

Or I'm wrong and I don't know it! ;-)

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


[ Parent ]
are you asking people to act out of integrity
to violate their professional or legal obligations?  Or...what?  I'm not sure what I'm reading here...

Perhaps in the future, when you have advanced warning about something important, (and this goes for anyone in a position of confidence) log on with a different screen name and post the info... keeping vital info out if you think necessary to keep your cover.

Apologies if I mis-read this.  Frankly, I'm a little shocked.  I would have thought that you of all people would demand honesty.

To me, honesty means either not say something, or say it clearly and unambiguously, and take responsibility for saying it.  Using alternate IP addresses (What do they call it, Sock puppets?) is deceptive, dishonest, and does great damage to the person's credibility.  Not to say probably illegal in some situations, if you are violating confidentiality obligations, for instance.

Silence is not falsehood.  Pretending to be someone else is.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
or alternate screennames n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
it is anathema to a blogger
and grounds for instant banning on reputable web sites.

[ Parent ]
ok
Yes agreed... in a moment of insanity I blurted out xxx when i should have said...

you could always ask another member to post for you as we have done in the past.

The key issue here is that we need to know as much as possible about everything happening in the world of Panflu.

If every member withheld vital info, where would we be now?

I am glad they ran the drill. Next time maybe they'll throw a bunch of major real world wrenches in the works to see how the staff holds up.

Maybe we could stand outside of the area and hand prep fliers as the victims drive up to the gate. We need advanced warning for that.

Tell the truth


[ Parent ]
Goju, you have a good heart
and (thank goodness) a hard head.

there'll be a next time.


[ Parent ]
PS note this event took place on private property
and private roads. I am not at all certain how that would work. I know the Bethel police would be unhappy from a safety perspective. Drills are not the right venues for this.

[ Parent ]
see? i thought you were angry, when in fact you wanted to *contribute more*!
So it's not that you felt upset at secrecy (what I believed at first), but that you felt the urgent need to be notified:
- just in case it's vital information (no withholding of that, of course!)
- and in advance so that you could help more and contribute more.

That said, I'm personally amazed at how Dem and others keep their cool when we all know it could start at any time (and that always includes today).  Of course it's also true that we could have months or maybe even years and we have to do important things carefully and effectively (in this case, craft a specific pattern that's effective and replicable so millions will benefit).  That's why I started the diary about all 4 corners.

I know I'll be understood if I say my emotions run high sometimes. :-)

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


[ Parent ]
Invited? Me?
Ah my dear Dem... although it is true that i couldn't have made it,  as life intruded into this weekend a couple of weeks ago, You never invited me. You maybe mixed up the invite with a lunch that you asked me, Pix and miniG to attend similar to our last shindig.

I did ask you if i could attend when you first told me about it and you were quite evasive with an answer.

I would have made an excellent flu victim. but i dont think the doc who examined me would have appreciated it if i shoved my hand down my throat and vomited all over him... all along me moaning and coughing like a REAL pandemic flu victim would. Maybe even a touch of catsup dripping down my nose or spurted out in a cough... nice touch eh? Also writhing in pain, freaking out from fear... demanding the vacine or Tamiflu. I hope there was Tamiflu for the early cases.

I just returned home after an all day event in the city and have not had much chance to read all about the drill... but i did catch your comment and felt I had to respond.

I attended a pandemic drill in my town and it was a complete joke. Cant wait to read about this one.

You'll hear back from me in a few hours.  

Tell the truth


[ Parent ]
sorry you couldn't make it
you'd have made a great victim.

[ Parent ]
we set up a crisis intervention tent
in anticpiation of your response.  

[ Parent ]
interesting reference
I bolded that bit about catasatrophes.

COMMON BARRIERS TO CONDUCTING SUCCESSFUL EXERCISES

Just the thought of planning and implementing exercises can
be overwhelming. Today's first responders and public officials are faced with more and more demands on training time and resources. It simply is not possible to spend as much time as one might want planning, implementing, and addressing the issues uncovered by exercises. And yet this is one of the most important challenges for all of us in the emergency response and management community. Some things that often get in the way of success include:
> Overcomplicated scenarios and drills
> The wrong people or too many people at the table
> Unclear objectives
> Time constraints
> Lack of funding
> Competing interests and priorities during the exercise
> Difficulty getting buy-in and/or funding for exercises that address catastrophic issues that would have huge consequences but are of relatively low probability
> Thinking of the exercise as a demonstration that you know
what you are doing and that you cannot or should not make
mistakes; similarly, thinking that nothing should "go wrong"
during the exercise

http://www.hhs.gov/disasters/p...

from

http://www.hhs.gov/disasters/p...


good TV coverage tonitght of the event
Fox news 61 in CT. I got a chance to push preparedness a bit (heavily edited comments).

Go Here!
To see TV Coverage!

http://fox61.trb.com/news/

www.EmergencyHomePreparation.org -- A 'card-catalog' style of prepping information.   -


thanks for finding it! n/t


[ Parent ]
Dem, I've written up my comments about the exercise
here:

http://www.singtomeohmuse.com/...

They are quite lengthy, but hopefully will give a glimpse into my experience of being a "flu victim" in the exercise, as well as offer some of my observations on what was happening around me as I was processed through the system.

There's no question that the exercise was very worthwhile for all to participate in, and will provide many hours of productive after-action analyis and discussion moving forward (which is really the point, after all). I'm very glad my state has moved forward in this way, and am hopeful that they will continue to plan and exercise in this way.  


they are excellet comments
and response here:

Pixie, great job! That's pretty much what happened, accurately portrayed, with some additions I need to make.

Pixie recognizes that the purpose of this exercise is to find the flaws. As a drill, and as a just-in-time training exercise, it was very well done. And the cycle of plan, train, execute, evaluate, modify, NEW plan, train, execute, etc has to continue. We found a lot more things wrong than the ones you mentioned, and we can do better next time. And we found many things that were done well. Wink

Some comments on the excellent and constructive comments:

it may be that the expense of this kind of drill (the MFH is a 1.5 million dollar piece of equipment, people's hours were tracked and even volunteers might quickly become employees in a real thing) precludes us doing it for a year here, but others can do it elsewhere sooner. Also, planning cycles take a long time if you want to maximize correcting flaws, while convincing others to do what we did. Still, a year for us can be a less than a year elsewhere.

We had a first selectman and a state representative there, and the PIO and I gave them a site tour and did an interview on WSHU public radio that should play Tuesday where we talked about the preparedness need. We need to collect media responses as well; in one sense, they're a more typical public than you are. But we also need to continue to get political support and public reassure for exercises like these. I want everyone to ask why haven't we done one?

Specifics:

communication: we had 10 satellite laptops from American Red Cross and an excellent redundant communication system that ranged from ham radios to paper via the many teen runners. We could communicate quite well amongst ourselves and the area hospitals and nursing homes, all of whom checked in real time.

language: the field hospital, the medical facility and the tent had to be carefully scripted. The tent was the psychosocial tent. The triage hospital (only half of which as set up because of high winds) was the MFH (mobile field hospital), and the nursing home was the medical facility. it'd be easy to confuse them so the JIT language needs better teaching and enforcement so a patient sent to the tent got to the right place. Lots of that got worked out within the first hour, so it was smoother at the end. That's normal for a drill, accident scene, etc where the first hours is chaos and thereon is controlled chaos.

volunteers/staff: we had a big number, and if it were for real, even if it were as we scripted, we'd run them in shifts to prevent exhaustion. But we had to train them, so everyone got thrown in.

patient disposition Pixie went through and played 3 patients:All three of my patients were told to go home. I found that interesting. 12 of the patients per 100 needed hospital or nursing home (23 hour) admission. We made that small to see if the triage people could find them amongst the well, the mildly ill, the somewhat ill and the worried. they found them all and got them to the right place.

Also, it seemed that much of the educational materials on home care of patients really needs to be pre-positioned beforehand, and is the kind of thing that telephone operators trained to do the sort of triage the nurses did on site could guide patients or their caregivers to if it were available online (and perhaps printed daily in the newspaper).

Absolutely! These would be newspaper supplements, phone instruction, website availability, etc. in addition to whatever we do. If people threw away the instructions, they'd be available elsewhere post-positioned, too.

infection control:As I was waiting to enter the triage garage for the first time, I noticed a woman in an official jacket being stopped by the National Guardsman at the entry to the garage. He told her that she must have a mask on in order to enter the area. A conversation ensued, during which the woman kept asserting to him that she was "special" for some reason, and was exempt from that rule. The Guardsman, to his credit, insisted at least three times that she have a mask in order to enter the triage area

The Guardsman (bless him!) was wrong. Observers are supposed to be invisible (they are the evaluators, and there were 10 of them or so) and ignored and they were not required to wear masks. Speaking of the tent., more video here:
http://www.newstimes.com/

Several times as I moved about the site I saw people wearing their masks half-on, and half-off. Most of the masks in use were surgicals, so this was not due to any real discomfort.

That's training. More of it. I did one walk around telling people to put their masks on or leave the area. Of course, patients will do what patients do.

So, rather than broadening authority of the workers they had on hand, someone had made the decision to make more narrow the parameters of operational authority - this I just don't believe will be able to be done under the stresses of a pandemic.

See one, do one, teach one. You can't possibly do this until you have run through this exercise. Now, however...

Also, Pixie noted a Sobering moment: that was a separate area for the very ill who need ventilators. Physician assistants and nurses were being just in time trained using project xtreme to run a vent. That's part of the "broadening authority" that was included in the exercise.

Re the Indo patient that Pixie mentions: here's another sobering moment: we can't save everyone. Why would you think we could? But that patient would have been identified if ill at the facility and if well, but crashed at home would have skipped the triage clinic and called an ambulance. A bed would have been found, or not, depending. A patient could have been moved from the hospital to the nursing home where there were beds (separate area, own entrance, for infection control) freeing up one in the hospital. If there's a better system, I'm all ears.

Supplies and tamiflu were assumed to be absent from the SNS. The nursing homes and hospital would have resupplied us until we ran out. At that point, perhaps a week later, it's a different plan.

More video here:
http://www.newstimes.com/  


[ Parent ]
Also, please keep in mind -
It is very significant that this drill took place, to begin with! I think we are loosing sight over the fact that a mere few weeks, leading into months, we NEVER thought that we would see such an event!!

Oke, there were flaws ... it was the FIRST one (drill), folks! In the COUNTRY! It got television news coverage, newspaper coverage and geeeze, after this and PFI's threads some extensive Forum coverage. That's all good. We need to look at the positive side of all this.

I would hope that there will be another one. I would also hope that another community sees this and takes the lead to hold one of their own.

As far as RMs not being there ... like it was mentioned, this was a drill where, for the most part there was a lot of drive-through evaluations. And, if I remember correctly, there was significant handouts being given to the attendees from the Get Pandemic Ready site and the Red Cross.  That's good material that got handed out. -k  

www.EmergencyHomePreparation.org -- A 'card-catalog' style of prepping information.   -


me angry?
Nah.. just outraged and you all are doing a fine job of managing the outrage ;)

I dont buy the "we didnt tell because we thought it might rain" story.

And there are several here who would (or may) have contributed if we had advanced warning....

Yes there will be a next time..... hopefully.

Tell the truth


yes there will be a next time ;-)
And in the meantime, may I ask everyone who are interested and who may have contributed to consider contributing at the Seasonal and Pandemic Flu 2008 meeting.  

This of course is not a drill, but honestly, it is one of the most important meetings to attend with regards to pandemics.  I've heard previous year's attendees tell me how excited they are that they are invited again cos they personally know a few people who have apparently been dropped from the list.

Anyone interested, follow this link for more information - Opportunity to Attend  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
i wonder what it takes to set up something different
I really do.

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
share your design Goju
OK Goju, seriously -- please step up to the plate here.

What kind of design would you suggest instead, for the "next time" since this one you think is a "sham".

And, what organizations would you invite?

And (realistically) would they participate in the type of  event you have planned?

And -- what about funding for your event?   Who will fund it?

Design it, find funding, and you know what?  I bet a lot of us will support you.

I will.  I'll drive up from DC to support you.  

Just make it happen.



GetPandemicReady.org - non commerical website with practical ways for families to prepare.


[ Parent ]
what are your ideas for the "really bad, really soon" quadrant?
http://newfluwiki2.com/showDia...

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
AND WHO WILL FUND IT?
Seriously, Goju, I think you are a businessman, right?

You know these things cost money.

You know the feds aren't coughing it up for "preparedness", and it doesn't appear the states are either at the moment -- so realistically, if you cannot come up with an idea AND FIND PEOPLE TO PAY FOR IT and find people willing to make it happen...well, it is just an idea on the back of a napkin, do you get my drift?


GetPandemicReady.org - non commerical website with practical ways for families to prepare.


[ Parent ]
what i think off the top of my head
Run a blizzard of tv, radio and print PSA'S to educate the public in simple terms... what panflu is, what it can do to effect your life and what you can do to prepare and treat loved ones at home. When to know its time to go to the hospital or triage area.

Do not water it down to avoid panic. Produce them to avoid panic.

Partner with businesses that routinely send out bills and sales offers to customers with pandemic flu info contained in the envelope - either piecemeal or as part of their printing. Like cable tv bills, power bills, telephone bills.

Give those businesses tax credits, to help pay for it and make it worth their while. make sure that each utility covers their area of service.

Work with national retailers to design panflu prep sections in the stores where you can get all your prep supplies in one place with clear instructions on what to buy for how many people. Use space on the info printing for advertising that can be sold to ad agencies to pay for it.

Hold town hall meetings and be honest about how bad it could be and what we as a town are doing. Obviously it is such a big undertaking that as many people in town that can volunteer to help can.

Feed the news media stores they can run to educate the public.

Force the states to buy the tami and PPE they will really need for a pandemic.

Join the oil, gas and electric companies in hardening their systems down to the local gas station and local power transmission tower.

This is just a beginning... but wont happen if we do all this planning for drills that will quickly fall apart once the pandemic gets going.

Tell the truth


[ Parent ]
Just make a little more room in your thinking :-)
(Similar comment made at PFI)

Good drills engage key players in the process of thinking together resourcefully. If they learn to do that, then they can adapt their responses as they will surely have to do. We need drills PLUS all the things you have mentioned. It's not either/or; it's both/and. Either/or is a false choice. This drill is not the action you long to see, but that doesn't make it wrong-headed. The journey from here to there always begins with first steps. I'm glad to hear that materials from getpandemicready.org, etc., were handed out as a part of the drill. Hopefully participants will look at the rest of the site, along with other resources. I don't see how they could have walked way without a measure of consciousness raising.

We need the rest of the actions you list (very good list), now, desperately, of course, which is why we'll keep plugging away in every area where grassroots action and leverage are possible.  


[ Parent ]
its just money & time
theres not enough money and time to spend on everything.

they have to pick and choose what to do.

I feel they picked wrong.

Tell the truth


[ Parent ]
do you ever even CONSIDER the possibility
that they may be right and you may be wrong?  Like, what was your assessment of when the pandemic was going to happen, 2 years ago?  Were you ever so sure that it would have happened by now?  If you were, well, guess what?  Look around you.  Has it happened?  Are people dropping dead with a flu virus with 60% CFR?

Just checking here, you know...

Or, can't you just let others do what they do, and you do what you do?  There IS a difference between just making a point, stating your case, and INSISTING repeatedly that you MUST be right, you know.  The latter smacks more of a NEED to be right than real expertise, if you don't mind me saying so.  

I'm not saying you are wrong in your beliefs, necessarily, but I think you are very misguided to believe that there is only one way to do drills, that there cannot be some specific, technical, and professional reasons, unknown to you, why the participants needed to be trained in a particular way, and why THE FIRST TIME they do a drill, it may be more effective to choose certain methods over others.

That maybe those who work in certain jobs may know quite a bit more about their jobs than YOU do.  Did you ever consider that?

Agreeing to disagree is a sign of strength, of openness to new ideas, of respect that is much more likely to be reciprocated, such that you can keep the channels open for future communication and cooperation.  Bashing everyone with your one and only viewpoint, that yours MUST be the right way, and that NO ONE ELSE who think differently can possibly be right or have the right intention or right approach - My God, how many 'clueless' officials have you won over by your 'charm' campaign?

I really wonder, have you ever been wrong in your life?  Do you ever think back and realize that, even just one second before you finally discovered yourself to be wrong, you were EVER SO SURE that you were right?

I don't know.  I envy you your certainty; it must feel great to believe (if you do) that you are never wrong.  I also pity you, the day when you finally discover how wrong THAT particular belief is....



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
More video:
http://www.newstimes.com/

www.EmergencyHomePreparation.org -- A 'card-catalog' style of prepping information.   -

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