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Perennial Issues

Dirty Bombs: A Day Late And A Dollar Short

 

This is the second in a series of articles published in Family Security Matters, a blog dedicated to engaging families in our Nation's Security. The article includes information based on the author's recent book: “Unready: TO ERR IS HUMAN, The Other Neglected side of Hospital Safety and Security”, a critical overview of the current state of readiness to support healthcare provision in the face of natural and manmade disasters. This and subsequent articles will include pending material for the upcoming book titled “Deadly Neglect: Act of God vs. Apathy and Denial”.

It is an eye opening account of current gaps in Healthcare Emergency Readiness, which underpins the current characterization of the Public Heath and Healthcare Sector as the “weakest link in the Homeland Security Chain”.

Bio Threats, Bio Terror and Bio Error

This is the third in a series of articles published in Family Security Matters, a blog dedicated to engaging families in our Nation's Security. The article includes information based on the author's recent book: “Unready: TO ERR IS HUMAN, The Other Neglected side of Hospital Safety and Security”, a critical overview of the current state of readiness to support healthcare provision in the face of natural and manmade disasters. This and subsequent articles will include pending material for the upcoming book titled “Deadly Neglect: Act of God vs. Apathy and Denial”.

It underscores the existing threats posed by recent proliferation of bio-labs and internal and external threats posed by to increasing access to deadly biological agents. This contributes to the current characterization of the Public Heath and Healthcare Sector as the “weakest link in the Homeland Security Chain”.

An Old Soldier Looks at The Fort Hood Killings

This subject hits close to home for me, as a retired senior officer in AMEDD (Army Medical Department) and it is written without the filter of political correctness which allowed this incident to happen in the first place. It is the fifth in a series of articles published in Family Security Matters, a blog dedicated to engaging families in our Nation's Security. The article includes information based on the author's recent book: “Unready: TO ERR IS HUMAN, The Other Neglected side of Hospital Safety and Security”, a critical overview of the current state of readiness to support healthcare provision in the face of natural and manmade disasters. This and subsequent articles will include pending material for the upcoming book titled “Deadly Neglect: Act of God vs. Apathy and Denial”.

It underscores the existing threats posed by the shift to softer targets using multiple teams of terrorists, of which hospitals are a favorite international target, contributing to the current characterization of the Public Heath and Healthcare Sector as the “weakest link in the Homeland Security Chain”.

Pediatric H1N1: "Children are not Miniature Adults"

Despite an initial optimistic announcement on H1N1 readiness (“H1N1 preparedness is going well”) from the White House, experts have identified meaningful gaps in preparedness in general and for special populations in particular.

There is a cruel irony in the fact that this nation’s Public Health Policy celebrates robust themes such as “no child left behind” and “every child must have access to quality health care” but fails to promote a reasonable level of protection for them during natural and man-made disasters. Law makers authorized multi-millions of dollars each year to save the smallest among us, neo-natal populations, but fail to adequately resource plans for millions of vulnerable children.

Responding to the 21^st century threat environment has become increasingly more complex. The decision-making matrix is built on critical bits of information on which viable alternatives are dependent. Those who are entrusted with the safety and welfare of vulnerable healthcare populations, in times of high risk, must be ready to make crucial decisions associated with “protect in place or evacuate”. Hospital stakeholder’s survival depends on timely responses made with alacrity and based on comprehensive, well designed pre-planned actions.

The “just in time” supply chain model, a widely accepted and highly valued practice has shifted warehousing and availability of age-and condition-appropriate equipment and supplies away from treatment sites. The intended or unintended consequence has cancelled out onsite inventories so vital to meeting “protect in place” all-hazards options. Most federal and state emergency medical stockpiles do not adequately stock emergency supplies in pediatric sizes.

Segregation of hospital populations into age-and condition-specific domains has resulted in higher levels of inpatient acuity requiring advanced life support systems and other technologies has profoundly influenced all-hazards survival choices for special populations.

These special populations, critically-ill neonates/children, immuno-compromised, severely injured, and mild to severe behavioral child patients pose a significant challenge to any evacuation protocol. As recently as September 3^rd, the CDC released information which would lead one to believe that there is evidence of a higher of mortality and morbidity among children, specifically those from ages 5 to 17.

Source: DC Public Health Examiner, Examiner.com

H1N1 Children at Risk: Kids are not Miniature Adults

Low dose exposures to Chemical, Biological (H1N1), Radiological and Nuclear sources which may cause minor disruptions among adults may well be fatal for children. If past is prologue, hospitals and other healthcare sites serve as beacons of safety and hope during known or perceived calamities (H1N1 Pandemic). Parents of children with known special needs illnesses will seek treatment and comfort from their traditional tertiary/specialty facilities as will other sick children. These facilities will be overwhelmed.

General acute care hospitals do not serve large pediatric populations and do not have staff credentialed or trained in pediatrics. The community-based facilities also have limited supplies of critical resources such as pharmaceuticals in pediatric dosages, and appropriately sized equipment e.g. mechanical ventilators and other respiratory equipment (ambu masks).

The "just in time" supply chain, discussed in the previous article takes on a high profile. Location and distribution of life-saving equipment and supplies takes on a life of its own. The brief 9/11 anthrax scare in the nation’s capital resulted in hospitals having to "lockdown" with angry local mobs accusing the hospitals and their staff of hoarding limited supplies of life-saving drugs. Relief supplies on their way to a devastated New Orleans after Katrina were hi-jacked by roving mobs.

The non-federal healthcare sector has designed and constructed its workplace sites with little regard to facility safety and security. The industry's shift of resources away from "cost centers" to "profit centers", leaves many hospitals ill prepared to deal with challenges associated with protection of hospital stakeholders and critical supplies and equipment. The dual challenges of hospital employee’s as H1N1 victims and the need to care for their own infected children at home will find hospitals in desperate need of qualified back-up personnel. Volunteers are the life’s blood of continuity of operations. Vetting volunteers during a pandemic is not only difficult but very dangerous. This is especially true when large numbers of infected children are in involved. The requirements for traditional "code pink" infant and child abduction must be maintained along with a watchful eye for enterprising child predators.

"Trust but Verify" is sound advice. Is your local healthcare facility "beacon of hope" prepared to meet its expected role and responsibilities to protect and care for your vulnerable infant and child population.

Source: DC Public Health Examiner, Examiner.com

Who is Minding Homeland Security for Hospitals?

This is the first in a series of articles published in Family Security Matters, a blog dedicated to engaging families in our Nation's Security. The article includes information based on the author's recent book: “Unready: TO ERR IS HUMAN, The Other Neglected side of Hospital Safety and Security”, a critical overview of the current state of readiness to support healthcare provision in the face of natural and manmade disasters. This and subsequent articles will include pending material for the upcoming book titled “Deadly Neglect: Act of God vs. Apathy and Denial”. 

It is a sobering account of the current state of affairs, which underpins the current characterization of the Public Heath and Healthcare Sector as the “weakest link in the Homeland Security Chain”.

You Think the Military Healthcare System has Security Problems?

Take a look at the Nation’s Non-Federal Healthcare Sector

We are still reeling from the Fort Hood massacre, how could this happen in a protected gun control space where all personal firearms are registered and secured? A space where deep background checks are mandatory. Where the hospital and healthcare facilities are accredited by a national external evaluation system which reviews and attests to the quality and safety of care to their patient population. Where a culture of preparedness is taken for granted. Contrast that with the non-federal Hospital and Healthcare sector.
 

“The history of man is a graveyard of great cultures that came to catastrophic ends because of their incapacity for planning, rational voluntary reaction to challenges”
- Eric Fromm

In earlier posts we have concentrated on the lack of all-hazards readiness (outside threats) of the non-federal healthcare sector. It has long been characterized as the “weakest link in the Homeland Security chain”. The industry has failed to design and construct its hospitals to protect against known hazards including terrorist attacks. They have failed to consistently perform background checks on employees. They have even failed to prepare for a 2nd wave of H1N1 pandemic flu.

The Fort Hood event demonstrates the potential for devastating death and injury at the hands of single source attacks. Some speculate that international terrorists will have to get in line after homegrown (Jihadist cells, gangs, Anti-everything groups) domestic terrorists to do their harm. The advent of women bombers seeking equal rights to kill and maim innocent populations adds to an already complex security landscape.

The UK experience with physician terrorist in their National Health System and the need to secure their medical radioactive sources against insider theft or explode-in-place should be taken seriously by the industry. The changing face of terrorism dictates that a “trust but verify” vetting process for all is no longer an option. The current litigious and regulatory landscape places hospital and healthcare Board and Directors/Trustee’s at substantial criminal and civil risk. Unlike the Fort Hood event where there is a "cafeteria style menu" of entities to sue, processing accountability for a similar attack by one of your employees may be a simple matter.

We don’t pretend to be legal advisers, see you legal Council for specific advice.

H1N1 Swine Flu Treatment Priorities: Kicking Grandma off the Ventilator

Availability of and access to mechanical ventilators in advanced stages of H1N1 Swine Flu is a Life/Death issue. The DHHS has initiated an action to identify the number and location of mechanical ventilators within the country (this information will not be available to the public). Earlier studies indicated that 70-80% of existing mechanical ventilators are  already being used by patients. Some models estimate that in a severe pandemic the nation would need 750,000 ventilators; however we are not sure of an exact count until the information is released (if released). How these will be allocated is a fundamental issue that remains to be clarified; the New York Legislative body made a noble attempt (see report) to address this, however it is not clear whether grandma’s ventilator would be re-allocated to a sixteen year incarcerated juvenile – who falls into the new priority treatment cohort.

Federal H1N1 Swine Flu treatment priority policies abound. According to all accounts they are driven by groups of selected, well intentioned, experts within multiple governmental and academic domains. Many times these groups have limited experience, “up-close and personal” exposure, to these situations and fail to consider important intended and unintended consequences of their guidance. This tendency to promote “one size fits all” guidance through “stove pipe” communications creates confusion and chaos at the “hands- on” levels of response.

Guidance generated at state and local levels also lack consistency and clarity. Many state legislative bodies have not removed material barriers (moral, ethical and legal) which hamstring realistic, effective planning and response for pandemic mass treatment events. Responding to these calamities is difficult at best and more often than not responders are faced with limited supplies of life-saving medicines and equipment. Our next two posts will deal with the bewildering range of decisions which community and healthcare organizations face in life-death decisions associated with meeting the needs of all victims in a severe H1N1 Swine flu pandemic.  We will focus on two governmental levels (Federal and State) of populations often overlooked by community and hospital organizations: Federal and State Inmate Populations.

Source: DC Public Health Examiner, Examiner.com

NOT IN MY BACKYARD: GITMO DETAINEES TO U.S.; MORE THAN “NO INMATE HAS ESCAPED YET” ISSUE

Guantanamo-North- Lower Manhattan

 

The issues discussed in this article come at a time when selected GITMO detainees are to face trial in New York City. The future home of the remaining GITMO detainees has not been determined.
The issue of closing GITMO - and what do we do with the current occupants - has intensified in recent months. The residents in the town of Leavenworth Kansas have been discussing the issue since it surfaced as a possibility early in the last Presidential campaign. The Leavenworth Community is no stranger to the coexistence of a community with high profile Federal and Military prison facilities. 

To our knowledge, there have been no recent escapes from the Leavenworth Lock-ups. One would think that the community would welcome new additions to their economic base. This has not been the case. The community’s increasing concerns for housing the GITMO group in their midst are not based on their lack of faith that these facilities are able to secure new occupants. Many high profile dangerous inmates have populated the prison facilities without any organized threat to secure their release. This perception that fellow terrorists pose an unacceptable risk to the community persists, even in a community living with some of the nation’s worst criminal elements, as written in our blog post published on this subject in on July 22nd.
 

The issues surfaced relative to the pending terrorist trials in lower Manhattan N.Y. are of serious concern in a number of safety and security domains. The 9/11 attacks on the twin towers provided a number of lessons learned for the hospital community. Many use the healthcare response to that disaster as a measure of the system’s ability to respond to a mass casualty event. Unfortunately it was more of a mass mortuary event. Had the attack been accompanied by any of a number of chemical, biological or, radiological, single or combined, the areas healthcare capabilities would have been rendered useless within hours. The lack of crowd control and free access to these facilities compromised any reasonable attempt to defend against secondary hospital attacks from outside or inside sources. 
 

We salute the city’s administration on their public announcements that they are ready to secure the area during the up-coming terrorist trials. This is an excellent opportunity for the city’s healthcare community to “double-down” on their readiness. 
 

As we listen to this week end’s talking heads discuss the pros and cons for holding the trials in the U.S. we pondered the issues which were not identified: if I were a GITMO detainee facing a military court could I ask for a U.S. trial?  If I were a defense lawyer would I attempt to pack the Jury with the defendant’s peers, not terrorists, but those of the Muslim Faith? How do prosecutors or defense lawyers select jurors who can creditably say that they are or were not influenced by the 9/11 attack?; how would the court deal with those defendants who choose to defend themselves? How do you have an open trial which demonstrates the “American Way” without the release of information which would place the nation at great risk.
 
Source: DC Public Health Examiner, Examiner.com