Category Archives: Articles

Scarce Resource Allocation During Disasters

Scarce Resource Allocation During Disasters: A Mixed-Method Community Engagement Study

Published by Biddison, MD, MPH, et al., in CHEST Journal, Official Publication of the American College of Chest Physicians

Background: During a catastrophe, health care providers may face difficult questions regarding who will receive limited life-saving resources. The ethical principles that should guide decision-making have been considered by expert panels but have not been well explored with the public or front line clinicians. The objective of this study was to characterize the public’s values regarding how scarce mechanical ventilators should be allocated during an influenza pandemic, with the ultimate goal of informing a statewide scare resource allocation framework.

Methods: Adopting Deliberative Democracy practices, we conducted 15 half-day community engagement forums with the general public and health-related professionals. Small group discussions of 6 potential guiding ethical principles were led by trained facilitators. The forums consisted exclusively of either members of the general public or health-related or disaster professionals and were convened in a variety of meeting places across the State of Maryland. Primary data sources were pre- and post- deliberation surveys and notes of small group deliberations compiled by trained note takers.

Results: 324 individuals participated in 15 forums. Participants indicated a preference for prioritizing short and long-term survival, but they indicated that these should not be the only factors driving decision-making during a crisis. Qualitative analysis identified 10 major themes that emerged. Many, but not all, themes were consistent with previously issued recommendations. The most important difference related to withholding versus withdrawing ventilator support.

Conclusions: The values expressed by the public and front-line clinicians sometimes diverge from expert guidance in important ways. Awareness of these differences should inform policy-making.

Ethical Guidance for Disaster Response

Ethical Guidance for Disaster Response, Specifically Around Crisis Standards of Care: A Systematic Review

Published by Leider, PhD, et al., in the American Journal of Public Health, September 2017

Plain-Language Summary:
Ethical guidance, alongside legal and medical frameworks, is an increasingly common component of disaster response plans. This systematic review examines how frequently ethical guidance is offered for crisis standards of care (CSC) during disaster response. A CSC declaration is a recognition that resources are limited and that everyday standards of clinical care are not possible under the circumstances.

When we screened 580 peer-reviewed articles mentioning ethics and CSCs or disaster planning, 38 (6%) included substantial discussion of ethical considerations (rather than, for example, focusing primarily on scientific treatment protocols.) The systematic review of the CSC ethics literature since 2012 showed that authors were primarily focused on the ethical justifications for CSCs (n=20) as well as a need for ethics guidelines for implementing CSCs; the ethical justifications for triage (n=19), both as to which criteria to use and the appropriate processes by which to employ triage; and the notion of a “duty to
care” or respond in disasters (n=11).

As governments and health care systems plan for disasters, ethical guidance that is theoretically sound and practically useful can — and should — form an important foundation from which to build practical guidance for responding to disasters with morally appropriate means.

DHS Announces Funding Opportunity For Fiscal Year 2017 Preparedness Grants

Release Date: June 2, 2017

For Immediate Release
Office of the Press Secretary
Contact: 202-282-8010

WASHINGTON—Secretary of Homeland Security John Kelly today announced the release of Fiscal Year (FY) 2017 Notices of Funding Opportunity for 10 DHS preparedness grant programs totaling more than $1.6 billion. The grant programs provide funding to state, local, tribal, and territorial governments, as well as transportation authorities, nonprofit organizations, and the private sector, to improve the nation’s readiness in preventing, protecting against, responding to, recovering from and mitigating terrorist attacks, major disasters and other emergencies. The grants reflect the Department’s focus on funding for programs that address our nation’s immediate security needs and ensure public safety in our communities.

“The administration remains committed to strengthening the security and resilience of our state and local communities,” said Secretary of Homeland Security John Kelly. “FEMA grant programs are flexible by design and will be used to help to address evolving threats, and each grant will go toward building and sustaining capabilities across all levels of government and the whole community to maximize preparedness.”

The FY 2017 grant guidance will continue to focus on the nation’s highest risk areas, including urban areas that face the most significant threats.  For FY 2017, the Urban Area Security Initiative (UASI) will enhance regional preparedness and capabilities by funding 33 high-threat, high-density urban areas. This represents Congressional intent to limit FY 2017 UASI funding to those Urban Areas that represent up to 85 percent of the nationwide risk, as stated in the Explanatory Statement accompanying the Department of Homeland Security Appropriations Act, 2017 (Pub. L. No. 115-31).

Consistent with previous grant guidance, dedicated funding is provided for law enforcement and terrorism prevention throughout the country to prepare for, prevent and respond to pre-operational activity and other crimes that are precursors or indicators of terrorist activity.

Grant recipients are encouraged to use grant funding to maintain and sustain current critical core capabilities through investments in training and exercises, updates to current planning and procedures, and lifecycle replacement of equipment.  New capabilities that are built using homeland security grant funding must be deployable if needed to support regional and national efforts.  All capabilities being built or sustained must have a clear linkage to the core capabilities in the National Preparedness Goal.

State Warns First Responders About Deadly Opioid Drug

State Warns First Responders About Deadly Opioid Drug: It can pose a grave danger to law enforcement and other first responders in an emergency medication situation

Published by Standard-Speaker, Hazleton, PA on
Aug. 12, 2016

(TNS) – Government officials are warning local first responders and law enforcement about the dangers of a drug not yet seen in the area but having tragic consequences elsewhere in the state.

Luzerne County District Attorney Stefanie Salavantis, along with the Pennsylvania District Attorneys Association and Pennsylvania Department of Health, issued the warning about a drug named carfentanil, which is causing an “overwhelming” number of overdoses in western Pennsylvania.

Salavantis said 20 of the about 200 overdoses were fatal.

The health department states carfentanil is a synthetic opioid with a clinical potency 10,000 times greater than morphine or pure heroin and 100 times that of fentanyl.

First responders were advised to use caution and use appropriate protective equipment when handling carfentanil. Due to the drug’s ability to be absorbed into the skin, it can pose a grave danger to law enforcement and other first responders in an emergency medication situation.

Signs of exposure to carfentanil are consistent with opioid toxicity and include pinpoint pupils, shallow or absent breathing, dizziness, lethargy, sedation or loss of consciousness, nausea and vomiting, weak or absent pulse and cold, clammy skin.

Ultimately, due to hypoxia, or oxygen deficiency, which can develop as a result of severe respiratory depression, onset of complete cardiac arrest and death can happen quickly.

Treatment should mirror those used in other opioid overdoses, focusing on aggressive airway management and mechanical ventilation.

Due to the potency of carfentanil, more than one dose of Narcan may be needed to reverse an overdose.

Salavantis requested that if any first responder is aware of a case involving carfentanil to contact her office immediately.

“Although we have not seen a case in our region, at least that we are aware of, it is important to be proactive and informed in the event this drug makes its way across the state,” Salavantis said in a news release. 

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Where to Go During a Communications Shutdown

Where to go During a Communications Shutdown: Local radio amateur group volunteers can help maintain communications until the normal operations resume

Published by Ken Reid on GovTech.Com
Feb. 3, 2016

 If you’ve been in meetings and exercises that simulate a total communications loss, you’ve likely wondered what you would do in the event of a catastrophic failure that takes down cellular, Internet, power, and even your own systems.
Haiti, Jan. 12, 2010. Within a few days after the quake, a team of amateur radio operators from WX4NHC at the National Hurricane Center was called upon to serve as the main source of medical communications. Over the next five weeks, the team manned a 24-hour net connecting Haiti field hospitals, the University of Miami Medical Center and the U.S. Navy hospital ship Comfort, relaying on-the-spot medical advice from stateside doctors, relaying medical supplies, charter airplane flight schedules and helping coordinate emergency helicopter and fast boat evacuations.

In Joplin, Mo., May 22, 2011. The hospital, two local fire stations and the town took a direct hit by an F5 tornado. All normal communications were down for weeks. Regional amateur radio operators were called in to help establish communications.

Fortunately, in these scenarios, there have been established relationships between government agencies and groups of volunteer amateur radio operators who were on call, up to speed and equipped to help.

There have also been multiple examples nationwide of 911 centers losing radio communications with police, fire and ambulance because of accidental cable-cutting, cybercutting, or simple equipment failure. Local radio amateur group volunteers are called upon to help maintain communications until the normal operations resume.

Your Plan B: Amateur Radio Support

What are your plans for emergency backup communications in the event of a serious failure, or if you need to communicate outside of your normal working range? Think no cell, no Internet service, no power, or the need to set up communications in a remote area.

Georgia’s emergency management community is tackling this challenge in partnership with the American Radio Relay League’s (ARRL) nationwide Amateur Radio Emergency Service (ARES) network: Here in Atlanta (and in counties around the state), groups of skilled volunteer radio operators are trained to respond to requests for backup support from local, state and federal agencies.

In my first year serving as Atlanta ARES emergency coordinator, we’ve made strides to ensure readiness. Our priorities are having a corps of volunteers who are well oriented and trained; building working relationships with emergency management agencies; ensuring that systems, technologies and protocols are in place; and participating in joint planning and drilling exercises.

Today, Atlanta ARES has a home base at the Atlanta-Fulton County Emergency Management Agency, which dedicated space in its EOP for a permanent radio room and multiple rooftop antennas. Amateurs also operate from a radio room at the state operations center of the Georgia Emergency Management Agency.

In coordination with the Georgia Department of Public Health, radio amateurs man an all-volunteer network operating from 30 amateur-radio-equipped hospitals around the state. This includes the 16 regional coordinating hospitals that train monthly to ensure effective back-up communications in the event of an emergency or disaster.

The Atlanta ARES team also participates in regional, multi-agency tabletop exercises several times a year, and runs amateur radio net control operations for major civic events, including the annual Peachtree Road Race and Atlanta Marathon.

Amateur Radio, in Brief

Here in Georgia, ARES members are required to complete FEMA 100-, 200-, 700- and 800-level classwork, so they can understand how to work within the Incident Command System. To align with served agency needs, members are also working to become fluent in three digital communication formats that enable us to send and receive text, email and ICS-213 forms. We use specially developed software, such as Fldigi, and support amateur communications formats like Winlink, and D-RATS. Our Atlanta ARES group practices digital and voice operations weekly.

VHF radios are similar to public service radios and are used for local line-of-sight talk up to 5 miles, and up to 25 miles with the use of a repeater. Most radio operators have an HT (portable 5 watts) and many have a mobile radio with up to 70 watts. Data can be sent over VHF with the use of a computer and relatively low-cost interface unit.

D-STAR (Digital Smart Technologies for Amateur Radio) is the digital counterpart to VHF, incorporating digital voice and data. It has both HTs and mobile units that usually incorporate VHF analog. A computer is still needed to send digital data. Other digital radio standards are available: D-STAR is our preference, due to state- and region-wide adoption and support from GEMA.

HF (high frequency) is for talking throughout the state, regionally, and beyond. Data can be sent over HF with an interface and a computer. HF is propagation-dependent, so the signal will not be easily heard in some conditions. Also, because HF signals bounce off the ionosphere, a relay may be needed when direct communication to the intended station is not possible. For example, a message sent from Atlanta may need to be relayed through a Chicago station to be heard in Miami, and we can do this.

Unlike public service encrypted radios, amateur radio by FCC regulation may not use encryption of any kind. Anyone with a radio that can tune to the frequency being used can hear the voice part of the transmission. Digital amateur radios can only be decoded by other radios equipped to receive digital transmissions.

How to Engage With Us

You’ll find local amateur radio groups eager to connect and explore how they can help. Learn more about ARRL’s ARES group and how to contact your local emergency coordinator at Contact your local radio club and ask if they have an ARES group and, if not, ask if they’d be willing to set one up. And rest assured that we know our role is supportive only:

Amateur radio operators will be stopped and turned away at building access points and on the road to emergencies, unless your security personnel have also been trained to recognize their identification and let them through. If you have requirements like background checks and TB tests for in-hospital sites, work with your local ARES group to get them handled. They’ll also need access to work with any installed gear to keep it operational and to keep their skills with that gear sharp.

ARES volunteers will go where they are needed with the gear they own, and do their best, but they may be limited by your systems. The essential first step is for your agency to install an outside permanent antenna. A robust VHF or wire HF antenna costs around $100 (plus the cost of coax cable), and goes a long way toward ensuring a reliable signal. A second step, which I’d urge you to consider, is investing in a fully operational radio station, which is a relatively small investment: you can set up a full HF and VHF radio station for about the same cost as two public service handheld transmitters.

If you believe there’s a possibility that you could have a total communications system failure, or be called upon to assist a fellow agency in need, consider bringing an amateur radio team on board. You’ll then have a group of easily integrated radio operators ready to support you.

Ken Reid is the ARES emergency coordinator, Atlanta; Net Manager of the Georgia Hospital HF Net; president of the Atlanta Radio Club; and a GEMA Certified Emergency Manager.

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