Indiana is slowly reopening for business, but the fight against COVID-19 is far from over. Wearing a face mask is one of the simplest, most effective ways to slow the spread of the virus, but we need everyone to do their part to keep our state safe. That’s why we are asking all Hoosiers to mask up — and speak up about how wearing your mask can save lives.

As Hoosiers, we pride ourselves on our hospitality. But right now, the best way you can be a good neighbor is by wearing your mask when you’re in public. After all, we don’t wear our masks for ourselves. We wear them to keep others safe.

We need you to #MaskUpHoosiers! As Indiana gets Back On Track, it’s still important to practice safety precautions and healthy habits to protect our neighbors. Wearing a mask helps prevent someone who unknowingly has COVID-19 from spreading the virus to others. Show us your face mask fashion and share why you choose to #MaskUpHoosiers!

Everyone wears their mask to protect someone — whether it’s for your grandma, your kids, or the strangers in line at the grocery store. Use the #MaskUpHoosiers hashtag to share an image of yourself wearing your mask and answering the question: who you wear your mask for?

Spread the word. Not the virus

Here’s how you can help! Download the toolkit below with #MaskUpHoosiers logos, profile photos, and signs for you to customize and share. Together, we can combat misinformation and encourage everyone to stay safe, mask up, and make a difference.

Get Involved

• Get your poster

• Facebook

• Twitter

• Instagram

• LinkedIn

• Mask Up Hoosiers Logo

Help Indiana get Back on Track!

• Learn More

• Get Tested

• Be Well

• Reopen Safely

• Join the Fight

All content within this post is provided by the Indiana State Department of Health (ISDH). The full content can be provided here-(ISDH)

As the country moves through the summer, countless families, parents, and educators are scrambling to figure out how to appropriately communicate to their children about what is going on in a way that they will comprehend, but not overwhelm. This has proved challenging as these are unprecedented times, where even as adults, we don’t necessarily know what lies ahead. Parents and educators are trying their best to organize school related summer activities, prepare for the next school year, and communicate to the children what their school year could look like going forward. This can be overwhelming for adults and children, especially if you do not have proper guidance, information, and resources to communicate effectively.

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Below you will find resources pertaining to adults and children, and what they can do to better understand and prevent the spread of COVID-19.

Smithsonian

“COVID-19! How Can I Protect Myself and Others? will help you, and your community, understand the science of the virus that causes COVID-19 and other viruses like it. It will help you to figure out how this virus is impacting or affecting you or may impact you in the future. It will help you to understand the actions that you can take to keep yourself and your community safe.

In this project, you will discuss how people feel about the virus. You will investigate the science of this virus. You will explore public health measures, which are things that are happening in your community or may happen soon to keep COVID-19 from spreading. You will take action to support health in your community.

Help us measure impact! By providing us with this basic information, you are ensuring that we can document the reach of the COVID-19 module, and help the Smithsonian Science Education Center to understand how to best support educators and parents as they undertake this module with their learners” Click here

My Hero is You, Storybook for Children on COVID-19

“This book was a project developed by the Inter-Agency Standing Committee Reference Group on Mental Health and Psychosocial Support in Emergency Settings (IASC MHPSS RG). The project was supported by global, regional and country based experts from Member Agencies of the IASC MHPSS RG, in addition to parents, caregivers, teachers and children in 104 countries. A global survey was distributed in Arabic, English, Italian, French and Spanish to assess children’s mental health and psychosocial needs during the COVID-19 outbreak. A framework of topics to be addressed through the story was developed using the survey results. The book was shared through storytelling to children in several countries affected by COVID-19. Feedback from children, parents and caregivers was then used to review and update the story.

Over 1,700 children, parents, caregivers and teachers from around the world took the time to share with us how they were coping with the COVID-19 pandemic. A big thank you to these children, their parents, caregivers and teachers for completing our surveys and influencing this story. This is a story developed for and by children around the world”

For access to the storybook go to the link below (multiple language versions are available and downloadable)

—>https://interagencystandingcommittee.org/iasc-reference-group-mental-health-and-psychosocial-support-emergency-settings/my-hero-you

Centers for Disease Control and Prevention-Talking with children about Coronavirus Disease 2019

Tips for talking with children (CDC)

• Remain calm. Remember that children will react to both what you say and how you say it. They will pick up cues from the conversations you have with them and with others.

• Reassure children that they are safe. Let them know it is okay if they feel upset. Share with them how you deal with your own stress so that they can learn how to cope from you.

• Make yourself available to listen and to talk. Let children know they can come to you when they have questions.

• Avoid language that might blame others and lead to stigma.

• Pay attention to what children see or hear on television, radio, or online. Consider reducing the amount of screen time focused on COVID-19. Too much information on one topic can lead to anxiety.

• Provide information that is truthful and appropriate for the age and developmental level of the child. Talk to children about how some stories on COVID-19 on the Internet and social media may be based on rumors and inaccurate information. Children may misinterpret what they hear and can be frightened about something they do not understand.

• Teach children everyday actions to reduce the spread of germs. Remind children to wash their hands frequently and stay away from people who are coughing or sneezing or sick. Also, remind them to cough or sneeze into a tissue or their elbow, then throw the tissue into the trash.

• If school is open, discuss any new actions that may be taken at school to help protect children and school staff.

Messages for parents, school staff, and others working with children

Centers for Disease Control and Prevention Caring for Children during COVID-19

Based on available evidence, children do not appear to be at higher risk for COVID-19 than adults. While some children and infants have been sick with COVID-19, adults make up most of the known cases to date.

Watch your child for any signs of COVID-19 illness

COVID-19 can look different in different people. For many people, being sick with COVID-19 would be a little bit like having the flu. People can get a fever, cough, or have a hard time taking deep breaths. Most people who have gotten COVID-19 have not gotten very sick. Only a small group of people who get it have had more serious problems.

CDC and partners are investigating cases of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. Learn more about COVID-19 and multisystem inflammatory syndrome in children (MIS-C).

Keep children healthy (CDC)

Teach and reinforce everyday preventive actions

• Parents and caretakers play an important role in teaching children to wash their hands. Explain that hand washing can keep them healthy and stop the virus from spreading to others.

• Be a good role model—if you wash your hands often, they’re more likely to do the same.

• Make handwashing a family activity.

• Learn more about what you can do to protect children.

Help your child stay active

• Encourage your child to play outdoors—it’s great for physical and mental health. Take a walk with your child or go on a bike ride.

• Use indoor activity breaks (like stretch breaks or dance breaks) throughout the day to help your child stay healthy and focused.

Help your child stay socially connected

• Reach out to friends and family via phone or video chats.

• Write cards or letters to family members they may not be able to visit.

• Some schools and non-profits, such as the Collaborative for Academic, Social, and Emotional Learningexternal icon and The Yale Center for Emotional Intelligenceexternal icon, have resources for social and emotional learning. Check to see if your school has tips and guidelines to help support social and emotional needs of your child.

Ask about school meal services

Check with your school on plans to continue meal services during the school dismissal. Many schools are keeping school facilities open to allow families to pick up meals or are providing grab-and-go meals at a central location.

Help your child cope with stress

Watch for signs of stress or behavior changes

Not all children and teens respond to stress in the same way. Some common changes to watch for include:

• Excessive worry or sadness

• Unhealthy eating habits

• Unhealthy sleeping habits

• Difficulty with attention and concentration

Support your child

• Parents can find more information about supporting their children during a COVID-19 outbreak on CDC’s Helping Children Cope page.

• Talk with your child or teen about the COVID-19 outbreak. Answer questions and share facts about COVID-19 in a way that your child or teen can understand.

• Learn more about common reactions that children may have and how you can help children cope with emergencies.

Versiti Blood Center of Indiana in dire need of blood donations throughout Indiana

WHAT: Versiti Blood Center of Indiana is now in dire need of blood donations.

WHY: With each day that passes, the need for life-saving blood at Hoosier hospitals escalates. That need has now been elevated to critical as blood donations have not met hospital demands in the past few days.

All blood types are needed, with the greatest need being O-negative and O-positive types. O-negative donors are universal blood donors, meaning their red blood cells can be transfused to all patients.

WHERE: Versiti is encouraging generous Hoosiers to donate life-saving blood immediately at a Versiti Blood Center of Indiana donor center near them or at a local community blood drive this week:

INDIANAPOLIS: 3450 N. Meridian St.

FISHERS: 11005 Allisonville Road

CARMEL: 726 Adams St., Suite 150

GREENWOOD: 8739 U.S. 31 South

LAFAYETTE: 2200 Elmwood Ave., Suite D-16

TERRE HAUTE: 2021 S. Third St.

 A complete list of local blood drives in Indiana is available on Versiti Blood Center of Indiana’s website.

WHEN: Donors are asked to make an appointment immediately by calling 317-916-5150 or visiting http://www.versiti.org/Indiana. Appointments are strongly encouraged. With coronavirus safety precautions in place, walk-in donors could experience wait times.

HOW: Donating blood takes about an hour. Anyone age 17 or older in good health who meets eligibility requirements is encouraged to give. Parental consent is required for donors age 16 to donate blood. Donors must present a photo ID that includes their birth date.

To ensure ongoing donor safety, Versiti requires all donors and employees to wear a face covering. Donors are asked to bring their own face covering with them to their appointment.

Red Cross

Blood donors needed to keep supply strong amid COVID-19 outbreak 

(May 13, 2020) — In times of need, people come together to support one another. The American Red Cross is asking for healthy individuals to step up to help patients experiencing health crises by donating blood or platelets. 

As COVID-19 continues to affect everyday life, people may not be thinking about blood donation. But blood and platelets are needed daily to help patients battling disease and facing the unexpected. Donating blood is an easy way to care for each other and ensure hospitals have the blood products patients rely on. 

As a thank-you for helping ensure a stable blood supply, all who come to give blood or platelets May 15-31 will receive a special Red Cross “We’re all in this together” T-shirt, by mail, while supplies last. Donors must have a valid email address on file to claim their T-shirt. 

How to help 

Healthy individuals who are feeling well are asked to make an appointment to donate this May by downloading the free Red Cross Blood Donor App, visiting RedCrossBlood.org, calling 1-800-RED CROSS (1-800-733-2767) or enabling the Blood Donor Skill on any Alexa Echo device. Donors are asked to schedule an appointment prior to arriving at the drive and are required to wear a face covering or mask while at the drive, in alignment with Centers for Disease Control and Prevention public guidance. 

Each Red Cross blood drive and donation center follows the highest standards of safety and infection control, and additional precautions – including social distancing and face coverings for donors and staff – have been implemented to safeguard donors, volunteers and employees. 

The Red Cross is also looking for blood drive hosts to help ensure a stable blood supply. Learn more and sign up to sponsor a drive by visiting RedCrossBlood.org/HostADrive. 

Upcoming blood donation opportunities May 15-31: 

Boone County 

Lebanon 

5/27/2020: 2 p.m. - 7 p.m., Boone County Sheriff's Office, 1905 Indianapolis Avenue 2020-APL-00592  

Delaware County 

Muncie 

5/28/2020: 12 p.m. - 5 p.m., Glad Tidings Church, 3001 S Burlington Drive  

Hamilton County 

Carmel 

5/27/2020: 2 p.m. - 7 p.m., Harvest Church, 14550 River Road 

5/30/2020: 8 a.m. - 2 p.m., Venture Christian Church, 14501 Hazel Dell Pkwy 

Fishers 

5/28/2020: 2 p.m. - 7 p.m., Hamilton Hills Church, 10293 East 126th 

5/29/2020: 2 p.m. - 7 p.m., Billericay Park Multi-Purpose Community Building, 12690 Promise Road  

Hendricks County 

Brownsburg 

5/15/2020: 2 p.m. - 7 p.m., Connection Pointe Christian Church, 1800 North Green Street 

Plainfield 

5/22/2020: 2 p.m. - 7 p.m., Vertical Church, 620 Carr Road  

Madison County 

Anderson 

5/31/2020: 1:30 p.m. - 6 p.m., Wesley Free Methodist Church, 3017 W. 8th Street 

Elwood 

5/29/2020: 2 p.m. - 7 p.m., Elwood Community Blood Drive, Quincy Lodge #230, 1136 N. Anderson Street  

Marion County 

Indianapolis 

5/18/2020: 11 a.m. - 4 p.m., American Red Cross Office IU Medical School Blood Drive, 1510 North Meridian 

5/28/2020: 2 p.m. - 7 p.m., Emmanuel Church - Banta Campus, 6602 S Harding Street 2020-APL-00592 

Putnam County 

Coatesville 

5/26/2020: 2 p.m. - 7 p.m., Heritage Lake Clubhouse, 1000 Clubhouse Road  

Bartholomew County 

Columbus 

5/21/2020: 10 a.m. - 4 p.m., The Commons, 300 Washington Street 

Brown County 

Nashville 

5/29/2020: 10 a.m. - 2 p.m., Brown County YMCA, 105 Willow Street  

Greene County 

Solsberry 

5/16/2020: 10 a.m. - 2 p.m., Solsberry Christian Church, Rural Route 2, Box 14  

Johnson County 

Edinburgh 

5/18/2020: 4 p.m. - 9 p.m., Edinburgh Apostolic Tabernacle, 701 South Main Street 

Franklin 

5/21/2020: 2 p.m. - 7 p.m., Emmanuel Church - Franklin Campus, 550 Homestead Blvd  

Lawrence County 

Mitchell 

5/28/2020: 1 p.m. - 6 p.m., Mitchell Church of Christ, 1004 Main Street

Monroe County 

Bloomington 

5/16/2020: 8 a.m. - 2 p.m., Bloomington Blood Donation Center, 1600 W. 3rd St. 

5/20/2020: 12 p.m. - 6 p.m., Bloomington Blood Donation Center, 1600 W. 3rd St. 

5/23/2020: 8 a.m. - 2 p.m., Bloomington Blood Donation Center, 1600 W. 3rd St. 

5/27/2020: 12 p.m. - 6 p.m., Bloomington Blood Donation Center, 1600 W. 3rd St. 

5/30/2020: 8 a.m. - 2 p.m., Bloomington Blood Donation Center, 1600 W. 3rd St. 

Morgan County 

Camby 

5/17/2020: 9 a.m. - 2 p.m., Grace Church, 4172 Allison Road  

Vigo County 

Terre Haute 

5/22/2020: 10 a.m. - 3 p.m., Vigo County YMCA, 951 Dresser Drive 

How to donate blood 

Simply download the American Red Cross Blood Donor App, visit RedCrossBlood.org, call 1-800-RED CROSS (1-800-733-2767) or enable the Blood Donor Skill on any Alexa Echo device to make an appointment or for more information. All blood types are needed to ensure a reliable supply for patients. A blood donor card or driver’s license or two other forms of identification are required at check-in. Individuals who are 17 years of age in most states (16 with parental consent where allowed by state law), weigh at least 110 pounds and are in generally good health may be eligible to donate blood. High school students and other donors 18 years of age and younger also have to meet certain height and weight requirements. 

Blood and platelet donors can save time at their next donation by using RapidPass® to complete their pre-donation reading and health history questionnaire online, on the day of their donation, before arriving at the blood drive. To get started, follow the instructions at RedCrossBlood.org/RapidPass or use the Blood Donor App. 

About the American Red Cross 

The American Red Cross shelters, feeds and provides emotional support to victims of disasters; supplies about 40% of the nation’s blood; teaches skills that save lives; provides international humanitarian aid; and supports military members and their families. The Red Cross is a not-for-profit organization that depends on volunteers and the generosity of the American public to perform its mission. For more information, please visit redcross.org or cruzrojaamericana.org, or visit us on Twitter at @RedCross. 

For more information on donating blood and setting up a blood drive visit, https://www.redcrossblood.org/

The MESH Coalition has created a specific webpage for all things related to the Novel Coronavirus outbreak. This hot topic is just a piece of the information provided on this webpage, as well as info distributed through our Daily Situational Awareness Brief’s. All information provided is via The Centers for Disease Control and Prevention and The World Health Organization. That webpage can be found by clicking the novel coronavirus banner image on the MESH Coalition homepage.

The Centers for Disease Control and Prevention (CDC) is closely monitoring an outbreak of respiratory illness caused by a novel (new) coronavirus (termed “2019-nCoV”) that was first detected in Wuhan City, Hubei Province, China and which continues to expand. Chinese health officials have reported hundreds of infections with 2019-nCoV in China, including outside of Hubei Province. A number of countries, including the United States, have been actively screening incoming travelers from Wuhan and human infections with 2019-nCoV have been confirmed in Taiwan, Thailand, Japan, and South Korea. The United States announced their first infection with 2019-nCoV detected in a traveler returning from Wuhan on January 21, 2020. Coronaviruses are a large family of viruses, some causing illness in people and others that circulate among animals, including camels, cats and bats. Rarely, animal coronaviruses can evolve and infect people and then spread between people such as has been seen with MERS and SARS. When person-to-person spread has occurred with SARS and MERS, it is thought to have happened via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread. Spread of SARS and MERS between people has generally occurred between close contacts. Past MERS and SARS outbreaks have been complex, requiring comprehensive public health responses. The Johns Hopkins Center for Systems Science and Engineering has built and is regularly updating an online dashboard for tracking the worldwide spread of the coronavirus outbreak that began in the Chinese city of Wuhan.

The following resources are available with information on 2019-nCoV

• CDC Travelers’ Health: Novel Coronavirus in China

• CDC  Health Alert Network Advisory Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV) in Wuhan, China

• CDC Health Alert Network Advisory information for state and local health departments and health care providers

• CDC Information on Coronaviruses

• World Health Organization, Coronavirusexternal icon

• To access the CDC’s homepage for the novel coronavirus go here: CDC novel coronavirus

• To access the WHO’s homepage for the novel coronavirus go here: WHO novel coronavirus

Background  

 MESH Coalition recently hosted a Grand Rounds event in partnership with IU Health. The featured speaker, Shane Booker, discussed the Noblesville West Middle School shooting and the Carmel High School explosion. Today, Mr. Booker serves as the Executive Director of Emergency Management for Hamilton County. He provided various professionals with background and insight on the opportunities and obstacles Hamilton County faced in both the Noblesville West Middle School shooting and the Carmel High School explosion events.

Hamilton County’s current population is approximately 350,000 people. The county has six public school systems, as well as, several private schools. Additionally, there are eight law enforcement agencies, ten fire departments, a county health department, a healthcare coalition, and several hospitals. The county’s emergency management consists of four full-time employees, two part-time employees, and volunteer community emergency response teams. 

Pre-Incident Noblesville West Middle School:

Prior to the Noblesville West Middle School shooting there had been several preparedness trainings including the April active assailant training, safe school meetings, emergency operations center training, and Alert, Lockdown, Inform, Counter, and Evacuate (ALICE) training for school students. A number of the people involved in these trainings were school administrators and representatives of multiple agencies throughout the county, in addition to emergency personnel. Furthermore, resources such as the Stop the Bleed/Trauma Kits were purchased.

Incident Summary Noblesville West Middle School:

On May 25, 2018, at 9:06 a.m., emergency services were dispatched to shots fired at Noblesville West Middle School. Officials had the name of the suspect within 60 seconds and he was in custody within 3 minutes of the initial call to dispatch. A teacher and student were wounded during the event. Officials activated the Emergency Operations Center (EOC). American Red Cross and Salvation Army provided support through resources including water, ice, and tents. Additionally, there were over 140 law enforcement officers on the scene.

Opportunities for growth included the following:  Students were advised to use the golf course pro-shop as a rallying point in the case of an emergency, but the golf course management was unaware of this plan. Students were also given a script to follow in the event of an active shooter situation, but 911 operators were not provided with that information, either; operators were left confused by student call-ins stating the situation at hand and hanging up.

In the days following the event, investigations continued, an internal review was conducted, and an increase in awareness was promoted. A critical incident response checklist was created, along with a dedicated liaison appointed to every school. Increased communication was emphasized after the incident due to miscommunication with a nearby golf course and 911 operators. 

During this event, social media posed an issue for authorities and families as false information was being dispersed. Mr. Booker discussed how intentions were good but self-deployment became an issue as too many people and resources can disrupt operations. Since the event, checklist and standard operation plans were implemented as part of the planning process. Coordination was further implemented through building and maintaining relationships to better facilitate communications and networks in the event of an emergency. 

Pre-Incident Carmel High School:

Prior to the Carmel High School explosion there had been continued preparedness trainings as result of the Noblesville West Middle School shooting, safe school meetings, emergency operations center training, and school evacuation drills. School administrators and representatives of multiple agencies throughout the county, in addition to emergency personnel, continued to collaborate.

 Incident Summary Carmel High School:

On December 26, 2018, at Carmel High School, a pool heater exploded in the rafters while activities were being held in the school’s gymnasium. Multiple calls to 911 were made; however, the initial reports indicated more damage than previously thought. Two individuals were injured, and one suffered from severe burns. Students in the facility followed evacuation procedures and assisted those who were unfamiliar with the evacuation plan and routes.

 During this event, social media continued to pose an issue for authorities and families as false information was being dispersed. For example, reports that the explosion was a terrorist attack were being falsely shared. Mr. Booker emphasized planning, preparation, and coordination as three takeaways. As a result of the Noblesville West Middle School shooting, the critical incident response checklist and standard operation plans were implemented as part of the Carmel High School explosion. After both of these events, Mr. Booker highlighted how fundamentals, realism, and repetition are key factors in preparation.

 Additional Notes and Information:

·       Throughout the day of the shooting incident, there were nearly 1,000 calls to 911 emergency services. In the 9 o’clock hour, there were 203 calls to 911 emergency services, which is equivalent to six hours worth of calls.

·       Outside of the on-scene incident, there were 3 suicides and 18 traffic incidents on the day of the shooting. Lapel Police Department back-filled Noblesville’s Police Department daily runs.

·       A number of hospital staff, as well as, staff of local businesses who had children at the school, left work that day in response to the shooting incident leaving hospitals understaffed and businesses to close.

·       The Hamilton County call center has 14 call lines available, in a surge event, such as the Noblesville West Middle School shooting, the 15th caller and those following were redirected to Madison county call center.

The Indiana State Fire Marshal is happy to share with you the Indiana Fire and Public Safety Academy (Academy) 2019 Strategy. These strategic priorities are predicated on the mission of providing quality training and leadership resources to the Indiana public safety community. The Academy will provide students with the knowledge, skills and abilities to foster a safe and secure Indiana. In addition, the continued responsible allocation of the Regional Public Safety Fund as well as additional infrastructure funds will enhance the support of local responders as they protect and serve Hoosiers.

• Executive Leadership: The Academy is committed to delivering leadership training via a modular approach relevant to all public safety disciplines. Courses are taught by subject matter experts using a statewide network of training locations. The modules are designed to be delivered in succession and when convenient for full-time public safety employees.

• ACADIS: IDHS and the Academy are committed to the continual upgrading of the Acadis training software, phasing in new releases and expanding accessibility and communication pathways between instructors and students. Our first upgrade will go live next month (March). Future upgrades will continue during 2019 and 2020.

• Recruit Academy: The Academy will provide the state a central training location for fire recruits sometime in 2020. The planning process involves identifying existing funding streams to offer coursework for newly hired firefighters seeking certification in Fire Fighter I/II, Hazardous Materials Awareness and Hazardous Materials Operations. The first recruit class tentatively is planned for late third quarter of 2020.

• Indiana Get Alarmed Smoke Alarm Program: Indiana experienced a dramatic increase in the number of fire-related deaths in 2018 (93, up from 72 in 2017). Many of these deaths occurred in homes with no smoke alarms or inoperable smoke alarms. The State Fire Marshal’s office has been awarded an Assistance to Firefighter Grant for Fire Prevention and Safety to support the purchase and installation of 10,000 photoelectric smoke alarms and 1,000 deaf and hard-of-hearing smoke alarms during the next 18 months. Partners in this initiative include the American Red Cross, local fire departments, other state agencies and service organizations. Additionally, community risk assessments and fire prevention education programs are available.

Please take the time to review these initiatives and contact the State Fire Marshal’s office with any questions. By sharing these priorities with you, we invite your feedback and participation as we expand and enhance training resources for Indiana’s fire and public safety communities.

Best regards,

James Greeson
State Fire Marshal

For more information, contact the Fire and Public Safety Academy at training@dhs.in.gov.

Today, vaccines have become one of the most inexpensive and effective means of disease control and health promotion. The World Health Organization (WHO) estimates that up to 3 million deaths per year are prevented due to vaccinations, and this number could increase by 1.5 million with improved vaccination rates globally. Measles mortality across the world has decreased by 84%, and polio has been almost completely eradicated. Vaccines even contribute to defense against the growing epidemic of antimicrobial resistance by helping reduce the incidence of infections that need to be treated by antibiotics. Vaccines are an essential component of public health improvement efforts. Although great progress has been made with the development and administration of vaccines, a growing trend of vaccine hesitancy is putting further advancement at risk.

Vaccine hesitancy, as defined by the WHO, is the “delay in acceptance, or refusal of, vaccines despite availability of vaccination services.” This problem is multifaceted and depends greatly on context. There are many individual as well as systematic level influences that come into play with vaccine hesitancy, with three main drivers being complacency, convenience, and confidence. It is important to note that being unvaccinated because of barriers to knowledge and access does not fall under the category of hesitancy; this is a separate issue that needs its own targeted efforts. Since vaccine hesitancy is such a complex problem, there are no straightforward solutions. Strategies to reduce vaccine hesitancy should be tailored to specific groups and collaborative between disciplines. Individual dialogue between various health information providers and patients is one of the most important ways of reducing vaccine hesitancy.

Unfortunately, there are many myths about vaccines that are becoming increasingly prevalent. Vaccines are a safe and effective way of preventing disease and keeping people healthy. It is important to correct any misinformation that people may have. There is no scientific evidence supporting the ideas that vaccines cause autism, that they are unsafe, or that they are ineffective. Below is an infographic from the World Health Organization that provides the truth behind the science of vaccines.

https://www.who.int/features/factfiles/immunization/en/

https://www.who.int/immunization/programmes_systems/vaccine_hesitancy/en/

https://www.aaaai.org/conditions-and-treatments/library/allergy-library/vaccine-myth-fact

https://www.who.int/campaigns/immunization-week/2017/infographic-5-facts.jpg?ua=1

https://respectfulinsolence.com/2017/07/26/surprise-relatively-small-decreases-in-vaccine-uptake-can-lead-to-big-increases-in-vaccine-preventable-disease/ (Only used for header photo)

An Introduction to the NTSB and Hospital Engagement

Executive Summary

September 13th, 2018

The MESH Coalition recently hosted another successful Grand Rounds event in conjunction with Franciscan Health Indianapolis at their Professional Education facility. The featured speaker was Dr. Elias Kontanis, Chief of Transportation Disaster Assistance Division for The National Transportation Safety Board (NTSB). This Grand Rounds event provided various professionals with an insight and background into what the NTSB responsibilities are and how they interact with a diverse group of organizations and agencies. Dr. Kontanis discussed various topics such as:

·      An overview of NTSB governance, agency mission, and scope of investigative responsibilities

·      Interfacing with healthcare facilities regarding investigative matters

·      Interfacing with healthcare facilities regarding family assistance services

·      Challenges associated with the victim accounting process following mass casualty incidents and the role of healthcare facilities

Background

 There is a misperception that the NTSB is just in charge of determining the probable cause of transportation accidents and making safety recommendations to prevent reoccurrences. However, the mission of the NTSB reaches further to include conducting special studies and investigations, certification appeals for airmen and mariners, and coordinating resources to assist victims and their families after an accident. The NTSB is a relatively misunderstood Federal agency in regard to their responsibilities and duty to the public. Unbeknownst to many, the NTSB is an independent Federal agency that has only 420 full-time staff and no regulatory authority, meaning they have no authority to enforce laws or regulations. Additionally, they are compromised of five Board Members who report directly to Congress.  

Investigative Interface 

All U.S. civil aviation and commercial space Railways, Highways, Marine, Pipeline, and Hazmat accident investigations are conducted by the NTSB (accredited representative for foreign aviation accidents). For suspected criminal actions that affected any of the above possible accident scenarios, the Federal Bureau of Investigations takes the lead as investigator and the NTSB serves as a subject matter expert in support of their efforts. In non-criminal cases, the NTSB will have its staff conduct interviews with surviving passengers and crew, obtain medical records, secure and coordinate shipment of blood and urine samples for toxicological analysis, and gather remaining crew personal effects. An area where the NTSB runs into some hurdles is obtaining medical records of the crew and passengers, which often relates to the Health Insurance Portability and Accountability Act (HIPAA). However, in order to complete a thorough investigation passenger and crew medical records will be obtained by the NTSB with or without the consent of the individual because their agency acts as a Public Health Authority (PHA). Per the Department of Health and Human Services, the NTSB being a PHA authorizes a healthcare provider to disclose protected health information to a Public Health Authority without the patient’s written authorization or opportunity to agree or object for purposes of controlling disease, injury, or disability. The NTSB will provide letters to hospitals explaining their authority and request for information. In extreme cases, the NTSB will obtain subpoena records and lab draws, but ultimately would like to avoid that process.

Family Assistance Interface

 The NTSB recognizes three different Federal Family Assistance Legislations after a transportation accident, the Aviation Disaster Family Assistance Act of 1996, Foreign Air Carrier Family Support Act of 1997, and the Rail Passenger Disaster Family Assistance Act of 2008. The criteria for the NTSB involvement is that it occurred in the United States or its territories (Puerto Rico, Guam, Virgin Islands, etc.), a major loss of life, Department of Transportation Certificate of Public Convenience and Necessity or Economic Authority (Aviation), and Amtrak and future high-speed rail operators. The NTSB has separated family assistance into four primary concerns: notification of involvement, access to resources and information, victim accounting, and personal effects. These four categories entail further actions and duties interconnected to those primary concerns that the NTSB plays a pivotal role in completing the entire process. The victim accounting and patient tracking task is a process that can become confusing with various healthcare and responding agencies. However, if this process is done effectively, it can reduce the panic, and bring closure to family and friends. The NTSB does their best to work with local authorities since the locals are responsible for the Mass Casualty Incident (MCI) that happens within their jurisdiction. Ultimately, the NTSB uses patient tracking and information from several different sources to come together and provide the most accurate and up-to-date data.

Some major challenges that are faced with Victim Accounting are as follows:

·      Open population MCI’s

·      Unidentified victims

·      Proximity of family members to accident location

·      Rapid dispersion of victims

·      Social and traditional media

·      Lack of coordinated data collection processes

·      Errors in data

·      Misconceptions regarding sharing of data

Who and How Healthcare might be Engaged:

·      Hospital linkage with Emergency Management and the local response community/agencies

o   Integration with patient tracking for the jurisdiction

o   Awareness of broader family assistance response

·      Healthcare Coalitions (Multidisciplinary)

·      Hospital Systems

·      Hospital Associations

·      ESF 8- Public Health and Medical

Source:

Kontanis, E., PhD, D-ABMDI. (2018, September 13). An Introduction to the NTSB and Hospital Engagement. Lecture presented at MESH Coalition Grand Rounds in Francisan Health Indianapolis, Indianapolis.

What Happened In Vegas?

MESH Coalition Grand Rounds

Speaker: Todd Nicolson

Background

The MESH Coalition recently hosted another great Grand Rounds speaker event, graciously hosted by Sidney and Lois Eskenazi Hospital. However, this Grand Rounds was special because we had such interest, that our speaker, Todd Nicolson, did his presentation at three separate locations. After completing his presentation at Eskenazi Health, he traveled to American Senior Communities (ASC) facilities in Kokomo and Columbus to present to over a hundred of passionate ASC staff and other local community partners. With the infamy of this tragedy, and the desire to learn from it, we worked with ASC to assure that best practices and lessons learned were spread throughout the state to professionals from various organizations. An extra special thanks to Eskenazi Health, Community Howard, and Columbus Regional for hosting this event at their respective hospitals, as well as a thanks to Health and Hospital Corporation for sponsoring the events.

For this Grand Rounds, the MESH Coalition was lucky enough to have Todd Nicolson, a Senior Public Health Preparedness Planner for the Southern Nevada Health District. Todd plans, develops, and implements the Southern Nevada District’s Public Health preparedness plans. His position provides direct input and review of the planning and technical support staff to support the District’s public preparedness and response plans. He also works with the State of Nevada on plan revisions, work groups, and exercises to fully evaluate the functionality of plans that impact the State and Clark County. Todd was actively involved in assisting and responding to the October 2017, Las Vegas Concert Venue Active Shooter that ended 58 lives and injured hundreds more.

Las Vegas, Nevada, commonly known as a popular tourist destination, continued their status as such while hosting approximately 22,000 people (only 2,000 Vegas residents) at the Route 91 Music Festival. For an event that spanned 17.5 acres of open area, there were 50 personnel from the Las Vegas Metropolitan Police Department (LVMPD), 16 personnel for Community Ambulances, and 1 inspector from the Clark County Fire Prevention. Unfortunately, that night, the number of police, fire, emergency medical services, and public safety officials needed to be increased as an active assailant began to open fire on the innocent and blindsided crowd of patrons at approximately 10:05 p.m.

The active assailant was in a Mandalay Bay hotel room on the 32nd floor with dozens of high-powered weapons, countless rounds of ammunition, security cameras to watch the hallways, and barricades for the doors. From this vantage point, the assailant had an unfair advantage over responding officers and ultimately concertgoers to commit this heinous act.

Healthcare Surge and Patient Tracking

The shooting took place for approximately 10 minutes before the assailant took his own life. The true acts of heroism and courage were on full display in the immediate aftermath with first responders, hospital personnel, random strangers, and other supporting citizens doing whatever they could to assist in the situation. Taxi Cabs, Ubers, and other citizens’ random vehicles were used as temporary ambulances and transportation vehicles for the wounded victims.

One of the biggest challenges for a mass-shooting event is the surge that hospitals see in the following hours. From that night 619 citizens were discharged, and 58 succumbed to their injuries. With hundreds of casualties, the closest hospitals to the Route 91 Music Festival were utilized to the fullest extent as countless non-ambulatory transports were using Siri to guide them to the closest hospitals, regardless of services provided. This created resource and patient tracking issues as non-trauma healthcare providers were bombarded with gunshot victims and injuries from fleeing. Initially, there were 9 unidentified persons throughout the healthcare system and it ultimately took up to 72 hours to identify them. One non-trauma hospital discharged 103 patients throughout the night and ultimately 266 patients were seen in non-trauma healthcare settings. In comparison, 344 patients were seen at various trauma centers, with one trauma center receiving 212 patients.

The list below gives more insight into the patient tracking struggles:

·      Non-traditional evacuation (Non-EMS) 54% or approximately 334

·      EMS (Triage/Non-Triage Tags) 46% or approximately 285

·      Patients lacked Identification (ID, Cell Phone)

·      HIPAA challenges (understanding of HIPAA/Legal Exceptions)

·      Resistance due to inundation of requestors (LE, Media, Medical Surge Area Command (MSAC), FBI)

Incident Command

Active Shooter training and exercises proved to be essential in how the Southern Nevada region established Incident Command Structure and utilized it throughout the event. The Las Vegas area is unincorporated so it is owned by Clark County instead of the city, which played a factor in how Incident Command was established. Ultimately, the Clark County Office of Emergency Management took the lead and activated the Multi-Agency Coordination Center (MACC), as well as the Medical Surge Area Command (MSAC).

MSAC Objectives:

·      Coordinates communication and decision-making related to medical issues

·      Develops Incident Support Plan to complement Incident Action Plans

·      Receives, consolidates, and recommends distribution of resources requested from hospitals, to state, and allocation to Healthcare Organizations

·      Monitor bed availability, assist in identifying patient destination for level loading in the healthcare systems, and receive updates on hospital statuses

·      Establish effective communications; assist in medical evacuations; demobilize

Healthcare Response Entities:

·      University Medical Center (UMC)

·      Member of Healthcare Facilities/Healthcare System

·      Southern Nevada Health District (SNHD)

·      Nevada Hospital Association

·      Veterans Affairs Southern Nevada Healthcare System

Additional First Responder Entities:

·      Clark County Office of Emergency Management

                 o   MACC

                 o   MSAC

·      Clark County Office of the Coroner/Medical Examiner

·      AMR/MedicWest/Community Ambulance

·      Clark County Fire Department

·      Special Weapons and Tactics (SWAT)

·      Las Vegas Metropolitan Police

As is common in most emergency incidents, things did not go according to the set plans and the Incident Command was forced to improvise. The MSAC ended up being managed by the SNHD instead of UMC. Furthermore, the SNHD was present in the MACC and MSAC, as well as having the Nevada Hospital Association available via phone.

Additional Notes and Information: 

·      Nearby airport shutdown for 45 minutes because of fleeing concertgoers running onto tarmac and the active assailant attempted to blow up fuel tankers at the airport

·      Only 2 full-time Emergency Managers in VA and UMC, the rest are part-time/dual hat positions

·      Had to establish temporary morgue for high amount of deceased and the large wave of concerned families and friends that came rushing to hospitals and healthcare provider locations

·      6 operational periods of 12 hours (shifts)

·      Joint Information Center was established

·      Coroner was responsible for Family Assistance Center

·      Las Vegas Hotels now doing 24 hour wellness check regardless of do not disturb signs

·      Mandalay Bay is a Closed Point of Dispensing location

Source:

Nicolson, T. (2018, June 21). 01 OCT 2017 Mass Shooting Incident Las Vegas. Lecture presented at MESH Coalition Grand Rounds in Sidney and Lois Eskenazi Hospital, Indianapolis.

Virginia A. Caine, M.D., to propose safe syringe exchange to City-County Council

 INDIANAPOLIS – With a backdrop of supportive leaders representing civic, religious, health care and public safety organizations, Marion County Public Health Department director Virginia A. Caine, M.D., today proposed the county’s first-ever syringe exchange program to combat the alarming increase in hepatitis C cases and to prevent a potential surge in HIV cases.

Caine began the day with a briefing session to public health organizations in Marion County, including those that work on the many issues impacting individuals suffering from drug addiction. She provided detailed statistics, which show a 1,000 percent increase in the number of hepatitis C cases from 2013 to 2017, a majority of which have been attributed to injection drug use.

Given the level of increase – and seeking to prevent an HIV outbreak similar to what Scott County, Indiana experienced in 2015 – Caine declared a public health epidemic for Marion County, the first step required by Indiana law for a county to implement a syringe exchange program. Once an epidemic is declared, the second requirement is approval by the City-County Council.

“After careful study and analysis, I am declaring an epidemic that is putting Indianapolis in a public health emergency for hepatitis C in Marion County,” Caine said. “The proposed syringe exchange program is medically necessary and will save lives by reducing the transmission of hepatitis C and HIV. Both are growing national problems brought on by the widespread increase in opioid addiction.”

City-County Council President Vop Osili joined the announcement and expressed his support for the syringe exchange program. He indicated the program would be introduced for consideration at the council’s next meeting on May 21.

“I strongly support moving forward with a syringe exchange program as it will improve public health in Indianapolis and Marion County while also saving taxpayers money by greatly reducing the burdensome health care costs related to injection drug use and infectious disease,” said Osili.

Osili stressed that the program will require no additional public investment, with conservative estimates showing a potential annual savings for taxpayers and health care providers of $193 million in HIV treatment costs alone.

Caine highlighted several data points signifying the troubling surge in both hepatitis C and HIV in Marion County:

·         The rate of reported acute hepatitis C infection in Marion County rose from 0.6 to 7.6 per 100,000 population between 2013 and 2017.

·         That rate is likely understated. The Centers for Disease Control and Prevention (CDC) estimates that true number of acute hepatitis C cases are nearly 14 times what is reported, which translates to approximately 1,000 new cases in Marion County in 2017 alone.

·         In at least 86 percent of the new cases in 2017, patients reported injecting drugs within the last six months, and at least 58 percent reported sharing drugs and paraphernalia.

·         The CDC estimates a prevalence between 9,200 and 11,400 cases of chronic hepatitis C for a population of Marion County’s size; however, more than 21,000 county residents with chronic hepatitis C have been reported since 1990.

·         HIV cases have also spiked. Newly reported HIV cases were decreasing steadily from 2011 to 2015 but in 2017, the rate per 100,000 was 25.3, up from 20.0 in 2015.

Caine said the proposed program would ensure injection drug users have access to clean needles to prevent infections, keep used needles off the streets and connect individuals with needed health services.

Initially, the program would operate as a mobile unit. Sites would be based on overdose deaths by location, residences of decedents, Indianapolis EMS use of Narcan, and recommendations by the Indianapolis Metropolitan Police Department.

Support services vital to the program would include:

·         HIV and hepatitis C rapid screening

·         Safer drug use practices

·         Referral for substance use disorder and mental health treatment

·         Wound care education

·         Immunizations

·         Referral to primary care

·         Access to health insurance coverage

Studies show that participants in a syringe exchange program are five times more likely to enter drug treatment than injection drug users who do not participate in the program.

Caine also highlighted national statistics and the successes of other counties in Indiana that have implemented a similar program. She cited CDC findings that syringe exchange programs:

·         Curtail drug use

·         Reduce needlestick injuries among first responders

·         Decrease overdose deaths

For more information, visit marionhealth.org/SafeSyringe.

What are Marion County health care and health education leaders saying about this health emergency and safe syringe program?

Krista Brucker, M.D., Medical Director of Project POINT and an Emergency Medicine Physician at Eskenazi Health

“At first glance, a syringe service (needle exchange) program might seem counter intuitive, but I'm an ER doctor on the front lines of this epidemic and I can tell you that we need all the tools we can muster to help stem the tide of needless death and disease. Syringe service programs have decades of evidence showing that people who use them, use less drugs, use more safely, are more likely to get into medical care and less likely to transmit diseases like HIV and hepatitis C. Beyond the evidence, I can assure you that when our patients are in the depths of active addiction beyond where they can hear or feel the love and support of family, friends or others who are trying to help, a syringe service program may be the only way to reach them. It is the only place that feels safe and non-judgmental, where they can begin to build the trusting relationships that might help them take those first painful steps into recovery.” – Krista Brucker, M.D., Medical Director of Project POINT and an Emergency Medicine Physician at Eskenazi Health

Naga Chalasani, MD, David W. Crabb Professor and Associate Dean for Clinical Research, Director, Division of Gastroenterology and Hepatology, Indiana University School of Medicine

“As a physician and researcher who specializes in liver diseases, I support the establishment of a needle exchange program in Marion County. Once acquired, both hepatitis C and HIV can become lifelong diseases with major consequences not just for suffering individuals and their families, but for tax payers as well. Needle exchange programs have repeatedly been shown to be effective in reducing the rates of hepatitis C and HIV infections.” – Naga Chalasani, MD, David W. Crabb Professor and Associate Dean for Clinical Research, Director, Division of Gastroenterology and Hepatology, Indiana University School of Medicine

Joan Duwve, MD, MPH, Associate Professor, Associate Dean of Public Health Practice, IU Richard M Fairbanks School of Public Health at IUPUI

“The IU Richard M. Fairbanks School of Public Health at IUPUI is committed to improving the health of all Hoosiers through evidence-based practices. We continue to work with community partners statewide to prevent opioid misuse and respond to the epidemic of opioid overdose and death. Syringe services programs have been proven to reduce the spread of hepatitis C

and HIV in communities, and do not increase drug use. They also reduce overdoses and death by offering their clients naloxone and referral to addiction treatment programs. We support the Marion county decision to open a syringe services program to promote the health of its residents by addressing the worsening epidemics of hepatitis C and drug overdose death in the community." — Joan Duwve, MD, MPH, Associate Professor, Associate Dean of Public Health Practice, IU Richard M Fairbanks School of Public Health at IUPUI

Richard K. Freeman, MD, MBA, Chief Medical Officer, St. Vincent Indiana

“St. Vincent Indiana is committed to delivering compassionate, personalized care to all, with special attention to those who are most vulnerable. We recognize the public health challenge before us and the opportunity through outreach to encourage individuals suffering from the illness of addiction to enter treatment.” – Richard K. Freeman, MD, MBA, Chief Medical Officer, St. Vincent Indiana

Karen Hardin DNP, RN, NE-BC, CNE, Director Workforce Development, Coordinator of Faith Community Nursing Program, Assistant Professor, Marian University

“As a nurse, you are called to this profession because of a desire to do something important. You want to make a difference in the lives of others. You want a career that taps into all that you are. Our country and county are facing a health crisis. We want to do something important to make a difference and to tap into all in what we are. We are proud to stand with Marion County Public Health Department.” – Karen Hardin DNP, RN, NE-BC, CNE, Director Workforce Development, Coordinator of Faith Community Nursing Program, Assistant Professor, Marian University

Lisa E. Harris, M.D., CEO, Eskenazi Health

“At Eskenazi Health, we follow a patient-focused model of care that encourages participation with an emphasis on prevention. Implementing Safe Syringe is a medically necessary step that has been proven to immediately reduce the transmission of hepatitis C and HIV. It will also greatly increase the likelihood of individuals entering treatment programs for opioid addiction. This program will save money and more importantly will save lives.” – Lisa E. Harris, M.D., CEO, Eskenazi Health

Leslie A. Hulvershorn, MD, Assistant Professor of Psychiatry, Indiana University School of Medicine

“I applaud the decision to establish a needle exchange in Marion County. In addition to reducing the spread of hepatitis and HIV, needle exchange programs also connect individuals with substance use disorders to important treatment resources that can help them work toward recovery from injection drug use. We know that people who engage with treatment providers are many times more likely to recover from substance use disorders.” – Leslie A. Hulvershorn, MD, Assistant Professor of Psychiatry, Indiana University School of Medicine

Kathleen Lee, Ed.D., Chancellor, Ivy Tech Community College Indianapolis

“As the State of Indiana’s Community College system we believe it is necessary to support our local communities in a variety of ways. One such way is to promote the public health of those communities. Ivy Tech supports Dr. Caine and her staff as they implement a needle exchange program to combat the transmission of Hepatitis C. This program, although not a treatment for drug use or Hepatitis C has been proven to reduce the prevalence of new infections and increases testing and education. We stand ready to assist Dr. Caine in educational efforts related to a needle exchange program.” – Kathleen Lee, Ed.D., Chancellor, Ivy Tech Community College Indianapolis

Ryan D. Nagy, MD, President, Adult Academic Health Center, Indiana University Health

“From a medical perspective, we know that syringe exchange programs are proven to save lives and reduce the spread of disease. They also can serve as a first step toward helping people with substance abuse disease. The Safe Syringe program is a medically necessary effort to address this growing crisis in our county." – Ryan D. Nagy, MD, President, Adult Academic Health Center, Indiana University Health

Luke Nelligan, D.O., Interim Associate Dean for Clinical Affairs, Marian University

“The whole person approach to healing is what osteopathy is all about, so the 2013 opening of an osteopathic medical school was the obvious path for a Franciscan institution already dedicated to the education and nurturing of mind, body, and spirit. It is our whole person approach, which brings us to support efforts to reduce this health emergency and to support efforts which will reduce the spread of Hepatitis C and bring more people into treatment and recovery.” – Luke Nelligan, D.O., Interim Associate Dean for Clinical Affairs, Marian University

Robin P. Newhouse, PhD, RN, NEA-BC, FAAN Dean and Distinguished Professor, IU School of Nursing

“The IU School of Nursing has been empowering leaders for more than 100 years. Many of our faculty conduct research to study a wide variety of healthcare issues, including quality of life in chronic illness such as Hepatitis C. We are proud to stand with Dr. Caine and Marion County Public Health Department as they take the medically necessary steps to address this health emergency and reduce the number of individuals at risk of Hepatitis C infection and bring more people into recovery.” – Robin P. Newhouse, PhD, RN, NEA-BC, FAAN Dean and Distinguished Professor, IU School of Nursing

Charles M. Miramonti, M.D., Chief of Indianapolis Emergency Medical Services (IEMS), Chief of Care Integration and an Emergency Medicine Physician at Eskenazi Health, Associate Professor of Clinical Emergency Medicine at the Indiana University School of Medicine

“Many people in the community don’t realize how often overdoses actually occur. On average, IEMS dispatches 15 overdose runs every day at hotels, gas stations even in parked cars. A syringe exchange program is what our community needs right now to combat and reduce the

impending hepatitis crisis. This program will make our first responders and community safer.” – Charles M. Miramonti, M.D., Chief of Indianapolis Emergency Medical Services (IEMS), Chief of Care Integration and an Emergency Medicine Physician at Eskenazi Health, Associate Professor of Clinical Emergency Medicine at the Indiana University School of Medicine

Dr. Robin Ledyard, Community Health Network Chief Medical Officer

“We know people who enter syringe exchange programs are more likely to get into treatment. Addiction is a disease, and if we can help at any entry point to get someone treatment, then we are on the right path.” – Dr. Robin Ledyard, Community Health Network Chief Medical Officer

Mary Ian McAteer, MD, President, Indianapolis Medical Society

“The future of our country depends on the health and wellbeing of our children. It is imperative that we physicians advocate for strong policies that enable physicians, patients, families and communities to work together to create the healthiest environments for our children. As physicians, we stand shoulder to shoulder with Dr. Caine as she implements a medically necessary and evidence-based program to address this medical emergency and encourage more people to take a path of recovery, restoring families and providing a safer and healthier community for our children and all citizens.” – Mary Ian McAteer, MD, President, Indianapolis Medical Society

Bree A. Weaver, MD, Assistant Professor of Clinical Medicine and Clinical Pediatrics, Indiana University School of Medicine

“As we have seen before in Indiana, an increase in cases of hepatitis C can also be a precursor to a rise in HIV infections. As an infectious disease specialist, addressing HIV and hepatitis C and preventing new infections are my highest priorities, and a syringe exchange is a major step toward this objective.” – Bree A. Weaver, MD, Assistant Professor of Clinical Medicine and Clinical Pediatrics, Indiana University School of Medicine

Emily Zarse, M.D., Chief of Addiction Services for Eskenazi Health Midtown Community Mental Health

“Opioid addiction is increasing in our nation and community. It is an illness that affects people of all ages and from all walks of life. Individuals participating in Safe Syringe will be dramatically less likely to contract or spread Hepatitis C or HIV and five times more likely to seek treatment for their illness of addiction.” – Emily Zarse, M.D., Chief of Addiction Services for Esk

Antibiotic resistance is one of the biggest threats to food security, development, and global health today. Due to the ineffectiveness of antibiotics, it is becoming increasingly harder to treat infections. According to the World Health Organization, antibiotic resistance is impacting healthcare worldwide as there are now high levels of resistance prevailing in both high- and low-income countries. Antibiotic resistance occurs when the bacteria in our body changes in response to a medication, making the medicine less effective. The resistance process can be accelerated by the misuse and or overuse of certain antibiotics. Humans and animals can be infected and impacted by antibiotic-resistant bacteria, which can then lead to higher medical costs, prolonged hospital stays, and increased mortality. According to Pharmaceutical Microbiology, by the year 2050 antibiotic resistance will lead to more deaths than cancer and diabetes combined.

The World Health Organization’s Global Antimicrobial Surveillance System (GLASS) has shown that antibiotic resistance has impacted 22 countries and more than 500,000 people. With the connectivity of today's world, the transmission of pathogens is increasingly easier to pass to one another, especially when traveling. The most commonly reported antibiotic-resistant bacteria have been Escherichia coli, Klebsiella pneumoniae and Salmonella spp. Furthermore, Penicillin and ciprofloxacin are among some of the most commonly used antibiotics that are now susceptible to antibiotic resistance.

A few major infectious diseases like pneumonia, tuberculosis, gonorrhea, and salmonellosis are diseases being influenced by resistant bacteria. Some ways to reduce the transmission and spread of antibiotic resistance is through individual safety measures like tracking and reducing the amount of antibiotic prescriptions. In addition, preventing infections on an individual basis can consist of being vaccinated, safe food preparation, hand washing and using antibiotics as directed by your physician. The World Health Organization is working towards improving surveillance of antibiotic resistance with GLASS in order to develop strategies to prevent the spreading of both infectious diseases and antibiotic resistant bacteria. These organizations have begun the tracking process and it is starting to make a difference in several impacted countries that have adopted this methodology.

Sources

1. http://www.who.int/mediacentre/news/releases/2018/antibiotic-resistance-found/en/
2. http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/
3. https://www.cdc.gov/drugresistance/pdf/4-2013-508.pdf
4. http://www.who.int/campaigns/world-antibiotic-awareness-week/2017/infographics/en/
5. http://www.pharmamicroresources.com/2017/12/efforts-to-combat-antibiotic-resistant.html

The MESH Coalition recently hosted a Grand Rounds event in partnership with Eskenazi Health where presenter Dr. John Urbanetti discussed Sarin and other chemical substances and how prepared we are to effectively respond to their release as a weapon. Dr. Urbanetti is National and International expert on medical implications of and response to nerve agents, chemicals, and other weapons of mass destruction. Additionally, Dr. Urbanetti is a Consultant to the U.S. Army Medical Research Institute for Chemical Defense, as well as being a part of the faculty at Yale University Medicine and Pulmonary Diseases. This presentation was a great insight into Sarin and chemical substances that are affecting communities across the world.

Sarin - Intentional Release as a Weapon

Executive Summary

(12/8/17)

Timeline of modern chemical weapons use:

·  1915 - First major gas attack was used by Germany in WWI when they released chlorine gas, they were also the first to develop nerve agents

·  1925 - Geneva Protocol signed for the prohibition of gas and biological attacks

·  1900s - Mustard gas became a popular substance used in warfare

·  1980s - Sadam Hussein infamously used deadly chemicals and nerve agents as a weapon in the Iraq-Iran war, with an estimated 45,000 deaths by nerve agents

·  1993 - Sarin was banned and classified as a Schedule-1 Chemical by the Chemical Weapons Convention

·  1995 - Aum Shinrikyo, a Japanese doomsday cult, releases Sarin in Tokyo subway - killing 12 and over 5,500 developed symptoms and sought treatment at 278 healthcare facilities; most arrived at hospitals not by ambulance.

·  2013 - Sarin attack in Syria kills numerous innocent civilians and injures up to 1,000 more

·  2017 - Sarin attack in Syria kills 89 and injures 300. President Trump orders airstrike on Shayrat Air Base, the presumed source of the attack

Sarin Properties:

·  Clear, colorless liquid (NOT NERVE “GAS”)

·  Freeze / melt ~ - 56 º C

·  Boil~ 147º C

·  Tasteless with faint (fruity) to NO ODOR

·  Volatility ~ Water

·  Exposure most commonly respiratory

·  Liquid & vapor both easily penetrate skin / clothing

 Sarin Symptoms:

·  VAPOR EFFECTS: Occur within seconds, peak within minutes, no delayed onset

·  MILD exposure: MIOSIS (dim vision, eye pain) rhinorrhea, dyspnea

·  MODERATE exposure: Pronounced dyspnea, secretions, nausea, vomiting, diarrhea, weakness

·  SEVERE exposure: Immediate LOC, seizures, apnea, flaccid paralysis

Detailed Summary

Chemical warfare and terrorist tactics are starting to coincide with the use of substances that can bring great health risk to those exposed and the community health providers and responders that come in contact with them. Many nerve agents have been used throughout history, but Sarin has become a prevalent nerve agent because of the destructive affects it has against its victims. With the progressive advancements of technology, drone usage has become a weapon that can be used without the deployment of people. In terms of chemical warfare, Dr. Urbanetti believes that the number 1 nemesis for chemical delivery is the drone. Additionally, with Sarin being relatively easy to make compared to other complex chemical agents, it is of great concern to the public because of its past history of harm and the types of groups that are starting to test their ability to make and use it.

The Tokyo subway attack is a prime example of how Sarin could cause a massive medical surge; 278 healthcare facilities were involved in treating patients. There were more than 5,500 people that developed symptoms; most of which presented by other modes of transportation and not by ambulance. It is imperative that healthcare and public safety organizations prepare for cases like these by working together using a community approach, with the goal of reducing the pressure and chaos brought on by the event and the subsequent medical surge on healthcare facilities.

Treatment of Nerve Agent Exposure

The first and foremost important step to treating someone who has been contaminated is to start the decontamination process. This is an extensive and detailed process that must be done carefully in order to not further contaminate other responding individuals. First, it is imperative that anyone treating a contaminated person should wear appropriate personal protective equipment to avoid exposure. This is normally done by removing contaminated clothing, thoroughly washing body and hair with soap and water, and flushing eyes with large amounts of water or saline solution. Contaminated clothing should be double-bagged after removal to prevent further exposure. contaminated clothing, thoroughly washing body and hair with soap and water, and flushing eyes with large amounts of water or saline solution. Additionally, the responder should maintain adequate circulation. If trauma is suspected, maintain cervical immobilization manually and apply a decontaminable cervical collar and a backboard when feasible. Furthermore, they should apply direct pressure to stop arterial bleeding, if present. Nerve agents can be treated using Atropine, +2-PAM, and Diazepam, as pictured below.

The pictures above are autoinjector treatments for nerve agents, such as sarin.

Resources

Centers For Disease Control and Prevention. (2014, October 21). Toxic Substances Portal - Nerve Agents (GA, GB, GD, VX). Retrieved December 08, 2017, from https://www.atsdr.cdc.gov/MMG/MMG.asp?id=523&tid=93

Kimball, D., & Davenport, K. (n.d.). Fact Sheets & Briefs. Retrieved December 08, 2017, from https://www.armscontrol.org/factsheets/Timeline-of-Syrian-Chemical-Weapons-Activity

New York State Department of Health. (n.d.). Facts About Nerve Agents. Retrieved December 08, 2017, from https://www.health.ny.gov/environmental/emergency/chemical_terrorism/nerve_agents_tech.htm

Ontario Medic. (n.d.). A Look at Sarin. Retrieved December 8, 2017, from http://ontariomedic.ca/2017/04/14/a-look-at-sarin/

Urbanetti, Dr. John. “Sarin in Syria.”, MESH Coalition Grand Rounds, 5 December 2017, Eskenazi Health Center-Pecar, Indianapolis, IN. 6940 N Michigan Rd, 46268.

We are excited to share a letter of support for the 2017 National Healthcare Coalition Preparedness Conference from senior program officials at the
Office of the Assistant Secretary for Preparedness and Response.

We are thrilled to announce that Jake Wood, Co-Founder and President of Team Rubicon, will be speaking at #NHCPC17 in San Diego on November 30, 2017. 

Jake Wood is cofounder and CEO of Team Rubicon, the only nonprofit disaster response organization that utilizes the skills of military veterans to rapidly deploy emergency response teams. In giving veterans an opportunity to continue their service, Team Rubicon provides them with a sense of purpose, community and identity. 

 Since the organization's founding in 2010 following the massive Haiti earthquake, Team Rubicon has responded to over 100 disasters and grown from eight to 35,000 volunteer members. Under Wood's leadership, the organization has responded following the tornado in Joplin, Missouri, Hurricane Sandy, the tornado in Moore, Oklahoma, Typhoon Haiyan in the Philippines, the 2014 wildfire in Pateros, Washington, and the 2015 earthquakes in Nepal.

As a Sergeant in the United States Marine Corps, Wood deployed to Iraq and Afghanistan as a Scout Sniper and earned the Navy-Marine Commendation Medal. A leading veterans' advocate, Wood has briefed President Obama on veterans' issues, met with former Presidents Bush and Clinton on veteran transition and disaster response and testified before a Senate committee to improve mental health care services for returning veterans. He has also appeared in the major media, including MSNBC, CNN, NBC, ABC, Al Jazeera, US News & World Report, Forbes, Fox News and penned an op-ed for The New York Times. 

In 2014, Crown Publishing published Wood's book, Take Command: Lessons in Leadership. Jake will be signing copies of his book after his speech at #NHCPC17.

Don't miss Jake at #NHCPC17! 
Register today and stay tuned for more exciting content announcements.

2017 hurricane season was the worst in recent memory, as storm after storm bore down on the United States and her territories. Irma, Harvey, and Maria were ruthless in their destruction, leaving record-breaking floods, power outages, and storm surges in their wake.

#NHCPC17 experts and attendees were (and still are) on the front lines of hurricane recovery and relief efforts. During our afternoon general session on November 29, we'll hear from just a few of those emergency responders and healthcare coalition leaders. They'll share processes that worked, as well as lessons learned. 

The hurricanes we witnessed in 2017 will change the way we prepare and respond to future storms; join us to find out how.

While responding to disasters this year, many hospitals are also confronting supply chain disruption. How are coalitions and healthcare organizations facing this challenge and continuing to operate at their full potential? 

Join Dr. Amy Kircher on November 29th at #NHCPC17 as she addresses these issues and more.

Dr. Kircher is the Director of the Food Protection and Defense Institute (FPDI), a Department of Homeland Security Center of Excellence and an Assistant Professor in the College of Veterinary Medicine at the University of Minnesota. She leads a talented staff and coordinates a research consortium of experts dedicated to protecting the food system through research and education. Her current research includes identification and warning of food disruptions through data fusion and analysis. 

Prior to coming to the University of Minnesota, Dr. Kircher held epidemiologist positions at NORAD - US Northern Command and with the United States Air Force where she worked on health informatics, biosurveillance, and data analytics. She has an extensive background in Homeland Security and Defense, supporting preparedness and response for real-world and exercise events to include Hurricane Katrina and H1N1. Dr. Kircher completed her Doctorate in Public Health at the University of North Carolina - Chapel Hill.

Don't miss Dr. Kircher at #NHCPC17!

You asked for more small group sessions, networking, and hands-on learning. We listened! 

Join one of these intimate, peer-facilitated discussions on November 28 and get answers to the questions you really want to ask. Special Interest Groups are free to attend. 

Make sure to sign up for an afternoon Pre-Conference Workshop on 11/28 to get the most out of your #NHCPC17 experience. If you've already registered for the conference, it's easy to add an additional session!

We are excited to announce that the newly appointed ASPR, Dr. Robert Kadlec, will address NHCPC attendees in San Diego on November 29, 2017.

Dr. Kadlec spent more than 20 years as a career officer and physician in the United States Air Force before retiring as a Colonel.  Over the course of his career, he has held senior positions in the White House, the U.S. Senate, and the Department of Defense. Most recently, he served as the Deputy Staff Director to the Senate Select Committee on Intelligence.

Join Dr. Robert Kadlec and other top leadership in emergency preparedness at this year's conference.

Not registered for #NHCPC17 yet? 

Hepatitis A virus (HAV) is a highly contagious viral illness that can lead to serious morbidity and occasional mortality. As shown by the most recent outbreak in California, HAV is proving to present a renewed public health challenge. To aid in the fight against HAV, a new tool has been developed by researchers from the University of California and from San Diego County EMS to help emergency physicians become more familiar with the identification and management of patients with Hepatitis A virus. 

Check out the recently published tool and the corresponding paper below.

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