THE ESSENTIALS OF EMERGENCY PREPAREDNESS: A PRIMER FOR HEALTHCARE PROVIDERS

By Thomas Calhoun MD MS FACN FACS

The book is intended to be a reference source, for any healthcare provider, in the broad area of Emergency Preparedness.
Because the world is so “closely connected” now, transportation and inter-net wise, perhaps this Book can be a tool to help us become better prepared as healthcare providers for these events…but what can we do to help us truly believe and live by “The Golden Rule…the principle of treating others as one wants to be treated”?

• Language: English
• Publisher: AuthorHouse
• Release date: May 29, 2024
• ISBN: 9798823017848

Thomas Calhoun MD MS FACN FACS

Dr. Calhoun was born on October 6, 1932, in Marianna, Florida. He attended Elementary and High School at St. Pius Catholic School in Jacksonville, Florida, graduating in June, 1949, from Stanton High School also in Jacksonville. In September 1950, he enrolled in Florida A & M College, and after a name change of the College, graduated from Florida A & M University, Tallahassee, Florida in 1954 with a Bachelor of Science Degree in Pre-Med. He served as an Officer in the US Army Artillery for 2 years, with specialized training in Chemical and Biological warfare and was honorably discharged as a First Lieutenant. He entered Meharry Medical College in Nashville, Tennessee in 1959 and graduated with a MD Degree in 1963, then Interned at Homer G. Phillips Hospital (now closed) in St. Louis Missouri for one year, then began a General Surgery Residency at Howard University in Washington, DC, 1964 through 1968. He is certified by the American Board of Surgery, a Fellow or the American College of Surgery, and a Fellow and Emeritus member of the American College of Nutrition. He holds the position of Emeritus, Clinical Associate Professor of Surgery, at Howard University Medical School in Washington DC. He has published over 20 articles, and has a Chapter in a major Japanese Textbook on Clinical Pathways. In February 2003, he began working as Medical Director in Emergency Preparedness for the District of Columbia (DC) Department of Health (DOH), and in October 2004 with the Addiction Prevention and Recovery Administration (APRA). He was a Principal Author of the Districts All Hazards Infection/SARS Disease Plan, a primary contributor to the Districts Pre- and Post Small Pox Prevention Plan, and a principal contributor to the Districts All Hazards Mental Health/ Substance Abuse Plan. In May 2007, he received a Masters of Science Degree from Georgetown in Biohazardous Threat Agents and Emerging Infectious Diseases, as a Scholar Studiorum Superiorum ! He was the Physician Chair of the Nutritional Support Committee of Providence Hospital, Physician Advisor for Case Management, working extensively with the Intellectually Disabled. Doctor Calhoun has been married to Shirley Kathryn Jones from Charleston, West Virginia for 55 years. They have 3 adult children, Thomas Jr., Christine and Kathryne, and five grandchildren, Their youngest daughter Maria, was killed on August 19, 2003 by a hit and run truck driver.

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© 2023 Thomas Calhoun MD, MS, FACN, FACS. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse  05/29/2024

ISBN: 979-8-8230-1785-5 (sc)

ISBN: 979-8-8230-1784-8 (e)

Library of Congress Control Number: 2023922064

Any people depicted in stock imagery provided by Getty Images are models,

and such images are being used for illustrative purposes only.

Certain stock imagery © Getty Images.

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Dedicated to my wife Shirley, who is her quiet, subtle way would often say/ask, It`s nice that you have finished your other Books, but what about the one on Emergency Preparedness, I think that`s the one people need?

The views expressed in this book are solely the work of the author, with the material noted in the quotes (…), all having been meticulously searched for and reviewed for accuracy.

With the constant changing of the Internet, any links and web addresses listed here-in, may well have changed, or no longer exist, since this book was started in 2008.

I would like to thank my brother, William. M Thompson, PhD, Clinical Psychology, and his wife Mary, for their assistance in writing Chapter 12, and my sister-in-law, Margaret Jones Woody for designing the cover for the book.

"We have grasped the mystery of the atom and

rejected the Sermon on the Mount".

Omar Bradley

CONTENTS

Foreword

Preface

Chapter 1

Incident Management System (Ims)

Hospital Emergency Incident Command System (HEICS)

Chapter 2

Personal Protective Equipment (PPE)

Chapter 3

Healthcare Risk Communications

Chapter 4

Biological Agents

Category A Diseases:

Anthrax

Botulism

Covid-19

Dengue

Glanders

Hanta Virus

Influenza

Respiratory Syncycial Virus (RSV)

Legionnaires` Disease

Leprosy

Lyme Disease

Plague

Rocky Mountain Spotted Fever (RMSF)

Small Pox

Tuberculosis

Viral Hemorrhagic Fevers (VHF)

Ebola

Marburg Virus

Tularemia

West Nile Virus (WNV)

Zika (CDC)

Category B Diseases:

Cholera

Q-Fever

Ricin

Food Borne Disease

Fungal Diseases

Coccidioidomycosis (Valley Fever)

Malaria (M)

Mad Cow Disease

Chapter 5

Chemical Agents

Nerve Agents

Thallium

Novichok

Lead

Mercury (Hg)

Chapter 6 A

Bio-containment Laboratories

Chapter 6 B

The Bio-watch Program

Chapter 7

Radiological And Nuclear Agents

Chapter 8

Explosives, IEDs, Booby Traps, Suicide Bombers

Chapter 9

Foreign And Domestic Threats

Agroterrorism

Cyberterrorism (CT)

Demonic Terrorism

Chapter 10

Special Populations

Dentistry

Nursing Homes

Intellectual Disabilities

Jails, Prisons

Colleges, Universities, Schools

Telehealth

Veterinary Medicine

Chapter 11

Current State of Preparedness

Basic Life Support (BLS)

Strategic National Stockpile (SNS).

Evacuation

Numbering Resources

Quarantine/Isolation

Start

Vaccines

Clinical Trials

Chapter 12

Emotional and Psychological Effects of Disasters

Afterword

FOREWORD

It was a busy Thursday afternoon, around rush hour, and numerous healthcare providers offices were filled with patients.

Suddenly, TV`s in the waiting rooms interrupt their usual programs with breaking news; The Mayor has just indicated that a Dirty Bomb has exploded in the middle of down town, and he has issued an order that all facilities and residents must Shelter in place"!

There is a stir in the waiting rooms and in a trice, as if with one voice, there is a question from the waiting room, Are we going to die?

So what is the healthcare providers’ response?

Given the current state of world affairs, healthcare providers should be prepared, or are preparing for how to respond to any All-Hazardous Emergency if/when called upon.

This Book is a handy reference to help those providers respond in a calm, professional manner, whether in the private office setting, or to the local Department of Health, which may reach out for assistance.

Accompanying this Book also, are 101 questions and answers, which the Academic community can use in conjunction with their Mission in training competent professionals to confront these issues.

PREFACE

On Wednesday October 17, 2001, about 3:30 pm, I received a phone call from the Chief Operating Officer of the Delmarva Foundation for Medical Care, the Professional Review Organization (PRO), for the State of Maryland and the District of Columbia (DC). At the time I was the Medical Director for the DC PRO.

The charge, find out what information Physicians in the District of Columbia needed about Anthrax.

It was on October 9, 2001 that a letter containing Anthrax spores had been mailed to the office of a United States Senator and eventually opened by the Senator’s staff 6 days later. By October 30, 2001, 5 individuals who worked at the Brentwood United States (US) Postal facility would be hospitalized at local hospitals, 2 of whom would die, one within 5 days of the onset of symptoms, one within 7 days. ¹a

This mandate was going out nation-wide from the Healthcare Finance Administration (HCFA) to all 50 PROs`, representing all 50 States and the District of Columbia, and responses were expected by close of business on Friday, October 17, 2001.

HCFA is now the Centers for Medicare and Medicaid Services (CMS).

A phone call went out from my office to various Chairs of Departments of Medicine and Surgery whom I knew in the DC area, asking for help. By mid-day on Thursday, October 18, I had input from a number of individuals and I prepared a one-page list of 5 questions (Unfortunately I did not retain a copy of those questions) which I passed out at the quarterly Medical Staff meeting which was held at Providence Hospital here in DC the following Thursday evening.

This very unscientific approach resulted in the collective statement, I need as much information as possible and as soon as possible!

That week-end, I was one of the volunteer physicians who provided prophylactic antibiotics to the approximately 30, 000 individuals who presented themselves at the old DC General Hospital in Southeast Washington.

These were individuals who were exposed, or thought they were exposed to the Anthrax.

Other than the two Post Office employees who died, as noted above, no other cases of Anthrax were discovered in the District of Columbia.

In March, 2003, I began work in the Emergency Health and Medical Administration (EHMSA) for the DC Department of Health as the first Medical Director for Bioterrorism. Later I would be named Interim Administrator for EHMSA.

In this position, along with the Director of the DC Department of Health, I attended multiple medical and community meetings, discussing various aspects of Bioterrorism, which following the Anthrax event, along with the September 11, 2001 terrorists` bombings, had resulted in Emergency Preparedness becoming the number one health and safety issue in the country.

Personally, I would be vaccinated with the Small pox vaccine March 17, 2003. I recall having been previously vaccinated at a young age, perhaps 9 or 10, at St. Pius Catholic School in Jacksonville, Florida.

As best I can recall, at that time all of us stayed in school and had no concerns about Small pox or the vaccine; nor did the Teachers or our parents, I think, not knowing anything about complications of the vaccine.

Now, there are specific criteria for who should be vaccinated in a pre-event Small pox outbreak which will be discussed later.

Age was a risk factor for being vaccinated. I was 71 years old but I had no complications from the vaccine.

A few years later, May 18, 2007, I would receive a Master`s of Science Degree in Bio-hazardous Threat Agents and Emerging Infectious Diseases from Georgetown University here in the District of Columbia, and the seed for my writing this book was sewn.

In part, because of my own interests and experiences as Medical Director and interacting with various healthcare providers in many disciplines, it became very clear to me that there was a dearth of information on Emergency Preparedness available in one easily read document for the busy healthcare professional, not directly associated with Emergency Preparedness.

This was again brought to mind while attending the National Medical Association`s annual meeting in Las Vegas, Nevada, in August, 2009.

A representative from the CDC was presenting information on the H1N1 Influenza and one of the Physicians from the audience asked if there was a document available with information on Emergency Preparedness?

The response was that one could go to the CDC website for information.

At that moment, I knew as a practicing Physician myself, that the average Physician would not have the time, nor inclination, to go on line to look for information if an emergency arose, and they were in an Office setting with numerous patients.

The need, in my opinion, was a single document which could be used as a quick reference and which covers in a general sense, the broad area of Emergency Preparedness.

I, the Author, do not in any way intend to imply that I am an expert, of any sort, but am writing material which is in the literature, and which I have meticulously searched for and quoted.

Accompanying the book is a set of 101 questions and answers for those who would choose to become more thoroughly grounded in Emergency Preparedness, and which can be used in conjunction with this book for the students at the undergraduate or graduate level.

The information presented here-in is entirely within the public domain in some format, and this is an attempt to present in organized form, what should be an efficient approach to aid in recognizing threats from the agents described, and an appropriate response from the healthcare provider.

Moreover, the healthcare provider would understand the collaborative role they may have with local, state and federal agencies should they become a part of the disaster.

Indeed, in an article in the Journal of the American Medical Association (JAMA) dated February 20, 2002 ¹b entitled Bioterrorism Preparedness and Response: Clinicians and Public Health Agencies as Essential Partners, the authors discuss the multiple medical specialties involved in the response to the intentional distribution of the Bacillus anthracis spores through the postal system. The article notes that 22 individuals were infected with 5 deaths from the infection. This resulted in some 30,000 individuals being given prophylactic antibiotics here in the District of Columbia, the Author being one of the physicians providing the antibiotics.

It should be paramount in the providers` thought process that self-protection and prudence must prevail when dealing with a disaster.

If those who have some degree of training and expertise become compromised, they may well become a liability to more than themselves.

This response is further emphasized later in the discussion on Situation awareness.

For all who may have the occasion to read this Primer, a major feature of your involvement should be participating in and or strongly recommending frequent preparedness exercises and All-hazards drills, not just Fire drills.

As the country has moved farther away from the initial event in October 2001, the desire and will to participate in many Table-Top Exercises and full-scale Exercises appears to have been lacking, at least as recognized by large scale press coverage.

It is not a small undertaking to practice and actually evacuate an office or clinic or building, but if this has not occurred, with a safe secondary site for relocation, when the actual emergency occurs, that will become much more problematic.

The following are some common terms which may be associated with Emergency Preparedness:

Emergency-an event which may result in physical property destruction and or injury, with possible loss of life or limb. These events usually will not exceed local emergency response capability.

Cataclysm- the same as a disaster but exceeds all response capacity, e.g., the massive earthquakes in China where 255,000 were killed in 1976, Indonesia in 2004, triggering the tsunami which killed 228,000 and the earthquake in Haiti, 2010 with the estimated death toll of over 200,000. ²

Critical Incident- a generally unexpected challenging event with the potential for causing significant human distress. The response may create new positive growth as the region may be forced to interact with local, state or federal agencies.

Disaster- an unplanned or unexpected event that results in a large amount of physical destruction, injury, loss of life and a high degree of social disruption, which usually exceeds local emergency response capability. (Hurricanes Katrina in New Orleans, Rita in Mississippi, August 2005, and Ike in Galveston and Houston, September 2008).

Endemic- The habitual presence of a disease within a given geographic area. ³

Epidemic- The occurrence in a community or region of a group of illnesses of similar nature, clearly in excess of normal expectancy, and derived from a common, or from a propagated source.

Pandemic refers to a world-wide epidemic. ³

Terrorism-as defined by Law Enforcement is the premeditated and unlawful use or threat of force or violence as a punitive or coercive measure.

As defined by the Military it is war or military action against civilians or non-combatants.

As defined in the Healthcare community, it is a psychological or behavioral tool with the goal to create fear and helplessness and to break down resistance or the will of the population or its government.

An example of this is Russia`s current bombing of schools and hospitals in Ukraine.

Post-Traumatic Stress (PTS) - a normal behavioral survival response, generally requires no significant long term healthcare input.

Post-Traumatic Stress Disorder (PTSD)-an abnormal or pathological variant of the normal behavioral survival response and may require significant long term healthcare intervention.

Herd Immunity-the resistance of a group to an attack by a disease to which large numbers of the group have been vaccinated, or were previously infected, and are immune. ³

Incubation Period-the interval of time from which an infection occurs to the time of onset of clinical illness. ³

Attack Rate-the number of people at risk, who develop a particular illness, divided by the total number of people at risk, multiplied by 100.

Case Fatality Rate-the number of individuals dying during a specified period of time after disease onset, or diagnosis divided by the number of individuals with