November 16, 2006 InfoGram

This InfoGram will be distributed weekly to provide members of the Emergency Services Sector with information concerning the protection of their critical infrastructures. For further information, contact the Emergency Management and Response - Information Sharing and Analysis Center (EMR-ISAC) at (301) 447-1325 or by email at emr-isac@fema.dhs.gov.

Continuity of Emergency Operations

The Emergency Management and Response - Information Sharing and Analysis Center (EMR-ISAC) has frequently written that the protection of emergency department or agency critical infrastructures will enhance organizational survivability, continuity, and response-ability. Since continuity of operations (COOP) is a desired outcome of critical infrastructure protection (CIP), the EMR-ISAC continues to examine new and old insights about COOP.

During the past week, the EMR-ISAC reviewed the COOP suggestions prepared by the Department of Homeland Security (DHS) for YELLOW (High) to RED (Severe) Alert Levels. Because of the current threat from domestic and transnational terrorism, the following DHS minimal essential recommendations warrant another look and, therefore, have been abbreviated for the continuing CIP consideration of Emergency Services Sector rank and file:

YELLOW (High)

• Conduct a vulnerability assessment of organizational personnel, physical assets, and communication/cyber systems.
• Correct or mitigate identified vulnerabilities as soon as practicable.
• Keep personnel informed of existing threats and ongoing preparations to eliminate rumor and unnecessary alarm.
• Assemble disaster supplies including food, clothing, medicine, fuel, etc.
• Regularly test internal procedures, generators, communication/cyber systems, etc.
• Periodically conduct refresher training for disaster response.

ORANGE (Elevated)

• Revise COOP plans as necessary given information about the impending threat.
• Restrict access to department or agency facilities consistent with the threat.
• Conduct daily security inspections of organizational physical assets to include facilities, vehicles, apparatus, equipment, HVAC systems, etc.
• Advise personnel to alter patterns by varying their routines and habits.
• Remain aware of all local and regional developments and be prepared to adjust accordingly.
• Encourage personnel to prepare their family emergency plan with emphasis on methods to communicate whereabouts, etc.

RED (Severe)

• Monitor local and regional emergency alert broadcasts for awareness and operations purposes.
• Follow the internal COOP plans and actions that have been approved and rehearsed.
• Modify those COOP plans and actions, but only in recognition of the specific threat.
• Alert all personnel of the current situation and their immediate responsibilities.
• Provide personnel with specific directions based on the current situation.
• Pre-position supplies and equipment as required by the situation.
• Prepare to support the short-term feeding and housing of all organization personnel.

Preparing Families of First Responders

Homeland Security Secretary Michael Chertoff continues to remind all Americans to take some basic steps to prepare their families for emergencies. He recently stated: "By simply taking a little time to sit down together and make an emergency plan, families can help answer important questions, such as where to meet, how to communicate with each other, and what to do in the event of an emergency."

The Emergency Management and Response - Information Sharing and Analysis Center (EMR-ISAC) maintains that critical infrastructure protection (CIP) begins at home for all citizens, but particularly for Emergency Services Sector (ESS) personnel. First responders who don't get home during an emergency or must quickly leave home to perform disaster response duties must have the confidence that their families understand what to do in their absence. The typical law enforcer, firefighter, paramedic, and emergency medical technician will likely function more effectively at the scene of a long-term incident if they know the following key pieces of information that should be included in every family emergency plan:

• The means by which to quickly contact immediate family members.
• Primary and alternate sites where immediate family members may be located.
• Current health and medical needs of each immediate family member.

Properly preparing families of first responders was a valuable lesson learned last year from Hurricanes Katrina and Rita. Too many police officers and firefighters were unnecessarily distracted by genuine concerns regarding the status of their families. Therefore, the EMR-ISAC encourages emergency responders and their adult family members to view the 5-minute PREPnet video stream, Lessons from Katrina by New Orleans District Fire Chief Gary Savelle (streaming WMV file), regarding family protection. More information can be acquired by visiting www.ready.gov or by calling 1-800-237-3239 (1-800-BE-READY) for assistance in preparing a family emergency plan.

MRSA Infection Threat

Methicillin-resistant Staphylococcus aureus (MRSA) infections are occurring with greater frequency among members of the Emergency Services Sector (ESS) according to reports reviewed by the Emergency Management and Response - Information Sharing and Analysis Center (EMR-ISAC). These recent reports of multiple serious cases are alarming enough to justify precautionary measures and specialized training to safeguard the personnel infrastructure.

MRSA is so named because bacteria have developed a resistance to treatment with the drug methicillin, but the acronym increasingly refers to a multi-drug resistant group of bacteria. Staphylococcus aureus is familiar to the ESS as staph or staph A, a type of bacterium commonly found on the skin and/or in the noses of healthy people. Although usually harmless at these sites, it occasionally enters the body through breaks in the skin causing the MRSA infection. These infections may be mild (such as pimples or boils) or serious infections of the bloodstream, bones, or joints. Warning signs can include fever, and at the site, warmth, inflammation, pus, redness, tenderness, or pain. A number of victims initially guessed they had suffered spider bites and were treated accordingly. When that treatment failed, they continued to visit medical facilities until a specimen was eventually cultured and the type of infection correctly identified. At that point, a common course of treatment includes incision with drainage and an appropriate antibiotic. Serious cases can require hospitalization and intravenous antibiotics. Recovery periods have ranged from 1 to 36 weeks.

Healthcare-associated (HA-) MRSA has long been a serious problem in hospital settings, but it is community-associated (CA-) MRSA that is threatening emergency personnel responding to areas populated by individuals who have overt MRSA infections or associate with those who do. Although prevalent among the homeless, CA-MRSA also appears in locker rooms and on military bases. MRSA can colonize on the skin and body of an individual without causing sickness, and in this way be transmitted unknowingly to other individuals. In one metropolitan area, 20 responders were infected in a month.

Some emergency organizations are contemplating changes such as replacing wooden tables, benches, and chairs with stainless steel that can be disinfected. Additional prevention activities include installing industrial hand sanitizers and having personnel wipe down department vehicles before and after shifts with a 10 per cent bleach solution. Furthermore, to protect their families, responders are encouraged to shower before entering their homes and keep dirty uniforms out of family quarters. Foremost is to treat all skin wounds, keep them covered, and seek medical attention immediately if any of the warning signs are observed.

ESS organizations considering education and training on MRSA can visit the Centers for Disease Control and Prevention Website to read a March 2006 report on minimizing the impact of MRSA in the community. This link will lead to supplementary information on the topic.

Cyanide Poisoning Danger to ESS

The Emergency Management and Response - Information Sharing and Analysis Center (EMR-ISAC) last wrote about the dangers of cyanide poisoning to Emergency Services Sector (ESS) personnel in May 2006, when it introduced the Cyanide Poisoning Treatment Coalition.

A presentation this week at the American Public Health Association's annual meeting reviewed results from a survey of Emergency Medical Services and Advanced Life Support organizations. These entities were queried about the risks associated with cyanide exposure and personnel awareness and preparedness regarding cyanide poisoning. The study was conducted by RTI International, a nonprofit research and technology development corporation that serves federal agencies, state governments, and private sector organizations.

Hydrogen cyanide is produced when products (e.g., wool, paper, cotton, silk, and plastics) containing carbon and nitrogen burn. Cyanide itself, which is transported extensively on highways and railways, is considered an ideal terrorist weapon. Cyanide exposure also can occur during industrial accidents. All of these scenarios place first responders in the path of danger.

A key finding was that only 35 per cent of survey participants believed they were likely or very likely to be exposed to cyanide as a result of fire, despite the fact that "the majority of cyanide produced in the United States is found in products used in building construction, interior decorations, or furnishings." According to the study's principal investigator, RTI found that "cyanide risk factors are often overlooked by emergency planners ..." He stated: "By better understanding the prevalence of cyanide and severe risks associated with cyanide toxicity, emergency responders can prepare for the health hazards associated with exposure."

The study's authors recommend that policymakers develop cyanide educational materials, and work with first responders to create guidelines for stocking antidotes and devising deployment strategies. Currently 79 per cent of those surveyed do not stock antidote kits as standard items.