Be Aware Of Carbon Monoxide (CO) Poisoning

Winter months are the peak danger season for carbon monoxide poisoning. Review this information from the CDC.

Carbon monoxide (CO) is an odorless, colorless gas that can cause sudden illness and death if inhaled.

Carbon monoxide is found in combustion fumes, such as those produced by small gasoline engines, stoves, generators, lanterns, and gas ranges, or by burning charcoal and wood. CO from these sources can build up in enclosed or partially enclosed spaces. People and animals in these spaces can be poisoned and can die from breathing CO.

Exposure to CO can cause loss of consciousness and death. The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and confusion. People who are sleeping or who have been drinking alcohol can die from CO poisoning before ever having symptoms.

Important CO Poisoning Prevention Tips

• Never use a gas range or oven to heat a home.
• Never use a charcoal grill, hibachi, lantern, or portable camping stove inside a home, tent, or camper.
• Never run a generator, pressure washer, or any gasoline-powered engine inside a basement, garage, or other enclosed structure, even if the doors or windows are open, unless the equipment is professionally installed and vented. Keep vents and flues free of debris, especially if winds are high. Flying debris can block ventilation lines.
• Never run a motor vehicle, generator, pressure washer, or any gasoline-powered engine outside an open window, door, or vent where exhaust can vent into an enclosed area.
• Never leave the motor running in a vehicle parked in an enclosed or partially enclosed space, such as a garage.
• If conditions are too hot or too cold, seek shelter with friends or at a community shelter.
• If CO poisoning is suspected, consult a health care professional right away.

ftp://ftp.cdc.gov/pub/epr/disasters/hurricanes/video/high/CarbonMonoxideCarbonMonoxide.rmvb

CDC: Winter Weather Indoor Safety

This information is provided by the Centers for Disease Control and Prevention (CDC). For more resources, please visit http://www.bt.cdc.gov/disasters/winter/

Heat Your Home Safely
If you plan to use a wood stove, fireplace, or space heater, be extremely careful. Follow the manufacturer’s instructions and remember these safety tips:

• Use fireplace, wood stoves, or other combustion heaters only if they are properly vented to the outside and do not leak flue gas into the indoor air space.
• Do not burn paper in a fireplace.
• Ensure adequate ventilation if you must use a kerosene heater.
• Use only the type of fuel your heater is designed to use—don’t substitute.
• Do not place a space heater within 3 feet of anything that may catch on fire, such as drapes, furniture, or bedding, and never cover your space heater.
• Never place a space heater on top of furniture or near water.
• Never leave children unattended near a space heater.
• Make sure that the cord of an electric space heater is not a tripping hazard but do not run the cord under carpets or rugs.
• Avoid using extension cords to plug in your space heater.
• If your space heater has a damaged electrical cord or produces sparks, do not use it.
• Store a multipurpose, dry-chemical fire extinguisher near the area to be heated.
• Protect yourself from carbon monoxide (CO) poisoning by installing a battery-operated CO detector and never using generators, grills, camp stoves, or similar devices indoors. Cook SafelyNever use a charcoal or gas grill indoors—the fumes are deadly.
• Never use an electric generator indoors, inside the garage, or near the air intake of your house because of the risk of carbon monoxide poisoning.
• Plug in appliances to the generator using individual heavy-duty, outdoor-rated cords.
• Do not use the generator or appliances if they are wet because of the risk of electrocution.
• Do not store gasoline indoors where the fumes could ignite.

If there is a power failure:

• Use battery-powered flashlights or lanterns rather than candles, if possible.
• Never leave lit candles unattended.
• Conserve Heat
• You may need fresh air coming in for your heater or for emergency cooking arrangements.
• However, if you don’t need extra ventilation, keep as much heat as possible inside your home.
• Avoid unnecessary opening of doors or windows. Close off unneeded rooms, stuff towels or rags in cracks under doors, and close draperies or cover windows with blankets at night.
  

Monitor Body Temperature
Older adults often make less body heat because of a slower metabolism and less physical activity. If you are over 65 years of age, check the temperature in your home often during severely cold weather. Also, check on elderly friends and neighbors frequently to ensure that their homes are adequately heated.

Eat and Drink Wisely
Eating well-balanced meals will help you stay warmer. Do not drink alcoholic or caffeinated beverages—they cause your body to lose heat more rapidly. Instead, drink warm, sweet beverages or broth to help maintain your body temperature. If you have any dietary restrictions, ask your doctor.

Avoid Exertion
Cold weather puts an extra strain on the heart. If you have heart disease or high blood pressure, follow your doctor’s advice about shoveling snow or performing other hard work in the cold. Otherwise, if you have to do heavy outdoor chores, dress warmly and work slowly. Remember, your body is already working hard just to stay warm, so don’t overdo it.

Avoid Ice
Walking on ice is extremely dangerous. Many cold-weather injuries result from falls on ice-covered sidewalks, steps, driveways, and porches. Keep your steps and walkways as free of ice as possible by using rock salt or another chemical de-icing compound. Sand may also be used on walkways to reduce the risk of slipping.

Be Cautious About Travel
Listen for radio or television reports of travel advisories issued by the National Weather Service. Do not travel in low visibility conditions. Avoid traveling on ice-covered roads, overpasses, and bridges if at all possible. If you must travel by car, use tire chains and take a mobile phone with you. If you must travel, let someone know your destination and when you expect to arrive. Ask them to notify authorities if you are late. Check and restock the winter emergency supplies in your car before you leave. Never pour water on your windshield to remove ice or snow; shattering may occur. Don’t rely on a car to provide sufficient heat; the car may break down. Always carry additional warm clothing appropriate for the winter conditions.

What to Do if You Get Stranded
Staying in your vehicle when stranded is often the safest choice if winter storms create poor visibility or if roadways are ice covered. These steps will increase your safety when stranded:

• Tie a brightly colored cloth to the antenna as a signal to rescuers and raise the hood of the car (if it is not snowing).
• Move anything you need from the trunk into the passenger area.
• Wrap your entire body, including your head, in extra clothing, blankets, or newspapers.
• Stay awake. You will be less vulnerable to cold-related health problems.
• Run the motor (and heater) for about 10 minutes per hour, opening one window slightly to let in air.
• Make sure that snow is not blocking the exhaust pipe—this will reduce the risk of carbon monoxide poisoning.
• As you sit, keep moving your arms and legs to improve your circulation and stay warmer.
• Do not eat unmelted snow because it will lower your body temperature.
• Huddle with other people for warmth.
  

NOW’S THE TIME: THE READY CAMPAIGN ENCOURAGES AMERICANS TO RESOLVE TO BE READY IN 2009

WASHINGTON, D.C. — With the new year approaching, the U.S. Department of Homeland Security’s (DHS) Ready Campaign is reminding Americans to Resolve to be Ready in 2009. Resolve to be Ready is a nationwide effort designed to encourage individuals, families, businesses and communities to take action and prepare for emergencies in the new year.

“Individual planning is the cornerstone of emergency preparedness,” said Homeland Security Secretary Michael Chertoff. “Since establishing this department and Ready, we have come a long way in raising the baseline of preparedness in this country, but we still have a long way to go. As 2009 approaches, I urge all Americans to consider the importance – and real value – of being prepared for all hazards.”

Being Ready for emergencies can be an easy new year’s resolution to keep by following the Ready Campaign’s three simple steps: 1) Get an emergency supply kit; 2) Make a family emergency plan; and 3) Be informed about the types of emergencies that can happen in your area and their appropriate responses.

By taking these three steps – in particular having an emergency supply kit both at home and in the car – Americans will be prepared for winter mainstays like power outages and icy roads. Each of these kits should include basic necessities such as water, food and first aid supplies to help you survive if you are without power or become stranded in your vehicle. Complete checklists for each kit are available at http://www.ready.gov/.

This year, the Ready Campaign is employing new media strategies to promote emergency preparedness. By using Twitter, a social networking tool, Ready hopes to not only reach new audiences, but also to open the lines of communication with the public, ensuring emergency preparedness is top of mind year-round. Twitter users can stay up-to-date on the latest Ready activities by following their username, “ReadydotGov,” on Twitter.

By making the decision to Resolve to be Ready in 2009 and following the simple preparedness steps in advance, Americans will minimize the impact of emergencies on themselves, their family and their businesses. By visiting http://www.ready.gov/ or calling 1-800-BE-READY, individuals can access free materials that will help them make and keep a new year’s resolution that will bring their families peace of mind.

February 2008 marked the Ready Campaign's fifth year at the Department of Homeland Security. Launched in 2003 in partnership with The Advertising Council, Ready is designed to educate and empower Americans to prepare for and respond to emergencies, including natural disasters and potential terrorist attacks. It has proven to be one of the most successful campaigns in Ad Council's more than 65-year history. Since its launch, the campaign has generated more than $756.5 million in donated media support. Individuals interested in more information about family, business and community preparedness can visit http://www.ready.gov/.

Holiday Home Safety Tips

Holiday Home Safety Tips

A beautiful home is a safe home, this holiday. If you decorate for the season, the National Safety Council urges doing so with care - especially if you use candles or electrical items that have potential to start fires. December and January are the peak months for fire-related fatalities, Council data shows, and 80 percent of fire deaths occur inside the home.

Candles are the biggest cause of holiday fires, according to the Consumer Product Safety Commission. Each year there are more than 14,000 candle-related fires in the U.S. that cause about 170 deaths and $350 million in property loss. Live Christmas trees are another risk. Last year there were about 200 residential fires involving Christmas trees.

But fires aren't the only danger. Each year in November and December, the CPSC estimates about 10,000 people are treated in hospital emergency rooms as a result of falls, cuts, shocks and burns related to holiday decorating.

To put home safety at the top of your holiday wish-list:
Keep lighted candles far removed from trees, curtains or other potentially flammable items.
Check decorative lights for broken or cracked sockets, frayed or bare wires, or loose connections. Replace or repair any damaged light sets.

Use indoor-certified lights indoors only, and outdoor lights outdoors. Look for the Underwriters Laboratory (UL) label. Use no more than three light sets on any one extension cord. Place extension cords against the wall to avoid tripping hazards - not under carpets or through windows or doors.

If your holiday does not feel festive without a live tree, select a fresh tree that is green and has a trunk sticky with sap. Cut about 2 inches off the trunk and put it in a sturdy, water-holding stand. Keep the stand filled with water so the tree does not dry out quickly.
Stand your tree away from fireplaces, radiators and other heat sources. Make sure the tree does not block foot traffic or doorways.

Remember, it is "lights out!" for trees and other decorations when you leave home or go to bed. The NSC offers more tips for Christmas tree safety, holiday safety and preventing home fires. Please enjoy a safe and happy season.

Report Finds Economic Crisis Hurting U.S. Preparedness for Health Emergencies

Trust for America’s Health (TFAH) today released the sixth annual Ready or Not? Protecting the Public’s Health from Disease, Disasters, and Bioterrorism report, which finds that progress made to better protect the country from disease outbreaks, natural disasters, and bioterrorism is now at risk, due to budget cuts and the economic crisis. In addition, the report concludes that major gaps remain in many critical areas of preparedness, including surge capacity, rapid disease detection, and food safety. In addition to assessing state and federal progress on indicators of emergency preparedness, the report offers specific recommendations to Congress, including restoring funding for health emergency preparedness, incorporating preparedness into healthcare reform, and enhancing research and development of technology and countermeasures.

Below is the national press release. The full report and a video release are also available on our website at http://healthyamericans.org/reports/bioterror08/. A playback of the audio press conference detailing highlights of the report will also be available this afternoon on the website.


Report Finds Economic Crisis Hurting U.S. Preparedness for Health Emergencies; More Than Half of States Score 7 or Lower Out of 10 in Readiness Rankings

Media contacts: Liz Richardson (202) 223-9870 x 21 or lrichardson@tfah.org or Laura Segal (202) 223-9870 x 27 or lsegal@tfah.org

WASHINGTON, DC, December 9, 2008 – Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) today released the sixth annual Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism report, which finds that progress made to better protect the country from disease outbreaks, natural disasters, and bioterrorism is now at risk, due to budget cuts and the economic crisis. In addition, the report concludes that major gaps remain in many critical areas of preparedness, including surge capacity, rapid disease detection, and food safety.

The report contains state-by-state health preparedness scores based on 10 key indicators to assess health emergency preparedness capabilities. More than half of states and D.C. achieved a score of seven or less out of 10 key indicators. Louisiana, New Hampshire, North Carolina, Virginia, and Wisconsin scored the highest with 10 out of 10. Arizona, Connecticut, Florida, Maryland, Montana, and Nebraska tied for the lowest score with five out of 10.

Over the past six years, the Ready or Not? report has documented steady progress toward improved public health preparedness. This year however, TFAH found that cuts in federal funding for state and local preparedness since 2005, coupled with the cuts states are making to their budgets in response to the economic crisis, put that progress at risk.

“The economic crisis could result in a serious rollback of the progress we’ve made since September 11, 2001 and Hurricane Katrina to better prepare the nation for emergencies,” said Jeff Levi, PhD, Executive Director of TFAH. “The 25 percent cut in federal support to protect Americans from diseases, disasters, and bioterrorism is already hurting state response capabilities. The cuts to state budgets in the next few years could lead to a disaster for the nation’s disaster preparedness.”

Some serious 2008 health emergencies include a Salmonella outbreak in jalapeño and Serrano peppers that sickened 1,442 people in 43 states, the largest beef recall in history in February, Hurricanes Gustav and Ike, severe flooding in the Midwest, major wildfires in California in June and November, and a ricin scare in Las Vegas.

Among the key findings:

Budget Cuts: Federal funding for state and local preparedness has been cut more than 25 percent from fiscal year (FY) 2005, and states are no longer receiving any supplemental funding for pandemic flu preparedness, despite increased responsibilities.

In addition to the federal decreases, 11 states and D.C. cut their public health budgets in the past year. In the coming year, according to the Center on Budget and Policy and Priorities, 33 states are facing shortfalls in their 2009 budgets and 16 states are already projecting shortfalls to their 2010 budgets.

Rapid Disease Detection: Since September 11, 2001, the country has made significant progress in improving disease detection capabilities, but major gaps still remain.

Only six states do not have a disease surveillance system compatible with the U.S. Centers for Disease Control and Prevention’s (CDC) National Electronic Disease Surveillance System.
Twenty-four states and D.C. lack the capacity to deliver and receive lab specimens, such as suspected bioterror agents or new disease outbreak samples, on a 24/7 basis.
Only three state public health laboratories are not able to meet the expectations of their state’s pandemic flu plans.

Food Safety: America’s food safety system has not been fundamentally modernized in more than 100 years.

Twenty states and D.C. did not meet or exceed the national average rate for being able to identify the pathogens responsible for foodborne disease outbreaks in their states.

Surge Capacity: Many states do not have mechanisms in place to support and protect the community assistance that is often required during a major emergency.

Twenty-six states do not have laws that reduce or limit liability for businesses and non-profit organizations that help during a public health emergency.
Only eight states do not have laws that limit or reduce liability exposure for health care workers who volunteer during a public health emergency.
Seventeen states do not have State Medical Reserve Corps Coordinators.

Vaccine and Medication Supplies and Distribution: Ensuring the public can quickly and safely receive medications during a major health emergency is one of the most serious challenges facing public health officials.

Sixteen states have purchased less than half of their share of federally-subsidized antivirals to use during a pandemic flu outbreak.

Every state now has an adequate plan for distributing emergency vaccines, antidotes, and medical supplies from the Strategic National Stockpile, according to the CDC. In 2005, only seven states had adequate plans. The CDC changed to a different grading system in 2007. However, questions still remain about the contents of the federal stockpile.

“States are being asked to do more with less, jeopardizing our safety, security, and health,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation. “We all have a stake in strengthening America's public health system, because it is our first line of defense against health emergencies.”

The report also offers a series of recommendations for improving preparedness, including:

Restoring Full Funding. At a minimum, federal, state, and local funding for public health emergency preparedness capabilities should be restored to FY 2005 levels.
Strengthening Leadership and Accountability. The next administration must clarify the public health emergency preparedness roles and responsibilities at the U.S. Department of Health and Human Services and U.S. Department of Homeland Security.

Enhancing Surge Capacity and the Public Health Workforce. Federal, state, and local governments and health care providers must better address altered standards of care, alternative care sites, legal concerns to protect community assistance, and surge workforce issues.

Modernizing Technology and Equipment. Communications and surveillance systems and laboratories need increased resources for modernization.

Improving Community Engagement. Additional measures must be taken to engage communities in emergency planning and to improve protections for at-risk communities.
Incorporating Preparedness into Health Care Reform and Creating an Emergency Health Benefit. This is needed to contain the spread of disease by providing care to the uninsured and underinsured Americans during major disasters and disease outbreaks.

Score Summary:

For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest.

The data for the indicators are from publicly available sources or were provided from public officials. More information on each indicator is available in the full report on TFAH’s Web site at http://www.healthyamericans.org/ and RWJF’s Web site at http://www.rwjf.org/. The report was supported by a grant from RWJF.

10 out of 10: Louisiana, New Hampshire, North Carolina, Virginia, Wisconsin
9 out of 10: Alabama, Indiana, Michigan, Pennsylvania, South Carolina, Tennessee, Vermont,
8 out of 10: Arkansas, Delaware, Georgia, Hawaii, Iowa, Minnesota, North Dakota, Ohio, South Dakota, Washington
7 out of 10: California, Colorado, D.C. Illinois, Kentucky, Missouri, New Jersey, New Mexico, New York, Oklahoma, Oregon, Rhode Island, Utah, West Virginia, Wyoming
6 out of 10: Alaska, Idaho, Kansas, Maine, Massachusetts, Mississippi, Nevada, Texas
5 out of 10: Arizona, Connecticut, Florida, Maryland, Nebraska, Montana

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. http://www.healthyamericans.org/

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need—the Foundation expects to make a difference in our lifetime. For more information, visit http://www.rwjf.org/.

National Special Needs Population Registry Beta Testing

National Special Needs Population Registry - Beta Test Underway

Center for Disaster Risk Policy at Florida State University is currently Beta Testing a new National Special Needs Population Registry in three southeastern states.

The registry’s design allows for registration of all individuals with special needs as defined by FEMA’s Planning Guide for Special Needs Populations

Designed to allow local disaster planning and response agencies to provide the highest level of assistance to special needs individuals through the latest in web based applications, the registry will allow users, at a minimum, to assign individuals to shelter locations and transportation routes, to generate route pickup maps for the transportation disadvantaged and to generate numerous (over 200) types of reports on the data contained within the registry.

For additional information please visit the following web site: http://www.spinreg.org

National Influenza Vaccination Week

December 8 – 14, 2008 is National Influenza Vaccination Week.

The Centers for Disease Control and Prevention (CDC) has announced the week of December 8-14, 2008, as National Influenza Vaccination Week. This week-long event is designed to raise awareness of the importance of continuing influenza (flu) vaccination, as well as foster greater use of flu vaccine in December, January, and beyond. Since flu activity typically does not peak until February or later, December and January still provide good opportunities to offer flu shots. This year, Thursday, December 11th, is designated as Seniors' Vaccination Day. The Centers for Medicare & Medicaid Services (CMS) needs your help to ensure that people with Medicare get their flu shots. Please use this week long event as an opportunity to place greater emphasis on flu prevention. If you have Medicare patients who have not yet received their annual flu shots, we ask that you encourage these patients to protect themselves from the seasonal flu and serious complications arising from the flu virus by recommending that they take advantage of the flu shot benefit covered by Medicare. And remember, health care professionals and their staff are also at risk for contracting and spreading the flu virus, so don’t forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your Flu Shot -- Not the Flu!

NOTE: - Influenza vaccine plus its administration are covered Part B benefits. Influenza vaccine is NOT a Part D covered drug.

For More Information
Health care professionals and their staff can learn more about Medicare’s coverage of the flu vaccine and other Medicare Part B covered vaccines and related provider education resources created by CMS, by reviewing Special Edition MLN Matters article SE0838 located at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0838.pdf on the CMS website.

For more information about National Influenza Vaccination Week, please visit the Centers for Disease Control and Prevention’s website, http://www.cdc.gov/flu/nivw/

FDA: Innohep (tinzaparin sodium injection)

Innohep (tinzaparin sodium injection)

FDA has received information about the clinical study: Innohep in Renal Insufficiency Study (IRIS) that was stopped in February, 2008 by the study’s Data Safety Monitoring Committee because of an interim finding of an increase in all-cause mortality in patients who received Innohep. Information on the patients enrolled in the study, on the heparin used to manufacture Innohep, and on the heparin used in the study is still being collected and analyzed.

In July 2008, the company revised the prescribing information to restrict the use of Innohep in patients 90 years of age or older. FDA is concerned that the preliminary data from the IRIS study suggest that the increased risk of mortality is not limited only to patients 90 years of age or older. Therefore, FDA has requested that the company revise the labeling for Innohep to better describe the overall study results which suggest that, when compared to unfractionated heparin, Innohep increases the risk of death for elderly patients (i.e., 70 years of age and older) with renal insufficiency. Healthcare professionals should consider the use of alternative treatments to Innohep when treating elderly patients over 70 years of age with renal insufficiency and DVT, PE, or both. This communication is in keeping with FDA’s commitment to inform the public about its ongoing safety reviews of drugs. FDA anticipates submission of the final IRIS study report in January, 2009 and plans to complete its review soon thereafter. FDA will communicate its conclusions and any resulting recommendations to the public at that time. FDA will consider additional regulatory actions as appropriate after thorough review of all applicable data from the manufacturer of Innohep.

Read the complete MedWatch 2008 Safety summary, including a link to the FDA Communication, at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#Innohep

Tule Fog

Tule FogCalifornia's Tule Fog season usually begins in November, after the first substantial rain and lasts until the end of March. Tule fog is a dense ground fog produced over land by the cooling of the lower atmosphere and is also known as radiation fog. Areas of dense fog can reduce visibility to less than 1/8 of a mile. Since the Central Valley of California has no air drainage other than mountain passes, day time heating or turbulent winds are required to break up the fog layer once it develops. Tule fog can be accompanied by drizzle and black ice. Accidents caused by Tule fog are the leading cause of weather related casualties in California. Examples of major accidents include:

December 1997 - 25 cars and 12 big rigs collided in fog near Elk Grove, south of Sacramento. 5 killed, 28 injured.
February 2002 - 80-plus car pileup on Hwy 99 near Kingsburg resulted in 2 killed.
November 2007 - a pileup involving 108 cars and 18 big rigs resulted in 2 deaths and 39 injuries.

During periods of dense fog the California Highway Patrol runs traffic breaks and pace cars on major highways to help slow traffic when visibility drops below 500 feet. Message signs provide information on changing conditions. (NOAA National Weather Service, FEMA Region IX)

CNN: An unusually destructive hurricane season ends

From Azadeh Ansari and Reynolds Wolf
CNN


(CNN) -- The 2008 Atlantic hurricane season ended Sunday, marking the finish of one of the busiest and costliest hurricane seasons ever.

The damage caused by this year's Atlantic hurricanes is estimated at $54 billion, according to the National Climatic Data Center. That's second in recorded history only to 2005, the year Hurricanes Katrina and Rita devastated the Gulf Coast. The total that year was an estimated $128 billion.

Government studies have noted that, when adjusted for inflation and other factors such as population density in coastal areas, some hurricane seasons from early last century could be seen as more expensive.

Still, the huge financial impact of this year's storms took their toll on an already-struggling economy.

It was the fourth busiest Atlantic hurricane year since 1944. The National Climatic Data Center said 2008 is "the only year on record in which a major hurricane existed in every month from July through November in the north Atlantic."

The most destructive was Hurricane Ike. Its unstoppable force wiped out neighborhoods in parts of Texas. Even a week later, remnants of its impact were still being felt in the Great Lakes region.

Texas had earlier taken a beating from Hurricane Dolly, which battered South Padre Island with 100 mph winds, making it the worst storm to hit the island in more than three decades.

Hurricane Gustav was also responsible for much of the 2008 devastation, leaving crippled communities, businesses, and homes from Haiti to Louisiana. Hurricane Hanna, not long after, brought massive floods to Haiti, killing hundreds and leaving thousands helpless, homeless, and hungry, before churning its way toward North and South Carolina.

In all, there have been 16 named storms since the Atlantic hurricane season started on June 1. Eight were hurricanes, five of them major -- meaning Category 3 or higher. Three -- Dolly, Gustav, and Ike -- made landfall in the United States, though none was a major hurricane at the time of landfall.

http://www.cnn.com/2008/US/11/30/hurricane.season.ends/index.html

CDC Factsheet: Wildfires

Health Threat From Wildfire Smoke

Smoke from wildfires is a mixture of gases and fine particles from burning trees and other plant materials. Smoke can hurt your eyes, irritate your respiratory system, and worsen chronic heart and lung diseases.

How to tell if smoke is affecting you
Smoke can cause—

• Coughing
• A scratchy throat
• Irritated sinuses
• Shortness of breath
• Chest pain
• Headaches
• Stinging eyes
• A runny nose
• Asthma exacerbations

If you have heart or lung disease, smoke might make your symptoms worse.

People who have heart disease might experience—

• Chest pain
• Rapid heartbeat
• Shortness of breath
• Fatigue

Smoke may worsen symptoms for people who have pre-existing respiratory conditions, such as respiratory allergies, asthma, and chronic obstructive pulmonary disease (COPD), in the following ways:

• Inability to breathe normally
• Cough with or without mucus
• Chest discomfort
• Wheezing and shortness of breath

When smoke levels are high enough, even healthy people may experience some of these symptoms.

Know whether you are at risk

If you have heart or lung disease, such as congestive heart failure, angina, COPD, emphysema, or asthma, you are at higher risk of having health problems than healthy people.

Older adults are more likely to be affected by smoke, possibly because they are more likely to have heart or lung diseases than younger people.

Children are more likely to be affected by health threats from smoke because their airways are still developing and because they breathe more air per pound of body weight than adults. Children also are more likely to be active outdoors.

Protect yourself

Limit your exposure to smoke. Following are ways to protect your health:

Pay attention to local air quality reports. Listen and watch for news or health warnings about smoke. Find out if your community provides reports about the Environmental Protection Agency's Air Quality Index (AQI). Also pay attention to public health messages about taking additional safety measures.

Refer to visibility guides if they are available. Not every community has a monitor that measures the amount of particles that are in the air. In the western part of the United States, some communities have guidelines to help people estimate AQI based on how far they can see.

If you are advised to stay indoors, keep indoor air as clean as possible. Keep windows and doors closed unless it is extremely hot outside. Run an air conditioner if you have one, but keep the fresh-air intake closed and the filter clean to prevent outdoor smoke from getting inside. If you do not have an air conditioner and it is too warm to stay inside with the windows closed, seek shelter elsewhere.

Do not add to indoor pollution. When smoke levels are high, do not use anything that burns, such as candles, fireplaces, or gas stoves. Do not vacuum, because vacuuming stirs up particles already inside your home. Do not smoke, because smoking puts even more pollution into the air.

Follow your doctor's advice about medicines and about your respiratory management plan if you have asthma or another lung disease, Call your doctor if your symptoms worsen.

Do not rely on dust masks for protection. Paper "comfort" or "dust" masks commonly found at hardware stores are designed to trap large particles, such as sawdust. These masks will not protect your lungs from smoke. An “N95” mask, properly worn, will offer some protection. For more information about effective masks, see the Respirator Fact Sheet provided by CDC’s National Institute for Occupational Safety and Health.

Safe evacuation

As you evacuate and then return home, be cautious and take the same safety measures you would when there is no emergency: buckle up and do not drink and drive. See CDC’s Impaired Driving fact sheet for more information on these hazards.

Also, make sure that children are properly buckled up and in the rear seat. See CDC’s Child Passenger Safety fact sheet for more information.

Power outages

Power outages can be more than an inconvenience. Click on the What You Need to Know When the Power Goes Out page for more information about carbon monoxide poisoning, food safety, safe drinking water, power line hazards and more.

Medicare Publishes New Information on Quality of Care at Dialysis Facilities

Medicare Publishes New Information on Quality of Care at Dialysis Facilities

Changes to Web Site Will Help Consumers Compare Care and Make

Informed Health Care Choices

The Centers for Medicare & Medicaid Services (CMS) today announced important additions to the Dialysis Facility Compare consumer Web site (http://www.medicare.gov/dialysis) that will give consumers even better insight into the quality of care provided by their local dialysis patient facilities.

The improvements include two new quality measures that demonstrate how well dialysis patients are treated for anemia (low red blood cell count) as well as updated information that will help patients better understand survival rates by facility.

To view the entire Press Release, please see: http://www.cms.hhs.gov/apps/media/press_releases.asp

Notice: ReliOn Insulin Syringes for use with U-100 Insulin (Tyco Healthcare - Covidien)

The kidney community uses a variety of products and resources to ensure the health and safety of patients and healthcare professionals. The United States Food and Drug Administration (FDA) issues alerts and notifications when these products and resources are unsafe or being recalled.

As directed by CMS, the KCER Coalition issues notices on FDA recalls via email and this website for the kidney community. To join the email list, please email sburris@nw7.esrd.net.

November 6, 2008

ReliOn Insulin Syringes for use with U-100 Insulin (Tyco Healthcare - Covidien)

Covidien and FDA notified patients and healthcare professionals of a recall of ReliOn sterile, single-use, disposable, hypodermic syringes with permanently affixed hypodermic needles. The mislabeled syringe may result in patients receiving an overdose of as much as 2.5 times the intended dose, with serious health consequences, low blood sugar, and even death. These syringes are sold only by Wal-Mart or Sam's Club pharmacies under the ReliOn name. The recall applies only to lot number 813900. The product was distributed from Aug. 1, 2008 until Oct. 8, 2008, and includes 471,000 individual syringes in 4,710 boxes. FDA urges patients and health care professionals to check syringe packaging carefully for products with this lot number, not to use the product, and return the product to the pharmacy for replacement. The lot number can be found on the back panel of the 100 count syringe carton, or on the white paper backing of each individual syringe “peel-pack”.

http://www.fda.gov/bbs/topics/NEWS/2008/NEW01911.html

It's always disaster season...

As we try to move out of hurricane season (which ends officially November 30), it's critical to remember there are many other hazards that could impact during the winter months. Severe winter weather, such as ice and snow storms; floods, which can occur year-round; and especially fires, due to the drier weather. Talk to your local emergency management agency to find out what winter hazards are in your area and how to protect yourself!

KCER Supports Fire Prevention Week: October 5-11

From October 5-11, 2008, fire safety advocates will spread the word to their communities that, with a little extra caution, preventing the leading causes of home fires – cooking, heating, electrical and smoking-materials – is within their power.

Did you know...?

• Cooking fires are the number one cause of home fires and home fire injuries.
• Heating fires are the second-leading cause of home fires.
• The majority of home fires start in the kitchen.
• Older adults are at the highest risk of death or injury from smoking-material (cigarettes, cigars) fires even though they are less likely to smoke than younger adults.
• January and December were the peak months for home fires and home fire deaths.
• Working smoke alarms cut the risk of dying in reported home structure fires in half.

For more fire facts and for information on how YOU can prevent home fires, log on to the National Fire Prevention Association at www.nfpa.org

KCER anuncia los recursos del desastre en español.

KCER anuncia los recursos del desastre en español.

Las necesidades y capacidades de cada persona son únicas, pero cada persona puede adoptar medidas importantes para prepararse para todo tipo de emergencias e implementar planes.

• Ancianos: http://www.listo.gov/america/getakit/seniors.html
• Para personas discapacitadas: http://www.listo.gov/america/getakit/disabled.html
• Cruz Roja Americana: http://www.cruzrojaamericana.org/index.asp
• Anuncios de servicio público sobre desastres naturales: http://www.bt.cdc.gov/disasters/psa/es/
  

National Preparedness Month

The Kidney Community Emergency Response (KCER) Coalition is a proud member of the National Preparedness Month Coalition.

September is National Preparedness Month and we would like to use this time to educate ESRD Networks about the tools and resources available through the KCER Coalition.

This is also a chance for Networks to collaborate and share resources they have developed for disaster preparedness. Special thanks to the Networks that shared their resources for this activity.

Please feel free to distribute these to your dialysis and transplant facilities, patients, staff, and other key stakeholders.

KCER is always available to help answer your disaster preparedness and response questions or concerns. Our volunteers are knowledgeable and dedicated to providing quality care to the kidney community.

You can also find more information about National Preparedness Month at www.ready.gov.

Additionally, the KCER Coalition continues to communicate and collaborate with ESRD Networks and stakeholders in response to Hurricane Ike's impact on Texas and Louisiana.

www.kcercoalition.com

Federal Support Stands Ready As Hurricane Ike Brushes Florida, Aims For Gulf Coast

Federal Support Stands Ready As Hurricane Ike Brushes Florida, Aims For Gulf Coast.
Release Date: September 9, 2008Release Number: HQ-08-192

WASHINGTON, D.C. -- The Department of Homeland Security's Federal Emergency Management Agency (FEMA) is coordinating the preparations of its partners in federal, state, tribal and local governments as Hurricane Ike is now expected to make landfall in Texas later this week. But with the record this year of storms shifting course before they strike the coast, all Gulf Coast residents are reminded to "Get Serious: Be Prepared."

In Florida, state and local resources are meeting the initial needs of communities impacted by the outer bands of the storm which swept over the Florida Keys. President Bush had previously issued a disaster declaration that enables federal aid to supplement and support any of the immediate response efforts.

In Texas, evacuations are scheduled to begin as early as tomorrow and residents are strongly encouraged to heed the direction of state and local officials. Federal assets will support these evacuations to ensure that everyone can get to safety.

Individual and community preparedness is the responsibility of everyone. Individuals, families and businesses should prepare emergency supply kits and develop family emergency plans. Emergency preparedness information for individuals and businesses is available online at www.ready.gov.

Federal agencies maintain multiple teams of key personnel as well as stockpiles of needed supplies and commodities across the country so that a response in one area does not impact on the needs of another. Key staff and commodities are already being pre-staged along the Gulf Coast to ensure a swift response wherever Hurricane Ike eventually strikes the coast.
Snapshot of Federal Activities:

U.S. Department of Homeland Security (DHS)Federal Emergency Management Agency (FEMA)
· FEMA has identified and designated specific staff and assets to ensure their availability for any preparations or response activities. FEMA liaisons are on-site in each of the state Emergency Operation Centers along the Gulf Coast.
· FEMA has deployed Incident Management Assistance Teams (IMATs) in Austin, Tex., Jackson, Miss., Atlanta, Ga. and Tallahassee, Fla. IMAT teams provide essential situational awareness and are the initial federal coordinators on the ground.
· Urban Search and Rescue (USAR) Teams are pre-deployed to Houston, Tex., Lafayette, La., Meridian, Miss., Montgomery, Ala., and Jacksonville, Fla. in order to assist in rescue operations in the immediate aftermath of a storm.
· FEMA maintains supplies of commodities and emergency resources placed strategically around the country. Contracts are in place to replenish supplies without shifting resources from other disaster operations.

U.S. Coast Guard (USCG)
· USCG forces have been deployed to conduct response, recovery and clean up operations, and are working with port and industry partners.

Transportation Security Administration (TSA)
· TSA deployed personnel, including Federal Air Marshalls, to facilities Texas to assist with planned evacuations.

U.S. Citizenship and Immigration Services (USCIS)
· USCIS is contacting community organizations and the media to inform them that USCIS will reschedule all appointments in offices that close. USCIS is advising customers to take all necessary actions to protect their documents and inform them that if they are evacuated, or a USCIS office is closed, they can temporarily make an appointment in another USCIS office.

National Protection and Programs Directorate National Communications System (NCS)
· NCS personnel are actively reaching out to the states on Ike's potential path to confirm access procedures for restoration teams, and are adjusting critical communications infrastructure analysis.
· The Shared Resources High Frequency Radio Network is scheduled to be activated 12 hours prior to landfall and the Disaster Information Reporting System 24 hours prior to landfall.

Infrastructure Protection (IP)
· Eight IP Protective Security Advisors have deployed to Texas to coordinate and support preparedness and response efforts and to beginning to identify critical infrastructures in the storm's projected path, and assessing any potential impacts.
· IP's National Infrastructure Simulation and Analysis Center will begin pre-landfall impact modeling as appropriate.

National Oceanic and Atmospheric Administration (NOAA)
· NOAA's National Hurricane Center is issuing watches and warnings as needed.
· NOAA aircraft are conducting flights into Hurricane Ike. A NOAA aircraft is pre-staged to conduct any damage assessment flights needed.

U.S. Department of Energy (DOE)
· DOE remains in close contact with Gulf Coast utilities as they monitor the path of Hurricane Ike and make advance preparations.
· Personnel have been evacuated from 200 production platforms (27.9%) and 15 rigs (12.4%) in the Gulf of Mexico.

U.S. Department of Defense (DOD) U.S. National Guard Bureau (NGB)
· NGB units are coordinating efforts to send people and equipment to assist civil authorities and first responders in Texas, Louisiana, Mississippi and Alabama.
· The Texas and Louisiana National Guard are staging provisions, prepositioning people and equipment, and coordinating with federal, state and local governments.
· The Texas National Guard is prepared for search and rescue missions.
U.S. Northern Command (USNORTHCOM)
· USNORTHCOM has deployed units to Corpus Christi and Brownsville, Texas to support medical evacuations.
· USNORTHCOM has identified additional units able to provide a wide range of additional support including helicopter support, medical evacuation, high-water vehicles, mobile communication packages, bridging and engineering support, medical assistance, search and rescue, and Incident Awareness and Assessment airborne platforms that provide after-landfall water level and surge assessments.

U.S. Army Corps of Engineers (USACE)
· USACE has over 40 specially trained response teams to support National Response Framework missions. These teams are trained and equipped with field guides, mobile response equipment, and prepositioned contracts.
· USACE stands ready to perform debris removal, commodities procurement and delivery, temporary emergency power, temporary housing, temporary roofing, infrastructure assessment, and support to urban search and rescue missions.

U.S. Department of Veterans Affairs (VA)
· Veterans who receive monthly compensation for disabilities, education, pension or other benefits will continue to receive regularly scheduled payments. VA is identifying those veterans in the affected areas that receive their checks by mail and has plans to issue convenience checks if mail delivery will be interrupted for an extended period of time.

U.S. Department of the Treasury (Treasury)
· Treasury is working with the U.S. Social Security Administration and the U.S. Postal Service to provide early payment delivery for SSA Cycle payments dated Wednesday, September 10th.
· Checks will be delivered early to specified ZIP Codes in Florida, Alabama, Mississippi, Texas and Louisiana, including New Orleans (a total of approximately 40,150 checks).

U.S. Department of Transportation (DOT)
· DOT activated is coordinating with the Texas Department of Transportation (T-DOT) in support of evacuation plans.
· DOT's Federal Highway Administration is supporting T-DOT as it conducts safety inspections of buses designated to support any evacuation.
· DOT's Federal Aviation Administration is deploying personnel to airports along the Gulf Coast and placed those facilities on alert in anticipation of any needed evacuations.

U.S. Department of Health and Human Services (HHS)
· HHS is supporting state and federal efforts to assess and plan for the evacuation of patients and nursing home residents in the path of the storm.
· Medical and pharmacy caches are in place to support medical needs of impacted communities in states across the Gulf Coast.
· HHS' Centers for Disease Control and Prevention is providing information across the region to educate residents on how to protect health and safety when authorities tell them to evacuate from the path of a hurricane.
· All U.S. Public Health Service commissioned officers are on alert, ready to deploy to states that need assistance in preparing for Hurricane Ike, responding to and recovering from these devastating storms. More than 500 of Public Health Service officers are currently staging or pre-positioned in Georgia, Louisiana and Texas.
· Four Federal Medical Stations (FMS), which provide care for evacuated patients from hospitals, nursing homes and other healthcare facilities, remain in place in Louisiana and are prepared to receive patients who have been or will be evacuated from other locations.

U.S. Environmental Protection Agency (EPA)
· EPA has staff on-site in the region and EPA's Office of Environmental Justice and Tribal Affairs has initiated information sharing with its Texas Gulf Coast network and Kickapoo Tribe.

U.S. Small Business Administration (SBA)
· SBA is reminding business owners to have an emergency plan in place that includes:
· Make backups of important business, financial and property records, and store that information offsite, in fireproof storage units.
· Eliminate costly power outages, businesses should invest in a backup generate to maintain full operation of critical functions such as refrigeration, lighting, security systems and computers. · Photograph or videotape the inside of your facility to document what inventory, furniture, equipment and other items.

U.S. General Services Administration (GSA)
· GSA is coordinating Logistics and Resource Support for all federal activities and is providing critical resources to effected areas.

The American Red Cross (ARC)
· ARC continues to move supplies to staging points in the region, including toiletries, clean-up kits, cots, blankets.
· Evacuees are encouraged to call a friend or family member before leaving home to communicate their plan and to ask that contact to register them on "Safe & Well," located at www.RedCross.org, to help keep family updated on their well-being once they have left.

U.S. Department of Agriculture (USDA)
· Consumers with food safety questions can "Ask Karen," the FSIS virtual representative available 24 hours a day at AskKaren.gov. The toll-free USDA Meat and Poultry Hotline 1-888-MPHotline (1-888-674-6854) is available in English and Spanish and can be reached from l0 a.m. to 4 p.m. EDT Monday through Friday. Recorded food safety messages are available 24 hours a day.

FEMA coordinates the federal government's role in preparing for, preventing, mitigating the effects of, responding to, and recovering from all domestic disasters, whether natural or man-made, including acts of terror. For more information on FEMA activities visit www.FEMA.gov and for more information on personal preparedness see www.Ready.gov.

FEMA Individual Assistance declared for 34 Louisiana Counties

President Declares Major Disaster For Louisiana
Release Date: September 2, 2008
Release Number: HQ-08-182

WASHINGTON, D.C. -- The head of the U.S. Department of Homeland Security's Federal Emergency Management Agency (FEMA) today announced that federal disaster aid has been made available for the state of Louisiana to help people and communities recover from the effects of Hurricane Gustav on September 1, 2008, and continuing.

FEMA Administrator David Paulison said the assistance was authorized under a major disaster declaration issued for the state by President Bush. The President's action makes federal funding available to affected individuals in the parishes of Acadia, Allen, Ascension, Assumption, Avoyelles, Beauregard, Cameron, East Baton Rouge, East Feliciana, Evangeline, Iberia, Iberville, Jefferson, Jefferson Davis, Lafayette, Lafourche, Livingston, Orleans, Plaquemines, Pointe Coupee, Rapides, Sabine, St. Bernard, St. Charles, St. James, St. John the Baptist, St. Landry, St. Martin, St. Mary, Terrebonne, Vermilion, Vernon, West Baton Rouge, and West Feliciana.

The assistance, to be coordinated by FEMA, can include grants to help pay for temporary housing, home repairs and other serious disaster-related expenses. Low-interest loans from the U.S. Small Business Administration also will be available to cover residential and business losses not fully compensated by insurance.

Federal funding also is available to state and eligible local governments and certain private nonprofit organization on a cost-sharing basis for in the parishes of Acadia, Allen, Ascension, Assumption, Avoyelles, Beauregard, Cameron, East Baton Rouge, East Feliciana, Evangeline, Iberia, Iberville, Jefferson, Jefferson Davis, Lafayette, Lafourche, Livingston, Orleans, Plaquemines, Pointe Coupee, Rapides, Sabine, St. Bernard, St. Charles, St. James, St. John the Baptist, St. Landry, St. Martin, St. Mary, Terrebonne, Vermilion, Vernon, West Baton Rouge, and West Feliciana for debris removal.

Paulison named Michael J. Hall as the Federal Coordinating Officer for federal recovery operations in the affected area. Hall said that damage surveys are continuing in other areas, and more counties and additional forms of assistance may be designated after the assessments are complete.

The Agency said that residents and business owners who sustained losses in the designated counties can begin applying for assistance tomorrow by registering online at http://www.fema.gov or by calling 1-800-621-FEMA(3362) or 1-800-462-7585 (TTY) for the hearing and speech impaired. The toll-free telephone numbers will operate from 8 a.m. to 6 p.m. (local time) Monday through Sunday until further notice.

FEMA coordinates the federal government's role in preparing for, preventing, mitigating the effects of, responding to, and recovering from all domestic disasters, whether natural or man-made, including acts of terror.

http://www.fema.gov/news/event.fema?id=10489

ESRD Networks continue collaboration for tropical weather threats

The KCER Coalition is continuing daily communication with ESRD Networks, CMS, providers, and key stakeholders in the kidney community for the impact of Gustav and the threat of Hurricane/Tropical Storm Hanna.

The KCER website has been updated with information to include helpline numbers and information for Hanna.

As always, everyone should monitor conditions through the National Hurricane Center, your local weather service office, your local emergency management agency, and local news media for information specific to your area.

www.kcercoalition.com

Kidney Community Collaborates for Gustav

End Stage Renal Disease Networks in the Gulf Coast are communicating daily with the KCER Coalition, CMS, and other stakeholders to ensure kidney community issues are addressed for Hurricane Gustav.

As of 5pm (EST), Gustav was 215 miles south-southeast of the mouth of the Mississippi River, heading northwest at about 18 miles per hour. Gustav is a Category 3 hurricane with winds of 115 mph. There is an increased threat for storm surge, tornadoes, and locally heavy rainfall.

Patients and providers are encouraged to contact their dialysis provider hotline and ESRD Network for information or assistance.

* DaVita: 800-400-8331 (operational 24/7)
* Fresenius: 800-626-1297 (operational 24/7)
* DCI Donor Hotline/Transient Patients: 800-969-4438

ESRD Network 13 (Louisiana, Oklahoma, Arkansas): 800-472-8664
ESRD Network 14 (Texas): 877-886-4435
ESRD Network 8 (Mississippi, Alabama, Tennessee): 877-936-9260 (Patients only) 601-936-9260

KCER Monitors Tropical Weather Threats Gustav, Hanna

The KCER Coalition is actively monitoring Tropical Storm Gustav and Hanna. ESRD Networks, CMS, and KCER Response Team leaders are in communication regarding preparations for these storms.

We encourage everyone to continue to monitor the progression of Gustav through the National Hurricane Center: http://www.nhc.noaa.gov/, and their local weather service office and emergency management agency.

National Hurricane Center forecasts are typically issued every six hours (5am, 11am, 5pm, 11pm). Gulf Coast areas and Florida should monitor the forecasts, as they change daily and remember not to focus on "the skinny black line" of the projected landfall.

Mississippi Emergency Management Agency:
www.msema.org/

Louisiana Office of Homeland Security And Emergency Preparedness:
www.ohsep.louisiana.gov/

Texas Division of Emergency Management:
www.txdps.state.tx.us/dem/pages/index.htm

Alabama Emergency Management Agency
http://ema.alabama.gov/

Florida Division of Emergency Management
www.floridadisaster.org/index.asp

Anniversary Reactions to a Traumatic Event: The Recovery Process Continues

http://mentalhealth.samhsa.gov/publications/allpubs/NMH02-0140/default.asp

As the anniversary of a disaster or traumatic event approaches, many survivors report a return of restlessness and fear. Psychological literature calls it the anniversary reaction and defines it as an individual's response to unresolved grief resulting from significant losses. The anniversary reaction can involve several days or even weeks of anxiety, anger, nightmares, flashbacks, depression, or fear.

On a more positive note, the anniversary of a disaster or traumatic event also can provide an opportunity for emotional healing. Individuals can make significant progress in working through the natural grieving process by recognizing, acknowledging, and paying attention to the feelings and issues that surface during their anniversary reaction. These feelings and issues can help individuals develop perspective on the event and figure out where it fits in their hearts, minds, and lives.

It is important to note that not all survivors of a disaster or traumatic event experience an anniversary reaction. Those who do, however, may be troubled because they did not expect and do not understand their reaction. For these individuals, knowing what to expect in advance may be helpful. Common anniversary reactions among survivors of a disaster or traumatic event include:

Memories, Dreams, Thoughts, and Feelings: Individuals may replay memories, thoughts, and feelings about the event, which they can't turn off. They may see repeated images and scenes associated with the trauma or relive the event over and over. They may have recurring dreams or nightmares. These reactions may be as vivid on the anniversary as they were at the actual time of the disaster or traumatic event.

Grief and Sadness: Individuals may experience grief and sadness related to the loss of income, employment, a home, or a loved one. Even people who have moved to new homes often feel a sense of loss on the anniversary. Those who were forced to relocate to another community may experience intense homesickness for their old neighborhoods.

Fear and Anxiety: Fear and anxiety may resurface around the time of the anniversary, leading to jumpiness, startled responses, and vigilance about safety. These feelings may be particularly strong for individuals who are still working through the grieving process.

Frustration, Anger, and Guilt: The anniversary may reawaken frustration and anger about the disaster or traumatic event. Survivors may be reminded of the possessions, homes, or loved ones they lost; the time taken away from their lives; the frustrations with bureaucratic aspects of the recovery process; and the slow process of rebuilding and healing. Individuals may also experience guilt about survival. These feelings may be particularly strong for individuals who are not fully recovered financially and emotionally.

Avoidance: Some survivors try to protect themselves from experiencing an anniversary reaction by avoiding reminders of the event and attempting to treat the anniversary as just an ordinary day. Even for these people, it can be helpful to learn about common reactions that they or their loved ones may encounter, so they are not surprised if reactions occur.

Remembrance: Many survivors welcome the cleansing tears, commemoration, and fellowship that the anniversary of the event offers. They see it as a time to honor the memory of what they have lost. They might light a candle, share favorite memories and stories, or attend a worship service.

Reflection: The reflection brought about by the anniversary of a disaster or traumatic event is often a turning point in the recovery process. It is an opportunity for people to look back over the past year, recognize how far they have come, and give themselves credit for the challenges they surmounted. It is a time for survivors to look inward and to recognize and appreciate the courage, stamina, endurance, and resourcefulness that they and their loved ones showed during the recovery process. It is a time for people to look around and pause to appreciate the family members, friends, and others who supported them through the healing process. It is also a time when most people can look forward with a renewed sense of hope and purpose.

Although these thoughts, feelings, and reactions can be very upsetting, it helps to understand that it is normal to have strong reactions to a disaster or traumatic event and its devastation many months later. Recovery from a disaster or traumatic event takes time, and it requires rebuilding on many levels - physically, emotionally, and spiritually. However, with patience, understanding, and support from family members and friends, you can emerge from a disaster or traumatic event stronger than before.

If you are still having trouble coping, ask for help. Consult a counselor or mental health professional. In the workplace, you may be able to get assistance from your human resources department or your company's Employee Assistance Program.

NMH02-014010/02

More resources:
http://mentalhealth.samhsa.gov/cmhs/katrina/
http://www.usa.gov/Citizen/Topics/PublicSafety/Hurricane_Katrina_Recovery.shtml

CDC Hurricane resources

http://www.emergency.cdc.gov/disasters/hurricanes/

The Centers for Disease Control and Prevention (CDC) offer a useful tool to help citizens and responders prepare and respond to, and recover from hurricanes and tropical storms. There are podcasts, videos, sign language videos, and more to help you and your family prepare for hurricanes.

Tropical Storm Fay is currently impacting Florida. Residents should stay tuned to local media for their weather reports. Florida Dialysis providers should notify Network 7 of any issues or facility closures due to the storm. Dialysis providers needing technical assistance should call 813-383-1530. There is also a patient hotline, 800-826-3773.

CMS Draft Interpretive Guidelines Published

The Centers for Medicare & Medicaid Services (CMS) has posted the “draft” interpretive guidance that will guide the survey process for the new ESRD Conditions for Coverage.

The document includes the regulatory language that was published as a final rule for the ESRD program in the Federal Register on April 15, 2008, as well as regulatory text that was incorporated by reference in that final rule.

Comments and rationale pertaining to the “draft” Interpretive Guidelines can be submitted to the CMS mailbox at ESRDSurvey@cms.hhs.gov no later than 5:00 p.m. Eastern time on August 18, 2008. A template to submit comments and rationale is included in the guideline document.

You can locate the “draft” Interpretive Guideline document on the FMQAI website at http://www.fmqai.com/ESRD/.

Disaster Training & Education

The Kidney Community Emergency Response (KCER) Coalition developed a new webpage to assist the kidney community in locating low/no cost training and education options. www.kcercoalition.com/education.htm provides a brief list of free online courses on emergency planning, disaster basics, healthcare focused planning, and more. If you know of a low/no cost program, please let us know!

All Hazards I: Identifying and Preparing for Potential Emergencies and Disasters.
This free online continuing education course will provide 1.0 continuing education contact hour for Florida nurses, social workers, and dietitians. This is an exciting opportunity for dialysis providers to fulfill the CMS Conditions for Coverage which outline staff training on disasters. For more information on the course, visit http://edu.flqio.org/ and click on "ESRD Courses."

FEMA Independent Study Courses at the Emergency Management Institute (EMI) http://www.training.fema.gov/is

The Emergency Management Institute (EMI) offers online, self-paced courses designed for people who have emergency management responsibilities and the general public. Courses are free-of-charge to those who qualify for enrollment. These courses can provide education on disaster planning, mock disaster exercise planning, and more. Some courses are healthcare-specific, including:

• IS-100.HC: Introduction to the Incident Command System for Healthcare/Hospitals
• IS-197.SP Special Needs Planning Considerations for Service and Support Providers
• IS-200.HC Applying ICS to Healthcare Organizations
• IS-808 Emergency Support Function (ESF) #8 – Public Health and Medical Services
  

CDC Public Health Training Network
http://www2.cdc.gov/PHTN/alpha.asp

South Central Center for Public Health Preparedness
http://www.soph.uab.edu/scphp/

The Johns Hopkins Center for Public Health Preparedness
http://www.jhsph.edu/preparedness/training/online/index.html


If you would like to add a course or website to this list, please email sburris@nw7.esrd.net.

2008 KCER Exercise

The Kidney Community Emergency Response (KCER) Coalition hosted an annual mock disaster drill on July 17, 2008. This activity provided training and practice to KCER Coalition members. It also demonstrated that the KCER Coalition can support CMS, the ESRD Networks, members of the kidney community, and individuals with kidney disease during an actual emergency. The 2008 KCER Exercise aimed to validate the capability to initiate each Response Team’s activation plan and coordinate comprehensive response activities.


Design

KCER Coalition members are dispersed throughout the country. Communication between team members is limited to telephone, email, and fax transmissions. Due to these geographic constraints, the 2008 KCER Exercise combined principles from orientation seminars and tabletop exercises. The KCER Response Teams utilized their charters and activation plans to familiarize other KCER Coalition members with their roles and responsibilities.


The Exercise

More than 50 people registered for the KCER Exercise. Representatives from all the ESRD Networks and each of the eight Response Teams actively participated in the exercise. The 2008 KCER Exercise was set in “Metropolis.” This fictional city was the setting for extended severe weather, rainfall, and a landslide event impacting municipal power and water supplies, and thus, dialysis operations.

An orientation provided an overview for participants regarding roles, plans, procedures, and equipment. KCER staff then simulated an emergency situation using a facilitated discussion-based exercise. Coalition members participated in three distinct modules:

· Module 1: Incident Notification
· Module 2: Initial Response
· Module 3: Ongoing Operations and Recovery

Each module began with an update via conference call to summarize the key events occurring within that time period. Participants read through the scenarios and developed response actions to each module, engaging in functional group discussions related to response issues via direct telephone calls, conference calls, and emails. Each Response Team documented its actions and identified potential problems for all three modules.

Following completion of the last module, all exercise participants were asked to submit feedback and evaluation forms. The feedback form was a tool to allow each participant to voice their experiences during the exercise, while the evaluation tool assessed the usefulness and effectiveness of the activity.

Follow-Up

All participants were asked to join the debriefing conference call on Friday, July 19th to discuss any issues and lessons learned. Several questions and best practices were discussed, which will ultimately lead to a more efficient response in the future. Two examples were:

• Recommendation for an online training course that outlines the purpose of disaster exercises and how these activities apply to the Coalition.
• Need for a new member packet to ensure that new Coalition members understand the Coalition’s mission, activities, Response Teams, and their own roles and responsibilities as a Coalition member.
  

Participants on the debrief conference call expressed that the exercise structure and length were appropriate for the activity. It was recommended that the structure and length remain the same for next year’s exercise.

FMQAI is currently summarizing all feedback and evaluation forms, which will be documented in the 2008 KCER Exercise Final Report, to include concerns, as well as ideas for solutions. This Report will be a useful tool for future KCER activities, and will assist in continuously improving the renal community’s ability to provide uninterrupted quality care to our ESRD patients during emergencies.

Community Partners

The Kidney Community Emergency Response (KCER) Coalition would like to reach out to emergency management agencies across the U.S. to provide education on the unique requirements of individuals living with end stage renal disease (ESRD).

KCER mailed out 450 Community Partner Packets to state and federal emergency management, public health preparedness centers, and legislators on homeland security and emergency management committees. Thank you to all the KCER Coalition members who made this packet such a success!

For more information, or to download your own packet, visit http://www.kcercoalition.com/CPP.htm

Wildfire Smoke

Individuals with kidney disease may be at a higher risk of dangers from wildfire smoke. If you live near an area that is experiencing a wildfire, you should take special care to avoid smoke and ash, if possible.

The CDC has information on wildfire smoke and how to protect yourself:
http://www.bt.cdc.gov/disasters/wildfires/facts.asp

After a flood...

The following are FEMA guidelines for the period following a flood:

• Listen for news reports to learn whether the community’s water supply is safe to drink.
• Avoid floodwaters; water may be contaminated by oil, gasoline, or raw sewage. Water may also be electrically charged from underground or downed power lines.
• Avoid moving water.
• Be aware of areas where floodwaters have receded. Roads may have weakened and could collapse under the weight of a car.
• Stay away from downed power lines, and report them to the power company.
• Return home only when authorities indicate it is safe.
• Stay out of any building if it is surrounded by floodwaters.
• Use extreme caution when entering buildings; there may be hidden damage, particularly in foundations.
• Service damaged septic tanks, cesspools, pits, and leaching systems as soon as possible. Damaged sewage systems are serious health hazards.
• Clean and disinfect everything that got wet. Mud left from floodwater can contain sewage and chemicals.

The Centers for Disease Control and Prevention (CDC) website is a valuable source of flood safety information: http://www.bt.cdc.gov/disasters/floods/

Additionally, there is information for reopening dialysis facilities, here: http://www.fda.gov/cdrh/emergency/dialysis.html

Lightning Safety Week

When Thunder Roars, Go Indoors!

Lightning Safety Week: June 22-28, 2008

In the United States, an average of 62 people are killed each year by lightning. Already in 2008, 8 people have died due to lightning strikes. In 2007, 45 people were struck and killed by lighting in the U.S.; hundreds of others were injured.

Most people who are struck by lightning are not killed, but they are left badly bruised and burned. The force of being hit by lightning can literally blow off people's shoes, shred their clothes and throw them violently through the air. It not only hits you hard, but at 50,000 degrees, it also burns right through you, leaving you with disfiguring scars and internal damage. Lightning survivors often have pain, loss of memory and other bad effects that sometimes last a lifetime.

A darkening cloud is often the first sign that lightning may strike. As soon as you see lightning or hear thunder, you are immediately at risk. By playing another inning or waiting even a few minutes to see if the storm is getting closer, you could be risking your life.

Go immediately inside a house or other enclosed structure to stay safe. No place outdoors is safe! Covered vehicles are fairly safe locations, but remember to keep your hands and feet away from the side of the car and away from the dashboard, steering wheel and windows.

People that have been struck by lightning do not carry an electrical charge. If you and the victim are in a safe area, it is safe and recommended to perform life saving first aid. You will not “get shocked” by touching the victim.

How far away is lightning from you? Use the FLASH to BANG method:

• When you see the FLASH
• Count the number of seconds to the BANG of thunder,
• Divide this number by 5,
• And this gives you the MILES the lighting is away from you.

It is recommended that if the thunder arrives within 30 seconds or less from your location, you should seek shelter. Wait thirty minutes after the last thunder before going outside.

http://www.lightningsafety.noaa.gov/

"All Hazards" now an online continuing education course

FMQAI: The Florida ESRD Network (Network 7) is pleased to present All Hazards I: Identifying and Preparing for Potential Emergencies and Disasters. This free online continuing education course will provide 1.0 continuing education contact hour for Florida nurses, social workers, and dietitians.

This is an exciting opportunity for dialysis providers to fulfill the CMS Conditions for Coverage which outline staff training on disasters.

For more information on the course, visit http://edu.flqio.org/ and click on "ESRD Courses."

Flood Safety

Flooding is one of the most common and most destructive disasters in the United States. Floods can happen anywhere, and sometimes without warning.

There are some important things to remember when facing a flooding disaster in your area:

Stay tuned to local news on the television and radio. Keep in touch with family members, neighbors, and friends. If your home is threatened, gather your important belongings and always listen and follow the directions from local emergency personnel (sheriff, police, fire/rescue, emergency management).

If you are told to evacuate, DO SO! Evacuate out of the danger area to a shelter, friend's house, family, or a hotel. Tell your family and friends where you are evacuating to. Take important items with you, including medicine, medical records, food, clothing, cash, insurance documents, and other items. Do not leave your pets. If you are going to a shelter, take bedding and food with you and tell the shelter that you are a dialysis or kidney transplant patient.

Do not drive or walk though standing water. You have no idea how deep the water is or how fast it is moving. As little as six inches of water can carry away a vehicle or knock you off your feet. Remember, "Turn around, don't drown!"

If you are on dialysis, remember that your dialysis facility has a disaster plan. Contact your facility and find out where else you can get your treatments if your unit is closed due to flooding or you are unable to reach your facility because the roads are shut down or you evacuated out of the area.

The Kidney Community Emergency Response (KCER) Coalition develops and disseminates preparedness materials for the kidney community. KCER is actively monitoring the current Midwest storms and flooding situation in Iowa, Kansas, Illinois, Indiana, Minnesota, Wisconsin, Missouri, and Nebraska.

To find and open or closed dialysis facility, go to www.dialysisunits.com. Dialysis providers should notify their local ESRD Network if there are any changes in status.

If your community needs assistance or information on dialysis and kidney transplant operations in your area, contact your local providers or your local ESRD Network.

To find your local ESRD Network, visit http://www.esrdncc.org/

To contact the KCER Coalition, email KCER@nw7.esrd.net or visit our website for information - http://www.kcercoalition.com/.

For important flooding information, visit http://www.fema.gov/hazard/flood/index.shtm

It's always Disaster Season

There are hundreds of thousands of dialysis and kidney transplant patients in the United States. Do you know how many of them live in a disaster-prone area?

ALL OF THEM.

June 1 marks the beginning of the Atlantic Hurricane Season. Forecasters expect an above average season. The average season has 11 named storms. For the complete forecast, visit
http://www.noaanews.noaa.gov/stories2008/20080522_hurricaneoutlook.html

Remember, while hurricanes can be deadly, many other types of disasters are happening around the country. Tornadoes strike without warning. Floods leave little time to prepare. Hazardous materials spills can threaten any neighborhood. Are you prepared?

KCER Exercise: July 17

The Kidney Community Emergency Response (KCER) Coalition requests that you save the date July 17, 2008 to participate in the 2008 disaster exercise.

Disaster exercises, sometimes called drills, are focused practice activities that place participants into a simulated situation which requires them to function in the capacity that would be expected of them in a real event. Its purpose is to promote preparedness by testing policies and plans and training personnel. Exercises are conducted to evaluate an organization’s capability to execute one or more portions of its response plan.

The 2008 KCER Exercise is a functional exercise (FE) designed to evaluate and validate organization and staff capabilities. This activity will focus on exercising the plans, policies, procedures, and staff. Exercise participants should be able to demonstrate the capacity to execute their disaster plans, communicate with staff and other key players, and participate in a coordinated response effort.

KCER staff and Response Teams will execute the drill on Thursday, July 17 from 12-4pm EST. KCER staff will lead the exercise, hold actual conference calls with Team Leaders/key decision makers and send real-time emails to the participants regarding the "disaster" situation.

Registration is required for all KCER members wishing to participate in the exercise. Only those registered will receive player handbooks, dial-in information for teleconferences, email notifications, and materials.

To maintain reality in the disaster scenario, the materials will not be sent out to participants until the day before the exercise. ESRD Networks and local disaster coalitions are welcome to observe/participate and/or use the materials for their own exercises/drills.

An exercise debriefing conference call will be Friday, July 18. This is not required, but everyone who registered is encouraged to give feedback on his or her experience.

For more information about this activity, visit www.kcercoalition.com/drills.htm.

Disaster Preparedness Videos

We have received a number of requests for disaster preparedness videos. Here is a list of online and free videos covering general preparedness, special needs, pets, safety, hurricanes, earthquakes, and pandemics.


http://www.ready.gov/america/about/instructional.html (general)

http://www.soph.uab.edu/scphp/default.aspx?ID=724 (general)

http://www.utbtsc.edu/safety/video/welcome.html (hurricanes)

http://floridadisaster.org/index.asp and click on the "Media Center" near the top righthand corner (hurricanes)

http://wsfltv.sun-sentinel.com/news/weather/wsfl-hurricane-tips,0,3896722.htmlstory?coll=wbzl-home-nav (hurricanes, general)

http://www.cepintdi.org/default.aspx?pageid=174 (Click on "Being Prepared" and then scroll to "Emergency Preparedness Video") for the deaf and hard of hearing.

http://www.bt.cdc.gov/disasters/hurricanes/psa.asp (hurricanes, general)

http://www.emd.wa.gov/publications/pub_index.shtml scroll through for videos (*earthquake) ** There are also PDF documents of a family emergency plan in English, Amharic, Arabic, Cambodian, Chinese, Farsi, Ilocano, Korean, Laotian, Romanian, Russian, Serbo-Croatian, Somaly, Spanish, Tagalog, Tigrigna, Ukranian, and Vietnamese.

http://www.nwcn.com/sharedcontent/features/flash/quake/during.html (earthquake)

http://www.sanmiguelcounty.org/portal/page?_pageid=118,148583&_dad=portal&_schema=PORTAL (pandemics)

http://a1881.g.akamai.net/7/1881/26640/v0001/redcross.download.akamai.com/26640/psa/movie/PandemicFlu/PF_Video1.html (pandemics)

http://readymontco.montcopa.org/readymontco/cwp/view,A,1553,Q,64828.asp (pandemics)

Florida Wildfires

The Kidney Community Emergency Response (KCER) Coalition is currently monitoring the wildfire situation in Florida.

If you are in the impacted area, it is vital to listen and obey your local officials' emergency orders. Most importantly, evacuate if you are told to do so. For individuals with kidney failure, remember to take your medicines, medical records, supplies, food, and insurance information. Call your dialysis clinic and tell them that you had to evacuate and tell them where you are staying.

Wildfires can also cause problems even if you are not in the impacted area. Smoke can reduce visibility on roads which can cause traffic accidents or close important roads. Make sure you know alternate routes to reach your dialysis facility, pharmacy, or family member's home.

The wildfire smoke can hurt your eyes, irritate your nose/throat/lungs, and can worsen illness. If you have respiratory problems, try to stay indoors away from the smoke. For more information, visit the Wildfire Smoke Health and Safety page from the Arkansas Division of Air Quality.

For information about wildfire safety, visit the American Red Cross site http://www.redcross.org/services/disaster/0,1082,0_594_,00.html