You Might be a Floridian if...

...You exhibit a slight twitch when introduced to anyone with the first names of Charley, Frances, Ivan, or Jeanne.

This is one of several statements listed on an e-mail circulating in Florida. Although we can tease about it now, it has certainly been a terrifying hurricane season filled with one disaster after another. When beginning this article about disasters, I started by answering the question, "What does an infection control professional do before, during, and after one?" However, I decided I would rather share some of the personal and work-related experiences expressed through e-mail by my Florida colleagues during and after the hurricanes. I hope they give you the sense of what was going on in Florida. No part of the state went untouched.

Our hospital made it through the storm very well. We were crowded with patients that could not be discharged-mostly just oxygen dependent. The Boynton Beach Police Department, their families, and their dogs evacuated to our hospital for the duration. What a nightmare. I was here from Friday morning through Monday night. I found that the shower in the morgue is the best one in the whole house. We have no power at home. Phone service just came on this morning. My husband was out of town until last night. He came home and started the generator but all our cold food is gone. I can’t imagine if this had been more than a Category 2.
--Claire Arnold

I was home through the storm as my assistant wanted to be at the hospital. Our electricity and phone came back on early Monday, but we are still under the boil water order. Electricity came back on at the hospital on Sunday evening, although the other buildings on campus still don’t have it. We didn’t have water or sewer at the hospital until yesterday. Since the water is not drinkable, we opened up a limited amount of sinks and we can flush toilets again, which has made everyone joyous. Many of our staff lost their homes so we feel sad for them. Also many of the staff are still without water or electricity. I can’t remember when we last got mail service so I’ll have much catching up to do once that resumes.
--Diane Spicer

I was at the VA Medical Center from Friday until Tuesday evening and I was finally able to take a shower at home last evening when our power and well water were restored. The "hurricane proof" VA took on lots of water from the 90 mph horizontal rain which saturated the inside of the building from the air vents. We evacuated patients internally from several floors to the nursing home and PACU. We lost power and chiller as well as water. There are many horror stories. I have several new titles including "Princess of Poop" and "Wex-Cide Wench." The VA served as a shelter for families of mandated employees, and we found ourselves in a health threatening situation with "full to the brim" toilets which I had the personal pleasure of manually flushing - all nine stories of the building - 1,000+ bathrooms - it took a Sunday to accomplish this with water siphoned from the surrounding ponds and firehose into garbage cans and 5 gallon buckets. The plunger is an amazing instrument!

Full PPE, which includes face shields connected to masks, gowns, rubber gloves, and hazmat boots, is VERY HOT to wear with no A/C. Ceiling tiles crumbled onto the floor in patient rooms. Our beautiful medical center has sustained $13 million in damage... all of the exhaust vents (including the operating room exhaust system) were torn off the roof and landed on cars in the parking garage. We never could find the fourth system but it put over 150 holes in the roof. The corner gutters were all torn off of the roof and it rained into the inside of the building from a 32 foot hole during the entire storm. Teams from VA Central Office and FEMA are here assisting.

We have a Certified Industrial Hygienist (CIH) from Central Office coming to the VA tomorrow to work with infection control on moisture issues. We have an instrument which is designed to check moisture levels in wood, concrete, sheet rock, and other materials to guide us in our facility-wide assessment. (There may be a future educational program borne from this visit!)
--Cindy Lang

I could go on and on with the stories because every infection control professional in Florida has one. I speak for each and every one of them when I say thank you for your prayers and concern. In the next issue, I’ll get back to what we should address in disasters, but for now I’ll leave you with one more ditty from that "You might be a Floridian" list - "you’re putting a collage together on your driveway of roof shingles and mailboxes from your neighborhood" (if anyone sees Kathy’s would you please send it to her, its still missing).

--Submitted by Barbara Russell, RN, MPH, CIC, ACRN
(expert in manual toilet flushing)

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Hurricane Andrew

By Jane Pool, RN, MS, CIC
Infection Prevention and Control, DeWitt Healthcare Network
Fort Belvoir, VA

On Monday, August 24, 1992, Hurricane Andrew struck South Florida and caused an estimated $30-billion in damages and left a quarter-million people homeless. The storm’s effects were far-reaching, and residents in Orlando spent a scary night, "hunkered down" without power, listening to the tempest raging outside. When I reported to work for my infection control position at Orlando Regional Medical Center (ORMC), our infection control office began planning a relief trip. We sent an announcement to all the staff and got administration to support our efforts by providing a bus, medical supplies, food, and linens, as well as making scheduling adjustments to allow nurses to leave ORMC for this mission.

On Thursday morning, 20 ORMC staff left for Miami. The drive south on Interstate 95 revealed an unbelievable landscape - roofs gone, trees snapped in half - and the golden arches lying in the middle of an empty parking lot. The most unforgettable sight was a suburban strip mall that was completely leveled - except for one door and doorframe that remained standing. There was a sign on the door "We’re Always Open."

We pulled into downtown Miami and located the Health and Human Services building where we would receive our assignments. The first nurse exiting the bus fell and broke her ankle on the curb. After we put her leg in a splint (we had the supplies) and arrived at the ER entrance at Cedars Medical Center, she became our first patient. We put her leg in a cast and propped her up in the triage area and assigned her with telephone duty. Employees at Cedars Medical Center were very tired and worried about their homes, as most had not been able to leave until relief arrived. We got busy taking vital signs, starting ivs, and transporting patients for X-rays. We slept on mattresses on the floor in an empty wing of the hospital - we were told that one of the administrators had dragged the mattresses by himself to the unit earlier that day. There were warning signs on all the fountains and sinks - and no power. We used bottled water to brush our teeth by flashlight beam.

Coral Castle

The next day I joined a group of nurses on a bus headed for a field hospital that had been set up at a famous Homestead landmark - The Coral Castle. This was the main tourist attraction and claim to fame for most tourists traveling thru Homestead in 1992. There were tents set up in the courtyard where physicians were suturing lacerations and nurses were counseling patients, administering wound care, and taking vital signs. We pitched in and offered assistance where we could, but much of the healthcare consisted of providing a shoulder to cry on and listening to the myriad of heartbreaking stories. A makeshift central supply was arranged in the Gift Shop, next to racks of cameras and postcards. A group of healthcare professionals departed in search of some areas where the migrant workers were hiding (they were fearful of being deported and were reluctant to seek medical help).

The next day, we were taken by bus to Homestead. I remember the incredible sight of parking lots littered with huge piles of clothing that were being blown about and rained on. There were pallets loaded with six-packs of water labeled "Pabst Blue Ribbon" that had been emergently manufactured by beer companies - a very unusual sight. The Army had set up tents in many areas for the homeless, and Jeeps and Humvees driven by soldiers were a common sight. There were lines of people everywhere.

Businesses (what was left of them) were passing out goods and food for free to anyone who stood in line. We arrived at our assigned area - Homestead Elementary School -a small one-story cinderblock school fashioned in a square with a courtyard area in the center. There was a flurry of activity in progress. Children and families were sleeping on floors and piles of belongings were everywhere. Medical personnel who had arrived before us had initiated a makeshift medical center. The library was the central supply area - there were boxes of medical supplies stacked everywhere. In a classroom, a temporary OB/GYN clinic and delivery suite were arranged - protected by sheets they hung from ropes threaded into the ceiling tiles. Everyone was wearing surgical scrubs and a weary expression. A nurse wearing scrubs and clogs was washing a child’s hair on a bench in the courtyard - the children were very frightened and cried whenever there was a thunderstorm - screaming their terror at the thought of another hurricane.

I was assigned to the isolation area - easily identified by red bags hanging in the trees outside in the courtyard. The staff that had been there before me had chosen the far wing across the courtyard and the rooms were stocked with isolation supplies, PPE, red bags, bottles of bleach, trash cans lined with red bags, and alcohol foam handwash. There was only one patient, a small child with a fever accompanied by his very anxious mother. I was called to assist in the next room where I discovered a Brazilian physician wearing full PPE - he was suited up with mask, goggles, cover gown, gloves, and booties. I feared the worst until I realized he was saying "Varicella - Varicella" in broken English. The child he was examining had multiple fire ant bites around his feet and ankles - they are angry little pustules and a very familiar site to any Florida resident; certainly not chickenpox. It turns out that this MD had never had chickenpox and it is not endemic in many parts of South America.

Flew in a helicopter
The next crisis occurred when we were ready to get on the bus to return to Cedars - there was no bus. The person in charge of communications advised that if we wanted to run out into the middle of the ball field - we could get on a Coast Guard helicopter to go back to Miami. Four of us ran thru mud up to our knees and scrambled over a wire fence to board the chopper. Without headphones, we could only communicate with the pilot and crew by hand signals, so we wrote down the name of the hospital where we were going. We flew over more unbelievable sights, boats upside down in the middle of the road - entire communities and trailer parks flattened like matchsticks. I had flown with the ORMC helicopter to observe compliance with infection control practices, but never with the door wide open. We landed on the heliport on the roof of Jackson Memorial Hospital and the crew waved goodbye and took off. There we stood, in the dark, alone on the roof, and no one came to open the door. The pilot had not notified the team we were landing and no one knew to meet us! Finally, the door opened and a very surprised security guard grumbled while they arranged transportation for us back to Cedars Medical Center. We drove over in style in the back of a pickup truck. We were sad to leave the next day - but it was five days I will never forget, and I was reminded to never take a single moment for granted.

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CDC Offers Emergency/Disaster Resources, and More

Communication is absolutely critical to any successful emergency response effort, particularly in the event of disease outbreaks or terrorist activities. In recent years, we have recognized the need for enhanced systems and technologies to meet this need. Toward this end, the Centers for Disease Control and Prevention (CDC) has established partnerships with APIC and other national clinician organizations for the purpose of timely communication of information on disease outbreaks and terrorism events. This outreach effort, Clinician Outreach and Communication Activity (COCA), is designed to:

Smallpox 
Influenza/Avian Influenza 
Ricin 
SARS 
Radiation 
West Nile virus 
Chlorine 
Anthrax
Botulism 
Plague 
Nerve Agents 
Tularemia 
Viral Hemorrhagic Fevers 
Hurricane Recovery
Mass Trauma/Blast Trauma
Mad Cow Disease

• Assist clinicians in offering optimal care to patients by providing them with the most current and reliable information available on emerging diseases and terrorist threats;
• Provide information on infection control and protective measures for preventing spread of disease; and
• Provide a system through which clinicians can communicate their educational needs to CDC and receive answers to questions related to emerging diseases and terrorism from subject matter experts.

CDC communicates with these partners via monthly conference calls and weekly e-mail updates. Partner organizations, in turn, serve as networks for dissemination of CDC communications to their respective memberships. Conference calls serve as a venue for clinician partners to question CDC experts and to provide input to CDC about their needs and concerns. In the event of an emergency situation, these communications with partners would occur on a more frequent basis.

Sign Up Today

To facilitate the rapid dissemination of information to clinicians, CDC operates the Clinician Registry for Terrorism and Emergency Response Updates and Training Opportunities. This free registry is a system through which CDC informs clinicians via weekly e-mail updates of recent changes to information on smallpox, SARS, and other related health issues. CDC also uses the registry to announce new training opportunities for clinicians related to terrorism and emergency response topics. As of July 20, 2004, the registry has distributed nearly 2 million messages.

To sign up for the registry and receive e-mail updates, please go to http://www.bt.cdc.gov/clinregistry/index.asp

The following is an example from the September 10th COCA e-mail update. There are some helpful links and resources contained in the message that you may access when building a disaster/emergeny plans.

UPDATES TO INFORMATION AND GUIDANCE
The following updates were made to CDC information and guidance during the period of September 3, 2004 - September 10, or reflect that week’s current events. If you have any questions on these or other clinical issues, please call our toll-free Clinician Information Line at 877.554.4625 or write to us at coca@cdc.gov.

HURRICANE READINESS AND RECOVERY

Protect Yourself from Carbon Monoxide Poisoning After an Emergency
Included is information on:

• How to recognize carbon monoxide (CO) poisoning
• Important tips on how to avoid CO poisoning

Translation is now available in French: français

For English, Spanish, and Vietnamese:
http://www.bt.cdc.gov/disasters/carbonmonoxide.asp

Hurricane Home Page
For those who may be in the path of Ivan:
http://www.bt.cdc.gov/disasters/hurricanes/index.asp

Key Facts about Hurricane Recovery
Included is information on:

• Storing food safely
• Making sure water is safe
• Cleaning mold
• Preventing injuries
• Coping with stress
• Dealing with wild and domestic animals in a disaster
• Handwashing without water
• Preventing West Nile virus

Available in: English, Spanish, French, Vietnamese, Hmong, and Creol
http://www.bt.cdc.gov/disasters/hurricanes/index.asp

Traumatic Incident Stress: Information for Emergency Response Workers
Included is information on physical, cognitive, emotional, and behavioral stress.
http://www.cdc.gov/niosh/unp-trinstrs.html

Index of Printable Hurricane Materials
Hurricane materials suitable for printing in Adobe Acrobat (PDF) format. Documents are available in several languages.
http://www.bt.cdc.gov/disasters/hurricanes/printindex.asp

FLOODS

Water Quality
Includes water quality information for drinking, cooking, and personal hygiene, as well as instructions for disinfecting wells.
http://www.bt.cdc.gov/disasters/floods/water.asp

INFLUENZA

Flu Gallery
CDC announces the opening of the "2004-05 Flu Gallery", where you can view and download all of this season’s influenza education materials, including posters, flyers and brochures from the web for the following audiences:

• Healthcare providers
• Seniors
• Pregnant women
• Parents of 6-23 month olds and other kids at high risk
• People 18 or older with high risk conditions

Most materials are in English and Spanish. You can print most on office printers, and separate files can be taken to a professional (offset) printer.
www.cdc.gov/flu/gallery

ANTHRAX

Anthrax Q&A: Treatment
Updated: Treatment protocol for patients with inhalational and cutaneous anthrax.
http://www.bt.cdc.gov/agent/anthrax/faq/treatment.asp

Anthrax Q&A: Preventive Therapy
Updated: Recommendations for prevention of inhalational anthrax.
http://www.bt.cdc.gov/agent/anthrax/faq/preventive.asp

WEST NILE VIRUS (WNV)

2004 WNV Activity in the United States
Provides updated information on West Nile virus activity in the United States. One thousand three hundred and nine cases have been reported to CDC this season as of September 7, 2004. Of the 1,309 cases, 461 were reported as West Nile meningitis or encephalitis (neuroinvasive disease), 511 were reported as West Nile fever (milder disease), and 337 were clinically unspecified at this time. Thirty-five deaths have been reported.
http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount04_detailed.htm

West Nile Virus Audio News Releases, September, 2004
Audio news releases for media outlet use:
http://www.cdc.gov/ncidod/dvbid/westnile/misc/anr082604/index.htm

What You Need to Know about Mosquito Repellent
This informative sheet is available in Chinese and Vietnamese (in addition to English, Spanish, and Tagalog).

español  |  Tagalog  |  Chinese  |  Vietnamese
For English: http://www.cdc.gov/ncidod/dvbid/westnile/mosquitorepellent.htm

Fact sheet: West Nile Virus What You Need to Know is now available in Russian
http://www.cdc.gov/ncidod/dvbid/westnile/russian/pdf/wnv_factsheet.pdf
This information is also available in:
Português| Hmong| español| Chinese| français| Tagalog| Vietnamese| lao
For English: http://www.cdc.gov/ncidod/dvbid/westnile/wnv_factsheet.htm

Fight the Bite: Avoid Mosquito Bites to Avoid Infection
This information is now available in Portuguese and Hmong.
Português| Hmong| español| Chinese| Tagalog| Vietnamese| lao
For English: http://www.cdc.gov/ncidod/dvbid/westnile/prevention_info.htm

Maps of West Nile Virus Activity
Provides updated maps showing West Nile virus activity and WNV viremic blood donor activity in the United States.
http://www.cdc.gov/ncidod/dvbid/westnile/surv&control.htm

RABIES

Health Alert Network (HAN)
European-wide Alert about Rabies in France
This official CDC Health Update addresses a European-wide search for people who may have had recent contact with a rabid dog in southwestern France. CDC is providing information about this situation in the event that state and local health departments receive inquiries from persons who may have traveled recently in Europe.
http://www.phppo.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00213