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2009: A Year of Swine Fools

By Mike McEvoy

As we responded into 2009 decked out in ANSI compliant safety vests, our pockets loaded with ice packs to cool the first arrest we worked, little did we know that a pandemic flu virus was silently brewing and soon to pounce. Forget SARS, forget the bird flu; H1N1 threw the whole world into a tizzy. As 2009 bids us a fond farewell, Swine Flu has booked at least another year stay. While children seem disproportionately affected, the number one H1N1 victim is common sense.

Swine flu caught us with our pants down in April. A new, novel virus, appearing simultaneously in Mexico, California and Texas put health officials on alert and proceeded to spread like wildfire, traveling worldwide within months. We're commonly led to believe that local government, fire, EMS, and law enforcement should initially plan to fend for themselves during any catastrophe.

We develop local plans with intent to remain self sufficient for a few days or maybe a week before expecting help to arrive from the feds. Well, SOS: it's December and the utter lack of coordination, conflicting information, and often foolish messages coming down the pipeline cast serious doubts about our capability as a nation to respond.

Granted, our plans were all off-kilter from the get go. The United States presumed that future pandemics would follow those of the past, starting in Europe or Asia, giving us a lead time of weeks or months to gear up. Not so helpful when this pandemic started in our backyard.

Compounding the problem was the World Health Organization Pandemic Staging — a plan premised on body counts. H1N1 met every pandemic criterion, but it proved not so lethal. Without a pile of bodies, much of the WHO plans were overkill (pardon the pun). No one was quite prepared for a pandemic that made a whole lot of people sick but killed very few.

Of course, we needed a vaccine. We weren't sure if Swine Flu planned to stay but every indication from our neighbors, whose seasonal flu seasons ran during our summer months, told us that H1N1 would be back with a vengeance. And it was. So began the mixed messages and misinformation.

Sure, it was a, "continually evolving situation," (the CDC's favorite qualifier), but did we really need daily changes in advice about serious actions like closing schools, quarantine and PPE? It got so crazy that by June, many State Public Health Officials took matters into their own hands, countermanding CDC advice and advising health care workers that simple surgical masks were sufficient protection from H1N1. Why the CDC failed to find these published scientific data credible smacks of one thing: politics.

So it continued into the fall. No one knew where the vaccine was, how much was available, when or where it would arrive, who could administer it, or when more could be expected. Weather predictions were more accurate than vaccine delivery estimates. Most states followed the lead of the federal government, distributing vaccine indiscriminately about with little rhyme or reason; in some locales shots were in surplus, in others, no vaccine could be had even when H1N1 outbreaks loaded local ICUs to the gills.

A couple of recently released CDC instructions paint a picture of an agency that may have truly lost every last marble and perhaps, much of their credibility to lead the battle against H1N1 or any future outbreaks. Despite published research and consensus letters from infectious disease experts, the CDC chose to ignore science and scientists, issuing "Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel." On October 14, some might call it coincidence, but when OSHA simultaneously announced inspections and enforcement actions would rely on the just-issued CDC guidance, I call it foul. Does it make sense when you have no science behind you to use labor law to get your way? Apparently it does to the CDC. And like a whole bunch of attorneys out there, I say to OSHA, "Bring it on, baby!" The first employer cited is going to have a field day watching OSHA try to prove in court that the CDC guidance actually protects workers. The cow finally jumped over the moon on November 23 when the CDC issued "Prevention of 2009 H1N1 Influenza Transmission in Dental Health Care Settings," advising dentists wear N-95 masks and patients wear surgical facemasks. Ridiculous? Stay tuned; you can be sure there's more to come.

Of course, you've heard of the trickle-down effect. Swine foolishness, that is. The New York City Health Department advised health care providers in November that any patient unable to afford prescribed antiviral meds for H1N1 would now be able to get them for free, courtesy of the City, no questions asked. Hmm, an apparent move to use up their antiviral medication cache before it all expires? Coincidence maybe, but the FDNY is working with State EMS officials to train EMS providers on dispensing antiviral medications. Jeepers, that's not anywhere in the CDC Guidelines, yet…

So what's it gonna be in 2010? Hold onto your ice packs, grab all the surgical masks and hand gel you can find, be thankful that Ryan White is back in town. Keep your eyes peeled for the new EMS educational curriculums and another round of CPR and ACLS changes (I'm predicting the return of procainamide). If all goes well with the NFPA Ambulance Committee, expect a DRAFT ambulance design standard by the end of the year. If you're pulling out your hair looking for the wonder drug hydroxocobalamin (CYANOKIT®) used to resuscitate fire victims, fret no more: Meridian Pharmaceuticals has been selected as the new supplier and will announce their marketing plans shortly. Lastly, on the subject of fire, take a peek at Disaster Medical Systems' new fire rehab tags. This could be your answer to compliance with NFPA 1584 Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises, in case you need a helping hand. When next fall comes around, get your flu shot — H1N1 will be included in 2010. Happy holidays and stay safe!

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