Category Archives: Public Reports

Update to CDC’s Response to Ebola

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CDCCDC Tightened Guidance for U.S. Health Care Workers on Personal Protective Equipment for Ebola

CDC is tightening previous infection control guidance for health care workers caring for patients with Ebola, to ensure there is no ambiguity. The guidance focuses on specific personal protective equipment (PPE) health care workers should use and offers detailed step by step instructions for how to put the equipment on and take it off safely.

Recent experience from safely treating patients with Ebola at Emory University Hospital, Nebraska Medical Center and National Institutes of Health Clinical Center are reflected in the guidance.

The enhanced guidance is centered on three principles:

  • All healthcare workers undergo rigorous training and are practiced and competent with PPE, including putting it on and taking it off in a systemic manner
  • No skin exposure when PPE is worn
  • All workers are supervised by a trained monitor who watches each worker putting PPE on and taking it off.

All patients treated at Emory University Hospital, Nebraska Medical Center and the National Institutes of Health Clinical Center have followed the three principles. None of the workers at these facilities have contracted the illness.

For more information visit:

CDC Newsroom — Tightened Guidance for U.S. Healthcare Workers on Personal Protective Equipment for Ebola Fact Sheet – Oct 20

http://www.cdc.gov/media/releases/2014/fs1020-ebola-personal-protective-equipment.html

CDC Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing) – Oct 20 Continue reading →

Governor Malloy Outlines State’s Efforts to Safeguard Against Ebola

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1000px-seal_of_the_governor_of_connecticut.svgAnnounces that Commissioner Mullen has Invoked DPH’s Quarantine and Isolation Authority in New Haven

 (HARTFORD, CT) – Governor Dannel P. Malloy announced today that the State of Connecticut is taking additional steps to strengthen the level of preparedness for the Ebola virus by enacting the quarantine and isolation protocols that were authorized under the order he signed last week.  In addition, the Governor is directing that every hospital in the state perform a drill within the next week to assure that procedures and Emergency Medical Services (EMS) are up to standard.

While conversations between different levels of government and state hospitals have been ongoing for months, the Governor today also announced that he is convening a Unified Command Team (UCT), chaired by Jewel Mullen, Commissioner of the Department of Public Health (DPH), to serve as point in the state’s ongoing emergency management efforts.  The team will be responsible for the coordination of resources and personnel and provide a single point of contact for communication with the public.  They will also be responsible for certifying that front line personnel at both acute care and community health care facilities and first responders have received the necessary training to deal with a potential case effectively and safely.

“We have been taking this situation very seriously for weeks,” said Governor Malloy.  “Over that period of time, we have been working with health officials to prepare for a potential case here in Connecticut, and I am today formalizing that effort with the establishment of a Unified Command Team.  While we don’t yet know if there is a confirmed case of Ebola in our state, the report that a Yale student has exhibited symptoms demonstrates why preemptive action is the right approach.  I believe we must go above and beyond what the CDC is recommending, just as we did last week when I issued a preemptive declaration.  I want everyone to know – from the nurses in our emergency rooms to our first responders and our law enforcement personnel – we will provide whatever resources we have at our disposal so that you can do your critically important jobs safely and effectively.”

The UCT will be composed of officials from the Governor’s Office, the Department of Public Health, the Department of Emergency Services and Public Protection, the State Department of Education, the State Department of Energy and Environmental Protection, the State Department of Administrative Services and the Department of Corrections.

Governor Malloy said that for several weeks, the state has been communicating with Connecticut hospitals and other health care providers providing them with the most up to date information and guidance from federal health authorities.

Last week, Governor Malloy issued an order declaring a public health emergency as a precautionary matter. The order gives the Commissioner of the Public Health Department the authority to quarantine and isolate an individual or a group of individuals whom they reasonably believe has been exposed to the Ebola virus or infected with the Ebola virus. The order was executed as a precautionary and preparatory measure in the event that the state has either a confirmed infection or has confirmed that someone at risk of developing the infection is residing in the state.

Earlier this month, Commissioner Mullen asked each hospital to complete a detailed hospital checklist for Ebola preparedness. During the Unified Command briefing, Commissioner Mullen said that all acute care hospitals had completed and returned the checklist. She said DPH also held a conference call with hospital representatives this week to review their preparedness efforts.

“Connecticut hospitals clearly have a heightened level of awareness for detecting a patient with Ebola, given the level of cooperation we have received in preparing for a possible case,” said Dr. Mullen. “The survey shows that every hospital is engaged in planning and preparedness around Ebola.  Critical to preventing an Ebola outbreak in the United States is that all hospitals are able to recognize when a patient may be at risk for Ebola and take the appropriate steps. We continue to work with hospitals to ensure they can detect a patient with Ebola, protect health care workers so they can safely care for the patient, and respond in a coordinated fashion with their healthcare system.”

United Way 211 is providing information and links on its website at www.211ct.org, or you can call 2-1-1.

Today, the Governor and the Commissioner are issuing the following guidance, which is more stringent than the guidelines thus far issued by the Federal Center for Disease Control and Prevention (CDC): If you become sick with a fever a fever with and/or any of the symptoms of Ebola virus disease such as nausea, vomiting and diarrhea, and you:

  • Have traveled to Liberia, Sierra Leone, or Guinea in the last 21 days, or
  • Have had contact with a person who has Ebola virus disease.

You will be sent to a hospital for evaluation and placed in room separate from other patients – this is called isolation.

If you are not sick, but have traveled to affected areas or been in contact with an infected individual, you will be required to stay at home for 21 days and take your temperature twice a day.  Public heath health workers will contact you twice a day by phone to see how you are doing.  This is called quarantine. If you develop a fever or other symptoms suggestive of Ebola virus during the time that you are required to be home, you will be sent to a hospital for evaluation and placed in room separate from other patients.

“The first responder community continues to monitor the current situation and prepare for any potential threat to public safety or health using their established protocols,” said Department of Emergency Services and Public Protection Commissioner Dora B. Schriro. “We are at the ready to assist and support our local partners in this critical state-wide effort.”

According to the CDC:

  • You can’t get Ebola though air
  • You can’t get Ebola through water
  • You can’t get Ebola through food.

You can only get Ebola from:

  • Touching the blood or body fluids of a person who is sick or has died from Ebola
  • Touching contaminated objects, like needles
  • Touching infected animals, their blood or other body fluids or their meat.

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For Immediate Release: October 16, 2014

 

Ebola Preparedness and Treatment by Emergency Medical Services

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CDCMANCHESTER and HARTFORD — The following are a list of documents, checklists and other background information related to the Ebola virus for use by Emergency Medical Services providers.

Ebola Case Definition

Ebola PPE Poster from CDC

Detailed EMS Checklist for Ebola Preparedness

Known cases remain isolated to the Dallas, Texas area and healthcare providers should continue to get their information from credible and reliable sources such as the Centers for Disease Control and Prevention.

Department of Public Health Provides Update on Ebola to EMS

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CDOFHThe following is a message from CT-Department of Public Health:

To all EMS Organizations (including Fire and Police First Responders) and EMS Sponsor Hospitals:

Good afternoon. Attached is a “Detailed Emergency Medical Services (EMS) Checklist for Ebola Preparedness” issued by CDC and ASPR as well as a general press release from the Office of Governor Malloy on the issue.

Governor Malloy Briefed on Ebola Situation

As stated in the checklist, its purpose is to “ensure the agency is able to help its personnel detect possible Ebola cases, protect those personnel, and respond appropriately.” Coordination and communication with receiving hospitals will also be an important element of managing any suspected cases of Ebola. Please review this information and consult with your EMS Sponsor Hospital for specific guidance.

EMS Ebola Checklist

Additionally, the CDC has updated their Interim Guidance for EMS and 9-1-1 PSAPs for Management of Patients with Known or Suspected Ebola Virus Disease in the United States. The guidance may be accessed at:

http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-emergency-medical-services-systems-911-public-safety-answering-points-management-patients-known-suspected-united-states.html

ASM’s Alpha Five: Volume 6: Johnson Memorial Hospital Renovates EMS Work Area

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Note the ASM ambulance outside. From left to right: Patrick Mahon, chairman, JMMC Board of Directors; Neil Moynihan, M.D., president, JMH Medical Staff; Paul Wentworth, EMS coordinator; Beth Van Alstyne, senior director, Nursing; Patricia Jagoe, assistant vice president, Patient Care Services; Jennifer Moskal, Emergency Department manager; David Herr, M.D., chairman, Department of Emergency Medicine; and Stuart E. Rosenberg, president & CEO, JMMC. (Gregory Palmer / February 27, 2014)

Note the ASM ambulance outside. From left to right: Patrick Mahon, chairman, JMMC Board of Directors; Neil Moynihan, M.D., president, JMH Medical Staff; Paul Wentworth, EMS coordinator; Beth Van Alstyne, senior director, Nursing; Patricia Jagoe, assistant vice president, Patient Care Services; Jennifer Moskal, Emergency Department manager; David Herr, M.D., chairman, Department of Emergency Medicine; and Stuart E. Rosenberg, president & CEO, JMMC. (Gregory Palmer / February 27, 2014)

by Gregory Palmer Read the full Hartford Courant article here…

STAFFORD — In 2007 Alan and Terry Silver made a generous donation to Johnson Memorial Hospital (JMH) for the renovation of the EMS work area and lounge. Seven years later the room has been updated to better meet the needs of the EMS community. Hospital staff and EMS professionals recently gathered at JMH to celebrate the event and ribbon cutting. Johnson Memorial Medical Center, parent organization of JMH, is grateful for the dedication and support the EMS members provide throughout our service area and our surrounding communities.
About Johnson Memorial Medical CenterJohnson Memorial Medical Center (JMMC) is the parent organization of Johnson Memorial Hospital (JMH), Evergreen Health Care Center (EHCC) and Home & Community Health Services (H&CHS). JMMC provides a full spectrum of health care to those living and working in North Central Connecticut and Southern Massachusetts. For more information please visit: www.jmmc.com.

External Winter Storm Update from DESPP / DEMHS

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Hercules2014

STATUS OF THE STATE EMERGENCY OPERATIONS CENTER – MONITORING

Winter Storm Warnings remain in effect for the entire state until Friday morning.  A Coastal Flood Watch (Minor Flooding Expected) is in effect from 10:00 PM until 2:00 AM Friday morning for Coastal Fairfield and New Haven Counties.

At 1:45 PM radar showed bands of light snow falling across the state with temperatures ranging from the mid teens in Northern CT up to low 20’s along the coast.  According to DOT Camera’s secondary roads are currently slush or snow coated in many areas.  Most highways are still fairly snow free in the travel lanes.  Northeast Winds are currently gusting to 20 MPH inland and up to 30 MPH along the coast with wind chills near 0 F in Northern CT up to +10 F at the coast.

This Afternoon: Bands of light snow becoming steadier by 4:00 PM with around an inch of accumulation during the afternoon.  Northeast winds gradually increasing and gusting to 25 – 35 MPH by late this afternoon.  The impact on the afternoon rush hour is expected to range from minor in the valleys and highways to pockets of moderate impact in the rural areas and in the higher elevations.  Temperatures are forecast to fall into the low teens by late afternoon with wind chills ranging from -10 F to +10 F.

Tonight: Northeast winds increasing to 30 – 35 MPH with snow becoming moderate to heavy at times.  The heaviest snow and wind (with near blizzard conditions expected along the coast) is currently expected between 11:00 PM and 5:00 AM.  During this time snowfall rates are forecast to be approximately 1” per hour with low visibilities, blowing and drifting of snow and a moderate to major impact on overnight travel.  Temperatures will also be bitter cold overnight with lows between +5 and +10 F and wind chills ranging from -5 to -15 F.  Total overnight snowfall of 5 – 7” is expected.  Minor coastal flooding is expected around the time of high tide at midnight in Western Long Island Sound with tide departures around 2 feet above the normal high tide.

Friday Morning: Snow tapering off to flurries from West to East between 7:00 – 10:00 AM and ending completely by early afternoon.  The impact on the morning rush hour is expected to be to moderate to borderline major with several inches of snow cover on most roads, light snow falling early and considerable blowing and drifting of the dry snow across roads.  Highs on Friday are only expected to reach the low teens with wind chills ranging from -10 to 0 F during the day.  Blowing snow is expected thru the Afternoon with a minor impact on the afternoon rush hour expected.

Total snowfall for the storm is forecast to range from 7 – 10” statewide with the lowest amounts in Southwestern CT and the highest amounts along the Southeast coast and in far Eastern CT.

Friday Night: Very cold conditions are expected with lows ranging from -10 to -15 F in Northern CT up to +0 F along the coast.  Lighter winds are expected to push wind chills down to –10 to -20 F at times.

The Department of Emergency Services and Public Protection, Division of Emergency Management and Homeland Security will continue to monitor the latest weather conditions and will issue another update at 6:00 PM this evening.

The Hartford Circus Fire and Aetna Ambulance: Volume 6

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by Sam Porcello

Miss earlier volumes? Click here…

bb20d332c8One of the things that surprised me the most during my project research was the fact that the Gradys concealed their ownership of Aetna Ambulance, afraid that, 20 years before the Civil Rights Amendment, people would be reluctant to do business with African Americans.  As Mrs. Grady recounted:

“(My family) found it difficult to get loans to finance their business.  My dad was a local artist and would use what money he received from selling his paintings into the ambulance business.  He was also a barber!  They would conceal their ownership in the following ways: 1) By calling their business Aetna [ostensibly named, with permission, after the insurance company that they worked for] instead of Grady Ambulance because they knew that the general public would probably not do business with them because of the color of their skin; 2) When they appeared in photographs together helping patients they were careful not to have their names recorded or their actual relationship to the business recorded.  People would believe that they were only the ‘ambulance attendants’ which was the intention.”

The Hartford Circus Fire and Aetna Ambulance: Volume 5

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by Sam Porcello

Hartford Circus Fire - Aetna Ambulance Service, Inc.Miss earlier volumes? Click here…

Mrs. Grady was really helpful and supportive, and provided me with photos and additional information about her family. She also referred me to Robert John Titus.  I was fascinated to learn how the Grady brothers, who received some basic medical training in the Navy, were inspired to begin a full time ambulance company following the Hartford Circus Fire.  They saw a need for the service, and became only the second private ambulance company to serve Hartford.

More importantly, Aetna Ambulance was the first private ambulance company in Hartford to provide formal medical training to its employees.  The Gradys didn’t stop there, reaching out beyond Hartford to help train other ambulance services.  Mrs. Evans wrote to me that:

“My Aunt Jean was a member of the Red Cross and was a medical instructor. She helped state wide ambulance employees including Ambulance Service of Manchester, Wethersfield and Rocky Hill Volunteer Ambulance Service members retain their licenses…as Emergency Medical Technicians.”

EMS Structured for Quality: Volume 1

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specialevents4Essential Performance Results

In 2008, the American Ambulance Association issued a best practices white-paper entitled EMS Structured for Quality. The paper was intended as a guide for “those who want to achieve the balance between quality and cost factors, while earning the satisfaction of patients, taxpayers, elected officials, ambulance service managers, employees, and other customers.”

The white paper identified four Essential Performance Results for high performance emergency ambulance services:

  1. Clinical Excellence.
  2. Response-time Reliability
  3. Economic Efficiency.
  4. Customer Satisfaction.

The next four volumes will describe how Aetna and ASM match up to and use these results to succeed and thrive.

The Hartford Circus Fire and Aetna Ambulance: Volume 4

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HartfordCircusFireAerial-610x477by Sam Porcello

Miss earlier volumes? Click here…

Reading the 1944 Transportation Committee of the Hartford War Council report on the Circus Fire from the State archives, Aetna Florist was listed as providing a delivery van to the scene of the fire to be used to transport the injured.  In fact, Lucille Grady, who was in her twenties at the time, ran her brother’s florist business while they were away at war, and drove the van to the scene of the fire. (Prior to leaving for the Navy in 1942, Herman and Howard decided to convert one of the delivery trucks into an ambulance.) 

I checked the Aetna Ambulance website, read about the company’s history, and emailed members of management to find out more. Aetna management got back to me right away, answered a lot of my questions and also put me in touch with Dianne Grady Evans, daughter and niece of Howard and Herman Grady, founders of Aetna Ambulance.   

NHTSA Releases Report on EMS in Connecticut

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resources_clip_image001_0000HARTFORD — On August 17, 2013 the Department of Public Health’s Office of Emergency Medical Services (OEMS) released a report entitled “A Reassessment of Emergency Medical Services” that represents a review of recommendations made by the National Highway Transportation Safety Administration’s Technical Assistance Team. The last such review was ten years ago.

The report includes of Regulation and Policy, Resource Management, Transportation, Evaluation among other general components of the EMS system in Connecticut. The full report is informative and provides an enlightening look at EMS in Connecticut from the perspective of expert outsides. The report can be found here:

Final CT EMS Reassessment July 30 2013

The Hartford Circus Fire and Aetna Ambulance: Volume 3

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Hartford Circus Fire - Aetna Ambulance Service, Inc.

by Sam Porcello

Miss earlier volumes? Click here…

Aetna Ambulance employee and Hartford Circus Fire survivor Robert John Titus wrote to me that:

“My most poignant memory was that there was no fire engine responder on standby.  My second most poignant memory was that some people used jack knifes to make their own exits…I remember sitting and looking at the tent starting to burn and then coming down…people panicking, running and screaming, stepping over people to get out using the exits of which there were  only 3.  I remember Emmett Kelly the clown along with the Flying Wallendas helping people to get out.”

I started my research by attending a July 6, 2012 service at Hartford’s Circus Fire Memorial honoring the 68th anniversary of the fire.  There, I learned about the fire from memorial plaques and interviewed a survivor.  As I dug into newspaper articles, microfiche, secondary books, ordinances and the Circus Fire archive at the Connecticut State Library, I found many changes in local, state and National laws that were created as a result of the fire.  Something else also caught my eye – I noticed a single article from the Hartford Courant written about 20 years ago that discussed Aetna Ambulance’s history.

Check back for future volumes…

The Hartford Circus Fire and Aetna Ambulance: Volume 2

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Hartford Circus Fire 1944

by Sam Porcello

Read Volume 1 here…

In Hartford, there was just one private ambulance company at the time, Maple Hill, provided through the Talarski Funeral Home.  (Many funeral homes including Ahern on Farmington Avenue provided ambulance services in the early 1900s, since hearses were large enough for people to lay down in). Penicillin was newly available, and approximately 85% of the world’s supply was being used in the war to treat infections, including pilots’ burns.

There were several factors that contributed to the Hartford Circus Fire.  Small circus fires were actually pretty common in 1944, because more than 41% of Americans smoked.  Safety codes at the time applied mostly to buildings.  Since tents were “just” temporary structures, they did not generate a lot of attention.  Requirements for detailed safety inspections, exit widths and having fire equipment onsite did not exist for outdoor events.  With resources depleted from the war, manpower was scarce, so there were fewer Ringling employees watching inside the tent for fires.

The tent itself was waterproofed with a highly flammable mixture of paraffin and 6,000 gallons of gasoline, which accelerated the spread of the fire.  From the time the fire started until the tent was completely burned away, a total of 10 minutes elapsed.   A total of 168 people died, and another 484 were injured….(more to come, check back for future volumes).