Global & Disaster Medicine

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2017 Wildland Fires and Potential Impacts to Critical Infrastructure

2017+Wildland+Fires+and+Potential+Impacts+to+Critical+Infrastructure:  Document

2017 Wildland Fires and Potential Impacts to Critical Infrastructure – 8 June 2017, has been posted to the Office of Cyber and Infrastructure Analysis (OCIA) page on the HSIN-Critical Infrastructure (CI) portal. This new product can be found under the Recent OCIA Products section of the portal.  

Scope Note
This product provides an overview of the National Interagency Fire Center (NIFC) Predictive Services Unit’s National Significant Wildland Fire Potential Outlook for June through September 2017. It examines the potential effects to U.S. critical infrastructure and is an update to the May 2016 Office of Cyber and Infrastructure Analysis (OCIA) Wildland Fires and Potential Impacts to Critical Infrastructure infographic. This update supports U.S. Department of Homeland Security (DHS) leadership; DHS Protective Security Advisors; and other Federal, State, and local agencies.
Key Findings
  • For June through September 2017, the NIFC predicts above normal fire potential across parts of Arizona, California, Florida, Georgia, Hawaii, Nevada, and New Mexico as fine fuels (twigs, needles, and grasses that ignite and burn rapidly) become available to burn.
  • Most areas of the United States are expected to see normal significant wildland fire potential throughout the fire season. It is important to note that normal fire activity still represents significant numbers of fires and acres burned.
  • OCIA assesses the critical infrastructure sectors most vulnerable to wildland fires are Emergency Services, Food and Agriculture, Healthcare and Public Health, Transportation Systems, and Water and Wastewater Systems.
Please read the attached document for further information regarding 2017 Wildland Fires Outlook.
Current Drought Conditions
According to the NIFC, overall drought conditions improved in May 2017. Southern Georgia and Florida saw preexisting extreme drought conditions worsen while abnormally dry conditions along the Mexico border with Arizona and New Mexico developed into a moderate drought. Abnormally dry conditions were also observed across portions of central and southern Texas as well as across portions of the Alaskan interior.
Please read the attached document for more information on the effects of wildland fires on critical infrastructure.
This product was developed in coordination with the DHS/National Protection and Programs Directorate/Office of Infrastructure Protection/Sector Outreach and Programs Division, DHS/Federal Emergency Management Agency, U.S. Fire Administration, U.S. Department of the Interior/Office of Wildland Fire, and NIFC.
If you did not receive this OCIA New Product Alert directly, you can join the Critical Infrastructure Community of Interest (HSIN-CI) by sending your first and last name, your e-mail address, and your reason for requesting access to HSIN-CI to BOTH of the following addresses: and HSIN-CI members can access all of OCIA’s past products and join Sector-specific COIs.
Access to the site will require the use of your assigned HSIN-CI user name and password. Upon linking directly to the site, the user can then also navigate within HSIN-CI as well as within those Communities of Interest to which they have access.
If you need to update your HSIN password, please click here to be directed to a self-service portal.  For technical assistance, you may contact the HSIN Help Desk or toll free at (866) 430-0162.
Please take the time and fill out the NPPD Customer Feedback Survey located on the last page of the product. Please direct any additional comments you were unable to address regarding the newly posted product to OCIA
The 2017 Wildland Fires and Potential Impacts to Critical Infrastructure Report is wholly UNCLASSIFIED and is approved for the widest dissemination.
2017 Wildland Fires and Potential Impacts to Critical Infrastructure Report can be accessed via the OCIA HSIN-CI page by clicking the following link:
This and other OCIA products are visible at the following websites:
Please include feedback and suggestions using the NPPD Feedback Survey located as a second attachment compared to its usual location on the last page of the product.

A comprehensive publication presenting recommendations from the Hartford Consensus developed in response to Active Shooter events.

Compendium of Strategies to Enhance Victims’ Survivability from Mass Casualty Events

This comprehensive publication presents recommendations from the Hartford Consensus developed in response to a Presidential Policy Directive.

A compendium of expert recommendations on strengthening the security and resilience of U.S. citizens after mass casualty events was released in September 2015 as a supplement to the Bulletin of the American College of Surgeons.

The compendium, titled Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events: A Compendium, contains reports that represent the deliberations of the Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active Shooter Events.  The recommendations of this collaborative committee are called the “Hartford Consensus.”

The compendium comes in response to a Presidential Policy Directive from President Barack H. Obama, “aimed at strengthening the security and resilience of the U.S. through systematic preparation for the threats that pose the greatest risk to the security of the Nation, including acts of terrorism, cyber-attacks, pandemics, and catastrophic natural disasters.”

 Download the Compendium

Executive Summary

Increasing survival, enhancing citizen resilience
David B. Hoyt, MD, FACS
Executive Director, American College of Surgeons

This one-page article describes the process of the Hartford Consensus and summarizes its work and major principles. The leadership of Dr. Lenworth Jacobs in bringing about the Hartford Consensus is highlighted.

Letter from the Vice-President
Joseph R. Biden, Jr.
Vice-President of the United States

This letter states that the lessons learned on the battlefield to control external hemorrhage must now be applied to civilian life. It concludes that the common sense recommendations of the Hartford Consensus have the potential to equip citizens with the skills and confidence to save lives.

Presidential Policy Directive: National preparedness
Barack H. Obama
President of the United States

This directive from the President of the United States outlines national preparedness goals and the necessary processes for building and sustaining preparedness. It highlights that preparedness for the United States is a shared responsibility of all levels of government, the private and nonprofit sectors, and individual citizens. A national preparedness system is described and roles and responsibilities within the federal government are outlined.

A systematic response to mass trauma: The public, organized first responders, and the American College of Surgeons
Andrew L. Warshaw, MD, FACS, FRCSEd(Hon)
President (2014–2015), American College of Surgeons

This article summarizes the role of the American College of Surgeons in convening the Hartford Consensus and endorsing its recommendations. It describes the new, integrated response system that is needed to increase survival in active shooter and intentional mass casualty events.

Strategies to enhance survival in active shooter and intentional mass casualty events
Lenworth M. Jacobs, Jr., MD, MPH, FACS
Chairman, Hartford Consensus; Vice-President, Academic Affairs, Hartford Hospital; Member, Board of Regents, American College of Surgeons

This article describes the purpose of the compendium, Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events, as a means of assisting President Obama’s directive to strengthen the security and resilience of U.S. citizens. Topics presented in the compendium are reviewed.

Roundtable meetings

A description of the roundtable meetings at the White House in 2015 is presented. The meetings served as educational platforms of those involved in the management and care of injured victims as well as organizations at risk for active shooter or intentional mass casualty events. Attendees included physician leaders of major medical organizations, those involved in emergency response, key federal personnel, and the National Security Council staff. Lists of attendees and organizations represented are provided.

The military experience and integration with the civilian sector
Jonathan Woodson, MD, FACS
Assistant Secretary of Defense for Health Affairs, Department of Defense

This article reviews the success of the military health system in improving survival of those injured in a battle and how knowledge gained from the military can be incorporated into civilian partnerships. The integration of the military health system and the American College of Surgeons is highlighted.

The Department of Homeland Security’s role in enhancing and implementing the response to active shooter and intentional mass casualty events
Kathryn H. Brinsfield, MD, MPH, FACEP
Assistant Secretary for Health Affairs and Chief Medical Officer, Department of Homeland Security

Ernest (Ernie) Mitchell, Jr., MPA
U.S. Fire Administrator, Federal Emergency Management Agency, Department of Homeland Security

The Department of Homeland Security’s support of first responders is reviewed. The key themes in responding and managing casualties from active shooter and intentional mass casualty events are presented. These are early and aggressive hemorrhage control, the use of protective equipment by first responders, and greater response and incident management.

Initial management of mass-casualty incidents due to firearms: Improving survival
Lenworth M. Jacobs, MD, MPH, FACS; Karyl J. Burns, RN, PhD; the late Norman McSwain, MD, FACS; and Wayne Carver, MD

This article describes aspects of mass casualty firearm events that require a renewed examination of medical scene management and tactical emergency medical support. The implementation for military-like response to enhance the rapid assessment, treatment, and triage of victims is proposed.

Improving survival from active shooter events: The Hartford Consensus
The Joint Committee to Create a National Policy to Enhance Survivability from Mass Casualty Shooting Events

This is the document produced from the first Hartford Consensus meeting. The concept of THREAT (Threat suppression, Hemorrhage control, Rapid Extrication to safety, Assessment by medical providers, and Transport to definitive) highlights the critical response actions. The need for a fully integrated response is emphasized. Care of victims is identified as a shared responsibility of law enforcement, fire/rescue, and EMS.

Active shooter and intentional mass-casualty events: The Hartford Consensus II 
The Joint Committee to Create a National Policy to Enhance Survivability from Mass Casualty Shooting Events

This is the document produced from the second meeting of the Hartford Consensus. A call to action to achieve the overarching goal of the Hartford Consensus that no one should die from uncontrolled bleeding is presented. Steps that need to be enacted by the public, law enforcement, EMS/fire/rescue, and definitive care are identified.

The Hartford Consensus III: Implementation of bleeding control 
Lenworth M. Jacobs, Jr., MD, MPH, FACS, and the Joint Committee to Create a National Policy to Enhance Survivability from Intentional-Mass Casualty and Active Shooter Events

The third document of the Hartford Consensus identifies three levels of responders. These are immediate responders or civilians at the scene, professional first responders, and trauma professionals. Steps for building educational and equipment capabilities, and resources for bleeding control programs are presented.

The continuing threat of intentional mass casualty events in the U.S.: Observations of federal law enforcement
William P. Fabbri, MD, FACEP
Director, Operational Medicine, Federal Bureau of Investigation

This article reviews statistics and characteristics of active shooter incidents in the United States. It discusses law enforcement response at the national level with highlights of what the Federal Bureau of Investigation has done to be prepared and to prepare police across country for active shooter events.

Public health education: The use of unique strategies to educate the public in the principles of the Hartford Consensus
Richard H. Carmona, MD, MPH, FACS
17th Surgeon General of the United States

This article focuses on what is needed to educate the public to be immediate responders to all-hazards threats. Retention of perishable skills, competency, and certification issues are discussed as is the need for developing health-literate and culturally competent content for an immediate responder curriculum.

The continuing threat of active shooter and intentional mass casualty events: Local law enforcement and hemorrhage control
Alexander L. Eastman, MD, MPH, FACS 
Major Cities Chiefs Police Association

This article presents hemorrhage control as a law enforcement responsibility and describes the progress that has been made to train and equip police officers across the country for hemorrhage control. The role of the Major Cities Chiefs Association in adopting the principles of the Hartford Consensus is discussed. An example of a local law enforcement response to an attempted mass casualty event is reviewed.

Military history of increasing survival: The U.S. military experience with tourniquets and hemostatic dressings in the Afghanistan and Iraq conflicts 
Frank K. Butler, MD, FAAO, FUHM
Chairman, Committee on Tactical Combat Casualty Care, Department of Defense, Joint Trauma Systems

The resurgence of tourniquet use in the U.S. military that originated from the Tactical Combat Casualty Care program is discussed as are the specific events that contributed to the expanded use of tourniquets in the military. Statistics regarding the decrease in preventable battlefield deaths in the from extremity hemorrhage are presented. The use of hemostatic dressings in the military is reviewed.

Hemorrhage control devices: Tourniquets and hemostatic dressings
John B. Holcomb, MD, FACS; Frank K. Butler, MD, FAAO, FUHM; and Peter Rhee, MD, MPH, FACS, FCCM
Committee on Tactical Combat Casualty Care, Department of Defense, Joint Trauma Systems

This article draws from the military’s experience with tourniquet use to describe what type of trauma victims are appropriate for tourniquet use in a civilian setting. Teaching points about tourniquets are presented as are common mistakes regarding their use. The role of the Committee on Tactical Combat Casualty Care in recommending tourniquets and hemostatic dressings is reviewed.

Intentional mass casualty events: Implications for prehospital emergency medical services systems
Matthew J. Levy, DO, MSc, FACEP
Senior Medical Officer, Johns Hopkins Center for Law Enforcement Medicine

This article describes what changes are needed in the prehospital emergency response to increase survival due to hemorrhage from active shooter and intentional mass casualty events. The necessary education, training, equipment, partnerships, and pre-planning are discussed.

Role of the American College of Surgeons Committee on Trauma in the care of the injured
Leonard J. Weireter, MD, FACS, and Ronald M. Stewart, MD, FACS
Vice-Chair and Chair, respectively, American College of Surgeons Committee on Trauma

The history of the American College of Surgeons Committee on Trauma (COT) is reviewed as are its major functions. It is suggested that the COT, through its educational programs, can expand its outreach to teach bleeding control to anyone who might be in a position to stop bleeding. This is virtually everyone.

Integrated education of all responders
(the late) Norman E. McSwain, MD, FACS
Medical Director, Prehospital Trauma Life Support

This article describes resources available to meet the recommendation of the Hartford Consensus, calling for multidisciplinary education. It emphasizes that for integrated emergency responses, all potential responders should train and drill together. The specific education needs of the public, law enforcement, EMS/fire/rescue, and definitive care are presented. Courses offered that teach hemorrhage control are presented and described.

Implementation of the Hartford Consensus initiative to increase survival from active shooter and intentional mass casualty events and to enhance the resilience of citizens
Lenworth M. Jacobs, MD, MPH, FACS
Chairman, Hartford Consensus; Vice-President, Academic Affairs, Hartford Hospital; Member, Board of Regents, American College of Surgeons

This article calls for response systems that can be effective 24 hours a day, seven days a week in any locale at any level. To develop such systems it is critical to identify the organizations and government entities that are responsible for ensuring that a plan can be executed immediately. Strategies used to achieve the recommendations of the Hartford Consensus by Hartford Hospital, the City of Hartford, the metropolitan region of Greater Hartford, and the State of Connecticut are discussed.

Tsunami evacuation buildings (TEBs): Indonesia preparing for the next tsunami

TEBs: Document

Tsunami evacuation buildings and evacuation planning in Banda Aceh, Indonesia

Hendri Yuzal, MURP, Karl Kim, PhD, Pradip Pant, PhD, Eric Yamashita, MURP
Journal of Emergency Management


Indonesia, a country of more than 17,000 islands, is exposed to many hazards. A magnitude 9.1 earthquake struck off the coast of Sumatra, Indonesia, on December 26, 2004. It triggered a series of tsunami waves that spread across the Indian Ocean causing damage in 11 countries. Banda Aceh, the capital city of Aceh Province, was among the most damaged. More than 31,000 people were killed. At the time, there were no early warning systems nor evacuation buildings that could provide safe refuge for residents. Since then, four tsunami evacuation buildings (TEBs) have been constructed in the Meuraxa subdistrict of Banda Aceh. Based on analysis of evacuation routes and travel times, the capacity of existing TEBs is examined. Existing TEBs would not be able to shelter all of the at-risk population. In this study, additional buildings and locations for TEBs are proposed and residents are assigned to the closest TEBs. While TEBs may be part of a larger system of tsunami mitigation efforts, other strategies and approaches need to be considered. In addition to TEBs, robust detection, warning and alert systems, land use planning, training, exercises, and other preparedness strategies are essential to tsunami risk reduction.

Stockpiling Ventilators for Influenza Pandemics


Commentary:  VentStockpilingCommentary-EID-June_2017


Emerging Infectious Diseases • • Vol. 23, No. 6, June 2017

“Diligent preparation and effective countermeasures are critical to mitigating future influenza pandemics. The 1918 influenza pandemic, the most severe in recent history, resulted in ≈50 million deaths globally, of which nearly 675,000 occurred in the United States (1). The 1957 and 2009 pandemics were less severe, causing ≈70,000 and 9,000–18,000 US deaths, respectively (1).

US Department of Health and Human Services (HHS) estimated that 865,000 US residents would be hospitalized during a moderate pandemic (as in 1957 and 1968) and 9.9 million during a severe pandemic (as in 1918).

When severe influenza outbreaks cause high rates of hospitalization, a surge of medical resources is required, including critical care supplies, antiviral medications, and personal protection equipment. Given uncertainty in the timing and severity of the next pandemic, as well as the time required to manufacture medical countermeasures, stockpiling is central to influenza preparedness (3). However, difficulty in forecasting and limited public health budgets often constrain decisions about sizes, locations, and deployment of such stockpiles. Mechanical ventilators are essential for treating influenza patients in severe acute respiratory failure. Substantial concern exists that intensive care units (ICUs) might have insufficient resources to treat all persons requiring ventilator support. Prior studies argue that current capacities are insufficient to handle even moderately severe pandemics and that sentinel reporting and model-based decision-making are critical for managing limited resources (4–6). For this reason, the United States has stockpiled mechanical ventilators in strategically located warehouses for use in public health emergencies, such as an influenza pandemic. The Centers for Disease Control and Prevention (CDC) manages this Strategic National Stockpile (SNS) and has plans for rapid deployment to states during critical events (7).

However, SNS ventilators might not suffice to meet demand during a severe public health emergency. In 2002, the SNS included ≈4,400 ventilators (8,9), and 4,500 SNS ventilators were added during 2009 and 2010. The American Association for Respiratory Care suggested the SNS inventory should increase to at least 11,000–16,000 ventilators in preparation for a severe influenza pandemic (10). The American Association for Respiratory Care and CDC (11) provide training on 3 types of SNS ventilators—LP10 (Covidien, Boulder, CO, USA); LTV1200 (CareFusion, Yorba Linda, CA, USA); and Uni-vent Eagle 754 (Impact Instrumentation, Inc., West Caldwell, NJ, USA)—to ensure proper use nationwide. In addition to the nationally held SNS, some US states maintain their own stockpiles. Successful deployment of central ventilator stockpiles, whether federal or state, requires rapid distribution to healthcare facilities with patients in need, along with adequate bed space, requisite supplies, and trained personnel Robust methods for sizing and locating ventilator stockpiles have not yet been developed (15). Wilgis (16) discussed the relative merits of central stockpiling of ventilators to be distributed during an emergency versus distributing ventilators to hospitals a priori. Centralized stockpiles benefit from better inventory tracking, more timely repairs, and superior allocation of a limited resource, but hospital-based supplies facilitate staff training, enable immediate use, and avoid the cost and logistical challenges of central storage and deployment. …..”


How the Paris medical community responded so quickly and effectively to the 2015 terror attacks

MedResponse-ParisTerror: Document

MedPage Today

Famine: South Sudan

Famine-SouthSudan_Lancet-2017: Document (   Vol 389   May 20, 2017)

“South Sudan, together with Yemen, Somalia, and Nigeria pose what the UN calls the biggest humanitarian crisis since 1945 as millions flee conflict and drought…”


NYC’s Unified Victim Identification System (UVIS)


Unified Victim Identification System (UVIS) document:  UVIS Information Guide-NYC

“…..In concert with the City’s 311-call center, UVIS enables a centralized communications and data collection processes to support the family assistance center (FAC). This coordinated system is essential to developing an accurate manifest of potential victims – a critical step in victim identification. Most importantly, the coordinated UVIS-311 call center system keeps the lines of communication open to the families, friends and associates of possible victims.  Such a resource is invaluable in the chaos that follows any tragic event…..

UVIS is designed to handle multiple types of scenarios, and can manage up to 156 simultaneous events if needed.  For example a terrorist operation may target different discrete areas of a large city (multiple incidents), as was the case on July 7th 2005 when a series of coordinated bomb blasts hit London’s public transport system during the morning rush hour resulting in more that 121,000 call center reports.

Most importantly, UVIS enables the OCME to meet its primary objectives following a catastrophic incident.  They include:

• Investigate, Recover & Process Decedents in a Dignified and Respectful Manner

• Accurately Determine Cause & Manner of Death

• Perform Accurate & Efficient Identification of Victims

• Provide Families with Factual & Timely Information in a Compassionate Manner

• Conduct Rapid Return of Victims to their Legal Next of Kin ……..”

Helping hands across a war-torn border: the Israeli medical effort treating casualties of the Syrian Civil War


TreatingSyrianWarCasualties: Published article in Lancet

Tourism vs. Child Protection: A Compilation of Good Practices

15 Years of the UNWTO World Tourism Network on Child Protection: A Compilation of Good Practices

Copyright © 2014, World Tourism Organization (UNWTO)
15 Years of the UNWTO World Tourism Network on Child Protection: A Compilation of Good Practices
Published by the World Tourism Organization (UNWTO) First printing: February 2014 All rights reserved.


4th case of Yellow Fever reported in Europeans who had recently traveled to South America in the past 8 months.

Yellow Fever in Europe

A travel-associated case of yellow fever has been reported by the Netherlands in March 2017 after travel to Suriname. During the past eight months, four travel-associated cases of yellow fever have been identified among EU travellers returning from South America. This represents a significant increase on four travel-associated cases of yellow fever among EU travellers during the last 27 years (1999 to July 2016).

Brazil has been experiencing a yellow fever outbreak since January 2017 and travel recommendations have been updated accordingly [1,2]. Therefore, EU travellers travelling to areas at risk of yellow fever in South America should be informed of the potential exposure to yellow fever virus and an individual risk benefit analysis should be conducted during pre-travel medical consultation. The ongoing yellow fever outbreak in Brazil should be carefully monitored, as the establishment of an urban cycle of yellow fever would have the potential to rapidly affect a significant number of people. The risk of introduction and further transmission of the yellow fever virus in the EU is currently considered very low.

Advice to travellers EU citizens who travel to, or live in areas where there is evidence of periodic or persistent yellow fever virus transmission, especially those in outbreak-affected regions, are advised to:

• Be aware of the risk of yellow fever in endemic areas throughout South America, including recently affected States in Brazil. WHO publishes a list of countries, territories and areas with yellow fever vaccination requirements and recommendations [1-3].

• Check vaccination status and get vaccinated if necessary. Vaccination against yellow fever is recommended from nine months of age for people visiting or living in yellow fever risk areas. An individual risk benefit analysis should be conducted prior to vaccination, taking into account the period, destination, duration of travel and the likelihood of exposure to mosquitoes (e.g. rural areas, forests) as  well as individual risk factors for adverse events following yellow fever vaccination.

• Take measures to prevent mosquito bites indoors and outdoors, especially between sunrise and sunset when Aedes and sylvatic yellow fever mosquito vectors are most active [4]. These measures include: − the use of mosquito repellent in accordance with the instructions indicated on the product label; − wearing long-sleeved shirts and long trousers; − sleeping or resting in screened/air-conditioned rooms, or using mosquito nets at night and during the day.

Advice to health professionals: Physicians, health professionals and travel health clinics should be provided with or have access to regularly updated information about areas with ongoing yellow fever transmission and should consider yellow fever in the differential diagnoses for illnesses in relation to travellers returning from affected areas.  To reduce the risk of adverse events following immunisation, healthcare practitioners should be aware of contraindications and comply with the manufacturers’ precautionary advice before administering yellow fever vaccine [5].

	Map: South America showing areas at risk for Yellow Fever Transmision in Columbia, Venezuela, Guyana, Suriname, French Guiana, Brazil, Paraguay, and parts of Ecuador, Peru, Bolivia, Argentina, and Uruguay


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