Global & Disaster Medicine

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Global causes of blindness and distance vision impairment: 1990–2020

The Lancet

Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis
Flaxman, Seth RBourne, Rupert et al.
The Lancet Global Health

“…..Among the global population with moderate or severe vision impairment in 2015 (216·6 million [80% uncertainty interval 98·5 million to 359·1 million]), the leading causes were uncorrected refractive error (116·3 million [49·4 million to 202·1 million]), cataract (52·6 million [18·2 million to 109·6 million]), age-related macular degeneration (8·4 million [0·9 million to 29·5 million]), glaucoma (4·0 million [0·6 million to 13·3 million]), and diabetic retinopathy (2·6 million [0·2 million to 9·9 million])…..”

“….Among the global population who were blind in 2015 (36·0 million [12·9 million to 65·4 million]), the leading causes were cataract (12·6 million [3·4 million to 28·7 million]), uncorrected refractive error (7·4 million [2·4 million to 14·8 million]), and glaucoma (2·9 million [0·4 million to 9·9 million])…..”

Interpretation:  “….The number of people affected by the common causes of vision loss has increased substantially as the population increases and ages. Preventable vision loss due to cataract (reversible with surgery) and refractive error (reversible with spectacle correction) continue to cause most cases of blindness and moderate or severe vision impairment in adults aged 50 years and older. ….”

 


Somalia: Two truck bombs in Mogadishu killed at least 189 people

Washington Post

 


Summary of FEMA’s Response to Hurricane Maria

FEMA

Overview of Federal Efforts to Prepare for and Respond to Hurricane Maria

(Español) On August 25, 2017, FEMA’s National Response Coordination Center (NRCC) was fully activated to a Level I with all emergency support functions operational, including Department of Defense (DoD) liaisons in preparation for Hurricane Harvey. The NRCC remains at a Level I activation. Prior to the arrival of Hurricane Maria, federal personnel were already positioned on Puerto Rico and the U.S. Virgin Islands in response to Hurricane Irma.These personnel included federal coordinating officers and Incident Management Assistance Teams (IMATs) on both the U.S. Virgin Islands and Puerto Rico, and staff from FEMA’s Caribbean Area Division.  Additional resources and personnel were strategically located out of the storm’s path, including ships from the Department of Defense. After the hurricane passed, those additional federal resources and personnel recommenced flowing in, as part of a unified federal response. The below is a summary of mobilization of resources and personnel:

Sunday, September 17 – Pre-Landfall

  • FEMA’s National Response Coordination Center (NRCC) remains fully activated with all emergency support functions operational, including Department of Defense (DoD) liaisons.FEMA holds daily video-teleconference with leadership across various departments and agencies.
  • FEMA has a Federal Coordinating Officer (FCO) and Incident Management Assistance Team (IMAT) co-located with the Governor on St. Croix, as well as liaisons on St. John and St. Thomas that will remain in place throughout the storm’s potential landfall.
  • FEMA has an FCO and Incident Management Assistance Team co-located with key staff from the Caribbean Area Division at the FEMA Distribution Center in Puerto Rico, who will remain in place throughout the storm’s potential landfall.
  • DoD Civil Authority Information Support(CAIS) element assisting with communication and outreach support to communities in the U.S. Virgin Islands.
  • The U.S. Army Area Support Medical Company and the U.S. Air Force Ground Surgical Team operating in St. Thomas are sheltering aboard the amphibious ship USS Kearsarge and will return to U.S. Virgin Islands after Hurricane Maria passes.
  • The Department of Transportation, through the Federal Aviation Administration (FAA), is working on the relocation and protection of the mobile air traffic control tower at St. Thomas airport ahead of the storm.
  • The U.S. Geological Survey (USGS) is prepositioning assets in Puerto Rico, including storm surge and rapid deployment gauges, to support water-level measurements and flood forecasting.
  • FEMA temporarily repositions the remainder of the federal employees in the U.S. Virgin Islands in order to resume operations as quickly as possible, while also freeing shelter resources for island residents.
  • , including U.S. Army Corps of Engineers (USACE), personnel deployed to support Hurricane Irma response efforts will ride out the storm on the USS Kearsarge just off the coast of the islands. They will be ready to continue existing operations as soon as the storm passes.

Monday, September 18 – Pre-Landfall

  • FEMA’s NRCC is fully activated with all emergency support functions operational.FEMA holds daily video-teleconference with leadership across various departments and agencies.
  • President Donald J. Trump issues federal emergency declarations for the Territory of the U.S. Virgin Islands and the Commonwealth of Puerto Rico in advance of Hurricane Maria’s landfall.
  • FEMA and federal personnel remain co-located with the Governor on St. Croix, as well as liaisons on St. John and St. Thomas that will remain in place.  FEMA and federal personnel also remain in place and in close coordination with the Governor of Puerto Rico.
  • Two Type 1 FEMA Urban Search and Rescue (US&R) teams, two canine teams, one logistics package, and one Type 4 US&R team in Puerto Rico.
  • FEMA’s efforts in the U.S. Virgin Islands include an increased push of commodities over the last several days to Virgin Islands Territorial Emergency Management Agency (VITEMA) points of distribution to ensure residents have extra food, water, and supplies ahead of the storm.
  • U.S. Virgin Islands has six open shelters, with additional shelters scheduled to open prior to the storm’s potential landfall.

Tuesday, September 19 – Storm Approaches Landfall in U.S. Virgin Islands

  • FEMA’s NRCC is fully activated with all emergency support functions operational.  FEMA holds daily video-teleconference with leadership across various departments and agencies.
  • FEMA and federal personnel remain co-located with the Governor on St. Croix, as well as liaisons on St. John and St. Thomas that will remain in place.  FEMA and federal personnel also remain in place and in close coordination with the Governor of Puerto Rico.
  • One Type 4 FEMA US&R team and one canine team to arrive in Puerto Rico.
  • The Department of Health and Human Services (HHS) deploys one Disaster Medical Assistance Team to Puerto Rico.

Wednesday, September 20 – Storm Makes Landfall in Puerto Rico

  • FEMA’s NRCC is fully activated with all emergency support functions operational.  FEMA holds daily video-teleconference with leadership across various departments and agencies.
  • President Donald J. Trump issues major disaster declarations for the U.S. Virgin Islands and the Commonwealth of Puerto Rico.
  • FEMA and federal personnel remain co-located with the Governor on St. Croix, as well as liaisons on St. John and St. Thomas that will remain in place.  FEMA and federal personnel also remain in place and in close coordination with the Governor of Puerto Rico.
  • HHS activates National Disaster Medical System Definitive Care Reimbursement Program, which reimburses medical facilities and hospitals for the medical care costs of patients medically evacuated following disasters.
  • Bureau of Alcohol, Tobacco, and Firearms is coordinating airlift and deployment of four Quick Response Teams to San Juan post landfall to conduct forecasted security measures.

Thursday, September 21 – Post-Landfall

  • FEMA’s NRCC is fully activated with all emergency support functions operational.  FEMA holds daily video-teleconference with leadership across various departments and agencies.
  • There are more than 3,500 federal staff on the ground in Puerto Rico and U.S. Virgin Islands supporting response and recovery operations from Hurricanes Maria and Irma.
  • Two FEMA US&R task forces and support resources are in Puerto Rico conducting reconnaissance and search and rescue. An additional team is on St. Croix conducting search and rescue and reconnaissance.
  • Commodities in FEMA’s Puerto Rico Distribution Center include more than 274,000 meals, 25 generators, and more than 500 cots.
  • USACE completes a Blue Roof install on Cyril E. King Airport on St. Thomas. Additionally, USACE has 27 generators on hand in St. Thomas with additional commodities to be delivered when conditions permit.
  • HHS declares a public health emergency in Puerto Rico and the U.S. Virgin Islands. Four additional DMATs will arrive in Puerto Rico on September 22.
  • Vessels are loaded for U.S. Virgin Islands with 1.3million meals, 2 million liters water, 30 generators, 6,000 cots.
  • There are six U.S. Navy helicopters stationed and three Marine Osprey aircraft in the Caribbean.
  • More than 700 National Guard are mobilized to Puerto Rico and more than 900 National Guard are mobilized to the U.S. Virgin Islands.
  • Western Area Power Administration, in coordination with Department of Energy, deploys an eight-member advance team in Puerto Rico.
  • Department of Interior Office of Law Enforcement has 50 personnel in Puerto Rico.
  • Air support (MH-60s) and other assets from the amphibious ships USS Kearsage and USS Oak Hill  begin performing search and rescue flights and aerial damage assessments over U.S. Virgin Islands and Puerto Rico, and assist with restoration of damaged airfields.

Friday, September 22

  • FEMA’s NRCC is fully activated with all emergency support functions operational.  FEMA holds daily video-teleconference with leadership across various departments and agencies.
  • There are more than 7,000 federal staff, including 280 FEMA staff, on the ground in Puerto Rico and U.S. Virgin Islands supporting response and recovery operations from Hurricanes Maria and Irma.
  • Four FEMA US&R teams and support resources are in Puerto Rico, and one US&R team is in U.S. Virgin Islands conducting reconnaissance and search and rescue. These task forces assist in the rescue of 65 individuals, searching 45 buildings. The U.S. Coast Guard (USCG) is conducting search and rescue operations in St. Croix, and in the surrounding waters.
  • National Guard Bureau (NGB) has 1,600 service members in the U.S. Virgin Islands and Puerto Rico.
  • Vessels loaded with commodities are arriving or awaiting port opening and clearance with an air bridge to deliver commodities to Puerto Rico and the U.S. Virgin Islands.
  • More than 70 Federal Law Enforcement Officers are in San Juan supporting search and rescue and medical teams. Three ATF Quick Response Teams (QRT) are arriving to join the four QRTs operating in San Juan.
  • USACE and other supporting agencies have completed several temporary power installs on Puerto Rico and the U.S. Virgin Islands, and completed nearly 100 inspections. Additional generator support is en route. USACE has 120 responders in Puerto Rico and the U.S. Virgin Islands.
  • The General Services Administration (GSA) is assessing 80 leased/owned properties.
  • USS Kearsarge/26th Expeditionary Unit Amphibious Ready Group (MEU ARG) aircraft including helicopters and MV-22s, continue damage assessments over the U.S. Virgin Islands and Puerto Rico, and complete patient evacuation movements from St. Croix to nearby facilities.

Saturday, September 23

  • FEMA’s NRCC is fully activated with all emergency support functions operational.FEMA holds daily video-teleconference with leadership across various departments and agencies.
  • The Department of Transportation announces three airports are open for military and relief flights in Puerto Rico and two airports open for military and relief flights in the U.S. Virgin Islands.One port is open with restrictions in Puerto Rico and five ports are open with restrictions in the U.S. Virgin Islands.
  • Support for federal response continues from the amphibious ships USS Kearsage and USS Oak Hill including search and rescue flights, aerial damage assessments, logistics support and route clearance for U.S. Virgin Islands and Puerto Rico.
  • There are six commercial barges transporting meals, water, generators, cots and other commodities to Puerto Rico and U.S. Virgin Islands.
  • The SS Wright is carrying 1.1 million meals and one million liters of water to the islands.
  • The Defense Logistics Agency (DLA) is transporting 124,000 gallons of diesel fuel to Puerto Rico, with arrival anticipated in the coming days.
  • There are 180 American Red Cross volunteers and staff in the Caribbean.

Sunday, September 24

  • FEMA’s NRCC is fully activated with all emergency support functions operational.  FEMA holds daily video-teleconference with leadership across various departments and agencies.
  • Federal partners establish a fuel distribution site in San Juan for federal and local entities to support first responder and critical facility needs.
  • The port of San Juan re-opened for daylight operations and other ports are undergoing assessments.  On St. Thomas, the ports of Crown Bay, Cruz Bay, East Gregerie Channel, Red Hook, and West Gregerie Channel are open with restrictions while other ports are being assessed.  On St. Croix, the ports of Krause Lagoon and Limetree Bay are open with restrictions while other ports are being assessed.
  • The Department of Energy is coordinating with industry on mutual aid for Puerto Rico, and transported crews from New York Power Authority to support damage assessments.
  • Eight FEMA US&R task forces are stationed in the Caribbean.
  • At the federal staging area in St. Croix, there are more than 43,000 liters of water and more than 20,000 meals available for distribution by territory officials.
  • USACE and the National Oceanic and Atmospheric Administration (NOAA) continue to survey damaged channels and ports in Puerto Rico.
  • DoD CAISE re-inserted into the U.S. Virgin Islands to assist with communication and outreach support and DoD Area Support Medical Company re-inserted to U.S. Virgin Islands to assist with medical support needs.
  • DoD assets from amphibious ships USS Kearsage and USS Oak Hill continue support for search and rescue flights, medical evacuation, aerial damage assessments, logistics support, port surveys and route clearance for U.S. Virgin Islands and Puerto Rico.

Monday, September 25

  • FEMA’s NRCC is fully activated with all emergency support functions operational.  FEMA holds daily video-teleconference with leadership across various departments and agencies.
  • There are more than 10,000 federal staff, including more than 700 FEMA personnel, on the ground in Puerto Rico and U.S. Virgin Islands supporting response and recovery operations from Hurricanes Maria and Irma.
  • Nine FEMA US&R task forces are stationed and conducting operations in the Caribbean. FEMA US&R task forces saved or assisted 516 individuals. The U.S. Coast Guard (USCG) is conducting search and rescue operations in St. Croix, and in the surrounding waters.
  • Officials in the U.S. Virgin Islands and Puerto Rico establish points of distribution for survivors to get meals, water, and other commodities. The National Guard supports commodity distribution.
  • Power is restored to Centro Medico Hospital in San Juan and San Pablo Hospital in Bayamon, Puerto Rico.
  • Fuel arrives for several hospitals in Puerto Rico running on generators: Ashford Presbyterian, Pavia Santurce, Pavia Hato Rey, San Francisco, and Clinica Metro Pavia. The Schneider Regional Medical Center mobile hospital in St. Thomas was re-established.
  • DLAU.S. Northern Command, the U.S. Navy, and USCG, in coordination with the private sector, provide federal support for fuel transportation via air and sea logistical support.
  • FEMA, working in coordination with federal partners, provide more than 1.5 million meals, 1.1 million liters of water to the U.S. Virgin Islands and Puerto Rico since Hurricane Maria’s landfall.
  • HHS and DoD conduct medical evacuations for more than 100 patients from the islands to the continental United States. Medical evacuations from the islands will continue. Additionally HHS medical teams are on the ground in Puerto Rico and the U.S. Virgin Islands.
  • NGB has more than 4,300 Guard members on the ground in Puerto Rico and the U.S. Virgin Islands taking part in security and support operations. The Air National Guard is focused on transporting food, water, and communications capabilities as well as rapidly increasing airlift into affected areas.
  • Coast Guard mobile communications convoy is en route to Puerto Rico to help improve communications across the storm-impacted area. Coast Guard personnel continue to deliver critical FEMA relief supplies to Puerto Rico and the U.S. Virgin Islands.
  • DoD assets from the USS Kearsage and USS Oak Hill continue support for response efforts including search and rescue flights, medical evacuation, aerial damage assessments, logistics support, commodity lifts, port surveys, and hospital assessments with HHS for U.S. Virgin Islands and Puerto Rico.

Tuesday, September 26

  • FEMA’s NRCC is fully activated with all emergency support functions operational.  FEMA holds daily video-teleconference with leadership across various departments and agencies.
  • FEMA is delivering food and water to points of distribution and regional staging areas in Puerto Rico, St. Thomas, St. Croix, and St. John.
  • American Red Cross (ARC) mobilizes to Puerto Rico 9,000 comfort kits and several thousand of tarps, flashlights, batteries, blankets, and hand sanitizer. To U.S. Virgin Islands, ARC will also send tens of thousands of bags of rice and beans with cots, blankets, comfort kits, tarps, trash bags, sponges, hand sanitizer, and insect repellent.
  • Corporation for National and Community Service deploys two AmeriCorps to Puerto Rico and four Disaster response teams for Save the Children support.
  • Ten FEMA US&R task forces are stationed and conducting operations in Puerto Rico. FEMA US&R task forces have saved or assisted 557 individuals and five pets, while searching over 2,600 structures.
  • There are currently 32 points of distribution for commodities in Puerto Rico and U.S. Virgin Islands.
  • More than 180 Federal Law Enforcement Officers are in San Juan and the U.S. Virgin Islands supporting search and rescue, medical teams, and other federal responders.
  • In support of Hurricane Maria relief and reconstitution operations, the U.S. Government established temporary air traffic flow management procedures for flights into San Juan International Airport in Puerto Rico. Roosevelt Roads and Aguadilla Airports in Puerto Rico are open for military and relief flights during daylight.
  • Federal Aviation Administration (FAA) operations personnel are onsite in St. Thomas to evaluate, fix, and install FAA equipment, in support of air traffic control operations.
  • USCG identifies eight ports with some restrictions in Puerto Rico, and nine open in U.S. Virgin Islands with restrictions. USCG reports the ports of Guayanilla, Salinas, and Tallaboa are fully open, and the ports of San Juan, Fajardo, Culebra, Guayama, and Vieques are open with restrictions in Puerto Rico. The ports of Crown Bay, Charlotte Amalie, East Gregerie Channel, West Gregerie Channel, and Redhook Bay on St. Thomas, the ports of Krause Lagoon, Limetree Bay, and Frederiksted on St. Croix, and the port of Cruz Bay on St. John are open with restrictions. Other ports are undergoing assessments.
  • 14 DoD flights arrived September 25 to deliver water and meals, helicopters, communications equipment, additional security forces, and communications and contingency response units for Puerto Rico and the U.S. Virgin Islands.
  • USACE coordinates transportation of more than 300 FEMA or DLA generators from across the U.S. to meet anticipated requirements in the islands. In Puerto Rico, the team completes 27 of 32 requested temporary power assessments of critical facilities. In the U.S. Virgin Islands, USACE completed 90 of 131 requested temporary power assessments of critical facilities and began generator installations.
  • DoD assets from the USS Kearsage and USS Oak Hill continue support for response efforts including logistics support, route clearance, port restoration, and hospital assessments with HHS for U.S. Virgin Islands and Puerto Rico.

Wednesday, September 27

  • FEMA’s NRCC is fully activated with all emergency support functions operational.  FEMA holds daily video-teleconference with leadership across various departments and agencies.
  • DoD expands its response, and sustainment forces to augment those already on the ground to support the Commonwealth of Puerto Rico and FEMA.
  • FEMA and its federal partners continue 24-hour operations to reach inaccessible areas of Puerto Rico to reach survivors, provide fuel to hospitals, and re-open.
  • FEMA US&R task forces have saved or assisted 841 individuals and five pets, while searching over 2,600 structures. FEMA US&R is also conducting operational assessments of hospitals in Puerto Rico.
  • U.S. Customs and Border Protection has ten members providing security to two FEMA ships.
  • DoD CAIS is assisting with communication and outreach support to communities in Puerto Rico.
  • Half of the dialysis centers in Puerto Rico are open and accessible for patients.
  • USACE is conducting assessments and planning for power grid restoration in Puerto Rico, and addressing the 1.4 million cubic yards of debris across the U.S. Virgin Islands.
  • In Puerto Rico, fuel is delivered to 19 hospitals for power generators. Fuel continues to be delivered to hospitals and other locations around Puerto Rico.
  • The U.S. Virgin Islands Water and Power Authority drinking water system is back online, and other drinking water systems on the islands are top priority for receiving generators.
  • 17 chainsaw teams (34 individuals) and one Incident Management Team (IMT) (23 individuals) from the Department of Agriculture United States Forest Service arrive in Puerto Rico to conduct emergency road clearance and manage logistics.
  • To bolster the delivery of fuel throughout Puerto Rico, 100 delivery trucks were dispatched by the DLA.

Thursday, September 28

  • FEMA’s NRCC is fully activated with all emergency support functions operational.FEMA holds daily video-teleconference with leadership across various departments and agencies.
  • FAA reports Luis Munoz Marin International Airport (SJU) accommodated 25 commercial flights and processed 5,000 ticketed passengers.
  • Two generators are installed at Concordia Fresh Water Pump Station and the Herbert Grigg Shelter.
  • Recovery efforts are now supporting more than a dozen commercial passenger flights per day at SJU in San Juan, Puerto Rico.
  • The Concordia potable water pump station is online in St. Croix.
  • FEMA search and rescue teams have accessed 90 percent of Puerto Rico, conducting search and rescue operations and helping to assess hospitals.
  • All municipalities in Puerto Rico have been reached by FEMA US&R, the Department of Health and Human Services, Commonwealth officials, and/or the National Guard.
  • Additional National Disaster Medical System staff arrive to support hospital assessments and medical needs of these in Puerto Rico.

Friday, September 29

  • FEMA’s NRCC is fully activated with all emergency support functions operational.FEMA holds daily video-teleconference with leadership across various departments and agencies.
  • There are more than 10,000 federal staff representing 36 departments and agencies, including more than 800 FEMA personnel on the ground in Puerto Rico and the U.S. Virgin Islands engaged in response and recovery operations from hurricanes Maria and Irma.
  • The Federal Highway Administration (FHWA) made $40 million available to the PR Highways and Transportation Authority (PHRTA) for emergency relief work to impacted roads.
  • In Puerto Rico, 56 of 68 hospitals are partially operational, and one hospital is fully operational.
  • FAA reports SJU begins international commercial service with two flights.
  • The U.S. Postal Service (USPS) has limited handout mail service available today at 49 locations in Puerto Rico, which represents 43 percent of all post offices on the island. 41 of these locations are also able to provide postal retail services. Limited handout mail service, along with limited retail service, begins today in St. Croix. Limited mail service continues in St. Thomas. On St. John, limited mail service continues with no retail services available.

Saturday, September 30, 2017

  • USACE and other supporting agencies are completing several temporary power installs on Puerto Rico and the U.S. Virgin Islands and completed more than 160 inspections and more than 250 assessments have been requested for facilities.
  • Seven U.S. Northern Command vessels are scheduled to arrive in Puerto Rico between September 30 and Oct. 5 delivering 3.5 million liters of water, 5.5 million meals, four generators and 11,500 rolls of sheeting.
  • ARC has more than 600 volunteers on the ground in Puerto Rico and U.S. Virgin Islands distributing ready-to-eat meals and water.
  • HHS medical teams have seen more than 245 patients at the emergency and trauma center in San Juan, Puerto Rico.

Sunday, October 1, 2017

  • U.S. Northern Command is conducting 11 flights to transport approximately 310,000 meals, 150,000 liters of water, generators, tarps, additional sustainment units, and leading components of aviation command and control.
  • ARC is distributing more than 34,000 relief items to survivors in U.S. Virgin Islands and Puerto Rico, such as comfort kits, clean up kits and other bulk items, and has provided more than 2,800 mental health and health services to people in need.
  • NGB is conducting a mission to deliver 2,000 gallons of diesel fuel to San Juan Capestrano Hospital to continue providing care to patients. NGB has also provided 22 personnel to assist local police department to secure gas stations. Over 4,000 NGB service members from 21 states are now supporting Puerto Rico and the U.S. Virgin Islands.
  • HHS medical teams are providing support at medical facilities in Puerto Rico that are partially operational. HHS medical personnel have seen more than 200 patients at these new locations and at Centro Medico, an emergency and trauma center in San Juan where HHS staff have been providing medical support for the past six days. HHS is deploying five Federal Medical Stations which can be used to support medical services at hospitals.
  • HHSDoD, and Veteran Affairs partners are transporting almost 100 dialysis patients to Atlanta, today. These patients had been evacuated from St. Thomas to Miami after Hurricane Irma.
  • EPA is continuing to coordinate with the U.S. Virgin Island government on results of drinking water sampling and to ensure disinfection measures are taken where needed. EPA now has 28 personnel on site in the U.S. Virgin Island. In St. Croix, EPA personnel have sampled 59 public drinking water systems for contamination. EPA continues to disinfect the water sources but there are continuing concerns about running out of bleach.
  • The National Protection and Programs Directorate (NPPD) reported as of Sept. 30, that 13 percent of Puerto Rico and 30 percent of U.S. Virgin Islands cell sites are operational. Communications carriers on Puerto Rico are coordinating efforts to keep those cell sites and towers on-line. ESF-2 (Communications) is delivering 100 satellite phones to support essential response personnel supporting communications restoration efforts.
  • U.S. Northern Command conducted 11 flights to transport approximately 310,000 meals, 150,000 liters of water, generators, tarps, additional sustainment units, and leading components of aviation command and control.
  • ARC is distributing more than 34,000 relief items to survivors in the U.S. Virgin Islands and Puerto Rico, such as comfort kits, clean up kits and other bulk items, and has provided more than 2,800 mental health and health services to people in need.
  • NGB is conducting a mission to deliver 2,000 gallons of diesel fuel to San Juan Capestrano Hospital to continue providing care to patients. NGB also provided 22 personnel to assist local police department to secure gas stations. Over 4,000 NGB service members from 21 states are now supporting Puerto Rico and the U.S. Virgin Islands.
  • HHS medical teams are providing support at seven medical facilities in Puerto Rico that are partially operational. HHS medical personnel have seen more than 290 patients, to date, at these new locations and at Centro Medico, an emergency and trauma center in San Juan where HHS staff have been providing medical support for the past six days.
  • HHSDoD, and Veteran Affairs partners are transporting almost 100 dialysis patients to Atlanta today. These patients had been evacuated from St. Thomas to Miami after Hurricane Irma.
  • EPA continues to coordinate with the U.S. Virgin Island government on results of drinking water sampling and to ensure disinfection measures are taken where needed. EPA now has 28 personnel on site in the U.S. Virgin Island. In St. Croix, EPA personnel sampled 59 public drinking water systems for contamination. EPA continues to disinfect the water sources.

Monday, October 02, 2017

  • FEMA Administrator Brock Long visits Puerto Rico for the third time to meet with Governor Rossello and the unified interagency command and assess the progress being made.
  • Puerto Rico NGB armories continue to act as additional Points of Distribution (PODS) for food and water for a total of 23 points of distribution sites in Puerto Rico.
  • Medical teams have seen more than 336 patients, to date, at seven medical facilities in Puerto Rico. HHS continues to provide behavioral health assistance through the Disaster Distress Helpline at (800) 985-5990. The helpline has answered 6,275 calls from people affected by hurricanes.
  • U.S. Northern Command has 11 scheduled flights to aid in the transportation of approximately 230,000 meals, 136,000 liters of water, and additional sandbags for the Guajataca Dam.
  • U.S. Postal Service (USPS) mail service is continuing today across Puerto Rico and the U.S. Virgin Islands as mail is transported and processed across the islands. Some operations may be limited depending on facility damage. Customers are being asked to use recipients’ regular mailing addresses as USPS continues to restore service across the Caribbean.
  • The USACE continue to clear debris from the U.S. Virgin Islands roadways. They are continuing debris clearance for Puerto Rico roadways, with 33 kilometers or 20 miles of assigned roads cleared, to date.
  • The Government Services Administration (GSA) is sourcing more than 200 vehicles for federal agencies’ use on the islands.
  • ARC distributed more than 211,000 relief items to survivors in the U.S. Virgin Islands and Puerto Rico, such as comfort kits, clean up kits and other bulk items, and has provided more than 5,800 mental health and health services to people in need.
  • DOE emergency responders on Puerto Rico continue to assist in damage assessments, restoration efforts and the stabilization of critical infrastructure. The government of Puerto Rico estimates that power has been restored to at an estimated 5.4 percent of customers in Puerto Rico, now that the airport and marine terminals have been reenergized.

Tuesday, October 03, 2017

  • President Donald J. Trump, along with First Lady Melania Trump visited Puerto Rico today to meet with survivors, Governor Rossello and the unified interagency command to assess the progress that is being made.
  • To date, the Department of Veterans Affairs (VA) has 129 Disaster Emergency Medical Personnel System (DEMPS) volunteers in Puerto Rico supporting veterans and VA requirements. Today, 35 DEMPS volunteers travelled to Puerto Rico in support of the HHS Federal Medical Station mission.
  • HHS medical teams have seen more than 425 patients in Puerto Rico and more than 100 patients in the U.S. Virgin Islands.
  • The FAA continues efforts to support five major airports that include: Rafael Hernandez Airport, Aguadilla (BQN), Mercedita Airport, Ponce (PSE), Jose Aponte de la Torre Airport/Roosevelt Roads (RVR), Fernando Luis Ribes Dominicci Airport, San Juan (SIG), and Cyril E. King International, St. Thomas (STT) with no restrictions. All other airports on Puerto Rico and the U.S. Virgin Islands are open with restrictions and, at a minimum, are accepting military, emergency, and relief flights with St. Croix also accepting air carriers with less than 35 passengers. All air traffic management facilities have be restored to normal operation and San Juan airport is now receiving 50% commercial power and has working air conditioning.

Wednesday, October 4

  • The Pennsylvania NGB is utilizing rotary wing assets to place 900 super sandbags in the Guajataca Dam spillway, stabilizing the infrastructure that has continued to erode with recent rainfall.
  • According to the Puerto Rico Aqueduct and Sewer Authority (PRASA), an estimated 49 percent of Puerto Rico has potable water restored. EPA continues to strategize with FEMA, USACE, Puerto Rico Environmental Quality Board, Puerto Rico Solid Waste Management Authority, and private contractors on the management of hazardous and household wastes and the establishment of regional debris collection and processing centers.
  • DOE emergency responders on Puerto Rico are assisting in damage assessments, restoration efforts and the stabilization of critical infrastructure. The government of Puerto Rico estimates that power is restored to at least 8.6 percent of customers in Puerto Rico now that the airport and marine terminals have been reenergized.
  • The U.S. Naval Ship (USNS) Comfort, a medical vessel, arrived in Puerto Rico with 800 medical personnel and support staff yesterday. The USNS Comfort medical care capabilities include general practice, family medicine and pediatrics—capable of serving 200 patients per day.

Thursday, October 05, 2017

  • The Department of Veterans Affairs has opened all facilities with the exception of Ponce Outpatient Clinic, Ponce Veterans Center and the St. Thomas Veterans Center. The Caribbean VA Healthcare System, Regional Benefits Office, and National Cemetery continue to restore service to Veterans. Reports show 2,562 Veterans received healthcare services, five veterans interred at our national cemetery, and 4,500 meals provided to employees, veterans, and families.
  • ARC distributed more than 381,000 relief items to survivors in the U.S. Virgin Islands and Puerto Rico, such as comfort kits, clean up kits and other bulk items, and has provided more than 7,700 mental health and health services to people in need.
  • The USPS reports that all incoming mail service is available to Puerto Rico and the U.S. Virgin Islands, with the exception of the shipments of live animals. When it is safe to do so, 131 offices are providing outgoing mail distribution with 99 offices attempting delivery.
  • The National Park Service has begun distribution of supplies from the NPS Motor Vessel (M/V) Fort Jefferson docked at Christiansted.
  • The Federal Communications Commission is monitoring the status of communications networks in the areas affected by Hurricane Maria and coordinating with communications providers and federal government partners to support restoration. The FCC will provide up to $76.9 million to help restore communications networks in Puerto Rico and the U.S. Virgin Islands.
  • U.S. Northern Command is aiding in the transportation of 191,000 gallons of fuel, 572,000 meals, 1.6 million liters of water, and clearing 65 miles of roads. There are approximately 6,000 active duty service members supporting the response located in Puerto Rico.
  • Social Security Administration checks are being delivered daily to San Juan, Puerto Rico, where beneficiaries can pick them up at all 120 post offices.
  • DOE emergency responders on Puerto Rico continue to assist in damage assessments, restoration efforts and the stabilization of critical infrastructure.

Friday, October 06, 2017

  • DOE emergency responders on Puerto Rico are assisting in damage assessments, restoration efforts and the stabilization of critical infrastructure. Power is restored to at least 10.7 percent of customers in Puerto Rico now that the airport and marine terminals have been reenergized. Approximately 10.5% of customers on St. Thomas have been restored. Critical facilities, including the airports and hospitals have been restored on both St. Thomas and St. Croix.
  • Social Security Administration offices in Puerto Rico and the U.S. Virgin Islands remain closed indefinitely. SSA continues to assess when they might be able to open a small number of offices for basic services. Social Security benefit payments are now being delivered daily to Puerto Rico. All 120 post offices are open on a shortened daily schedule of 9:00 a.m. – 3:00 p.m., with a few open until 4:00 p.m. The post office will hold our checks for 45 days.
  • is opening all facilities with exception of the St. Thomas Vet Center. The Damage Assessment Team (DAT) travels to St. Croix today to assess the damage of VA facilities.
  • medical teams have seen more than 1,000 patients in Puerto Rico. HHS teams are also working with federal and territorial partners to make contact with elder care facilities to ensure their needs are being met. In a partnership with DOD, HHS is working with private sector health care systems on sustainment strategies while electricity is being restored. The Centers for Medicare and Medicaid Services has confirmed that 99 percent of dialysis patients are receiving regular treatment.
  • The Federal Transit Administration (FTA) continues to work with public transportation providers in Puerto Rico to assess their current transportation capabilities and recovery needs, and will work with FEMA on any potential mission assignments. As of Oct. 3, FTA is awarding $8.4 million in critical formula funding to Puerto Rico to support their transit systems on the island.
  • With all 17 priority dam inspections complete, the Pennsylvania NGB is scheduled to utilize heavy-lift helicopters to place 900 super sandbags in and around the Guajataca Dam spillway on Saturday, working with the Army Corps of Engineers to stabilize the dam.
  • Veteran Affairs staff traveled to Vieques, an island off Puerto Rico’s coast to assist a veteran in need. The veteran was transported to the San Juan VA Medical Center to recieve medical care. An important part of VA’s emergency response efforts is to reach out to veterans of high-risk populations.
  • The U.S. Geological Survey with assistance from other agencies is installing a second camera and enhanced satellite networking at the Lago Guajataca Dam for enhanced monitoring of the dam’s condition with live video feed.
  • National Park Service personnel are coordinating plans to secure museum collections located at St. Croix and St. John totaling more than 200,000 artifacts that will be transferring to the National Capital Region.

Saturday, October 07, 2017

  • Law enforcement and force protection are supporting responder accountability for U.S. Virgin Islands and Puerto Rico operations, providing a security presence throughout the islands to enable restoration activities. In addition to providing assistance to the federal and Puerto Rican law enforcement partners with safety and security efforts, the Bureau of Alcohol, Tobacco, Firearms and Explosive Miami Field Division is cutting downed trees at homes and near businesses that could become safety hazards, and getting much needed resources to partners while they’re out helping the communities.
  • The U.S. Geological Survey have repaired 30 water monitoring gauges in Puerto Rico.
  • The National Protection and Programs Directorate continues to support carriers with establishing short-term communication capabilities, such as temporary cell sites, maintaining generators supporting cell tower sites and facilitating satellite phone capabilities to local officials. Telecommunications service has been restored to approximately 58% of customers in Puerto Rico.
  • Emergency responders on Puerto Rico are assisting in damage assessments, restoration efforts and the stabilization of critical infrastructure. Power is restored to at least 11.7 percent of customers in Puerto Rico now that the airport and marine terminals have been reenergized. Approximately 14.4 percent of customers on St. Thomas have been restored and 12 percent on St. Croix. Critical facilities, including the airports and hospitals have been restored on both St. Thomas and St. Croix.
  • NGB has more than 6,000 Guard members on the ground in Puerto Rico and the U.S. Virgin Islands taking part in security and support operations. The Air National Guard is focused on commodity distribution, security, communications, and route clearance in Puerto Rico.

The American Red Cross during the Harvey response up to 8/31/17

ARC

 

  • Served more than 180,000 meals and snacks;
  • Activated 200 emergency response vehicles to bring meals, water, information and support with damage assessment;
  • Positioned six kitchens capable of producing 10,000 meals a day, with six more trailers on the way.
  • Provided safe refuge for 32,000 people in more than 230 Red Cross and partner shelters in Texas, including people affected in Louisiana;

 


2 killed and 6 others hospitalized in a stabbing attack in the Finnish city of Turku

CNN

 

 


54 people received medical treatment (51 hospitalized) after a Spanish commuter train crashed into the buffers in a station in northeastern Barcelona early Friday

ABC

 


Texas: First human case of indigenous Zika Virus infection

Texas Health

 


Measles continues to spread and take lives in Europe

WHO

Press release

Copenhagen, 11 July 2017

Ongoing measles outbreaks in the WHO European Region have caused 35 deaths in the past 12 months. The most recent fatality was a 6-year-old boy in Italy, where over 3300 measles cases and 2 deaths have occurred since June 2016. Several other countries have also reported outbreaks; according to national public health authorities, these have caused 31 deaths in Romania, 1 death in Germany and another in Portugal.

“Every death or disability caused by this vaccine-preventable disease is an unacceptable tragedy,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “We are very concerned that although a safe, effective and affordable vaccine is available, measles remains a leading cause of death among children worldwide, and unfortunately Europe is not spared. Working closely with health authorities in all European affected countries is our priority to control the outbreaks and maintain high vaccination coverage for all sections of the population.”

The Region has been progressing towards measles elimination. A total of 37 countries have interrupted endemic transmission, according to the assessment of the Regional Verification Commission for Measles and Rubella Elimination based on 2015 reporting. However, remaining pockets of low immunization coverage allow the highly contagious virus to spread among those who choose not to vaccinate, do not have equitable access to vaccines or cannot be protected through vaccination due to underlying health conditions.

In response, several countries are adopting measures, such as school-entry checks, to increase coverage rates for routine vaccinations against measles and other diseases. WHO recommends that every eligible child receive 2 doses of measles-containing vaccine. It also encourages adults who are not fully immunized, or who are not sure of their immunity status, to get vaccinated.

In line with the Regional Director’s call for intensified efforts, Romania conducted a nationwide campaign of enhanced routine immunization activities. Italy implemented outbreak control measures including notifying suspected cases, tracing contacts and offering post-exposure prophylaxis and vaccination.

On 21 June 2017 in Rome, Italy, experts from the WHO Regional Office for Europe contributed to a consultation with regional public health officials, representatives of the Italian Institute of Health (ISS), and measles and rubella laboratory officials. Together they decided on further strategies to improve vaccination coverage among adolescents, adults, vulnerable population groups and health-care workers. The range of identified activities includes strengthening disease surveillance and communication practices.


 


A U.S. military plane used for refueling crashed into a field in rural Mississippi, killing at least 16 people aboard

ABC

 


Wildfires continue to barrel across the scorched landscape of the western U.S. and Canada

IMSR Summary
July 9th, 2017

National Preparedness Level


Level 3
National Fire Activity
Initial attack activity: Moderate (230) new fires
New large incidents: 20
Large fires contained: 9
Uncontained large fires: 50
Area Command Teams Committed: 0
NIMOs committed: 0
Type 1 IMTs committed: 6
Type 2 IMTs committed: 10

Source:
Incident Management Situation Report


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