Global & Disaster Medicine

Archive for September, 2019

FEMA SitRep 9/5/19

FEMA

Situation

Hurricane Dorian continues to move along the Southeast US coast and is expected to approach South Carolina today. Life-threatening storm surge and dangerous winds expected along portions of the coasts of GA, SC, and NC and portions of southeast VA and the southern Chesapeake Bay, regardless of the exact track of Dorian’s center.

Hurricane Dorian (CAT 3) (Advisory #48A as of 5:00 a.m. EDT)

• 70 miles SSE of Charleston, SC

• Maximum sustained winds 115 mph; moving N at 8 mph

• Hurricane-force winds extend 60 miles and tropical storm-force winds extend 195 miles

Lifeline All lifelines remain GREEN

Safety and Security • Mandatory evacuations in effect in FL (1 county); SC (8 counties) and NC (6 counties)

Food, Water, Shelter • FEMA Commodities have arrived at ISBs (NBEOC) •

Region IV: 113 (-26) shelters with 6.6k (-2.7k) occupants (FL: 32/1816; GA: 13/2,038; SC: 33/2015; NC: 35/792) (ESF-6 as of 6:00 a.m. EDT) • 1 Mega shelter open in Durham, NC with 1.5k capacity (ESF-6 as of 4 Sept 11:00 a.m. EDT)

Energy • SC: 190K reported without power (Eagle- I as of 7:30 a.m.EDT);   Fuel industry partners affirm fuel supplies and distribution remain stable (NBEOC)

Transportation • Airports: SC: Charleston International Airport, Florence Regional Airport, and regional/county airports closed; NC: Wilmington International Airport closed (FAA as of 6:00 a.m.) • Ports: Canaveral and West Palm Beach re-opened with restrictions; GA: Savanah and Brunswick closed; SC: Charleston closed; NC: Wilmington and Morehead City closed

Local Preparations/Response • FL, GA, SC, NC, and Seminole Tribe of Florida EOCs at Full Activation; VA EOC at Partial Activation • TN, MS EOCs at Monitoring • Governors declared a State of Emergency for all counties in FL, NC, VA, STOF and for the coastal counties of GA and SC
Federal Preparations/Response • NRCC at Level I, 24/7 with all LNOs and ESFs  • Region III RWC at Enhanced Watch; RRCC Level II (day shift only) o LNO deployed to VA • Region IV RRCC at Level I, 24/7 o LNOs deployed to FL, STOF, GA, SC, and NC • IMAT Teams deployed: o National IMAT East: FL o Region III IMAT: VA EOC o Region IV IMAT-1: FL; IMAT-2: GA o Region VII IMAT: SC o Region VIII IMAT: NC • ISB Teams deployed to AL, GA, NC, and SC o Charlie Team at Fort A.P. Hill, VA

 


Hurricane Dorian Lashing the Southeast US Coast; Tropical Storm, Hurricane, and Storm Surge Warnings in Effect from East Coast of Florida to Southeast Virginia

Southeast sector loop

Northeast sector loop


Food Safety form your FDA

FDA

Prepare Yourself Before Power Emergencies

  1. Make sure you have appliance thermometers in your refrigerator and freezer.
    • Check to ensure that the freezer temperature is at or below 0° F, and the refrigerator is at or below 40° F.
    • In case of a power outage, the appliance thermometers will indicate the temperatures in the refrigerator and freezer to help you determine if the food is safe.
  2. Freeze containers of water for ice to help keep food cold in the freezer, refrigerator, or coolers in case the power goes out. If your normal water supply is contaminated or unavailable, the melting ice will also supply drinking water.
  3. Freeze refrigerated items such as leftovers, milk, and fresh meat and poultry that you may not need immediately. This helps keep them at a safe temperature longer.
  4. Group food together in the freezer. This helps the food stay cold longer.
  5. Have coolers on hand to keep refrigerated food cold if the power will be out for more than 4 hours.
  6. Purchase or make ice cubes in advance, and freeze gel packs ahead of time. Store all of these in the freezer for future use in the refrigerator or in coolers.
  7. Check out local sources to know where dry ice and block ice can be purchased, in case it should be needed.
    1. Store food on shelves that will be safely out of the way of contaminated water in case of flooding.
    2. Make sure to have a supply of bottled water stored where it will be as safe as possible from flooding. If your bottled water has an odor, do not drink or use it. Instead, dispose of it, or if applicable, call your bottled water provider to make arrangements to get a replacement.

    During an emergency, if you use food or beverage containers to hold non-food substances like gasoline, dispose of them after use and do not recycle them.

    Power Outages: During and After

    When the Power Goes Out . . .

    Here are basic tips for keeping food safe:

    1. Keep the refrigerator and freezer doors closed as much as possible to maintain the cold temperature.
      • The refrigerator will keep food cold for about 4 hours if it is unopened.
      • A full freezer will keep the temperature for approximately 48 hours (24 hours if it is half full) if the door remains closed.
    2. Buy dry or block ice to keep the refrigerator as cold as possible if the power is going to be out for a prolonged period of time. Fifty pounds of dry ice should keep an 18 cubic foot, fully stocked freezer cold for two days.
      1. If you plan to eat refrigerated or frozen meat, poultry, fish, or eggs while they are still at safe temperatures, it is important that each item is thoroughly cooked to a safe minimum internal temperature to ensure that any foodborne bacteria that may be present are destroyed. However, if at any point the food was above 40º F for 2 hours or more (or 1 hour if temperatures are above 90 º F) — discard it.

      Once Power is Restored . . .

      Determine the safety of your food:

      1. If an appliance thermometer was kept in the freezer, check the temperature when the power comes back on. If the freezer thermometer reads 40° F or below, the food is safe and may be refrozen.
      2. If a thermometer has not been kept in the freezer, check each package of food to determine its safety. You can’t rely on appearance or odor. If the food still contains ice crystals or is 40° F or below, it is safe to refreeze or cook.
      3. Refrigerated food should be safe as long as the power was out for no more than 4 hours and the refrigerator door was kept shut. Discard any perishable food (such as meat, poultry, fish, eggs, or leftovers) that has been at temperatures above 40° F for 2 hours or more (or 1 hour if temperatures are above 90º F).

      Perishable food such as meat, poultry, seafood, milk, and eggs that are not kept adequately refrigerated or frozen may cause illness if consumed, even when they are thoroughly cooked.

      If Flooding Occurs

    3. Be prepared to safely handle food and water in the event that flooding occurs.

      Keep Water Safe

      Follow these steps to keep your WATER SAFE during and after flood conditions.

      1. Only use water from a safe source for drinking and washing or preparing food.
      2. Use bottled water that has not been exposed to flood waters, if it is available.
      3. If you don’t have bottled water, you should boil or disinfect water to make it safe. (see steps below)
      4. If you have a well that has been flooded, the water should be tested and disinfected after flood waters recede. If you suspect that your well may be contaminated, contact your local or state health department or agricultural extension agent for specific advice.

      How to Boil or Disinfect Water To Make It Safe

      If the water is cloudy, first filter it through clean cloths, or allow it to settle and then draw off the clear water for boiling/ disinfecting. Then, follow one of these two procedures:

    4. Boiling Boiling water will kill most types of disease-causing organisms that may be present.
      1. Boil the water for 1 minute.
      2. Let it cool, and store it in clean containers with covers.

      Disinfecting with Bleach

      Bleach will kill some, but not all, types of disease-causing organisms that may be in the water.

      • Add 1/8 teaspoon (or 8 drops) of unscented household (5.25% concentration) liquid bleach for each gallon of water.
      • Stir it well and let it stand for 30 minutes before you use it.
      • Store disinfected water in clean containers with covers.

      Keep Food Safe

      Follow these steps to keep your FOOD SAFE during and after flood conditions.

      1. Do not eat any food that may have come into contact with flood water.
      2. Discard any food and beverage that is not in a waterproof container if there is any chance that it has come into contact with flood water.
        • Food containers that are waterproof include undamaged, commercially prepared foods in all-metal cans and “retort pouches” (like flexible, shelf-stable juice or seafood pouches).
            • Food containers that are not waterproof include those with screw-caps, snap lids, pull tops, and crimped caps.
            • Also discard cardboard juice/milk/baby formula boxes and home canned foods if they have come in contact with flood water, because they cannot be effectively cleaned and sanitized.
          1. Discard any food in damaged cans. Damaged cans are those with swelling, leakage, punctures, holes, fractures, extensive deep rusting, or crushing/denting that is severe enough to prevent normal stacking or opening with a manual, wheel-type can opener. See box on next page for steps to clean/save undamaged packages.
          2. Thoroughly wash metal pans, ceramic dishes, and utensils (including can openers) with soap and water, using hot water if available. Rinse and then sanitize them by boiling in clean water or immersing them for 15 minutes in a solution of 1 tablespoon of unscented household (5.25% concentration) liquid bleach per gallon of water.
          3. Thoroughly wash countertops with soap and water, using hot water if available. Rinse and then sanitize by applying a solution of 1 tablespoon of unscented household (5.25% concentration) liquid bleach per gallon of water. Allow to air dry.

          How To Save Undamaged Food Packages Exposed to Flood Water

        • Undamaged, commercially prepared foods in all-metal cans and “retort pouches” (like flexible, shelf-stable juice or seafood pouches) can be saved if you follow this procedure.
          1. Remove the labels, if they are the removable kind, since they can harbor dirt and bacteria.
          2. Brush or wipe away any dirt or silt.
          3. Thoroughly wash the cans or retort pouches with soap and water, using hot water if it is available.
          4. Rinse the cans or retort pouches with water that is safe for drinking, if available, since dirt or residual soap will reduce the effectiveness of chlorine sanitation.
          5. Sanitize cans and retort pouches by immersion in one of the two following ways:
            • Place in water and allow the water to come to a boil and continue boiling for 2 minutes.
            • Place in a solution of 1 cup (8 oz/250 mL) of unscented household (5.25% concentration) bleach mixed with 5 gallons of water and soak for 15 minutes.
          6. Air dry cans or retort pouches for a minimum of 1 hour before opening or storing.
          7. If the labels were removable, then re-label your cans or retort pouches, including the expiration date, with a permanent marking pen.

          Food in reconditioned cans or retort pouches should be used as soon as possible thereafter.

          Baby Formula Tip

          For infants, try to use prepared, canned baby formula that requires no added water. Otherwise, dilute any concentrated baby formula in reconditioned, all-metal containers with clean drinking water.


9/5/1972: Black September terrorists take Israeli Olympians as hostages in Munich

HxC

“……Twenty hours after Black September had begun their attack, a German police official, 5 Palestinian terrorists, and 11 Israeli athletes lay dead…….”


Hurricane Dorian is expected to slowly move northwestward along the Florida east coast through Wednesday. Dorian will remain a dangerous hurricane, spreading impacts along and near the Florida east coast and the coasts of Georgia, South Carolina, and North Carolina through late week. This will be a long-duration event with heavy rain, storm surge, damaging winds, and isolated tornadoes.

NHC

SUMMARY OF 500 AM EDT…0900 UTC…INFORMATION
———————————————-
LOCATION…29.2N 79.5W
ABOUT 90 MI…145 KM E OF DAYTONA BEACH FLORIDA
MAXIMUM SUSTAINED WINDS…105 MPH…165 KM/H
PRESENT MOVEMENT…NNW OR 330 DEGREES AT 8 MPH…13 KM/H
MINIMUM CENTRAL PRESSURE…963 MB…28.44 INCHES

DISCUSSION AND OUTLOOK
———————-
At 500 AM EDT (0900 UTC), the center of Hurricane Dorian was located
near latitude 29.2 North, longitude 79.5 West.  Dorian is moving
toward the north-northwest near 8 mph (13 km/h), and a northwest or
north-northwest motion is expected through this morning.  A turn
toward the north is forecast by this evening, followed by a turn
toward the north-northeast on Thursday morning.  On this track, the
core of Hurricane Dorian will move dangerously close to the Florida
east coast and the Georgia coast through tonight.  The center of
Dorian is forecast to move near or over the coast of South Carolina
and North Carolina Thursday through Friday morning.

Maximum sustained winds are near 105 mph (165 km/h) with higher
gusts.  Some weakening is expected during the next couple of days,
and Dorian is expected to remain a powerful hurricane during the
next few days.

Hurricane-force winds extend outward up to 60 miles (95 km) from the
center, and tropical-storm-force winds extend outward up to 175
miles (280 km).

The minimum central pressure reported by an Air Force Reserve Unit
Hurricane Hunter aircraft is 963 mb (28.44 inches).


The Bahamas: “….Dozens of people were going back and forth to help with the rescue. Some of the people rescued were utterly exhausted after spending all night clinging to their roofs or being stuck in their attics….”


How to evacuate from your home safely as the hurricane looms……

NYT

“……The Food and Drug Administration recommends switching your refrigerator and freezer to the coldest possible settings and moving fridge items to the freezer so they stay cold longer if the power goes out. Even in a power failure, a tightly packed freezer can stay cold for 48 hours. If you can’t fit everything into the freezer, add containers of ice to the fridge.

Keep thermometers in the fridge and freezer so you can check the temperature when you return. Anything that has remained at 40 degrees Fahrenheit or colder is safe to eat. Move pantry items and a supply of bottled water to high, secure shelves so they will be safe from floodwaters……”


Health authorities in Liberia on Monday declared a health emergency following the outbreak of Lassa fever which has so far claimed 21 lives this year.

Xinhua

Lassa Fever distribution map.  Countries reporting endemic disease and substantial outbreaks are Guinea, Sierre Leone, Liberia, and Nigeria.  Countries reporting few cases, periodic isolation of virus, or serologic evidence of Lassa virus infection are Mali, Burkina Faso, Cote d'Ivoire, Ghana, Togo, and Benin.


Emergent BioSolutions today announced that it was awarded a contract worth about $2 billion over the next 10 years to deliver the ACAM200 smallpox vaccine to the Strategic National Stockpile.

Emergent

A transmission electron micrograph (TEM) of smallpox virus particles.

“…….About ACAM2000 Vaccine
ACAM2000 vaccine is the primary smallpox vaccine designated for use in a bioterrorism emergency, with almost 269 million doses having been supplied to the U.S. Strategic National Stockpile. ACAM2000 vaccine is also licensed in Australia and Singapore and is currently stockpiled both in the U.S. and internationally.

ACAM2000 is indicated for active immunization against smallpox disease for persons determined to be at high risk for smallpox infection.

The labeling for ACAM2000 contains a contraindication for individuals with severe immunodeficiency. Severe localized or systemic infection with vaccinia (progressive vaccinia) may occur in persons with weakened immune systems. Individuals with severe immunodeficiency who are not expected to benefit from the vaccine should not receive ACAM2000. The risk for experiencing severe vaccination complications must be weighed against the risk for experiencing a potentially fatal smallpox infection.

Additionally, there are warnings and precautions for myocarditis, pericarditis, encephalitis, encephalomyelitis, encephalopathy, generalized vaccinia, severe vaccinial skin infections, erythema multiforme major (including Stevens-Johnson Syndrome), eczema vaccinatum resulting in permanent sequelae or death, ocular complications; blindness and fetal death have occurred following either primary vaccination or revaccination with live vaccinia virus smallpox vaccines. These risks are increased in certain individuals and may result in severe disability, permanent neurological sequalae and/or death.

Please see full Prescribing Information for full boxed warning and additional safety information…..”


FEMA 9/3/2019 SitRep

FEMA

Situation Projected Impacts:

• Wind: hurricane conditions are expected within the hurricane warning area in Florida by today; hurricane conditions are possible in the hurricane watch area beginning Wednesday

• 4-7 feet of Storm Surge north of Deerfield Beach to Lantana, FL 2-4 feet; water levels could begin to rise well in advance of the arrival of strong winds and will be accompanied by large and destructive waves

• Rainfall accumulations: coastal Carolinas 5-10 inches, isolated 15 inches; Atlantic coast from the Florida peninsula through Georgia 4 – 8 inches, isolated 10 inches; may cause life-threatening flash floods

• Surf: large swells are affecting the Florida east coast and will spread northward along the southeastern U.S. coast during the next few days; likely to cause life-threatening surf and rip current conditions

• Tornadoes: isolated tornadoes are possible through Tuesday along the eastern coast of Florida

Watches/Warnings:

• Storm Surge Warning for Lantana to Altamaha Sound

Storm Surge Watch from north of Deerfield Beach to south of Lantana; Altamaha Sound to South Santee River

• Hurricane Warning for Jupiter Inlet to Ponte Vedra Beach

• Hurricane Watch from north of Deerfield Beach to Jupiter Inlet; north of Ponte Vedra Beach to South Santee River

• Tropical Storm Warning for north of Deerfield Beach to Jupiter Inlet

• Tropical Storm Watch for north of Golden Beach to Deerfield Beach and for Lake Okeechobee

Lifeline All lifelines remain GREEN

Safety and Security

• FL: Mandatory evacuations for 11 counties; voluntary evacuations 6 counties

• GA: Mandatory evacuations for 6 counties • SC: Mandatory evacuations for 8 counties

• NC: Mandatory evacuations for 2 counties

Food, Water, Shelter  *

• FL: 52 shelters open with 6,271 occupants

• GA: 10 shelters open with 283 occupants

• SC : 19 shelters open with 290 occupants

Health and Medical

FL: Hospital Evacuation: (3 in progress, 3 complete, 3 planned); Nursing Home (5 in progress, 11 completed, 3 planned); Health Care Facilities (24 in progress, 20 completed, 24 planned

Energy

• FL: retail fuel availability continues to improve as state expedites resupply shipments

Transportation • Airports: FL: Vero Beach Regional, Palm Beach International, Ft. LauderdaleHollywood International and Orlando-Melbourne International closed

• Ports: FL: Miami, Everglades, West Palm, Jacksonville, and Canaveral closed; Key West, and Fernandina open with restrictions

• Train: Amtrak will not operate south of VA between Sept 3-5

• GA DOT will begin contraflow operations for I-16 and I-75

 

Local Preparations/Response

• FL, GA, SC, NC, and Seminole Tribe of Florida EOCs at Full Activation

• TN, MS and VA EOCs at Monitoring

• NC Governor requested an Emergency Declaration on September 2

• VA Governor declared a state of emergency on September 2

Federal Preparations/Response

• FEMA-3421-EM-SC approved September 1, 2019

• FEMA-3422-EM-GA approved September 1, 2019

• FEMA-3420-EM-STOF approved August 31, 2019

• FEMA-3419-EM-FL approved August 30, 2019

• NRCC at Level I, 24/7 with all LNOs and all ESFs

• Region IV RRCC at Level I, 24/7

• Region III RWC at Enhanced watch; RRCC activated to Level II, day shift only

• IMAT Teams deployed: o National IMAT East deployed to FL o Region III IMAT will re-deploy from WV to VA EOC at 9:00 a.m. today o Region IV IMAT-1 to FL; IMAT-2 to GA o Region VII IMAT to SC o Region VIII IMAT to deployed to NC

• Region IV LNOs deployed to FL, GA, Seminole Tribe of Florida, SC and NC • Region III LNO deployed to VA • ISB Teams deployed to AL, GA, NC and SC • ISB Charlie Team restaging to Fort A.P. Hill, VA; ISB established at Fort Bragg, NC

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