A Journey Through The World of Pandemic Influenza

UK DoH Mass Casualty Incident Planning Framework

The Sunday Telegraph (UK) ran a piece on the Department of Health's planning framework for operations during a Mass Casualty Incident (MCI).  An MCI is an incident where a large number of sick or injured occur due to a chemical, biological, radiological or nuclear incident.  Pandemic Influenza would fall under this designation.

Security guards could be posted at hospitals to stop casualties gaining entry and contaminating other patients in the event of a "chemical" terrorist attack, government plans show.

 

Guidance published last week instructs every hospital to "retain control of access to its facilities" following a chemical, biological, radiological or nuclear incident.

 

The advice is part of the Department of Health's planning framework for dealing with "mass casualty incidents" - whether from terrorist attack or infectious diseases, such as a flu pandemic.

 

This planning framework is probably reasonably workable during a localized event but not during severe PanFlu (Pandemic Influenza).

Understanding that there are often differences in meaning and usage of words between English and American "English", I sit here wondering what the operative definition is of "security guard" as used in this piece.  Does the term mean anyone functioning in that role, such as military or law enforcement personnel, or does it mean, literally, a privately employed security guard? 

If it is the privately employed type I'm afraid their "framework" still needs "work".   It will be a dangerous and difficult task to hold back a desperate and determined crowd, even a small one, which is determined to gain entry.

It is well understood that the health care system, in every country, will be rapidly over run in the event of a moderate to severe pandemic.  Many more people will be in need of treatment than will be able to be handled.  Hospital beds are a finite resource, as are the supportive equipment, staff, and medical supplies.  When capacity is reached the others will have to be turned away.  Those denied treatment, either for themselves or a loved one, will not be happy.

 

The most recent official prediction of the number of people who could die in a flu pandemic is 750,000; and the framework admits that the main problem would be finding "dignified and suitable" temporary storage for the dead within hospitals.

 

Although certainly a part of the PanFlu picture, …dignified and suitable temporary storage for the dead within hospitals…, is neither the main problem, nor should it be a hospital problem.  This was also a bit of a surprise because the UK has made no secret of their intent to utilize mass graves if a sever pandemic were to happen and bodies overwhelm their mortuary capacity.

 

While the NHS would attempt to "provide the best care possible", normal medical protocols might have to be suspended, the document warns.

    …   

However, he warned that the current hospital system in the UK - with no designated "major trauma centres" to take charge in an emergency - would result in "chaos" in the event of a full-scale crisis.

Chaos.  At least they know, and understand, that much. 

What is never publicly addressed in any of these plans is the fact that should our health care systems become over run the "triage" plans will be immediately rendered nothing more than so many hollow words.

It will not be deciding who is a "better" candidate for treatment, a 27 year old mother of two, a 7 year old little girl, or a 77 year grandmother, it will be deciding which few of the 100's of 27 year old mothers, 100's of 7 year old little girls, and 100's of 77 year old grandmothers, along with 1,000's of others is the "better" or more "deserving" treatment candidate.  In an average size small city of 100,000 residents it is reasonable to plan for 10% of the population being ill at the same time.   That's 10,000 potential sick and dying vying for that finite health care resource at roughly the same time.

Yes, they are wise to consider security needs as person after person is told that their loved one will receive no care, even such as it will be reduced to during a severe pandemic.  And, I certainly hope they plan on using personnel better trained and equipped than those who fall under the American concept of "security guard".

 

SZ

 

 

 

 

The Military and PanFlu: Part I

I have a deep and abiding love for our men and women who serve our country in uniform.  Most of my minority was spent as a Navy Brat and I am married to a man who did his requisite stint during the Vietnam Era, also in the Navy.  Of course, each branch of the military thinks they are the best, the special, the chosen, but the Marines… well… they are Special. 

Never have I met a current, or former Marine (some say there is no such thing as a former Marine), that I didn't instantly peg him as being such.  Sorry ladies, I have never met a woman who served in the Marines. 

I often dwell on the Military's role during a severe pandemic, in my mind, on the forums, and in this blog.  The men and women in uniform will be the biggest chunk of the Federal Government's response to the societal and humanitarian issues that will likely arise.  The concept is a sound one, after all, no other organization, in the world, is better able or better equipped to address those issues.

The problem, the huge, insurmountable, ignored problem, is that there is just not enough military to go around.

In total, the men and women under uniform, or readily made so, comprise no more than 1% of the American population.  That's in total. 

I have read references over this past year to the government's commitments to the idea of providing assistance to other nations during a severe pandemic.  When I read them I have always experienced this split personality, one  part wanted to laugh, hysterically, and the other wanted to scream in despair… and then slap someone up-side the head (as we say here in the South) for blatant stupidity on a grand scale.

There is little doubt that much of our critical infrastructure will be strained, under-provisioned, and under staffed, perhaps to the point of collapse. 

Should our power generation and water systems fail US citizens will be looking to the military to make it better.  Should our food deliveries significantly slow, or stop, US citizens will be looking to the military to make it better.  Should social order break down US citizens will be looking to the military to make it better.  On and on and on, in every sector of critical need of a modern society we will be looking to our military men and women to make it better.

We will be looking to one percent to save the other ninety-nine percent of us.  I will readdress the fallacy of even that one percent in another post of this planned series, but for now, it suits for illustration purposes anyway.

 

The inspiration for this post and those that will follow in the series was this piece from The Stars and Stripes...

III MEF ready to respond if avian flu pandemic hits 
By David Allen, Stars and Stripes
Pacific edition, Monday, April 9, 2007

CAMP COURTNEY, Okinawa — If the avian flu becomes a real pandemic threat to humans, especially in the Western Pacific, the III Marine Expeditionary Force will be ready.

During a recent humanitarian relief deployment to the Philippines, MEF corpsmen tested technology a Portsmouth, N.H., firm developed for almost instant tracking of vital information that in the past would take days or even weeks to analyze.

And a team of Marines and sailors has developed a detailed pandemic influenza response plan for Okinawa.

Global Relief Technologies was awarded a $3.5 million contract last fall to provide about 120 PDAs — hand-held computer devices — to the Marine Corps, which at any time has personnel scattered on deployments throughout Southeast Asia. The region is considered ground zero for the bird flu that could one day mutate and become the next great human pandemic.

The equipment, along with accompanying computers and satellite hookups, was delivered to the 3rd Medical Battalion before they deployed last month for a humanitarian mission to southeast Luzon, the Philippines island where some 15,000 people lived in camps after being displaced following a series of natural disasters in December.

"This initiative is driven by the need to collect and record data for tracking the avian flu — and any other humanitarian crisis — quickly and accurately," said Navy Capt. David Lane, Force Surgeon for the III MEF. "It worked exceedingly well."

Continues at link….

 

Bless the Marines.

Bless the Marines, and slap their leaders upside the head.  Just what are they thinking? 

 

These are men and women who are presumed to have the highest risk of death from H5N1 solely because of their age bracket.  These are men and women who, if left in their OCONUS duty assignments, will be left in crumbling countries with little or no infrastructure remaining, with little or no government left standing,  with no advanced medical treatment facilities, and little or no resupply, and quite possibly sick and dying.

They will be on foreign soil, attempting to Band Aide a hopeless situation, meanwhile their fellow citizens will have their own hopeless situation(s) that will be in desperate need of those very Band Aides.

Bless the Marines.  They don't understand the phrase "hopeless situation".  And for those responsible for this action plan… consider yourselves slapped up-side the head by a Southern Mother.

 

SZ

Pandemic Planning and the Courts II

Part One of my Courts entries is located here.

As has recently been stated on one of the forums, we as average citizens and employees is if our institutions and businesses insist on maintaining "normal" operations during a moderate to severe pandemic.  The Courts pandemic planning guidence document found here highlights this as well as anything does.  While our Rule of Law and our Constitutionally guaranteed rights demand that our courts operate in as smooth and efficient manner as possible there would likely come a time when the very operation of the courts pose a real life threatening situation in and of itself.

If and when a severe Influenza Pandemic is to strike it is presumed that it will strike with rapidity and in most areas nearly simultaniously.  There will likely be very little, if any, time for the courts to wrap up any in-progress court hearings, allthough, of course, those cases and items close to completion should be able to be finished up with no problems.

What happens to all of those people "in the pipe-line" that haven't had their cases adjudicated yet?  No where that I could find in the Court's Guidence document does it address this question.  The reason is simple, they assume that while it may be difficult and require "out-of-box" thinking, they will be able to continue operations... it is afterall, a Continuity of Operations Plan.

So, what's wrong with that?

When you deprive someone of their freedom of movement and/or their self determination you, in this case society, are responsible for that person.  You are morally and legally required to do all within your power and means to safeguard their overall well being, no where in the legal system is this more true than for those in jail who have not been convicted and sentenced yet.

It is safe to assume that our prisons and jails will be nothing more than infection factories laying waste to all who reside within their walls.  A closed population to be sure, but the guards and staff will be coming and going, assuming they report to work, and the larger assumption that they are able to.  Prisoners and detainees have communal dining, as well as shower, and recreational areas, there will be no chance of the recommended "social distancing" in prisons and jails unless they are placed on 24/7 lock-down. 

Should  a severe pandemic happen the courts will either be the reason or the mechanism that will decide what happens to prisoners not yet convicted, and I am quite surprised that the issue was not at least mentioned in their COOP as one likely to come up.  Everything else will likely take care of itself, given circumstances, personnel, or lack of, and degree of the restrictions imposed by Martial Law (assmuned necessary in a severe PanFlu event). 

This is just a glaring, but sadly typical case of the planners failing to consider exactly how bad it could get in a severe pandemic.  And, should a severe pandemic occur, it is a failure that will cost lives, probably many lives.

Pandemic Dominoes: HCW's Stand at the Apex

Yesterday Fla_Medic called attention to a piece that was released in JEMS:The Journal of Emergency Medical Services titled "Will emergency health care providers respond to mass casualty incidents?". Having my curiosity shot off the scale I spent roughly an hour tracking down the paper the JEMS article referred to and purchased it straight away. 

Before I dig into the very disturbing findings of this paper I would like to lay some ground work. 

I have been involved with the Cyber Flu Community for two years now in one way or another.  We are an interesting, eclectic group comprising professionals and laymen, deeply involved to casually informed.  When the issue of workers reporting to their jobs comes up two things have always been cited, the SARS response and the presumed illness attack rate.  The two figures mesh nicely, both pointing to a roughly 30% absenteeism rate at the height of a "severe" PanFlu event.  A thirty percent staff reduction in any industry or service would be extremely difficult to work around, but assumed not impossible. 

The thirty percent absenteeism in all Essential Services sectors is supposed to be one of the major points that their respective Influenza Pandemic Plans are to address... and that's assuming they actually have formalized plans... a BIG assumption because many are still stuck at the "Plan to Plan" stage.  This paper points to the possibility that the 30% assumption may be grossly optimistic. 

As some who have read my Blog for awhile will know, I am acutely interested in PanFlu from an LEO's (Law Enforcement Officer) perspective.  My only child is a street officer on a small city PD who has every intention of working during the PanFlu, should one materialize.  During a moderate to severe PanFlu police will be stretched as thin as HCW's as they will be operating in situations that will facilitate infection, and at the same time not having adequate means of personal protection.  And, just as the Health Care System can not operate at 18-30% staffing levels, neither can Law Enforcement, so with that in mind, I will now introduce the actual paper this entry addresses. 

WILL EMERGENCY HEALTH CARE PROVIDERS RESPOND TO MASS CASUALTY INCIDENTS?

James I. Syrett, MD, MBA, John G, Benitez, MD, MPH, William H. Livingston III, MD, Eric A. Davis, MD 

ABSTRACT 

Introduction: Emergency response plans often call on health care providers to respond to the workplace outside of their normal working pattern. Hypothesis. Providers will report to work during a mass casualty emergency regardless of family duties, type of incident, or availability of treatment. Methods. Survey of emergency personnel needed to respond to a mass casualty incident. Two scenarios were presented: one involving the release of a nontransmissible biological agent with proven treatment and the other the release of a transmissible biological agent with no treatment. At critical time points, participants were asked whether they would report to work. Additional questions considered the effect of commonly used treatment dissemination methods. Results. A total of 186 surveys were issued and returned. (45 physicians, 29 nurses, 86 EMS personnel, and 20 support staff); 6 were incomplete and excluded. Initial commitment rates were 78%. The highest immitment rate identified was 84% and the lowest was 18%. Any treatment dissemination method excluding providers’ family members led to decreases in commitment rate, as did agents identified to be transmissible. Conclusions. As an event develops, fewer health care providers will report to work and at no time will all providers report when asked. This conclusion may be generalizable to several types of incidents ranging from pandemic influenza to bioterrorism. Identification of the causative agent is a major decision point for providers to return to or stay away from work. Offering on-site treatment of providers’ family increases commitment to work. These factors should be considered in emergency planning. Key words: emergency preparedness; disaster response; mass casualty incident. PREHOSPITAL EMERGENCY CARE 2007;11:49–54

Even though the abstract states: Two scenarios were presented: one involving the release of a nontransmissible biological agent with proven treatment and the other the release of a transmissible biological agent with no treatment. What the body of the paper states is: 

The scenarios differed in two aspects. In the first scenario, there was an effective pro­phylaxis or treatment available, and the agent was iden­tified as being nontransmissible. In the second scenario, there was only an unproven experimental prophylaxis or treatment available and the agent was identified as being person-to-person transmissible. The final ques­tion in each scenario concentrated on specific methods of prophylaxis/treatment dissemination

So, as can plainly be seen, at no time does the survey ask the respondents if they would report to their assigned duties if there were no treatment available.  Since it is reasonably assumed that roughly two weeks into a severe PanFlu event there will be no supplies left to treat anyone this question would have been useful to have seen addressed.  In fairness, the survey seems to have been put together prior to the SARS HCW debacle or the general awareness of an Avian Influenza Pandemic.

One of the more disturbing aspects of this survey is the fact that it was administered at a hospital that had up to date training in response to a terrorist's attack involving mass casualties since it is a designated decontamination and treatment facility.  The authors speculated that being informed on a higher level of the likely issues involved may have motivated some of the responses, on the negative side.

 

After reading the paper twice in its entirety I was deeply disheartened.  While no one can say with any certitude how they will or will not respond in any given situation of the magnitude of a severe PanFlu it is, I feel it is helpful to understand the thought processes of those we will be depending on, and how they will potentially play out.

Since it is safe to assume that any person who is dedicated enough, some might say stupid enough, to report to work during a situation such as is my focus will likely find themselves needing medical attention themselves at some point in the crisis how soon should we expect to see the drop off of Emergency Services personnel reporting?  I would venture to guess pretty quickly.

Will police, even those dedicated to their mission, risk reporting in a crisis situation, where the chances of injury and/or infection, are great knowing that there will be no treatment for them should they become injured or ill?  What if an officer has an auto accident while responding to someone's urgent call for help and there is no EMS to transport him/her to the (unstaffed) Emergency Room?  The exact same scenario question could be posed for Truck Drivers as well.  Will they report knowing that if they become infected or injured there will be no one to treat them?  What happens if they don't report?

 

Essential Services are called that because that's what they are... ESSENTIAL.

 

I am not pointing an accusatory finger at Emergency Room doctors, nurses or EMS, EMS crews are "Brothers/Sisters in Blue" and as such I consider them equally members of my very extended "family", but I do feel obligated to point out... shout really... the nightmare cascade of consequences should the people that stand at the pinnacle refuse to "stand."  And I feel that I only addressed the superficial surface of the issues this paper brings to mind.

It would be prudent for Hospital... and County/City... Administrators to sit up and take note of this paper.  The problems it identifies could be blunted by bringing in a reasonable amount of PPEs (Personal Protection Equipment), planning to give priority treatment to the Emergency Responders... AND THEIR FAMILIES, and actually demonstrating that they care about the health and welfare of those they depend upon to perform these very important and ESSENTIAL functions.

Will Police Report for Duty During a Pandemic

A concept has been floated on the Flu Forums that police should be assigned to the geographical areas that they live in the event of a severe pandemic, my definition: a 10% CFR (Case Fatality Ratio) or higher.

At first blush, this makes a lot of sense.  Less gas consumed, and officers would have a vested interest in the local area where they live.  It is even a model that my county's Sheriff's Department utilizes during a Category 2 or above hurricane landfall.  Stay home, come out as soon as is possible, be responsible for calls in your area.  It works for hurricanes because personnel are fairly well dispersed and roadways are often rendered impassible anyway, and the Sheriff's Deputies have county wide jurisdiction.  Reality is though many police live in a jurisdiction different from where they work

During a moderate to severe pandemic two areas where policing would be thin are the two ends of the socioeconomic spectrum, the bottom and the top.  Not many police live in the worst or best neighborhoods.

But, as one astute Flubie pointed out, exactly how vested and committed will a police officer, or department, be to areas where they consistently suffer abuse, denigration, and even verbal, physical and legal attacks?  A tough question.

Surprisingly, it is the same two areas as lack of residential representation put at risk.  While physical attacks may not be common in the upper socioeconomic neighborhoods, the other maltreatment categories surprisingly are.  The very first time I was spat upon was by a woman in one of the best neighborhood's of my city.

It brings the phenomena of "There's Blue and then there's every body else", or the variant, "There's Blue and then there's you" to light.  Police and the community at large are often at odds, viewing each other with less than friendly gazes.

Unfortunately there appears to be the very real possibility that we, society at large, will be asking our law enforcement officials to serve and protect us in a totally unprotected state.  No PPE (Personal Protective Equipment) such as masks, gloves and hand sanitizer. 

Expert assumption (yeah, there's that word again) has it that PPE will probably be totally depleted in about two to four weeks, even in the most well prepared organizations and hospitals.  Our First Responders, Police, Fire, EMS will be expected to perform their duties unprotected.  A callused position could be taken that the threat to life and limb are integral to their jobs and a risk was, de facto, accepted.  It's what they get paid for, right?

In a word: NO.

Although the risk of life and limb is a fact of life for our police, it is something that a great deal of training, continuing education, and money are expended to minimize.  And, while they accept the fact that every time they pin the badge on may be their last, giving their life is not part of the contract.

You see, there is a distinction.  Giving one's life is an act of conscious volition, with full understanding that death will be or likely will be the final outcome.  Having one's life taken is an act or circumstance, that while possibly foreseeable, every action was taken to prevent.

There's the rub.

...EVERY ACTION WAS TAKEN TO PREVENT.

So, there are two, diametrically opposed, factors effecting motivation to report in a probable life threatening and crisis situation, a strong sense of duty and an "Us vs Them" mentality.  Sitting smack in the middle of those two polar opposites is the will to live.  The more connected to a community an officer is the more likely he/she will be to report to duty, even at great danger to themselves.

How will a community ensure that their police tilt toward the "sense of duty" side of the line?  At the risk of stating the obvious, ensuring that they have sufficient PPE would be a good start.  Since a sufficient supply of PPE is probably not a goal that can be accomplished, at least a honest effort to get in place what can be gotten would go a long way.  A community that cares for its cops will have cops that care about the community.

During a moderate to severe pandemic everything will contract down to the community level.  Ensuring that as many public service employees are vested in the community only makes sense.  The purchase of adequate PPE for the police is cheap considering the alternatives.  Communities must not find themselves in the position of having to ask their police to give their lives protecting those who failed to do everything within reason to protect them.

Community planners should also be aware that those they depend on to police their streets, put out their fires and respond to medical emergencies may be a pandemic resource that their communities of residence may compete for.  Since police are commonly viewed as an enemy, or at best, an intruder by the communities they police, they may be easily convinced to contribute their talents and skills where they feel more "at home."

LAW ENFORCEMENT DURING A PANDEMIC

However you may feel about your local police or sheriff’s department, they serve a function that society is unable to do without. The risk of punishment keeps 90% of us law-abiding citizens, and we pay our law enforcement officers to stand between us and the remaining 10%.  Failing that, we pay them to track down the offenders and facilitate the legal process.

First, I would like to address the “Katrina Syndrome” as it has now come to represent the general “vision” of a police response to a grand-scale disaster.

We all sat in fascinated horror, those of us who didn’t live through it of course, as the tragedy unfolded on our televisions in all its ignominious details. We heard of police officers failing to report for duty, abandoning their jobs, and even looting. As a nation we were stunned and many even allowed those few despicable examples to affirm all the negative thoughts and feeling that were ever entertained about cops.

Yes, there are bad cops out there; we would never attempt to convince anyone otherwise. However, there are bad and downright awful in every profession, from priests, doctors, lawyers, architects and truck drivers. What many fail to account for is that the police force in New Orleans is one of the most corrupt, under-paid, and demoralized police departments in America. To compare it, and its officers, with almost any other department is like comparing a General Practitioner with a Neurosurgeon; different levels of training, different temperaments.

There are, however, legitimate parallels to the New Orleans police response and what we will likely see in our own department during a severe pandemic.

LAW ENFORCEMENT DURING A SEVERE PANDEMIC

Generally the actual functions of a law enforcement entity, although they vary depending on the level, can be listed as follows:

• Patrol
• Intervention/Interdiction
• Investigation
• Technical Analysis
• Reporting
• Crime Prevention
• Community Outreach
• Enforcement
• Arrest/Detention
• Prosecution

All but the smallest departments operate twenty-four hours a day, seven days a week, although not all functions are 24/7. The list of functions could be narrowed to a bare minimum during a severe pandemic. They consist of the following:

• Intervention/Interdiction
• Enforcement
• Arrest/Detention

In most modern departments, as in any well run modern-model private sector business, staffing is determined on a “current needs assessment.” In other words, manpower is determined by the day-to-day enforcement, investigation, and deterrence needs of the civil entity. It is not based on the needs of that entity during an emergency, whether it’s a hurricane or a pandemic.

When an extraordinary incident occurs and extra police need to be deployed onto the streets several things happen at one time. All medically fit sworn officers are pressed into service and the department is placed on a twelve-on/twelve-off around the clock schedule, seven days a week, week in, week out, until the emergency passes. In almost all cases this schedule does not need to be maintained for more than a couple of days, occasionally several weeks, and even more rarely, a month. Katrina was the first law enforcement mobilization that lasted into the several-month time frame.

The next thing that happens is that the National Guard is activated and deployed, followed immediately by an influx of law enforcement manpower and materials from surrounding locations, or in the case of Katrina, from around the country.

These three actions allow a community, city, county or state, to mount a police response to the emergency, even if it is less than optimal.

During a severe pandemic there will be no reinforcement from the “outside.” Each city, community, county and state will be on their own, making do with what they have, and what they have may be frightfully little.

Police officers will suffer the same 30-60% absenteeism due to illness, theirs or a loved one, refusal to risk infection, and death forecast for the private sector. To those categories must be added those that will initially report but drop out due to the exhausting, emotionally overwhelming conditions that they will have to work in day in, day out, without a break.

There is also a dynamic to the demographic of patrol officers. Most are in exactly the same age range that will be at highest risk of death from an infection of H5N1, those under forty. As is often said, “Police work is a young man’s (or the PC term, person’s) profession.” Most who start in law enforcement leave before they reach middle age, finding that the horrid hours, relative low pay, the risk of civil and criminal liability, maiming and death, coupled, finally, with the “shoveling sh** (offal) against the tide” syndrome, out weighs any sense of civic duty, and the “I’m gonna make a difference” pipedream.

And let’s face it, as those remaining see their fellows starting to drop, the motivation to report to work will lessen with each passing day.

At a time when we will need our law enforcement officials to maintain order and assist in emergency relief they will be over-worked, over-whelmed and dangerously understaffed.

Intervention/Interdiction/Enforcement

With the assumption that law enforcement agencies will suffer greater staff shortages as the ‘civilian’ work force and the need to operate a police presence 24/7, we have to next look at what may be faced by the police that remain in the field and by the public left unprotected by a significantly less than full compliment of law enforcement officers.

Crime is still going to happen, and certain types of crime may well sky-rocket. A listing of crimes likely to experience a dramatic increase would look something this:

• Looting – As was seen in Katrina’s aftermath, it doesn’t matter whether the items are useful or even necessary to survival, looting will occur if an opportunity presents itself.

• Rioting – It is presumed there will be medical care and food riots. People in the Western World are not used to having their needs unmet. Nor is the population likely to sit silently by while they are hungry or want medical preventives (vaccines, medicines).

• Breaking and Entering – People who have failed to prepare will be desperate to feed themselves and their families. Many will view “taking” from someone else their only option.

• Armed Robbery – Same as above.

• Home Invasion – Adding to the above will also be society’s predatory criminals who will be emboldened to take advantage of people in homes who are not usually prepared to defend themselves. We will expound further on this in another section.

• Aggravated Assault – Tempers and nerves will be strained to the breaking point. Add fear and need and we will see people resorting to physical violence more and more and with less provocation.

• Kidnapping/Hostage Taking – Again, desperate times will see desperate measures being resorted      to. Someone with a sick loved one could resort to taking a medically trained individual by force in the hopes of gaining that medical care. Or, take a group of people hostage with threat of mayhem or death to demand treatment.

• Murder – Fear, anger, need will drive many murders, as well as a sense of no longer being constrained by a society that may at one point break down.

We also need to consider two distinct groups of people in our potential crime rise. Those are drug addicts who will be without (presumed) a ready supply of their chosen poison and the mentally ill who will be without their required medications (presumed).

The above categories of crimes likely to rise in a severe pandemic are all crimes that receive an immediate, multiple officer response; some require special skill-sets and/or equipment not possessed by every sworn officer. The supposition we challenge is that there will be multiple officers and the requisite skill sets to respond with the immediacy and thoroughness required.

We posit a thirty percent staffing level, for 24/7 coverage. At that staffing level the 12-on/12-off shift structure will almost certainly have to be utilized, and when will the opportunity to take a day off arise? How long can a law enforcement officer function under these possible conditions? Perhaps they could function for quite some time, but they will not be functioning at the high level of mental alertness that their job and function requires.

Priorities will have to be made, police triage, if you will.

What will happen when there is a food riot? A storming of a clinic? A gang of hungry marauders busting down your door to see if you have any food left?

There really will only be two potentialities if we are correct. One is that police will respond with a ‘no questions asked/no prisoners taken’ approach. Or, worse, will not respond at all. How high on the priority list will crimes against property be? And make no mistake, a food riot, a storming of a clinic, or busting down of your door to steal your food, are all property crimes.                                                                            
Which would be worse? Which will be viewed as the most egregious post-pandemic? If you ask us, it’s a no-win situation, and that is why we factor in a drop-out factor at the rate that we do. If you have no chance of winning, why fight the battle? Of course, there will be officers who stick to the job till the bitter end, either theirs or the pandemic’s, but how effective will these few brave and stubborn souls be by the time we reach the “exit point?”

Now that I have laid out the very real problems, as I see them, I would like to offer a few workable solutions, a rarity in considering issues in a severe pandemic. For once, there are options that will cost little or no money and easily instituted without massive changes or new infrastructure.

As stated above, many law enforcement officers leave police work early, most of them voluntarily, in good standing. There are also many retired officers, again in good standing that are over forty-five and still under sixty, many of these would still be in good physical health.

These ex-officers are a specialized labor pool that could be tapped, outfitted, and given a rapid re-training in the space of two-six weeks. As soon as the pandemic strain presents itself as having sustained transmission ability these ex-officers could be activated, trained and see deployment at just the time when attrition began to appear.

Departments can inform and educate their personnel about the likely issues to arise during a severe pandemic and how they, the officers themselves, can mitigate those effects. Get informed, prepare, plan.

Departments need to make plans to house and feed officers who will either not want to go home to their families and possibly infect them, or have no family to go home to.

Recommend all personnel receive a pneumonia vaccine, which should be covered by existing health care plans. I would also recommend that patrol officers receive the same vaccines recommended to travelers to third world countries.

If civil unrest and questionable civilian safety is a real possibility then arrangements could be made to house officer’s families in a secured location, protected and provided for. Many officers will not want to leave their own families vulnerable only to come out and protect yours. Assuaging the fear of a loved one’s vulnerabilities could entice many ex-officers to step up to the call to service.

A Mobile Police Force

Fuel for vehicles will be a “must-have”, but not necessarily a “gonna-have” if the supply chain concerns come to fruition. Maintenance of the fleet must be added to fuel concerns. Patrol vehicles are high maintenance, high failure rate vehicles. They are abused as a matter of course and suffer high breakdown rates as a consequence. Will spare parts be available to fix them? Again, the JIT supply chain rears its ugly head.

There is, however, a benefit to a reduction in force; there will be more vehicles to supply fewer officers. While that could potentially cover the inability to maintain and repair vehicles due to ware and tear, it will not last long as a fall back if vehicles are damaged wholesale in civil unrest or deliberate sabotage because of an identified weakness.

Law enforcement departments are no different than any other business or entity in our modern times, needed parts are not stocked, or only stocked in very limited quantities, instead they are ordered in on a regular basis for basics and “as needed” for the less common items.

Where will spare parts come from? Who will perform the repairs? Has anyone even asked these questions?

My critique is by no means meant as any form of criticism. It is however, a summation of what I think will be in play during a severe pandemic. If only 40-60% of healthcare professionals surveyed are willing to report during a pandemic, why would police be any different? But no one has thought to poll them, unlike doctors and nurses, as to their likely response, so we can only surmise based on an extrapolation of the groups that have been surveyed.

In the best, most nationally acclaimed departments, most of police work is reactive, with a healthy sprinkle of proactive actions. In other words, much of police work is after the crime has been committed, reports, investigations, follow-ups, interviews, more reports, arrests, more reports, and sometimes, with luck, trials. While there is no real good way to measure proactive police work, crime not committed, it is still there, even if unquantifiable.

During a severe pandemic, there will be no proactive police work, and I challenge the assumption that there will be much reactive police work either. Furthermore, sadly, there is no official leadership as of this date to ensure that I am wrong in my assessments.

Our police will be hanging on by their fingertips…just like everyone else.

SZ

Ripples, Waves, or Tsunami

When I think about pandemic issues (like I STOP thinking about them) I tend to become overwhelmed.  Terms like "Domino Effect", "Ripple Effect", and my personal favorite, "Cascade" quickly come into play. 

I try to read all the published data on the latest Table Top exercises and all the various and sundry expert opinions on the likely effects of a pandemic.  Unfortunately there are few that offer a Grand Overview.  One of the latest and perhaps one of the best to date is the BoozAllen Simulation which can be found here. I encourage any who have not read this yet to do so at the first opportunity.

The Response in the Simulation

Participants recognized that their world had changed--it was not business as usual, and the decisions they faced were both complex and morally difficult. (Emphasis mine)

The team found that the telecommunication infrastructure would likely shut down sometime in the first week of a pandemic and thus the telecommuting we hear touted so frequently would not be an option for the average citizen.  Calling for a prioritization scheme for key organizations and individuals to avert an overload of the Internet.  That means you and I will be locked out.  Does that make you sit up and scratch your head?  It did me.

I have counted on the government busting their butts to keep the Internet up and accessable so that we can stay informed and proactive in our responses to a pandemic.  I am not even sure how the Internet would or could be restricted.  I suppose if you shut down all the civilian ISP's that would work.  But, as you can guess, I have a vested interest in hoping for continued civilian access to the Internet.  Our forum and this blog, to say nothing of the fact that I am a total new junkie.  I can't even begin to imagine the withdrawal I would suffer cut off from the information flow.

Federalizing of food, fuel and health care was also mentioned.  Now, those were no surprise and I can only hope that it will happen early on so that we are not faced with a Katrina type debacle where the government comes in after everything has been destroyed and attempts to put the pieces back in functioning condition.  Notice please I didn't say back in order, just up and running, there is a world of difference.

An interesting section is included quoting Dr. Nabarro called "Ten Things I learned"

1. The response needs to be both strategic and opportunistic.

2. Emphasis has to be as much on the people as on the virus.

3. Quite likely by Day 28 all systems will have fallen apart-It is essential and perhaps the most important factor of all.

4. Engaging business from the start is not a luxury-it is essential and perhaps the most important factor of all.

5. Media s an essential part of the response and you need to learn to work with them.

6. Encourage joint work by government, business, and community organizations at all levels.

7. Martial law is not an end but a means, and you need to understand the end state you are working toward when using it-people are precious-martial law should be used to protect the people.

8. We need to define a pandemic state and how business and government will work in that state - must do this now.

9. “Flu-casters” - need to dashboard to track flu statistics and progress around the world.

10. Military must be involved in the response to help keep the peace and deliver essential goods and services.

And then there's the closing...

The economic, health, and social consequences of an influenza pandemic could be devastating if effective and coordinated preparedness activities and timely response actions are not undertaken.  Governments and businesses will face tough, practical, moral, and ethical decisions as they enter a world where not all sections of society are equal, where infrastructure is debilitated, and where irresponsible behavior may emerge as a consequence.

The report also addresses the interesting concept of forced conscription of people who have recovered from a bout of H5N1.  What they fail to mention is that most, all though not all, of recovered H5N1 patients take weeks and months to become functional again.  Children seem to suffer less lasting effects than adults, but it is the adults that will be looked to for conscription, not five year olds.

Martial Law

If you are an American citizen the thought of martial law sends you into screaming fits of hysteria.  We just don’t like the idea of troops on our streets, weapons trained on us with the intent of controlling our freedom of movement.  It also doesn’t help that the dramatizations of what a BF (Bird Flu) pandemic may look like almost always show an overwhelmed and frightened soldier shooting some civilian in the back.

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What will be the likely truth of martial law in America?  While I don’t have a crystal ball I would like to hazard a few guesses.

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First and foremost, please remember that the troops will be Americans.  Our sons, brothers, husbands, daughters, wives, sisters.  And even our fathers, mothers, grand fathers and grand mothers given the military’s reliance on the Reserves.  They also take an oath, sworn or affirmed to uphold the Constitution of the United States and defend her against all enemies both foreign and domestic.  Get that last bit?  AND DOMESTIC.  That means they are charged to protect us from any megalomaniac who may want to play fast and loose with the tenants of the Constitution.  We can argue how much of the Constitution will remain in place later.

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Troops deployed in our cities and on our streets are not our enemies. And as much as the whole concept is anathema, when you are in a crisis situation, YOU will be glad to see them.  I know, I’ve been there.  1989 Hurricane Hugo.  I wanted to run up and kiss the first National Guardsmen I saw roll into the city, but I will also admit that I was really glad to see them leave when they had us back on our feet.  Troops on city streets… bad ju ju, but sometimes they are the only ones that can save us.

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Another glaring example is,of course, New Orleans.  It took the US Military and the selfless men and women who put their own safety on the line to rescue literally thousands who may have perished without their intervention.  These men and women were professional, skilled and singularly dedicated to their mission of saving lives in conditions that were hellish by any American’s standards.

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Second, there simply won’t be enough of them to be standing on every street corner waiting to shoot unwary citizens in the back at the first opportunity.  America is a nation of 300 million +/- souls occupying roughly 354,000 square miles.  As a comparison, Iraq has a population of approximately 27 million populating about 172,000 square miles . American troops are doing all they can to maintain law and order in that country.  See my point?  There will only be enough troops deployed to cover the major population centers and within those, the critical infrastructure, hospitals, supply depots, power stations, fuel depots, vaccine distribution points.

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If pandemic happens and you are LUCKY enough to have a soldier or guardsman on your corner, smile at them (behind your N95 mask of course), thank them, and remember, they are probably just as scared and disconcerted as you are.

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SophiaZoe