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Tue Sep 9 10:28:24 BST 2008

Hi all,

I am looking for plans (or suggests /thoughts) in which patients at ICU’s
were evacuated in the disaster situations. Do you have any experience or
literature ? Any response either positive or negative would be apreciated.

Mehmet ERYILMAZ
Col. Turkish Army
General Surgeon, Ass Prof.
Dept. Emergency Medicine and Surgery
Gulhane Military Medical Academy
Etlik 06018 Ankara TURKEY
mehmeteryilmaz at hotmail.com
drmehmeteryilmaz at gmail.com
www.mehmeteryilmaz.com
Mobile: +90 533 291 3601

Coordinator: Medical Intervention Course for Combat Medic, Turkish Armed
Forces 
Coordinator: Triage Simulation and Moulage Kit Application  Course for
Military Medical Person, Turkish Armed Forces
Editor. Textbook of Disaster Medicine (Incl. 150 contribitors. 2nd
Published)
Editor. Turkish Journal of Disaster Medicine
Deputy Commander. DAKIK Military Mobile Surgical Hospital, Turkish Armed
Forces
Scientific Secretary of The National Congress of Disaster Medicine, 2004

To: 
From: Jeff.Rubin at tvfr.com
Subject: NATO MCI FW: Biosecurity Briefing: proposed OSHA guidance
Date: Wed, 21 May 2008 18:30:54 -0700

Please note the item in the Center for Biosecurity's excellent newsletter on
OSHA's proposed guidance on workplace stockpiling of certain PPE for pan-flu

The proposed guidelines may be viewed online at http://www.osha
gov/dsg/guidance/stockpiling-facemasks-respirators.html, or downloaded in
PDF at http://www.osha
gov/dsg/guidance/proposedGuidanceStockpilingRespirator.pdf.  The website for
comments is at http://www.osha.gov/pls/oshaweb/owadisp
show_document?p_table=FEDERAL_REGISTER&p_id=20383, but if you really want to
submit them it's  a convoluted path, so you can skip the search and go
straight to http://www.regulations
gov/fdmspublic/component/main?main=SubmitComment&o=0900006480556ffa:
comments due by 7/9/08.  Comments or not, it worth a look.  If you have not
seen the Initial guidelines to which this serves as an appendix, it's at
http://www.osha.gov/Publications/influenza_pandemic.html.  These documents
are also linked on our workplace pandemic preparedness site, http://www.tvfr
com/dept/em/em_business.html#panflu.

JNR

Jeff Rubin, PhD, CEM®
Emergency Manager
Tualatin Valley Fire & Rescue
(503) 642-0399 (O - direct)
(503) 970-3611 (cell/pager)
(503) 642-4814 (fax)
jeff.rubin at tvfr.com
http://www.tvfr.com
Hospital Preparedness website: http://www.tvfr.com/dept/em/em_hospitals.html
"Man invented language to satisfy his deep need to complain."
(Lily Tomlin)

From: Center for Biosecurity of UPMC [mailto:bb_editor at upmc-biosecurity.org]

Sent: Friday, May 16, 2008 12:10 PM
To: Rubin, Jeffrey N.
Subject: Biosecurity Briefing

Biosecurity Briefing

  Please add bbeditor at upmc-biosecurity.org to your email contacts.
May 16, 2008

FDA Approves Antimicrobial for Pediatric Inhalational Anthrax Exposure 
OSHA Seeks Public Comment on Workplace Stockpiling Guidance 
Indonesia to Share H5N1 Data with New GISAID Database

FDA Approves Antimicrobial for Pediatric Inhalational Anthrax Exposure
According to a Drug Industry Daily news report, the U.S. Food and Drug
Administration (FDA) approved Levaquin® (levofloxacin) for use in pediatric
patients who have been exposed to Bacillus anthracis.1 This is the first and
only pediatric indication for Levaquin. Levaquin, which is a quinolone
antimicrobial agent manufactured by Ortho-McNeil, is approved for this
indication in children six months of age or older in 250 mg, 500 mg, and 750
mg strength tablets, 5 mg/mL injection, and 25 mg/mL oral solution.1,2 While
it has not been tested in humans for the post-exposure prevention of
inhalational anthrax, Levaquin was already approved by the FDA to treat
adults “to reduce the incidence or progression of disease following exposure
to aerosolized Bacillus anthracis.”2
Brooke Courtney
References

Astor A. Levaquin approved for pediatric anthrax exposure. Drug Industry
Daily. May 8, 2008. http://www.fdanews
com/newsletter/article?articleId=106558&issueId=11568. Accessed May 15, 2008

Levaquin: Highlights of Prescribing Information. February 2008. http://www
levaquin.com/levaquin/shared/pi/levaquin.pdf#zoom=100. Accessed May 15, 2008

OSHA Seeks Public Comment on Workplace Stockpiling Guidance
On May 9, 2008, the Occupational Safety and Health Administration (OSHA) of
the U.S. Department of Labor released proposed guidance on workplace
stockpiling of facemasks and respirators for pandemic influenza and is
seeking public comment. OSHA recommends workplace stockpiling “because
manufacturing capacity at the time of an outbreak would not meet the
expected demand” and “employers will be able to better protect their
employees as well as lessen the impact of a pandemic on their business,
society, and the economy.”1 The guidance recommends that employers
categorize employee positions into four risk types, “according to the
likelihood of employees’ occupational exposure to pandemic influenza.”1 The
categories are:

Very High Exposure Risk: Healthcare or laboratory employees who perform
tests on pandemic patients or work with patient samples in a laboratory 
High Exposure Risk: Healthcare employees who work in patient rooms,
transport patients, or perform autopsies on pandemic patients 
Medium Exposure Risk: Employees who interact frequently with and have
exposure to the general population 
Low Exposure Risk: Employees with limited contact with patients or the
general public
At each risk level, the guidance provides formulas for determining the
number and type of respirators or facemasks needed and for calculating the
total approximate cost of respirators and facemasks associated with a 120
day pandemic period. There is also a description of the types of respirators
to use during a pandemic, including disposable, surgical, reusable
elastomeric, and powered air purifying respirators. Additionally, the
document provides benefits, drawbacks and price ranges for each type of
respirator.
According to OSHA, although inexpensive, surgical facemasks provide only a
physical barrier against “large droplets of blood or body fluids.”1 In
contrast, respirators “reduce an employee’s exposure to airborne
contaminants;” however, they can cost between $0.50 and $1200 per unit,
depending on the sophistication of the device.1
The OSHA guidance is being offered as an appendix to Guidance on Preparing
Workplaces for an Influenza Pandemic (jointly issued by the Department of
Labor and the Department of Health and Human Services) which was released in
February 2007. The new guidance document will be open for public comment
until July 8, 2008, and instructions for submitting comments can be found
at: http://www.osha.gov/pls/oshaweb/owadisp
show_document?p_table=FEDERAL_REGISTER&p_id=20383
Kunal Rambhia
Reference

Occupational Health and Safety Administration. U.S. Department of Labor.
Proposed guidance on workplace stockpiling of respirators and facemasks for
pandemic influenza. May 9, 2008. http://www.osha
gov/dsg/guidance/stockpiling-facemasks-respirators.html. Accessed May 16,
2008.

Indonesia to Share H5N1 Data with New GISAID Database
On May 16, 2008, health officials from Indonesia announced that the republic
would begin sharing information about H5N1 cases with a new global database
known as the Global Initiative on Sharing Avian Influenza Data (GISAID).
According to an Associated Press (AP) report, GISAID is a free online
database that launched on May 15, 2008; it is not affiliated with the World
Health Organization’s flu database.1
The new database “calls on users to reach an agreement with data providers
before applying, for example, for patents needed for vaccines.” In addition,
GISAID has created “an electronic tracking system that enables site users to
see who has sent or received virus data—from government laboratories to
pharmaceutical companies” in order to preserve transparency.1
The AP article notes that GISAID was developed after a group of more than 70
preeminent scientists published a letter in the journal Nature that calling
for avian influenza information be shared “more quickly and openly.”1
Specifically, the scientists rejected the traditional practice in which
individual organizations maintained private databases of viral genetic
information. According to the article, the WHO’s H5N1 flu information was
held in a database based out of Los Alamos, New Mexico, which was accessible
to only 15 laboratories.
In 2007, the WHO acknowledged an urgent need to address the international
skepticism about process for sharing flu data. However, the AP article notes
that the WHO does still believe that “some genetic data should be kept
behind closed doors.” To that end, the WHO is seeking $10 million to
implement “another database and tracking system.”1
The AP article notes that scientists, including members of WHO’s four
influenza collaborating centers, have expressed skepticism regarding the
WHO’s plans to develop a new database now that GISAID has been launched.
These scientists have said that GISAID has been “tailor-made by and for
influenza scientists” and they argue that “full transparency will not hinder
efforts to carry out their vaccine strain selection process.”1
Jennifer Nuzzo
Reference

McDowell R. Indonesia hands over bird flu data to new database. Associated
Press. May 16, 2008. http://ap.google
com/article/ALeqM5ilPWosUPwePm-tfuKZJ_-YVEd81QD90M8FAG0. Accessed May 18,
2008.

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