1. Battalion Chief Keith Long Fairmount Fire Protection District Golden, Colorado

2. Who is this Guy?

3. Our Journey Perception vs. Reality Our Mission has Changed Situational Awareness Infectious Disease MRSA Where do we go from here?

4. Perception vs. Reality Finished files are the result of years of scientific study combined with years of experience.

5. How many letter “F”s in previous slide 3? 4? 5? 6?

6. Character “The ultimate measure of a person is not where they stand in moments of conflict and convenience, but where they stand in times of challenge and controversy” MLK

7. C Copyright Silva, Sweden, all rights reserved

8. Then Wildfire

9. Our Mission is Changed Wildfires Hurricanes Tornados Earthquakes WMD 911 Snow Storms Pandemics and Epidemics Etc

10. Infectious Disease Foodborne Waterborne Airborne Bloodborne Zoonotic/Vectorborne

11. Pathogens Transmitted in Camp We will be specifically talking about strategies for containing pathogen potential spread person to person.

12. Transmission Modes Respiratory – e.g. influenza Direct Contact – e.g. Staph Infections Contaminated Environments - e.g. Norovirus

13. Questions? How many of you folks are on Teams? How many of your teams have Emergency Response Plans? When did you last practice the Plan? How many of your Teams have Infectious Response Plans? Have you ever practiced the Plan?

14. IDRP/ERP for IAP Position Checklist – Field Organization Division/ Group Supervisor Medical Group Supervisor Triage Unit Leader Treatment Unit Leader Transportation Unit Leader

15. Four Routes of Entry Inhalation Ingestion Absorption injection

16. Its too late to duck!

17. Preparation N95 Masks for all members *Must be fit tested* Safety Glasses Exam Gloves Hand Sanitizer

18. Masks and Respirators N95 Mask or Respirator (goes on you) Surgical Mask (goes on them)

19. Resources Local Health Department Local clinic or Hospital State Health Department Center for Disease Control

20. Specific MRSA – Methicillin – Resistant Staphylococcus Aureus

21. MRSA Background Signs and Symptoms Incubation Period Treatments

22. MRSA and Firefighters Methicillin Resistant Staph Aureus is a Staff infection that is resistant to normal antibiotic treatments. It exists on the skin and in nasal passages and is “colonized” in 20 to 30% of all people with no symptoms

23. MRSA and Firefighters The Centers for disease control estimates that by 2015, all of us will carry some form of MRSA. It used to be solely a hospital problem but is now found in the community. MRSA can survive on some surfaces for up to 2 months.

24. MRSA and Firefighters Why Fire Fighters? FF’s move through the community, hospitals and patient environs more that the general public. Combined living/working environment High potential for skin irritation/lacerations Do not regard small injuries as a threat. Why be concerned? If MRSA enters the bloodstream it can cause death or damage that makes you disabled. Most MRSA treatments average cost to treat is between $15000.00 and $20000.00.

25. MRSA and Firefighters THIS IS NOT A NEW PROBLEM FOR FIRE FIGHTERS It is a problem in many fire stations, fire crews and at least one case of MRSA has been found in every state across the nation.

26. MRSA and Firefighters It starts as a pimple with red tender edges. What does it look like?

27. MRSA and Firefighters Progresses into an abscessed infection quickly. If it enters the bloodstream it is hard to treat. – Only two antibiotics can cure it then. Can result in Fever, Malaise, Hospitalization and lost work time.

28. MRSA and Firefighters Almost all MRSA can be treated by drainage of pus with or without antibiotics. If antibiotics are used, a sample must be analyzed first to determine the strain and type of antibiotics to use. Open skin wounds must be covered and dry. Do not use ointments for treatment of MRSA. Regard breaks in skin as potentially serious issu es

29. MRSA and Firefighters What can we do? MRSA cannot live if there is not moisture. Dry PPE, shirts and pants after use. Make new bleach solutions everyday… Needs a ten minute contact time to be 100% effective. Use alcohol cleaners with at least 70% alcohol. Cover any skin irritations or lesions with a dry bandaid. Don’t wear the same clothes consecutive days when sweating a lot.

30. MRSA and Firefighters What can we do cont. What can we do cont. WASH YOUR HANDS, FACE and ARMS WASH YOUR HANDS, FACE and ARMS » Wear Gloves and PPE & CLEAN! CLEAN ! CLEAN!CLEAN! CLEAN ! CLEAN!

31. Alcohol Based Hand Sanitizers What about alcohol based hand sanitizers!

32. A Gift from the NLW Myclyns – immediately after contact with –Blood –Saliva –Vomit –Coughing –Feces –Open wounds

33. Myclyns Kills 50 pathogenic bacteria upon contact 99.99% MRSA TB Hep A, B, and C H1N1 Hepatitus

34. ExtendaClyns Hand Sanitizer Non Alcohol based Broad Spectrum Last up to 4 hours Kills 99.99% of germs

35. Leadership Development In High Risk Environments Training Field Experience Self Development Exercises

36. Fireline Leadership Challenge Time Pressure High Stakes Inadequate Information Ambiguous Objectives Poorly Defined Procedures Rapidly Changing Conditions Requirement of Team Coordination

37. Train as you fight, fight as you train

38. Cognitive Memory System Complex and connects memories togetherComplex and connects memories together Well integratedWell integrated Treats information neutrallyTreats information neutrally Subject to control and filteringSubject to control and filtering

39. Emotion & Fear Memory System Responsible for special emphasisResponsible for special emphasis Stimulus-drivenStimulus-driven Direct and quickDirect and quick Highly emotional, inflexible, and fragmentaryHighly emotional, inflexible, and fragmentary Connected directly to fear responsesConnected directly to fear responses

40. Are we setting ourselves up for failure? Wildland vs. Structure vs. All Risk Emergency Response Plans Incident within an incident Infectious Disease Response Plans

41. Lessons Learned 95% of illness comes from inadequate washing of Hands, Sleeping in Dirty Clothes Incident Emergency Medical Task Group

42. Ideas and Suggestions Medical Unit Leaders utilize Isuite Injury/ Illness section. Brief your folks, Give Expectations Have your people do evaluations on you

43. 6 Priorities in Fire Camp 1.Case Isolation or cohorting 2.Personal Hygiene 3.Environmental Sanitation 4.Crowding 5.Education and Awareness 6.Pre-deployment Interventions

44. Copyright 1995, Universal Studios, all rights reserved

45. Final Thoughts I don’t have all the answers, Hopefully I never will. When I do it’s time for me to leave. Empower your people. Mentor your people. Utilize SME (subject matter experts) Thank you for all you do!