A damsel(fly) in distress

Took some of my pics of a yellow dumped warbler eating a damselfly and made them into a Gif using Giphy.

 
via GIPHY

Preparing for the Worst-case Scenario

"ROTTERDAM, HOLLAND - SEPTEMBER 5, 2010: Demonstration of handling of car crash victim by medics at the annual World Harbor Days in Rotterdam, Holland on September 5"
New York City completed a functional exercise to help the city’s hospital system prepare for emergency medical personnel to treat and transport children, like this young girl, after a catastrophic event.

Setting the Stage

Celia Quinn
Celia Quinn, MD, MPH CDC Career Epidemiology Field Officer assigned to NYC Department of Health and Mental Hygiene

Imagine this: Explosions across New York City target elementary schools. Hundreds of severely injured and traumatized children, teachers, and parents flood hospital emergency departments in the five boroughs. Municipal emergency medical services (EMS) are rushing to respond.

Fortunately this scenario wasn’t really happening – it was part of an exercise conducted on May 25, 2017. The exercise was designed to test the ability of the New York City (NYC) Healthcare System to respond to a massive surge of pediatric trauma patients, exceeding the usual resources of this large and complex healthcare system.

Identifying the Players

As a CDC Career Epidemiology Field Officer assigned to NYC, I worked with the experts in the Pediatric Disaster Coalition and the Fire Department of New York (FDNY). We designed an exercise that reflected the number of injured children who would need to go to the hospital and the type of injuries they might experience if a similar event really happened.

NYC has 62 acute care hospitals that participate in the 911 system. Of these, 16 are level 1 trauma centers designated by the NYC Department of Health  (this includes three pediatric level 1 trauma centers and 4 burn centers). A total of 28 hospitals care for pediatric patients and have, during the past seven years with the assistance of the NYC Pediatric Disaster Coalition, developed pediatric-specific components of their overall disaster plans to prepare them to receive pediatric patients from an incident like the one invented for this exercise. All 28 hospitals participated in the exercise.

Coordinating Resources

Hospitals who participated in the exercise were challenged to rapidly respond to more than 60 simulated patients with a range of injuries and conditions:

  • a 7-year-old boy unresponsive after a traumatic injury to his head

    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
  • A toddler with burns to the face, chest, and abdomen
  • A 12-year-old distraught after witnessing another child lose arms in an explosion

Hospitals had to assess the resources that were available to care for the patients, including

  • What nursing and specialty staff could be made immediately available?
  • What medications and equipment, including imaging equipment and burn supplies, were needed to care for the children?
  • What communications and incident command processes would each hospital use to mobilize staff and other resources in the situation described in the exercise?
  • Which patients needed to be transferred to specialty hospitals to receive care for their injuries?

Coordination between FDNY and hospitals was critical to the success of this exercise – it supported interfacility transfers for patients who required specialty care or to better match hospital resources with patient needs. During the exercise, I met with FDNY leadership from EMS and Office of Medical Affairs physicians, and leaders from NYC Emergency Management and the Health Department at the Fire Department’s Operations Center. There, we tested the communications between hospitals, FDNY, and a volunteer pediatric intensive care physician who was trained to assist FDNY’s Office of Medical Affairs to prioritize patients for urgent interfacility transfers.

Measuring Success

Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.
Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.

This exercise revealed that 28 NYC hospitals were able to rapidly and dramatically increase their pediatric critical care capacity. It was the largest exercise NYC has done that was focused primarily on caring for injured children. During the exercise, these hospitals:

  • More than doubled the number of beds in pediatric intensive care units (PICUs) and added 1,105 pediatric inpatient beds, so children could stay in the hospital for an extended period of time
  • Opened 203 operating rooms that could treat children who needed surgery

During the exercise, we also identified some challenges, including

  • More than half of the hospitals did not have enough supplies that could be used to treat critically injured children
  • A limited number of pediatric specialists, including doctors who could perform brain surgery on children as well as ear, nose, and throat specialists
  • Hospital resources (beds, supplies, and staff) would have been further strained if the disaster scenario had also included large numbers of adults

We were able to identify ways to improve each hospital’s process and further develop our citywide plans to respond to any emergency that strains our healthcare system. As a pediatrician and a parent of two young New Yorkers, I’m grateful that so many dedicated people are working together to make sure that city and hospital plans account for the unique needs of children in disasters.

The NYC Department of Health and Mental Hygiene receives federal funds used to support state and local public health and healthcare system preparedness through the aligned Hospital Preparedness Program (HPP) – Public Health Emergency Preparedness (PHEP) cooperative agreement. NYC used HPP funds to fund the NYC Pediatric Disaster Coalition to design and conduct the exercise, and coordinate participation of hospitals in the exercise.

Read our other National Preparedness Month blogs:

Preparing for the Worst-case Scenario

"ROTTERDAM, HOLLAND - SEPTEMBER 5, 2010: Demonstration of handling of car crash victim by medics at the annual World Harbor Days in Rotterdam, Holland on September 5"
New York City completed a functional exercise to help the city’s hospital system prepare for emergency medical personnel to treat and transport children, like this young girl, after a catastrophic event.

Setting the Stage

Celia Quinn
Celia Quinn, MD, MPH CDC Career Epidemiology Field Officer assigned to NYC Department of Health and Mental Hygiene

Imagine this: Explosions across New York City target elementary schools. Hundreds of severely injured and traumatized children, teachers, and parents flood hospital emergency departments in the five boroughs. Municipal emergency medical services (EMS) are rushing to respond.

Fortunately this scenario wasn’t really happening – it was part of an exercise conducted on May 25, 2017. The exercise was designed to test the ability of the New York City (NYC) Healthcare System to respond to a massive surge of pediatric trauma patients, exceeding the usual resources of this large and complex healthcare system.

Identifying the Players

As a CDC Career Epidemiology Field Officer assigned to NYC, I worked with the experts in the Pediatric Disaster Coalition and the Fire Department of New York (FDNY). We designed an exercise that reflected the number of injured children who would need to go to the hospital and the type of injuries they might experience if a similar event really happened.

NYC has 62 acute care hospitals that participate in the 911 system. Of these, 16 are level 1 trauma centers designated by the NYC Department of Health  (this includes three pediatric level 1 trauma centers and 4 burn centers). A total of 28 hospitals care for pediatric patients and have, during the past seven years with the assistance of the NYC Pediatric Disaster Coalition, developed pediatric-specific components of their overall disaster plans to prepare them to receive pediatric patients from an incident like the one invented for this exercise. All 28 hospitals participated in the exercise.

Coordinating Resources

Hospitals who participated in the exercise were challenged to rapidly respond to more than 60 simulated patients with a range of injuries and conditions:

  • a 7-year-old boy unresponsive after a traumatic injury to his head

    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
  • A toddler with burns to the face, chest, and abdomen
  • A 12-year-old distraught after witnessing another child lose arms in an explosion

Hospitals had to assess the resources that were available to care for the patients, including

  • What nursing and specialty staff could be made immediately available?
  • What medications and equipment, including imaging equipment and burn supplies, were needed to care for the children?
  • What communications and incident command processes would each hospital use to mobilize staff and other resources in the situation described in the exercise?
  • Which patients needed to be transferred to specialty hospitals to receive care for their injuries?

Coordination between FDNY and hospitals was critical to the success of this exercise – it supported interfacility transfers for patients who required specialty care or to better match hospital resources with patient needs. During the exercise, I met with FDNY leadership from EMS and Office of Medical Affairs physicians, and leaders from NYC Emergency Management and the Health Department at the Fire Department’s Operations Center. There, we tested the communications between hospitals, FDNY, and a volunteer pediatric intensive care physician who was trained to assist FDNY’s Office of Medical Affairs to prioritize patients for urgent interfacility transfers.

Measuring Success

Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.
Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.

This exercise revealed that 28 NYC hospitals were able to rapidly and dramatically increase their pediatric critical care capacity. It was the largest exercise NYC has done that was focused primarily on caring for injured children. During the exercise, these hospitals:

  • More than doubled the number of beds in pediatric intensive care units (PICUs) and added 1,105 pediatric inpatient beds, so children could stay in the hospital for an extended period of time
  • Opened 203 operating rooms that could treat children who needed surgery

During the exercise, we also identified some challenges, including

  • More than half of the hospitals did not have enough supplies that could be used to treat critically injured children
  • A limited number of pediatric specialists, including doctors who could perform brain surgery on children as well as ear, nose, and throat specialists
  • Hospital resources (beds, supplies, and staff) would have been further strained if the disaster scenario had also included large numbers of adults

We were able to identify ways to improve each hospital’s process and further develop our citywide plans to respond to any emergency that strains our healthcare system. As a pediatrician and a parent of two young New Yorkers, I’m grateful that so many dedicated people are working together to make sure that city and hospital plans account for the unique needs of children in disasters.

The NYC Department of Health and Mental Hygiene receives federal funds used to support state and local public health and healthcare system preparedness through the aligned Hospital Preparedness Program (HPP) – Public Health Emergency Preparedness (PHEP) cooperative agreement. NYC used HPP funds to fund the NYC Pediatric Disaster Coalition to design and conduct the exercise, and coordinate participation of hospitals in the exercise.

Read our other National Preparedness Month blogs:

West Nile to Zika: How One Virus Helped New York City Prepare for Another

New York City helicopter used for larviciding.

No one told the Aedes mosquito that New York is the city that never sleeps.

The type of mosquito that can spread Zika virus (Zika) is most active during the day and hides at night when our city’s mosquito control efforts are in full swing, meaning that our scientists had to find a way to reach it during pre-dawn hours. The solution? Wake it up, force it to take flight, and then kill it.

This is just one of many innovations New York is using to bolster the fight against Zika.

A tale of two mosquitoes

By the time the Zika outbreak was making news, causing birth defects and threatening pregnant women, New York City already had over a decade of experience in tackling mosquito problems related to the spread of West Nile virus. In facing Zika, we have been able to apply many of our existing resources and lessons learned from the West Nile virus response.

However, the mosquito that carries Zika is different than the one that carries West Nile virus, and it needs to be handled differently. New York is home to Aedes albopictus, which has been known to carry Zika – although, unlike the Aedes aegypti of the south, it has not yet been determined how likely Aedes albopictus is to spread the virus to humans in the United States. Because this is still unknown, people need to protect themselves.

To find out more about the risks, we need to catch the mosquitoes and test them. But we can’t use the same traps to catch the Aedes albopictus that we use to catch the West Nile virus-carrying Culex. Culex mosquitoes can be trapped with a combination of carbon dioxide and light. Being daytime creatures that prey mostly on people, Aedes albopictus don’t fall for the same tricks. So we developed traps that use human pheromones to lure them in.

Building on what we have

Aedes albopictus mosquito feeding.
Aedes albopictus mosquito

Meanwhile, some of the things we have always done for West Nile virus work well in the current response.

We know from previous mosquito-control efforts that pesticides are a last resort. Although there are lots of ways to kill a mosquito, West Nile virus taught us that an effective response takes cooperation on many fronts. In New York, we have laboratories for testing, disease control experts to track cases in people, and a call center that manages tests and information from clinicians. Our communication department gets the word out because the best thing we can do for viruses like West Nile and Zika is educate people about how to prevent mosquito bites – wearing the right repellent, removing standing water, and staying indoors when you can.

Many of the resources we acquired for fighting West Nile virus are proving indispensable for fighting Zika. Ten years ago, we got a hand-me-down helicopter from the NYPD, and we’ve been able to use this for aerial spraying over marshlands and unpopulated areas. In the city, we use the same late-night spray trucks. A police car moves ahead of the truck, warning anyone who may still be out on the street. The distinctly New York voice bellowing from the loudspeaker (that of retired assistant commissioner Allan Goldberg) is even the same one we’ve always used.

 Sharing what we know

Zika presents us with a very steep learning curve, and it reinforces the need for transparent communication. We’ve set up an interactive website where we can share what we’re discovering with the public. We put out data on a weekly basis: people can zoom in and out on their screens to see where we’re finding mosquitoes. We want everyone to understand about the preventive work we’re doing to help keep Zika at bay.

The complex nature of Zika reveals the strongest and weakest points of the public health system. One thing in particular public health has always struggled with is how to change people’s behavior, which is critical and must happen if we want to stop Zika. We really hope that pregnant women or women who plan to become pregnant will not travel to areas with Zika, but it’s hard to stop people from visiting family or simply enjoying the world.

So far, all of the reported Zika cases in New York – including, as of August, 49 among pregnant women – have been the result of global travel. But just because we haven’t seen local transmission doesn’t mean the potential isn’t there.

This is why we’ve expanded our efforts by hiring extra staff and extending the areas where we do mosquito control and education. We need to continue to collaborate across agencies and in the field – and, in fact, all over the world – to manage a complex response that touches on so many areas. Working together and staying vigilant is our only hope for getting – and staying – ahead of this potentially devastating disease.

Read our other National Preparedness Month blogs:

 

The Art of Science: DIVE

As part of New York’s “Summer Streets” program, artist Jana Winderen has converted seven blocks of the Park Avenue tunnel into an undersea sound experience for pedestrians. The art installation is designed to provide a progressive experience of moving from the shore into deeper water as the viewer walks from the south end of the tunnel to the north.

*Hat tip to artnet news and Michele Banks.


Filed under: The Art of Science Tagged: Jana Winderen, New York City, ocean, sound, Summer Streets