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As a youngster, I would go with my parents to visit my grandparents' graves in a Catholic cemetery in south St. Louis. As youngsters do, I would wander away and find myself walking among the tombstones and grave markers. What I noticed back then and I still can remember today is an entire section of the cemetery where all the tombstones and grave markers had pictures of babies or young children. What struck me was that most of them died between 1918 and 1921.
I did not realize the significance of all of these unfortunate deaths of babies and children who died before their time until last year, when the media started talking about avian flu, bird flu or pandemic flu. Most of these unfortunate souls died from the Spanish Flu of 1918, when 20 million to 40 million people died worldwide, including approximately 675,000 in the United States.
Unless you have been on a sabbatical to some remote mountaintop for the past year, you have undoubtedly heard something in the media about avian flu, bird flu or pandemic flu. The H5N1 virus, known as avian flu, started in the Far East and has spread as far west as Europe and Africa and as far north as Russia. World health experts and those in the United States fear that it will one day become a pandemic. A pandemic is a global outbreak of a new flu virus from which few or no people are immune. It affects people of all ages, and it can occur at any time of the year. Mainly, a pandemic flu starts in countries where swine, fowl and humans all live under the same roof. Major pandemic influenzas of the 20th century include the Spanish Flu of 1918, the Asian Flu of 1957 and the Hong King Flu of 1968.
In order for avian flu to become a pandemic flu, the virus will need to transfer from an animal to a human, mutate, transfer from one human to another and continue to spread. Lately, there have been reported rare cases of human-to-human transfer in the Far East. As of late July 2006, there were 231 cases of humans contracting avian flu, with 133 deaths, or about a 57% mortality rate. The virus continues to evolve with many sub-strains, but it has not yet reached the United States.
Some health experts, though, doubt the veracity of the threat and are calling avian flu such names as "Y2Bird" (referencing the Y2K scare when computers worldwide were supposed to shut down on Jan. 1, 2000). However, whether avian flu becomes the next worldwide pandemic is still unknown. But health experts assert that even if this is not the one, another one will pop up in the future.
What should fire departments do? Should they wait until the first case of avian flu hits the United States? No. Fire departments should be planning now and have a plan ready to go, whether this flu or another one becomes a pandemic. If avian flu becomes a worldwide pandemic, it is estimated that about 30% of the U.S. population will be affected. Of that 30%, about half will seek hospital treatment. On average, each person will infect two or three other people if no precautions are taken. Most will become ill about two days after exposure and the highest risk will be among the young and the pregnant.
If avian flu becomes a pandemic flu, it an be expected to move through communities in waves, with each of the waves lasting approximately six to eight weeks. Typically, there will be two waves, occurring months apart. The entire period of the pandemic will be approximately 18 months to two years and the illness will break out in multiple locations simultaneously.
What can fire departments expect during a pandemic flu? It is estimated that fire departments will see a greater than 25% increase in call volume, especially if your service transports. It is further estimated that 40% of firefighters will be absent from work because of being sick, fear or for caring for a sick family member. And, fire departments can expect an interruption in service delivery from vendors. Also expect food and water supplies to be interrupted, schools and day-care centers to be closed, causing child-care problems for firefighters, and medical care for people with chronic illnesses will be disrupted.
The first priority for any fire department during a pandemic flu period is to protect the health of its firefighters. One method is to provide firefighters with a facemask, not the facepiece from self-contained breathing apparatus (SCBA). Typically, they look like surgical masks. The federal Centers for Disease Control and Prevention (CDC) recommends the N-95 disposable filter mask while the International Association of Fire Fighters (IAFF) recommends the P-100 disposable filter mask.
What fire departments should be doing is planning now. The plan should include such items as how to protect your firefighters. Start with reviewing National Fire Protection Association (NFPA) 1581 â€” Standard on Fire Department Infection Control program (chapters 5 and 6). Your plan should address how your department will deal with an increased call volume, excessive absenteeism or supply interruptions.
What happens if you suspect someone has avian flu in a crowded closed area with other people such as an airplane, train, subway car or classroom? Does your plan include quarantining everyone who may have been exposed? Your plan should also include who in your community has the authority to declare a public health emergency. Fire departments should also plan with law enforcement to maintain law and order. If you remember last year, when there was a flu vaccine shortage, there was some chaos at vaccination sites as people lined up to get what little vaccine was available.
Your plan should also include working with the local health department to make sure firefighters are vaccinated and that surveillance is in place to monitor the health of the community. Make sure psychological support services are available for firefighters who may be working long hours or handling a higher than usual amount of deaths. Fire departments, in their plan, should also create an incident command system following the National Incident Management System (NIMS) format in the event the pandemic flu becomes a reality.
If your fire department transports, are decontamination procedures in place for cleaning an ambulance after transporting a suspected avian flu patient? Finally, hopefully not, but what do you do if a firefighter dies? Is it a line-of-duty death? Can it be proven the firefighter contracted the flu while on the job? These, plus many more other issues will confront your fire department if avian flu becomes a pandemic.
Only through proper planning, anticipating possible scenarios, and an informed and protected workforce will the challenges your department faces during a pandemic be minimized.
GARY LUDWIG, MS, EMT-P, a FirehouseÂ® contributing editor, is a deputy fire chief with the Memphis, TN, Fire Department. He has 28 years of fire-rescue service experience, and previously served 25 years with the City of St. Louis, retiring as the chief paramedic from the St. Louis Fire Department. Ludwig is vice chairman of the EMS Section of the International Association of Fire Chiefs (IAFC), has a master's degree in business and management, and is a licensed paramedic. He is a frequent speaker at EMS and fire conferences nationally and internationally. He can be reached through his website at www.garyludwig.com.