STREETWISE POST-MORTEM CARE FOR FIRST RESPONDERS

WE ARE NOW 10 DAYS INTO THE KATRINA DISASTER. AND THERE ARE MANY BODIES ON THE STREET. THEY ARE DECOMPOSING.THIS POSES NEW THREATS DAILY AS THEY SIT OUT UNATTENDED AND UNREMOVED LYING NEAR OR CLOSE TO FETID CONTAMINATED WATERS. THE AMERICAN MILITARY HAS SET UP POST MORTS OUTSIDE THE NOLZAZONE. THIS POST EXPLORES STREET LEVEL TRIAGE OF THESE BODIES THAT COULD PROVIDE A RESPECTFUL HYGENIC RESPONSE THAT MIGHT ALSO DETER DISEASE AND DECOMPOSITION RISKS IN THE CONTAMINATION ZONE. IF ANY OF THESE REMEDIES WERE EMPLOYED THEY WOULD PROVIDE IMPROVED HEALTH PROTECTION AS WELL AS PSYCHOLOGICAL BENIFITS FOR ALL INVOLVED, INCLUDING THE SURVIVORS WHO BY NOW KNOW THAT RELATIVES HAVE BEEN ROTTING ON THE STREET. TO KNOW THAT LOVED ONES ARE BEING TREATED WITH DIGNITY IS A HEALING MEASURE. THE METHODS PRESENTED ARE NOT PREHAPS IN LINE WITH THE MILITARY STRATEGY THAT IS CURRENTLY PLANNED BUT HAS BEEN USED IN OTHER MASS DISASTER ZONES WITH MASSIVE LOSS OF LIFE.
*****[Warning: Please read this knowing it is a sensitve subject written in an effort to protect health.]*******

(1) STREET DEATHS: CARE AT STREET LEVEL:
We have all watched and seen that there are many bodies laying in the Streets of NOLA. We all know that it is a reality of this Disaster. For Most people the most disturbing aspect of this catastrophe is not the SIGHT of the Bodies, it is the Lack of Care. As we now move into Day 11, there will be more bodies, and less survivors. There are health risks for the responders and reporters in the Zone. The Military will try to remove all Spectators as they will be told by Government that this will make the next few weeks more palatable to the public. This strategy is not going to psychologically or hygenically assist the situation. After and During the Tsunami some very practical methods were employed that could be used now to deal with bodies being left that are openly decomposing. ( There are risks to all the living that are exposed to this putrid siutation if left untreated). Instead of leaving bodies untreated there could now be mobile teams put in place with the following supplies and given the Cover and Powder Chore.

COVER AND POWDER CHORE ( FOR MOBILE UNITS):
RESPONDERS AND REPORTERS IN AREA COULD ENCOURAGE THESE METHODS IN AREA , AND IT WILL NOT INHIBIT POST MORTEM CARE AND REPONSE THAT THE MILITARY ALREADY HAVE PLANNED. THIS IS A STATIONARY POST MORTEM METHOD OF CARE.
(1) Small crews and boats could be used. Bodie would be photographed in place. in log book any thing identifying would be noted as well as address. ie. "on roof of blue Toyota liscense #", photo taken, and length taken, age and gender estimated. This should be done within next few days before decomposition sets in.
(2) A bag of absorbant Kitty litter and one box of Armor Hammer Baing Soda could be spread under and around body to absorb fluids. Then body could be covered with simple dark absorbant blanket, and identifyed number could be sprayed on edge to identify it, and match a number given in log book.
(3) All logs of this could later be turned over to authorities to aid the pick up process by mort teams to asist with any and al planned Forensic Process. In the meantime the crews in area and reporters would be able to show the Public that bodies are being care for and treated with respect.
(4) Please also scatter mothball powder around body , or mothballs, and charcoal briquettes. These together will absorb fliuds , but also deter wild animals, in this area especially rats and snakes.

***[ if the bodies are to be left about in open, even once covered they also will need to be sprayed with insect repellent. In Indonesia and Thailand after the Tsunami it was one of the reason that massive amounts of insense was burned, was to repell mosquitoes. Eventually there the dead could not be gathered quickly enough either and funeral pyres were used.]***

***[ Please also consider having Religous Chaplains and Representives participate in this action, this would provide much comfort to the Surviving Refugees.Psychologically as a nation this would have many healing attributes than seeing people just left dead off on the side of the road. This is also Culturally very Important for this region, NOLA is known for their rituals and respect of the Dead. There might even be Deacon and Relgous figures that would want to assist in the Process.If a call was put out to the pUblic there might be crews of people that would volunteer for this duty, morticians and Medical examiners from around the country might donate time to such a worthy duty. This must be examined as a way of providing Comfort to all involved with this Disaster.]]]]****

NEW RISKS FOR DISASTER WORK AND SURVIVORS:CHOLERA AND TYPHOID

DAY 8 KATRINA DISASTER:
CRITICAL READ FOR RESPONDERS AND REPORTERS!!!!
[[[PLEASE NOTE AS OF SEPT 7,2005 WE HAVE NOW LEARNED THAT THE INIATIAL 5 INFECTED ARE NOW DEAD FROM THE CHOLERA, I CAN NOT AGREE AS A NURSE WITH THE ASSESSMENT BY DR.HEALY THAT IT IS A "BENIGN" KIND OF CHOLERA.]]]]

Tonight a New danger has been raised for the Responders and Reporters in the Disaster Zone.Cholera, has shown up in 5 survivors, as of 8pm no information has been given on their condition or status. There was a bit of information given by some government doctor on Larry King on CNN. She stated that it was not a" dangerous "form. I question this statement, there are no Benign forms of this disorder, especially when we all know that 1000's of people were and are being exposed to the Toxic Cesspool in NOLA. And the people that are now suffering from it came down with it under dire circumstances. And now they are being dispersed to multiple states in 100's of shelters without accessto proper healthcare. Many should be in hospital and recieving IV fluids and medical care. Especially the ones that are now weakened and are now the walking wounded, these folks over the next weeks need very close observation and care. They are are at risk of Hep A, and Cholera and Typhoid, and E.coli. All because they were exposed to tons of sewage and had no access to hygeine conditions or sanitary toilets. Not having a place to wash hands litterally will and has placed these folks in line for a whole unanticipated challenge.

( and Corpses floating and Decomposing in the Toxic Cesspool is VERY much a prescription for disaster.period)

They should all be on prophylactic broad spectrum antibiotics- CIPRO- the government has it stockpiled. If you are working in the area-please make sure to go on this prophylactically.They also should be given Typhoid Vaccines NOW and also Hepatitis A vaccines. And now the walking wounded are all over the Country and many of these people have NOT had FULL assessments,evaluation and medical care ( blood work, stool samples).They have had basic Rushed Triage Move-em-out Shuffle assessments- that is not the same thing as a thorough head to toe assessment. And now the surviving children are starting school in schools all over the country- this is a set up for a Huge Health Crisis. I have not seen ANY DHHS explain this lack of mass health monitoring program.These Survivors are refugees and International Law does require that they recieve better care and monitoring than this haphazard shuffle. Houston has been wonderful about having 230,000 new residents, and a better plan would also protect all their generous community.

THE CHILDREN STARTING IN NEW SCHOOLS IN NEW AREAS COULD HAVE BEEN STARTED ON
2 WEEKS OF ANTIBIOTICS AND ALSO GIVEN TYPHOID AND HEPATITIS A VACCINES.
( as well as HEPATITIS B, AND TETANUS) They also should have been allowed atleast a few days to regroup with their families recover for their trauma and recieve rest, nutrition, and TLC. And they should be monintored for atleast a week to monitor for fevers and intestinal symptoms.

I don't mean to be a Doomsayer- but cholera if comes up in people that are malnourished and starved and dehydrated left out exposed in the Cesspool of Multiple Bacteriae, and multiple virulent organisms. This is a Toxic Roap Map for an Imminent Health Care Crisis.

IF YOU ARE WORKING IN A SHELTER REMEMBER THE ELDERLY, IMMUNE COMPROMISED, AND PREGNENT WOMEN, AND BABIES AND YOUNG CHILDREN ARE AT INCREDIBLE RISK.

PEOPLE IN THE ZONE MUST BE PROTECTED- GLOVES, MASKS, AND PROPER SANITATION SUPPLIES AND PROTECTIVE WEAR.PLEASE PLEASE READ PREVIOUS POST ABOUT WHAT KIND OF PROTECTION KITS ARE NEEDED. STAT....
ATLEAST CARRY BLEACH AND GLOVES.

(1) Cholera is an Invisible Danger, it comes on VERY quickly, it is PAINLESS, and that is different
than Dysentary, because dysentary is VERY painful. Both need IV fluids immediately. Cholera is treatable
but must be treated with antibiotics Immediately. Until You get the person care- give them gatorade
and jello- mix with water- and have the person drink, the elctrolyte imbalance situation can be serious quickly
The watery diahrrea can dehydrate a person quickly,especially ones that are already dehydrated before it hits.
Also carry salt tablets. ( gatorade and pedialyte ) Pedialyte is critcal for kids, but also is good with the elderly.
This does need Hospitalization Period.These folks also can not be in large shelter, or community shelter.It poses
mass risk. **** PROTECTION IS CRITCAL:EYEWEAR, MASKS, GLOVES, ETC. Risk by inhale, mucous membrane exposure, of eyes, mouth and also skin.****

(2) Typhoid: Risk number two. If you are seeing cholera- it is only a matter of time before Typhoid appears. Typhoid actually is caused by Salmonella. It has painful urination, pain in joints and back, it quickly has painful intestinal cramping, bleeding,
and bloody stools. It is treatable with fluids and medication, but it requires immediate in hospital care.

(3) E.coli: This Infection also needs immediate IV fluids and antibiotics and hospital care. Sadly it has symptoms that are very similair to other intestinal infections, but is deadly to children and infants if untreated.
*****THE BOTTEM LINE ALL THOSE SURVIVORS THAT COME DOWN WITH ANY GI SYMPTOMS ARE IN NEED OF MEDICAL
CARE AND ACCESS TO IV FLUIDS AND IV MEDS.******
****** AND RESPONDERS / REPORTERS THAT GET SICK NEED TO BE CHECKED IMMEDIATELY AS WELL*************

{{{{{ Is it advisable to be puming this "water" into the lake unfiltered and untreated into the Lake. Are the even the Army Corp.
of Engineers workers are protected, they are not wearing masks, sturdy gloves.etc. }}}}

TAKING CARE OF YOURSELF IF IN NOLA:DANGERS OF FLOOD WATER CONTAMINATION

THIS POST IS ABOUT WATER CONTAMINATION ISSUES FACED BY THOSE IN THE FLOODWATERS OF NOLA, AND THE GULF.
THE FLOOD WATERS OF NEW ORLEANS ARE TOXIC AT THIS TIME, PRECAUTIONS NEED TO BE TAKEN BY THOSE GOING TO RENDER CARE, SUPPORT RESCUE AND RECOVERY, AS WELL AS THOSE REPORTING FROM THE SCENE.THIS TOXIC CESSPOOL IS DANGEROUS, FULL OF CHEMICALS, OILS, DEBRIS, ROTTING GARBAGE, SEWAGE AND ROTTING CORPSES. IT WILL BE MANY WEEKS FOR THE CITY TO BE DRAINED, AND MANY OGANISMS WILL BE BREEDING BY THE HOUR IN THE HEAT. THIS WATER IS NOT JUST DANGEROUS ON THE SKIN CONTACT, IT ALSO CAN MAKE PEOPLE SICK FROM THE FUMES BEING INHALED. AT THIS POINT THE ODORS MIGHT INDICATE HOW TOXIC IT IS. BUT WITH PROTECTION AND PRECAUTIONS ALL CAN PROCEED WITH THEIR WORK AND BE SAFER.
RISKS INCLUDE: HEPATITIS, DYSENTARY, SHIGELLA, KLEBSIELLA, E.COLI, AND TETANUS TO NAME A FEW.
**** After watching CNN live reports today I realized that the many of the workers and reporters could be exposed to a wide array of contaminants, and need better protection. This also includes many of the citizen rescuers that have showed up to help with their watercraft. Other people have said that they want to go to the area to help- but they should be aware of risks. After examining online sites at DHHS, I realized I could compile a fairly complete helplist.It also is good for people to be aware that people that were in these flood zones were exposed to a horrendous amount of contamination, they need to be monitored for symptoms. And they need shelters that now provide the best hygiene possible, and why mass shelter may indeed lead to massive disease out breaks.

PROTECTION:
[1]SHOT UPDATE: Workers and reporters from scene will need to make sure their shots are up to date. This includes Tetanus.
This is critical as there will be a risk of open wounds being exposed to the flood waters. Also it would be advisable to get a full hepatitis series if possible. Meningitis vaccine should aslo be persued. All of these should be advised with consultation of physician.
[2]ESPECIALLY REPORTERS IN AREA NEED BETTER PROTECTION :
PROTECTION KIT:
1) In fanny packs: gloves, face masks, and gloves. While they are reporting, they can remove masks, but while wading through sludge, or even riding around in boats. Some Sewage born illnesses can be airborne. Masks don't have to be Medical supply. Ones can be picked up from Home Depot- heavy duty construction masks are fairly protective, but they need to be changed daily or they get too wet or moist. They do hold germs when wet. They also can help with the odors, and relieve nausea. There is a way to make them also effective against odor control. On inside of mask a drop or two of peppermint oil or lavender oil.
2) Hygiene when in Zone: foam soap. Wipes, the best would be antibacterial Kitchen wipes.
3) Hip waders or dry suit
4) Sturdy Steel Toed Boots ( Walmart or Hardware Store)
5)Bugs/Mosquito control : One of the things that African Relief workers have been using is Oil with Eucalyptus, it repels.
CDC /NIH still examining and encourage DEET, but oil would work better in Wet environment.
6) Good Mobile First Aid Kit. Extra Towels and buy a couple sets of cotton sheets to keep for first aid.
7) Carry extra water, gatorade powder and jello powder in case of heat /vapors related nausea.
8) Extra bottle of Bleach. Bottle of Peroxide- good for water, and wounds.
9) Water purifying tablets- Hiking stores usually have. ( REI in Seattle) Could use in emergency for water to use topically- not drinking water.
10) Salt Tablets to prevent dehydration
11) Carry small bottle of peroxide with you to rinse wounds, and also a tube of antibiotic ointment.

PART II: DYSENTERY:
Unfortunately since we have discussed Risks of Contaminated waters, we may as well talk of Dysentery.
Tonight the first Round appeared from a group that was staying in a Mississippi shelter, and it sounds as if there was no toilet and there was contaminated water coming from a pipe that people had started to use. As of tonight 20 from that shelter are hospitalized.

Dysentery is actually a Disorder first noticed on mass, the troops of WWI had it from living in the trenches- they had no facilities for hygiene and then they also were using the trenches as their latrines. ( Vietnam vets know it as well)

Dysentery starts with cramps of the gut, the intestines because they become imflamed and irritated. If there is an organism involves especially if there is sewage involved it is usually shigella. ( In this situation there could indeed be a mixed bag, including aomeba,and other parasites). After cramping comes the diahreea and the nausea. it will come in waves.

And if not treated it will lead to dehydration. A common mistake is that people will try to Stop the diahrrea- and take OTC med, an opiate product to do that, but this usually makes the cramping worse because then the organism really causes more inflammation of the intestine. If one has cramping and diahreea, chances are this is what it will be this, and not stop with the diarrhea. And the diarrhea will lead to dehydration. Person sick with this will need metronidiazole, sometimes if someone is going in a Critical zone they can be issued this script- and take with them so they have in case they have limited access to medical care.( 400mg 2-3x/d).

In 24-48 hours people can get severely dehydrated and need IV fluids and medication IV, because they can't keep meds donw by mouth. So once it starts it is important to treat right away. Seek medical attention and monitor closely.

If you are working in a zone without a toilet, you can choose to use a container, or bag so that you do not have to squat down on ground. And then dispose of waste elsewhere. It is the proximity to the ground , esp.contaminated ground that contributes to getting this disorder. And again Definently carry the Antibiotic wipes with you.

Even when gut is being treated it still needs rest- a BRAT diet would help , applesauce, bananas, and rice and tea.
While the gut is healing, avoid nuts, acids, and milk products,raw frutis and vegis or anything that would agitate the gut.
Gatorade or even warm jello water will feel good on the gut.


MENINGHITIS
If a person working in the Zone should have symptoms, or fever, they MUST be checked out. Especially if they develope any symptoms such as Headaches, vomiting,dizziness, or stiff neck, light sensitivity. (for these can be indicative of meninghitis- very serious- get care immediately). Sometimes people will think they are just dehydrated, but if they have a sore neck or if they can not touch their chin to their chest they may have a meningeal infection. Now I mention this after the Intestinal Infections because even with treatment Intestinal Infections can spread to other sytems. So if someone is being treated for Intestinal infection and then they complain of any of the neuro symptoms I mentioned they need Hospital Care STAT- because they will need stronger meds and IV meds and IV fluids.

But with these precautions above illness rates can be decreased....hopefully.

****Remember this is a blog by just a grumpy old nurse- I am not a doctor****