Japan's Nuclear Reactors and Iodine-131

20 March 2011 - Speculation and misinformation have accompanied the news about Japan's nuclear power plants, particularly the Fukushima plant.

When you hear reports of radiation releases keep in mind that we normally receive about 0.5 mSv per year from cosmic rays and terrestrial sources (e.g. rocks and earth). SV, or sievert, is the international SI unit for evaluating the biologic effects of radiation. 1.0 Sv = 100 rem (the old non-SI unit)

Typical Doses:
- Brain CT scan: about 0.8 mSv.
- Mammogram: about 3 mSv
- First detectable signs of acute radiation sickness: 250 to 1,000 mSv

Concern about radiation reaching the US has caused a "run" on iodine pills. Iodine only protects against Iodine-131, one of the many isotopes being released by the Fukushima facilities. I-131 can cause cancer and other thyroid problems when it is taken up by that gland. Those with an iodine-poor diet are especially susceptible.

The risk in the US is minimal because:
1. I-131 will become diluted in the atmosphere as it crosses the Pacific ocean.
2. some of the I-131 will be washed out of the air with rain during the crossing.
3. I-131 has a half-life of about 8 days. It will likely take that long for it to reach California.

See:
Radiation Basics 101
ATSDR Iodine 131

HHS Issues New Rules on Privacy and Security

8 July 2010 - HHS announced important new rules and resources to strengthen the privacy of health information and to help all Americans understand their rights and the resources available to safeguard their personal health data.

The proposed rule would strengthen and expand enforcement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Enforcement Rules by:

• expanding individuals’ rights to access their information and to restrict certain types of disclosures of protected health information to health plans. 
• requiring business associates of HIPAA-covered entities to be under most of the same rules as the covered entities;
• setting new limitations on the use and disclosure of protected health information for marketing and fundraising; and
• prohibiting the sale of protected health information without patient authorization.

HHS Press Release here.

Bioterrorism Resources

U.S. Army Medical Research Institute of Infectious Diseases - Excellent source of training materials.

Center for the Study of Bioterrorism, Saint Louis University School of Public Health - Good source of disease specific information and more.

Centers for Disease Control, Public Health Emergency Preparedness & Response - The CDC's site dedicated to mostly bioterrorism information. Includes good training materials.

Chemical Incidents and Terrorism

United States Army Medical Research Institute of Chemical Defense - A good source for text-based courses and textbooks, including the must have Medical Management of Chemical Casualties Handbook.

Interviews with survivors of the Bhopal Incident - An Indian site with a collection of interviews. Very good first hand perspective.

Emergency Preparedness

Advanced HAZMAT Life Support (AHLS) - International provider of training and "verification" on toxic terrorism: Chemical, Biological, Radiological, and Nuclear. The target audience includes paramedics, nurses, toxicologists, physicians, industrial hygienists, and military personnel.

U.S. Department of Health & Human Services, Office of Emergency Preparedness - Information for disaster responders, public health officials, emergency managers, and educators.

Federal Emergency Management Agency (FEMA) - Information on current national terror alert level, news, and links to useful resources.

Federal Bureau of Investigation - News and information on war on terror.

U.S. Department of State, Counter terrorism Office - coordinates all U.S. Government efforts to improve counter terrorism cooperation with foreign governments.

U.S. Environmental Protection Agency (EPA), Chemical Emergency Preparedness and Prevention - Risk management plans, laws and regulations.

Education Design

Gagne's Nine Events of Instruction - Robert Gagne is recognized as a key theorist in educational design, especially adult education. His 9 instruction points are included in the design of most Medfilms' courses.

Dual Coding Theory - Allan Paivio's theory that says recall and recognition is enhanced by presenting information in both visual and verbal form. Paivio is recognized as one of the most important theorists on cognition. All Medfilms' productions utilize dual-coding techniques.

Power Point Does Rocket Science - PowerPoint is an important tool for educators. Like any powerful tool, it's essential to understand it's limitations and how it can be misused. This is a sample from Edward Tufte's famous essay on what's wrong with Power Point.  Tufte, Yale University, is one of the best known theorists and writers on visual communication.  He was employed by the Columbia Accident Investigation Board to review the role of Power Point in the accident.

Modernizing Emergency Training - Article by Alan K. Reeter on the value of story-based training, interactivity, and exercises. It recounts how training saved more than 30 lives during the crash of United 232. Section of Emergency Medicine. Newsletter of the American College of Emergency Physicians, V 15, N 2 April 2006.

Ethics Resources

AMA Principles of Medical Ethics

Ethics in Medicine, University of Washington School of Medicine - This site is rich in content and readings.

Center for Ethics in Healthcare, Oregon Health & Science University - This site is an especially good resource on end of life issues.

National Bioethics Advisory Commission (NBAC) - Reports on human cloning, stem cell research, use of human biological materials, human subjects research, etc.

General Health Information for Professionals and Consumers

National Institutes of Health - Founded in 1887, the National Institutes of Health today is one of the world's foremost medical research centers, and the Federal focal point for medical research in the U.S. The NIH, comprised of 27 separate Institutes and Centers, is one of eight health agencies of the Public Health Service which, in turn, is part of the U.S. Department of Health and Human Services.

MayoClinic.com -Provides access to the experience and knowledge of the more than 2,000 physicians and scientists of Mayo Clinic.

WebMD - A corporation providing services that help physicians, consumers, providers and health plans navigate the complexity of the healthcare system.

InteliHealth - Aetna InteliHealth provides credible information from the most trusted sources, including Harvard Medical School and University of Pennsylvania School of Dental Medicine.

Government Activity

The final rule, COP: Patient Rights, is almost entirely about "patient restraints" and seclusion. The rule includes some significant changes related to training. Training is now required initially and, then, periodically. See the annotated version of the Federal Register for more in depth information. Medfilms new "Patient Restraints and Seclusion" DVD provide the training required by the final rule.

HHSA Grants & Cooperative Agreements - The most recent information from the HHS Health Resources and Services Administration.

HIPAA Resources

U.S. Department of Health & Human Services, Administrative Simplification - includes information on the most recent regulations.

U.S. Department of Health & Human Services, Office of Civil Rights - This is the organization charged with enforcing the HIPAA rules.

Centers for Medicare & Medicaid Services (CMS) - CMS's HIPAA page.

Hospital Incident Command System

FEMA/NIMS FY 2006 NIMS Training Requirements - Training requirements that must be met as a condition of receiving federal preparedness funding.

National Standard Curriculum Training Development Guidance (NIMS/FEMA) - FEMA's PDF describing the 17 Elements for adopting NIMS. Includes a description of the required training and a checklist (page 16) for evaluating training courses provided by governmental and private organizations. October 2005.

NIMS Training Guidelines Fact Sheet - This is a one page FEMA/NIMS chart listing personnel duties and the training that they are required to receive.

NIMS/FEMA ICS-100 Training Checklist - FEMA's IICS-100 training checklist. A two page executive summary excerpted from cited source documents.

Modernizing Emergency Training - Article by Alan K. Reeter on the value of story-based training and exercises. Recounts how training saved lives during the crash of United 232. Section of Emergency Medicine. Newsletter of the American College of Emergency Physicians, V 15, N 2 April 2006.

Infection Control, Influenza and Pandemic

• Education for all HCWs is recommended for the first time.
• Masks should now be donned before entering a room under Droplet Precautions.
• The addition of Respiratory Hygiene/Cough Etiquette and Safe Injection Practices.
• Update on the components of the Protective Environment (PE).
• The term “nosocomial infections“ is replaced by “healthcare associated infections” (HAIs).

Medfilms DVD on "Standard and Transmission-Based Precautions" provides the training recommended by the new Guideline.

WHO - Avian Influenza Situation Updates - The World Health Organization's current situation updates are published as the events occur. Updated about every 2-7 days.

SARS Commission Final Report - Released to the public 9 January 2007. The Commission was established by the Government of Ontario. It reported on how the SARS virus came to the province, how the virus spread, how it was dealt with, and lessons learned. We highly recommend reading the "Thirteen Essential Questions in Vol. 1, Executive Summary".

CDC's Weekly Influenza Map - CDC's Weekly US Map: Influenza Summary Update.

Current Flu US Flu Map - A very nice map sponsored by Roche. Click on the map to see specific state information. Be sure to look at the lower right corner of the map page to see the Interactive Flu Seasonal Maps. It displays animations of the spread of flu from previous seasons.

PandemicFlu.gov - Managed by the Department of Health and Human Services.

APIC Practice Guidelines - Reprinted infection control guidelines from CDC and HICPAC.

Morbidity and Mortality Weekly Report (MMWR) - Published weekly by the CDC.

Influenza Training: Changing Culture - Article by Alan Reeter in Managing Infection Control, Oct 2006.

Medical Research

PubMed - This is the National Library of Medicine site providing access to over 12 million MEDLINE citations back to the mid-1960's and additional life science journals. PubMed includes links to many sites providing full text articles and other related resources.

Radiological Terrorism

Radiation Emergency Assistance Center/Training Site (REAC/TS) - provides support to the U.S. Department of Energy, the World Health Organization (WHO), and the International Atomic Energy Agency (IAEA) in the medical management of radiation accidents.

Terrorism and Threat Information

Global Incident Map - Provides a fascinating interactive map of incidents world wide. When you first open the map it will be cluttered. To reduce the clutter, scroll down to select "event types" and time span. The map is interactive, meaning you can click on an event to see the details of the incident.