THE NEWSLETTER OF THE BUREAU OF HEALTH SERVICES • COUNSELING SERVICES UNIT • FDNY Vol.1 • No. 7 • April 2003

SARS Update

The emergence of an apparently new disease entity has raised the attention and concern of the world. SARS, Severe Acute Respiratory Syndrome has infected well over 2400 people, killing over 89 people reported from 29 countries. This illness first appeared in Mainland China with subsequent spread to neighboring Hong Kong, Viet-nam and Singapore. SARS is under investigation by many health organizations, including WHO (World Health Organization) and the CDC (Centers for Disease Control and Prevention). On a daily basis, new knowledge has been gained as some of the patterns of this disease emerge.

The cause of this infection appears to be a virus, called the corona virus. Although the corona virus belongs to a family of viruses that can cause the common cold, this strain has a virulence that has led to deaths and severe respiratory illness in many individuals. People traveling to these affected areas, and health care workers who took care of these victims are especially at risk. With additional information and precautions, the spread of this illness seems to be slowing.

In the US, over 100 cases of suspected SARS cases are reported. The vast majority of these cases have occurred in people who had traveled to Asia. Two cases in the U.S. have involved health care workers and four cases occurred in family members who lived with ill family members. Those reported ill in the US have not had severe symptoms. No deaths have occurred, suggesting this is a less virulent strain.

The disease does not respond to antibiotics because it is caused by a virus.

The current criteria for inclusion as possible SARS includes:

• Cough
• Difficulty breathing or ANY shortness of breath
• Fever over 100.
• Body aches, fatigue, headache
• Other criteria include travel to Asia within the last 10 days
• or Exposure to someone ill who has traveled to Asia.

This definition is very wide, and will include patients who will not be confirmed as having SARS. Confirmation will be made by further testing for antibodies to the corona virus.

The emergence of this illness has raised concerns about the threat of bioterrorism. Although there is no evidence that this illness represents an act of terrorism, it does demonstrate that the natural emergence of a virulent strain of a known germ entity represents a real threat. It further highlights the need to use universal precautions.

The CDC has once again reminded health care workers, and first responders to use their available Personal Protection Equipment (PPE) and follow common sense precautions.

• Put a mask on the patient whenever possible.
• Wear latex/latex-free gloves
• Eye goggles
• N 95 respirator mask.
• Wash hands well after each patient encounter.

This practice remains your best level of protection.

If SARS is suspected, notify the receiving facility before bringing the patient into the facility.
These precautions remain your best defense.

The disease spreads though close contact,and through droplet spread. Although this virus may live for up to three hours on surfaces, wearing gloves and careful, frequent hand washing will reduce risk.

Members who interact with potential SARS cases should be following the rules of universal precautions on each and every run.

SARS remains a disease entity that will be watched closely with each case carefully monitored. There is no drug prophylaxis and no treatment. The CDC website remains an important source of education as new knowledge is gathered.

In the meantime , protect yourself and your loved ones by using your protective gear. The moment it takes to put on your N95 mask, goggles and gloves will protect you during the patient encounter. After each encounter wash your hands. Take the time to protect yourself, on each and every run.

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Parenting

My mother always told me “parenting is the most important job in the world.” Most parents would not only agree but maintain it is also one of the hardest jobs in the world. In these uncertain times, an already tough job becomes even harder and that difficulty is felt by the child as well as the parent.

Understandably, many parents wish to protect their children from the fears of war and terrorism but such protection is neither possible nor helpful. Between the TV, the radio, and peers at school, children will undoubtedly be exposed to current events. Avoiding the topic can only make your child feel isolated as he or she starts to worry that their concerns are foolish or wrong. Instead, validate a wide range of emotions in your child, including uncomfortable ones. Children benefit from learning that all emotions are legitimate and benefit even more by learning positive ways to express those emotions. Create a time and place for kids to ask questions and let your child know that you are available. Don’t force them to talk; they’ll do so when they feel ready.

Many parents may wonder how to explain events to a child when they are having a hard time comprehending it themselves. Though you cannot protect your child from the worry that is natural in times like these, there are certain rules of thumb that have proven helpful:

• Answer your children’s questions with language that is appropriate to their age and level of understanding. Give honest information; children can usually tell if you are not being honest.
• Put a limit on time in front of the television. Younger children often confuse broadcasts of past events with newly occurring events. Older children may become desensitized or overly worried due to the constant intake of violent information.
• Maintain a predictable routine through extra-curricular activities, family schedules, and school work. Children are reassured by structure and familiarity.
• Coordinate communication between home and school. Parents should know about related activities and discussions at school. Teachers should know of your child’s specific fears and concerns.
• Keep an eye out for significant changes in sleeping or eating, an increase in excessive worry, aggression, or inappropriate behavior, and regressions to earlier behavior like bedwetting and baby talk. These are signs your child is having trouble adapting.
• Older children understand more of the politics involved in the war. It’s important to respect your child’s opinion and to openly discuss differences in thought and ideology between family members, friends, and countries.
• Learn to manage your own emotions and be open about it. The better you take care of yourself, the better your child will take care of theirself.
• Research has shown that parents say more to their kids about war than peace and use action-oriented terms to do so. Most parents would prefer that their children learn to use constructive, nonviolent methods to resolve conflict and the best way to impress this is to increase your own knowledge of alternatives to violence. Expose these to your children and teach them about nonviolent role models.

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SMALLPOX UPDATE

The smallpox vaccination program began on March 19, 2003 at the Bureau of Health Services.
This voluntary program is part of the National Preparedness Program from the Centers for Disease Control and Prevention and administered through the NYC Department of Health and Mental Hygiene. In phase one, the cities and states have been asked to vaccinate workers who can care for persons with small pox and who can begin to vaccinate the rest of the population. In NYC, the plan calls for vaccinating hospital workers as well as first responders. FDNY has begun vaccinating three groups: BHS health care work force, EMS field personnel and SOC units.
The first group of volunteers included Dr. Kerry Kelly, Dr. David Prezant and Chief of Operations Salvatore Cassano along with other medical officers, nurses, and paramedics and Special Operations Command firefighters.

The program continues until the end of May. Members must attend an educational session before they can be vaccinated. This educational program helps each potential vaccinee understand more about this vaccine and answers questions about the care of the vaccine site and the bandage aftercare.

Concerns about covered benefits have been met. The unions including the UFA, UFOA, EMS Local 2507 and EMS Officers unions are now supporting these efforts.

Members must be in good health to be vaccinated. Since this is a live virus vaccine, their family members must also be in good health. Members with children under one year of age cannot be vaccinated.

Recent concerns about cardiac risks have been raised with publicity about three cardiac deaths. In those cardiac events, review of records of these patients revealed substantial risk factors.
The Department of Defense has vaccinated over 350,000 members of the armed services and civilians. The vast majority has had little or no side effects, with minimal time lost. Some 10 members have developed myocarditis/pericarditis, an inflammation of the heart muscle. In most cases, this was a self-limited problem with complete resolution within a week. Those who developed this problem were young people who had never been vaccinated in the past.
Currently all of our newly vaccinated members are feeling well. We will continue to screen our vaccine candidates so that each member is protected. The current guidelines have been expanded to include cardiac risk factors.

Now members CANNOT be vaccinated for the following reasons:

• History of immune problems (HIV, Cancer under treatment) in the member or family living with member.
• History of eczema or allergic dermatitis (NOW OR IN THE PAST) in member or family living with member.
• History of current illness in the member (temporary deferral).
• Pregnancy for member or spouse.
• Child under one year of age in the household.

NEW GUIDELINES
If a member has a current heart condition

• angina
• coronary disease
• history of a heart attack
• history of cardiomyopathy
• history of any heart condition
• including valvular heart problems

Or three (3) risk factors:

• high blood pressure
• diabetes or high sugar
• elevated cholesterol
• smoking now and a first-degree relative with a heart condition under the age of 50.

If you have three (3) or more of those risk factors, or any one of the other heart conditions you cannot take the vaccine.

Please remember our goal is safety. It is possible these guidelines could change in the future. If there were a true case of smallpox in the world, the risk benefit ratio would shift and the benefit of vaccination would outweigh the risks.

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QUESTIONS:

I want to be vaccinated against smallpox, and I missed the first week of education. How can I sign up for the program?
There are new educational programs being scheduled weekly. The upcoming schedule will be available at the EMS stations or through SOC administration. Also you can call our scheduling coordinator Ms. Brenda Sheppard LaHens at 718- 999-1766.

I went to the educational program and now I WANT to be vaccinated. Who do I call?
Call our scheduling coordinator, Ms. Brenda Sheppard LaHens at 718- 999- 1766.

When is the next educational meeting?
Tuesday April 15th at EMS Local 2507 at 5:30pm, Long Island City, NY

Also, future meetings will be held at UFA headquarters, during the health and safety programs on April 24 and 25th Details to follow.

Remember stay informed. The CDC website and the FDNY website remain excellent sources of information.

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