2007 BIOPOD Summary
On Friday, November 6, 2007,
FDNY Bureau of Health Services
conducted its annual bio
preparedness drill. In this city wide drill,
all on duty members, fire and ems were
directed to 12 PODS (points of distribution).
The drill ran from 0800 hours to
During the drill members were offered
the flu (influenza) vaccine. This exercise
does provide a recommended vaccine to
our members. However, it is designed to
ensure that FDNY can respond to a biological
Biological threats can be from nature
(pandemic flu) or from terrorist threat
(anthrax attack). As a Department, we
must be able to respond quickly to protect
our members. As first responders, on
the front lines, the protection and safety
of our members is critical. The services
that FDNY provides to the city must continue,
uninterrupted, in the face of emergency.
In the BioPod exercise, many bureaus
of the FDNY came together to develop
and refine this response: DISPATCH,
COMMUNICATIONS, BTDS, ETC.
In this year’s exercise, changes were
made to further improve our program.
The drill ran from 0800 hours to 2400
hours, ensuring that both the day and
night tour for on duty fire and for all three
tours of EMS could be vaccinated.
The day and night timeframes provided
the challenge of moving members to
the 12 sites with different traffic patterns.
The sites of the PODS were selected
to utilize both Fire and EMS facilities
while ensuring that FDNY response
remained in place. Deployment consisted
of 11 stationary PODS and 1 Mobile
At headquarters, in the auditorium,
both the on duty civilian workforce along
with on duty FIRE and EMS responded
to this POD site.
Visitors from NYPD, DOHMH and
NYS Homeland Security viewed the
drill. An exercise of this undertaking has
attracted national attention.
The computer programs utilized to
compile the immunization data is recorded
real time. It is automatically entered
into the individual immunization record
maintained for all our members. This
program was developed to meet FDNY
needs with the Katrina deployment to
ensure that all members were protected
with needed vaccinations before departure
to New Orleans.
The numbers of individuals who were
seen at the 12 PODS are impressive:
516 civilians, 4,371 firefighters/officers
and 968 EMS personnel were seen.
Unfortunately less than 50 percent of
our workforce chose to be immunized.
The flu vaccine remains a safe vaccine
that provides recommended protection to
our FDNY members.
BioPOD 2007 was successful in its
mission to keep FDNY prepared. If a true
biological exposure occurred, the lessons
learned from this drill would be utilized
in responding to that emergency. This
exercise is not just a day of giving out the
flu shots; this drill is a critical exercise in
remaining prepared. Thanks to all the
individuals who helped make this a success.
BE WELL AND STAY SAFE ON
MRSA Questions and Answers
Both the FDNY in partnership with
the NYC Department of Health
wish to address questions that
have been posed to us by members in the
field. We wish to specifically answer these
questions to give you the most up to date
information we have with regard to the
transmission of this infection along with
the guidelines set forth by the CDC that
we all must take to protect ourselves.
Community Acquired Methicillin
Resistant Staph Aureus (CA-MRSA) infection
presents most commonly as relatively
minor skin and soft tissue infection, but
severe invasive disease, including necrotizing
pneumonia, necrotizing fasciitis, severe
osteomyelitis, and a sepsis syndrome with
increased mortality have also been
described in children and adults, as recent
media has shown. MRSA colonized
patients more frequently develop symptomatic
infections. How safe is it for a colonized
patient to be in an environment such
as the firehouse?
There are no studies that we
are aware of that measure risk of infection
of coworkers in this setting.
In most cases Staph infections of the
skin remain localized skin infections. In
the rare cases with more invasive disease,
the host (patient) is often very
young, very old or there are underlying
medical conditions or immunity issues.
For example, recent hospitalization for a
surgery or illness, diabetes, etc.
Resistance to infection is based on many
variables. Would a FF be more susceptible
to contracting MRSA after a strenuous job,
with a cold, minor cuts/abrasions? What
about similar conditions for a colonized
Resistance to infection
means the ability of an individual to
defend against an infection. Anything
that impairs the immune system might
affect resistance, such as influenza.
Any open cut or wound can get
infected. Wounds should be cleaned and
covered to prevent infection. Whether
the patient is colonized or not, the care of
the wound remains the same.
Transmissions within hospitals of
MRSA strains first described in the community
are being reported with increasing
frequency. Changing resistance patterns of
MRSA (according to tracking from 1992-
2003) provide additional evidence that the
new epidemic MRSA strains are becoming
established. Have any studies been conducted
regarding transmission in an environment
such as the firehouse?
None found in recent review
of the published medical literature.
Staph has shown resistance to antibiotics
since the 1970’s. Initially, it became
resistant to the penicillin family, and
alternative antibiotics were given.
MRSA means methicillin resistant.
Therefore, once again, alternatives must
be given. Resistance occurs with
increased usage of antibiotics as bacterial
strains develop new forms that
become more difficult to fight. The
MRSA infections that were once seen
primarily in hospitals are now seen in
the communities where we live: our
schools, our playgrounds, ball fields and
even our firehouses. The means of transmission
relate to open wounds and cuts
with close body contact and shared environmental
conditions, close contact,
shared personal items, etc. FDNY firefighters/
officers when on medical leave
are seen at BHS before return to duty.
This allows us to follow patterns of illness
and injuries. There have been cases
of MRSA. BHS has worked with the
NYC Dept of Health/Mental Hygiene
and the State Dept of Health to review
our policies and protect our work force.
The numbers of cases have been small.
The lateral transmission of cases has not
been seen. Members are not returned to
work until there is no evidence of infection
and with clearance by an Infectious
Recent media has demonstrated that it is
possible to have a skin infection and a
physician not recognize it as MRSA. How
does BHS determine if an infection is
Recognition of MRSA infections
remains a challenge for the medical
community. The continued education of
both the public and our medical physicians
is ongoing. The absolute way to
confirm a MRSA infection is by cultureopening
the wound or pustule to obtain
If someone in the firehouse believes that
they may have MRSA, what action should
Members who believe they
have an active MRSA infection should
go see their own physician or come to
BHS for evaluation. Stopping the transmission
of illness or infection to others is
important. Early treatment and evaluation
may prevent worsening of an infection.
Is a person with a first degree burn (sunburn)
more likely to get MRSA?
Any disruption of the skin’s
integrity could make one more susceptible
to infection with MRSA or any
Prior strategies to curb outbreaks of
MRSA in other environments (hospitals,
schools) have included improvement/
adherence to hand hygiene, isolation, environmental
cleaning, and temporary unit
closure. We are aware of the importance of
good hygiene pertaining to MRSA. How
feasible are these courses of action for the
Good hygiene remains the
cornerstone of prevention and reduction
of transmission. Removing the actively
infected member/patient from the work
environment is helpful until the infection
has cleared completely. Keeping wounds
covered prevents infection. Maintaining
individual personal items such as towels
and razors, toothbrushes and soap is
helpful. Washing sheets after personal
use is helpful. Maintaining of a clean
environment with regularly scheduled
washing of bathrooms and kitchens is
Contact precautions are routinely taken
in hospitals to prevent transmission either
directly or indirectly, providing single
patient rooms and wearing a gown and
gloves due to contact with the patient or
potentially contaminated areas, even with
the disinfecting of surfaces. Under the right
environment, MRSA can live on surfaces
for quite some time. Given these factors,
how likely is it that MRSA could be
brought out of the firehouse?
MRSA is everywhere we
live. It should be presumed to be anywhere.
Every day in the paper, we are
made aware that in every level of society,
every age group, every play, home and
work environment, people can get
Although MRSA can survive in the
environment, it is not likely that this
plays a major role in transmission. Person
to person contact is the more likely
mechanism. Prevention of transmission
whether at the firehouse or home is the
same: attention to personal hygiene.
Once a person is colonized with MRSA,
can they be decolonized? Are they more
likely to get re-infected?
People who are colonized
with MRSA in their mucous membranes,
documented by nasal cultures,
can be treated with intranasal antibiotic
ointment/cream to treat this colonization.
This may need to be repeated but
methods to decolonize do not always
In addition, changes in behavior that
may create skin infections (body shaving,
body piercing) are addressed, with
use of washing substances such as phisohex.
These changes may reduce the likelihood
Anyone can get re-infected. Bacterial
infections do not provide lifetime immunity.
A person can get recurrent bacterial
infections. Once colonized, the risk of
re-infection with those bacteria remains.
Reducing infections with good wound
care and attention to hygiene remains
essential. Currently there is research
investigating a vaccine to prevent staph
infections. It is not available at this time.
Once a person has had MRSA, is it a
good idea to have routine cultures taken?
No, it is not necessary unless
there are recurrences.
If a FF known to be colonized with
MRSA requested a transfer to an Engine
company that responded to an average of
1100 CFR-D runs a year, (many of them in
overcrowded apartments, contact with
homeless people, shelters, and/or AIDS
facility) would this be a concern to his/her
safety, since he/she may be considered at
risk to have an outbreak?
On each and every run, universal precautions
should be utilized. Following
each run, members should wash their
hands using liquid soap or the alcohol
based sanitizers. Each day nurses, physicians,
medical care providers and
Emt/Paramedics as well as CFR-D
responders take care of individuals with
multiple medical problems and risk factors.
They are able to safely do their job,
and return to their homes safely by using
A recent study (Roline, CE, Crumpecker,
C, Dunn, TM). Can Methicillin-Resistant
Staphylococcus Aureus Be Found In
an Ambulance Fleet? Pre-hospital emergency
Care.2 007;11:241-244) found that
47.6% of ambulances tested positive for
MRSA. Would a FF with MRSA be safer
working in a company that doesn’t routinely
do CFR-D duties?
This study highlights the
prevalence of these bacteria in our environment.
Placement of members in
engines versus ladders would not change
the standards utilized to prevent infections.
As the concern for CA MRSA grows,
and firefighters, who share close living
quarters and equipment, is the job considering
classifying it as a work related hazard?
Each case is reviewed on an
individual basis. MRSA remains a part
of the community in which we live. Certainly,
with secondary infections from
work related lacerations, surgeries and
burns, those infectious complications
have been covered as service connected.
Are there any legal ramifications if a
member’s child tests positive for MRSA,
and it is found that the child’s parent works
with a known colonized MRSA FF?
Currently, this infection has
been found in school age children, young
adults playing team sports, professional
athletes, family members, hospitalized
patients, nursing home patients, and all
ages, sexes, ethnicities, socioeconomic
groups. Every person must assume that
the persons that we live with, work with
and interact with could have this infection
and we must use precautions as outlined.
According the NYS Dept of Health
Website, there is a strain of MRSA that is
resistant to vancomycin. If a FF is found to
have this strain, can he/she work in the firehouse?
The standard of return to
duty includes: no active infection, and
evaluation and clearance by an infectious
disease specialist. CDC guidelines
are followed and we will continue to follow
their recommendations for return to
duty as well as those of the NYC Dept of
Currently this strain of MRSA has
only been seen in hospitalized patients.
According the NYS Dept of Health
Website, some people can carry MRSA for
days to many months, even after their
infection has been treated. Does FDNY
verify that the person doesn’t carry MRSA
before they are returned to the firehouse?
We will continue to follow
the recommendations of CDC as well as
the Dept.of Health/Mental Hygiene. The
current standard is no evidence of active
infection and clearance by an infectious
According to the NY State Health Dept,
outbreaks nationwide and in NYS are being
reported with increasing frequency in a
variety of community settings, especially
where there is close physical contact or
close living conditions, as well as the dormitory
setting. In fact, it was just reported
(11/06) that 2 more FDNY FFs were diagnosed
with MRSA. Is FDNY concerned
now that CA-MRSA is becoming more
common, especially among emergency
It is a concern that is being
addressed. The recommendations for
firehouses and ems stations have been
sent out again (see HEALTHCONNECTIONS).
BHS and Dept. of Health have
partnered in sharing information and
advice. I have addressed the UFA general
membership meeting along with Dr.
James Mellius. I have made site visits to
several firehouses, with Dept of Health
and the Union leadership. Recommended
additions to the firehouses include liquid
antibacterial soap for the kitchen
and bathrooms with alcohol hand sanitizers
for the apparatus floor were made.
This remains an ongoing situation with
new recommendations and monitoring
of the situation. Safety for our members
is of critical importance. Fair treatment
of our members is also important.
Our number of members with MRSA
infections remains small; our mutual
goal must be prevention.
Since MRSA is difficult to diagnose (as
evidenced by recent media), in a firehousemember be penalized if he/she goes sick
because they think they might have contracted
According the NYS Dept of Health
Website, NYC Dept of HMH will soon ask
NYC Board of Health to make MRSA a
reportable condition in NYC. The concern
with strains showing reduced susceptibility
is genuine. Does FDNY share this view? (Is
there a concern given the environment in
As a reportable condition, it
will be easier for the Dept of Health to
track patterns of illness or outbreaks.
For members who have contact with
an ill patient, who is later discovered to
have had MRSA, NO PROPHYLAXIS
is required. Unlike meningitis, exposure
to this infection does NOT require prophylactic
or preventive medication.
On each and every run, utilize universal
precaution and wash after each
If a member contracts MRSA, does
he/she have to notify FDNY?
Members on medical leave
for illness do notify FDNY. They should
notify us of the nature of the illness, such
How often is routine hand washing recommended
in an environment known to
have a colonized MRSA patient?
Routine hand washing is
recommended after direct patient contact,
before eating, after using the bathroom
and when hands are soiled. Hands
should be washed before preparing food
and after touching raw foods such as
meat, fish, eggs and poultry. When in
doubt, wash up.
Since the first reported episode of
MRSA infection in the US reported in
1968, there has been a significant increase
in reported cases. Formerly limited primarily
to patients in hospitals or long-term
care facilities, recent reports of CA-MRSA
infections raise concern. Have studies been
conducted within FDNY or EMS to determine
if there should be similar concern
within the department?
As discussed, this infection is
of concern to the community at large,
certainly including FDNY/EMS. BHS
monitors medical leave patterns.
If a FF comes down with MRSA, what
is FDNY’s procedure? Does an infectious
control physician determine the status of
Each member has an individual
evaluation, depending on the
presentation of their infection. Before
clearing to return to duty, a member
would have to show no signs of active
infection or skin problem, and a note for
clearance by an infectious disease specialist. The guidelines of the CDC
remain in place as will be followed as we
continue to monitor our members.
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WTC Treatment Sites
The FDNY WTC Treatment sites are now open in all the satellite locations.
8 TO 4 PM
8 TO 4 PM
12 TO 6 PM
10 TO 4 PM
9 Metro Tech
7 DAYS A WEEK
8 TO 4 PM
TO MAKE AN APPOINTMENT,
CALL OUR TREATMENT APPOINTMENT STAFF AT 718 999 1858
ALL ACTIVE AND RETIRED MEMBERS CAN BE SEEN FOR EVALUATION AND
TREATMENT OF WTC CONDITIONS WITH FREE MEDICATIONS FOR THESE CONDITIONS.
Conditions of participation include a WTC Monitoring Medical/Annual after July 2005.
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Dr. Kerry Kelly
Chief Medical Officer
Dr. David Prezant
Chief Medical Officer
Mary T. McLaughlin