Home Front: eww, don't get your Ebola on me!

So, I've been asked by a few different people "just what CAN we do to be safe from Ebola?"

Before I get into the details of PPE and other practices and procedures, I think it's worthwhile checking out some details on how you CAN'T get Ebola: I go to the CDC for all my Ebola guidance, and take their advice to heart. These are the people who know. Listen to the local guides ....

"In healthcare settings, Ebola is spread through direct contact (e.g., through broken skin or through mucous membranes of the eyes, nose, or mouth) with blood or body fluids of a person who is sick with Ebola or with objects (e.g., needles, syringes) that have been contaminated with the virus. For all healthcare workers caring for Ebola patients, PPE with full body coverage is recommended to further reduce the risk of self-contamination.

• Avoid contact with blood and body fluids of any person, particularly someone who is sick.
• Do not handle items that may have come in contact with an infected person’s blood or body fluids.
• Do not touch the body of someone who has died from Ebola."

 So, if you aren't currently in an Ebola affected area, treating suspected Ebola patients or planning to either eat bushmeat or take up embalming in West Africa, you probably don't need to worry much, right now.

That said, we're all about being prepared here, so in the interest of education and edification, here are some guidelines for how to protect against a virulent, non-airborne, aerosol-capable infective agent like the Ebola virus.


 N95 Respirator: Here is what the FDA have to say about the N95 rating on a facemask, or respirator

"An N95 respirator is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles. In addition to blocking splashes, sprays and large droplets, the respirator is also designed to prevent the wearer from breathing in very small particles that may be in the air.
To work as expected, an N95 respirator requires a proper fit to your face. Generally, to check for proper fit, you should put on your respirator and adjust the straps so that the respirator fits tight but comfortably to your face. For information on proper fit, refer to the manufacturer’s instructions.
The ‘N95’ designation means that when subjected to careful testing, the respirator blocks at least 95% of very small test particles. If properly fitted, the filtration capabilities of N95 respirators exceed those of face masks. However, even a properly fitted N95 respirator does not completely eliminate the risk of illness or death.

N95 respirators are not designed for children or people with facial hair. Because a proper fit cannot be achieved on children and people with facial hair, the N95 respirator may not provide full protection."

Sorry kids and Tactical Beard Owners ...

Nitrile Examination Gloves:
 These tough and resistant gloves have a different feel to the more common latex examination glove, somewhat less tactile and more stiff, they have the become the standard for infection control PPE for this kind of situation.

Alcohol Based Hand Rubs are more effective against most bacteria and many viruses than either medicated or non-medicated soaps. Its common for me to squirt my hands with this stuff at work (even in my technical role) two or three times a day. It's ubiquitious at ever ward entrance and lift-well.

There is even some debate around alcohol-only ABHR versus alcohol-chlorhexidine ABHR: The addition of a low concentration of chlorhexidine to an ABHR results in significantly greater residual activity than alcohol alone and therefore potentially improves efficacy.

Then there is the "what do I do if I really, really don't want to be exposed, clinical worker level protection. Guidelines from the CDC again:

Recommended PPE for Trained Observer during Observations of PPE Doffing

The trained observer should not enter the room of a patient with Ebola, but will be in the PPE removal area to observe and assist with removal of specific components of PPE, as outlined below. The observer should not participate in any Ebola patient care activities while conducting observations. The following PPE are recommended for trained observers:

• Single-use (disposable) fluid-resistant or impermeable gown that extends to at least mid-calf or coverall without integrated hood.
• Single-use (disposable) full face shield.
• Single-use (disposable) nitrile examination gloves with extended cuffs. Two pairs of gloves should be worn. At a minimum, outer gloves should have extended cuffs.
• Single-use (disposable) fluid-resistant or impermeable shoe covers. Shoe covers should allow for ease of movement and not present a slip hazard to the worker.

Trained observers should don and doff selected PPE according to same procedures outlined below. Of note, if the trained observer assists with PPE doffing, then the trained observer should disinfect outer-gloved hands with an *EPA-registered disinfectant wipe or ABHR immediately after contact with healthcare worker’s PPE.

So, there you go: full fluid-proof gown, double-gloved, face-mask, booties. Even then, getting all this gear ON right isn't the only challenge. Getting it OFF again, when you have potientially been exposed is another task entirely. Which is why in hospital settings hey have those "Trained Observer" positions in the first place. All the PPE in the world isn't going to do you a lick of good if you rub that last contaminated piece of clothing on your face as you are getting it all off.

The University of Nebraska Medical Centre have these two excellent visual guides, which you may find useful:

Donning Visual Guide

Doffing Visual Guide

The question of "how long until it is safe to go back in there? "comes up: Again the CDC have all the answers:

How long does the Ebola virus persist in indoor environments?

Only one laboratory study, which was done under environmental conditions that favor virus persistence, has been reported. This study found that under these ideal conditions Ebola virus could remain active for up to six days. In a follow up study, Ebolavirus was found, relative to other enveloped viruses, to be quite sensitive to inactivation by ultraviolet light and drying; yet sub-populations did persist in organic debris.
In the only study to assess contamination of the patient care environment during an outbreak, conducted in an African hospital under "real world conditions", virus was not detected by either nucleic acid amplification or culture in any of 33 samples collected from sites that were not visibly bloody. Virus was detected on a blood-stained glove and bloody intravenous insertion site by nucleic acid amplification, which may detect non-viable virus, but not by culture for live, infectious virus.³ Based upon these data and what is known regarding the environmental infection control of other enveloped RNA viruses, the expectation is with consistent daily cleaning and disinfection practices in U.S. hospitals that the persistence of Ebola virus in the patient care environment would be short – with 24 hours considered a cautious upper limit.

Lastly, for area and surface disinfection, the relatively simple method of 1:10 chlorinated bleach in water to decontaminate highly soiled areas, and 1:100 to spray, soak and pre-wash infected areas bedding and equipment,  is believed to be highly effective.

So, be safe out there, but don't panic. There are far more common killers in the microbial world....

When

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common

household

bleach

and

other

appropriate

disinfectants

may

be

effective

alternatives.

•

Use

a

1:10

solution

of

bleach

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water

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1

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Home Front: Ebola 2014

One of the things that that working in the industry I do, with the academic background I have, when things like the West Africa 2014 Ebola outbreak occur, I have both a cold clinical reaction, and a very fierce panic about all the possibilities.

One of the advantages of working where I do, is that we are kept very well informed of trends and the prospects of this kind of event to affect us as "health workers" but also because of the particular nature of our cohort. We get all the notifications for all the major illness outbreaks from swine flu to gastroenteritis. 

We even get annual influenza immunization as part of our workplace amenities.   The notifications we get are the same kind that hospitals and government agencies around the world issue.

I also follow sources like the CDC, via twitter
through its main site and generally pay attention. I might not be able to tell you who won the World Cup, but this is the kind of news I follow closely.

I lived in Gabon, west Africa when I was 4, and contracted malaria whilst there. Malaria, by way of mosquitoes is one of the biggest killers of humans of all time, nicely tabulated here, and I can personally attest that it is not pleasant at all. However, it is not anywhere as visceral and horrific as Ebola hemorrhagic fever. 

It's also worth noting that Gabon also had it's own Ebola outbreak, in 2002 as did Sudan, and a raft of other central African countries between 1995 and 2014. I've lived and traveled to some exciting places, and have been pretty lucky, health wise.

Given how much air travel has increased since the first modern documented outbreak of Ebola in 1974 has come, and the particularly unpleasant nature of the disease, it's little wonder that it has so vividly peaked our collective imagination.

However, it's methods of transmission, symptoms and prevention methods are now well understood and documented, and the fact that it is so very debilitating runs in favor of public health reaction.

It's horrific presentation and high mortality rates are rightfully alarming, especially when you consider that historically many of its victims were primary healthcare workers. Check out his graphical representation of the history of Ebola outbreaks for some perspective of the current situation. 

The scariest part of this, and other pandemic type threats, especially for a scientifically minded prepper like myself, is that there are diseases with long enough incubation times, and infectivity rates, with symptoms that might be otherwise shrugged off or ignored that we could be exposed to just going about ones normal life.

My recent pieces on public transport, on holiday travel and even going to the supermarket are just reminders of the interactions and environments that most take for granted, that could well leave even the most diligent and forward thinking planners, who happen to look, dress and act like regular folks, without gown, glove and mask.

Who knows what you might be bringing home to your family, into your bunker with you?

The trick, to my mind, however is to not be petrified, but to remain cautious, aware and informed of the risks, likelihoods and trends.

Wish Lust: Geigerrig Tactical Guardian hydration pack

Following on from this years SHOT show, I saw a link from the guys at Soldier Systems, reporting from the OR (I presume that stands for Outdoor Recreation, or something to that effect) on a really cool hydration system.

The Geigerrig comapny have a rather unique offering, with a pressurized hydration system. This system involves having a bladder with a hand pump (like the kind Dr's use to take your blood pressure on a elbow collar) to pump air into the bladder, squirting it out of the bite-valve.

This is the Guardian model, which I fell in wish-lust with ....

 It features a 2L (70oz) bladder (although they do offer a 3L bladder as well) which has fittings for drinking tube and pressurization tube which are both quick-release valved, and offers a slide-top for easy filling and cleaning. Skanky hydration bladders are no-ones friend!

Better yet, they have a variety of carriers for these bladders, all designed to contain the pressure, and give you a secure, continuous pressure water-source. 

The fabric of the carrier is a light and rugged 500D Cordura, with PALS/MOLLE strips on top and bottom, six D-ring attachment points for lashing it your pack, vest, plate carrier or what-have you, should you decide to forgo the built in (but stowable) pack straps. 

Twin compression straps add to the pressure and stability of your water-load, but the real magic here is the hard nylon "guardian plate" which backs the carrier. This was the real magic for me, as it offers something that I've noted was missing, a slick, hard backing to my hydration carrier. I am very happy with my Platatac Bravo but I found that when on Tough Mudder, crawling through pipes and under netting, and barbed wire, that it caught on occasion, as well as getting in and out of vehicles with it, a slick turtle-back would be a great advantage to both toughness, and drag-reduction.

Couple this with the in-line cyrpto and virus filters and you have a very resilient, functional pressurized hydration system. Hydrate, wash wounds, clean goggles all on the bounce, from a secured and armoured platform!

What's NOT to lust after?

Home Front: Injury and Illness

Being sick sucks. Being injured sucks. I've been both often enough just in the last year to make me strongly consider what options and risks would be apparent in the event of a disaster both for those with chronic illness or injuries, and those with incidental illnesses and injuries. One of my partners has some fairly hefty pharmaceutical requirements for the condition she has. The other has torn cartilage in her knee and a history of respiratory problems. The idea of loss of access to the medical facilities and the pharmacopeia that modern industrial society provides us is chilling. Even the idea of long trips "off-grid" would require significant stockpiling, and preparation, and this is not a bad thing, but costly and difficult to arrange.

Even taking stock of our little bathroom medicine cabinet at home, just to take stock, made me realise how dependent we are on the infrastructure both to have such things produced and also distributed. I recently watched the disease-thriller "Contagion" which really impressed me with its sensible and pretty accurate portrayal of both lab-science and disease epidemiology. It reminded me that in the event of a wide-spread disease, resources will become scare not only due to demand, but also as the infrastructure required to produce and disseminate it is affected by the disease. Not only medical supplies, but later on, all supplies and services, depending on the severity of the outbreak could be unavailable. Healthcare workers are often on the front lines, as the very sick are brought to hospitals and from there, it can spread. That not only means my workplace, but also the people who would care for and supply treatments to my loved ones, and children.

Fortunately, there are several sources for being kept aware of these kinds of events, both sickness, and natural.

The Centers for Disease Control (CDC)
The World Health Organization (WHO)

both of which I follow via Twitter on:
https://twitter.com/CDCemergency
https://twitter.com/WHO

I'm also fortunate enough to be sent bulletins like these through work, from the Bureau of Meteorology

 
Sent: Tuesday, 4 September 2012 3:15 PM
To: undisclosed-recipients
Subject: ** State Health Command Advisory - damaging and destructive winds **


Good afternoon all,

The Bureau of Meteorology has issued a severe weather warning for damaging winds in the following forecast districts:

Mallee
Wimmera
Northern Country
North Central
North East
South West
Central
West and South Gippsland
East Gippsland

Damaging winds around 60 to 80 km/h with peak gusts of 100 to 120km/h are forecast to develop over the Southwest and Wimmera districts this evening, and will extend to remaining districts overnight and early Wednesday morning.

Over Alpine areas, winds are expected to average 80 to 100 km/h Wednesday with peak gusts of 140 km/h

The Victorian health sector should:

Maintain situational awareness via the Bureau of Meteorology website: http://www.bom.gov.au/vic/warnings/
Consider the dissemination of this advisory


Being aware is part of the battle, looking after my family and loved ones in the event of such an event, short or long term, is another. I have first-aid kits, but when it comes down to it, do we have enough medical supplies laid in? No.

Do I know where to go to get some, and what to get? Mostly. More work required.

It also occurred to me that improving my First-Aid training is always a good thing.

Review: EcoFuture - Organic Hand Cleanser

I've been in touch with a firm that produces a range of cleaning products, to both industrial and household, as well as food-grade standards, EcoFuture. I originally contacted them after hearing about a call for testers of products, as a part of my day-job. Hopefully I'll cover some of their other products at some stage, but here is one that I've had in my bag for a little while, and wanted to discuss, their Alcohol Free Organic Hand Cleanser

Being a molecular microbiologist by training, and a hospital microbiologist for a number of years for a living, before moving away from the messy and stinky labs, I have some pretty strong beliefs on cleaning and hygiene. I've been a very big supporter of the 70% ethanol and/or chlorohexadine to do my bug-blasting, (although regular old scrubbing with soap is tried and true). However, with the coming of first Triceratops Girl, then a year ago, Tactical Baby,  I realised that I could possibly go for something gentler on their delicate flesh than lab-standard skin and surface cleaners.

This is where EcoFuture's world-first, certified organic, alcohol free, vitamin based, hand cleanser comes in. Medically researched and laboratory proven* to be bactericidal (>99.999 reduction of organisms in between 15 seconds and 9 minutes) to a range of common pathogens, (such as Escherichia coli O157:H7, Listeria
monocytogenes, Enterocuccus faecium, Pseudomonas aeruginosa, Streptocuccus pyogenes and  Staphylococcus aureus) at a 0.5% concentration. The interesting thing about this is that it is assertion that the active ingredients are organically derived (I make the distinction between "organically farmed products" and "naturally produced organic compounds" in this if not all cases. The product notes indicate citrus-derived complex bioflavonoids, Vitamin K-12, Ubiquinol and it appears the principle antibacterial would be rosmarinic acid.

So, how well does it work? Well, I have been spraying my hands, and Tactical Baby's bum with it during nappy changes. She looks startled by the pump-spray, but does not mind the feeling, has suffered no rashes, soreness or discomfort from the spray, and we seem to have avoided any of the bacterial gastro woes that new-parents often fall victim to. Being alcohol free, it is gentle on the skin, a bonus for sore-baby-bums, hands, faces and the like. It's also not a fire-risk, for those of us that occasionally have a tendency to spray things  around open flames.

 The product is currently available in a 60ml pump spray (150 applications), which I have previously stashed in our Crumpler Hillman Hunter nappie bag, my Bullock Echo daypack or just left on Tactical Baby's staging area (read: nappy change table). Thus far, all looks good, and handy to have for the aftermath of those "aghhhh, no! baby-fistfull of poopy nappie!" moments, or other delicate unclean times you may encounter, where "stiff wire brush and Detol" isn't an option...


*they sent me both an MSDS and an analytical testing lab's reports

Review: AUSCAM Medical Field Pack

Happy Australia Day! In honour of this auspicious day, I wanted to do a review of another piece of mystery swag my mysterious benefactor connected with the Australian Defense Force delivered. This is what the package insert listed as "Field Pack Medical, Camouflage Pattern". For all impressions, a fairly standard looking rectangular backpack, not unlike a hefty school bag and just as exciting looking, (apart from being in the much loved "hearts and bunnies" AUSCAM). There are hidden delights, so stick around and we'll get to them. Firstly the pack is made from the same rough wearing nylon as the previously reviewed Raven backpack. On the front of the pack are two external pockets, both fixed with twin Fastex buckles and webbing straps. The pockets are fairly shallow but probably good for documents and snacks.

The pack also has a fairly standard backpack style set of shoulder straps, padded with nylon straps. A sternum strap assists with stability and load bearing. There is a nylon handle on the side, for carrying the pack like a briefcases, which is an interesting variation from most carry handles, found on the top. A zippered pocket lines the whole of the back, and a cunningly designed pocket in the top conceals a waterproof cover. The pack is 445mm x 300mm x 190mm and whilst may appear to be Volvo-designed, the magic is all on the inside.

The interior of the pack is home to four pouches, each with a clear plastic face to see the contents, and webbing handles at each end. These pouches are all held in place by hook-side hook-and-loop backing, with the entire of the back wall of the pack being loop-side. Each pouch is fully zipperable and comes with a ID pocket for labeling. I'd estimate that each of the pouches has a 2-3L capacity and being removable, can be configured as you see fit. How I love the modularity of this set up!

I was fortunate enough that the pack came to me partially filled, as it had been retired from active use on the static range it was intended for. Inside are a number of bandages, gauze packs, tapes, gloves, sutures and the like. Pretty awesome as a starter kit. Some of the items seem to have passed their "best before" date, and will need to be replaced, but its a great windfall nevertheless. The included package insert tells me that a there is room for quite a number more items, which I will endeavor to accumulate or substitute.

Inside the front flap of the bag are some interesting features. A series of elastisised loops allow the retention of a number of items or tools, I'll put some more Cyalume sticks in them, and perhaps some labeled centrifuge tubes filled with medicines. A wide mesh pocket makes for storage of larger items, and the roll at the side is a waterproof mat that unfolds to give a large, "clean" drop cloth for laying out supplies in the course of treating an injury. Far better to place bandages on the mat from within the kit, rather than the muddy forest floor you might find yourself treating an injury on.
 
Having a big, well equipped first aid kit, with a wide range of consumables, ready for a range of situations, is a very good idea, especially when considering the needs that may arise following a disaster or catastrophe of some kind.  Regular supply lines will become strained if not cut, and those sterile and medicated products that we use to counter infection and treat injury can and will make a big difference, especially in the hands of those trained in their use.

So, Happy Australia Day, I hope nothing bad happens to you, your culture or civilization. Today.
Twice on one day would be annoying and lead to conflicts on my calendar.

Home Front: Perservering Preserving

 Food, and the correct storage of food is a major component of medium and long term disaster preparedness, in my opinion, not only from a pure survival point of view, but also from a morale and social well being point of view. Any starving student can tell you that you can live on beans, porridge, rice or ramen, but that it isn't a lot of fun. Same goes with MRE's and other stockpileable staples. I've read through the LDS preparedness manual, and it didn't strike me as setting an exciting table. There are ways and means to not only make long lasting supplies, but make them interesting, and also make good use of the ample times in ways that many modern folks may simply overlook. I've done a fair bit of reading on preservation, and my background in Microbiology has served me well too. There are some basic aspects that are easy to grasp, and apply to almost all food preservation; Sterilize, aseptic technique, reduce water, inhibit growth and inhibit oxygen. By no means an exhaustive list, but a good guide.

Here's how I use these aspects to preserve food, and keep it tasty, for far longer than the base products would last fresh. The tomatoes we grow in our vegi-patches all ripened at once, and faster than we could eat, so in the grand Southern European tradition, I dried them. I used an electric dehydrator with herbs also from the garden after scalding them with boiling water, and packed them in a steam sterilised jar, covering them with oil. Dehydrated, [naturally acidic], inhibited oxygen (the oil), delicious. I also make my own beef (and other meat, although I haven't been allowed to use our rabbits) jerky, which alas, I have none remaining to photograph, but, really, dehydrated meats are an awesome means of preserving them, if not making delicious snacks.

A girlfriend of mine had a lemon tree overburdened with fruit a couple of years ago, and we collected a cooler full. As well as lemon tart, lemon juice and the like, we quartered many of them, packed them with salt and covered this in juice. This salt-lemon juice slurry eventually jellified, and the lemon quarters took up the salt. Again, dehydrated, oxygen inhibited and delicious. A combination of super high salt and acidity inhibits bacterial growth. These will last for years, and make an amazing addition to my cooking.

Similarly, a glut of fruit from my partners family's house gave us the opportunity to try our hand at making quince jam. This was harder, quinces requiring a bit more preparation to being good, but as an experiment we had nothing to lose. Jam is again, a dehydrated, acidic, highly concentrated, (and if made properly, with good aseptic technique) long lasting method at turning a crop of fresh food into a long lasting  food stuff that can improve man simple recipes, add valuable calories and be utilized in a variety of ways.  We've added it to sauces, marinades, on toast and into baking. Jam-making can be laborious, but is well worth the effort, month if not years down the track. Its a skill anyone with thoughts of preparedness should ad to their repertoire.

Salting and sugaring are not always the best ways to preserve all foods though, and pickling is just as ancient, and downright tasty a means to make fresh produce last a long time. A combination of acidic and oxygen depleted environments, as well as good sterilization lets you preserve a variety of foods (eggs from our chookens here, with herbs from the garden, mustard and garlic). Looks horrific, tastes amazing. A layer of olive oil on top acts and a further oxygen barrier. Eggs, cucumbers, cabbage, fish, the range of foods than can be pickled is vast, and it's really easy to do. Just be sure to read up and follow instructions to ensure its all done safely, because as will all preservation, getting food poisoning from it would be terrible!

Which leads me to the last means by which I preserve foods, fermentation. I have a home brewing kit, and a rather large collection of Grolsch swing-top bottles thanks to my beer-drinking friends, and have turned apples, ginger, honey and the like into a variety of bacteria-free, yeast enhanced, safe to drink beverages containing anywhere from a slight tingle to fountainously foaming carbonation. The fact that these may have also been mildly to highly inebriating is merely a side effect, but after a day of converting car tyres to body armour, or fighting off waves of triffids, a relaxing home made foamy drink is a great refresher!