M14.4 Disaster Preparedness

Think About It-Website Exploration

The National Center for Disease Medicine and Public Health (NCDMPH) website had great information and resources related to natural disasters and infectious diseases. I specifically looked at information regarding influenza outbreaks, mass gatherings & explosions, and earthquakes because these are the most likely situations to affect me. While reading through the materials, I learned several things I had not even previously thought of. For example, there are standardized steps to take when an unaccompanied minor is found after a disaster like an earthquake. Another example includes how to talk to a child after a bombing or an explosion. I remember the fear I felt after 9/11 and it was nice to have supportive adults to talk to. With the rise of social media since then, it is more important than ever before to know how to talk to children about traumatic events. Furthermore, I learned there is significant public health planning prior to a mass gathering. Mass gatherings for an event like the Super Bowl can dramatically increase infectious disease transmission and tax local resources. Having a website like the NCDMPH is extremely useful for all healthcare professionals, not just those in public health, in order to learn how to prevent and prepare, as well as mitigate the effects from an event. However, many of the links were broken suggesting the website is not regularly maintained. 

The disaster healthcare volunteer site is a wonderful idea to help connect local personnel during a disaster. Within my county specifically, there is a unit called Medical Volunteers for Disaster Response (MVDR). MVDR has three main objectives: to assist in medical/health emergencies and mass casualties, as well as participate in community outreach to raise awareness. Several modules have inspired me over the course of this semester, but I feel extremely compelled to volunteer as a disaster relief provider after reading through the materials in this module. It seems to be the perfect combination of my professions (nursing and public health). One easy way to start this journey could be to volunteer via this website. I'd also be interested in further trainings related to disaster response. Notably, hospitals should also use this concept as a model so they can easily identify staff who live close and would be willing to work extra shifts during times of disaster. This is another way we can prepare as healthcare professionals. 

References

https://ncdmph.usuhs.edu/KnowledgeLearning/2012-Learning1.htm

http://ncdmph.usuhs.edu/Learn/PedsTR/images/cards/USUHS_TR_card_detailed.pdf

http://www.nctsn.org/sites/default/files/talking_to_children_about_the_bombing.pdf

https://disaster.nlm.nih.gov/enviro/massgatherings.html#a3
https://www.sccgov.org/sites/ems/Pages/mvdr.aspx

M12.9 Climate Change

Reflections on Climate Change

1) What do you personally find most troubling about climate change?

            On a personal level, I am most concerned about the melting ice caps and the subsequent rise in the sea level. According to the BBC movie, Earth Under Water (2010), it is estimated that the sea level will rise between four or five meters each century. Even a rise of three feet will start to cause severe changes to life as we know it. For example, Miami will be flooded by the end of this century if we do not make drastic efforts to reduce our carbon emissions. A rise in ocean level will put significant strain on our Earth’s already maxed out resources. There will be severe financial loss, fresh water sources will be contaminated, food supply will be compromised, land will be lost, and thousands if not millions of people will be displaced as refugees. These severe changes will instill widespread panic and fear among the remaining population.

2) As a public health professional, what do you think needs the greatest attention right now?

           

            As a public health professional, the greatest efforts need to be placed on reducing carbon emissions, lessening greenhouse gases, and subsequently slowing the increase in Earth’s temperature. We can attribute the deleterious effects of climate change to the massive amount of carbon emissions we produce as a society. If we can eliminate our reliance on plastics and fossil fuels, we can make a positive impact by stopping the rise in Earth’s temperatures. However, this will require extreme effort and commitment from the global community. Public health professionals need to advocate for the government to acknowledge global warming as a serious threat and stop allowing conglomerates to dictate US policy. We will be in imminent danger if we do not start allocating resources to solving the problem of climate change.

3) If you were visiting with a long-lost relative who had never heard about climate change, how would you describe it and its attendant human health and ecological threats?

Climate change is a multi-faceted and complex issue that stems from generations of unsustainable practices. In short, climate change is a series of changes in weather patterns secondary to a rapid increase in carbon dioxide and other greenhouse gasses. Many of our everyday practices cause a rise in carbon dioxide. The burning of fossil fuel is one of the largest contributors. Changing weather patterns cause planetary destabilization through severe droughts and heatwaves, more frequent natural disasters, high intensity storms, extreme swings in weather, and a rise in sea level. These events have a significant impact on humans including financial loss; food insecurity; higher rates of water-borne illnesses, food-borne illness, vector-borne illnesses; increased morbidity/mortality; exacerbations of chronic diseases; and an increase in reactive airway disease due to pollution. There will also be millions of people displaced due to extreme natural disasters and flooding, which will exacerbate the spread of disease and shortages of resources. (Sattler, 2017).

References

Remme, T. (Writer & Director). (2010). Earth under water [Television broadcast]. United States: Picture Films, Ltd. for National Geographic Channel. 

Sattler, B. (2017). Climate change: A public health perspective [PowerPoint slides]. Retrieved from https://usfca.instructure.com/courses/1569184/pages/m12-dot-1-personal-account-of-katrina-relief-and-its-implications-for-climate-change-preparedness?module_item_id=16450475

M10.1 Occupational Health

Occupational Health and Safety

As an inpatient nurse, I face chemical, biological, radiological, and ergonomic exposures on an almost daily basis. Some of the more common hazards I encounter include, infectious diseases, chemotherapy, radiation, and strenuous patient handling. Because it is impossible to eliminate or even substitute these sources of harm from the work environment, other methods must be utilized to maintain the health and safety of the hospital’s employees.

• Engineering Controls: negative pressure rooms, hoods, closed system tubing, walls resistant to X-Ray waves, separate chemo disposal bins, sharps containers, adjustable beds, lift assistant devices, and safety needles
• Administrative Controls: mandatory annual online training modules that review health and safety topics, required vaccinations, implementation of policies and procedures, audits, exposure plans, and mandatory lifetime radiation exposure trackers
• Personal Protective Equipment: goggles, face shields, gloves, gowns, booties, chemo gloves, surgical masks, PAPR, and respirators (along with annual fit testing)

In reality, all of these interventions are taking place due to the strict regulations that were established to protect workers in hazardous occupations. Working at a unionized hospital is also advantageous because union representatives fight for the implementation of safe practices to protect their members. The only area I find hospitals lacking in is the Hazard Communication Standard. As stated in the presentation, most companies provide a general out of the box training module that is not tailored to the specific chemicals in each individual unit.

Workers may be fearful to report violations of health and safety regulations for a variety of reasons. Barriers include a fear of retribution, fear of financial loss, fear of job insecurity (getting fired), fear of social isolation, and fear of deportation based on immigration status. Laws, such as the Whistleblower Protection Act, were enacted to help protect employees when reporting such violations. 

M11.5 Zero Waste Life

Reflections on Zero Waste Living

I was beyond impressed with Lauren Singer's motivation to live with intention and her success at producing zero waste. I, like many people, often make the excuse that I do not have enough time to live a zero waste life, but Lauren exemplifies how this is possible while still being a student and a working professional. When reflecting on what I could do better to live a waste free life, I immediately think of my guilty pleasure-- shopping! I love buying shoes, clothes, purses, and accessories. My sense of style and fashionable trends have changed many times over the years. For example, when I moved two years ago, I donated seven garbage bags full of clothes to Goodwill! This shows the extreme excess of items I own. 

I recently read a magazine article about having a capsule closet, meaning you limit yourself to 30 items in your closet. This includes shirts, pants, jackets, and shoes. The purpose of this limited closet is to allow the owner to focus on what is important, live with intention, and learn to take better care of those pieces. Now imagine if you did this with your whole life. I believe you would feel a sense of freedom and as Lauren spoke to, have a greater appreciation for your things. From now on, I plan to shop with intention meaning I will only buy things that I really need and that are exactly what I have been looking for. I will not impulse shop or buy things just because.

In addition, I would really like to learn how to make some of my own personal care products. Through this class I have learned the hidden dangerous chemicals most of these products contain and would like to lessen my exposure to these toxins. When looking at recipes on the blog site, Zero Waste Home by Bea Johnson, I found a recipe for lip/cheek stain. This is a product I currently use and would be interested in trying this all-natural recipe as a replacement. The recipe calls for red beet juice as the color additive. I also found many other creative and fun ideas on both Bea and Lauren's websites. I look forward to trying these and implementing sustainable lifestyle practices in my own home. 

M10.5 Occupational Safety

Cal/OSHA and the Adult Film Industry

In 2004, there were several new cases of HIV among workers in the Southern California adult film industry. This exposed the potentially dangerous hazards of the employees in this industry. Since then, officials have been working with the adult film industry to ensure workers know their rights and employers are compliant with state regulation.

Under the California Health and Safety Act, the adult film industry is required to create a healthy work environment for its employees. Some of these provisions include an injury and illness prevention program, employee training, bloodborne pathogen transmission reduction, sanitation, and electrical safety.

Within the adult film industry, employees are at greatest risk for bloodborne pathogens and other STIs. Prevention methods are closely aligned with those of universal precautions, which treat all bodily fluids as hazardous. Engineering practices were established to protect the employees. Examples include simulation of sexual acts with fake bodily fluid, ejaculation outside of the body, use of barriers (condoms), readily available sharps containers, and plastic sheets for easy set clean-up. Personal protective equipment must also be provided to further protect the employees (condoms, dental dams, gloves, and eye shields). Notably, producers are not required to show these barrier methods or other engineering practices in the final version of the movie. Another prevention measure includes vaccinating all employees who may be exposed to bodily fluids with the Hepatitis B vaccine. 

Additionally, all employers must have a written exposure control plan and policies to prevent disease transmission. If exposure to bodily fluids does occur, employers must provide medical evaluation and any necessary treatment to the exposed individual. Furthermore, if a worker tests positive for a bloodborne pathogen, the employer must notify all exposed contacts. This can be done anonymously.

Lastly, many workers in the adult film industry are categorized as independent contract workers. The provisions of the California Health and Safety Act applies to independent contract workers and full-time employees alike.

Complaints against the adult film industry can also be filed confidentially at 714-558-4300

Reference

https://www.dir.ca.gov/dosh/adultfilmindustry.html

M10.2 MSDS and ToxNet

Chemicals at Work

I chose to research Sani-Cloths because I have high exposure to the chemicals in these wipes and I see many health care staff using the wipes without PPE.  

MSDS

1. What are the health risks associated with this chemical?

According to the MSDS, the HMIS/NFPA rated this chemical product as a level 3, which indicates serious health risk. Potential health risks include irreversible eye damage, harmful effects if absorbed through skin, and moderate irritation with skin contact (drying, cracking, redness, defatting, dermatitis, and edema). 

2. Is the chemical a carcinogen?

Isopropanol is not classified as a human carcinogen. 

3. What personal protective equipment or special precautions should be taken when working with this chemical?

The MSDS instructs users to "wear gear as deemed necessary. Follow label directions." The label instructs users to "wear disposable protective gloves, protective gowns, masks, and eye coverings when handling HIV-1, HBV or HCV infected blood or body fluids." It does not indicate what PPE is needed when you are using a wipe to clean a surface that does not contain one of these microbes. 

4. If this is a chemical found in your workplace, what training/education were you given about any risks associated with this chemical? 

We were trained on proper usage and what microbes are killed by this product. I was instructed to use gloves as a student nurse when touching these wipes. However, I was not informed about the health side effects associated with this chemical. 

ToxNet

Isopropanol is extremely dangerous by ingestion and can be fatal at a dose of 250mL. Other side effects caused by ingestion/inhalation/skin absorption include persistent nausea, vomiting, diarrhea, abdominal pain, hematemesis, generalized muscle tenderness, hypotension, CNS depression, areflexia, decreased respirations, coma, and oliguria. Prolonged skin contact can cause corrosion. 

Reflection

The MSDS does not accurately describe the severe side effects that isopropanol can have. It states that inhalation and ingestion are "not a normal route of exposure." Therefore, it does not elaborate any further on ant associated signs or symptoms. Additionally, it simply states that the chemical can "be harmful if absorbed through skin." However, it does not further explain the side effects associated with this route of exposure. Lastly, it does not clearly identify what PPE is needed when handling the wipes. It assumes the reader is already familiar with the product because it instructs the user to "wear gear as deemed necessary." 

The MSDS was not clearly written for several reasons. First, there was medical/industry jargon used throughout. For example, a lay person most likely would not know what edema or defatting means. As mentioned previously, it also assumes the reader has prior knowledge about proper procedure and protective gear. The MSDS could be revised to make it more user-friendly, especially for non-medical personnel. 

References

http://www.unimedcorp.com/MSDS/sds_Sani-ClothAF3.pdf
https://www.toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~E6Q29F:3