NBSB September Meeting – Disaster Medicine

On Sept 23, 2008 the National Biodefense Science Board (NBSB) held an afternoon meeting to review the report and recommendations for the National Disaster Medical System (NDMS) that had been prepared by the Disaster Medicine Working Group. The Working Group had assembled an assessment panel which evaluated previous reports done on the NDMS and put together their own report and specific recommendations which, with the approval of the NBSB, would be transmitted to the Assistant Secretary for Preparedness and Response.
Kevin Yeskey, Director of the Office of Preparedness and Response and Deputy Assistant Secretary for Preparedness and Response began the meeting by giving an overview of NDMS and its capabilities. He also highlighted the recent response to hurricanes Gustav and Ike and contrasted NDMS participation to what occurred in response to hurricane Katrina. For Gustav and Ike they had been able to mobilize fully equipped teams, totaling 1100 response personnel rather than the 37 in the wake of Katrina.
Next, Dr. Stephen Cantrill, the Chair of the Working Group presented the assessment panel’s key recommendations and the NBSB had the chance to go over each and comment. Below is an outline of the recommendations, as the panel chose to organize them.
Recommendation 1: Envisioning the Future
1.1 Develop a clear strategic plan for the NDMS and integration of all other disaster medicine response mechanisms.
1.2 Develop a civilian advisory group for NDMS.
Recommendation 2: Integrating the Past
2.1 Establish a formal mechanism to track the implementation of lessons learned and recommendations from after-action reports.
Recommendation 3: Strengthen the team
3.1 Ensure teams are fully staffed and well-equipped
3.2 Improve and streamline application process for all personnel – *This point was removed during the discussion because based on Director Yeskey’s opening presentation, the NBSB determined that this has been done. Yeskey reported that the application and hiring process has been reduced from 8-12 months to 42 days.
3.3 Implement a uniform training program across NDMS.
3.4 Put into place a system to register non-overlapping personnel so that response capability can be precisely accounted.
Recommendation 4: Serving the patient
4.1 Determine who the patient is, consider patients that have been displaced across state lines NDMS patients even if they were not receiving NDMS care.
4.2 Expand reimbursement so that it is not limited to NDMS hospitals. Ensure that it is timely.
4.3 Define a concept of operations for patient moving and tracking.
4.4 Expand Electronic Medical Records for field use.
4.5 Examine barriers to patient care in emergency response and define criteria for temporary suspension of HIPPA or other requirements during an emergency.
Recommendation 5: Engaging Partners
5.1 Partner with state and local organizations.
5.2 Seek out public/private sector partnerships for patient transport and care.
Recommendation 6: Secure Funding
6.1 Funding is inadequate for the program. Seek out new sources for sustained funding.
Recommendation 7: Future
7.1 Request feedback from ASPR for the NBSB Spring/Summer 2009 meeting on which of the recommendations are complete, in progress or will not be undertaken.
7.2 Recommend that a longer term follow-up study be conducted to focus on the NDMS and these recommendations – * This point was added by the NBSB during the discussion.

The next NBSB meeting will take place Nov 18-19, 2008 and the Board is expecting to hear a presentation from the Disaster Mental Health Subcommittee, a report from the Medical Countermeasure Processes Working Group, a report from the Personal Preparedness Working Group and receive a white paper from the Education and Training Working Group.

“30% Solution” Falls Short of Full Adoption

I’m back from my trip out to Denver for the ASCE AEI Conference, so I’ll be putting up a few posts to catch up on a few things. The first I’d like to update on is the “30 Percent Solution” – an attempt to increase the performance of the model energy code by 30 percent – that I referenced a few posts back.

The final hearings were held in Minneapolis last week, and unfortunately the overall package of energy improvements narrowly failed (receiving over 60% of votes in favor, but not enough to reach the required two thirds majority).

Still, energy efficiency will substantially improve in the nation’s 2009 model energy code governing new home construction, as several individual measures were passed. The 2009 IECC will have several significant new provisions to boost energy efficiency, including:

  • Increased insulation in basements, floors and walls;
  • Improved window efficiency;
  • Reductions in wasted energy from leaky heating & cooling ducts;
  • Reductions in tradeoffs that fail to capture energy savings from efficient heating & cooling equipment;
  • High-efficiency lighting; and
  • Improved air sealing within the building envelope.

While FAS is disappointed the measures were not fully passed, these incremental improvements are encouraging. It is also heartening that over 60 percent of attendees voted in its favor, a clear demonstration of its growing support. We hope (and fully expect) that these efforts will continue, and model energy codes will continue to improve.

More information can be found at the EECC’s website.

ASCE AEI Presentations

I just got done presenting at the ASCE AEI Conference out in Denver. Overall, I was pretty happy with how the session went well. I introduced the speakers and topic, and then John Millhone, a senior advisor to FAS, made a very good presentation about the current energy crisis, and how and why buildings need to play an important role in its solution. I think his presentation really gets to the core of FAS’s mission, and is a great preface to our work in policy and new technologies. John’s powerpoint can be found here.

Eric Tompos, the Vice President of NTA Inc., followed John with a presentation on the sources of design information for engineering SIPs, as well as the ways SIPs typically perform. Eric’s discussion taught me quite a few things I hadn’t realized about panel performance, and was huge for any designer planning to use panels. His powerpoint can be found here (with a supplementary, more comprehensive presentation that describe the methods for developing an engineered design method for SIPs in detail found here).

Khalid Mosalam, a professor Civil and Environmental Engineering out at UC Berkeley followed Eric. Professor Mosalam’s presentation explained much of the work he’s been doing in conjunction with FAS. He explained the current approach to seismic evaluation, the development of a pseudo-dynamic approach that is cheaper than large scale shake table tests, and then how that applies to SIPs and CSIPs. A copy of his presentation can be found here. That said, Professor Mosalam’s research deserves a much more in depth look – I’ll write something more significant about it soon.

I concluded the presentation with a discussion of our Pankow research – how to apply CSIPs to multi-story buildings. My presentation can be found here. The followup discussion to the presentations was good – some very interested people from all different segments of the building industry, from engineers to construction managers.

Nuclear Policy Paper Embraces Clinton Era “Lead and Hedge” Strategy

By Hans M. Kristensen

The new nuclear policy paper National Security and Nuclear Weapons in the 21st Century published quietly Tuesday by the Defense and Energy Departments embraces the “lead and hedge” strategy of the first Clinton administration for how US nuclear forces and policy should evolve in the future.

Yet the “leading” is hard to find in the new paper, which seems focused on hedging.

Instead of offering different alternative options for US nuclear policy, the paper comes across as a Cold War-like threat-based analysis that draws a line in the sand against congressional calls for significant changes to US nuclear policy.

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