Be aware of carbon monoxide poisoning

Winter months are the peak danger season for carbon monoxide poisoning. Review this information from the CDC.

Carbon monoxide (CO) is an odorless, colorless gas that can cause sudden illness and death if inhaled.

Carbon monoxide is found in combustion fumes, such as those produced by small gasoline engines, stoves, generators, lanterns, and gas ranges, or by burning charcoal and wood. CO from these sources can build up in enclosed or partially enclosed spaces. People and animals in these spaces can be poisoned and can die from breathing CO.

Exposure to CO can cause loss of consciousness and death. The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and confusion. People who are sleeping or who have been drinking alcohol can die from CO poisoning before ever having symptoms.

Important CO Poisoning Prevention Tips

• Never use a gas range or oven to heat a home.
• Never use a charcoal grill, hibachi, lantern, or portable camping stove inside a home, tent, or camper.
• Never run a generator, pressure washer, or any gasoline-powered engine inside a basement, garage, or other enclosed structure, even if the doors or windows are open, unless the equipment is professionally installed and vented. Keep vents and flues free of debris, especially if winds are high. Flying debris can block ventilation lines.
• Never run a motor vehicle, generator, pressure washer, or any gasoline-powered engine outside an open window, door, or vent where exhaust can vent into an enclosed area.
• Never leave the motor running in a vehicle parked in an enclosed or partially enclosed space, such as a garage.
• If conditions are too hot or too cold, seek shelter with friends or at a community shelter.
• If CO poisoning is suspected, consult a health care professional right away.

ftp://ftp.cdc.gov/pub/epr/disasters/hurricanes/video/high/CarbonMonoxideCarbonMonoxide.rmvb

NOW’S THE TIME: THE READY CAMPAIGN ENCOURAGES AMERICANS TO RESOLVE TO BE READY IN 2009

WASHINGTON, D.C. — With the new year approaching, the U.S. Department of Homeland Security’s (DHS) Ready Campaign is reminding Americans to Resolve to be Ready in 2009. Resolve to be Ready is a nationwide effort designed to encourage individuals, families, businesses and communities to take action and prepare for emergencies in the new year.

“Individual planning is the cornerstone of emergency preparedness,” said Homeland Security Secretary Michael Chertoff. “Since establishing this department and Ready, we have come a long way in raising the baseline of preparedness in this country, but we still have a long way to go. As 2009 approaches, I urge all Americans to consider the importance – and real value – of being prepared for all hazards.”

Being Ready for emergencies can be an easy new year’s resolution to keep by following the Ready Campaign’s three simple steps: 1) Get an emergency supply kit; 2) Make a family emergency plan; and 3) Be informed about the types of emergencies that can happen in your area and their appropriate responses.

By taking these three steps – in particular having an emergency supply kit both at home and in the car – Americans will be prepared for winter mainstays like power outages and icy roads. Each of these kits should include basic necessities such as water, food and first aid supplies to help you survive if you are without power or become stranded in your vehicle. Complete checklists for each kit are available at www.ready.gov.

This year, the Ready Campaign is employing new media strategies to promote emergency preparedness. By using Twitter, a social networking tool, Ready hopes to not only reach new audiences, but also to open the lines of communication with the public, ensuring emergency preparedness is top of mind year-round. Twitter users can stay up-to-date on the latest Ready activities by following their username, “ReadydotGov,” on Twitter.

By making the decision to Resolve to be Ready in 2009 and following the simple preparedness steps in advance, Americans will minimize the impact of emergencies on themselves, their family and their businesses. By visiting www.ready.gov or calling 1-800-BE-READY, individuals can access free materials that will help them make and keep a new year’s resolution that will bring their families peace of mind.

February 2008 marked the Ready Campaign's fifth year at the Department of Homeland Security. Launched in 2003 in partnership with The Advertising Council, Ready is designed to educate and empower Americans to prepare for and respond to emergencies, including natural disasters and potential terrorist attacks. It has proven to be one of the most successful campaigns in Ad Council's more than 65-year history. Since its launch, the campaign has generated more than $756.5 million in donated media support. Individuals interested in more information about family, business and community preparedness can visit www.ready.gov.

Report Finds Economic Crisis Hurting U.S. Preparedness for Health Emergencies

Trust for America’s Health (TFAH) today released the sixth annual Ready or Not? Protecting the Public’s Health from Disease, Disasters, and Bioterrorism report, which finds that progress made to better protect the country from disease outbreaks, natural disasters, and bioterrorism is now at risk, due to budget cuts and the economic crisis. In addition, the report concludes that major gaps remain in many critical areas of preparedness, including surge capacity, rapid disease detection, and food safety. In addition to assessing state and federal progress on indicators of emergency preparedness, the report offers specific recommendations to Congress, including restoring funding for health emergency preparedness, incorporating preparedness into healthcare reform, and enhancing research and development of technology and countermeasures.

Below is the national press release. The full report and a video release are also available on our website at http://healthyamericans.org/reports/bioterror08/. A playback of the audio press conference detailing highlights of the report will also be available this afternoon on the website.

Report Finds Economic Crisis Hurting U.S. Preparedness for Health Emergencies; More Than Half of States Score 7 or Lower Out of 10 in Readiness Rankings

Media contacts: Liz Richardson (202) 223-9870 x 21 or lrichardson@tfah.org or Laura Segal (202) 223-9870 x 27 or lsegal@tfah.org

WASHINGTON, DC, December 9, 2008 – Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) today released the sixth annual Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism report, which finds that progress made to better protect the country from disease outbreaks, natural disasters, and bioterrorism is now at risk, due to budget cuts and the economic crisis. In addition, the report concludes that major gaps remain in many critical areas of preparedness, including surge capacity, rapid disease detection, and food safety.

The report contains state-by-state health preparedness scores based on 10 key indicators to assess health emergency preparedness capabilities. More than half of states and D.C. achieved a score of seven or less out of 10 key indicators. Louisiana, New Hampshire, North Carolina, Virginia, and Wisconsin scored the highest with 10 out of 10. Arizona, Connecticut, Florida, Maryland, Montana, and Nebraska tied for the lowest score with five out of 10.

Over the past six years, the Ready or Not? report has documented steady progress toward improved public health preparedness. This year however, TFAH found that cuts in federal funding for state and local preparedness since 2005, coupled with the cuts states are making to their budgets in response to the economic crisis, put that progress at risk.

“The economic crisis could result in a serious rollback of the progress we’ve made since September 11, 2001 and Hurricane Katrina to better prepare the nation for emergencies,” said Jeff Levi, PhD, Executive Director of TFAH. “The 25 percent cut in federal support to protect Americans from diseases, disasters, and bioterrorism is already hurting state response capabilities. The cuts to state budgets in the next few years could lead to a disaster for the nation’s disaster preparedness.”

Some serious 2008 health emergencies include a Salmonella outbreak in jalapeño and Serrano peppers that sickened 1,442 people in 43 states, the largest beef recall in history in February, Hurricanes Gustav and Ike, severe flooding in the Midwest, major wildfires in California in June and November, and a ricin scare in Las Vegas.

Among the key findings:

Budget Cuts: Federal funding for state and local preparedness has been cut more than 25 percent from fiscal year (FY) 2005, and states are no longer receiving any supplemental funding for pandemic flu preparedness, despite increased responsibilities.

In addition to the federal decreases, 11 states and D.C. cut their public health budgets in the past year. In the coming year, according to the Center on Budget and Policy and Priorities, 33 states are facing shortfalls in their 2009 budgets and 16 states are already projecting shortfalls to their 2010 budgets.

Rapid Disease Detection: Since September 11, 2001, the country has made significant progress in improving disease detection capabilities, but major gaps still remain.

Only six states do not have a disease surveillance system compatible with the U.S. Centers for Disease Control and Prevention’s (CDC) National Electronic Disease Surveillance System.
Twenty-four states and D.C. lack the capacity to deliver and receive lab specimens, such as suspected bioterror agents or new disease outbreak samples, on a 24/7 basis.
Only three state public health laboratories are not able to meet the expectations of their state’s pandemic flu plans.

Food Safety: America’s food safety system has not been fundamentally modernized in more than 100 years.

Twenty states and D.C. did not meet or exceed the national average rate for being able to identify the pathogens responsible for foodborne disease outbreaks in their states.

Surge Capacity: Many states do not have mechanisms in place to support and protect the community assistance that is often required during a major emergency.

Twenty-six states do not have laws that reduce or limit liability for businesses and non-profit organizations that help during a public health emergency.
Only eight states do not have laws that limit or reduce liability exposure for health care workers who volunteer during a public health emergency.
Seventeen states do not have State Medical Reserve Corps Coordinators.

Vaccine and Medication Supplies and Distribution: Ensuring the public can quickly and safely receive medications during a major health emergency is one of the most serious challenges facing public health officials.

Sixteen states have purchased less than half of their share of federally-subsidized antivirals to use during a pandemic flu outbreak.

Every state now has an adequate plan for distributing emergency vaccines, antidotes, and medical supplies from the Strategic National Stockpile, according to the CDC. In 2005, only seven states had adequate plans. The CDC changed to a different grading system in 2007. However, questions still remain about the contents of the federal stockpile.

“States are being asked to do more with less, jeopardizing our safety, security, and health,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation. “We all have a stake in strengthening America's public health system, because it is our first line of defense against health emergencies.”

The report also offers a series of recommendations for improving preparedness, including:

Restoring Full Funding. At a minimum, federal, state, and local funding for public health emergency preparedness capabilities should be restored to FY 2005 levels.

Strengthening Leadership and Accountability. The next administration must clarify the public health emergency preparedness roles and responsibilities at the U.S. Department of Health and Human Services and U.S. Department of Homeland Security.

Enhancing Surge Capacity and the Public Health Workforce. Federal, state, and local governments and health care providers must better address altered standards of care, alternative care sites, legal concerns to protect community assistance, and surge workforce issues.

Modernizing Technology and Equipment. Communications and surveillance systems and laboratories need increased resources for modernization.

Improving Community Engagement. Additional measures must be taken to engage communities in emergency planning and to improve protections for at-risk communities.

Incorporating Preparedness into Health Care Reform and Creating an Emergency Health Benefit. This is needed to contain the spread of disease by providing care to the uninsured and underinsured Americans during major disasters and disease outbreaks.

Score Summary:

For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. The data for the indicators are from publicly available sources or were provided from public officials. More information on each indicator is available in the full report on TFAH’s Web site at www.healthyamericans.org and RWJF’s Web site at www.rwjf.org. The report was supported by a grant from RWJF.

10 out of 10: Louisiana, New Hampshire, North Carolina, Virginia, Wisconsin
9 out of 10: Alabama, Indiana, Michigan, Pennsylvania, South Carolina, Tennessee, Vermont,
8 out of 10: Arkansas, Delaware, Georgia, Hawaii, Iowa, Minnesota, North Dakota, Ohio, South Dakota, Washington
7 out of 10: California, Colorado, D.C. Illinois, Kentucky, Missouri, New Jersey, New Mexico, New York, Oklahoma, Oregon, Rhode Island, Utah, West Virginia, Wyoming
6 out of 10: Alaska, Idaho, Kansas, Maine, Massachusetts, Mississippi, Nevada, Texas
5 out of 10: Arizona, Connecticut, Florida, Maryland, Nebraska, Montana

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. www.healthyamericans.org

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need—the Foundation expects to make a difference in our lifetime. For more information, visit www.rwjf.org.

National Special Needs Population Registry - Beta Test Underway

National Special Needs Population Registry - Beta Test Underway

Center for Disaster Risk Policy at Florida State University is currently Beta Testing a new National Special Needs Population Registry in three southeastern states.

The registry’s design allows for registration of all individuals with special needs as defined by FEMA’s Planning Guide for Special Needs Populations

Designed to allow local disaster planning and response agencies to provide the highest level of assistance to special needs individuals through the latest in web based applications, the registry will allow users, at a minimum, to assign individuals to shelter locations and transportation routes, to generate route pickup maps for the transportation disadvantaged and to generate numerous (over 200) types of reports on the data contained within the registry.

For additional information please visit the following web site: http://www.spinreg.org

National Influenza Vaccination Week

December 8 – 14, 2008 is National Influenza Vaccination Week.

The Centers for Disease Control and Prevention (CDC) has announced the week of December 8-14, 2008, as National Influenza Vaccination Week. This week-long event is designed to raise awareness of the importance of continuing influenza (flu) vaccination, as well as foster greater use of flu vaccine in December, January, and beyond. Since flu activity typically does not peak until February or later, December and January still provide good opportunities to offer flu shots. This year, Thursday, December 11th, is designated as Seniors' Vaccination Day. The Centers for Medicare & Medicaid Services (CMS) needs your help to ensure that people with Medicare get their flu shots. Please use this week long event as an opportunity to place greater emphasis on flu prevention. If you have Medicare patients who have not yet received their annual flu shots, we ask that you encourage these patients to protect themselves from the seasonal flu and serious complications arising from the flu virus by recommending that they take advantage of the flu shot benefit covered by Medicare. And remember, health care professionals and their staff are also at risk for contracting and spreading the flu virus, so don’t forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your Flu Shot -- Not the Flu!

NOTE: - Influenza vaccine plus its administration are covered Part B benefits. Influenza vaccine is NOT a Part D covered drug.

For More Information
Health care professionals and their staff can learn more about Medicare’s coverage of the flu vaccine and other Medicare Part B covered vaccines and related provider education resources created by CMS, by reviewing Special Edition MLN Matters article SE0838 located at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0838.pdf on the CMS website.

For more information about National Influenza Vaccination Week, please visit the Centers for Disease Control and Prevention’s website, http://www.cdc.gov/flu/nivw/

CrownWEB is Nearly Here

The following announcement is being mailed and faxed to Administrators of all dialysis facilities in Florida. If you are not the correct person to receive this email, we ask that you forward it to the correct individual(s).

CROWNWeb is Nearly Here

The implementation date for the electronic data submission required by the new Conditions for Coverage is just around the corner. CROWNWeb is the application designated by CMS to meet this requirement.

How Do I Get Access to CROWNWeb?

Every facility (whether they are an independent, a regional chain or part of a large dialysis organization) will need to identify their Security Administrator and Backup Security Administrator for CROWNWeb. This will be the person responsible for assigning roles and scope within the CROWNWeb application for other users at your facility. To designate your facility’s Security Administrator you need to fill out the CROWNWeb Authentication Service (CAS) Account Form. This is an online form available at https://www.qualitynet.org/crown/registration_form.pdf. The form must be either TYPED directly into the online form and printed; or printed as a blank form and TYPED on a typewriter. No hand written forms can be accepted. The printed form must then be signed by both the person designated as the Security Administrator and their manager and notarized. The original notarized form, not a fax or copy, should be sent to the Network office no later than December 15. If your facility does not designate a Security Administrator, your facility will not be able to submit data electronically to CMS and will unable to comply with new Conditions for Coverage for electronic data submission.

NOTE: The CAS form requires signatures from three different people. Do NOT sign as your own manager and neither you nor your manager may notarize the form.
Important Date to Remember:

12/15/2008
DEADLINE for submitting Notarized CAS form for CROWNWeb access

This date applies to VISION users also.

FDA: Innohep (tinzaparin sodium injection)

Innohep (tinzaparin sodium injection)

FDA has received information about the clinical study: Innohep in Renal Insufficiency Study (IRIS) that was stopped in February, 2008 by the study’s Data Safety Monitoring Committee because of an interim finding of an increase in all-cause mortality in patients who received Innohep. Information on the patients enrolled in the study, on the heparin used to manufacture Innohep, and on the heparin used in the study is still being collected and analyzed.

In July 2008, the company revised the prescribing information to restrict the use of Innohep in patients 90 years of age or older. FDA is concerned that the preliminary data from the IRIS study suggest that the increased risk of mortality is not limited only to patients 90 years of age or older. Therefore, FDA has requested that the company revise the labeling for Innohep to better describe the overall study results which suggest that, when compared to unfractionated heparin, Innohep increases the risk of death for elderly patients (i.e., 70 years of age and older) with renal insufficiency. Healthcare professionals should consider the use of alternative treatments to Innohep when treating elderly patients over 70 years of age with renal insufficiency and DVT, PE, or both. This communication is in keeping with FDA’s commitment to inform the public about its ongoing safety reviews of drugs. FDA anticipates submission of the final IRIS study report in January, 2009 and plans to complete its review soon thereafter. FDA will communicate its conclusions and any resulting recommendations to the public at that time. FDA will consider additional regulatory actions as appropriate after thorough review of all applicable data from the manufacturer of Innohep.

Read the complete MedWatch 2008 Safety summary, including a link to the FDA Communication, at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#Innohep

Medicare Publishes New Information on Quality of Care at Dialysis Facilities

Medicare Publishes New Information on Quality of Care at Dialysis Facilities

Changes to Web Site Will Help Consumers Compare Care and Make
Informed Health Care Choices

The Centers for Medicare & Medicaid Services (CMS) today announced important additions to the Dialysis Facility Compare consumer Web site (http://www.medicare.gov/dialysis) that will give consumers even better insight into the quality of care provided by their local dialysis patient facilities.

The improvements include two new quality measures that demonstrate how well dialysis patients are treated for anemia (low red blood cell count) as well as updated information that will help patients better understand survival rates by facility.

To view the entire Press Release, please see: http://www.cms.hhs.gov/apps/media/press_releases.asp

Notice: ReliOn Insulin Syringes for use with U-100 Insulin (Tyco Healthcare - Covidien)

The kidney community uses a variety of products and resources to ensure the health and safety of patients and healthcare professionals. The United States Food and Drug Administration (FDA) issues alerts and notifications when these products and resources are unsafe or being recalled.

As directed by CMS, the KCER Coalition issues notices on FDA recalls via email and this website for the kidney community. To join the email list, please email sburris@nw7.esrd.net.

November 6, 2008

ReliOn Insulin Syringes for use with U-100 Insulin (Tyco Healthcare - Covidien)

Covidien and FDA notified patients and healthcare professionals of a recall of ReliOn sterile, single-use, disposable, hypodermic syringes with permanently affixed hypodermic needles. The mislabeled syringe may result in patients receiving an overdose of as much as 2.5 times the intended dose, with serious health consequences, low blood sugar, and even death. These syringes are sold only by Wal-Mart or Sam's Club pharmacies under the ReliOn name. The recall applies only to lot number 813900. The product was distributed from Aug. 1, 2008 until Oct. 8, 2008, and includes 471,000 individual syringes in 4,710 boxes. FDA urges patients and health care professionals to check syringe packaging carefully for products with this lot number, not to use the product, and return the product to the pharmacy for replacement. The lot number can be found on the back panel of the 100 count syringe carton, or on the white paper backing of each individual syringe “peel-pack”.

http://www.fda.gov/bbs/topics/NEWS/2008/NEW01911.html

FKDC Supports Fire Prevention Week

From October 5-11, 2008, fire safety advocates will spread the word to their communities that, with a little extra caution, preventing the leading causes of home fires – cooking, heating, electrical and smoking-materials – is within their power.

Did you know...?

• Cooking fires are the number one cause of home fires and home fire injuries.
• Heating fires are the second-leading cause of home fires.
• The majority of home fires start in the kitchen.
• Older adults are at the highest risk of death or injury from smoking-material (cigarettes, cigars) fires even though they are less likely to smoke than younger adults.
• January and December were the peak months for home fires and home fire deaths.
• Working smoke alarms cut the risk of dying in reported home structure fires in half.

For more fire facts and for information on how YOU can prevent home fires, log on to the National Fire Prevention Association at http://www.nfpa.org/

FKDC anuncia los recursos del desastre en español.

FKDC anuncia los recursos del desastre en español.

Las necesidades y capacidades de cada persona son únicas, pero cada persona puede adoptar medidas importantes para prepararse para todo tipo de emergencias e implementar planes.

• Ancianos: http://www.listo.gov/america/getakit/seniors.html
• Para personas discapacitadas: http://www.listo.gov/america/getakit/disabled.html
• Cruz Roja Americana: http://www.cruzrojaamericana.org/index.asp
• Anuncios de servicio público sobre desastres naturales: http://www.bt.cdc.gov/disasters/psa/es/

FKDC Supports National Preparedness Month

The Florida Kidney Disaster Coalition (FKDC) supports September as National Preparedness Month. On our website, you'll find resources to help educate staff and patients on the critical need to prepare for emergencies.

http://www.fkdc.org/NPMR.htm

Disaster Recovery Centers open for Florida residents impacted by Fay

Community Relations teams and Disaster Recovery Centers (DRCs) will still be assisting individuals, households and businesses affected by Tropical Storm Fay in Brevard, Hendry, Okeechobee, St. Lucie and Volusia counties.

The DRCs will operate daily from 8 a.m. to 6 p.m. They are located at:

Brevard County:

Agricultural Center
3695 Lake Drive
Cocoa 32926

Near Lamplighter Village
503 N. John Rodes Blvd.
Melbourne 32901

Grant Street Community Center
2547 Grant St.
Melbourne 32934

Hendry County:

Labelle Rodeo Grounds
100 Rodeo St.
Labelle 33935

Okeechobee County:

[Across from County Courthouse]
304 N.W. 2nd St.
Okeechobee 34972

St. Lucie County:

St. Lucie Logistics Center
3855 S. U.S. Highway 1
Fort Pierce 34982

Volusia County:

Wal-Mart parking lot
2400 Veterans Memorial Parkway
Orange City 32763

The DRCs are staffed with Federal Emergency Management Agency (FEMA), State Emergency Response Team (SERT) disaster recovery specialists and representatives from voluntary agencies. They are ready to help survivors through the process of applying for disaster assistance.

Applicants should register by calling FEMA's toll-free line at 800-621-FEMA (3362). Those with a speech or hearing impairment may call TTY number at 800-462-7585. Multilingual operators are available. The toll-free telephone numbers will operate 7 a.m. to midnight daily until further notice. Application for disaster assistance can also be made by registering online at www.fema.gov or at a Disaster Recovery Center.

Once registered, FEMA disaster recovery specialists can check an individual's case, answer questions about their claim, or request information FEMA needs to process their claim. Recovery specialists can also supply contacts for other programs that may be able to help.

In addition, Community Relations teams visiting the declared disaster counties will provide information about disaster registration to businesses, homeowners and renters who suffered uninsured damages and losses due to Tropical Storm Fay.

FEMA coordinates the federal government's role in preparing for, preventing, mitigating the effects of, responding to, and recovering from all domestic disasters, whether natural or man-made, including acts of terror.

FEMA Declares Florida Counties Eligible for Disaster Assistance

FEMA DECLARES SOME COUNTIES ELIGIBLE FOR DISASTER ASSISTANCE
Brevard Hendry Okeechobee St. Lucie Volusia

Disaster assistance is money or direct assistance to individuals, families and businesses in an area whose property has been damaged or destroyed and whose losses are not covered by insurance. It is meant to help you with critical expenses that cannot be covered in other ways. This assistance is not intended to restore your damaged property to its condition before the disaster.

While some housing assistance funds are available through our Individuals and Households Program, most disaster assistance from the Federal government is in the form of loans administered by the Small Business Administration.

First and foremost, to qualify for assistance, your losses must have occurred in an area covered by a disaster declaration.

Secondly, if you have insurance, you must file a claim with your insurance company.

Two types of disaster assistance, "Housing Needs" and "Other than Housing Needs", are available to individuals, families and businesses in an area whose property has been damaged or destroyed and whose losses are not covered by insurance.

Whether applying online OR over the phone, you should have a pen and paper and the following information ready:

Your Social Security number.
Current and pre-disaster address.
A telephone number where you can be contacted.
Insurance information.
Total household annual income
A routing and account number from your bank (only necessary if you want to have disaster assistance funds transferred directly into your bank account)
Lookup your bank routing number.
A description of your losses that were caused by the disaster.

Residents and business owners in the declared areas are encouraged to contact the FEMA Tele-registration Line at:

1-800-621-FEMA (3362)
Speech or hearing disabilities call TTY 1-800-462-7585

VISIT WWW.FEMA.GOV FOR MORE INFORMATION

President Declares Major Disaster for Florida

President Declares Major Disaster for Florida
Release Date: August 24, 2008Release Number: HQ-08-168

WASHINGTON, D.C. -- The head of the U.S. Department of Homeland Security's Federal Emergency Management Agency (FEMA) today announced that federal disaster aid has been made available for Florida to supplement state and local recovery efforts in the area struck by Tropical Storm Fay beginning on August 18, 2008, and continuing.

FEMA Administrator David Paulison said federal funding is available to state and eligible local governments and certain private nonprofit organizations on a cost-sharing basis for emergency work and the repair or replacement of facilities damaged by Tropical Storm Fay in the counties of Brevard, Monroe, Okeechobee, and St. Lucie.

Federal funding is also available on a cost-sharing basis for hazard mitigation measures statewide.

Paulison named Thomas P. Davies the federal coordinating officer for federal recovery operations in the affected area. Davies said additional designations may be made at a later date if requested by the state and warranted by the results of further damage assessments.

FEMA coordinates the federal government's role in preparing for, preventing, mitigating the effects of, responding to, and recovering from all domestic disasters, whether natural or man-made, including acts of terror.

Tropical Storm Fay

As of 9:00 a.m. (Eastern Time) Thursday morning, the center of Tropical Storm Fay was located in the east central Florida coastal waters, approximately 20 miles east of Daytona Beach. Maximum sustained winds remain near 60 mph. Fay has been nearly stationary during the past few hours but is expected to begin a slow west-northwest motion towards the east central and northeast Florida coast line during the morning hours. Sustained tropical storm force winds will spread along coastal areas of northeast and east central Florida through Thursday morning.

Rain bands along the south side of Fay’s circulation will continue to produce flooding over the saturated soils of east central Florida. Locations south of Brevard County could experience storm totals near 30 inches of rain. Flood watches remain in effect for central and northeast Florida. A flash flood warning is in effect for Brevard County until 12:00 pm Thursday. A flashflood warning means that flooding is imminent or occurring. Take immediate actions to protect life and property.

Travel is not recommended anywhere in east central Florida tonight. A tropical storm warning is in effect for Fort Pierce northward to Altamaha Sound, Georgia. A tropical storm warning means that tropical storm conditions are expected within the next 24 hours. An inland tropical storm warning is in effect for interior section of east central and northeast Florida. This means that tropical storm conditions are expected within the next 24 hours.

Even if you are not in the path of the storm, it is a good opportunity to review and practice your disaster plans. This includes educating your patients and helping them to develop their disaster plan. Patients should be informed where to go, what to do and who to contact. The following are key areas to address in preparing patients:

• The Network has made available patient ID cards. Encourage your patients to use them. Additional copies can be downloaded from the FMQAI website at http://www.fmqai.com/ESRD/pdf/Emergency%20Hurricane%20Cards.pdf
• If an evacuation order is issued, patients should be given a copy of their treatment orders, medications, instructions on their emergency diet, a list of Florida dialysis facilities and facility emergency contact information. (Please do not distribute the phone numbers marked for “Staff Use Only” to patients.)
• If the patient is evacuating, ask where they plan to go and for an out of area contact number.
• Peritoneal dialysis patients and home hemodialysis patients should be contacted and prepared with ample supplies and information on how to contact their supplier.
  

Due to the current weather situation, please remain aware of updated advisories. The following are useful links that may benefit you as well as your patients:

Link to local EOC
http://www.floridadisaster.org/County_EM/county_list.htm

Link to Emergency Guide for People on Dialysis
http://www.medicare.gov/Publications/Pubs/pdf/10150.pdf

Link to Emergency Preparedness Guide for Dialysis Facilities
http://www.fmqai.com/ESRD/pdf/CMSDisasterPlanningGuide.pdf

Following the storm, please contact the Network to advise of your facility’s status and if you are in need of assistance. Also, please notify the Network if you are unable to locate one of your patients, as well as if you are assisting another facility by dialyzing one of their patients. Thank you for your ongoing attention to the safety of your patients.

Network Office – 813-383-1530

CMS Draft Interpretive Guidelines Published

The Centers for Medicare & Medicaid Services (CMS) has posted the “draft” interpretive guidance that will guide the survey process for the new ESRD Conditions for Coverage.

The document includes the regulatory language that was published as a final rule for the ESRD program in the Federal Register on April 15, 2008, as well as regulatory text that was incorporated by reference in that final rule.

Comments and rationale pertaining to the “draft” Interpretive Guidelines can be submitted to the CMS mailbox at ESRDSurvey@cms.hhs.gov no later than 5:00 p.m. Eastern time on August 18, 2008. A template to submit comments and rationale is included in the guideline document.

You can locate the “draft” Interpretive Guideline document on the FMQAI website at http://www.fmqai.com/ESRD/.

Coping with disasters

Disasters can have a far-reaching impact on victims and responders. But you don’t have to be a disaster victim to experience the anxiety and stress. Disasters can cause widespread physical damage, but they can also cause emotional damage.

A disaster can make you sad, angry, confused, or scared. These emotions are very common. But sometimes, these emotions can last a long time or keep you from doing daily activities. You should be able to recognize the warning signs that you or your loved ones are experiencing difficulty.

Sometimes anniversaries of disasters can trigger anxiety. There are many organizations that can help you cope with disasters. If you are a dialysis or transplant patient, talk to your social worker about your feelings.

There are many resources on the Internet where you can find help. Here are just a few:

• http://mentalhealth.samhsa.gov/disasterrelief/psa.aspx
• http://emergency.cdc.gov/mentalhealth/
• http://www.redcross.org

Lightning Safety Week!

When Thunder Roars, Go Indoors!
Lightning Safety Week: June 22-28, 2008

Florida is the Lightning Capitol of the U.S., leading the nation in lightning deaths. Lightning kills an average of nine Floridians each year, more than any other weather hazard, and injures an additional 37 people.

Most people who are struck by lightning are not killed, but they are left badly bruised and burned. The force of being hit by lightning can literally blow off people's shoes, shred their clothes and throw them violently through the air. It not only hits you hard, but at 50,000 degrees, it also burns right through you, leaving you with disfiguring scars and internal damage.
Lightning survivors often have pain, loss of memory and other bad effects that sometimes last a lifetime.

A darkening cloud is often the first sign that lightning may strike. As soon as you see lightning or hear thunder, you are immediately at risk. By playing another inning or waiting even a few minutes to see if the storm is getting closer, you could be risking your life.

Go immediately inside a house or other enclosed structure to stay safe. No place outdoors is safe! Covered vehicles are fairly safe locations, but remember to keep your hands and feet away from the side of the car and away from the dashboard, steering wheel and windows.

People that have been struck by lightning do not carry an electrical charge. If you and the victim are in a safe area, it is safe and recommended to perform life saving first aid. You will not “get shocked” by touching the victim.

How far away is lightning from you? Use the FLASH to BANG method:

• When you see the FLASH
• Count the number of seconds to the BANG of thunder,
• Divide this number by 5,
• And this gives you the MILES the lighting is away from you.

It is recommended that if the thunder arrives within 30 seconds or less from your location, you should seek shelter. Wait thirty minutes after the last thunder before going outside.

http://www.lightningsafety.noaa.gov/

"All Hazards" now an online continuing education course

FMQAI: The Florida ESRD Network (Network 7) is pleased to present All Hazards I: Identifying and Preparing for Potential Emergencies and Disasters.

This free online continuing education course will provide 1.0 continuing education contact hour for Florida nurses, social workers, and dietitians.

This is an exciting opportunity for dialysis providers to fulfill the CMS Conditions for Coverage which outline staff training on disasters.

For more information on the course, visit http://edu.flqio.org/ and click on "ESRD Courses."

Disaster Preparedness Videos

We have received a number of requests for disaster preparedness videos. Here is a list of online and free videos covering general preparedness, special needs, pets, safety, hurricanes, and pandemics.

http://www.ready.gov/america/about/instructional.html (general)

http://www.soph.uab.edu/scphp/default.aspx?ID=724 (general)

http://www.utbtsc.edu/safety/video/welcome.html (hurricanes)

http://floridadisaster.org/index.asp and click on the "Media Center" near the top righthand corner (hurricanes)

http://wsfltv.sun-sentinel.com/news/weather/wsfl-hurricane-tips,0,3896722.htmlstory?coll=wbzl-home-nav (hurricanes, general)

http://www.cepintdi.org/default.aspx?pageid=174 (Click on "Being Prepared" and then scroll to "Emergency Preparedness Video") for the deaf and hard of hearing.

http://www.bt.cdc.gov/disasters/hurricanes/psa.asp (hurricanes, general)

http://www.sanmiguelcounty.org/portal/page?_pageid=118,148583&_dad=portal&_schema=PORTAL (pandemics)

http://a1881.g.akamai.net/7/1881/26640/v0001/redcross.download.akamai.com/26640/psa/movie/PandemicFlu/PF_Video1.html (pandemics)

http://readymontco.montcopa.org/readymontco/cwp/view,A,1553,Q,64828.asp (pandemics)

http://www.emd.wa.gov/publications/pub_index.shtml * There are PDF documents of a family emergency plan in English, Amharic, Arabic, Cambodian, Chinese, Farsi, Ilocano, Korean, Laotian, Romanian, Russian, Serbo-Croatian, Somaly, Spanish, Tagalog, Tigrigna, Ukranian, and Vietnamese.

Florida Wildfires

The Florida ESRD Network is currently monitoring the wildfire situation in Florida. If you are in the impacted area, it is vital to listen and obey your local officials' emergency orders. Most importantly, evacuate if you are told to do so.

For individuals with kidney failure, remember to take your medicines, medical records, supplies, food, and insurance information. Call your dialysis clinic and tell them that you had to evacuate and tell them where you are staying.

Wildfires can also cause problems even if you are not in the impacted area. Smoke can reduce visibility on roads which can cause traffic accidents or close important roads. Make sure you know alternate routes to reach your dialysis facility, pharmacy, or family member's home.

The wildfire smoke can hurt your eyes, irritate your nose/throat/lungs, and can worsen illness. If you have respiratory problems, try to stay indoors away from the smoke.

For more information, visit the Wildfire Smoke Health and Safety page from the Arkansas Division of Air Quality.

For information about wildfire safety, visit the American Red Cross site http://www.redcross.org/services/disaster/0,1082,0_594_,00.html

Tampa Bay Hurricane Expo 2008

The City of Tampa and Hillsborough County are pleased to announce the Hurricane Expo 2008: Are You Ready Tampa Bay? Know your Zone, Make a Plan on May 31, 2008 at the Museum of Science and Industry (MOSI). The purpose of the Expo is to educate our residents on the importance of knowing their evacuation zone and making an effective plan in the event of a hurricane. The Expo will be a family-friendly, multi-cultural event featuring vendors, live entertainment, educational seminars, and giveaways.

It is important that our community is educated and prepared. In the past both the City and County have hosted similar events that have attracted a wide cross-section of residents from our community. In 2006, the City’s Neighborhood Fair and Expo attracted over 5,000 visitors. It is our goal to expand on that success with this year’s expo. We hope to see you there to learn your zone and how to make a plan to be safe during this hurricane season.

For more information, visit http://www.hillsboroughcounty.org/hurricaneexpo/

2008 Atlantic Hurricane Forecast

http://typhoon.atmos.colostate.edu/forecasts/

April 9, 2008
Philip J. Klotzbach1 and William M. Gray
Colorado State University

ATLANTIC BASIN SEASONAL HURRICANE FORECAST FOR 2008

• 15 Named Storms
• 80 Named Storm Days
• 8 Hurricanes
• 40 Hurricane Days
• 4 Intense Hurricanes

Probabilities for at least one major hurricane (Category 3 or higher) landfall on each of the following coastal areas:

1. Entire U.S. coastline - 69% (average for last century is 52%)
2. U.S. East Coast Including Peninsula Florida - 45% (average for last century is 31%)
3. Gulf Coast from the Florida Panhandle westward to Brownsville - 44% (average for last century is 30%)
4. Above-average major hurricane landfall risk in the Caribbean

Current conditions in the Atlantic basin are quite favorable for an active hurricane season. Both of our early April predictors call for a very active hurricane season in 2008. The current sea surface temperature pattern in the Atlantic is a pattern typically observed before very active seasons. Waters off the coast of Iberia as well as the eastern tropical Atlantic are very warm right now (Figure 6). The Azores High has also been quite weak during the month of March. Typically, a weakened Azores High leads to weaker trade winds that enhance warm SST anomalies due to reduced levels of evaporation, mixing and upwelling in the eastern tropical Atlantic.

ESF-8 ... New FEMA Independent Study Course

FEMA Independent Study (IS) courses are online, free courses available to the public. There is a new course, IS-808 Emergency Support Function (ESF) #8 – Public Health and Medical Services.

http://training.fema.gov/EMIWeb/IS/IS808.asp

As part of the NRF, Emergency Support Functions (ESFs) are primary mechanisms at the operational level used to organize and provide assistance. This series of courses is designed to overview each of the 15 ESFs. This course provides an introduction to Emergency Support Function (ESF) #8 – Public Health and Medical Services. Support.

This online course is aboue 30 minutes and offers a certificate of completion if you choose to take (and pass) the final exam.

Emergency and Disaster-Related Conditions for Coverage

For the complete document, please visit the Centers for Medicare and Medicaid Services (CMS) at http://www.cms.hhs.gov/CFCsAndCoPs/13_ESRD.asp

Emergency and disaster-related Conditions for Coverage are outlined in the paragaphs §494.60 Condition: Physical environment.


§494.60 Condition: Physical environment

(d) Standard: Emergency preparedness. The dialysis facility must implement processes and procedures to manage medical and nonmedical emergencies that are likely to threaten the health or safety of the patients, the staff, or the public. These emergencies include, but are not limited to, fire, equipment or power failures, care-related emergencies, water supply interruption, and natural disasters likely to occur in the facility’s geographic area.

(1) Emergency preparedness of staff. The dialysis facility must provide appropriate training and orientation in emergency preparedness to the staff. Staff training must be provided and evaluated at least annually and include the following:

(i) Ensuring that staff can demonstrate a knowledge of emergency procedures, including informing patients of--

(A) What to do;

(B) Where to go, including instructions for occasions when the geographic area of the dialysis facility must be evacuated;

(C) Whom to contact if an emergency occurs while the patient is not in the dialysis facility. This contact information must include an alternate emergency phone number for the facility for instances when the dialysis facility is unable to receive phone calls due to an emergency situation (unless the facility has the ability to forward calls to a working phone number under such
emergency conditions); and

(D) How to disconnect themselves from the dialysis machine if an emergency occurs.

(ii) Ensuring that, at a minimum, patient care staff maintain current CPR certification; and

(iii) Ensuring that nursing staff are properly trained in the use of emergency equipment and emergency drugs.

(2) Emergency preparedness patient training. The facility must provide appropriate orientation and training to patients, including the areas specified in paragraph (d)(1)(i) of this section.

(3) Emergency equipment. Emergency equipment, including, but not limited to, oxygen, airways, suction, defibrillator or automated external defibrillator, artificial resuscitator, and emergency drugs, must be on the premises at all times and immediately available.

(4) Emergency plans. The facility must--

(i) Have a plan to obtain emergency medical system assistance when needed;

(ii) Evaluate at least annually the effectiveness of emergency and disaster plans and update them as necessary; and

(iii) Contact its local disaster management agency at least annually to ensure that such agency is aware of dialysis facility needs in the event of an emergency.

(e) Standard: Fire safety.

(1) Except as provided in paragraph (e)(2) of this section, by [OFR - insert 300 days after publication in the Federal Register], the dialysis facility must comply with applicable provisions of the 2000 edition of the Life Safety Code of the National Fire Protection Association (which is incorporated by reference at §403.744(a)(1)(i) of this chapter).

(2) Notwithstanding paragraph (e)(1) of this section, dialysis facilities participating in Medicare as of [OFR - insert 180 days after publication in the Federal Register] utilizing non-sprinklered buildings on such date may continue to use such facilities if such buildings were constructed before January 1, 2008 and State law so permits.

(3) If CMS finds that a fire and safety code imposed by the facility’s State law adequately protects a dialysis facility’s patients, CMS may allow the State survey agency to apply the State’s fire and safety code instead of the Life Safety Code.

(4) After consideration of State survey agency recommendations, CMS may waive, for individual dialysis facilities and for appropriate periods, specific provisions of the Life Safety Code, if the following requirements are met:

(i) The waiver would not adversely affect the health and safety of the dialysis facility’s patients; and

(ii) Rigid application of specific provisions of the Life Safety Code would result in an unreasonable hardship for the dialysis facility.

Press Release: CMS Releases Regulations Modernizing Dialysis Centers

For Immediate Release: Thursday, April 03, 2008
Contact: CMS Office of Public Affairs202-690-6145

CMS RELEASES REGULATION MODERNIZING DIALYSIS CENTERS

The Centers for Medicare & Medicaid Services (CMS) today released a final rule that will modernize the Medicare conditions for coverage for the nation’s dialysis centers and promote higher quality of care for patients receiving dialysis.

The final regulation will enhance the quality of care available to more than 336,000 Medicare beneficiaries with End-State Renal Disease (ESRD) who receive dialysis treatment from more than 4,700 Medicare-approved renal dialysis facilities across the U.S. The regulation reflects important clinical and scientific advances in dialysis technology and standards of care practices. The regulation also updates the current requirements that were first published in 1976.

“By bringing the standards of care for dialysis patients up to date, we are improving the health and quality of life for thousands of Medicare beneficiaries,” said CMS Acting Administrator Kerry Weems. “With the new rules, people living with ESRD can be assured that they are getting the best care possible.”

The final rule went on display today at the Office of the Federal Register and will be published April 4, 2008.

These regulations will serve as minimum standards that dialysis facilities must meet in order to meet to be certified under the Medicare program. These conditions for coverage are part of the Medicare survey and certification process.

The rule focuses on the importance of patient rights, patient safety and the patient’s participation in the development of his or her own plan of care. Each facility is required to develop a quality assessment and performance improvement (QAPI) program that would track the facility’s performance in patient health outcomes. This regulation also reduces the detailed and burdensome requirements that dialysis facilities had to meet previously and provides flexibility for facilities to use their resources to meet the needs of individual patients and achieve better outcomes of care.

“This rule was designed with patient care in mind. We’ve added requirements for facilities to conduct a comprehensive assessment of the patient’s health condition when starting dialysis treatment, as well as to work with an interdisciplinary team to develop an individualized care plan for every patient,” said Barry M. Straube, M.D., CMS Chief Medical Officer and Director of CMS’ Office of Clinical Standards & Quality.

“Facilities must work with patients to achieve and maintain the best possible outcomes of care,” Straube said. “We’ve also added important protections to assure that all facilities develop a quality improvement system that helps them better assess patient outcomes and make positive changes that will improve health care delivery.”

Beneficiaries will benefit by the following updates in the rule:

· Adopts updated Centers for Disease Prevention and Control (CDC) guidelines for hemodialysis facilities to increase patient infection control procedures.
· Adopts updated American Association for Medical Instrumentation (AAMI) water quality guidelines to promote safer water for dialysis use.
· Requires defibrillators in every dialysis facility, to allow facility staff to respond rapidly to individuals that may be having a heart attack.
· Incorporates sections of the 2000 Life Safety Code, which upgrades fire safety standards.
· Expands patient rights protections, including:
o A requirement to inform beneficiaries of their right to have advance directives,
o A facility-level grievance process that explains how a facility must respond to a patient’s grievance, and
o A policy that provides a 30-day written notice to the patient before a facility can involuntarily discharge a patient.
· Requires a comprehensive patient assessment based on current medical practices and the patient’s unique needs.
· Requires a personalized patient plan of care, based on current standards of care
· A facility-level quality assurance and performance improvement (QAPI) program to demonstrate how the facility will improve the quality of care it provides to patients.
· Minimum qualifications and training requirements for patient care technicians.
· Increases Medical Director involvement in the outcomes of the QAPI program and involuntary transfers or discharges.

The final rule meets CMS’s overall goal of protecting patient safety, enhancing ongoing quality improvement, and improving patients’ experience receiving dialysis services. CMS continues to work to improve the quality of health care by measuring and improving outcomes of care, educating health care providers about quality improvement opportunities, and educating beneficiaries to make good health care choices.

The final rule is displayed at: http://www.cms.hhs.gov/CFCsAndCoPs/13_ESRD.asp#TopOfPage

FKDC Supports Florida Hazardous Weather Awareness Week

The Florida Kidney Disaster Coalition encourages Floridians to take part in the statewide Hazardous Weather Awareness Week. Since 1999, this annual event recognizes that Florida has more weather dangers than just hurricanes. Thunderstorms, lightning, tornadoes, floods, rip currents, and extreme temperatures can impact the State, too.

The "Weather Report" is a culmination of efforts from many state agencies and newspapers that aims to educate Floridians about each of these weather dangers, and also about disaster housing, boat safety, and NOAA weather radios. Full of colorful pictures and games, this publication is suitable for adults and children.

To download your copy of the "Weather Report," visit http://floridadisaster.org/kids/Documents/2008_guide.pdf

Upcoming FKDC Meeting

This is a reminder for the FKDC meeting on Tuesday, January 29th. The meeting will be held from 10:30 - 3:00. The location is the 9th floor boardroom at FMQAI.

Please RSVP for the meeting, via email to fkdc@nw7.ersd.net no later than Wednesday, January 23rd. This will allow us to get an accurate count and make sure there is enough food and materials for all. Due to technical considerations, we will not have a conference line available for this meeting.

FMQAI: The Florida ESRD Network
5201 West Kennedy Blvd., Suite 900
Tampa, FL 33609