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