Ivy Mike: A foray into the Appalachian redoubt and some lessons learned

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Life, lived beyond the keyboard.

Imagine that.

Fred: Black Power

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Grievance as a lifestyle.

‘Murika!

DTG: Stoicism – Necessary Development for the NPT Leader and Member

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Read it all.

Tough mind.

Strong body.

Hard heart.

Quote Of The Month

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The definition of a Dark Age is not one in which we have forgotten things; it is a time when we no longer know we ever knew them. We appear to be entering a Dark Age for a fairly large part of our population. Of course that makes self-government nearly impossible, but the smart one in charge have a remedy for that.

Jerry Pournelle

Webspinning

Kaci Hickox, Ted Wilbur

Released Ebola Nurse Kaci Hickox Works For CDC…Her Lawyer Is A White House Visitor

Things that make you say “Hmmm….”

The United States Of Babel

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Curtis connects the dots.

You are a herd animal in the eyes of the Masters.

Moo!

Airborne – Just Not Technically So

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Ebola Now Acknowledged To Be Transmitted Via Droplets

Read all of the embedded links.

For those interested, here is an Ebola treatment best practices online course.

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Want happy dreams?

Then don’t read this post by Aesop on logarithmic growth.

Max V: Discovery Channel Watchmen – Comments

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Thoughts on another “militia” television program.

Never go on TV.

If you think you should, review the rule above.

RITR: New Tactical Medical Device – The TopClosure 3S TMS

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Very interesting.

Drop a comment at RITR’s place if you know of a source.

Two Exercises

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1) For the hardcore DX hams out there, what say trying to make contact with Liberian or other West Africa boots on the ground for a SITREP to be shared in comments?

2) It’s January, 2015. The “Ebola scare” pre-election is now the Ebola reality. The combination of political/medical hubris and continued unrestricted travel from West African countries have created an unprecedented crisis in FUSA. Your rural county retreat in a relatively remote area of the country protected you and your people somewhat from the disease, until the progressive county chairman and the director of your local hospital volunteered the use of that facility as a “temporary supplemental healthcare site”.

Within three days, five critically-ill Ebola patients were relocated from the state capital to your county. Three days after that event and the inevitable contamination incidents, the transferred patients were dead, the hospital had been abandoned, at least one doctor and three ICU staff were symptomatic, and nearly 30 associates of the medical personnel were potentially exposed. When a longtime waitress at the local breakfast place is diagnosed as symptomatic with the disease, the lack of any connections between her and the hospital exposures creates a near-panic in your community. Before going into hiding, the county chairman assures residents via a local radio broadcast and Facebook postings that help is on the way from the state capital, but will be somewhat delayed due to uncertain conditions there.

In comments, explain what you will do regarding

a) your team’s health/safety, and

b) the community’s health/safety.

You can assume for the purposes of this exercise that little or no help will be arriving from either state or Federal resources due to other demands and your county’s political alignment. Your local sheriff is part of your ad hoc response group, although his resources are very limited.

Your answers should include references to roadblocks/access control, maintenance of community food/medical/POL supplies, supportive care for individuals in self-quarantine, public health measures to be used against exposed or potentially exposed individuals who refuse to self-quarantine, facilities and resources needed for same, contents of public safety advisories, and corpse disposal (complicated due to groundwater issues and the thin soil in your mountainous region). Assume a 30% minimum mortality rate, a county population (with refugees) of 35,000, and a transmissibility factor of 2 (i.e., every exposed infected person can create no less than 2 other exposed infected people).

References should be cited/linked where possible. Start with these two resources.

Good luck.

West_Africa_Ebola_2014_5_cum_case_by_country_Oct_28(Graphic via Vinny)

Two From Mosby

Commandos and coalition forces neutralize insurgent networks in Wardak

At his new Forward Observer post:

The Four Pillars Of Individual Proficiency – Part I

The Four Pillars Of Individual Proficiency – Part II

Two Related Posts

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State Department plans to bring foreign Ebola patients to U.S.

WHO Comes To Jesus; We Have LIFTOFF!

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The Next President Of The Former United States Of America…

Watch the whole thing; h/t Maggie’s.

Do you understand yet?

Aesop: “Allow me to lovingly smash that foolish dumbshittery to bitsy pieces with my 18# surgical steel sledgehammer of reality, just one more time.”

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First, go up to today’s masthead at the top of the page and read the quote from GEN Mattis.

Second, cogitate a bit on that quote, as it applies to your group – especially if they have been reading material such as this two-parter.

Finally, go and read Aesop’s above-titled opus.

You will feel some mild pinching and scraping.

CANCELLED: Jefferson Family Reunion & Yapfest – Coeur d’Alene, ID – 1 NOV 2014

Will try to resched in spring; the delay in posting is on me – the organizer had too few responses and cancelled three weeks ago. Apologies for any inconvenience.

Guerrillamerica: BESTMAPS

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Sam instructs on another key acronym.

Have you subscribed to Forward Observer yet?

You should.

Two From Aesop

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Oz Slams Door, Media Pissed – Plus Bonus New Patient Being Memory-Holed In MD

Progressive Apparatchik Princess Mimi Crybaby About To Get Second Spanking

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Bonus Bonus: Two People In CLT Being Monitored

Doc Grouch: Should We Shut The Borders?

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The latest:

Should we shut the borders?

Well, obviously. But that little bit of common sense predates Ebola by a considerable margin. Like, the entirety of human history.

So let’s ask the question, in regards to quarantine for Ebola.

What are our goals with this infection?
1. Prevent Ebola from infecting those in the US, and/or
2. Prevent folks infected with Ebola from arriving in the US
3. Chose #1 or #2, but accomplish that goal without giving .gov power that you will regret giving, later.

Allow me to point out the underlying assumptions between Goal #1 and Goal #2. Goal #1 is less stringent, and assumes that there is some low-level amount of Ebola that is acceptable in the US. It furthermore assumes that Ebola, while deadly, is not The Pestilence That Will End The World, and that we can successfully treat patients who get it, with acceptable mortality. There is also an undercurrent of hubris and/or normalcy bias inherent in this viewpoint.

Goal #2 makes none of those assumptions.

And the real deal, folks, is that no one knows. No one has any idea if this will turn out badly or not. The best current method to start an argument in the doctor’s lounge is to assert either that Ebola is a nothing virus that will cause no harm, or that Ebola is the next Black Plague that will kill us all. We all have our beliefs and guesses, but absent the gift of prophesy, no one knows.

Currently, .gov has chosen goal #1, and the protocol is:
1. If you have symptoms, you are isolated and tested.
2. If you do not have symptoms, they don’t waste money on testing* but instead asses your risk. Assumes truthful travelers.
—Low risk: observation by state dept of health, voluntary home quarantine
—High risk: observation by state dept of health, home quarantine, but voluntary or mandatory depends on various factors.
(at this time, there is no medium risk category)

*The virus is undetectable by standard testing until at least the time of symptoms, and in some patients not until 3 days after testing. Which is why the NJ nurse’s claim that she should be released because her “ebola test is negative” demonstrates a profound ignorance of reality.

The specific changes to the protocol above depend on whether you have selected Goal #1 or Goal #2.

Some changes being considered for Goal #1 are to enforce mandatory home quarantine on any non symptomatic patient, who is from or has traveled to the most infected area.

For Goal #2, some changes being considered are to 1) either enforce mandatory quarantine on everyone who is from, or has traveled through, the most infected areas, or 2) shut down flights from that area completely. There is some noise that the quarantine should be held at some as-yet-undefined location, not at home.

Those who can think of additional changes to the above protocol are welcome to chime in, down in the comments section. Having MD after your name does not make you a Certified Galactic Intellect. That honor is reserved for old computer programmers.

I am all in favor of enforcing mandatory home quarantine on folks who are from or who have visited the affected area, at a MINIMUM; but let’s face it: this is merely a slightly gilded version of what we are already doing, with a suboptimal track record. The points of breakdown in this strategy are well known: the patient skips down and cannot be found for the health department to follow, they do not follow the quarantine rules (Ebowling!), and when the patient finally goes to the hospital, they infect other folks. The second and third degree effects cannot be predicted.

The liberal argument that folks will fly from west Africa to Europe, rest up a few days, then come to the US on a flight not obviously connected to west Africa is stupid. This implies that Europe, as a whole, would not act in the same fashion to block flights from that area. In fact, it has; only Belgium accepts flights from that area. It can’t be that hard to track all passengers from that area for the last 21 days.

If you want to enforce Goal #2 by isolation in the US, then we have a big logistical problem. Every state–or perhaps just the 5 where all those travelers will be routed–will need to set up an MSF-style isolation wing. It will need to be of sufficient quality that those monitoring the patients won’t get sick, and the patients won’t infect each other. Each camp will have to be able to accept at least 30 (that is, 150 people per day divided by the 5 different camps) patients per day, and hold them for 21 days, which works out to 630 people. And the wherewithal to feed, clothe, wash, and test them all. And survive the inevitable lawsuits and crybaby BS by entitled jerks. And it almost certainly will have to be actual brick-and-mortar buildings, not just tents, given the approaching winter. And it has to be in place, starting yesterday. And let’s face it, folks–they will put FEMA in charge of this. Or perhaps the DHS. Pick your poison.

This looks like an easy way to screw up Goal #3.

So let’s turn to Method #2, Goal #2. There will be shouts of outrage from the Left. Weeping and wailing, and gnashing of teeth. “It will make the outbreak in Africa worse!” (compared to what?) “We need to take care of the problem over there!” (most assuredly, but it does not follow that we have to import cases here.) “It will be difficult to implement, and people will slip through!” (True, true, and neither are related to whether or not we should try.)

There is an argument out there, exemplified here, that states that if we implement a travel ban, then our risk is still relatively high. This may or may not be true, but it misses the key fact: It gives us time to catch up with the OODA loop of the virus.

We need time!

Time to sort out the PPE issues and get trained. Time to determine which hospitals will take these patients. Time to set up the logistics of developing a crew of at least 18 (if not more) ICU nurses to take care of a single patient on a long term basis. Time to report on what has been done with the patients, worldwide, who have been treated with first world medicine, and try to come up with a game plan for treating them. Time, folks. Time to get the monstrous leviathan aroused.

That’s why we should shut down the border. Protection is nice but will eventually fail. The time it gives us, if used well, will be critical.

And let me leave you with this final thought, dedicated to those politicians and boot lickers that have botched everything so far:

Folly, thou conquerest, and I must yield!
Against stupidity the very gods
Themselves contend in vain. Exalted reason,
Resplendent daughter of the head divine,
Wise foundress of the system of the world,
Guide of the stars, who art thou then if thou,
Bound to the tail of folly’s uncurbed steed,
Must, vainly shrieking with the drunken crowd,
Eyes open, plunge down headlong in the abyss.
Accursed, who striveth after noble ends,
And with deliberate wisdom forms his plans!
To the fool-king belongs the world.

——–Friedrich Schiller

nyny

Two From JC Dodge

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The Hypocrisy Of The Powers-That-Be

Sparks31 Is Comin’ To Town

Be there or be square.

Winter Muster – GA – February, 2015

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Training in small unit communications, land navigation, and patrol methods. Event will culminate in an FTX that will utilize all of the skills covered in the instruction.

More to come.

Doc Grouch Sends

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From over the transom:

… I would be willing to answer questions that any of your readers might want to know about. It may take a bit for each question; I tend to do some research on each topic, and frankly some topics will be moving targets. I don’t know Aesop’s background, but I am an Internal Medicine/Pulmonary/Critical Care physician in the Appalachian area. It may be that we offer complementary skill/knowledge sets.

And complements to him, BTW, whoever he is; he is on this outbreak like ugly on Hillary Clinton.

————————–

This week, after copious amounts of useless BS, woe is me, and Statist talking points, the New England Journal of Medicine published the first paper that is a highly detailed case report of what an Ebola patient actually suffers from, and how they are dealt with using First World medicine. This was published by a German BSL 4 facility, and I commend its reading, to include the supplementary appendix, to all readers that are in the health care business.

One specific action they should probably take is look at the phases of the illness, which are: 1) fever, body aches 2) horrific, cholera-like diarrhea, on the order of 3 gallons per day. Enough that IV fluid PLUS oral intake could not keep up, then a quick transition to 3) total shutdown of the guts, with intestinal swelling, inability to eat or drink, and probably micro perforation of the intestines, then 4) septic shock, with bleeding and multi organ failure.

Once you have admired your potential future should your PPE protocol break down, I would recommend committing that Heresy of Heresies: thinking for yourself. (h/t Tom Baugh). How would you take care of a patient that is covering the floor in highly infectious poop? What happens if Nurse A slips in Ebola-poo and faceplants? Who will clean up? What if this person needs a chest Xray? How are you going to give them meds? Are you aware that the MSF guidelines indicate that things like lab draws and NG tubes are considered highly dangerous? And so forth.

My own hospital is working through all these questions. One needs the cooperation of the administration/higher ups in order to have adequate logistics (and even legal support–some hospitals automatically make these patients DNR/DNI on arrival, which requires some heavy lifting from the legal department to justify it). But MAKE SURE those who will actually go into the rooms and risk their lives are in on the planning. The higher ups go back to their fancy house, in their fancy cars, to their fancy wife, and decide which fancy flowers to send to your funeral. They cannot possibly be as motivated to get it right as the nurse or doctor who knows they will literally be walking in a sea of death.

Note well this video demonstration of donning and doffing PPE by the CDC to the hospital group in New York. (Nice timing, guys.) This is probably a PPE protocol worth respecting for basic patient needs; however, I would be unwilling to wear that open gown if there is a risk of getting something under the gown. Remember Nurse A, who face plants in Ebola-poo? She would almost certainly contaminate the under layer of scrubs. And then off we are to the races.

Also, note how the nurse does her hand hygiene–she just rubs her hands together, and never gets in between her fingers. There’s a break in protocol right there, and an entirely predictable one given the alcohol scrub they use. MSF has their docs immerse their hands in a bleach solution and hold them there for 1 minute; this will cover everything, with little chance of missing hidden nooks, like this nurse did. This is what I mean by thinking for yourself. The devil is no longer in the details–Death is in the details. Little things like this are why you must commit an Act of Cognition.

Health care providers may also benefit from this presentation, which is by the docs at Emory that took care of the two Ebola patients (actually there were 3, the third did not want publicity). Practical advice that you may want to evaluate.

All of the above assumes that only health care providers will take care of Ebola patients, and that there will be adequate beds to take care of them all. Depending on the severity of the outbreak, it may be that you, the family, will be taking care of these patients. Or not, as Aesop has mentioned.

It may be that Ebola will be a paper tiger, and that First World medicine will send it slinking back to the jungles. It may be world-ending. The only way to know for sure is to look back 5 years from now. Looking forward, there is merely the unknown.

———————–

Cheers,

Grouch

Work, then Questions

Screen shot 2014-10-26 at 10.44.20 PM1. Read this, please.

2. Scary picture!

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3. Now read this and this and this.

4. Happy picture!

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5. Feel reassured. Mmmmm, mmm, mmm…

6. Read this to bolster the happy feeling.

Questions:

A) Where the effing eff are all of the effing adults?

B) Am I the only one getting more and more persuaded that this whole she-bang is a con?

c) If it is a con, what is/are the objective(s)?

We already know who the marks are.

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UPDATE 0800 27 OCT 2014: A brief message from our EVD correspondent:

Christie, Cuomo & DiBlasio go “off-script” risking offending Caesar?

Doubtful.

They are really not off-track at all (you must read the link to fully understand):

http://www.governor.ny.gov/press/10262014-jfk-ebola-screening-fact-sheet

The new Ebola Screening/Quarantine protocols achieve which of the following?

A. Establish full state power to imprison based on illness.

B. Give sheeple impression that “something is being done!!!!” to stop the madness.

C. Allow for Liberians and Leonians to continue to enter the US largely unimpeded based upon their ability to answer a few questions at the airport.

D. Allow for the continued potential spread of disease.

E. Allow President Obama and his CONgressional flunkies to skirt the travel ban issue during an election cycle.

F. All of the above.

Oh, and read these:

NYPost: 5-year-old boy tested for Ebola in NYC after return from Africa

Public Health Agency Of Canada EVD Safety Data Sheet – see especially the “Survival Outside Host” section

Screen shot 2014-10-27 at 8.15.11 AMBanzai!

The Only Issue That Matters

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Straight Line Logic on freedom and the 2014 elections.

Just say “no” to tyranny.

AmMerc: Marksmanship Training Drills

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Good suggestions.

Got practice?

Tempus fugit.

Two From Aesop

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Living Up To All Expectations

Call The Waaaaaaaahmbulance

Top men.

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