| 10 February 2006 Stockpiles It is beginning the blizzard as I write. They say it will come on through the day, heaping up. The first flakes began just at dawn, but the ground is still warm enough that it is melting. That will change, they say, or and begin to accumulate. But this being Washington, there is a contrarian streak to the weather. A little today is the best guess, and a lot tonight, with thunderstorms. I am prepared to watch and see. I have finished looking at the incredible list of crap from my navy intel buddies- some still arguing about the 4th Amendment and the rights of the Executive in wartime, and the passage of a Sovremenny-class DDG equipped with deadly sea-skimming SS-N-22 SUNBURN cruise missiles across the Indian Ocean en route China. Those babies are scary elements of technology, mach-plus, flying at the target just over the waves. Literally no defense against them, and the Chinese are going to be stockpiling them after they reverse engineer them. The ships that carry them are sleek and fast, the last great gift of Cold War Soviet technology, transferring to the rising power of the Pacific. I scrolled through some notes that conveyed the whining of the Taiwanese Ministry of Defense about the US Navy sabotaging their attempt to purchase eight Air-independent diesel submarines-the production of those boats would be a threat to the Nuclear Power Mafia in the dear old Nav, since they are cheaper than the nuc boats. I think they are building the Virginia Class now, to preserve the nuclear ship-building art. Or rather, General Dynamics is, which is really the defense department. Or the Industrial Base, as we used to call it back at Black and Decker University. Technology is a funny thing, and of course sometimes the national defense needs to take a back-seat to corporate and professional interests. I should go downstairs, and gather the dry-cleaning together. I can still walk over to the strip mall, having resolved not to take the vehicles out into the chemical environment until Monday. I need to husband their capabilities against an uncertain future. It is just wet outside, but I don't have the grit for it. I think I may just go downstairs, but work lurks down there. There is the morning story, which I was going to do about respirators and triage policy in the coming pandemic, and then the retyping of the Standard Form 86, to update my clearance information for the five-year reinvestigation. They will need to dispatch the bloodhounds to see if I have changed my stripes and become disloyal in the intervening years. This will be the first one since the divorce, so goodness knows what they will hear. I hope they don't talk to my ex-brother-in-law. He is a weasel, and a slanderous one at that. It seems like a very long way away, now, and since I am getting painfully close to finishing paying off the college bills, I idly clicked up a real estate site in Mississippi, and found a house that cost less than twenty thousand dollars, and would have a monthly payment much less than my car. I actually could retire on my little pension, though I suspect I would have to spend a lot of time on the porch with a shotgun. Beyond the passing dream of an affordable house, and leisure, is the looming specter of the Quarterly, the bones of which I should be laying out this weekend to make things painless, and the final couple weeks of Great Grandfather's Grand Tour in the crumbling little leather notebook. But beyond that is the caption list of all the pictures, and the text of the letters he wrote, and that makes me feel a little daunted. I still have a cough from my brief illness two weeks ago, and that is what brought the thought of medical equipment to mind. In fact, the respirator thing has been lurking in the back of my mind for years now, since my last strange time in the government at the Department of Health and Human Services. One of the many moving parts in the National Stockpile of medical stuff-drugs and material- is the ventilator. That is the device that is used to plunge a tube down a patient's throat and breathes for them until they can manage once more on their own. They cost around $30 grand apiece. For people with severe respiratory problems, that is the only way to survival. In a mass casualty situation, with a large number of people needing them at the same time, the competition is going to be fierce, and the numbers are just not there. When the Station Nightclub burned after the start of a pyrotechnic display by the aging metal band White Shark, a hundred people died outright, and another hundred had severe lung burns and needed to be intubated immediately and maintained on ventilators. Between the need for burn treatment and the respirators, the victims were spread all along the Northeast corridor of the United States. We deployed national Disaster medical teams from HHS, and Disaster mortuary teams to support the local folks, but it was a mess. That was one fire in one building, and it literally stretched the resources of the whole region. I have wondered since ten, along with a lot of good people, how on earth we were going to deal with something big. They said on the radio yesterday that New York had 2,700 respirators. I couldn't tell if they meant the State or the City. But that doesn't matter, since in either case there are not enough to deal with even a moderately severe outbreak of a nasty strain of the flu. So, the reasonable question is, how so we formulate a policy that permits the Quacks to triage the population and give those with the best chance of living first access to the respirators? Like submarines, this is technology we have to deal with. The ventilators come with all sorts of bells and whistles. A front-line model might be mounted on a little rolling cart, and feature a control panel with switches for Inspiratory and Expiratory Hold, 3 minute Oxygen, Suction Disconnect and Preset Vent Settings for ease of use. Some of them are self-calibrating, with integrated oxygen monitor with alarms, panel lock, and an internal battery to provide smooth ventilator management necessary to peace of mind. Unless, of course, there is a mad house in progress, and the Doctor has a cough and fever. I don't know if time will permit and accurate reading of 24 hour trend data, or the History Log that records the 600 most recent occurrences of both alarm violations and changes to ventilator settings, or the Wave/Loop Freeze with Cursor function. The manufacturer can't afford to stock the machines in the sort of numbers that will be needed, not without going broke, so it would be up to local officials or the Feds to build up stockpiles that will sit idle for months, or hopefully years. But who will do the maintenance, or change all the batteries in the stockpile anyway? We can't afford to stock enough of the machines, so we need to make some policy, which doesn't cost nearly so much. Of course, we will have to deal with some pretty angry people. "Your Dad smokes, so please move him over to that side of the room. He won't be needing our help. Not enough machines." That is not the least of the policy questions that need to be taken on. If the medical community is hit as hard as they were in the 1918 flu, who is going to be empowered to dispense drugs? It should be easy enough to mobilize retired or formerly licensed people, and then nurses, or nurse assistants, but what about a law holding harmless your pharmacist? Or maybe the Postman? There was talk about using the Postal Service as the delivery mechanism for drugs in a pandemic situation. Is anyone going to sign up for that? We need to do something. I don't see us purchasing enough respirators to get through a crisis, man-made or natural. So, like the man said, we are running out of money and must now begin to think. We moved away from the notion of stockpiles in the latter part of the Cold War, and only uncomfortable events like Katrina have reminded us how important it is to be prepared. We were fooled by the old doctrine of "hostage populations." It is too hard to defend against mass destruction, so no defense provides an equivalency of vulnerability. But of course, that calculus no longer works. Even if there is attribution, the adversary is small in number, and hiding in a sea of innocents. Our other foe, of course, is uncaring natural and chance mutation. Nothing you could strike out at, nothing to fight except the contageon itself, and the only attribution possible in that case is the Life Force itself, or the One God or the Trinity, meaning no disrespect to anyone's diety or Phrophet in particular. People are so sensitive these days, you know? Copyright 2006 Vic Socotra |