Somatostatin neurons in the dentate gyrus participate in down-regulating firing rate of granule cells abana 60pills with mastercard cholesterol levels table uk. The alterations of hippocampal somatostatin system were detected in the kindling and in the kainate epileptic models discount abana 60 pills fast delivery cholesterol levels 21 year old male. In the kindled hippocampus discount abana 60 pills visa cholesterol test coffee before, somatostatin level was increased, especially in the dentate gyrus. The change may contribute to control the latent neuron-firing of the kindled brain and prevent excessive discharge and spontaneous seizures. In consistent with somatostain, pharmacological activation of somatostain receptors exerts antiseizure effects (Binaschi et al. Unlike in rats, evidences that somatostain system do not medicate anticonvulsant effects also appeared. The number of tonic-clonic seizures was reduced by 50% in behavior and the onset time of seizures was doubled on average. The important role of dynorphin in the pathogenesis of seizures was supported by lots of epileptic models. Dynorphin modulates neuronal excitability in vitro in hippocampal slices and potentiates endogenous anti-ictal actions in animal models and humans. Recently, an investigation of dynorphin actions in central nervous system viral injury triggered new interest on dynorphin functions in epileptogenesis and epilepsy treatment (Solbrig and Koob 2004). Acupuncture was reported to suppress seizures through regulating enkephalin (He and Cao 1989). The decrease of dynorphin in perfusate during epilepsy and its increase after acupuncture was also confirmed in electroconvulsive shock model (Wang and Cheng 1995). The acupuncture was also detected to enhance dynorphin 1-8 immunoreactivity by its density and distribution in mossy fiber and hilus of rat hippocampus using immunohistochemistry in penicillin-induced epileptic model. Dynorphin A 1-13 antiserum (Gao and Cheng 1998a) or dynorphin blocker could abolish the anticonvulsant effect of acupuncture in rat. Seizure sensibility is also thought to be mediated by P-opioid receptor activation partially. P-opioid receptor immunoreactivity was increased in the inner molecular 349 Acupuncture Therapy of Neurological Diseases: A Neurobiological View layer of the dentate gyrus after animal seizures. In kainic acid-induced seizures, these increases are restricted to presynaptic, postsynaptic, or glial profiles. Additionally, some P-opioid receptor-labeled terminals in kainic acid-treated rats possessed excitatory-type morphology and contained enkephalin or dynorphin. Kainic acid modifies P-receptor binding in young, adult, and elderly rat brain (Perez-Cruz and Rocha 2002). Agonists for P-receptor could induce limbic seizures in rats, using intracerebroventricular administration. In addition, the receptor density in the caudate nucleus showed a decrease tendency. Sodium channel mutation has been known to casually link to human epilepsy (Mantegazza et al. Interestingly, it was observed that in the mutant brain exhibiting + spontaneous epilepsy, Na channel is up-regulated (Xia et al. In some experimental models of epilepsy, endogenous enkephalin 350 12 Effect of Acupuncture on Epilepsy levels are greatly increased in the brain with epileptic seizures (Tortella and Long 1985; Madar et al. Since Na channels play a major role in neuronal excitability including epileptic hyper-excitability and most of anti- + epileptic drugs are actually inhibitors of Na channels (Remy et al. Therefore, it is likely that acupuncture may inhibit epileptic seizures by + inhibiting hyper-excitability due to an up-regulation of Na channel. However, more studies are needed to clarify this issue because of some controversial observations in the literature. Also, Danielsson et al (2006) and Jutkiewicz et al (2006) showed the similar results. A more reliable approach is needed to correctly elucidate the roles of different opioid receptors in acupuncture therapy for epilepsy. Nitric oxide modulates low-Mg - induced epileptiform activity in rat hippocampal-entorhinal cortex slices (Schuch- mann et al. Abnormal expression of neuronal nitric oxide synthase triggers limbic seizures and hippocampal damage in rat (Bagetta et al. Nitric oxide concentration in rat hippocampus increased after penicillin-induced epilepsy (Huang et al. Different isoforms of nitric oxide synthases from different pathways appeared different functions in acupuncture anticonvulsion. Acupuncture decreased neuronal and inducible nitric oxide synthases but had no effect on epithelial nitric oxide synthase (Yang et al. Acupuncture reduced the severity of the kainic acid-induced epileptic seizure and the rate of neural cell death, and also decreased the expressions of c-Fos and c-Jun induced by kainic acid in the hippocampus. During and after electro-acupuncture treatment, the frequency, amplitude and duration of epileptiform discharges decreased significantly. The frequency and amplitude of epileptic waves were significantly different in comparison with that of the non-electroacupuncture group. Acupuncture may inhibit neural pathway of cholinergic transmission, enhance activity of cholinesterase in caudate nucleus and thalamus, and inactivate Ach (Zou and Ou 1993). Dynamic variation of Ach was observed in the focus of epileptiform discharges induced by topical application of penicillin on rat sensorimotor cortex. Acupuncture decreased the increase of Ach while attenuating epileptiform discharges. Cortical epileptiform discharges induced by penicillin and surface-negative waves of cortical recurrent inhibition induced by antidromic stimulation of pyramidal tract were detected and recorded. Both amplitude and frequency of cortical epileptiform discharges was retarded and recovery of surface-negative waves was delayed. Electric stimulation of dorsal raphe neclei attenuated epileptiform discharges and shortened its duration. When dorsal raphe nuclei were destructed by electrolytic damage, seizure duration prolonged and the antiepileptic effect of electroneedling was reduced. A capillary electrophoresis-electrochemical detection method was used to determine melatonin contents. It had no change in serum in the beginning and then significantly enhanced during seizure crisis. Because melatonin was considered as an antistressor and a natural downregulator of epileptiform activity, the elevation in melatonin level during seizures was postulated to be possibly one endogenous mechanism that counteracts convulsions and seizure-induced stress. Many electroacupuncture types including stimulation of body, facial and auricular point, have anticonvulsant and neuroprotective effects for epilepsy. Stimulation of acupoints on the extremities results in stimulation of the vagus nerve. It may be also the center for afferent pathways of facial, scalp and auricular acupuncture. The neuroprotective pathways of electroacupuncture to hippocampus, thalamus, cortex and amydala may be through the nucleus of the solitary tract via vagus nerve stimulation.
An echocardiogram showed severe coarctation of aorta with 50 mmHg pressure gradient across the aortic arch buy 60pills abana with amex cholesterol test ebay. Management: The pressure gradient across the aortic arch was significant resulting in upper body hypertension order cheap abana online cholesterol test australia. Relief of coarctation of the aorta at this age can be per- formed effectively and safely through balloon dilation and typically with stent placement to reduce the possibility of restenosis after initial improvement effective 60pills abana hdl cholesterol in shrimp. Findings at the cardiac catheterization: Cardiac catheterization revealed a pressure gradient of 45 mmHg across the aortic arch. The areas proximal and distal to the site of coarctation were 22 and 23 mm respectively. The systolic pressure gradient across coarctation dropped to 8 mmHg post stenting and angioplasty. Angiography after the balloon dilation showed good position of stent with adequate aortic arch patency (Fig. Results: Echocardiography performed the next morning showed stent in good position with no significant pressure gradient across the aortic arch. On follow up 3 months after the procedure, she was found to be doing very well with no cardiovascular symptoms and no claudication. The latter is a communication between the 2 atria due to patency of a normal in-utero structure caused by the space between the 2 membranes forming the atrial septum. Hanrahan Incidence Defects in the interatrial septum are a common congenital heart defect. As an isolated anomaly, atrial septal defects are the fifth most common congenital heart defect, com- prising 6% of all lesions. Pathology There are many types of atrial septal defects, classified according to location of defect. These include: • Secundum atrial septal defect: the defect is in the foramen ovale membrane, which is the central portion of the atrial septum (Fig. These are the most common type of atrial septal defects and most likely to close spontaneously. Secundum atrial septal defects are more common in females who tend to be tall and thin. The first and more com- mon is when the defect is close to the superior vena cava junction with the right atrium. This is frequently associated with abnormal drainage of right upper pul- monary vein to the right atrium (partial anomalous pulmonary venous return). The second type is when the sinus venosus atrial septal defect is close to the inferior vena cava junction with the right atrium. Defect in this region results in secundum atrial septal defect (white arrow) which is the most common type of atrial septal defect. Mixing of well- saturated blood from the pulmonary veins with that of the desaturated blood from the systemic veins occurs in this anomaly leading to mild cyanosis. Pathophysiology Abnormal communications between the right and left cardiac chambers or vessels create an opportunity for blood to move from one side to the other. Left to right shunting of blood will result in the reduction of cardiac output to the body (Qs) and increase in cardiac output to the pulmonary circulation (Qp) (Fig. The pulmonary vascular resistance is significantly less than the systemic vascular resistance, therefore, any abnormal communication between the left and right sides of the heart will result in left to right shunting. In this diagram, 6 l/min/m2 of blood return from the pulmonary circulation, 4 l/min/m2 cross the atrial septal defect to go to the pulmonary circulation while the remaining 2 l/min/m2 go to the systemic circulation. In this scenario, the pulmonary blood flow to systemic blood flow ratio is 6:2 or 3:1. The greater this ratio, the more is the pulmonary blood flow and consequently, the worse is the extent of congestive heart failure 94 Ra-id Abdulla and A. Hanrahan Increase in blood flow to the lungs will eventually lead to pulmonary edema. Drop in systemic cardiac output tends to be marginal since it is minimized by increasing the blood volume through water retention. Most of the symptoms noted in atrial septal defect, such as shortness of breath and easy fatigability are a result of pulmonary edema. Increased pulmonary blood flow over several decades will eventually cause progressive damage to the pulmonary vasculature wall resulting in pulmonary vascular obstructive disease in the third or fourth decades of life. Clinical Manifestations Small and moderate size atrial septal defects are typically asymptomatic. Larger defects result in pulmonary edema manifesting as easy fatigability and shortness of breath. Only very large defects result in significant congestive heart failure and failure to thrive. On examination there is a hyperactive precordium with a prominent right ventricular impulse due to right ventricular dilation. Second heart splitting is fixed throughout respiration due to increased blood flow through the pulmonary valve causing delay in pulmonary valve closure regardless of respiratory cycle. A systolic ejection (crescendo– decrescendo) murmur is heard at the left upper sternal border due to increase in blood flow across the pulmonary valve. In larger atrial septal defects, an early diastolic murmur is heard at the left lower sternal border due to increased blood flow across the tricuspid valve (Fig. S1 first heart sound, S2 second heart sound, A aortic valve closure, P pulmonary valve closure. Increase in blood flow across the pulmonary valve results in a systolic ejection murmur, while the increase in blood flow across the tricuspid valve causes a middiastolic murmur. Unlike pulmonary stenosis, the systolic murmur is not preceded by a systolic click. The second heart sound is fixed in its splitting (through respiration) due to the excessive pulmonary blood flow and the need for the pulmonary valve to stay open longer throughout respiration 6 Atrial Septal Defect 95 Diagnosis Chest X-Ray Prominent pulmonary vasculature due to left to right shunting is present. In addition, increase in blood flow through the right heart will cause right atrial and right ventricular dilation manifesting as cardiomegaly on chest X-ray; how- ever, this is noted only when there is significant extent of left to right shunting. Excessive pulmonary blood flow may cause dilation of the main pulmonary artery manifested as prominent pulmonary artery at the midleft cardiac silhouette border (Fig. Left to right shunting causes increase in blood volume in the right heart resulting in cardiomegaly. The engorged pulmonary vasculature could be seen on chest X-ray as prominent pulmonary vessels in the hilar region as well as being able to see pulmonary vessels in the peripheral lung fields 96 Ra-id Abdulla and A. Hanrahan Electrocardiograph Right atrial and right ventricular dilation/hypertrophy may be noted. Right atrial enlargement manifests as tall P waves (taller than 2 mm in children and 3 mm in adolescents and adults).
An elonga- ted styloid process may impinge against carotid arteries and cause disturbances in Fig purchase cheap abana line cholesterol levels targets. The patient comp- Various operative procedures followed are lains of parietal headache and pain along the shown in Figure 51 order online abana cholesterol medication natural alternatives. The diagnosis of an enlongated styloid Four-flap method A release cut is made on either process can be made by palpating for process side at the periphery of the palate and an through the tonsillar bed and by radiography abana 60pills without prescription cholesterol ratio formula uk, oblique cut from the point of junction of the which shows an abnormally long process. The four flaps of mucoperio- Treatment steum thus shaped are raised from the bone. Treatment of a symptomatic elongated styloid A “push back” of the flaps brings the edges process is its surgical removal. The edges are paired, mucoperiosteal In transpharyngeal excision, tonsillectomy is flaps are raised from the nasal septum and done and the styloid process felt through the suture of these flaps closes the gap. The styloid process of the temporal bone is The enlarged styloid process can also be about 2. An incision the population the styloid process is grossly is given along the anterior border of the enlarged and may give rise to symptoms. The sternomastoid from the tip of mastoid to the elongated styloid process can be felt through hyoid bone. The anterior border of the sterno- the pharynx in the tonsillar bed or posterior mastoid muscle is retracted, the process pillar and the process is in close relationship exposed by a deep dissection and a portion of with the glossopharyngeal nerve. Cartilages of the Larynx The developing laryngotracheal tube gets The thyroid cartilage, epiglottis and cricoid elongated and becomes bilobed. Each lobe cartilage are single while the arytenoids are later becomes the primary bronchus and gives paired cartilages. Besides, two small cartilages, rise to the rest of the bronchial tree and lung (Figs 52. Thyroid cartilage Two swellings appear at the upper end of the fused ridges of the diverticulum and form It is the largest cartilage and forms a promi- arytenoids. The two The epiglottis develops from the posterior lateral laminae fuse together in midline in a part of the hypobranchial eminence and gets V-shaped manner and its upper and lower connected with arytenoids by aryepiglottic ends are continued into horns called superior folds. This cartilage is connected to the hyoid The thyroid cartilage develops from the bone by the thyrohyoid membrane and to fourth arch while the fifth and sixth arches the cricoid cartilage by the cricothyroid form other cartilages. Folds Extending from the Epiglottis The aryepiglottic folds extend from its lateral margins to the arytenoid cartilage. The glossoepiglottic fold extends from the tongue to the lingual aspect of the epiglottis, creating two depressions on either side called valecullae. The pharyngoepiglottic folds the extend from the lateral margins of the epiglottis to the pharyngeal wall. Pre-epiglottic space: This is a potential space in front of the epiglottis which contains Fig. It is bound in front by the thyroid cartilage, posteriorly by the epiglottis and above by the hypoepiglottic ligament. The space is important surgically as tumour cells may involve lymph vessels of this space and hence this space should be excised along with the growth area. Paraepiglottic Space: Cricoid Cartilage It is a ring cartilage which has a narrow anterior arch and a broad posterior lamina. The anterior arch is connected with the inferior border of the thyroid cartilage by the cricothyroid membrane. The posterior lamina gives attachment to the muscles and articu- lates with the arytenoid cartilages at the cricoarytenoid joints. Abduction the pyramid articulates with the cricoid facet posterior cricoarytenoid, B. Corniculate Cartilage (Cartilage of Santorini) The muscles are subgrouped according to This is situated at the apex of the arytenoid their action and are named according to their cartilages on either side in the mucous attachments (Fig. The lateral Cuneiform Cartilage (Cartilage of Wrisberg) cricoarytenoid is the main adductor. It It is situated in each aryepiglottic fold just in arises from upper border of the lateral part front of the corniculate cartilage. Abductor muscle: The posterior cricoary- Muscles of the Larynx tenoids are the sole abductors of the vocal cords. The muscles arise from the lower These are divided into two groups, extrinsic and medial surface of the posterior of muscles and intrinsic muscles. When these other structures and includes the sterno- muscles contract, they move the vocal thyroid, thyrohyoid, sternohyoid, omohyoid, cords apart causing widening of the glottis. Tensors of vocal cords: These include Saccule of the Larynx cricothyroid and thyroarytenoid muscles. From the anterior part of the ventricle, a pouch The thyroarytenoids arise on each side called saccule of the larynx extends between from the inner aspect near the angle of the the vestibular fold and inner aspect of the thyroid cartilage and vocal ligament proceed- thyroid cartilage. Its dilatation is thought to ing backwards to the arytenoid cartilage and be the cause of laryngocele. The transverse arytenoid muscle is a single Vocal Cords muscle which extends from the posterior These are fibroelastic bands which extend aspect of one arytenoid to the other and helps from the angle of the thyroid cartilage ante- in closing the interarytenoid region. These are formed by reflection of The cricothyroid muscle is supplied by the the mucosa over the vocal ligaments which external laryngeal nerve which is a branch of are the free edges of the cricovocal membrane. Other intrinsic The cords have stratified squamous epithe- muscles are supplied by the recurrent lium with no submucous layer. Interior of the Larynx The rima vestibuli and rima glottidis: The The laryngeal inlet is bounded above and in space between the two vestibular bands is front by the free margin of the epiglottis, late- called rima vestibuli while the space between rally by the aryepiglottic folds, and posteriorly the vocal cords is called rima glottidis. It lies between the inlet of larynx and the level of vestibular folds or false cords. Blood Supply of the Larynx It is bounded above by margins of the Larynx is supplied by the superior and infe- laryngeal inlet, in front by the posterior aspect rior thyroid arteries. The superior thyroid of the epiglottis, laterally by the inner aspect artery is a branch of the external carotid artery of the aryepiglottic fold, and posteriorly by while the inferior thyroid artery arises from the mucosa covering the anterior surface of the thyrocervical trunk of the subclavian the arytenoid cartilage. Sinus of the Larynx Lymphatic Drainage of the Larynx It is a small recess, the opening of which lies between the vocal cord and the ventricular The part of the larynx above the vocal cords fold. It secretes mucus and thus lubricates the is drained by lymphatics which proceed vocal cords. Glottis It consists of the vocal cords, anterior The part of the larynx below the vocal cords commissure, and posterior commissure. Posterior commissure is the area at the The vocal cords themselves are practically posterior end of the vocal cords, between the devoid of lymphatics. Subglottis It is the area of the larynx which Nerve Supply of the Larynx extends from 5 mm below the level of the vocal The superior laryngeal nerve is sensory to the cords up to the lower border of the cricoid laryngeal mucosa above the vocal cords. The undersurface of the cords is Besides it is motor to the cricothyroid muscle excluded. Mucosa Supraglottis It is the region of the larynx above of the larynx below the vocal cords and all the level of the vocal cords and includes the other intrinsic laryngeal muscles are supplied ventricles, vestibular bands and vestibule. Comparison of Infantile with the Average Measurements of Adult Larynx Adult Larynx 1. Size: The difference in size is not only real, Up to puberty the size of the larynx both in but also relative, for the lumen of infantile males and females is almost the same but larynx and trachea is smaller in proportion thereafter in males it increases nearly twice in to the body as a whole. The measure- “choke” is present in the subglottic region ments are given in Table 52.
August 2007 Student Manual 5-25 International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally cheap abana 60 pills on line cholesterol test drinking coffee before. Infuenza is spread from person to person by contact with respiratory secretions from an infected person abana 60pills without a prescription cholesterol levels vary day to day. When an infected person coughs or sneezes abana 60pills with mastercard definition du cholesterol, large droplets carrying the virus land on the surfaces of the upper respiratory tracts of persons who are within three feet of the infected person. The virus can also spread by direct or indirect contact with respiratory secretions – touching contaminated surfaces and then touching the eyes, nose, or mouth. Respiratory Protection During the class discussion, use the space below to take notes on respiratory protection. Surgical mask N-95 P-100 August 2007 Student Manual 5-27 International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. If you taste or smell the agent, you will test another disposable mask size (or type). August 2007 Student Manual 5-2 International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. Immediately after activities involving contact with a patient’s body fuids, gloves should be removed and discarded and hands should be cleaned. Do not rub eyes after using eyewear, or after handling patients or equipment until you have thoroughly washed your hands. August 2007 Student Manual 5- International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. You are dispatched as part of Ladder Company to West Point Drive where a -year-old male complains of shortness of breath. As you talk to him, he reveals that he works as a consultant to a company that produces down comforters and has spent a great deal of time in factories that house ducks. August 2007 Student Manual 5- International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. If the turnout gear is visibly contaminated by bodily fuid, it should be placed in a biohazard bag at the scene and washed, following prescribed laundry procedures. August 2007 Student Manual 5- 5 International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. The vaccine could be used in the event the current H5N avian virus were to develop the capability to effciently spread from human to human, resulting in the rapid spread of the disease across the globe. Should such an infuenza pandemic emerge, the vaccine may provide early limited protection in the months before a vaccine tailored to the pandemic strain of the virus could be developed and produced. The vaccine was obtained from a human strain and is intended for immunizing people 18 through 64 years of age who could be at increased risk of exposure to the H5N1 infuenza virus contained in the vaccine. H5N1 infuenza vaccine immunization consists of two intramuscular injections, given approximately one month apart. The vaccine has been purchased by the federal government for inclusion within the National Stockpile for distribution by public health offcials if needed. The vaccine was generally well tolerated, with the most common side effects reported as pain at the injection site, headache, general ill feeling, and muscle pain. The study showed that 5 percent of individuals who received the 0 microgram, two-dose regimen developed antibodies at a level that is expected to reduce the risk of getting infuenza. Although the level of antibodies seen in the remaining individuals did not reach that level, current scientifc information on other infuenza vaccines suggests that less than optimal antibody levels may still have the potential to help reduce disease severity and infuenza-related hospitalizations and deaths. National Institutes of Health and other government agencies and manufacturers are working to develop a next generation of infuenza vaccines for enhanced immune responses at lower doses, using technologies intended to boost the immune response. Meanwhile, the approval and availability of this vaccine will enhance national readiness and the nation’s ability to protect those at increased risk of exposure. August 2007 Student Manual 5- 7 International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. In this unit, you learned: • Basic facts about avian and pandemic infuenza • How a pandemic could affect the fre house, the department, your family, the wider community and the nation • How to prepare the department for a pandemic • How to keep yourself safe • How to care for and transport patients who may be infected with avian or pandemic fu • How to decontaminate equipment • Why vaccinations are important Based on what you learned in this course, what proactive steps can you take before a pandemic occurs? Work individually to describe how you will prepare for an outbreak of pandemic fu. August 2007 Student Manual 5- International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. A5- 2 Unit 5 Appendices August 2007 Infectious Diseases International Association Unit 5 – Avian & Pandemic Infuenza of Fire Fighters Appendix 5-A Facilitators Guide to Preparing for a Pandemic Flu: What First Responders Need to Know A Shift-Based Training Program August 2007 Unit 5 Appendices A5- International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. A5- Unit 5 Appendices August 2007 Infectious Diseases International Association Unit 5 – Avian & Pandemic Infuenza of Fire Fighters Facilitators Guide to Preparing for a Pandemic Flu: What First Responders Need to Know A Shift-Based Training Program Overview Many health experts believe that the next outbreak of a pandemic fu isn’t a question of if, but when. This training program is for frst responders who play a vital role in outbreak response. It is crucial that rank and fle fre fghters learn basic information about the pandemic fu to protect themselves, their families, their department and their community. This program provides hands-on activities and discussion questions to teach frst responders to prepare for a major emergency, such as a pandemic fu outbreak. Learning objectives • Predict and summarize effects of a pandemic fu on the individual, family, the department, the community and nation. Materials needed • White board, chalk board, easel w/ pad or white paper taped to wall • Markers Facilitator Instructions 1. Guided Discussion on the Pandemic Flu (10 minutes) To understand bigger picture of a pandemic fu outbreak, start with basic facts about the pandemic fu. Suggested responses : • A pandemic is an outbreak that spreads across a region • There is the potential for a current strain of the avian fu (the H5N1 strain) to begin to infect humans. Several cases have been reported, but only from bird to human transmission (not human to human). Guided Discussion with Writing Activity (20 minutes) Instructor will draw the fre house they work at in the center of the board. Around it, instructor will draw a fre fghter, a family, a fre department and a town. A5- Unit 5 Appendices August 2007 Infectious Diseases International Association Unit 5 – Avian & Pandemic Infuenza of Fire Fighters Module 1: In My Fire House continued… Start with the fre house. Suggested responses: • More calls because so many people are sick • One third of workforce would be out sick is predicted by experts • Continuous restocking of equipment or limited supplies • Death of coworker • Quarantine or isolation Next, ask them to step into the shoes of the fre chief. Suggested responses: • Staffng issues, such as mandatory staffng, overtime Is the department ready? Suggested responses: • Family sick • Shift changes • Child care unavailable • Deaths of elderly or young members of family • Quarantine or isolation What might happen in the community? Suggested responses: • Schools close • Grocery or other stores understaffed, limited supplies available • Banks close • Transportation system running slow • Lack of available medical care • Quarantine or isolation Can you name other areas that might be affected across the nation? It is important that frst responders have a plan for their families so that, with the peace of mind that their own families are prepared, they can do their job in the event of pandemic fu or any major emergency that may occur.