American hospitals face increasing threat of violence

For most Americans, the local community hospital serves as a backdrop for contrasting milestone events in their lives. It is the place where children are born, and the place where loved ones are often lost. It is the place we long to reach when in the midst of a medical crisis but dread to enter when the purpose is to diagnosis a potentially life-threatening disease. It is perhaps these dramatic contrasts which in the end, leave most people with a neutral passion with regards to the local hospital. But top security experts and even regulators are growing increasingly concerned that violence in the hospital setting is escalating and may spike even further as passions and perceptions are shaped by the ongoing national health care debate.

According to the federal Occupational Safety & Health Administration (OSHA) more assaults occur in the health care and social services industries than in any other. Reliable statistical data is difficult to obtain because physical violence in the hospital setting is generally manifested in one of three forms – and sometimes protected from disclosure by privacy laws.

Patient Violence (PV)

Since the beginnings of medical science, healers have been subjected to the threat of physical violence from the very patient they are trying to help. Persons with mental or neurological disorders have long been appreciated as having a propensity for violence when first brought into the clinical setting of a hospital. In more modern times the risk posed by powerful drugs like cocaine and pcp have added to this threat.

Jeff Aldridge of Security Assessment International noted in 2010 that the increasing trend in hospital violence could be the result of, “more people are on alcohol and drugs and a lot more people with health issues can’t afford medical care.”

Aldridge also noted that the aging American population is resulting in more patients with dementia and behavioral problems.

Non-Patient Episodic Response Violence (NPERV)

Hospital Emergency rooms have long dealt with violence triggered between families and friends following a medical emergency. This form of violence frequently accompanies scenarios such as fights breaking out in the waiting room while the injured combatants are being treated. Another familiar circumstance occurs when the conflict erupts between the loved ones of automobile accident victims where one party is deemed to have been at fault for inflicting injury or death on a second party.

Aldridge also noted that violence in the hospital setting is more prevalent because society as a whole is more violent.

Recent years have seen cash-strapped Emergency Departments forced to spend more money on items like armed security guards, metal detectors, video surveillance and advanced access control entry systems in response to this violence.

Institutionally Specific Violence (ISV)

The third category, Institutionally Specific Violence, and its increasing occurrence in the past three years is the area that raises the most concern among security experts. ISV incidents can occur between any of the three general groups to be found in a hospital: caregiver, patient and visitor as well as a fourth group –intruders. But unlike the foreseeable typical examples of Patient Violence and Non-Patient Episodic Response Violence, ISV events are almost impossible to anticipate and difficult to prevent.

Some recent examples of ISV include:

· A wife who brought a gun into a cardiac intensive care unit and shot her husband to death.

· An unconscious drunk being wheeled into treatment on a stretcher suddenly produces a gun and shots several hospital staff.

· A retired school teacher distraught over the recent death of his mother comes into a hospital and opens fire killing three people.

· A hospital employee comes to work with a gun and proceeds to kill two fellow employees before committing suicide.

· A man, who officials say was neither a patient, employee or visitor, is shot to death by police outside the emergency room of a major hospital following a violent confrontation.

Last year, in response to the rising tide of violence in hospitals the Joint Commission on Accreditation of Hospitals, (now known as simply ‘The Joint Commission’) took the dramatic step of issuing a ‘Sentinel Event Alert’ on the issue.

A Sentinel Event is broadly defined as something that can happen in the hospital setting resulting in injury or death to the patient. The term has traditionally been applied to events such as medication errors, acquired infections and general patient safety. Alert 45 did not include violence against hospital staff but rather focused specifically on, “assault, rape or homicide of patients and visitors perpetrated by staff, visitors, other patients, and intruders to the institution.”

The JCAH Alert offered guidelines for hospitals on balancing between security and access to the facility while remaining open and accessible for patients and visitors.

Among the wide range of possible violent scenarios which could occur in a hospital is the threat of a possible terrorist attack. Concerns over the likelihood of one or two heavily armed terrorists attacking a vulnerable facility such as a hospital have increased in the wake of the deaths of Osama Bin Laden and other high level Al Qaeda operatives. On Friday (June 3, 2011) Al Qaeda Spokesman American Adam Gagahn, also known as “Jihad Joe” issued a nationwide call for Islamic radicals living in the west to purchase guns at American gun shows and immediately go out and kill Americans. Gagahn called the easy availability of assault rifles a, “golden opportunity and a blessing” and implored followers to, “rush” to capitalize on this opportunity. He ended the brief statement with a frightening challenge to followers in the words, “so what are you waiting for?”

All these factors form a witch’s brew of potential conflict ingredients just waiting for a catalyst which may come in the form of the passionate and highly polarized debate over health care reform legislation.

The American public, which is just beginning to come to terms with accepting the intrusive security associated with aviation travel may soon discover that getting into a hospital as either a patient or visitor may be as demanding as boarding a commercial airliner.

Regardless of WHO advisory, cell phone danger is simple matter of proven science.

The question of which technology played the greatest role in securing victory for the Allies in World War II has a plainly obvious answer: the atomic bomb. But the opportunity to develop and eventually use the A-Bomb may never had occurred if not for another technology which in fact, was actually used in the Fat Man and Little Boy devices to determine the altitude for detonation: radar. Radar was also critical to the British efforts to resist a German invasion and thusly provide a critical base for the eventual invasions of Europe on D-Day in 1944.

Radar, the term meaning RAdio Distance And Ranging is a title given in 1940 to a phenomena of radio waves discovered fifty years earlier by Heinrich Hertz. For decades, radio researchers observed that high frequency radio waves bounced off solid objects and actually reflected part of their signal back to the transmitting location. It was the British during the precarious years between their declaration of war against Germany in September 1939 and the entry by America in December 1941, who made the greatest advances in radar science. These advances allowed them to counter the relentless attacks by German submarines on the vital supply line of ships transiting the Atlantic sea lanes. Radar also proved indispensible in the Royal Air Force’s victory during the Battle of Britain air war of 1940. Without radar, the under staffed and poorly equipped British air force may have faltered leading to the defeat of Great Britain. The result would have allowed Hitler to concentrate his forces totally on the invasion of Russia and ultimately achieve a Eurasian Nazi empire stretching from Ireland to the Bering Sea.

Emphasis on radar research and development actually intensified in the years following the war as governments saw the need to see further and better to guard against attacks from missiles carrying nuclear weapons. But radar safety training for troops was not always emphasized. While exact numbers are hard to determine, more than a few servicemen standing guard at radar installations in the frigid northern latitudes sought the strange warming effect realized by standing in front of fixed high-powered radar antennas. What few knew or appreciated was that they were in effect being cooked from the inside out in exactly the same way a microwave oven functions. Most of the victims simply dropped dead from organ failure within a few hours of exposure.

In the 1950’s, some sailors engaged in a dangerous short-term self-sterilization process prior to shore leave. It was generally believed that radar treatments killed off most sperm cells. Taking a “radar treatment” was seen as a safeguard to assure that if their shore bound spouse conceived while they were on active duty the pregnancy could not be attributed to them (the sailor father) and had to be the result of infidelity.

Radar signals are of such high power and frequency they cannot travel through wire cables and instead are channeled from transmitter to antenna in special hallow tubes knows as “wave guides”. For a typical shipboard radar treatment the radar operator disconnected the waveguide at a convenient point and the sailor simply stood in front of the open tube as radar waves were beamed directly at his groin. Anecdotal research in the years that followed are said to have shown that many men who developed testicular and prostrate cancers were Navy veterans who admitted to taking “radar treatments”

By 1960 the issue of radar safety had grown into an international concern as the super powers fired increasingly more powerful rays at each other, often with innocent persons in the line of fire. An international conference was convened and experts agreed on a universal safe exposure limit of one micro-watt (one-millionth of a watt) per square centimeter of body surface area. But when the standards were published in the United States, something was lost in translation.

In the nomenclature of scientific terminology a measurement of ‘micro’ is defined by the character mu ‘µ’. The unit of measure for ‘milli’ (one-thousandths of a unit) is represented by a lower case ‘m’. In America where few typewriters offered the ‘µ’ character, technical writers often used an upper case “M” for milli and a lower case “m” for micro. In some cases they used the lower case ‘m’ for Milli and a lower case ‘u’ for micros. When the standards were published to the scientific community as 1 mw/cm they were taken at face value and the safe limit of radar microwave exposure was assumed to be 1 milliwatt; a level 1,000 times greater than the actual standard of 1 microwatt. As a consequence, for decades the allowable leakage of high frequency radio waves from a typical American microwave oven was one thousand times more than the allowable amount of exposure for an active duty Russian military person.

The many dangers of radar, microwaves and other forms of manmade non-ionizing radiation were explored in great depth in 1978’s controversial book The Zapping of America by Paul Brodeur.

Brodeur’s work which was published before the cell phone communications revolution focused not only on the possible dangers of radar and microwave radiation but also that which radiates from low frequency high voltage electric power transmissions lines. His work was robustly attacked by the electric power industry as ‘scaremongering’. The issue of radar and microwaves is important to understand in that they operate very near the same frequencies as cell phones.

The recent announcement by the World Health Organization that cell phones may pose a health risk was driven not by a single conclusive scientific study but an increasing volume of work which seems to be pointing to a possible risk-link with cell phones. The great problem for scientists and lay persons in understanding the issue of the possible effects of electromagnetic radiation lay in the relationships between the power, the frequency and the length of exposure to a particular type of electromagnetic radiation.

The above illustration from the EPA helps to understand the science and the debate. (A better image and more information can be found on the EPA site)

The Electromagnetic Spectrum is defined by the frequency at which repeating pulses of energy occur. These pulses are sometimes referred to as cycles-per-second (cps) or simply after the Father of Radio Science as “Hertz” after Heinrich Hertz. They begin at the familiar 50-60 Hertz rate used to send alternating current through the world’s electrical transmission systems. When an electrical signal approaches a frequency of 100,000 Hertz it begins to want to leave its wire conductor and propagate into space as radio waves.

AM broadcasting occurs in a narrow band of frequencies around one million or one Megahertz. Moving up the broadcast spectrum from AM you’ll find shortwave bands and some older police and fire radio bands before arriving at FM radio which begins at around 88 Megahertz. From there it’s a rapid rise through the broadcast television bands and then finally the ultra high frequencies approaching 1 Gigahertz (1 billion oscillations per second).

Most cell phones operate at a frequency around 900 Megahertz. Just above them is the beginning range for microwave ovens and radar which cover the 1-30 Gigahertz part of the spectrum. Moving ever higher in frequency, electromagnetic energy manifests itself as forms of visible and invisible light. Finally, at its highest regions you enter the ‘death zone’ of ionizing radiation. Ionizing radiation simply means the energy is so powerful it can literally strip away parts of the atom and has been proven to break apart human DNA.

Even at these highest levels, scientific debate still rages over the possible health risks of exposure to ionizing radiation. The issue is a confusing jumble of terms including Roentgen, RAD, REM, and Millisevert. The issue is further complicated by considerations of the amount of time of the exposure, percent of the body exposed and even the age of the person exposed.

Up to a point, the human body has the ability to repair itself from very large doses of radiation provided there are no subsequent exposures (as evidence by the many survivors of Hiroshima and Nagasaki). But such survivors are known to face significantly increased risks of certain cancers as the years progress.

Today, scientists generally agree that an exposure of between 3,000-5,000 Milliseverts over a 1 hour period is usually lethal with the value of 4,500 msv assumed as universally lethal provided it is a “full body exposure” and last for about 1 hour.

Ionizing radiation kills by literally ripping apart cellular DNA. The immediate impact is generally seen in those body systems which are known for rapid cellular replacement: skin, digestive tract, hair and bone marrow. Victims of radiation sickness usually lose their hair and the ability to keep food in their stomachs within hours of exposure. Their skin becomes blackened and boiled and their bone marrow stops producing red blood cells leading to death in 3-5 days.

The problem, which ultimately manifests itself later down the electromagnetic spectrum as you move from ionizing into non-ionizing radiation, is: “does the body eventually suffer cellular/DNA damage due to the cumulative exposure to lower frequency but much longer term non-ionizing radiation?”

A good example of the confusing benefits/risks of ionizing/non-ionizing radiation can be found in that band of frequencies generally referred to s ultra-violet. The highest UV frequencies are regarded as ionizing with the same dangerous aspects of gamma and beta radiation. But a large segment of the UV spectrum is also deemed as non-ionizing.

UV light is known to kill pathogens and is often used in sterilization. It also can break up excess bilirubin in infants with neonatal jaundice. Of course, it is also part of normal sunlight and artificially generated in tanning beds for cosmetic purposes but there is no debate, excess exposure here can lead to cellular damage leading to deadly skin cancers like melanoma.

As we move lower in frequency away from the visible and invisible light spectrum we arrive in the radio spectrum where-in lies the cell phone debate. As indicated in the chart, the known effects of the radiation in this segment are thermal (heating i.e. microwave) and high electrical currents.

At this point it is important to understand the exponential component which impacts the strength of a single-point energy source, such as a cell phone antenna. Whether the electromagnetic source is a cell phone or a 1 megaton hydrogen bomb, the amount of energy dissipates to the square root of the distance. If the power of any energy is ‘X’ at a given distance, then if you increase the distance by a factor of two, you actually decrease the amount of energy by a factor of four (X/4). Double it again and you drop to just 16^th of the power at your starting location (X/16).

The current cell phone risk debate follows the same hypothesis as that offered by Brodeur in Zapping, namely that while the lower non-ionizing frequencies are not known to cause DNA damage and thusly cancer, when living tissues is exposured to sufficient power over a long enough period of time the effect becomes cumulative. Just as the human body suffers measurable damage over time to longer and higher power exposures of the ionizing energies, the very same “point of lethal danger” can be achieved with much lower frequency over much longer time.

The second line of thought on the possible impact of non-ion ionizing radiation does not assume a DNA altering impact similar to ionizing radiation, but instead seeks to understand if the known effects of heating and/or induction of electrical current could be responsible for carcinogenic pathology. This is where proven science comes into the argument.

It is absolute that the electromagnetic field generated by a cell phone pressed against the skull will induce stray electrical currents inside the brain. While these voltages are very small there is also proven science that suggests human cells subjected to electrical stimulation grow faster. Each year, thousands of people are treated with the FDA approved therapy provided by ‘Bone Growth Stimulators (BSG)”. BGS’s are most often used to pass a small electrical current across a broken bone that is slow to heal (non-union fracture). While not always successful, BGS’s are regarded as an effective treatment.

The logical conclusion leaves little uncertainty. Small electrical charges are essential to cellular metabolism. BGS’s are known to stimulate this metabolism and promote cellular growth. Therefore, there is no reason to believe that a small cluster of cancerous brain cells would not be stimulated to grow faster and more aggressively when exposed to the induced voltages generated by the electromagnetic field of a cell phone.

Just as the electric power industry waged all out war against Brodeur, the cell phone industry is certain to counter the WHO’s pronouncements on cell phone safety.

One interesting note from an ‘inside-the-industry’ perspective on the possible dangers of exposure to all radio waves has been quietly in evidence for over a decade. Starting in the 1990’s, a company or person selling a standard broadcasting (AM-FM-TV) outlet in the US has been forced to indemnify the buyer from: “any and all future claims which may arise from the negative health effects of exposure to RF (Radio Frequency) radiation emitted by the Facility during Sellers ownership of the Facility.” In simple terms while the industry is vigorously denying any connection it is covering its’ bet by pushing the responsibility backward onto owners and corporate entities which no longer exist.

Over the coming years, a definitive link between cancer, birth defects and other illnesses will almost certainly be linked to the exposure to non-ionizing electromagnetic radiation (NIEMR). When this happens the position of the cellular industry will likely change from one of denial to one of shifting responsibility to other ‘emitters’ of NIEMR, and the point may be valid.

Over 3 decades ago Brodeur lamented on the fact that our modern world was awash in sources of NIEMR. Today’s world with cell phones, WiFi, security scanners, and a myriad of other NIEMR emissions makes Brodeur’s 1978 world seem nearly pristine.

Long before medical science understood how the human body worked, there was an understanding that many bodily functions were a careful balance of chemistry and when the body was exposed to some chemicals, that balance was destroyed and the body died.

Today, we know that electricity also plays a vital role in the functions that regulate and maintain life. NIEMR , like chemical poisons, must be researched and assessed for its true impact and where warranted, treated the same as a potentially toxic substance.

This Summer's Best Investment - FOOD!

A sampling of NACs analyst gathered recently to enjoy a traditional Memorial Day cook-out. While there was a deliberate effort to avoid “shop talk” and focus our chatter on sports, family and summer vacation plans, the discussion inevitably melted down to a late evening patio summit replete with laptops, note pads and a energetic and at times dire assessment of a future trend. The subject was food prices and the causative object that launched it was a humble can of Pork and Beans. It was observed that as recently as 2009, a shopper could find Memorial Day weekend sales which offered three cans of ‘P & B’ for $1.00. It was then observed that for Memorial Day 2011, those merchants who continued this traditional offering had replaced the once traditional 15.75 ounce can with a slimmed down 11 ounce container. It was then noted with some nostalgic lamentations that this popular summer food staple had realized a 30% inflationary cost increase in just two years.

The discussion turned serious when all realized that a confluence of events in America and around the world are indicating possibility the sharpest upward spike in food costs which could have a greater impact on consumer spending than the recent spike in petroleum prices.

At the core of this concern are some toned-down but potentially catastrophic crop status reports from the USDA. Assuming the ever-worsening news regarding corn and wheat crop harvests for 2011 is less than a worse-case scenario, food costs based on these staples are certain to see double digit inflationary increases before year’s end.

On May 23^rd the USDA warned of a “poor” to “very poor” winter wheat harvest for North America due to a drought during the growing season. Further complicating matters is a wet spring which has delayed both the harvesting of the winter crop and long delays in plating the year’s second crop. The same meteorological conditions have likewise impacted wheat production in Europe.

The price of wheat futures on the Chicago Board of Trade are currently trading at nearly 80% above year ago levels. The only nation poised to possibly benefit is Russia where unusually favorable conditions are forecast to increase wheat yields by 30%. But it is unclear if the Russians bounty will be shared with other nations. Chronic shortages and under production have created a political resistance to exporting Russian wheat and some analysis claim the crop itself is likely to be of poorer quality than what is the custom on American and European tables.

More dire than wheat is the possibility of a massive failure of the 2011 American corn crop. The same heavy rains and flooding in the Midwest which has lead to problems are now impacting corn. On May 22^nd the USDA echoed concern in reporting that in Ohio, less than 18% of the state’s corn crop had been planted due to millions of acres of soggy muddy fields. Overall , 18 states are reporting on average 20% or more of their annual seed corn has yet to hit dirt as farmers wait anxiously for the fields to dry out. Meanwhile many areas of already planted corn in the lower Mississippi Valley were accidently drowned due to flooding, or intentionally sacrificed as in Louisiana where over a million acres of sprouted corn was destroyed when flood gates were opened to stave off a potential downstream disaster in New Orleans.

While there is still potentially ample remaining growing season in North America, it is generally desirable to have corn crops planted by mid May so the plant can tassel and begin seed formation before the traditionally hotter and drier months of July and August. With corn already trading at near record levels above $7 per bushel, the prospects of $10 plus bushels remains a solid possibility and a near certainty if there are further delays in planting. There is widespread agreement that $10 per-bushel prices for corn will have significant impact on nearly all foodstuffs and major impact outside the food segment of the economy.

$10 per bushel corn would be the final coffin nail for the domestic ethanol fuel program which has already been decimated by the constant increases in corn prices. Most of the corn destined for human consumption makes its way into the food chain via the preferred alternative to cane sugar; High Fructose Corn Syrup. $10 corn would result in double digit increases for all products with HFCS and significant surges in prices for items like soft drinks, candy and sweetened cereals. The impact will also have a dramatic effect in the meat aisle.

Nearly all corn grown on the flat expanses of the Delmarva Peninsula is consumed by the regions poultry growing industry. Unlike the Midwest, Delmarva farmers have enjoyed ideal planting and growing weather so far. Unfortunately, they will not benefit from the short term spikes in corn prices since most pre-contract with the areas major poultry farms at a fixed rate. None-the-less at least one major poultry producer was quoted recently as saying they plan to cut back on the number of chicks placed with growers who raise the birds to market size and also to focus production on the already higher margin products like boneless chicken breasts because of corns surging price. Chicken of course will not be the only food impacted by the surge in corn prices. Similar increases will apply to domestically raised beef and pork which also rely on a mostly corn-based diet.

While weather in the US, Canada and Europe has been the major force driving future prices and predictions it is not the only one. The jump in global oil prices is certain to have some impact on all crops due to the cost of fuel used to plant, tend and harvest along with the cost of petroleum based pesticides, herbicides and fertilizers. The March 11 earthquake in Japan which resulted in disruption to the Japanese auto industry is believed to have had similar impact on the worldwide export of Japanese manufactured farm machinery and spare parts just as growers throughout the Northern Hemisphere were preparing to plant their 2011 warm weather crops.

Just as with oil and gasoline prices, when Americans have to pay more for an essential commodity like food, there are less available monies for discretionary spending. When this happens, unemployment in sectors such as entertainment, fast food, and retail can rise further exacerbating the current slow pace of recovery.

There are some signs that Americans may be aware of the potential crisis in food costs. There is a reported increase in backyard gardening and the stockpiling of canned food items. Whether these actions are motivated by awareness of the commodity markets, the increasing fears of natural disaster or a belief that one of the many recently forecast “doomsday” prophecies may come to pass; the result is many will be able to mitigate to some degree, a sudden spike in prices or reduction in actual food supplies.

It may not seem as attractive as gold or a hedge fund, but that $1,00 you invest right now in 33 ounces of Pork and Beans may, by Thanksgiving dinner, have grown in value to $1.50. A 50% return, regardless of size or nature of the investment is always worth celebrating.