Allergic Reactions Spur Alerts Over Pfizer Vaccine

Health authorities in the United Kingdom say people with a history of allergic reactions should delay taking the new Pfizer-BioNTech coronavirus vaccine after two people had reactions following the rollout of the national vaccination program.

The U.K.’s Medical and Healthcare Products Regulatory Agency (MHRA) doesn’t know yet if the vaccine caused the reactions, The Guardian reported. The two people are National Health Service employees with a history of allergies. Their identities and the nature of their reactions have not been revealed.

“As is common with new vaccines, the MHRA have advised on a precautionary basis that people with a significant history of allergic reactions do not receive this vaccination after two people with a history of significant allergic reactions responded adversely yesterday,” Stephen Powis, medical director for the NHS in England, said in a statement. “Both are recovering well.”

The world is watching how the U.K. administers its vaccine program, the first in the world to vaccinate the public with the Pfizer vaccine outside clinical trials.

U.K. health care regulators approved the Pfizer vaccine on Dec. 2 and began giving vaccinations on Tuesday — only 6 days later. The first people to be vaccinated were health care workers and people over 80.

In the United States, an FDA committee is expected to consider the Pfizer vaccine on Thursday. If approved, vaccinations could begin in the U.S. within days.

The Associated Press reported that MHRA Chief Executive June Raine told a Parliamentary committee about the allergic reactions during previously scheduled testimony on the pandemic.

“We know from the very extensive clinical trials that this wasn’t a feature” of the vaccine, she said. “But if we need to strengthen our advice, now that we have had this experience in the vulnerable populations, the groups who have been selected as a priority, we get that advice to the field immediately.”

Baby Microbiome: Nurturing Your Baby’s Healthy Bacteria

By now, you’ve heard the news: The trillions of bacteria that inhabit your gut and other bodily regions can have a critical impact on your overall health. The same holds true for babies, new research shows.

“The microbiome is important for many aspects of health, from gut health to mental health to immune health, and we’re finding that the first couple of months of life is a really critical window for its development,” says Meghan Azad, a microbiome researcher and assistant professor of child health at the University of Manitoba.

Recent studies suggest that babies whose microbiome development is disrupted via a cesarean section delivery, early antibiotic use, limited breastfeeding, or other factors are at greater risk for a host of health conditions, including asthma and allergies, respiratory infections, irritable bowel disease, type 1 diabetes, and obesity. But they also suggest that no matter how a baby is delivered, parents can take steps to get baby’s bacterial ecosystem off to a good start.

Birth and the Microbiome
By the time people reach adulthood they host between 500 and 1,000 species of gut bacteria, many of them beneficial, which serve to fight off infection-causing microbes, digest food and metabolize nutrients, and interact with the central nervous system to influence mood and cognitive health. The foundation for that bacterial collection is established by age 3, and what happens in the first three months of life is key.

“Babies are born with essentially no microbiome and a very immature immune system, and the two develop together, informing each other,” says Azad, noting that the first microbes to colonize a baby’s gut, skin, and mouth help teach the immune system what’s harmful and what’s not. “When there are microbes missing, and that immune system doesn’t develop properly, there can be a greater risk of developing problems.”

Vaginal birth, when possible, marks a critical step, exposing an infant to a diverse array of mom’s bacteria as he or she passes through the birth canal.

“Babies born via cesarean section don’t get that same degree of exposure,” says Sara Edwards, PhD, a certified nurse-midwife and microbiome researcher at Emory University School of Nursing.

Read more…

How to Have Meetings With Value

Dr. Sudip Bose gives a talk at a meeting.

By Dr. Sudip Bose, MD, FACEP, FAAEM

No matter what you think about meetings – whether you love them or hate them, attend them or lead them – they are ingrained in modern business life in almost any organization, from the smallest independent businesses to the largest corporations in America and the world.

Everyone who goes to or who holds a business meeting has two points of anxiety related to attending: 1) that the meeting will be a waste of time, and 2) that you might embarrass yourself by appearing unprepared or uninformed about what is being discussed.

My motto, which applies to being a successful leader, can also apply to being a successful meeting leader or attendee, and that is to remember to “keep your inner army strong.” What do I mean by that, and how can that apply to business meetings? I’ll again reach back to a core principle I learned when I was a US Army officer and physician, and that is to always be training and preparing in “peacetime” – when things are going fine in the organization and all is well – so you are ready for what occurs during “wartime” – those moments of stress or significant change.

We want our meetings to mobilize others and build armies so that we can move ahead swiftly and accomplish the goals we set; we want to inspire attendees to move forward and lean into the mission.

As a meeting leader, I can think of at least a half-dozen action points that will increase the effectiveness of meetings. You can probably think of more, but I believe these are crucial:

1) Agenda — Be sure you get the meeting agenda items and any reading material or points of discussion expected to the meeting group a day or two ahead of the meeting. If you try to distribute relevant material at the meeting, guess what? Almost everyone will have their noses in the material and will only provide marginal participation in the session. That, and they won’t have the time needed to consider and react to the material with any depth of thought.

2) Efficiency — Keep the meeting on point and don’t allow tangential issues to take you off track. Start the meeting on time and end the meeting on time.

3) Invite Right — Make sure you have the right people at the meeting. Nothing will derail a meeting quicker than not having a key stakeholder there whose input is critical to moving the mission forward.

4) Demand Accountability
– Now, I don’t mean that you pound the conference table and transform yourself into a tyrant, but everyone at the meeting should know they have a responsibility to contribute and that there’s an expectation to make sure tasks are done by the next meeting.

5) Action Items — Always be sure to end the meeting by setting and getting buy-in on the “next steps” that need to be taken to complete the task at hand. Also be sure to give praise to the others who attended the meeting. Make sure they know you appreciate their attendance and their contributions.

6) Follow Up! — Absolutely make sure you follow up with meeting attendees. Make sure you summarize key points of the meeting, memorialize decisions made, and outline responsibilities and timelines for action items discussed and agreed to at the meeting. Nothing, and I mean nothing, will ensure that the half-hour or hour you spent leading a meeting was worthless more than the absence of follow up.

As a meeting attendee, first, be sure you’re the right person from your team to go to the meeting. In vertical organizations, sometimes the person organizing the meeting makes assumptions about who should attend from other departments but might miss a key person.

There’s a great piece of advice about attending meetings that Mindy Hall told to Eric J. McNulty in an interview: Show up with two questions you want to ask and two things you want to contribute, McNulty said Hall told him. Hall is the President & CEO of Peak Development Consulting and author of the book, “Leading With Intention.” McNulty is the director of research at the National Preparedness Leadership Initiative and writes frequently about leadership and resilience. According to McNulty, Hall went on to say that putting the two together requires considering who will be there, the context, and the power dynamics of the meeting. She said to know your objective in attending the meeting, and what the meeting convener hopes to achieve; understand that preparing two questions activates a learning mind-set, whereas articulating two contributions ensures that you are prepared to add value.

That paragraph contains a couple of the best ideas regarding meetings that I’ve ever read or heard – particularly the point about coming to a meeting ready with questions. Someone once said, “You can tell a man is clever by his answers. You can tell a man is wise by his questions.” So be prepared to be both clever and wise.

Most people will remember 20 percent of what you do, usually at the beginning and end of the time you’re together. That’s especially important to consider regarding meetings. Be positive, be confident, bring energy to the table, be present. Don’t be the person fiddling with your iPhone or iPad. Avoid the temptation. Remember the admonition about first impressions: You never get a second chance to make a first impression.

Being an Army veteran, I was especially struck when I found this gem of advice as I was getting ready to speak to and lead a large group, which was written by TIME magazine contributor Eric Barker: “The military makes soldiers stand up straight for a reason; there’s an implicit connection between posture and power that has been demonstrated time and time again. Want to increase confidence? Make yourself tougher? Stand up straight.” Simple advice when you’re looking to make an impression.

Be conscious of your body language throughout a meeting. Having closed body language with arms folded, legs crossed and a bit of a frown on your face will at a glance convey to the speaker your disagreement with what is being said, and you won’t have said a word. That may be inappropriate or appropriate given the context of what’s going on. I’m just making the point of being aware of the unspoken signals you’re sending with your body language. Nuance matters.

To sum up the main points I made to be a good meeting contributor (and to add a few other quick points to round out to a half-dozen):

1) The Right Invite — Make sure you’re the right person to be attending the scheduled meeting.

2) Timeliness — Get to the meeting on time. Don’t be the person who straggles in 10-15 minutes late after key points already have been discussed and made.

3) Questions — Have a couple questions ready that hopefully will move the meeting in a positive direction and be of benefit to all attending.

4) Contribute — Ensure you come to the meeting armed with at least a couple of items you believe will contribute to the meeting. Come prepared and do your homework.

5) Presence — Be positive, be confident, bring energy to the table, be present.

6) Stand Up Straight — Remember the connection between posture and power. And remember the influence of body language. Your unspoken communication through body language matters a great deal.

To learn more about Dr. Sudip Bose, MD, please go to and visit his nonprofit where 100 percent of donations go directly to injured veterans.

The Complicated Middle East in About 1,000 Words

By Dr. Sudip Bose, MD, FACEP, FAAEM

What is to be gained by meddling in the Middle East? Is there a positive end game for the United States in inserting itself into Middle Eastern affairs? Is there an end game at all?

War Fatigue in the Middle East

Mosul is in the news again. It’s a perfect example of how the Middle East seems to grow more confusing and more dangerous on a daily basis. And in viewing coverage of it, it feels like we’ve been there, done that before. And we have.

What happens in Mosul does affect us. Mosul and the Middle East may seem like a long way off and largely forgettable in Americans’ day-to-day lives, but the violence stemming from the region has crossed borders. It’s not just America that has been affected by it — remember the attacks in Paris just a year ago in which 130 victims lost their lives; remember the bombings on mass transit (the Underground trains) in which 56 people were killed; remember the terrorist bombings in Brussels, Belgium just earlier this year in which 32 people were killed and more than 300 injured; of course, none of us will ever forget 9-11 and other terrorist attacks right here on our own soil (the shootings in Fort Hood, Texas; the Boston Marathon bombings to name just a couple prominent ones).

The history of Mosul shows that for centuries it was a walled trade city that straddles the Tigris River and linked trade routes to the east with cities to the west. It also has endured war and conflict, not unlike the tug of war over control of it that is going on today.

Back in 2003 during the Iraq war, US-led forces under Gen. David Petraeus entered the city of Mosul and occupied it while going about the task of making civil peace with local Sunni tribes. However, in November 2004, as some US soldiers were filtering out of the city to support the attack on Fallujah, insurgents were coming into Mosul where they began attacking Iraqi police and coalition forces. The insurgents flooded the streets of the city and had splintered the city’s security, such as it was.

But in heavy fighting, US-led forces overcame the insurgents and quelled the uprising, regaining control of the city. However, the insurgents were able to remain in pockets in the western part of Mosul, from which they conducted raids over the coming months.

Even with vastly superior forces, (the Iraqis had 30,000 troops facing the ISIS insurgents, which numbered about 1,500), the Iraqis lost Mosul in early June of 2014.

Now, Iraqi forces have begun their assault to retake Mosul with support from Kurdish militias and coalition special operations units, including those of the US.

History Shows to Stay the Heck Out of There

And so it goes. The cycle of the power struggle in Mosul is a reflection of the greater power struggle in the Middle East region over centuries. There has been conflict in the region dating back to the Crusades and beyond — in fact, back to the onset of Christianity and the rise of Islam.

The Greeks fought against Persia over diverging ways of life in the Middle East in a struggle most famously highlighted by the battle of Thermopylae in which 300 Spartans led by Leonidas clashed vastly outnumbered against a Persian army led by Xerxes. This conflict took place in the 5th Century, BC.

Among the many reasons that led to the fall of the Roman Empire was their expansion into the Middle East — the eastern half of their empire. It was centered in Byzantium, or as it would later be known, Constantinople. When the Roman Empire fell, generally attributed to be in 476 BC, it gave rise to the Byzantine Empire.

Is it right and/or appropriate for an outside entity to try to influence the direction of the region? Is democracy right for all?

As a Western civilization and Western culture, we have vastly different experiences and heritage than do Middle Eastern civilizations or other civilizations around the world. Is it right to force those Western concepts on a different people? Take my own country of heritage, India. My parents immigrated to the US from there in the 1960s. India was and is vastly different in every way from the British culture of the west. Yet the British influence grew in India until resentment resulted so much in opposition that the Indian people revolted in what turned out to be a barbaric fight to overcome British rule. The Indian revolt initially was unsuccessful, and British ruled over India for almost a century before India regained its independence, largely through nonviolent means.

Much of the conflict in India centered around the tolerance, or lack thereof, of the British for the Indian culture as well as the growing number of Christian ministries coming into India to try to convert the Hindu majority as well as Indian Muslims. That didn’t go so well. For example, the Indian city of Bombay was once known as “the burying ground of the British.”

If you look at the history of the Middle East, you’ll see that invading forces have never had any long-term success when they try to insert themselves into the affairs of any of the countries in the region.

So with competing religious beliefs and cultural disparities steeped in a region for centuries, it’s pretty much impossible to avert the march of history through outside force or influence.

Isn’t that an important lesson to understand?

I’ve been in the middle of conflict in the Middle East. I served in the U.S. Army as a front-line combat physician for 15 months while in Iraq. My service in war was one of the longest continuous tours of combat by a physician since World War II. I treated thousands of our troops during that conflict and also provided medical care for Iraq’s deposed dictator, Saddam Hussein, after his capture.

I was in the middle of it all, observing the struggle. There was a basic good vs. evil struggle going on there that made my mission an easy one to keep focused on. However, I keep coming back to the history of the region, looking beyond the current day-to-day struggles and understanding the clash of cultures and religion. We removed Saddam, and we gave Iraq a chance at democracy by doing so. But they did not take to democracy. Not everyone can bear the responsibility of democracy. All we can do is give them a chance.

In my experience and from studying the region, it appears to me that modern armies are good at waging war and removing Jihadists, but they are bad at rebuilding countries afterward. Just look, again, at what is going on right now in Iraq. We will be bankrupt, if we’re not already, from this war. The fighting in the Middle East has been ongoing for centuries and it’s very likely to continue.

Sometimes, you have to remove a source of conflict and pull back, and just observe, and let history play itself out. But there are alternatives between the options of violence and turning our backs.

Alternatives to Military Engagement

If not military action, then what? How do we influence hearts and minds?

I think there are a number of fronts we could progress on:

1) Electronic — Radical groups communicate electronically. Use social medial media to bring like-minded Muslims together and give them a safe way to spread the call of reform to a wider audience. Bring together the voices who believe:
a. Scriptures should not be misused to justify violence
b. Value of this life in addition to the focus on life after death (which glamorizes violence and martyrdom)
c. Religion and state should be more separated
2) Smart borders — Discernment! Key word here. We can still heavily vet refugees and let in those who need help
3) Increase resources (security) — and bring in International help as a presence (not just from the US)
4) Military — We’re doing this to some extent already, but we need to continue to have special forces accompany Iraqi military and train on tactics and strategy. We’re the best in the world at that and we’re good at removing combatant forces but not at rebuilding and maintaining. Islamist governments are failing to deliver on their promises, causing Muslims to look to Western countries for a better life. And with more Muslims moving to Europe and North America, they will inevitably be lead toward reform.
5) Diplomacy — Shiites, Sunnis, Alawites, Kurds can all live in peace and govern. It’s possible if they don’t become intimidated by anyone trying to silence thoughts and stifle discussion and compromise. In order to resolve conflict, we first need to be able to voice our doubts or criticism about a subject – any subject, from Qur’anic interpretation to nuclear waste – and then have a peaceful discussion.
6) Laws — Emergency measures are ok, but warrantless searches can be abused
7) Gray zone — This is where loyalty is divided between radical Islam and a country where they feel they don’t belong. Use the moderate Muslims to lead the way and support them. Assuming everyone of all races and religions want the best life for themselves and their children. Radical fundamentalism has little to offer in that regard. We have to show that to them – common sense has to prevail.

On that last point, let’s think about this: Before Nazi Germany rose up, most would say by and large that the German people were good. But they became brainwashed, and those in power — the most radicalized — silenced the majority and initiated violence against other peoples that throughout World War II would cost some 60 million lives.

Christianity used to be an extremely violent religion, as the Crusades will attest to; but Christian leaders eventually gave up its militancy. To mirror this practice with Muslims, to help the clerics lead a similar change within Islam, means that people have to stop suggesting that Islam is a peaceful religion and address that. The politically correct suggestion that Islam is a peaceful religion will only justify the authorities’ not taking action. But by the same token, we have to watch hate speech. It radicalizes more people if they’re constantly attacked. You can’t throw a brick into someone’s window just because they are a Muslim. Please revisit the “grey zone” point number 7 above.

And I’ll leave you with one last piece of discourse that I find incredibly insightful and powerful. It’s a clip from a Heritage Foundation forum in which they were discussing the attack on the Americans in Benghazi in which four Americans were killed. You can view it here: Not All Muslims Are Bad.

For more about Dr. Sudip Bose, MD, please go to and visit his nonprofit where 100% of donations go directly to injured veterans.

Become an Effective Public Speaker

Dr. Sudip Bose spins his laptop on his finger as if it’s pizza dough while making a point at a recent speaking engagement.

By Dr. Sudip Bose, MD, FACEP, FAAEM

It’s been said that the one thing that people fear more than death is speaking in public. I was struck by comedian Jerry Seinfeld’s observation on that. He said, in effect, that more people attending the memorial service would rather be in the casket than delivering a eulogy at the podium in front of the gathered crowd. Interesting observation, right?

Sure, public speaking can be intimidating. You’re up there, out front, all alone, your words echoing around the venue, sometimes with very little reaction. Are you hated? Are you liked? Are you loved? Is anyone even paying attention to you? All those thoughts flash through your mind as you search the crowd in front of you for a face that seems sympathetic. You hope the person you lock in on as that person with the seemingly sympathetic-looking face isn’t merely trying to abstain from passing gas and has his own worries in mind.

Will your jokes ring hollow, or will you get a reaction? Will your brief demo of spinning a laptop on your finger tip like you would do with pizza dough be a source of rousing recognition and perhaps even applause?

It can be tough to be a speaker in a public arena. But I’ve found by keeping the acronym CHIPS in mind, you can master public speaking. Let me go through each letter of the acronym and explain:

C is for Confidence

This is an absolute must. You must be confident. You must be sure of your subject and your ability to deliver and communicate the information you are speaking on effectively to your audience.

It’s amazing how an audience can sense fear. And it’s amazing how quickly a talk can unravel if you don’t have confidence in your delivery of information. Sure, almost everyone is nervous when walking on stage or a lectern to deliver a speech in front of dozens, hundreds or thousands. Performers at the top of their game who are wildly popular sometimes have literally gotten physically ill before they went on stage. The singer Lorde, for example, who burst onto the scene with her hit “Royals” said in an interview that she has thrown up before her show. “I am reduced by nerves,” the singer said. “I can be completely crushed by feelings of all kinds … I get nervous, I get freaked out …”

Other celebrities with stage fright include the singers Rod Stewart and Barbara Streisand (who dodged performing for years because of it), actor Mel Gibson, and comedienne Carol Burnett (who reportedly threw-up before many of her performances).

Yet they gathered themselves up, shoved their fear into a virtual closet, shut it away and went on to do their work with confidence. It’s the only way. You must project confidence in front of an audience. That said, it’s not the end of the world if you don’t; everyone has a bad day every now and then. But to be an effective public speaker, having confidence leads the list of attributes you want to have.

TJ Walker is a public speaking expert and has this to say about the importance of speaking with confidence: How to Speak With Confidence.

H is for Humility

Remember, I said confidence, not arrogance. There’s a difference. You must work to convey a sense of humility when you’re in front of people and not come off as being an arrogant a… Well, you know. There can be a fine line between confidence and arrogance.

Don’t think you can just wing it – at least not at first. Don’t be that arrogant person who thinks he or she can just jot down a few notes the night before, get out on stage and give a masterful performance. If you can do that, you’d be one of the very few. More often than not, you’ll let yourself and your audience down. Arrogance can lead to your undoing.

Why humility, though? After all, you’re speaking to a group for a reason. You’re a leader in your field and recognized as such or you wouldn’t have gotten the speaking engagement in the first place. But you’ve got to be able to show that you’re serving something beyond your own interests – perhaps there’s something you struggled with in the past and had to overcome. Sharing an experience like that creates empathy, shows humility in exposing a vulnerability, and helps make a connection with your audience.

Quite often as human beings, we connect with each other through struggle – shared in real time, or shared with an audience after the fact. When you connect with others through struggle, you’re communicating with your audience in a way that shows that you and they are on an equal level in that regard. They think, “I’ve had to deal with that, too.” Or, “I’ve felt that way, too.” Or, “I know how that feels.”

Tony Robbins, perhaps currently one of the top public speakers, says that, “The way to move an audience is by becoming moved yourself, which can only happen if you’re being genuine.” And, he says, “You need to be in the moment and flexible to make it real and raw. You’ll enjoy it, they’ll enjoy it, and you’ll be memorable.”

He gave a Ted Talk where that principle was on display: Tony Robbins’ 2006 TED Talk.

It’s a delicate balance – showing confidence and humility at the same time – but one you should strive for when speaking to an audience.

I is for Inspiration

Speak to serve. Speak to inspire. Public speaking is not about you, it’s about your audience. You’re giving the talk, theoretically, to benefit your audience and to communicate your life experience to provide, hopefully, a different way of looking at things. You’re there to hopefully connect with the listeners. Inspire them as best you can; give them a different perspective; allow them to access your experience, your learning, your development, to motivate, and hopefully along the way, to entertain.

Focus on inspiring your audience, and that can also help you with your confidence, because it takes the pressure off your self-consciousness and introspection and places the focus on your audience and flips the speaking process into a mode of being an extroverted speaker with the listeners placed in the spotlight. That’s what I try to do when I talk, and I try to focus on the following goals to hopefully benefit the audience:

  • Teach executives leadership tactics in crisis situations
  • Develop quality leaders with integrity in an organization
  • Improve decision making to increase company sales
  • Enhance communication strategies to better engage employees
  • Train, inspire and motivate
  • Keep the audience laughing, learning and energized
  • Raise funds and awareness for injured combat veterans

In the preparation work I do leading up to my presentation, I keep those goals – my purpose in speaking – in mind. I think, “How can I help the audience achieve their goals? It’s an outward focus rather than inward focus.

A little inspiration: Why Do We Fall?

P is for Preparation

You can’t prepare for a talk enough. Practice, practice, practice. Don’t just write your presentation, give it. Talk to the furniture in your house. Have your husband, wife, son, daughter, friend, stranger – whomever – listen to you give your speech. Stand in front of a mirror and give your talk. Videotape yourself and play it back while watching with a critical eye.

Revise, redo and keep trying to find that presentation sweet spot. The more you practice, the more comfortable you’ll feel during your talk. When you feel like your speech is as familiar as that comfortable, well-worn flannel shirt you own, you know you’re at the right spot.

Listen to what Les Brown, among the most sought-after motivational speakers in the world, has to say about preparation: Be Unstoppable; Prepare for an Opportunity.

S is for Speech

Speech, as in speaking, as in using your voice effectively – as in using your voice as a tool to connect with your audience. Understand the effective use of your voice. As part of your preparation, you must learn how to speak with effective modulation, tone, pacing and … the proper use of pausing for effect.

One of the most effective speakers I’ve ever heard was Jim Rohn. He had such a way of modulating his voice for effect and throwing in very calculated pauses in some very unusual ways and in unexpected places as he spoke. His voice rose, almost in question; it dropped very low when making a point; it paused often, to great effect.

It’s very hard to write about it, but you certainly can hear him and perhaps better understand what I mean by checking out this video of him speaking. This is a great talk on the need to have discipline in your life:

Jim Rohn | Habits of the Wealthy: Discipline

You can use the links that populate with that video to springboard to other links of him speaking. Listen to how he modulates his voice, how he slows down his words, then speeds them up, almost staccato-like. Pay attention to the pauses he places in his talk – very effectively. Listen to him repeat his key points.

Remember to repeat. And repeat often to drive home key points. There’s so much you can learn from listening to great speakers.

As far as my speaking engagements go, here’s a clip that contains a compilation of a handful of appearances I’ve made: Keynote Speaker: Dr. Sudip Bose.

I enjoy giving back and educating others. I frequently speak at corporations and take the skills I learned in combat and in the emergency room to teach leadership lessons and how to apply them to everyday life – it’s probably my favorite topic to speak on. Through my lectures and media appearances throughout the country, I’m able to raise awareness and funds for The Battle Continues Inc. is a 501(c)(3) nonprofit organization aimed to raise awareness and help veterans who have returned from war; 100 percent of money donated to the organization goes towards assisting and supporting veterans. I also promote healthy living and awareness on health care issues so that people can make better-informed decisions regarding their health. I’m a firm believer that our health is our single most important asset.

So remember the acronym “CHIPS” when it comes to public speaking; and remember, as my motto proclaims, to “keep your inner Army strong.”

To learn more about Dr. Sudip Bose, MD, please go to and visit his nonprofit where 100 percent of donations go directly to injured veterans.

Coping With Disaster: A Medical Overview

NASA Earth Observatory

By Dr. Sudip Bose, MD, FACEP, FAAEM

First there was Harvey, then Irma and, most recently, Maria. Hurricanes have hit Texas and the Gulf Coast, have torn through Florida, and have raked across the Caribbean, devastating Puerto Rico and the Virgin Islands. These disastrous power punches have left scores dead, millions uprooted and much physical and emotional devastation in their wake.

As of this writing, Hurricane Harvey has been reported to have caused 82 deaths; Hurricane Irma’s U.S. death toll stands at 75; and so far, Hurricane Maria has claimed 27 lives and likely will go higher. Some of those killed as a result of Irma involved nursing home patients.

How can that happen, you ask? Shouldn’t these kinds of victims have been our top priorities for keeping safe? Of course. But sometimes, all the planning and precaution in the world can’t overcome the unpredictability of Mother Nature, a disabled infrastructure and the failure of emergency backup power.

Every natural disaster, such as hurricanes Harvey, Irma and Maria, also becomes a looming public health disaster. As the storms approach, each hospital, nursing home and medical facility that houses patients must make difficult decisions between evacuating patients and staff and battening down to ride out the storm. Evacuations pose major logistical issues as patients, staff, equipment and medications all have to be transitioned from one location to another. An evacuation for a chronically or critically ill patient can be life-threatening. During the height of the storms, hospitals and other medical facilities face critical issues in trying to keep their patients not only alive, but also well cared for. Shortages of food, water, medicine and power can turn very bad very quickly.

After the Storm

After the brunt of hurricanes like Harvey, Irma and Maria push through, health resources re-focus on fighting infections, both from bacteria in floodwaters and from mosquitoes. Physicians scramble to contain potential epidemics that might arise after flooding. Based on the health problems that arose after Hurricane Katrina, medical professionals have to prepare to try to avert major public-health emergencies, environmental illnesses, and outbreaks, which could intensify in the aftermath of the devastating blows dealt by these hurricanes. Sewage that has overflowed its containment can pose a major health issue, as can spilled fuel and chemicals from tanks and pipelines torn apart during the hurricanes.

And not only that, but for hospitals and other facilities that made the decision to move patients, those same patients have to be transitioned back home to their original facilities at some point, assuming those facilities are able to open and operate again.

As you can see, there is much to consider when preparing for a natural disaster like hurricanes Harvey, Irma and Maria. In fact, the Centers for Medicare and Medicaid Services have established an Emergency Preparedness Rule that all hospitals and health care facilities must have a plan in place and be in compliance by Nov. 16, 2017. This emergency preparedness plan, by CMS guidelines, must address an all-hazards risk assessment and contain four core elements:

Four Core Elements of Emergency Preparedness
RISK ASSESSMENT AND EMERGENCY PLANNING (include but not limited to):

  • Hazards likely in geographic area
  • Care-related emergencies
  • Equipment and power failures
  • Interruption in communications, including cyber attacks
  • Loss of all/portion of facility
  • Loss of all/portion of supplies
  • Plan is to be reviewed and updated at least annually


  • Complies with federal and state laws
  • System to contact staff, including patients’ physicians, other necessary persons
  • Well-coordinated within the facility, across health care providers, and with state and local public health departments and emergency management agencies.


  • Complies with federal and state laws


  • Complies with federal and state laws
  • Maintain and at a minimum update annually

The plan must also consider those individuals locally who may be deemed “at risk.” To quote from the CMS guidelines:

“At-risk populations are individuals who may need additional response assistance, including … [those] from diverse cultures, [who] have limited English proficiency, or are non-English speaking.”

In addition to shelters, hospitals are often a focal point of their communities during a crisis. In addition to patients already admitted to a hospital, during a natural disaster like a hurricane, new patients are very likely to seek medical assistance by coming to the emergency department either on their own or after being rescued by a first responder. And first responders need to know the status of a hospital to ensure they’re transporting patients to an open, operating, safe medical facility. Hospitals need to work with other hospitals to know where to send or receive patients if any of the open facilities become overwhelmed. And as always, hospitals need to remain HIPAA-compliant regarding patient information; just because a hospital might be operating within a disaster doesn’t mean it can be casual or careless with personal patient information.

Once hurricanes like Harvey, Irma and Maria have passed and done their damage, the next challenge is keeping the most critically ill patients cared for. We’re seeing that now, and especially so, in Puerto Rico, which is an island. You just can’t drive trucks there loaded with food, fuel, water and medical supplies. All that has to be flown in or shipped in.

Finding Comfort

“The other challenge that we face, is unfortunately because of the severity of the hit [from Hurricane Maria] there is diminished capacity of local governments and state government to respond similar to what we saw with Texas and Florida,” said Brock Long, FEMA Administrator. “So therefore, it is requiring us to push forward a lot of resources, including the USS [sic] Comfort, which is on the way.”

The USNS Comfort is a Navy hospital ship that sails to points of distress when needed to assist medical personnel on the ground with there most dire patients and circumstances. It is heading to Puerto Rico. It has one of the largest trauma facilities in the United States. It has a supply of 5,000 units of blood, according to a U.S. Navy fact sheet about the vessel, and is equipped with a full spectrum of surgical and medical services including X-ray machines, CAT scan units, a dental office, an optometry facility, a physical therapy center and a pharmacy. The 1,000-bed ship was sent to Haiti in 2010 after a large earthquake killed upwards of 300,000 people. In 2005, the ship sailed to the Gulf Coast after Hurricane Katrina hit and more than 1,500 people were treated aboard the vessel. In 2003, the hospital ship spent two months in the Persian Gulf during the invasion of Iraq, and it also was deployed to New York in the aftermath of 9-11.

Getting medical support to areas ravaged by these hurricanes and other natural disasters can be formidable. The news media may leave these areas after the initial news is reported and the days march on; however, the support needed for medical personnel, supplies and treatment carries on for months until the area stabilizes.

Right now in Puerto Rico, according to a report by Reuters, “For hospitals across this region, the challenges are mounting. After the power went out, back-up generators at some hospitals failed quickly. Other hospitals are running critically low on diesel. Fuel is so precious that deliveries are made by armed guards to prevent looting, according to Dr. Ivan Gonzalez Cancel, a cardiovascular surgeon and director of the heart transplant program at Centro Cardiovascular,” the report said.

People line up for blocks trying to get enough fuel to power generators and vehicles, waiting for sometimes up to seven hours. Everything else there is in a shambles as well, adding to the urgency and stress. Food is scarce. The island’s electrical grid has gone down and may stay that way for months.

“Cellular service, internet, and email have virtually disappeared, hurling a modern society into a bygone era,” Reuters reported. “Radio has become a primary source of information.”

For hospitals that need to transfer critical patients because they can’t support them due to lack of electricity, the situation is dire. For them, the USNS Comfort can’t arrive fast enough. If necessary, the most critical patients can be evacuated via medevac and transferred to the USNS Comfort while it’s still underway and sailing towards Puerto Rico.

And in the meantime, if medical staff on the island can’t get gasoline for their cars, how can they even get to work to care for the sick and injured?

FEMA’s Twitter feed has been carrying photos of ongoing efforts in Puerto Rico: The American Red Cross is on the scene, as is the Salvation Army, U.S. state urban search and rescue teams, the National Guard, Customs and Border Protection is assisting, the U.S. Coast Guard, the U.S. Navy, Veterans Administration medical centers are supporting by taking in evacuated patients … it goes on and on. The effort is just massive and won’t end anytime soon. (Also see, The Guardian: Photos After Hurricane Maria)

Getting Help

All these areas – Texas with Hurricane Harvey, Florida with Hurricane Irma, and Puerto Rico with Hurricane Maria – need our continued help and support on a variety of fronts. And we also should not forget those suffering in Mexico, which was hit recently with major earthquakes resulting in a death toll of at least 333 people and counting. Here are some links and suggestions for ways you can donate, if you are moved to do so, culled from relief websites and media:

Those are just a handful of entry points for support and donations and sources for helping victims. Use your discretion for any donation should you decide to help out. Let’s hope these areas get the continued support they desperately need.

To learn more about Dr. Sudip Bose, MD, please go to and visit his nonprofit where 100 percent of donations go directly to injured veterans.