Nov/Dec 2005 - Volume 4, Issue 6

Killer Lakes of Cameroon

Two lakes in Cameroon, West Africa, emitted a hot toxic gas cloud containing carbon dioxide that asphyxiated about 1800 people, mostly while they slept, and an uncounted number of livestock and other animals in August 1984 and 1986. The names of the two lakes are Lake Monoun and Lake Nyos. A dramatic NASA zoom photo shows the location of Lake Nyos (Lake Monoun is 60 miles south) on the surface of the earth at the following URL:
http://aboutfacts.net/Things/Things5/nyosout.mpeg (accessed December 7, 2005).

1. Lake Monoun Disaster 1984

Early on August 16, 1984, Cameroon parish priest Foubouh Jean and a companion discovered a motionless man on his motorcycle on the side of the road that ran along the edge of Lake Monoun, Cameroon, West Africa. Jean ran to a nearby village named Njindoun after ascertaining that the man was dead and that the air smelled of “car battery fluid.” By 10:30 a.m. later the same morning, Cameroon authorities had located an additional 36 bodies along 600 feet of the road, apparently asphyxiated by an unknown gas as they made their way to market in the early morning. Mucus and blood exuded from the victims’ mouths and noses and their skin “showed damage” (although their clothes did not), according to a physician named Dr. Emmanuel M. Njock Bata who allegedly examined the bodies but did not perform autopsies, as per the Cameroon authorities. (1)

The Cameroon Government, which had recently survived an attempted coup, raised the possibility of foul play as the cause of the deaths, e.g., chemicals or explosives dumped into Lake Monoun. As a result, a full public accounting of the event did not occur until more than a year later in December 1985, which gave scientist Haraldur Sigurdsson, among others, sufficient time to study the situation and determine that the poisonous cloud was a natural, not a human-produced, phenomenon.

Lake Monoun, like its nearby neighbor Lake Nyos, is a “maar” located near the center of huge volcanic fields that are part of a line of volcanic activity stretching from the Atlantic Ocean into northwest Cameroon. This line is evident in the NASA zoom photo noted above. A maar is a circular low-rimmed crater usually filled naturally with water. Scientists attribute its “punched out” appearance (most noticeable from aerial shots) to formation from the sudden violent explosion of gases. Dr. George W. Kling of the University of Michigan has identified some thirty or more maar and crater lakes in the area of Lakes Monoun and Nyos. Many of these maars are less than 1000 years old. (2)

What Dr. Sigurdsson Found

Sigurdsson and his colleagues visited Lake Monoun in March 1985, seven months after the toxic cloud event. They learned from villagers that on August 15, 1984 at 11:30 p.m., a “loud noise or explosion” came from the direction of Lake Monoun. Italian tourists about four miles north of the lake reported an earthquake that was not confirmed because the local seismograph was not functioning. Sigurdsson determined that the toxic cloud left the east part of the lake, most likely from a submarine crater in the lake he discovered, which was about 1000 feet in diameter and at least 300 feet deep. The victims were located along the eastern side of the lake where vegetation was flattened for 300 feet from the lake’s edge, suggesting a water wave as much as 25 feet above lake level. Survivors located on the fringes of the cloud told Sigurdsson that it hovered less than ten feet above the ground, smelled “bitter and acidic”, and dissipated by 10:30 a.m. on August 16, 1984.

When he first arrived at the lake, Sigurdsson suspected that an abrupt volcanic eruption from under the lake exploded volcanic gases through the water, emitting an asphyxiating cloud of carbon dioxide and other gases. He based his theory on the submarine crater on the east side of the lake (source of gas?), very high levels of bicarbonate ions deep in the lake water, and his experience of hauling up from deep in the lake a capped bottle of water whose top popped off when it reached his boat.

But Sigurdsson switched his theory from a volcanic to a limnic (lake) origin of the toxic cloud. He based this change of mind on the uniformly and relatively low lake temperature (23-24 degrees Centigrade); the absence of new tephra in or around the lake; and the chemistry of the lake water and sediments, e.g., very low content of sulfur, halogens, and other chemicals typically associated with high-temperature volcanic activity. He concluded that gradual emission of carbon dioxide from volcanic vents led to a buildup of bicarbonate ions deep in the lake. An earthquake, internal seiche (wave), landslide or something else upset the density stratification of the lake’s deep bicarbonate levels, bringing the bicarbonate to the surface as carbon dioxide, which “overturned” the lake similar to the process of opening a soda bottle. Sigurdsson was unable to explain the skin damage apparent on the bodies of the deceased.

When Sigurdsson presented his findings in December 1985, many scientists deemed his explanation far fetched. The news about the Lake Monoun carbon dioxide disaster quickly faded.

2. Lake Nyos Catastrophe 1986

In a horrific apparent replay of the 1984 Lake Monoun disaster, a cloudy toxic mixture of carbon dioxide and water droplets rose violently from Lake Nyos, Cameroon, on Thursday evening, August 21, 1986, killing over 1,700 people and an unknown number of livestock and other animals, mostly while they slept. This time, many scientists from around the world converged to Cameroon to study the Lake Nyos event. A highly-recommended NASA three-dimensional photo shoot moving from Lake Monoun to Lake Nyos is available online at: http://svs.gsfc.nasa.gov/vis/a000000/a002300/a002350/ (accessed December 7, 2005).

A witness named Joseph Nkwain described the August 21, 1986 event to interpreter Dr. E. Shanklin on March 25, 1987. At the time of the catastrophe, Mr. Nkwain was at the village of Subum (about three miles from Lake Nyos) where 400 people perished and 400 lived. This is what he said:

“I was the first person to come out of the area. I was in Subum with my daughter who came to spend holidays with me. It was the evening [9:30 p.m.] of the 21st and we were sitting at the table reading, trying to help my small daughter with her studies. Then she went to bed and fell asleep; I also went to bed without noticing any sign of anything. We didn’t have any sign of anything.

“It was around midnight I didn’t even imagine the time when I started felling some heat. I felt as if rain was threatening to fall, so I got up from bed, got a bucket and went outside, expecting that rain would fall. Then I went back to the house and went back to sleep. I was in a very deep sleep. I felt as if it were becoming hot, you know when it is starting to be the rainy season, the first rain, we used to get some heat; yes; I felt that feeling that very night.

“Then I fell back to sleep; I heard some sound, something sounded like an airplane. I heard the sound. It went and bounced like this: boom. It was as if I was in a dream, I heard that noise as if I were dreaming…

“All of a sudden, my skin became very hot and I perceived something making some dry smell. I could not speak. I became unconscious. I could not open my mouth because then I smelled something terrible and could not speak. I just closed my mouth and remained silent.

“All of a sudden, I heard my daughter snoring in a terrible way, very abnormal. So I forced myself to stand up from the bed, I was already weak. I tried to see what was happening with my daughter and find out really what was smelling in the house. Id did not really know what the smell was, the smell was terrible. So just when I stood up, I fell. When crossing to my daughter's bed, in the middle of the floor, I collapsed and fell. I fell, I remained there, I didn’t stand up. I was there till nine o'clock in the morning, Friday morning. I don’t know whether I was sleeping, I don’t really know. I was there until a friend of mine came and knocked at my door. The door was locked, he hit it very loudly, so much noise that he woke me. I heard it as if I was dreaming, I was surprised to see that my trousers were red, had some stains like honey. I saw some starch, some starchy mess on my body. My arms had some wounds…these are the wounds [he showed us circular scars ½ to ¾ inches in diameter on the right and left forearms]. I had some marks here. I didn’t really know how I got these wounds, where they came from. My face, too, had some wounds, these marks. So I managed, I stood up, opened the door. I was unable to speak. I wanted to speak, my breath would not come out. I sat in silence for some time, my friend was talking outside, asking me a question, my voice would not come out. I was breathing abnormally…My daughter was already dead. I didn’t know that she was dead, I thought she was still sleeping. When I drank that milk and water, it was around 11:30 a.m. I fell back to sleep. I went to my daughter’s bed, thinking that she was still sleeping. I slept till it was 4:30 in the afternoon, almost getting to evening, on Friday. I slept with my daughter, not knowing that she was already dead. When I recovered, I really stood up at 4:30, with my clear senses. I really felt as if I was dreaming. I never knew what was happening until I went outside. Everywhere was quiet, I managed to go over to my neighbors’ houses. They were all dead. I tried my neighbors’ doors, they were bolted inside, I shouted through the window, I saw them lying. The friend who came and knocked my door, I went to him and I saw him resting the same as I did. He was just lying on the bed, he told me that he cannot stand up, he was just resting. Everybody was asleep, those who survived. Myself, what I did was I went back. I saw that my daughter was already dead. It was ten minutes to five o’clock in the evening. I felt that I had a little strength; I decided to leave because there was no vehicle, since morning. The rest of my family was absent. So I decided to leave; I thought that, this thing must have happened all over and most my family was in Wum. If I am dying, I will die on the way. I got my motorcycle; I rode. When I just started my motorcycle, I heard the sound [of the engine], it was quite normal.

“I wore my dresses, and wore my cap, I tied on some mask in case of any smell, I would not feel it much. A friend whose father died left with me to Wum…about [36 miles]. As I first arrived, I went to my boss [at WADA] I passed his door. Then he took me in his car, because I could not ride from there…I was unable to walk, even to talk. My hands were all frozen, when I reached the hospital, my body was completely weak…

“As I rode through from Subum, passing through Nyos, I didn’t see any sign of any living thing; the only [other] person was that friend I carried.” [At Nyos, 600 died, 6 lived.] (3)

What Investigators Found

Three hundred people required hospitalization at Wum District Hospital following the August 21, 1986 event. Samples taken from the lake and nearby streams and medical evaluation suggested that victims, whose locations at death were carefully charted on a map, were suffocated by carbon dioxide gas. There was no evidence of carbon monoxide or hydrogen cyanide. Many survivors reported the smell of “gunpowder” or “rotten eggs” for two days after the event and many had chemical burns on their skin.

Positions of dead animals suggested that the gas plume reached as high as 300 feet above the lake surface as it moved out of the crater, over low spots in the rim, and blanketed areas north over the outflow to the lake along two heavily populated stream valleys, west along the Cha valley for miles, south along the lake’s inflow streams, and east into a low-lying pocket. “Portions of the gas cloud had enough density and velocity to knock down corn and banana plants in a few areas as it moved outward.” (2)

“Prior to the event, Lake Nyos had been clear, but afterward the upper [30 feet] was red/brown in color, and the water had a high [carbon dioxide] content. No gas bubbles had been observed before the event, nor were there reports of earthquakes. [At the beginning of] the event, however, bubbling and low rumblings were heard by a few people living close to the lake. One witness saw a cloud that appeared to be luminous suspended above the lake for a time. Another witness observed a large surge of water wash onto a small peninsula on the south side of the lake, and F. LeGuern later measured its height at 80 m above the lake. Along the E shore the surge height reached 18 feet and water had overflowed the natural spillway to the north by twenty feet. [Associated with] the emergence of the cloud, the lake level dropped by about three feet. Carbon dioxide apparently continued to emanate from the lake water for several days after the event, as people collapsed at low-lying stream crossings.” (2)

Sigurdsson and colleagues were quickly dispatched back to Cameroon to study the Lake Nyos event. They concluded, based on their findings of uniform lake temperature, lack of sediment disruption on the flat 600 foot deep crater floor, high deep water bicarbonate levels, effervescent water brought from the deep, high iron content, and no sulfur smell, that “the gas has a magmatic source but the mechanism that triggered its release from the lake remains uncertain.” (2)

A technical team sent by the Italian Ministry of Civil Defense (huh?) arrived seven days after the event. Dr. Chiara Monzali, a medical expert with the Italian mission, concluded that the victims who had sustained first-degree skin burns were burned by a hot humid cloud of between 120 and 160 degrees Fahrenheit, and not by acid gases. This observation seemed to be confirmed by the mild damage to the vegetation in the area around the victims. “Investigations of industrial carbon dioxide accidents in the US have shown that breathing high levels of the gas can cause some failure of the circulatory system near the skin. This can lead to sloughing of the skin, producing lesions similar to those seen on some of the survivors. Survivors in some areas remained unconscious for many hours. An anesthesiologist noted that they would remain unconscious as long as high levels of carbon dioxide remained in the air.” (2) The Italian team postulated that the gas blast was produced by a sudden injection of hot fluids with a high CO2 content into the lake bottom.

One researcher named Dr. Haroun Tazieff noted the following amazing story about his colleague Rose-Marie Chevrier:

"Rose-Marie Chevrier spent 4 days at Lake Nyos, 30 December-2 January [1986-1987]. During this period, she carried out a series of measurements of the CO2 content, pH, and electrical conductivity of the air, lake water, and soil. She collected a series of gas, water, soil, and rock samples that will be analyzed in the laboratory.

"On 30 December at 1955, she felt slightly unwell as she measured the CO2 content of the air, discovering that it was ~4x the normal value that she had previously measured. The night was moonless and the weather foggy. At 1959, an explosion occurred in the lake, followed within 3 minutes by two stronger ones. The last one was accompanied by one flare of white light. The next morning, a red stain, 200 m across, was observed in the central part of the lake, which is ~800 m wide. Such a stain had been observed during the week that followed the catastrophic event of 21 August. On 31 December, Chevrier received evidence from several witnesses that similar stains had also been observed one week before. These red stains are most probably due to the colloidal oxidized iron on the silt accumulated on the lake bottom, 220 m below the surface.

“These facts tend to corroborate the phreatic [having to do with groundwater] eruption hypothesis to account for the 21 August disaster. They also show that the phreatic crisis is not yet over and that the phreatic eruption that occurred in December and probably those that could still occur will be far less violent than the 21 August event. To the contrary, the latter ones are not accompanied by a huge amount of practically pure CO2. The fact that a few minutes before the first 30 December eruption the CO2 content in the air had almost certainly been quadrupled is most likely due to the initial phase of the phreatic eruption. Experience previously acquired by the team Tazieff, LeGuern, Chevrier, and Faivre-Pierret induced us to ascribe this content increase to the sudden release of the trapped gas from its deep-seated reservoir. Such a release begins with the opening of narrow fissures in the rock reservoir cap. The affected section of these fissures allows a small amount of accumulated gas phase to escape. It escapes, because of its own pressure and the thinness of the fissure section, at very high, even supersonic, speed. The total amount of gas released during this initial phase is comparatively small but large enough to pollute the atmosphere. This initial phase ends when the total effective section of the fissure has been enlarged by mechanical abrasion of the violent gas stream over a certain threshold, above which huge amounts of gas phase may be rapidly liberated, so starting the second or main phase of the phreatic eruption. The first phase according to our own experience lasts some tens to a few hundreds of seconds. The main phase lasts until the gas pressure in the reservoir is high enough to provide the violent emission, characterizing this type of event, ending abruptly because the water acts as a stopper.”

The phreatic cause of the degassing of Lake Nyos led to a technological degassing attempt funded by the French Government and the European Union whereby a pipe was inserted into the depths of the lake to permit the gradual escape of carbon dioxide so that it did not get pent up. A description of this preventive attempt is beyond the scope of this article. For more information, go to Dr. George W. Kling’s website: “Degassing Lakes Nyos and Monoun, Cameroon, Africa” at: http://www.biology.lsa.umich.edu/~gwk/research/nyos.html; accessed December 7, 2005.

Sources:

1. “The ‘killer lake’ of Cameroon. (lethal natural cloud generated in Lake Monoun)”, Science News; 12/7/1985; Weisburd, Stefi. Available at: http://www.highbeam.com/library/docfree.asp?DOCID=1G1:4053108
&ctrlInfo=Round18%3AMode18c%3ADocG%3AResult&ao=; accessed December 7, 2005.
2. “Index of Volcanic Activity Reports” at: http://volcano.und.nodak.edu/vwdocs/current_volcs/nyos/nyos.txt; accessed December 7, 2005.
3. F. LeGuern, E. Shanklin and S. Tebor: “Witness accounts of the catastrophic event of August 1986 at Lake Nyos (Cameroon)”. “Journal of Volcanology and Geothermal Research”; 51, (1992) 171-184. Elsevier Science Publishers B.V., Amsterdam.

How Toxic Carbon Dioxide Cloud Killed 1,700 Cameroonians

The acute health effects of carbon dioxide vary with its concentration in the air and the length of time a person breathes the gas. The usual carbon dioxide content in fresh air is only 0.03%, and in exhaled air approximately 4.5%.

Persons (and animals) breathing 17-30% (or greater) carbon dioxide concentration for less than a minute will have sudden loss of controlled and purposeful activity, unconsciousness, convulsions, coma, and death, according to Environmental Protection Agency data (see http://www.epa.gov/ozone/snap/fire/co2/appendixb.pdf; accessed December 8, 2005). Carbon dioxide at these high concentrations has a direct effect on the central nervous system, and also displaces oxygen (usual amount by volume is 20.947% by volume) from the air, which leads to acute oxygen deprivation and suffocation (asphyxiation). This is the mechanism by which carbon dioxide fire extinguishers extinguish fires, i.e., they displace oxygen required by the fire (for more information, see http://www.epa.gov/ozone/snap/fire/co2/co2report.html; accessed December 8, 2005).

\

The nearly 1,700 Cameroonians and uncounted livestock and other animals who quickly succumbed to the carbon dioxide toxic clouds emitted from Lakes Monoun and Nyos in 1984 and 1986, respectively, were exposed to these very high levels of carbon dioxide (see accompanying article: “Killer Lakes of Cameroon”).

People exposed to lesser concentrations of carbon dioxide, say between 10 and 15% for one to several minutes, experience dizziness, drowsiness, severe muscle twitching, and sometimes unconsciousness. Exposure to 7-10% levels of carbon dioxide in the air for a few minutes and up to an hour for some people may result in mental clouding and confusion to the point of unconsciousness or near unconsciousness, and for other people, lesser symptoms including headache, increased heart rate, shortness of breath, dizziness, sweating, and rapid breathing. Speed of performance of reasoning task is significantly slowed at these higher levels of carbon dioxide concentration.

Mr. Joseph Nkwain, who survived the toxic carbon dioxide plume and whose interview is reproduced in the accompanying article, “Killer Lakes of Cameroon”, probably was exposed to fluctuating levels of carbon dioxide of between 7 and 15%, based on the symptoms he described. There is not a better clinical description of severe carbon dioxide toxicity than the one provided by Mr. Nkwain.

At carbon dioxide concentrations of 6% for 1-2 minutes, persons will have hearing and visual disturbances, at less than 16 minutes, headache and shortness of breath, and for several hours, tremors. At concentrations of 2-5% for minutes to hours, persons complain of headache, shortness of breath and sweating.

An Experiment You Can Perform

Earth science teacher Rod Benson of Helena, Montana, teaches his students about the density of gases with his ingenious “Lake Nyos Demonstration, which is available in a kit from “WARD’s Natural Science Establishment” for $49.95 (for more information, see http://formontana.net/nyosdemo.html and http://www.wardsci.com/Product.asp_Q_cm_E_1_A_pn_E_360730).

Three candles cut to different heights (1/2 inch, 1 inch and 1 and ½ inch) are positioned in the bottom of a clear box, as shown. Vinegar (1 ½ cups) is added to an empty jug. To the jug containing the vinegar is added ¼ cup of baking soda. After 30 seconds, the reaction between the vinegar and baking soda should end. While the reaction is occurring, someone lights the three candles. Which candle do you think will extinguish first when the carbon dioxide gas in the jug is poured into the clear box—the shortest, the middle, or the tallest candle? Then carefully pour the gas into the box.

Carbon dioxide is denser than air, so it fills the plastic box from the bottom up, just as water would. As a result, the shortest candle is snuffed out first even though it is farthest from the source of gas (jug), followed by the medium candle, and finally the tall candle.

What does this experiment have to do with the 1,700 people and animals that died in Cameroon from the toxic carbon dioxide clouds emitted from Lake Nyos and Lake Monoun? The lakes emitted a very high concentration of carbon dioxide, which, being denser than air, hugged the ground where people were sleeping and later on, traveling in low areas where the gas had collected. The carbon dioxide emission displaced the oxygen sufficiently to asphyxiate the unfortunate Cameroonians in a manner similar to the way in which the candles extinguished in the Lake Nyos Lab experiment. Indeed, Cameroonians who lived at slightly higher altitudes in the area did not succumb to the gas.

Mandatory Public Health Directives during Epidemics:
The Troubled Toronto SARS Experience

In Canada, the primary responsibility for containing infectious diseases during the 2003 SARS outbreak was supposed to reside with local governments. However, the Ontario Health Ministry became actively involved, leading to problematic mandatory directives that hospitals were unable to implement for a number of reasons.

Canada has 13 separate provinces. Ontario, its most populous province (about 11 million people in 2001), boasts 37 local public health agencies each governed by a medical officer of health and a local health board. (1-2) The province of Ontario has 160 hospitals. The Greater Toronto Area affected by the 2003 SARS epidemic has 44 hospitals.

Toronto Public Health Department

Canada’s most populous city is the capital of Ontario, the City of Toronto (population about 4.5 million in 2001). Toronto’s municipal public health unit is called “Toronto Public Health” or “TPH”. Its medical officer of health during the SARS epidemic was Toronto-native Sheela Basrur, MD. (3)

Not surprisingly, TPH is Canada’s largest public health unit. Of 1,700 employees, 300 were employed by the communicable diseases division of the TPH during the SARS epidemic. The remainder worked in divisions of health promotion, health protection, and prevention of chronic diseases. The communicable diseases division received about 40,000 communicable disease reports each year and oversaw 300 minor disease outbreaks each year, generally controlled in two or three days. (Varley, p. 6)

Ontario Public Health Department

During the 2003 SARS epidemic at the provincial (Ontario) public health-unit level, Dr. Colin D’Cunha served as chief medical officer of health, commissioner of public health, and assistant deputy minister of Ontario Ministry of Health and Long-Term Care. (4) He had been appointed to the newly created position of commissioner of public health and assistant deputy minister on January 21, 2003, just months before the SARS outbreak. When he accepted this appointment, he continued on with his earlier appointment as Ontario’s chief medical officer of health, a role he had held since 1998. (5)
Dr. D’Cunha began his career in his native India, where he graduated in medicine from the University of Bombay. After immigrating to Toronto, D'Cunha obtained a masters of health sciences degree from the University of Toronto in 1985. Before becoming Ontario’s head of public health, he had a lengthy stint as the City of Scarborough’s medical officer of public health. (6) He was replaced by Dr. Sheela Basrur the year following the SARS epidemic (February 16, 2004). (7)

Ontario Provincial Government

Dr. D’Cunha reported to Minister of Health Tony Clement, a conservative party lawyer who was appointed to his position in 2001 by Ontario Premier Ernie Eves. The offices of the provincial and municipal public health units are located in the City of Toronto.

Issuing Public Health Directives to Hospitals: Plagued with Problems

A directive is an order or instruction, especially one issued by a central authority. On March 26 Health Minister Clement announced that Premier Eves had formally declared the SARS outbreak an emergency, which automatically activated the “Provincial Operations Center” (POC) for information exchange and cooperative decision making among the 12 Ontario ministries deemed pertinent to the emergency at hand. Day-to-day management of the crisis fell to D’Cunha and Dr. James Young, the city coroner and Ontario public safety commissioner, who Premier Eves appointed co-chairs of an emergency response unit under the mantle of the POC. D’Cunha and Young reported to Health Minister Clement who kept Premier Eves informed.

Dr. Basrur (Toronto’s medical health officer) recalled that “[i]nitially there had been an assumption by the provincial authorities that we could establish a planning structure, get some advice consider on what the best approach would be, and then issue something as guidance to local hospitals.” (Varley, p. 4) But the local public health and hospital people were extremely anxious to issue directives immediately, and so the provincial leaders stayed up most of the night of March 26, 2003 crafting these emergency operating procedures.

The inexperience, anxiety, and desire for control of some of the provincial health leaders resulted in the decision to make these hastily-developed directives mandatory because “[i]f you sent out ‘guidelines’ to 100 hospitals and 100 hospital administrators and then 100 doctors got hold of them, there’d be 400 ways of doing it by the end of the day if they did it at all,” so declared Coroner Young (who did not work in a hospital). (Varley, p. 4) “The administration would think they were doing one thing, and the doctors would think another, and the nurses would get on with the job and do it their way,” he continued. This could not be allowed, even if it was unclear whether the provincial health leadership had the authority to issue/impose the “rather draconian set of restrictions on all the hospitals in the Greater Toronto Area.” The directives were so important that the provincial group faxed or emailed them to 44 hospitals (no phone calls or overnight mail here). Four days later on March 31, the ad hoc provincial health leadership extended the mandatory directives to all 160 hospitals in Ontario.

The first set of directives required hospitals to activate their emergency plan, tightly restrict access to the hospital, screen everyone entering the hospital, create a SARS unit with a negative pressure ventilation system, and require ALL hospital personnel to wear an “N95” mask, isolation gown, gloves, and protective eye ware or face shield. Hospitals were left to figure out how to comply with the directives. There was no mechanism to determine whether they did in fact comply “beyond their interest in remaining on the safe side of the law with respect to medical malpractice,” notes Varley (p. 6).

The problem with writing directives was the lack of daily data and information on which to base decisions embodied in the directives. Another problem was the chain of command through which each directive passed to “ensure accuracy” (even though 100% accuracy was impossible). For example, D’Cunha insisted that all data from the “Epi Unit” go to him so that he could ensure its accuracy before passing it on. This, reportedly, became quite a bottleneck, though D’Cunha denied that it caused any significant delays. He was, however, adamant that his department not release flawed data (e.g., counting some SARS patients twice), and preferred no data to flawed data. This drove other people crazy who preferred SOME data, even if slightly flawed, to no data at all on which to base decisions articulated in directives. Apparently D’Cunha also prohibited information flow between different groups managing the crisis, which enraged participants further and led to “sideways pathways” to get things done.

The Ontario Health Ministry sent out at least 50 bulletins and directives to hospitals and other medical settings during the outbreak. “From the perspective of the hospitals, these directives were cumbersome, overly long, and overly complicated—not at all what was needed in an emergency,” wrote Varley. The point was conceded by the Ministry personnel who said: “We didn’t have the time or the strength to be able to simplify it more than we did. The science advisory group was made up of individuals who each had expertise in an area, but had never met as that kind of a group before, and had zero time to be able to exchange knowledge enough so that we could translate the infectious disease expertise into emergency response expertise—and so it came out cumbersome.” (Varley, p. 21) (bolding by author).

“Even more exasperating to the hospitals was the fact that, based on new information and complaints from the field, the [operations center] would re-issue directives. The new version would be sent out without summaries of what changes had been made, so hospital personnel had to spend hours wading through them all over again, hunting out the new bits and pieces. The problem was that there were many changes, scattered all through the documents.” (Varley, p. 21)

Hospital administrators noted that some of the mandatory directives were impossible to comply with, such as the requirement that ALL hospital personnel don N95 masks, a requirement that wasn’t even based on evidence since no one yet knew how the virus was transmitted (e.g., N95 masks may not have been needed). As it turned out, Ontario hospitals cleaned out the entire supply of N95 masks in North America and still could not meet the requirements because not enough masks existed. The provincial staff insisted on the N95 masks. (Varley, p. 22) One planner said, “I think it is the idea that people need to be pushed to do what they need to do—and I don’t think that anybody was particularly punished for not following the directives—but there had to be a fire lit under them to understand the seriousness of the problem. And, ultimately, people were able to procure the masks, and I think there was some leeway given in terms of fit testing from Labor.”

The Root Cause of Public Health Authority-Issued Mandatory Directives

A former Ontario Chief Medical Officer of Health named Dr. Richard Schabas seemed to hit the nail on the head as to why the directive initiative failed so miserably. He argued that the “whole notion of sending out detailed directives during the outbreak was benighted from the beginning. ‘Hospitals are large and complex and, for the most part, very sophisticated organizations,’ he [said]. ‘The provincial leaders of the response were dealing with institutions that in many cases had far more expertise than they did at the Health Ministry. Basically, the Ministry’s approach was to deal with the hospitals like they were small children: ‘Here are Our Rules, written down.’ Of course, it’s enormously difficult to write a coherent policy in black and white, yet that’s what they tried to do. And of course as a result, they had to change their policies every few hours because people found flaws in them.

“They should have issued general guidelines and left it to the hospitals how they implemented them—and they should have had the capacity to respond to questions and to troubleshoot. That’s not what they did—and so there was tremendous wasted effort, tremendous ill will created between the hospitals and the Ministry.” (Varley, p. 23)

Notes:

1. Much of the information for this article was taken from the John F. Kennedy School of Government case written by Pamela Varley entitled “Emergency Response System Under Duress: The Public Health Fight to Contain SARS in Toronto (B)”. This case is available online for a modest fee at: http://www.ksgcase.harvard.edu/.
2. Please see Biot #302 “Emergency Departments and Epidemics: The 2003 Toronto SARS Experience” at: http://www.semp.us/biots/biot_302.html for additional information on the Toronto SARS experience.
3. Sheela Basrur, MD, was promoted from Toronto’s medical officer of health to Ontario’s chief medical officer of health and assistant deputy minister of the public health in 2004.
4. A power point presentation by Dr. D’Cunha is available at: http://www.csg.org/NR/rdonlyres/esnd45bpvqxgu7hqosrggbnret7qagbu3o6lueujq6d63nr4nejgqrazqv5
ozreqi6n3ajw2hsed7zekr7zrrxizy5g/D'Cunha.ppt#5; accessed December 1, 2005.
5. “Toronto: Provincial government announces new Commissioner of Public Health.”
21 January 2003 Canada NewsWire. Available at: http://www.goanvoice.ca/2003/issue2/colin.htm; accessed December 1, 2005.
6. “The politics of public health: “ ‘Province's chief medical officer under microscope.’”
Toronto (Ont) Star, 2003-03-23. Author: Betsy Powell, Staff reporter. Available online at: http://www.tobacco.org/news/120725.html; accessed December 1, 2005.
7. Newsline Canada: “Dr. Colin D'Cunha is stepping down as Chief Medical Officer of Health.” Issue 2004-02. January. 24, 2004. Available at: http://www.goanvoice.ca/2004/issue2/newslinecanada.htm; accessed December 1, 2005.

On the Road to Homeland Security
By Margaret O’Leary

Government and non-profit organizations such as law enforcement agencies and hospitals have come under increasing pressure to improve their homeland-security capabilities since the attacks of September 11, 2001 and the anthrax poisonings of fall 2001. Homeland security means preventing terrorist attacks within the United States, reducing America’s vulnerability to terrorism, and minimizing the damage and recovery time from attacks that do occur. Improving homeland security processes challenges most organizations because the threat is poorly localized in time, in space, and by kind; the organizational learning curve is steep; and the time period available for building homeland security performance systems is short. Yet accredited government and non-profit organizations can improve their homeland security performance, and accrediting bodies can help direct that process.

1. What is Accreditation?

Accreditation is a formal voluntary process whereby an accrediting body recognizes an organization as complying with certain professional standards for a limited time typically measured in years. The accreditation process circulates best practices among accredited organizations in a never-ending process; creates an impetus for organization self improvement through compliance with best practices formulated as standards; improves the level of user confidence in services provided by the accredited organization; and provides a mechanism for updating best practices among accredited organizations in response to unexpected changes in the environment, including international terrorism on US soil.

2. History of Organization Accreditation in the US

Schools first embraced the accreditation process. For example, the North Central Association Commission on Accreditation and School Improvement originated in 1895.

The hospital accreditation movement began in 1917 with the one-page “Minimum Standard for Hospitals” issued by the American College of Surgeons, which in 1951 begat (along with the American College of Physicians, American Hospital Association, American Medical Association, and Canadian Medical Association) the Joint Commission on Accreditation of Hospitals, in 1986 renamed the Joint Commission on Accreditation of Healthcare Organizations.
The law enforcement agency accreditation movement began in 1979 with the formation of the Commission on Accreditation of Law Enforcement Agencies (CALEA), created by the four major law enforcement membership associations: International Association of Chiefs of Police, National Organization of Black Law Enforcement Executives, National Sheriffs’ Association, and Police Executive Research Forum.
The fire service accreditation movement followed next in 1988 with the creation of the Commission on Fire Accreditation International (CFAI) undertaken collaboratively by the International City/County Management Association and the International Association of Fire Chiefs.

The American Public Works Association (APWA) began its innovative accreditation program in 1996.

Seven public-health partners developed public health agency standards in 2002 and named their entity the National Public Health Performance Standards Program (NPHPSP). The seven national partners are: the Centers for Disease Control and Prevention, Public Health Practice Program Office, American Public Health Association, Association of State and Territorial Health Officials, National Association of County and City Health Officials, National Association of Local Boards of Health, National Network of Public Health Institutes, and Public Health Foundation.

Table 1:
Major Accrediting Bodies, By Sector

3. Standards Development

Each accrediting body independently develops and applies standards, which are usually collected in standards manuals composed of multiple chapters. For example, the CALEA “Standards for Law Enforcement Agencies” manual has nine subject areas, beginning with “Chapter 1: Law Enforcement Role and Authority.” This first chapter contains standards relating to the role, authority, and discretion of agency personnel; clear, written policy on the use of force and deadly force; the authorization, training and proficiency testing of agency weapons; and report and review requirements for incidents where force or weapons are used. Standards in “Chapter 15: Crime Analysis” govern the collection, collation, analysis, and dissemination of data relating to crime. Standards in “Chapter 51: Intelligence” deal with procedures to ensure legality and integrity of the agency’s intelligence operation as well as the security of information and records. As discussed further below, Chapters 15 and 51 are integral to homeland security performance by local law enforcement agencies. CALEA anticipates publication of its fifth edition of the standards manual in 2006, seven years after publication of the fourth edition. A lot has happened since 1999.
Accreditation standards, which are statements of performance expectation, are typically developed via expert consensus and evidence-based research, to the degree this research exists and is available. Accrediting bodies vary in how they measure the degrees of reliability and validity of each standard before its publication. Reliability testing and validity testing are very resource intensive. Accrediting bodies sometimes choose standards based on their “face validity”, the degree to which a measure makes sense or appears to be a reasonable reflection of the variable of interest to an informed user. Face validity is the most superficial type of validity; nevertheless, it often contributes to the presumed legitimacy of a standard and is, therefore, an important consideration in gaining acceptance of a standard by standards developers and users.

4. Strengthening Homeland Security through the Accreditation Process

The accreditation award is an organization performance measure with high face validity. It indicates that the accredited organization is well led, well run, and adaptive. Updating relevant accreditation standards or adding new ones has the potential for strengthening homeland security, although the Department of Homeland Security is not pursuing this as policy, to the best of my knowledge. Instead, commissioners and other contributors of individual accrediting bodies are figuring out the place of homeland security in the accreditation process on their own. As standards manuals are updated, e.g., the 2006 CALEA standards manual mentioned earlier, more information may become available on strengthening homeland security through the accreditation process.

Community Indicator Development Task Force Update

Members of the SEMP Community Indicator Project begun in summer 2003 (see http://www.semp.us/securitas/mar_may05.htmland http://www.semp.us/securitas/aug_sept04.html) are writing chapters for the new SEMP book on strengthening community homeland security and emergency preparedness scheduled for publication in fall 2006. The following excerpt is one of the 22 draft indicators developed by the task force.

SEMP Community Indicator Project Indicator #22:
Municipal Law Enforcement Agency Accreditation in DuPage County, IL:
A Measure of Community Homeland Security Performance

I. Introduction

Municipal and county law enforcement agencies have been thrust into the war on terror. Since September 11, 2001, local law enforcement agencies at the municipal and county level have become active participants in homeland security analysis and intelligence. National law enforcement agency standards governing homeland security analysis and intelligence are published by the Commission on Accreditation of Law Enforcement Agencies (CALEA).* (1) Voluntary compliance with CALEA standards by law enforcement agencies is one measure of local homeland security performance.

II. Indicator Statement and Definitions

The indicator statement is: “Commission on Accreditation for Law Enforcement Agencies (CALEA)-accredited municipal law enforcement agencies in DuPage County, Illinois.

The Commission on Accreditation for Law Enforcement Agencies (CALEA) is an international standards-development and accrediting body headquartered in Virginia. A group of law enforcement leaders recognized the need to develop a body of standards for their profession and, in 1979, established CALEA to meet that need. CALEA is the joint effort of four national organizations: the International Association of Chiefs of Police, the National Organization of Black Law Enforcement Executives, the National Sheriff's Association, and the Police Executive Research Forum.

Municipal law enforcement agencies are the organizations chartered and empowered to enforce laws in cities, towns, or villages incorporated for local self-government. DuPage County is one of the basic units for administrative decentralization of the government of the State of Illinois established to implement state policies, programs, and services. DuPage County DuPage County contains 38 municipalities whose areas lie partly or wholly within the county.

III. Indicator Rationale

Every local law enforcement agency has a stake in homeland security. Law enforcement agency homeland security-related standards are expectations of performance. Compliance with nationally-recognized homeland security standards is thus a measure of homeland security performance at the local level.

IV. Type of Indicator

This indicator is a rate-based indicator (proportion type). The numerator is the “Number of Commission on Accreditation for Law Enforcement Agencies (CALEA)-accredited municipal law enforcement agencies in DuPage County, Illinois.” The denominator is the “Number of municipal law enforcement agencies in DuPage County, Illinois.”

# CALEA-accredited municipal law enforcement agencies in DuPage County, IL
= ________________________________________________________________

# Municipal law enforcement agencies in DuPage County, IL

This indicator measures a process, i.e., accreditation, which is linked to an outcome, i.e., local homeland security performance. The indicator measures a desirable process, that is, law enforcement agency compliance with standards AND the award of accreditation.

Dimensions of performance measured by the indicator include the following: appropriateness (the degree to which the correct homeland security operations are performed by the law enforcement agency, given the current state of knowledge), coordination (the degree to which the law enforcement agency performs homeland security processes in a congruent action across the agency, and regional, state, and federal entities), effectiveness (the degree to which homeland security processes are performed in the correct manner by the law enforcement agency, given the current state of knowledge), safety (the degree to which homeland security operations reduce terrorism risk in the community), and timeliness (the degree to which homeland security operations are performed at the time they are most beneficial or necessary).

V. Data Collection

Numerator indicator data for 1989-2005 was collected from the CALEA website at: http://www.calea.org/agcysearch/searchagcy1.cfm; accessed December 1, 2005. See Table 1.

Denominator data was collected at the DuPage County “municipalities” webpage at: http://www.dupageco.org/economicdevelopment/generic.cfm?doc_id=534; accessed December 1, 2005. See Table 2.

Table 1
Indicator Numerator Data Collection Sheet
Accredited Police Depts. by Year of Accreditation

Table 2
Indicator Denominator Data Collection Sheet
Municipalities in DuPage County, IL

VII. Data Graph
See Figure 1 below.

Figure 1
Percent CALEA-Accredited Municipal Police Departments
in DuPage County, IL, by Year (1989-2005)

VIII. Data Accessibility, Reliability, and Validity Issues

The indicator data were accessible free of charge on the Internet at the CALEA website. The CALEA database is the gold standard for data reliability for this indicator (i.e., the degree to which the data resulting from the data collection process is accurate and complete). Data validity (the degree to which the data is a reasonable representation of the phenomenon it is collected to measure) was not measured for this indicator at this time. On expert with the Miami-Dade (FL) Police Department strongly supports the validity of the accreditation data as a measure of improving homeland security performance. (2) One way to measure data validity for this indicator is to survey the data users (accredited municipal law enforcement agencies and municipal, county, state, and federal homeland security agencies) to determine the usefulness of the accreditation process in homeland security performance.

IX. Data Interpretation

The data show a strong desirable upward trend in the percent of municipal police departments in DuPage County that have voluntarily become accredited by CALEA, from 0 percent to 40 percent in just 16 years. This upward trend represents strong, innovative, and action-oriented thinking by elected and appointed municipal leaders, and their support by citizenry and businesses that provide the tax base to pay for the ongoing accreditation process.

There is still room to improve. Sixty percent of municipal law enforcement agencies have elected not to become accredited by CALEA. Homeland security requires sharing of information across municipal boundaries, which occurs best when all police departments are using the same state of the art standards to guide their operations. Unaccredited municipal law enforcement agencies may represent a potential vulnerability in the county and state homeland security fabric.

X. References

1. CALEA home webpage at: http://www.calea.org/; accessed December 2, 2005.
2. Michael Ronczkowski: “Analysis and Intelligence Driven Enforcement--The Future for Law Enforcement and Homeland Security.” Available at:
http://www.calea.org/newweb/newsletter/No85/aide.htm; accessed December 2, 2005.
3. CALEA standards: http://www.calea.org/newweb/accreditation%20Info/descriptions_of_standards_approv.htm; accessed December 2, 2005.
4. “Primer on Indicator Development and Application.” Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois, 1989.
5. “The Measurement Mandate.” Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois, 1995.
6. DuPage County statistics available at: http://www.dupageco.org/economicdevelopment/generic.cfm?doc_id=534; accessed December 1, 2005.

* CALEA was not associated with the development of this indicator by the SEMP Community Indicator Group.

The Dictionary of Homeland Security and Defense

A new SEMP book titled “The Dictionary of Homeland Security & Defense” compiled by Margaret R. O’Leary; reviewed and improved by Kifah Alsharifi, Peter Burchard, Larry Deguisne, David Dial, John Flannery, Gary Karafiat, Louise Kuhny, Ed Leab, Patrick Mullen, Dennis O’Leary, Allen Panek, Bob Plant, Jean Sloboda, Pete Smith, Dave Van Vooren, and John Wu; and in press at IUniverse Publishers, will be available for purchase in Spring 2006.

The Dictionary of Homeland Security & Defense is the first comprehensive specialty reference devoted to the lexicon of securing and defending the American homeland against terrorism. It provides readers with the most up-to-date words and terms shaping thought and action in America’s fight to stay free of terrorism. Language is a constantly changing resource, growing in some areas and shrinking in others from day to day. The lexicon presented in The Dictionary of Homeland Security and Defense paints a sharply-focused picture of the times, to be remembered for the ages.

In Memoriam: David Meyers

David Meyers, long-time SEMP contributor and friend, passed away suddenly in his Chicago home on Sunday, November 5, 2005, at age 53 years from a rupture of the aorta. David’s life was remarkable for the professional heights he reached including as executive director of the American Society of Health Risk Management, director of the publications department at the Joint Commission on Accreditation of Healthcare Organizations, and his most recent affiliation as head of risk management at the Illinois State Medical Society. He was an outstanding editor and writer, fluent in German and a German literature expert, a world traveler, a lover of jazz , and a person who especially adored the City of Berlin to which he always dreamed of moving, if he could. He leaves dumbfounded at his departure friends and colleagues throughout the United States and world who miss his unique sustaining friendship, his wicked sense of humor, and the luminous depths of his intelligence.