UK | Wales – ‘999? I’ve got a fly in my ear!’ – And other tales of woe from emergency dispatch

The Welsh Ambulance Service is reminding people not to call 999 unless it is a genuine emergency.

The service took 31,219 non-urgent calls in the last 12 months (see Notes for Editors), only 670 of which required an ambulance and just three of which resulted in a patient being taken to hospital.

They include a woman who dialled 999 to ask if the green part of a potato was poisonous and a caller whose daughter had drunk water from a dog’s bowl.

One woman called 999 because her boiler had broken and she had no credit to call the gas board, while one man said he needed an ambulance because he had a ring stuck on his finger.

One woman had fallen out with her brother and called 999 for advice.

The Trust is urging people to choose the appropriate service for their healthcare needs so that call takers and ambulance crews are not tied up unnecessarily when a call to a genuine emergency comes in.

Richard Lee, Head of Clinical Services at the Welsh Ambulance Service, said: “We don’t want to deter anyone from calling 999, but we want them to think twice before they do. Sadly, we still receive a significant number of inappropriate calls that do not require an ambulance response.

“When people misuse the service it means our precious time is being taken away from someone who really does need our help. During peak periods, like the summer, every non-essential call has the potential to delay a response to a serious emergency.

“Please remember only to dial 999 if someone is seriously ill or injured or their life is at risk – let’s keep our emergency ambulances for emergencies.”

The thousands of non-urgent calls received via 999 last year include:

- A man who dialled 999 because he had a fly in his ear (Milford Haven, June 2014)
- A woman who had eaten cherries and felt constipated (Porth, August 2013)
- A man who had discovered a bruise on his foot (Tywyn, November 2013)
- A woman who asked whether the green part of a potato was poisonous (Bangor, November 2013)
- A man with a ring stuck on his finger (Burry Port, June 2014)
- A woman whose boiler had broken and had no credit to call the gas board (Swansea, October 2013)
- A woman who dropped a television remote and needed someone to pick it up (Llandudno, December 2013)
- A woman who didn’t have enough money to buy a train ticket (Newport, March 2014)
- A man with a cotton bud stuck in his ear (Bridgend, August 2013)
- A mother whose daughter had drunk water from a dog bowl (Swansea, December 2013)
- A woman who was intoxicated and needed a lift home (St Asaph, April 2014)
- A woman who needed advice because she had fallen out with her brother (Hereford, November 2013)
- A man with blisters on his foot (Penmaenmawr, January 2014)
- A woman with a cast on her leg and wanted it taken off (Tredegar, January 2014)

“The emergency healthcare system across Wales is facing unparalleled pressure,” said Richard Lee.

“We are asking the public to support NHS Wales’ ‘Choose Well’ campaign to ensure busy emergency services are available for those who need them most urgently. If you think you need medical attention, but not necessarily in the form of an ambulance, there are a host of other options you can consider.”

For advice and treatment of most illnesses, visit your GP, or contact NHS Direct Wales, the health advice and information service available 24 hours a day, every day, if you are feeling unwell and are unsure what to do.

“Using this service instead of dialling 999 inappropriately will free up the valuable time of emergency call handlers, and of ambulance crews whose job is to deal with the most serious and time-critical of incidents,” said Richard.

Website users can get tailored advice on an illness or ailment by using more than a dozen symptom checkers, including the Stings Symptom Checker, Sunburn Symptom Checker, Hay Fever Symptom Checker and Mole Symptom Checker or take the Choose Well Quiz to test their knowledge on the different available healthcare services.

They can learn more about their general health through the A-Z Encyclopaedia and even search for GPs, dentists, pharmacies or support groups in their area.

And if they still cannot find the answer to their question, or need advice about long-term conditions or help with health costs, they can email their query to the team of health information specialists via the Ask Us Your Health Question section of the website.

Alternatively, anyone concerned about their health can call NHS Direct Wales on 0845 46 47, available 24 hours a day, 365 days a year, for over the phone advice from Health Information Advisers, Nurse Advisers and Dental Health Advisers.

If the problem is very serious, advisers can arrange for an ambulance on the caller’s behalf.

Treatment for minor injuries, such as cuts, bites, stings and muscle and joint injuries, can be provided at your local Minor Injuries Unit, where there is no need for an appointment.

The Welsh Ambulance Service is working hard to reduce unnecessary hospital admissions and support care close to patients’ homes.

Since September 2012, more than 5,270 patients, including non-injured fallers, and people who have suffered an epileptic and hypoglycaemic attack, have been referred on an Alternative Care Pathways instead of having to go into hospital.

Advanced Paramedic Practitioners (APPs) also provide a wider range of specialist healthcare at the scene of an incident or at a patient’s home.

Approximately 20 APPs operate throughout Wales with a further 19 currently in education and training, and latest figures show that around 50 per cent of patients seen by an APP are treated at scene or at home.

In addition, the Trust supports the discharge and transfer of patients out of hours to release beds in hospitals which in turn supports the improvement of patient flow in the emergency departments.

UK | Special reunion for Cadnam Resident with SCAS Crews who helped save his life

Tuesday last week marked a very special day for one Cadnam man as he was reunited with South Central Ambulance Service NHS Foundation Trust (SCAS) crews who helped save his life following a cardiac arrest.

Graphic artist, Andy Puntis, 55, who has been a lifelong bike enthusiast, collapsed whilst cycling on his push bike on a busy street in Totton, Southampton in March.

Fortunately, one of Andy’s neighbours, Penny Lilley, was passing him at the time and noticed Andy fall off his bike and collapse. Thanks to CPR training, Penny was able to quickly and effectively perform CPR on Andy for the first few critical minutes before SCAS land and air ambulance crews arrived. Off duty police officer Paula Symes also assisted by searching for Andy’s details.

Andy was treated and stabilised at the scene by a range of SCAS crews including ambulance crews, doctors and other emergency personnel before being taken to Southampton General Hospital for further treatment.

Since the incident, Andy is making a steady recovery and has had an internal defibrillator fitted to help prevent any further cardiac arrests.

Tuesday’s reunion at Winchester and Eastleigh Resource Centre was special not just for Andy and his family, but the crews who helped him too.

Andy said: “I had no idea how very lucky I was to survive this incident. We can’t even begin to think what life would have been like without the prompt actions of all those involved on that day, thank you can never be enough.”

Jude Millar, Team Leader for SCAS, added: “It was an honour and a privilege to meet Andy and his lovely family. I was so pleased to see him looking so well and for me that was a special moment.

“There was a huge team effort on that day from the bystanders that stopped to help, SCAS crews including the HART team and the Hampshire and IOW air ambulance who all contributed to saving Andy’s life and I am very proud to be part of that team. I wish Andy and his family all the very best for the future.”

UK | Tour de Care – Yannick helps to keep the NEAS wheels in motion


When the 101st Tour de France recently raced through Yorkshire to euphoric scenes of adulation from thousands of sports fans,  how many of those people stopped to think about the essential ‘behind the scenes’ planning that went into staging part of the world’s elite cycling showcase?

Yorkshire Ambulance Service NHS Trust (YAS) worked in collaboration with the event organisers to plan medical support for the event.

As the overarching medical framework was developed they asked North East Ambulance Service NHS Foundation Trust (NEAS) for support in implementing the plan and seconded a specialist medical care representative from NEAS to work at YAS.

He was embedded within the Tour de France planning team, working through months of intricate preparation that went into ensuring the safety of spectators and riders throughout the event.

With large-scale international sporting events such as the Tour de France, neighbouring ambulance trusts can be called upon to support their colleagues to manage the sheer extent of the operation.

The skills of Yannick Raimbault, of the Hazardous Area Response Team (HART) and Resilience Manager for NEAS, were put into practice with his previous experience of working on Le Tour in his native Nantes making him an ideal candidate for the specialist secondment. Yannick is based at HART’s main office in Russell House, Monkton in South Tyneside.

Yannick worked extensively with all twelve local authorities who were integral in securing and staging the race up and down the country.  ‘Welcome to Yorkshire’ was the lead organisation that spearheaded Yorkshire’s campaign to host the Grand Départ section of the sporting centrepiece.

Yannick supported YAS and contributed to writing and delivering the tactical and operational medical plan, coordinating the dedicated private medical providers through Venture Medical Services that would be used during Le Tour.

Alongside YAS colleagues, Yannick also worked closely with Tour de France Hub 2014 Ltd to map out the potential route decisions and judge where to best assign the nurses and doctors.

Yannick helped to put the medical framework in place and studied the research data that was produced to estimate the level of crowd attendance. This was an important element as his professional judgement and that of the YAS Medical Directorate was used to determine the overall medical provision needed to treat the expected gatherings.

Here are some impressive facts taken from the Yorkshire stages of the Tour de France:

584 people in the crowd or located within the race route were treated by YAS and hub medical teams over the course of the weekend.  Out of all those patients, only 43 were subsequently transferred to hospital for further treatment.

The medical provision at each of the identified spectator hubs certainly helped to ease the impact of such a high profile event on the ambulance service and the wider NHS.

Yannick knew from his past operational knowledge of Le Tour that spectators tended to congregate en masse in the rural areas due to the wonderful vantage points and idyllic settings. His predictions were accurate as at one point nearly 60,000 people watched the race along the winding roads of the Yorkshire Moors.

French-born Yannick, aged 42, of Ellington in Northumberland has been with NEAS for thirteen years. He comes from a strong cycling family with his father having twice taken part in Le Tour back in the 1960s, and at the age of 73 still cycles 300 miles a week.

Yannick said: “All of the thorough planning by everyone involved and team work really paid off, as the figures have shown that our intervention significantly reduced the impact on the NHS during the Tour de France.”

Yannick continues: “The successful roll-out of the whole operation was tantamount to people trusting our judgement. The distribution of appropriate medical care to particular areas of the route was justified in the number of patients we effectively treated during Le Tour.

“All of the challenges and levels of expectation were achieved through the specialist clinical and paramedic skills that were available to us.  YAS, NEAS, North West Ambulance Service and East Midlands Ambulance Service and their partners should be proud of the high level of patient care that was accomplished during this world class event.”

The famous cycling road race started on July 5th in Leeds and speeds through into France until July 27th with the riders completing 21 stages – covering a total distance of 3,664 kilometres.

NEAS provided a selection of resources and nearly 30 staff for the two-day event in Yorkshire that included four mountain bike paramedics, three ambulances and their crews and various other emergency vehicles.

No frontline vehicles or paramedics were taken from the North East resources as all of the staff involved were off-duty and volunteering their time to take part in the momentous occasion.

Yannick concludes: “The feedback we’ve received from NEAS staff who took part in the Tour de France has been excellent. They thought it was a privilege to work at such a prestigious event, and to help keep the massive crowds safe to enjoy the sporting spectacle.”

Ian Walton, Associate Director of Resilience and Special Services at Yorkshire Ambulance Service, said that Yannick has been a great asset to YAS and the TDF Hub planning team: “His focus in supporting the delivery of the medical provision for the race itself has been excellent. Our TDF planning team will miss him on his return to NEAS but I hope this leads to greater partnership working with them in the future and I would like to express my personal thanks to Yannick and all his NEAS colleagues who came to Yorkshire and helped to make the event such a great a success.”

UK | Busiest weekend yet for EEAST

While many people were out and about enjoying the sun over the weekend, ambulance staff and volunteers were working hard as they experienced their busiest weekend so far in 2014.

The East of England Ambulance Service NHS Trust (EEAST) received 6,424 emergency 999 calls on Saturday and Sunday. The service took 300 more calls that its previous busiest weekend.

Nicholas Jones, manager for one of EEAST’s control rooms, said: “This weekend was our busiest yet. We saw a particularly large volume of calls on Saturday, taking more than 700 calls extra compared to the average day.

“It’s important to remember that 999 is for life-threatening emergencies such as strokes, chest pain, breathing difficulties and serious bleeding. Other options are available, even at the weekends, such as your out-of-hours GP and the pharmacist, and of course you can always ring 111 for health advice at any time of day or night.”

The high number of calls coincided with soaring temperatures across the country, and EEAST has previously issued health advice to help people cope with the hot weather.

“We do tend to experience peaks in calls due to extreme weather such as the heat we saw at the weekend, and we’d ask people to take a moment to familiarise themselves with our safety advice, in order to keep their families safe this summer,” added Nicholas.

The ambulance service was keen to praise the efforts of its staff, with Chief Executive Dr Anthony Marsh saying: “I’m incredibly proud of how hard our staff work day in day out, and particularly on busy days such as this weekend. I’d like to say a huge thank you to everyone for their efforts over the weekend: from our call handlers, to our dispatchers, to all of the crews working on the road, and of course our volunteers.”

Read more about EEAST’s summer safety advice and follow the ambulance service on Twitter.

UK | Selling England by the pound – LAS recruiting paramedics in Northern Ireland and Australia

This week (22 July) London Ambulance Service is launching a campaign to recruit Northern Irish paramedics.

With a surplus of paramedics in the region, the Service is advertising vacancies tempting NI medics to come and work for the world’s busiest ambulance service.

London Ambulance Service’s Director of Operations, Jason Killens, said: “As the largest city in Europe and one of the most densely populated, there is never a dull moment and every single day is unpredictable. It’s fast paced, but nowhere else will you experience such diversity.

He added: “This month alone, we’ve treated patients at music concerts in Hyde Park, Tour de France which came through London and after a collision between a barge and a river bus on the Thames, and hot-weather related incidents amongst just some of our thousands of calls.”

The campaign, London, No Ordinary Challenge, aims to recruit frontline staff, including 250 paramedics and will be recruiting both in the UK and overseas.

Managing Director of the Association of Ambulance Chief Executives, Martin Flaherty, said: “The national shortage of paramedics is affecting all trusts and ambulance services are having to think of ever more creative ways to recruit to vacant posts.”

More paramedics are needed due to year-on-year increases in demand and because of a move to have more registered healthcare professionals overseeing the care of patients.

London Ambulance Service Paramedic, Josh Smith , 24, based at Pinner in Northwest London, said, “As a non-Londoner, I can vouch living and working in London is incredible and I’d recommend other paramedics to check us out. I couldn’t imagine working anywhere else after being on top of the Shard treating a patient suffering a heart attack.”

If you would like to apply to work for the London Ambulance Service, please visit:

Australian paramedics are being urged to apply now for a chance to work for the world’s busiest ambulance service in one of the most famous cities.

Up to 245 Australian paramedics who apply now will be assessed and interviewed in September when a team flies over from London to visit Sydney, Adelaide, Melbourne and Brisbane.

The Service’s Director of Operations Jason Killens said: “We’re looking to recruit paramedics from Australia where the skills and training closely match those in the UK. We’ll be in Sydney, Adelaide, Melbourne and Brisbane for interviews and assessments but medics need to apply now.

“As the largest city in Europe and one of the most densely populated, the work of London paramedics is fast paced, but nowhere else will you experience such diversity. This month alone, we’ve treated tens of thousands of patients, including those at music concerts in Hyde Park and at Tour de France which came through London.”

More paramedics are needed in London due to year-on-year increases in demand and because of a move to have more registered healthcare professionals overseeing patient care.

The campaign – London, No ordinary challenge – aims to recruit frontline staff, including 250 paramedics and will be recruiting both in the UK and overseas. The Service is offering support for prospective staff with their application, visa and relocation costs, and will cover the Health and Care Professions Council paramedic registration fee.

Once paramedics are recruited from Australia they will undergo a short conversion course enabling them to treat patients in the UK.

Emergency Ambulance Crew Verity Reinke said: “Moving from Adelaide to Europe’s biggest city was an incredible change. There are better opportunities for career progression here than anywhere else and being exposed to more diverse cases and more exciting challenges is really improving my clinical skills.

“Nothing can beat the experience of working in this city. It’s busier, faster and more exciting than anywhere else.”

If you are interested in applying to work for us, please visit

Notes to editors:

  • Medics need to apply now at to attend an assessment and interview in Australia on the following dates:
    • Sydney 8-9 September
    • Adelaide 12-13 September
    • Melbourne 15-16 September
    • Brisbane 18-19 September

Iran | Additional confirmed case of infection with MERS

On 12 July 2014, the National IHR Focal Point of the Islamic Republic of Iran reported to WHO an additional laboratory-confirmed case of infection with Middle East respiratory syndrome coronavirus (MERS-CoV).

The patient is a 67-year-old woman from Kerman Province. The patient had Chronic Obstructive Pulmonary Disease (COPD) and was admitted to a hospital on 6 June 2014 due to a COPD exacerbation. The patient was discharged on 14 June 2014 and continued treatment at home. She was in a stable condition until she developed severe acute respiratory symptoms and was readmitted to a hospital on 25 June 2014. The patient was laboratory-confirmed with MERS-CoV on 5 July 2014 and died on the same day. The patient had no history of travel and no known history of contact with animals or consumption of raw camel milk products in the 14 days prior to becoming ill. The patient did not have known contact with a previously reported MERS-CoV case. However, during her first hospitalisation, the patient had close contact with another patient with severe acute respiratory infection.

Investigation of contacts in the health care facility and family of the case is ongoing.

Additionally, Saudi Arabia reported 3 deaths among previously reported MERS-CoV cases.

Globally, 837 laboratory-confirmed cases of infection with MERS-CoV including at least 291 related deaths have officially been reported to WHO.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

UK | Continuation of whooping cough vaccination programme in pregnancy advised

Public Health England (PHE) welcomes today’s (16 July 2014) announcement from the Joint Committee on Vaccination and Immunisation (JCVI) advising the Department of Health (DH) that the whooping cough (pertussis) vaccination programme for pregnant women should continue for a further 5 years.

The advice reflects new data on vaccine effectiveness and safety published by PHE and the Medicines and Healthcare Products Regulatory Agency (MHRA).

The DH announced the temporary vaccination programme for pregnant women in October 2012, in response to a national whooping cough outbreak that led to several infant deaths. Vaccinating women against whooping cough in pregnancy (between 28 and 38 weeks) means that the mother passes immunity on to her unborn child, protecting the baby until they receive their first whooping cough vaccination at 2 months old.

Deputy Chief Medical Officer, Professor John Watson said:

Babies too young to start their vaccinations are at greatest risk from whooping cough. It’s an extremely distressing illness that can lead to young babies being admitted to hospital and can potentially be fatal. The JCVI’s advice will be welcomed by families and we will work with NHS England to ensure the programme continues to be offered to mums-to-be.

New PHE research published today in The Lancet Infectious Diseases shows that vaccinating pregnant women against whooping cough has been highly effective in protecting young infants from this potentially fatal disease. Babies born to women vaccinated at least a week before delivery had a 91% reduced risk of becoming ill with whooping cough in their first weeks of life, compared to babies whose mothers had not been vaccinated.

These findings are supplemented by the first large study of the whooping cough vaccine safety in pregnancy, published by the MHRA in the British Medical Journal. Reviewing data from around 18,000 vaccinated women from the Clinical Practice Research Datalink (CPRD), the research found no evidence of risk from the vaccine to pregnancy or the developing baby, and rates of normal, healthy births were similar to those seen in unvaccinated women.

Dr Katherine Donegan, lead author of the MHRA study, said:

Coupled with the new evidence from Public Health England on the effectiveness of the vaccine, our research should provide further reassurance on the safety and benefits of the vaccine for expectant mothers and healthcare professionals who offer the vaccine.

Out today, the latest PHE data also show an overall decline in whooping cough cases since the pregnancy programme started in October 2012. The greatest decrease in disease seen has been in infants under 6 months old, who are targeted by the maternal vaccination programme, which provides good evidence it is working.

There were 14 deaths in infants diagnosed with whooping cough in 2012 and born before the vaccination in pregnancy programme started. Eight deaths have been reported in infants diagnosed with whooping cough in 2013 and so far this year. The mothers of 7 of these 8 babies were not vaccinated in pregnancy.

PHE’s head of immunisation, Dr Mary Ramsay, said:

We welcome JCVI’s advice that the vaccination programme for pregnant women is continued, particularly while whooping cough continues to circulate at elevated levels. It has been highly effective at preventing disease, and deaths in young babies.

The latest figures show that around 60% of pregnant women have received the whooping cough vaccination, which is a testament to the health professionals implementing this programme. However, these infant deaths reminds us how important it is that every pregnant woman is informed about the benefits of the vaccine, and given the opportunity to receive it at the right time so their babies are protected from birth.

Although we have also seen a decline in cases in older children and adults from the peak in 2012 the numbers still remain considerably higher than those in 2011, suggesting the infection has not fallen to background levels.

Today, we urge pregnant women to ensure they are vaccinated between 28 and 32 weeks of their pregnancy wherever possible, although vaccination may be given up to 38 weeks. We are also working with GPs, midwives and other health professionals to ensure they have the facts at hand, including the latest evidence from the PHE and MHRA studies, to help women take up this highly effective and safe vaccine.

Whooping cough affects all ages and is highly infectious. Young infants are at highest risk of severe complications and death from whooping cough as babies do not complete vaccination until they are 4 months old. In older children and adults whooping cough can be an unpleasant illness but it does not usually lead to serious complications.

Dr Ramsay, continues:

Parents should also be alert to the signs and symptoms of whooping cough – which include severe coughing fits which may be accompanied by difficulty breathing (or pauses in breathing in young infants) or vomiting after coughing and the characteristic ‘whoop’ sound in young children. In older children or adults it may present simply as a prolonged cough.

Parents must also ensure their children are vaccinated against whooping cough on time, even babies of women who’ve had the vaccine in pregnancy – this is to provide continued protection through childhood.

France | La communauté médicale et scientifique endeuillée

Marisol Touraine, ministre des Affaires sociales et de la Santé, a appris avec une très vive émotion les disparitions de membres de la communauté médicale et scientifique présents dans le vol MH-17 de la « Malaysia Airlines » qui s’est écrasé sur le sol ukrainien.

La ministre souhaite notamment saluer les mémoires du professeur Joep Lange, éminent spécialiste de la recherche contre le SIDA, ancien président de la Société Internationale du SIDA (SIS) entre 2002 et 2004,  et de Glenn Thomas, l’un des portes-parole de l’organisation mondiale de la santé (OMS). Ils ont perdu la vie alors qu’ils se rendaient au Congrès international du SIDA qui se tient actuellement à Melbourne.

Marisol Touraine tient à adresser ses plus sincères condoléances aux familles et aux proches des victimes, à Françoise Barré-Sinoussi, présidente de la Société internationale du Sida (SIS), à Margaret Chan, directrice générale de l’Organisation mondiale de la Santé (OMS), ainsi qu’à l’ensemble de la communauté médicale et scientifique.

NC | Residents reminded to take precautions following first locally acquired cases of chikungunya virus in Florida

State health officials are urging North Carolinians to remain diligent in personal efforts to protect themselves from mosquito bites. The reminder comes on the heels of Thursday’s announcement by Florida health officials that they have confirmed the state’s first two locally acquired cases of the mosquito-borne virus known as chikungunya (chik-en-gun-ye).

Sometimes referred to as CHIKV, the virus has been spreading throughout the Caribbean and Central and South America, and has now reached the continental United States.

“Until now, people in this country who have become sick with the virus were travelers who acquired the infection abroad,” Acting State Health Director Robin Gary Cummings said. “The cases confirmed in Florida shows that the virus could eventually be transmitted in North Carolina as well.”

So far this year, the nine cases that have been confirmed in North Carolina were people who recently traveled to the Caribbean. Chikungunya virus is transmitted through the bite of an infected mosquito, and the Asian tiger mosquito that is commonly found in North Carolina could effectively transmit this virus. At this time, there have not been any cases of the disease known to have been acquired in North Carolina.

Dr. Cummings strongly encourages residents to take precautions against mosquito bites at home as well as when traveling to places that already have chikungunya and other mosquito-borne viruses.

“Perhaps the easiest and most effective thing to do around the home is to empty any containers that can hold water where mosquitoes breed,” Dr. Cummings said. “When traveling to areas known to have mosquito-borne viruses, we recommend that people take personal precautions to prevent mosquito bites and to immediately consult a medical provider if they develop a fever in the two weeks after their return home.”

Symptoms of chikungunya usually begin three to seven days after being bitten by an infected mosquito. Symptoms typically include the sudden onset of fever and severe, often disabling, joint pains in the hands and feet. Many patients feel better within a week; however, the joint pain may persist for months in some people. Newborns exposed during delivery, adults over 65 years and people with chronic medical conditions have a greater risk for a severe form of the disease.

To protect yourself and your family against mosquito bites in North Carolina and abroad:

  • Wear light-colored long pants and long-sleeved shirts.
  • Reduce time spent outdoors, particularly during early morning and early evening hours when mosquitoes are most active. However, you should exercise precautions against mosquito bites at all times.
  • Apply EPA-approved mosquito repellents such as DEET, picardin, oil of lemon eucalyptus or IR3535 to exposed skin areas. Always follow guidelines when using mosquito repellent.
  • Since mosquitoes may bite through thin clothing, spraying clothes with repellent containing permethrin or another EPA-registered repellent will give extra protection.

DHHS’ Division of Public Health strongly recommends that all North Carolina residents take measures to decrease environmental conditions favorable to breeding for the species that could transmit this infection, the Asian tiger mosquito. This mosquito is an aggressive daytime biter, breeds in small water containers and does not travel long distances.

To reduce mosquito breeding areas around your home:

  • Remove any containers that can hold water;
  • Change the water in bird baths and pet bowls frequently and repair leaky outdoor faucets;
  • Cover rain barrels with tight-fitting screens or lids;
  • Keep gutters clean and in good repair; and
  • Use screened windows and doors and make sure screens are not torn and fit tightly.

To learn more about how to prevent mosquito bites, click here.

Click here for frequently asked questions on chikungunya.

To learn more about chikungunya virus, click here.

To learn more about chikungunya and its introduction into the Americas, click here.

WA | Wildfires hold steady; fire victims begin to get help

The state’s lead fire fighting agencies—the Department of Natural Resources (DNR) and the State Fire Marshal’s Office of the Washington State Patrol (WSP)—continued to lead state government’s response today to multiple wildfires in central and eastern Washington today.

Okanogan County: Fires were cooler this morning on the Carlton Complex, but were bad yesterday as 41 homes were destroyed near Alta Lake. County emergency management estimates a total of 150-200 homes have now been destroyed in Okanogan County. The Carlton Complex has burned 299,897 acres. Brewster, Pateros, Twisp, Winthrop and other communities in the county are temporarily powering water systems and sewer services on generator. Two of the four gas stations in Winthrop have power now, making it less of a problem to gasoline and diesel fuel.

While Okanogan County has been the hardest hit due to the sprawling Carlton Complex, wildfires are also burning in Chelan, Grant, Kittitas, Lincoln, Spokane and Yakima counties.

  • The Chiwaukum Complex has burned 11,051 acres and continues to grow.

o   The Mills Canyon Fire, branch of the Chiwaukum, has burned 22,571 acres

  • The Saddle Mountain Fire in Kittitas County has burned 20,200 acres but will demobilize at midnight.
  • The Watermelon Hill Fire in Spokane County has burned 8,000 acres.

Other state activities

The Washington State Department of Transportation is working to keep roads open. The latest on road closures and openings is at

The Department of Commerce’s Energy Office says approximately 7,000 customers of the Okanogan PUD and Okanogan Electric Cooperative are without power. Power for feeders along Interstate and state highways and from there into Pateros and Winthrop is estimated to be restored by the end of week. It is estimated that full restoration along county roads and to individual homes and businesses in Okanogan will take several weeks.

The Washington National Guard has four Blackhawk helicopters, two fuel trucks and 21 personnel deployed to Carlton Complex. There are two Chinook helicopters, two fuel trucks and 17 personnel on the Mills Canyon Complex. An incident communications package staffed by five personnel is setting up at Omak. Having completed pre-mobilization preparations, 100 National Guard soldiers are standing by in Yakima to support Department of Natural Resources fire fighters. Through July 19, Guard helicopters dropped 400,440 gallons of water on fires.

Personnel from the Department of Health’s (DOH) Environment Public Health Division are consulting with wildfire-impacted counties about air quality and water quality issues. DOH and the Department of Ecology are partnering to analyze and monitor how smoke and ash are affecting air quality.

The Department of Social and Health Services (DSHS) deployed two trained crews with a total of 20 youths to support DNR firefighting efforts.DSHS and the American Red Cross are co-leading state-level mass care and emergency assistance efforts with support from FEMA Region 10.

The Department of Enterprise Services is assisting Okanogan County with a liaison to manage donations, and another liaison to support operations in the county’s emergency operations center in Omak.

Gov. Jay Inslee and Maj. Gen, Bret Daugherty from the Washington Military Department toured the Paschal-Sherman Indian Boarding School, a Bureau of Indian Affairs facility on the Colville Indian Reservation. The school is being considered for housing displaced individuals from the Carlton Complex fire, or National Guard and emergency services personnel supporting fire-fighting efforts.                                                                                                                    

Non-government agencies—The American Red Cross is operating shelters in Chelan, Omak and Winthrop and opening a shelter in Brewster tonight. The Red Cross and Southern Baptist Disaster Services began providing meals in Okanogan County today. The Red Cross is establishing a shelter in Brewster so residents from there will be closer to home. Many Brewster residents are currently using the shelter in the town of Chelan. The Chelan shelter will not close until people are no longer staying there. In coordination with the Red Cross, Okanogan County Health is contacting medical suppliers to ensure that Winthrop residents are able to get replacement oxygen bottles.

State agencies coordinate their support to the wildfire response through the State Emergency Operations Center (EOC) at Camp Murray. The Logistics Section of the State EOC is processing requests for generators from Pateros, Twisp and Winthrop. The three communities are already using back-up generators to power utility services and need more. A liaison from the State EOC’s Operations Section worked with utility officials in Okanogan County today as they assessed power requirements in Twisp and Winthrop.

Be well. Practice big medicine.