How Long Has It Been Since Anything Was Said About Ebola? Fresh From the CDC In Atlanta: CDCEbola (Ebola Virus Disease)U.S. Healthcare Workers and SettingsPersonal Protective Equipment (PPE)


CDCEbola (Ebola Virus Disease)U.S. Healthcare Workers and SettingsPersonal Protective Equipment (PPE)
For U.S. Healthcare Settings: Donning and Doffing Personal Protective Equipment (PPE) for Evaluating Persons Under Investigation (PUIs) for Ebola Who Are Clinically Stable and Do Not Have Bleeding, Vomiting, or Diarrhea
http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance-clinically-stable-puis.html

Who this is for: Healthcare providers in the U.S. evaluating PUIs for Ebola who are clinically stable AND do not have bleeding, vomiting, or diarrhea

What this is for: Provides guidance on the processes for donning and doffing PPE for healthcare workers and staff who are evaluating a PUI who is clinically stable and does not have bleeding, vomiting, or diarrhea

How to use this, how it relates to other guidance documents: Use this guidance with frontline and assessment healthcare facilities described in Interim Guidance for U.S. Hospital Preparedness for Patients Under Investigation (PUIs) or with Confirmed Ebola Virus Disease (EVD): A Framework for a Tiered Approach. It offers step-by-step processes for donning and doffing PPE described in Identify, Isolate, Inform: Emergency Department Evaluation and Management for Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD). These procedures do NOT apply to healthcare workers caring for patients with confirmed Ebola or to healthcare workers caring for PUIs who have bleeding, vomiting, diarrhea, or who are clinically unstable and/or will require invasive or aerosol-generating procedures (e.g., intubation, suctioning, active resuscitation). In those cases, use the Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S. Hospitals, Including Procedures for Donning and Doffing PPE.

http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/hospitals.html

http://www.cdc.gov/vhf/ebola/healthcare-us/emergency-services/emergency-departments.html

http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html

Recommended PPE:

While evaluating and managing PUIs who are clinically stable and do not have bleeding, vomiting, or diarrhea, healthcare providers should at a minimum wear:

Single-use (disposable) fluid-resistant gown that extends to at least mid-calf or single-use (disposable) fluid-resistant coveralls without integrated hood
Single-use (disposable) full face shield
Single-use (disposable) facemask
Single-use (disposable) gloves with extended cuffs. Two pairs of gloves should be worn. At a minimum, outer gloves should have extended cuffs.
In this guidance, fluid-resistant means a gown that has demonstrated resistance to water or a coverall that has demonstrated resistance to water or synthetic blood. The specific test methods that assess resistance are listed in Table 1. When purchasing gowns and coveralls, facilities should follow specifications in this table to ensure they select recommended gowns and coveralls.

Table 1. Specifications for fluid-resistant gowns and coveralls
Gown Coverall
Fluid-resistant
Surgical or isolation* gown that passes:

ANSI/AAMI PB70 Level 3 requirements
or
EN 13795 high performance surgical gown
Coverall* made of fabric that passes:

AATCC 42 ≤ 1 g and AATCC 127 ≥ 50 cm H20 or EN 20811 ≥ 50 cm H20
or
ASTM F1670 (13.8kPa)
or
ISO 16603 ≥ 3.5 kPa
*Testing by an ISO 17025 certified third party laboratory is recommended

For more details, refer to technical document Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids, which provides a more detailed explanation of the scientific evidence and national and international standards, test methods, and specifications for fluid-resistant and impermeable protective clothing used in health care settings.

http://www.cdc.gov/niosh/npptl/topics/protectiveclothing/default.html

http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html

Facilities should ensure that healthcare providers are trained and able to demonstrate competency in donning and doffing recommended PPE before being allowed to care for PUIs. Facilities should also designate areas for PPE donning and doffing as specified below (for more information, refer to the Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S. Hospitals, Including Procedures for Donning and Doffing PPE.

Ensure that areas for donning and doffing are separate from the patient care area (e.g., patient’s room) and that there is a predominantly one-way flow of movement of healthcare providers from the donning area to the patient care area or room to the doffing area.
Confirm that the doffing area is large enough to allow freedom of movement for safe doffing, has space for waste containers, a new glove supply, and alcohol-based hand rub (ABHR) for use during the doffing process.
Donning PPE

Donning PPE – This donning procedure applies to PPE recommended for evaluating and managing PUIs who are clinically stable and do not have bleeding, vomiting, or diarrhea. There is a lower risk of splashes and contamination in these situations. An established protocol, combined with proper training of the healthcare worker (HCW), helps to facilitate compliance with PPE guidance.

Remove Personal Clothing and Items: The HCW should wear surgical scrubs (or disposable garments) and dedicated washable (plastic or rubber) footwear. No personal items (e.g., jewelry [including rings], watches, cell phones, pagers, pens) should be worn under PPE or brought into the patient room. Long hair should be tied back. Eye glasses should be secured with a tie.

Inspect PPE Prior to Donning: Visually inspect the PPE ensemble to ensure that it is in serviceable condition (e.g., not torn or ripped), that all required PPE and supplies are available, and that the sizes selected are correct for the HCW.
Perform Hand Hygiene: Perform hand hygiene with alcohol-based hand rub (ABHR). When using ABHR, allow hands to dry before moving to next step.
Put on Inner Gloves: Put on first pair of gloves.
Put on Gown or Coverall: Put on gown or coverall. Ensure gown or coverall is large enough to allow unrestricted movement. Ensure cuffs of inner gloves are tucked under the sleeve of the gown or coverall.
Put on Facemask: Put on facemask.
Put on Outer Gloves: Put on second pair of gloves (with extended cuffs). Ensure the cuffs are pulled over the sleeves of the gown or coverall.
Put on Face Shield: Put on full face shield over the surgical facemask to protect the eyes, as well as the front and sides of the face.
Verify: After completing the donning process, the integrity of the ensemble should be verified by the HCW (e.g., there should be no cuts or tears in the PPE). The HCW should be comfortable and able to extend the arms, bend at the waist, and go through a range of motions to ensure there is sufficient range of movement while all areas of the body remain covered. A mirror in the room can be useful for the HCW while donning PPE.
Doffing PPE

Doffing PPE – PPE is doffed in the designated PPE removal area in the healthcare facility. As with all PPE doffing, meticulous care should be taken to avoid self-contamination. Place all PPE waste in a leak-proof infectious waste container.

1. Inspect: Inspect the PPE for visible contamination, cuts, or tears before starting to remove. If any PPE is visibly contaminated, disinfect by using an *EPA-registered disinfectant wipe.
http://www.epa.gov/oppad001/list-l-ebola-virus.html
If the facility conditions permit and appropriate regulations are followed, an *EPA-registered disinfectant spray can be used, particularly on contaminated areas.

2. Disinfect and Remove Outer Gloves: Disinfect outer-gloved hands with either an *EPA-registered disinfectant wipe or ABHR. Remove and discard outer gloves, taking care not to contaminate inner gloves when removing the outer gloves. Dispose of outer gloves into the designated leak-proof infectious waste container.
http://www.cdc.gov/vhf/ebola/healthcare-us/cleaning/hospitals.html

3. Inspect and Disinfect Inner Gloves: Inspect the inner gloves’ outer surfaces for visible contamination, cuts, or tears. If an inner glove is visibly soiled, then disinfect the glove with either an *EPA-registered disinfectant wipe or ABHR, remove the inner gloves, perform hand hygiene with ABHR on bare hands, and don a new pair of gloves. If a cut or tear is seen on an inner glove, immediately review occupational exposure risk per hospital protocol. If there is no visible contamination and no cuts or tears on the inner gloves, then disinfect the inner-gloved hands with either an *EPA-registered disinfectant wipe or ABHR.

4. Remove Face Shield: Remove the full face shield by tilting the head slightly forward, grabbing the rear strap and pulling it over the head, gently allowing the face shield to fall forward. Avoid touching the front surface of the face shield. Discard the face shield into the designated leak-proof infectious waste container.

5. Disinfect Inner Gloves: Disinfect inner gloves with either an *EPA-registered disinfectant wipe or ABHR.

6. Remove Gown or Coverall: Remove and discard.
(a) Depending on gown design and location of fasteners, the HCW can either untie fasteners or gently break fasteners. Avoid contact of scrubs or disposable garments with outer surface of gown during removal. Pull gown away from body, rolling inside out and touching only the inside of the gown.
(b) To remove coverall, tilt head back to reach zipper or fasteners. Unzip or unfasten coverall completely before rolling down while turning inside out. Avoid contact of scrubs with outer surface of coverall during removal, touching only the inside of the coverall. Dispose of gown or coverall into the designated leak-proof infectious waste container.

7. Disinfect and Change Inner Gloves: Disinfect inner gloves with either an *EPA-registered disinfectant wipe or ABHR.
(a) Remove and discard gloves, taking care not to contaminate bare hands during removal process.
(b) Perform hand hygiene with ABHR.
(c) Don a new pair of inner gloves.

8. Remove Surgical Facemask: Remove the surgical facemask by tilting the head slightly forward, grasping first the bottom tie or elastic strap, then the top tie or elastic strap, and remove the front of the surgical facemask without touching it. Discard the surgical face mask into the designated leak-proof infectious waste container.

9. Disinfect and Remove Inner Gloves: Disinfect inner-gloved hands with either an *EPA-registered disinfectant wipe or ABHR. Remove and discard gloves, taking care not to contaminate bare hands during removal process. Dispose of inner gloves into the designated leak-proof infectious waste container.

10. Perform Hand Hygiene: Perform hand hygiene with ABHR.

11. Inspect: The HCW should inspect for any contamination of the surgical scrubs or disposable garments. If there is contamination, shower immediately, and then immediately inform the infection preventionist or occupational safety and health coordinator or their designee.

*EPA-registered disinfectant wipe: Use a disposable wipe impregnated with a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus); see EPA list of Disinfectants for Use Against the Ebola Virus at http://www.epa.gov/oppad001/list-l-ebola-virus.html.

ENENews

ENENews:

(Photo Courtesty AP News)
US Gov’t Contractor: Fukushima so fragile it can turn globally catastrophic at any moment — Concern about impact to West Coast from another meltdown — Danger of something “far worse” than initial event — “Substantial risk to stability of Asia-Pacific” — National Lab: Fukushima already a global disaster
http://enenews.com/govt-contractor-fukushima-fragile-turn-globally-catastrophic-moment-concern-about-another-meltdown-affecting-west-coast-poses-substantial-risk-stability-asia-pacific-national-lab-fukushima-al


NOAA: Beaches full of dead baby sea lions off California, many aborted fetuses — Garbage bags filled with animals along coast — Carts in freezer overflowing with bodies — Official: Pollution may well have had an effect… We deliberately didn’t test for it
http://enenews.com/noaa-beaches-full-dead-babies-california-many-aborted-fetuses-lot-death-scent-rotting-sea-lion-along-coast-garbage-bags-filled-dead-animals-govt-official-pollution-effect-deliberately-didnt-test

From Alerts USA: Hospitals Told Not to Report Ebola Cases to the Public – This Is Outrageous!

FLASH: CDC insider tells AlertsUSA that U.S. hospitals being advised to NOT
publicly report suspected / confirmed Ebola cases using privacy laws as shield.  

Who do these assholes think they are?  

Using the privacy laws, in order to infect as many people as possible?  

What other reason could they have, to secret the Ebola cases?

At one time, the CDC seemed to be the good guys.  Now they are just like the rest of those who intend to harm us.  The only way to stop Ebola is to educate the people, for everyone to be properly prepared, shut down the open borders, and quit flying sick people into our country.  We know that that is not going to happen.  It does not meet the agenda of the Globalists.

MERS Virus Raising Alarms, Ukraine Nuke Plant Attacked, U.S. & Russia Trade Jabs

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May 17, 2014
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WEEKLY THREAT ROUNDUP
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MERS Coronavirus - ALLOW IMAGES
MERS Virus Raising Global Alarms
May 17, 2014
On May 12, 2014, AlertsUSA issued the following
related Flash messages to subscriber mobile devices:

5/12 (b) – CDC: 2nd MERS case a healthcare worker who flew SA Flt 113 from Jeddah > London > Boston > Atlanta. Now hospitalized in Orlando. 500+ exposed & being notified.

5/12 (a) – CDC: 2nd confirmed US case of deadly Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Florida patient. Awaiting more details from 2:00 PM press conf.

What You Need To Know

Twice this week AlertsUSA subscribers were notified via text messages to their mobile devices regarding a 2nd confirmed case the deadly Middle East Respiratory Syndrome Coronavirus (MERS CoV) here in the U.S.. This week’s case also involved an individual who traveled from Saudi Arabia through via flights through London, Boston, Atlanta and into Orlando. CDC’s Div. of Global Migration and Quarantine is working with Pan-American Health Org. (PAHO), Public Health England, Public Health Agency of Canada, and U.S. state and local public health authorities to contact and interview all travelers that may possibly have been exposed to the Florida patient between when he left Saudi Arabia and was ultimately diagnosed and quarantined here in the U.S..

As of May 12, 536 laboratory-confirmed cases of MERS-CoV infection across 18 countries have been reported by the WHO, of which 145 have died. All reported cases have been directly or indirectly linked through travel or residence to seven countries: Saudi Arabia, UAE, Qatar, Oman, Jordan, Kuwait, and Yemen.

As previously reported by AlertsUSA and Threat Journal on multiple occasions since the virus was first identified in the Spring of 2012 (see this and this), public health and epidemiology professionals tend to cringe each year when the annual Hajj pilgrimage to Mecca rolls around, planned this year for the first week in October. It goes without saying that when millions of international travelers from all points on the globe converge in one city for a physically active, horrendously overcrowded, hot and humid gathering involving communal shaving, touching common surfaces and staying in tightly packed quarters, one is considered lucky to leave without having contracted some respiratory or digestive bug, if not worse. Even a cursory search of the Internet shows that cholera, pneumonia, meningitis, all forms of hepatitis , measles, mumps, typhoid, dysentery and a host of other communicable diseases run rampant during the Hajj. Then the Pilgrims, just a quickly, return to their countries of origin.

BioMosaic Map - ALLOW IMAGES

While this year it is widely reported that camels appear to be the primary hosts for the virus, listeners may recall that in 2012 and 2013, health authorities were reporting that genomic analysis suggested that the coronavirus circulated among bats before jumping to humans.

CDC WARNING TO CLINICIANS

In the May 14th edition of the Morbidity and Mortality Weekly Report, the CDC cautioned clinicians and other healthcare professionals of the need to consider MERS-CoV infection in persons who have fever and pneumonia or acute respiratory distress syndrome and either a history of travel from countries in or near the Arabian Peninsula within 14 days OR close contact with a symptomatic traveler who themselves have traveled to the region within 14 days. Additionally, the CDC points out that individuals who have recently traveled may seek medical care far from cities that are served by international flight connections. Therefore, all health care professionals should be cautious and ” prepared to consider, detect and manage cases of MERS.”

On Wednesday the World Health organization reported that while concern about the virus had “significantly increased,” the disease was not yet a global health emergency. Late this week Saudi health authorities reported 20 new cases as well as 10 more deaths.

Despite the WHO statement, 22 international airports across the U.S. this week began prominently displaying health advisory posters from the CDC warning of the MERS virus. In addition to educating travelers about the symptoms of MERS, the posters warn those who travel to the Arabian Peninsula (including Bahrain, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Palestinian territories, Oman, Saudi Arabia, Syria, the United Arab Emirates, and Yemen) to wash their hands often, avoid touching their face, and to avoid close contact with sick individuals.

RESOURCES

World Health Organization (WHO)

MERS-CoV page
Latest Case Updates
Latest Risk Assessment (Apr 24, 2014)
Interim Case Definitions (Jul 3, 2013)
Interim Surveillance Recommendations (Jun 27, 2013)
Risk Factors for Health Care Personnel (Jan 27, 2014)
Clinical Management (Feb 11, 2013)

Centers for Disease Control (CDC)

MERS-CoV page
Case Definitions (Aug 19, 2013)
Infection Prevention and Control Guidelines (May 4, 2014)
Interim Guidance for Healthcare Professionals (May 2, 2014)
Interim Guidance for Home Care and Isolation (Sep 27, 2013)
Information and Guidance for Travelers (May 12, 2014)
Information and Guidance for Clinicians (Jun 18, 2013)
Information and Guidance for Airline Crews (Mar 10 , 2014)

Public Health Agency of Canada (PHAC)

Risk Assessment (May 12, 2014)
Interim Case Definition (Sep 23, 2013)
Public Health Notice (May 7, 2014)
Travel Health Notice (May 8, 2014)
Infection Prevention and Control Guidance (Oct 4, 2013)

PERSONAL RISK MITIGATION

In public health emergencies, officials will ALWAYS downplay a threat so as to minimize panic. Thus, while it is important to follow what officials SAY, it is equally important to watch what the professionals actually DO.

If the CDC is hanging MERS warning posters in airports and issuing guidance to healthcare professionals on identifying, isolating, caring for infected individuals and protecting staff (see this and this), these are clues that perhaps you should be taking some steps on your own to protect yourself and family. In the event that the MERS coronavirus infections become more widespread, the following items will disappear from availability overnight:

Medical Grade Skin Cleanser

In principle, it is the current understanding that the MERS-CoV can be transmitted by three routes: aerosols, large droplets, and direct contact with infected surfaces and secretions. One of the best risk mitigation steps you can take is to acquire a medical grade skin and surface cleanser. One of the gold standards in hospitals and other clinical settings is Chlorhexidine Gluconate, which is sold under the product name HIBICLENS. The product is intended for use as a surgical scrub and personnel hand wash, a patient pre-operative skin preparation and a skin wound cleanser. The antimicrobial cleaner bonds to the skin to create a persistent antimicrobial effect and protective germ-killing field against a wide range of microorganisms.

Hibiclens Chlorhexidine Gluconate
Medical Grade Skin Cleanse
r

Particulate Masks / Respirators

An ESSENTIAL risk countermeasure for reducing the spread of MERS-CoV, not only for caregivers but also for the sick, is to acquire a supply of N95 particulate masks. The N95 respirator filters at least 95% of airborne particles, is in wide use within hospitals and will be impossible to find during a any major disease major outbreak or pandemic. These are (currently) inexpensive and a critical element for one’s preparedness supplies.

NIOSH-Approved N95
Particulate Masks / Respirators

AlertsUSA continues to closely monitor the overall situation with the spread of the MERS virus and will immediately notify service subscribers of reports of new U.S. cases or the release of updated information from health authorities indicating an increased threat environment as events warrant.


AlertsUSA.com

OTHER ALERTS ISSUED THIS WEEK

5/12 US STRATCOM begins major nuclear arms drill involving cross spectrum DoD resources. Expect heightened security + gate delays at mil bases nationwide & abroad.

5/14 San Onofre nuclear power plant near San Diego now being evacuated due to approaching wildfire. Monitoring…

5/17 Overnight: USGOV issues travel alert for Thailand, partic Bangkok, due to political & social unrest over gov corruption. Avoid all protests, vigilance urged.

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NATO Military Exercise - ALLOW IMAGES
U.S. and Russia Trade Jabs,
NATO Launches Massive Military Drills,
Ukraine Nuke Plant Attacked
May 18, 2014
On May 13, 2014, AlertsUSA issued the following
Flash message to subscriber mobile devices:

5/13 – Russia to end operation of all 11 U.S. GPS stations on Russian territory on 6/1, + bans U.S. use of Russian rocket engines for defense satellite launches.

What You Need To Know

On Tues of this week AlertsUSA subscribers were notified via text messages to their mobile devices regarding Russia’s response to the latest round of economic sanctions.

According to Russian Deputy Prime Minister Dmitry Rogozin who is himself a target of U.S. sanctions, Russia will ban the U.S. from using Russian-made MK-33 and RD-180 rocket engines for launching defense satellites. The engines are used to power Atlas V rockets lofted by United Launch Alliance LLC, a joint venture between Lockheed Martin Corp. and Boeing which is currently the sole supplier of rocket launches for the Pentagon. A day after Russia’s threat, Pentagon spokesman Col. Steve Warren revealed that United Launch Alliance has a two-year supply of the engines already in hand.

Rogozin also told reporters that Russia will not be extending its role in the Int’l Space Station beyond 2020, thus indirectly threatening the taxi service for U.S. astronauts. He also stated that Moscow would switch off 11 U.S. Global Positioning System satellite ground stations in Russia on June 1 unless the U.S. allows placement of similar stations in the U.S. for Russia’s competing Glonass system. It is reported that the loss of the GPS stations across Russia would result in a decrease in system accuracy in the region.

[ It is interesting to note that on Thursday, two days after Rogozin’s threats, a Russian rocket failed 9 min into it’s flight while attempting to loft an advanced communications satellite into orbit. The unmanned Russian Proton-M rocket was launched from the Baikonur Cosmodrome in Kazakhstan. A Stuxnet coincidence perhaps? ]

Late this week the Kremlin announced it would be holding a large military drill involving dozens of fixed wing fighter aircraft and attack helicopters within the three military regions directly on the border of Ukraine in the days leading up to and on the day of Ukraine’s national elections (May 25th).

The announcement was followed by yet another threat from Secretary of State John Kerry who warned, “If Russia or its proxies disrupt the elections or stand in the way of the Ukrainian people being able to exercise their vote, that is when and if there would be additional sanctions.”

On Friday NATO kicked off a major military exercise in Estonia involving 6000 troops from nine countries. Known as “Steadfast Javelin 1” the exercise is based on a fictitious scenario and involves allied forces repelling an attack on Estonia. Participating units include an extensive array of air and ground forces.

LATE ADDITION – Nuclear Power Plant Attacked

Reports are emerging regarding some type of attack on one of Ukraine’s nuclear power facilities (see this and this). Given the experience of the country with the Chernobyl disaster, one can logically assume that authorities would intentionally downplay / distort / alter / or otherwise intentionally misrepresent the details so as to prevent panic. We remind readers that just one week ago, Threat Journal reported that NATO had deployed security advisers to Ukraine to specifically address security issues at the country’s nuclear power facilities.

AlertsUSA continues to closely monitor the increasingly tense situation in Eastern Europe and will immediately notify service subscribers of changes in the overall threat environment, major escalations and force deployments or the outbreak of hostilities as events warrant.


Travel Security Update

The U.S. Dept. of State is the authoritative federal source for information on the security situation at travel destinations worldwide. With tensions rapidly increasing in most regions, readers planning on international travel, even to such common destinations as Canada, Mexico or the Caribbean Islands, are strongly encouraged to do a little research on the security situation prior to departure.

New USGOV Travel Alerts and Warnings

05/16/2014
05/15/2014
05/08/2014
04/10/2014
See all USGOV Travel Alerts and Warnings HERE.

Take Advantage of These Resources

Our social media channels provide a steady steam of important news and resources between issues of Threat Journal with little or no overlap of content. Combined with the AlertsUSA service for instant mobile notification of the really bad developments, you have an unmatched set of tools to keep yourself fully up to speed on the nation’s threat environment. With times getting worse by the day, we urge you to utilize these resources.

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Ezekiel 33:2-6

But if the watchman sees the sword coming and does not blow the trumpet to warn the people and the sword comes and takes someone’s life, that person’s life will be taken because of their sin, but I will hold the watchman accountable for their blood.”