Friday
Apr012016

VOL. 16, NO. 3 - APRIL, 2016

Mark Your Calendar

  • Apr 01-30: On-Call
  • May 14: Team Meeting
  • Jun 08-10: Moffett FTX
  • Jul 01-31: On-Call
  • Aug 13: Team Meeting
  • Sep 09-12: Urban Shield
  • Oct 01-31: On-Call
  • Nov 05: Team Meeting
  • Dec 03: Holiday Party

Monthly Recap

Commander's Corner - Updates from the Commander
The Logistics Scoop - From your Logs Chief
Fitness Self-Assessments - Next steps in the fitness program
Who Are We? Meet the Team - Getting to know more members
Citizen of the Year - Kudos to one of our own!

Friday
Apr012016

Commander's Corner

David Lipin - Unit Commander

Welcome to April, our second on-call month of 2016! It's been a "slow news" month for us, especially since I updated everyone at our team meeting only a few weeks back. So not much from me this month:

Moffett FTX Planning

The planning cycle is well underway for this year's FTX in June. We're still looking for some help on the planning team though, so let me know if you're interested. There are only a few weeks left, but so much left to do!

It's looking to be another fun year; looks like we'll add a medical/rescue helicopter or two to the mix this year, along with our usual partners from FEMA US&R, VA, EMSA, and NASA. Coast Guard might jump in as well (no pun intended, even though it's April Fool's day)!

Monthly Status Reports

Thanks to everyone who noticed that the meeting attendance stats were "off" for the March monthly status reports. That problem has been fixed, so hopefully you'll see a change for the better when the April reports come out next week.

Pilot Project

You will soon hear directly from HQ about a pilot project partnering NDMS with the Secret Service. This is a high-intensity pilot, so if you're interested you should be prepared for lots of additional work and time demands, as well as meeting the Arduous fitness standard. And of course this is in addition to your regular commitment to the team. When the info comes out, contact me if you're interested and qualified.

Dare to Prepare Day

EMSA is participating in the Dare to Prepare Day on Saturday, 30 Apr, 1100-1500 hrs at the Sunrise Mall (6041 Sunrise Mall Rd, Citrus Heights, near Sacramento, in the North/East mall parking lot). Dare to Prepare Day is a disaster preparedness day for the public, with many federal, state and local public agencies setting up demonstrations and equipment. EMSA will be showcasing some of its response vehicles and CAL-MAT assets. They are looking for some volunteers to represent CAL-MAT during this event. EMSA will set up a single CAL-MAT tent, and simulate responses to different disaster scenarios. This will be an important opportunity for EMSA’s CAL-MAT program, and a very visible media campaign as well. All volunteers will be wearing their CAL-MAT uniforms, and this event will be aired on live TV.

All CDMSA/CAL-MAT members are welcome to participate. Contact me if you're interested.

Training and more training

We have quite a few team members "on the road" for training over the next few weeks:

  • Currently, Keith Perry is in Frederick, MD for a Safety Officer's training session, 28 Mar - 02 Apr.
  • Brandon Bond will be heading to Anniston, AL to serve as Safety Officer for the DMAT Fundamentals session, 03 - 09 Apr.
  • Hunter will be in Anniston, AL for training with Logistics personnel from other teams, 18 - 23 Apr.
  • Then we are sending Mark Caplin, Roger Harper, Cynthia Hellman-Wylie, Mark Weston, and Ada Wong to Anniston, AL for the DMAT Fundamentals course, 01 - 06 May.
  • And finally, Hunter and Carol Masterson are scheduled to deploy for the Peace Officers Memorial in Washington DC, in conjunction with being trained on the new Mobile Lifesaving Kit that the team will soon be receiving, approximately 14 - 18 May (still in the mission planning phase).

We hope they'll all bring back some good stuff to share!

ANCC needs your help

[Submitted by Carol Masterson, RN] The American Nurses Credentialing Center is looking for healthcare professionals with disaster experience to help develop a new multi-disciplinary certification: National Healthcare Disaster Certification. If you're interested, click here for a short screening survey (deadline 10 Apr).

That's it for me this month. Pack your gear and keep an eye on the news for the month!

Friday
Apr012016

The Logistics Scoop

Joseph Telles - Logistics Section Chief

The next Logistic Section meeting will be May 10th, by conference call starting at 6:30 pm. Directions for participation in the conference call will be sent out by email to participants on the Logs email list. If you are not on this list and would like to be added, send me an email (see Contact Us link on the team website). All team members of DMAT and CDMSA our welcome to attend the Logistics meetings.

Advanced Shelter Systems training took place on March 19th on Treasure Island. We had six team members attend the joint training with San Francisco Public Health and San Francisco Fire. Our next shelter training will be at our May team meeting. For those of you that have not set up shelters (or if it has been a long time since you’ve done so), please attend this training. Remember: all of us our Logistics members, especially when it comes to basecamp set up. It is not the optimum or safest situation to train people in shelter set up at an incident.

A reminder to all Logistic Section Members to continue your physical preparation to meet the arduous fitness standard of walking 3 miles in 45 minutes with a 45 lb. pack (lower of 45 lbs or 20% of your body weight). At the next team meeting I would like to see all Logistics Section members do 2 miles with a 25 1b. pack at the next lunch walk. A heads-up for Logs folks, at the August meeting our goal for Logs personnel will be walking 2 miles with a 45 lb. pack in 30 minutes!

Friday
Apr012016

Who Are We? Meet the Team!

Welcome to a series of profiles of Team members. Please answer a few questions about yourself using the Member Background link on the website so we can include you too!

Jimmy Duarte, Communications Officer - In real life, Jimmy is a Communications contractor and COO of a San Francisco video surveillance firm. He was recruited by David Otey, and has been a member for two years. He enjoys public service and helping people. He says, "It is very rewarding to provide the infrastructure for the medical team to perform with. It is very challenging to be tier one deployable." His most interesting deployment was the Pope Francis visit 2015. His passion? "My passion is communications from radio to video overt to covert. I live and breathe communications and IT systems." And he likes sailing on the Bay!

[Photo of Jimmy at work in Alaska, -30° F]

Laura Miller, NP - has been on the team for eight years as a Family Nurse Practitioner. Her personal goal was to become a participant in disaster medicine, and she says, “The deployments have been very gratifying; I've enjoyed the opportunity to take my medical skills, and apply them to populations in dire need. I feel that there has been a slow evolution to incorporate the Nurse Practitioner role; but it has been evolving.” She adds, “Haiti was quite interesting, I also lived in Banda Aceh after the tsunami for a month, which was quite an interesting experience.” She loves being out in nature, music, reading.

Gregg Hauser, IT, EMT - with a background in architecture, illumination engineering, computers, network administration, and child care, Gregg aspires to be a good EMT, a contributing traveller, and a physicist. His day job includes being a dad, and volunteering as an EMT with event medical groups. He was recruited by his wife, Judy O’Young. As for DMAT, he's been "awaiting the IT position definition since 2009", in addition to being an IT teaching assistant and a Comm instructor since 2015. Most rewarding forming teams and the personal bonds that go with performing as a team. Challenging: jumping into the middle of situations and figuring out how to improve them. His missions have been equipment repair/medical secretary/gopher/caterer/medical transport/recovery room tech on medical missions before he had kids. Gregg adds, "Communications are supposed to be plain English, free of jargon. I still use 'copy' to acknowledge messages. LoL"

Friday
Apr012016

Fitness Self-Assessments #2

Joseph Telles - Logistics Section Chief

A good exercise program combined with eating healthy for each of us can result in amazing changes both physically and mentally resulting in a higher quality of life. An example of this is one of our own team members, John McPartland. Two years ago, John weighed 265 lbs. and was diagnosed with pulmonary problems causing respiratory difficulty that was life threatening. He was also told by his doctor that he was borderline hypertensive and also well on his way to becoming a Type 2 diabetic. John decided to make a drastic life change, making a commitment to an exercise program along with changing his eating habits.

Today he weighs 195 lbs. (a 70 lb. loss). John’s swimming regimen has compensated for the pulmonary problems he encountered in 2012. He has regained lung capacity to breathe normally and even resumed deep sea diving, his blood pressure is normal, and he is no longer considered pre-diabetic. John states, "My energy level has tripled along with my quality of life!" John is an inspiration! Here is John’s workout:

  • 3 times a week swim 1 mile (combination of strokes and kickboard)
  • 2 to 3 times a week ride stationary bike for 30 to 60 minutes.

Based on our last lunch walk it looks like the majority of our team has started the process of preparing for the fitness assessments later this year. So for those of you that have been walking or working out 3 or 4 times a week without experiencing any injury or health problems it is time to add another workout day to your routine. Your goal now should be working out four or five times a week continuing to build up your endurance.

For those that have built up their endurance after two or three months of working out, it is time to think about customizing your walking and fitness program to  specifically prepare yourself for the upcoming fitness assessments. To increase your endurance to an even higher level you should now walk a minimum of 40 minutes. Successful exercise programs that prevent injury use a philosophy of rotating hard and easy days. A four-day program meeting our goals of building walking spend and endurance would be the following:

  • Monday – 40 minutes of slow walking with a 10 to 20 lb. pack
  • Tuesday – 40 minutes of walking without pack consisting of 10 minutes slow walking, 20 minutes of fast walking at your target heart rate, and finishing with 10 minutes slow walking
  • Wednesday – Day off
  • Thursday – 40 minutes of slow walking without pack
  • Friday – 40 minutes of walking with a 10 to 15 lb. pack consisting of 10 minutes slow walking, 20 minutes of fast walking at your target heart rate, and finishing with 10 minutes slow walking.
  • Saturday – Day off (do something fun but physically active)
  • Sunday – Day off (do something fun but physically active)

For our team meetings we'll continue to schedule an extra half hour for lunch to make it more convenient for team members to participate in the walk. Remember to bring comfortable shoes to walk in and also your go bag to carry. If you are unsure about your fitness level or medical condition for these walks, you should check with your physician or ask Brian Blaisch or Ari Stern (our Medical Director and Deputy Medical Director; email them using the Contact Us link at the top of the website page). It never hurts to schedule a physical checkup with your physician that includes a stress and fitness evaluation.

For those of you interested in sharing your health story or fitness program please send me your information via email. Thanks.

Friday
Apr012016

Citizen of the Year

Belvedere has chosen our own Dr. Tom Cromwell as its 2015 Citizen of the Year in honor of his decades of service to the Tiburon/Belvedere peninsula. Tom has worked tirelessly to get the communities, on an isolated peninsula with limited access, prepared for disasters. He lobbied for a first aid base, organized citizens into block captains, and has trained citizens to be prepared. He has been called “the Tiburon peninsula’s godfather of emergency response,” by a city council member.

Tom credits his 2005 DMAT deployment to Hurricane Katrina for his inspiration to make sure his community was prepared for a disaster. Tom has also served on the City Council, and was the Mayor of Belvedere. He is currently the chair of the Southern Marin Branch of the Marin Medical Reserve Corps, and is the Vice-President of the MMRC Foundation. He was a volunteer firefighter and medical consultant with the Tiburon Fire Department 35 years ago and he helped develop the paramedic program in Marin. Currently he chairs the Belvedere/Tiburon Joint Disaster Advisory Council and is on the board of directors of the Southern Marin Emergency Medical Paramedic System.

Tuesday
Mar012016

VOL. 16, NO. 2 - MARCH, 2016

Mark Your Calendar

  • Mar 19: Logs Training Day
  • Apr 01-30: On-Call
  • May 14: Team Meeting
  • Jun 08-10: Moffett FTX
  • Jul 01-31: On-Call
  • Aug 13: Team Meeting
  • Sep 09-12: Urban Shield
  • Oct 01-31: On-Call
  • Nov 05: Team Meeting
  • Dec 03: Holiday Party

Monthly Recap

Commander's Corner - Updates from the Commander
The Logistics Scoop - Logistics Section meetings and training days
Fitness Self-Assessments - More details on the program and getting started
Ch...Ch...Changes... - AHA changes to CPR and emergency cardiac care
App Review - Help your community with CPR and AEDs

Tuesday
Mar012016

Commander's Corner

David Lipin - Unit Commander

Happy March, everyone. It seems like the Bay Area managed to survive the Super Bowl; I hope all of our members who were involved through their day jobs are finally unwinding and catching up on their "real" work backlog!

I don't have much to say this month that I didn't cover at our Feb team meeting (great to see everyone after our winter/holiday hiatus), but that's ok because we have plenty of good stuff this month. Speaking of which, we're always looking for newsletter contributors so if you've got a favorite app for your phone, or widget for your gear, or relevant disaster or medical topic you'd like to write about, please let me know.

And now on to the few items I've got for this month:

April On-Call

Don't forget that next month is an on-call month for us, and we need as many people as possible for roster coverage! Sign-ups "close" on Mar 05; you can still sign up after that and we may still roster you, but you won't get on-call credit for it because we'll have already requested backfill from another team if we need it.

Anniston FTX

We still have one opening available for the field training exercise (FTX) opportunity in Anniston, AL, May 02-07. This is a USERRA-covered training that includes salary and covers travel expenses. Details are in the Training News newsletter article from last month. It's a great opportunity, so let me know if you're interested.

NDMS Code of Conduct

We received quite a few email inquiries about the mandatory NDMS Code of Conduct class showing as incomplete on members' status reports. HQ has corrected this problem, so if you've completed this online course (and the associated user survey) then it should appear "complete" on your next monthly status report later this week. If not, please let me know and we'll look into it further. You do not need to submit completion certificates for this (or any other) Responder eLearn course.

Meet the Team

Many members have commented about all of our "new" faces on the team (hard to believe that most have been with us for more than a year now!) and have asked about their background and history, and I'm sure the newer members also have the same questions about the more senior members.

To address this, Katie Amatruda would like to slowly introduce members to each other via very brief segments in the newsletter that are more interesting than a standard bio. So we'd like team members to answer a few questions via a form on the website. When you have a few minutes, please log into the website and click the Member Background link on the right side to answer a few questions about yourself. Don't ponder long and hard on your replies, just a few short sentences will do! You can even upload an interesting photo of yourself. Katie will write up a few members for each article. Thanks!

Tuesday
Mar012016

The Logistics Scoop

Joseph Telles - Logistics Section Chief

At the Feb 18 Logistics Section meeting, we finalized the Logistic meeting schedule for the rest of 2016. The meeting dates will be May 10, Aug 09, and Nov 01, all by conference call starting at 6:30 pm. All members are welcome to attend the Logistics Section meetings. Directions for participation in the calls will be sent out by email to participants on the Log’s email list; contact Joe Telles if you’d like to be added to the email list (click on the Contact Us link at the top of the website after logging in).

In addition to quarterly Section meetings, the Logistics Section conducts logistics training a few days each year. The first of these this year will be Mar 19, and the rest will be announced as they are finalized. On Mar 19, we will conduct Advanced Shelter Systems training on Treasure Island off the Bay Bridge. All members (particularly new members) are encouraged and welcome to attend this training session. Setting up the shelter system quickly yet safely takes coordination and teamwork, which are built by practicing and working together! So get your gloves on and help set up tents! If you plan on attending, please RSVP to Joe Telles. I would like to thank the City of San Francisco and Steve La Plante for letting us use San Francisco's shelter systems and training location.

A reminder to all Logistic Section members that logistic personnel should target the arduous fitness standard of walking 3 miles in 45 minutes with a 45-lb pack. This is not easy, so begin your training now if you have not already done so. Also it was noticed that nearly all of the logistic personnel participated in the lunch walk (one missing). Good job!

Thanks to all the team members that helped with the cleanup of the training facility after the Feb team meeting. All team members should make every effort to help with cleanup at the end of the team meeting – we notice those who do (and don’t)! This last team meeting it took only 20 minutes to clean up with all the help available. Thanks again to everyone who helped out; your Logs Section appreciates it!

Tuesday
Mar012016

Fitness Self-Assessments

Joseph Telles - Logistics Section Chief

Wow! What an outstanding turnout for the walk at the last team meeting; over 50 people participated in the 1-mile walk to the nearby mall for lunch. Many team members carried their go bag, loaded to 25 lbs. Thank you to Steve Woolpert for setting the pace. Among the many participants in the brisk walk were our Team Commander Dave Lipin and our Medical Director Brian Blaisch, reinforcing how important these walks are as we prepare for the upcoming fitness assessments. We will continue to have these walks at each team meeting as we prepare for our fitness assessments. So next team meeting remember to bring comfortable shoes for the walk.

It is still early in the year, so we still have plenty of time to prepare for this, For those of you that haven't exercised in a while and are just getting started, don't concern yourself with your walking speed. Just focus on walking, starting at 20 minutes 3 times/week and slowly increase as you get comfortable. The goal for all of us in this early preparation stage is to build up endurance, create muscle memory, and avoid injury with a manageable exercise program.

After one or two months of walking 3 to 4 times a week, most of us will begin to feel comfortable walking and will have an adequate fitness foundation to add fast walking to our exercise routine. A good way to increase your speed is to add fast walking by increments at a walking speed where you feel no pain but where you feel exertion. You should walk fast enough where you put yourself at the upper end of your target heart rate.

Here is an example of a workout to increase your walking speed. In a 30-minute walk you will start out going your normal comfortable pace for 10 minutes, then you will go at a faster pace for the next 5 minutes, then you will slow down to your comfortable pace for another 5 minutes, then once again your faster pace again for 5 minutes, and finally a slow pace for 5 minutes to finish up your walk. You should do this at least once or twice a week in order to increase your walking speed.

Below is a target heart rate chart provided by the American Heart Association. The figures are averages, so use them as general guidelines:

     Age Target HR Zone 50-85% Average Maximum Heart Rate, 100%
     20 years 100-170 beats per minute 200 beats per minute
     30 years 95-162 beats per minute 190 beats per minute
     35 years 93-157 beats per minute 185 beats per minute
     40 years 90-153 beats per minute 180 beats per minute
     45 years 88-149 beats per minute 175 beats per minute
     50 years 85-145 beats per minute 170 beats per minute
     55 years 83-140 beats per minute 165 beats per minute
     60 years 80-136 beats per minute 160 beats per minute
     65 years 78-132 beats per minute 155 beats per minute
     70 years 75-128 beats per minute 150 beats per minute


Important Note: A few high blood pressure medications lower the maximum heart rate and thus the target zone rate. If you're taking such medicine, ask your healthcare provider if you need to use a lower target heart rate.

For our team meetings we'll continue to schedule an extra half hour for lunch to make it more convenient for team members to participate in the walk. If you are unsure about your fitness level or medical condition for these walks, you should check with your healthcare provider, or ask Brian Blaisch or Ari Stern (our Medical Director and Assistant Medical Director; email them using the Contact Us link at the top of the website after logging in). It never hurts to schedule a physical checkup with your physician that includes a stress and fitness evaluation.

The goals we're aiming for are:

  • Light Duty (1-mile walk in 16 minutes) – This is for members who want to deploy into controlled environments, such as working in a hospital, medical shelter, or established BoO.
  • Moderate Duty (2-mile walk with a 25-pound pack in 30 minutes) – This is where we'd like most of our members to be, for deployment into an austere post-disaster environment (helping to set up the BoO, move patients, etc).
  • Arduous Duty (3-mile walk with a 45-pound pack in 45 minutes) – For our Logs folks in a first-in, austere environment, working to unload trucks, set up BoO infrastructure, move supplies, etc.

Once again, all the participants did a great job with the walk at the last team meeting. Hope to see all of those that participated and those that didn’t at the next lunch walk. Take care and be healthy.

Tuesday
Mar012016

Ch...Ch...Changes...

Highlights of the 2015 AHA Guideline Changes1
By Mark Caplin, PA-C

François de la Rochefoucauld famously said, "The only constant in life is change." And so it is with the newest round of the 2015 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC), which goes into effect April 2. This update marks the end of a 5-year revision cycle for the AHA and guidelines will now be changed as needed. Current and future guidelines can now be found at ECCGuidelines.heart.org. Fortunately, there aren't any massive changes but we do say goodbye to some recommendations (can you say "bye bye vasopressin"?).

Social media is now officially recommended as a method to notify potential rescuers of a cardiac arrest. Several apps are available for download such as Pulsepoint, an app that we should all have on our phones, that will let you know if there is a cardiac arrest nearby and the location of the nearest AED. (See App Review article below.)

Regionalized care for cardiac arrest is also recommended, which involves diverting cardiac arrest patients to specialized centers that provide comprehensive care. This is already being done in some Bay Area counties, but the system may be expanded in other places.

Basic Life Support (BLS)

CPR: The ratio stays the same at 30:2 for adult CPR regardless if you are doing 1- or 2-rescuer care prior to insertion of an advanced airway. Once an airway is in place, provide continuous chest compressions, ventilating once every 6 seconds. Upper limits have been added to the chest compression rate (now 100-120 per minute, with 110 being the "sweet spot") and compression depth (2-2.4 inches, or 5-6 cm), no bad outcomes resulted from going too deep, just broken ribs. Minimizing compression pauses continues to be emphasized and the concept of a compression fraction is introduced. This is the percentage of time that hands are on the chest actually performing compressions, and the goal is at least 60%. So you can still hum "Stayin' alive", just faster.

Compression-only CPR (or cardio-cerebral resuscitation) is now considered a reasonable alternative to conventional CPR for witnessed out of hospital cardiac arrest (OHCA) with a shockable rhythm. This includes providing 3 cycles of 200 continuous compressions and defibrillation with only passive oxygen administration and an airway adjunct, and should only be performed after completing adequate training in this approach.

CPR Devices

Mechanical CPR devices: Despite the increased popularity of the impedance threshold device (ITD) and mechanical CPR devices, no randomized clinical trial has shown them to be superior over manual CPR. Consequently, the AHA does NOT recommend their use over manual CPR. However, an important caveat is made with regards to "challenging or dangerous" settings such as prolonged hypothermia, a moving ambulance, and the angiography suite. In these scenarios, a mechanical CPR device may be a reasonable alternative.

Advanced Cardiac Life Support (ACLS)

Vasopressin is no more in the pulseless arrest algorithm. It has gone the way of atropine and so many other drugs before it. Epinephrine remains with the same dosing and frequency (1 mg every 3 to 5 minutes).

Intralipid therapy has entered the guidelines! Consider it for patients with suspected drug toxicity, such as from local anesthetics and other drugs. The recommended dosing is an initial bolus of 1.5 mL/kg of lean body mass over 1 minute followed by 0.25 mL/kg/min for 30-60 min. The maximum total dose is 10 mL/kg in 1 hour.

Ultrasound continues to be regarded as useful during cardiac arrest; however, it should never interfere with high quality CPR. There was a new indication listed in the AHA guidelines– endotracheal tube placement confirmation.

End tidal CO2 continues to take on a more important role in addition to endotracheal tube placement confirmation. Persistently low levels in the intubated patient after 20 minutes of CPR are strongly associated with a poor prognosis and should be only one component of a multimodal approach in determining whether to terminate resuscitation

Titration of oxygen administration: The maximum possible inspired oxygen should be given during CPR. After ROSC, however, it should be titrated to maintain an SpO2 of at least 94% as before.

Return of Spontaneous Circulation (ROSC)

Early coronary angiography has a new indication. Not only is it indicated for ST-elevation MI (STEMI) patients but it is also indicated for those WITHOUT ST segment elevation but have a high concern for an acute coronary event. It is specifically recommended that a poor neurologic status should not factor into the decision to perform angiography as early prognostication is very unreliable.

Target Temperature Management (TTM): This is the new name for "therapeutic hypothermia". It is recommended for all comatose patients for at least 24 hours. The goal temperature range is 32-36 degrees Celsius. Pre-hospital induction of hypothermia with cold IV fluids is not recommended.

Pediatric Advanced Life Support (PALS)

The CAB approach has been solidified as the preferred approach for pediatric resuscitation, similar to ACLS recommendations. The pediatric chest compression rate is now the same as adults at 100-120 per minute, as is the maximum compression depth (2.4 inches or 6 cm).

Epinephrine and targeted temperature management continue to be recommended for pediatrics.

Atropine has been removed from routine rapid sequence induction (RSI) pre-medication recommendations. Remember that it should still be used if there is evidence of bradycardia though, at a dose of 0.02 mg/kg. Further, the old minimum 0.1 mg dose of atropine has been removed.

Intravenous fluid bolus: The initial pediatric fluid bolus for pediatrics remains at 20 mL/kg. Based on a 2011 New England Journal of Medicine publication in Africa2, if you are working in a resource-limited setting, this should be done very cautiously as it was shown to worsen outcomes.

Other

Some areas are adding Narcan, and a second dose of the epi-pen, to their protocols for EMT-Basics.

Of course the usual caveat is in place – you have go by your local protocols and procedures.

_____

1Adapted from Sean Kivlehan, MD MPH, Department of Emergency Medicine, Brigham and Women's Hospital
2Maitland et al (2011). Mortality after Fluid Bolus in African Children with Severe Infection. New England Journal of Medicine, 364:2483-2495. doi: 10.1056/NEJMoa1101549

Tuesday
Mar012016

App Review

[From the editor: this is a periodic article on apps that might be useful to DMATers or disaster responders in general. If you have some suggestions for apps to review, please submit them!]

PulsePoint AED

Recommended by Mark Caplin: Help build the most comprehensive registry of AEDs for use during emergencies. When a cardiac emergency strikes, finding an Automated External Defibrillator (AED) can help save a life. But that takes knowing where AEDs are located. PulsePoint AED lets you report and update AED locations so that emergency responders  nearby citizens trained in CPR or local firefighters, police or medics can find an AED close to them when a cardiac emergency occurs.

 

PulsePoint Respond

PulsePoint Respond empowers individuals, within covered communities, with the ability to provide life-saving assistance to victims of cardiac arrest. Application users who have indicated they are trained in cardiopulmonary resuscitation (CPR) are notified if someone nearby is having a cardiac emergency and may require CPR. If the medical emergency is in a public place, the application uses sophisticated location-based services to alert trained citizens in the immediate vicinity of the need for CPR. The application also directs these citizen rescuers to the exact location of the closest public access Automated External Defibrillator (AED).

Monday
Feb012016

VOL. 16, NO. 1 - FEBRUARY, 2016

Mark Your Calendar

  • Feb 20: Team Meeting
  • Apr 01-30: On-Call
  • May 14: Team Meeting
  • Jun 08-10: Moffett FTX
  • Jul 01-31: On-Call
  • Aug 13: Team Meeting
  • Oct 01-31: On-Call
  • Nov 05: Team Meeting
  • Dec 03: Holiday Party

Monthly Recap

Commander's Corner - So much to catch up on!
Training News - Feb mtg agenda, Anniston training opportunity
2016 Fitness Self-Assessments - get ready, this is the year!
The Logistics Scoop - Logistics Section Meeting, getting your gear ready to go
Who are we? Meet the Mental Health team! - Getting to know more team members

Monday
Feb012016

Commander's Corner

David Lipin - Unit Commander

Hello everyone, and welcome to the first edition of The CA-6 Chronicles for 2016! I certainly enjoyed a couple months of down-time from the hectic pace of DMAT (but also wouldn't have minded if they'd sent us to some nice, tropical climate somewhere). Since we've been on haitus for two months, I've got a lot of material to catch up on, so I'm going to get right to it.

Coming Soon!

To start with, I'd like to remind everyone that we have a team meeting coming up on Feb 20. There's a great program coming together for this year -- take a peek at the Training News item down below. Hope to see you there!

We have a field training exercise (FTX) opportunity coming up in Anniston, AL, and are taking names for people that are interested. Details are also in the Training News article below, and the sign-up deadline is soon so please consider this great opportunity and let me know if you're interested.

NDMS Code of Conduct

There's a new NDMS Code of Conduct that all members must acknowledge reading. It's basically the same as the CA-6 Code of Conduct, but you must log into Responder e-Learn to read and acknowledge it. Every member must complete this, so if you haven't already then take a look at the instructions in Training News below. As a reminder, this will show up as "incomplete" on your monthly status report starting this month, if you haven't completed it.

New NDMS Policies

Please read the new Social Media and Active Intermittent Employee policies, both found under our Policies and Procedures page. There's nothing new or dramatic in them, but please read them so you understand. We'll discuss them further at the Feb meeting.

Mar Backfill On-Call

We had a great Jan on-call response and only needed a couple people to backfill us, and we even "loaned out" a few folks to other teams as well (thanks to those of you who volunteered for that). Now we're starting to receive requests from the Mar on-call teams for backfill, particularly in hard-to-fill positions (MD, PA, NP, RPh). So if you're willing to help out, please use the Backfill Sign-up link under Event Signups to let us know.

EMT Renewal?

If you're looking to renew your EMT license soon, we're thinking about doing a refresher course at the Feb 20th meeting. Please let me or Andy know if you're interested, so we can plan ahead for how many people might attend.

Physical Fitness

We are continuing to ramp up our physical and medical fitness standards program, which must be fully functional by the end of this fiscal year (30 Sep). Joe has written a nice piece on the physical fitness portion of this below. I'd like to remind everyone that the goal is to deploy safely, knowing our own strengths and limitations. You will be able to declare yourself at whatever level at which you feel comfortable and capable, and the team will make reasonable accommodations based on your declaration and the needs of the mission. Not everyone needs to be in peak form, and mission requirements often vary quite a bit, but obviously some missions are quite physically taxing and we need to be able to take enough capability with us to accomplish these mission.

So we're going to do as we usually do, work on this as a team and support each other through the process! At the meeting this Feb, we will have a "no pressure" opportunity to assess ourselves, and for the "gear heads" amongst us a chance to compare our Go Bags! So bring yours, see how comfortable it turns out to be, and maybe you'll even get some ideas to work on.

New Forms Submittal Process

For those that pay close attention to the website, you'll notice that we've finally changed the way we submit information to the team. This is a change that I've been talking about for a while, to increase security and protection of team member information. We're now going to start phasing out our use of the "forms" email account and the team fax for submitting documentation to the team. Instead, members should log into the team website and use the Document Upload link in the right column. This way, potentially sensitive information does not end up in your (or our) email accounts, or on any number of email servers along the way!

This will take some getting used to, so we'll overlap for a couple of months (and remind people to use the Document Upload link next time), then we'll switch the forms email account to send an auto-reply if you send email to it.

Federal Employees' Compensation Act (FECA) extended to NDMS!

Finally, after over two decades of teams reporting this as a significant impediment to NDMS members, HHS was able to convince Congress to amend the NDMS authority in the Public Health Service Act to adjust the FECA computation of benefits for NDMS intermittent employees. This means that if an NDMS intermittent gets injured or dies in the line of duty, they are eligible for FECA benefits as if they were a full-time federal employee. Previously, their benefit was calculated as a percentage of their NDMS income over the previous year (which for most of us was negligible), but now it is calculated as if they were employed full time. If you would like to understand this further, you can read the Consolidated Appropriations Act of 2016 (PL 114-113), and visit the Department of Labor's FECA webpages.

HQ continues to work on getting NDMS members classified as Public Safety Officials, so that project is still underway. If successful, then people who are convicted of violent crimes against on-duty NDMS members are subject to enhanced penalties, and NDMS members who die in the line of duty are entitled to benefits similar to those for police officers and firefighters.

Continue to Disregard Federal Email Notifications

As we've detailed before, HQ has many offices and components that are not aware that we are intermittent employees, and often distribute email messages "to all employees" that don't actually apply to us. One such recent announcement was for a "mandatory" 2015 Records Management Course which some (but not all) of us received. As usual, all announcements and email messages that do not come directly from the team should be disregarded unless someone from the team (typically the Team Commander or Administrative Officer) tell you otherwise. We would prefer to spend our limited time working on necessary team activities than responding to the "is this real or should we ignore this?" queries that we receive each time one of these messages come out. We know that a lot of our members are eager, or nervous when they receive an email that seems to require a response soon, and we ask for your patience because these HQ notices are beyond our control (and even beyond the control of the NDMS office at HQ).

In Closing

That's all I've got for this month. I hope everyone enjoys Superbowl weekend next weekend (and no, we're not likely to get activated for that, but of course we always stay flexible)!

Monday
Feb012016

Training News

Feb 20th Meeting
Our next team training will take place at the usual time and place (see the Calendar on the team's home page). If you need a USERRA letter, contact Crystal Wright.

We'll have an interesting meeting to kick off the year:

General Member Tract:

  • William Smirles from Zoll will orient us to the Zoll Propak MD (the new defibrillator/monitor that NDMS is switching to)
  • Dr. Lori Klein from Stanford will present on religious and cultural aspects of medical care (as part of a cultural awareness series that we're embarking on)
  • Wendy Hess et al will present Pain Management
  • And our usual Electronic Medical Records and Equipment Lab hands-on opportunities

New Member Tract:

  • Personal Gear Orientation
  • Team Requirements & Mission Documents
  • Logistics & Basecamp Overview (in preparation for next meeting's Shelter Systems Overview and an upcoming Advanced Logistics training)

Look for the agenda and meeting documents to be published under Training Documents (link on the right in the Members Area) in the days prior to the meeting.

Coming up later this year, the US Coast Guard will discuss Disaster Preparedness Training on the Bay, medical/cultural aspects of Islam, and a discussion on the quickly emerging Zika V epidemic.

Anniston Training Opportunity
CA-6 had been identified as one of the 11 teams to send 5 people to NDMS training at the Center for Disaster Preparedness training in Anniston, AL from May 02-07.

We are accepting applications from MDs, PAs, NPs, RNs and EMT-Ps. Attendees will be paid, reimbursed for travel, and covered by USERRA. To be eligible, you must be hired into one of these positions, not have attended this training in Anniston in the past, and be in appropriate physical health to participate in a simulated disaster exercise (e.g., lots of walking, outdoor activities over uneven terrain, long hours, exposure to temperature extremes).

This is an excellent training, and we strongly encourage people to apply! Preference will be given to newer members who have not yet deployed, but we will also make an effort to balance the roster. If you are interested, please send email directly to me by COB 16 Feb. We will announce the selections at the Feb meeting, and then the selectees must promptly complete some application paperwork.

NDMS Code of Conduct
All NDMS members must read and acknowledge the new NDMS Code of Conduct via Responder e-Learn. Here are the steps for completing this:

  1. Log into Responder e-Learn (instructions on the team website under Other Member Sites)
  2. Select My Courses from the menu bar across the top
  3. Select the NDMS Available Courses link rom the My Courses page (note this is the one in the middle o the page, not the one under Enrolled Courses)
  4. Select the NDMS Verifications course
  5. Click the link in the left column to Enroll in this course (you might need to perform steps 6 and 7 before the Enroll option appears for you, or you might already be enrolled in which case you can simply skip this step)
  6. Select the Modules link from the left column
  7. Click Code of Conduct under Modules (main page)
  8. Download and read the Code of Conduct (linked under Course Conduct, main page)
  9. Take the Exam by clicking Code of Conduct under Code of Conduct Exam, and answering the single question acknowledging that you've read the Code of Conduct.

You do not need to send us the course completion certificate for this. We'll receive it automatically.

Monday
Feb012016

2016 Fitness Self-Assessments

Joseph Telles - Logistics Section Chief

Last team meeting we had a great turnout for the lunch walk; we had over 20 people participate in the 1-mile walk to the nearby mall. These walks are important as we prepare for our fitness assessments later this year.

For our Feb team meeting we'll schedule an extra half hour for lunch to make it more convenient for team members to participate in the walk. Bring your fully-loaded Go Bag (just as you would for a deployment), and some comfortable walking shoes to change into if you'd like! We'll have some easy-to-use luggage scales so you can see how much your daypack weighs. Also to stress the importance of team member participation in the walks, we're going to extract our Commander Dave Lipin from his lunch-time conversations to walk with us; you can still talk to him if you need to, but it'll be a walk-and-talk!

If you are unsure about your fitness level or medical condition for these walks, you should check with your physician or ask Brian Blaisch or Ari Stern (our Medical Director and Assistant Medical Director; email them using the Contact Us link at the top of the website page). It never hurts to schedule a physical checkup with your physician that includes a stress and fitness evaluation; that's important for all team members, especially for those of us over 40 years old who may not have been as active recently, have a history of a cardiac condition or high blood pressure or loss of balance, or have a joint or bone problem that could be made worse by a change in physical activity. The fitness assessments we'll be taking require cardiac health for a moderate level of physical exertion. The standards we're aiming for are:

  • Moderate Duty - 2-mile walk with a 25-pound pack in 30 minutes, or
  • Light Duty - 1-mile walk in 16 minutes (no pack required)

You can pick which one you're aiming for, and once we know that will help us design suitable assignments for you on missions. If you don't think you're ready to try this, then talk to Brian or Ari about a temporary medical waiver.

To prepare for the assessment, we suggest that you start out slow with a manageable exercise program. Develop a program for yourself that is a realistic one that you will be able to stick too. Initially as you prepare yourself for the walk, don't concern yourself with walking speed; instead just concentrate on the amount of time you exercise. Your goal should be to walk at least 3 or 4 times a week in 20 to 30 minute increments.

If you start out your exercise program trying to immediately meet a challenging pace without any previous training, the end results can be undesirable -- soreness afterwards that discourages you from working out the next time, or even an injury!

So certainly pace yourself. We have most of the year to prepare for these self-assessments so there's time! With that said though, we need to start preparing now. Hope to see all of you at the lunch walk, so we can have fun while we're doing it! Take care and be healthy.

Monday
Feb012016

The Logistics Scoop

Joseph Telles - Logistics Section Chief

Logistics Section Meetings
The first Logistics Section meeting of 2016 will be February 16th at 1830 hrs. The Logistics meetings are at The Englander, on 101 Parrott St., San Leandro, CA and begin at 6:30 pm. All DMAT and CDMSA members or others interested in disaster logistics are welcome to attend.

At the meeting we will establish future meeting and training dates for the 2016 calendar year. This will be the only in-person Logistics Section Meeting of the year; the rest will be by conference call so please attend.

Gear Inspections at the Feb Meeting
For team members needing gear inspections at the February 20th team meeting, remember to look at the meeting schedule to see when gear inspections will be conducted. Please don't wait until the team meeting is over to ask for a gear inspection; the inspectors would like to get home too! For those that need uniform items, find the Uniform person (usually Carol) inside the building in the hallway before the meeting and during lunch.

Preparing Your Gear
Our next on-call month is April. You should have your uniforms and sleeping bag cleaned on off-months so that you are not put in a situation where you are asked to deploy and your set of uniforms or sleeping bag is unavailable to you because they are at the cleaners or need to be dried. Remember, we don't always get the recommended 8 hours to prepare for deployment; many deployments are short notice events. It is recommended that you clean your uniforms, sleeping bag, and equipment the month after our on-call month. The added benefit is that you will look sharp at the team meeting!

Monday
Feb012016

Who are we? Meet the Mental Health Team!

Welcome to a series of profiles of Team members, by specialty, so please be on the lookout for an email inviting you to go to a link on our website and answer a few questions about yourself.

First up - Meet the Mental Health Team!

Toby Nelson, PhD - DMAT CA-6 member for 10 years, Chaplain and Mental Health, is in real life the Senior Pastor at Auburn Presbyterian Church, and "as a law enforcement Chaplain I train alongside the police. On duty I wear a vest but don't carry a gun. I am proficient in the use of the weapons in a worse case scenario." Here's how he joined: "Andy Swartzell was attending my church when I gave a sermon on my experiences at Ground Zero on 9/11. He said there was a vacancy for a chaplain on CA-6, I said 'Count me in!' Like everyone else, it took a year to get on the team." The most rewarding part of being on the Team for Toby is, "Being in the worst possible disaster with heroic team members; I serve with people who are at their very best in the very worst circumstances." Toby's passion: "To be at the center of a crisis offering hope and encouragement. It is a 'terrible honor.'" Ask our "Disaster Pastor" about his writing when you see him.

Katie Amatruda, PsyD, MFT, EMT - 8-year team member as a Mental Health Specialist and EMT, is a licensed psychotherapist in private practice, and she conducts Critical Incident Stress Debriefings (bank robberies, murder in the workplace, etc.), is a Military Family and Life Consultant, working worldwide on military bases, and she is also a writer, living on a boat in Sausalito. Here's how she joined: "I was in Batticaloa, Sri Lanka, working with children after the tsunami. I was staying at an orphanage and met a doctor from SF, Mihir Meghani, a former team member, who told me about DMAT. I came back and tried to join in 2005, but got caught in the post-Katrina Homeland Security/FEMA loop, so it took me two years to get on the team." Best parts of a deployment: "Best – the work, the compassion, that we are making a difference, and the feeling that we have each other's backs. The people! Worst – In a tent, exhausted, sweaty, being dive-bombed by mosquitoes, and the person next to me is a horrible snorer. And the porta-potties!" Regarding deployments: "My most moving deployments have been international – Haiti, Sri Lanka, and American Samoa. I love working with people from cultures other than my own; I have learned so much! And Burning Man - that practically counts as a new culture." She is pictured here working with a zombie...

Judy Boore, MFT - 5 years on CA-6, previously served on CA-3, the former Mental Health Team - is a marriage family therapist who also does critical incident interventions and disasters. She joined DMAT when "a friend joined the Los Angeles Mental Health DMAT during the Northridge earthquake. I wrote that off because I wasn't into combat boots. Then I debriefed her after Hurricane Katrina and realized that I wanted to join." Then she joined CA-6, "When my Mental Health Team was not sent to Haiti, I realized I was on the wrong team. Besides, CA-6 is closer to home than LA, and I was attending San Francisco meetings anyway." The most rewarding part - "The finest people have joined this team. Knowing and working with them is hugely rewarding. I have great respect for them all." Most frustrating: "E-classes and bureaucracy are teaching me... patience." Judy's passions: "My passion is relationships, improving and enjoying them. And I can't ignore hiking, ballet and pointe, travel, art, science. Grandson surely tops the list."

Lisa Sebasco, PsyD, MFT - member of CDMSA, (waiting for a DMAT opening!) is a staff psychologist at California Medical Facility, a state prison in Vacaville, where she also works as the Mental Health Consultant for the Hostage Negotiation team for the prison Crisis Response Team. Lisa has been on "multiple disaster deployments with the Red Cross and has worked in highly stressful crises situations in my job, I have discovered I have a knack for disaster work and have found personal fulfillment meeting the challenges of this type of humanitarian work." Most interesting deployment: "Being under a tornado warning while traveling through rural Alabama as a member of a Red Cross condolence team visiting surviving family members of the most deadly swarm of tornadoes ever in the state." She is also a "former Air Force brat psychologist who balances the contentious environment working in a prison with a happy marriage, goofy dog, VW camper, skiing, surfing, and hoping this will be the year the A's pull it together." Her passions include "Kettlebells & CrossFit." When you see her, ask her what a kettlebell is, if you don't know...

Tuesday
Dec012015

VOL. 15, NO. 11 - DECEMBER, 2015 - JANUARY, 2016

Mark Your Calendar

  • Dec 05: Holiday Party
  •           2016
  • Jan 01-31: On-Call
  • Feb 20: Team Meeting
  • Apr 01-30: On-Call
  • May 14: Team Meeting
  • Jul 01-31: On-Call
  • Aug 13: Team Meeting
  • Oct 01-31: On-Call
  • Nov 05: Team Meeting
  • Dec 03: Holiday Party

Monthly Recap

Commander's Corner - Closing out the year
Holiday Party - It's not too late to RSVP!
In My Gear Bag - Staying charged up
Election Season Rules Review - How federal employees can participate

Tuesday
Dec012015

COMMANDER'S CORNER

David Lipin - Unit Commander

And finally we come to year's end. We combine the December and January issues of The CA-6 Chronicles to give everyone a bit of a break over the holiday season, so this is it for us for a couple of months. Enjoy your time away from us!

2016 Calendar and Jan On-Call

Our 2016 calendar is published above. Please add these dates to your calendar, or subscribe to ours via the website Calendar link.

As you hopefully know by now from our notification system, we're taking sign-ups for our Jan '16 on-call month. We've "moved up" the sign-up period for our on-call months by 5 days, so now the sign-up period is the 25th through the 5th. This is an indirect result of the extended hiring freeze across NDMS -- staffing is getting so low that teams are starting to struggle to fill their rosters, and as a result are requesting backfill from other teams earlier in the month. The longer we wait, the harder it is to fill these open slots. (See the details in my article from last month.)

Of course, this is great for those of you "can't get enough DMAT". We encourage you to sign up for backfill to help out our fellow teams, because we need to support each other. The Backfill Signup form is on our website below the On-Call Signup.

Hiring Update

We just finished interviewing some new RN candidates from the August hiring posting. We didn't get as many as we'd hoped; it appears that the federal application website is difficult to use, so much so that most people who tried did not successfully submit a complete application. They're working on improvements for the next time around. We'll keep you posted, but please continue to spread the DMAT word to people that you think might make good team members.

EMT Renewal?

If you're looking to renew your EMT license soon, we're thinking about doing a refresher course at the Feb 20th meeting. Please let me know if you're interested, so we can plan ahead for how many people might attend.

Physical Fitness

Our luggage scales have been ordered, so we'll be ready to weigh your ready bag (carry-on daypack) at the Feb 20th meeting! Please bring your bag, packed as you would for a deployment, so you can do a "test walk" at lunch to see how you do. The eventual goal (later next year) is to walk 2 miles in 30 minutes with a 25-lb pack.

New Web Forms

A few days ago we added two new forms to the website: Confirm Availability and Confirm Fitness. Both of these appear in the Event Signups column (below On-Call Availability). These forms are designed for use when the team is rostering for a specific event or mission. We'll send out an email or notification informing members to complete one or both of the forms; please wait until we ask for it, because we'll empty out the data in between requests so if you fill it out too soon we'll end up erasing it.

The Confirm Availability form will be used when we need to get specific confirmation from members. Normally for on-call months, we collect general availability and build an "all purpose" roster. But we know that people's availability may change when specific mission parameters come our way, so we might ask people to use this form to confirm that they're available for a specific mission, or to acknowledge that they've received a specific message. So we might ask you to submit this form multiple times for a single event (e.g., on day 1 we might ask "are you able to go", on day 2 we might ask "have you received your travel orders", and so on).

The Confirm Fitness form is a last-minute health and fitness check for people that intend to deploy, so that we can look for last-minute issues and compare your current status against the specifics of the upcoming mission. Our CMO (or Deputy CMO, or Chief Nurse) might contact you with more specific questions or suggestions in response to submitting this form. This is a "quick and dirty" form, and is not a substitute for our regular health and fitness screening affidavit or immunization records (which you should also be keeping current and submitting as needed through the regular mechanisms).

Travel Accountability

We've made a slight improvement in how we track our members in-transit to and from a disaster. Check out the Deployment Instructions page on the website, listed under Deployment Docs. There are some new instructions that direct you to send email when you depart your house, and when you arrive at the other end of your travel (and the same on your return trip home). Sending this email will notify people at the team level and at HQ of your travel status. (We're not listing the email address here because it's only for team members.) I'd suggest that you print that Deployment Instructions page and stick it in your ready bag.

That's it for this month. Hope to see you at the holiday party (info below)!

Page 1 ... 2 3 4 5 6 ... 11 Next 20 Articles »