VOL. 11, No. 5 - June, 2011

Mark Your Calendar Jun 01-30: On-Call Month Jun 18: Team Meeting Sep 01-30: On-Call Month Sep 10: Team Meeting Oct 14-17: Urban Shield Nov 5: Team Meeting

In This Issue Commander's Corner - Welcome to Hurricane Season 2011! Medical Directions - ITS Update Administrivia - Really IMPORTANT, TIMELY information The Logistics Scoop - Get your gear ready! Training News - June meeting and clinical hours Plans Briefing - Not your mother's DMAT On the Road - Caplin reports from Afghanistan Worth Reading - Suggestions for websites and books

COMMANDER'S CORNER

David Lipin - Unit Commander

Welcome (officially) to both hurricane and fire season, and our June on-call month! Time to pack those gear bags, give your employer a heads-up, and prepare your family for your possible absense. Gas in the car? Set to pay the bills? An alternate to take the kids to soccer practice?

While you're at it, go ahead and bring your gear to the June 18 team meeting for your next gear inspection! Some of you may be relieved to know that we have decided to postpone requiring the 3rd of the series of gear inspections until next year, so two inspections will get you to Tier 1 (and 1 inspection will earn you Tier 2) until then.

Thanks to everyone who signed up for June on-call. We made it! We managed to roster the personnel needed for the new 50-person roster. This isn't strictly required until next year, but the rest of this year is a "test period" for us to see where our gaps are. We still have a few, which means that we put some Tier 3 people on the roster for June. But we hope to complete the full 50-person roster by year's end without anyone from Tier 3.

Speaking of the Tier system, you will notice when you receive your monthly individual status report that we have added the training requirements to the report. It will list the classes that you need to take, and if/when we think you last took them. That will help you determine which classes to take at the June meeting (make a note, or bring your status report with you). We are still measuring "meeting attendance" for now, but will be switching over to "training completed" as we continue to roll out the new training curriculum. The curriculum is designed so that those who attend all 4 trainings each year will complete the curriculum (Tier 1), so we really encourage everyone to arrange to get the time off to attend. The training days are USERRA covered, which can help get you those days off; contact our Administrative Officer (Bonnie) if you need a USERRA letter.

We also plan to post the training curriculum to the website this week (in conjunction with the monthly status reports), so that you can read up on the classes, see when they're offered, etc. If you think you've already taken a class that the database doesn't reflect, send me an email and we'll investigate.

Don't forget to watch a few minutes of news each night, to see if there's "anything brewing" out there that might result in an activation. And see everyone at the June meeting!

MEDICAL DIRECTIONS

Brian Blaisch - Team Medical Director

Following last year's Integrated Training Summit (ITS), I reported that CAPT Allen Dobbs, MD, the NDMS Chief Medical Officer, laid out some very specific objectives and plans for the operational arm of NDMS/DMAT. I was optimistic at that time that the organization was evolving very dynamically and in a more positive direction from a medical operations perspective relative to the many challenges the organization and the country have faced over the last number of years. I am happy to report, following the May 2011 ITS, that the amount of progress being made in this area by CAPT Dobbs and his team is both impressive and heartening.

It is hard as a team member (and even as a member of the command/general staff) to really get a sense of what work is being undertaken behind the scenes that ultimately will translate to real differences in the field, both with respect to member experience and patient outcome. Nonetheless, I can say that much of what all of us who have been participating in deployments have reported back has clearly been listened to and has helped to drive positive changes in medical operations. And, for all that goes into participating in DMAT, from paperwork to training to travel and administrative processes, in the end, the role of DMAT is, in fact, medical operations. So, while the pace of change continues, it is refreshing to see that focus of attention on medical operations at a time when the complexity and intensity of our deployments has intensified.

There is a heavy emphasis improving operational communication and information dissemination. We will do our best to share this information in detail over the next few months via the website, in the newsletter, and at the team meetings. Here are some very brief highlights:

• DMIS (Disaster Medical Information System) and Information Management: DMIS has been completely upgraded and will clearly improve care in the field, monitoring of events and trends from the “10,000 foot view”, better track patients, better monitor outcomes, improve documentation of team member injuries in the field, and improve access to supplies and resources in a much more timely fashion. It’s better and easier than what you are using in your office or your ER for the job we have to do in the field. Believe it!
• Hazard Exposure Risk Analysis (HERA): This a more formalized way to evaluate the environment and circumstances encountered during deployment. Appropriate parts of these reports will potentially be shared with team members during activation so that team members can deploy properly prepared
• Health & Safety Plan (HASP): A more formalized way to incorporate concerns of the Medical Officer and Safety Officer as part of efforts to improve force protection.
• DMAT-50: This is the newer roster configuration, which includes the addition of an Emergency Care clinical module, as well as other improvements to the roster. This has been a tall order for teams to fill but we can feel proud that CA-6 set, and met, this as goal for our June on-call month.
• Operational Medicine Science, Safety and Effectives: This is a new group headed up by CDR Lewis Rubinson, MD, PhD. Some of the exciting programs that fall under this group include coordination of ESF-8 research proposals, an Operational Clinical Assessment and Investigation Program (OCAIP), an Operations Clinical Assessment and Investigation Team (OCAIT), rapid clinical assessment tools (facility- and patient-based), and best evidence clinical protocols and guidance. These are all programs that will help ensure that we deliver the best possible care in the field. Suzy Fitgerald and Vivian Reyes were able to talk with CAPT Dobbs and CDR Rubinson at the ITS about bringing some of their rich experiences to this process. They got very good feedback and I suspect will bring some good work to this endeavor. They have also agreed to be Assistant Medical Directors for our team. We (I, in particular) are lucky to have them continue to step up their commitment to the team. 
• NDMS Disaster Medical Acuity Scale: Finally, this is an attempt to bring light and solutions to the concerns we have when we have patients for whom we cannot provide adequate medical care in the adverse post-disaster environment. Details to follow, but mostly it is important to acknowledge that this issue has weighed heavily on team members and NDMS leadership. There is good and substantive work addressing these concerns. 

To summarize, NDMS and the CMO, with his capable deputies, and many others working in many different capacities, including our Commander, have worked very hard to move this organization forward positively and those efforts are bearing fruit. More to follow.

ADMINISTRIVIA

Bonnie Atencio - Administration Section Chief

Credentials
Our Commander has mentioned that NDMS will soon be conducting its own credentialing and privileging. The company, CredentialSmart, no longer has that task. We’ve removed the link to CredentialSmart from the website, but some people have saved the link in their personal web favorites. If you are one of these people, please delete that link from your favorites file. They have turned all of our information over to NDMS and cannot help you.
You’ll be hearing more about credentialing soon. There are a lot of new and exciting things coming up for us.  It’s sure to make us even stronger and more responsive than we are now.

Verification of Clinical Hour
In line with credentialing (above), privileging will also be something NDMS will determine. That will be based, in part, by your licensure, place of employment and the amount of time you spend providing direct patient care.  Currently we require 112 hours of clinical hours a year. This is verified by the submission of the Verification of Clinical Hours form found on our website, under “Forms and Instructions.” Several members have received notice that they are overdue in submitting this form. If you fall into this category please do it right away.

The instructions state that a pay stub showing hours worked will suffice, but this only applies if your hours are separated into clinical and non-clinical categories. This is not uncommon with hospital-based physicians, but we don’t see it too often with other care providers.

New Notification System for Federal Responders
In the coming weeks, HHS will be testing a new notification system called SendWordNow. It is a system similar to what CA-6 uses for its notifications, as HHS looks for a system-wide notification solution. They have uploaded contact information from the NDMS personnel database as a starting point. All NDMS personnel (this means you!) should receive an email message from SendWordNow, clearly worded as a test message (look for the terms HHS, ASPR, OPEO or NDMS). THIS IS NOT SPAM. The message will provide instructions on acknowledging the test by updating your contact information in the SendWordNow database; please follow those instructions.

We will send out a separate email message to CA-6 personnel using our existing system as well, notifying you that the test took place so that you can contact us if you did not receive the test message or had difficulties responding to it.

Questions about the new system should come to Administration.

Did You Know??
We have an e-mail address (forms@ca6dmat.org) that can be used to send scans (yes I said scans), PDF files, license copies, forms, etc., as e-mail attachments. This address goes to several of us in the Command Staff at the same time. Just write a note in the e-mail message about who the document goes to, and we’ll take it from there.

No scans for GovTrip vouchers yet.

Did You Also Know?
Did you know that as a federal NDMS employee you have access to a team federal website? The website address is teams.hhs.gov (no www). You will find ID and password information on our website. It contains minutes of some meetings, most of the forms we utilize, procedures followed by NDMS, etc. Check it out.

NDMS ID Card Renewals
Many of our NDMS ID cards will expire this year. Check the expiration date of your ID card. When your NDMS ID card is within 60 days of expiration you must complete a PIV form (e-mail me for the attachment).  I’ll send you the instructions for completing the form with the attachment. YOU MUST HAVE A CURRENT NDMS ID TO DEPLOY.

myPay
Now is a good time to go to myPay and confirm all your information. Remember the information in myPay is the information used for payroll.

Passports
During our last activation we had issues with passports. One person almost didn’t deploy because there wasn’t a current passport on file with us. At this time passports are not a team requirement. However, they are required for international missions, or for missions to remote US territories that might require transit through another country (e.g., Guam, American Samoa). Since we’ve now been activated for four such missions (Guam in '04, Haiti in '10, Guam/Saipan in '09, Japan in '11), all members should be sure to either obtain a passport, or renew your existing passport in a timely manner. Then make sure you FAX a readable copy to us.

June On-Call and Team Meeting/Training
If you haven’t done so already, don’t forget to remind your employer that June is our on-call month. This works towards good employer relations with you and the team. If you need a letter for your employer for the upcoming training/meeting defining your USERRA status, drop me a line and I’ll get that out to you.

Change of Address, etc.
As always, let me know when you move, change phone numbers, banks, etc. There are things you and I both need to do. It’s how you get paid, so don’t delay.

THE LOGISTICS SCOOP

Joe Telles - Logistics Section Chief

We are on-call for the month of June, so inspect your gear closely to make sure you have all required gear items and personal items needed for a successful deployment. Having your gear ready for deployment will also prepare you for your next gear inspection at the team meeting, June 18. A lot of people will be getting their third gear inspection at this meeting. The third gear inspection is the strictest; that’s not to say that the first two gear inspections are not as important, but rather, no leeway be will given during the third inspection. (And failing that inspection will set you back to the starting line, requiring 3 more inspections!)
The Logs section had its second quarterly meeting of 2011 on May 12. One of the subjects discussed at the meeting was the expansion of team deployment size from 35 to 50, including an increase of Logs personnel from 4 to 7 on deployments. Because of the increase in the Logs deployment size, it is important that personnel put in their availability early on the team web site. Also discussed was the Logs Section progress on implementing the five goals that were set earlier in the year. Only two goals are left to be completed in the final 7 months of the year: electrical and forklift training. The next Logs section meeting is scheduled for August 11, 2011.

TRAINING NEWS

Sam Bradley - Training Officer

Classes at June Meeting
For new members: Introduction to Shelter Systems; Family/Employer Preparedness;
 Disaster Mental Health;
 Flightline Operations

For operations (medical) members: Electronic Medical Records (EMR) for both RN/EMT-P/EMT/RT and for EMT/Other;

 Obstetrics Management;
 Mental Health Patients;
 Pediatric Management; 
Basic LP-12 In-Service;
 Splinting;
 Basics & Skills

Make-up class for all who need it: Travel Documentation

Need Clinical Hours?
Urban Shield will be October 14-17. There will be baseline medical screening on Friday, October 14. Shifts for the main event will start at 0500 on Saturday, October 15 and run continuously until Monday morning. They need a variety of clinicians from EMT to MD. The actual locations are to be determined, but you can expect they will be in Alameda, Contra Costa, San Francisco, San Mateo, or Santa Clara counties. If this sounds interesting, please clear your schedule for the weekend. Applications will be coming out soon. If you have any questions about this year’s event, please e-mail Chris Burgardt.

PLANS BRIEFING

Kathy Burgardt - Plans Section Chief

Previously in the CA-6 Chronicles, we learned about changes coming to deployments near you.

Privileging
Basic/Primary Care (think doctor's office, urgent care center, or what some healthcare facilities call Fast-track or ambulatory care; managing chronic and low-acuity conditions), Acute Care (think typical or average ER patient), and Emergency Care (think unstable patient that needs immediate intervention).  

Your upcoming monthly status email will indicate your privileging. Questions or concerns should be sent to Operations or the Medical Director. Your privileging assignment is a temporary determination until NDMS implements a rule-based determination of privilege levels.

Modularization
If you deploy this month, you will find that practitioners are grouped by functional modules: EC, AC, and PC. Instead of dividing the roster by provider type (e.g., grouping all the physicians together), we're going to divide the roster by care modules (e.g., an acute care module consisting of 2 practitioners, 2 nurses, 2 medics). Then we'll do our best to travel that group together, assign them to the same treatment site (tent), etc.

50-Person Roster
We are now submitting 50-person rosters for deployment. Yes, there will be greater opportunities for deployment because of the larger team, but that also means that each of us has more responsibility to be ready to deploy. Get your required documentation to Admin and clear your calendar for on-call months. 

In other CA-6 news: 

Congratulations to Lynn Farizell, who was named Nurse of the Year at John Muir Hospital!

Welcome Home, Kate Amatruda. Learn more about her assignment in Germany at the June meeting.

Computer Advice from Lombardi
We asked Steve Lombardi to share his experience with conquering the complexities of responding to CA-6 computer requests. Here is his advice to the electronically challenged.  

Find someone who is competent with computers and have them help you. Trade a skill of yours for their help. Also find out what programs (Adobe, etc.) need to be downloaded in order to facilitate the access to DMAT forms. The "powers that be" among our administration can also help by having forms easily sent such as our on-call/availability form, for example. Hope that this information starts you on your way. Sorry for any typeos' and miss spellings....I haven't learned how to access spell check yet.

Our contributors welcome your feedback: click on the author’s name to send an email. Send your newsletter contributions to the editor. Stay safe in June, whether you deploy or vacation. 

ON THE ROAD WITH CA-6

Mark Caplin - DMAT CA-6 PA

Kandahar, Afghanistan - It is the start of the hot, dusty season. Just after the rainy, muddy season. Those are our weather choices here. The military has just issued guidelines for hot weather injury prevention that we have to pass on to the civilian contractors that we take care of. Here, at Kandahar Air base (KAF) and out to the FOBs and Hubs. A FOB is a Forward Operating Base, staffed with paramedics. A Hub is a larger base with paramedics and one mid-level provider. I work for OnsiteOHS, a subcontractor to Dyncorp International, one of the three big players in Afghanistan. We take care of the Southern part of the country. It is estimated that for every Soldier, Sailor, Airmen or Marine in country it takes 10 support personnel to support him or her. And most of those people are now civilians. Our job is to provide medical care to those civilian contractors. We are like a permanent DMAT. And, like DMAT, we have logistics problems and communication problems and other problems. The power goes out, we run out of water and - worst of all - no internet. We get our supplies from the Army (which sometimes runs out), our power is from a generator which sometimes breaks, and we live in a desert so water can be an issue. We do eat well, though. There are chow halls, called DFACs, that feed us 4 meals a day. We either live in a tent or a 10x10 room made from shipping containers, called Conex boxes, which offer a certain level of privacy. Our clinic is a permanent building, but others are in tents or Conex boxes. We see patients from all over the world who have come to Afghanistan to work. We are an urgent care and occupational medicine clinic. We do physicals for food service workers and are responsible for keeping up with everyone’s immunizations. We do not do primary care. If the patient has a long term medical problem, we send them home to get it dealt with. If they need a consult, then we arrange for a flight to Dubai to see a specialist. There is a trauma center that we call a “Role 3.” Our clinic is considered a “Role 1”. This is a NATO designation, as KAF is a NATO base. The Role 3, which is also serves as the base hospital, will treat civilians if they fall into certain categories.

Much like the DMAT, there is a very high level of teamwork involved in working here. We rely on each other to get the job done and to ensure each other’s safety, as occasionally a rocket gets lobbed our way. We have a procedure that we follow when that happens, and then we go back to work. All part of a day’s work. We work 7 days a week, 12 hours a day. The days can be long and sometimes boring. But there is never a dull moment. Much like being deployed, you never know what to expect after you open the clinic doors.

WORTH READING

Here are some suggestions from the editor. Send your suggestions for the next CA-6 Chronicles.

Check out the FEMA website and get on their mailing list. Roger Harper, Mark Weston, and Toby Nelson strongly recommend their classes as well. Sign up at the FEMA website.

If you want to get in shape or upgrade your diet, you can subscribe to Real Age.com. Practitioners can find out what the public is reading about nutrition and general good health.

Want to know more about the origin of the cultural divide in the Middle East? Check out Destiny Disrupted by Tamin Ansary.  Ansary has lived and studied in the US since his youth, and he is knowledgeable about both Western and Middle Eastern cultures.

The Secret Life of the Grownup Brain by Barbara Strauch is a book for DMAT members of all ages. For those of us of a certain age, the author cites research that provides hope that we can still think and learn. For those of us who have not yet reached a certain age, the author provides research results that tell us how to prolong our mental acuity.