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Dental Training 6-24-08 by Yuut Elitnaurviat & YKHC Staff According to the Alaska Native Tribal Health Consortium (ANTHC), Alaska Natives experience dental caries, or tooth decay, at 2.5 times the rate of the average American. There are numerous factors contributing to this imbalance. The most crucial is the lack of access to oral health services. $8 million Legislative Appropriation allotted for Long-Term Care facility 6-18-08 The Yukon-Kuskokwim Health Corporation is at the threshold of realizing the long-awaited dream of bringing long-term care for elder and disabled persons to the people of Southwest Alaska. On May 23, the passage of Senate Bill 221 solidified $8 million in Legislative appropriations for YKHC’s Long-Term Care Facility. Curves Bethel 10-9-07 Curves Bethel is celebrating its first anniversary by teaming with the American Cancer Society’s Making Strides Against Breast Cancer. New members who join in the first three weeks of October will pay only $25 for the service fee if they have a current mammogram. Other activities will stress breast cancer awareness and fundraising. Dining with Diabetes 9-19-06 by Dr. Lucy Jackson Bayles The Cooperative Extension Service has brought a new educational program to Bethel and enlisted the collaboration of the YKHC Diabetes Program, YKHC Healthy Hearts Program, and the Bethel Family Clinic. New Kid’s Don’t Float stations in Bethel! 6/27/06 by Kyla Hagan The Bethel Boat Harbor has started off the summer with safety of its boaters in mind. The Port of Bethel, led by Port Director, Heath Martin, have constructed brand new loaner life vest stations to hold vests of all sizes for boaters who do not have their own vests. These new structures serve as a great reminder to all families that wearing a life vest is essential to the safety of everyone on board. Wearing a life vest dramatically reduces one’s chances of drowning when falling overboard.
Revisiting the carbon monoxide threat 4/17/06 by Dr. Lucy Jackson Bayles
The presence of carbon monoxide (CO) in our homes is dangerous. How can you protect your family from carbon monoxide? How do you choose the right CO detector for your home? These are questions that we continually are asked at the Cooperative Extension Service. Recently Dr. Richard Seifert, the CES Housing and Energy Specialist from UAF visited Bethel to conduct two workshops on Cold Climate Building. Dr. Seifert told us that the first step is to make sure that carbon monoxide never enters your home. The second step is to install at least one CO detector in your home. What Is Carbon Monoxide? Carbon monoxide is a colorless and odorless gas. Because you can?t see it, taste or smell it, it can affect you or your family before you even know it?s there. Even at low levels of exposure, carbon monoxide can cause serious health problems. CO is harmful because it will rapidly accumulate in the blood, depleting the ability of blood to carry oxygen. Where Does Carbon Monoxide Come From? Carbon monoxide is a common by-product of the combustion (burning) of fossil fuels. Most fuel burning equipment (natural gas, propane and oil) if properly installed and maintained, produces little CO. The by-products of combustion are usually safely vented to the outside. However, if anything disrupts the venting process or results in a shortage of oxygen to the burner, CO production can quickly rise to dangerous levels. How Can I Eliminate Sources of CO in My Home? The most important step you can take to eliminate the possibility of CO poisoning is to ensure that CO never has an opportunity to enter your home. This is your first line of defense. Review this list to minimize the risk of CO in your home. ?Have a qualified person inspect and clean fuel-burning appliances yearly, before really cold weather sets in, to ensure they are in good working order. ?Inspect chimneys and vents yearly for cracks, blockages, rust or holes. ?Check fireplaces for closed or blocked flues. ?Before you enclose any heating or hot water equipment in a small room, ensure there is adequate air for proper combustion. ?Never use propane or natural gas stove tops or ovens to heat your home. ?Never start a vehicle in a closed garage; open the garage doors first. ?Pull the car out immediately onto the driveway, and then close the garage door to prevent exhaust fumes from being drawn into the house. ?Do not use a remote automobile starter when the car is in the garage, even if the garage doors are open some carbon monoxide will seep into the house. ?Never operate propane, natural gas or charcoal barbecue grills indoors or in an attached garage. ?Avoid the use of a kerosene space heater indoors or in a garage. If its use is unavoidable provide combustion air by opening a window while operating. Refuel outside after the unit has cooled. ?Regularly clean the clothes dryer ductwork and outside vent cover for blockages such as lint, snow, or overgrown shrubs. Carbon Monoxide Detectors: Is one really necessary? If you take the actions listed above, you will greatly reduce your risk of CO poisoning. However, unanticipated dangerous incidents may still occur despite your best efforts to avoid CO. Remember the family of five that all died in Anchorage about one year ago because of CO poisoning. The installation of at least one CO detector in your home is a good safety precaution. In some cities, it is the law to have CO detectors in homes. What Features Should I Consider when Purchasing a CO Detector? Most CO detectors are designed to sound an alarm when CO levels reach a high-level in a short time. However, health agencies advise that long term, low-level exposures are also of concern, especially for the unborn and young children, the elderly and those with a history of heart or respiratory problems. Detectors that display both high and low levels are more expensive but they do provide greater accuracy and more information. Check Consumer Reports either at the library or on-line (www.consumerreports.com) for ratings and best buys in CO detectors. Models are available with either digital or non-digital display. Where Should I Place a CO Detector in my Home? Most manufacturers specify where you should locate their CO detector. In general, the best place to put the detector is where you will hear it while sleeping. CO is roughly the same weight as air and distributes evenly throughout a room, so a detector can be placed at any height in any location, as long as its alarm can be heard. Additional units could be installed in several other locations around the home, such as a child?s bedroom. To avoid both damage to the unit and to reduce false alarms, do not install CO detectors in the following places: ?In unheated attics or garages ?Where they will be exposed to chemical solvents or cleaners, including hair spray, deodorant sprays, etc. ?Near vents, flues or chimneys ?Within 6 feet of heating or cooking appliances ?Near forced-or unforced-air ventilation openings ?Where directly exposed to weather Once you have installed a CO Detector in your home, make sure that you test it on a regular basis according to the manufacturer?s directions. For more information about this topic or any other housing questions, please call the Cooperative Extension Service for the Yukon-Kuskokwim Delta at 907/543-4557 or call Dr. Seifert at 1-800-478-8324. Stay safe and healthy! Dr. Lucy Jackson Bayles is the Y-K District Home Economist for the UAF Cooperative Extension Service.
Quick Test boosts AIDS/HIV testing 4/4/06 by Shane Iverson
The Yukon Health Care Corporation was the first medical institution in Alaska to offer the AIDS/HIV Quick Test, a breakthrough testing procedure that offers results in 20 minutes. Previous tests could take two weeks to produce results making many too anxious to return for the results, or even come in for the initial test. Since YKHC adopted the Quick Test in late 2003, the number of people tested for AIDS/HIV per year has nearly doubled. Those tests are an important first step in preventing the further spread of the HIV virus. It is estimated that there are 950 cases of HIV in Alaska, but the number is rising. In 1995, there were approximately 500 cases. There are no official numbers on the amount of people in the YK currently diagnosed with HIV but it is on the rise, according to Carl Evans, YKHC Circle of Care Coordinator The Circle of Care is a program within the Department of Community Health. Their purpose is to increase the number of individuals living in the YK who know their HIV status, and to provide community education and health aide training about the virus. ?It?s treatable and preventable, but not curable,? said Evans. Evans says he has seen some major changes in the area just within in the last few years. ?There?s a willingness to look at the problem,? he said of the villages he has visited. ?People are real receptive. They want to be tested.? Patients find a 20 minute wait more tolerable than a two week one. The procedure is much easier too. In the past, a tube of blood was needed but now only a blood drop, which can easily be extracted from the finger in a painless manner is required. ?Many are anxious because they know they have the risk factors,? says Carl Evans, Circle of Care Coordinator. ?You can see their hands sweating.? While waiting for results, Circle of Care provides material and counseling to educate patients about HIV. Risk factors include having unprotected sex, sex with multiple partners or with a partner who has had many partners, sex while under the influence of alcohol or marijuana, being diagnosed with a sexually transmitted disease or shared injection drug needles. ?They are very relieved when the results are in,? he said. He has witnessed many people express a desire to make safer decisions. ?The test is a life changing event,? said Evans The Quick Test looks for anti-bodies that are produced by the body as a response to the HIV virus. It does not test for the virus itself. The test is 99.9% accurate. Because it takes time for the immune system to produce sufficient ant-bodies to battle the virus, there is a 3 month window period where the virus is undetectable. The Center for Disease Control estimates that 1 in 3 people with HIV are unaware that they are infected, making them potential spreaders of the virus. HIV is contracted through unprotected sexual intercourse or blood transfer, such as sharing needles. It can also be given to a baby through breast milk. Other risk factors that lead to this behavior include drug or alcohol abuse. Early detection gives patients a chance to live a normal healthy life and reduces the risk they will spread the virus. Testing is available through Public Health at the Bethel Health Center, the Bethel Family Clinic, and the YK Hospital. Evans says that sub-regional will be set up to administer the test in the near future.
The real news on salt ? what do you have to be concerned about? 2/7/06 by Angela Hochreiter MPH, RD ? YKHC?s Healthy Hearts Program
Q: I?m pretty healthy. Should I really be worried about using less salt? A: In some studies, it has shown that the more salt we have in our diets, the greater chance we have for having high blood pressure. And high blood pressure (hypertension) can lead to an increased risk of heart attack and stroke. But there are other factors involved. First, while reducing salt in our diets makes a difference in blood pressure for some, for others it doesn?t. Second, there have been many studies showing that a high-salt diet increases cardiovascular risk. But there has been only one study linking a low-salt diet to a decreased risk of cardiovascular disease - that study was in a Japanese population where the ?low-salt? diet was still more than the average American consumes. Lastly, even those who suggest a low-salt diet admit that the high blood pressure brought on by salt might only affect some people. Q: Who might benefit from a low-salt diet? A: People that are salt-sensitive, which means that when they eat salt, their blood pressure rises dramatically. Elders, people with a family history of hypertension, and often African Americans are more likely to be salt-sensitive. About 26 percent of Americans with normal blood pressure are salt-sensitive and about 58 percent with hypertension are salt-sensitive. For those people, it is important to have no more than 2,400mg of salt a day (about one teaspoon). Q: If my blood pressure is okay, do I still need to worry about salt? A: Yes, even if your blood pressure is okay you should still be concerned about salt. High-salt diets are also related to brittle bones and stomach cancer. The extra salt washes out calcium in the urine while diets high in dried, smoked, salted or pickled foods might damage cells lining the stomach leading to stomach cancer. So just because your blood pressure is okay (about 130/80 or under), having too much salt is not. Q: So how much salt is too much? How much salt should I have daily? A: Between half a teaspoon and one teaspoon is a good range to aim for. Most of us eat more salt (also referred to as sodium) than we need and we only need about 500mg of sodium each day for nerves and muscles to work and for the fluids in our body to be in balance. In general, less than 2,400mg (about 1 teaspoon) is required for most adults according to the National Institutes of Health. Q: Why is sodium/salt added to lots of foods? What?s the difference between them? A: We all know that salt makes food taste good, but it also keeps food from spoiling, improves the texture of preserved foods, helps the fermentation in breads and cheeses. Many times we talk about ?salt? and ?sodium? like they are the same thing. But actually, sodium is just a part of salt. Salt is about 40 percent sodium and 60 percent chloride (its chemical name is sodium chloride). Sodium is found not only in salt, but also in other items like the flavor enhancer monosodium glutamate (MSG) used in Chinese food. Some medications also have sodium (two Alka Seltzers have 1,064mg). It?s important to check the nutrition labels for amounts of sodium. Q: How can I use less salt and still eat good food? A: Here are some tips: drain and rinse canned vegetables and beans before using them (there?s a lot of salt used in the canning process). Try out some different spices and use salt substitutes (like Mrs. Dash) for seasoning. Here are some recommendations: Allspice ? stew, tomatoes, gravy Basil ? salads, soups, sauces Cayenne pepper ? soups, casseroles, cheese sauces, egg dishes Cinnamon ? breads, squash, oatmeal Cumin ? chili, stews, beans Curry ? tomatoes, sauces, rice Dill ? vegetables, potatoes, pasta Lemon or limejuice ? salads, vegetables, sauces Rosemary ? stuffing, potatoes, peas Sesame ? breads, salads, vegetables Vinegar ? tomato sauces, salads, marinades, vegetables Excerpts from ?Has Salt Gotten a Bad Shake?? by Carla Davis, Vegetarian Times, February 2006 In next month?s column, we will discuss ways to lower your blood pressure. Also, you can call us at 543-6999 or 1-800-478-4471 ex. 6999 if you want more information about heart disease or just recipes to use with low sodium and high flavor! Next month: 5 Steps to Lower Your Blood Pressure Bethel Health Fair March 4th! February is National Heart Health Month ? visit Healthy Hearts (CHSB #236) and pick up a free stylish travel mug!
Protect your home against fire with the AK Home Fire Safety Improvement Project 1/24/06 by K.J. Lincoln
The Bethel Fire Department is sponsoring a project where you can have them do a walk-through of your house to determine what it needs to be fire safe. A trained Home Fire Safety Survey Crew will then equip and install anything your house needs such as smoke detectors, fire extinguishers, escape ladders, power strips for your electronic equipment, carbon monoxide detectors, plus FireStop for your stove and videos and CDs that teach you how to put together a fire escape plan for your home. The survey and the equipment are free. The project is funded by a grant from the Department of Homeland Security through the Alaska Division of Fire Prevention. Any community member in Bethel can request the survey and it is especially intended for homes with children under the age of 14 and elders over 65. Bethel was one of 16 communities that had recent fire fatalities in Alaska that received the grant. Last December, Mahlon Greene, Public Education Coordinator for the Division of Fire Prevention came to Bethel to train the volunteers for the survey crews. He assisted them during the first survey they did. ?We did a survey at one of the homes by invitation, and they had 1 smoke detector and the battery was dead. We took it out and put a new one in. We put in a carbon monoxide detector, installed a new fire extinguisher, gave them a fire safe surge strip for the TV and VCR, gave them a kitchen timer to use when they?re cooking, and pointed out a few things that might be a danger in the home,? said Greene. The survey takes about 1 hour to 1 1/2 hours. In addition to equipment, the survey crew also can give tips on how to make your home safer. ?That is the beauty of this survey,? said Fire Captain Bruce Perry who is spearheading the project. ?We go to people?s homes and offer suggestions on better fire safety procedures. We?re giving away the equipment for free. It is a lot of good protection to have.? Perry would like to invite everyone who is interested in the Alaska Home Fire Safety Improvement Project to come to a community meeting on Wednesday, January 25, 2006 at the U.S. Fish & Wildlife building at 7:00pm. To request a fire safe home survey for your home, call the Bethel Fire Department at 543-2131.
Chevak school students celebrate Martin Luther King, Jr. Day
by Edwina Ulroan
On January 16, Chevak School celebrated Martin Luther King, Jr. Day. We were going to march all around Chevak but it was stormy with a vicious wind. About half or more students marched down the hallway from the high school wing to the middle and elementary wings. It was cute when young children were marching with their signs up. While we marched, we sang a song that was called, ?We Shall Overcome.? There were some good quotes from Dr. King and some students made slogans on their own. ?If it were up to me, there would more Martin Luther King days,? said sophomore Chester Slats. After the march, we went to the cafeteria and continued singing the song. After we sang, we read our signs out loud and explained the meaning of them. Teachers passed out cookies to students who participated. Edwina Ulroan is a senior at Chevak School.
What is the Medicare prescription drug benefit all about? 1/17/06 by Karen Sidell, YKHC Patient Registration
Many seniors and disabled people are receiving letters in the mail about Medicare Part D. In order to explain this new benefit, let?s first talk about the differences between Medicaid and Medicare. Medicaid is a State of Alaska health program that covers people with low income and limited resources. People with Medicaid have to prove low incomes on a continuous basis. This health coverage is for any age, but primarily elders, children, pregnant women and disabled people qualify for services. Medicaid pays for hospital and clinic visits and travel, lodging, transportation, meals and prescription medication related with receiving medical services. Medicare is a federal government health insurance. Anyone who has worked and paid Medicare Tax for 10 years qualifies as a beneficiary, and so does his or her spouse. To use Medicare people must be 65 years or older or someone with a qualifying disability. Medicare insurance has three parts. Part A pays for inpatient hospitalization and is free to people who qualify. Part B is optional; you do not have to have it. It pays for outpatient visits and costs money; the amount is deducted from the person?s Social Security check. And starting in 2006, there will also be an optional prescription drug program, Part D. Medicare does not pay for travel, lodging, transportation, meals and prescription medication related with receiving medical services. Medicare Part D is an optional program, beginning January 1, 2006, to help those people on Medicare pay for prescription drugs. Presently, Medicare does not pay for prescription drugs. There are state and federal programs that patients can apply for to pay for the cost of a Medicare prescription drug plan. For those who do not qualify for extra help programs and have chosen to have Part D, the cost of the prescription drug plan will be deducted from the person?s Social Security check. There are four basic groups patients are placed in: The first group, people with both Medicare and Medicaid, are called Dual-Eligibles. These groups of people are automatically enrolled in one out of seven prescription drug plans for Dual-Eligibles. The plan will pay for their prescription drugs at the Pharmacy. The second group of people has Medicare and have lower income and limited resources, but do not qualify for Medicaid. These people are encouraged to apply for the state and federal programs that help pay for a prescription drug plan. If they do qualify for extra help, they will also need to choose a prescription drug plan. The third group of people has Medicare and commercial insurance. The commercial insurance can be active and/or retired insurance. These patients received a ?Creditable Coverage? letter from their commercial insurance carrier, which means the commercial insurance drug coverage is as good or better than a Medicare prescription drug plan. It is best for these people to keep their commercial insurance coverage and not enroll in a Medicare prescription drug plan without assistance. The fourth group of people has Medicare, but is over income and resources to qualify for extra help. This group will have to determine if they will pay for a prescription drug plan. This is a good option for those patients who travel outside of Alaska. At the YKHC hospital, when a patient obtains prescription medication from the Pharmacy, there is a large amount of billing behind the scenes. IHS beneficiary patients generally do not receive bills from the hospital, and are generally not aware of how the cost of the prescription medication is paid. It is important to inform patients that IHS funds do not cover all the costs of medical services, and if a patient has alternative resources, those must be used before IHS benefits. Thus, it is important to provide insurance information to the hospital to assist with the costs of medical care and prescription medication. Medicaid Travel Program A year ago, on January 1, 2005, the State of Alaska Department of Health and Social Services implemented changes to how Medicaid non-emergency travel is arranged. Your health care provider calls First Health Services for a prior authorization. When travel is approved, you or your health care provider calls the State Travel Office at 1-800-514-7123 to make the reservations. The State Travel Office is open Monday ? Friday 7:30a.m. to 6 p.m., Saturday 9 a.m. to 6p.m., and Sunday noon to 4 p.m. Only the State Travel Office can arrange your Medicaid-approved travel. These arrangements include reservations and ticketing.
Protect your family from the rabies virus 1/10/06 by the Yukon-Kuskokwim Health Corporation Office of Environmental Health and Engineering
Did you know that foxes commonly carry the rabies virus? Foxes can have the virus and appear not to be sick themselves. The main danger to us is when a rabid fox bites a dog, or a dog eats a fox with the virus. Rabies is fatal to humans! If you catch the rabies virus and it goes untreated, you will die. Rabies is a virus that is most commonly transmitted by the saliva of an infected animal. Foxes are the most common reason our pets get sick with rabies, and once an animal has rabies there is no cure. Signs of rabies in animals include: sudden changes in behavior, difficulty moving, problems swallowing, increased drooling, aggression, and not eating. Human exposure is most likely because of a bite or scratch from an infected animal. However, exposure can occur when skinning fox and other wild animals. It is important to use precautions and proper protection so that you do not come into contact with their brain, spinal fluid, or salivary glands. If a human is exposed to rabies, immediate medical attention is crucial in all cases of potential exposure because rabies is lethal in humans if not treated. The first step in treatment is to immediately wash the site with lots of soap and water. Washing the site is perhaps the most effective way to prevent the transmission of rabies when an exposure has occurred. In addition, when rabies is suspected, treatment with post-exposure prophylaxis is given in five doses over the period of 28 days. If you suspect an animal could be carrying the rabies virus and the animal is killed, the head must remain complete and undamaged so that the specimen can be analyzed for rabies. There must be enough undamaged tissue located in the head to perform the tests. To help ensure that the proper procedure is followed and limit the risk of someone dying from rabies, it is essential that you report ALL potential rabies exposures or suspected cases of rabies to the YKHC Office of Environmental Health and Engineering (OEHE) at 1-800-478-6599. In the YK Delta, dogs and cats are the most common culprits for transmission of rabies to humans. This doesn?t mean that you should avoid all dogs and cats, but you should protect your pets and family by vaccinating your pets against rabies. Dogs and cats need to be vaccinated against rabies at the first opportunity after 12 weeks of age. After the first rabies vaccine is given, regardless of the animal?s age, a booster must be given approximately 12 months later. Afterwards, the animal should be given rabies vaccine at least every three years. The State of Alaska has initiated a Lay Vaccinator program that is designed to allow community members to become certified to give rabies vaccines in their community. If anyone is interested in becoming a lay vaccinator, please contact YKHC-OEHE at 1-800-478-6599.
Why is knowing your blood pressure important?
by Angela Hochreiter MPH, RD
What is blood pressure? Blood pressure is what keeps the blood flowing in our bodies. Our blood pressure naturally changes during the day. If it stays high over time, it is called hypertension or high blood pressure. High blood pressure means that the heart has to work harder to carry blood to the vital organs in the body. High blood pressure can cause heart attack, stroke, kidney disease, and other serious medical problems. Even though people can die from high blood pressure, the only way to know if you have it is to have your blood pressure checked. What do the numbers mean? A blood pressure reading has two parts: The first number is sometimes called the top number, or the systolic pressure. It measures your blood pressure when the heart contracts and is pumping blood. The second number is sometimes called the bottom number, or the diastolic pressure. It measures your blood pressure when the heart is at rest, between heartbeats. Normal blood pressure is less than 120/80. When we say this reading out loud, we say ?120 over 80?. If your first number is 120 or higher or your second number is 80 or higher, there is reason to be concerned. These numbers naturally change during the day, so you should have your blood pressure checked again on another day. If your blood pressure is between 120/80 and 139/89, then you have prehypertension. This means that you don?t have high blood pressure now, but are likely to develop it in the future unless you adopt healthy lifestyle changes. By making small changes in your behavior, you can make big improvements in your blood pressure numbers. Changes such as including regular physical activity in your day, lowering your levels of stress, and choosing to stop smoking cigarettes if you smoke are all ways to improve blood pressure. How do I know if I have high blood pressure or hypertension? If your first number is higher than 140 or your second number is higher than 90, you may have hypertension or high blood pressure. In addition to lifestyle changes, your doctor may prescribe medicine. Don?t stop taking the medicine if your blood pressure reading is okay ? that means the medicine is working! People with higher blood pressure numbers have a greater risk of heart attack, stroke and kidney disease. For example, a person with blood pressure of 160/100 is three times more likely to have a heart attack or stroke than a person with blood pressure of 140/90! Getting your blood pressure tested and knowing your numbers will help you take control of your health. The people who love you will be glad that you are taking care of yourself. In next month?s column, we will discuss ways to lower your blood pressure. Also, you can call us at 543-6999 or 1-800-478-4471 ex. 6999 if you want more information about heart disease. Next month: 5 Steps to Lower Your Blood Pressure Angela Hochreiter is a MPH, RD for YKHC?s Healthy Hearts Program.
The five levels of Responder in Alaska 12/13/05 by John Dickens
Have you ever wondered what an EMT is? What an ETT is? What a MICP is? In Alaska we have five different levels of EMS responders. We start with ETT: This stands for Emergency Trauma Technician. This is a 44-hour course that corresponds to the National First Responder Certification. This is an entry-level course that goes beyond basic first aid, and is often given to police officers, firefighters, and SAR teams that would be on a scene first. All Health Aides are at least at the ETT level. ETT is a good course to get started with. The next step is EMT1, Emergency Medical Technician 1. This is a 120-hour course that goes in to more depth than the ETT course and has a 150 question written exam and a demanding formal five-station proctored practical exam. This course is worth six college credits. The National equivalent is called EMT Basic. The next step in Alaska is EMT2. This is a 50-60 hour class that covers IV therapy and advanced airway techniques. A student must complete 10 successful IV sticks plus be able to intubate a patient. This class also has a 150-question written exam (75 EMT1 plus 75 EMT2 questions) as well as a demanding five station practical exam. You must be an EMT 1 for six months and have the endorsement of your physician sponsor before you can take an EMT 2 class. After this comes EMT 3. This covers Advanced Cardiac Life support (ACLS). It covers the special drugs and equipment, like defibrillators, that deal with cardiac emergencies. This is a 50-60 hour course and has a 150-question written exam (50 EMT 1, 50 EMT2, 50 EMT3) along with a nerve-wracking thorough practical with five stations. On the National level both the Alaska EMT 2 and EMT 3 are combined: this is called the EMT Intermediate level. In Alaska the highest EMS level is MICP. This stands for Mobile Intensive Care Paramedic. This is a license, like a nursing license, not a certification like EMT1, 2,or 3. The National equivalent is EMT-P. Emergency Medical Technician-Paramedic. The requirements for Paramedic are very intense.
Scene safety 12/6/05 by John Dickens
In a life-threatening emergency, who is the most important person at the scene? You are. If you do not take care of yourself, you can?t help the victim. Every year many responders are killed or injured while trying to help out on an emergency scene. Then we have two medevacs to deal with instead of just one! Have you ever been in a wreck or a fight when everything seemed to go in slow motion? The name for this phenomenon is ?tachypshycia.? It was first explored when scientists studied the stress reactions of police officers in gunfights. This is a normal reaction to a potentially life threatening situation, where the human body shuts down all the ?extra stuff? and focuses on the immediate task of survival. Your adrenal gland dumps large amounts of adrenaline into your bloodstream; your blood pressure, pulse and respirations go up dramatically. Your peripheral (side) vision decreases as much as 80 percent. Your ability to do fine motor tasks drops while your strength and stamina for coarse motor tasks increases to superhuman levels. The stories you hear about mothers picking up cars to save their babies are due to the ?fight or flight? mechanism that is the adrenal gland. Why all this info, you ask? Well, it is important to take into account how these facts affect us and our decisions and performance in an emergency scene. EMP America, a Eugene, Oregon, based first aid training provider, has developed a handy acronym known as S.E.T.U.P. to help responders keep their personal safety foremost in their minds. S is for STOP. Take a deep breath and look around. Situational awareness is the most important concept in an emergency scene. Ask yourself, ?Why is someone hurt? Am going to get hurt by whatever hurt them?? Look before you leap! Summon help immediately?call 911, get the VPSO, health aide, etc. Make sure that help is on its way. E is for ENVIRONMENT. Where is the victim? Are they in the water? Can you swim? Even if you can swim like a Navy SEAL, wouldn?t it be better to go get a boat? If the weather is bad, are you dressed for it? If you get hypothermic, are you going to be much help? T is for TRAFFIC! When focused on an injured person it is easy to forget that a truck or snow machine driver may not see you in time. Be very careful when helping someone on a road or trail. Make sure you do not get run over. U is for UNKNOWN hazards. Is there a poison gas present? Is this a violent crime scene? Was there a weapon involved? Is the weapon secured? Has law enforcement secured the scene? Is there criminal evidence present that may be damaged by you? Is there an animal involved? Always be on the lookout for unexplained or ?weird things.? P is for PROTECT your self and the patient. Do not risk exposure to any body fluids to yourself or the patient. You can die from the slightest exposure to infected persons? body fluids. You must use barriers at all times when responding to an emergency! These include gloves, mouthpieces, etc. To be able to help on an emergency, you really need to get formal training. The life you save may be your own!
The effects of Meth 11/29/05 by John Dickens
This is a really touching poem?very important especially with its rise of use among people, and Native people. There needs to be more awareness of the negative effects of drugs? This article was written by a young Indian girl who was in jail for drug charges and was addicted to meth. She wrote this while in jail. As you will soon read she fully grasped the horrors of the drug as she tells in this simple yet profound poem. She was released from jail but true to her story, the drug owned her. They found her dead not long after with the needle still in her arm. Please keep praying for our Native People to understand. This thing is worse than any of us realize... My Name Is Meth I destroy homes, I tear families apart, take your children, and that?s just the start. I?m more costly than diamonds, more precious than gold, The sorrow I bring is a sight to behold. If you need me, remember I?m easily found, I live all around you - in schools and in town I live with the rich, I live with the poor, I live down the street, and maybe next door. I?m made in a lab, but not like you think, I can be made under the kitchen sink. In your child?s closet, and even in the woods, If this scares you to death, well it certainly should. I have many names, but there?s one you know best, I?m sure you?ve heard of me, my name is crystal meth. My power is awesome, try me you?ll see, But if you do, you may never break free. Just try me once and I might let you go, But try me twice, and I?ll own your soul. When I possess you, you?ll steal and you?ll lie, You do what you have to ? just to get high. The crimes you?ll commit for my narcotic charms Will be worth the pleasure you?ll feel in your arms. You?ll lie to your mother, you?ll steal from your dad, When you see their tears, you should feel sad. But you?ll forget your morals and how you were raised, I?ll be your conscience, I?ll teach you my ways. I take kids from parents, and parents from kids, I turn people from God, and separate friends. I?ll take everything from you, your looks and your pride, I?ll be with you always ? right by your side. You?ll give up everything - your family, your home, Your friends, your money, then you?ll be alone. I?ll take and take, till you have nothing more to give, When I?m finished with you, you?ll be lucky to live. If you try me be warned - this is no game, If given the chance, I?ll drive you insane. I?ll ravish your body, I?ll control your mind, I?ll own you completely, your soul will be mine. The nightmares I?ll give you while lying in bed, The voices you?ll hear, from inside your head. The sweats, the shakes, the visions you?ll see, I want you to know, these are all gifts from me. But then it?s too late, and you?ll know in your heart, That you are mine, and we shall not part. You?ll regret that you tried me, they always do, But you came to me, not I to you. You knew this would happen, many times you were told, But you challenged my power, and chose to be bold. You could have said no, and just walked away, If you could live that day over, now what would you say? I?ll be your master, you will be my slave, I?ll even go with you, when you go to your grave. Now that you have met me, what will you do? Will you try me or not? It?s all up to you. I can bring you more misery than words can tell, Come take my hand, let me lead you to hell. If you care enough, please share the deadly outcome of this drug that is killing our Native People.
AIDS in a changing world 11/21/05 by Dr. Marin Granholm, YKHC Family Medicine
Recently, I was watching an old television rerun that included a character diagnosed with AIDS ? his family was pictured grieving, his future limited. I found myself reacting to the show, as I know what may not yet be common knowledge: AIDS no longer equals the end of a person?s hopes. With the introduction of new treatments in the late 1990s, the rate of death from AIDS in the U.S. declined by 75 percent. With appropriate prenatal care, the transmission from mother to child is now rare. If a person takes his or her medicines as prescribed, it may even be possible to live a relatively normal life. A person with AIDS is now much more like a person with diabetes or high blood pressure than a person with a fatal infectious disease. However, there are some important differences: a person with AIDS must be 95 percent successful or better at taking his or her medicines correctly, or the virus starts to develop resistance to the medications. Although there are several medication options, it is possible to develop resistance to all of them. People who have developed resistance to all medications still benefit from treatment, however, because resistant virus tends to be weaker. People with AIDS undergoing treatment are still infectious, although it is still a pretty difficult virus to get; you can only get AIDS through exposure to a person?s blood, semen, vaginal fluid or breast milk. HIV is present in the YK Delta. It is also easier to become infected with HIV when there is another sexually transmitted infection present. The YK Delta and the North Slope of Alaska have the highest rate of Chlamydia (a sexually transmitted infection) in the United States. This makes it doubly important that we think about HIV, get tested and protect ourselves. The fastest growing segments of people with AIDS are women and youth. We used to think about HIV as a gay men?s disease; it is now most commonly acquired through heterosexual sex. There are three ways to protect yourself: remain abstinent, remain monogamous with a single uninfected partner who is also monogamous with you, or use a condom every time. To know if you and your partner are uninfected, you must get tested. Testing is available at YKHC, at Public Health Nursing, and at Bethel Family Clinic. AIDS is still changing and growing worldwide. There are 40 million people in the world living with HIV, the virus that causes AIDS. 90 percent of them live in developing countries, and (in contrast to the U.S.) only 12 percent of those that need medicines are able to get them. Worldwide, 20 million people have died of AIDS so far. December 1st is World AIDS Day. It takes place every year on this day and is an international day for increasing awareness, education and fighting prejudice. This year the theme is focused on wearing the red ribbon, as a sign of support for people living with HIV and a symbol of hope for the future. There will be a vigil in Bethel December 1st at Watson?s Corner from 5:00 pm until 5:45, when we will reconvene at Sackett Hall for hot chocolate and a short film. I hope that you will help recognize this event with me by wearing your ribbon, in recognition that while HIV/AIDS is different now for people in the United States, it remains a challenge for much of the world. Take care of yourself. Get tested today. Dr. Marin Granholm specializes in Family Medicine at the Yukon-Kuskokwim Health Corporation.
Scene Safety 11/15/05 by John Dickens
In a life-threatening emergency, who is the most important person at the scene? You are. If you do not take care of yourself, you can?t help the victim. Every year many responders are killed or injured while trying to help out on an emergency scene. Then we have two medevacs to deal with instead of just one! Have you ever been in a wreck or a fight when everything seemed to go in slow motion? The name for this phenomenon is ?tachyphsycia.? It was first explored when scientists studied the stress reactions of police officers in gunfights. This is a normal reaction to a potentially life threatening situation, where the human body shuts down all the ?extra stuff? and focuses on the immediate task of survival. Your adrenal gland dumps large amounts of adrenaline into your bloodstream; your blood pressure, pulse and respirations go up dramatically. Your peripheral (side) vision decreases as much as 80 percent. Your ability to do fine motor tasks drops while your strength and stamina for coarse motor tasks increases to superhuman levels. The stories you hear about mothers picking up cars to save their babies are due to the ?fight or flight? mechanism that is the adrenal gland. Why all this info, you ask? Well, it is important to take into account how these facts affect us and our decisions and performance in an emergency scene. EMP America, a Eugene, Oregon, based first aid training provider, has developed a handy acronym known as S.E.T.U.P. to help responders keep their personal safety foremost in their minds. S is for STOP. Take a deep breath and look around. Situational awareness is the most important concept in an emergency scene. Ask yourself, ?Why is someone hurt? Am going to get hurt by whatever hurt them?? Look before you leap! Summon help immediately?call 911, get the VPSO, health aide, etc. Make sure that help is on its way. E is for ENVIRONMENT. Where is the victim? Are they in the water? Can you swim? Even if you can swim like a Navy SEAL, wouldn?t it be better to go get a boat? If the weather is bad, are you dressed for it? If you get hypothermic, are you going to be much help? T is for TRAFFIC! When focused on an injured person it is easy to forget that a truck or snow machine driver may not see you in time. Be very careful when helping someone on a road or trail. Make sure you do not get run over. U is for UNKNOWN hazards. Is there a poison gas present? Is this a violent crime scene? Was there a weapon involved? Is the weapon secured? Has law enforcement secured the scene? Is there criminal evidence present that may be damaged by you? Is there an animal involved? Always be on the lookout for unexplained or ?weird things.? P is for PROTECT yourself and the patient. Do not risk exposure to any body fluids to yourself or the patient. You can die from the slightest exposure to infected persons? body fluids. You must use barriers at all times when responding to an emergency! These include gloves, mouthpieces, etc. To be able to help on an emergency, you really need to get formal training. YKHC?s EMS Department has a wide variety of courses available for you. The life you save may be your own!
Civil defense 11/8/05 by John Dickens
?And let none say it can not happen here?? The ancient Greek dramatist Sophocles words at the fall of Troy ring true even today. The recent earthquake and tsunami in south Asia is a grim reminder, of how delicate and fragile our time on this planet can be. The USGS says ?one out of every ten earthquakes in the world occur in Alaska.? There have been dozens of tsunamis recorded in Alaska since 1788. A massive array of geologic, anthropologic and archeological evidence points to frequent, catastrophic events in Alaska that changed everything overnight. Are you and your village ready? Where will you go when the big wave comes? When the great floods of yesteryear return? How are you going to feed your family? Keep warm? Stay alive? Care for the wounded? Rescue the stranded? Keep it together till help arrives? Have you thought about it? You had better start! Geologists point to possibly two huge 9.0 or bigger earthquakes that are long overdue. The Shumagin gap and the Yakutat gap. These geologic time bombs have got all the earth scientists sweating. In many ways, we are probably the one of the least prepared regions in the whole state. Other areas, even ones poorer and more remote than ours have Borough governments preparing and planning for these upcoming events. What are we doing? From what I can tell, not very much. If Anchorage was hit by a 1964 style 9.2 earthquake, do you really think that they could help us quickly enough? If the ?Big One? occurred tomorrow, do you think your town is really ready to stand on its own for a few days? If you knew that a tsunami was coming, where would you go? The time to start thinking about these issues is right now! I am calling on all the people of this great Delta of ours to start thinking about this. Start preparing now. Consult the Elders, meet with your family, your tribe, your town. There are tremendous resources available for those who will look. Do it now, before it is too late. Our fate, is in our hands?
Disaster preparedness 11/1/05 by John Dickens
?How do you eat a whale?? ANSWER: ?One bite at a time.? It is easy to feel overwhelmed when facing the daunting task of preparing for an emergency. The American Red Cross has come up with six steps that will help you through the process: They are TALK, PLAN, LEARN, CHECK SUPPLIES, TELL, PRACTICE. TALK: Talk with your family and friends about disasters that can happen where you live. Talk with your family about why you need to prepare for these events. Calmly explain the potential dangers, and plan to share responsibilities and work together as a team. Make sure family members and friends know their job. Pick an alternate in case that person is absent. PLAN: Plan where to meet after a disaster. Choose two places: Right outside your home, in case of a fire. Outside your neighborhood, in case you cannot return home or are forced to evacuate. After picking your meeting places you should also determine the best two escape routes out of your home, and out of your town. Maybe a fish camp or a nearby village can provide shelter. Ask an out of town friend to be your ?family contact?. After a disaster, getting word to that friend using phone, VHF, or runners can help you find your family. All family members should know how the contacts name, number and location of the rally point. LEARN: Try www.redcross.org or www.ready.gov these sites have an immense amount of information available, of what to do in a disaster, including specifics about making kits and what dangers you will face. Try to learn what others in your village are planning. It takes a whole village to make these plans effective and efficient. Learn about disaster plans that your village institutions may already have. Consult the elders, they often have keen insights and historical knowledge of what people did in disasters in the past. Remember folks out here have survived in the area for thousands of years, the elders may know of precedents that can help you. CHECK SUPPLIES: Try to stock up on some water, food, batteries, fuel, ammo, cash and other essentials items like medicines ETC. Remember that we are on the very extreme end of an incredibly complex and fragile supply line. Remember how quickly the shelves of our stores emptied during the 9/11/01 crisis. Ask the elders about this and the great famines of our past. They have great knowledge of these matters. Their hard won knowledge is priceless and they are our biggest hope of making it through these hard times that may be coming our way. TELL: Tell your family and friends and neighbors about what we have to do. The time is now to talk about these frightening possibilities. Get with your tribal/traditional councils; talk with your village, your neighboring villages. BE BRAVE and STRONG. PRACTICE: Practice what you have found out. Remember the more we sweat now, the less we will suffer then. I know this is very scary stuff, but remember what one of our greatest Presidents; F.D.R. said during the dark days after Pearl Harbor ?The only thing we have to fear is fear itself.? The people of this great Delta of ours are survivors and we will prevail!
National Interagency Incident Management System 10/25/2005 by John Dickens
Originally called the Incident Command System, it was developed for wildland fires, the National Interagency Incident Management System (NIIMS) is the official way to handle emergencies in the United States. NIIMS was developed to provide a common system that emergency service providers can use at all levels of an emergency. It is flexible and well tested. I have seen it in action and it works very well. NIIMS consist of eight key components and five key areas or subsystems that provide a complete approach to incident management. The eight components of NIIMS are: ?Common Terminology: It is absolutely imperative that any management system and especially one used in an emergency/joint operation with many different users have a common terminology for, organizational functions, resources and facilities. All players need to be on the same sheet of music. Everyone must understand each other! ?Integrated Communications: Communications must be managed by a common communications plan. You must have a common communications center and your radios must be able to talk to each other. Ideally, you should have P25 type radios available. ?Modular Organization: The structure of the organization must be flexible and modular based upon the particular incident. It can get bigger or smaller as the need arises. This is one of the key attributes, IMS works for a small house fire or motor vehicle crash all the way to a huge earthquake or hurricane. ?Unified Command Structure: The concept is that all agencies that have jurisdiction contribute to the process of; determining the objectives, strategies, and tactics, along with ensuring efficient and effective maximum use of resources. There can only be one boss at the top! ?Manageable Span of Control: In general, an individual in emergency management should have responsibility for a team ranging from three to seven people with five being ideal. ?Consolidated Action Plans: You need a plan! Small stuff might need a plan that is not written down. Big stuff does need a written plan especially when resources from multiple agencies are used, when several different jurisdictions are involved or changes in shifts of people and equipment are anticipated. ?Comprehensive Resource Management: An accurate timely picture of the status and locations of all resources must be kept. Waste not, want not! ?Pre-Designated Incident Facilities: There are several kinds of facilities that can be established like command posts, emergency operation centers, staging areas ETC. The five functional areas or subsystems are: ?Command or Management: The Commander might have staff like Safety Officers, Liaisons, Public Information officers ETC ?Planning: A planning section involved in collecting, evaluating, forecasting information of the incident. ?Logistics: The ?beans and bullets? of the incident. Things like transportation, supplies, fuel, feeding, communications, and maintenance. ?Finance: People and vendors must get paid! The bean counters must do their thing! ?Operations: Initially in any incident the resources that are used will report to the incident commander. As the incident grows in size, the commander may designate an ?OPS BOSS? who assumes tactical direction. If you and your village are serious about getting ready for the ?big one? you must participate in NIIMS. If you want to get any assistance from the myriad of help available out there, learn and practice the NIIMS method. Try www.fema.gov. It is said that people out here are ?always getting ready? Let us start now!
Candle safety 10/18/2005 by John Dickens
?Blow out before you go out.? This years fire prevention theme is candle safety. IT IS VERY IMPORTANT TO REMEMBER THAT A CANDLE IS AN OPEN FLAME. IT CAN EASILY IGNITE ANY COMBUSTIBLE MATERIAL NEARBY. The National Fire Protection Association came out with some startling statistics. -During 2002, candles started an estimated 18,000 home fires. These fires killed 130 people, caused 1,350 injuries and resulted in a property loss of 333 million dollars! -Candle fires accounted for an estimated 5% of all reported home fires. -40% of home candle fires started in the bedroom causing 30% of the fire deaths. -Reported home candle fires have more than tripled since the low of 5,500 in 1990. -December had almost twice the number of home candle fires of an average month. -50% of home candle fires occurred when combustible material was left near or came too close to the candle. 18% started after the candles were unattended or abandoned. 5% were started by people (mostly children) playing with the candle. -Falling asleep was a factor in 12% of home candle fires and 25% of the home candle fire deaths. -Christmas Day was the peak day of the year for home candle deaths for 1999-2002. New Years Day and Christmas Eve tied for second. SAFETY TIPS: These are important things to remember! -Extinguish all candles when leaving the room or going to sleep. -Keep candles away from items that can catch fire, like clothing, books and curtains. -Use candleholders that are sturdy, will not tip over easily, are made from a material that cannot burn, and are large enough to collect dripping wax. -Keep candles and all open flames away from flammable liquids. -Keep candlewicks trimmed to 1/2 inch long and extinguish taper and pillar candles when they get within 2 inches of the holder. - During power outages avoid carrying a lit candle. Use flashlights. NEVER EVER LET CHIDREN PLAY WITH CANDLES OR ANY KIND OF FIRE!
FIRES: Underestimated danger 10/11/2005 by John Dickens
We still underestimate it? In a new survey, the National Fire Protection Association found that Americans still underestimate their risk of fire. Choosing from a list of disasters, only 27% named fire as the highest risk. Many folks picked things like tornadoes, hurricanes, earthquakes and even terrorist attacks as being the biggest risks. They were wrong! Of all disasters, fires are actually much more common and many times more deadly! Last year U.S. fire departments responded to 1.6 million fires, these fires killed 3,925 people. To give you perspective, our country loses about 70 people a year to tornadoes. The property loss to fires is more than all other disasters combined. And many of these other disasters lead to fires while often diminishing the ability to fight them. While 96% of U.S homes have a smoke detector, about 20% of the smoke detectors do not work! This why it is so important to test them. Only 25% of households have developed and rehearsed plans for escaping their homes in a fire. In our country, fire occurs in a structure once every 61 seconds. A person is injured in a fire every 29 minutes and dies in one every 134 minutes! And four out of five fatal fire deaths occur in the place people feel the most safe: the home! Here in Alaska we face even greater danger. Traditionally Alaska has experienced a high rate of death from fire. At one time, an Alaskan had a 3 times higher risk for fire death than a lower 48 resident. If you lived in Western Alaska you had an 8 times higher risk than the lower 48! Thanks to the Fire Marshal?s office, it is better now but still way too high. Did you know? On the average, 19 Alaskans die from fire every year, 4 of those are children under 11 years old. The most common cause of fire deaths in Alaska is careless smoking while drinking alcohol. On the average, twice as many males die from fire than females. More Alaskans die from fire in a single-family residence than any other structure. From 1993-2003 all residential fires that had a fatality, 82% of the homes did not have a smoke detector installed or it did not work. Here are some things you can do to prevent a fire in your home: Cook Safely-Always keep an eye on your cooking Extinguish all cigarettes completely Keep combustibles away from heat sources Do not overload electrical outlets Keep matches and lighters away from children Extinguish all candles when leaving a room or going to bed Store all flammable liquids in an approved container in a secure location Space heaters need space Keep your vehicle well maintained to prevent vehicles fires Keep you heating system clean and maintained Together we can do a better job of fire prevention.
S.T.A.R.T. Simple triage & rapid treatment
by John Dickens
?It is a race against time?? You?re first at the scene of a horrible, terrifying wreck. People are screaming in pain and fear, writhing in agony and despair. You freeze; you want to run, so many hurt people, where do you START? The woman with a broken femur sticking out of her thigh? The kid choking on his own blood, the other kids squirming like a bucket of blackfish? You feel overwhelmed and your mind is overloaded. This is a problem all responders may face sooner or later. Too many patients and too little resources, you will need to triage (from the French word ?to sort?) and you need to do it fast. In 1983, the Newport Beach Fire Dept. developed the START system. This stands for Simple Triage and Rapid Treatment. This triage system has been updated and has rapidly become ?state of the art? for triage in the United States. The system comes in a red fanny pack, with about 35 colored and numbered triage tags along with some paramedic shears and tie wraps and some red reflective adhesive ?immediate stickers?. It is simple, it was designed for rescuers with basic first aid skills and it has been proven in the field. First as with any scene, ensure your safety! Then you want to move the ?walking wounded? They get green tags. For example, Aeromed Delta did this in the April 2001 Nelson Island aircraft crash. Gene Wiseman MICP shouted, ?Everyone who can walk come over here!? All but two of the patients then got up and walked over. He then knew which patients were the most serious. Open the airway, if they are not breathing, after a head tilt chin lift and an oral pharyngeal airway insertion (OPA) this patient will get Black tags (dead/dying). Remember R.P.M. Respirations, Pulse, Mental Status. Then you check respirations - if they are over 30 a minute, the patient gets a red tag (immediate). Check the patient?s radial pulse, if they have none, they get a red tag (immediate). Check the patients Mental Status; if they are unable to follow simple commands, they get red tag (immediate). Otherwise all patients will get a yellow tag (delayed). All red-tagged patients get the adhesive reflective sticker placed on them. This helps the responder keep track of the immediate patients in low light situations. More information can be found a www.start-triage.com.
C SPINE or cervical spine immobilization
by John Dickens
It is the most easily injured part of the spine? The top seven vertebrae are the cervical vertebrae. They are the most easily injured part the spine. Whenever the mechanism of injury (how the patient got hurt) indicates a possible head, neck or back injury, you must protect the spine from further injury. You do this by holding the head in a neutral inline position. The American Spinal Association estimates that one out of four people that are crippled by spinal injuries were actually crippled after their accident by unnecessary movement of the spine. If you suspect the presence of spinal injury, it is absolutely essential that the injury be splinted and protected until hospital tests rule out a spinal cord injury. At my old fire department (Central Emergency Services in Soldotna), three times in one-year we had patients with broken necks who did not even know it. The bones or vertebrae were damaged but the nerve cord was not yet broken, if the patient had turned suddenly or sneezed. The nerve cord could have been cut and they would have crippled for life. This is why responders are so adamant about protecting the spine, by good C-spine protection and back boarding. Always try to approach the patient from the front; this will help prevent them from twisting around to see you. As soon as you are within earshot of a patient who may have a possible spine injury, ask them to not move. Get in a stable position usually behind them and hold their head in a neutral in line position with your fingers spread wide. Make sure you are in a stable position that you can maintain until another responder relieves you. Do not let go of C-Spine until you are properly relieved. Talk to your patient softly and try and explain to them why you are doing this. See if they can feel and wiggle their toes and fingers. Monitor the airway, breathing and circulation.
A Hooper Bay success story
by John Dickens
So as iron sharpens iron, one person sharpens another? When I think of the many everyday heroes in this great delta of ours, my friend Grant Funk of Hooper Bay comes to mind. On March 19th of this year, the Hooper Bay Guardian Angels had their first formal meeting. This event was two years in the making. This rescue squad now has about 15-20 members, six of whom are adults, and four of these adults are EMT1s. The rest are all teenage high school students who are over 16 years of age. This unique group of responders is divided into four response groups. Alpha - Is Reverend Grant Funk himself who is always on call. Bravo - The four adults who are EMT1s. Charlie - The High school ETT students. Delta - Stretcher-bearers, some are ETT trained, these folks help in fetching and hauling all the EMS gear and helping in transporting the patients. The Guardian Angels now have an average response time of less than five minutes! My colleagues at YKHC Injury Control and EMS have helped this squad receive grants for much of the EMS equipment and recently procured six Motorola Minitor Five pagers for them. Now the Hooper Bay Police Department can dispatch them to the scene. This squad is activated to assist the Village Health Aide that is on call. I am very proud of this elite group of volunteers. Already they are hard at work improving their capabilities, skill sets and equipment inventory. The Hooper Bay Guardian Angels, like the Aniak Dragon Slayers are shining examples of what people out here can do to make their towns better places to live. IF THEY CAN DO IT, SO CAN YOU!
The Star of Life
by John Dickens
You will see it throughout EMS? The Star of Life is the common symbol used by U.S. Emergency medical services. You will see it on ambulances and all sorts of EMS gear. Leo R. Schwartz created the star of life in 1973. Leo was the EMS branch Chief of the National Highway Traffic Safety Administration (NHTSA). The NHTSA was instrumental in starting the modern EMS programs that we often take for granted today. The star of life was designed in response to the complaints from the American National Red Cross objecting to the use and imitation of the Red Cross symbol by ambulance services through out America. You will still see the use of the Red Cross symbol on military vehicles, hospital tents and buildings to protect wounded civilian and military personnel as per the Geneva Convention. Each bar on the Star of Life represents one of six functions. They are as follows: 1.Detection 2. Reporting 3. Response 4. On Scene Care 5. Care in Transit 6. Transfer to Definitive Care The snake and staff in the symbol portray the staff of Aesculapius, son of Apollo, the staff represents medicine and healing. The Star of Life can be seen as a means of identification on ambulances and ambulance equipment worldwide. Its used on EMS patches in the U.S. and other countries signifies the wearer has been trained to meet National or State EMS training standards.
911: The North American Emergency phone number
by John Dickens
The first link in the chain of survival is: early access. ?Getting help?. In the U.S. and Canada the universal phone number for emergency is ?9-1-1?. In Bethel we have enhanced 911, you pay 75 cents a month on your phone bill to help pay of the cost of this awesome life saving system. Enhanced 911 uses state of the art caller I.D. technology to locate the emergency, record and enhance the audio and dispatch the appropriate emergency vehicles to the scene. A few towns like Aniak and Hooper Bay have basic 911: this system does not enable to Dispatcher to locate the scene or any other enhancements, but does expedite the emergency call. Most of the villages in our area do not have even basic 911. This problem occurs throughout rural Alaska. In Juneau, there has been an attempt to rectify this problem with the implementation of Regional 911 Centers. This will (like most important things) take time and money. In the meantime, in the village without 911, you should memorize the clinic and VPO/TPO/VPSO phone numbers and 1-800-478-9112, this phone number goes directly to ?C? Detachment of the Alaska State Troopers in Bethel. After hours, it is forwarded to the Bethel Police Dept. Dispatch, who then calls the appropriate agency. The first catalyst for 911 came in 1957 when the National Association of Fire Chiefs recommended the use of a single phone number for reporting fires. By 1967, the president?s Commission on Law Enforcement and Administration of justice recommended that a single phone number should be established nationwide for reporting emergency situations. Other agencies and organizations expressed a keen interest and the FCC was asked for a solution. In November of 1967, the FCC met with AT&T to find a universal emergency phone number. In 1968, AT&T announced it would establish 9-1-1 as the emergency code throughout the U.S. The code 9-1-1 was chosen because it best fit the needs of all parties involved. First and most important, it met the public requirements because it is brief, easily remembered and can be dialed quickly. Second, because it is a number, never having been used as an office code, area code or service code, it best met the long range numbering plans and switching configurations of the telephone industry. On February 16th 1968, Senator Rankin Fite made the first 911 calls in Haley, Alabama. On February 22nd 1968, Nome, Alaska implemented 911 services. In 1973, the White House issued a national policy statement, which recognized the immense benefits of 911. By 1976, 17% of the U.S. had 911 services. By 1979, 26% had 911 services - the U.S. was increasing 911 by about 70 systems a year. By 1987, about 50% of the U.S. had 911 and Canada had adopted 911. By the year 2000, nearly 93% of the U. S. had some type of 911 services. 95% of this was enhanced 911. Some type of 911 covers about 96% of the geographic area of the U.S. Someday I hope all of Alaska will have 911?
On death and dying
by John Dickens
We are only here for a little while? If you are in EMS for the long haul, it is only a matter of time before you will treat someone who is dying or has already died. As an EMS person, you will also encounter sudden, unexpected deaths. Often these deaths may be of a violent nature. How we handle these deaths will greatly affect how we can help patients and their families deal with this grim, inevitable reality. In EMS, you will undoubtedly be called to patients who are in various stages of a terminal illness. Understanding what the families and patients go through can help you deal with the stress they feel as well as your own. When a patient finds out they are dying, they go through emotional stages, each varying in duration and magnitude, sometimes overlapping, and all affecting both patient and the family. DENIAL or ?Not Me.? The patient denies that he is dying - this puts off dealing with the inevitable end of the process. ANGER or ?Why me?? The patient becomes angry at the situation. This anger is commonly vented upon family members and EMS personnel. BARGAINING or ?Okay but first let me?? In the mind of the patient bargaining seems to postpone death, even for a short time. DEPRESSION or ?Okay but I haven?t?? The patient is sad, depressed, and despairing, often mourning things not accomplished, dreams that will not come true. He retreats into a world of his own, unwilling to communicate with others. ACCEPTANCE or ?Okay, I?m not afraid.? The patient may come to accept death, although he does not welcome it. Often, the patient may come to terms with the situation. There are several steps or approaches that you can take in dealing with the patient and family members confronted with death or dying. Recognize the patient?s needs. Treat the patient with respect and do everything you can to preserve the patients dignity and sense of control. For example, talk directly to the patient. Avoid talking about the patient to family members in the patient?s presence as if the patient were incompetent or no longer living. Be sensitive to how the patient seems to want to handle the situation. For example, allow or encourage the patient to share feelings and needs, rather than cutting off such communications because of your own embarrassment or discomfort. Respect the patient?s privacy if he does not want to communicate personal feelings. Be tolerant of angry reactions from the patient or family members. There may be feelings of helpless rage about the death or prospect of death. The anger is not personal. It would be directed to anyone in your position. Listen empathetically. You cannot ?fix? the situation, but listening with understanding and patience will be very helpful. Do not falsely reassure. Avoid saying things like ?Everything will be alright,? which you, the patient, and the family all know is not true. Offering false reassurance will only be irritating or convey the impression that you do not really understand. Offer as much comfort as you realistically can. Comfort both the patient and the family. Let them know that you will do everything you can to help or get them whatever help is available from other sources. Use a gentle tone of voice and a reassuring touch, if appropriate. An old paramedic once said ?When we see a patient, it is often the worst day of their life - and it does not take much to be the best thing that happens to people on their worst day!?
Heroes of the delta
by John Dickens
Village Health Aides They are the Warriors for Wellness? In the never-ending battle for Health Care in the YK Delta, there are many participants; we have doctors, nurses, paramedics and specialists in many fields. In the war for wellness, the front line infantry and the backbone of our Health Corporation are the Community Health Aides (CHA) and the Community Health Practitioners (CHP). YKHC employs about 40% of the health Aides in Alaska, by far the most of any Health Corporation. At any one time, there are about 170-180 Health Aides that staff the 48 village clinics that YKHC operates. The amount of training that it takes to bring a CHA on line is staggering. After YKHC Corporate orientation, they must complete a one-week Emergency Trauma Technician course and a one-week Pre-session. Then they must complete Session 1 (four weeks) Session 2 (four weeks) Session 3 (three weeks) and Session 4 (four weeks). These Sessions consist of rigorous and demanding training in complex technical subjects, 8 hours day and 5 days a week with homework every night. Since most Health aides are from the villages, this training involves lengthy periods away from home and family - this is a hardship and sacrifice that should not be underestimated. Between each of these challenging training sessions come Field visits that involve 200 clinical hours and 60 patient encounters along with intense training in YKHC Standing orders. After completing all four sessions plus a preceptorship, they are eligible to become a CHP or Community Health Practitioner. All CHA and CHP must be recertified every 2 years from the time they were certified as Session 1. For this they must have 48 hours of Continuing Education (24 hours must be EMS CME). Every 6 years they must go through a recredentialing that requires 144 hours of CE (72 hours CE plus 72 hours of EMS CME). In the field at the clinics, these brave people wear a great many different hats: they are a receptionist, a registrar, a triage person, a health provider, a lab tech, a pharmacist, a health educator, an appointment maker, a well child examiner, an immunization provider, an emergency provider, a behavioral health specialist, a mid-wife, a crisis intervention specialist - the list goes on. As one old timer said, ?In most villages, the only person the villagers can count on to help them is the Village Health Aide.? It has been my honor to work with village health aides. They see a lot of action. Just about every one of them has dealt with life threatening emergencies, of the most stressful and demanding type. Often the CHA?s coming in from the villages remind me of soldiers coming from the front line battles. They often show signs of Posttraumatic Stress disorder. Sometimes a review of a particular injury, or a treatment skill will bring one of them to tears from the memory of a past event. In a recent CPR class, 7 of the 11 CHA had done CPR for real in the field. When reviewing childbirth procedures one veteran CHA told me that she had delivered 22 Babies in her own village! The stories these people tell me could fill books. In most health care systems, providers do not have to treat their own families, especially in an emergency. I know of many CHA who have had to work on there own kin; treating gunshot wounds on cousins, CPR on their own Mom or Dad, life threatening airway problems on their own child! The next time you see a Health Aide, please shake their hand and let them know how much you appreciate them. Let them know that you care and ask them how you can help them. They are my heroes of the delta!
Anatomical terms
by John Dickens
Learning the words is half the battle? The body is made up of a number of regions. Certain terms are used to describe directions and positions of the body. In EMS, you must become familiar with and learn to use a standard method of referring to places on the body when describing illness or injury. For example, the direction right and left refer to the PATIENT?S right or left. All descriptions of the body start with the assumption that the body is in anatomical position, even if the patient is not in that position when found. ANATOMICAL POSITION is best described as a person standing, facing forward, with the palms forward. This is a very important concept, this enables all health care providers to refer to this standard position, it helps everyone be on the ?same page? when referring to a patient. We need to be able to think of the body as if it were divided into planes. A PLANE is a flat surface, the kind that would be formed if you sliced straight through the body. If you sliced from top to bottom, the body would be in right and left halves or front and back halves. Drawing an imaginary line down the center of the body, passing between the eyes and going down past the navel or bellybutton creates the MIDLINE of the body. The term MEDIAL refers to a position closer to the midline, and the term LATERAL refers to a position farther away from the midline. I could say, ?The bridge of my nose is medial to my eyes?. The term BILATERAL refers to ?both sides of anything?. A patient with pneumonia might have ?diminished lung sounds bilaterally?. The MID-AXILLARY LINE extends vertically from the mid-armpit to the ankle. This imaginary line divides the body into front and back halves. The term for the front is ANTERIOR. The term for the back is POSTERIOR. A synonym for anterior is VENTRAL (referring to the front of the body). A synonym for the posterior is DORSAL (referring to the back of the body or back of the hand or foot). The terms SUPERIOR and INFERIOR refer to vertical, or up-and-down, directions. Superior means above; inferior means below could say, ?My nose is superior to my mouth.? The terms PROXIMAL and DISTAL are relative terms. Proximal means closer to the torso or trunk. Distal means farther away from the torso or trunk. My elbow is distal to my shoulder yet proximal to my hand. We use these terms usually to describe the location of injuries on the extremities (arms and legs). Sometimes you will hear the terms PALMAR (referring to the palm of the hand) and PLANTAR (referring to sole of the foot). You may also hear the term MID-CLAVICULAR LINE; this is an imaginary line that runs through the clavicle (collarbone) and the nipple below it. Since you have two clavicles, you also have two mid-clavicular lines. When talking about the abdomen, which contains great many organs, it helps if we divide into four parts, or Quadrants, drawing imaginary horizontal and vertical lines does this. ABDOMINAL QUADRANTS are the right upper quadrant or RUQ, the left upper quadrant or LUQ, the left lower quadrant or LLQ and the right lower quadrant or RLQ. This is just a beginning, but remember in any field of knowledge ?learning the words is half the battle!?
Hazardous materials
by John Dickens
They are everywhere? Hazardous materials (HAZMATS) are defined by the U.S. Dept. of Transportation as ?any substance or material which poses an unreasonable risk to health, safety and property when transported in commerce.? One of the undesirable aspects of modern life is the growing number of HAZMATS. It is estimated that every day there are hundreds new HAZMATS being made. In every village of our great Delta you can find HAZMAT. You can find it at the power plant, the water treatment plant, the store, the school, even in your own home. Two federal agencies ? the Occupational Safety and Health Administration (OSHA) and the Environmental Protection Agency ? have developed regulations to deal with the increasing frequency of HAZMAT emergencies. The regulations are described in OSHA publication ?29 CFR 1910.120?Hazardous and Emergency Waste Operations and Emergency Response Standard.? According to the regulations, it is the responsibility of employers to determine, provide, and document the appropriate level of training for each employee. Training is required for ?all employees who participate, or who are expected to participate, in emergency response to HAZMAT situations.? The four levels are * First Responder Awareness * First Responder Operations * HAZMAT Technician * HAZMAT Specialist HAZMATS are required to be marked by placards. These will have coded shapes, numbers and |