PULSE Magazine | October 2018 Issue PE

P U L S E October 2018 ANAUSTIN-TRAVIS COUNTY EMS PUBLICATION

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October 2018

Contents

Featured News

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OCTOBER IS SUDDEN INFANT DEATH SYNDROME (SIDS) AWARENESS MONTH

October is a great time to share information concern- ing a safe sleep environment with parents of children. Recently the ATCEMS Injury Prevention Team hosted “Train the Trainer” to help educated local healthcare providers about ways to reduce the risk of SIDS and other sleep-related causes of infant death. Watch the recent KVUE story and interview with Captain Randy Chhabra!

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HEALTH ALERT: ACUTE FLACCID MYELITIS

Acute flaccid myelitis (AFM) is a rare but serious condi- tion, that looks like/mimics polio. AFM affects the nervous system, specifically the area of spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak. There have been 62 confirmed by the CDC in 22 states, and of those confirmed cases 8 are in Texas with one here in Travis County thus far.

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WHAT I LEARNED FROM JAIL

Clinical Specialist Walt Settlemyre recently had the opportunity to visit with Central Booking in an effort to better understand not only how the Jail works, but what their capabilities are and how their protocols govern their practice at both Central Booking and at the Travis County Correctional Complex in Del Valle.

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EXPLORER SPOTLIGHT

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This month’s Explorer in the spotlight is Andy Rather Murray. Andy has been a Post member since Decem- ber 2017 and is a Lieutenant and Honor Guard member .

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FREE ONLINE TRAINING FOR FIRST RESPONDERS

The Alzheimer’s Association is pleased to offer a FREE online course for First Responders that will help prepare you to respond to common calls involving a person with dementia.

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Division News

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COMMUNICATIONS CALL OF THE QUARTER

Congratulations to Kyrstin Larose and Esme Harvey for winning the Communications Call of the Quar- ter. Read the very touching letter they received recognizing them for their role in the care of one of our citizens.

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PINNING AND SWEARING CEREMONY

In Every Issue

Congratulations to the ATCEMS personnel who were formally recognized for their recent promo- tions!

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YOUR PHOTOS

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Catch a glimpse of your coworkers in action.

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EMPLOYEE RECOGNITION

ATCEMS employees receive kudos, special thanks and congratulations for a job well done.

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COMMUNICATIONS Call of the Quarter

Kyrstin Larose / Esme Harvey

You all may remember reading about Kyrstin and Esme in last month’s PULSE. They received a very touching letter recognizing them for their role in the care of one of our citizens. Here is an excerpt from the letter received by the department:

“We don't underestimate all the events that followed, the CPR, the shocking of her heart, all the medication, and all the care that got her to the hospital including her first helicopter ride, the great care at the hospital by dedicated people, and many, many prayers from all over the country, but you got it started on the right track. What you did was amazing and even though I don't know a name or a face, we will be eternally grateful for what you did.”

Sincerely,

- Ron and Lorraine

I now ask you all to join us in recognizing these two communications medics for winning Call of the Quarter. Keep up the great work!

Captain Nikki Alston, QA/ QI - Communications

Kyrstin Larose

Esme Harvey

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Did you know that SIDS is the leading cause of death in infants between 1 month and 1 year of age? Each year, about 4,000 infants die unexpectedly during sleep time, from SIDS, accidental suffocation, or unknown causes. This is a good time to share information concerning a safe sleep environment with parents of children. ATCEMS Injury Prevention Team aims to educate parents, caregivers, and health care providers about ways to reduce the risk of SIDS and other sleep-related causes of infant death. SIDS is every parent’s worst nightmare, but there are several things you can do to prevent the sudden loss of a child. It is our goal to prevent as many unnecessary deaths as possible through public educa- tion and outreach programs. ATCEMS offers Safe Baby Academy training free of charge to all parents and caregivers on safe sleep environments, CPR and baby chocking. Below are a few important tips on safe sleep for your little one. 1. Place a baby on his or her back when you are putting them to bed. Make sure to do this at all times. It’s a common mistake that parents think placing a child on their back to sleep may cause them to choke on spit-up, but their gag reflex will wake them up and stop them from choking. If a child sleeps on their stomach, they are more likely to breathe in less air. 2. Use a firm sleep surface, like a mattress in a safety approved crib. Put a tightly fitted sheet over the mattress. It’s very important That you keep toys, even cuddly teddy bears, out of the crib while the infant sleeps. The less that’s in the crib, the less chance there is of suffocation when a baby is rolling around in their sleep. 3. The baby can share your room, but not your bed. Even though it may be tempting to snuggle your little one at all hours of the night, accidental suffocation and strangulation can happen quite easily if you share a bed. Sharing a bed may increase the chance of SIDS by about 50%. October is Sudden Infant Death Syndrome (SIDS) Awareness Month!

4. Dress your baby in cozy sleep clothing instead of using a blanket.

5. DO NOT allow smoking around your baby. Smoke in an infant’s surroundings is a major risk factor for SIDS.

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By Walt Settlemyre, Clinical Specialist

What I Learned From Jail

Clinical Specialist Walt Settlemyre Visits with Central Booking and the Travis County Correctional Complex

The tones go off, the address is 510 West 10th for an attended patient. Not long ago had I gotten that call I would have had a somewhat different reaction. But recently I had the opportunity to visit Central Booking with Chief Hofmeister in an effort to better understand not only how the Jail works but what their capabilities are and how their proto- cols govern their practice at both Central Booking and at the Travis County Correctional Complex in Del Valle. Our goal in this visit was to bridge the gap between our providers and the jail nursing staff as well as create improved communication between our two distinctly different practices of medicine. Something we've lacked for a very long time. It was eye opening and very informative to say the least, and in this article I hope to dispel some of the misconceptions that ATCEMS as a system has when running calls at both locations, and give our providers a greater understanding of how the jail operates.

While we only had the opportunity to visit Central Booking, we spoke with new Director of Inmate Medical Services for TCSO, Mary Gallo, and the outgoing Director, Shelly Redman who is moving in to a new position as Nursing Case Manager for the Travis County Jail System. While speaking with them as a medic in our system I was able to get a much better understanding not only of why some inmates become patients, but also what each of these facil- ities can offer in regard to medical treatments, observation, and transfer of the inmates. For as long as I have been a medic with ATCEMS, some eighteen years now, I have not fully under- stood what their capabilities are or what guidelines they must follow. I've always operated under the assumption that they were [loosely] able to function like the other RNs I typically come into contact with within the scope of our job.

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This was a poor assumption on my part in that the surrounding security issues inherent at Central Booking alone make practical nursing an all but impossible task. And while the Del Valle site has more ER type capabilities, they also have some of the same security issues. First, I'll focus on Central Booking as the majority of the calls to our system for assistance start there. Hopefully I can answer some of the ques- tions you may have as to why some patients need transport to a medical facility. There are plenty of instances where the need for transport is apparent but it's the ones that don't fit the EMS thought process that always seem to cause the most friction. Those are the ones I hope to shed some light on; if I'm able to help bridge the gap of misunderstanding it benefits all involved and ensures the inmate the best possible medical outcome. In the end, both our medics and the jail nursing staff are part of the city and counties continuum of care. First and foremost you have to understand that Central Booking is a non-permanent jail facility. Long term incarceration is at the Del Valle site. While that may seem obvious reading this now, this consideration is often overlooked when EMS responds there. Once someone has been arrested and taken to Central Booking for intake, they go through a medical screening. If they meet certain criteria that has been mandated by the Medical Director for TCSO Inmate Medical Services, Dr. Alexander Meagher and the TCSO Jail System protocols, this prompts the nursing staff to follow through with whatever their standard of care is regarding the corresponding protocol. Most of the operating systems that Travis County uses are fairly standard throughout the prison systems and jails in the US. Meaning that when an arrestee comes in for arrest review and intake, part of that intake is a medical screening. This is to protect the inmates’ health, safety, and rights, but also to protect Travis County and the City of Austin, or whatever jurisdiction the arresting officer represents. The nursing staff at Central Booking actually has very little medical capability secondary to the transitional nature of people who have been arrested. They do not have the ability to observe a patient like an ER nurse can, especially at busier times such as weekends and during the many and nearly constant activities here in Austin that often facilitate ETOH consumption. We as the city and

county EMS provider see those spikes as well.

The people being arrested are only going to be housed at Central Booking for a short time and the nursing staff downstairs at intake, staffed at one or two people depending on the situation don't have the ability to fully treat then monitor patients. Occasionally I forget about the level of autonomy I enjoy in comparison to that of nurses in general, but especially the RNs working in the triage intake area of Central Booking. They must have a physi- cian’s order for EKGs or X-rays and that physician must then read and interpret them. While medics don't do X-rays, our ALS staff routinely do EKGs and not only interpret them but are able to treat and transport to appropriate facilities. The staff at Central Booking have a BLS medical bag and AED abilities readily available. They have a very small array of drugs they can give: EPI pens, Narcan, and Benadryl. These are limited for a number of reasons; the amount of people a nurse is responsible for at any given time, the inability to monitor patients after a medicine admin, and liability issues to name a few. In contrast, the Del Valle site is basically a small ER. They have a physician on staff, the ability to monitor patients, start IVs, and treat the usual suspects like chest pain, dehydration, and OD. Central Booking simply does not have that capabil- ity due to the transient nature of housing along with a varied and constant influx of inmates and the security of all involved. Consternation is caused when someone is arrested on scene, but was seen by EMS at the scene and a refusal was obtained before this person is trans- ported by law enforcement to Central Booking. Once this person reaches the intake process, the jail nursing staff must complete a questionnaire for each new arrestee. This includes any recent trau- ma, MVAs , etc. The patient and officer can tell the nursing staff that a refusal was generated by EMS on scene, however the nursing staff have no pa- perwork or any way to confirm that the patient waived medical liability. This creates liability for both the nurse's licensure and Travis County. Since these people are now basically under the protection and care of Travis County, you can see where liability plays a large role in many of the jail nurse functions and ability to operate. Their proto- cols require the patient to be cleared by a physi- cian or medical authority with some type of docu- mentation supplied to the jail nursing staff.

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There is some question as to whether the jail nurs- ing staff can obtain some kind of refusal of their own, but I have not been able to confirm or deny this as of this writing. It was one of the questions I hadn't thought of when interviewing these ladies. It's my under- standing that they have some kind of refusal pro- cedure in place but I'm unsure of its parameters. As you can see, many of the patients we transfer from Central Booking either meet some liability criteria or are beyond the scope of practice for the limited resources and protocols of the nursing staff there. Another thing to keep in mind is the tenor of most of the people the jail nursing staff sees. None of them are happy to be in jail and don’t want to be seen by medical personnel. Many have known psy- chiatric histories, are repeat offenders, or still ag- gressive after their interaction with law enforce- ment. That does not make for the most positive work environment. While a percentage of our pa- tients may be difficult to handle in a given shift, 100% of theirs are unhappy, scared, agitated or combative. This translates into a very challenging work environment. With that in mind, being cognizant of how EMS providers approach these calls in regard to attitude and professionalism is important. In full disclosure, the reason I have taken on this project is because I was involved in a verbal altercation with one of the jail nursing staff. It was nothing more than a misunderstanding but I am grateful for the incident because it helped me gain insight into how the jail nursing staff operates. Understanding their limita- tions has greatly improved my own ability to com- municate with jail nursing staff and I now under- stand the “whys” of many of the calls generated there. As medical providers we all experience the onus of compassion fatigue and its effects are very real. Dealing with high stress situations on a regular ba- sis, different types of difficult patients we see in the downtown area given our high homeless popu- lation and the ease of accessibility to both alcohol and illegal drugs wears on every medical provider. However, we must stay vigilant and continue to demonstrate the decorum and professionalism I believe we personify as an EMS system. In the past I have transported patients the nursing staff at Central Booking deemed too violent for jail and I asked about this situation because at face value it seems odd. There are times when inmates have either ingested a substance that is making

them aggressive, or have some type of mental is- sue that makes them prone to extreme episodes of violence to either themselves and/or others. The nursing staff have no way to sedate or monitor the patient to ensure that patient’s safety. Think of the typical presentation of an excited delirium patient and all it necessitates in treatment and monitoring, and you begin to understand their limitations and reasoning for transport. Also, from a security standpoint this type of inmate creates not only a need for more personnel to manage but also diverts attention away from the rest of the inmates in the general area. In the past this has given inmates an opportunity to attack another inmate while the jail staff are occupied. Again, many of the protocols and SOPs that the jail uses are standardized and widely accepted to miti- gate injuries, safety risks, and liability concerns. Remember, whoever has jurisdiction over the in- mates is responsible for their inherent safety. There are reasons these procedures are in place. Another way the jail nursing staff is hindered is when there is a need to transport patients. They can recommend whether the patient “can go by sedan”, to use their terminology, or by EMS. In this case the arresting officer is the determining factor in whether they are comfortable transport- ing the patient themselves, if not EMS is called to transport. I was not aware of this procedure but some of these patients are transported without EMS intervention. In a recent CE session Dr. Pickett mentioned that the jail was getting remote medical consulting and partnering with Dell Seton but this is only partially correct. The Del Valle site is testing the program now and it’s estimated that Central Booking may have something similar in the next 1-2 years depending on budget and availability of equip- ment. In summary, the nursing staff at Central Booking have much more constraint than I realized. They have a difficult job and very limited resources and protocols, not only from a medical standpoint but from Travis County Corrections Department Stand- ard Operating Procedures as well. Hopefully this article has given you some insight in to what those constraints are and more importantly the ephem- eral “why” for some of the calls we respond to there. Please feel free to direct questions to me or to Chief Hofmeister. Till then, see you out there.

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Alzheimer’s Association FREE Online Course for First Responders

Our vision is a world without Alzheimer's

Formed in 1980, the Alzheimer's Association is the world's leading voluntary health organization in Alzheimer's care, support and research. The Alzheimer’s Association is pleased to offer a FREE online course for First Respond- ers that will help prepare you to respond to common calls involving a person with dementia. Start at the Briefing for tips and information that can help in any situation. Then, hear from other first responders and learn how to respond to typical calls. In each topic you'll take a quiz yourself to test your new knowledge of the new tips. If you'd like to learn more, you can explore all of the topics in greater detail. Complete all topics to earn a certificate or simply review those most relevant to your role.

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The First Event In 1985, the first Breast Cancer Awareness Month (BCAM) was observed in the United States. In the US this event is referred to as National Breast Cancer Awareness Month (NBCAM). Initially, the aim of this event was to increase the early detection of breast cancer by encour- aging women to have mammograms. As many women know, a mammogram is an x-ray of the breast used to detect abnormalities in breast tissue. Early detection means that cancer can be more effectively treated and prevented from spreading to other areas of the body .

The Color Pink & The Pink Ribbon

With the founding of The Breast Cancer Research Foundation in 1993, the pink ribbon, which had previously been used to symbolize breast cancer, was chosen as the symbol for breast cancer awareness. The color pink itself, at times, has been used to striking effect in raising breast cancer awareness. Many famous buildings and landmarks across the globe have been illuminated in pink light during this event; Sydney's Harbour Bridge, Japan's Tokyo Tower and Canada's Niagara Falls to name a few.

Due to the success of this awareness event, for many people, the color pink and breast cancer awareness ribbons are now associated with breast cancer awareness.

It is alarming to know that 1 in 8 women will be diagnosed with breast cancer in her lifetime . While you can’t prevent cancer, it is important to be proactive about your health

Support the fighters... Admire the survivors… Honor the fallen… Raise the awareness… Wear the pink.

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The Facts:

Thanks to largely stable incidence rates, improved treatment, as well as earlier detection through screening and increased awareness, a woman's risk of dying of breast cancer dropped 39 percent between the late 1980s and 2015, translating into more than 300,000 breast cancer deaths avoided during that time.

Despite that progress, there's much more to be done. Breast cancer is still the second-leading cause of cancer death in women, second only to lung cancer. There is still a large racial gap in mortality, with African-American women having higher death rates compared to whites, even as incidence rates are similar.

The American Cancer Society's estimates for breast cancer in the United States for 2018 are:

 About 266,120 new cases of invasive breast cancer will be diagnosed in women.  About 63,960 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer).  About 40,920 women will die from breast cancer.  While black and white women get breast cancer at roughly the same rate, the mortality rate is 42% higher among black women than white women.

At this time, there are more than 3.1 million people with a history of breast cancer in the United States. (This includes women still being treated and those who have completed treatment.)

Risk factors:

 Numerous studies have confirmed that alcohol consumption increases the risk of breast cancer in women by about 7%-10% for each one drink of alcohol consumed per day on average. Women who have 2-3 alcoholic drinks per day have a 20 percent higher risk of breast cancer compared to non-drinkers.  Obesity increases the risk of postmenopausal breast cancer. Risk is about 1.5 times higher in over- weight women and about 2 times higher in obese women than in lean women.  Growing evidence suggests that women who get regular physical activity have a 10%-25% lower risk of breast cancer compared to women who are inactive, with stronger evidence for postmeno- pausal than premenopausal women  Limited but accumulating research indicates that smoking may slightly increase breast cancer risk, particularly long-term, heavy smoking and among women who start smoking before their first pregnancy. If you or someone you love are concerned about developing breast cancer, has been recently diag- nosed, are going through treatment, or are trying to stay well after treatment, the American Cancer Society provides important information on these topics and more.

When it comes to surviving breast cancer, early detection remains one of the most crucial steps, and mammograms remain the gold standard.

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Catherine Logeman

Jennifer Roberts

Kyrstin Larose

Jason Freitag

Tyler Weldon

Sweet Sixteen! Cardiac Arrest Survivor Meets her Rescuers on her 16th Birthday

A little over two months ago, 15 year old Catherine Logeman suffered a sudden cardiac arrest. October 23rd was Catherine's 16th birthday and she got to celebrate with ATCEMS Medics and STARFlight personnel who took care of her that day as well as members of her family, Chief Rodriguez and several EMS employees at Headquarters who gave her a hug and wished her a happy birthday. On August 17, 2018, ATCEMS Communications Medic Kyrstin Larose received a 911 call form Catherine's grandfather. Medic Larose identified that Catherine was in cardiac arrest and started to provide CPR instructions to Catherine's grandfather. Moments later the call was discon- nected and Medic Larose made multiple attempts to call back to Catherine's grandfather with no success. During this time Communications Medic Esme Harvey received a 911 call and

quickly identified it was Catherine's grandfather back on the line. Medic Harvey gave CPR instruc- tions and Lake Travis Fire Fighters arrived first on scene with the AED and were able to success- fully defibrillate Catherine. EMS Clinical Special- ist Adam Bostick, Medic Tyler Weldon and Commander Temple Thomas arrived on scene shortly after and continued resuscitation efforts. Travis County Starflight crew members Jason Freitag and Jennifer Roberts arrived on scene and assisted with caring for and transported Catherine to the ER. Catherine surprised her responders with personal- ized cards and we surprised her with cake and flowers.

Happy Birthday Catherine!

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Catherine and her family presented handmade thank you cards to her rescuers

Dad, mom and sister

Catherine’s grandparents

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ACUTE FLACCID MYELITIS

Acute flaccid myelitis (AFM) is a rare but serious condition, that looks like/mimics polio. AFM affects the nervous system, specifically the area of spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak. This condition is not new, but the increase in cases the past three years is new. The US Centers for Disease Control and Prevention recently reported 28 new cases in just one week. There are 155 patients under investigation this year for acute flaccid myelitis, a condition that can cause paralysis and mostly affects children. Of these, 62 have been confirmed by the CDC in 22 states, and the remainder continue to be investigated. Of those confirmed cases 8 are in Texas with one here in Travis County thus far.

The average age of patients confirmed to have AFM is 4 years old, and more than 90% of cases over- all occur in children 18 and younger, according to Dr. Nancy Messonnier, director of the agency's National Center for Immunization and Respiratory Diseases.

CDC has been actively investigating AFM, testing specimens and monitoring this disease since 2014. Most AFM cases peak in the late summer and fall, in addition there has been no geographic clustering of the disease.

Symptoms

Most people will have sudden onset of arm or leg weakness and loss of muscle tone and reflexes. Some people, in addition to arm or leg weakness, will have:

facial droop/weakness,

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difficulty moving the eyes,

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drooping eyelids, or

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 difficulty with swallowing or slurred speech.

Numbness or tingling is rare in people with AFM, although some people have pain in their arms or legs. Some people with AFM may be unable to pass urine (pee). The most severe symptom of AFM is respiratory failure that can happen when the muscles involved with breathing become weak. This can require urgent ventilator support (breathing machine). In very rare cases, it is possible that the pro- cess in the body that triggers AFM may also trigger other serious neurologic complications that could lead to death.

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Diagnosis

AFM is diagnosed by:

 Examining a patient’s nervous system in areas presenting with weakness, poor muscle tone, and de- creased reflexes.

 An MRI (magnetic resonance imaging) to look at a patient’s brain and spinal cord.

 Multiple lab tests on the cerebrospinal fluid (the fluid around the brain and spinal cord),

 Evaluation of nerve conduction (impulse sent along a nerve fiber) and response.

It is important that testing is done as soon as possible after the patient develops symptoms. AFM can be difficult to diagnose because it shares many of the same symptoms as other neurologic diseases. With the help of testing and examinations, doctors can distinguish between AFM and other neurologic conditions.

Causes

Potential causes may include certain viruses, environmental toxins and genetic disorders. It is unclear who could be at higher risk of developing AFM, Messonnier said. The CDC does not fully understand long- term consequences or why some patients recover quickly while others continue to experience paralysis and weakness.

Treatment

There is no specific treatment for AFM, a Neurologist may recommend certain interventions on a case-by -case basis.

Prevention

Poliovirus and West Nile virus may sometimes lead to AFM. You can protect yourself and your children from poliovirus by getting vaccinated. This vaccine does not protect against other viruses that may cause AFM. Protect against mosquitoes bites, they can carry West Nile virus, by using mosquito repellent, staying indoors at dusk and dawn (when bites are more common), and removing standing or stagnant water near your home (where mosquitoes can breed). As always washing your hands often with soap and water is one of the best ways to avoid getting sick and spreading germs to other people.

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Ambulance Show & Tell on William Cannon Dr. with Capt. James Dionizio/ MII Candidate, Marcus Lara

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by Allyson Hall

Explorer Spotlight

Future career goal?

Andy looks forward to one day become a police officer with Austin Police Department.

Interests?

He enjoys boxing, technology, and programming.

Most memorable experience?

Winter camp 2016 when Andy and his fellow explorers performed a search and rescue to find their missing commander, unaware it was training. They created an extrication path, back boarded him, and carried him out of the woods before they found out it was a scenario. He notes that he will “NEVER forget the moment” he found out it wasn’t real.

Accomplishments

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Community Service Recognition

Andy Rather Murray Lieutenant

Honor Guard member since December 2017

Interested in getting to know more about Andy and the other members of Explorer Post 247? Visit emspost247.org to learn more and register to join

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Community Health Paramedic

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Community Health Immunization Drive

On October 11th 2018, Community Health Clinical Specialist Craig Fairbrother helped facilitate an immunization drive that he coordinated between multiple agencies at the Austin Transition Center (ATC) with immunizations administered by clinical staff from Austin Public Health. This event provided immunizations to the residents & staff at ATC including this year’s flu vaccine, vaccines for hepatitis A & B (as well as planning for follow up clinics so that residents might complete the series,) and pneumonia vaccines among the vaccines available for administration. This clinic required not only coordination between Community Health and Austin Public Health, but also the ATC administration, and because the residents are parolees, also coordination with Texas Department of Criminal Justice and the Texas Board of Pardons and Paroles. This was the first big immunization drive held at ATC, and resulted in 97 residents and staff receiving immunizations with each person receiving 3 immunizations, on average!

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Former EMS Telecomm Intern Michael Buchholz separated from Academy 1016 to deploy with the US Army's Alpha Company 2-149th Aviation Company as a UH-60L Blackhawk pilot. While on deployment and on mission over Taji, Iraq, former Intern Buchholz flew an American flag from his aircraft which he gifted to Division Chief Adam Johnson and Austin-Travis County EMS.

The flag, along with certificate of authenticity, are on display at EMS HQ.

Thank you Michael Buchholz for your service and show of appreciation for ATCEMS.

JC Ferguson, Commander

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Our values and principles are Excellence in Service, by People Who Care. Your dedication and commitment serve as a vital link in the chain which drives our department. The years of service award symbolizes the time you’ve given to help us as we pursue those values and principles. It is also a token of appreciation for the part you’ve played in making ATCEMS what it is today. Your talents and efforts already have helped us achieve excellence in many areas.

D. LeClere 10 years

M. Valenzuela 10 years

M. VonWupperfeld 10 years

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Ambus Medic 21 DC4

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Employee Recognition

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WELL DONE

I received a call from Mr. Buddy Bayer requesting the opportuni- ty to meet the EMS crew that saved his life. Captain Aaron Maxwell, Ross Copland, and Kyle Sanchez responded to Mr. Bayer’s house on August 17, 2018. Upon arrival they found Mr. Bayer in cardiac arrest. They were able to successfully resuscitate Mr. Bayer. Ross and Kyle were able to meet with Mr. and Mrs. Bayer on September 16. They were both very grateful for the job done by both EMS and AFD.

Sincerely, James M , DC 05

CONGRATULATIONS

LaShondara Bradford, Scheduling Supervisor

Jeff Gaytan , Special Events The Special Events section is pleased to announce the lateral transfer of Jeff Gaytan to Special Events during fall event season. In this position, Jeff will work to meet the logistical needs of the many events that EMS resources are dedicated to. Mr. Gaytan comes to Special Events with a wealth of knowledge. He has been a Clinical Specialist for Austin-Travis County EMS since June 2006 and most recently was assigned to Medic 4 A-shift Jeff has significant experience in Special Events. He is a Motor, COTA, and Bike medic and works many events throughout the year. We are excited about the opportunity to enhance the professional development of Jeff and the development of our section’s bench strength. Please congratulate Jeff when you see him at your next special event. It is with great pleasure that we are announcing the promotion of LaShondara Bradford to the position of EMS Scheduling Supervisor. In her new role, Ms. Bradford will be assuming oversight and leadership of the EMS Scheduling section as the Department embarks on a city-wide payroll and time-keeping movement to Workforce Dimensions and Workforce Timekeeper. Ms. Bradford began her career with EMS as a Scheduling Specialist in fall of 2008 after spending time in the private sector. She holds a Bachelors of Computer Science from Grambling University. Please congratulate LaShondara on her promotion.

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EXCELLENT

Lockett, Yvonne Flores, Roman

This attached note was left on my unit while I was inside the HEB at 41st street one evening. I would like to pass this on to the entire system.

KUDOS

Ed Johns , Commander

This is how you move your office if you work for EMS (Chief Piker is in the process of moving his office).

Kudos to Jackie for helping at the customer window on her busy day.

The person at the window is one of our most time consuming difficult patients. Jackie was able to get her to sign two authorizations when she has refused in the past. In addition, the patient told Jackie that her blood sugar was falling and she needed something to eat but she was riding the bus. Jackie escorted her to our snack machines to get a snack and gave her a cup of coffee.

Thank you Jackie for going over and above.

Margaret Hackett

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PINNING AND SWEARING CEREMONY

Andy Hofmeister—Assistant Chief Brian Bregenzer—Division Chief Ed Piker—Division Chief JC Fergusson—Commander

Neda LaFuente—Commander Cory Crouch—Captain Jeremy Davis—Captain Shaun Pursley—Captain

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DATA FROM WORLDATLAS 4/2017

The top 5 animals that kill the most humans world- wide each year? WHAT IS...

The modern day human has evolved over millions of years in spite of considerable obstacles. The fact that we exist today means that have adapted to and were able to escape the threat of death through century's of education. With the expansion of agriculture and civilization came infectious diseases spread by animals nearly wiping out the entire world population on several occasions. Today, animals still present a hazard to humans, and this article looks at which of them kill the biggest number of humans.

Mosquitoes and humans themselves could be regarded as the deadli- est animals responsible for the largest numbers of human deaths.

Animals that Kill the Greatest Number of Humans

The Mosquito Surprisingly, the most dangerous animal to humans is not a large, sharp-toothed predator but rather a tiny, buzzing insect. Mosquitoes are responsible for around 725,000 deaths per year. Most people consider them nothing more than a summer evening nuisance, but they are the deadliest animal on earth. Mosquito-borne illnesses such as malaria, dengue, West Nile disease, yellow fever, and Zika disease cause widespread suffering and death. Humans Approximately 475,000 people die every year at the hand of fellow man. In a world filled with conflict, war, murders, and acts of terrorism, this is unfortunately not that surprising. Deaths among humans are intentional and pre-calculated making them beyond tragic. Snakes Perhaps one of the least appreciated animals on earth is also the third most dangerous. Snakes kill at least 50,000 people annually. Fatal bites by venomous snakes often go unreported which could mean that the figure of 50,000 could be even higher. Public health officials often overlook this potential threat. Dogs Man’s best friend? Not always. Dogs kill 25,000 people yearly. These deaths are not because of vicious mauling's by household pets, however. Feral and stray dogs infected with rabies attack people and spread the disease. Tsese Flies, Kissing Bugs (Assassin Bugs), Freshwater Snails Tsetse flies throughout Africa are carriers of the parasite that causes the sleeping sickness disease and responsible for 10,000 reported deaths each year. This disease affects sub-Saharan Africa particularly in very rural and undeveloped areas where people rely on livestock which can also become infected. Kissing bugs, are attracted to lights in homes where they find their prey, humans. These bugs bite peo- ple spreading the parasite that causes Chagas disease. Chagas disease leads to major organ failure and kills 10,000 people every year. Another 10,000 lives are lost to freshwater snails which carry parasites. Infected snails can pass along schistosomiasis to humans which cause flu-like symptoms, blood-vomits, and leg paralysis. All of these parasites have increasingly spread to wider areas due to the rise in global climate change and increasing populations that lead to unsanitary living conditions.

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Follow These Ghoulishly Good Practices

Regarding Spooky Safety Tips

 Plan costumes that are bright and reflective. Make sure that shoes fit well and that costumes are short enough to prevent tripping, entanglement or contact with flame.  Consider adding reflective tape or striping to costumes and trick-or-treat bags for greater visibility. Give your children flashlights with fresh batteries so they can see and be seen.  Because masks can limit or block eyesight, consider non-toxic makeup and decorative hats as safer alterna- tives. Hats should fit properly to pre- vent them from sliding over eyes. Makeup should be tested ahead of time on a small patch of skin to ensure there are no unpleasant surprises on the big day.

sional. While the packaging on decora- tive lenses will often make claims such as "one size fits all," or "no need to see an eye specialist," obtaining decorative contact lenses without a prescription is both dangerous and illegal. This can cause pain, inflammation, and serious eye disorders and infections, which may lead to permanent vision loss.

 Small children should never carve pumpkins. Children can draw a face with markers, then parents can do the cutting.

 If your older children are going alone, plan and review the route that is acceptable to you. Agree on a specific time when they should return home.

 Candlelit pumpkins should be placed on a sturdy table, away from curtains and other flammable objects, and not on a porch or any path where visitors may pass close by. They should never be left unattended.  To keep homes safe for visiting trick-or -treaters, parents should remove from the porch and front yard anything a child could trip over such as garden hoses, toys, bikes and lawn decora- tions. Parents should check outdoor lights and replace burned-out bulbs.

 When shopping for costumes, wigs and accessories look for and purchase those with a label clearly indicating they are flame resistant.

 If a sword, cane, or stick is a part of your child's costume, make sure it is not sharp or long. A child may be easily hurt by these accessories if he stum- bles or trips.

 Do not use decorative contact lenses without an eye examination and a prescription from an eye care profes-

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