DMAT San Diego CA-4 * February 2004 Newsletter

****Volume 13,  Number 2   ****
A deployable  Disaster Medical Assistance Team. Affiliated with the National Disaster Medical System. Founded 1991
DMAT San Diego CA-4 is a public benefit, non-profit  501(c)3 corporation., registered  in the State of California and with the IRS.

Co-Sponsored by: UCSD Medical Center & International Relief Teams
Mailing Address: 200 West Arbor Drive, San Diego, CA 92103-8676

DMAT CA-4 Information Line: 619-543-6216
eMail address of Newsletter Editor, Jake Jacoby:
DMAT CA-4 WEB site:

Calendar Of Events..........................................Page 1
Commander's Log.......................................... .Page 1
January Team Minutes.....................................Page 1
BookReview: La Catastrophe: The Eruption of Mount Pelée, the Worst Volcanic Disaster of the 20th Century
. .......................................................................Page 3
Comprehensive disaster web site:........................Page 4
Recent communictions.......................................Page 4
DMAT CA-4 Team Meeting
Wed. , Feb. 25, 2004
18:00 hours
DMAT CA-4 Ops Center
8830-G Rehco Road,  San Diego

*NDMS Annual Meeting, Dallas, TX Apr. 17-21, 2004.

The 12th Annual Tri-Service Combat Stress Conference dates are 30 April (Friday) through 6 May (Thursday) 2004 at the San Luis Rey Officers Club, Camp Pendleton.  Conference segment 1-2 May; Critical Incident Stress Management (CISM) certification courses 3-4 May and 5-6 May.

Commander's Log
The  DMAT CA4 Skills Training Day originally scheduled for  January was rescheduled due to our basic load being on trucks as part of the response to the Code Orange Alert held over from December. On Feb 8th, approximately 27 team members took part in the skills training event held in our Ops Center. Peggy Perkins, Nursing Director, organized the training modules. Many thanks go out to the trainers: Bob Downey, Chief Lab Technician, who organized the training for the glucometers;  Peggy Perkins, who did the LifePack 12 training; Chuck Perkins, who did litter bearer training;   and , Respiratory Technologist, who led the training  on the Eagle Portable Ventilator and the Impact Suction machines. This was a reasonably well attended event for a short notice, rescheduled event. We look forward to scheduling more of these training events soon.

* The VMAT-4 fiasco has now resulted in the official disbanding of the VMAT-4 team. The AVMA has sent a letter to VMAT-4 requesting their federal property be transferred to the AVMA . It is a great loss to the system, and shows the nation  what artful manipulators run  the American Veterinary Medical Association. Although we are more than happy to allow the VMAT members to join our team, we never get veterinary missions, [the AVMA would see to that],  and so it would truly be a waste of effort. It is way past time for the people who believe that this was a fiasco to pursue the AVMA  in court, or to attempt to persuade the AVMA Board of Directors of the pettiness of their leaders.  Only a replacement of the AVMA officials or a court-ordered injunction  could get the AVMA to reverse their decision. This was the team whose members  accounted for over 50% of all VMAT deployment  days in the  hx of NDMS, who were responsible for outstanding presentations at the NDMS Annual Meetings in past years  on the UK foot and mouth disease response, and the avian influenza response on the east coast 2 years ago. They also organized the first-ever national VMAT training, and have done excellent training events on the west coast.  The AVMA relationship with NDMS was depicted as a "contractual one" instead of the MOU relationship that it is, which has an escape clause in it that  could have been used to good measure in this setting. Woe be the system if another major veterinary response is needed. The  crisis of leadership is of course not in Simi Valley, but in Chicago, Illinois, home to the AVMA. We wish great  luck to our veterinary friends in Simi Valley and across the country, in their search for a new sponsor and a new format acceptable to NDMS, whether as a Disaster Veterinary Assistance Team (DVAT)   or  as a Veterinary Medicine Response Team (VEMERT).

* Reminder to all members that the On Line web based training course is NOW REQUIRED. all team members must get through their core courses in order to be able to continue to have their Federal Khaki Uniform checked out. This is a new requirement for our newest members, while our older members will have 3 months in order to get this done. Additionally, members must complete the rest of the on-line training course within 1 year. We will discuss when we will "start counting" the year, at our next team meeting.

January  Team Meeting Minutes
The January 28th team meeting was held at the DMAT CA-4 Operations Center, and was  opened by Jake Jacoby, team CDR  @ 1805 hours
  All new faces and guests were welcomed. Arthur Brown  from CA-3 was introduced . Arthur is an EMT and a commo officer on CA-3, but who lives in San Diego and is adding his name to our team roster. He was available to be rostered in December as a commo officer for our Code Orange Alert.

Two agendas for the meeting were distributed:    Agenda-A (previous/old) format and, on the back side,    Agenda-B . Each were basically the same except that the chronology and format for Agenda-B were intended to be consistent with Incident Command Structure.This and the next meeting or so will be organized along ICS lines, and then an evaluation of the two styles of meetings will be assessed.  
I. Planning Issues: 
A.)  Re: County of San Diego Contract for Study of Hospital Bed Surge Capacity: Feedback received from Steve Wood,  Director of the  Disaster Medical and Bioterrorism Division of the  County EMS agency . was received. It was overall extremely positive. A  follow-on project  has been proposed  in the field of hospital surge capacity. Details were reviewed and the feeling is that these deliverables are quite "do-able".  The deadline for completion of this new project is May 30th, 2004. Volunteers signed up to work on the project, and   a list of "deliverables" was distributed for discussion.
B.)  NDMS team evaluations and reclassification -  It was reported that  NDMS administration staff has decreased from 131 to only 35.  In an unrelated development, Jake commented on a letter written by NADMATs (National Association of DMATs) in response to a memo from Capt. J. Gary Sirmons, the Acting NDMS Section Chief  to all of the DMATs regarding new/ updated NDMS Developmental Team Benchmarks.  These new benchmarks were developed by NDMS after information was collected and compiled relating to team strengths, weaknesses and capabilities.  In addition, each team's deployment history, training program, staffing, funding and team management practices were reviewed.  The resulting reclassification scheme was a "disappointing" development in that several teams had their "deployability status" downgraded
from being Fully Operational  to  one of three other lower  designations.  A key sticking point with some of the DMATs was the lack of notice given by NDMS for responding to and implementing corrective measures in order to prevent being essentially "downgraded" by NDMS. 
DMAT San Diego CA-4 was categorized  as a Type-I "Fully Operational Team."   However, the "shakeup" of the classification scheme has reduced the number of Level-I teams from 38 to only 22 nationally.
a.)  Training committee (Jake - for Sara) - The new guidelines essentially mandate  that the NDMS web-based training will become mandatory and that the amount of financial support that teams receive will be linked to team members' completion of the training modules.  For example, during the 1st year of implementation of these standards team management must complete NDMS web-based core training.  During the 2nd year, "...a minimum of 50% of recruited personnel must complete web-based core training within 12 months of joining the team."  per the new guidelines.  Failure of a team to meet these standards may result in a cessation of NDMS funding until this requirement is met.  Take-home message:  All CA-4 members must make a concerted effort to completed the NDMS web-based training.
b.)  Website committee (Michael Sohmer) - Michael reported that CA-4's website was used for CA-4 Member of the Year voting for the first time.  There was a brief discussion about exploring the feasibility of a secure link for team members' use only.

c.)  Annual NDMS Conference - Current funding levels should permit funding for up to 19 team members to receive reimbursement for travel, lodging and registration fees (some restrictions apply) for the conference.  Jake also described what criteria (e.g., dues current, status of web-training, work party attendance, etc.) would be used to determine a priority list for "reimbursable attendees". Must sign up for the reduced rate for registration by Feb. 17th, otherwise the rate goes up. All members should report (1) their airline reservation and the amount of their ticket, and (2) the amount of their registration (just the standard registration, or whether they are taking pre-courses and the amount) for planning purposes, to Jake, in case we are under budget and can support others on the waiting list.
 Gina Anderson from the County of San Diego was introduced.  The County has offered to allow DMAT to use this system, and just days before the  team was place don ALERT in December, we had just completed getting our membership  contact numbers into the system.  Ms. Anderson outlined several of the attributes of the County Alert Service System also known by the acronym CASS . CASS is a high-speed notification system for alerting and/or activating emergency response teams  via phone, pager, fax and email.  A handout was provided to all CA-4 members in attendance which details how the system works as well as helpful tips for team members when responding to call outs or pages from CASS.  It is important for all CA-4 members to memorize (or otherwise have in a a readily retrievable location) the "Company Code" 4825 as this is the unique number that identifies San Diego.  Any team member who does not have a copy of this handout should consider getting a copy from Zona or Jake. Gina will be returning next month to do an actual computer screen display of how the system works. We will be doing at least two or three communications drills per year with the system,and using it for ALERTS and ACTIVATIONS. 
a.)  ALERT (12/21/03 - 1/13/04) After Action Debrief:  Jake reported some "bugs" with the alert system including difficulty encountered by some team members in opening up the team roster in Microsoft Excel format.  On another front, a team member suggested a preestablished roster and/or format for truck loading/unloading work parties as it seems as if the same cluster of team members show up for these vital but unglamorous events.
b.)  Committee reports:  Michael Sohmer (Pharmacy) reported that RxERT (SD County Pharmacists Emergency Response Team) was coordinating a "mass prophylaxis" exercise for employees of local hospitals. 
Zona W. (Admin.) has been working to revise/update contact info for all of the team members. 
Jake Jacoby (Finance) reported that the team is awaiting reimbursement for $4,500 in expenses  from the State of CA EMS Authority for the State Budget. Current bank deposits  are $54,000 not   including reimbursement to the associated hospital staff members for their participation in the surge capacity study.   Jake suggested changing the fund raising committee to a recruitment committee to help shore up holes/deficiencies in the team's roster of deployable members.  In addition to the NDMS training guidelines, Fully Operation Teams (Type I/Level I) must have 12 or more deployable physicians, and 3 or more deployable PA/NPs, RNs, pharmacists and paramedics.  This subject will likely be pursued at future meetings.
SAFETY/SECURITY: Jake introduced CA-4's new safety officer,  George Durgin.
New/old business:
1.)  Extra Back-to-Basics T-shirts are available for purchase, at only $10.00 each.  We still also have many CA-4 Winter Olympics Pins from the SLC deployment; some of the members who ordered them never picked theirs up. If those who ordered them do not pick them up by the February meeting, we will  be selling them. Only $2.50 each.
Buy 4 and get a fifth one free, at the February meeting only.
 (2.)  Team members reminded to take uniform shirts to Gall's for "name tapes" and "NDMS" tapes. Members should remove the old USPHS tapes themselves elves before taking them in to Gall's,  as they charge for them  to be removed.  CA-4 pays for the tapes.  Direction to Gall's can be found on CA-4's website.

3.)  Team members asked to sign up to provide snacks/munchies for the team meetings,a and are reminded that the sign up includes cleaning up after the meetings as well. .  It's OK to spend $20-25 for the goodies and CA-4 will reimburse with receipts and a properly filled out and signed request for reimbursement...check with Zona for details and the form. Meeting was adjourned at 1950 hours. 
-Meeting notes transcribed and submitted by Ken Rogers
La Catastrophe: The Eruption of Mount Pelée, the Worst Volcanic Disaster of the 20th Century. by Alwyn Scarth. New York and Oxford, England: Oxford University Press, 2002. 246 pp.  $22.00 hardcover edition.
With a title like this, I had to read this book. Disasters of such magnitude will have many lessons for all of us. Those who do not learn from history are doomed to repeat it. 
  On May 8th, 1902, after weeks of teasingly small eruptions of plumes of steam, dust and ash falls,  and ground shaking,  Mt.. Pelée, a volcano on the northern end of the island of Martinique,  exploded in a nuee ardente that headed directly at Saint Pierre, a city of over 26,000 people, leveling every structure in the city, and killing over  99% of the populace. Clearly, there were no experts on volcanoes at the time, and the ability to predict the course of events surrounding a volcanic cataclysm at the turn of the last century was nil. No one knew what to do. Those who panicked weeks before when the volcano started to stir, and left the island, became survivors.  Those who listened to the "experts" who told them the worst was over, would become its victims.  Even worse, of  the many refugees who were rescued from the villages and towns surrounding Saint Pierre, who were evacuated south to Fort-de-France, were forced to return to their homes in their villages, by  the Acting Governor, after Mt.. Pelée became almost completely calm from mid-July until mid-August of that same year.  The some 1200 individuals were essentially rewarded with food assistance if they returned to their homes in Le Morne Rouge, on the SE flank of the crater, but were to have all assistance cut off if they stayed. Without a choice, they returned  before the Aug 15th date.  ON that same date, glowing lava appeared as a red-hot dome, rising above the rim of the crater, followed by a series of earthquakes. A request to be evacuated again fell on the deaf ears of the island's administrators, and on August 30 a 3rd pyroclastic flow enveloped the area, and flattened this second village, and others as well. At least 1085 more deaths occurred that day, with over 250 injured. Clearly a result of discrimination against the native population by the colonial French government, this appears to be an historic example of an administrative  cover-up that has escaped notice for almost a century.    The politics of disasters became a death sentence for some.  This should be required reading for ANY FEMA or NDMS persons who might be in charge of operations at a volcano response. The accounts  include tales of heroism, stupidity, ignorance, and dedication. Mortal lessons about disaster responses to volcanoes abound.  Have things changed that much a century later?  Once you read this account of  the eruptions of Mt.. Pelée,  and the politics of disaster response and refugee assistance, you will quickly see parallels to Mt.. St Helens and other disasters.
                  --Jake Jacoby, MD
Comprehensive disaster-related web site
Check out this great web page.   It has been
added to our team web page under "LINKS"
Recent communications from members:

Karen Taylor, RN
,  who has moved to Colorado, tells us she misses us and wishes she were back here just so she could deploy again with us. 

John Unger, EMT-P,  has moved to North Carolina, and is transferring to the NC-1 team. He has taken a civilian job with the military


Irving "Jake" Jacoby, MD, FACP, FACEP
Team Leader, DMAT San Diego CA-4
Attending Physician, Dept. of Emergency Medicine, UCSD Medical Center, San Diego, CA

Associate Director, UCSD Hyperbaric Medicine Center, San Diego, CA
Clinical Professor of Medicine, UCSD School of Medicine, La Jolla, CA

200 West Arbor Drive
San Diego, CA 92103-8676
Telephone: 619-543-6216
FAX: 619-543-3115
Pager: 619-290-2700

DMAT CA-4 24 hour STATUS/Information Line: 619-543-6216