DMAT San Diego CA-4
A Level 1 Disaster Medical Assistance Team.
affiliated with the National Disaster Medical System
UCSD Medical Center, Dept. of Emergency Medicine
200 West Arbor Drive
San Diego, CA 92103-8676
Tel. 619-543-6216 Fax 619-543-3115
& International Relief Teams
3547 Caminito del Rio South, Suite C, San Diego, CA
DMAT CA-4 Information Line: 619-543-6216
eMail address of Newsletter Editor, Jake Jacoby:
Combined May-June 2000 Newsletter
Volume 9, Number 5&6
Calendar/Upcoming events.................Page 1
Member of the Year(again?).............. Page 1
Operation Rough and Ready 2000, Kharkiv,Ukraine. The scoop.............Page 2-4
New Dues Policy.............................Page 4
Next CA-4 Team "Meeting." Wednesday, June 28, 1999, at 6:00 p.m.
CA-4 Basic Load Familiarization and the New Inventory Plan.
Come see how the team Supply Chests are being loaded, and how you will find things in them.
Location: DMAT Operations Center
Address: 8540-B Production Avenue, SD
hFuture CA-4 Team Meetings and Training topics: Meetings held 4th Wednesday of month, except Nov. and Dec., when they are held third Wed. of month. Always call the Info Line if there is any question of possible changes, or to confirm.
Wednesday, July 26, 2000 @ 6:00 pm
Wednesday, August 23, 2000 @ 6:00 pm
Wednesday, Sept. 27, 2000 @ 6:00 pm
Please mark these dates in your calendars now.
hDMAT Information Booth at 2nd Annual UCSD Trauma Prevention Community Street Fair. Wednesday, July 12, 2000, from 10:00 am till 2:00 pm, outdoors on the Arbor Drive lawn, outside UCSD Medical Center-Hillcrest. Sign ups needed.
Volunteer Member of the Year Award AGAIN?
Believe it or not, the year is just about half over, and we have been quite busy with our new warehouse; getting people out to Port Hueneme for the Alaska Airlines response; and our deployment to Kharkiv, Ukraine for Rough and Ready 2000. I know the year is half over when the memo arrives from Admiral Knouss reminding us about thinking about our Member of the Year Award for NEXT year's annual meeting in Dallas,TX. In fact, he of course is correct, this IS a good time to start thinking about it. It is also a good time to start thinking about what you can do to help the team, and how you can get involved. Think about when might you be free to come down to the warehouse and operations center, and when the last time was that you came to a meeting .
Things we still need at the Ops Center... we still need carpet in the Briefing Room. The floor is quite cold, and sounds are distorted. Perhaps you would like to volunteer to call some carpet companies and see if you can get them to donate a remnant of industrial carpet large enough to cover the floor. Maybe you have a relative in the carpet trade, and your contact will help us all out?.. Once you have identified such a lead, contact Chuck Perkins or Larry Griffin and let one of them know.
Operation Rough and Ready 2000, Kharkiv, Ukraine
Six DMAT CA-4 members participated in the Rough and Ready 2000 exercise. This extravaganza was over a year in the planning, with many major hurdles along the way. For the first time, civilian medical disaster responders were included in the annual exercise involving the Ukrainian military and the California National Guard.
CA-4 members who participated were: Jake Jacoby, Marianne Ingels, Stuart Sprung, Ricky Rod, Thérèse Rymer and Mary Welsh.
Day #1: Sunday, May 14th, Busses from the 147th Combat Communications Squadron, located in Kearney Mesa, left with the DMAT contingent and members of the Air Guard, for the 3 1/2 hour ride up to Point Mugu Naval Air Station for the weigh-in. At noon, a chartered American Trans Air (ATA)B-757 departed Point Mugu,Ca at 1200 hrs, PDT, on American Trans Air (ATA), with refueling stops en route at Bangor, Maine and Shannon, Ireland. Smooth flights all the way, excellent meals.
Day #2: Monday, May 15th. Arrived Kharkiv Airport approximately 1500 hours local time, 17 hours after first wheels up. (San Diego is ZULU minus 7 hours, Ukraine is ZULU plus 3.) Busses to Kharkiv Hotel, in downtown area of the city. Briefing on security status, schedule, plans, local customs by representatives of California Air Guard, CA EMS A.
Day #3: Tuesday, May 16: Up at 0500, breakfast at hotel, bus departed 0600. Transfer by bus to Chuguyev Air Base, by bus/police convoy escort, outside Kharkov, to site set up by Ukrainian Ministry of Emergencies. There were 3 CA Air Guard C-130s on the tarmac.
Tents, similar to GP Mediums, Eastern style. Briefing of days events by Dan Smiley, CA EMSA. Teams begin set up of DMAT supplies previously shipped by Air Guard C-130 aircraft, for exercises the next day. Return to Kharkiv Hotel (approx 30 minutes from Air Base). Then busses to the Auditorium at Tractor Assembly Plant #4, where Opening Ceremonies were held to Officially open the "workshop," as it was called by our hosts. Honor Guards of Ukrainian Army and CA Air Guard brought in the colors, then the official welcomes from both sides were delivered, with appearances from each agency involved. Then busses back to the hotel.
Day #4: Wed., May 17th . Up at 0500, bus departed at 0600.The most ambitious day of the event. A thoroughly scripted disaster exhibition by the Ministry of Emergencies and Ukrainian military: 3 scenarios: Scenario #1: Flood. Simulated roof tops were built atop barges in the Pochingi Reservoir, outside Kharkov, about 40 minutes from Air Base. Over a dozen victims were placed there, then rescued thru numerous methods: a radar-enhanced CA Air Guard C-130 dropped boat, then American Parajumpers (PJs) from 4500 feet, first pass then Ukrainian PJs dropped by same craft, landed next to boat, and both groups performed their rescues. Also used were: Ukrainian helicopter rescue squads, boats, & amphibious vehicles. Rescued moulaged victims, many with hypothermia, were brought to a Triage site, tagged, and transferred to a field DMAT treatment site set up on a small mesa overlooking the reservoir, and were treated and transferred to Ukrainian ambulances. (Weather was perfect). This treatment site was run by DMAT CA-2 physician KR Spotts, and her Ukrainian counterpart.
Scenario #2: Aircraft collision: 15 victims of a simulated aircraft accident were found, evacuated by Ukrainian Ministry of Emergencies rescue personnel, and delivered to DMAT treatment site. This DMAT set up was directed by DMAT CA-4 physician and Team Leader Jake Jacoby, plus a Ukrainian set of parallel personnel.
The first serious health problem of the trip we learned, had occurred just before we arrived at the aircraft crash site. A member of the CA Guard who had ridden up from San Diego with us, had apparently had a seizure, and was transported to a local hospital for care. From there he did require air evacuation out, early the next day, to a U.S. military hospital in Germany. We hope he is fine, and will have no serious sequelae. He was doing fine at the time of the transport.
Scenario #3: Building explosion and release of Ammonia gas, with victims spread out within and around a large building. Demonstrations by: 5 Ministry of Emergencies search dogs; one Ukrainian Air Force helicopter used to place and then remove fire fighters onto roof, to set up pulleys for rescue baskets which could be pulled up to roof (4 story equivalent). Other fire fighting and US&R activities also took place. Also demonstrated was a new helicopter with design which allow it to land in a lake, take on a water load, take off and drop water on fire, claim made of only one in all of Europe. Impressively scripted exercise demonstration. Victims were then brought to DMAT treatment site, and were triaged and treated, and loaded into ambulances, under direction of DMAT CA-2 Unit team leader Dr. Conrad Salinas and his counterpart.Thus the three scenarios were completed, under the close observation of 2-3 bus loads of Ukrainian VIPs, (military and civilian) the international and local press, and international visitors from numerous European and Asian countries (I met some from Byelorus, Moldavia and Japan). Each of the sites had Ukrainian shadow civilian participants with same ICS titles, and were working shoulder to shoulder, with interpreters intercalated among everyone.
Additionally, a Ukrainian medical camp set up was on display, with about 10 tents, each prepared for a specific function, e.g. sleeping, patient care, kitchen, latrines, showering or cooking. Return to Chuguyev Air Base to return supplies for third day of actual events, then to hotel at 1900.
Day #5: Thurs., May 18th: up at 0500, breakfast at hotel, Busses departed 0600 for Chuguyev Air Base, where the day was broken into two halves: first half is demonstration of DMAT Patient Treatment Site by all 24 members of a merged "statewide" CA EMS Authority DMAT (members from DMATs CA-1, 2, 4, 6, and 9).
55 patients moulaged by CA Air Guard were rushed thru the tents sites, with the injuries same as day before, simulating their arrival at field "hospital" or treatment site. 10 of these were to be selected for loading on C-130. After 2 hours, play was stopped and 30 more patients were triaged thru a three year old Ukrainian Field Hospital, with OR capabilities. This facility is inflated, and is designed for cold weather. It had been used for 24 days during Ukrainian MOE response following earthquake in Turkey, and apparently handled 4,900 patients during those 24 days. It is an impressive, meticulously clean facility, but without air conditioning and was quite warm on this particular day. Plans apparently have been made to add air conditioning and a pharmacy to it. I was told it was designed to function down to -20ºC., when it will apparently stay at an even 24 degrees (centigrade) inside. The Ukrainian hosts did an excellent job of demonstrating their techniques at dressing wounds. Their moulage was interesting, to the extent of demonstrating how they repair a liver laceration, by placing a calves liver on a patient's abdomen, so it could be sutured up. At least they said it was calf liver. (Where's Waldo?) Ten more patients were to be selected out for air evacuation on the C-130 Hercules of the CA Air Guard, but they lost their orange markings and so another set of 20 Ukrainian and US volunteers was selected, put on litters and loaded by joint DMAT/CA Air Guard and Ukraine litter bearers, two from each side per litter.
Day #6: Fri., May 19th. This day is more of a winding-down day. Teaching interactions planned at Chuguyev, starting late in the morning, to allow some folks to get into town and find souvenirs...Cant find any stores that sell post card!! (Kharkov is not known as a tourist city, has some historic churches, small airport, and a very large, impressive, modern, opera house/theater. Featured film was an F. Scott Fitzgerald flick. But hardly any post cards). The training was in airway management, DMAT training curricula, and assorted other topics.
This also turned out to be a quite memorable day for those who attended the Barbecue and dinner reception at Chuguyev. Although I did not attend, there was quite a spread, and large amounts of 90 proof two-carbon fragments were toasted (as were some of the attendees). Significant amount of bartering of patches and military items took place .
Day #7: Sat., May 20th. Last day in Ukraine. Bus departure was 9 AM to the Closing ceremonies, back at Tractor Assembly Plant #4 Auditorium. ( I wish they had had it at the Opera House). Speeches by the politicians, the military representatives, the civilian medical catastrophe workers, and the California folks. (I was sorry no one from NDMS was there. What a shame. I would have thought some one from NDMS would have been able to participate, or at least observe, as did some of the California folks but it just didn't happen. Maybe then the words DMAT and NDMS might have been mentioned more, or at all.) Following the ceremonies, we returned to the hotel, and then a few free hours before getting ready for the bus trip to the airport, at 1630 hours. Departure of our charter was scheduled for 1900 hours. A real time test for the system and our skills occurred, when one of the travelers developed symptomatic SVT while waiting to board the aircraft. Since our own team ECG machine was already packed on one of the C-130s for the trip back to the states, we used a Ukrainian ECG machine, off one of their ambulances, to document the rhythm, and as well, to document successful conversion with a facial ice pack, and the ability to load and go. Takes longer to fly west than it does to fly east.
Day #8,Sunday, May 21st. Arrival back at Point Mugu NAS occurred approx. 0700 hours, local time, 22 real hours after leaving, with stops back in Shannon, Ireland and Bangor, Maine.
On a personal note, Kharkov is my paternal ancestral home. My father was born here in 1901, left Ukraine in 1919, (was at that time Russia, in middle of second Revolution) and came to the US in 1922. I grew up listening to many stories about Kharkov (the Russian pronunciation and spelling), today a city of 1.7 million. I still have family there, remnants of the large family he came from. I had never met any of the Kharkov contingent, and only recently started communicating with a first cousin, by eMail, found thru the Internet. I called the first cousin I knew I had, as soon as I arrived at my hotel, and we made plans for dinner and meeting. I finally met Vitaliy, an engineering professor, his wife Svetlana, and their daughter Natalya, who just had a new baby six months ago. We dined at the Metropole Restaurant on Monday night, and talked about the family and reviewed the entire family tree, stemming from the 10 brothers and sisters my father had. We also had dinner at his apartment on Friday evening, where I also met their son - in - law. In our conversations, carried out in mixed English and Russian, I learned I had another first cousin that I had not known about. I met him the next morning, before we had to leave.
Over all, this was both an exciting event for our participating team members, and the rest of the 175-200 Californians who participated. I believe it was also a landmark event for NDMS. I believe this may have been the first international DMAT exercise ever executed. (Let me know when the IMAT does one). There were many lessons learned, far more than I anticipated. For one, going to a new democratic country that was once part of the USSR, and more a "prisoner" country than an agreeable participant in the Soviet experiment, represented an opportunity to truly see how things evolved in disaster response, with minimal American influence. The parallels are many, and the details are certainly interesting to have observed. Although the miniaturization of many medical monitoring devices impressed many of the Ukrainians, they appear to still be able to get their tasks done with what they do have. They seemed to be intrigued with our colored triage tags. Theirs serve the same function, but require writing to circle the appropriate categories. The fact that the Ukrainian Ministry of Emergency Situations has their own inflatable hospital that has been deployed overseas, to Turkey following the earthquake last year, gives them really credible operational experience. It also makes our 1330 square feet of patient care space ( two 19 X 35 foot tents) seem tiny in comparison. [The proper comparison would be to a DRASH Unit]. It appears that most of their medical volunteers are trauma surgeons and general practitioners. Would that we could have more trauma surgeons involved on our own DMAT. They register their patients on a computer, while we still write them in by hand on an NDMS log.
I hope we can continue to be involved in the future, particularly when the Ukrainian civilian medical responders get to come to California and see us with all our toys, many of which we did not have with us. We are all very appreciative of the amount of work needed to make this exercise happen. It would never have taken place without the tireless efforts of Dan Smiley, from CA EMSA, his department; and all the people in the CA National Guard office.
I also look forward to having NDMS welcome our new friends and colleagues to the next NDMS Annual Meeting, to discuss their impressions of the exercise, as well as their experiences in Turkey, their unfortunate experiences with Chernobyl, and their operational philosophies, which we certainly did not have enough time to discuss during the exercise. I do hope there is a way for their leaders to travel to the U.S. to participate in the training that there is to be had, and to exchange views with us.
DMAT San Diego CA-4: One of three teams Up First for the Western US, June and October 2000
NEW DUES POLICY
Due to the inordinate amount of repetition apparently needed to get members to pay their dues, discussion has been held at team meetings, and suggestions were elicited. This has resulted in a new dues policy, which will be sent out under separate cover for member to vote on. Essentially, dues are due on July 1st for fiscal year of July 1-June 30th yearly. Dues must be paid within 60 days, after which time the dues amount will increase by $5./month until it becomes doubled. Dues will accrue if it is not paid. After 2 years, unpaid members will be dropped, will need to return personal gear (including uniforms) signed out from the team, and their NDMS ID card. It is hoped that members will have a real incentive to pay their dues in a timely fashion, and we can then get on with other important issues and not have to keep reminding them to pay their dues. Look for the policy in a separate mailing, and RETURN YOUR VOTE as soon as possible.
Q.: How long is the list of California Earthquakes with 10 or more deaths? A.: Ten.
Apr. 18, 1906, San Francisco 600- 3000
Mar. 11, 1933, Long Beach, 115
Feb. 9, 1971, San Fernando 65
Oct. 18, 1989, Loma Prieta 62
Jan. 17, 1994, Northridge 60
Mar. 26, 1872, Owens Valley 60
Dec. 8, 1812, San Juan Capistrano 40
Oct. 21, 1868, Hayward 30
June 29, 1925, Santa Barbara 13
July 21, 1952, Kern County 12
Ref.Iacopi RL. Earthquake Country: How, why and where earthquakes strike in California, 4th ed.,Tucson, AZ. Fisher Books, 1996. Excellent trip down the San Andreas Fault.