DMAT San Diego CA-4

SEPTEMBER 2003 Newsletter
****  Volume 12,  Number 9   ****
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
After Action Report: Joint training event........... .Page 1
Minutes, Aug 27, 2003 team meeting...................Page 2
Commander's Report........................................Page 3


Next Team meeting --
Wed., September 24, 2003 @ 1800 hrs.
Training Subject:   Head Injuries and Burr holes: how to manage in the field
by Dr. Hal Meltzer,
Professor of Neurosurgery,   UCSD School of Medicine/Children's  Medical Center San Diego
Where?  DMAT San Diego CA-4's  New Operations Center

8830-G Rehco Road,  San Diego
From  I-805:  Take Miramar Rd Exit EAST. Go 1.3 miles EAST  to Camino Santa Fe, Make left, proceed 0.5 miles to Carroll Road,  Make another LEFT onto Carroll Road, proceed west to the next light (Rehco Road) and make a LEFT . Look for DMAT Ops Center on the Right.

From  I-15: Take Miramar Road exit and head WEST on Miramar Road for 2.3 miles to Carroll Road. Make a RIGHT turn on Carroll Road (immediately past  the Pyramid building). Proceed approximately 1.0 miles to Rehco Road (It's the first light after Camino Santa Fe)..  Make  LEFT turn on Rehco Road, DMAT Ops Center is first driveway on the right.   Remember, we have no mail box at the
Ops Center, so never use this address for mailing purposes.

* Operation "BACK to BASICS  2003. March Air Reserve Base, October 24th-25th and 26th, 2003. Joint exercise with all CA DMATs plus visitors from other DMATs. Planning in progress, Sara Ontiveros, Planner for CA-4. Sign ups now being accepted.
*NDMS Annual Meeting,
Dallas, TX Apr. 17-21, 2004.
After Action Report

Dates of Drill/Exercise/Training:  Tuesday, August 5 and Wednesday, August  6, 2003

US Navy Submarine Base Point Loma(NSBPL)/ Anti-Submarine Warfare Training Center
Names of all CA-4 participants:
Chavez, Rachel - RN
Domino-Snyder, Valerie - RN
Downey, Robert -Lab Technician
Forney, Harold - Physician/Orthopedic Surgeon
Hicks, Toni - RN
Jacoby, Irving "Jake" - Physician/Emergency Medicine/Unit Team Leader
Leung, Susana - Pharmacist
Lyell, Amelia -Respiratory Technician
Norton, Scott-  Logistics/Information Technology
Reeves, Mark - Chaplain
Rymer, Therese- Nurse Practitioner/Deputy Unit Team Leader
Snyder, Ed -Logistics/Information Technology
Soderbery, Robbin - LVN
Sohmer, Michael - Pharmacist
Spuhler, Kevin -RN/Critical Care Nurse
Thoreson, Jack - EMT-1/Acting Logistics  Officer
Van den Hout, Carla - RN
Wahrenbrock, Zona - RN/Administrative Officer

Participants from USPHS Commissioned Corp Readiness Reserve: Course Director, Dr. Renee Joskow, USPHS plus 53 trainees (names  available-contact Renee Joskow)

Narrative description of the activity:

At request of USPHS CCRF, DMAT San Diego CA-4 provided a staff of instructors to give CCRF Course Attendees "hand-on" training of field medical and living skills needed for field deployments. None of the USPHS course attendees had ever deployed with a DMAT before.
DMAT CA-4 also made this event a training event for recent new members. The training event was used to simulate an actual deployment.. A rental truck was leased, and items needed for the hands on training were loaded on the morning of August 5th. Truck was then moved to the US Navy Sub Base Point Loma (NSBPL), Anti-Submarine Warfare (ASW) Training Center. The initial plan was to set up the tent outdoors, and have team members set up the tent for sleeping overnight, and then use the tent in the morning for training the CCRF on how to do a field tent set up as a patient treatment site.

Tent training was done in the evening, after formal lectures were over, to a group of CCRF and new team members of CA-4 on first night of training..
The following morning,, the CCRF members were broken up into groups of 4 and were given individual hands-on exposure and training  to the following equipment and skills, and taught by instructors listed::
: Life Pack-12 (Kevin Spuhler); Impact Portable Suction devices (Jake Jacoby); I-STAT Clinical Analyzer and other field laboratory equipment (Robert Downey & Therese Rymer); Broslow-Hinkle Pediatric Resuscitation System  Jake Jacoby); Emergency Field Extremity Splinting ( Hal Forney); Western Shelter Tents (Mark Reeves);  Field computers ( used to present photographs of prior deployments)(Therese Rymer);
Litter bearer training was provided by CA-4 team members for both CA-4 members and CCRF trainees. (Kevin Spuhler)
Ongoing opportunities were present for one-on-one and small group interactions and networking between CCRF and CA-4 members.

Provide a brief critique summarizing the Lessons Learned and recommended changes for improvement:
1) This was an excellent interaction between CCRF and DMAT members. Should be considered as part of theCCRF Training in the future when it is done in other venues.
2) Difficulty with  Navy Sub Base personnel thwarted the plan to have the team stay overnight in tents outdoors as part of the training exercise. Although  advanced approval  was obtained from the Sub Base Security to put up two tents on site, this was  negated on the first day of the training event by  groundskeepers at the ASW Training Center, and the impediment had to be  resolved by applying for and receiving permission to set  one tent up indoors. This affected our team to some degree, but in fact the opportunity for the same experience will be occurring in less than 2 months at a larger field exercise, Rough and Ready 03, in  which CA-4 will be participating .
(3) This training exercise could be improved by:
(A) Having planned an alternate location for the tent instruction, such a site  might have been found if we had known with more advance planning what alternate nearby locations might have been available, without use of busses or other added expense for participation.
(B) having it extend for an additional day. This would free up our team members to participate in more of the other didactic training sessions being conducted for the CCRF, and increase the interactions of both groups.
(C) Better planning of mealtime to include a joint meal, either MREs or BBQ

Provide an accurate summary of the costs associated with the activity (please include any equipment purchases made to support this activity):
Truck leasing for 2 days, to transport tents, biomedical equipment, cots, litters: $245.22
Diesel fuel for truck: $14.00
Reimbursement of team members for participation: $6,505.36
Reimbursement of team members for  mileage to and from site + per diems:  $2,151.44
Batteries for I-STAT clinical analyzer: $43.06

Total identifiable cost: $8,959.08 (all charges and costs to be paid for from team budget via VW Int'l, or by CA-4 team funds  ($43.06)

AUGUST 27th   Team Meeting Minutes
 Aug 27, 2003 Team Meeting Minutes
I. Greetings
        By Dr. Hal Forney Professor of Orthopedics, UCSD School of Medicine
Dr. Forney with the help of Jo Markland, demonstrated the techniques of field splinting of extremities

III. Nursing Director's Report
Critique of Training event with USPHS Commissioned Corps held on Tuesday, Aug 5th
          & Wednesday, Aug 6th, at US Navy Anti-Submarine Warfare, San Diego
            Overall CCRF were very impressed with the whole training events, and would like to continue  having similar training with DMAT. One request was to include straps for the litter exercise
       2) Peggy reported that  CA-4 did not get put on alert in the month of August at all because  there were 10 teams, instead of the usual 6, up first for the month. The last two teams put on alert  on the 21st were AR-1 and NY-1

       3)Peggy reported that CA-4 purchased a used forklift per Dave Holland from Hawthorne Lift Equipment. It is a CATERPILLAR, 5000 pound lift capability, with lights, side shift, 187 inches lift capability. Current lease will be terminated at the end of September.
       4) Peggy reported that per Jake CA-4 have spent all except $740 of our federal budget of $99,896.00  and there are a number of items that we paid for with team funds that we will be requesting  reimbursement for, which will likely get us back that amount of money to our team
       5) Peggy reminded team members to pay dues before the first late fee kicks in on October 1st. (When dues will go up from $20.00 to $25.00);
6) Jake and Therese were both out of town, attending a 3 day course at the Noble Training Center in Anniston,Alabama, called "Hospital Executives Leadership and Decision-making for WMD."
IV. Old Business
County of San Diego Contract for Study of Hospital Surge capacity
           Peggy reported that the Surge capacity study is still on going, and progressing well.
       2)Skills Tracking
Peggy reported that skills tracking for RNs will be scheduled on one Saturday morning in October

V.Committee Reports
    1)Administrative Officer (Zona)
       -Zona reported that 100 uniforms were purchased. There will be forms to sign out uniforms to take to
          the uniform store
           GALLS INC./ LONG BEACH UNIFORM, 8841 Clairemont Mesa Blvd., San Diego, CA 92123
           voice: 858-505-1900
           fax: 858-505-1940
       -Zona reminded team members to pay dues and submit copy of the current license
       -Zona reported that construction work will start on Sept 8 for about 25 days, will need team members  to sign up a 4 hour block of time to safe guard the Op Center during the remodeling period
       -Bob Downey passed out copies of lab order form and ask for feedback

     2)Communications (vacant)
       -Ed Snyder expressed interest in filling the vacancy

     3)Financial - deferred

     4)Fund raising - no  report
     5)Logistics - no report
     6)Nursing - no report

V.Committee Reports
    -Michael reported that Jake Jacoby and Michael saw a demonstration of the FFI Pharmacy Program, but  the cost of $5000 is too costly for the team and the vendor was unwilling to reduce the cost even though we area non-profit organization.
    -Michael reported that CA-4 purchased 5 HP-IPAQ 5400PC to download medical information for deployment
    -Michael announced that on Aug 28 Thur & Aug 30 Sat SDRxERT presented "The San Diego Emergency Plan, Emphasis on Mass Prophylaxis and the Role of the Pharmacist" at North County and South Bay respectively. Both
Michael Sohmer and Susana Leung will present part of the program

     8)Safety Committee (open)

     9)Supply - no report as Larry was absent

    10)Tactical Strike Team Committee - no report
    -Sara reported that 2004 budget requires 35% of team members complete the core modules
    -Sara reported that currently only 4% completed the core modules, 17% had logged on the training program
    -Sara reported that Rough and Ready 2003 name has  changed to "Operation Back to Basics" and will be on Oct 24-26 at March Air Reserve Base. (1.5 hour drive one way from San Diego)
    -CA 6 & CA 11 will be flown in. NV 1, OR-1, HA-1 and MN-1 were invited to participate, in limited numbers.
    -CA 4 have been assigned to be in charge of medical equipment training and administration forms and provide  cots
    -Friday Oct 24 will be Commo set up
    -Saturday Oct 25 CA 4 will have THREE 2 hour each session of training on medical equipments and will   need volunteers to sign up to instruct.

V.New Business - none

VI.Adjourn at 7:10 pm
-----Submitted by Susana Leung

Commander's Log
The allowed tenant improvements began  at our Ops Center on September 8th, being done by  Starrett Construction Company in El Cajon. Many of you have signed up to man the Ops Center during the construction, and it is most appreciated. The computer was set up so that members can use the Internet to sign on and get some of the training modules done, and other members are invited to come down between the hours of 7 AM and 2 PM to take advantage of the opportunity, if you do not have access to high speed internet connection at home or work.  Thanks to Michael Sohmer,for installing the new software and modem, and getting us up and running. Thanks also to the following persons who have worked at the site the first week: Jeff Keely, Kevin Spuhler, Michael Sohmer, Zona Wahrenbrock, Susana Leung, Hal Forney, Amanda Lyell, and Ed Snyder.  Others are still scheduled to work during the next 1 to 2 weeks.  Work should be done by our next meeting, or the day or two afterwards. The new meeting room will be much roomier, and three additional office spaces are being  created, including a battery recharging room.

* The 2002-2003 Federal contract budget for our DMAT  is now history. We were able to spend 99.994% of it, leaving an unspent amount of only $5.88. without going over. We will shortly get to work on our current budget for 2003-04. The budget crunch in Sacramento has left us without a signed contract from the state. That amounts to  $23,000. that we cannot start spending.
DMAT CA-4 will be undergoing an audit on Thursday, Sept 25 and Friday Sept 26th. It is being done by an accounting company from Omaha, NE, which has been subcontracted by  NDMS. We are told the team was chosen at random, and is one of 8 DMATs to be so audited, as part of an effort by DHHS to demonstrate the compliance of DMATs with their rules for managing Federal funds. Should any  member's assistance be needed to demonstrate any aspect of our DMAT's activities, including logistics, we will get in touch with you. The auditors have been invited to our team meeting on Wednesday evening the 24th.  Please make every effort to welcome them to our meeting and to San Diego.
* Our team training officer, Sara Ontiveros, has been actively involved in planning for this year's joint Statewide DMAT Exercise. It should be an excellent opportunity to get field living skills  basics, if you are a new member, or refresh your memory as to how things are done, if you have been a member for awhile. It is especially important that members who did not participate in the joint exercise with the CCRF take part in this exercise, in order to get deployability points , in case we need to choose among team members for deployment slots.
* A California DMAT BACK to  BASICS 2003  Tee shirt has been designed by Anne Bybee of the State of CA EMS Authority and the National Guard, and we will need to know how many members   wish to purchase one.  This is NOT going to be a large order, like at R&R 2001, and we will not be opening up the sales as a fund raiser, they are essentially for team members only. They will be black, with EMSA and National Guard logos as part of the 2003 Back to Basics Logo., on them. They will cost $10.00 each, including tax. DMAT CA-4 will be advancing the funds needed to  purchase the  shirts, as the budget crunch in Sacramento means that EMSA cannot be using state funds to purchase T shirts.
* Due to the problem of "No shows" in the past, and the added expense if someone signs up for the exercise and then does not show up, for the first time the state has proposed that there will be a $50.00 penalty charged to the team, for every no show.  More on this at the next meeting.
  FOR THE TEAM  MEETING: MAKE SURE TO BRING A VOIDED CHECK to the next meeting, to attach to  the new  direct deposit form for the Dept of Homeland Security, if you have not already done so. This is a requirement for everyone, old and new members alike.
* And while you are at it, if you have not already paid your dues, bring along a check for that too. That way you can avoid the late fees which will increase dues to $25.00 after October 1st, to $30.00 after November 1st, and to $40.00 after December 1st.
* Be prepared with the following items, to complete your sign up for the BACK to BASICS Exercise:
** Valid Driver's License number
        **Know your license plate number, color, mode; year,  and make of POV ("Privately owned vehicle") if you are driving to the base for the exercise.
      **Make sure you have proof of insurance with you when you drive to the base. Otherwise, you will NOT be allowed to enter, so don't even try. No exceptions. This is for security reasons, per Guard Base. If you do not have auto insurance, you  will need to carpool with someone.
Plan on spending 30 minutes at the gate on a line in order to gain access, by going through security.       ** Make sure you have your NEW NDMS/ Homeland Security ID card. If you haven't picked yours up yet, please bring your old card to the meeting, as you will need to trade  it in to get the new one. If you haven't taken your picture, or if you have been informed that you will need a  new photo , make sure you get this done AS SOONS AS POSSIBLE as time is running out in order to get new ID cards before the exercise .


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