Launched in December 2003, Sonoma County Public Health's Medical Reserve Corps is going strong. Since its inception, 18 volunteer orientations have been held, resulting in the enrollment of over 450 health professionals, including 54 physicians, 30 pharmacists and 380 nurses. With 143 trained support staff, the MRC grand total is 607 volunteer members. MRC volunteers have attended a variety of advanced trainings on public health preparedness, including for pandemic influenza. Many of you have participated in Public Health's emergency preparedness drills and exercises. Other activities have included delivering a hand hygiene program in the schools, providing West Nile virus education in the community, and staffing community flu shot clinics.

For the past three years, the primary mission of the MRC has been to recruit and train health care professionals for staffing mass vaccination and prophylactic medication dispensing sites in the event of a public health disaster. As the MRC began its fourth year, its mission broadened to include planning for hospital emergency surge staffing. Now, as the MRC enters its fifth year, we are expanding by recruiting licensed mental health professionals, such as licensed clinical social workers, marriage and family therapists, and psychiatric technicians, to be part of the MRC response team, and providing training in disaster mental health.

Another exciting project is our new hospital emergency auxiliary teams. To better respond as surge staff for hospital emergencies, MRC hospital auxiliary teams are in the process of being formed. MRC auxiliary team volunteers will be pre-assigned to, and trained by, a local hospital for possible work assignments during emergency duty. Palm Drive Hospital is being tested as the model for this new concept. Once this model has been tested and refined, it will be rolled out to other hospitals in the county. At that time, you will be invited to join an auxiliary team at a hospital in your geographic region. So stay tuned...

Looking for a New Year's resolution? Is your family emergency plan completed? Is your emergency go-kit ready to go if we call you? If not, for inspiration, read the article in our new column "Volunteer Voices" on go-kit preparation. You can also download a copy of our new Family Preparedness Guide (pdf), which provides a monthly checklist to help you become better prepared. Also, check out how you can help organize and prepare your neighborhood: read our guest columnist's article about the "COPE Neighborhood Preparedness Program."

FYI, our MRC website (www.sonoma-county.org/mrc) has a new streamlined look. Plus, you will now find a link there to our new MRC archives and resource library. Once there, you can access copies of previous MRC newsletters, emergency preparedness planning materials, disaster mental health guides, and reporting for duty guides and geographic fire zone maps.

Please take a few minutes to answer our short MRC Volunteer Survey. To do this online, go to www.sonoma-county.org/mrc and complete the survey by January 1, 2008. Your feedback will help us to help you be better prepared...thank you!

Lastly, from all the members of the Public Health Preparedness team, we thank you for your ongoing commitment to the safety of your community. Looking forward to another exciting year!

Regards,
Gabrielle C. Trubach, MA
MRC Coordinator

Pandemic Influenza Update 2007

By Kim Caldewey, PA, Program Planning Analyst

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The Sonoma County Public Health Preparedness team is tasked with the responsibility of developing response plans to mitigate mortality and morbidity in the event of a public health emergency.

What IS a public health emergency? According to the California Department of Public Health's Emergency Preparedness Office, a public health emergency is "an event or disaster that threatens the health of communities or groups of people." Some examples are biological threats, chemical spills, severe weather such as extreme heat, natural disasters such as earthquakes, and pandemic influenza.

County public health officials are working with regional and state partners, with the goal of increasing our capacity to respond effectively. As members of the Medical Reserve Corps, you are key partners in our work.

What's happening with Pandemic Influenza planning? Here are updates on the situation globally and at home:

International Update

Avian influenza cases reported to date in 2007: a total of 72, mostly in Egypt and Indonesia. Case fatality rate: 61% in Egypt, 81% in Indonesia.

These individuals were infected by birds with a virus that has NOT mutated to be able to be passed from human to human. If or when that mutation occurs, we could experience a rapid transmission of the disease across the globe - a "pandemic."

The international community, through the World Health Organization (WHO), is exploring an approach to the possible pandemic that is based on principles of disease "containment." The idea is to identify initial cases (index cluster) as early as possible, while they are still limited to a small geographical area. Inside this area, the index cluster would be placed in isolation and treated. The contacts to the index cases would be traced and given antiviral prophylaxis and quarantined. A "containment zone," a geographic ring round the index cluster, would then be created where antivirals and non-pharmaceutical interventions would likely be widely used.

To read more about this strategy, read the WHO document published in October 2007 WHO Interim Protocol: Rapid operations to contain the initial emergence of Pandemic Influenza.

National Update

At the national level, the Centers for Disease Control and Prevention (CDC) in Atlanta have developed strategies to mitigate the effects of a pandemic influenza when medications are in short supply or are not effective. The strategies are referred to as "non-pharmaceutical interventions" and are detailed in the 2007 CDC publication Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States (pdf). Using easy-to-read, colorful tables (pdf), the reader is taken to the heart of a planning document that details what communities can do to decrease disease transmission. The "community mitigation" actions, taken to soften the impact of the disease, range from patient isolation and voluntary quarantine to mandatory student dismissal, staggered work schedules, closure of mass transportation and wearing face masks when not at home.

State Update

In California, the California Department of Public Health continues emergency preparedness and pandemic influenza planning through the Emergency Preparedness Office. This office coordinates the federal and state health grants that fund our county Public Health Preparedness team's work, which includes the coordination of the Medical Reserve Corps.

Sonoma County Update

Closer to home, we have completed our Pandemic Influenza Response Plan, an appendix to the several pounds-heavy Public Health Preparedness Plan, which in itself is a part of the Sonoma County Emergency Operations Plan. The Plan has traveled to Sacramento for review by the state experts. When it is ready to be published you'll find it on our website at www.sonoma-county.org/pandemicflu.

The Plan reflects the most current national and international work on pandemic influenza, OSHA guidelines for health workers, as well as lessons learned from our regional and county planning partners. The role of the MRC in Sonoma County is a key component to planning for a surge of patients in the event of a public health emergency. Gabrielle C. Trubach, our MRC coordinator for the county, is busy planning more training events, exercises and recruitment projects to help us be even better prepared!

Tips for Staying Healthy This Winter

By Ann Baechler, RN, MSN, Public Health Preparedness Nurse

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Hand hygiene continues to be an important part of infection control and the prevention of communicable disease. According to the U.S. Department of Health and Human Services the following recommendations will help you stay health this winter. For additional information, visit: www.pandemicflu.gov/plan/individual/index.html#healthy.

Tip #1: Take common-sense steps to limit the spread of germs. Make good hygiene a habit.

Wash hands frequently with soap and water.
Cover your mouth and nose with a tissue when you cough or sneeze.
Put used tissues in a waste basket.
Cough or sneeze into your upper sleeve if you don't have a tissue.
Clean your hands after coughing or sneezing. Use soap and water or an alcohol-based hand cleaner.
Stay home is you are sick.

Tip #2: It is always a good idea to practice good health habits.

Eat a balanced diet. Be sure to eat a variety of foods, including plenty of vegetables, fruits, and whole grain products. Also include low-fat products, lean meats, poultry, fish, and beans. Drink lots of water and go easy on salt, sugar, alcohol, and saturated fat.
Exercise on a regular basis and get plenty of rest.

Tip #3: Get a flu shot!

Get a flu shot to help protect your self from seasonal flu.

Tip #4: Get a pneumonia shot!

If you are over the age of 65 or have a chronic illness such as diabetes or asthma, get a pneumonia shot to prevent secondary infection. For specific guidelines, talk to your health care provider or the Centers for Disease Control and Prevention (CDC) website.

Tip #5: Make sure that your family's immunizations are up-to-date.

If you are in need of a tetanus booster, the new recommendation is for all adults to have Tdap:

Give Tdap booster every 10 years after the primary series has been completed. For adults age 18-64 a one-time dose of Tdap is recommended the replace the next Td. (Source: www.immunize.org/va/va20.pdf)

Volunteer Voices

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Is Your MRC Go-kit Ready?

By Marian McDonald, RN

Is your go-kit or pack all lined up, ready to go for the day when you get called out to serve? If yours is, more power to you! You may be a better (or at least better organized) person than I am! I've got to admit it - my intentions are always top notch. But just like every other MRC volunteer, I expect, I have lot on my plate. My go-kit remains a good intention at this point.

One thing I know about myself - not much happens if I do not have a deadline. I know I have to turn in this article by November 15th, and today is November 4th. And I sure can't ask you to do anything I have not done myself. So that gives me 11 days. I think I'll make it 10 days just to give myself some slack. November 14th - a week from Wednesday. I think I can do that.

I already got out my MRC Field Guide (pdf), which has TWO lists of things to bring - one on page 5 called "Prepare Yourself" and the other on page 9 called "Ten Things to Bring With You When You Serve." There is a lot of overlap but not completely, so I guess I will do both. And here is ANOTHER single-sheet list. So I will use it and check to be sure that everything from the other two lists is on my working list. I will check them off as I pack them. I will keep that copy IN the pack so I will know if I need to put anything in at the last minute.

OK, I have made a start! I went to my stash of packs and bags not in use and picked out one I think would be a good size. If it is too big I can cut back to a smaller one later. This pack has four sections, so I will make each section a category: hands-on fast, ID and paperwork, professional gear, and personal maintenance.

I'm going to start with the "low-hanging fruit" next - the EASY stuff I can start tonight. Some of the stuff on the list I have only one copy of, like my driver's license and RN license. But I guess I can put in a copy of those - done! And some I already have here in the house, like plastic bags. And I need to make a shopping list for a few things I need to buy. Wow - my list only has 5 things on it. I thought it was going to be more.

Enough for tonight! I have made a start! I'll put a sticky note on the bathroom mirror with the deadline before I go to bed.

Saturday morning - November 10: Over this week I have scrounged up several more items already in the house - work gloves, local map, tissues, first aid kit, etc. I bought a box of nitrile gloves and will put 12 pairs into a bag for the kit. I bought nitrile over latex since I know that latex gloves have a distinct "shelf life' - they get weak if stored too long and I do not want to have to worry about that. I have my shopping list for a few things in my purse and hope to get them today. I am making good progress!

Monday evening - November 12: I just went through and checked my "still have to do" list. A few were easy (pens) and I made a shopping run last weekend for a notebook. I put in a few things that were not on the list (tape, goggles) and decided I did not need a couple of things that were on the list - I always have a pocket knife and my emergency contact in my regular purse, for example. A few I just decided I would not bother with, like spare eyeglasses. I could get burned, but I will gamble. I still need to buy "go food" and ibuprofen. I added a note to pick up and put in my "nurse pocket." I can't duplicate all that stuff but I can add it in as I go.

A lot of the small stuff went straight to the bottom of the pack, and I know, if I ever have to use it, I will likely be stressed. So I put all the small stuff for each of the four pockets into a zip lock bag so I can find and see these items easily. This is my calm "today me" looking out for my stressed "future me."

The pack IS the right size. It is not jammed full but reasonably close. It is pretty heavy but I do not expect to carry it far.

So what made the difference to get me going?

I committed to an external deadline.
I did not try to do it all at once.
The sticky note on the mirror really helped me keep it in the front of my mind.
I checked off on a list as I went.
I amended the list to my own practices, and I did consider everything on it.
I divided the pack into categories and I used plastic bags for the small stuff in each category.

If I can do it, you can do it! And thanks for the deadline, Gabrielle! It worked!

3 Steps to Recognizing a Stroke

Submitted by Kathie Russo, RN
Source: American Heart Association

(Thank you, Kathie, for helping to circulate this important information! - Gabrielle)

Remember the 3 steps to recognizing a stroke: "STR"

Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke.

Neurologists say that if they can get to a stroke victim within three hours they can totally reverse the effects of a stroke. The trick is getting a stroke recognized, diagnosed, and getting the patient medically cared for within the three hour limit, which can be tough.

Now doctors say a bystander can recognize a stroke by asking three simple questions ("STR"):

Question #1: Ask the person to SMILE (the "S").
Question #2: Ask the person to TALK (the "T") and speak a simple sentence coherently (such as "It is sunny out today.").
Question #3: Ask the person to RAISE (the "R") both arms.

Another sign of a stroke is this: ask the person to stick out his or her tongue. If the tongue is "crooked," if it goes to one side or the other, that is also an indication of a stroke.

Guest Columnist

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Bring the COPE Neighborhood Preparedness Program to Your Neighborhood

By Paul Hess, Emergency Preparedness Coordinator, City of Santa Rosa

Over 3,500 households in Santa Rosa, and many more all over northern California, are joining the COPE program and becoming Citizens Organized to Prepare for Emergencies. The COPE program was recently awarded the California League of Cities Helen Putnam Award for Excellence in 2007 for Best Public Safety Program.

What makes COPE different and successful?

1. Having FUN with the process! COPE participants are learning how to organize their families and neighborhoods for earthquake, fire and other disasters, but they are also having cook-offs, pot-lucks, and wine and cheese parties to make the learning fun! Some COPE neighborhoods are planning how to have an "after earthquake" party, to cook up the food in their freezers that would otherwise spoil if electricity is out for several days.

2. COPE Neighborhood Preparedness Fairs. Many COPE groups have held preparedness fairs to bring the area together and focus on preparedness. Country Club Apartments in Santa Rosa became the first apartment complex in the city to organize under the COPE program. Under the direction of manager Julie Bowman, they held a pancake breakfast for COPE this summer with safety vehicles, kids activities, and of course, great food! The turnout was awesome and as a result, they are now well organized in how they will respond in an emergency.

3. New Tools to help COPE leaders! The City of Santa Rosa, with the help of Homeland Security funding, has developed five video segments, as well as flyers, booklets, and brochures, to assist families and neighborhoods to get prepared. Our city now has over 350 neighborhood leaders in the COPE program covering about 3,500 households (about 5 percent of the city). The COPE program had doubled in the last year, and is on its way to helping Santa Rosa become the most prepared city in California.

For more information check out the COPE web page at ci.santa-rosa.ca.us/departments/adminservices/emergencyprep/Pages/COPE.aspx, or contact Paul Hess at 707-543-3711 or phess@srcity.org.

MRC Volunteers in Action

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Community Clinic and Education Programs

Flu Shot Saturday clinics: For the fourth year in a row, MRC licensed volunteers (with active licenses) helped staff Flu Shot Saturday clinics at a variety of locations around the county. This year's clinics focused on providing vaccination to children age 6 months to 18 years old. Over three dozen MRC volunteers participated in this worthwhile community project! These clinics are organized annually by the Sonoma County Flu Task Force, a coalition of health care provider organizations and agencies including Public Health.

Here's what some of you had to say about this year's Flu Shot Saturday:

"MRC volunteers are a huge help!" - Marian McDonald, RN, Site Manager, Palm Drive Hospital clinic (and MRC volunteer!)

"It's so wonderful that MRC volunteers step up to the plate. It really helps bring the medical community together." - Bo Minson, RN, Site Manager, Roseland Elementary School clinic

"It's fun! Plus, I give back to the community, and I help the community to get immunized." - Sandy Bartee, RN

"It's a happy thing; it's a chance to see my MRC peers every year." - Erin Moilanen, FNP

"It's a fun atmosphere; it's a conection to the community, which is really important to me. And besides, it's a chance to do direct services with my nursing skills, instead of just making a living with them." - Judith Whiteside, RN

"Working Flu Shot Saturday is a chance to give back to the community." - Gail Ohlander, RN

It is the MRC volunteers' contributions that make the community flu shot clinics possible. Without the participation of the MRC, the clinics might not happen!

Hand Hygiene/Respiratory Etiquette Program for Schools: Another project in its fourth year is our Hand Hygiene/Respiratory Etiquette program coordinated by our Public Health Preparedness nurse, Ann Baechler. Assisting her this year is Eileen Van Cleave, RN, an MRC volunteer who is completing her bachelor's degree and doing her public health internship here at Public Health.

New this year is our online training for this program. This training includes: a Powerpoint presentation of the core concepts of hand hygiene, two new flyers, a presenter's checklist, and a feedback form to evaluate this new training. If you would like to view this training go to our website: www.sonoma-county.org/mrc. For this year's program, 22 MRC volunteers have signed on to be presenters to school-age children in our county. To date, twelve have completed the training and are ready to go!

Since this project's inception, MRC volunteers have educated 8,800 school-age children at 25 schools in our county. This program has been very successful and well received by educators throughout Sonoma County.

Remember:

"Spread the word and not the germ," says Henry the Hand.

"Clean hands are the single most important factor in preventing the spread of dangerous germs and antibiotic resistance in health care settings," explains Julie Gerberding, MD, MPH, Director, Centers for Disease Control and Prevention.

Redwood Regional Training

The Redwood Regional Training University (www.redwoodregionaltraining.org) is a public health emergency preparedness training partnership between the Northern California counties of Sonoma, Lake, and Mendocino and is designed to provide tools, knowledge, and practice in the field of public health emergencies and disaster response.

The courses provided are designed and taught by experts in public health, fire and hazardous materials, law enforcement, and the medical community. As MRC volunteers you are invited to attend many of these training events.

In 2007, MRC volunteers were invited to and attended these trainings:

Mental Health Issues Related to Disasters, March 20th
Conference for Emergency and Hospital Staff, June 28th
Disaster Service Worker Conference, July 20th
Working Together for All-hazards Readiness, October 2nd & 3rd

Online Training Opportunities

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New Norovirus Strain Spreads Across the U.S.: Self-study article in Nurseweek, October 8th, 2007. This article is packed with new information essential for all nurses. Take time to read the article and take the online test for one (1) CE unit.
Nurse on the Front Line: Preparing for and Responding to Emergencies and Disasters: The National Nurse Emergency Preparedness Initiative (NNEPI) recently launched this training module, which provides online training and resources for nurses. This FREE online training is a terrific resource and includes the option for up to 6 CE units for a small fee.
NIMS/ICS Web Seminar: Free online seminar for hospital emergency program managers and for personnel who are likely to assume an incident command position. Also useful for any MRC volunteers who participate in our hospital auxiliary team project.

Emergency Preparedness Resources

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Family Preparedness Guide (pdf): Make 2008 the year that you resolve to put together (or to complete, if you have already started) your emergency go-kits for yourself and your home. To help you do this, check out our new month-by-month "Family Preparedness Guide (pdf)." On one side you will find suggestions for three things that you can do every month. On the other side are checklists for your home kit, you go-kit and your family emergency communication plan. This guide is available on our website at www.sonoma-county.org/mrc, or call Gabrielle at 565-4427 for a copy.

MRC Field Guide (pdf): The MRC Field Guide summarizes what volunteers need to know when they serve, with topics such as "Prepare Your Family," "Prepare Yourself," "When you Serve," and "Volunteer Participation Levels." This guide is available on our website at www.sonoma-county.org/mrc, or call Gabrielle at 565-4427 for a copy.

Books about the Influenza Pandemic of 1918: If you are interested in learning about the influenza pandemic, here are two books that you might consider reading:

The Great Influenza: the Epic Story of the Deadliest Plague in History, by John M. Barry (Viking 2004).
America's Forgotten Pandemic: the Influenza of 1918, by Alfred W. Crosby (Cambridge University Press 1990).

Update Your Profile

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For more information, please contact:
Sonoma County Medical Reserve Corps
625 5th Street
Santa Rosa, CA 95404
Phone: 707-565-4427