Speakers and Reactors:

Dr. Charles Denham – Moderator
Dr. Greg Botz
Chief Bill Adcox
Randy Styner
Jennifer Dingman


Dr. Charles Denham:  Good day. I’m Dr. Charles Denham. I’m chairman of TMIT Global and one of the co-founders of the MedTech bystander rescue care program.

I’ll be both a speaker and your moderator today. We’re so very blessed you’re joining us to learn how to keep your family safe. And it’s my pleasure right now to introduce Jennifer Dingman. Jennifer has been a long-standing patient advocate we’ve worked with for more than 12 years.

She has been a wonderful contributor to the safe patient safety movement. And it was a view that watch both of our webinars every month. This this webinar we started thinking that that the COVID crisis would be short term.

And we said, look, we’re going to do one every month and we’ve got we’ve had great reviews of this particular one, which is focused on critical essential worker families and the families of our caregivers and 17 industry sectors.

Jennifer’s been a long-standing patient safety advocate. She’s a co-author with us on multiple publications. She’s served on a number of federal programs and probably most importantly been recognized by the Pete Conrad Patient Safety Award for her work on the hacks that hospital acquired conditions, which are the paper performance program that has driven many, many, many lives to be saved. And I don’t want to exaggerate the numbers. It’s almost scary to see how much impact that program has had. Jennifer, thank you so much for being the voice of the patient and for being a reactor when we finish the program. Jennifer, can you set our course today?

Jennifer Dingman:  Thank you, Dr. Denim for your kind introduction. I’m honored to be here today and I’d like to welcome all of our speakers and participants. This is going to be a very informative and great program. I encourage you to please share the video with your friends, colleagues and family members. And looking forward to hearing everything that’s going to happen today and I’ll give it back to you, Dr. Denham.

Dr. Charles Denham:  Thank you, Jeni. And we really appreciate your attention to detail and your help in this area. So, we have a wonderful set of speakers today. Thursdays are the days that Professor Botz, Dr. Botz is in the ICU at MD Anderson.

So, we have to pre-record his content, but he’ll kick us off today with kind of an overview of each of these questions that we’ll address. He is both a professor, a full professor at University of Texas, MD Anderson Cancer Center, as well as a clinical professor at Stanford Medical College and has done a fellowship in addition to his work, academic work. He has a formal fellowship in simulation and has been a longtime champion of patient safety and quality.

We have Chief Bill Adcox, who is both a Vice President at the MD Anderson Cancer Center, as well as the University of Texas Police Department Chief, and one of our real leaders in threat safety science, a real pathfinder and a great leader involved in multiple programs and our MedTech program.

Charlie Denham, III, is my son, who on the recorded longer broadcast, you will hear about the Family Lifeguard Program and checklists, which he helped deploy to know it’s 20,000, 30,000 families to help families in gathering.

Randy Steiner is the Director of Emergency Preparedness at the University of California, Irvine, a wonderful contributor to our community, both as a scout leader, but also helping us get the message out to essential critical workers, bestselling author, and has a terrific heritage.  I highly recommend it to you read his book.

And we have Heather Foster, who has been a frequent speaker, who is a nurse preventionist, who’s at the front line and really providing the frontline nursing direction, and I’ll be your host today so we’re really delighted to have you join us.

The MedTech program started and you’ll hear a little bit of redundancy in the video we show so I’ll go through the slides very quickly. Those of you that have downloaded the slides there are 160 slides, because we’ve covered very comprehensive areas and topics.

And we’ll keep this brief.  The MedTech program started in 2015, focused on the eight leading causes of death that good Samaritans can impact by bystander rescue care.

Chief Adcox who is on today and Dr. Botz were co-founders of this program that we started at Texas Medical Center, and they are co-authors in the six articles that you see on the slide here which I won’t go into and a seventh article upcoming in the, in the journal that the campus safety magazine. Our February progress reports on our website, which is a longer form video that you may watch if you wish to find out more, and you’ll learn more about through our programs those of you that are first timers of our more than 1000 critical essential – we just want to draw your attention to the more than 20 courses that we’ve developed since the COVID crisis started.

We’ll see that on slide 19, and we continue to address a number of issues testing to navigate cares on the second row. Our next will be public safety in the pro COVID world and you’ll see a number of other topics that will be covering in the next five months to go.

I’m going to be remiss if I didn’t address the student outreach team that we have from leading universities who are doing a great job but to hear a little bit more about that as, as we go through the videos.

I’m going to skip ahead on the slides for those that are watching this live those that those that watch the video won’t hear me talk about this, but I’ll come back to some of the topics that will cover.

As we get to those, because I’d love to really hear from our reactors and address this issue of testing to navigate care. We’re going to take this graphic this complex I-chart graphic and kind of break it down for you because every family really needs to understand what this chart means because this helps you decide what test, when, why, and how, but I would be remiss not to have Dr. Botz set the stage for us. He’s going to cover each of the topics very briefly that gives you an introduction will cover them again very briefly before we get into a deep dive and the purpose is so that you know when you show it to those who educate we have a lot of educators that are on our program today.

Dr. Greg Botz:  I don’t know what short sections to cover those of you are watching it for yourselves. Forgive us for a little bit of redundancy.

Well, you’re absolutely right, viral load is an important concept to understand when thinking about COVID infection, viral load really speaks to the number of particles the viral particles that you’re exposed to.

And if you think about it, the more particles you’re exposed to the more likely they’ll stick and cause infection. And so, efforts to reduce your exposure to large numbers of particles or a high viral load can help reduce the risk of infection.

Dr. Charles Denham:  Dr. Botz, when we talk about testing. There’s so much confusion and we’re hopeful that explaining the right timing of the test and the pros and the cons and helping to understand the nuances of the test will be helpful for families that certain will certainly was helpful to us as we developed it for our audience.

Dr. Greg Botz:  You’re absolutely right. There are a number of different testing techniques that we use to detect the coronavirus and they use a little bit different science. One of them, the PCR test is a very advanced scientific technique that’s been used in molecular biology and other sort of things like cancer research and cancer therapy for many years and it’s just been used now for the COVID virus.

It’s a very sensitive test – means it picks up things in really small amounts, maybe early and maybe later than when someone might be infectious because there’s still viral particles sticking around.

But the one that we’ve seen most recently is the home Rapid Antigen test, which is a very good test. It may not be as strong at detecting the virus as the PCR test, but it’s very good.

It seems to be limited at the time when you’re actually infectious. There’s not say any lead time where you detect the virus. And you may not detect it after the infectious state starts to go away. But when you’re infectious, it’s a very good test to detect the virus to see if you are currently infected with the coronavirus.

Dr. Charles Denham:  Dr. Botz, there’s been a lot of confusion regarding quarantine and isolation and in our programs, we try to help differentiate those and, in this program, we’ll be talking not so much about what each of those are, but the value of testing and knowing if you’re infectious after a period of time in either quarantine and isolation. Your thoughts.

Dr. Greg Botz:  Well, you’re absolutely right. We use those terms pretty freely, but they really speak to different parts of the spectrum of the COVID virus. You know, quarantine is what we use when people are either exposed or have the potential for exposure before, we know whether they have the COVID virus or not.

We do that for things like work or travel or, or other things. We have a period of time when someone might be exposed and might be getting the virus, but they’re not yet sick. And they may not yet test positive on a test. But they may a couple of days later. Whereas isolation is what we do when someone has a confirmed case of the COVID virus. And we know that they are likely infectious and we want to make them be very careful to isolate away from others so that they don’t spread the infection to others. And testing plays a real important role in each of those different points in time, whether it’s quarantine or isolation, but maybe for a little bit different purpose.

Dr. Charles Denham:  Dr. Botz, we’ve learned a lot from our 1000 family household study, which is more than 1000, but it’s a good rounding number and focused on making family gatherings safer and your wonderful development of the idea of a cure huddle.

We applied to family gatherings with our concept of the family lifeguard checklist. We’ve now learned a lot about the variants. And now we know that testing can be included in preparing for a family gathering to make sure that everybody may not be infectious right before that event.  Do you think this is of value to our families as they anticipate getting together on holidays or on weekends?

Dr. Greg Botz:  I absolutely do. I think that using testing as part of the preparation for a family gathering to keep everybody safe is an important tool that we can use.

If we have the ability to test at home or if we have readily available testing in our community that we can obtain safely and then get results relatively quickly. It’s really an important part of preparation for a family gathering so that if someone happens to be exposed and perhaps has the coronavirus but doesn’t yet have symptoms, they may detect it and be able to isolate themselves from the family so that others don’t get sick. It’s certainly a value add to our preparation strategy.

Dr. Charles Denham:  Dr. Botz, as we think about going back to work and staying at work, we talk about safely returning to work but staying at work. Testing can have some real value and we think that that will be more and more common, especially if we have more variants coming down the pipe and we start to live with this virus and coexist with it.  The testing could be of real value to our HR leaders.

Dr. Greg Botz:  Fair statement. I think that using testing in our ability to go back to work and stay safe is very important. I think that it gives us the ability to maybe return to work at an interval that makes us more comfortable that we’re not infectious and not able to infect other people.

The original estimates for isolation or quarantine that we were using for people that may have been exposed were necessarily long because we didn’t understand the virus as well as we do now.

The variants seem to be perhaps faster onset and maybe a little faster offset than the original COVID virus was. So, this makes us more aware and perhaps more certain that it’s safe to return to work or it gives us some idea of when it’s important to stay away from work if you’ve been exposed and are infected so that the community of workers, the essential workers and others stay safe.

This is going to be part of our armamentarium moving forward. The COVID virus unfortunately will not go away. We’re going to have to adapt to living with it in our communities.

Dr. Charles Denham:  Dr. Botz, the concept of a test to travel is a good one and there really is an opportunity for us to integrate testing into making sure that we may not infect someone else and we may not be bringing the virus home. Is that a reasonable approach to applying testing to test to travel?

Dr. Greg Botz:  This strategy of using testing as part of the approach to test to travel is a really important strategy.

We now have the ability to do a rapid test with results in 15 to 20 minutes that allow us to add to our assurance that we aren’t currently infectious.

And so, using testing, say before you embark on a travel adventure and then perhaps mitigating your risk of exposure during that travel with the other public health strategies that we’ve used all along.

Followed by perhaps a rapid antigen test before you convene in another gathering, whether it’s with family or in a business setting or in any other place where there might be people who are gathering who aren’t from the same family or the same COVID bubble, as we say.

Using testing at those intervals helps us to have more insight to try to reduce exposing people to the coronavirus because someone may be infected and infectious during that travel epic.

Dr. Charles Denham:  Dr. Botz, we’re aware that there are dishonest people that are preying on the public and just a bit of a cautionary tale and a word of warning to all consumers to make sure that the test site that they use is maybe longstanding an organization one recommended by their providers and just be aware of the fact that identity theft can occur.  They can get a test result that might be fictitious, or they may get vaccination validation and verification cards that can get them into real trouble.

Dr. Greg Botz:  You know that’s absolutely true, and I’m constantly amazed at how people will try to exploit others in these very difficult challenging times.

You know, they’ll either spam you or scam you. So, you have to be careful with your medical information. You have to be careful when you are looking for testing to make sure that it’s a reputable organization because you don’t want to get caught up with false testing results and certainly don’t want to be involved in getting a falsified vaccination record because there are serious consequences in doing so.

Not only sort of the criminal activity of falsifying a vaccination record, but also being scammed into thinking that you’ve been vaccinated and you’re not and you’re still at risk for getting the COVID virus yourself or spreading it to others unintentionally.

Dr. Charles Denham:  Dr. Botz, many thanks for your steadfast support over this almost two years of running our program. You’ve been just a wonderful asset and answered so many questions for our families and we are eternally grateful. Thank you so much.

Dr. Greg Botz:  Thank you.

Dr. Charles Denham:  This film provides the answers to critical questions about COVID testing that will help us more safely navigate our journey ahead.

Med Tac Film narrated by Dr. Denham:  COVID testing is becoming a very important component to our new normal, not only getting back to where we work, play and pray, but more importantly, safely staying there.

What is viral load and why is it important? What is the right test at the right time? Quarantine, how does testing impact it? And isolation, how does testing impact it?

Can testing make family gatherings safer? How does test to stay work? And how do we best test to travel? This Med Tac film is a product of our 1000 Essential Worker Household Study, launched in 2020 in collaboration with major medical centers and supported by more than 130 subject matter experts, leaders and commentators in our two Discovery Channel documentaries.

We had great contributions from our youth and young adult outreach team of students, faculty members and alumni and alumna from many of our leading universities.

As of January of 2022, we had conducted more than 20 90-minute live broadcasts that have been produced for on demand viewing. The answers to these questions about testing will help us navigate our care and through the challenges of our daily lives, keeping us and those we love safer through the COVID surges.

What is viral load and why is it important? Infection risk is just basic math. The greater number of virus particles you potentially breathe, the greater the risk for infection and the greater the risk for severe disease.

It’s a numbers game. In medicine, we call this dose or viral load. People become infected by the virus entering the body through the wet mucus membranes that are the moist linings of our eyes and the nose, mouth and throat which comprise the upper respiratory tract.

The virus then can move into the lower respiratory tract comprised of the trachea or major airway that branches into bronchi for each lung and ultimately can reach and infect both lungs.

The Delta variant had 1000 times the viral load in both vaccinated and unvaccinated individuals. That’s 1000 times more than the original coronavirus.

And Omicron compared to Delta grows 70 times faster in the airways and upper respiratory tract, however 10 times slower in the lung tissue.

Omicron has explosive transmissibility, is capable of immune escape, and although it’s causing less severity in some age groups, it’s having an enormous impact on our society.

If you were to care for someone at home who is sick, remember that you want to reduce the dose or the number of virus particles you might absorb. Your best defenses are distance, speed and barriers. Keep your distance from the patient. Minimize the time in the same room or nearby and properly use barriers. A mask is a barrier.

We now know so much more about fighting the virus in 2022. We know aerosol spread is the main way it infects us, that viral particles can project much further than 6 feet, and that distance and ventilation are vital safety factors.

What is the right test at the right time? Testing requires collection of samples from the nose or throat with a swab or collecting a sample of saliva from the mouth. The goal is to capture viral particles. Good sample, good test. Poor sample, poor test.

The incubation period of the original alpha virus was about 5 days. The Delta variant 4 days, and according to the CDC, the Omicron variant roughly 3 days.

The infectious period is defined as the length of time an individual has enough virus in the respiratory tract that they can infect others. And some people will be infected and be infectious and never experience symptoms.

We’ll briefly cover four types of tests. The PCR or RT-PCR laboratory test, the rapid antigen test, the NAAT home test, and the antibody test.

When we understand how these tests work, we learn that timing of the test is absolutely critical to the meaning of the result. The most important tests you need to know about are the RT-PCR test, or called PCR test for short, that is processed by a laboratory, and the rapid antigen test that can be undertaken at home.

The strength of the PCR test is that it is the gold standard, which makes sure you have COVID. It can detect the virus even before you are contagious.

The minus is that you may have a positive PCR test after the infectious period because it detects pieces of the virus that are still in your body after the live virus is gone.

It can be used as a tiebreaker if the rapid antigen tests are negative in a symptomatic person. The strengths of the rapid antigen test are that they are inexpensive, can be done at home, and are typically positive during the infectious period.

The minus is that these are not as sensitive as the PCR test to detect the virus, so a false negative result is much more frequent than a false positive result of the test.

This is why it is recommended that multiple antigen tests are taken serially over days, at least 24 hours apart. Multiple tests increase the accuracy of the results.

You may hear about the home nucleic acid amplification test, or NAAT. It is similar to the laboratory PCR test and needs a reading device to be used in the home.

Although uncommon and more expensive than the rapid antigen test, the NAAT test is a molecular test of the same type as the PCR test. Some experts believe that the home NAAT test devices can be as accurate as the laboratory PCR tests. Others believe that they are not as sensitive to detecting the virus.

A quick word on antibody tests that detect antibodies against the virus, which we don’t hear much about anymore. As the CDC states, they should not be used to diagnose a current infection, but may indicate if you’ve had a past infection.

Antibody tests help scientists learn about how human immune systems defend against the virus. Putting the whole testing story all together, there are two primary tests to know about, and the right test at the right time depends on the goal.

The PCR test is the most sensitive to make sure someone has COVID. A PCR test will even detect the virus before a person is infectious, which is a benefit to know early. Since the PCR test is so sensitive, it detects fragments of the virus after a person is no longer infectious, so we must keep this in mind as we plan activities. People who have symptoms should be tested. The rapid antigen test is the best to use in the moment just before an event or travel to know if you’ve become infected by the virus and more importantly, that you may infect others.

If one is exposed, it’s reasonable to consider testing. And given Omicron’s shorter incubation period, many experts now recommend taking a rapid test two to four days after a potential exposure.

The CDC recommendations on their website regarding self-testing underscore the possibility and importance of a false negative test. Quotes, a negative self-test result means that the test did not detect the virus and that you may not have an infection, but it does not rule out infection.

Repeating the test within a few days with at least 24 hours between tests will increase the confidence that you’re not infected. Quotes, the CDC website provides overview information including infographics that can be downloaded and followed as guides for capturing samples and for decision support.

Quarantine, how does testing impact it? An isolation, how does testing impact it? The antigen test is the test of choice to use when guiding decisions regarding quarantine and isolation because it helps determine if one might be contagious.

Quarantine keeps someone who was in close contact with someone who has COVID-19 away from others. You must quarantine if you’ve been in close contact with someone who has COVID-19 unless you’ve been fully vaccinated and boosted.

Isolation keeps someone who is sick or who has tested positive for COVID-19 without symptoms away from others, even in their own home.

People who are in isolation should stay home and stay in a specific sick room or area and use a separate bathroom if available. Please see our detailed videos that describe how to practice quarantine and practice isolation in your home.

This is especially important if you have family members at higher risk for COVID-19. On December 27th, the Centers for Disease Control announced updates and shortened the recommended isolation and quarantine periods for the general population.

It shortened both the isolation time for people who have had a positive test result and the quarantine time for those who have had exposure to someone who is infected with a virus or what is called a close contact.

The CDC announcement states “given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation from 10 days for people with COVID-19 to 5 days if asymptomatic, followed by 5 days of wearing a mask when around others.”

The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness. Generally in the 1-2 days prior to the onset of symptoms and the 2-3 days after.

Therefore, people who test positive should isolate for 5 days and if asymptomatic at that time, they may leave isolation if they can continue to wear a mask for 5 days to minimize the risk of infecting others.

The CDC further stated that if you have a fever, continue to stay at home until your fever resolves for 24 hours. Additionally, CDC is updating the recommended quarantine period for those exposed to COVID-19.

For those who are unvaccinated or are more than 6 months out from their second mRNA dose or more than 2 months out after the J&J vaccine and not yet boosted, CDC now recommends quarantine for 5 days, followed by strict mask use for an additional 5 days.

Alternatively, if a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure.

Individuals who have received their booster shot do not need to quarantine following an exposure, but should wear a mask for 10 days after the exposure. For all those exposed, best practice would include a test for the SARS-CoV-2 at day 5 after exposure.

If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19.

As mentioned earlier, the CDC has stated that transmission of the virus is likely to occur in the day or two before symptoms appear and the two or three days thereafter as it’s justification for shortening the isolation period.

Scientists and public health leaders voiced concerns that people may be infected longer. As a result, the CDC updated its guidelines to note that people who wanted a test could take a rapid antigen test, “towards the end” of the 5-day isolation period, but the CDC stopped short of formally recommending it.

The CDC references to testing have been made whether someone is COVID positive with symptoms or without symptoms. Many academic and public health leaders have strongly encouraged using the rapid antigen test to help inform whether someone is infectious.

This is the summary graphic from our deep dive video on quarantine and isolation. You can see where testing may be used to assess infectiousness.

Many believe a positive test is likely to be true. However, leaders like Dr. Osterholm of the University of Minnesota believe the key issue is the false negative test.  He cites the CDC reporting on a study that actually found among people who were truly positive but asymptomatic about two-thirds had false negative results on the rapid test.

In his podcast entitled Smart Testing in the Omicron Surge, he described that only about half the time the PCR and rapid antigen test agree.  He also cites that the FDA provided a high-level statement that rapid antigen tests may be less sensitive for Omicron. However, we just don’t know how much.

This again proves how messy the science is and that we can’t have binary thinking and think that a test is either 100% positive or negative.

A key question challenging employers are a test to stay at work options. We won’t cover schools in this film as those scenarios differ in many ways from the challenges of employers.

There are a number of topics employers must consider as they evolve their policies for return to work, return to work after travel, stay at work, and hybrid combinations of working from home and coming into work on certain days.

Employers must develop guidelines that include recommendations of behavior that may not be required and the rules that must be followed as requirements of employment.

Employers must decide how they’re going to handle the unvaccinated, those that are not “up to date” with boosters now that we know that’s critically important to infectiousness and their own safety, those with medical exemptions, and those with religious exemptions from the vaccine.

If employers require testing of any type, they must consider the pros and cons of their testing options. They must consider rapid antigen home test results that are self-attested by the employee that require the most trust.

They may consider rapid antigen home test results proctored by a licensed caregiver via telemedicine viewing who will attest to the test being taken by the employee.

They may consider proctored sampling via telemedicine viewing where the proctor will attest to the sampling being done by the employee for a PCR lab test that will be sent in for processing.

They may consider on-site proctored rapid antigen testing, on-site NAAT testing, or on-site sampling and laboratory PCR testing.

As employers consider implementing a testing program, we recommend they understand what we learned from our 1000 worker household study. That the Achilles heel of our workforce are family transmission chains that start in their own communities. If we break those transmission chains, we can save the worker and their family or their housemates.

Prior to COVID, 6% of employees have health conditions that generate 80% of the cost, and 1 in 6 employees are a caregiver of someone else spending 15 hours a week providing care. 70% of those people say that such caregiving is degrading their work performance. Our best employers’ corporate values are in sync with their employees’ greatest core value, that of their family’s health.

Great employers focus on helping the workers’ families. In doing so, they yield enormous business benefits of cost reduction and a great increase in their rewards and success.

Employers need to understand the value of testing, that rapid antigen tests are not absolute, that singular tests are merely a snapshot at a certain point in time.

Dr. Michael Osterholm of the University of Minnesota likens the singular tests to return to work as having a smoke detector in your new home that only works on the day you buy it.

There are a number of issues that employers need to keep in mind. Dr. Osterholm brings up four issues. The test performance accuracy discussed earlier for decision making, the value of the one-time test, availability of testing, and the delay of test results.

Serial rapid antigen tests separated by a day or two increase the accuracy of identifying infectiousness in people without symptoms according to the CDC.  They should be performed following the manufacturer’s recommendations. They will bring greater value to safety in the work environment and PCR tests can be used as a tiebreaker.

The unavailability of testing during surges is a problem, whether it’s the availability of home tests at retail outlets, or whether it’s scheduling appointments for provider or telemedicine proctor tests.

It’s hard to develop a process for organizations to maintain continuity. Therefore, employers need to get ahead of this issue with good solutions that evolve with the science.

The delay of receiving PCR laboratory results can occur with surges. This allows a highly transmissible virus to infect someone between the time the samples were taken for the test and when they receive the result.  Real test negative people can get infected while they’re waiting. Test positive people can infect others while they’re waiting for their results. The value of the PCR tests drop precipitously with the delay in receiving the results.

So what can be employer recommendations for workers and their families? The COVID safe practices are a great start. Social distance, proper and effective masking, hand hygiene, and disinfection of high contact surfaces.  Given the high aerosol risk of transmission, recommendations of avoiding indoor exposure and poorly ventilated spaces are critical.

We now know so much more about fighting the virus in 2022.  We know aerosol spread is the main way it infects us, that viral particles can project much further than six feet, and that distance and ventilation are vital safety factors.

There is much employers can do to employ testing, not only to bring workers back to work, but to keep them there safely. Our pitch to all employers is to engage and support the family household.  Learn from what we’ve found studying essential critical workers. Employees are very mobile and spend more time with their families than on the job. We now know where they get infected.  If you educate the family household to break transmission chains, you can turn the science into safety. And when you save the family, you save the worker.

Dr. Charles Denham:  That’s a lot of information and we’ve blasted through it because we’ve decided to separate these programs into shorter, shorter pieces that then can be discussed.

I’d like to turn the microphone to Chief Bill Adcox. Chief, you are really a pathfinder and I believe a leading threat safety scientist, helping us with the understanding of all the threats, not just COVID but across the board.

You’re also a big employer and you’re also responsible for tens of thousands of researchers, students and caregivers at Texas Medical Center.  Your thoughts on testing and maybe reaction to this, this information.

Chief Bill Adcox:  Thank you very much, Dr. Denham and thank everybody for being on today. Very good information. I think testing is very critical. It’s another tool in our toolkit for safety and taking care of ourselves and our families.

I’d like to just, you know, sort of go into this area of being prepared and being cautious. Make sure in advance that not only do you understand the different tests but that you understand where to obtain them from, reputable place to obtain them, reputable testing manufacturer.

Same thing goes for your PCR testing. If you’re going to go out and have it done professionally, make sure that it’s a, it’s a licensed and reputable place. You understand how to set up the appointment, what it’s going to take, how you will get your results. Be very prepared. Get these things done in advance and be ready so that you can do the things you need to do and get done.

In terms of fraud, the worst thing you’ll get is a falsified test. That’s not the worst thing you’ll do. You’ll get a falsified test that can, that expose you and your family to some severe health issues, obviously with COVID.

You could also have your identity stolen. And if you go to the wrong places or you do the wrong things. So just be really careful and make sure that these are reputable places and that you know what you’re doing.

And go back and look at the materials. Make sure that you’ve got your checklist and you’re just getting prepared. Stay prepared and be ready. That’s the best I can say. But again, great information and, you know, couldn’t ask for anything more. Thank you very much.

Dr. Charles Denham:  Randy, you are doing a lot of great work at the University of California Irvine. And you want to kind of frame in because we do have the time, your scope of your work, and then how you’ve implemented testing at the University of California Irvine.

Randy Styner:  Thanks Chuck. Thanks for being a lot of great information. You know, we’ve been doing, you know, both a sub-bag testing at UCI for well over a year now. I mean, you know, back in the towards the end of 2020 we started our onsite testing programs for, you know, students that were still, you know, remaining on site.

Of course, we were closed down, you know, and remote, but, you know, for a very long time. But the, you know, many students and some staff were still on campus. So, we had testing sites set up for everybody who was there and any students that were on campus have always been doing, you know, weekly testing.

You know, we have a requirement for that. And since we’ve had a return to campus, you know, those requirements are still in place. All students on campus are required to get tested on a weekly basis. And, you know, we’re doing the PRC testing, or I’m sorry, PCR testing.

It’s been our primary testing capability on campus. So, it’s been, you know, pretty accurate and you’ve managed to really, you know, identify cases on campus very quickly, move them into quarantine locations. Of course, we’re taking, you know, all the preventative steps that we can including masking requirements and, you know, still we’re distancing in classrooms and, you know, all those, those tools that we’ve been talking about over over the last very several seminars.

We are going to be moving to antigen testing as well for part of our return to work for staff that, you know, come down with COVID. Of course, we do have, you know, they’re required to stay home and isolate for a period of time after their diagnosis.

And we do have actually a random testing for staff and faculty as well that if, you know, you get called in, they’re required to take a test.

And, you know, a few weeks ago we did launch a program where we received multiple tests for the university went out and purchased the home testing kits and we passed out almost 50,000 home testing to our staff and faculty and students on campus and that’s so we’ve been really active and encouraging testing you know through people who whether they come to campus and get tested or they go to local testing sites near their homes.

But that’s been just a keystone of everything we’ve been doing at UCI.

Dr. Charles Denham:  Fantastic. We’re going to cover now family gatherings and address that. I thought it would be interesting to hear your reaction of what we’re doing and what we recommend it for the four organizations before we cover the gatherings.

MedTac Film narrated by Dr. Denham:  Can testing make family gatherings safer?  You know it’s critical to focus on the word safer and not safe. We have to use our common sense. We need to understand the relationship between threats, vulnerabilities and risks.

For given threats, our vulnerability actually determines our risk. So, when we consider going to a gathering or meeting, we need to assess the threats intrinsic to the group in the setting or the inside threats.

And we have to consider the outside threats, the community immunity and the background infection rate at the time of the meeting. The inside threats relate to whether everyone is “up to date” on their vaccinations.

Has everyone who are eligible for the boosters been boosted? You know the waning immunity of those who have not been boosted puts them at risk for breakthrough infections. And more importantly, they may be a threat to infect others at the gathering.

Next, consider those who are at risk due to age, immunocompromised conditions or children who are not yet eligible for vaccination. Are there any other unique vulnerabilities of the group who are being gathered?

The outside threats include the level of community immunity, the community infection rate in the city where the gathering is occurring, and any unique threats on site such as poor ventilation or close quarters.

Your strategy should be to reduce vulnerabilities to be safer. You will never be 100% safe. However, you can make any gathering much safer by very simple practices and by paying attention to the details.

Finally, consider rapid antigen testing of everyone just before the event to reduce the likelihood of spread. Design the seeding to reduce risk. Separate the unvaccinated or those who are not up to date on their boosters and travelers from high risk areas from the attendees who are at great risk.

Pick the best ventilated venue. Maintain the safe practices of social distance, use of high quality masks, hand washing and disinfection of high contact surfaces.

Now that we know that aerosol transmission is enormous, what we tell our young people is don’t dare share air. We’ve developed our Family Lifeguard Checklist to make family gathering safer using this strategy and we have deployed it to tens of thousands of families.

Rapid testing should be considered as just one defense mechanism and not a guarantee of safety. The data is evolving and the false negative test result is the riskiest factor to consider.

The more virus you have, the more likely you are to have a positive test. A negative test does not mean a person is in the clear, just that they are less likely to be infectious.

Given how mobile our society is, the test to travel question is very important. Here we rely on our threats, vulnerabilities and risk model and apply the model to the travel loop of a typical business traveler.

From when you leave your home and use a ride sharing service to when you’re in the airport, to boarding the plane, to enroute travel, to deplaning back through the airport and through the car trip to your destination.

Finally, the on-site threats, your vulnerabilities and the risks of the gathering or meeting location and the population of the participants in the meeting or gathering.

We should consider the return leg in the same way. A step-by-step approach to assessing the threats, vulnerabilities and risks along a travel loop can help travelers prioritize their behaviors and know where testing can deliver the best value.

The inside threats and vulnerabilities are the vaccination status of the travelers, are they up to date with boosters, are there underlying medical conditions putting the travelers at risk, and are there any other unique vulnerabilities of the travelers?

The outside threats are threats along each leg of the trip, especially the community immunity and community infection rate along the travel route. The threats at the meeting, gathering or work site include whether the participants are tested immediately before the meeting, what is the vaccination status of the participant and are they up to date with boosters, whether the meeting is indoor, outdoor or has poor ventilation, and whether the participants will be maintaining the COVID-safe practices including distancing, mask use, hand hygiene and disinfection of high contact surfaces.

The airport public spaces, bathrooms and jetways are the most dangerous segments of the travel path due to the population density, mixing of air and poor ventilation.

Once airplane engines are running and air is being forced through HEPA filters, you’re much safer. We should never take our masks off enroute unless we have to. Then during car travel to your meeting or gathering, repeat the safe practices. Testing before a meeting or gathering is critical as you’ll hear in a moment. Just before re-entering your home on the return trip, consider using rapid antigen testing before closely interacting with your family or housemates.

If a traveler becomes symptomatic, it’s wise to talk to their personal physician and decide whether a PCR test might be the best choice of testing in light of the risk of false negative results with the rapid antigen test.

For this short segment, we’ll highlight some of the safe practices we’ve learned. Please watch our videos addressing the best practices in science behind safety in planes, trains and automobiles for more detail.

Consider rapid antigen or PCR tests before departure and follow the requirements of the airlines and destination, state or country. Minimize your aerosol risk whether you’re being given a ride or using a rideshare vendor. Masks and airflow are critical. See our video addressing masks, filter, fit and finish to optimize their use.

The airport spaces, bathrooms and jetways are the most dangerous segments of an air travel path due to the population density, mixing of air and poor ventilation.

Once airplane engines are running and the air is being forced through HEPA filters, you’re safer. Remember, never take your mask off en route unless you have to. Repeat the safe practices traveling by car en route to your meeting. Testing before a meeting or gathering is critical as you will hear in a moment.

The testing requirements for domestic U.S. travel and international travel will likely continue to evolve. We almost pay close attention to what is required and the latest updates as the science evolves.

At the time of this broadcast, the public health and testing experts recommend rapid antigen testing as soon before the departure on a trip as possible or a PCR test with fast results that make them meaningful.

A delay in getting the results increases the risk that you were infected between the time of sampling and the results. Dr. Michael Mena, a former Harvard epidemiologist who is now the chief science officer for E-MED, a company that distributes home tests, advises tightly coupling the rapid antigen testing 15 minutes before an event or traveling.

Two tests serially over two days can be more accurate. Well, if we look at all sectors of society, there is one population which is clearly the highest risk for spreading the virus, and those are people who are known to be infected.

In his words from a New York Times article “a test will not protect you from getting infected. A test will protect you from infecting other people.”  If there’s one takeaway from a test to travel safer approach, it is that testing is only one layer of protection that must be used with the other COVID safe practices.

It must be mapped to the threats, vulnerabilities, and risks of every segment of a trip. The ultimate goal is to keep from bringing the virus home to our families and housemates.

One final word on threats. There are people and organizations running fraudulent COVID test sites, some generating false test reports, and some who are defrauding our seniors.

The U.S. Department of Health and Human Services Office of the Inspector General is alerting the public about fraud schemes related to COVID and COVID testing. Fraudsters are offering COVID-19 tests, HHS grants, and Medicare prescription cards in exchange for personal details, including Medicare information.

These scammers use the coronavirus pandemic to benefit themselves and beneficiaries face potential harm. The personal information collected can be used to fraudulently bill federal health care programs and commit medical identity theft.

These fraudsters are also preying on those with private health care insurance. Please listen to the following message from the Department of Health and Human Services. The coronavirus pandemic is a time for Americans to pull together to help each other, but it is not a time to let our guard down.

I’m Chris Schrank, Assistant Inspector General for Investigations at HHS, and here are five things to know about COVID-19 fraud. First, scammers are active right now. They are preying on the public spheres by offering COVID-19 tests or cures in exchange for personal details.

However, the services are unapproved and illegitimate. Fraudsters are using phone calls, text messages, social media platforms, and door-to-door visits to steal your information.

Second, the personal information that scammers collect can cause harm. Scammers may fraudulently bill federal health care programs or commit medical identity theft.

If Medicare or Medicaid denies the claim for an unapproved test, you could be responsible for the cost. Third, COVID-19 fraud is rapidly evolving. Be cautious of unsolicited requests for personal information, such as Medicare or Medicaid numbers.  Be suspicious of any unexpected calls, text messages, or visitors offering COVID-19 tests or supplies. Do not respond to or open hyperlinks in text messages about COVID-19 from unknown individuals.

Ignore offers or advertisements for COVID-19 testing or treatments appearing on social media sites. Fourth, talk to your doctor. A physician or other trusted health care provider should be the one to assess your condition and approve any requests for COVID-19 testing or treatments.

Fifth, if you suspect COVID-19 fraud, take action. If you think you or a loved one have been the victim of COVID-19 testing fraud, report it immediately online at oig.hhs.gov or call 1-800-HHS-TI-PS. That’s 1-800-447-8477.

Produced by the U.S. Department of Health and Human Services at taxpayer expense.

The Swiss cheese model of accident causation we use to describe how accidents happen in healthcare, aviation, and nuclear power can be used to describe how COVID testing is just one of the imperfect layers of defense we must use with the other layers to prevent harm, disability, and death.

The CDC is doing its best to provide us with what we need to do. Our team will continue to do our best to provide you the how, the how to turn science into safety.

We are working with human resources and corporate leaders to help integrate testing into their systems to navigate their way to the new normal. Used properly, testing is just one of the important layers of defense that we need to put in place to protect our loved ones and employees.

The care of our communities is absolutely critical. Thank you for all you’re doing to protect those at risk and those who are most vulnerable.

Dr. Charles Denham:  So, that covers our video segments.

I’d like to come back to you, Bill, now. We’ve looked a little bit more deeply into the travel issue and then the fraud issue. Bill, your thoughts, you have a lot of officers that are moving in and out of close quarters and then frequently have to put people in their vehicles and that kind of thing.

How has testing been helpful to you all? I know at MD Anderson you’ve got a pretty rigorous program. MD Anderson is very, very concerned obviously from the types of patients we have in the new compromised population. So we have extreme measures in place to include very strong and testing program.

Chief Bill Adcox:  We have protocols that are in place and if you’re exposed, we get you tested. We have ways to reassign you, put you in a different area, things like that that goes on. One of the things, for example, that we are transporting people is ventilation is critical. Like you said, it’s about the doses or how much of a virus load you’ll take.

For example, you’ll crack one of the front windows and then the opposite back window. So, you’ll keep that the air ventilating in the cars. I’d recommend that people do that themselves, even when they’re traveling from place to place with family members or you pick up your children’s friends or you take them somewhere, always keep the ventilation, keep the load down if at all possible.

But that’s what we do. We have a lot of testing. We will test our personnel if we feel like they’ve come into contact with anybody. All of our personnel when they’re in the outside of the hospital, we’ve issued a mask, N95 mask, they’ve all been fit tested. They understand how to utilize those.

In the hospital, depending on where they’re at, they’ll use the surgical masks that are issued. Everybody’s checked coming in. So pretty robust program. So, we have space and distancing, reinforced.  We make sure we have our meetings are either in large conference rooms very far apart, or we try to do the meetings outside. Luckily, the weather for the most part allows that.  Again, whatever the cost is that we have that are in place, we’re going to put them there and put them to use.

Fantastic. That’s great. We’ll be coming back to you on the fraud issue. Randy, your thoughts on, you know, we covered a couple of topics.  One is the family gatherings and I know you’re a scout leader and trying to manage young people getting together and using outdoor venues, but also some pretty good COVID procedures that relate to traveling because, you know, we’re trying to kind of keep that aerosol risk down.

Randy Styner:  Well, part of, you know, what we were dealing with from the get go, you know, when the COVID crisis first hit in March of 2020.

And, you know, we shut down the campus and, you know, one of the biggest issues that we had to deal with was suspension of research on campus because there is camp research that’s going on that is critical, you know, that it can’t just be stopped and, you know, research labs have to continue to operate even if it’s a limited capacity, but that, you know, in terms of the travel piece of a lot of this research is happening all across the world where we have researchers who are based at UCI who need to, you know, in one instance we had a researcher who had to go up to Alaska to check monitors to physically check air monitors from our air research project that she was working on.

And there’s other, you know, instances of that of researchers having to travel for the sake of the research to deal with actual research studies. You know, so we had a team together, you know, we do have a global engagement office at UCI that really deals with, you know, international travel largely but also research-related travel and the university put together a team that I was part of as the emergency manager to assess these travel requests.

So, you know, we’re still getting a lot of requests for travel from students who wanted to study abroad, you know, which is a big part of the college experience but that we really had to kind of put the brakes on and say, you know, that’s it’s just not safe.  And every one of those travel requests that we received from in the office, which were required so that the researchers as travelers could be covered under the university’s insurance policies and the one where they were traveling.

We did, you know, multiple reviews of those a whole team, including our risk management, our global engagement folks, you know, professors from from, you know, representatives from our research community where we would do an assessment of all these travel requests and and review them to make sure that the travel was really essential.

But with that travel to get really more to the point is what did we do to make sure that people were protected. And we would, you know, ensure that anybody leaving the, you know, the local area and coming back before they came back to to UCI they’d have to come back with negative tests which is pretty much part of our course so it was everywhere.

You know, all of our staff and faculty and students on campus are required to be vaccinated and we’re up around 99% compliance on that so which is just incredible.

So that vaccination status is really important piece of it. But you know, on the other end of we do have, you know, multiple people coming on to campus for various things we have contractors, you know, buildings that are being constructed we have perspective professors that want to do a tour of the campus.

And the labs and the like before they accept a position and we have to have safety guidelines in place for them which includes you know, quarantining when they come before they come to the campus making sure that they, you know, are tested and continue through with whatever testing if they’re going to be here for multiple weeks going through that weekly testing program.

So, we’re taking a lot of those precautions on an institutional point of view, but there’s, you know, we, we, there’s a lot of I was just in a meeting earlier today where we’re talking about the case rates on campus which are dropping and they’re dropping everywhere we’ve gone through that peak I mean it’s dramatic you look at the, and I’m sure you show that the cases. And it’s really easy to get complacent and say okay well we’re coming out of this once again and really dropping you know those basic protective measures that we’ve been talking about for all these months on this this program of just you know the masking and you know the distancing what do we do for scouts for example we’ve continued scout activities you’ve talked about this on past programs. You know how we did that and you know lots of meeting a lot outside but we’re still you know, if we go on outings making sure first of all that there’s one scout per vehicle.

And that’s really the mantra that we’ve been putting at here we had a period of time where we were able if we wanted to go back inside for our meetings, we had been meeting outside every week for our scout troop.

And you know the church that we met in, you know with the requirements when they started to loosen up. You know we had the opportunity to go meet inside we opted not to we said Well we’re doing okay we’re meeting outside are still productive.

We’re still you know doing everything when the when the boys are in there, their groups together they’re wearing masks and you know we’re trying to keep people, you know, to mind what they’re doing and stay separated that’s not always you know, these things to do and these groups.

But you know, just continuing to you know, put that message out there and to really pump that message that you know they we have these protective measures we know they work masking works; you know vaccinations work.

You know distancing works and not having you know separating people are not putting people together in cars at works and we just have to continue to drive those, you know those messages that we’ve been doing this whole time we figured all that out way early in this pandemic of what was effective in terms of protective measures and we just have to continue to drive that message home, no matter how loud people the opposition those messages we all see it, people are loud about it and rightly so people are frustrated people and get back to normal and you know get back to the lives before the pandemic whether that’s whatever happened or not it says really up in the air but you know we just have to continue to drive it that if we want to get out of this if we really want to get to the other side of this pandemic and get back to more of what was normal before it all started.

These measures are what’s going to get us there not ignoring these measures not saying you know it’s an offense to me to make me or impose these measures on me that my freedom to, to not participate in these measures is more important than, then, pushing the society, the global society towards the end of the pandemic by everybody, you know stopping spreading the disease that’s what is going to get us out of this so I guess that’s really the message is just continue pressing the message of what works and what we need to do to protect ourselves and to protect each other.

Dr. Charles Denham:  Well, fantastic. Great comments, Randy and I’m looking at our time and we are ahead of time and we will, since you’re on and you and Chief Adcox is on.

So, I’m going to show our latest adopt a cove Med Tac program to fulfill the full 90 minutes of continuing education credit because we have the time to do it. Was there anything that you would like to add to what we discussed.

Jennifer Dingman:  It was such great information I thankfully I’ve learned so much through these webinars and from you Dr. Denham and your colleagues in the past. Just wanted to tell you how grateful I am to you all for all of this great information. One thing I didn’t know though it was about the fraud going on with cove it testing. I understand there’s problems with fraud and medical identity theft, but I had no idea that it kind of slithered into this pandemic.

I just want to add that the misinformation is so tragic we’re almost we’re at 900,000 deaths almost in our country and it’s so preventable.  I was looking at a chart yesterday at other countries and vaccination rates and death rates, and there is definitely a correlation.  I just don’t know how to reach people and it just breaks my heart.

I guess we just need to just be steadfast and supportive and prayerful, and hopefully things will change soon and perhaps this pandemic will kind of, you know, go away for the, for the most part and it will become like the seasonal flu.  I am encouraged that all Omicron isn’t as bad as the others where I understand it’s a little bit milder, but we still have to really be vigilant and get those vaccines in arms and boosters.  I think in the United States, what I was seeing was only 27% of people are boosted which is just unbelievable.  So, I want to thank you all for doing these webinars and I just hope that they spread and more and more people listening get real good information from physicians and people in the health care and science.

And I’ll hand it back to you Dr. Denham, I’m anxious to hear the next video.

Dr. Charles Denham:  Thank you, Jennifer. And so, for those of you that are earning continuing education credits, we’re going to show you a program that does have a COVID feature to it, not testing, but the COVID feature of COVID safe delivery of bystander rescue care.

Med  Tac Film narrated by Dr. Denham.  The Med Tac adopt a Cove program evolved out of the Med Tac bystander care program, founded by a Cub Scout in his family with a gift from a co-founder of Med Tac. The program teaches the public critical emergency bystander care skills to help save lives for the eight leading causes of death in those vital minutes before professional first responders arrive.

A lifeguard surf program led by Charlie Denham, a Med Tac founder and Preston had a former Laguna Beach lifeguard and UCLA water polo star, is expanding from Orange County to as far away as the Hawaiian Islands.

Through ocean rescue experts who will train schools, scouts, faith-based organizations, and the public. Our gifts of tourniquets and trauma care supplies, CPR, Bluetooth enabled simulators, and self-contained packaged stop the bleed kits that anyone can assemble have been very well received in California and Hawaii.

Recent near-death experiences from major bleeding events, such as the one at Emerald Bay and Laguna Beach, led the Med Tac team to provide two tourniquets for every lifeguard tower at beaches in Laguna and Waikiki.

Through our collaboration with the lifeguards, professional first responders who have to deal with beach terrain and emergency medicine physicians who have to serve along our coastlines, we found that the response to care times to beaches can be much longer than the average urban response time of 10 minutes.

We know that survival drops 10% for every minute without CPR and the use of AED for out-of-hospital sudden cardiac arrests, of which we will have a thousand every single day in the United States.

The goal of our Adopt-A-Cove program is to get life-saving automated external defibrillators and bleeding control supplies placed at each beach so that there is less than three minutes from drop to shock for sudden cardiac arrest and less than three minutes to stop bleeding from any traumatic cause at the beach.

Individual donors have stepped up to pay for a care pack with an AED and trauma stopped the bleed kids, where all weather care cases placed at lifeguard towers or at the most visible locations at the beaches.

The individuals and families that have donated the funds for the care packs and care cases for local beaches have led the way to inspire businesses to do the same.

Local businesses such as Killer Dana’s Surf Shop are helping raise funds for a Cove such as with the Start a Wave Save a Life T-shirt sales initiative, and they are sponsoring free Med Tac training programs specifically for our avid surfers and boogie boarders and skateboarders who are at risk for very specific injuries and for those who work and play at our great beaches.

The Eagle Squadron is a group of Eagle Scout candidates who are earning their Eagle Scout rank, the highest rank a scout can attain by placing Med Tac rescue stations at beaches, schools, and parks.

The entire group works together as a team to help each scout develop the most ideal rescue station that will save the most lives at its location. They are advised by a world-class group of critical care and emergency medicine physicians, biomedical engineers, threat safety experts, first responder and emergency response leaders, EMTs, nurses, lifeguards and ocean rescue experts, film and performance art students, and scout leaders.

Our team of life scouts and student leaders with the support of our medical expert advisors have placed and are placing rescue stations and rescue gear at schools, churches, scout camps on Catalina Island, and at our great beaches and coves.

Some are fixed units and many are mobile configurations on bicycles, golf carts, and security vehicles. The team is continuously surveying our beaches and coastline from San Inofri to Newport Beach, including each of the harbors, to identify the best locations for rescue stations to save lives.

Harbors are important locations in light of the density of the population, the added risk of watercraft and water sports, the inaccessibility of victims by EMS, and because mobile phone GPS location will not help EMS dispatchers, direct professional first responders, the way a land-based dedicated 911 phone line will to a direct address.

Using rangefinders, satellite maps, and by calculating the walking speeds of the general public, the team identifies the best sites that will ensure three minutes from drop to shock for sudden cardiac arrest and three minutes to stop severe bleeding through bystander rescue care.

Our student leaders work directly with the professional first responders and community leaders to pick the location and signage to allow the general public to have access to the bystander rescue gear.

All sites and rescue gear are approved by the lifeguards and professional first responders that serve the locations. Rescue gear, placement, signage, a website, and a briefing video are all produced by the Eagle Scout candidate through their project.

All Eagle candidates must be certified in CPR and AED use at the same level that doctors and nurses do to maintain their licenses. Our scouts must also be certified by the American College of Surgeons, stop the bleed program for severe bleeding control, and the scouts assist in our community training programs.

They serve as assistant instructors in our community training of the public and are trained the trainer programs where we certify law enforcement officers, firefighters, EMTs, and lifeguards. This allows us to keep expanding our program across communities.

One, two, three, META! We are looking forward to other scouts building rescue stations for beaches near them for the Eagle Scout project.

Every rescue station is unique. Our young leaders work with the local lifeguards, EMS, first responders, and the community to synchronize the rescue gear with what they already use and need.

The rescue stations provide an opportunity to teach the community about bystander rescue care, including how to make the best 911 call, the latest updates on cardiopulmonary resuscitation, CPR, and stop the bleed skills, how to care for severe bleeding including the use of tourniquets, pressure, and wound packing.

In 2022, our METAC youth leaders who are competitive surfers and our instructors began teaching bystander rescue care to competitors and spectators at Southern California surf meets.

Surf coaches, high school students, and their parents and siblings are learning rescue skills between heats. High school students and scouts are earning service hours as they contribute to their communities.

Our student-led Surf Safe Surf Great podcast and live webinars will be tackling water safety from the home pool to the beach and back again, emphasizing drowning prevention in children and rescue care of beachgoers.

Drowning is a leading cause of death and many families have missed swimming lessons during the COVID crisis. Finally, we are expanding our efforts to help teach our youth about total cove care, how to protect and prevent harm to our sea creatures as we enjoy being guests in the bays and in the coves that are their homes.

The oil spill off our California coastline has allowed us to help engage students, teams, and schools in not only focusing on failure to rescue of humans, but also to prioritize failure to rescue the very fragile ecosystems of our bays, coves, and harbors.

Our ocean rescue, Rescue Our Ocean message, depicted on our latest fundraising t-shirt, captures the essence of our expansion to address the total cove care concept, battling failure to rescue of the entire ecosystem of beachgoers and marine life.

Three lives have already been saved through our core team, who we honor with our Soaring Eagle Award. They and the wonderful community leaders who have supported our cause will be featured in the global broadcast documentary, Three Minutes and Counting by Standards Care.

This is a third broadcast film following Chasing Zero, winning the war on healthcare harm, and surfing the healthcare tsunami, both distributed globally on the Discovery Channel.

We want to thank the families and businesses who have joined our cause. Your gifts will save even more lives. Our donors’ tax-deductible donations purchase supplies for multiple stop-the-bleed kits, the best AEDs with a serviceable life of eight years, COVID-safe rescue gear, and a waterproof care case.

Please contact us for more information. We’re happy to arrange a visit to one of our rescue station sites or undertake a Zoom meeting.

Dr. Charles Denham:  So, we had enough time to be able to cover the program. Randy, your comments on your as an emergency professional, we know that everybody is afraid of taking care of somebody else.  We know that 27% women are 27% less likely to get AED and CPR care because people are afraid of touching their chests. So COVID has added a new layer of fear, but we really can save people and we can be good Samaritans in the COVID.  Isn’t that correct?

Randy Styner:  Oh, absolutely. You know, that’s one of the things that I’ve always taught in my CPR courses as an instructor. You know, we focus almost a large chunk of those classes on that overcoming the barriers to care.  And that’s such a big part of that is, you know, understanding, you know, what to do, how to go into that situation in the first place, you know, overcoming that hesitancy while remaining safe.

You know, there’s so many stories of, you know, tragedy because people ran into situations too quickly without doing a proper assessment of the scene. You know, training people to understand that, you know, there’s a safe way to go into things. You’re obviously protecting yourself, but overcoming that barrier and really talking about that clock that’s ticking that, you know, that three minutes that you, you know, every second that you wait to start those chest compressions and then you could get that AAD on somebody is a second they are closer to dying and, you know, overcoming those boundaries are so important so part of that training, you know, that’s a big part of the training is that psychological part training people to say you know not only can you go through these barriers,

Dr. Charles Denham:  You’ve participated in training with us where we mask up we’re either outside or a well ventilated area.  We really think we can keep the training going safely don’t you and I also believe we’re doing lifesaving and swimming merit badges for young people with family members with the family, you know we have 2 million people going in the Southern California waters here and in swimming lessons have stopped we know our leading cause of death in our children are drowning, drowning at home in the pool and drowning at the beach but don’t you believe that with proper COVID safe practices that we can help protect our kids.

Randy Styner:  Oh, absolutely. And I think it’s necessary. I think it’s, you know, we have to continue to train, some cardiac arrest and bleeding, you know, life’s life threatening bleeding has continued to happen.  I don’t think that the numbers in terms of how many people have had heart attacks has gone down because of COVID you know still continue to have cardiac arrest. Yeah, people are still going to have cardiac arrest.

Dr. Charles Denham:  1000 a day.

Randy Styner:  Yeah, so it’s, you know, it’s critical. It’s not just, you know, that we can, but it’s critical that we find ways to do it. And you know, through the trainings, you know, I’ve continued to provide trainings, you know, through the COVID crisis with, you know, CPR trainings and stop the bleeding and you know it’s just those same protective measures that we’ve been talking about the whole time you know the being able to you know it’s no different in a code environment that it is you know and biological, you know contamination or something like that how do you protect yourself from getting hepatitis when you’re working on somebody or how do you stop you know contact with blood or other bodily fluids it’s the same process that the protective measures that we take for those are the same ones where we can take for COVID

Dr. Charles Denham:  Pre pre-covid universal precautions.

Randy Styner:  Absolutely, absolutely. I got to emphasize it’s not just that we can it’s we have to, we have to continue to train people in these life saving techniques because those, those issues are still out their people’s lives are still online, and this bike standard care, you know, concept that this program is based around is so important the more people who learn these techniques, the safer this world is going to be so we have to continue to do it we have to do it in a COVID environment, but we can, and we’ve proven that we can.

Dr. Charles Denham:  Well thank you and we really appreciate your passion. Bill, your comments about Med Tac, and I want everybody to know there would not be a Med Tac if it hadn’t been for Bill Adcox.  He put me in touch with a guy named Michael Dorn, who had done more active shooter studies than anybody in the world. And it was due to Michael showing us the eight leading causes of death in schools that resulted in Med Tac. Bill, we just will always be thankful to you for your initiative and focus and then your stead-fast support of this program.

Any other thoughts about Med Tac before we give Jennifer the chance to close.

Chief Bill Adcox:  I know I believe that the eight leading causes of death, preventable deaths are very critical to any, any of us. And even though we’re in the COVID pandemic has going on, you know you need to guide yourself by what is right.

What would you do what would you want to do if it’s one of your family members. If it’s your child or your parent. So, we have to do what’s right. So, what we can do is be knowledgeable enough through these training programs to know what precautions to take, and how to go ahead and treat somebody, and then how to summons to help this necessary.

So, Med Tac, the principles are critical. We all should really adhere to those so thank you for very much for continue to bring that up and put it on the forefront.

And I want to thank everybody that’s participated today and all of our audience.

Dr. Charles Denham:  Well, thanks for everything. Jeni, we’re going to let you close and we’re right on the button for our time so that 90-minute continuing education credits will be right on the button for 90 minutes. Jennifer will give you the chance to close.

Jennifer Dingman:  Thank you, Dr. Denham it was a great webinar today, I learned a lot. As I always do. Thank you for everything that you’re doing and I want to thank all of the participants who have come and those who are going to listen later please share all of the information here with your colleagues’ families and friends.

And let’s all work together in unity to try to get rid of this virus and get it under control. I just want to thank everybody again and God bless, and we’ll see you next month.

Dr. Charles Denham:  Very good. Thank you to everyone and to Kyle Kemp for operating our system.  We will see you – those of you that are with us on our patient safety program will see you in two weeks and those of you that are with this program will see you in a month.