Speakers and Reactors:

Dr. Charles Denham – Moderator
Dr. Greg Botz
Chief Bill Adcox
Dr. Brittany Barto Owens
Dr. Christopher (Toff) Peabody
Charlie Denham
David Beshk
Heather Foster
Randy Styner
Jennifer Dingman


Dr. Charles Denham:  I’m Dr. Charles Denham and I am chairman of TMIT global and founder of the Med Tac Bystander Rescue Care Program, TMIT global and this initiative of the coronavirus community of practice. We’re now at August 4, 2022. We’re heading our way through the summer and heading into fall. And we’ve got some real challenges because we’ve got a surge as you can see on the slide and those of you that are joining us with from on a podcast, you’ll be aware of the fact that we’ve got a surge with the BA five virus.

If we look at the – and we highly recommend the Hopkins maps and the heat maps as well as the graphs that show what’s going on. We see a real surge going on. I live in Southern California.  And we have our office in Austin, Texas. Also seeing a surge and we have a real challenge there. If we look at the deaths, we see that our deaths have remained pretty high, although the attention of the press has been pretty minimal. We definitely are seeing that. So today, our topics are the family lifeguard, and our intention is really to update a lot of the information that we’ve delivered over the last nearly 30 months of this coronavirus community of practice.

We’re going to address the layers of protection as a reminder and then update where these layers really fit misinformation and disinformation and why it’s so critical that we really pay attention to the trusted sources of information, waning immunity and vigilance regarding this new virus, this Omicron sub lineage, BA five and probably more to come, reinfections and long coven, which is a significant risk for people that are getting infected and reinfected and preventable holiday risks, which are critical. We have a number of wonderful speakers today, hailing from medicine emergency preparedness, our ends, MDs, law enforcement and great educators to update some of the information that we’ve covered today.

We always want to start with the message from the patient and the voice of the patient and we have Jennifer Dingman sharing that today for us. Jennifer is the founder of Pulse, an organization focused on medical error. She’s worked very closely with us for many years. She’s a winner of the Pete Conrad Global Patient Safety Award. We meet almost every other Saturday with a small group who had a huge impact on US health care by starting a grassroots approach to tackle medical error and what are called the hospital acquired conditions. And so, we’re really delighted to have Jenny share opening thoughts with us today.

Jeni, thank you so much for your steadfast support of our program. You have been with us since March of 2020. I can’t believe how long we’ve been doing this. I want to ask you to be the voice of the patient and the voice of the family today. Can you set our course?

Jennifer Dingman:  Thank you so much, Dr. Denham. It’s a pleasure to be here. COVID is something that we have to all learn how to live with and this is such a perfect topic for today being the family lifeguard. Here we are in the middle of summer and we’re still fighting COVID in the middle of something that should be a really wonderful summer. It still can be if we just listen and do everything that we can to take care of our families through this COVID. I am so thankful for everybody that’s here today and I encourage you to please share the program with your colleagues, friends, and neighbors. Excited to hear everything that we’re going to hear today so we’ll hand it back to you, Dr. Denham.

Dr. Charles Denham:  Thank you, Jeni.

So, our purpose, mission, and values are critical to us and for those of you that are new to us and those on the podcast. Our purpose is that we will measure our success by how we protect and enrich the lives of families, patients, and caregivers. Our mission is to accelerate performance solutions that save lives, save money, and create value in the communities we serve. We take our values very seriously. They spell I care, integrity, compassion, accountability, reliability, and entrepreneurship. We learn the critical nature of core values by one of our wonderful partners, co-founder of JetBlue, Ann Rhodes, who taught us the specificity and importance of the behaviors tied to values. Not that we live them every day but we aspire to do so.

None of our speakers today have any relationship with product, service, or technologies that will be discussed. The funding of this program is entirely by family philanthropy. No money direct, indirect, or in affiliated fashion comes from the pharmaceutical or device industry. For those of you that want to come back to see the information and watch the video or listen to the podcast from our website, you may go to safetyleaders.org and you’ll be able to then look at the bios and actually watch the videos that we’ll be showing today or listen to the audio. We have finished our Q3 progress report and that may be found on our website as well.

Our coronavirus care community of practice is located there and you may go to www.Med Tacglobal.org and coronavirus response and be able to watch a longer video than what we’ll cover today. For those of you that are with us for the first time, TMIT is a non-profit medical research organization founded in 1984. We have worked in many areas of innovation and focused on the area of medical error as well before COVID hit and over those many years we’ve collected more than 500 subject matter experts and 3100 hospitals in our research test bed where we’ve conducted much work.

Our coronavirus care community of practice and for those of you that are on the podcast, we have images of the contributors. We started with about 60 experts in March of 2020 and that has grown to more than 150 that include doctors, nurses, finance, business people, people in middle school all the way through from I would say from 8 to 80. We also have contributions from the Discovery Channel documentaries we’ve produced chasing zero and serving the healthcare tsunami and we have a series of three minutes and counting videos focused on bystander rescue care with a number of experts and I won’t go through the list of our experts from government and from major medical centers. Our coronavirus care results as of today if you look at that by the numbers we’ve launched a 1000 family household study which is continuous.

We’ve undertaken 53 90-minute broadcasts both in medical error as well as in the coronavirus program and we’ve produced 29 as of this month 29 survive and thrive family training programs including this one. We have a number of topics that we’ve covered we won’t go through that list for you today.

However, you can go to the website to see the many areas we’ve covered because today are really we’re covering highlights and we’ve covered everything from what families can do at home to testing to bystander rescue care through the various surges and even fraud in the ecosystem.

We’re particularly delighted to have a wonderful group of youth and young adults that are chaired by leaders that are and served by leaders in some of our greatest universities and high schools and this under 30 group have made enormous contributions to the work that we’re doing.

For those that are on the podcast just to rattle off some of the university’s Harvard, Stanford, UCI, UCLA, Chapman University, USC, San Diego, UCSB, and Santa Barbara Yale, University of Florida, Tufts, NYU, Princeton University. Our focus has been on the essential critical workers that those were the 16 industry sectors that had to keep going to work when we were locked down and then in August of 2020 the educators were declared essential critical infrastructure workers and we expanded our work there. We’ve realized that if we save the families to save the families, we have to save our workers and what has been critical is we’ve really learned that a lot of our essential critical workers especially in healthcare today are suffering and out of work right now sick with the BA5 Omicron sub strain because they’re getting sick in the community not at work. So please feel free to go and watch any of our 90-minute courses on video on your phone or as podcasts as we’ve recorded all of them.

Finally, our 1000 worker family study and so these are worker families and living units including college students focused on readiness, response, rescue, recovery, and resilience. These are the components of our family plan that we recommend and the deep dive that we’ve undertaken. So, one year ago we undertook the development of a checklist for families to make things safer and this was really led by Mr. David Beshk award-winning educator, our Med Tac master instructor and Eagle Scout advisor and Merit Batch counselor and my son who’s a high school student a co-founder of the Med Tac Vice Data Rescue Care Program back in 2015, avid surfer and competitive surfer and they put together a checklist with the help of a number of the young people that were in our schools and college as well and a family huddle checklist that covered before it event what to do during an event and after an event to focus on what we’ve known then and the idea was the family lifeguard was lifeguards spend 90% of their energy and their time and their training on prevention and 10% rescue. We think of them as always being the rescue leaders which they are but they do a ton of prevention to keep people out of trouble and so when we focused on the safe practices for COVID of social distancing, use of masks, hand washing and disinfecting services those were built into this family huddle checklist and we’re delighted that we were delighted to have a visitor actually many of you in healthcare may know, Bill George.  And we had Bill George, the former CEO of Medtronic who was also a full professor at Harvard Business School, visiting and agreed to be our guinea pig for this checklist when we got started, and so we’ll cover some of the updates to that.

But we ask Mr. David Beshk, who’s actually teaching today, to actually answer a few questions and address this issue. David thank you so much for taking your time today to help us really update this concept of the family lifeguard now – here – towards the end of the summer of 2022 heading into fall.  You actually saved the first life through our Med Tac program when we started way back in 2015 and we’re just so grateful for your steadfast support in this idea.

David as a science teacher and as a leader and guide to the chief family officers, what’s your message about heading through summer and into fall now that we have the omicron BA5 virus that is probably the worst we’ve had very transmissible of AIDS natural and vaccination immunity isn’t it really important now that the family really get organized and try to minimize infections?

David Beshk:  Absolutely Chuck and thank you for this opportunity the chief family officer is a critical role within any organization but particularly families and since we’ve all been kind of living through COVID and all of the updates and the changes people’s guards are starting to become a little bit let down and now especially with this new version it’s critical that we that we stay informed and that we update our family our family plan and we make sure that everybody knows their role so that we can continue to stay safe.

Dr. Charles Denham:  David, you’ve really established for us the principles that the kids really want to be involved they want to have tasks and they really can learn this science regarding the virus is that still you’re feeling now here you know almost 30 months since we got started?

David Beshk:  Absolutely I think that that feeling has become even stronger and I would even go so far as to say that it’s not just that children want to be involved it’s that children must be involved, I think that too often adults underestimate the abilities and the desire of children to be part of a family plan and they are critical in helping keep everybody focused and they can play active important roles within a family unit, absolutely.

Dr. Charles Denham:  What about the principle that has been lost because our public health system has really kind of become fractured and the communication systems have not been the best and we love our leaders in public health but that that that we’ve just not been able to get the message out that wearing a mask keeping your distance is protecting others like our elders like the people that are immunocompromised. You and I have been teaching kids since they you know Med Tac from third graders on up and kids from eight to eighty is it reasonable to keep enforcing the principles that it’s not just about protecting you it’s about protecting grandma grandpa those people that have cancer or are immune compromised is that still something we really need to emphasize?

David Beshk:  Well, I think with as somebody who has a relative who is battling cancer right now and is severely immunocompromised, it’s critical that we continue to keep that as a focus and that when we can we do what we do what we can to make sure that we’re keeping others safe.

Dr. Charles Denham:  Thank you so much and isn’t it exciting to see what bystander care can do now and you know a lot of people didn’t believe now we’re still having Bible studies and seeing kids that you and I started with many years ago when they were just Cub Scouts and we were testing CPR and the AED and using AEDs and stop the bleed and we really didn’t know back then that they could retain it and learn how to use it. You are continually surprised by how much these kids can actually learn and apply?

David Beshk:  You know Chuck, I don’t know if it’s if it’s so much surprise – I think it’s  we all know it back to the back to the children being part of the family plan. Children and especially young adults they have tremendous abilities and potential and to see this group of children that we started with many years ago that are now implementing their Eagle Scout projects and keeping communities and beaches safe it’s something that doesn’t surprise me but it just makes me incredibly proud.

Dr. Charles Denham:  Fantastic the other topic I just wanted to touch on is that there really is R&D research and development that can be led and supported by kids. You want to kind of just report to our audience the response of the kids as we taught this smer about stingray injuries here in Southern California and how to take care of people and prevent long-term infections and harm and take care of pain.

David Beshk:  Oh absolutely. So we – we headed three day camps over the course of the smer with over 60 students and each of those camps got trained by Charlie Denham about stingray safety and ways to keep yourself safe in the water, ways to keep the stingray safe in the water and what to do if you, if you are unfortunately stung and I can tell you that the excitement level, the responsibility while at the beach, the communication within the campers to remember to do the stingray shuffle, identify where lifeguard stations are in case anybody is stung. It’s something that they enjoy learning and they enjoy taking down to the beach and again they have the ability and the potential to communicate and to help keep others safe and I think the more that we can do to continue to communicate and train young people the better off our communities will be.

Dr. Charles Denham:  Well, thank you David, and thank you for your steadfast support of bystander rescue care and for being such a great role model.

David Beshk:  Well, thank you Chuck, it’s my pleasure.

Dr. Charles Denham:  So, David Beshk one of the one of our real leaders in in our community of practice across COVID but also across multiple areas of multiple areas of science as a science teacher.

So, what’s new for 2022 because of community immunity and aerosol transmission the checklist that was developed and it continues to be refined is now before an event knowing the vaccination status of the guests maintain the four pillars that we always talk about of distance hand hygiene disinfection of surfaces and mask use we know some are more important than others. Now, why would we want to know the vaccination status and know the threat status? Yes, it’s precisely because of what Mr. Beshk had said, we have elders – we have people that are immunocompromised they might be transplant patients’ cancer patients. I’m a retired cancer doctor – when their white blood cell counts are bottoming out and they still want to be with their families you can have a very low immunity and still feel pretty good and want to see your grandkids.

So, the additional element we add and was prepare the bathroom make sure that you’ve got optimal ventilation wherever you have an area with the airspace that is not being well ventilated you have the opportunity for the virus to linger.  The former health minister of Switzerland, our partner there, who’s actually the founder of the WHO foundation, actually caught COVID in a room where someone had been occupying it earlier and turned out to be COVID positive and Dr. Zeltner went in to record a zoom meeting.  No one else was in the room – you thought you didn’t need to wear a mask and he caught COVID and then potentially put another family member at risk.  So it’s really important then during the event to protect the at-risk guests and just say hey because grandma’s under-taking chemotherapy, we’re going to put her over here and spend time where they’re in the most ventilated area, and then after the event, we had food  to clean up and we realized that it’s probably optimal to wash surfaces and make sure not to touch our faces and hands but that aerosol spread is way more important than these other areas.  So, Charlie Denham, for those of you that’ll be listening to the longer audible and podcast, you’ll hear more detail from him regarding the checklists.

So, we also asked Christopher Peabody, Christopher I’ve known since I was an advanced leadership fellow at Harvard and non-faculty there and Toff Peabody goes by Toff, was a third-year medical student. He’s now an Associate Professor of Emergency Medicine.  We’ve worked on numerous projects together he’s also the Director of the Acute Care Innovation Center at the University of California in San Francisco and we’ve asked Toff to give an updated message yet now that – now where we are.  And he has a personal experience that he’s going to share with you regarding his whole his own family.  So what we’ll ask him to do – and we’ve recorded this message because he’s on duty in the emergency department.

Well Toff – Dr. Peabody, we really appreciate your constant support of this coronavirus community of practice.  We’re now in the summer of 2022. I can’t believe that together we’ve been working with you and others at your organization and across the country for well over two years.  Tell us what’s your view of where we are today with this new omicron sub-linage BA5 and where you see us heading this summer.

Dr. Toff Peabody:  Chuck, thanks for the question. I would say that we’re not very different than most emergency departments around the country.  What we’re seeing now is a crisis of being able to staff our emergency department, and that’s for two reasons.  One is that folks are tired –  especially our nursing staff has been on the front lines of the COVID-19 prognosis for four or two years with limited support in many cases and they’re burned out, and I don’t blame them. It’s been a rough time they’ve dealt with we have dealt collectively with a lot and so we’re starting to see some attrition from folks going away from emergency medicine and critical care medicine into other parts of medicine or quitting medicine altogether.  But the second thing with the BA5 is that it’s incredibly infectious and so what we’ve been seeing is a lot of staff going on medical leave because they got the infection itself.  This was very different than at the beginning of the pandemic and so we have been incredibly understaffed which has resulted in us shutting down beds in the emergency department and increasing our wait times.  And like I said, I don’t think we’re very different than a lot of emergency departments around the country.

Dr. Charles Denham:  You know I had a conversation this week with Dr. Casey Clements who leads the emergency medicine service clinical lead at the Mayo Clinic in Rochester and he said the same thing. That they’re very short of staff and it’s not that they’re getting it at work, they’re getting it from the community.  Which leads me to the next question – your advice regarding masking, ventilation, distance – these layers that we’ve held in high regard prior to COVID and have been politicized negatively and positively – but your take on the importance of masking, distance, poorly ventilated areas versus well-ventilated areas, and what families can focus on.

Dr. Toff Peabody:  Thanks Chuck.  You’re absolutely right.  When we do contact tracing and we speak to folks that have to go out on leave, this is via what we call community spread – usually from family members and staff contact.  My own family though, it was contracted this way.  My five-year-old daughter who came home with COVID and being with us, and infected the entire family. I’m not atypical amongst the emergency department staff, so yes we get this through community spread and I’ll tell you what our family does. I think this is you know now becoming more and more of a personal decision because a lot of the public health mandates that we saw early on to help mitigate the spread of COVID-19, are no longer in place, but we still mask when we go indoors. I wear an N95 when I go to the grocery store and I also you know, wear full PPE at work but in, well as far as well-ventilated spaces, could not recommend that enough – most of my social settings are outdoors. I have advantage of living California where that’s more appropriate than other places in the country, but yes I still mask when I’m indoors. I still – my social situations are mostly outside those are the and then – what we test our family anytime anyone’s symptomatic.  You know that could be fatigue, runny nose, you know just general cold like symptoms, and I think the reason I’m doing this Chuck, is not necessarily for us because we had COVID, but with BA5 you can get COVID again really quickly even out – even with that we thought it was a three-month protection.  But with BA5 we’ve seen that that’s not the case.  You can get reinfected very fast after you’ve had COVID.  And so we’re doing this really to help with our community and not spread it to vulnerable populations because frankly we’re lucky our family had a really mild case when we did get COVID.  But we’re still taking our precautions to be good stewards of public health.

Dr. Charles Denham:  Fantastic.  And I don’t think that we can – first off I underscore everything you’re saying.  My family, thank you Lord, that we haven’t gotten it and we have some risk factors all three of us in my core family and then extended family, and we’re really blessed that the three of us that live together haven’t had it but we’re vigilant. I just went and picked my dogs up from grooming – was the only guy wearing the mask – grocery stores we insist on it – we’re going to restaurants and fortunately we live in California, too, so we can be outdoors.  We have not interfered with our social life – we host scouting events and high school student events on the beach, and you know fortunately we can do that where we live and I know others can’t.  We have a lot of people from across the country and you know they have to be pretty creative to do that. Toff, you helped me as I put together the five rights frameworks for a number of areas and the area that I had you advise me on was the five rights of emergency care.  It has received rave reviews from everyone. Is there anything we would change about the five rights that we put together?

Dr. Toff Peabody:  As I review it, I wouldn’t change anything other than this transmissible BA5 is super transmissible – the recurrent infections. But then also making sure that we know who’s vaccinated and who isn’t and be vigilant on follow-up.

Dr. Charles Denham:  But am I missing something – is it as pertinent as it was?

Dr. Toff Peabody:  I think for folks that need to go to the emergency department you know should follow the five rights and have them unchanged I think that if you need to go to emergency department realize that we’re there to serve and we’re there to serve our community and if you need to go we want to see you so don’t put off going to the emergency department.  But I would say the realization, the reality, excuse me, of emergency departments right now are that we are understaffed, and we’ve seen a huge surge in workplace violence.  So not unlike the flight attendants and the viral videos of folks who don’t want to wear their masks and are screaming at people.  We see that in the emergency department more and more since basically the second year of COVID, and that’s another thing that’s really been hard about our work environment, is we’re seeing a lot more staff assaults from patients.  Some of those are COVID related.   We think – we’re you know, the wait times are slightly increased for folks that you know that can wait, we will see you expeditiously once you’re triaged and you need you need to be seen right away that is our priority, but folks that can wait are waiting a little longer because of our staffing shortages.  And just realize that when you go, you’re getting a staff that has been through a lot and they’re taking a lot more from a workplace violence perspective than they ever have and so we we just welcome you and your kindness as we try to take the best care of you that we know how.

Dr. Charles Denham:  Well, thank you on behalf of all of us, Toff.

Dr. Toff Peabody:  Thank you.

Dr. Charles Denham:  For you guys who are the unsung heroes.  We’ve recently – my son’s surfing coach shattered his leg and one of our other colleagues Dr. Chris Fox helped us get him into the program and get him seen right away.  And you guys are really the unsung heroes and at the tip of the spear right now so on behalf of all of us, thank you.

Going to shift gears with you right now real quick to the area we talked about before we started this interview and that’s the opioid overdose crisis and the really critical issue in middle school, high school, college, and young adults, where fentanyl laced counterfeit oxy pills, cocaine and even the medications that people are taking for attention disorder to help them study are being laced with fentanyl.  And an enormous number of first timers who have ever taken something are dying because of respiratory suppression.  You want to address how big a problem this is for those of us that have kids and have college students and those that are in our families.

Dr. Toff Peabody:  Well Chuck, I can’t  overstate this problem.  We had more deaths from opioid overdose in San Francisco than we did from Covid.  You know – so to put it in perspective, this is a huge public health emergency.  We’ve seen this fentanyl, which is a cheap product to make, flood the market, and it’s basically any drug that you purchase from you know a non-pharmaceutical place, is potentially laced with fentanyl.  Like you say, as far as from a public health perspective, my recommendations are that anyone that had – you know had that – buys drugs, needs to have fentanyl test strips.  Every single thing you put in your body should be tested for fentanyl if you’ve gotten it from a non-pharmacy.  So, this is including folks that are trying to find cheaper Ativan you know or cheap, cheaper Xanax.  We’ve had a number of patients that went online, thought they were buying from a reputable source – had some – had this drug delivered to their house and it was laced with fentanyl.  And these folks almost died.  So, if you can test everything with fentanyl test strips.  We’re trying to make those as widely available as possible and familiarize yourself and obtain in some jurisdictions.  It’s harder to get  in others – naloxone.  And Chuck, i know your organization has done naloxone administration teaching.  I could not think of a more pertinent public health intervention at this point we need to make naloxone widely available in all different communities and all walks of life.  Because Chuck, just like you mentioned, this is not just isolated to a to a few people – this is a ubiquitous problem – fentanyl is flooding the market.  It’s extremely potent and if you’re opioid naïve – never taken opioids before – you have a high likelihood of overdosing.  Which leads to respiratory – to your inability to breathe and for you to have a high likelihood of dying. Which is what we’re seeing in the statistics and on a day-to-day basis.

Dr. Charles Denham:  Thank you Toff, we really appreciate your thoughtfulness there.  The issue of good Samaritan care is so critical.  I just want to underscore – have you underscore for us the importance of people in the community knowing CPR and AEDs, use stop the bleed kits for severe bleeding – now with so many active shooter events and even the Heimlich maneuver which seems so simple but in a crisis situation it’s something you really should have practiced. What about these good Samaritan rescue care principles – these bystander care principles?

Dr. Toff Peabody:   Well the studies are clear Chuck, if you have a sudden cardiac death, your chances of survival or if someone next to you knows CPR if you can get good quality CPR as an outpatient – meaning like you’re at a basketball game, someone collapses – good quality CPR is initiated right away – someone can go and get an AED while simultaneously calling 911 – you’re out of hospital your ability to come out of hospital and be neurologically intact – you know walking out of the hospital on your own is dramatically increased – that’s known.  And so it’s a matter of getting folks to know to know these interventions you know –  having our families take CPR certification courses and Chuck, I know you know because you’ve been very close to some mass shootings, recent ones where you’re living, and unfortunately, so many of us around the country have been in that situation and we see gun violence going up and up in this post-covid era – that knowing stop the bleed – no anyone – how to stop the bleed will save lives in these situations and others.  And then the Heimlich maneuver – this is a very simple maneuver, honestly, and can save lives from folks who are choking.  So, you know we talk about public health interventions, but this is something we can do ourselves to protect our family members because we know they’re effective and so anybody that has children should be CPR certified in my opinion – anybody.  And if your child is old enough to be going out on their own, then knowing  stop the bleed, then knowing the Heimlich, then knowing CPR themselves will also improve survival of people around them, and also, your immediate family.

Dr. Charles Denham:  Final question Toff, and you’ve been so generous with your thoughtfulness.  The critical importance to Nanette Hausman of college 911 opened our eyes to the fact that everyone who has a college student, these rising freshman college students and anybody in college or singles that are over 18, unless you have a Medical Power of Attorney for where they live, you can’t be consulted by the physicians properly to help with decision making in a crisis. And she lost her dear son Corey and has been a real champion and a hero in patient safety for what she’s done – the critical importance for having a Medical Power of Attorney for loved ones.

Dr. Toff Peabody:   Well, I think Chuck, you gave a great summary on it right there.  We want your help in the emergency department.  You know your family member better than anyone.  So to be able to be there and help make medical decisions is something that I think that healthcare system should welcome.

Dr. Charles Denham:  Toff, thank you so much for your generous contributions to this program now over two years and I look finally back to when we met in Boston so many years ago.  Thank you for all that you’ve done for patients and what you’re doing there in San Francisco and globally.

Dr. Toff Peabody:   Thank you Chuck it’s a pleasure to be here.

Dr. Charles Denham:  So, Dr. Christopher Peabody covered a number of issues that we think need to be part of the Family Lifeguard Program not just for COVID.  We’re going to shift gears for a moment and talk to our pediatrician – a community pediatrician who is Brittany Barto.  I’ve known her since she was a little girl.  She’s a terrific pediatric – community pediatric specialist and we’ve asked her to help us get an update on where we are now mid-summer heading into the fall.  And Brittany has been terrific all the way through the course of COVID and we’ll ask her to share her thoughts with her with us.  Now Brittany, first off I just want to thank you so much for your wonderful contribution, now over almost 30 months of this COVID crisis and you’ve just been a godsend to us and really help us with a lot of practical information for our folks that have kids and our grandparents that have kids and our doctors and researchers from the major medical centers as we head into this BA5 surge we’re experiencing today.  What are you telling families about what they need to do to protect themselves?

Dr. Brittany Barto Owens:  So, the message hasn’t changed that much I know that people have gotten a little more lax on their COVID precautions but I’m still telling people similar things especially higher situations like crowded indoor spaces especially where you don’t know anyone else I’d recommend masking. We still have masking in our office.  And you know just making smart decisions -maybe going to that amusement park isn’t the best idea right now – doing like a park where things are a lot more you know like an outside park where things are a lot more spread out or smaller activities would be a good idea at this point.

Dr. Charles Denham:  What are you telling families about kids heading back to school?

Dr. Brittany Barto Owens:  It looks like we may continue to have a surge right up into September with this virus that is really evading immunity and it looks like a real beast.  Some of the people have been saying it’s a tough virus, so I definitely mention the one thing that we can all do and get vaccinated. Everyone over the age of six months that can get the vaccine so I’m definitely recommending that for every family that comes in.  I got the vaccine for my five and a six-year-old.  They just put the vaccine for my three-year-old, so I’m excited to have that extra protection getting into the school year.   And especially for parents who maybe had the first two vaccines but were wondering about the booster.  It’s a really good time now to get that booster for their you know five and up kids because they’re going to get that extra little bit of protection going into the school year.

Dr. Charles Denham:  How long do the boosters last?

Dr. Brittany Barto Owens:  Now as we look at the omicron sublimit linages and we look at the current virus I’m not sure if that’s changed much. I think that they’ve estimated the shots are lasting like three four five months before they start waning so again, that’s similar to the flu shot, getting that shot in right before the fall surge is a good idea because you’re getting that immunity when we’re expecting that rise in numbers.

Dr. Charles Denham:  So, parents and grandparents we’re hearing that the recommendations are get the booster if you haven’t had it and then it’ll be right about the right time in October, November, December, when you might get the booster and that would be focused on the omicron sub variants.  Is that that a fair statement?

Dr. Brittany Barto Owens:  That is what I’ve been hearing.

Dr. Charles Denham:  That and I don’t think there’s anything official yet but I’m hoping that that’s what they do as we look at the families and we go through the five Rs we’ve been studying now with many more than a thousand family units and living units and we go through the thought of readiness what can a family do to be ready in case somebody gets sick and gets this particular virus so again similar to before we know so much about COVID now we know it’s spread through respiratory contact we know that masking helps so if someone in the household is sick it’s really about isolating them and if they have to be in common areas masking and 95s are fantastic with that kind of protection.  So again, using all the same tools we’ve been using over the past two plus years masking and isolation if you’re sick and then when we think about response the second hour is response and when we think about someone does get sick they are positive with a home test or a PCR test quarantine and isolation not much has changed has it I mean these principles really remain to be the same.

Dr. Brittany Barto Owens:  Yep so there was a little bit of a change on the length of time that they were recommending to be completely isolated.

Dr. Charles Denham:  So five days completely around no one and then from day five to ten around people in an N95 but essentially it’s the same idea that you’re contagious for 10 days so you shouldn’t be unmasked around anyone for 10 days from the onset of your symptoms,  and reasonable to have what one of my colleagues who came to work with us today tested before he flew in from Texas and then tested when he arrived here so that we know that if he caught something on the plane he’s not communicable and he’ll do another test probably in the morning and be following that up just so that we can protect everybody here and then we don’t have to mask because we know that we’re negative is that a reasonable approach when people travel is to use testing that way?

Dr. Brittany Barto Owens:  I think it’s a reasonable approach if you’re not having symptoms and doing that double testing you know a day apart or so because even if maybe a couple of days you could become symptomatic the rapid is pretty good for kind of like knowing if you’re contagious at that point, so it is it’s another good layer to try to help prevent spread.

Dr. Charles Denham:  Our third R is rescue so when somebody really gets sick we’ve been recommending great care and taking them to the hospital or taking them to be seen with masking windows down if you’re in a climate where you can so that the air so that you’ve got really good ventilation not putting the whole family in the car with the person who might be sick but one person and then making sure to get them in and get them tested and being prepared in case they do get severe disease which people are still doing being prepared to be there for a while charged phones and and be aware of the fact that we have to keep our distance.  Are all these things still the same they appear to be and this is what we’re hearing?

Dr. Brittany Barto Owens:  Yep absolutely, we’re using all the same precautions all this in preparedness – we’re unfortunately still seeing severe disease kids are still getting hospitalized more so now with all these omicron sub variants than in the past so kids are still definitely getting sick tell us about the third r which is recovery are we seeing as much as much of the multi system inflammatory disease in in kids is it getting worse is it getting is not as bad we’re hearing from the male clinic that a lot of people are really sicker than they were from some of the other virus lineages so I can’t speak specifically to the severity of my SC but Omicron again has been causing more illness in kids especially the zero to four and causing more hospitalizations in kids and the kids are going to hospitalized one in four of them have to be in the ICU which is not great so they’re getting a little more sick with omicron so a little more sick and that’s why vigilance is really important now what about long covet are you seeing long covet in the families because you know you may not see it in the kids but you I’m sure you hear about families in your community we’re seeing a lot of people that have extended symptoms and fatigue and not being able to be up to their typical cognitive or their physical  pre status pre-covid infection status

Dr. Brittany Barto Owens:  Yeah it means we’re hearing about it indirectly through the parents we’re seeing it a little bit with the kids I’m seeing more prolonged loss of smell and taste unfortunately and then some of the teenagers are getting the sort of prolonged fatigue you sometimes get with something like mono so we’re seeing it.  It’s not as severe maybe as in the grown-ups but it’s definitely happening in the kids as well.

Dr. Charles Denham:   The final R is resilience so as we kind of learn what we can do oh throughout the fall and in the winter how can we as we say in in law enforcement harden the target of our family how can we what can we do to kind of be more resilient as we head through this that and this might be  to you know have lots of masks have the tests available  plan trips and plan holidays with family knowing that we may have immunocompromised or seniors reasonable to kind of take that kind of a view kind of a family lifeguard approach say how are we going to really kind of protect the family throughout the year yeah I mean something I’ve learned in the past couple of years is anything can happen in any moment a person can get COVID in everyone’s schedules and plans get completely flipped on their head so I guess that resilience is recognizing that you can’t control what’s happening and being flexible when the plans change and being ready with what you mentioned masks testing  flexibility in your plans because we’ve had a lot of that in the past couple years so this layered approach wouldn’t change at all just that we’ve learned a lot more.  Is that reasonable?

Dr. Brittany Barto Owens:  Yeah we’ve learned so much about this infection and have gained so many tools over the past couple of years that we just have a lot more available; again, the rapid tests, the masks and N95s are readily available, we know a lot about the virus transmission and it’s making us a lot more prepared hopefully for the next – for the next ones.

Dr. Charles Denham:   So, the final question is many of us have family members that are suffering from cancer and might be on chemotherapy/radiation immunotherapy – are immunocompromised.  What do you recommend to a family if we head towards the holidays and grandma, or grandpa are immunocompromised as we head to – want to be with them and share that time with them?

Dr. Brittany Barto Owens:  So, something you touched on earlier – the possibility of doing rapid tests and succession to try to prevent having any exposure to the immunocompromised person and depending on their vaccine status and everyone else’s vaccine status, considering masks again.

Dr. Charles Denham:   Gotcha. And since you brought up masks, it’s such a controversial area, you know well.  Do you believe there will be recommendations, if we continue to have a surge, for masks in schools and what are you telling families about wearing masks in schools?

Dr. Brittany Barto Owens:  Because you know they get a lot of peer pressure not to do it – a lot of political pressure not to do it, and you and I know that we’ve been using masks for over a hundred years in medicine with great utility.  I think there is a little less enthusiasm for universal masking in schools.  Our school district has an automatic mask threshold, so it’s not really a discussion for us.  But for parents who don’t have strict masking rules, I think it’s good to kind of look at the CDC recommendations of like the high and the low-risk areas and maybe mask based on that map versus based on your school’s policy – if your school is a little more lax with masking.

Dr. Charles Denham:   Brittany, you’ve just been so gracious and such a great contributor to our team, and you know when we started, you were one of the original 60 people and we now have 150 people that have contributed and continued to, and we’re very grateful. So thank you for all the great advice.

Dr. Brittany Barto Owens:  Sure, happy to help.

Dr. Charles Denham:   So, we really  appreciate Dr Barto’s help.  So let’s address this issue of layers of protection – the Swiss cheese model that was popularized by Professor James Ries and I had the wonderful opportunity of working with him and collaborating with him and he was so gracious to say that it was actually a young lady graduate student that was the originator of the application of this metaphor, but it really is something that we can learn we look at. Distancing, masks, disinfection, ventilation, and testing – not necessarily in that order, are the layers of protection that we need to kind of focus on.  Distancing alone won’t do it; masks alone won’t do it; disinfecting surfaces are probably less important than they were before; ventilation now we know because of the airsoft spread, is much more important and something critical that we really need to be aware of and something that is very important; and then testing.  As Dr. Bartow had mentioned it is absolutely critical for those of you that are on the podcast, we show this the Swiss cheese model – are a series of slices of Swiss cheese with holes at various different locations.  And the fact that the virus – once those holes line up, that’s when we’re going to get infected.  We use this Swiss cheese model and layers of protection when we think about infections in the hospital, but also medical error, and we think about the various mistakes that we might be able to address and not make.  So, masks – what about the update on masks?  You know we’ve been producing videos, writing articles and doing a tremendous amount of work on this area since the very beginning.  I’m showing an image now of the N95 mask by my son Charlie wearing the N95 mask, the surgical mask, and a cloth mask. So, we’ve updated our video which you may go to our website to watch, for those of you that are on the podcast you may listen to it but then go back and watch on your phone.  And we’re going to address these critical issues of filter fit and finish.  These are the real principles that are critical even now in 2022 in heading towards fall.  These principles continue to be really important.

Video:  Good day, I’m Dr. Charles Denham, Chairman of TMIT Global and one of the co-founders of the Med Tac Bystander Rescue Care Program.  Now in the summer of 2022 and heading into fall, we’ve learned a lot after battling the evolution of the coronavirus variants and we now battled the omicron BA5 sub-variant which is extremely transmissible and has significant capacity to evade both natural immunity and that generated by vaccines we’re having a number of reinfections.  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.  It is believed that individuals become infected by the virus entering the body through the wet mucus membranes that are the moist linings of our nose, eyes, mouth, and respiratory system.  Masks have become increasingly recognized as critically important; however, there no substitute for social or physical distancing which is most important, hand washing and avoiding touching our faces and disinfecting high contact surfaces.  Masks are one of these four pillars, and they all work together.  The three critical factors of your use of masks are the filter the fit and the finish – the quality of the mask as the filter, the fit with no air escape during breathing, and your finish – how you remove clean or dispose of the mask safely.  Dr. Michael Osterholm is an internationally recognized medical detective and Director of the Center For Infectious Disease Research and Policy or Sidra at The University Of Minnesota, with more than 45 years of experience investigating infectious disease outbreaks.  As I’ve stated, dating way back to April of 2020 in the earliest days of the pandemic, we know that this virus is transmitted largely by aerosols. Those very tiny particles that right now as I speak are filling this room.  If i want to understand an aerosol, I would be in a room with someone who is smoking a cigarette and say oh my i can smell that very quickly even if I’m 20 feet away, and then i would say does whatever I’m using to protect myself prevent me from smelling that.  If you don’t, then you know what you’re going to have viruses leak into whatever you have and what I’ve been really strongly urging is, yes mask, but mask with the most highly efficient and effective means you have, and these are the N95 masks.  So now for the critical issues of masks filter.  When we talk about filter, we mean how the materials of the mask block the virus from entering your mouth and nose.  Before we talk about the types of masks and how they filter we need to understand the basics of droplets and the two types of airborne transmission, large droplet and aerosol spread.  The typical sneeze may unleash as many as 40 000 droplets.  These not only cause direct spread to others but land on surfaces we come in contact with all the time.  First it’s important to know how small the corona virus is.  They’re smaller than a micron or a millionth of a meter and a droplet that can carry the viruses is about five microns. A hair might be at 100 microns in diameter, a red blood cell might be seven microns, and you just can’t see anything under 40 microns so what infects us is just too small to see.  We can become infected by breathing droplets expelled by infected patients who breathe, talk, sing, cough, or sneeze.  The virus particles are encased in globs of mucus saliva and water.  Bigger globs fall faster so they splash down quickly, traditionally called droplets, they fall rapidly onto anything nearby.  Before new technologies were developed, scientists thought they only drop within three to as far as six feet from those infected.  Smaller globs evaporate faster than they fall, therefore the viruses can linger in the air and drift farther afield.  These are called a competition between droplet size, inertia gravity, and evaporation determines how far droplets and aerosols travel through the air.  Gravity is stronger than evaporation on larger droplets and they settle faster and land on surfaces nearby.  Aerosols are smaller and evaporate faster than they settle and float in the air.  We now know that aerosols are a major root of spread that combined with the contagiousness of the omicron variant and subvariant such as BA5, this is a lethal combination.  The filter is the first critical factor of masks and the N95 mask is being recommended by many experts now.  However, they need a good fit to deliver the optimal performance of 95 percent filtration.  Masks work by a combination of filtration and electrostatic attraction that catch viruses an electrostatic charge is put on n95 and surgical masks in the factories this helps them catch germs by attraction.  The plus is this really works – the minus is that we have to be careful about how we might clean them for reuse in case it would take away the electrostatic charge.  N95 masks catch droplets and viruses with very refined filtration materials they’re specified to catch 95 percent of 0.3 micron particles and that’s how they get their name.  N95 masks are typically used in hospitals when caregivers are performing medical procedures with clear aerosol risk.  They must be fit tested using a method defined by the manufacturers to make sure there’s no leakage around the seal of the mask and the face.  In fact, due to the resistance they generate without a fit test verification process, a surgical mask may offer more protection because more airflow may pass through the mask.  An N95 mask with a valve such as an industrial grade mask that lets airflow out, will not afford protection to the public.  Surgical masks or what many call procedural or medical procedural masks, have been the mask of choice until the delta surge arrived.  Early in the pandemic they were thought to block 99 percent of exhaled droplets and 75 percent inhale droplets.  The American Society of Testing and Materials is an international organization that sets the standards for surgical masks. They establish three levels of barrier protection: level one – low, level two – moderate, and level three – maximum.  Levels two and three are recommended for COVID protection with equal filtration capability; however, level three is the most fluid resistant surgical mask.  Surgical masks catch droplets and viruses by both electrostatic attraction and filtration through the processes of physical interception and inertial impaction.  These are just technical terms for how they physically catch the particles.  A two-layer cloth mask is thought to block both exhale and inhale droplets by 60 percent – now believed to be woefully inadequate to protect us from Omicron and Omicronsub variants.  Cloth masks only catch droplets and viruses by filtration, that’s why they’re less breathable and less effective.  HEPA, high efficiency particulate air filters which are in airliners and in certain buildings, work by three processes: inertial impaction interception and diffusion, but not by electrostatic attraction.  When you consider using cloth barriers, keep in mind that duke researchers found that neck fleece gators or bandanas offer very little protection.  The second critical factor is fit.  If air is escaping around the mask, the purpose of the mask is defeated.  The better the seal, the better protection, and don’t touch the surface of the masks while wearing them.  The second aspect of fit is to wear the mask properly, which is a major issue, and when you use them please don’t wear them under your nose.  Up to a quarter of the people routinely put whatever they have under their nose.  That’s nothing more than a chin diaper and it doesn’t provide you any protection, and so again we also need to instruct people on how to use them and i think that’s the important message on masking.  A mask should completely cover the nose and mouth and should be tight around the ears or head for a snug fit.  Some of the most commonly seen mistakes are wearing them without a good fit and failing to cover both the nose and the mouth.  In our certification course we show how professional caregivers remove masks they will have to reuse after they’ve cared for someone with known COVID-19.  We show how to store them for reuse and how to make them last.  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.  The last dimension of fit is the use of multiple masks or layers either because an ideal filter cannot be found or that multiple layers help provide a better seal.  Many of our leaders in government and industry double mask.  The third critical factor of masks is the finish safe and careful removal of the mask.  After use, washing your hands and decontamination of reusable masks remember don’t touch the surface of the mask while wearing them carefully remove the mask by the straps again without touching the surface of the filter section wash your hands thoroughly after you handle the mask, and remember we naturally touch our faces about 23 to 24 times an hour.  If you’re using cloth masks as a second layer over a surgical mask wash them with warm soap and water dispose of disposable masks carefully and if you’re forced to reuse disposable masks, rotate them and store them in a dry place to allow them to air out and allow the virus to die.  Many caregivers put them in lunch bags so that they can dry out and they rotate one for each day of the week.  A final word on buying masks.  Make sure if you are buying level three surgical masks, N95 or KN95 masks made in China, that they are approved for medical use and that you are purchasing them from a trusted source.  There are many counterfeits.  Early in the pandemic, Dr. Atul Gawande, the best-selling author and global leader in health care quality, said it best about masks, “I protect you and you protect me”.

Rick Warren, Best Selling Author of Purpose Driven Life, “…but I just want to say for your benefit and for the benefit of all your family and for everybody else around you, please, please, please, wear a mask.  All right.  It’s not a political statement, it’s a statement of unselfishness, it’s a statement of love, it’s a statement of responsibility, it’s a statement of good stewardship, it’s a statement of loving your neighbor as yourself.”

Thank you so very much for sharing these resources with your families colleagues and friends you’ll be in our prayers god bless you 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 as we say to all of our Med Tac bystander rescue care teams we have to fight the good fight finish the race and keep the faith. Everyone is a patient and everyone can be a caregiver.  End of video.

Dr. Charles Denham:   So that video is available on our website for those that want to watch it and we put it on today without interruption. The Omicron sub variant or sub variant linage is really, really very transmissible and masks are absolutely critical.

So, as we come through the the final 30 minutes of our formal 90 minute program and we’ll have longer content on with our podcast.  We want to address misinformation and disinformation.  We frequently use the example from the TV show ‘Bull’ of what the narrative is, and the narrative is – Michael Weatherly is the star of that that television program – a narrative is the story that’s told that makes sense of the version of the facts that support the argument made by an organization or individual.  Unfortunately, we have a lot of political barriers and political conflict going on and so it’s very important for you for your family to understand the science. Attorneys take advantage of the existence or absence of documentation to support their clients, that’s their job.  It’s critical patients manage their medical information and supplement it with the best you can find and trust your caregivers.  So, misinformation disinformation and malinformation are on the screen for those of you that are on the podcast they really, these three categories really are different depending on the falseness of the information and the intent to harm.  The intent to have an impact misinformation are unintentional mistakes that are inaccurate – photos, dates, statistics, translations, and are not don’t have the intent to persuade dishonestly, they’re just mistakes.  Misinformation and disinformation are frequently misused in terms of being referring to either one being the same, but disinformation is fabricated or deliberately manipulated audio or visual content intentionally created conspiracy theories or rur-rumors.  So this is intentional it’s in the intention is the harm and it’s false and then malinformation is the the idea of using information that may be true but the intent to harm is there we always draw attention to the nurse Kimberley Hyatt in our Pacific Northwest, where her HR file was released to the public and released to journalist, when medical error had occurred and Kimberley, a great nurse who’d never had any problems in the past who was you multiply certified, found that that was the straw that broke the camel’s back when they released something from her hr file that was an innocuous statement about a hug that she gave to someone who complained and she was somebody of an alternate  non-traditional lifestyle, but a great nurse and she committed suicide.  So we always draw attention to that.

Now weaning immunity and vigilance is critical regarding where we are today the Omicron BA5 sub variant  evades natural immunity evades vaccine vaccination generated immunity and those that have had both an infection and vaccines are hybrid immunity it also evades that we’ve got multiple examples of infection that occur within weeks after a first infection the vaccinated may get mild infections they may get less severe disease with mortality but even mild infection infections can cause long COVID so as we look at this evolution of the virus it’s critical to kind of recognize that  that we really have a terrific outbreak of what many are calling a real beast  because of its transmissibility and its ability to evade  the natural and now what we’re using that, we’re using the term immunity wall.  And so what we like to do is we as we look from the alpha to the beta to the delta to the Omicron transmissions and those variants that we really see that there really is a real problem with these.  And we’ve asked  Heather Foster who’s a frontline rural caregiver winner of the Pete Conrad Global Patient Safety Award, trained as an infection preventionist, and really helped us through throughout the program to share her thoughts.  So Heather, thank you so very much for being such a great contributor over the last almost 30 months that we’ve been running this program.  A couple of quick questions – what’s your message to families regarding the BA5 virus?  We find it to be very potent and it evades the immunity walls.  We’ve got a lot of caregivers out, not that they got it at work, but they got it from the community.  What would you recommend to families now in the mid-summer and heading into fall about being careful with their families?

Heather Foster:  Well, I think the narrative is just to continue to be aware that we’re not quite out of the woods yet Chuck, and to continue to be mindful of protecting our own and others.  That means hand washing if you’re in a high-risk area or a potential of getting in contact with an unknown COVID source, wear your mask, that has never changed.

Dr. Charles Denham:   And we’re finding that the testing – a lot of people aren’t testing but we certainly are, and a lot of people that are knowledgeable are testing before a meeting and testing after a flight and before flights.  Would you recommend that as we head into the holidays.  We certainly are.

Heather Foster:  Well, I think it’s important to again you know just be considerate of one another  it’s something that I treat I’m rarely seeing anymore but we still have high risk populations and if you have been in a high risk area such as airports or traveling and you you’re going back to work, it’s just consideration for others and around you.  I’m not going maybe in some areas that’s not warranted I think it’s very individualized as well, but it doesn’t hurt  to protect others.

Dr. Charles Denham:   And the last question is that from a nursing perspective and as a nurse taking care of immunocompromised patients, the message that we are trying to continue to broadcast is you may not need to do this to protect you or your family but there are so many people that are cancer patients under care, immunocompromised patients with some fundamental immune disease, or even transplant patients, there are many many people out there now on drugs that then inhibit their immunity, and it’s really something that we can do as a good Samaritan for others.  Is that a fair statement?

Heather Foster:  Right, exactly, and I think you couldn’t have put it better  I think that’s highlighting how we may be or should have been practicing all along we we kind of forget about those vulnerable populations when we’re out and about and so whether it be COVID or the flu season, I think it’s just it’s yeah it’s within our best interest within our communities to protect one another.

Dr. Charles Denham:   Fantastic.  I’m glad you brought up the flu, and it’s just important for any of the future respiratory viruses that we can get that if we apply these fundamentals we can have a happier better life and our families can be a little bit a little bit safer through their holidays and vacations.  You agree?

Heather Foster:   Correct.  Yes, I agree completely with that, yes exactly.

Dr. Charles Denham:   Well, thank you so much for taking time away from family.  You’re on your day off but on behalf of all of us thank you for all for what you’ve done and all the nurses who step into the gap every single day.  We really appreciate it.

Heather Foster:  You’re so welcome.

Dr. Charles Denham:   So next we want to hear from Chief Adcox.  Chief Adcox is the Chief Security Officer and Chief of Police at the University of Texas in Houston and a real pathfinder in the area of emerging threats.  Well Chief Adcox, thank you so much for taking time today to kind of address this issue of the family lifeguard.  We’re now at the 29-mark, month level of   putting these programs on, and from your perspective as a law enforcement leader as a Chief Security Officer of a major medical center, what’s your message to families regarding the care that they need to take?  It looks like we’re losing a lot of staff in health care right now to BA5 and they’re catching it from their families and at home not at work.

Chief Bill Adcox:  Right. What I would say is that we can’t give in to the fatigue and that the family lifeguard really needs to continue to make sure they’re doing everything we can with our families to be as cautious as possible and taking the prudent steps because I think you can pretty much see at most workplaces that the employees aren’t becoming ill as much from working in the in their offices or working in the hospitals or working elsewhere most of it now is outside of the workplace and they’re getting infected through contacts with family and friends and outing so it’s not a time to relax it’s a time for us to continue with the vigilance and protect our families.

Dr. Charles Denham:   So Bill, you know you and I are working very closely with other leaders on active shooter events and the of all the  the massacre and the other bad events that have occurred have really caught the  attention of leaders however we’re in real threat fatigue with covid and the more we hear about all these threats at a certain point we just we’re just kind of overwhelmed any advice to us and you’re the leaders of the medical centers and the families regarding threat fatigue and and doing what the dr boats are our real ins for inspirational leader always talks about which is  deliberative practice and that we just need to keep deliberately practicing  what we would do to respond to these threats

Chief Bill Adcox:  Well certainly.  I believe that it’s quite important that because there is so much fatigue and there’s so much unknown and there is a tremendous amount of of activity that’s going on in and around us.  We just really have to support one another.  We have to take advantage of peer support groups.  We’ve got to take advantage of our employee assistance program.  We’ve got to make sure that our employees are healthy.  We’ve got to make sure they’ve got the proper amount of time to do the things they need to do and  have balance in the workplace and have as many support systems and mechanisms. We’ve got to remind everybody that we’re in this together and that it is critical and that we support one another.

Dr. Charles Denham:   Bill, as we focus on these active assailant events, active shooter events, lethal force incidents, we know that no one technique will protect us and so we take a layered approach and it’s really the same for Covid, isn’t it?  And with our family there are multiple layers of protection and things can get through one or two layers but if the layers are all working together that we have a better shot.

Chief Bill Adcox:  You’re absolutely correct.  I think it’s important to think of prevention has primary prevention and secondary prevention primary protection prevention is primary prevention is taking all the necessary measures whether it’s masking it’s making sure that you know you take you take the precautions when you leave the hot zone being your work you get to your home it’s making sure that you do your best not to get in get up in places where there’s large crowds with very little ventilation so you got your primary prevention and there’s things you can do so your prevention is is that if something gets through the layer approach that you mentioned is that we have to then move to a very sensible and reasonable you know quarantining in our homes doing the things to prevent secondarily prevent the person in our homes that that is is compromised with the virus from passing it on to the other family members so you’ve got to look at it in a layered approach and you also got to look at it from you know whether it’s primary or secondary prevention and at all times you’ve got to look at it that your family lifeguard has to do his or her job your chief family officer has to do his or her job and everybody needs to to be in this together but again you’ve got to have it you’ve got to have an outlet you’ve got to have some things that you can enjoy together you’ve got to you got to do something to keep them from getting overly stressed and basically paralyzing yourself from doing the things that you should be doing so

Dr. Charles Denham:   So, Bill, the final question is you are a real role model as one of our threat safety scientists but also a role model in terms of leadership and this this intersection of leadership best practices and technologies is really the sweet spot of high performance.  Doesn’t that also apply to the family lifeguard approach?

Chief Bill Adcox:  Oh absolutely, absolutely.  If you look at those three principal pieces that you talked about whether it’s leadership or it’s the practice etc., it’s important that they that they’re integrating they work really closely together and if you will as a family we’ll take a look at – okay in my family who’s going to do this process, who’s going to be responsible for this and you kind of work it out in advance, then you’ll have a real good system in place for you and your children and your spouse and so forth.  But yes, they’re equally important, they’re interchangeable practices, they’re interchangeable processes.

Dr. Charles Denham:   Well, thank you Bill and thank you for your vigilance and overcoming the overwhelming fatigue and COVID fatigue and I know although everybody’s really hot to get their best foot forward on active shooter events, the great work you do. We never hear about it if you keep doing such a great job and so safety’s a quiet success and very visible.  And so, thank you for being one of our safety leaders.

Chief Bill Adcox:  Well thank you very much for putting this program on. Thank you very much for allowing us to have input, and we just we just hope everyone stays safe and does everything they can to protect themselves.

Dr. Charles Denham:   Well, thanks Bill, take care.  So Chief Adcox really addressed this issue that we look at in threat safety science, of inside and outside threats and the fact that we have to be vigilant in resilience building and if you watch any of our other programs regarding the the threat safety science you’ll see that our goal is really we’ll never isolate or remove all threats but we definitely can do more and most recently with the BA5 omicron lineage, the inside threats and our outside threats to the families, of our essential workers are far greater and we’re running a far greater risk there and it’s really important that people really understand that.  And so as we kind of end up here and head to the home stretch, when we think about why masked, vaccinated or not, can I catch it, can I spread it, can I get sick now and can I get long-haul disease.  The answer is universally yes in all age groups and we’re seeing because the immunity wall is not protective either vaccinated generated immunity wall or prior infection immunity wall or hybrid meaning somebody that got sick after they were vaccinated are still getting sick.  So, we’ve got to really be vigilant about distance, masks and the contact surfaces as well.  So, we really appreciate Bill sharing that with us as we think about going forward.  It’s really vital that we think about testing and the issue of testing as we’ve mentioned and we’ve gone back to our testing webinar.  We highly recommend that you if you want to take a deep dive and understand how the home tests and how the PCR tests work please do that we don’t have time today to cover it at the end of the webinar i’ll play a short section of regarding the  testing but the difference between the PCR and the rapid antigen testing and the pros and cons and why well we would use the rapid antigen to make sure that we’re not contagious if we’ve been exposed that we have to take it over multiple times and the fact that the PCR test is much more the gold standard however their drawback with that is that it detects the virus viral debris after you’re infectious and so understanding how these work are critical and when we think about traveling safer.  We need to assess the threats, vulnerabilities, and risks. Test before departure, maintain safe practices in cars – they’re very poorly ventilated – practice airport and boarding safety.  We know that when you’re on the jetway, when you’re in the potty, when the plane ventilation systems are not running, you’re really at significant risk.  And then enroute safety – it’s far better to wear a mask and oh and use a straw and not eat when the other people are eating when they’ve got their masks off all these things are really basic science.  But we tend to forget them.  Repeat airport safety practices when you get to the destination, repeat safe practices in cars, test before a meeting, if you’re on the way to a meeting, or to meet with family, and repeat the processes going home.  We think that these are really great ways to make sure that we could get this work done.

Dr. Gregory Botz covered for us our family safety plan in the five hours which we won’t cover today but what we’ll do today is we’ve asked one of our great leaders to share his thoughts with us and that is Randy Styner.  We actually caught him last night after we were working on an emerging threat program with the University of California Irvine and I’m going to play the video of his latest recommendations now.

So Randy, thank you so much for your constant support of our initiatives and focused on so many different areas of emergency management now mid-summer, heading to the fall and we’re looking at so many of our university students and families going back to the typical curriculum, you’re really trying to prepare for that.  The BA5 virus is a really bad virus.  Your advice to families to be ready and to be able to be prepared for people to get infected.

Randy Styner:  Well first of all you know keep your guard up you know.  It’s we’re with the big cities like Los Angeles, even Orange County, and the bigger institutions.  We have this issue of you know people are burnt out, they’re burnt out, they’re sick of this virus, they’re sick of dealing with it.  So things like mask mandates – we just saw it in LA where they were really at the point where they needed to reenact mask mandates they didn’t because primarily because of the pushback that they were afraid they were going to get.  But we got to be vigilant you know those masks help those masks prevent infections, so you know keeping that mask on when you go into a grocery store put that mask on when you go into an enclosed area you know that’s what’s that’s probably going to be your best protective measure right there.  As vaccines come you know new vaccines are coming, keep up on your vaccines that that has been shown to reduce infection rates all over across the board across the world you know we we can’t give in to the fatigue you know it’s the virus doesn’t have that fatigue – that the virus is going to continue to mutate it’s going to continue to spread it’s not going to get tired – we’re getting tired and I get that, everybody is.  I’m tired too, but we have to remain vigilant. We have to keep our guard up. The only way that we’re going to control this thing is to contain it, and the way we contain it is to stop people from getting infected.  So using those same measures – washing your hands, staying home if you’re sick, if you’ve got a cough or a fever, not going to other people and spreading it, and not going to places where people may spread it to you, where you in turn spread it to your family. So keeping those those defensive measures up is so important right now we’re getting ahead of this for the first time in what two years and if we continue those defensive measures that we’ve been doing we can get ahead of this we can get back to that that new normal whatever that is but you know somewhere beyond COVID and and you know get back to some semblance of life but we have to do the work now.

Dr. Charles Denham:   So, Randy, you are responsible for emergency response at one of our major universities and tens of thousands of students and thousands of faculty, we talk about the lifeguard as the role of a lifeguard is 90 prevention and 10 percent rescue and most people always think of lifeguards and rescue but your job is that way as well isn’t it?

Randy Styner:  Yeah it is.  I mean you know we are our job is to not ask what are the odds or to say that’ll happen or this won’t happen our job in emergency management is to ask what if it happens i mean you can put a priority on things what’s the likelihood we do hazard vulnerability assessments for just that reason to try and figure out you know what are our priorities for planning but we have to look at everything and we can’t say that something will or won’t happen we have to say what if it does happen are we prepared and we do that by you know going through our planning process and understanding you know.  I’ve said it time and time again that a plan is flexible it’s adaptable and it’s scalable.  It’s got to be at a level where you can address things as they come it can’t be what we say in the weeds where you know you’re planning everything out in such details you have to have a flexible adaptable and scalable plan so that’s the first part of the process is have a plan identify what you need to plan for and then make a plan to deal with that so that you’re not caught flat footed if you do that that’s the prevention piece.  Like you said Chuck, it’s you know that’s the that’s the biggest part of the process we spend very little of our time in response mode.  The Emergency Operations Center at UCI has only been activated once in a real event you know so the vast majority of our time is on that planning effort and every university has a counterpart like me and so does every city you know it’s we’re paying this person to develop these plans and to go through this method of method of preparing us for whatever will come.

Dr. Charles Denham:   90 percent of – well 99 percent of time nothing happens – nothing does come but when it does, having that plan in place makes all the difference and so you recommend that for families?

Randy Styner:  absolutely families have their plans that’s part of our our our standard emergency preparedness training is going to the individual that in everything starts at the individual plan it’s you know the the big earthquake scenario let’s take that for example that the success of that and the of the response and the recovery from that is all going to depend on those individual family plans.  Your first responders aren’t going to get to you right away and that’s in most scenarios whether it’s a fire whether it’s a big earthquake and any sort of natural disaster you’re going to have a period of time when you are on your own if your plan is to just bunker down and wait for emergency response or EMTs or firefighters to come and get you.  You have to go get your water you have to go get make sure you’ve got medications you got to make sure you have food for your pets you got to make sure that you have food for yourself and your family to to survive for up to three days in some searches that’s the catastrophic earthquake scenario.

So those individual plans are so important because in any big disaster or big event the responders are going to be overwhelmed and what’s going to make them be able to get to you and to save you or protect you or rescue you is going to be your ability to take care of yourself in those first few critical hours and days and man you had personal experience with this in a plane crash losing your mom and your dad – worked with other physicians then to really put together our emergency response system, didn’t you?

Randy Styner:  Yeah and that’s you know, a story – that’s good story I mean sort of on the opposite side we went down in a in a field in the middle of winter in Nebraska miles away from any help. We ended up in that field for eight hours before my dad decided to finally go out and get help which he was able to find and bring back to the airplane and evacuate us to a to a small hospital.  But he didn’t have a plan – he never thought I’m going to crash an airplane in the middle of a field in the middle of winter with my family on board – I should have a plan for that.  But that’s exactly what the planning process entails, is looking at things like that if you’re going to fly an airplane you should have a plan to say if we go down what do we do what is what do I have the equipment my dad had to find a pen light – he’s a doctor and found a little exam pen light that was the only light on the on the airplane a light source on the airplane he didn’t have a flashlight he didn’t have a first aid kit in the plane he’s a doctor so you know it’s that’s one type of of incident but those are the types of things we have to look at if you’re going to be doing these you know any kind of activities you need to be prepared for it – in your car – we could have a big earthquake in Southern California that brings down overpasses and you could be stuck between two of them do you have a hat in your car, do you have water in your car, do you have a couple granola bars or something do you have a good pair of shoes that you may need to put on it to walk out of there – it’s those kind of things that you have to think about and making those plans i think is is so important.  And there’s so many resources where you know it’s not contingent on me to tell you there’s so many resources that you can tap into to help you build that plan and help you make that plan.

Dr. Charles Denham:   Randy, that strikes home to me.  As a pilot on my first nighttime cross country, I lost all lights in the in the cockpit and had to go by memory and by field to fly back because I couldn’t see any of the instruments.  Unfortunately, I was vfr so I was flying visual flight rules and I knew where I was going but it really taught me to have a headlamp so I had in my gear bag a headlamp that I could put on my head and my forehead and not have to hand on hang on to the light. So, well listen Randy, thank you so much for your thoughtfulness.

Randy Styner:  You’re welcome Chuck.

Dr. Charles Denham:   So we are very very grateful for all of our leaders that helped us today develop this this program for you and we will be continuing to work with these leadership organizations to develop better and better content for you as we go through the work that we’re doing what we’d like to do now is to have our Voice of The Patient, Jennifer Dingman will close us we’re just a couple minutes over for those of you that are caregivers who have shift work and are doing our and getting certified for continuing education i will show after Jennifer closes us officially for our webinar.  I will close with a section of one of our programs on testing for those in the podcast that wish to listen so we’re so grateful thank you very much for attending today and what we’ll do is listen to Jennifer Dingman officially close this webinar and then i will play the the testing video and then we will be done with our with our podcast.  Thank you for being with us today we are very appreciative of all that you do for your families Jeni, thank you very much for being so supportive of our program today.  We want to give you the last word as the patient and representative of families – would you please close us.

Jennifer Dingman:  Thank you Dr Denham.  Today was a wonderful wonderful program and I really appreciate everything that you and your team are doing Dr Denham.  As I said earlier, I strongly encourage everyone here to please share the recording of this webinar with all of your friends, colleagues, and neighbors.  This is something as I said earlier that we all need to live with and having our lifeguard in our family is just something that is going to help us get through all of this together.  God Bless and we’ll see you all next month.

Thank you Jeni. We’re very appreciative of Jeni being our voice of the patient throughout our program and when we close our program, we like to draw attention to kind of a maxim or a motto that we like to use which is: fight the good fight, finish the race, and keep the faith because everyone is a patient and everyone can be a caregiver and we believe that this is really critical for everyone.

What we’ll do now and we have additional resources regarding our bystander rescue care area we won’t go through those now we’ll see you next we’ll see you next month and for those of you that want to stay on and listen or watch our videotape on testing i will be showing that and then and then when that fades to black we’re done today can testing make family gatherings safer you know it’s critical to focus on the words 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 booster has 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 a hundred percent 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 seating 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 gatherings 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.

Thank you for your attendance today and we’ll see you next month.