Taking Vitals

When it comes to one facet of the “rescue” half of our SAR duties, acting as a medical responder can be one of the toughest aspects of the job. Learning the EMR skills is one thing, but keeping those skills fresh and in practice is another. To help with that, some of the more experienced members of the team (who also have EMT, nursing or other medical credentials) have offered some tips they use for a critical basic skill: taking vital signs.

The following are collected from Jeremiah Dees, Jim Gay, Chris Nichols, Catrina Christian, Frank Moschetti, Tom Bates, Alan Mathews and Dawn Curran:

Respirations
• To count breaths, observe the rise and fall of belly/chest movement.
• Ask a teammate to count the respirations (by observation) while you take other vitals.
• Misdirect the subject so he doesn’t alter his breathing by telling him you are taking his pulse. Fold the subject’s arm back to his chest, holding it there while taking the pulse, with your watch facing you so you can count. This can then segue into counting the respirations as you feel your arm rise and fall.
• Note not only the number of respirations (normal is 12 to 20), but the quality: normal/quiet, gasping, shallow, labored, wheezing, etc.

Radial Pulse
• Take the arm closest to you. Slide your first two or three fingers over the top of the radial artery (below the thumb pad on the inside of the wrist, just below the bend). Count the beats for 15 seconds and multiply by four.
• Some prefer using only the fingertips; others say using more of the pads of your fingers can help with finding the pulse as you cover more surface area. Never use your thumb as it contains a radial pulse and you may confuse your own with the patient’s. Practice to see what works best for you.
• Reaching your fingers around from the top of the wrist and curling the fingers toward the underside can be a more comforting way to take a pulse than grabbing the wrist. This also works well when holding the arm to the chest to count respirations.
• If you can’t find the pulse at first, adjust the pressure. Press harder and then ease up. Some pulses are deeper than others.
• In certain cases, particularly trauma events, checking the pulse for bilateral consistency (both arms) is advisable.

Blood Pressure – Auscultation
• It can help to ask the subject what he thinks his blood pressure is. That can be a useful starting point. Pump up the cuff about 15 to 20 points above the expected systolic (first) number. You should not be able to hear the pulse.
• When putting on the blood pressure cuff, locate the “artery” notation and place that just above the interior side of the elbow over the brachial pulse. Be sure the cuff is put on snugly.
• Place the stethoscope diaphragm on the inside of the elbow at the bend and below the cuff.
• Position the subject’s arm so that it is fully extended. One field technique is to secure their hand in your armpit in order to stabilize the arm extension.
• Do not inflate the cuff until you are ready to take the reading. Make sure the earpieces are in your ears (angled toward your nose), the diaphragm is properly placed (test for sound first), and the cuff is snug before you begin inflation.
• Close the thumb valve on the bulb (right) before inflating, but not so tightly that you can’t loosen it with just a twist of your thumb and forefinger.
• If you hear the Velcro begin to pull apart as you inflate, recheck the cuff; you may have it on backwards.
• Don’t partially inflate and then deflate the cuff and try to re-inflate it. If you begin to deflate it, go all the way, and if you need to start again, start from the beginning.
• Open the thumb valve on the bulb (left) in order to slowly and smoothly deflate the cuff in one continuous process. Pay attention and note the number when you first begin to hear the pulse (systolic) and again when the sound of the pulse fades completely (diastolic).
• Note the subject’s position at the time of the reading: sitting, standing or lying down.
• Do not rely on any visual needle “bounce” as an accurate reading indicator. Generally, the needle may “bounce” during the period the pulse is strongest, but does not react to the first pulse sounds and ends before the last. Don’t be afraid to ask those around you to be quiet so you can listen for the beats.

Measured Growth

This has been a very good month.

We just completed an extremely successful New Member Academy.  The team graduated 38 new Type 3 Team Members. This number included 13 very enthusiastic Explorer youth members.  To a person, this was a great group. Our recruiters, HR team and oral board evaluators did a great job putting this year's academy together.  The academy staff and the additional 80+ team members who assisted during the academy set a gold standard for the new members.  We’ve added the new graduates to the callout roster. They’re going to pay huge dividends in the near future.

Separately, on October 5th, the Red Cross honored the Search and Rescue Team with a Community Heroes award. This award recognized the incredible work that the team has performed over the past year.  This award was also accompanied by proclamations from the State Assembly, State Senate, a member of Congress and the Board of Supervisors recognizing the team for outstanding achievement. 

We as a team do not do what we do for recognition and accolades.  But it is professionally rewarding to know the work each and every member contributes is recognized by groups like the Red Cross as well as our elected bodies.  As long as the team stays focused on the mission and performs at a level way beyond expectations, people will notice.  That is what is happening with the latest trend.  We’re being recognized for consistently providing the best service in the State. 

Finally, I want to give special recognition to our K9 program. As you know we recently got two trailing dogs on-line.  Additionally the K9 leadership has been working to update their SOPs and training manual to create a firm resource foundation.  The COCOSAR K9s have been working in coordination with our CARDA-affiliated members.  This group as a whole is really improving our K9 capabilities across the board.

This month the state has requested K9 trailing services through mutual aid to assist other counties.  In addition our HRD/Decomp dogs have been requested to assist with several crime scenes in Hercules and San Joaquin county.  This past week our handlers recovered human remains from a train vs. pedestrian in Oakley that weren’t recovered during the initial investigation. 

I’ve said it before and I’ll say it again, having a strong K9 program is going to increase the team’s missions.  The recent Clayton hasty search was originally a straight request from Clayton PD for “bloodhounds” to search for a medically at-risk 63-year-old man.  The officers were only looking for a dog to assist them.  When we spoke to them, we offered up the Hasty squad in addition to the K9s.  Clayton PD didn’t know that was an option.  Our Hasty squad responded (as did our K9s) and as a direct result of the Hasty squad's subsequent investigations, the subject was located.  We’ll see more of these situations as our dogs get requested.

We are going to see an uptick in requests for service as our overall capability expands.  The hard work the K9s are doing is going to ensure the work keeps coming.  This coupled with the great work all of you are doing ensures when we are called we provide the best service we can to the Office of the Sheriff and the county.  Thanks again

This Is What I’m Hearing

When I took on the role of Ombudsman for the team, I heard everything from, “You’re going to get an earful!” to “No one ever says much.” I found just the opposite – of both. Whether through an anonymous email, a private phone call or a casual conversation at a training, I heard team members offering thoughtful observations, asking insightful questions, extending praise and challenging the status quo with the goal of making us an overall better team.

A few themes came out of all the feedback: Team members want to have a better understanding of what the organization’s staff is doing (communication); team members want to know the rules of the road (standard operating procedures); and, team members want to consistently strengthen the team’s expertise and experience (proficiency). These themes fit very well with the feedback team members offered through the team survey conducted in the spring of 2011. At that time, team members offered 83 suggestions through the comments section. The command staff reviewed each one and 41 were accepted and put into motion. Another 27 were considered and put into the “maybe” category for further consideration, and 16 suggestions were rejected for various reasons. I was pleasantly surprised by the data. I had no idea what had been done with the survey results and was happy to see that so much of the information was put into action. That’s my goal as Ombudsman—gathering feedback from team members and putting good ideas into action with the Command Staff.

The command staff just held its annual strategic planning session in September for the coming year. We spent six hours one Saturday, as well as another evening meeting, discussing everything from the primary mission focus for 2013 to reviewing the organization’s staffing to combing through the 2013 budget line by line to ensure every dollar is spent wisely. As Ombudsman, I took the opportunity to make sure that all the valuable feedback I have heard from team members over the last six months – the insightful observations and the challenging questions – were a part of the discussion. Here are a few of the ways your feedback shaped the Command Staff’s strategic plan for 2013:

Communication
• Team meetings will be reorganized to provide more relevant and valuable information to team members, including an ongoing review of strategic projects.
• A condensed team meeting, held at the beginning of our monthly full-team training, will be reintroduced.
• Monthly Command Staff highlights will be posted to the team website and communicated to the team at large – probably through the Callout or team website.
• A Feedback Committee will be formed to collect, review, and present feedback to Bob Nelson, the Office of the Sheriff’s organizational consultant.
• And, we will conduct another team member survey in the spring.

Standard Operating Procedures
The started but stalled SOP project will be dusted off and re-invigorated with a goal of posting high-level SOPs for key business areas within the team.

Proficiency
We cannot succeed in our core mission if we do not have the core skills and this is reflected in the Command Staff’s attention to our proficiency. A large portion of the strategic planning session was dedicated to identifying and prioritizing the key objectives for 2013 – all related to our team’s proficiency in searching. The five objectives for 2013 will be 1) search management; 2) medical; 3) USAR integration (disaster response) 4) snow and ice; and 5) processes and systems.

Across the board, the staff is cataloging our team’s skillsets. CoSoSAR has developed an extensive database for all team member’s certifications and fulfillment of type-specific requirements. In the coming year, the staff hope to transition the manual database to an integrated, Office of the Sheriff-supported database for all volunteer departments. This transition will allow the command staff to continue to ensure that all team members have the expertise and physical training to perform our core mission.

I think you’ll agree that there are many areas in which you had direct influence on the priorities set for the coming year. Thank you for sharing your suggestions with me, and giving the Command Staff the opportunity to know what you are thinking. While we will never be able to accommodate every suggestion, many of the best ideas come from you. Please keep them coming. Email or call me anytime. My contact information is listed on our phone roster. If you prefer anonymity, feel free to use the feedback box within the members section of our website.

Searcher Spotlight: Joe Keyser

Image

When Joe Keyser joined the SAR Team in 2009, he had it in mind to “give back to the community,” as so many others do. He also thought he might pick up some useful training. But what he didn’t know about was the Mountain Rescue Group (MRG).

“Getting involved with the MRG was an unexpected bonus,” he says.

He also probably didn’t know how much he was going to get to use the wilderness-survival skills he had accrued over the years. These came into play in August when he taught the SAR Wilderness First Responder class.

Joe is a native of Portland who went to college in Washington, but has lived in Contra Costa County now for over 20 years. He, his wife, and lab-mix dog live in Concord.

Joe’s day job as a management and accounting consultant circles an office environment, so when he wants to get away he goes outdoors. For fun, he backpacks, hikes, skis, rides his mountain bike and travels. He also combines both work and fun as a backpacking guide in Yosemite during the summer.

During the WFR course, Joe emphasized improvisation. “While it’s important to have your gear ready,” he says, “you can’t possibly always carry everything you might need. Learn to make do with what you have.”

SAR has given Joe a wide range of experience, some of it surprising. “You never know where SAR might take you,” he says. “When I joined the team four years ago, I never would have thought I would help tear down sheds where a kidnap victim was held; become an EMT and teach a medical course; or search remote river canyons and mountains in parts of the state I’d never heard of before. The opportunities to serve the community while growing as a person as a member of the SAR team are almost limitless.”

Searcher Spotlight: Judi Apfel

Image

Though she has lived in Concord for 30 years, Judi Apfel is still sometimes in a New York state of mind. “I was originally from New York City and generally return at least once a year to visit family and refresh my New York accent and attitude,” she says.

She may have attitude, but so does SAR, she says – it’s an upbeat attitude and she enjoys that. She also likes the jokes, camaraderie, and yes, the hard work, too. 

Judi has a resume of what her mother called “do-gooder jobs.” She spent most of her career working to help others, starting with the Peace Corps in Honduras right out of college. When she moved to the Bay Area, she landed a job next door to OES, at Juvenile Hall, where she worked as a counselor. In her 40s, she went to law school and passed the bar, but then continued working for government agencies and nonprofits.

When she retired seven years ago, she joined SAR because she was looking for “something fun and exciting to do,” she says.

Judi’s dedication to search and rescue is exemplified in the many, many hours she has put in as a member of the Canine Resource with her dog Neva. Judi spent some 40 hours a month training Neva. However, Neva didn't make it to certification and two years ago, then age 9, she found a new job as the SAR PR pup and Judi’s loving it. “It has turned out to be one of the most rewarding activities that I participate in on the SAR team,” she says.

Though it seems as though Judi is ever-present with SAR, she does have a life outside the team with her partner of 40 years, Pat. The two share a common love of the water and belong to the San Francisco Dolphin Club. Pat enjoys open-water swimming while Judi kayaks.

But when it comes to fun, for Judi, SAR fits the bill. Though she has been around a lot of people bent on service, the SAR team is special, she says: “I have never worked with a more dedicated and selfless group of people than those on the SAR team.”

Medical Skills Refresher

CPR is one of the more perishable skills SAR members learn. Because it is not something that you use everyday (or perhaps ever), the techniques and procedures can easily slip from memory. The American Red Cross recognizes this and has developed a series of quick and free on-line refresher courses. They recommend you complete a refresher every three months to keep your knowledge and skills sharp.

The American Red Cross website is: http://www.redcrossrefresher.com/ There you’ll find refresher courses for both the lay responder and for “Professional Rescuers and Health Care Providers” (that’s us). There are four breathing and cardiac emergencies sessions covering professional rescuer scenarios.

You are also welcome to take the first aid scenarios. If you take the lay responder (for workplace, school, and individuals) CPR refresher, keep in mind that there are some differences between that course and CPR for professional rescuers (for example, lay responders don’t check for a pulse, we do).

For those who have CPR/AED skills down pat, there are other on-line quizzes you can take. A good one is the Wilderness Medicine Institute’s wilderness medicine quiz http://wmiquiz.com/wmi/index.asp  You can choose from six categories: anatomy, assessment, environmental, medical, trauma, or other (or a random mix). This site has 150 questions so it’s one you might want to come back to every once in a while.

So take a minute or two and refresh your CPR/AED and first aid knowledge before it slips away.

A Night on the Rocks

SAR team members had the opportunity to reach some new heights September 19 at the Diablo Rock Gym. Thanks to arrangements made by Matt Shargel, some members – both adult and Explorer – took to the rocks for the first time and others reacquainted themselves with their climbing gear. This event not only proved to be good exercise and practice for agility and strength, but it was also a teaching moment for trusting teammates as they held the belay lines for climbers.

September Mock Search

The September full-team training was held in the senior community of Rossmoor in Walnut Creek. A handful of role players got “lost” and/or “hurt” and the team set about to find them. About 80 SAR members showed up to trudge the streets and climb the hillsides around the valley. In the end, all the subjects were found and treated, including an Alzheimer’s walkaway who ventured to the dog park; her desperate husband, who was found on the trails after suffering an angina attack; and two mischievous boys who got themselves in a spot of trouble on a hillside, with one needing packaging and transport. Assistant Sheriff Sean Fawell came out to visit the training and got some insight into the way the Command Post is run.

Team Commendations, October

Caroline Thomas Jacobs was chosen for member recognition for the month of October.  As our team’s ombudsman, Caroline has done a super job as the team’s representative on the Command Staff.  She has marketed her responsibilities to the team, collected their feedback, represented their requests and questions to the Command Staff, and communicated back to the team.  She has put systems in place to collect feedback, and written articles for The Callout to communicate with the team.  She has raised the level of effectiveness of the position many times over what it has been in the past. Thank you Caroline for your ingenuity and hard work!