Speakers and Reactors:

Dr. Charles Denham – Moderator
Dr. Greg Botz
Chief Bill Adcox
Vicki King
Dr. Christopher Peabody
Dr. Brittany Barto
David Morris
Jennifer Dingman

Dr. Charles Denham:

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. I’ll be both your speaker and moderator today. We’re so blessed you’re joining us to learn how to keep your family safe. It’s my pleasure to introduce Jennifer Dingman, who has been a longstanding leader in patient safety, served on national committees, National Boards, is a published author, and most importantly, has been our voice of the patient throughout this coronavirus crisis. She is the 2018 winner of the Pete Conrad Global Patient Safety Award for her great work in national programs that have saved many lives and millions of dollars. Jennifer, would you please set our course heading for today?

Jennifer Dingman:

Thank you, Dr. Denham. It’s great to be here. I’m really looking forward to today’s program about how stressed our emergency safety net is. This is very important for all our participants. I urge you to share the future video with your colleagues, friends, and families. And again, thank you all for being here. I’ll hand it back over to you, Dr. Denham.

Dr. Charles Denham:

Thank you, Jenny, and thank you for all you do. So today, we’ll be covering our safety net. These are the questions we want to answer: What is the state of our public safety net, and why is it important for your family? How do you now deal with family medical emergencies given that the safety net has huge gaps, which you’ll hear more about? What do I need to know about EMS? How do we help loved ones get to the emergency department now that we’re coming through the Coronavirus crisis and hopefully will not be in a crisis state, but now have a frayed safety net with many gaps? How has Covid impacted law enforcement in addition to the divisive things that have been going on that have put enormous challenges against the leaders of our law enforcement community? How has Covid impacted our firefighters? And then finally, what can good Samaritans do now in this covid world, and what do we need to be aware of that’s critically important?

As we develop the documentary “First Responders, Best Responders: Out of the Danger Zone,” we’re applying principles that we’ve learned are extremely valuable for leading high performance. You’ll hear from Dr. Botz about high reliability organizations. The high-performance envelope intersects three spheres: great leadership, best and better practices, and enabling technologies. Leaders drive values, values drive behaviors, behaviors drive performance, and the collective behaviors of your organization are its culture. So leaders are absolutely critical, and good leadership skills are fundamental. What are the evidence-based practices in law enforcement, firefighting, emergency care, and even family care? And then finally, what technologies can enable those best, better practices led by our great leaders? We’ll keep coming back to that.

I’m delighted to have not only Jenny Dingman, but Dr. Greg Botz, who has dual faculty appointments at the University of Texas MD Anderson Cancer Center and Stanford Medical School, Chief Bill Adcox, who is the Chief Security Officer and Associate Vice President at the University of Texas MD Anderson Cancer Center, and Dr. Christopher Peabody, who prerecorded today. Due to the lack of staff to deliver emergency care, he couldn’t be on live, but we have his recorded discussion.

Charlie Denim will reference the checklist that Dr. Botz inspired, which we now use with families to help them stay safe throughout the Covid crisis. Dr. Brittany Bartow Owens is a community pediatrician who’s given us insights on caring for our young ones. Vicki King, the Assistant Police Chief at the University of Texas MD Anderson Cancer Center, along with Chief Adcox, is a leader in threat safety science. We also have David Morris, a forensic psychologist and JD, who’s passionate about what we can do in this public safety net, including law enforcement, firefighters, EMS, and the emergency department. And we’ll briefly mention David Bash, an award-winning educator who worked with Charlie Denim and Dr. Botz to develop the Family Lifeguard Program.

Our purpose is to enrich the lives of families, patients, and caregivers. Our mission at TMIT and the Med Tac Bystander Rescue Care Program is to save lives, save money, and create value in the communities we serve. Our core values, as taught by Anne Rhodes, are critical. What’s the DNA of your organization or its core values? We strive to live and breathe integrity, compassion, accountability, reliability, and social entrepreneurship. None of our speakers have anything to disclose. No money has been received from pharmaceutical or device companies, and we won’t discuss any products or influences. You can visit our website at www.Med Tacglobal.org to watch more content that we’ll continually update, including videos and monthly progress reports.

We’ve been through a tough time with the varied evolution of the virus. We have to be humble, recognizing that we may face more curveballs from the virus. Today, however, we’ll focus on our stressed public safety net. You can visit our website, where we post our 90-minute programs and break them into individual talks for easier consumption. We update these continuously as the science is constantly changing.

About three years ago, before the Covid Crisis hit, Chief Adcox and I, supported by Vicki King, Dr. Botz, and leaders from multiple organizations, including Mayo Clinic and former Swiss Health Minister Thomas Zeltner, focused on emerging threats in the threat safety science area. What keeps us up at night? Interestingly, readiness for epidemics was one of the recognized threats, with over 200 tracked annually by the WHO. However, there are other topics that we cover in a series of webinars. Throughout this program, we’ll remember we’re talking to you as families and family leaders of essential critical workers in our major medical centers and the 17 industry sectors Homeland Security defines as essential infrastructure. Just FYI, we also address healthcare employee fraud, patient fraud, and other areas.

TMIT is an organization comprised of more than 3,100 hospitals in 3,000 communities. It began as a nonprofit 37 years ago and has grown through collaborations with the Leapfrog Group, the National Quality Forum, CMS, and various federal agencies. CMS, or Centers for Medicare and Medicaid, pays the bills for those over 65.

Over the years, TMIT has established communities of practice with hospitals to improve their practices. We have amassed an impressive group of dedicated experts in various fields of healthcare, such as clinical, operational, financial, law enforcement, biomedical engineering, and many more. Additionally, TMIT works with numerous nonprofits and technology leaders. Our community now includes over 500 subject matter experts, with our community of practice now featuring about 130 subject matter experts.

The contributions to TMIT’s work come from various sources, including documentaries produced by the Discovery Channel and contributions from noteworthy leaders like Bill George, former CEO of Medtronic, professor Christensen from Harvard, Jim Collins, author of Good to Great and Built to Last, and Jim Besian, an astronaut and former patient safety leader for the Veterans Administration Hospital.

We conducted a study with over 1,000 families of essential critical workers to focus on readiness, response, rescue, recovery, and resilience. Our aim was to provide better educational information to families dealing with the ongoing crisis.

Our approach emphasizes head, heart, hands, and voice – what you need to know, what you need to feel, what you should do, and what you can share with others. We encourage viewers to watch our previous programs for more in-depth insights.

To date, we’ve conducted 42 90-minute broadcasts and online programs for families and professional caregivers, as well as 22 Survive and Thrive training programs. We have covered numerous topics and continue to update our materials in response to the ongoing crisis, including videos on masks and the latest CDC guidelines.

Our Survive and Thrive Guides began with a focus on coming home safely. Today, we’re revisiting emergency rescue skills. Other topics we’ve covered include fraud in the COVID ecosystem, COVID-safe practices, and updates on our household COVID study.

We are grateful for the contributions of our team of students and young leaders from high schools, colleges, and the community. They help us reach a wider audience and make a bigger impact.

In conclusion, TMIT remains committed to helping families navigate the ongoing crisis. We’re collaborating with a tenured professor at the USC Film School on a documentary and learning program focused on applying the lessons learned from the COVID-19 pandemic to future crises. We also recommend the recently released film “Team Player,” which addresses the latest issues on vaccination.

Now, let’s discuss the state of our public safety net. Most people assume it’s there until they face an emergency. This safety net has been severely stretched during the ongoing crisis, and we must adapt to deal with the new challenges we face.

Most of us believe that people are working tirelessly to improve and build our public health safety net. However, that’s not happening. We’ve lost one in five caregivers. Chief Adcox and Vicki King will tell you how difficult it is to recruit law enforcement officers. Dr. Morris will be addressing the challenges we have in terms of getting the right people in place, hiring them, training them, and promoting them. Most of us think that people are working on our community safety net, but that’s not really the case. Our public health safety net is pretty archaic. The COVID challenges have shown us that it’s not very good at all. We’re 60th in the world on our effectiveness, as evidenced by the terrible accident of a guy falling through the net.

Unfortunately, there are holes in our net, just like you see in that videotape. There are gaps in our safety net that are happening. As you see this now in slow motion, we’ve put it together for you to see that there is a hole, and the fellow went right through it. That’s what we’re dealing with now, holes in the safety net. Here’s the fellow going through it. Today, we want to talk about gaps in law enforcement, firefighting, and our emergency departments. What can you do to prevent an accident like this? As you watch, they miss the safety net because it wasn’t positioned correctly. Another one shows someone falling off the edge. Our safety net has evolved slowly, but our society has changed. Many things are new, and I hope our speakers will address some of those things. Not only do we have gaping holes in our safety net, but our safety net also doesn’t cover all potential dangers. The Melinda family performs without a safety net. I know these images are traumatic, but I want you to realize that we have problems with the safety net. It’s important that we recognize this and understand what’s going on.

Working with Chief Adcox, Vicki King, and Dr. Botz, we’ve identified that there are inside and outside threats to our safety. Inside threats are intrinsic to our family and put us at greater risk, while outside threats come from the community and events like COVID. Our goal is to create resilience, but staffing shortages due to COVID have increased outside threats and the risk to our families of getting timely care and early diagnosis. You need to become the Chief Family Officer in your family and address these threats. So, how do we deal with family medical emergencies?

We’re pleased to have Dr. Christopher Peabody, Associate Professor of Emergency Medicine at UCSF School of Medicine, which is a top 10 medical center in the US. He is the director of the UCSF Acute Care Innovation Center. I’ve known him since he was a third-year medical student. He’s an outstanding leader who has done a great deal of work. We consider him a guiding star of our Med Tac program, along with two other emergency department chiefs from Mayo Clinic and UCI. Let’s hear from Dr. Peabody regarding these issues related to emergency care. He and I identified the five rights of emergency care: the right provider, right diagnosis, right treatment, right discharge, and right follow-up. In the slide deck, which I won’t read, you can learn more about these rights and watch the videos because we want to get to our speakers. Let’s hear from Dr. Peabody, who recorded this yesterday because he is so busy in the emergency department.

Dr. Christopher Peabody:

Hello, everyone. Thank you for having me back. I want to talk to you first about the secondary effects of the Covid-19 pandemic. We’ve all been sacrificing for the past two years, and no one more so than those in the safety net system – the firefighters, EMTs, paramedics, police officers, emergency physicians, and ED staff who have felt this pandemic to their core. We can no longer staff our emergency department due to factors like burnout from taking care of patients with Covid-19. Our ED has had to close down beds, causing backups in the waiting room. Hospital beds are unavailable, leaving admitted patients waiting in the ED. Ambulances are turned away because we can’t receive patients.

This pandemic has taken a toll on us. Caring, diligent people have had to step back or leave the profession entirely. The social safety net is bruised, but we’re still here for you. Given the gaps in the public safety net, ambulance diversion rates, and ED wait times, I ask for your patience. We’re here to serve you, but there will be delays due to staffing shortages. We welcome you with open arms for true emergencies, but non-emergent conditions may experience delays.

The five rights of emergency care are even more critical now – the right provider, diagnosis, treatment, discharge, and follow-up. In many states, visitor policies haven’t changed, which makes it challenging to operate without visitors. Loved ones can advocate for you and help with discharge instructions. Understand your diagnosis, discharge instructions, and reasons to return to the ED.

In case of another surge, I recommend guarded optimism. Prepare by getting vaccinated and boosted, understanding the CDC mask guidelines, and knowing your personal risk tolerance and high-risk environments for contracting Covid-19.

Um, but first and foremost, it’s the vaccinations. These vaccines work; they’re the best tool we have to prepare and prevent another surge like the one we saw with the Omicron variant. I can’t predict the future, but I hope we don’t see the deadliness of another variant or another surge like we went through with Delta and Crottin. However, we’d be fools not to prepare for it. So prepare your family, make sure you’re vaccinated, and follow the guidelines if another booster is needed. Regarding immunocompromised family members, what is your advice going forward?

I know this group fully understands the details of rapid antigen testing for specifically immunocompromised individuals, so I won’t belabor that point. But what I would like to emphasize is, if you have an immunocompromised family member or you’re immunocompromised yourself, remember, you’re at a much higher risk. Not only are you at a higher risk of complications from COVID-19, but your precautions will differ from the general population. If they’re vaccinated and boosted, they might choose to go to more indoor dining, whereas you may want to continue avoiding poorly ventilated indoor areas, wearing high-quality masks, and taking other appropriate precautions.

Anything you can do to prepare for an emergency will pay off in spades should that time come. So have a checklist of your medical conditions, make sure your medical records are available, and have updated emergency contacts in your phone, especially if you live alone, are away for college, or have a senior in your family living alone without a constant advocate. For many of us, updating the medical alert portion of our phone is essential. When someone arrives by ambulance, it’s crucial to know their goals of care should they face a life-threatening emergency. Update your POLST form, have that goal of care discussion with your physician, even over a telemedicine visit. Understanding your goals for care in a life-threatening situation helps your emergency team know your past medical history, your medications, and provides the right care at the right time for you in the emergency department. Please take these steps now. This small amount of preparation could save your life.

Why is Good Samaritan care training important? Why should everyone get CPR, AED, Stop the Bleeding, pressure tourniquets, wound packing, EpiPen, and Narcan training? In emergency medicine, we have a phrase that emergency care starts in the field, meaning that what happens before you get to the hospital can dictate how well you survive, or even if you survive at all. When you’re trained in CPR, how to use an AED, how to stop the bleed, or how to revive someone with Narcan, you become a first responder or bystander with lifesaving skills for your family members.

Now, Chuck, you and I may be on the extremes of this, but you were kind enough to help my family get an AED, which I now have at home. We have more family members, two young children, and my sister-in-law just moved next door. I feel an obligation as a physician to be prepared for my family should they have a life-threatening cardiac arrest. I have an AED, a Stop the Bleed kit, and lots of first aid supplies in our house. We’re starting to teach other family members how to use these, how to perform CPR, use a tourniquet, and revive people with an EpiPen or Narcan in the case of anaphylaxis or unintentional overdose.

In San Francisco, where I work as an emergency physician, we’ve had more deaths from Fentanyl overdoses than from COVID-19 in the last two years. Narcan saves lives, and we’ve saved numerous lives with this opioid overdose reversal agent. We should all learn how to use it and carry it in our cars if possible. In an emergency, call 911, assess the situation, know how to perform CPR, use an AED, Stop the Bleed kit, EpiPen, and Narcan. These are great steps, and I’m so proud of you all for learning this. Chuck, it’s amazing that your organization provides these resources and training for free, getting people certified and equipped to be leaders in emergencies. Thank you for that.

Dr. Charles Denham:
We’re deeply grateful for Dr. Peabody’s insights, but we want to move on to our other distinguished speakers. Please review the slides and read them carefully for the five rights he discussed. We provide more detail on them and offer videos as well. This information can help prepare your family. Now, I’m delighted to introduce Dr. Brittany Barto Owens. I’ve known her since she was a child, and she’s now a community pediatrician. Over the past 24 months, she has provided invaluable content to us. Today, she will give us a quick update on what we should consider regarding children and emergencies. Many of us have younger children or older children caring for younger ones. Brittany, we’re so grateful for your time and expertise. You’ve been instrumental in helping us understand community pediatric issues and how to care for our families. With the safety net stretched thin, what should families know about taking their children to the emergency department and seeking emergency care?

Dr. Brittney Barto Owens:
First, it’s essential to understand that even though emergency rooms are stretched thin, your pediatric office is still available for questions. So, if you’re worried your child might need to go to the emergency room, call your doctor’s office for guidance. Many times, parents assume kids need to go to the ER when they actually don’t. Use your office as a resource to avoid unnecessary ER visits and ensure proper care for your child.

Dr. Charles Denham:
That’s a fantastic tip. If a child does need to go to the emergency department, what should we know, especially post-covid and post-omicron? We hope another surge won’t happen, but we know the emergency departments are stretched. What should we consider when taking our child to the emergency department?

Dr. Brittney Barto Owens:
For non-emergent ER visits, be prepared for delays due to the shortage of nurses and the increased workload. Please have patience if your child needs stitches on their forehead, for example. The nurses are doing their best, so avoid getting angry if things take longer than expected. It may take more time for non-emergent cases since those needing immediate care will be prioritized. Understand that you might be waiting because another child requires urgent attention, and you would want the same care if it were your child.

Dr. Charles Denham:
We’ve adapted the original SBAR tool (Situation, Background, Assessment, Recommendation) used by nurses to communicate emergencies to doctors, creating an SBAR for patients. It helps parents organize their thoughts by stating the situation, giving the background, sharing their assessment, and making a request. Is that a reasonable approach to help communicate, especially when everyone is so overwhelmed?

Dr. Brittney Barto Owens:
Absolutely. That’s an excellent way to present your concerns to others and stay organized.

Dr. Charles Denham:
Brittany, what are the most common myths you have to dispel regarding Covid, vaccines, and family care?

Dr. Brittney Barto Owens:
Early on, there were some misconceptions about the vaccine that made parents hesitant. One was that the vaccine causes infertility, especially concerning for young girls approaching puberty. However, there’s no plausible connection. In every vaccine, we’ve never seen any infertility issues. There was a study done to address these concerns, comparing a group trying to get pregnant and found no difference in successful pregnancies between those who had the Covid vaccine and those who didn’t. Actually, the Covid infection itself caused temporary infertility in men. So, that’s a significant misconception. The vaccine doesn’t seem to cause any issues, but the Covid infection itself can have effects.

Dr. Charles Denham:
So, there are risks to unborn children, moms, and potential dads from Covid, but no risks to any of them from the mRNA vaccine?

Dr. Brittney Barto Owens:
Correct.

Dr. Charles Denham:
Good. So, Dr. Brittney Barto Owens, some people are hesitant about vaccinating children against COVID-19 because they believe children have a mild disease. Can you share your perspective on this?

Dr. Brittney Barto Owens:
Certainly. It’s true that some children may have mild disease, but when we compare COVID-19 to other diseases that children are vaccinated against, such as measles, the number of deaths from COVID-19 is much higher. In fact, around 66 kids might die from COVID-19 each year, which doesn’t even account for the additional mortality and morbidity caused by children spreading the virus. The goal of many childhood vaccines is not only to protect the child but also the wider population. This is the same rationale for the COVID-19 vaccine – to protect both the child and the community.

Dr. Charles Denham:
I see. What about the new guidelines for mask-wearing? What advice are you giving to parents?

Dr. Brittney Barto Owens:
I’m glad that the CDC has provided a framework for reducing mask-wearing, helping us transition from pandemic mode. Their guidelines consider factors such as cases per 100,000 people, hospitalizations, and hospital bed occupancy, which is great. This allows us to feel more comfortable unmasking when cases and hospitalizations are low. However, the CDC’s threshold for cases per 100,000 is higher than previously used, without any data shared to justify this change. In low case and hospitalization scenarios, I would recommend masking indoors at a lower threshold than what the CDC currently advises.

Dr. Charles Denham:
So, in essence, you’re advising families to be more cautious with mask-wearing because the CDC’s recent guidelines may be too liberal in terms of unmasking. Is that right?

Dr. Brittney Barto Owens:
Yes, that’s a reasonable statement. The decision to wear a mask should consider community immunity, infection rates, and hospitalization rates. When immunity is high and rates are low, it’s safer to unmask. However, when infection rates are high and community immunity is low, we should be more cautious. I’m particularly careful as I have immunocompromised family members and a son who’s had severe reactions to viruses in the past. I recommend wearing high-quality N95 masks and avoiding indoor areas when necessary.

Dr. Charles Denham:
Thank you for providing some clarity in this confusing area where misinformation, disinformation, and malformation abound. You’ve really helped us navigate these murky waters.

Dr. Brittney Barto Owens:
You’re welcome! Take care.

Dr. Charles Denham:
That was Dr. Barto. We have a slide covering the concepts of misinformation, disinformation, and malformation if you’d like to see a more detailed framework. Now, moving on to EMS (Emergency Medical Services), they are facing similar challenges as described by Dr. Peabody. Many caregivers have died, and some websites have even stopped counting the deaths. With one in five healthcare workers leaving the profession and many others suffering from long COVID and unable to work, EMS coverage has been significantly affected, especially in metropolitan areas. Be prepared to take care of a loved one and get them to the emergency room yourself. You may have to wait in the parking lot or even go to a different hospital due to diversions. It’s important to have a pulse oximeter at home, wear masks, and ensure good ventilation when transporting someone to the emergency department.

And then, as Dr. Peabody had said, after discharge, it’s important to make sure you have everything you need, know what the discharge precautions are, get the proper medications and equipment for home, and be aware that someone will have to take care of these tasks if people are feeling sick. Now, we’re moving on to discuss law enforcement and its importance for our families. Interestingly, at the last count, there were five times as many police officers dying from Covid as from gunfire, which is quite remarkable. We’ll now hear from Vicki King, Assistant Chief of Police for Converged Threats, Risk Protection, and Investigations at MD Anderson Cancer Center and the University of Texas Health Science Center. She will be joined by Chief Adcox, Vice President and Chief of Police for the University of Texas at Houston, who provides protection and is a key figure at the Texas Medical Center, with whom we work daily. He’s a co-founder of the Med Tac Program and the Emerging Threat Program for top medical centers. We’ll ask them to give a snapshot of what’s going on in the police and law enforcement, what you should know for your family and community, and why it’s important to not defund our police but to fund the right and best players. I’ll stop sharing now and ask Vicki King to begin. Vicki has also been the Assistant Chief of Police in Houston and had all departments reporting to her. She is a thoughtful academic in this field and a great speaker for our programs. Vicki, would you kick things off?

Vicki King:

Thank you, Chuck. I will share my screen, and Bill and I have decided to team teach this session. Each of us will take a part of the presentation if that works for this group. Can everyone see our screen?

Dr. Charles Denham:
Yes, ma’am.

Vicki King:

Alright. So, Bill, take it away.

William Adcox

Thank you, Vicki. And thank you, Dr. Denham, and everyone on the program today. We’ll try to provide some context regarding the erosion of police services and the public safety net. Most of you are aware of the tremendous increase in violent crime in our communities. However, you may not know that we are facing what could be called a perfect storm – not only is crime increasing, but there’s also an erosion or shrinking of the public safety net. Vicki and I will walk you through a data-driven overview of this issue, highlight the healthcare issues at play during the pandemic and crime increase, discuss the impact, and briefly talk about potential improvements or solutions. So, if we go to the next slide, Vicki, you can take it from there.

Vicki King:

Thank you. We all know that COVID-19 turned our world upside down. When we look at the impact of COVID on healthcare and its relationship to law enforcement, we know that our healthcare communities are target-rich environments. Pre-COVID, workplace violence was rampant, particularly in emergency departments, where instances of violent rage could lead to violent events. We were also combating cyber attacks, ransomware, denial of service, and data breaches, attempting to strengthen our firewalls and protect our PHI and communities. We were also aware of insider threats, drug diversion, patient safety concerns, PHI breaches, theft of intellectual property, and sometimes these were due to careless acts or coordinated malicious actors trying to harvest lucrative PHI information from our hospital IT systems. And, of course, there was theft and fraud, grant research fraud, Medicare insurance fraud, and criminal enterprises targeting prescription drugs for illicit use. These were pre-COVID threats targeting our healthcare institutions. Post-COVID, workplace violence in the emergency rooms began to shift, with those opposing vaccines, the politicization of treatments, increased domestic violence, and more volatility from patients.

Just because you become ill doesn’t mean that the world’s problems you had at home, you didn’t bring those with you. In a high-stress environment, it’s likely that it will bring you closer to an affective response, a violent response to frustrations, wait times, and other stressors you may encounter in the healthcare environment. In today’s world with the geopolitical situation in Ukraine, cyberattacks are real. They can come from state-sponsored actors or individual hackers who are targeting our institutions. We saw a massive influx of false and fraudulent workers’ compensation claims, as well as unemployment claims hitting many of our healthcare institutions. Malware and Trojans became more prevalent, exacerbated by the fact that many of our administrative staff were sent to remote work locations, outside the protection of institutional firewalls. In the at-home environment, they were sometimes more careless with IT and which emails they clicked on, adding a whole new layer of complexity.

Certainly, the insider threat became more pronounced. The theft of PPE, once abundant and hardly considered a target for theft, became our most treasured commodity when the supply chain was disrupted at the start of the pandemic. People were desperate to protect themselves and their families, and there weren’t enough supplies to go around. Many healthcare workers had to improvise or reuse PPE, which isn’t optimal for protecting against communicable diseases and other pathogens.

As for theft and fraud, the black market for PPE and supplies flourished, along with Medicare and insurance fraud schemes related to COVID testing and treatment. The snake oil salesmen were in full force when the pandemic hit. Layering on the environmental impact of the criminal justice system, we saw court delays as they struggled to adapt to remote proceedings, compassionate release of jail offenders without proper assessment of risk, and reductions in new jail admissions. District attorneys stopped prosecuting certain types of crimes, and there was a trend towards no or low bail, even for those who committed subsequent crimes while out on bail.

From a law enforcement standpoint, social distancing practices made it difficult to interact with the public while trying to maintain personal safety, especially when there was a lack of PPE for law enforcement. There was a shift to taking phone reports rather than in-person reports, less evidence collection at crime scenes, and a reduction in the arrest of offenders. Fewer proactive policing measures were taking place, including traffic stops, suspicious person stops, and Terry stops. All of these factors contributed to the erosion of our safety net in the criminal justice system.

 

William Adcox
On May 25th, 2020, during the pandemic, George Floyd was murdered by four Minneapolis police officers who knelt on his neck until he died. This horrendous event ignited widespread outrage against police brutality and racial injustice across the U.S. As Dr. Martin Luther King Jr. stated in his letter from the Birmingham Jail in 1963, “Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.” These words have never been more true than during the events following George Floyd’s murder.

This event forced a reevaluation of policing, where officers are supposed to be the guardians of peace, facilitators of justice, and protectors of the vulnerable. However, some unforeseen impacts arose from this reckoning, and we will discuss them further. Next slide.

Vicki King:

As calls to defund the police and abolish the police began to grow around the country, Gallup initiated a panel. This was extremely illuminating. Black Americans were surveyed, and they said that they wanted the same or increased levels of police presence in their neighborhoods. The slogan of defund the police and abolish the police, while a great rallying cry, is not reflected in reality. 81% of those surveyed wanted the police to stay or increase in their neighborhoods, and just 19% wanted less police presence. These figures are consistent with earlier surveys, where only 22% of black Americans wanted to abolish the police as we know them.

Serving the community is what people want. All Americans—black, white, Hispanic, Asian—we all want to live in safe communities. No one wants to be oppressed or abused; they want to feel safe and secure in their communities. The calls to defund or abolish the police may sound great on a placard, but the unintended consequences are severe. Unfortunately, some community politicians took it to heart. The defund the police movement seemed to correspond with a rapid rise in crime. FBI data shows an unprecedented spike in murders across the nation in 2020. The trend data suggests that 2021 may exceed the levels of 2020.

As this mantra spread across the nation, the reduction in police services had a very real effect in communities. Blood was shed, and lives were lost because police were not there. In urban environments, the FBI tracks data by city. As you can see, is your city on this list? What was the increase from 2019 to 2020? What occurred during this abolish the police movement? What does the data show us? We can also look at the number of arrests. Police began to pull back, retirements increased, and officers left the profession. This resulted in unsolved crimes and arrests not occurring. This left many victims and their families suffering with no recourse. If a predator escapes, they will continue until there are consequences for their actions. Crime is going up, and arrests are going down. Officers pulled back, and they also suffered a tremendous burden with assaults on police officers. Murders of police officers increased by 58.7%. This is astounding, and as a parent of police officers, my heart is in anguish when we see these events happening within our communities.

William Adcox

There are multiple factors causing the nation’s shortage in police staffing. The COVID-19 pandemic, anti-police rhetoric, surging workloads, and talks of abolishing protections like qualified immunity are all contributing. Qualified immunity is a court ruling that applies to all government workers, including teachers and sanitation workers. It needs to be looked at in terms of its real meaning across the board. Abolishing it could have unintended consequences, opening up cities and counties to litigation, and making police officers feel unprotected while lawfully doing their jobs. Obviously, if a police officer does something unlawful, they should be held accountable.

There are increased dangers for police officers. As Vicki mentioned, there was a 58.7% increase in murders of police officers from 2019 to 2020. There is also reduced accountability for individuals committing crimes in our communities for a multitude of reasons. The labor pool for police officers is also shrinking, with fewer people applying to become police officers, which is a growing trend.

Vicki King:

So when you examine the implications for our communities, a 2021 survey by the International Association of Chiefs of Police revealed some concerning trends. The survey found that 78% of agencies had difficulty recruiting qualified candidates, struggling to pique people’s interest in law enforcement careers. In addition, 65% of agencies reported an insufficient number of applicants for law enforcement positions, a stark contrast from the time I applied when there were often 100-150 applicants for a single opening. Furthermore, 75% of agencies found that recruiting had become more difficult over the past five years. Given the many stressors associated with policing, it’s no wonder that family support for pursuing a career in law enforcement has diminished, making it harder to attract recruits.

50% of agencies reported changing agency policies to increase the chances of attracting qualified applicants. These changes range from seemingly trivial matters, like allowing officers to have facial hair, to more concerning alterations, like reducing requirements regarding previous convictions for misdemeanors, theft, or drug use. This leads to worries about the potential for lower standards in hiring officers, as past convictions for theft and similar offenses can reflect on an individual’s character and ability to resist temptation in the workplace.

Moreover, 25% of agencies reported having to reduce or eliminate certain services due to staffing difficulties. For example, last November, the Austin Police Department announced they would no longer respond to non-emergency calls, urging citizens to document and collect evidence from break-ins themselves. This raises questions about how evidence will be submitted, analyzed, and how investigations will be conducted to hold perpetrators accountable. If citizens are left to investigate their own crimes and police only respond to the most severe incidents, it will likely further erode public confidence in law enforcement.

William Adcox

While policing is undoubtedly at a tipping point, we must work to change the narrative by emphasizing accountability and professionalism. We need to repair and strengthen the safety net that law enforcement provides. Key to this effort is the hiring and selection process, ensuring that police forces are reflective of the communities they serve. Diversity, encompassing race, sexual orientation, and other factors, is crucial.

Additionally, it is vital to increase the representation of women in policing, which currently stands at a mere 12-13% nationwide. Numerous studies underscore the importance of having more women in law enforcement roles. Once a diverse workforce is recruited, it’s essential to evaluate the character of applicants, as this will have a significant impact on their performance as police officers.

Vicki King:

So when you consider the implications for our communities, it’s essential to have the ability to screen individuals to ensure they possess solid character. They should not be racist, thieves, sexual predators, or members of extremist groups that are antithetical to the values our great country represents. This is a critical component. We also need to implement early warning systems and values-driven corrective action processes. While policing has often focused too much on the conduct of officers, we need to look at their overall behavior and ensure they comport themselves daily with the values the community demands and expects, which is essential for the job. Policies should be in place that allows for holding them accountable. This involves development, making sure they can fulfill these expectations.

Another crucial component is the continuous development of personnel. Hiring the right people and providing the right development leads to the right candidates for promotion. We need the best promotional systems, and Dr. Morris is one of the best in the country at implementing these. Furthermore, we must be able to retain competent employees, especially those with great character and leadership qualities. Strong accreditation and oversight are also necessary. Less than 6% of the nation’s police departments are accredited, but accreditation helps set standards and develop a foundation, although it is not the complete answer. Community involvement in police departments and their oversight is vital, providing checks and balances. While police unions should focus on areas like safety and compensation, management should retain authority over work assignments and corrective action. This should be done quickly and appropriately, with due process. Now, I’ll let Vicki take the next point.

Vicki King:

Right. When we talk about building social capital with our community, it’s important to create transparency and inclusion with community stakeholders, even outside of crisis situations. There are many excellent programs that foster these connections with school boards, PTAs, youth sports groups, NAACP, LULAC, ACLU, and more. By reaching out, listening, and having informal exchanges, we build relationships that prove invaluable during crises. If community members trust you enough to call you and know you’ll be honest with them, they’ll stand with you even when an officer fails to live up to community values, knowing that you’ll take strong corrective action to ensure officers represent our constitution, value civil liberties, and serve as guardians and protectors, not merely enforcers. It’s also important to direct resources toward community needs and priorities. If your community isn’t concerned about rigid traffic enforcement and perceives it as a revenue generator rather than a protection strategy, you’ll lose credibility.

I’m not saying that traffic enforcement isn’t important, it is, but what I’m saying is that the resources have to be commensurate with the protection of the community. And you can’t listen to community needs and issues if you are walled off and you don’t have those informal interactions, and you don’t go to them. They’re not going to come to you. You have to meet them in their community, in their environment, and listen. If they know that you’re going to listen and they know that you’re going to respond, you’re going to build that social capital that you need to gain the respect of the community. And trust is the most important thing. We have to rebuild trust. When we rebuild trust and we recruit our next generation of police officers from that community, and they know that we hold those values true, then we’re going to work out of this problem. There will not be calls to defund you. There will be calls to support you. And those are the things that we’re trying to build in our community as we move forward. So, Bill, I’m going to let you see if there’s any final questions.

Dr. Charles Denham:
We’re going to move right to Dr. Morris, because we’re a little short on time, so we’ll move directly to him. And if you can stop sharing, Vicky, then I will share, and we’ll have Dr. Morris bring us home. And for those that are watching our extended program, we will be hearing from Dr. Cox as well, or Dr. Fa, I’m sorry, Dr. Bots as well. And what we’d like to do is have Dr. David Morris now, and I’ll be advancing slides for him. He’s a forensic psychologist, an attorney, an expert advisor to public safety organizations on performance improvement. His bio is on our website, which is very impressive, as are both Bill’s and Vicki’s. And Bill and Vicki, thank you so much for giving us a comprehensive view of where the gaps are and why our law enforcement safety net is so important. David, would you like to kick it off here? David, are you there? If you’re on mute, please unmute.

David Morris:

Oh, I’m sorry. That was the most popular expression in 2020. I should have known, I apologize for that. You alright? So, I want to thank you, Dr. Dunham. I enjoyed listening to Chief King and Chief Adcock and all the others on the issues that we’re facing in this safety net. I am the CEO and president of a small firm whose primary mission is to help build a stronger and more diverse public safety. And we do this all over the country, from California to New England to Florida, and everything in between, for over 260 agencies. I’m proud to provide that service, but what I’ve learned along the way is that the old way we used to test won’t work anymore. And this is what everyone needs to remember when they’re engaged in selection, diversity is key in all your personnel decisions.

Public safety is the face of government. If people do not see themselves represented in public safety, then it is a psychological certainty that that government is courting dissension from those people. I’ve seen that all over the world. I’ve seen it in our own country. We all have. So the challenge is that we want to increase and strengthen public safety using good testing procedures and assessment procedures. And we want to do that to increase not only quality but also diversity. That’s going to be a challenge, and it’s going to challenge the traditional way of using assessments. So, Chuck, can you give me that next slide? In the face of emergency, public safety is who we call. They’re the people who come to help us. So they’re essential. They’re facing numerous challenges, and we’ve got to adapt to these new challenges.

And so we’re up to the challenge. We’re there, we’re adapting, and we’re achieving diversity and increased quality under some really different dynamics. Next slide, please. When Chief King was talking about when she first applied, it would be like a hundred candidates for every one selected. So if you look at this diagram, there’s a few blue dots in there. Most of them are red dots. The blue dots are people who will be successful in public safety. Our challenge is to find them. The old traditional way of testing once every two years, trying to find those blue dots, that’s not going to work. Public safety, like every other element of human resources, is a flowing river out there. Those dots are here today, but if you wait until tomorrow, those dots will be diminished.

They will no longer be there. So, next slide. You’ve got to imagine that you’re trying to catch and identify these blue dots among the massive red dots because not everyone is able to serve. Research shows that about 70% of all the people who even want to be in public safety, which Chief King said has diminished a lot, won’t make it. You’ve got to identify not only among the people who want to be in public safety but those who can be in public safety, those true blue dots. You’ve got to imagine yourself as a fisherman or fisherperson, I should say. If you throw that net out there today, that’s good. But if you wait a year from now, the dots that were there, the good people that were there a year ago, won’t be there anymore.

You need to adapt your testing. As Chief Adcock says, you need to look at character and reconsider how you do the testing. We’ve been able to increase the diversity of African Americans in public safety positions by 208%, not by lowering the quality but by changing the metrics we use. We’ve also increased the percentage of women in public safety three times the national average, not by lowering the standards but by changing the way the assessments were conducted. So when it comes to entry-level positions, you need to think of it as a river rather than focusing solely on promotional assessments or promotional procedures, which should be conducted more frequently. I’m working with one of the third largest jurisdictions in America, and they haven’t conducted a promotional exam for 12 years. I feel sorry for those who joined public safety as a career and are anxious about how they might perform on such a rare promotional exam. We need more frequent and regular promotional programs that look at more than just a multiple-choice test. The traditional methods used by HR need to change. We can’t have multiple hurdles. If you don’t pass one, we won’t even consider you. Most assessments are compensatory, meaning that if someone doesn’t score well on one test, they might excel on another.

You need to rethink how you conduct assessments to get the quality you’re looking for and even increase it, along with diversity, as both are essential in public safety. Consider a written test to assess knowledge, but also consider structured or constructed oral assessments to identify the best decision-makers who can multitask effectively. They might not be the top multiple-choice test takers, but they’re the best supervisors, men and women in public safety. Please consider changing the way you set the hurdles and tests. Although we’re a small agency, we are one of the primary providers to most major cities in America, and our goal is to push them to adapt to new ways of assessing and selecting people. What Chief Adcock said is true. We used to think you had to be the smartest person in the room to be a good public safety officer. That’s not the case. You just have to be smart enough. Character is essential. It’s about your commitment to the organization and serving the community. You can assess character through multiple-choice tests developed in the last 20 years, but there’s no substitute for a background check. So, what does this mean for you, a typical family of four, your children, your loved ones? It means you need public safety to be there when you need help. Thank you for the opportunity to talk to you. Chuck, it’s always a pleasure, and Vicki, it was good to see you and Bill. I’m pleased to be part of this, and it was amazing to listen to everyone provide information.

Dr. Charles Denham:
Thank you very much, Dr. Morris. We’re going to wrap up at about the 90-minute mark. We have an extended program with comments from Dr. Botz regarding the eight leading causes of death that Good Samaritan Care can address. We want to make sure everyone knows that firefighters are experiencing the same burnout and attrition. It’s a popular job, but they’re all being stretched, especially EMTs working diligently. We’ve had the great opportunity to work with them in our Med Tac program. I’ll tease that for a moment, and then we’ll come back to our participants. On the left are our Cub Scouts, who are now in their mid-teens.

In the upper picture, you can see three firefighters working on our Med Tac program. This program aims to bring the necessary skills to Good Samaritans and work hand in hand with firefighters, law enforcement, and our emergency departments. I would like to return to Chief Adcox, Vicki King, and Dr. Morris in just a moment. However, for those watching the extended program or interested in Dr. Botz’s take on our Care University program with Med Tac, I’d like to highlight our certificate program. We are certifying EMTs and teaching people to become instructors in Stop the Bleed and CPR, addressing the eight leading causes of death displayed on your screen.

I’ll quickly go through the next part. We have six articles, with a seventh one addressing some of the points Dr. Peabody discussed. For those staying for the extended session, you’ll hear Dr. Botz address why, in a post-COVID world with a safety net full of gaps, cardiac arrest, CPR, choking, drowning, resuscitation, Narcan for opioid overdoses, EpiPens and reversal agents, epinephrine for anaphylaxis, Stop the Bleed for bleeding, infection care beyond COVID, and transportation injuries and deaths are crucial. We see a hundred drive-overs a week, with 60% involving drivers who are either parents or known to the victims, resulting in four deaths. Finally, let’s address bullying.

To keep those pursuing their CME training within the 90-minute limit, let’s return to our live speakers. Chief Adcox, thank you for the comprehensive presentation. It’s valuable to have you and Vicki share insights on the importance of funding and understanding law enforcement. Would you like to react to what you heard about the other groups? We often discuss how firefighters, EMS, emergency departments, law enforcement, and Good Samaritans need to collaborate. Could you address why this is crucial post-COVID and as we navigate these challenges?

William Adcox:

Absolutely, thank you. I’ll use the example of the spike in murders. The murder rate would be much worse without bystander care and Good Samaritans willing to help with Stop the Bleed and CPR. Nowadays, they have cell phones for immediate location reporting, no need for landlines. The EMS and firefighters are well-trained and equipped with the best medical technology, some even carrying whole blood. They can transport victims to top-tier emergency rooms and trauma centers, saving more lives than ever before. However, murder rates remain high, emphasizing the need for bystander care and the high-quality front-line personnel trained to save lives. We’re fortunate to have TMIT and Med Tac teaching everyone how to treat the eight most preventable causes of death. It’s working, and it’s a great program.

Dr. Charles Denham:

Thank you, Bill, for being a pathfinder and a threat safety scientist. Vicki, your thoughts on the same question about weaving together the safety net strands, considering the trapeze analogy and the gaps created by recent events. How can we broaden the net as things evolve dramatically? As an innovator and creative thinker, what can you add about working together to integrate these four net strands?

Vicki King:

Yes, and I have to piggyback on what Bill said. The beautiful thing about community and unity is that when we come together to solve a problem, there’s nothing we can’t overcome. Med Tac is a great opportunity to weave all and be that safety net, that Swiss cheese, the safety net under the safety net, the bystander care that a good Samaritan can bridge the gap and help give someone in distress those extra couple of minutes when it takes your first responders to get there. When we have a safety net that is stretched and stressed, that has gaping holes in it, we have to find another way to overlay. Bystander care is probably one of the most innovative and effective ways to help be a force multiplier in our community. So, sharing that information with our community and supporting your firefighters, your police officers, and being there as their underpinnings when the going gets tough, don’t abandon them, help them. We can all, as a community, get through this crisis together. Hopefully, Covid will not be with us forever. It’s in the endemic stage. There will be new variants, but if we work together to combat the problem, care for one another, using all the tools that are available so that we can get that person to those level one trauma centers and the best chance for survival, we will save lives.

Dr. Charles Denham:
Thank you so much, Vicki. And thank you for being such an articulate communicator of the complexity of what we’re facing. I know many of our audience are families, but they’re family members who have spouses and loved ones that are right up there on the front line. You and Chief Edcock have provided some real granular detail that makes it make sense why we’ve got to fund things. Let me come back for the final comment from Dr. Morris. Dr. Morris, you’re so passionate about training and promotion, and we ask you to apply to the narrow scope of law enforcement, but really the principles that you describe are what we’ve really got to do to integrate. The way I’m kind of thinking of it is the safety net is like that trapeze safety net. It’s got big holes in it, and we gotta make the net broader because things are evolving. We’ve got a lot of new things happening, that means the net’s gotta be wider, deeper, and longer. So not only do we miss the holes in the net, but also capture some of the new things that are happening. Is that a fair statement? And how would you like to build on what Chief Adcox and Assistant Chief King have said?

David Morris:

Yes, it’s a very fair statement, Chuck, and there’s no question that the net is in danger, but we can do it. We can actually repair it and we can adapt to the circumstances we’re faced with. I’m a passionate believer that public safety is an essential element of that safety net, along with the medical and other services that you’ve described quite aptly. The adaptations that we have to make are in place, and we’re actually making sure that we adapt to that. You’ve got to have stronger public safety that has to be more diverse to have a sustainable government. And that is really where we need to recognize that we’re going to have to do things differently.

Dr. Charles Denham:
Well, listen, I would like to thank all of you so much for speaking. For those that are getting continuing education credits, this will be your 90 minutes if you’d like to apply for two hours. We’re going to play the recorded message from Dr. Botz who’s in the ICU today, addressing the Med Tac eight, and why each one of these is so important for you and your family. There are gaps in the net. The first thing you could do is to recognize that EMS is not going to be an 8 to 12-minute response time. And even if it is, you may be sitting in the parking lot with your loved one. We’ve had one of our dear close friends have an accident this week, and it does take longer. So for those of us that have families, it’s so important to learn some of these basic skills. Three minutes from drop to shock, three minutes from a gunshot or a severe bleeding event to stopping the bleeding can save lives and long-term harm. So, what we’ll do is we’ll thank everybody right now. I’m going to just play the short clip from Jenny Dingman to close us for the 90 minutes. And then those of you who want to stay on, we’re going to have Dr. Botz discuss the Big Eight of Med Tac. But thank you to our speakers. If you all have to go, we understand. Many thanks and God bless all of you.

David Morris:

Thank you.

Dr. Charles Denham:
So, Jennifer, would you please close us out today?

Jennifer Dingman:
Of course. To the audience, the patients, and thank you for all you do for Patient Safety and quality. Thank you, Dr. Denham. I also want to extend my thanks to all of our speakers for their valuable knowledge and insights today. I urge everyone listening to please share this recording with friends, colleagues, family members, and neighbors. I look forward to seeing you all again next month. God bless, and thank you for being here.

Dr. Charles Denham:
We want to extend our thanks to those of you who are staying with us. What we’re going to do now is address the topics of Med Tac and Good Samaritan Care, which are too broad to cover fully in our 90-minute session. However, we do have a message from Dr. Botz, who will speak to these issues. Dr. Botz is a full professor of anesthesiology and critical care at MD Anderson and the University of Texas in Houston. He’s also an adjunct clinical professor in the Department of Anesthesiology at Stanford University School of Medicine. We are truly grateful to have him as one of our leaders.

Dr. Botz is our clinical lead on the Med Tac program. He, along with several emergency medicine doctors, will be discussing why it’s critically important for everyone to learn CPR and how to use an automatic defibrillator for cardiac arrest. It can dramatically reduce not only deaths but also the long-term effects. We have several videos covering topics such as choking and drowning, which are especially critical now that we have two years of children who haven’t had swimming lessons returning to pools, beaches, and lakes. The opioid crisis is devastating, with more than 258 deaths per day. This number has increased significantly during COVID. The public now has the opportunity to obtain Narcan, a reversal agent that anyone can use. We are helping the public learn how to use it and training security officers, lifeguards, EMTs, and others to address the terrible problem of opioid overdose.

We know that one in 10 schools will have a child experience an anaphylactic event, an allergic reaction to a medication, insect bite, or food. It’s incredible how many adults have these reactions as well. The Stop the Bleed program, part of the American College of Surgeons, is an excellent program. We are teaching it, even training instructors via Zoom, including tourniquet application, wound pressure, and wound packing. Infections are a significant concern, not just COVID but dangerous pathogens in our soil and environment that can lead to death. Sepsis, a widespread infection, can start from a simple wound. Transportation accidents are frequent, and as our children become more active and return to school, these safety measures are critical. That’s why we’ve included it as our seventh target area. Lastly, bullying, which can lead to “bullcide” or suicide, is a critical issue. There’s a lot of pent-up anger from COVID, and we have critical problems to address. Now I will play an overview by Dr. Gregory Botz, and then we will close the extended session. Dr. Botz, one of our eight topics that we focus on with Med Tac is out-of-hospital sudden cardiac arrest. Is it reasonable to say that to protect our families and loved ones, this Good Samaritan care is important and that perhaps more of us should get CPR trained in light of the safety net being stretched?

Dr. Gregory Botz:

I think now, more than ever, bystander rescue care, including CPR, is an important component in lifesaving in our communities, especially during the times of COVID. As we try to transition from the pandemic to an endemic phase, our first responders are stretched. They don’t have as many providers to cover the real estate that they have to cover, and so response times may be prolonged. We know that in sudden cardiac arrest, the most important thing is early and effective CPR. So if our bystanders can provide good hands-only CPR in the event of a cardiac arrest until our professional first responders can get there, the chances of a good recovery are much better.

Dr. Charles Denham:
Terrific. Dr. Botz, the second topic is choking and drowning. Given that during the COVID period of almost 24 months, many children haven’t been able to get swimming lessons, and now we’re opening up the floodgates with summer approaching. How important is this? Let me restate that. Okay, Dr. Botz, the second topic that we focus on in Med Tac is choking and drowning. Given that over the 24-month period that we’ve been undertaking this program, very few kids have had swimming lessons, and yet we know it’s one of the leading causes of death, drowning is one of the leading causes of death. Do you think it’s important that we kind of revitalize our focus on the Heimlich maneuver for choking and knowing what to do if someone has drowned?

Dr. Gregory Botz:

It’s absolutely crucial that we implement our measures to manage choking with the Heimlich Maneuver and other maneuvers, and the rescue care that we use for people who are suffering from drowning or near drowning because of the factors you suggest. Our response times are certainly challenged, and the population is not as well-versed in water safety. So we need to augment the response to these medical emergencies with bystander rescue care.

Dr. Charles Denham:
Dr. Botz, one of the problems we had before COVID, but one that has really accelerated in terms of its severity and its impact on our population, is opioid overdose. I know you’re very passionate about the fact that we all need to learn how to use reversal agents. How important is that now, and why should many of us understand how to use these agents given that we have friends and family who might be addicted and we also have friends and family that might be on pain medicines?

Dr. Gregory Botz:

You’re absolutely right. The opioid pandemic didn’t take a break while the pandemic was front and center for our communities. In fact, it’s probably worse now than it has ever been. More than a hundred thousand Americans last year died from a drug overdose. So having the skills to both recognize an opioid overdose and intervene to save someone with the use of a reversal agent like Narcan, or if it’s a family member providing artificial ventilation like mouth-to-mouth ventilation, is lifesaving and crucial to our response to these very threatening problems. Many times, people who are overdosing don’t know that there’s a powerful drug like fentanyl in whatever they’re ingesting, and that is such a powerful drug that causes respiratory depression. People often overdose and are at very high risk for dying, even with the first exposure. So our public safety interventions with recognizing the signs and symptoms of a drug overdose, activating EMS, and providing life-saving care, whether that’s using Narcan to try to reverse the effects of the opiates which cause severe respiratory depression, stop your breathing, and lead to low oxygen levels in the body, which can have very serious consequences, or even providing artificial ventilation in the interim until professional first responders can get there, is a lifesaving intervention. Those are things that we want our bystander rescue care providers to be able to do.

Dr. Charles Denham:
You know, Dr. Botz, we were really surprised when we found out that one in 10 of our 100,000 public schools, and the other schools that we have across the country, will have someone who has an anaphylactic event this year. And the second thing that is really shocking is that adults, one in 20 adults, will have an anaphylactic event at some point in their life. And the third was that 40% of people will have one without any prior knowledge that they might have allergies. Now that kids are going back to school and people are returning to outdoor activities, how important is it that we all know how to use an EpiPen?

Dr. Gregory Botz:

I think it’s crucial that our bystander providers are able to recognize the signs and symptoms of a severe allergic reaction, something we call anaphylaxis, and treat it appropriately if they have the resources at hand. An epinephrine autoinjector or an EpiPen is life-saving in those circumstances because of the overwhelming inflammatory response that can happen with this severe allergic reaction to insect bites, medications, or foods. So, our ability to both recognize and manage those problems until professional first responders can get there is a life-saving intervention.

Dr. Charles Denham:
Dr. Botz, the one area that you and I really enjoy teaching is the Stop the Bleed program. That was launched as a collaborative effort after the Sandy Hook active shooter event, and other events. It’s been really fun teaching people how to control severe bleeding, and we’ve incorporated it into our Med Tac program and our rescue stations that we’re placing at beaches, schools, and churches. How important is it for everyone to know how to stop severe bleeding?

Dr. Gregory Botz:

Again, the ability to recognize life-threatening bleeding and to intervene to stop that bleeding is so important in reducing the risk of severe harm or even death to people with injuries that cause excessive blood loss. The Stop the Bleed program teaches bystanders without medical knowledge how to recognize and manage severe hemorrhage or bleeding until first responders can get there. So, the use of direct pressure over a bleeding wound, using a tourniquet on the extremities, or packing a wound and providing pressure over a bleeding wound if it’s not on the extremities, is a crucial intervention. We know from the military that it’s lifesaving on the battlefield. They’ve used it now for years and have shown tremendous improvement in survival from penetrating wounds. It translates well into our communities, and the ability to have bystanders provide that simple intervention until professional responders can get there is so important to reduce the likelihood of a bad outcome like severe injury or death after those events.

Dr. Charles Denham:
Thank you, Dr. Botz. And you know, we started this Coronavirus community of practice because one of our eight causes of death and harm were infections. And we have not really focused as much attention on how to take care of infections that our scouts, our athletes, or our campers might get with the pathogens that are now lurking in the soil and in our community. And so, although we are going to focus tremendously through our program on tackling the coronavirus variants, vaccines, and masks, what about treating infections and lacerations and why that’s so important now compared to maybe what it was like when you and I were kids?

Dr. Gregory Botz:

Well, you’re right. That’s a very important focus for our bystander care. I practice in an intensive care unit and I deal with the consequences of sepsis and septic shock on a daily basis. The ability to recognize a serious infection and treat it aggressively before it gets to the point of severe sepsis or septic shock is a life-changer. So, the ability to try to prevent the body from having a severe infection and the reaction to that severe infection is so important. Early recognition and early intervention with cleaning a wound and using appropriate antibiotics or antimicrobial medications that are appropriate for the potential infection is so important. But really recognizing that someone has that sort of wound that’s at risk for an infection and keeping it clean and seeking medical attention as soon as possible are good interventions for a bystander rescuer to initiate.

Dr. Charles Denham:
Fantastic, Dr. Botz. We learned in our development of the Med Tac program about the enormous number of transportation accidents that harm children every year, every week – more than a hundred a week, including four fatalities. Over 60% of the drivers are a parent or a friend. Now that we are back and much more active with school and athletic activities, and we have kids who haven’t been around cars and parking lots, and we have kids like my son who’s now 16 and learning to drive, we often don’t recognize how frequently terribly traumatic and even fatal events can occur without the prevention of transportation accidents. Your thoughts?

Dr. Gregory Botz:

Well, you’re absolutely right. We know from the data that’s coming out now as we have emerged from the pandemic shutdown, and more and more people are driving and many people are driving in a reckless fashion, that the number of injuries and fatalities from traffic-related incidents is on the rise. And so, it’s surprising that there are so many young kids who are seriously injured or killed with transportation events that are so preventable. And so, having good practices, especially in places of transition like where kids get in and out of vehicles, is so important.

Dr. Charles Denham:
You know, being a pilot and you being an expert in simulation, we rely on checklists. The one checklist my son and I use before we drive in the morning, as he’s practicing driving and going to surf events, is this: before you turn the key, make sure that you can see. It’s our very first checklist item. It came from the work we’ve done with you on transportation accidents. We were just really unaware of how traumatic they could be and how frequent they are. The last topic is bullying, and it really overlaps with the opioid overdose issue and understanding CPR. We know that bullying can be a very important issue. In our healthcare system, we have an enormous amount of workplace violence, but we also have a large number of young women, teenagers, who are suicidal. We understand that for every successful suicide, there are 25 attempts, and many of them have to do with opioids. So how important is it to prevent bullying?

Dr. Gregory Botz:

Well, bullying is a very important topic to address in our communities. It falls along the spectrum of violence that includes workplace violence, domestic violence, and random acts of violence that are occurring in our communities in increasing numbers. It’s a behavior that is so damaging to our young children, especially school-aged children, who are so affected by external perceptions of how people think of them. The effect of bullying on someone’s self-perception and identification can be very injurious when bullying takes place. We have to do what we can to recognize and manage the events where bullying occurs and try to stop the cycle of psychological and physical damage that it does.

Dr. Charles Denham:
Well, thank you Dr. Botz, and thank you for your inspiration, your leadership, and for being our clinical leader in the Med Tac program. It’s been awesome working with you.

Dr. Gregory Botz:

Thank you very much.

Dr. Charles Denham:
So, as we conclude our discussion, we put together a family lifeguard program in 2021. This was with Mr. David Bash, an award-winning teacher, and a group of young people who started as scouts and have now grown up to be teenagers. Together, we developed a checklist program for families that would help them protect their loved ones during an event. This program addresses safe practices such as social distancing, the use of masks, handwashing, and disinfection. We even address how to improve ventilation. As we close this program and discuss things slipping through our safety net, we must return to some of the fundamentals concerning COVID-19. Social distancing, masking, ventilation, and testing are all crucial elements that we must not forget. We need to be ready and prepared as we move forward. We’re so grateful for our group of speakers, both prerecorded and live. Those of you who watched the long form will be pleased to know it will be broken up into shorter segments for easier viewing. We’re very grateful to have this group of great speakers. God bless you, and thank you for attending this webinar. We look forward to seeing you next month.