This information appeared in our Fall 2013 Update Community Newsletter.
By Brad Salzmann, PA-C
This September marks the 10th annual National Preparedness Month. Sponsored by the Federal Emergency Management Agency (FEMA) and endorsed by the president of the United States, the month urges all Americans to recognize the importance of preparedness and working together to enhance national security, resilience and readiness.
All disasters are first and foremost local, and all emergency response starts locally. Individuals, families, communities, and businesses that are even somewhat prepared fare far better than those who are not prepared. While it’s impractical to prepare for all possible scenarios, every bit of preplanning and preparedness does make a difference. Outside help is not always immediately available. Think back to past emergency events you were involved in, or talk to someone who has been affected; what were some of the things you wished you had thought of and prepared for ahead of time?
The basic mantra is: Be informed, make a plan, build a kit, and get involved.
Being informed means staying updated on local situations and information and knowing what to do before, during, and after an emergency. All types of media, including social media sites, are used now for news, information, and directions. VT 211 (Get connected, Get answers) is a free, confidential, 24/7, reference to access hundreds of community resources, sponsored by the Vermont United Way (www.vermont211.org); it is not for emergencies (911), nor is it directory assistance (411). VT 511 (www.511vt.com) is free reference sponsored by the Vermont Agency of Transportation with updated road information.
Making a plan starts with where to meet; how to communicate with loved ones; evacuation and shelter-in-place options; plans for pets and livestock; plans for infants, elderly and those with special needs; obtaining important medications; and retrieval of important documents. Businesses and communities should also plan for identifying and preparing for alternate ways to continue crucial operations, and recovery. Plans really should be tested, updated, and adjusted periodically. September is a great time to do this!
Kits are generally divided into three categories: Personal “go” kits are in a backpack or duffle that can be easily grabbed and carried. They should have sufficient supplies for you to survive for 24 hours. Mobile kits are in a larger container that can be put or kept in a vehicle. Supplies should be adequate for three days of survival for you and your family. Home kits contain enough supplies and equipment needed in event of an extended shelter-in-place situation.
Getting involved means working with family, friends, community or larger organizations in planning for, preparing for, responding to, and mitigating for emergency events. There are a variety of organizations and groups that are always looking for volunteers.
You may have heard of the survival rule of threes: three minutes without oxygen, three days without water, and three weeks without food. My rule of threes has to do with redundancy. One should strive for three ways to obtain water, shelter, food, and light, as well as three methods of communication, three routes of evacuation, three alternate places to go, and methods to get there, and so on.
There is an abundance of good information available on emergency preparedness. For those of you with Internet access, there are excellent sources from FEMA (www.ready.gov), the Centers for Disease Control and Prevention (http://emergency.cdc.gov/preparedness or http://bt.cdc.gov/planning), the Red Cross (http://redcross.org/prepare/location/home-family, or http://redcross.org/prepare/nationalpreparednessmonth), the Vermont Department of Public Safety, and many others. The Vermont Department of Emergency Management has printed an excellent Family Emergency Preparedness Workbook, which is available online at http://vem.vermont.gov, as well as by calling 1-800-347-0488 or writing to 103 South Main Street, Waterbury, VT 05671-2101. There are even smart phone apps now available with vital emergency preparedness information. If this all seems overwhelming, check out Do1Thing, at http://do1thing.com. This breaks down preparedness into monthly doable and affordable projects.
Finally, watch out for scams and fraud. Unfortunately, there are a few individuals who prey on the misfortunes of others. Never give out your account numbers or Social Security number, or pay in advance for anything unless you are 100 percent sure it is safe.
Please, take this opportunity to enhance your preparedness for emergencies, even if it’s just to make a few lists and jot down a few ideas.
Brad Salzmann is an orthopedics physician assistant at Gifford in Randolph. He also has a master’s degree in disaster medicine and management, and serves as part of the national Disaster Medical Assistance Team based in Worcester, Mass.
By Brad Salzmann, PA-C
Even short periods of high temperature, humidity, or exertion can cause serious health problems. Heat-related illness and deaths are preventable, yet many people suffer serious health illness or death every year.
The Centers for Disease Control and Prevention reported an average of 618 heat-related deaths per year in the United States from 1999-2010. Extreme heat is defined as temperatures that are substantially hotter and/or more humid than are typical for that location at that time of year.
HOW MUCH HEAT IS TOO MUCH?
There is no specific temperature or humidity level that must be obtained for heat-related illness or death to occur. The National Institute for Occupational Safety and Health, for example, reported a healthy 30-year-old landscaper died of heat stroke on a day that never went higher than 81 degrees. Heat-related illness and death rather occurs when heat pushes the body beyond its ability to compensate. The human body cools itself by sweating; the sweat brings heat to the surface where it evaporates. High humidity reduces the ability of sweat to evaporate.
WHO IS AT MOST RISK?
Body heat is produced two ways: internal (metabolic) heat is generated by physical exertion, and environmental heat is from high air temperature; humidity; direct sun exposure; heavy clothing; and lack of water, rest, and cooling. Anybody can succumb to heat. However, the elderly; very young; people with handicaps who are unable to take care of themselves or communicate; those with mental illness, cardiovascular, lung or other chronic diseases are at increased risk. Outdoor workers in agriculture, construction, logging, and firefighting are at increased risk, as well as those involved in exertional exercise outdoors. Statistically, 68 percent of heat-related deaths are male. There are some studies that predict risks will increase with climate change.
Heat rash is a skin irritation caused by excessive sweating; it is most common in young children. Heat rash looks like a collection of pimples or small blisters, usually on the neck, chest, or in the groin and elbow creases. Treatment for heat rash is to provide a cooler, less humid environment; dusting powder may help.
Heat cramps are caused by excessive sweating, which depletes the body of salt and fluid. Heat cramps are muscle pains or spasms, usually in the abdomen, arms, and legs. Heat cramps can be serious for those with heart disease or who are on a low-salt diet, and medical attention should be obtained. Otherwise, stop all activity, sit quietly in a cool place, drink clear juice or a sports beverage, and rest for several hours after cramps subside. If cramps do not subside within an hour, seek medical attention.
Heat exhaustion is a body’s response to an excessive loss of fluid and salt. It can develop after several days of exposure and inadequate replacement of water and electrolytes. Symptoms of heat exhaustion include heavy sweating, paleness, muscle cramps, tiredness, weakness, dizziness, headache, nausea/vomiting, and fainting. Signs include cool, moist skin; rapid, shallow breathing; and a fast, weak pulse. The elderly and people with high blood pressure or who work or exercise in a hot environment are at higher risk. Treat heat exhaustion with cool (non-alcoholic) fluids, rest, cool shower/bath, air conditioning, and light-weight clothing.
Heat stroke is a medical emergency; call 911 immediately. The body is unable to regulate its temperature, which can rise rapidly. The sweating mechanism fails and fatal temperatures can rise to 106 degrees or higher within minutes. Heat stroke can present with an extremely high body temperature; red, hot, dry skin (no sweating); rapid, strong pulse; throbbing headache; dizziness; nausea; confusion; unconsciousness; or seizures. Immediate cooling is necessary! Begin cool water immersion, shower, spray, sponging, wrapped in cool wet sheets, and vigorous fanning until emergency medical services are available. Do not give fluids by mouth.
Sunburn can cause first or second-degree burns. Ultraviolet radiation (sun exposure) damages the cells of the skin. Protect skin from excessive exposure by seeking shade, especially during the midday hours; wearing lightweight clothing, hats, sunglasses with UVA and UVB protection; frequent application of sunblock (SPF 15 or higher); and avoiding indoor tanning.
Skin cancer risk is increased with exposure to the sun. The three most common types are basal cell, squamous cell, and melanoma. Skin cancers can invade normal nearby tissue and sometimes spreads to other parts of the body. Prevention is the best treatment.
Air conditioning is the number one protective factor for heat-related illness and death. Increase fluid levels during hot weather. Don’t wait until you are thirsty; thirst is a late indicator of dehydration. Don’t drink fluids with alcohol or large amounts of sugar. If you are not urinating every two to three hours or the urine is dark, then you need to drink more. Acclimation occurs over the course of several weeks and actually causes a body to sweat more efficiently.
Minimizing exposure, staying well hydrated, frequent rests, protective clothing, and acclimation all reduce the risks of heat-related illness.
Brad Salzmann is an orthopedics physician assistant at Gifford. He also has a master’s degree in disaster medicine and management, and serves as part of a national Disaster Medical Assistance Team based in Worcester, Mass.
Experienced orthopedics physician assistant Bradford “Brad” Salzmann has joined Gifford Medical Center’s orthopedics team in Randolph.
Salzmann grew up in primarily Massachusetts and had two careers – first as a carpenter and then as a hospital-based paramedic – before becoming a physician assistant.
He also did ski patrol along the way and through his role as a ski patrol director got to know a physician assistant who ran a local clinic. Salzmann was inspired. He decided to pursue the “up and coming” profession.
He attended Springfield College in Massachusetts, earning his bachelor’s degree and physician assistant certification in 1996.
He went on to work as physician assistant in orthopedics at Saint Vincent Hospital in Worcester, Mass., from 1996-2012 and at Wing Memorial Hospital in Palmer, Mass., since 2000. He also worked in hospitalist medicine for a year for IPC Hospitalist of New England.
In addition, he has a master’s degree in disaster medicine and management and as part the Disaster Medical Assistance Team based in Worcester, Mass., responds to government requests for assistance in national disasters.
As part of this group, he’s responded to hurricanes in Florida, Louisiana, Georgia and the earthquake in Haiti. He was also recently part of the Hurricane Sandy response team.
His decision to come to Vermont was prompted by his love for the state.
“One of the reasons I’m here is we have family property and a little cabin in Stockbridge, so I’ve been coming here all of my life,” said Salzmann. “I love it here.”
Increasingly, he was excited to travel to Vermont, and reluctant to leave.
Now here to stay, Salzmann is living in Royalton, enjoying the Vermont outdoors and working full-time at Gifford seeing both outpatients and assisting Gifford’s two orthopedic surgeons in surgery.
“I like it. I’m really excited to be at Gifford,” he says, noting he turned down an offer at a larger hospital for the opportunity to work in a small hospital setting. “It’s personable. You get to know people and make more of a difference.”
Salzmann is certified by the National Commission on Certification of Physician Assistants. He is a member of the American Academy of Physician Assistants and the Physician Assistants in Orthopaedic Surgery.
This compassionate caregiver with a quick smile describes his practice style as respectful and truthful. He works with patients to explore options, such as therapy, injections or a visit to the chiropractor. “There are some things,” however, he notes, “that don’t get better without surgery.”
Call Salzmann at Gifford’s Randolph orthopedics office at (802) 728-2455.