Wednesday, June 29, 2016

OHN Trainee Profile: Jane Vaccaro, MPH student, works with Northwest Tribal Emergency Management Council to develop Medical Reserve Corps Toolkit

They hadn’t planned on wildfires when Jane Vaccaro decided with the Confederated Tribes of the Colville Reservation to work together. Vaccaro, an MPH student in Occupational and Environmental Health Nursing, was ready to start her practicum.  She wanted to apply her substantial experience in different kinds of nursing and as a Medical Reserve Corps (MRC) volunteer to developing a resource guide for starting MRCs within the Tribes.
An MRC is a cadre of volunteers who are trained to respond in the event of a disaster or an emergency. The MRC program is run by the US Department of Health and Human Services’ Assistant Secretary for Preparedness and Response. There are approximately 203,000 volunteers enrolled in 1000 units across the U.S.
Only, the wildfires in the summer of 2015 raged in Eastern Washington. The Confederated Tribes of the Colville Reservation not only lost thousands of acres to the wildfires, they lost traditional hunting and gathering grounds.
For Vaccaro, whose practicum under the Colville Tribe fell through, the wildfires underscored the impact that a disaster can have on Northwest Tribal communities who are often geographically isolated, who have been historically and economically disadvantaged, and who are culturally connected to the environment.
Vaccaro has been a nurse for several decades. She worked in emergency nursing, public health, case management, and life-care planning. When she heard about the MPH degree program in our department, she was volunteering with the Pierce County’s MRC and assisting UW Tacoma and Pacific Lutheran University senior nursing students conduct a community resilience survey.
With the help of Adjunct Associate Professor Butch de Castro who is principal investigator for a hazardous materials handling and disaster-preparedness training grant from the National Institute of Environmental Health Sciences, Vaccaro found a new practicum opportunity. She was hosted by the Northwest Tribal Emergency Management Council (NWTEMC) as an MRC Coordinator for unit #1273. Her practicum was supervised by Lynda Zambrano, its Executive Director.
The NWTEMC’s members include federally recognized Tribes in Alaska, Idaho, Oregon, and Washington. Its goals are to assist Tribal members build capacity within their Tribal nations to respond to and manage hazards, terrorist or other security threats, emergencies, and disasters.
Zambrano helped found the NWTEMC in 2003 and later the National Tribal Emergency Management Council, which is organized like FEMA into 10 regions. The NWTEMC is in Region 10.
“We don’t come in and run an incident for the Tribe,” Zambrano explains. “We’re not a response organization.” Instead, NWTEMC helps develop offices of emergency management and provide training in the skills and access to resources so that Tribes can manage their own incidents.
Zambrano also helped start the first Tribal MRC in the U.S.
In the work that the NWTEMC does in the field, Zambrano and member Tribes wanted to create Tribal-based MRC units that could not only help build their community’s emergency response, but would be culturally sensitive and understand Tribal sovereignty.
As sovereign nations, Tribes self-govern and enact their own laws. Tribal councils are governing bodies federally recognized that work directly with federal and state governments.
In Washington state, there are four MRCs.  One unit in the Tulalip Tribe and another in the Shoalwater Bay Tribe, and the Lower Elwha Klallam. The MRC through the NWTEMC is regional; its members are the NWTEMC’s Tribal emergency managers. The emergency managers can deploy the MRC, which includes medical and staff personnel, to assist Tribes in the Northwest.
Zambrano said she will never forget the text message sent by the Chairman of the Sauk-Suiattle Tribe after the Oso Landslide on March 22, 2014:  “The river is rising a foot every seven minutes. Please send help.”  The Tribal reservation is located less than 22 miles from the landslide. Telecommunications, internet, and emergency medical services were cut off, as was access to Interstate 5. In addition to the coordinated response from the NWTEMC, the regional MRC was deployed to help.
With Zambrano, Vaccaro developed a toolkit that included information and a number of resources: a handbook on how to start a MRC unit, policies and procedures, laws, codes, ordinances, Tribal resolutions, incident command, how to activate an MRC, and the Tribal government’s role.
Zambrano hopes that after the CD of the materials is available, the MRC toolkit will make it easy for a Tribal emergency manager to understand the importance of developing an MRC and for local, state, and federal partners to understand the importance of Tribal MRCs. 
She said, “Jane did an amazing job.” Zambrano’s goal in mentoring students like Vaccaro is to help others gain a deeper understanding of Native American culture, and the challenges and differences in developing and sustaining emergency management in Tribal nations.
The MPH program and this practicum, she says, has been a great match. In addition to helping compile the toolkit, Vaccaro also held a blood drive at the annual Northwest Tribal Emergency Management Conference hosted by the Kalispel Tribe. She contributed to the NWTEMC’s social media strategy in the event of a disaster. Twitter and Facebook have a lot of advantages: they’re two-way, have a broad reach, and can connect people and resources to unmet needs.
One of the most valuable aspects of this practicum involved attending NWTEMC meetings, reflected Vaccaro, and hearing NWTEMC members share the emergency situations they have recently faced. In just little over a year, issues have included: wildfire, smoke exposure, first responder safety, floods, hazardous material spills, and avian flu.  Future issues of critical importance include the security of their “first foods” and threats from hazardous rail shipments. “The practicum really drove home what we can learn from the Tribes, and the relevance of the work we are doing in DEOHS,” said Vaccaro.
Vaccaro plans to look for a career in disaster planning after she graduates. Her “encore” career, she explains, would address the public health implications of climate change, and impacts on community resilience to disaster.  
Published: 
06/06/2016 by Elizabeth Sharpe, DEOHS

Occupational Health Nursing PhD student, Kimiko Sasaki, selected for the Jonas Nurse Leaders Scholar Program


Kimiko Sasaki, MN, RN, a current Northwest Center PhD student specializing in occupational & environmental health, was selected for the Jonas Scholar Environmental Health in Immigrant Communities Award at the UW School of Nursing. The goal of the Jonas Nurse Leaders Scholar Program is to increase the number of doctorally-prepared faculty available to teach in nursing schools nationwide.

The Jonas Center for Nursing and Veterans Healthcare is a philanthropic organization that supports the advancement of the nursing profession through grants and programs designed to develop outstanding faculty, advance scholarship, and spark innovative practice.

Ms. Sasaki was appointed as a Jonas Scholar from August 1, 2016 through July 31, 2018. She will partake of leadership opportunities and build her leadership skills under the guidance of her appointed mentor, Dr. Jenny Tsai, Associate Professor in the Department of Psychosocial and Community Health, School of Nursing and Assistant Director of the Occupational Health Nursing Program of the Northwest Center for Occupational Health and Safety. 

Congratulations Kimiko!

Thursday, April 21, 2016

Northwest Center Researchers focus on Occupational Health among Veterinary Workers

A recent article in the Journal of the Veterinary Medical Association highlighted a recent study on mental health risk factors for professionals working in the veterinary field. This risk factors study found that mental health and well-being issues run high among veterinary professionals, and risk factors for depression and suicide are prevalent.

Dr. Heather Fowler
Photo: University of Washington
Following these findings, Dr. Peter Rabinowitz and Dr. Heather Fowler, of DEOHS's Center for One Health Research, reached out to the principle investigators with an interest in addressing mental health issues among veterinary workers through an occupational health approach.

Through the new Northwest Center ERC training program in Occupational Health at the Human-Animal Interface (OHHAI), the Center for One Health Research will focus on the occupational health of animal and veterinary workers.

They plan to implement research that would incorporate mental health into occupational health outcomes, and encourage greater interdisciplinary collaboration on this issue. Dr. Rabinowitz hypothesizes that increased collaboration and communication between human health workers and animal workers may be essential to achieving better mental health outcomes for veterinary workers and students.

Drs. Rabinowitz and Fowler will look at professional burnout, compassion fatigue, and stress from animal euthanasia, along with other factors as they work to understand mental health outcomes for veterinary professionals.


Friday, April 8, 2016

Treating Patients with Highly Contagious Infectious Diseases: Using Technology to Advance Safety

On April 6, 2016 the Northwest Center for Occupational Health and Safety hosted a course designed to increase healthcare worker safety when treating patients with highly contagious infectious diseases such as Ebola. Course participants learned about tactics used by Harborview Medical Center during the last outbreak and explored new training technologies that can help to better prepare employees for hazardous situations.

Participants had the chance to experience 3 workshops, during which they experienced different training tools designed to help healthcare workers do their jobs effectively and safely.

 In the first workshop participants worked with Dmitri Bouinov, CEO of Context VR, to explore how virtual reality technology could be used in a healthcare training setting. A sample Google Glasses VR experience was created in which participants had to look around the room for objects they needed in order to treat an infected patient. Participants were presented with questions and could walk around the space viewing more information as they clicked on items.

The course participants also had a chance to put on a full VR helmet and perform surgery on an alien. While not related to the course content, this fully immersive VR experience gave participants the chance to imagine how the technology could be used in a healthcare training setting.

In the VR workshop course attendees learned that nearly anything can be designed into a virtual reality environment. They were also excited to learn that individuals in different geographical locations can work together in the same virtual environment, allowing for collaboration between professionals at different hospitals across the world.

 In the second workshop participants donned full PPE and entered a simulation lab where they practiced high risk procedures on specially designed mannequins. They practiced intubation, rectal tube placement, and IV insertion and were faced with simulated bodily fluids and other hazards. Simulation training allows for healthcare workers to get as hands-on as possible and practice different scenarios they might encounter when treating a real patient. Participants learned one the greatest values of simulation training is the ability to de-brief and watch the simulated procedures back. This kind of de-briefing allows workers to identify where they went wrong and where they could have been harmfully exposed had they been treating a real patient.

The third workshop focused on team communication through a program called Team STEPPS, developed by the WAMMI Institute for Simulation in Healthcare (WISH). Team STEPPS teaches individuals the importance of communication and organization in high stress, high hazard situations. Teams completed stressful tasks together and learned about techniques for improving their outcomes through communication, assignment of roles, and cooperation.

Northwest Center ERC Trainee Kali Turner, MPH Student with the Center for One Health Research, attended the course and was excited to share her experience:

"As a first year MPH student in DEOHS with a background unrelated to public health, but an interest in infectious disease and prevention, this was a perfect opportunity to learn in an interdisciplinary setting. I learned about the challenges and next steps regarding the Ebola response at the international and local level, including improving training through virtual reality and practice. I hope to continue learning about response efforts and prevention for all disasters, including infectious disease outbreaks throughout my time at UW and hope to apply these techniques in a future career. I really enjoyed the diverse presentations and now appreciate the effort it takes to don full PPE for multiple hours in a high pressure situation; it's much harder than it looks!"

You can view presentations and resources from this course! Click here to visit the course resource page.

Thursday, April 7, 2016

"A Day's Work" - the Dangers of Temporary Work

Recently, the Northwest Center for Occupational Health and Safety and the Department of Environmental and Occupational Health Sciences joined with the Harry Bridges Center for Labor Studies to sponsor the Seattle premier of the film "A Day's Work" and a panel discussion on the dangers of temporary work. "A Day's Work" focuses on the story of Day Davis, a temporary worker at the Bacardi factory in Florida who lost his life 90 minutes into his very first shift.

Event attendee opinion piece:



I've been working in occupational health and safety for a while now, I've never formally studied it, I didn't even get in to the field "on purpose", but now that I'm here, and I'm living it, and I'm seeing the impacts every day..."wow" I say to myself, this work we're doing is so important. 

As somebody who works in occupational health and safety this film immediately caught my eye. A worker died 90 minutes into his shift on his very first job. "Where was his safety training?" I thought to myself, "Where was his supervisor? Why was a brand new worker immediately assigned to a dangerous position?" So many questions came into my head, "how are we still allowing these incidents to happen in America?"

Although I've worked in health and safety for a while, I didn't know much about the temporary work industry before watching this film. They're invisible in the typical picture of American industry, they hide in the shadows providing poorly trained and desperate workers to big companies with dangerous factories and big bottom lines. They disappear when their "product" gets damaged or destroyed, leaving families with their livelihood diminished and the host workplaces with little more than a hand slap. Nobody seems to regulate the training given to these employees, and nobody takes responsibility for their safety. These workers are treated like a product for getting the job done at a low cost with little to no liability. If a worker gets hurt or killed, "Who cares? Just get a new one".  The workplace where the incident occurred doesn't owe that worker or their family a thing, the temp agency was that person's employer and they're nowhere to be found or playing a "he said, she said" game.

Before the big rise of the temp industry, investing in safety was a win-win for employers and employees. Now temporary agencies have taken on the roles of employers, leaving big companies with little financial incentive to invest in safety. The host companies are not financially responsible if a temporary worker is injured, so why spend the money to train them? As health and safety workers this is the biggest hurdle we have to overcome - how do we convince big businesses that safety is still important when it is no longer feeding their profits?

As I was watching the film several things stood out to me. The first, Day Davis was killed doing a job he wasn't hired for. He hadn't been trained to work around the heavy machinery, in fact his only training was a 15 minute orientation before the start of his shift. When a machine malfunctioned and created a mess the supervisor said "get me a temp to clean it up". In the Bacardi factory, like many others, the temporary workers were treated like second class citizens, and the supervisor didn't see it as his job to check on what Day had been trained for or watch out for his safety - after all he wasn't a "real" employee.


The second, was a statement made by Day's younger sister Antonia. While talking about what happened to her brother she said "It just doesn't add up." Antonia states that in life you are trained on how to drive, you're trained on how budget your money, and how to care for your house - nobody expects you to come into life knowing these things, "so why can't you be trained on how to do your job safely?" These are such wise words from a 17 year old. You wouldn't let a bank teller work without being trained on handling money, you wouldn't let a fire fighter enter a burning building without being trained on fire safety, so why are companies so willing to let temporary workers enter a factory with essentially zero safety training? The answer: safety no longer pays in an economy where temp agencies are allowed to be legal employers.

When OSHA was established the United States Government declared that all workers in America have a right to go home at the end of the day. With the rise of the temporary work industry, and the loopholes created by temporary staffing agencies taking on the roles of employers, this right is no longer being protected for many Americans. So the question I left this experience with was, "what can we as health and safety professionals do to restore this right?" It is a very hard question to answer, but it is one that must come to the forefront as we move into the future of occupational health and safety.


*All photos featured in this blog post are the property of the Temp Worker Film.
**All views and opinions expressed in this blog post belong to the individual who contributed the post and do not necessarily represent the Northwest Center for Occupational Health and Safety, The Department of Environmental & Occupational Health Sciences, The School of Public Health, or the University of Washington.






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