Tulare Regional Medical Center- Medical Tower Ground Breaking May 12, 2010

On May 12, we gathered to witness the groundbreaking ceremony for the new medical tower at Tulare Regional Medical Center. The call to order was prepared by Bill Postlewaite, followed by the Presentation of Colors by the United States Navy, the national anthem sung by Rebakah Felix, and “God Bless America” performed by Satish Kesavaramanujam, M.D., Randal May, M.D., and Cesar Ramos, M.D. We enjoyed hearing from: Parmod Kumar, M.D. and Chairman/President of the board; Shawn Bolouki, Chief Executive Officer; Mayor Craig Vejvoda of the City of Tulare; Lynn Dredge and Bill Postlewaite, Co-Chairs and Bond Oversite Committee members; and Linda Wilbourn, President, Tulare Hospital Foundation about their hopes and dreams for the new medical tower and how it will impact the county. The ceremony was wrapped up by a project blessing/prayer and time capsule contributions. After the prayer the board members rolled up their sleeves and each took turns breaking the ground for the start of the project. Lunch was provided by Koetsier Ranch Catering.

National Fallen Firefighters Foundation Golf Tournament

The National Fallen Firefighters Foundation held its third annual San Joaquin Valley National Fallen Firefighters Foundation Benefit Golf Tournament at the Ridge Creek Golf Course in Dinuba on June 11. The foundation was created in 1992 to lead a nationwide effort to honor America’s fallen firefighters. This nonprofit foundation’s mission is to honor and remember America’s fallen heroes and to provide resources to assist their surviving families in rebuilding their lives. We were glad to be a part of the tournament and to help sponsor such a great cause.

EMS BBQ

Kaweah Delta Medical Center and California Emergency Physicians recognize the importance of an excellent Emergency Medical Services (EMS) system and the impact it has on patient care. On May 19, in honor of National EMS Week, Kaweah Delta and the ER physicians group sponsored and hosted a free barbecue for all personnel who are part of the EMS system. The event was open to the Emergency Department staff and all first responders (EMS, Fire, Law Enforcement and Dispatch) who tirelessly respond to the public’s calls for help, twenty-four hours a day, seven days a week. More than 250 people attended.

Paul Main from American Ambulance of Visalia was the cook for the event and spent the afternoon grilling hot dogs and hamburgers. Mark Walker, also from American Ambulance of Visalia, assisted him. AMR Mobile Life Support provided the dessert. Fred Wu, Physician Assistant from Kaweah Delta Emergency Department, who was assisted by Dave Sanbongi, Prehospital Liaison Nurse, organized the event. Ted Ganiron, Assistant Nurse Manager from Kaweah Delta Emergency Department, and John Leal, Assistant Nurse Manager from Kaweah Delta’s Urgent Care Center, were also instrumental in the coordination of this event.

Battle of the Badges

This year’s Battle of the Badges was held at Plaza Park on Sunday May 23^rd. The event raised money for Greg Hernandez’s Family who lost a wonderful man in the line of duty last year. Thank you to all of the participants who helped make this year’s event a success. There were two winners, one for both the lower and upper divisions. The Corcoran Department of Corrections team, Bad Timez, won for the upper division and the Tulare County Sheriff’s Department’s team, The Brawlers, took home the award for the lower division.

Until we read this issue’s cover story, it’s fair to say no one on our staff was aware of what a significant problem car theft is in our Valley. Sure, we all knew it went on, but after meeting the T-RATT (Tulare County Regional Auto Theft Team) unit, our eyes were opened to an entirely new reality.

In staging our cover photo, we collaborated with California Highway Patrol Sergeant Chuck Mosley, head of the T-RATT unit, to give readers an authentic glimpse of the type of criminal activity they deal with on a daily basis. Although the unit is a collaborative effort, composed of officers from various local agencies, it is most definitely a full-time unit.

For our cover, photographer David Swann and photo assistant Jordan Saba recruited Matthew Lepper as the car stealing “thug,” who allowed the arresting officers to perform a full-body search while Swann snapped the scene with his camera.

T-RATT members routinely work undercover, so with the exception of the two arresting officers who are transferring to a different unit and are no longer required to remain anonymous, the men and women of T-RATT must remain nameless and faceless for their safety.

On the Cover: Arresting officers (left to right): Detective Chris McGuire, Porterville Police Department; Officer Baldo DeHaro, Woodlake Police Department.

There has always been something about the warming of the weather and arrival of summer that fills me with an urge to travel. Whether it’s across the country, across the pond, or simply over the Grapevine, summer in my book has always been a season to gallivant. Perhaps it’s the extreme heat of the Valley from which I find myself needing a break, or merely the happy habit of “summer vacation” ingrained in me during my student years. Whatever the case, the hankering for a temporary change in scenery is ever-present this time of year.

Fortunately for Californians, and particularly for us here in the Central Valley, an escape from the everyday landscape is easy to achieve. We have a beautiful coastline to our west, gorgeous mountains to the east, and several exciting and bustling metropolitan locales to both the north and south. With that in mind, this issue of Valley Response Magazine introduces a new feature for our readers—a section that ventures beyond our conventional theme of safety and “travels” to a lighter side of editorial content.

For the inauguration of our new travel section (page ____), we take readers to the Central Coast, a favored destination for many in the Valley, with a rundown on some of the region’s most popular water recreation activities. And because safety is the thrust of our publication, you can rely on Valley Response for tips on how to keep yourself and your family safe while enjoying these activities.

Also beginning with this issue is our expansion into Kings County. We will now be in circulation amongst our friends and neighbors in both Hanford and Lemoore. With that, I would like to wish our new readers “Welcome!” I hope that you will enjoy our publication and provide us with feedback and comments about how we can make your community a bigger part of the magazine. We look forward to earning your support and readership.

In addition to our new travel section and expanded distribution, we have also undergone a bit of face-lift with regard to the magazine’s layout and design. Our talented Creative Director Bryan Pickens has integrated some new design elements and styles into this issue to freshen up our look. We are always seeking ways to improve our publication, so apart from our constant search for relevant and compelling story content, we hope that you’ll enjoy the new look as well.

Whether you’re an aspiring traveler like me, or plan to stick around on home turf this summer, I wish you all a safe and enjoyable season in the sun.

By Kristi Emo

The Central Coast of California is a popular destination for residents of the Valley. In the winter, we go to escape the chill and fog. The summer heat is a perfect excuse for a weekend getaway or family vacation.

There are many great activities and attractions to enjoy, from golfing, hiking, riding ATVs in the dunes near Pismo Beach, or touring Hearst Castle in San Simeon to wine tasting near Paso Robles, or relaxing in the mineral hot springs in Avila. But for many visitors, the biggest draws are the amazing beaches where you can stroll for hours, fish from the piers, build a sandcastle, dig for clams and enjoy some great watersports.

Watersport options range from swimming, boogie boarding, surfing, and kayaking to the newest craze called stand-up paddle boarding or paddle surfing. This ancient form of surfing is done standing up on a board longer than a modern surfboard, using a single paddle to propel yourself.

The Morro Bay Estuary, with its calm waters created by a four-mile-long sandbar, is perfect for kayaking. Novice and experienced kayakers alike enjoy up close viewing of the playful otters, harbor seals and birds that make their home in the bay. Another popular kayaking spot is Dinosaur Caves near Pismo Beach, with its kelp beds and caves to explore. Surfing is popular in Pismo Beach, Avila Beach, Morro Bay and Cayucos. There are surf schools in the area that will teach students of all ages, and many local companies that offer equipment rentals, surfing and kayaking lessons and escorted kayak tours.

For all the allure of the beach and ocean, the coast also holds its own particular risks for visitors. Sun exposure is a concern in all types of coastal weather; even on overcast days it is possible to get sunburned. Sun exposure and sunburns can cause long-term skin damage, skin cancer, and premature aging and wrinkling. Experts recommend avoiding the peak sun hours of 10 a.m. to 3 p.m., and urge wearing clothing that offers good protection, including hats, sunglasses, shirts with long sleeves and long pants.

A good sunscreen is also a must. There are different levels of sun protection factor (SPF), which refers to the ability of a sunscreen to block the ultraviolet rays that cause sunburn. Sunscreen products can range from an SPF of 2 up to 100. The higher number, the greater the protection afforded, although no product blocks 100% of the UV rays. For the best protection, sunscreen needs to be applied about 30 minutes before sun exposure and then reapplied frequently, especially after prolonged time in the water. It is better to apply more sunscreen rather than too little.

Swimming in the ocean is different than swimming in a lake or pool because of currents and tides. No one should swim alone and people who are not strong swimmers should stay in shallow water. Even in shallow water, waves can be strong enough to knock children or older people off their feet. If possible, swim where there are lifeguards on duty, as at Pismo Beach and Cayucos. Many beaches have signs posting beach flag warnings that indicate hazards in the water like high surf and riptides. They are color-coded like traffic signals, progressing from green (calm waters) to yellow (light surf or currents, caution advised) to red (hazardous conditions). Pay attention to them.

According to the National Oceanic and Atmospheric Administration (NOAA), riptides are strong currents of water flowing away from the shore at surf beaches. They typically extend from near the beach, through the surf and past the line of breaking waves. Swimmers or waders who get caught in riptides and do not know how to escape may end up drowning. NOAA offers this advice on how to escape a riptide: Stay calm; don’t try to swim straight to shore against the current, as this is both exhausting and not effective. Think of a riptide as being like a treadmill that cannot be turned off; you need to step to the side to get off. Swim parallel to the beach until you do not feel the pull of the current carrying you farther out from shore, and then swim at an angle—away from the current—back toward shore. Try to catch the attention of a lifeguard or someone on the beach by yelling and waving your arms.

If you see someone who is caught in a riptide, do not attempt to rescue them yourself as this can lead to both of you drowning. Instead call 911 and throw the person something that floats.

At beaches with piers, like Pismo Beach and Cayucos, some swimmers are tempted to explore the area underneath the pier. Lifeguards strongly caution against this, as permanent riptide currents can exist at these structures.

On your next trip to the Central Coast, have fun in the sun at those great beaches, but be aware of the conditions before you go in the water and always play it safe.

By Jim Blanks

Senior citizens have been targeted in increasing numbers by scam artists looking to make a quick score. The scams come in many forms, including cold calls, email proposals, and even in-person meetings. As Detective Brian Young of the Visalia Police Department explains, the emergence of Internet-based scams means that there are many new ways to be swindled. But you don’t have to be a victim.

According to Det. Young, most new scams are actually variations on old schemes; many just have slight twists that make them well-suited for a new group of victims. And of all victims, senior citizens are particularly vulnerable.

“Senior citizens are targeted, in my opinion, due to their willingness to talk to cold callers and because of the trust that most seniors display,” Det. Young explained. “This generation grew up not locking their doors and leaving keys in their vehicles without the fear of burglary.”

Senior citizens can also fall prey to Internet scammers if they are not up-to-date on current technology and trends.

“Seniors generally do not use the Internet or email as others do, so they are not aware of current scams,” and they often don’t have someone to consult on technical topics, except friends and family members, Young said. “This is also a direct link to financial elder abuse committed by family members, which is a problem that is increasing dramatically.”

A number of scams seem to reappear frequently. Although they might appear in nuanced forms, they are all scams. One fraud involves a series of professional looking emails sent to the victim with the arrangement that a $300,000 money order will be sent in the mail; upon receipt, the victim is instructed to remove $5,000, and then wire the remaining money to China. The money order later comes back fraudulent, costing the victim the entire amount of the funds.

A second common scam starts with a cold call, advising the victim that he has won $800,000 in a foreign lottery. Over the next thirty days, the victim is instructed to send various money orders to cover taxes.

“During this time, both the victim’s bank and local money order vendors become concerned, but the victim explains that he is helping distant relatives,” Det. Young said. “This cover is provided by scammers.”

After two weeks, the police are also notified, but by this point the victim has generally invested a lot of personal income into the scam and does not listen to the advice of others.

“The victim continues being involved with this scam until the date the winnings are supposed to be flown in via private jet,” Det. Young said. “Which, of course, does not happen.”

This scam can cost victims up to $30,000, and highlights one of the main reasons scams work so well. The victim, once he is involved in the scam, often ignores the advice of his friends, family, and even law enforcement officials.

“Senior citizens are often on a fixed income, so the offer of additional money is embraced,” Det. Young said. “On the other hand, younger victims facing mounting bills and raising children also can fall prey. And sometimes, the plain old sin of greed takes over and the victim wants something for nothing.”

The idea of “something for nothing” might be a big reason another scam is successful: In this scenario, a victim is contacted outside a major retail store and offered a gold bar because the suspects do not have the necessary identification to exchange the gold for currency. The victim agrees to complete the bank transaction for a percentage of the profit. However, the victim must first pay the suspect $5,000 as “good faith” to ensure that the victim will not run off with the gold. After the money and gold are exchanged, the suspect leaves, and the victim discovers that the bar is painted metal.

Another classic scheme is what is known as the “sweetheart” scam. In this situation, the victim is befriended by a member of the opposite sex. A friendship develops, and after a period of time, a tragedy occurs in the sweetheart’s family, requiring money. The victim, wanting to help a new friend, supplies the necessary funds. This continues, with the sweetheart needing additional money for food, furniture, clothing, and other provisions until the victim runs out of money or confronts the suspect. At this point, the sweetheart scammer moves on to another victim. Losses in this scam have ranged between $10,000 and $20,000, but often the emotional damage is even greater.

The scam is especially troubling, Det. Young explains, because “generally the victims are targeted because they have previously lost a loved one. This tragic loss is preyed upon by the suspects.”

There are a variety of emotions that scammers play upon to take money from a victim. Along with appealing to a sense of obligation, or to a victim’s need for easy money, scam artists also thrive on the humiliation that someone feels upon being victimized. This can make the investigation process especially difficult on law enforcement.

“If you happen to fall victim, please consult your local law enforcement and confide in friends and family,” Det. Young said. “One issue is often embarrassment; however, this is what the scammers like. The issue goes unreported and the scammers are allowed to continue without any type of investigation.”

Another difficulty in the investigation process, Det. Young says, is tracking the scammers, who often “funnel money via various routes, allowing accounts to be changed and housed in locations that do not share information with law enforcement. This causes the investigation to come to a halt, leaving us with a database of victims and no way to identify or prosecute the suspects.”

Therefore, the best way to beat scammers is to avoid falling victim in the first place.

“Do not accept cold calls or give any type of information over the phone or in writing if you do not know exactly to whom you are giving the information,” Det. Young said. “Most scammers are good at what they do, so official sounding names with titles to match make them sound legitimate and trustworthy.”

Overall, Det. Young says, the best way to avoid becoming a victim is to use common sense. Scammers cannot succeed unless the victim goes along with the scheme. If you remain wary, and contact law enforcement at the first sign of suspicious behavior, you will keep yourself from becoming a victim.

By Jim Blanks

Every day, hazardous materials pass through Tulare and Kings counties on the highways, the railroad, and through the airport. Businesses use dangerous chemicals and some generate materials that need to be properly disposed of. Fortunately, a team exists for the purpose of dealing with these dangers: The Visalia Fire Department Hazardous Materials Response Team.

The team, made up of twenty-one highly trained firefighting personnel, responds to calls from area businesses, transportation companies and even hospitals. Led by Chief Mark Nelson, the team ensures the community’s safety in a number of ways.

“We respond to hazardous materials emergencies in all of Tulare and Kings counties, so we get to see a wide variety of incidents,” Nelson said. “Incidents can occur in many different locations, including during transportation, at industrial facilities that utilize chemicals, at residential locations when items are spilled or mixed, and during possible terrorism-related incidents.”

Because of the wide range of calls and the varying dangers each incident can present, the Hazmat Team goes through extensive training. Before joining the team, each member completes a minimum of 240 specialized training hours—hours necessary to earn the title Hazmat Technician Specialist. Additionally, team members have twenty-five training hours each year.

Although the team often deals with chemicals such as pesticides, hydrocarbon products and ammonia, Nelson noted there are thousands of potentially dangerous materials in use today; therefore, not only must the team be specially trained, it has to use specialized equipment to deal with varying incidents.

“We carry equipment to provide decontamination to people who have been exposed to chemicals, equipment to stop leaks, and monitors and testing equipment to help identify unknown chemicals,” Nelson said. “We also use several different types of protective equipment during entries.”

With a well-trained staff and essential equipment, the Hazmat Team is prepared to respond to any number of emergencies. This is crucial, Nelson said, because of the amount of hazardous materials that pass through the region on a daily basis.

Danger Arrives by Air, Rail

“The Visalia Airport handles a considerable amount of hazardous materials, and in fact UPS and FedEx are two of the largest handlers of hazardous materials in the world,” Nelson said. “Although both companies have an incredibly low accident rate, the danger still exists.”

And the airport is not the only potential concern; the trains that run through Visalia carry hazardous materials as well.

“With the exception of Amtrak,” Nelson said, “there is not a train using the Southern Pacific tracks on the western edge of our community that does not carry an extremely large amount of hazardous materials. With the normal wind in Visalia coming from the northwest, a major train crash could quickly impact a major portion of Visalia.”

This is one of the main reasons why the Hazmat Team is so important, Nelson said: It provides rapid intervention during an emergency. If the team were not in place, a hazardous spill could have devastating consequences.

“Of the hundreds of businesses that store and handle hazardous products on a daily basis, many are located in or adjacent to residential neighborhoods,” Nelson said. “These are some of the greatest risks that we face regarding potential emergencies.”

Even if there is not an immediate threat to human life, a hazardous material spill can have a tremendous impact on the environment. An incident that initially appears innocuous can cause terrible damage in the future.

“The environmental risks associated with the release of hazardous materials are significant,” Nelson said. “Our ability to respond immediately to contain or control the leaking product is also significant in reducing the risk to the environment.”

Hazardous material emergencies are considered low-frequency, but high-risk; although the team does not face a great number of calls in a year, each incident has its own particular set of dangers. For example, Nelson recalled an incident at a hospital that could have been catastrophic had it not been for the rapid response of the Hazmat Team.

A Disaster Averted

“There was an emergency at Kaweah Delta Hospital that had the potential to impact a large portion of the downtown area,” Nelson said.  “With such a limited evacuation area, our team was able to make entry and quickly mitigate an emergency that could have had a dramatic impact on the entire downtown.”

In addition to handling transportation- and business-related emergencies, the Hazmat Team is also trained to deal with more deliberate incidents: potential terrorist activities. Working through a program called the California Mutual Aid System, the team is equipped to respond to the aftermath of terrorist acts.

“The team is prepared to respond to these types of incidents, including weapons of mass destruction, dirty bombs or explosive devices,” Nelson said. “We are trained to protect the citizens and assist statewide.”

Despite all the good it provides the community, the Hazmat Team has been involved in recent budget cuts. Unfortunately, the City of Visalia (like many other cities and California as a whole) has been faced with difficult budget decisions. Because the team is funded by the City of Visalia, there have been discussions to eliminate it. However, the team and the city are hard at work to develop a plan that will avoid cutting the program.

“While the Hazmat Team is very important, it does not produce revenue and is an impact to the city’s general fund,” Nelson said. “We have been given the opportunity to develop a model that will assist with the ongoing expense of maintaining our Hazmat Team, and we have been working diligently with other cities and Tulare County to find a revenue source.”

As recently as September, Nelson met with the Visalia City Council to discuss new methods of funding; in the short-term, the team is funded through June of this year, and plans are continuing to develop a long-term funding option. Although Nelson is hopeful the team will remain an active part of the region’s vital overall emergency response system, he understands the reality of the situation. The team’s future is presently unclear, and losing the team could have a serious impact on the community.

“The impacts of not having a Hazmat Team in Visalia would affect our community because we are able to quickly respond to anywhere in Tulare or Kings counties and provide immediate assistance,” Nelson said. “Without this team, the county would need to contract with another team in Fresno or Kern County. This would add valuable time in the response to a hazardous materials incident and could have a detrimental impact on the outcome of the emergency. We would also lose the local control that we currently have and would instead depend on other agencies that may be dealing with their own emergencies.”

Relying on an outside team would greatly increase response times, as well. Currently, the Visalia Hazmat Team can respond to an emergency within ten minutes; the average response time of an outside agency (which includes receiving the call, preparing the equipment, and driving to the site) is, at minimum, one hour.

Because a longer response time can mean the difference between mitigating a disaster and being too late, Nelson is seeking any way to keep the Hazmat Team operational.

“We are searching for any opportunity to partner with public or private agencies,” Nelson said. “It is important that we keep a team in Visalia. When you look at everything we do, we are a vital asset to the community.”

By Kimberly Sherman

In most career settings, there is at least one stand-out employee: one who treats work as a life calling rather than simply a job, and whose effervescent dedication helps to spur a radical change.

Meet Angie Graziano.

Ask Graziano what she does in her free time, and she charmingly stumbles over her words. She’s a single mother who likes to read, go to the movies, spend time with friends, and, um …

Ask her what she does at work, and after the disclaimer, “I’ve always been driven,” Graziano shares a captivating dissertation about her biggest career achievement, the development of the SART (sexual assault response team) program for Tulare Regional Medical Center.

Graziano, now the director of the Medical Services unit, recalls her introduction to the world of nursing, the precursor to her dedication to improving the lot of sexual assault victims. Her tone is modest and void of any puffery.

“I always wanted to be a nurse, but it was derailed when got into the milk industry as a lab tech for Los Angeles County,” said Graziano. “But I always felt my calling was in the nursing industry. I love children and the elderly.”

Ten years into her job, performing microbiology testing for all the milk in Tulare, tragedy struck. Graziano’s 18-month-old toddler was stricken with viral meningitis and became comatose for well over a week. Staying with her daughter day and night, Graziano found solace in a nurse who spent extra time consoling Graziano, offered words of encouragement despite doctors’ grievous concerns, and helped her understand her daughter’s condition.

Miraculously, after a three-week stint in the hospital, Graziano’s daughter emerged unscathed, dodging obstacles such as speech, bone, and neurological complications that the doctors had warned might plague her.

One year later, Graziano chased her nagging dreams by enrolling in the College of the Sequoias. “I graduated from the nursing program in 1988 and came to the hospital in 1989,” she said. Tulare Regional Medical Center has been her sole employer since her graduation.

Grass-roots Efforts Realized

Graziano, interested in dealing with patients in crisis, attended a seminar in 1990 designed to bring the special needs of sexual assault victims to light. With the success of the San Luis Obispo SART (Sexual Assault Response Team) program as a model and some tips for starting a local team, Graziano came home, vigor renewed. “I decided we could launch a program like that in our community to make a difference in assault victims and to inform the community,” she said. “Rape affects both children and adults, the rich and the poor. There are no barriers as to who it affects, and there were no local programs that took care of the victim from beginning to end.”

Graziano targeted the fragmented relationship between law enforcement, nursing services, and the district attorney’s office. She started her grass-roots effort by forming a partnership with “Rape Crisis” through Tulare County Human Services and garnering support from community services such as the victim witness program, each of whom would be a part of the sexual response assault team.

Along with training on how to take evidence with a rape kit, conduct a detailed interview, and take proper photographs, nurses involved in the program rode with police and sheriff’s officers and spent quality time with the district attorney and local gynecologist to fully understand anatomy and injury. “We spent a lot of time perfecting our abilities in order to qualify as expert witnesses in the courtroom,” she said.

In 1991, a year after campaigning and tying up partnerships with all the necessary agencies, the SART program was put into practice at Tulare Regional Medical Center—the first such team in the San Joaquin Valley.

A Much Needed Change

Typical protocol for the fragile rape or molest victim prior to the inception of the SART program was no different from that for a patient sick with the flu. “They had to compete for hospital services just like any other patient in the ER,” said Graziano. “Their information was taken in front of other people. A nurse would come in and get an assessment, followed by the doctor, then the police were called in. That victim had to try and tell a horrid story three to four times, and evidence was collected in spurts.”

Understandably, sexual assault victims often left the hospital without services rendered, harboring evidence and feelings of guilt, the potential for apprehending a violent suspect compromised or lost. Viable evidence of rape decreases significantly after three days, and the lack of physical evidence makes for a difficult prosecution.

Getting to court with an interview chain-of-command and evidence intact was key for a

successful prosecution. Providing enough emotional support to allow the victim to work through the crisis and face the perpetrator in court was the goal.

With the SART system in place, a nurse was on-call twenty-four hours a day to help rape or molest victims. The patient was secured outside of the emergency room setting and escorted into a private room with the freedom to move about during the two- to three-hour process.

With all pieces of the puzzle, in the forms of each agency, in place, law enforcement officials and a nurse took care to interview the victim one time only. A new set of clothing was provided (the old clothing collected as evidence) and a rape crisis advocate filled the role of emotional support. This freed the nurse to focus on treating any physical injury, administering medications—prophylactic antibiotics, a morning after pill if there was a chance of pregnancy—and helping with a hot shower.

“We had an array of patients, including men, those infected with HIV, gang rape victims, and those given roofies (the date rape drug),” said Graziano. “ The youngest victim was 7 months and the oldest was 64, but the majority of victims were 16 to 24 years old.”

Reaching a New Level of Care

Although the SART program at Tulare Regional Medical Center disbanded in December of 2000, Graziano is exuberant about the level of care that has superseded her grass-roots efforts begun ten years earlier.

“The level of expertise required to handle these cases has brought nursing into the level of forensics,” she said proudly. “Now, law enforcement officers take the victim to a designated hospital and a forensic team of nurses in Fresno are dispatched out to handle these exams.” Child victims are taken to Fresno for specialized care.

In 2006, Graziano was certified as a Palliative Care Trainer by the End-of-Life Nursing Education Consortium (ELNEC). She has since turned her skill and enthusiasm to a new program and facet of care.

“Our hospital is the first in our region to embark on improving the quality of advance care planning. All too often we find families and patients having to make difficult choices at the end of life rather than making these choices with loved ones in advance based on their values and healthcare goals,” she said. “The goal of advance care planning and advance directives is to ensure and respect patients’ wishes at the end of life. This program, too, will make such a difference in our communities.”

In recognition of her dedication and the milestones in the quality of nursing care that Graziano has achieved over the past 20 years, the humble nurse determined to provide the best in care for her patients has received a slew of awards.

Of her work with the SART program, Graziano summarized her intensive efforts: “We educated hospitals and law enforcement, strengthened prosecution, and helped victims become survivors.”

By Gary C. Kuncl

They work at all hours, generally for no pay, to help people get through some of the worst days of their lives. They stand beside peace officers in dangerous situations, though they themselves are unarmed. And sometimes they get hurt. Some are ordained ministers, and others are well-trained lay volunteers.

They are police chaplains.

Most law enforcement agencies in Tulare County are served by chaplaincy programs. Although the programs differ in form and size, all of them exist to support and assist the officers in their day-to-day work. Chaplains are available on a twenty-four-hour basis to support and assist officers and their families with personal crises. They also help crime victims and other community members get through critical or crisis events in their lives. Moreover, they do these things regardless of the person’s religious preference.

Here is a brief look at five representative chaplaincy programs within Tulare County.

Tulare County Sheriff’s Department

According to Kevin Mizner, coordinator of Chaplain Services for the Tulare County Sheriff’s Department, their program is diverse, extensive and involves twelve ordained ministers and lay chaplains. A retired sheriff’s captain, Mizner is also a minister with the Calvary Chapel of Visalia.

The chaplains serve in the Sheriff’s substation area in which they live. One chaplain serves in the Pixley Area, one in Porterville and one in the Orosi Area. The rest serve in the Visalia Headquarters Area. Most chaplains assist the sworn officers. However, one chaplain, Lydia Molinar, works directly with the clerical, dispatch and records personnel.

Police chaplains often serve “above and beyond their required duties and are in harm’s way while out patrolling with the deputies.” Mizner noted. When Deputy Kevin Elium was killed in a vehicle collision on October 7, 2005, Chaplain Lee Sorenson was riding with him. According to Mizner, Sorenson was so seriously injured, he was not expected to survive. However, Sorenson did in fact recover after an extended hospital stay and now serves as chaplain for a sheriff’s department in Washington State, Mizner said.

Another example: When Sergeant Greg Hernandez was gravely injured in a traffic collision on February 2, 2009, chaplains stayed with Hernandez and his family continually for four days in a Fresno hospital until he died. Because the family was keeping a vigil and could not attend church, the chaplains held a service at the hospital in a conference room large enough to hold 100 people. “It was filled with family and cops praying,” Mizner said.

To Tulare County Sheriff Bill Wittman, it is important to have a chaplain corps he can call on when an officer is injured or killed. The chaplains enable the department to do much more for the families of such officers. The chaplains lend support and can provide assistance. “Our chaplains can also help many people out in the community who have no one else to turn to,” Wittman added.

Woodlake and Farmersville Programs

Patrick Lozano serves as chaplain for both the Farmersville and Woodlake Police Departments. Although now a business owner, Lozano draws on eleven years of previous experience as a peace officer. For five years, he attended a weekend course for lay ministry and leadership through the Catholic Diocese of Fresno. Lozano rides along with patrol officers eight to ten hours each week and is constantly on-call. “It is the most fulfilling ministry work I’ve ever done in my life,” he said. Although new to Farmersville PD, Lozano has assisted Woodlake officers with a variety of situations, from suicide threats to guiding juveniles away from trouble with the law.

Visalia Police Department

Bob Grenier, pastor of Calvary Chapel of Visalia, heads up the chaplaincy program for the Visalia Police Department, overseeing the work of seven other chaplains. Visalia chaplains commit to be on-call for one week and ride on patrol for eight hours each month. Mike Buford, assistant pastor at Calvary Chapel, is another Visalia PD chaplain. Grenier, Buford and other Visalia PD chaplains deal with diverse situations, ranging from assisting crime victims to comforting families of injured and killed officers. They have also, on occasion, officiated at funerals for indigent persons or families who have no church affiliation.

Chaplains at Porterville PD

Pastor Don Roulsten of the Grand Avenue United Methodist Church is senior chaplain for the Porterville Police Department. Five other chaplains serve the department. Roulsten will never forget a situation in 1994 in which he dealt with the family of a little boy who had drowned. What he remembers most was the look on the officer’s face in the emergency room. The officer, Ernie Garay, was standing over the child. “And you could see he wanted to will life into that baby,” Roulsten said.

Riding Along

In all five departments, riding with the officers is both necessary and beneficial. Roulsten sees benefits to the chaplain from watching the officers work and learning what is happening in the community. According to Mizner, “It is important just to be there for the deputies to encourage and support them. Acceptance by the officers is crucial. It takes time to gain their trust personally and professionally. It only comes with time and a lot of nonjudgmental listening and confidentiality.”

Buford noted that, most of the time, the conversation is “small talk about the latest ballgame and such.” But periodically, officers bring up their own personal issues or ask questions about religion or scripture. “And for that to happen, the officer must trust you,” he said.

Delivering Difficult News

A sad and sensitive duty for peace officers is notifying members of the community that a loved one has died or been killed. By virtue of their training and availability, police chaplains are ideally suited to assist officers. Because officers are subject to being called to other incidents, and because most departments have constant calls for service, they are hard put to spend the necessary time with grieving survivors. Chaplains can do this.

According to Roulsten, chaplains can assist by remaining with the grieving persons to answer their questions, identify resources and provide emotional support. They also help by notifying, if possible, the person’s family and their spiritual advisor. A typical case for Buford involved assisting an officer with an elderly man whose wife had just died. The man, a poet, was in a grieving process. For more than two hours, Buford talked with the man about his poetry. “He just needed to share, and I basically listened. After our talk, he was in much better shape,” Buford noted. “I felt I had accomplished something that day.”

Officer-Involved Shootings

The hardest cases of all for everyone affected are officer-involved shootings. If the officer is killed or seriously injured, the officer’s family and fellow officers need the immediate support a chaplain can provide. On the other hand, if the officer has survived the confrontation, he or she needs a lot of support.

Ron Richardson is a chaplaincy trainer of national note. In addition to serving as a chaplain for the Fresno County Sheriff’s Office, he directs Chaplain Services International, an organization of 30,000 employees serving in all fifty states and in all Canadian provinces.

According to Richardson, “There is always a cost to the surviving officer’s well-being. This is why a chaplain should go to the scene of every officer-involved shooting. The chaplain’s job is to assess the officer’s condition and try to provide immediate care and comfort. I try to reduce the officer’s stress level and assist any other way I can. This includes being there for the family and for other involved officers.”

Officers In Trouble

Because peace officers are human, a few of them get into serious trouble and are fired from their departments. Some are prosecuted when a crime is involved. Here again, Richardson believes chaplains should stand ready to be good listeners and assist the officer and his or her family with emotional support. Richardson cited a recent case in which he dealt with a man in Austin, Texas who had just been fired as a result of an impropriety. Richardson phoned the man, who said he had a ninety-day supply of a prescription drug and intended to swallow the all the pills.

After talking at length with the man, Richardson learned his location and notified the Austin Police, who found and detained him. Two weeks later, the man telephoned Richardson and thanked him for preventing his suicide. Thanks to their lengthy conversation, the man had accepted responsibility for his actions and resolved to straighten out his life. Said Richardson of this happy outcome, “It was a ‘high-five’ feeling.”

By Bill Corliss

The primary causes of automobile accidents have changed in recent years. More drivers have learned that alcohol and driving don’t mix and that wearing seat belts reduces the severity of crashes. But an increase in traffic and the burgeoning variety of driver distractions are creating a high-risk environment on our roads. Although the number of collision fatalities is declining for the first time since the 1950s, the number of crashes and resulting injuries are still increasing, according to the National Highway Traffic Administration.

The skills, knowledge, and experience gained during many years behind the wheel cannot overcome what’s known as inattentional blindness—the phenomenon of not being able to perceive things that are in plain sight. Driving can be mundane, habitual, and boring. These long periods of boredom are sometimes only broken by spurts of crisis or panic. If drivers miss critical information at critical times, they cannot react appropriately.

There are four basic types of distractions: mental, visual, emotional, and physical. These can occur either inside or outside the vehicle. Passengers, cell phones, high-tech vehicle equipment, pets, eating or drinking, and loose objects are examples of distractions inside the car. Outside the vehicle, animals, unusual objects on or beside the roadway, accidents, fires, and even public events can rob drivers of that life-saving second needed to avoid a crisis.

Some distractions can be eliminated by drivers. Talking or texting on a cell phone, eating or drinking, putting on makeup, and looking at off-road events are examples of behaviors drivers control. Other distractions cannot be totally eliminated, such as turning on the defroster, feeling sad or even sneezing. Sometimes a driver is surprised by a distraction such as spilling a soda, by passengers playing, or by trying to kill a bee or other insect trapped inside the car.

Not all distractions are created equal. In determining the risk level of a distraction, there are several components that are important. How many seconds does the distraction last? What is the speed of the vehicle? What is the level of traffic? How well can the driver see? For example, texting creates four distractions at one time: mental, visual, emotional, and physical. Drive down Mooney Boulevard at 35 mph on a Saturday during intense traffic times. Now put down the cell phone and eat the hamburger and drink the soda, wave at the folks running the Cheerleader Car Wash and carry on a full conversation with your passengers. … You get the idea.

All drivers multitask, thus short-circuiting the skills they have gained over many years of on-the-road experience. At 60 mph, cars move at 88 feet per second. Traffic safety studies show that 80% of crashes are preventable if drivers were given one extra second. This spring, make an effort to reduce the number of distractions you face to gain that life-saving second. Treat driving your car as a full-time occupation, not a part-time job.

By Aaron Collins

Ah, glorious spring! The beautiful flowers, balmy temperatures, blue skies … the bee stings and anaphylaxis, followed by death due to asphyxia.

Small wonder that poets leave anaphylactic shock out of their odes to springtime: The medical condition is not exactly a thing of beauty. Whether due to insect sting or the inadvertent consumption of a food allergen, anaphylaxis strikes quickly and can be deadly if not treated promptly.

The season’s rare medical downside is not usually high on people’s minds. But wary individuals might breathe a little easier with sufficient education and awareness about the condition and how to avoid it—and what to do if it happens.

As more people are lured outside by the mild climate of the Central California spring, health care professionals find themselves treating an uptick in outdoor-related cases of anaphylaxis. The San Joaquin Valley’s agricultural industry and the Sierra Nevada’s outdoor adventures are just two of many regional factors that pose particular hazards.

But while the warmer weather may see a spike in certain types of incidents, the allergic reaction known as anaphylaxis is hardly just a seasonal threat. Bad reactions to food and medicine are a serious year-round problem, according to Tulare District Hospital Medical Director Benny Benzeevi, M.D., FACEP.

Life Is On the Line

“I think that—unless one has experienced an anaphylactic reaction or has witnessed one—it is sometimes difficult to understand how serious it can be,” said Dr. Benzeevi.

So what should you know about recognizing anaphylaxis and its potential severity?

“Anaphylaxis is the most severe and life-threatening form of an allergic reaction,” said Dr. Benzeevi. The symptoms include hives, diffuse swelling, including swelling of the tongue and throat, and difficulty breathing. Those effects are perhaps most commonly known. But there are many others, including redness, wheezing, abdominal cramping, nausea, vomiting, diarrhea, and low blood pressure.

During the panic of the moment, said Dr. Benzeevi, “The important thing to remember is that anaphylaxis is serious and life-threatening, and should prompt an immediate response concurrently with a trip to the emergency department. The symptoms should be taken very seriously the minute they begin.”

Visalian Carole Firstman knows firsthand those moments of high anxiety. As with so many prior experiences, after a coworker’s visit to a Visalia bakery, Firstman discovered the hard way that the establishment had used peanut flour in its products. Within moments of eating the treat her friend had provided, she began swelling and having difficulty breathing.

Firstman is in the top 10^th percentile of allergic sensitivity to peanuts. Fortunately for her, most food service establishments long ago ceased using peanut products or follow disclosure regulations, because a certain small percentage of the population can die from exposure to even the smallest trace of peanuts. Her level of acuteness means that eating food that merely touched a cooking surface that was previously in contact with peanut oil can result in death.

More People in the Know

Firstman sees greater awareness about peanut allergies than was once the case. “Within the last ten years or so, it’s been in the media and news, so many folks have heard of it,” she said. “The biggest difference is that now, all processed foods must list peanut ingredients on food labels, including the possibility of cross-contamination during the manufacturing process. That regulation makes a huge difference for people like me.”

In the past, she would eat something that had no peanuts listed in the ingredients, but for some reason would get the “peanut sickness” anyway, often ending up in the emergency room. “In those days, eating anything was potentially dangerous for me! But now when I see even the remotely threatening words ‘May have been processed on equipment that also processes peanuts,’ I know to avoid that food.” she said.

In a culture that values social conformity and stoicism, societal expectations can result in subtle pressures to minimize special dietary constraints. But the cost of ignoring one’s severe allergies can be life itself. Firstman thinks old attitudes are beginning to change. “People today are much more aware than they used to be. Today when I tell someone ‘I’m deathly allergic to peanuts,’ they know what I’m talking about, I don’t need to give lengthy explanations.”

But she still must be constantly aware of the foods she eats. “I have to ask about ingredients all the time. If I don’t know what’s in the food, I have to pass. I can’t tell you how many gift trays of Christmas cookies I’ve had to give away or throw away simply because I didn’t know what was in them,” she said regretfully.

Any food that she has not prepared herself poses a risk. “Any derivative of peanuts—like peanut oil or peanut flour, no matter how minute—will cause a reaction for me. So eating at restaurants is always dicey. I rarely eat Asian food out, for example, unless I can either see the food cooked in front of me or I can have a conversation with the chef.”

Another pitfall: Servers may be unaware of what they are serving. “In any type restaurant, even if I specifically ask about peanut products in the food, I’m sometimes told the food is peanut-free, but it is not. There might be ‘hidden’ peanut products that the staff isn’t aware of, like an ingredient in a pre-made salad dressing, for instance, that is then used as a marinade for an entrée,” she noted, so staff may simply not be helpful despite her caution.

How is Anaphylaxis Treated?

Upon going into anaphylaxis following the bakery incident, Firstman’s friend—who had never before given a shot—administered epinephrine, the main go-to drug for emergency situations. Fortunately for the drafted Good Samaritan, epinephrine can be administered via an easy-to-use EpiPen, a pre-filled, auto-injecting syringe.

“It is very natural to be squeamish about giving a shot,” said Dr. Benzeevi. “However, I would remind the person that the shot of EpiPen may very well save someone’s life.  I think looking at it that way may be helpful to get over the initial discomfort.”

People with allergies to bee stings and certain foods who keep a supply of EpiPens on hand may go long periods without incident, and the medication can expire. That may leave an inexperienced bystander to play caregiver to an incoherent anaphylaxis sufferer, a novice who must decide quickly what to do.

“Ideally, you would want to use medication that is not expired. I think in deciding (whether) to use a very old EpiPen, you have to assess the situation at hand,” said Dr. Benzeevi. “If the patient’s throat is closing and they are unable to breathe, and no help is available, you have to do whatever it takes to save a life. By the way, injections into the thigh are more effective than injections into the deltoid (upper arm).”

Dr. Benzeevi said the important thing with all medical emergencies is rapid response and to remember the ABCs: Airway, Breathing, and Circulation. Don’t hesitate to call 911. “Anaphylaxis can deteriorate very rapidly,” he emphasized.

While the first-line therapy for anaphylaxis is epinephrine, IV fluids, and oxygen, if airway swelling is imminent the patient must be intubated rapidly, he said. “Otherwise, the airway will be lost, and an emergency surgical procedure called a cricothyroidotomy must be immediately performed. Additionally, after the first-line therapies have been given, steroids, antihistamines, and nebulizers are administered. In more severe cases, epinephrine has to be administered through an IV and even as a continuous infusion rather than as an intramuscular injection.”

Dr. Benzeevi pointed out that in patients already taking beta-blockers (a class of cardiac medications), epinephrine by itself may not be effective and may cause severe elevation in blood pressure. “In those cases, if the patient does not respond to the first-line therapy, sometimes an additional medication called glucagon is administered.”

Finally, epinephrine can cause other deleterious effects on the heart, and those have to be monitored closely. These are all issues that are considered in the Emergency Department, but are not critical for the first-responders, Dr. Benzeevi said.

“It’s important to remember the ABCs and treat the patient in that order,” the doctor said. “If issues arise after the administration of the first-line therapies, the first responders should be in close communication with the Emergency Department as they transport the patient.”