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F14. Advocate for political, social or economic policies and programs that will improve health in diverse populations

This semester, one of the projects taken on by my practicum team was to create a preparation checklist for the upcoming spring Special Olympics games. Elizabeth led this project, and ended up delivering a very well put together recommendation. There are always many potential disaster challenges to address when planning large events, but they become even more complex with the introduction of large groups of people who have very specific special needs. Just a few of the basic needs at an event like the Special Olympics would include ample wheelchair access, more staff to direct athletes and spectators where to go, more emergency medical staff on hand, and special considerations for caregivers.

The information Elizabeth relayed to the group about her progress with the recommendation allowed us to collaborate with her about the strengths and potential shortfalls of the Special Olympics event. Her contact organizing the emergency protocols for the event has strong ties with law enforcement, and ensured the security and traffic concerns surrounding the event were well thought out. However, there was much room for improvement in other areas of the preparedness planning process, and that is where Elizabeth focused on advocating for the most positive change to ensure a safe and successful event.

Police, firefighters, and emergency medical technicians do not generally have rich resources to help them with the day-to-day mental stressors and hazards that come with the job of first responders. After all, they spend several hours of their workdays interacting with hospital staff and medical professionals who could assist them with such matters. The unfortunate truth is that mental health has always been an unaddressed elephant in stations and firehouses nationwide. According to an October 2015 nationwide survey from the Journal of Emergency Medical Services out of 4,022 EMS provider respondents, they were ten times more likely to contemplate suicide than the CDC national average of citizens. Even more troubling was the rate of suicide attempts among these respondents, which was over thirteen times the CDC national average. Research has only recently begun to determine the causes and subsequent solutions, and this is a major focus for Team Prepare.

There are few, if any, positive enabling factors to seek treatment, and a host of negative ones to dissuade seeking treatment. Contextually, mental health among first responders has been largely unrepresented, and has only recently begun being addressed. As a result, a blind spot exists in the public’s eyes pertaining to this issue. Surely if the majority of the public knew how dire the need is for rural mental health care, especially among first responders, there would be an outpouring of support for those who protect us when we call on them. But since the issue is largely unknown to the public, in many areas there are a lack of organizations, programs, and funds that specifically target mental health care for first responders.

A major advocacy project we undertook to address this disparity was the social media outreach for the mental health of first responders, spearheaded by Deanna. We all felt very passionate about this project, as we interacted weekly with the first responders of Buies Creek, and I have worked in the industry, as well. The goal for this practicum project was to spread words of support and reduce the stigmas that first responders almost universally feel toward mental health. As the “Fight The Stigma” campaign grows, we hope that it spreads and reaches the eyes and ears of policymakers, both locally as well as nationally, that they may influence real change.

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F7. Assess population needs, assets and capacities that affect communities’ health

            Preparedness issues revolve around drastic health emergencies and disasters. They are designed to prevent the most immediate, violent, existential threats to populations. These occurrences are rare, so governmental and public buy-in is often difficult, because of low perceptions of risk, and expense of preparation. However, when disasters do happen, the repercussions of being ill prepared can be devastating.

            In a rural area like Harnett County, one of the great benefits to preparedness is the cultural values largely embraced by the citizenry. Individuals are generally more self-reliant and do not depend nearly as much on public or governmental institutions to provide for them. Historically, they are more prepared for water and food shortages, electricity and communications outages, personal protection, and even extended or emergency medical needs. However, as technology progresses, rural and urban areas are overcoming geographic differences, bridging social divides and becoming more and more alike. Moving forward, rural populations will continue to rely more heavily on technology and become less self-reliant. This would have much worse negative potential in the case of a disaster for the rural area than the same event in an urban area, because resources are spread thinner and the population is less dense. Responders and health care providers depend on rural residents’ abilities to rely heavily on themselves so that the allocation of sparse resources can be done more efficiently.

            The Team Prepare practicum group had five diverse projects that we worked on this semester. We collaborated on each project, but each of us spearheaded one of the five projects. My project was to organize an education and informational booth at Erwin’s Denim Days event to share basic preparedness tips with the local public. To achieve success, we needed to determine what would be the most likely emergencies for which Harnett County residents should prepare. We determined that the most likely potential emergencies would be prolonged power outage, water supply contamination, hurricanes, communicable disease outbreak, and flooding. We then were able to requisition simple pamphlets from FEMA to hand out to the public. In the interest of making the information sharing as equitable as possible, we requisitioned each of the pamphlets in English and in Spanish. A wealth of basic preparedness tips were given out to the public, such as preparing for the specific needs of the elderly, children, pets, and family members with special needs or handicaps.

            In addition to the informational material, we displayed visual examples of emergency bags and medical bags that could be kept in a vehicle or the home. I have been keeping emergency bags and a medical bag for my wife and myself for a few years now, and Amy does the same. This was fortunate, because we were then able to display our bags to give a third dimension to the information we were delivering. Beyond that, we had informational trivia games for prizes, with topical questions. We were also able to integrate another project that was being led by Tyana. She was working on community training of hands-only CPR technique. She brought two CPR dummies to the event, and we were able to teach numerous individuals, many of them younger children, effective hands-only CPR. Overall, we felt that the Denim Days event was a success, with many informational pamphlets being dispensed and quite a bit of interest and awareness being generated in the community to take preparedness steps in their own lives.

            I believe that our work to educate the public at Denim Days was necessary for the health of the local community. In the case of a personal emergency, individuals in a rural setting faces greater emergency response times with less resources, and is farther away from comprehensive medical care. The prepared person understands this, and stocks basic resources to allow for a greater opportunity for self-preservation. In the case of a larger emergency or a disaster, the limited aid resources in rural areas will be overrun, and an emergency triage system will be set in place to respond to and treat the most life-threatening issues first. This means that the needs of most people will be ignored, potentially for some time. Those who are prepared for these types of events will have a greater chance of escape or survival.

            As technology advances, the social and cultural aspects of rural residents become more aligned with those of urban dwellers, which is not always a benefit. It is important that individuals in rural places keep in mind that their relatively recent de-isolation only lasts as long as the power and telephone lines stay on. When emergencies or disasters strike, it is even more imperative that these people have a preparedness plan and resources in place than urban residents. It is not a pleasant subject, but it is an important one that I believe we successfully promoted at denim days with simple yet comprehensive information in a palatable, fun way.

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R3. Develop strategies to prevent and respond to occupational health effects and safety risks of key industries in rural communities.

            First responders- EMS, firefighters, and law enforcement- respond to our emergencies all day, all night, every day. They work tirelessly for the good of the public to keep us safe. However, it is not often enough that their health is considered. The physical and mental stresses of emergency first response deter many, and cause even more people in these roles to seek other careers. After working in EMS for seven years, I have felt these pressures myself. That is one reason why I was most proud of the project my practicum team undertook to raise awareness of the mental health of first responders.

            The men and women working in prehospital emergency services operate to take charge of situations that are beyond the capacity of the people involved can cope. When people are at their weakest or are in danger, responders can be called to be strong enough to assist that person in crisis, whatever the problem. Because of this occupational attitude, these professionals must internalize their feelings and emotions on the job, which is even more important and more difficult in rural communities. Social cohesion and small population dramatically increases the chance that a professional will respond to a scene where they personally know the patient or a person involved. When I first started in EMS, a seasoned paramedic told me that medics on a scene are like swans on a lake. What everyone sees is confidence, grace, and control, but below the water, their feet are kicking like crazy. This attitude is even more vital and more difficult when the responder knows the person for whom they have been called.

Treating babies for immersion burns after being dipped in scalding hot water, ceasing CPR efforts on an overdosed mother with her children in the room, witnessing the worst horror movie carnage imaginable at high-speed car wrecks, and then, of course, the opioid overdoses- and that’s just a fraction of what I have personally experienced in just over a fourth of a typical EMS career. Comparatively, my experience is very little. Toeing the industry line means internalizing imagery and actions that people are not designed to see. They joke and laugh, drink, smoke, and do all manner of things to attempt to cope with what they see and do every day. Today, suicidal thoughts among first responders nationwide is ten times the overall national average, and actual suicide attempts are over 13 times the national average. It would be safe to say that is significant.

            As previously stated, first responders try myriad approaches to decompress after dealing with stressful or traumatizing situations. Smoking and drinking heavily are two very popular vices to which responders often turn. Overeating and unhealthy eating is very common, not just as a coping mechanism, but also as part of the lifestyle that develops when at any time one could be woken from a dead sleep to preserve or protect a person’s life. Responders have great difficulty changing back from bold, fearless type-A civil servants to normal citizens, husbands, and parents when they clock out of work. These personality changes, along with long hours spent away from home, easily develop into rifts between spouses. Divorce and promiscuity are the rule in these careers, rather than the exception. In fact, one of the running jokes in EMS is that the acronym actually stands for Extra-Marital Sex. All of these trends among first responders affect their physical and especially mental health. Therefore, it should not be surprising that mental health in this industry is so poor. In retrospect, it seems like it would clearly be inevitable. Nevertheless, it has persisted for roughly 50 years now, which in itself is evidence to the notion that this subject has been cast aside by the public, public health, and first responders themselves for some time. I am heartened to see this issue gaining increasing notoriety, and I will be very excited to at least a small part of it.

            To address this growing problem, we collaborated with our practicum group leader who is himself a firefighter/paramedic, to raise awareness of the mental health of first responders to both the public and especially to first responders themselves. With the near universal use of social media, we felt we could make the greatest possible impact by targeting social media outlets with an advocacy campaign that would hopefully be passed along, liked, reposted, retweeted, etc. Our hope is that at least one responder who is suffering would see one of the graphics and be encouraged to go and talk to someone about his or her problems before it is too late.

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R2. Identify and distinguish the access to care barriers and the health care utilization challenges that affect the health of rural communities

Rural communities have a particular set of challenges when considering access to care and utilization preparedness. Our practicum team was able to experience some of these issues in real time as the threat of Hurricane Irma loomed over North Carolina for several days. I was especially affected by the dangers of that event, as I experienced several facets of its influence at the same time. I observed the preparation measures (or lack thereof) of several of my Campbell University classmates, many of whom lacked the resources and money to comprehensively prepare for a worst-case scenario. My mother, stepfather, and my sister’s family still live in my hometown of Bradenton, Florida, the epicenter of Irma’s initial landfall in the continental United States, and they chose not to evacuate prior to its arrival. Lastly, I experienced the public’s rush to buy up emergency supplies at my workplace, Dick’s Sporting Goods.

Certainly, there are benefits to living in a rural area during a disaster on the scale of a category 5 hurricane. The immense destruction and loss of life in New Orleans during Hurricane Katrina, and more recently, Houston during Hurricane Harvey, illustrated many of the disadvantages of living through disasters in urban areas. In rural areas, lower population density means that fewer resources are needed and can assist more people. The people are generally more self-sufficient and prepared for adverse events, and there is greater social cohesion between community members. In contrast, however, rural citizens tend to have more health problems, lower incomes, less trust in government programs, and less access to care. Medical needs after a disaster in these areas would likely be greater per capita, and people’s access to such needs would be limited by lack of resources, transportation, or even damaged infrastructure, such as roads or bridges. Lower incomes in rural areas could prevent these people from purchasing supplies, extra medications, or to implement travel plans to evacuate a high-risk area.

Hurricane Irma struck me as particularly dangerous to rural areas such as here in Harnett County. Not only did Irma boast record-setting wind speeds, but it was also an incredibly large system. Many people had the attitude that central North Carolina is so far inland that we most likely would not suffer much damage, and I repeatedly reminded people that that is not the proper mindset of being prepared for the worst case scenario. My own family did not heed my advise, and instead left from their semi-rural home to stay overnight with my aunt, whose home is in a rather large city only a few miles from the beach which would be ground zero for Irma’s landfall. I spoke to a good friend who is a paramedic in that area, and he stated that if Irma was any less that devastating, he would be amazed. He had been working for approximately 72 hours straight, and once the wind gusts blew beyond 40 miles per hour, all emergency services shut down for the next 12 hours. This would be an even more dire sequence of events in a rural setting, as response times would be exponentially worse, with more damage to infrastructure, communications, less medical resources and personnel, lower level of care health care centers, and far-flung comprehensive care hospitals.

Several of my classmates found themselves in a precarious position during the lead-up to Irma making landfall. Some of them had lived elsewhere and had no experience with hurricanes. Additionally, many of them had no emergency supplies and could have faced some difficulty if they had lost power or if the water supply became contaminated. Many of us who were unfamiliar with the area, myself included, were not even aware of what medical care resources were close by, in case they were needed. This is most likely a very special case in comparison to most rural communities, but less access to care, less utilization, and less focus on preventive health predisposes many rural citizens to similar problems.

Thankfully, Hurricane Irma did much less damage to my hometown than was previously expected, and it mostly dissipated prior to reaching Harnett County. It acted as a wakeup call for me, however. I was very worried for several days over the safety of my family, my friends, and my wife and myself. Afterward, I developed a renewed appreciation for the importance of the work that Team Prepare is doing, and vigor to continue to reach out to the local rural community, that they may be prepared in case the next threat to this area becomes a disaster.

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Congratulating our Hazard Trivia participants at Denim Days 2017! They were really good sports

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The Campbell truck is out on display at our meeting- great photo opportunity!

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Part of our work involves assembling emergency plans, including a supply bag for the car or home. David’s bag is a great example of an emergency bag, and it goes everywhere that he goes. 

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Deep in the bowels of the Buies Creek Volunteer Fire Department, the ultra-secretive theater room is rarely seen by outsiders

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This is the face of a man who is tired of having his picture taken. Message received, sir!

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Meeting after class this week while David was called away to save the world

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When David’s happy, it’s a good day!

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 meeting for team prepper was a good one! Moving to Monday's is definitely going to work out well

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Project planning and updating with team Prepare! 

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Team Prepare, day 1!