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Mission:
CERT Responder Magazine is dedicated to providing CERT and first responders with information and tools to assist communities in times of crisis, as well as offering a platform for responders to share their stories.
PUBLISHERS: Bob Abrams, Fran Sherman Chris Wahoski
CONTRIBUTING WRITERS: Jeremy Dickson, Grace Potter, Emily Rosenblum, Linda Spall, Chris Wahoski
EDITOR/CREATIVE DIRECTOR: Fran Sherman
DIRECTOR OF MARKETING: Bob Abrams
OFFICE MANAGER: Chris Wahoski
Wow,
Here we are: our fourth edition of CERT Responder Magazine
The time went by quickly, and of course there is much more to come. Here are just a few things to look for in the coming year:
First, starting with this edition of CERT Responder Magazine, we will now offer the magazine in both hard copy and digital formats.
Second, we will be offering a survey for you to fill out. It is important that you give us your feedback because without it, we have no way of knowing if we are meeting your needs.
Third, please continue to send your stories, pictures, and ideas. CERT Responder Magazine is here to share information from you and your contemporaries to ensure your teams have the tools to succeed.
We thank you for all your support and want you to share in the success of CERT Responder Magazine. It is our desire to make the Community Emergency Response Team and related groups known commodities to the communities they serve, all around the world.
We wish you all a very happy holiday season and look forward to working with you in 2018.
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Amass casualty incident (MCI) is any incident, which exhausts the resources available to first responders, i.e. the patients greatly outnumber the ambulances and fire apparatus that are available to handle the calls received. This type of situation is usually due to a large number of injuries or casualties. Examples could be terroristic activity, natural hurricanes, and flooding, just to name a few.
In such situations, hospitals may have a surplus of patients already being evaluated. Then, when a disaster happens, more patients come to the ER for evaluation, creating further chaos for the ER staff. This requires emergency room managers to request additional resources from the hospital floors in order to continue to provide high quality patient care. This happened in Joplin, MO when the hospital was destroyed, and required extra help to set-up of temporary medical tents. Disasters wreak havoc on emotions; families are looking for loved ones, and are going to call 911 for rescues, even after an evacuation order was in place. Whether you are a CERT team member, first responder, police officer or EMS, stress will be at its peak!
While responders attempt to help others, some will still be angry about the delayed response. People need to understand everyone is running at full capacity. Tasks like handing out blankets, water or just keeping track of names on a clipboard are just as important, and everyone can get involved, no matter their age. More CERT members are needed to join these teams. There will always be times of crisis, and that’s why training to become a CERT member in your area is crucial.
First and foremost, everyone’s safety is a concern, and each person needs to be vigilant about observing his or her surroundings when helping others. If responders get hurt and go down, there is no more backup coming to help. Exact details of the situation are not important—the goal is to assist and help patients until first responders come in to address their needs. While CERT members are not necessarily medically trained, they can help provide general first aid for bleeding wounds, apply CAT tourniquets to arterial wounds, tend to abrasions and bandages, and just be there for emotional support until help arrives.
The big question is how does one prioritize patients? Who prioritizes the patients? A Triage Officer is one who coordinates the assignment of Triage Teams of emergency medical first responders who quickly evaluate and tag patients. Then as sorting continues, first responders are sent in to treat the victims according to tag code. There are many methods, but the tool used for MCI triage is called Simple Triage and Rapid Treatment (START). JUMP-START is used for children. These are just a few, but follow these simple instructions when using the START Triage method. This triage tool was developed in 1980’s and widely used by EMS and fire departments across the United States.
First and foremost, everyone’s safety is a concern, and each person needs to be vigilant about observing his or her surroundings when helping others.
• The first step is to separate the walking from the wounded. If people can walk, these are green patients, persons with minor injuries. These are the last individuals off the scene.
• Simply tell the patients: “If you can, please walk to a designated area.” Generally, the walking wounded are escorted to a staging area out of the “hot zone” to await delayed evaluation and transportation. These people are assigned “Green” (walking-wounded).
• Next, ask anyone who cannot walk please to raise their hand. This would also suggest they have cognitive function and are able to breathe on their own if they can answer commands appropriately Victims with potentially serious (but not immediately life-threatening) injuries (such as fractures) are assigned “Yellow” ( meaning second priority for treatment and transportation)
• Patients are next assessed for spontaneous breathing. If patients are not breathing, the airway must be respositioned and assessed again for any breathing. If the patient remains without breaths, they are classified as black tag/expected death
• For those breathing on their own, count the respirations. Greater than 30 per minute are categorized as red/ immediate life threat. Continue down algorithm.
• Check a pulse, if there is no radial pulse in the wrist that is present or capillary refill is greater than two seconds, they are categorized as red/ immediate life threat. Continue down algorithm.
• Check mental status/cognitive ability.
If the patient cannot follow simple commands such as raising their hand, then they are red/immediate life threat. If they can follow commands, they are yellow/delayed.
• There should always be someone to monitor all the patients above because some of these patients may be worse than first expected, and always can change in condition.
• Green – Any patient who can walk from the scene (meaning delayed treatment/transportation) Generally, the walking wounded are escorted to a staging area out of the “hot zone” to await delayed evaluation and transportation.
• Yellow/delayed – Any patient who can follow commands but cannot walk. Assess their respirations; more than 30 per minute become red/ immediate life threat. Yellow is moderate to serious injury/illness (not immediately life-threatening). Victims with potentially serious (but not immediately life-threatening) injuries (such as fractures) are assigned a “Yellow” (meaning second priority for treatment and transportation) Triage tag code.
• Red/immediate life threat – All with patients respiratory rate >30 per min, or patients > 2 seconds in capillary refill, or mental status is impaired. Serious but salvageable life threatening injury/ illness are victims with life-threatening injuries or illness (such as head injuries, severe burns, severe bleeding, heart-attack, breathing-impaired, internal injuries) are assigned a “Red” Triage tag code (meaning first priority for treatment and transportation). CERT
• START was developed by the Newport Beach Fire and Marine Department and Hoag Hospital in Newport Beach, California in 1983.
• Initially it used the ability to obey commands, respiratory rate, and capillary refill to assign triage category.
• Modifications to START in 1996 by Benson et. al. substituted radial pulse for capillary refill, with a report of improved accuracy, especially in cold temperature.
• The Benson revision (START - SAVE [Secondary Assessment of Victim Endpoint]), also incorporates additional factors that determine “survivability” over time as the event progresses and assumes limited response resources.
• There has been limited rigorous scientific review of various forms of mass casualty incident triage used around the world.
• New methods of triage using new algorithms have been proposed, but not tested in the field.
• At present START remains the most commonly used mass casualty triage algorithm in the US.
• TRIAGE: a French word meaning to “sort” by priority or life threatening nature of injury
Hrricanes, fires, earthquakes, floods, tornados, Yellowstone eruptions, North Korea seem like endless threats to our safety. We can easily throw their hands in the air in exasperation and helplessness. Besides praying and hoping for the best, how can we possibly cope? Lately, the darkness seems to be hanging all around us and sadly, more of us are sitting, waiting for the other shoe to drop..
After reading Tony Nester’s book, When the Grid Goes Down, I realized that we can empower ourselves and all is not lost! He teaches us in a positive, encouraging manner, that we can be pro-active and actually prepare as best we can for the best possible chance of survival if and when a disaster strikes. Being smart, aware and prepared gives a sense of comfort that only planning and organizing can do. Following the simple instructions in Nester’s how-to-book can actually save your life and the lives of your loved-ones. We especially need to listen. How can we as CERT Responders help our neighbors if we haven’t helped ourselves in a disastrous situation? Nester helps us help ourselves.
Living in Flagstaff, Arizona, he and his family live in a solar, strawbale house in the mountains. He has written four books, has 3 DVD and gives survival courses for the military, National Transportation and Safety Board and FAA. He was a technical consultant for the movie “Into The Wild”. He’s been a full time survivalist instructor since 1989.
My favorite thing about the book is that sense of empowerment and the positive gifts he shares. He lets us know that we can do simple tasks “just in case” . His words are not negative “Do This Or You Will Die” disciplinary mandates with a sense of doom but are positive suggestions that are easy to read, to comprehend (he includes pictures) and yet are still detailed information regarding storage techniques, necessary survival equipment and procedures. Touching upon
what he considers the six main priorities of survival, (1) water (2) food (3) first-aid (4) home security and defense (5), heating & cooling (energy) (6) hygiene and sanitation, Nester explains what you will need, how long it should last, how you should store it and other aspects of simple existing that only an experienced well-trained survivor would know to recommend. Would you remember to have enough medications with you if you were hunkered in your basement? What could you do if you had no toilet paper or working toilet? What about mental health tips for you, your spouse and your children? Did you know there is such a thing as wireless door stop alarms? How long will you have water? Enough Food? You will be quite grumpy eating Ramon noodles with no hot water and little nutrition.
To put this information in perspective, consider where I live in the hurricane-free, drought free, Midwest. We have tornados, live on the New Madrid earthquake fault, have local rivers all around us and in one of the bigger cities, with more crime than we care to admit. What could go wrong!?! Nester points out that after days of closed grocery stores, folks become desperate for medicine, drugs, food and water, diapers,etc so now our safety and home is also in jeopardy. If the grid goes down, how will you communicate without electricity or phone or cell phones? What about medical needs? Where can you find water? How do you do laundry? Nester has the answers! His love and passion for his family and his environment shine through his writing. As a CERT Responder, I highly recommend that you read his book and take his suggestions to heart. Doing something is better than doing nothing. Even if the book inspires you just to get a weather radio, you have made an effort to protect yourself and your family. To learn more about Tony Nester, his survival classes and or to order his books, check out www.apathways. com. CERT
1. You will need to lengths of rope, one will be the anchor while the other will be used for the knot/loop
2. Lay the anchor rope on a flat surface.
3. Tie both ends of the other rope to make a loop.
4. Place the loop underneath the anchor line
5. Pull one side of the loop over and underneath the anchor line – do this three times
6. On the last turn, tighten the knot around and through the other end of the loop.
is a friction hitch or knot used to attach a loop of cord around a rope, applied in climbing, canyoneering, mountaineering, caving, rope rescue, and
What’s unique about this knot is its ability to slip and slip at the person’s will. As a sliding or friction hitch, it relies on the presence of a load or pressure to slip or move. Simply put, if you tug on it, it will remain in position. But if you loosen the pull, it will release and move.
Picture this: You and your family, along with 40,000 other fans, are sitting in the stadium watching your favorite professional baseball team play a night-time game. It’s the bottom of the sixth inning, and the place is going crazy as the #1 hitter steps up to the plate. All of a sudden, the seats around you give way and collapse beneath you. The entire stadium begins to shake violently, causing the concrete stands above you to crack and tumble down on those around you.
There is complete chaos as the stadium goes completely dark and injured victims are crushed and screaming, while those who can are pushing and trampling their way over the rubble and trying to escape the area. Your family members are injured but alive. You look out over the top of the stadium and see some of the buildings on the city’s skyline crashing down, and others burning.
Do you know what happened? Was this an earthquake, an act of terrorism, or something else? Do you know what you would do in this situation? ARE YOU PREPARED?
In this particular scenario, since you are in a crowded public place, try to take cover where you won’t be trampled. Move to an open area – remember that the most dangerous
place to be is near walls, bridges, overpasses, underpasses, buildings or anything else that could collapse. Cover your head and torso to prevent being hit by falling objects. Stay calm, avoid panicking and do not rush for the exit. Help others if you are able and be prepared for aftershocks.
Unfortunately, nearly two thirds (65 percent) of Americans do not know what to do in a disaster. Most adults have not practiced what to do in a disaster by participating in a disaster drill or preparedness exercise at work, school, or home. Only one in ten Americans have taken appropriate preparedness steps — a family emergency plan, an emergency supply kit and training in first aid — even though 80 percent of these people live in counties that have been hit recently with
severe weather-related disasters.
Since 2007, FEMA has been measuring levels of specific preparedness behaviors (actions individuals take in advance of a disaster to be better prepared to respond to and recover from different hazards). Should a largescale emergency situation occur, the most likely locations are a shopping mall (46%), an airport or train station (43%), a stadium or arena (42%), on a bus/plane or train (38%), an outdoor sporting or community event (35%), a school (30%), a roadway or office building (28%), a bridge (27%), a hospital (25%), or at home (22%).
Preparation before a catastrophic event is key to your survival. Being prepared doesn’t have to cost a lot of money, and the personal and financial cost of not being prepared far outweigh the expense of preparing your family — 30% of Americans feel that preparation costs too much — even though most of the pieces needed for a disaster kit are already in your home and just need to be gathered together and stored in one place.
Several things that you can do immediately to help you prepare for an emergency, costing you little to nothing are:
• Look around your house for things that could fall or move.
• Know the danger spots.
• Create a family disaster plan.
• Post emergency telephone numbers by every phone.
• Have an out-of-state contact.
• Learn First Aid, CPR and AED use.
• Stay clear of windows, fireplaces, or appliances if a quake hits
• Stay away from anything that could conceivably fall on you.
• Secure a water heater by strapping it to wall studs and bolting it to the floor.
• Before and after a quake, repair any deep cracks in ceilings, chimneys, or foundations.
• Repair defective electrical wiring and leaky gas connections.
• Keep batteries in smoke and carbon monoxide detectors fresh.
• Secure all chemicals, including fuel and bleach.
• Keep food and water supplies on hand.
• Teach all family members how and when to turn off gas, electricity, and water.
Should a large-scale emergency situation occur, the most likely locations are a shopping mall (46%), an airport or train station (43%), a stadium or arena (42%), on a bus/plane or train (38%), an outdoor sporting or community event (35%), a school (30%), a roadway or office building (28%), a bridge (27%), a hospital (25%), or at home (22%).
• Learn how to help children cope with disaster. Training is available to youth and adults to learn how to respond to any emergency situation effectively and efficiently, without placing yourself in unnecessary danger, and to assist your families and emergency services in the event of an emergency and or natural disaster before professional first responders arrive. Contact Mid America TEEN CERT for more information. It is important to develop the habit of thinking, “If an emergency happened right now, what would I do?” CERT
There are many great parts to my job! From meeting former patients who, thanks to the flight teams, pre-hospital and hospital personnel, not only survive but go on to recover to knowing that you work for an organization that puts safety first and does what is best and right for the patient. There is no amount of money that can replace the feeling you have at the end of day when you know that your team or you individually made a difference, albeit small, for someone. Outside of my everyday work I am honored to collaborate and work with the Survivors Network for the Air Medical Community which is made up of survivors of air medical incidents and accidents.
We met the very impressive, intelligent, caring Tammy L. Chatman when we did our Drone article last issue. Not only was she a wealth of information, she is a dedicated vibrant professional in the field of air medical transport. As the Public Information Officer for Flight For Life in northern Illinois and Southeast Wisconsin, she understands the importance of providing high quality, critical care en route to trauma and tertiary care centers as efficiently as possible as well as the coordination and team efforts needed to increase patient survival and recovery
Flight for Life is the non-profit organization that provides air medical transport of criticallyill or injured patients whether it is from the scene or from one hospital to another. They also provide ongoing education and training to fire, EMS, law enforcement, as well as dispatch personnel and their hospital partners. We can only imagine the training and coordination that is required to ensure that safety is a priority and patients are provided the best possible care.
Wow this is a hard one as I have been doing this for 27 years! There are two that really stand out in my mind. The first is the research and then writing of the chapter on post accident/incident planning for the Air Medical Physicians Association book, “Principles and Direction of Air Medical Transport”. The second has been the opportunity to be a volunteer photographer and Public Affairs Officer for the National EMS Memorial Service that honors our fallen air medical and EMS providers who have paid the ultimate sacrifice in the service to others.
No one expects a “thank you” for doing this job; that is not why folks do it. When a former patient reaches out by stopping by the hangar, calling, writing or posting to our Facebook page it helps to remind everyone why they do this work. It is not just a job for most but rather a calling. In the end it is the simple things that the public can do to show they recognize how hard the job is and that they appreciate those who do it. EMS is a very under-recognized and poorly funded area of the first responder system. Showing appreciation is very important to help validate to those who do the job why they do it!
(EXAMPLE:
My dad’s mom, my mamaw, had a huge influence on me until I was 8 years old when she died. She suffered a stroke while cooking breakfast one morning. Back then stroke care was mostly non-existent and she died in the hospital. I spent a lot of time with her until that point when my mom and dad were working. She taught me how to work hard, take care of others, and appreciate the little things. She was in her 70’s and even though she always wore a dress with an apron over it, she split wood for the iron cook stove where she made every meal, drew water from the well, as well as planted and tended a big garden with never a complaint. She along with my mom was a strong role model. CERT
BY CHRIS WAHOSKI
Mass shootings are tragic and becoming regular occurrences.
On the night of October 1, 2017 in Las Vegas, when concertgoers were enjoying the Route 91 Harvest Festival, with country singer Jason Aldean onstage performing. Audience members were having fun, listening to 3 days of country music from various entertainers, including country stars Jake Owen, Big & Rich, Luke Combs, and Dylan Scott.
At approximately 10:05 pm, a couple single gunshots rang out from the 32nd floor of Mandalay Bay Hotel, shooting into the crowd. Thirty seconds later, automatic gunfire could be heard from video footage, with around 900 rounds fired into the crowd over the next 10 minutes in 12 bursts. Videos showed Jason Aldean and his crew rushing off the stage to avoid injury.
“Nonstop gunfire” sent more than 22,000 country music fans scrambling for their lives down back alleys and even jumping the fence to McCarran International Airport. According to sources, people took personal cars, cabs, and Ubers to flee the scene and take them to the hospital for care before the ambulances arrived.
The death toll was 59, with more than 520 injured out of the 22,000 attending the Harvest Festival event. The closest hospital was University Medical Center (UMC) which is Nevada’s only Level 1 Trauma center in the area. This is one of only a few free stand-alone trauma centers in the country. Their services cover more than 10,000 square miles of Nevada, parts of California, Arizona, and Utah. Approximately 79% of their regular patients arrive by ambulance, and 19% by air helicopter.
The night of this deadliest mass shooting, more than 100 patients required surgery, and the staff of the UMC, approximately 5 miles from the scene, delivered. In the first hour alone, more than 100 surgeries were performed, said Dr. Fildes, Trauma Center Medical Director. Extra surgeons, paramedics, and nurses were called into UMC that night. The COO was even wheeling in patients at the time the hospital called for help.
I know as a paramedic, the feeling of pride, even when you have worked exhausting hours, been yelled at, have been bled or puked on, are not sure if the scene will become unsafe, or even if there will be a child behind the door not breathing. I was in town for the EMS World Expo and was able to tour the UMC Trauma Center. It had been a couple weeks since the incident occurred. The feeling was calm and collective as the men and women were very proud of a job well done.
No patients were waiting for surgery; in fact, the surgeons were waiting on patients to be taken to the operating room, which is completely separate from the rest of the hospital. The patients on this day went to the lobby and were sorted on a scale from one to five based on priority of care needed. Most of the injuries that were seen were gunshot wounds to chest and abdomen, many wounds from shrapnel, when the 5.56 would hit the ground ricocheting, hitting people in the crowd. There were also individuals who had fallen while fleeing the scene and got hit by cars, who also had to be evaluated after the shooting.
“Nonstop gunfire” sent more than 22,000 country music fans scrambling for their lives down back alleys and even jumping the fence to McCarran International Airport.
We’ve learned a lot from the Pulse Night Club shooting in Orlando and adjusted some of our standard operating procedures in conjunction with Metro. In fact, we learned that self-delivery is used as a mode of transport with large Mass Casualty Incident (MCI) situations. Whether it’s by police car, ambulance, or private car, there is no wrong method when it comes delivering patients to the emergency room in a mass casualty incident. “Some patients even went back to their home state and then sought medical attention,” said Dr. Fildes.
The suspected gunman, 64-year-old Stephen Paddock of Mesquite, Nevada, was found dead in the Mandalay Bay Hotel on
the 32nd floor after opening up gunfire on the country event. Police said they believe Paddock killed himself prior to SWAT police entry. Police found 23 various handguns and rifle firearms along with 10 suitcases. No motive was given or suicide letter was found after the massacre.
Stephen Paddock was a licensed pilot who owned two planes. He also had a hunting license from Alaska. He was an accountant who had multiple houses and lived in a retirement community in Mesquite, Nevada. Paddock didn’t have a big online presence. In 2012, he sued one of the hotels, but it was handled out of court in arbitration. His gambling habits showed he sometimes spent $10,000-$30,000 dollars per night. Public records indicate Stephen Paddock lived a relatively transient life, having 27 different residences in California, Texas, and Nevada.
According to Bruce Paddock, Stephen’s brother who lives in California, his family grew up in Sun Valley, California. Their father, Benjamin Paddock, was on the FBI’s Top Ten Most Wanted list in the 1970’s for robbing banks and was described as a psychopath in an arrest warrant. According to the warrant, the suspect’s father carried a firearm and was considered “armed and dangerous.” It listed his nicknames as “Big Daddy,” “Chromedome,” and “Old Baldy.”
In 1960, The Arizona Republic described Benjamin Paddock as a three-time bank robber who was accused of stealing approximately $25,000. He was arrested in Las Vegas and “indicted on three counts of robbing Phoenix branches of the Valley National Bank,” an archived article said.
Las Vegas had more than 40 million visitors in 2016. The Consumer Electronics Show (CES) brings around 120,000
I know as a paramedic, the feeling of pride, even when you have worked exhausting hours, been yelled at, have been bled or puked on, are not sure if the scene will become unsafe, or even if there will be a child behind the door not breathing.
people during the yearly event, and around 320,000 attend New Year’s Eve, just to name a couple high profile events. Las Vegas is a very popular location for world travelers. There are many attractions such as gambling, entertainment shows, riding a pink jeep through Red Rock Canyon a few miles from the strip, and helicopter rides.
Las Vegas Metropolitan Police Department must and are having talks about tactical situations that arise, because these shootings are happening too often as regular occurrences. This includes talking about possible hardening stops and possible metal detectors in future meetings. “We are always looking at screening and how to keep people safe in Las Vegas” says Chief Joseph Lombardo of Clark County. Chief Lombardo has been with the Las Vegas Metropolitan Police department since 1988, and was promoted to Chief in 2015. Currently there are over 2,700 police officers and 750 correction officers of various ranks.
Prior to this shooting in Las Vegas, the 2016 Orlando, Florida Pulse nightclub was the second deadliest mass shooting. That shooter killed 49 and injured 58 people. His motive was terror, and it was considered a hate crime. The third most deadly shooting was in Blacksburg, Virginia killing 33 and injuring 17 people at VirginiaTech School by 23-year-old Seung-Hui Cho who had mental issues.
Thank you Las Vegas first responders for everything you do to keep us safe. Thank you to the men and women at UMC who had a steady hand to heal those injured. Be safe everyone and aware of your surroundings. #VegasStrong. CERT
On August 24, 2017 a tropical storm traveling Northwest in the Atlantic Ocean became a Category 4 hurricane heading for Texas, hitting landfall northeast of Corpus Christi on Aug. 25. Turning then into a fierce tropical storm by the time it reached the Houston area, it slammed 130 mile an hour winds and nearly 4.5 feet of rain causing massive flooding.
Mark Sloan is the Emergency Management Coordinator of Harris County, Texas. Not only is Harris County the most populated county in the state, but also the third most populated in the entire USA. Included therein lies Houston, the largest city in Texas and the fourth largest in the US. Houston is also the county seat. The combining factors put Mark in charge of the safety and welfare of almost 4 million people in 1770 square miles. Multiply that times the many corporate headquarters of top companies, large and small busi-
nesses, the transportation system, the oil petrochemical plants, the port activity, schools, fire, police, government and the tens of thousands residences and all the multicultural population, Mark obviously had his hands full. Throw in Hurricane Harvey, one of the worst hurricane disasters on American soil and one can only imagine the
responsibility, organizational skills, experience, and personal emotional toll that his job must demand. His department falls under Homeland Security and Emergency Management of which Judge Ed Emmett is head. To complicate matters, Houston is one of 10 of the highest risk urban areas in the country which means it is at a “ Tier 1” level, based on threat, vulnerability, and security and infrastructure. The oil industry, the port, the trains, ships and trains alone present a possible security crisis. Mark Sloan is also the head of CERT in his county.
911 calls numbered more than 50,000 on the first night which made authorities request that citizens only call in a life-threatening situation.
As of September 26, 36 deaths in Harris County had been counted, mostly drownings or due to delays in obtaining health care. A record had been set for the total rainfall from a single storm on the U.S. continent. 911 calls numbered more than 50,000 on the first night which made authorities request that citizens only call in a life-threatening situation. People trapped in their homes were asked to go on to their roofs where rescuers could find them and see them. The call went out for anyone with a boat to go out in their neighborhood and help with water rescue. However even then, boats were tangled in debris or wires, or capsized, caught in strong currents,in efforts to help.
Even though many CERT members themselves were trapped in their own surroundings, teams were quickly called into action. Starting with their own neighborhoods, they attended to themselves, their families and neighbors, offering help with communication, transportation, and comfort. Those with boats helped with water rescue.
Carole Chambers, the CERT Coordinator in Humble Texas located about 20 minutes north of Houston proper, said that many CERT teams helped with search and rescue water rescues. As soon as the water subsided, responders were able to get to the shelters and helped by passing out food, water, and supplies. “A few CERT members helped with going door to door in one of the flooded areas and assisted in the cleanup. Some of our CERT members assisted with traffic in some of the flooded out areas. We have CERT members who are Ham radio operators, that assisted at Transtar.” (Houston TranStar is the Traffic and Emergency
Management Center for Houston, Texas).
Mary Payne who works with Katy Area CERT also stressed that teams were out helping with search and rescue in the water. “CERT members teamed up with constables to drive around neighborhoods requesting they voluntarily evacuate from their homes. Some helped at a hotel where a fire department had set up a temporary command center for evacuees, logging in residents and helping them along with their pets, find shelter, food and get medical help. Many were grateful to have our team there. Some even asked how to become a CERT member.”
Along with more than 300 voluntary organizations, as well as military, government, and agencies such as Red Cross, our CERT Responders joined in to help Harvey survivors in their own communities and neighborhoods. Now, volunteers are helping with recovery efforts, cleaning the 200 million cubic yards of debris and aiding in the reconstruction of damaged homes and the relocation of those with no home. But Mark Sloan and his many resource and support teams are as resilient as the state of Texas. Our CERT Responders in that great state are up to the task. Everybody knows “You don’t Mess With Texas!” CERT
CERT members teamed up with constables to drive around neighborhoods requesting they voluntarily evacuate from their homes.
Being assigned to the Search and Rescue team in Joplin was more than what I had first anticipated. I had obtained the Search and Rescue skills from CERT training months earlier as the simulation exercise consisted mostly of two components: looking for clues on the ground to find someone who is lost while simultaneously remembering to look up as well. This simulation took course at the local State Forest where my family has been many times to share family fun and create worthwhile memories. However, this training did not mentally prepare me for my time in Joplin.
My first experience in Joplin was on day 6 post-tornado. I was assigned to accompany a SAR team in looking for human bodies and/or body parts. The briefing became difficult to comprehend as I was informed that I was to be looking for entire bodies under fallen trees or in the branches of the trees left standing. The five member team entered the woods that marked the exiting of the tornado from the mangled city. The team leader reminded us of the news reporting on the missing people and the possibility that they were lifted by the winds and dropped out of the sky in the heavily wooded area. The area that was once a forest of trees was now a field of debris amongst downed timber. As we walked in a line we picked up randomly displaced pictures that once were gazed at by their owners. The five person team quickly realized the area to search was much larger than first anticipated and regrouped at the edge of the perimeter. The leader then called in for a chainsaw crew to assist us with searching by opening up the walls of fallen trees
that had before made the field impassable.
We teamed up with the chainsaw team know as “Team Rubicon”-- a group of individuals from around the United States all of whom had military background. The heavily disciplined group assisted the small five member team by cutting through the thick area in order for a realistic search mission to be possible. I felt very fortunate and thankful for the CERT program that had instilled within me the training necessary that allowed me the opportunity to work side by side with medics, SAR team, and the military represented by different forces.
My mind started to question whether it was a good or bad thing that I have not located a dead body yet.
All of us knew our area to search and kept in visual contact with team members on both sides. As the enthusiastic morning turned into a hot quiet afternoon, I began to really think about what I was doing while in the moment.
I was looking for dead people.
My mind started to question whether it was a good or bad thing that I have not located a dead body yet. I sent a text message to
Linda Barger while I was in the field to try and gain clarity on the mission. The text read, “Is it better to find something or not to find something?” of which I received a reply that I was not considering. I stared at Linda’s replied message: “Best to find something because it will give closure to a family.” I felt misunderstood. I wanted to hear that it is best not to find something because it means we might find the missing person alive somewhere else. My previous training consisted of searching for LIVE people; not DEAD ones!
I felt alone in the woods while surrounded by a well trained group of individuals. I had thoughts of my unsuspecting wife back home continuing in her regular weekend routine as I look for dead bodies in the woods. I thought of my adult children enjoying the weekend weather as I wipe sweat from my eyes looking for feet or arms in tree branches.
As I was looking down on the ground I spotted a St. Louis Cardinals baseball card hiding under the branches. I picked it up and thought of the person back in my hometown who loves the Cardinals. This moment, as strange as it seems, helped me realize that I was on a mission. My mission was to do what needed to be done, whether it was to assist a family with finding closure by finding a body part or with giving a family hope because we found nothing. The team searched all day and did not find anything human in nature. We located many family photos, plucking them from the forest floor to be reunited with their owners. Our inability to find anything gave me hope to look for the living on the next day’s mission.
Day seven’s mission was different than looking for body parts. Instead, I was on a team looking for individuals on the missing person’s list. A sheet of paper with names and addresses was what the new team of five was given as a map to determine the fate of individuals not yet accounted for. Amongst the many homes we searched, one stands out to me the most.
GPS was the only way to find the house as street signs and address numbers were no longer reliable. The team found the site
CERT offered me the training, placed me in the house, and gave me the creative freedom to be heart to heart with a live person grieving her dead son.
of the home and deployed like clockwork asking surrounding neighbors questions regarding the whereabouts of the tenant in question. Another CERT member and I entered the condemned house to search for clues. The door was open as if it had been ransacked by thieves, but the valuables were still inside unprotected. The glass was blown out of all the windows and was still falling on the wet hardwood floor. The roof was partially gone and the belongings were scattered throughout the structure. As I stood on the soaked mattress flung on the floor, I found a cell phone bill. I called the number found inside, hoping the individual would answer; but it went straight to voicemail, stating the mailbox was full. The two of us were then called out of the house as the neighbor had confirmed the resident died in the tornado. The details were not clear but apparently the young man was walking home from his job at McDonald’s and was sucked up by the tornado and did not make it back out alive. As the team worked throughout the day locating individuals I received a call on my cell phone. I recognized the number as the one from the young man’s house from earlier. I answered the phone and was surprised to realize I was talking to the young man’s mother. She asked me how I got her son’s cell phone number. I informed her that I retrieved it when I was in her son’s home looking for him, and she started to cry. She had not yet been to the home but had been given the information about her son’s death. She asked me to assist her in finding a way to notify her son’s friends of his death. I shared in her sorrow as I told her I have a son similar in age. I encouraged her to continue paying her deceased son’s phone bill and answer the incoming calls. I shared with her that his friends might continue to call and she could inform them one at a time. She thanked me for my willingness to look for her son and for our help in the distressed
city. I have not heard back from her nor do I expect to. The thought of losing my son is impossible for me to think of as I know he is still alive. I was empathetic to her suffering but not to the degree of the total reality of what she was going through.
CERT offered me the training, placed me in the house, and gave me the creative freedom to be heart to heart with a live person grieving her dead son.
In an honest confession, my memory is slowly fading. I have forgotten how many individuals were part of Team Rubicon. I can imagine the sound of the chainsaw but it is an all too familiar sound and I no longer can designate it only to Joplin. I fail to recall the Cardinals baseball player or the name of the church where the team received a free lunch that afternoon. I no longer remember the young man’s name or the house I invaded or any of the 10 digits of his phone number. I do not remember his address or the cell phone company’s logo on the envelope. I do not remember the mother’s name or the sound of her voice. I do remember the rash I received while in the woods but do not remember when it went away. I would have liked to have remembered the boy’s name.
The question is asked again, “Is it better to find something or not to find something?” The answer was established during the telephone call I was involved in. I found out that I did not get to make the choice whether I would find something in the woods or whether I would be gripped by the voice of a heartsick mother while I was standing in the middle of the epicenter. Locating individuals on the telephone and congratulating them for surviving this horrific storm was no doubt a joyful experience. The reality is that if you get involved then you will find something. For me, I did not find what I was sent out to look for. Instead, I found much more. CERT
Let’s start by looking at some facts about stroke from the American Heart/American Stroke Association:
37% of all Americans cannot accurately identify even one stroke warning sign.
• Stroke is the #5 cause of death in the United States
• Each year, approximately 795,00 Americans will suffer from a new or recurrent stroke
• Every 40 seconds, someone in the United States has a stroke
• Every 4 minutes, someone in the United States will die from a stroke
In fact, 37% of all Americans cannot accurately identify even one stroke warning sign. Being ready for a stroke can save a life- possibly yours. Are you ready? You can spot a stroke- F.A.S.T!
Stroke, which is sometimes called a brain attack, is a medical condition that affects the blood supply to (or within) the brain. A stroke occurs when a blood vessel carrying oxygen and nutrients to the brain tissue is either blocked by a clot or bursts. When this happens, the brain cannot get the blood and oxygen it needs, so the affected brain tissue dies.
There are two types of stroke. The first type is called an ischemic stroke. This is the most common type of stroke, accounting for around 87% of all strokes. This type of stroke is caused when an artery to or in the brain becomes blocked. These blockages can be caused by a thrombus (a blood clot caused from fatty deposits) or an embolus (a blood clot that travels from somewhere in the body). This is a medical emergencyrapid treatment is critical in a patients long-term outcomes. About two-thirds of patients suffering an ischemic stroke can survive without major disability if prompt treatment is given.
The second type of stroke is a hemorrhagic stroke. These strokes account for around 13% of all strokes. A hemorrhagic stroke occurs when a blood vessel within the brain bursts. This causes bleeding that puts pressure on the brain. The most common type of hemorrhagic stroke is an intracerebral hemorrhage. The most common cause for this is hypertension. Small blood vessels within the brain tissue begin to “leak” into the surrounding tissue. Symptoms may be sudden or develop gradually over time. Another type of hemorrhagic stroke is
called a subarachnoid hemorrhage. In this type of stroke, there is a ballooning of a weakened spot in the lining of blood vessel, called an aneurysm. When this aneurysm “bursts” or ruptures, immediate stroke symptoms occur. Immediate treatment is needed to prevent death in these types of stroke. Only about one-third of patients suffering a hemorrhagic stroke will survive without major disabilities.
Transient Ischemic Attacks or “mini-strokes” are a warning sign of stroke. These episodes produce temporary stroke-like symptoms that last for a short period of time. They do not cause lasting damage. People with a history of TIAs are at a greater risk of a major stroke. TIA symptoms that are lasting longer or occurring more frequently need to be evaluated. Many strokes can be prevented by heeding the warning signs of TIA and treating the underlying risk factors.
There are some risk factors for stroke that you can do nothing about-
they are referred to as non-modifiable risk factors. These include a prior stroke history, family history, age, gender and race.
Modifiable stroke risk factors are those things that you can control.
These would include:
• High blood pressure
• Atrial fibrillation
• High cholesterol or lipids
• Diabetes
• Smoking
• Alcohol or drug abuse
• Inactivity or obesity
Other risk factors include
• Obstructive sleep apnea
• Internal carotid artery blockage
• Infection and immune dysfunction
• Trauma
• Sudden numbness or weakness of the face, arm or leg
• Sudden trouble speaking or understanding what is being said
• Sudden visual difficulty in one or both eyes
• Sudden difficulty walking, dizziness or loss of balance/coordination
• Sudden severe headache with no discernible cause
Only about one-third of patients suffering a hemorrhagic stroke will survive without major disabilities.
• Know all the stroke symptoms. There are certain stroke symptoms you should be able to recognize. Any sudden onset or trouble with vision, slurring of words or talking nonsense, or weakness one side of the face or body. If in doubt, get it checked out. Do not wait to see if they symptoms pass.
• Call 911 or your local emergency response number. Do not waste time by calling a family member, a friend or the person’s doctor. It is important to get stroke help immediately to increase the chance of a full recovery. It is okay if the symptoms turn out not to be from a stroke.
• Make a few notes. Note the time when the symptoms first took place. Emergency personnel will want to know when the patient was last seen looking and/or feeling normal. This time is important in the treatment plan for a stroke.
• Do not offer the person food or medicine. Although most strokes are caused by blockage in an artery, some strokes are caused by bleeding from an artery that burst. Giving aspirin to someone with this type of stroke can make the condition worse. The patient may also be suffering from undetected problems with swallowing. Giving
food or water could lead to aspiration into the lungs. This can cause unwanted complications.
• Stay calm. Although it can be difficult, it is important to compose yourself and assure the stroke victim that everything will be all right. Try to concentrate on the situation and remind yourself that you are doing everything you can to help. Reassure the patient that you are not going anywhere and help is on the way.
• Keep a positive outlook. When patients get the help they need, most will improve enough to return home and function independently, even if they have some permanent symptoms.
The sooner a stroke victim is assessed, sooner they can receive potentially life-saving treatment. Prompt arrival to an emergency room is a MUST. Every minute counts to save brain cells and brain function. Time is brain! Current emergency treatments for stroke include:
• tPA (Tissue Plasminogen Activator) is an IV medication that can break up blood clots to restore blood flow back to the brain. It is currently the only FDA approved treatment for acute ischemic stroke. This treatment improves chances of recovery, but only if the patient receives immediate
treatment. This medication works best when given within the first 90 minutes of stroke onset and can only be given within 4 1/2 hours from symptom onset. A major risk of this treatment is bleeding. Not all stroke patients can receive tPA. Patients with a hemorrhagic stroke, arriving to the hospital too late, or who have any one of multiple exclusion criteria will not be able to have tPA.
• Catheter Based Rescue therapy or mechanical thrombectomy is a highly specialized treatment that uses a catheter device to remove a clot located within an artery in the brain. This treatment requires specialized equipment and very specially trained physicians. It can be beneficial if given within six hours from the start of stroke symptoms. This treatment can only be used for blockages in the large vessels of the brain.
• Emergency treatments such as surgery, endovascular coiling and surgical clipping may be necessary for persons suffering a hemorrhagic stroke. These treatments are used to stop bleeding and allow for brain swelling. Other procedures can used to monitor the pressure on the brain.
The kinds of disabilities following strokes are similar for all age groups,
There are certain stroke symptoms you should be able to recognize. Any sudden onset or trouble with vision, slurring of words or talking nonsense, or weakness one side of the face or body If in doubt, get it checked out.
although younger people generally recover more than older people do.
According to the National Stroke Association, 10% of stroke survivors will recover almost completely and 40% will experience moderate to severe impairments that require special care. The types of disabilities most commonly seen after stroke include:
• A total or partial loss of the ability to use words or the inability to speak clearly
• Difficulty swallowing
• Cognitive impairment affecting shortterm memory, thinking, attention span, judgement and learning
• Spasticity and stiffness causing balance and coordination problems
• Sensory disturbances such as unawareness, pain, numbness or a mix of all three
• Emotional changes including depression, an inability to acknowledge the physical reality of the effects of stroke, frequent uncontrollable crying and tiredness
• Weakness or paralysis of one side of
the body. Almost half of all stroke survivors will have one or the other
Because stroke survivors often have many rehabilitation needs, recovery is unique for every person. The ultimate goal of rehabilitation is to help the stroke victim recover to the highest ability possible. The earlier rehab begins, the more likely survivors are to regain lost functional abilities and skills. Although a majority of functional abilities may be restored soon after the stroke, recovery is an ongoing process. Caring family and friends can be one of the most important factors in rehabilitation.
THE NATIONAL STROKE ASSOCIATION RECOMMENDS THAT YOU FOLLOW THESE GUIDELINES TO HELP REDUCE YOUR RISK FOR STROKE
• Know your blood pressure. Have it checked at least annually. If it is elevated, work with your healthcare professional to control it.
• Find out if you have atrial fibrillation (Afib). This irregular heartbeat can lead to small clots being sent from your heart to the vessels in your brain. If you have atrial fibrillation, work with your healthcare professional to manage it.
• If you smoke- STOP. Smoking places you at a 50% higher risk of having a stroke.
• If you drink alcohol, do so in moderation.
• Know your cholesterol numbers. If they are high, work with your healthcare provider to control them. This can be done through diet control, medications or both.
• If you are diabetic, follow your healthcare professional’s recommendations to carefully control your diabetes. Diabetics are twice as likely to suffer a stroke.
• Include exercise in your daily routine and lose weight if you are overweight or obese.
Call EMS to get you to the appropriate medical facility to treat your stroke. Not all stroke centers are the same. Not all can provide treatment with tPA. Even fewer can provide catheter provided treatment options. Cox Medical Center South is the area’s only Comprehensive Stroke Center. They are accredited by the DNV-GL and designated as a Level 1 Stroke Center by the State of Missouri. They provide the most comprehensive stroke treatment for all stroke patients. CERT
You can make a difference to yourself or others. KNOW THE SYMPTOMS OF STROKE AND ACT F.A.S.T.
Upon
The SSM Health Saint Louis University Hospital’s team of expert interventional cardiologists and surgeons were the first in the region to routinely utilize the Impella® device on high risk patients to treat the symptoms of cardiogenic shock by assisting the left ventricle during the cardiac cycle.
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What do you want to be when you grow up? Not long ago,the options for females were minimal. It seemed our choices were teachers,nurses,secretaries,seamstress or flight attendant. We were taught in “home economics” how to cook and sew. In scouts,we did crafts,sold cookies and sang by the campfire.
Thank goodness,with each passing year,daughters and granddaughters have proven their intellect,strength and abilities,enabling them to learn skills,earn livable salaries and rise above stereotypes. Empowering young women gives the invaluable gifts of self-respect,courage,a life of promise and the strength to conquer unforeseen challenges. Camp Fury of St. Louis does exactly that. In conjunction with the Girl Scouts,this summer
camp gives girls the opportunity to see life as a firefighter,police or EMT. Young females see first hand that they can pursue their dreams,overcome obstacles,find courage and complete tasks that they never have imagined.
Kate Wiegand is the co founder of Camp Fury STL. She herself is a first responder a firefighter and paramedic with the Metro West Fire Protection District. Along with Gina Anderson, a lieutenant and paramedic with the Fenton Fire Protection District, Kate contacted the Girl Scouts about bringing the camp here. She knows first hand what it takes mentally and physically. She is also very aware of how much satisfaction and pride comes from accepting challenges and overcoming fear. This is the first camp of its kind in the St. Louis area. This summer, JuIy 31- August 4, 2017,the campers stayed at Camp Tuckaho in Troy, MO but came to the St Louis County Police and Fire Academy each day for first responder training.
“I got involved because being a female first responder, I know that there needs to be more awareness that we exist in male dominated careers and that this is a career choice worth pursuing as a young female. The camp volunteers are all female first responders in the St Louis area and serve as mentors to the teen campers. It is important to all of us that we help build a generation of girls full of courage, confidence, and character.”
In what sort of activities did the girls participate? Things such as climbing a 75 foot aerial ladder, testing drugs in the crime lab, rappelling, and target practice in the Virtra firearms simulator!
Says Katie, “Girls were scared of completing some tasks, but they ALL did each of them. This kind of risk taking proves to them that they CAN pursue their dreams and they can overcome obstacles. When they entered the camp on Day 1 they were all strangers but when they left at the end of the week, they were all like family. That is a major part of the first responder community, we are all a family. So it was good for them to get that “team” feeling. “
Most of the campers were not Girl Scouts until they registered for Camp Fury STL. The answer is they do not have to be Girl Scouts to register, but after registering, they become Girl Scouts. They did not receive a “badge” but they did have a grad-
“I got involved because being a female first responder, I know that there needs to be more awareness that we exist in male dominated careers and that this is a career choice worth pursuing as a young female.”
uation ceremony where they received challenge coins and certificates.
Katie says that the female first responders ended up benefitting from the experience as well. Many did not know each other before the camp but now are still maintaining friendships.
“We all work at different departments and different shifts, there are very few of us in general. We all have a lot in common and understand the challenges of being female first responders. It was a great chance for us to get together while doing something great for future generations of first responders.” smiles Katie.
The camp originated in southern Arizona where it began in 2009. Since the creation of Camp Fury, STL is the 8th Camp across the US. Katie began working with the Girl Scouts of Eastern Missouri two years ago.
She is greatly looking forward to next year’s camp (June 24-29, 2018). They will build on their knowledge of search and rescue, as well as learn more about severe weather and disas ter response. As TEEN CERT qualification demands about 20 hours, there wasn’t enough time for a full Teen CERT program, however they were able touch on basic emergency management and safety skills.
A new camp will be released in 2018 for younger girls called “Catching Fury.” which will take place in August 2018 for ages 11-13 years old. Camp Fury STL is June 24-29, 2018 for ages 14-18.
Registration begins November 16, 2017. To register go to: http://www.girlscoutsem.org/ en/camp/camp-fury-stl.html
Donations accepted through the Girl Scouts of Eastern Missouri, “Camp Fury STL,” a 501C3. CERT
When entering a building for search and rescue, not only must first responders think about the imminent dangers of falling objects, and unstable floors and walls, but also of air quality and contamination. Perhaps you are well-versed watching for the notso-obvious threats in buildings such as toxic gasses, carbon monoxide or radon.
I had no idea of the dangers of radon or if I had to be worried about it when I was entering a building. In fact, I wasn’t sure what radon really was or how to protect myself on a mission inside a structure.
The very good news is that first responders are usually not in a building long enough to experience any health effects from radon. Long term exposure is different. We should be aware of the facts, origin, causes and effects of radon, as it can affect our personal lives and our health.
Throughout mining history, documents and literature reflected upon the deterioration of the lungs. Some called it “Mountain disease,” others “Consumption”. In the late 1890’s, doctors and scientists realized it was lung cancer. When Madame Curie discovered radium and began her theory of
radioactivity, little did she know that she was contaminating her body and would die from aplastic anemia. Aplastic anemia is caused by a lack of red, and white blood cells and platelets (cells in our blood that help to make it clot). This made it so her stem cells couldn’t make mature blood cells. Why? Because of her exposure to radium. Simply put, radium (Element # 88) breaks down and forms radon (Element #86). She discovered isotopes, which occur when forms of the same element have equal numbers of protons but different numbers of neutrons, making it radioactive. Madam Curie’s incredible work resulted in her permanent place in history by being the first woman to win a Nobel Prize, and the only woman ever to win it twice! Without her work, we might not yet have known the impact of the radium beneath our soil or about the radon in our homes.
Radium, a silver/white natural metal is at very low levels in soil, water, rocks, coal, plants, and food. When uranium and thorium (two other natural radioactive substances) break down, radon, a cancer-causing radioactive gas, results. You can’t see, smell, or taste it—therefore it can unknowingly easily be in your home or where you work.
Radon can seep in almost anywhere. Besides creeping through cracks and spaces in your walls, doors and windows, it can go through concrete, plastic bags, paints, building materials and most insulations and sheetrock. It is in igneous rock and soil and can easily be in well water. Humans can inhale or ingest it. So basically, radon is in our homes, at our work, outside, and in the air we breathe.
The Surgeon General says that radon is the second leading cause of lung cancer in the United States today. Smoking is the first. If you smoke and your home has high radon levels, you are jeopardizing your lungs bigtime. There are scientific studies that say children may be more sensitive to radon because their cells are more rapidly dividing which can make them be more vulnerable, plus small children breathe faster.
Confined air spaces, especially underground work areas like mines, caves, my basement at home which is an older building from the very early 1900’s, tunnels, etc. can have higher levels of radon’s decay. Radon-rich water affects businesses. According to the US EPA, about one in every 15 homes have elevated radon levels.
Sounds depressingly ominous, however there is good news. We now have all the knowledge of those before us. All is not lost. You can have your home tested. You can purchase a Do-It-Yourself test kit which can be as low as $20-$40 but you can’t beat a professional with the top equipment and experience. We now have certified radon mitigators who will test the radon levels and give suggestions. You can even get service agreements where they come
out periodically and check on a regular basis. Before buying a home, you can ask for the results of tests on the home, or if they have ever had it tested. Some homes now have radon-reduction systems built in! If you are having your home built, make sure and include this feature.
The Surgeon General says that radon is the second leading cause of lung cancer in the United States today. Smoking is the first.
Best part about getting a radon-reduction system is not only the security of a job well done and the comfort of not having to worry, but these systems will also remove moisture and help keep your basement dry, which gets rid of mold. Systems can also help detox your air by getting rid of bad air from pesticides, herbicides, methane, and carbon dioxide!
The EPA web site has great suggestions on how you can improve your home. You need to fix your environment if tests show 4 picocuries (pCi/L) or more. The site also goes into detail about the best ways to reduce radon through various systems, ventilations, sealing techniques (caulking, etc.) and radon removal systems. Remember every house is different. If possible, hire a professional that specializes in this sort of work. Shabby work incorrectly done can actually raise the radon level or pull in carbon monoxide!
In summary, you have plenty of other worries when you enter a building for rescue. Radon is not one of them. Wherever you reside or work longterm, you should be aware of your radon counts and the risks to you and your family, especially since efforts can be made to alleviate the danger to you and your loved ones. The biggest threat is the combination of a house of radon leaks and a resident smoker of cigarettes. CERT
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