Presented by their handlers from both the Visalia Police Department and the Tulare County Sheriff’s Department, this is an event the animal lovers of our community will not want to miss.One person in our community who can certainly attest to the strengths and capabilities of our furry friends is Dr. Nan Kuswa, a doctor of Veterinary Medicine in Visalia, who has been treating and caring for the Tulare County K-9 dogs for nearly twenty years. In light of the upcoming trials, a feature about Dr. Kuswa and her continued efforts and unrelent- ing care for the animals of this special unit can be found on page 12. She and her staff are unmistakably a group of real animal lovers.For those of you who enjoy hiking and spending time in the mountains, be sure to check our Briefing article about the Sequoia Mountain Rescue Team, a nonprofit group devoted to saving the lives of those who find themselves lost or stranded in the mountains up from our valley.

As the snow pack begins to melt, the temptation to explore nature’s beauty can be dangerous if you’re alone or find yourself in unfamiliar territory. Fortunately, this courageous group of volunteers is available to help the lost become the found.Regardless of how you choose to spend your time outside this spring, get out there and draw in the fresh air. Don’t let the pull of your daily responsibilities and routines outweigh the pull of the blossoming fruit and nut trees, the warm weather and the energy that spring brings. Don’t pass up the opportunity to stop and smell the daffodils—and enjoy this beautiful time in our valley.

By Gary C. Kuncl

It begins with a startling and unexpected phone call or visit. Officials report that your loved one, a peace officer, has been seriously injured on the job. Now everything becomes shock and confusion. Somehow, you get to the hospital. Sooner or later, you learn your loved one has died. Now, and for years to come, you and those around you must deal with a tragic loss and try to rebuild shattered lives.

That is how it was for Leon and Carol Isaac. Their son, Jeff, a Fresno County Deputy Sheriff, was killed on-duty in a vehicle collision in 1997. “After they told us about Jeff,” Leon said, “everything was in a fog,” Despite this, the Isaacs had to move quickly. “Jeff died on Monday, and we had to bury him on Thursday. After that, we were on our own with our grief.”

When a peace officer is killed on-duty, many things must happen at once—notifications, follow-up and scene investigations, arrests if a crime is involved, and coordination of the funeral services. The officer’s department is helpful and supportive, but it must keep the department running and support other officers in their grief. As time passes, the department’s ability to help becomes limited. This is where C.O.P.S. comes in.

Concerns of Police Survivors (C.O.P.S.) is a nation-wide organization, formed in 1984 to assist families of peace officers killed in the line of duty. C.O.P.S. members, who themselves have lost someone in law enforcement, volunteer to give comfort, support, and advice to devastated families. Over 14,000 families now belong. According to Jennifer Thacker, National President of C.O.P.S., between 140 and 160 officers are killed on the job each year. For every officer who dies in the line of duty, there are at least twelve people who are directly and adversely affected. “That is nearly 2,000 people each year who are forced into the throes of traumatic grief,” she said. Thacker’s husband, Brandon, a Kentucky Alcoholic Beverage Control Investigator, was murdered in 1998.

Central California C.O.P.S.

California C.O.P.S. has three chapters: northern, central, and southern. Founded in 1999, the Central California Chapter serves Tulare County and thirteen other counties. Leon Isaac is the president.

When tragedy strikes and an officer in this region is killed, the Central California C.O.P.S. Board of Directors contacts the officer’s department and offers help for the survivors. Leon said that upon meeting the family, “we all generally embrace because we know what they are going through. We stress to them that we’ll be there for them for the funeral, for the memorial ceremonies, and for the long haul. As the weeks pass, we are in contact with them by email, telephone and visits. Their biggest need from this point onward is for friends who understand and care.”

Debbie Elium-Uruchurtu was the former wife of Tulare County Sheriff’s Deputy Kevin Elium when he died in an on-duty auto accident in 2005. Debbie and their two children, Sean, 16, and Courtney, 15, have high praise for the C.O.P.S. organization. According to Debbie, “They were compassionate, eased our feelings, and later helped us attend the National Police Memorial. C.O.P.S. has been in contact with us regularly since; and it’s like we have gained a second family.”

According to Leon, C.O.P.S. members do not have to pay membership fees, because “the price paid is already too high.” A retired state parole agent, Leon says all of his efforts for C.O.P.S. are to honor his son and “to help other survivors during their time of agony and stress.”

Another tribute to Leon’s son, Jeff, came in the form of a metal cross, made by Fresno Deputy Sheriff Keith Gray, Jeff’s friend. In 1998, Gray installed it at the site of Jeff’s fatal accident.

The Central California Chapter raises funds each year with a motorcycle “run.” Scheduled for March 27, this year’s run will trace a route from the Visalia Harley-Davidson Agency to Millerton Lake. Other funding comes from police associations. All members of the Tulare County Deputy Sheriff’s Association donate $1.50 to C.O.P.S. from their paychecks. Similarly, individual members of the Fresno County Sheriff’s Office and the Fresno Police Department have opted to donate via payroll deductions.

C.O.P.S. Hands-On Programs

The National C.O.P.S. Organization provides Hands-On programs to help survivors rebuild their shattered lives. Each year, the California Police Memorial Board pays lodging for two survivors to attend the State Peace Officers’ Memorial Ceremony in Sacramento. C.O.P.S. pays lodging for other family members.

Also, in May during National Police Week, the Central Chapter pays airfare and lodging for other survivors to attend the National Police Memorial in Washington, D.C. Tulare County Sheriff’s Lieutenant Scott Logue attended the 2006 National Police Memorial. He said it was “a powerful, emotional, and gut-wrenching experience.” The C.O.P.S. Central Chapter also pays for survivors to attend annual retreats for spouses, children, siblings, parents, in-laws, and significant others

Bette Landin, whose husband, Joe, was killed in 1985, joined the Central Chapter last year and attended the spouses’ retreat. “It was amazing and really helped. The companionship was great; and you gain friends with whom you have a lot in common.” Bette said she wishes she had joined C.O.P.S. years ago. She sees her work with new survivors as a chance to “let them know we’ve gone through the same things and are there to help.”

Talking with survivors, one comes away understanding that theirs is a story of profound grief and loss. But in a larger sense, theirs is a story of strength, courage, helping others, and changing through tragedy. In much of this, C.O.P.S. plays an important role.

By Kimberly Sherman

Tulare County K-9s are intensely loyal to their partners, and Dr. Nanette Kuswa is intensely loyal to Tulare County’s K-9s. Kuswa, a Doctor of Veterinary Medicine, has been caring for the Tulare County K-9 dogs since 1991. She serves Visalia, Tulare, and Farmersville police departments, and the Tulare County Sheriff’s Office.

The tie Kuswa feels towards her four-legged patients and their police/sheriff handlers is obvious immediately. “A lot of people don’t understand the extent of this incredibly intense bond,” she says. “The handlers have to be animal lovers, and knowledgeable about animals. It’s a very special bond.”

There are three breeds of dog that have found their way into Kuswa’s care—and heart.

The Malinois is the current dog of choice for many agencies. A smaller, more compact dog than the time-tested German Shepherd, the Malinois looks like a shepherd in the nose and ears and has the black mask, but weighs in at a spry 10 to 20 pounds lighter. These dogs are often cross-trained for various tasks including protection, service, and finding drugs

“They are great working dogs, but they need a job,” says Kuswa. “They are very focused dogs and not commonly used as pets.”

Another working breed is the traditional “police dog,” the German Shepherd. “The German Shepherd has a very even temperament,” Kuswa explains. “This dog can be a family pet and then go out and work.” The German Shepherd is generally used to help its officer in the areas of both protection and agility.

Kuswa explains that, often, the job of a police dog is to help prevent a physical confrontation by its very presence. The Malinois and German Shepherd fit that mold well.

The Labrador Retriever, with its keen nose, is the third breed of K-9 that Kuswa treats. With just a few in service, Labradors serve primarily as drug search dogs due to their sharp sense of smell—and their playfulness. “Labs don’t have that intimidating look or temperament,” says Kuswa. “They really just like the play aspect of finding drugs.”

A police K-9 starts working at about 2 years of age, and generally works for about seven years before retiring from the force.

Healing Hounds

Though Kuswa has had to euthanize some K-9s due to their age, she feels fortunate to have been able to minimize what could have become fatal wounds in several of the working dogs. Aside from a broken leg sustained during a search, a dog who was shot in the face, and one who suffered a broken back, one of the most memorable of Kuswa’s patients literally jumped in front of a mentally ill man wielding a knife and took a couple of stabs to the chest, ultimately saving his handler’s life.

“The dogs have recovered and have gone back to work,” beams Kuswa. “They’re so important. They’re very much heroes in my mind.”

For nearly twenty years, Kuswa has had the opportunity to oversee these four-legged heroes as they showcase their abilities at the annual Sierra K-9 trials. This year marks the twenty-fifth annual event, making it one of the longest running events of its kind in the state.

“After nineteen years, I’m amazed at what these dogs can do and the sophistication in their ability to sniff out things at the trials,” says Kuswa. “On the streets it can take a team of qualified human officers hours to do what a dog can do in ten minutes.”

K-9 Trials

Sergeant Steve Phillips of Visalia P.D. outlines the event that draws law enforcement participants from Petaluma to San Diego, marking the Sierra K-9 trials as one of the state’s largest. This year the Sierra K-9 trials take place Friday, March 19 and Saturday, March 20.

Because most of the events take place within confined locations, Friday afternoon’s events are closed to the public, but the dogs will be evaluated on their working relationship with their handlers to prove their prowess in:

• Narcotics: The dogs search vehicles and buildings to quickly and effectively find narcotics.

• Evidence: Designed to simulate the act of finding evidence discarded by a fleeing suspect, the dogs pick up on the suspect’s scent in order to retrieve the article.

“A dog’s sense of smell is not just stronger; it’s more discriminating” than a human’s, says Kuswa. “The part of their brain that measures and analyzes scent is forty times bigger than (in) our brain. The sweat and hormonal fear aspect of a human gives them away.”

Saturday’s events bring in bigger audiences each year. The agility trials are at Visalia’s Plaza Park racetrack and events include obedience and agility competitions along with an area search, where K-9 dogs search for people hiding in boxes.

The protection phase of the event in the afternoon is a three-part event, which shows viewers the K-9s’ drive and ability to neutralize a threat, the advanced control a handler has over a dog, and the dogs’ ability to show restraint.

For more information on the twenty-fifth annual Sierra K-9 trials, call Sgt. Phillips at 713-4216.

Injuries sustained at the trials have included bite wounds and lacerations, a dog who suffered a fractured vertebra, and another who tore ligaments in his leg. Kuswa’s immediate treatment has proved vital; all of the injuries were caught early enough to be quickly treated so that the dogs could return to work.

With her extended understanding of the K-9 work dog, Kuswa explains the love the working dogs have for their career. “It’s a game to them; they love to work; it’s not a cruelty,” she says. “When their handler is putting on their uniform, the dogs get so excited. They want to work.”

By Jim Blanks

When we are involved in an emergency, we dial 911. The call goes through, and soon a calm, professional voice answers. Even in the most stressful situations, that voice remains cool, quickly extracting the necessary information to help us in our time of need. But how does a dispatch operator remain so poised in the midst of chaos? According to Visalia Dispatch Supervisor Gloria House, it is not always easy. It is, however, always rewarding.

The Visalia Police Department Communication Center is a hub of activity, handling about 800 calls per day. Besides 911 emergencies, the center also handles some business, in-house, and animal control lines. Dispatchers are always working.

“The dispatchers alternate duties throughout their ten-hour shifts,” House said, adding that dispatchers take calls and dispatch police, fire, and animal control. When a call comes in, the dispatcher must determine if police, fire, ambulance, or animal control is needed. After making this determination, another dispatcher working the radio channel will send the officers for the situation. If the call requires fire response, the dispatcher receiving the call will also alert the firefighters.

The work sounds straightforward, but House says that being a dispatcher can become complicated with each new call. This is part of what makes the job both difficult and exciting.

“Many people ask us if our jobs are extremely stressful,” House said. “The truth is that our jobs are enjoyable and fulfilling, but we have moments of stress. The shift may just be business as usual, when unexpectedly an officer is on the radio saying, ‘shots fired,’ or that he or she is in pursuit (of a criminal). These are the times that make you sit straight up in your chair, the surge of adrenaline rushing through your veins.”

The Dreaded ’11-99’

“The biggest fear every dispatcher has is to hear the dreaded ‘11-99’ over the radio,” House said. “This means that an officer needs help, and it is never good.”

In these situations, the dispatchers must be especially poised under pressure. House has experienced these situations, including an officer-involved shooting that occurred several years ago.

On one night, “it was so foggy that you couldn’t see across the street,” House said. “Our officer was under fire and the shots were coming from somewhere across the street. The dispatcher working the police radio was sitting straight up and her hands were shaking uncontrollably, but she never gave it away in her voice. She was steady and sure, and that officer knew we were going to get him help.”

This steady and sure demeanor does not come naturally; it is a product of intense training. To become a dispatcher, a candidate must pass through a rigorous screening process that includes a difficult state test, two separate oral board interviews, an extensive background check, and psychological and medical exams. After passing these, the candidate is offered employment. The newly hired dispatcher must then attend a 120-hour Basic Dispatch Academy and then complete eight to nine months of on-the-job training.

“The process is just as rigorous as the hiring process for a police officer,” House said, adding that many candidates do not get through the initial state test on their first attempt.

The process may be difficult, but it is necessary, and at the completion of this process, the dispatcher joins an elite, close-knit team.

“We have twenty full-time and three part-time positions,” House said. “One of the biggest challenges that nearly every communication center faces is working understaffed. We have faced this challenge for a long time, but have recently filled three vacant positions and are in the process of getting everyone trained.”

Even with so much training, House admits that there are still situations that a dispatcher may not expect, which makes it critical that the dispatchers work as a team.

A Safer Community

“Every day is different, and no matter how long you work here, you can never learn everything there is to know about the job,” House said. “We back each other up when it gets ugly, and we feel everything our partner feels.”

While sometimes this means sitting nearby while a dispatcher handles a difficult call, it can also mean sharing in the joy that comes from helping the police capture a criminal

“It is rewarding to know that you played a part in helping to capture a bad guy like a rapist or a robber, and that you are helping make the community safer,” House said.

And lately, the Communication Center’s efforts to make the community safer have been gaining widespread attention. The center has been the subject of a commercial and a television program. The reason for the commercial was a piece of emerging technology that aids dispatchers and the police.

“A citizen had been carjacked, and the vehicle had On-Star,” House said. “Because of this, we were able to find the vehicle while it was still rolling. On-Star then shut the engine down and the suspects were captured.”

Because this was the first time the technology was used, the company decided to film a commercial with the Communication Center and the dispatchers that took the call. Additionally, the center will be featured on an upcoming episode of the Discovery Channel program “Call 911.”

All of this is just part of what makes the job so exciting, House says. As a dispatcher, you are constantly facing new situations; you never know what the next call will bring. And, according to House, the dispatchers wouldn’t have it any other way.

“As the supervisor, I have met with all of the dispatchers individually,” House said, “and nearly all of them tell me the same thing. They love what they do and can’t imagine themselves doing anything else.”

These highly trained dispatchers handle our emergencies on a daily basis; they quickly assess the situation and send out the necessary officers. And as Dispatch Appreciation Month approaches, it becomes increasingly apparent that we also love the work that they do, and we also can’t imagine them doing anything else—being that steadying voice in the midst of often confusing times, the voice that says, “Remain calm, help is on the way.”

By Gary Dowd

It’s happened to many of us: You find yourself gasping for air after climbing a few flights of stairs, or you start playing a sport again and the next day your muscles are complaining —loudly. That’s when the realization hits, “I’m out of shape.” And so begins another round of resolutions, gym memberships, and the fitness program du jour.

For the average person, being out of shape is inconvenient. For a police officer or firefighter it can become a life and death matter.

To make things worse, statistics show police and firefighters have the odds stacked against them when it comes to physical health.

Police officers are 25% more likely to die from cardiovascular disease than the average American, and heart attacks were responsible for 47% of firefighter deaths in 2007. Why? The two main culprits are diet and stress. Long shifts make it hard to eat regular, healthy meals and police and firefighters face stress on the job every day.

“The stress levels when you go from zero to sixty in a matter of seconds, and do that several times during a shift—it takes a toll on your body,” according to newly appointed Tulare Police Chief Jerry Breckenridge.

That’s why many departments and officers across the country are making health and fitness a priority.

Breckenridge says the best way to have a fit department is to lead by example.

“I work out six times a week,” he said. “From a pure business standpoint, (fitness) reduces officer injury. Fitness level also comes into play when we have to perform our job. An officer who looks fit is less apt to get into a physical altercation.

Studies have shown that incorporating all of the components of a health, wellness, and fitness program can decrease the risk of cardiovascular disease by as much as 70 percent.

But what’s the best way to get started? Whether your top priority is losing a few pounds, strengthening your arms, or increasing your cardiovascular stamina, a personal trainer can guide you down the path to fitness by creating an exercise routine for you.

Lonzo Anderson, a two-year veteran with Tulare PD decided to take control of his wellness by signing up with Rocky Molina, a personal trainer from Snap Fitness in Visalia.

“I realized I was really out of shape when I tried to put on my tactical vest for the first time since being in the gang unit, and it hardly fit,” said Officer Anderson. “Working with a personal trainer sounded like a good idea to get back in shape.”

“Many of my clients are police officers or firefighters,” said Molina. “These guys are very motivated to get fit—and that’s half the battle.

At 28, Anderson is 6 feet tall and weighs in at 260 lbs. He has good muscle strength, but wants to trim down a bit and work on his cardiovascular health.

“Lonzo really needs a program tailored to his individual needs and lifestyle,” said Molina. “He has a family and usually works the early day shift.”

But if a personal trainer isn’t for you, don’t let that get in the way of your fitness goals.

“Whatever works for you may not work for everybody,” said Molina. “The most important thing is finding and sticking with the right program to get you fit—and keep you fit.”

The Basics

You can lose weight either by decreasing your calorie intake or increasing the number of calories you burn. Any health strategy should include both, but if you want to lose weight permanently, exercise is essential. Be cautious when a fitness program promises rapid weight loss. Quick-fix fitness does not lead to continuing and meaningful changes.

Moderate aerobic workouts incorporating brisk walking, cycling, aerobic machines, or swimming not only burn calories they also keep your heart healthy. You need at least thirty minutes of aerobic exercise three or four days per week.

But far too many who start a fitness program don’t stick with it. To buck that trend, try these steps for staying motivated in your fitness program

1. Set goals. Nothing will derail your new fitness program faster than setting unrealistic goals and then falling short. Set simple, short-term goals you know you can reach—say lose 25 lbs. by the end of the year.
2. Build up slowly. Starting too hard or at too advanced a level can cause injury and put you on the sidelines before you even get started. Take it easy at first. Work up from twenty minutes of walking to an hour over a period of six weeks.
3. Try variations. To keep boredom from setting in, try different activities to work your cardiovascular system. Alternate swimming, walking, aerobics, or bike riding. Play sports like soccer or basketball with your family or friends. Keep up the variety and it won’t feel so much like exercise.
4. Enjoy yourself. The biggest challenge to staying with a consistent exercise program is lack of enjoyment. Make it fun! Try something completely different, like ballroom dancing. Exercise doesn’t have to be a chore.
5. Make physical activity part of your daily routine. Once you have a scheduled routine, it becomes less of a burden and more of an enjoyment. Look for opportunities to incorporate physical activity throughout your day. Take the stairs instead of the elevator at work. Pedal a stationary bike or do strength-training exercises with resistance tubing while you watch TV at night.
6. Write it down. Want to drop pounds? Feel more energy? Get a better night’s sleep? Put it on paper (or on your computer). Chronicle your progress for motivation to stay with the program.
7. Use the buddy system. Invite a friend or ask your spouse—or even your children—to join you. Workouts are a lot more enjoyable when you have someone to do them with.
8. Keep a journal. Write down each exercise activity, amount of weights, repetitions, how you felt, etc. This provides you with a physical record of your daily and weekly progress.
9. Flexibility is key. Don’t beat yourself up for missing a workout—or let it get you off track. We all have busy lives. Give yourself permission to take a break for a day or two and get back to your schedule as soon as you can.
10. Give yourself a reward. Have a piece of pizza or that decadent dessert. As long as it’s not part of your regular diet, it’s OK. You can afford the extra calories once in a while.

There are so many benefits to regular exercise it’s hard to argue against it. You’ll reduce stress, look and feel better, have more energy, and live longer. Getting fit isn’t just a short-term goal—it’s for life!

Author’s Note: Snap Fitness offers a membership discount to local police and fire personnel. Check with your local gym to see if they have a similar program.

By Aaron Collins

Someday, when you’re on your way to work or chauffeuring the kids someplace, an average day could turn to disaster with a serious car accident. At that defining moment, you probably won’t be pondering what Kaweah Delta Medical Center’s new Level III Trauma Center designation means for you.

You’ll have other things on your mind—if you have anything on your mind at all. And at that moment, every second will matter.

Let’s hope that day never comes. But if it does, you’ll be glad to know in advance that Kaweah Delta’s Trauma and Acute Care Surgical Services (TACSS) program means you’ll receive greatly improved care, as well as much shorter travel time to a treatment facility.

The March 2009 opening of the expanded Emergency Department enabled the designation, but a big leap forward is the 24/7 emergency surgical coverage required to maintain Level III status. Cases that once would have been stabilized at Kaweah Delta then sent on to Fresno or Los Angeles for treatment can now be effectively handled in Visalia. Burn and head trauma cases will still likely go to Fresno because of its burn unit and twenty four-hour neurosurgeons on staff.

The Tulare County Board of Supervisors gave Kaweah Delta its Level III trauma designation based on the hospital’s certification by the Emergency Medical Services Agency, according to the medical center’s Trauma Program Coordinator Amber Myers, RN, BSN. Myers adds that the designation and certification are in accord with the standards of trauma care that are set by the American College of Surgeons. In the state of California a hospital can be certified directly by the American College of Surgeons or it can be certified by the Emergency Medical Services Agency, Myers says.

“The local Emergency Medical Services Agency sets standards of trauma care according the American College of Surgeons guidelines. These guidelines are recognized nationally,” Myers says. “Once a hospital feels it is in compliance with these terms, a lengthy application—approximately the size of a text book—is submitted, then certified surveyors from other trauma centers come to analyze our ability to function at the trauma center standard.”

Kaweah Delta’s advanced facilities, resources, and successful training were key to gaining the certification.

“This is a high bar to reach,” says Rebecca Zulim, M.D., a surgeon in the Kaweah Delta trauma unit, explaining that the certification required years of planning, as well as the recruitment of additional surgeons, critical care specialists, and orthopedic surgeons with expertise in trauma care.

Long Road to Certification

“In addition, we underwent a major expansion of our facilities especially in our emergency room, intensive care units, and operating rooms; to prepare for trauma designation,” says Zulim, whose early efforts paid off in accreditation.

Gaining trauma center designation took seven years. A trauma committee was established with the goal of improving trauma care at Kaweah Delta. “As part of that project a number of studies were done to determine if there was need for a trauma center in this area and whether it was feasible for us to do that,” Zulim says. “We determined that this would be very important to our community and, over a period of the last few years we have been working on obtaining the support of our medical staff, the hospital board, and the community.”

Last January, Kaweah Delta underwent its consultative review by an ACS reviewer and his team to see if the facility was, in fact, ready to become a trauma center. It then continued further preparations and on September 11, 2009, underwent official certification review and met the criteria.

As part of the expansion of Kaweah Delta’s Emergency Department, four specially designed trauma bays can now each accommodate up to two patients at a time. “These enable us to perform rapid assessment of critically injured patients, and also to perform a number of emergency procedures that might be needed to save lives,” Zulim points out.

Saving Lives 24/7

According to Myers, Level III Trauma Designation ensures that the community receives specialized trauma care. “We are required and currently have 24/7 general surgical coverage, 24/7 orthopedic coverage, Emergency Department physicians with additional trauma certification, Emergency Department staff with additional trauma certifications, as well as operating room and ICU staff with trauma education,” she says of the rigorous requirements.

Those efforts seem to be paying off in terms of lives saved. Just consider Kaweah Delta’s statistics, says Myers. “Since the inception of Kaweah Delta Medical Center’s trauma committee seven years ago, our in-hospital mortality has improved dramatically. Currently, our in-hospital trauma mortality rate is at 0.4%, which is well below the national standard.”

Myers estimates the overall budget to achieve the designation at around $6.3 million. That amount was required to expand the emergency room, add the trauma bays, fund staff training, and hire additional personnel, including physicians. The trauma bay equipment alone represented $1.5 million of the overall budget.

The hospital will soon have a sixty-four slice CT scanner, according to Myers, which reflects quite and upgrade from the four-slice scanner in current use. Myers says the new equipment will allow patients to be scanned for internal injury much faster, possibly saving lives. The sixty-four slice equipment also provides much better imaging, reducing the time from discovery of injuries to appropriate intervention. Further shortening that critical timeframe is the new trauma operating room adjacent to the existing Emergency Department, set to open by this spring.

Specialized new equipment includes a rapid transfusor for blood and fluid administration, a bedside ultrasound machine for immediate diagnosis of internal injuries, an additional OR suite, and additional radiological screenings. Those close-at-hand instruments also mean less time transporting trauma patients for care elsewhere within the labyrinthine hospital facility.

However, merely purchasing equipment, training and staffing up do not ensure continued Level III designation.

Continuing Effort

“While designation recognizes the work that has been done already, I believe that the most important aspect is that it requires that we maintain the highest standards in the treatment of injured patients in order to keep it,” Zulim says, pointing out that every trauma center is rigorously reviewed by outside staff from the American College of Surgeons every two years. “By setting and keeping the bar high, Trauma Designation assures that the citizens of Tulare County will have access to top-of-the-line trauma care both now and in the future.”

According to Zulim, Kaweah Delta intended to pursue the next higher level of trauma designation, Level II, but the shortage of neurosurgeons meant that it did not meet the standard, although Kaweah Delta sees more than the required number of cases to be considered for Level II.

“One of the advantages of being a trauma center is that is also integrates us into the regional and statewide trauma systems,” Zulim says. “This helps us obtain more seamless access to any highly specialized care that our trauma patients might need that can only be provided by a Level I trauma center.”

Myers says the new trauma care facility represents “a tremendous advance for health care in the Central Valley.” And that’s a leg up that might just come in handy someday.

After seven years of preparation and planning, on February 1 Kaweah Delta celebrated the long-awaited official opening of its Level III Trauma Center. A tremendous enhancement to a medical program already thriving in our community, the new center features an expanded Emergency Department, including four trauma bays with specialized equipment to accommodate the most critical trauma patients; an expansion of the ICU; additional operating rooms; supplemental surgeons to provide 24/7 coverage; and plans for the construction of a helipad to transport critical patients to and from the facility for immediate treatment.
“Our Level III Trauma designation is the result of the commitment and hard work of our medical staff and hospital staff to ensure the very best care possible for traumatically injured patients from throughout this region. We are proud of this designation. It will literally allow us to save lives and help trauma victims on their road to recovery,” said Lindsay Mann, Chief Executive Officer of the Kaweah Delta Health Care District.

By Paul Main

Sometimes we just want a meal that brings contentment and flavor, without the bulkiness of typical comfort foods. That may sound like sacrilege, but these lighter delights, Caesar salad with grilled shrimp and deviled eggs, are still favorites. My take on Caesar salad draws from my experience working with Executive Chef John Klein and kitchen boss Bob Rapazzi at the Grand Concourse Restaurant in Pittsburgh, Pennsylvania. Their Caesar salad is the best I’ve ever experienced.

In many of the Caesar salad recipes, the dressing includes anchovy and raw egg. This can be a stumbling block for those who prefer not to have the salty-briny fish or raw egg in the dressing. Personally, I like the flavor anchovy provides, but for those not willing to eat these little fish, Chow.com readers have made some interesting substitutions with capers, kalamata olives, and even miso. As to the raw egg, I offer this recipe using mayonnaise as a substitute—and it works.

Caesar Salad

Ingredients:

1 cup mayonnaise

1 clove garlic, minced (about 1/2 teaspoon)

1 1/2 teaspoons anchovy paste or about 3 anchovy filets (minced)

1 teaspoon Dijon mustard

1 teaspoon Worcestershire sauce

2 tablespoons lemon juice

1/4 cup finely grated Parmesan

pinch of cayenne pepper

salt and pepper to taste

8 cups Romaine lettuce (coarsely torn, cleaned and dried)

2 cups Garlic-Parmesan Croutons (recipe follows)

20 to 24 Grilled Shrimp (recipe follows)

shaved Parmesan and fresh cracked black pepper for presentation (optional)

Method:

In a small bowl, whisk together the mayonnaise, garlic, anchovy, mustard, Worcestershire sauce, and lemon juice. Stir in the Parmesan and season with salt and pepper.

In a large bowl, toss the dressing with the lettuce until well coated. Add croutons and toss to combine. Divide the salad onto plates. Top with shaved Parmesan and black pepper, and place 4-5 shrimp on each plate.

Serves 4.

Garlic-Parmesan Croutons

Ingredients:

3 cups ciabatta or other crusty bread (3-4 ounces)—cut into ½-inch cubes

2 teaspoons olive oil or olive oil spray

1 clove garlic, minced

2 teaspoons grated Parmesan cheese

1 pinch salt and pepper

Method:

Preheat the oven to 325 degrees F. In a medium bowl, toss bread with oil, garlic, cheese, salt, and pepper. Spread onto a baking sheet. Bake until bread is crispy and golden brown, stirring once or twice, about 10 minutes.

Grilled Shrimp

Ingredients:

1 pound large shrimp, peeled and deveined

2 teaspoons olive oil

1/2 teaspoon paprika

1/2 teaspoon black pepper

1/4 teaspoon salt

pinch of cayenne pepper (optional)

2 tablespoons lemon juice

Method:

Preheat a grill pan over a medium-high flame, or prepare grill. Toss shrimp with olive oil and seasonings and toss until well coated. Grill until cooked through, 2-3 minutes per side. Transfer the shrimp to a plate until ready to serve.

Deviled Eggs

Ingredients:

12 eggs

2 tablespoons mayonnaise

½ cup whipped cream cheese

1 ½ teaspoon yellow mustard

salt and pepper

paprika and snipped chive (optional for presentation)

Method:

Place eggs in a large wide saucepan. Cover with cold water. Bring to a boil for 12 minutes. Remove eggs and let cool. Remove shells. Slice each egg in half lengthwise. Place whites on a separate plate. Separate egg yolks and place into a bowl. Add whipped cream cheese, mayonnaise, and mustard to yolks. Add salt and pepper to taste and stir the mixture together until creamy and smooth. Using a star tip and a pastry bag, pipe the yolk mixture back into each egg white half. Dust tops with paprika and add snipped chive. Serve cold.

Playing it Safe with Eggs

The Food and Drug Administration offers information to help us consumers handle eggs safely:

Buy eggs only if sold from a refrigerator or refrigerated case.

Open the carton and make sure that the eggs are clean and the shells are not cracked.

Refrigerate promptly.

Cook eggs until both the yolk and the white are firm. Scrambled eggs should not be runny.

Casseroles and other dishes containing eggs should be cooked to 160°F (72°C). Use a food thermometer to be sure.

For recipes that call for eggs that are raw or undercooked when the dish is served—Caesar salad dressing and homemade ice cream are two examples—use either shell eggs that have been treated to destroy Salmonella by pasteurization or another approved method, or pasteurized egg products. Treated shell eggs are available from a growing number of retailers and are clearly labeled, while pasteurized egg products are widely available.

Chill eggs properly. Cooked eggs, including hard-boiled eggs, and egg-containing foods should not sit out for more than two hours. Within two hours, either reheat or refrigerate.

Use hard-cooked eggs (in the shell or peeled) within a week after cooking

Refrigerate leftover cooked egg dishes and use within three or four days.

For more information, contact the FDA at:

1-888-SAFEFOOD or 1-888-723-3366

consumer@fda.gov or

http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm077342.htm

By Aaron Collins

Matthew Ybarra, 13, went missing this winter in the mountainous far southeastern corner of Tulare County near Sequoia National Forest and the Chimney Peak area during a sledding trip with his family. He wandered away briefly just before sunset, unnoticed in the growing darkness as the others horsed around in the snow.

Matthew went to find a higher run and a greater thrill, but what he got was a dark, frozen night spent lost and alone in the deep winter snow, with overnight lows dropping below 15º F.

Things didn’t look good for Matthew. Sixteen hours is a long time in the cold. He lost a glove, and a shoe and sock along the way. Before long, his feet were beginning to blacken. Then, moderate hypothermic shock began to set in.

“I thought I was gonna die,” he told a reporter following rescue, the day after he went missing. The fare for his thrill ride to a Bakersfield hospital via a helicopter, aside from the considerable monetary costs, was a couple of frostbitten toes. “It could have been a lot worse,” he said.

Fortunately, there are rescue teams on call, like Sequoia Mountain Rescue, a nonprofit group of dedicated all-volunteer mountaineers. Groups like this exist for just such dire occasions.

The nonprofit group, sanctioned by the Tulare County Sheriff’s Office and working adjunct to that agency’s Search and Rescue Unit, draws upon broad and deep knowledge and certified technical training in just such occasions as Matthew’s emergency.

SMR shares a culture with other such organizations that means avoiding the limelight, though their dedicated volunteers make highly technical and heroic rescues.

Established in 2003 and granted nonprofit status the following year, the group works behind the scenes, called out to vast emergency scenes with little notice when hikers and tourists become lost in Central California’s great outdoors.

Tremendous Teamwork

Teamwork is vital to the group’s efforts. Ed Lorenzi of Visalia says he and the team, which consists mostly of men, like working with teammate Kristi Nanamura. “Not only is she fearless, but she’s thin and lightweight,” he says of the Porterville area resident. “That’s a real advantage when hoisting her up when she goes over the edge on a rescue or training mission.”

Putting her in means other team members are freed up to perform other urgent tasks: A single rescuer is required to sustain a 50-pound lift, which means only two team members are needed for the featherweight Nanamura, compared to the four men required to lift a 200-pound male. And in the chaos of emergencies, having two additional men free to perform other tasks means Nanamura’s physiology plays an important role when circumstances strain the human resources at hand.

“I don’t know if there’s anything she’s afraid of,” Lorenzi says. “She’s very adventuresome. And if there is anything a man can do well, she wants to do it first, or do it just as well or better as a man can do.”

Just as in law enforcement circles, a special bond arises when team members must rely on one another for their safety and survival, admiration for a team member is mutually returned in this tight-knit group.

Lorenzi “has the true heart of a volunteer,” says Nanamura. “And he keeps moving forward with his training, for which he often has to travel outside the area.” The group is also called out to rescues beyond its sanctioned area of Tulare County for rescues in surrounding counties.

“Ed is truly dedicated and an outstanding and humble individual,” says Nanamura

To say a group consists of volunteers has a way of downplaying their professionalism and skill and also of obscuring the fact that these people all have day jobs and highly responsible careers.

Skilled Volunteers

Nanamura now runs the Porterville-area food processing and retailing company founded by her parents in the1970s. When her mother passed away in late 2008, Nanamura took over the day-to-day business operations, which meant taking time away from SMR calls. However, she continues as the group’s treasurer, a role aided by her business experience.

“Each of us can’t always leave our jobs to go off on a (search and rescue) mission, but everyone takes the time when appropriate to do so,” says Lorenzi, who works in the citrus industry.

He says that others in the group bring a diverse range of technical skills to their volunteer work that stem directly from their primary careers. When the next family outing to the Sierra turns tragic, the Tulare County-wide team will grab gear and head for some of the highest and most remote land in the lower forty-eight states. They include a high school art teacher, a retired commercial airline pilot, a farm equipment business manager, a retired commercial photographer, and an aviation manager for a large farming operation who previously flew air tankers for the U.S. Forest Service.

In describing the breadth of skill members bring to each effort, Lorenzi says that one member has the memory of a ‘user guide,’ and has been a great asset as a training officer. Another founding member is an avid climber and outdoorsman with exceptional ability to teach people skills.

Members Make the Difference

Newer members include a sports medicine trainer with a local college “who can tell you just why that hurts when you do whatever hurts,” Lorenzi says. There’s a veterinarian and surgeon who has participated in climbing expeditions; a man who runs a local foundation for public outdoor awareness and environmental stewardship; an attorney with the District Attorney’s Office who is an avid kayaker and outdoorsman; and a man who owns his own construction business yet finds lots of time to cross country ski.

There’s also an EMT who is always entertaining with his adventures; an insurance agent with extensive back country experience; an electrical engineer, who Lorenzi says, has lots of back country hiking experience; and a fireman who also teaches rope rescue to the Forest Service.

“All of these people have a love of the outdoors and possess a very strong desire to help others and to this end volunteer their time in our community,” Lorenzi says of the diverse professionals who use their skills to save lives when they can, or retrieve the bodies of loved one for the grieving when they cannot.

These are the good-hearted and highly-technical volunteers who just show up—hardly the untrained villagers seen on the nightly news scouring the forests, armed with little more than flashlights and good intentions. SMR people know their way with pitons and artificial chocks. They can give a round lashing or a square lashing, too. Luckily for the next guy who gets stranded on a ledge high in the Sierra, they know their Munters from their Swiss Seats from a hole in the ground.

Perhaps just as amazing as SMR’s feats and skills and dedication is the group’s annual budget: Between just $5,000 and $8,000.

If your community organization would like to put Sequoia Mountain Rescue on its programming, contact Sequoia Mountain Rescue, PO Box 6904, Visalia, CA 93290. If you have technical skills that you might want to contribute to the group, review SMR’s technical certification requirements on the Web at www.sequoiamountainrescue.com.

Energetic and friendly, this group was also accommodating. Instead of high-tailing it for the parking lot at the end of a long shift, many of them stuck around for an extra hour or so to participate in the shoot for this issue’s cover. In honor of the official opening of the Kaweah Delta Trauma Center, we wanted the shot to relay a true sense of “trauma.” Authenticity was key.

A big thank you to all of the doctors and nurses who helped make this shoot a success. We know you were tired and ready to get home to your families, so we hope you know how grateful we are to you for your participation on our cover, and also for the care you provide our community on a daily basis. Your devotion to the wellbeing of the people in our community is what makes you part of the group of heroes we celebrate in this publication.
Talent: (from left) Dr. Rebecca Zulim; Annette Hale, RN; Wilfred Garcia, CPT II; Craig Dixon, RN, Trauma Team Lead; Amber Myers, RN, BSN, Trauma Program Manager; Dr. Steve Carstens. Patient: Trisha Gonzales, ED Tech