By Aaron Collins

To say the thin green line of marijuana criminality is a little hazy after a new pot law took effect January 1 is like saying that Cheech & Chong became a little famous by making light of pot smoking in the ‘70s. So just what will — and will not — fly these days?

Social attitudes are shifting, economic forces are in play and accordingly the law is changing, too — despite California voters’ recent rejection of controversial Proposition 19 by a slim margin in November. Fifty-three percent of Californians said no to legalized cannabis, while 46% were willing to support it. Even so, a different new law is on the books now.

Effective January 1, possession of 1 ounce or less was downgraded from a misdemeanor to an infraction in a bill signed by former Governor Arnold Schwarzenegger. The maximum fine for the infraction is $100. Pot possession by non-medical users is effectively equivalent to a traffic ticket. Possession up to an ounce could previously have resulted in a criminal record under California law, but no more.

“Gov. Schwarzenegger deserves credit for sparing the state’s taxpayers the cost of prosecuting minor pot offenders,” said National Organization for the Reform of Marijuana Laws (NORML) California Director Dale Gieringer in a prepared statement. “Californians increasingly recognize that the war on marijuana is a waste of law enforcement resources.”

Just Fine

Ironically, Prop. 19, had it passed, would have been stricter than the new law signed by Schwarzenegger for low-level possession situations, leaving in place the misdemeanor possession penalties for public use and smoking in the presence of children. Under the new law, SB 1449 by Sen. Mark Leno (who represents California’s 3^rd senate district, which covers Marin and portions of San Francisco and Sonoma counties), these two instances are now treated as infractions, subject only to fine — not imprisonment.

In his signing statement, the Republican former governor declared his opposition to decriminalizing the recreational use of marijuana and said that he opposed Prop. 19, but added that “in this time of drastic budget cuts, prosecutors, defense attorneys, law enforcement and the courts cannot afford to expend limited resources” in the prosecution of petty pot offenses. Considering that misdemeanor possession arrests rose to 61,164 in 2009, the removal of that number of cases by making them infractions will come as quite a relief to the courts. Given that economics partly drive society’s attitudinal shifts, and that near-term economic prospects appear mixed, Californians might reasonably expect a continuing trend toward devoting fewer resources to pot prosecution.

State, Federal Conflicts

Confusion between the intent and effect of SB 1449 and Prop. 19 is only furthered by contradictory federal law, which remains in effect via the Controlled Substances Act.

The medical marijuana factor also clouds matters of pot legality. “This is a subject of great attention lately,” says Shani Jenkins, Assistant District Attorney for Tulare County. “What I can tell you is that the law is still pretty clear as to medical marijuana. One may legally possess marijuana, within certain parameters, if they have a valid prescription for marijuana. Other than that, it is still illegal to possess marijuana.”

Those acceptable parameters include proof of California residency and possession of up to 8 ounces of usable marijuana and up to six mature plants or twelve immature plants. Specific diseases are named in the law, including multiple sclerosis, HIV and AIDS, cancer, chronic pain and nausea. In December, the California Supreme Court clarified that medical marijuana users in possession of more than the legal limits could use a medical necessity defense in court.

Jenkins also says that Tulare County is pursuing those pot smokers with no legitimate medical need who acquire medical marijuana cards in order to flout the law. “We here at the District Attorney’s office are aggressively prosecuting cases in which individuals have a valid medical marijuana card,” Jenkins says, “but are using that as a cover to illegally sell or transport marijuana. It is akin to someone who has a valid prescription for a controlled substance such as Vicodin, illegally selling or providing their drugs to someone else.” Jenkins says that her agency has prosecuted many such cases. “In addition, as with alcohol or prescription drugs, it is still a crime to drive while under the influence of marijuana,” she points out.

City and County ordinances, too, can create a patchwork of seemingly conflicting medical marijuana regulations. Tulare County has been pursuing a case against a medical pot growing collective near Ivanhoe — a legal operation under state laws — claiming that the land is zoned for agricultural use. Whether a crop like medical marijuana qualifies as an agricultural crop for zoning purposes appears to be at the heart of this case.

Los Angeles is finding that its numerous pot dispensaries have legal muscle as well as political clout, with a recent injunction against its city ordinance limiting medical marijuana dispensaries. In December, a judge’s decision derailed a city ordinance regulating medical marijuana, paving the way for numerous dispensaries to reopen after being forced to shutter operations in 2010. Los Angeles County Superior Court Judge Anthony J. Mohr ruled several parts of the city law as unconstitutional, including the complex process the city intended to use to decide which dispensaries would be allowed.

So the legalities of medical marijuana are still very much in flux, despite initial legalization in 1996 by California voters via Proposition 215, the Compassionate Use Act. However, the trend toward legalization continues, with New Jersey and Arizona becoming the 14^th and 15^th states to legalize medical marijuana as of 2010. Maryland has a law that now permits medical marijuana as a defense in possession cases, while not expressly legalizing medical marijuana.

Interestingly, states from across the political spectrum have legalized medical marijuana, from Montana and Arizona on the right, to Oregon and Vermont to the left. So the trend does not seem to track traditional liberal/conservative assessments of legalization arguments.

New developments in California promise to further the controversies of pot legalization. A new soft drink billed as medical marijuana called Canna Cola is in production. However, its branding and formula resemble a consumer product that one is more likely to find in a supermarket, not just in a medical marijuana dispensary. Furthermore, a bill has been introduced in the California Legislature that would forbid employers from discriminating against employees who have a valid medical marijuana prescription, shifting the debate from a live-and-let-live matter to one of employment law, a much stickier subject.

So while the laws and attitudes are in a cloud of flux, the issues and outcomes around medical marijuana and its relation to the ongoing push for overall pot legalization are anything but clear.

By Jim Blanks

Even as a young man, Brandon West knew that he wanted to become a firefighter. It was always a dream for him, and as a member of the City of Tulare Fire Department, he is living it. But as with anything important in life, this hasn’t come easily for West. There have been struggles, trials and obstacles — and he has overcome them to become the Tulare Firefighters Club Firefighter of the Year. The award has come to represent many things to West, among them is his commitment to achieving the lofty goals of his youth.

“As cliché as it sounds,” he says, “I think my dream started when I watched reruns of the TV show ‘Emergency.’”

West’s parents wanted him to become a doctor, so after high school he entered a pre-med program in Virginia. While working as a paramedic, two sparks reignited his early goal and shaped his ambition in life. The first was a ride-along with the Richmond Fire Department. The second was proximity: He worked just ninety minutes from the Pentagon.

“I was working on 9/11,” he says. “I think the brave actions of the men and women of the fire service that day cemented my desire to be a firefighter.”

Although the desire was there, West still had many difficulties achieving his goals — along with having little experience he had to drastically improve his health and fitness.

“When I started with the City of Tulare in November 2008 I was not a favorite of my peers. I came into the hiring process without my Firefighter I certification and I was about 100 pounds heavier than I am currently.”

Earning His Place

The job description stated that those without proper certification must be able to become certified within one year.

“I thought to myself, ‘I can get that,’” West says. And his determination paid off. “It was a struggle to make it through probation, but eventually I earned the trust of my peers and became part of the family here.”

Becoming “part of the family” was critical to West, because he has such respect and admiration for his fellow firefighters.

“I could not have picked a better fire department to work at,” West says. “Every member of our fire department challenges each other to become the best they can be at our profession. When you are hired by the City of Tulare you might be on the payroll, but what is not mentioned in the job description benefits is that you are inserted into a family.”

Being Firefighter of the Year means that West has found many ways to excel at his profession. In his presentation speech, retiring Fire Chief Michael Threkeld highlighted West’s work ethic along with his involvement in the community. West helps teach the department’s medical training program, is the Vice President of the Tulare Firefighters Club, helps organize fundraisers and has become an adjunct instructor at the COS Fire Academy.

“I am fortunate enough to speak to the cadets on their first night and explain to them what being a firefighter means to me,” West says. “I give them their first glimpse about the values of the fire service, and teach them what honor, dedication and family truly mean.”

It is a busy schedule for West, who above everything else is a committed family man. It is his family that deserves a large part of the credit for his success, West says.

“In truth all that I am able to accomplish would not be possible without my impeccable support system at home. My family should really receive this honor.”

Family Support

His family has supported him throughout his career, and West admits that this is not always easy. The long hours and extreme demands of this career can take a toll on a family unit. But there is joy, too, and West is always mindful of the role a firefighter can play both in a community at large and in the personal interactions with a young child.

“A few weeks ago, my son came to visit me at the station. He loves being at the firehouse as much as I do,” West says. On that particular day, West — who recently became a driver on one of the engines — allowed his son to sit on the captain’s seat. “He had his headset on and looked over at me and told me, ‘Dad, when I grow up I want to work on this fire engine with you, and be just like you.’”

For West, moments such as these are rewards, too.

“I measure success through the eyes of my son,” he says. “I try to always be a person he can be proud of, to show him a path that will allow him to succeed. My son has had to sacrifice a lot of his time with me because of my profession, yet at the young age of 9 he understands the importance of what I do. While it makes me unbelievably proud to receive the (Firefighter of the Year) honor, what my son said to me means that I have succeeded.”

And so West continues to live his dream — a dream that has required an incredible amount of dedication and hard work, but one that has developed into a life that he could only have imagined as a young man watching television reruns.

“It is hard to narrow down one thing,” West says, “but I think the best part of being a firefighter is being able to make a difference in someone’s life almost every time I get dispatched out of the station. Be it fighting a structure fire, trying to preserve life using CPR and Advanced Cardiac Life Support, rescuing a cat from a tree or giving a child a first look inside a fire engine on a station tour — everything you do is to help somebody. You learn very quickly that being a firefighter is not just a job. It is a commitment to a lifestyle.”

As the Firefighter of the Year, West serves as a fine example of what can come from this level of commitment. Still humble despite the accolades, West says that he is simply upholding the high standards of the City of Tulare Fire Department — and the award is a reflection of the department’s commitment, and his family’s, as much as his own.

“I see this award as an accomplishment of my mentors and family, the people who are responsible for me being able to be a firefighter to the best of my ability. Being recognized by my superiors reinforces to me what I teach to the cadets, and the way I live my life is consistent with the best traditions of the fire service. More than ever I feel that I owe my family, superior officers, the fire service and the citizens of Tulare my best effort to be there when someone needs a hand, and to never quit no matter how tired I may become.”

By Bill Corliss

Each month I teach a traffic ticket class at College of Sequoias and students are frequently surprised by laws I present in the class — laws they didn’t know existed. Many drivers in the class have been cited for violating new laws. This is a costly and time-consuming method of learning! Each January 1, the local newspapers run articles reviewing new legislation and usually include a list of laws pertaining to driving, but this list is only partial, and people who skip that article or do not read the paper that day miss it.

The best resource for new driving laws is the California Driver Handbook. Annually the DMV Handbook reaches drivers in February. Since the 2008 issue, all new driving regulations have been located on the first page after the table of contents. The DMV Handbook is also online at dmv.ca.gov.

Not all new legislation affects every driver, but much of it does. For example, minors’ law does not change laws for drivers over 18 and some laws focus on commercial driving rather than drivers with a Class C license for cars. Hopefully a review of changes since 2007 will not surprise you, but it might!

2008 NEW LAWS

Mobile Phone Use

Drivers who are 18 and older are required to use a hands-free device while driving and using their mobile phones.

Drivers under 18 are not permitted to use mobile phones or other wireless devices while driving.

Smoking

Smoking in a vehicle where a minor is present is an infraction.

Slow for the Cone Zone

Drivers are required to move over and slow down when approaching a roadside emergency along a state highway or freeway. The law is designed to reduce the deaths of police officers, tow truck drivers, paramedics and other emergency personnel who are aiding stranded or injured motorists. (A safe lane change or a reduction to a prudent speed is required if an emergency yellow or red light is flashing.)

Use of Windshield Wipers

You must turn on your headlights in inclement weather or low visibility (1,000 feet or less) that requires the use of windshield wipers.

Child Safety

You cannot leave a child aged 6 or younger unattended in a motor vehicle when the child’s safety is at risk. (Example: In a car on a hot day or with the engine is running, or if the keys are in the ignition.)

Evading a Peace Officer

You cannot deliberately run away or attempt to evade a peace officer performing his/her duties (police pursuit). The punishment is up to one year in county jail. If a serious bodily injury occurs during a police pursuit, the punishment is seven years in state prison. If a person is killed during a police pursuit, the punishment is ten years in state prison.

NEW 2009 LAWS

No-Texting

Drivers may not use a wireless communications device to write, send or read text-based communications while driving a motor vehicle.

Administrative Per Se (APS) Zero Tolerance

It is unlawful for a person who is on probation for a DUI offense to operate a motor vehicle at any time with a blood alcohol level (BAC) of 0.01 or greater. Violations of the law will result in a one-year suspension of the driving privilege. Refusal of or failure to complete an alcohol screening (PAS) or chemical test will result in a two-year revocation of the privilege. If you have two or more prior DUI convictions within the past ten years, refusing a PAS or chemical test will result in a three-year revocation of the driving privilege. Violators are not eligible for a restricted license for any of the above violations.

Effective July 2009

If you have a prior DUI conviction and are convicted of driving with a suspended driver license, you will be required to install an Ignition Interlock Device (IID) on your vehicle for up to three years, depending on your driving record.

NEW 2010 LAWS

Driving Under the Influence (DUI) Pilot Program

A DUI pilot program will be implemented that requires a first time or multiple DUI offender to install an IID in certain areas. Tulare County is one of five counties in the state in the pilot program.

New Information

Neighborhood Electric Vehicles (NEV) and Low-Speed Vehicles (LSV) have become fixtures on our roadways and part of the California driving culture. There’s a NEV and LSV section on page 59 of this Handbook with more information on these new passenger vehicles.

NEW 2011 LAWS

Motorcycle Law

People under the age of 21 must complete a fifteen-hour CHP motorcyclist training course prior to obtaining an instruction permit to operate a two-wheel motorcycle. The rider is required to have the permit six months before applying for a license.

Traffic Violator School Program

Court-approved programs of traffic safety instruction are eliminated and the Department of Motor Vehicles exclusively oversees the traffic violator school (TVS) industry, including classroom and home-study formats. The current dismissal of a traffic violation for a driver who attends TVS is changed to a traffic violator school conviction that will be held confidential (masked) only if there is no other TVS conviction reported within the preceding eighteen months.

California Teen Alcohol Safety Act

This law adds a “social host” liability on adults who knowingly provide alcohol to minors who are subsequently injured or killed as a result.

Many new laws or adjustments to current law appear each year. When a driver gets a ticket the process is currently changing. To learn about the changes visit the DMV website www.dmv.ca.gov. For complete information on chaptered bills, enacted in 2010, refer to the Legislative Counsel website at www.LegInfo.ca.gov.

By Kimberly Sherman

A recent trip to the school cafeteria was filling for a local 14-year-old boy and 11-year-old girl, but not because of the lunchroom special. The two had cavities in nearly 80% of their teeth and were in dire need of permanent molar extractions. They were treated to high-quality care by students of the USC dental program, through its world-renowned mobile dental clinic.

Pioneered in 1968, the USC mobile dental clinic has evolved from offering free dentistry to passersby on the occasional weekend outing into a more structured setting with a fleet of six Winnebago and fifth-wheel trailers. Four of the trailers house a total of fifteen dental chairs, one serves as the central sterilization center and the final is the fuel truck, providing generators to the rest of the fleet.

Currently, USC visits ten to twelve locations each year, including Bakersfield, San Diego, Oxnard, San Luis Obispo and, most close to home, Visalia.

For the past fifteen years, USC and Visalia Unified School District, in cooperation with Kaweah Delta Hospital, have collaborated to carry out critical care of more than 100 students in need of elaborate dental work, generally totaling over $1,000 per child, all at no cost to the children’s families.

Not Just Patients

Santosh Sundaresan, DDS, is the Director of the USC mobile dental clinic and Assistant Professor of clinical dentistry at USC. Not only does he oversee the care of children receiving services, he serves as mentor to USC dental students, providing them with both an intense clinical experience and life lessons.

“These aren’t just patients. We treat them as if they’re one of us,” said Sundaresan. “The senior dental students doing the work are there to serve, not just as a dentist, but as a model of the community.”

Lack of grant money broke the fourteen-year mobile clinic run in Visalia last year, so this year the Samaritan Center stepped in with the funding to bring USC back to Visalia Unified School District’s chosen location, Ivanhoe Elementary School.

The school district liaison for the project, Lucinda Majdell-Awbrey, has been involved with the project since its inception. She helps oversee the planning involved in whittling down the list of dozens upon dozens of elementary school children in need of services to find the 100 students who demonstrate the direst need for intense dental care.

“When we first started, at least 50% of the students needed care. Now, it’s more like 20-30% need care,” said Majdell-Awbry. “The dental health of the children has improved. The children have been treated and don’t need in-depth care anymore. The dental piece that goes along with this is that parents get education on dental hygiene that’s passed on to younger siblings.”

A Collaborative Effort

After finding the funding for the upcoming year’s program, Kaweah Delta and Visalia Unified School District work together to reach out and find the school in most need. In years past, neighboring school districts have even been called upon to serve as the location of choice. After agreeing upon a date that works for all agencies and obtaining approval and support of the principal, the school nurse calls upon a local dentist willing to volunteer his or her efforts and give screenings. The Dental Society has been integral in this step of the process.

Each child is then slotted into categories based on the level of need, and those with the highest needs are selected to be involved in the USC mobile clinic.

After permission slips are signed, health histories are completed and any insurance needs are met, the school district hands the paperwork over to Kaweah Delta, which prepares the students’ charts for the incoming dentists. The clinic always begins on a Friday, and the paperwork is ready for the USC unit.

Sundaresan outlined his staff and students’ process, which provides the most streamlined, thorough care of the youngsters initially apprehensive of masked, gloved adults who want to poke around their sore mouths.

On Friday a core group of fifteen third- and fourth-year volunteer dental students makes up the mobile clinic staff. The staff sets up and plans treatment for all 100 kids.

Early on Saturday morning the mobile clinic staff transforms the cafeteria into a massive dental unit with twenty-five mobile dental chairs and all the necessary equipment. They clean all the children’s’ teeth and give them oral hygiene instructions. All the parents are in the waiting room and receive instruction on how to keep their teeth clean and how to help their kids do the same.

The following week, the USC students work twelve- to thirteen-hour days completing plans for each of the kids, some of whom are pulled out of school every day for an intense session of fillings or extractions.

Kaweah Delta Partnership

John Tyndal is the Community Outreach Director for Kaweah Delta. Aside from securing funding to run the clinic, he offers the USC mobile unit additional volunteers.

“During the clinic, Kaweah Delta provides support staff. Two secretaries serve as the point of entry into the cafeteria clinic. Parents report there to get their badges and paperwork for their child’s treatment,” he said. “This year we needed help with nurses on-site because some kids had extractions, and we want someone to monitor their bleeding.”

Tyndal says that the USC mobile unit has never been a part of Kaweah Delta’s budget. The Community Outreach department is responsible for obtaining funds. In previous years, several grants have been utilized; in years that the grants haven’t covered the cost, the Kaweah Delta Foundation has bridged the gap.

The Samaritan Center has already stepped up to partner with Kaweah Delta and fund the project for next year. Meanwhile, fundraising efforts are a top priority.

Sundaresan attributes the epidemic of poor oral hygiene to lack of education, lack of access to care and lack of insurance.

“The lack of education is cliché — ‘It’s baby teeth, they can deal with it, they’ll fall out,’” he said. “Most of these kids don’t have access to a dentist, and dental insurance is expensive. But oral health has improved because of what we’ve taught them; the parents know that value of what we’ve done, and educating them does seem to help.”

Sundaresan points out that oral health is essential, noting that, no matter one’s opinion on the recent healthcare overall passed in Congress, dental coverage was not at all mentioned in the bill, which is tragic.

“There’s a direct correlation between physical and oral health, directly related to a child’s education. Studies show that kids get better grades if they are healthy, both physically and orally,” he said. “Dental health is not an option. It’s someone’s right and should be on the same par as medical health for a healthier community.”

Just ask the kid who had eighteen cavities filled.

Sidebar

How You Can Help

The Samaritan Center will be focusing on fundraising efforts over the next year to prepare for the next USC mobile clinic, slated for spring 2012.

How You Can Be Helped

Part of the Samaritan Center’s involvement in the community includes volunteer dentistry services.

For more information, call:

The Samaritan Center: Sally Altamirano: 733-7331

Kaweah Delta Community Outreach: 624-2605

Pull-Quotes

“These aren’t just patients. We treat them as if they’re one of us.”

— Santosh Sundaresan, DDS

Director of the USC Mobile Dental Clinic

“When we first started, at least 50% of the students needed care. Now, it’s more like 20-30% need care.”

— Lucinda Majdell-Awbrey

Visalia Unified School District Liaison

“There’s a direct correlation between physical and oral health, directly related to a child’s education.”

— Santosh Sundaresan, DDS

Director of the USC Mobile Dental Clinic

By Kimberly Sherman

Central California native Dr. James Smithson kept his feet planted on valley soil throughout his upbringing. But that didn’t stop him from uprooting himself to see the world’s highest sights and place his mark on the world of medicine.

Born in Visalia, Smithson lived in Exeter until he was 9, and then moved to Fresno, where he remained until the age of 20. After spending his college undergraduate days at UC Davis, the allure of the surf pulled Smithson to UCSF medical school, where he graduated and then stayed an extra year to become versed in the ultrasound field.

Then, Smithson got the itch to conduct a clinical trial.

On Mount Everest.

Though a dozen or so have followed in his footsteps, conducting similar clinical trials, Smithson’s claim to fame came in 2004 to 2005 when he became the first man to use an ultrasound machine at the Everest Base Camp in the Himalayas of Nepal to determine the causes of Acute Mountain Sickness (AMS).

“Acute mountain sickness is the syndrome that people experience when they’re not acclimatized to that high altitude,” Smithson said. “It includes loss of appetite, vomiting, headache, dizziness, and confusion. People can die from it — I saw a few very sick people.”

Smithson stayed at a small Nepal village with a mere three dwellings.

“I lived right in front of Everest,” said Smithson. “I designed my own solar (power) system. They were solar panels that powered the ultrasound machine.”

He installed solar panels on the roof, and began conducting ultrasounds, at 18,000 feet, on trekkers from all around the world.

In fact, though the mission was meant to be strictly a clinical study designed to uncover symptoms of AMS, two cases were so severe that one victim of the sickness had to be evacuated by a helicopter. Another suffered from partial loss of vision.

“I studied around 120 subjects, and of those, one-third to 40% were sick,” said Smithson. “Those people tended to have the abnormal results, which helped to better understand mountain sickness and the resulting edema of the brain.

“I was doing ultrasounds behind the eye, which is a window into the brain. It’s a research tool that people will use in the future.”

Smithson has presented the results of his research at national and international symposiums, in New York and Canada.

His days of roaming the world’s highest mountains are over, and Smithson has settled into a comfortable life alongside his wife and with a new set of challenges — children. Four year old Leila and 1 ½ year old Lucas are busy children. They, along with Smithson and his wife, Rajitha (Reggie for short) visit her home country of Sri Lanka whenever possible.

Smithson is happy to be home. “I live in the foothills below Kings Canyon. I ride the racetrack, but I ride motorcycles up into the mountains and down through the hills as much as possible.”

Now the Emergency Ultrasound Director at Kaweah Delta, which has been a trauma center for nearly a year, Smithson takes the graveyard shift because it’s the most challenging.

“We drop down to one doctor for three hours of the night shift, coordinating up to thirty patients at a time,” said Smithson. “I’m also working to further the education of our ER doctors by diagnosing at the bedside with the ultrasound.”

Family and career top his “most important” list, and Smithson says the most challenging aspect of his job is managing multiple sick patients. “I am constantly triaging and reprioritizing. I enjoy taking care of everyone in parallel instead of in a series.”

By Aaron Collins

Kaweah Delta Medical Center just hit the one-year anniversary of achieving its Emergency Department designation as a Level III Trauma Center, a seven-year effort that has changed the way emergency care is administered in Visalia and improved prospects for Tulare County trauma patients via Kaweah Delta’s Trauma and Acute Care Surgical Services (TACSS) program.

“Daily life has changed dramatically since receiving our designation,” says Amber Myers, RN, BSN, Trauma Program Coordinator for Kaweah Delta. “Since that time, the Trauma Acute Care Surgical Services have been available 24/7 for any trauma that rolls through our Emergency Department doors.

“Orthopedic surgeons have likewise committed themselves to excellence,” offering orthopedic care around the clock. “I am proud to say that all of our Emergency Department nurses, Operating Room nurses and ICU nurses have taken additional trauma courses. All ER nurses are currently Trauma Nurse certified and all ICU nurses will have Trauma Nurse certification within six months,” Myers says.

In the past year, KDMC treated over 800 trauma patients. Many of those patients would previously have lost precious minutes of lifesaving intervention during lengthy transport to hospitals outside the city, most often Fresno.

According to Kaweah Delta, the 76% of the patients treated were victims of “blunt trauma,” like motor vehicle crashes, falls and sports injuries. Trauma patients ages 18-29 accounted for 24% of the total. All trauma victims in the area now come to Kaweah Delta Medical Center, except for those with burn injuries or certain isolated head injuries.

Breathing Easier, Faster

Since the designation, Kaweah Delta Medical Center purchased glidescopes for the Emergency, Anesthesia and Critical Care departments. A glidescope is used for difficult airway intubations resulting from severe trauma. “Many times, trauma patients are so badly injured that it is difficult for the physicians to (see) the anatomy to place a tube that allows that patient to breathe,” Myers says. This device helps doctors relieve respiratory distress faster.

A new sixty four-slice CT scanner allows for faster imaging of the trauma patient and quicker diagnosis of internal problems, Myers says. This CT scanner sits within steps of the Trauma Bay in the Emergency Department to ensure the quickest response — one of many such requirements for the certification by the Emergency Medical Services Agency in accord with established standards of trauma care by the American College of Surgeons. Kaweah Delta’s advanced facilities, resources and successful training were key to earning that designation.

The Emergency Department physicians have also established bedside ultrasound courses. “ED physicians with training in reading of bedside ultrasounds ultimately improve the time from injury to diagnosis/treatment. The ED Physicians have also opened this up to all Trauma surgeons to attend,” Myers reports.

Increased interaction with other trauma centers is one major boon for patients following the designation. “KDMC has become very involved in the regional and state trauma system. We attend monthly Regional Trauma meetings that include Fresno, Tulare, Kings and Madera counties,” Myers says.

One of the advantages of being a Trauma Center is that it integrates the hospital into the regional and statewide trauma systems, helping to offer more seamless access to highly specialized care.

“We are very involved in the Central California Regional Trauma Coordinating Committees, which meet quarterly and include the following counties: Alpine, Calaveras, Tuolumne, Stanislaus, Mariposa, Merced, Madera, Fresno, Kings, Tulare and Kern,” says Myers, the Regional Director for Central California’s Rural Trauma Team Development Course. Dr. Tim Spade and Dr. Rebecca Zulim are members of the Executive Committee.

Additionally, every fifteen months KDMC participates in the State Trauma Summit, at which all California Trauma Centers come together. The department has become very well integrated into a system that improves information flow and care approaches.

Aside from these meetings and committees, Myers says, Fresno Regional Medical Center “has extended their hand and been very involved in establishing structure to our program. We have a trauma transfer agreement that allows any trauma patient at KDMC needing a higher level of care to be transferred to RMC in an expedited fashion.”

With a successful year under their belt, what lies ahead? The shortage of neurosurgeons in the region means that the next higher level, Level II designation, is unlikely. But public education about the benefits of local Level III services is on the agenda. “Kaweah Delta remains committed to attaining a high bar of trauma care delivered to Tulare County residents. We have been fortunate to receive great support from hospital administration, physicians and staff,” Myers says. “This support pushes us to become a Level III Trauma Center that offers the best in trauma services. In the upcoming year we would like to engage our local businesses, churches, schools and organizations in trauma services and education that Kaweah Delta Medical Center can offer them.”

For this issue’s cover shot, photographer David Swann and photo stylist Susan Thompson spent some time with Tulare City Firefighter Brandon West, who, in January, was named Tulare Firefighter’s Club Firefighter of the Year. Valley Response Magazine decided his accomplishment was worthy of recognition on the cover of our March/April issue.

While most of West’s professional accolades and achievements are detailed in the article by Jim Blanks on page ____, one of the more exciting new factors in his life right now is the recent engagement to his girlfriend of three years, Jennifer Flanagan, to whom he proposed during the cover shoot at Del Lago Park in Tulare.

After some co-conspiring with Swann, West planned to hide the ring inside the tackle box and fish it out unexpectedly to give to Flanagan. While the proposal itself was a private moment for the couple, Swann was able to capture a few shots from afar.

On behalf of the staff at Valley Response Magazine, we’d like to say congratulations to the happy couple and to send our wishes for many wonderful years to come. And to West, for his bravery as a professional firefighter and for earning of the title Firefighter of the Year, we’d like to say thank you and job well done. We appreciate your courage!

Spring Brunch

By Paul Main

As I understand it, a frittata is an Italian egg cake similar to a Spanish tortilla. Webster’s online dictionary refers to a frittata as an unfolded omelet often containing chopped vegetables or meat. I have even heard it called a quiche without a crust. Regardless of where you find the definition, a frittata is a cooked egg dish with endless variations of ingredients, and it can be cooked on the stovetop or finished in the oven. Personally, I like to bake frittatas in the oven to get a steady, consistent heat to allow the eggs to get a fluffy appearance and a slightly browned top.

When I spent time working shifts at the station, occasionally weekend brunch became the meal of the day. Often, my coworkers and I would push to quickly complete all of our shift duties and start our meal a bit early. To save time, one of us would typically have some of the items prepped and ready to go. This reduced the preparation-to-service time, but often our meal plans were foiled by a call for help. Just like the responders that serve you today, we had moments when a meal had to be missed or was found cold upon return. Despite the challenges of shift work, we always managed to enjoy a great brunch — even if brunch turned out to be dinner.

I enjoyed preparing this spring brunch menu, and I think you will too. I like to make individual frittatas so that each person can have their own dish. Whether at home or at the station, I hope you can take these ideas and turn them into a great brunch for your “crew.”

Spinach & Red Pepper Frittata

Ingredients:

2 tablespoons olive oil

1 small red onion, diced small

1 red bell pepper, seeded and stem removed, diced small

1 teaspoon salt

6 ounces baby spinach, cleaned and dried

8 whole eggs

2 egg whites, whisked until frothy

1/4 cup milk

4 ounces goat cheese

1/2 teaspoon black pepper

Method:

Set the oven at 425 degrees. Set four oval-shaped, ½-inch deep ramekins on a cookie tray. Spray each ramekin with cooking spray. In a nonstick skillet, heat the olive oil over medium heat. Add the onion, bell pepper and 1/2 teaspoon of the salt. Cook, stirring often, for about 10 minutes or until the vegetables soften. Add spinach. Cook, stirring, for 2-3 minutes or until spinach wilts. Remove from the heat and let cool for 2-3 minutes.

Spoon the cooled vegetables evenly into the oval ramekins. Using a spoon or fingers, place small drops of goat cheese over the vegetables.

In a large bowl, whisk the whole eggs, milk, black pepper and the remaining 1/2 teaspoon salt. Fold in the egg whites until they’re mixed in. Ladle the egg mixture over the cheese and vegetables, until each ramekin is 3/4 full.

Carefully transfer the cookie tray with ramekins to the oven and cook 15-20 minutes or until the frittata looks puffy, brown and cooked in the center when pierced with a paring knife. Serve warm in the ramekin or cut a portion and place it onto a plate.

Serves 4-6 depending on the size of the ramekins.

Lemon Muffins

Ingredients:

2 cups all-purpose flour

2 teaspoons baking powder

1/2 teaspoon salt

1/2 cup light margarine

1/2 cup sugar (or sugar substitute equal to ½-cup sugar)

Zest of one lemon

2 tablespoons lemon juice

2 eggs

1/2 cup low-fat lemon yogurt

1 teaspoon lemon extract

1/2 cup reduced-fat milk

Method:

Heat oven to 400 degrees. Grease just the bottom of 12 medium-sized muffin cups or line them with baking cups.

In a medium-sized bowl, sift together flour, baking powder and salt. Set these aside. In a separate medium-sized bowl, combine margarine and sugar, and mix until creamy. Add lemon zest, juice, eggs, yogurt and extract, and stir. Add the milk and the dry ingredients to the margarine mixture in thirds. Mix until the dry ingredients are incorporated.

Fill the muffin tins 2/3 full and bake for 20-25 minutes or until golden. Remove from the pan and let the muffins cool.

Serve them warm with marmalade or your favorite jam or jelly.

Makes 12 medium-sized muffins.

Fresh Fruit Salad

Ingredients:

1 pound strawberries, cleaned, stem removed, cut in half

6 ounces fresh raspberries, cleaned

6 ounces fresh blueberries, washed, stems removed

4 kiwi fruits, peeled, halved crosswise, each half quartered

2 oranges, peeled, cut into 1/2-inch pieces

2 cups grapes, washed

1 honeydew melon, rind removed, seeded, cut into 1/2-inch cubes

1 teaspoon lime zest

Juice of 1 lime

Low-fat yogurt — preferably Greek-style (optional)

Method:

Combine all fruits in a large serving bowl. Gently toss to combine with lime zest and juice. Keep chilled until you’re ready to serve. Spoon the fruit salad into individual serving bowls and serve immediately. Top with a dollop of yogurt, if you like.

Serves 8.

Safety Tip:

A kitchen is not the place to learn about shocking yourself. I want to stress the importance of using caution with all of the time-saving electronic gadgets that can be found in a kitchen.

1. Take note of all things electrical in your kitchen. Not only can bad wiring or shorts in an appliance electrocute you, it could cause a fire and even burn you.
2. Keep an eye on all electrical cords. Watch for any breaks or cuts, or frayed areas where the cord passes over an edge or something has been set on it. Repair any damage.
3. Don’t overload circuits by using multiple plugs, extension cords or the like. If you have old wiring, it is often a good idea to get it checked by a professional for load-carrying capacity.
4. Don’t use appliances near the sink or other water. If the appliance falls in, it can electrocute anyone nearby. If you must have a wall socket near the sink, make sure it has a Ground Fault Interrupter type socket assembly.

If you experience electrical trouble with an appliance or with your home’s wiring, contact the product manufacturer for guidance on repairs, an appliance repair specialist or an electrician. For more information on general safety tips for around the kitchen, go to: http://www.premiersystems.com/recipes/kitchen-safety/cooking-safety.html

By Aaron Collins

When a mail bomb exploded at a Visalia business in 2009, it wasn’t just a local rarity, it made headlines around the nation. “Nationally there are fewer than ten mail bombs sent a year. To my knowledge this was the first mail bomb in the area,” says Lieutenant Steven Phillips, spokesperson for the Visalia Police Department, whose Explosives Unit responded to the incident.

“We received the call after it had detonated, but fortunately no was injured,” Phillips says. “We then responded and discovered that the bomb was made up of several pipe bombs. When the device detonated only one of the five pipe bombs went off. The Bomb Squad responded and rendered safe the device and helped with evidence collection.”

The device consisted of five plastic pipes filled with black powder and .22 rifle cartridges, all arranged inside a plastic toolbox. Authorities arrested Vernon Dale Mustin, 51, in Spiro, Oklahoma, who had intended the explosive for his brother, Dan Mustin. However, Dan Mustin’s son opened the package at the family business, Cal-Air Cooling and Heating, and sustained non-life-threatening burns to his upper body when the bomb partially detonated.

Exploding mail bombs might grab the headlines, but Tulare County has a surprising array of potentially explosive sources that necessitate the services of the Explosives Unit, which has recently merged with Tulare County Sheriff’s equivalent unit.

Ordnance and Dynamite

One such likely source is agricultural. “In the past farmers used dynamite to put holes in hardpan to plant trees. As tractors became larger, the hardpan would be torn up with a ripper so dynamite would no longer be needed. The dynamite would then sit in a barn for years and deteriorate over time,” Phillips says.

Tulare County has little military presence, but military explosive sources also pose a latent threat. The trouble comes from souvenirs like hand grenades brought home by service members who return from duty with mementos of their days in the service. “Many times veterans who returned from WWII brought home ordnance as a souvenir. Their family will contact us to dispose of the item,” Phillips says. Other times, he says the Explosives Unit just doesn’t know how the person came in contact with the items.

The Explosives Unit “was formed due to the interest of Agent Rory Vadnais who is now retired. He started the program,” Phillips says. The Bomb Squad gets specialized training to deal with the threats and hazards of explosives. These may be from explosives that had a legitimate purpose at one time but were discarded, or for those with clandestine purposes, like the threat of improvised explosive devices. Frighteningly, gang members are using explosives.

Additionally, international terrorist threats have forced bomb squads to expand in order to cover biological and chemical threats. The age of terrorism has seen increased federal funding, equipment and training going to local bomb squads. “As a bomb squad we have to now consider how to deal with threats like homicide bombers and vehicle bombs,” Phillips says. “These circumstances require special training and equipment. Several special classes were created to offer the training to deal with the threat of terrorism.”

Staying Sharp

All Explosives Unit members attend a six-week course at a specialized school in Huntsville, Alabama. The Hazardous Devices School is run by the FBI and U.S. Army. Bomb Squad members are also required to attend a one-week recertification every three years.

Once that schooling is complete, the squad continues to train monthly, focusing on different topics each time. “We train with equipment and set up different scenarios to test our skills. A bomb technician is usually assigned the training day and it is up to him to determine what training will be held. For example, we may open a suspicious package remotely or build a fake device to test our skills on how to safely disarm it without being injured. We also take real-life scenarios and convert them into a training exercise,” Phillips says.

He says that currently, in order to form a bomb squad, jurisdictions have to determine that a need exists, in part based on calls and the proximity to other bomb squads. But scant state funding means that Explosive Units are looking to streamline services — and budgets. Agencies also must occasionally serve surrounding jurisdictions. In the mid-‘90s, Visalia Explosives Unit personnel were called to Corcoran when a mail bomb intended for an inmate was discovered just prior to its preset time to explode.

Members of the joint Explosives Unit are Sergeant Russ Gauger, Sergeant Alan Knight, Deputy Scott Doyle, Deputy James Gong, Deputy Matthew Hardy, Officer Jeremy Houser, Officer Clay Moffett, and Phillips, who is also Visalia District 1 Commander.

An officer must have nerves of steel to be on the Explosives Unit. “You have to be very calm under pressure and confident in your training,” Phillips says. But he also says that some of the nerve-wracking aspects lodged in the public mind are a product of media dramatizations, and that the public “might be surprised to learn that most of our job is done remotely. Unlike on TV we usually do not have to cut the ‘red wire.’” He also thinks that the public might be surprised at how many calls the Explosives Unit receives —an average of five per month, higher than many people might expect.

“We anticipate that our combined squads will respond to approximately sixty calls a year,” Phillips says.

One remote technology has greatly increased job safety. It is basically a robot. “This allows the technician to control the robot from a safe distance and approach a device and even disarm it. This is one of the greatest tools for the safety of Bomb Squad members. We also have a bomb suit that is made of composite materials that helps protect a bomb technician when he approaches a possible explosive device,” Phillips says.

On January 20^th, local Mediterranean restaurant, Pita Kabob, celebrated its First Annual “Can You Wrap” pita-making contest.  The event was held in honor of the popular restaurant’s 11th anniversary an event held annually in addition to their gyro-eating contest held during the summer.

This year’s Can You Wrap winner was Mark Avedian, who dubbed his creation the “Armo Wrap”, consisting of pita bread, garlic sauce, lamb shish kabob, rice pilaf, and Pita Kabob’s House Garden Salad topped with vinaigrette dressing. Avedian’s wrap was up against three others, but judges Amy Shuklian, Jennifer Farza, and Valley Response Magazine’s very own Staci Correia, selected the “Armo Wrap” as the winner. For that, Avedian took home a $50 Pita Kabob Gift Card as well as recognition for his creation on all menus and display boards at the restaurant’s two locations.