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Training & EventsFundamentals of DisasterMental Health Webinar

American Red Cross

September 10, 2014; 6:00pm – 10:00pm

Register here : Search for“disaster mental health” Participants should registerone week in advance andmust be a licensedindependent practitioner withtheir license numberavailable.

Emergency Responder

Health Monitoring andSurveillance (ERHMS)System Training CourseWB2254ERHMS training is nowavailable online. The trainingis free and provides thenecessary tools forimplementing healthmonitoring and surveillance ofemergency response workers.Important procedures for pre-deployment, deployment, and

post-deployment are outlinedContinuing education creditscan be obtained for those whoregister and successfullycomplete the course. Creditsinclude: CEU/CE; CHES;CME; CNE Contact Hours;Pharmacist Contact Hours;and AAVSB/RACE.

Register>>

IS-930: ERHMS System:

Leadership TrainingThis leadership trainingcourse introduces the ERHMSsystem to leaders inorganizations responsible forplanning and executingincident response activities.

The Michigan UpdateState of the Art Technology at MDCHSubmitted by Patty Clark, Outreach Manager, MDCH Bureau ofLaboratories

The Michigan Department of Community Health Bureau ofLaboratories has recently validated a MALDI-TOF MS (matrix-assisted laser desorption/ionization – time of flight massspectrometry) for use in the Bacteriology Laboratory. MALDI-TOFMS replaces the routine use of 16s sequencing and biochemicalidentification of microorganisms. Using the MALDI-TOF MS,microorganisms can be detected and identified within one dayinstead of the usual several days or weeks, at a fraction of the cost.

Currently, biochemical tests form the basis of most techniques usedto identify microorganisms. Organisms are added to mediacontaining specific carbohydrates or substrates. This leads, forexample, to a characteristic color change of the added reagent,

which can then be compared with reference values. Correlating theresults of a number of such tests on a sample culture provides anindication of the organism's identity.

The Bruker™ MALDI Biotyper uses a different methodology - itanalyzes the expression of a microorganism’s intri nsic proteinsusing mass spectrometry. This mass spectral pattern of proteinexpression is compared with reference patterns to determine theidentity of the microorganism.

Figure 1 . The MALDI-TOF target plate has ninety-six spots thatcan be inoculated using an applicator such as a toothpick. The spotis then overlaid with the matrix solution and after drying it is loadedinto the analyzer. The whole process takes just minutes.

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The course focuses onoptimizing the health andsafety of response,remediation, recovery, andvolunteer workers. Theintended audience includes

local, regional, state, tribal,and federal personnel whoare responsible for theoccupational safety andhealth of responders.

Participants can receive 0.1continuing education units forcompleting the course.

Register>>

MCRA Annual TrainingConferenceSeptember 21-23, 2014Tustin, MIThe Michigan CrisisResponse Association(MCRA) will hold its annualtraining for individuals andgroups interested in educationon Comprehensive CrisisIntervention Systems.

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Tools &ResourcesResponder Self Care AppThis mobile app aids thosedeployed to emergencyresponse events inmaintaining their ownphysical, emotional, andsocial wellbeing. It provideschecklists for before, during,and after deployment that

help responders pack fordeployment, take care of dailyneeds, maintain importantrelationships, reflect onexperiences, and more.

A longer time may be necessary if an extra extraction process isneeded adding approximately an hour.

Starting material for a classification using the MALDI Biotyper is anindividual colony from a culture on an agar plate. The sample istransferred to a position on a MALDI target (figure 1) and air-

dried. After drying, a small quantity of matrix solution is added.Once the matrix has crystallized, sample preparation is completeand the samples can be analyzed. If this straightforward samplepreparation method is unsuccessful, a supplementary protocolcontaining short chemical extraction steps can be used to increasethe range of organisms that can be identified by MALDI analysis.

MALDI-TOF mass spectrometry forms the basis of MALDI Biotyperanalyses. A laser in the MALDI-TOF mass spectrometer irradiatesthe matrix/sample mixture, evaporating the matrix and releasingpositively charged proteins. The ability of the matrix to absorb UVlight and transfer protons onto the extracted proteins is crucial tothis process. The protein ions are electrostatically accelerated over

a short distance and arrive in the flight tube at a speed that isproportional to their mass. Protein ions with different masses arriveat the detector after different time periods. Simply by measuring thetime between pulsed acceleration and the corresponding detectorsignal (in the nanosecond range), the speed of the ions can bemeasured very precisely and converted into an accurate molecularmass. Because this mass spectrum is species-specific for a largenumber of microorganisms, it represents a 'molecular fingerprint'.Unknown microorganisms can be identified by comparing their'fingerprint' with the thousands of patterns in thereference database.

A spectral pattern is compared to the database in the software’slibrary generating an identification of the microorganism. Often, theturnaround time for identification is within a day of receiving theisolate. Previously, using biochemical testing and 16s sequencing,it could take days or even a week or two for final identification.When an identification cannot be obtained using our laboratoryalgorithm the organism will be sequenced and submitted forbiochemical analysis.

Identification using MALDI-TOF has reduced the cost per test toless than a dollar compared to more than forty dollars with previousmethods. The use of the MALDI-TOF will be expanded in the nearfuture to other areas in the Bureau of Laboratories.

Brief Updates From Region 1Submitted by Matthew Price, Region 1 Healthcare CoalitionCoordinator

D1RMRC hosted a Basic Disaster Life Support (BDLS) on 6-5-2014at D1RMRC Training Center. Many attendees are a part of theDistrict 1 Emergency Response Team.

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Customizable remindersensure that critical tasks arenot forgotten and tips explainwhy certain aspects of selfcare are vital.

A variety of responders willfind this app useful to helpmanage their self care whileworking in demandingsituations, when caring foroneself is essential in order tohelp and care for others.

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Provider Resilience AppProvider Resilience giveshealth care providers tools toguard against burnout and

compassion fatigue as theyhelp service members,veterans, and their families.

Your responses to a shortself-assessment createratings of your risk forcompassion fatigue, burnout,and secondary traumaticstress. These ratings can alsobe viewed as graphs so youcan monitor them over time.

A clock showing time sinceyour last day off, inspirationalcards, stretches, and Dilbertcomics all encourage you totake restful breaks critical toavoiding burnout. Finally,videos by service membersdescribing the positive impacthealth care providers had intheir lives are there when youneed a reminder of the valueof what you do .

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This team is comprised of professional medical volunteers fromacross the region that could help with a coordinated medicalresponse.

D1RMRC conducted a DIRE PLAY 5 Mass Fatality FunctionalExercise on 6-12-2014 at Michigan State University. Multipledisciplines attended including representation from the regions’Medical Examiners. This exercise was critical to help evaluate longterm response for public health emergencies.

D1RMRC piloted the Advanced Disaster Management SystemTraining (ADMS) on 6-10-2014. Ten first responders attended thistraining. This training was a virtual environment training withartificial intelligence. This training helped EMS command staffdevelop more effective scene management skills using high levelsimulation enhanced training.

D1RMRC presented at the Business Continuity of Operations(COOP) meeting hosted by Sparrow Clinton Hospital on 6-6-2014.This meeting was critical in gathering businesses from across theClinton County area to obtain education on the necessity of havinga COOP plan and their relationship with different healthcarecoalition partners.

D1RMRC hosted a discussion based exercise workshop on 6-17-2014 to help healthcare organizations conduct drills, tabletops, andfull scale exercises within their organizations.

D1RMRC in conjunction with Shiawassee County Public HealthDepartment and emergency management conducted a VolunteerReception Center table top exercise and drill on 6-30-2014

exercising the volunteer request procedures and transfer ofvolunteers to a disaster site from areas across the state.

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ResearchThere Are No Victims Here: Creating an EmpoweredSurvivor CultureIn Emergency Management, authors talk about how to betterempower the public to become more resilient after emergencies.The campaign “Be your own hero” goes beyond the “Be Prepared”message in that it empowers the public to use what they alreadyknow and have access to be their own hero in an emergency. Theauthors say that anyone can be affected by disasters includingthose in the position of authority which the public depends on forsupport. Empowering the public to take charge of their ownresponse encourages less dependence on governmental agencysupport.

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CDC Biosafety Issues Regarding Unsecured LabSamplesThe Centers for Disease Control (CDC) released an after actionreport on the potential anthrax exposure in June of 2014.

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This publication is supported by Cooperative Agreement Number 1U90TP000528-01 from theCenters for Disease Control and Prevention (CDC). Its contents are solely the responsibility of

the authors and do not necessarily represent the official views of CDC.

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