Posts Tagged ‘Yuma’

EMS Overdrive

February 3rd, 2012

This month has been a doozy for our Bureau of Emergency Medical Services and Trauma System team.  This week we finished the 2nd of 2 high-profile and important decisions.  A couple of weeks ago I made a decision to let Yuma City take over part of the ambulance response in that town.  I thought the city folks had given solid evidence why they should be allowed to provide their own service (technically called establishing public necessity).  I also locked in the rates for the Yuma ambulance to the level they are at right now for 3 years. 

I also OK’d a merger of two ambulance companies in the Valley this week.  Rural Metro Ambulance will take over four areas where PMT ambulance used to respond, but they can’t raise rates on customers for at least 3 years.  I also required Rural Metro to keep the electronic health data that PMT is using in those four areas, as well as expand it to other areas it serves.  That electronic data provides an important window into how the system is doing in responding to emergencies, providing important interventions, and getting people quickly to the right kind of treatment.  Timeliness is important in any emergency, but we have been able to document the differences in quickly getting patients into medical care after cardiac arrest and traumatic brain injury. 

Some folks don’t realize just how closely ambulance service is regulated- it’s an important element of patient care and ADHS along with partners across the state have to make sure it’s the best it can be in Arizona.  The state is broken up into Certificate of Necessity areas where companies or cities have a contract to provide the service.  The contracts outline how long a company has to respond to a call, how much they can charge and what happens if they don’t do a good job.  You can learn more about this on our Bureau of Emergency Medical Services and Trauma System website.

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Fl- – An Inexpensive Public Health Intervention

January 11th, 2012

When I was a kid growing up in Tucson- it seemed like we lived at the dentist- and getting cavities filled was routine.  It’s way better these days because of a host of public health and dental product interventions…  but 75% of Arizona kids still have tooth decay by the time they’re in 3rd grade.

Around 1900 scientists speculated that fluoride might protect against tooth decay based on observations that different communities had different trends in tooth decay.  They didn’t exactly know that it was fluoride, but noted that fewer cavities were present in communities where folks had mottled teeth (now called dental fluorosis) which we now know is caused by high levels of fluoride.  Researchers in the 30s and 40s found the direct relationship between fluoride concentrations and tooth decay, and determined that moderate levels of fluoride prevent cavities.  Water fluoridation as a public health intervention began shortly thereafter.

Water fluoridation today reduces cavities by up to 40% relative to communities with low levels of fluoride.  It costs about 95 ¢ per person per year, saves $38 in unnecessary dental costs per person per year… and fluoridating a person’s water for a lifetime costs less than filling 1 cavity!

Some fluoride is naturally present in water and food. Because of our reliance on groundwater for drinking water In Arizona, many communities have naturally occurring fluoride- so all Arizonans get some.  When you hear the word “fluoridation” it basically means that the community adds enough fluoride to the water to bring the natural level up to the amount needed to prevent tooth decay.  Currently, 10 Arizona communities (Bisbee, Chandler, Gilbert, Glendale, Guadalupe, Mesa, Peoria, Phoenix, Tempe, and Yuma) fluoridate their water supply to the right level.  Many other communities in Arizona have naturally occurring optimal levels of fluoride in their drinking water.  Arizonans can check the fluoride levels in their water systems on the My Water’s Fluoride website.  Folks can also learn more about community water fluoridation on the CDC’s fluoride website and on EPA’s fluoride website. 

We also recommend everybody brush at least twice a day with fluoride toothpaste—when getting up in the morning and before going to bed.  For little kids, we recommend monitoring the amount of fluoride during tooth brushing by supervising and discouraging kids from swallowing toothpaste- and teaching them to only place a pea-size amount of toothpaste on the toothbrush.

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Posted in Prevention

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Guillain Barré Investigation Update

August 5th, 2011

Last month I told you about a rare cluster of Guillain-Barré Syndrome (GBS) along the US-Mexico border near Yuma, AZ.  Since then, we’ve identified 8 more cases for a total of 24 (7 in AZ, 17 in Sonora).  GBS is a rare condition that results in paralysis of the legs, but can sometimes affect the arms and face.  While the exact cause of GBS is not well understood, the condition usually occurs after an infection, most commonly from a diarrheal illness caused by the bacteria, Campylobacter.  Even with this association between Campylobacter and GBS, only one in 1,000 cases of Campylobacter infection develops GBS and outbreaks of GBS are extremely rare. 

 We pulled in a team of experts from county, state, and federal levels in both Arizona and Sonora to investigate this outbreak, with unprecedented collaboration on both sides of the border.  These dedicated folks have been working with the people who got sick as well as those who aren’t sick (called controls) about their exposures and risk factors – they interview healthy folks to help us identify foods or activities that are more common in sick people and may be causing infections. 

 The team interviewed over 100 people – now they are analyzing the data.  Initial signs indicate that there may have been an outbreak of diarrheal illness due to reduced water quality.  Chlorine levels have been increased throughout the water system and additional studies are being done to see if we can identify how Campylobacter may have made it into the water system.  It looks like the steps we are taking to stop the outbreak are working since we haven’t had any new cases since the beginning of July and cases of diarrhea have decreased.

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Guillain Barre

July 11th, 2011

A couple of folks from the CDC have been in Arizona this week to help us (and Sonora) to investigate an unusual number of cases (8 in Arizona and 8 in Sonora) of Guillain Barre syndrome

.  The Arizona cases are in the Yuma area.  It’s a rare condition that rarely (but occasionally) happens several days after a person has been sick with diarrhea- often from a foodborne bacteria called Campylobacter jejuni.  The illness happens when person’s own immune system damages the nerves, causing muscle weakness and sometimes paralysis.  Most people recover fully from it but some people have nerve damage that doesn’t go away.

Our epidemiology team is working with folks from the CDC and Yuma County to track down the cause.  Most of the work is gumshoe type epidemiology and includes reviewing medical records to confirm diagnoses meeting with hospital staff and neurologists to discuss clinical signs and symptoms (they have already reviewed 3 records and are currently reviewing a fourth case at a second hospital), and interviewing patients and family members to determine exposure history, particularly related to foodborne illnesses.

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