S2:E12: "Direct on Scene Education (DOSE) - A discussion with Jennifer Combs, MSN, ARNP and Captain James Carrol about preventing sleep-related infant deaths." Recorded December 10, 2020

In this episode, we introduce you to Jennifer Combs, MSN, ARNP,  from Healthy Mothers, Healthy Babies Coalition of Broward, Inc. and Captain James Carrol from Fort Lauderdale’s Fire Rescue.  These two fantastic people have teamed up for about the last ten years to create and grow the Direct On Scene Education Program, more commonly called DOSE.  DOSE is an innovative attempt at eliminating sleep-related infant death due to suffocation, strangulation or positional asphyxia by using First Responders to identify and remove hazards while delivering education on scene. First Responders are trained to identify and remove hazards from an infant's sleep space while on scene during emergency and non-emergency 911 calls.  To learn more about how you can implement DOSE or to obtain more info, go to their website, DOSEprogram.com.

Our guests give us the real-world facts as well as the intent and purpose of the DOSE Program.  Then, they’ll provide real life examples of how DOSE has made a continuous positive impact on the number of sleep-related infant deaths each year.  Finally, we will walk you through how first responders and their agencies can implement DOSE and make a huge impact in their community.

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Transcript

Geoff Lassers: 0:07

Hello and welcome to the EMS on AIR podcast. The mission of this podcast is to keep healthcare provider safe, informed and prepared today is December 18 2020. I'm Geoff Lassers, and I'll be your host. This episode was recorded on December 10 2020. Before we get started on today's topic, I have a few brief announcements regarding the COVID-19 vaccinations. First, we've had a huge response from Episode 11 titled COVID Q&A with Dr. Russell Faust and Dr. Steve McGraw, a discussion about the efficacy and safety of the forthcoming vaccines, which was recorded December 14 2020. I want to thank everyone who called emailed or texted to ask if they could share the info. Of course, please share this info and or podcasts with as many people as possible. That's the point. Dr. Faust and Dr. McGraw did a fantastic job of addressing the concerns of healthcare providers regarding the safety of the COVID-19 vaccinations. Steve and Russ laid out all the questions they've been receiving and delivered clear and concise answers. Most importantly, all of their answers were based in the latest scientific data and literature that clearly demonstrates the safety of the COVID vaccines that are currently available. I highly recommend that you listen to that episode, if you have not already. Now that the vaccines are actually being scheduled and administered. We're getting a lot more questions from the EMS and health care provider communities. The most common question we've received in the last few days is can I get the COVID vaccine? If I've had another vaccine recently? The answer is no. If you have had another vaccine in the past 14 days, you will not be able to have the COVID vaccine until after the 14th day. Once the 14 days have passed since your last vaccine, you will qualify to receive the COVID vaccine. This will be covered in detail along with many other frequently asked questions. In the next episode that I'm recording with Dr. Faust and Dr. McGraw this weekend. Please send in any questions points or other info that you'd like addressed to QI@ocmca.org. That episode will be released on December 21 or 22. Depending on how fast I can get the editing done. Okay, let's move on to today's show. Today we're going to get off the COVID train for a minute to focus on something totally unrelated but very important sleep related infant deaths. I know it's not exactly a more positive discussion than a pandemic. But it's a problem that we need to talk about. Recently, I was contacted by the state of Michigan EMS Education Coordinator Terry goatee and the state ms for children coordinator Dr. Samantha Mishra, about the incidence of preventable sleep related infant deaths. I learned that each year in the United States there are about 3600 Sudden Unexplained infant deaths or (SUID). These deaths include infants less than one year old with no immediate obvious cause. There are three most commonly reported types of suid. The first is Sudden Infant Death Syndrome, or SIDS, which is a term we're all familiar with about 1600 infants died of SIDS in 2017. The second includes approximately 1300 deaths each year from truly unknown causes. The third most common type of SUID is accidental suffocation and strangulation in bed. These preventable sleep related situations account for about 900 infant deaths each year. Here's another fun fact about the county where I live in work between 2010 and 2017. There were 77 sleep related infant deaths in Oakland County, Michigan. That's too many, especially when I learned that these are preventable. It is important to understand the difference between SIDS and accidental sleep related infant deaths. We need the entire first responder community as well as the communities that we serve to understand the difference too. According to Mayo Clinic, SIDS is unexplained to death. Usually during sleep of a seemingly healthy baby less than a year old. SIDS is sometimes known as crib death because the infants often die in their cribs. Although the cause is unknown, it appears that SIDS might be associated with defects and a portion of the infant's brain that controls breathing and arousal from sleep. In contrast, accidental sleep related infant deaths are unfortunate situations that could have been prevented. Again, these types of situations include accidental suffocation and strangulation in bed. Now, Terry, and Sam didn't just call me to drop these awful facts on me and hang up. No, that would be really rude and weird. They call to let me know that yes, this is a problem. But there are resources that have been designed to help prevent sleep related infant deaths. Terry and Sam were also kind enough to introduce me to Jennifer combs under practitioner from healthy mothers healthy babies coalition of Broward County, Florida and Captain James Carroll from Fort Lauderdale Fire Rescue these two fantastic people have teamed up for about the last 10 years to create and grow the direct unseen education program. More commonly called DOSE. DOSE is an innovative attempt at eliminating sleep related infant death due to suffocation, strangulation or positional asphyxia by using first responders to identify and remove hazards while delivering education on scene. First responders are trained to identify and remove hazards from an infant sleep space while on scene during emergency and non emergency 911 calls. To learn more about how you can implement dose or obtain more info, go to their website doseprogram.com doseprogram.com. In this episode, I'll introduce you to Jennifer and Jim from DOSE and allow them to give you their background on who they are and how they teamed up. They'll also set the stage with some real world facts as well as the intent and purpose of dose then they'll provide real life examples of how dose has made a positive impact on the number of sleep related infant deaths each year. Finally, we will walk you through how first responders and their agencies can implement a dose and make a huge impact on their community. Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR podcast team by email at QI@ocmca.org. Also, check out our website EMSONAIR.com for the latest information podcast episodes and other details follow us on Instagram @ems_on_air in fact, we've been releasing a lot of posts lately on Instagram, you might want to really check that out. And please whatever podcast platform you use, subscribe to our podcast and leave a rating and review. It really helps us grow this project. I really can't say this too much. Please leave us a rating and review and help us get noticed on a much larger scale. Remember, the mission of the EMS on AIR podcast is to keep healthcare provider safe, informed and prepared. So increasing our ratings and reviews gets us noticed by more listeners and more sponsors. And that will lead to increasing our reach, resources, experts and abilities. Bottom line ratings and reviews are vital to our growth. And your contribution will give us what we need to serve those that serve our communities. The only cost to you is a few minutes of giving us a rating and a review on whatever podcast platform you use. We're available on pretty much every platform. So it's quick and easy. Thank you and enjoy the podcast. Welcome to the show, Jennifer and Jamie. Jennifer combs, Let's start with you. Can you give us an overview of who you are, what you do, and where you do.

Jennifer Combs: 7:46

So Hi, thanks for having us today. My name is Jennifer Combs. I am a Nurse Practitioner, I specialize in the area of neonatal intensive care and maternal child health for the last 31 years. So I have really basically dedicated my life to decreasing infant mortality and improving overall infant health because I really truly believe that our community as a whole the health is reflected in our infant mortality rates. So if you have high infant mortality rates, whatever the causes may be preventable and non preventable, that's showing that overall your community is a very unhealthy community, which some people may say, oh, what's the big deal about that, but it is a big deal, because that translates into economic impacts, negative and positive in your community. And it just has like a domino effect. So I have worked both in the hospital and out of the hospital. I find my rewards in working in the community are vast. And that's kind of how I became involved with healthy mothers healthy babies coalition of Broward. I work as a maternal child health consultant for them developing educational programs and outreach. And that's how I use my knowledge as a nurse practitioner and translated into community education specifically targeted into mortality prevention and reduction programs.

Geoff Lassers: 9:09

Well, that's pretty impressive. I certainly understand Jimmy's admiration for you. And I'm guessing that part of your job is to be a part of making contact with EMS because you probably are aware that EMS is an integral part of the community. So I'm guessing that's how you picked up on this guy, Jimmy Carroll over here. So Captain Carroll, let me ask you, who are you? What do you do and where do you do it?

James Carrol: 9:32

Yeah, my name is Jim Carroll. I work for the city of Fort Lauderdale Fire Rescue department. I am a operations Captain on B shift in Fort Lauderdale. I work at station 16 which is Wilton Manors, Florida, which is a small city within Fort Lauderdale, but still within Fort Lauderdale. That's what I do. Again, I'm an operations captain. So I'm in charge of a fire trucks engine 16 and mccole crew fire engine crew and a rescue crew at the station. So that's what I do. I also helped develop the DOSE program with Jennifer Combs that started in Fort Lauderdale. And I currently still help run that and facilitate that within the department. But mostly now the training department does that. But I am basically just their spokesperson, I guess for DOSE within the city. So that's what I do.

Geoff Lassers: 10:18

Was it? Is it your choice of hats that got you the gig there? How did you tie together with Jennifer combs linked me on how Jim Carroll met Jennifer Combs and helped develop direct on scene education or DOSE?

James Carrol: 10:31

Well, basically, I was working at the time as an EMS captain in the EMS bureau. So I was given a, I wouldn't call it a promotion. But I was given a day gig. So I was not on the the truck. I wasn't on the engine, I was basically working a 9-5 in the EMS Bureau. So while I was doing that, I was pretty new. And there was an invitation that came by that said that somebody was hosting a conference at the Hard Rock Cafe, I heard that and I was like free food, hard rock. I was like, of course, I'll be happy to go. And so that's how I got there. Long story short, is I showed up, I started hearing all this information about safe sleep. I have two children. They're both healthy and strong and alive. But not much because of how I raised them when they were small. I didn't know any of this information. And so I was really frustrated that a person like me, who had been working in ems, since 1995, had two children had never heard about this, all they heard about is you know how babies have been dying, but mostly because of some strange syndrome that takes them in the middle of the night. And there's nothing you can really do about it, which I think is a crazy part of the message because there's everything you can do about it. And that's what motivated me. So at lunch break, I walked up and said, Jay combs I'd love to help out. I'm I had an idea. And I said, What if we train everybody, my fire department about these things. And while we're out in the houses, basically most of our calls are in homes. When we're inside the homes, we see so much stuff that nobody you know, like Jennifer combs can never just walk into somebody's house. But Fire Rescue department does it every single day over and over and over and over again. So I said why don't we just teach our guys how to identify these hazards. First of all, teach them about it. So we don't put our own children at risk. And then teach them how to identify these hazards while they're on shift, running 911 calls and then hopefully make a dent to the problem and run less pediatric codes, which is the ultimate desire stop working dead babies.

Geoff Lassers: 12:29

Yeah, prevention. Right?

James Carrol: 12:30

Yeah. And if you think about it, that's the big deal about this, especially in Fire Rescue department is fire rescue department, other than, you know, some educational things. But Fire Rescue departments are not in the business of that they're in the business of reacting to bad things, you know, we're not preventing many stuff. We're just reacting to bad things. So I was really surprised that I thought I would have got more pushback. But I was really surprised that most of the guys were really into preventing these bad things from happening, because that's where all the stress lies in the job. Just you know, the thoughts of these terrible things going down. And the fact that we can have something to do about it. It's good.

Geoff Lassers: 13:04

Yeah. I don't know how you push back on preventing dead babies.

James Carrol: 13:10

It's hard to but you'd be surprised.

Geoff Lassers: 13:13

No, I would I yeah, I've worked with the fire service a while as well, since about 2002. So I certainly have heard all of the reasons why people wouldn't want to implement and or do training. But so I certainly understand the sentiment. But man, once you say preventing dead babies, man, that's a tough one to Well, I guess I do got time for training today. Yep. So I see the absolute cool connection when you're like, Hey, here's somebody with information I can literally do something with. And then you went and actually did it. You presented it to your department. And it sounds like they were very instrumental in working together with you in concert to make sure this was implemented throughout the department. Because, you know, like we said prevention before, if we were constantly seeing things in homes that were a fire hazard, it would be neglectful for us to not address that as a situation. And so now we're seeing the same thing. We may not find people that are being abused, and not really even neglected. But we may find levels of Unknowing that could present problems or find problems lying in wait like Gordon Graham says. So I applaud you guys for doing something about it. Can you guys help me appreciate what is truly at stake for infants that sleep in potentially unsafe environment and give me the statistics and facts that will help our listeners understand the problem of sleep related deaths and things that we can actually prevent.

Jennifer Combs: 14:37

So every year in the United States, there are approximately 3600 babies that die of what we call sudden unexpected infant death. And sudden unexpected infant death or SUID, as it's known is kind of this umbrella heading through which these infant deaths are kind of classified by the government and one of those cases categories, which everybody is really familiar with is SIDS, which is Sudden Infant Death Syndrome. And then we have babies that die of truly unknown causes. And then we have babies that are dying of preventable sleep related deaths. And these all used to be just known as SIDS. People would go into a room unfortunately, and find a baby dead in the crib. And they would just call it SIDS. And what it was a sad situation, it couldn't have been prevented when we really didn't know what the cause was. And this went on for many, many years. It wasn't until the 90s and specifically 1992 that the American Academy of Pediatrics started doing more investigation, more education, and found that the majority of these deaths that were labeled SIDS are actually preventable sleep related deaths. And that accounts for about anywhere from 900 to 1000 deaths per year, you know, a true known cause of death. For example, the baby was found facedown in a pillow, or the baby was found wrapped up in a blanket in the bed. We know for sure sleep related deaths. And by knowing now that these deaths were not all SIDS, we were able as a profession as a government to have classification of guidelines for investigation. And as those guidelines have evolved and gotten better, we have more and more accurate diagnosis and classification of the deaths, which enables us to do more about preventing these deaths.

Geoff Lassers: 16:36

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Jennifer Combs: 18:28

Yes. What I like to say for sure, Geoff, is this, I can give you all those statistics. But the one thing that I think really drives it home is when I say this to people in our county where we live Broward County, there's about 22,000 births a year. And when you look at the deaths, there's about 300 fetal and infant deaths per year. When you break it down even further, there's about approximately 20 infant deaths that are directly related to sleep related deaths. Those are 100% of preventable deaths that happen every year. And people say, What are you getting all worked up about for 20 babies? I tell them to stop and think about this. That is a kindergarten classroom full of children. If you walked into an elementary school into a classroom, and you saw 20 empty seats, that is 20 children that will never go to school that will never graduate, go to college, get married, have their own families. And that puts it in perspective.

Geoff Lassers: 19:32

And to give even further context of that, that's per year and just that community correct?

Jennifer Combs: 19:39

Exactly.That's 20 babies in Broward County, Florida, that die every year that never had to die.

Geoff Lassers: 19:47

I'm assuming these are the types of statistics that you heard Captain Carroll that led you to saying Hey, I got an idea. Let's do this thing where I got all these providers already going into houses, they can easily recognize it. Potentially bad situation or problem lying in wait, and hopefully correct that to minimize the number from 20 to as close to zero as possible.

James Carrol: 20:08

Yeah, it was two-fold. For me, the first thing for me was as a paramedic, I became a paramedic in 97. So it's been a while, every time I would go to work, I would always try to go through protocols and run through things, drug dosages, and things in my head. But it was always the pediatric code that always kind of stressed me out, you know, I would sit there and be like, okay, you know, and try to go through it. And most of all those little numbers and things I've forgotten now, but at the time, they were right there, but I would go over and over and over them, because that I wouldn't say everyone feels this way. But I always felt like a pediatric code is the worst of the worst. I mean, a dead baby, there are so many things that go down and nothing happens quick enough. And nothing's ever right. And you have parents and loved ones who are on top of you. And it's just so many things going on, I would be very happy never to run one of those ever again. So that's my first thing. And the second thing for me was a no and I heard all this talk at the convention, including pretty big name people talking about how to prevent death. I was like, wow, first of all, this can be prevented. We don't have to run these dead babies. All we got to do is educate people how to put them to bed. I thought that's simple. And then I was like, you know, they talked about access. And ever since I've been helping to teach with Jennifer combs, I've learned about just getting access to these communities to be able to educate everyone, but to try to gain access to people and have them listen to you. So I thought as I was sitting there during this convention, I said, Well, wait a minute, we, you know, we go into homes all the time. And you know, whether we deserve it or not, we're considered medical professionals. And then the connection between the fire department and the community is has its own special connection, we have a different relationship than police officers do.

Geoff Lassers: 21:46

I always say that your local fire department is as American as apple pie.

James Carrol: 21:50

Yeah, well, yeah, that's the perception. I you know, I don't know if that's exactly the reality

Geoff Lassers: 21:55

that's what I'm getting at is that you are taking that perception and saying people are very comfortable with the fire department walking through their community. And I've always felt that a community has always been very accepting. I know, things have been very tumultuous in the last year, or 4,6,7, whatever, for a lot of our first responder, cousins and brothers and sisters. But I certainly understand the sentiment, there's a lot of trust to the fire service and leveraging that trust is huge when you're trying to do something positive like this.

James Carrol: 22:22

Yeah, think about it, how many strangers do let's just walk through your house, I mean, basically, we just walk into people's houses, and they say, we need help. And there you go. So I always thought that was an ace in the hole that, you know, people are in a position where they need help. So they're almost vulnerable. And that might be the best time to create change, because that's what you're really trying to do when you educate, right, you want to make a change in behavior, a change in what they think so a change will happen and what they do, because, you know, if you tell somebody, you need to put your baby on the back and make sure all the stuff is out of the crib, but they don't do it, then it really doesn't matter. So I thought you got all these things together. Obviously, it's not a 100% thing. But I would say we would have a better opportunity because of our access and our relationship to community then maybe even a Jennifer combs or another nurse practitioner, or health person or social advocate trying to get in there to do something. So that's what I always thought, obviously, that's what healthy mothers healthy babies and Jennifer combs are thinking along those lines when they asked us to get involved in the process.

Geoff Lassers: 23:24

Very cool. Yeah, I've walked into like you probably what 1000s of people's houses, right and said, Hi, how are you? What's going on today? And just asking that to somebody who called for help 1000s of times, you kind of learn this ability to walk into somebody's house under their conditions and make them disarmed. There's like an automatic trust sometimes, maybe it's not always deserved for all of our fellow providers. But man, it's pretty powerful statement when you walk in there and are able to help them identify these problems. So when you do have that, can you guys help me by understanding further its impact by maybe providing some examples of how DOSE has made a positive impact on the number of infant deaths each year.

Jennifer Combs: 24:09

So in the city of Fort Lauderdale, when we started DOSE, we targeted the highest risk zip codes, which was downtown Fort Lauderdale, where there's a lot of poverty, a lot of drug use, high crime rates, but we knew that's where we needed to go. And that's where Captain Carroll was stationed at the time. And they were averaging, I would say anywhere between 6-7 sleep related deaths per year in just one zip code, which was a lot by implementing dose within the first year. They had cut that number in half and down to about three deaths per year. The next year, they were down to one death per year. And now they consistently are between one to three sleep related deaths per year. So that just shows how successful the program can be when you target your efforts and your highest risk zip codes, and then you just spread out from there. And that's exactly what we did in Broward County.

Geoff Lassers: 25:10

That's amazing. Have you been able to maintain those numbers? Because here's the thing, we get new people I know Capt. Carroll, you're probably coming up in retirement in less than next five years, I'm guessing. And then you're gonna have to train some new guys to carry this torch. And the young guys got to the young people, I'm sorry, the young people need to understand how to maintain the level of service and carry on to the next level. So are you able to maintain the success or was this a blip in success,

James Carrol: 25:35

I would say we have been able to maintain, we have not had more than three dead infants in a year since we've been running DOSE, and most of them have been in the one range for a 12 month calendar. Another thing about doses, we want it to be something that continues, like you said, I'm going to retire in about five years, so I'll be gone. But we've integrated the system in the training. So basically, every new guy gets hired, he gets a dose training, every year, the whole department goes through a pediatric advanced life support refresher. And we placed the 20 minute dose refresher on top of that, so everyone gets the dose training, everyone gets the refresher. And so it's integrated into the system now. So hopefully, when I'm pulled out of it, it'll just go that's that was our ultimate hope, because I wasn't planning on doing this forever, I wasn't even planning on doing it at all, it just kind of happened. So I don't want to just leave and have it go away. Like we talked a little bit before, you know, firefighters are asked to do a lot of things. So if we ever got any pushback, most of it was from old timers who are like, you know, are you crazy, you know, this is so just one more thing, you know, and they couldn't see the forest for the trees, so to speak. But young people, almost like I was, you know, 25 years ago, they're highly motivated. And they really want to make a positive impact. They haven't been beat down by the system forever. So those guys take the torch up pretty well. And if it's continued that way in system, once they become old timers, they'll be the people behind him. It just keeps rolling hopefully.

Geoff Lassers: 26:59

Yeah, I think that's the right way to do it is to put it in process. And I call that when we do it at our agency, we call it getting our learning a legacy. Because let's say somebody does a fantastic job of creating this thing. We got to give it away that it exists next week, next year, the next five years because that guy might have the PowerPoint, but the way he conveyed it or he or she conveyed it during that time. You got to capture that. And then you got to capture a way to keep implementing it. If you want it to carry on like you guys have done by continuing you went you said six year was the or was 20 a year? And then you eventually got it down to six, and then you're going into three? Yeah, you don't need more data than that to show you. You're making a huge change here. So as soon as you identified it, your agency was working. How did you proliferate that amongst your local communities, not just in Florida, your local county, because I do know in Florida, you have big county systems as well. There's a lot of integration. I'm guessing sharing this as a resource wasn't that difficult. But it's not always as easy as you assume? How did that expansion happen?

James Carrol: 28:04

That had everything to do with Jennifer combs. So I let her speak to that. But it was really the fact that you have to work with a community partner. That's one of the things that I think is important to have somebody in the community that understands this stuff. Like when I went to the fire department, I started training this. I mean, this wasn't my thing. Jennifer combs had all the answers to that type of those questions. My part was just trying to integrate it within the fire department, you know, because obviously, Jennifer's not a firefighter. So that's why I worked real good together when you have someone from the fire department working with someone from an healthcare advocate for infants in the community and working together. But that's also how you branch out from the department is having somebody like Jennifer combs, who has multiple contacts in multiple different areas and departments.

Jennifer Combs: 28:47

I think that when it came to DOS, there's a couple different things that we have to think about. We started in Fort Lauderdale, and then we wanted to expand out within our own County, believe it or not, there was such resistance within the fire departments throughout Broward County because there's the different cities, the townships, then you have the county fire system, that we were not getting a real big buy-in at first. So we're like, well, let's just continue on, and we got interest nationally. And that's what we did. We just started promoting our product. People reached out to us via our website, and we started doing training first in the state of Delaware, and then it expanded to Georgia, Mississippi, Washington State, of course, Michigan, and just gradually slowly doing these trainings. And then we started to expand more within Florida. And then eventually our own County was like, Hey, what's going on? Why are they having all the success? Why are we not a part of this? And then we got the buy in from our own county and the different cities and townships within Broward County to expand DOSE, but I will say hands down the city of Fort Lauderdale has been the most successful DOSE program within Florida and obviously within Broward County itself, because you need somebody that is going to continually promote your program. And that in this case has been Captain Carroll, he has just led that good, slow, gentle pressure as he calls it to keep the program running. The other thing that Captain Carroll was speaking to is that vital linkage to outside to unity agencies. If you do not have a link to a maternal child health agency, which in this case for the city of Fort Lauderdale is healthy mothers healthy babies coalition of Broward County, you're not going to be successful because the maternal child health agencies and community agencies have all the data they have the extra resources that these families need. And they have access to grant funding that can often help get these DOSE programs up and running. Because DOSE is not just about educating the families when you get into the home. It's like what do you do when you get in there and you realize this family doesn't have the resources to even buy a safe place a crib for the baby to sleep in? Well, in the city of Fort Lauderdale case. That's where they turn to healthy mothers healthy babies. And we're able to provide them with a free pack and play for the family. So it's that vital connection that has really helped make dough such a success.

Geoff Lassers: 31:25

In Michigan, we have Terry Godde, who is the state EMS education coordinator, and she has done a great job of working with you guys in bringing dose to Michigan. I've been aware of dose for the last, let's say six to eight months probably. And then the last couple of months, I've learned that we have quite a problem here in Oakland County, Michigan. So we are figuring out how to minimize the impact here. We're gonna do another episode specifically on that later. But for now, we're in the process of adopting DOSE and figuring that out. Now it's easy for me because I'm talking to Jimmy and Jennifer, that's easy. But if I'm just some person in Montana, or Ohio or somewhere else, even in Michigan, what does this look like and actually implementing it? what resources are available? How do I get started? Walk me in from, hey, I'm interested. I'm in? What do I do?

Jennifer Combs: 32:19

That's a great question. Once they find us which they can, you know, find us through our DOSE website. I'm usually the point person that speaks to them.

Geoff Lassers: 32:27

What is the dose website?

James Carrol: 32:29

doseprogram.com.

Jennifer Combs: 32:32

So you go to the website. And once I make contact with the it could sometimes it's been somebody at the state level, or it could be at the county city, whatever local level, the first thing I say to them is, what do you know about your statistics. And a lot of times, they'll be like, Well, I know there's babies dying here, but they actually don't even have all the accurate information. So I usually refer them to connect with one of their local maternal child health agencies that would be running a fetal infant mortality review program, those are the programs that are gonna have the most accurate and current data about the sleep related deaths happening in their community. And once they have that data, then we talk about, well, what are your goals? Are you looking to implement training in all your fire departments? Or do you want to start small, which is what I usually recommend that we figure out through their femur or maternal child health data, which zip codes are having the highest rates of death, let's pick one of those, let's pilot a program. And we'll go from there. And basically, this whole process, Jimmy and I are involved from the beginning to the end, and walking them through finding the resources, then setting up a training, sometimes that can take a long time because they you know, they have to look for small amounts of grant money to be able to provide for the DOSE trainings, then we do the trainings. And we help them find the resources to have the availability for access to cribs, or pack and plays, whatever they're going to be using. And once they have that in place, then they're able to go ahead and start launching the program. And Jimmy and I are always available to help them with any bumps or roadblocks that they may encounter along the way. And then we just follow them as their program evolves. Because we always tell every organization or station that we're working with, we want you to take ownership of this program. We're giving you the idea we're giving you the materials, we want to see what you do with it. It doesn't need to be cookie cutter what we've done in Fort Lauderdale because every community is different, and we have to adapt. You may have a different cultural makeup in your community than we have in downtown Fort Lauderdale, Florida. So you need to be able to work with your community and your resources to take ownership of DOS and make it your own so that you'll have a really strong successful outcome.

James Carrol: 35:02

Can I say one thing real quick? I don't absolutely know if this need to be in the podcast. But Jennifer combs, I just typed in direct on scene education under a Google search, which I don't think I've ever really done before. And I'm just reading all the pretty crazy. There's a lot of people talking about DOSE. It's crazy. I'm a little impressed. So that's cool. I just like to tell Jennifer that. Okay.

Jennifer Combs: 35:24

Yeah, I'm glad that you did that to me, since we've been doing it since 2011.

James Carrol: 35:28

I know. But I've never just googled it. You know, I've just never googled it. And I just did. I'm like, wow, like,

Jennifer Combs: 35:36

Do you see Geoff, what I'm dealing with?

Geoff Lassers: 35:38

Okay, so what's why I'm laughing is because every Fire Department is the same clowns, just a different circus. I have Seven Jimmy's in my engine house. So I'm laughing because I feel your pain, Jennifer, because this is how my boss feels at med control I through keeps me in line. And she's like, why does this guy do this? But, um, okay, so you really let us down identifying the problem in our specific community and how it's impacting us locally, who our local assets are, and our stakeholders are or could be, because we might all have the same problem, we just can't work in a silo. So we need to identify who can help in the situation in our local communities. And then you just need to do it. And it sounds like the magic is more of just keeping your foot on the gas, rather than trying to convince people. Because at the end of the day, I think what kills a lot of ideas and projects and plans is just the follow through because life's hard, you get caught up doing something else, some other responsibilities come up, you don't go back to it. Sometimes it just takes a little extra effort to get something big rolling down the hill. I'm glad it's rolling down the hill very well in Broward County. And I hope to repeat that in Oakland, county, Michigan, and I hope other states are listening to this and can do the same.

James Carrol: 37:02

The very first place we went into was Delaware. And we had such a great push. But as in fire services, you know, people go, people leave. And so the person who was in charge of DOSE got promoted. And there wasn't a system set up yet for the implementation of the program over and over and the wheels of the department. So once that guy was taken out, and that was it, I would call be like, I'm just checking on the DOSE program. They're like, you know, theres no such thing anymore. I was like, so yeah, like you said, you have to have somebody who's in and but not only just bought in, you have to have it integrated into the system, because fire departments man, they move people like, quickly, you know, quickly.

Jennifer Combs: 37:41

Geoff, I did want to say something that I think is super important. And that is that overall, people in the public in the community are not aware of sleep related deaths. Infant Death is a pretty taboo subject in the United States, people don't really openly talk about it. And the only way we can break down those barriers or that taboo and get these changes implemented, you know, to prevent these deaths is by having open dialogues. I always tell people that reach out to us about dose, does your community even know how many babies are dying each year in your community that don't have to die? because one they know that information, then they're going to want to be more proactive, they're going to want to engage with you in doing whatever they can to prevent these deaths. And I think that that's one of the most important things. We look at ourselves. Whether you look at first responders and you have your hospitals, you have your nursing, you have physicians, you have social work, and all these people work in their little bubbles. But what we need to do is break down those barriers that exist between all of us and collaborate and work together. And that's what the idea originally was of DOS, was from a healthy mothers healthy babies point of view, maternal child health agency and nursing looking who can help us with this. And that's why we turn to ems. And now I want other ities, states, towns to do the same thing. But it starts with raising that awareness about this problem actually exist. And it's happening every month, every year in your own community.

Geoff Lassers: 39:24

I don't know that we could say anything else that would end this better than what you just said. Unless you got something better. Jamie I think that's about a good conclusion as I'm even gonna attempt.

James Carrol: 39:33

I got nothing better than a J combs dropping the mic.

Geoff Lassers: 39:37

I get it. I understand your admiration for this young lady. So um, thank you guys for joining me today. I really appreciate it. We are going to have you guys back in the future. We're going to do another episode with the state of Michigan ems for children hysician Dr. Mishra and Terry odde also at the state and talk about how it's available to people in Michigan and how they're trying to make it more systematic here because I think it speaks to what we're really talking about is we know it works, how do you implement it. So more to follow on that. Thank you guys very much. I appreciate you. Appreciate it.

Jennifer Combs: 40:14

Thank you.

Geoff Lassers: 40:16

That is all for the show today, everyone. Thank you for listening. And thank you to Jennifer combs and Captain James Carroll for coming on and sharing your passion and resources. DOSE is an amazing program and I hope we can put it to use right here at home. If you're trying to get ahold of Jennifer and Jimmy or want more information about dose, go over to doseprogram.com. That's d o s e program.com. in upcoming episodes, I'll introduce you to the team that we've been putting together here in Michigan to help reduce sleep related infant deaths and we'll help any agency that we can with the same mission. Remember this coming week on Monday or Tuesday we'll have another update from Dr. Russell Faust and Dr. Steven McGraw. covering more questions about the safety and efficacy of the current COVID-19 vaccinations. Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR podcast team by email at QI@ocmca.org. Also, check out our updated website emsonair.com. For the latest information, podcast episodes and other details. Follow us on Instagram@ems_on_air seriously lots of good stuff on there. And please whatever podcast platform you use, subscribe to the podcast and leave us a rating and a review. It really helps us grow this podcast. Thank you for listening to the EMS on AIR podcast. Stay safe and have a great day.