Emailing: CosUL_PCL

 

Volunteer for MRC

Join the Yakima Valley Medical Reserve Corps

• The MRC was founded after President Bush’s 2002 State of the Union Address, in which he asked all Americans to volunteer in support of their country. It is a partner program with Citizen Corps, a national network of volunteers dedicated to ensuring hometown security.



• MRC units are community-based and function as a way to locally organize and utilize volunteers who want to donate their time and expertise to prepare for and respond to emergencies. MRC volunteers supplement existing emergency and public health resources.



• MRC volunteers include medical and public health professionals such as physicians, nurses, pharmacists, dentists, veterinarians, and epidemiologists.




Types of Volunteers Needed:

• Pharmacist • Physicians/PAs • Dental Health Providers • EMT/Paramedics • Veterinarians • Nurses/CNAs •
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YAKIMA COUNTY MRC APPLICATION




VOLUNTEER APPLICATION FORM/  PERSONAL INFORMATION



Volunteer Name: ____________________________________________
Home Phone: ___________________________



Office Phone: _________________________Pager: ____________________
Cell Phone: _________________________



Address: ________________________________________________ City ____________________ Zip ______________



Date of Birth: Driver’s License Number:



Email Address:



Affiliations? (eg., school, agency, clinic):________________________________________________________________



EXPERIENCE

Current (Most Recent) Employer: ___________________________________ Supervisor: ________________________

Position: ________________________ Address __________________________________________________________ Phone: _________________________



 Full Time

 Part Time

 Retired

 Other: ________________



If less than one year at current employment, please provide second employer information:

Employer: _______________________________________ Supervisor: ________________________________

Position: ________________________

Address ___________________________________________________________ Phone: _________________________



 Full Time

 Part Time

 Retired

 Other: ________________

PROFESSIONAL INFORMATION: (mark or circle all that apply)

 Administrative/Support Duties

 Computer or Communications

 Dentist

 Emergency Medical Technician: Basic Intermediate Paramedic

 Environmental Health Specialist

 Health Educator

 Health Technician Type ____________________

 Interpreter

 Mental Health Practitioner

 Medical Assistant

 Media/Communications

 Nurse: RN LPN Nurse Practitioner Do you have prescriptive authority? Yes No Area of Specialty:__________________________

 Nurse Assistant

 Pharmacist

 Phlebotomist

 Physician: Area of Specialty:___________________________ Board Certified? Yes No



 Physician Assistant

 Veterinarian



Professional License Type/Number: _________________________________
Expiration Date: ______________________

Professional License Type/Number: _________________________________
Expiration Date: ______________________

Other Qualifying License(s) (commercial, equipment etc.) __________________________________________________

Brief description of what you want your role to be in the YC MRC:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

OTHER SKILLS

Are you CPR certified? Yes No

Are you first aid certified? Yes No

Other ____________________________________________________________________________________

Language Fluency: English  Spanish Sign Language Other ______________________

Please list any other special disaster training, certification, or skills that you would like us to be aware of:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

LEVEL OF PARTICIPATION AND ACTIVATION

Tier One ______ (Activation for Only large-scale events)

Tier Two ______ (Pre-event training as well as the Tier One Activation)

Tier Three _____ (Would like to be considered for a leadership role as well as level Tier Two Activation)

Do you volunteer for another emergency organization? Yes No If so, which is your priority?_________



RESPONSE JURISDICTION (Select the farthest distance you would be willing to respond)



County of Residence _____ State of Washington _____ United States _____



EMERGENCY CONTACT INFORMATION



Emergency Contact Name: ______________________________________
Relationship: _________________________



Day Phone: _______________________
Evening Phone: _____________________
Cell Phone: ____________________



Applicants are advised that the Yakima County MRC intends to conduct a background check.

Have you ever been convicted of a drug offense?  Yes  No

Have you ever been convicted of a criminal offense?  Yes  No

Have you ever been convicted of a motor vehicle offense (other than speeding tickets)?  Yes  No

Other than the above, are there any other convictions on your personal record?  Yes  No

Details: ___________________________________________________________________________________________________________

___________________________________________________________________________________________________________


All of the information that I have supplied is correct to the best of my knowledge. I do hereby give the Yakima Valley Office of Emergency Management (YVOEM) or their designee permission to inquire into my background, references, driving record, present and previous employment, licenses, certifications and criminal history. I further give permission to the holder of any such records to release the same to the YVOEM or their designee. I hold the YVOEM or their designee harmless of any liability, whether civil or criminal, which may arise as a result of the release of the information about me. I also hold harmless any individual agency, business or corporation that provides information to the YVOEM or their designee.

I understand that I am a volunteer and will not be paid for any of my services.



_____________________________________________________ ______________________________________

SIGNATURE DATE

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Confidentiality Statement

Yakima Valley Medical Reserve Corps

The Yakima Valley Medical Reserve Corps provides services to our community that may be sensitive in content. Per HIPPA (Privacy Act) regulations, we request to you sign and return the following document to your unit coordinator for placement in your file, indicating that you will keep information to which you have access confidential and not discuss it with anyone other than the staff person with whom you are working.

Confidentiality Pledge



I, ___________________________________ certify that I have read the following statement as listed below and agree to comply with the terms.

I realize that, as a Registered Emergency Worker in the State of Washington, the Department of Emergency Management and the Public Health Department for the Yakima Valley Medical Reserve Corps, I may acquire knowledge of confidential information from files, case records, missions, conversations, etc. I agree that such information is not to be discussed or revealed to anyone not authorized to have the information.

Signature: _______________________________________ Date: ____________

IRIS # : __________________

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Photograph and Media Consent

The Yakima Valley Medical Reserve Corps

The Yakima Valley Medical Reserve Corps may take photos, videos or otherwise document volunteers in action during trainings, exercises and or actual events. Such photographs may be used on the website, in newsletters and other publications without compensation to the volunteer or his/her representatives.

This consent does not apply to photos required for security identification.

Please choose the appropriate section:

The Yakima Valley Medical Reserve Corps has my permission to use my photo as stated above.

Signature: _______________________________________ Date: ____________



The Yakima Valley Medical Reserve Corps does not have my permission to use my photo as stated above.

Signature ___________________________________ Date ___________________

For questions please contact Yakima Valley Office of Emergency Management MRC Coordinator at (509)574-1908



Please send your completed application packet to:


kr.catlin@co.yakima.wa.us

or


Yakima Valley Office of Emergency Management MRC Coordinator: Room b-10, 128 North 2nd Street, WA 98901

SR 410 Nile Valley Landslide Open House

 

SR 410 Nile Valley Landslide

      Next Steps-“Open House”

BUILDING A PERMANENT HIGHWAY

OPEN HOUSE

6 to 7:30 p.m.

Thursday, April 15, 2010

Nile Valley Community Church

60 Bedrock Lane, Naches, WA

 

www.wsdot.wa.gov/projects/sr410/landslide          

 

VOLUNTEER CONTACT INFORMATION

VOLUNTEER  INFORMATION

  

With this update we are also asking for your assistance with a community exercise  on Thursday, April 22, 2010. We will facilitate Operation Eagle Eye Part #4 to test the different response agencies’ ability to respond to an act of terrorism.  To make the scenario as realistic as possible for the emergency responders we need volunteers of all ages to act in a wide variety of roles.  Volunteer actors will be given certain roles to play, and instruction before the exercise starts.  The exercise will last about 6 hours.  Lunch and snacks will be provided.

Our office needs help from volunteers in our community to make this exercise successful. If members of your group are interested in participating as actors, please fill out the attached form, and return to us by April 10, 2010. Mail, fax or cut-and-past it to an email or Word document and send to helga.staffan@co.yakima.wa.us . You may also call Helga Staffan@ (509) 574-1920. For more information about Operation Eagle Eye see the post below.

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Yakima Valley Office of Emergency Management

128 N. 2^nd Street, Yakima, WA 98901

Phone: 509-574-1920   Fax: 509-574-1901   Email: helga.staffan@co.yakima.wa.us

 

VOLUNTEER CONTACT INFORMATION

Please fill out one for each person.

 

 

Last Name: _________________________

First Name: _______________________________

Title: __________________________

Organization: __________________________________

Mailing Address: _________________________

City/Town: _________________

Zip: _______

Work Phone: _________________

Fax: ______________

Home Phone: ________________

Cell Phone: _____________

Email Address: ___________________________________________________

 

 

Additional information for Operation Eagle Eye #4 exercise, April 22, 2010.

 

Are you willing to be an actor for the exercise: 

________Yes

 _______No

 

 

Any additional information:

 

 

Please return this contact information to our office by April 10, 2010

 

*Operation Eagle Eye*

 

*Operation Eagle Eye*

Preliminary Event Scenario-YVOEM Training Exercise

 

 

…….THIS IS A TRAINING EXERCISE……..…….THIS IS A TRAINING EXERCISE……..…….THIS IS A TRAINING EXERCISE……..…….THIS IS A TRAINING EXERCISE……..…….THIS IS A TRAINING EXERCISE……..…….THIS IS A TRAINING EXERCISE……..

 

Scenario

There is a two day energy rally in Yakima.  It is advocating the use of a new technology for  nuclear fission to produce electrical energy.  The process has failed twice killing ten people at the only test reactor located in Russia.  Very little information has been reported on the accidents.  The group says it has fixed the problems and is ready to build a working plant on the Hanford Reservation here in the US.  Opponents claims the organization has completely sacrificed safety and cannot meet their claims.  The rally is well attended with over 3800 signed in.  The event is being seen as a potential shot in the arm economically by hotels and businesses in Yakima.

 

A significant number of scientific, environmental and two known radical activist groups have denounced the process as unsafe and unreliable.   There are several environmental groups busing protestors into town to protest the event.  There are approximately 2500 protesters being reported in town awaiting guidance by their parent groups.  This is an informal report being made to the national media’s in town to cover the event.

 

The two known radical groups are People Against Fission (PAF) and Militia Against Spontaneous Atom Splitting (MASAS). Although there are undoubtedly others these are the known radical groups against the new technology.   MASAS being the most violent having claimed responsibility for a bomb at the test reactor that caused one of the deadly failures in Russia.  Both groups have vowed to disrupt and if possible stop the rally in a flamboyant manor to draw attention to what they believe is an unsafe technology that could kill millions of people and potentially destroy the world.

 

The rally starts Friday morning and ends in the afternoon on Saturday.   It includes several speakers from Russia, one from China, and an a scientist who has defected from North Korea.  The North Korean scientist is the most controversial with his absolute assurance the technology which he says he developed is completely safe.  He claims the system does not even require a containment vessel to work. 

 

Soon after starting Saturday an unknown group of perpetrators unleashes an air born pathogen. As the audiences stampedes out,  the perpetrators take numerous audience members hostage.

 

…….THIS IS A TRAINING EXERCISE……..…….THIS IS A TRAINING EXERCISE……..…….THIS IS A TRAINING EXERCISE……..…….THIS IS A TRAINING EXERCISE……..…….THIS IS A TRAINING EXERCISE……..…….THIS IS A TRAINING EXERCISE……..

 

Medical Reserve Corps

An Introduction to the Medical Reserve Corps



http://www.medicalreservecorps.gov/


The Medical Reserve Corps (MRC) is a national program with a local, community-based emphasis. Its mission is to support community efforts to utilize local medical and health volunteers during emergencies and at other times of community need.

• The MRC was founded after President Bush’s 2002 State of the Union Address, in which he asked all Americans to volunteer in support of their country. It is a partner program with Citizen Corps, a national network of volunteers dedicated to ensuring hometown security.






• MRC units are community-based and function as a way to locally organize and utilize volunteers who want to donate their time and expertise to prepare for and respond to emergencies and promote healthy living throughout the year. MRC volunteers supplement existing emergency and public health resources.






• MRC volunteers include medical and public health professionals such as physicians, nurses, pharmacists, dentists, veterinarians, and epidemiologists. Many community members—interpreters, chaplains, office workers, legal advisors, and others—can fill key support positions.






• MRC units are provided specific areas to target that strengthen the public health infrastructure of their communities by the U.S. Surgeon General. These are outlined priorities for the health of individuals, and the nation as a whole, which also serve as a guide to the MRC. The overarching goal is to improve health literacy, and in support of this, he wants us to work towards increasing disease prevention, eliminating health disparities, and improving public health preparedness.

FW: JAN 14-Thursday 6 PM HWY 410 Meeting

 

 

JAN 14-Thursday 6 PM HWY 410 Meeting

 

(JAN 10-OEM Yakima, WA)

  We will be having a meeting JAN 14^th Thursday 6 PM at the Nile Valley Church. Responder agencies will be answering community questions regarding the future/ present situation of the HWY 410 Landslide site.

 

 

~Yakima Valley Office of Emergency Management