we're just going to let people kind of trickle in for the next few minutes. So welcome. And while we're waiting, if you'd like to use the chat at the bottom, just let us know where, what town you're zooming in from. We love to know where everybody's coming from. And you should have a chat button just at the bottom of your Zoom screen there. Hi, Lydia. Welcome back. Welcome. We're just going to give it to probably about 633 or so. To let people come in. Hi, Cordelia. Hi, guys. Welcome. If it does slow down, though, we'll get started. So we won't make everybody wait too long. Well, it looks like it's slowed down a little bit. So as people come in, I'm just going to go over a few of the basic Zoom rules, which I'm sure you've heard many times over the last couple years. But just to remind you again, this is a webinar. So that means that the panelists, which at the moment are myself and Tom Danielson, cannot see you or hear you. So if you have any comments, if you could go ahead and use that chat section there to put in any thoughts you have. If you have a question, we ask that you please, please use the Q&A button, which is also going to be at the bottom of your screen there. That just helps us keep track of questions a little bit better. We will be answering questions throughout the webinar. So please feel free to put them in at any time. And then at the very end of today, we're going to have a chance, if you're interested, we can turn everybody's video and mics on if you want to ask questions that way as well. It's definitely more of a conversation. And we know that sometimes it's much easier to ask your question when you're talking as opposed to typing it out. So again, if you have any or technical issues or anything like that, please use the chat for that. But if you have any questions related to the presentation, please use the Q&A for that. And we will get to those kind of as we go. If it's a question that seems very pertinent to that time, we'll go ahead and interrupt who's ever speaking. If we feel like it's something that can maybe wait a little bit, we will get to that at the end. So with that being said, I would like to welcome you to year three. This is a third year of Stream Explores. We are very excited to be able to continue this again. Very excited to have Tom Danielson, a DEP here with us for the third year as well as part of this training. So what we're going to do here, oh, I'm sorry, and just a couple more things. So we are recording this. So the link will be sent out to everybody. So if you have any questions or you want to see it again, you will be able to refer back to that. And then just as a reminder, there is a part two of the training tomorrow night. And you can register through that on our website. I'll also put the link in the chat again. Tomorrow night will be reported as well. So if you can't make that, we totally understand, but we'll send that link out to everybody. So first, what I would like to do is just introduce us. So I'm Hannah. I work with Maine Audubon. I know I've spoken with many of you, especially our returning stream explorers. So I work in the conservation department and am helping to organize a lot of our community science programs. And then I'm actually going to hand it over to Tom so he can introduce himself. Yeah, hi, I'm Tom Danielson. I am a biologist and aquatic ecologist from the Maine Department of Environmental Protection. And working on the stream explorers is one of my favorite parts of my job. So we're very, very, very lucky to have Tom organizing this and making a lot of the materials that you're going to be seeing soon. So without further ado, with the agenda, I'm going to get started and give you just a little bit of an overview of the stream explorers program and what we're asking you to do and how the program works. And then Tom is going to go more in depth into the actual methods and what you'll be doing. We'll then be joined in about an hour or so or maybe a little less by Doug Souter, who is a biologist at DEP, the Department of Environmental Protection. And he's going to show us how to use the Survey123 app, which is an online data form that you can put all your data straight into. He's also going to show us a new map viewer that's been created. And then we'll have some time for Q&A at the end. So let me just go ahead and share my screen. Okay. And if anyone can not see that, go ahead and let me know in the chat. But otherwise, I'm just going to get started here. So again, welcome to year three of the stream explorers, main stream explorers project. We're really happy to have you here. The goal of stream explorers is to recruit, train, and support our volunteers to collect and identify stream macroinvertebrates. So that's the whole point of what we're doing here. And while we've developed this program, we also want to acknowledge that it's been inspired by a slew of successful volunteer programs that came before us. And so we just want to thank them for starting and for us being able to kind of model some of our procedures after them. With programs like this, especially ones that take place over a larger geographic area, it's really important to have strong partnerships. And we're very, very lucky to work with some great organizations who have helped develop this program. So Main Audubon is one of the partners, and then the Department of Environmental Protection is really instrumental in this. And the biggest reason we're able to continue the program and expand it. We also have Lakes Environmental Association, which is based out of Bridgeton and Portland Water District. So both LEA and PWD have helped tremendously in their time and their expertise. And so we're very grateful to have everybody on the team. In terms of funding, so this program began in 2020, excuse me, with an initial grant from the Main Outdoor Heritage Fund. And then we've been able to continue it through some additional funding from the Onion Foundation. We also had some equipment donated and loaned by partnering organizations. So why are you here? Why did we ask you to join this project? Well, so DEP, and again, I'm going to, from here on out, refer to Department of Environmental Protection as DEP. It's a little bit less of a mouthful for me. So DEP uses aquatic macroinvertebrates as the primary indicator of stream health. And this is a phrase you'll hear probably a couple of times as a canary in the pool mine for troubled waters. So macroinvertebrates are extremely sensitive to temperature, to sediment, pollutants, and other environmental stressors. So really, it's a really good way to see what's going on with the stream. So Stream Explorer volunteers are going to help by providing screening-level macroinvertebrate data for these streams. And then from there, DEP will use that data to target which streams need more follow-up. So all the data that you go out there and collect that's shared with DEP, and then they're going to use that to help target and prioritize their funding and staff time some more comprehensive surveys. So it really is a big help. And then we know that macroinvertebrates are a really important food source for many other aquatic and semi-aquatic species. And they're often the basis for much of the stream food web. So if one or more of those species groups are missing or there's very few insects in a stream, the rest of the aquatic food web could be affected, which is really an important part of environmental education. And it helps kind of as the basis for more. So it's really a good way to start to get people involved in environmental education. And from there, we know that macroinvertebrates can be used as a really effective indicator of the health of our aquatic system. And so a more diverse group of species typically means a healthier stream. And we want healthy streams in Maine. We all want to be able to go out and enjoy the streams in Maine. And we want to be able to protect the healthy streams that are there and then to hopefully fix the streams that aren't as healthy. So through programs like this, we're hoping that we'll be able to build public support to help protect and restore streams that need them. So these are just some great pictures of some of the sites that folks have been out at. And so right now there are over 5,000 rivers and streams in Maine. So that's a lot. DP is only able to get out to sample a handful of those every year. So having stream explorer volunteers out there helping is really important. So there's this real need for these screening level surveys. We want to track water quality over time and also get information about streams that may have never been surveyed. And we have had volunteers last year, especially surveyed a few streams that had never been surveyed by DEP, which is a pretty cool thing because we're getting a lot more information that we wouldn't otherwise have. So in 2020, we initially focused on about 30 to 40 streams in the Sabago Lake watershed. This was a really important area. It provides water to over 200,000 manors. South of the watershed hadn't been surveyed recently by DEP in 2020. And then all of our partners are really focused around that area. So it can seem like a really great localized area to start with to do our initial project. These streams that we picked in 2020, we continue to survey in 2021. And we will also be surveying them in 2022 while expanding the program as well. So this is a slide of the samples locations in 2020. So all of those dots there are where our stream explorers surveyed. And then you can see that some of those places were also surveyed by DEP. And then this is just a nice little comparison. So 2021, these are where we surveyed in 2021. And you can see that it has expanded outside of Sabago Lake. And we did that because when we were able to, we had the resources and we had learned and heard from a bunch of volunteers that they were really interested in being a streamer explorer, but they didn't live near the Sabago Lake watershed. So, you know, one of the most important things about this program, which I mentioned earlier is environmental education and getting folks out to the streams in their area. So we definitely wanted to make sure that people had that choice. So we opened it up. And as you can see, people took full advantage, which is really great to see. You'll Doug Souter in a little bit will show you more about this map. But this is just showing again where where folks are surveyed. And then they can also see more information about real site, each site, which is nice as well. So in 2020, we had 24 volunteers surveyed 26 stream. And then in 2021, we had over 50 volunteers survey over 35 streams. So we saw a really wonderful jump in participation. And we're hoping to go over that this year as well. So how does this work? How do we know that the data that is being submitted is something that DEP can use. So we have a lot of quality assurance and quality control measures in place. In each of these, you'll, especially the materials, Tom will go over, you'll be able to explain better than I did as he has created these wonderful things. But we have a guide, we have keys and field sheets. So these are the first versions, we have updated them, which everyone will have access to. I'll be sharing those via email and they'll also be on our website. We do two training webinars. So these are our online webinars, our first one being tonight, our second one being tomorrow. And they're always recorded. So they are available to view at any time. If you need a little refresher, it's always, it's always nice to have. And then we also do some in-person workshops. So we'll be doing these in June. These are our June dates. The sign up information will be available soon. And again, I will email that out to everyone. But basically how it works is usually from 9am to 2pm, you sign up for an hour and a half slot. And then you're able to come to one of these three sites and actually practice, practice collecting and practice your identification skills. And we will have people from the different partners there to help and to walk you through the key and things like that. And this has proved to be really helpful, not only for all of our volunteers, but for us as well. I have learned quite a bit at these two. So they're a lot of fun. So again, more information about that we'll follow. Pictures. So we asked Stream Explorers to take photos, both of critters that you're not so sure about. And then also ones that you do know, because one, we want to see those. And two, they're just really cool pictures. So, you know, most people out in the fields, even if you don't have service, you have your smartphone with you. So if you find a critter that you're not sure what it is, you can snap a picture and then email it to either myself or Tom. And we can help with get make sure that you can get that identified. Another really helpful thing with these photos is all of our programs are based on grants. And so for our grant reporting, it's really nice to have these images to be able to share with people who give us the grants so that we can show them what's going on, what are people doing out in the field. So this has been a really, really helpful tool as well. And again, we all really enjoy seeing the photos. We had a wonderful AmeriCorps student last year working with the EP who created quizzes to help you practice your identification skills and then also learn a little bit more about the macro and vertebrates. So these are all linked on our website. And again, we'll share that link via email. But the fun thing is you can challenge your friends, you can set up teams, you can have competitions. So it's another really great tool to kind of hone your skill and to learn a little bit more. Our online survey 123 data form. So that's what this is here. And again, it is slightly updated and Doug will be sharing that with us. But this is really nice because you can put your information right in there and then it feeds directly to our map viewer so you can see where you are serving in relation to everybody else. And this can be done while you're out in the field or when you return to your home and have service. So this has been really helpful. Those of you who don't want to do it online, that's totally fine as well. We will still have paper data forms that you can fill out and just mail into me and we'll get that in there. So if you'd rather not do online, that's completely fine as well. So after all this training, and you've learned all about macro invertebrates and you've picked a site and your site can either be a stream that you're really interested in, it may be in your backyard, it may be down the road, or it may be picked off a list that DEP is putting together. So we have an initial list from our 2020 and 2021 seasons and then we will hopefully be adding some more streams this year to that list. So once you've picked your list, again either one you want to do, that's meaningful to you or is off the DEP list, then you need a sampling kit. So we have created these sampling kits that are now at six different locations and they really have everything in them that you need to sample. So they're going to have all of the guides and the keys that Tom has created and then they're going to have all of these different materials. We have people who didn't want to wait for a kit to be ready to be checked out so they put together their own kits. We actually had quite a few volunteers do that last year. Most of the things in the kit are readily available and fairly cheap except for the net and the guide to freshwater invertebrates. Both those are a little bit more pricey, but if you have any everything else and you would just like to grab a net from us we can also arrange that. So these are again these kits are all kind of put together in a nice little tote and then they're available at these six different locations. Don't worry about writing this down now, again we'll be available on our website and we'll be emailed out, but as you can see there's you know a fairly good range. So Falmouth, Standich, Bridgeston, Wyndham, Auburn and then we will be getting a kit up to Edgecom hopefully within the next two weeks. So that will be available up there as well and we have a checkout procedure so you essentially contact the person that's associated with that kit and they'll help arrange a time for you to pick it up and then again for drop off. So who is here? Who is volunteering? You know who might you be working with? We've had a really wonderful and wide range of people join this program so everything from you know retired science teachers to families you know we had a child as young as five participate which was wonderful. College student fishing buddies you know if you're out looking for brook trout you might as well search for a couple macro invertebrates as well and get that data in there that we would really appreciate that. And then this year so 2022 we are also expanding to include school groups, educators and classrooms. So we will have an additional educator training for stream explorers on May 12th that will also be a webinar. When I am done with this portion of the presentation I will link in the chat if you are interested in signing up for that. It'll be more of an abridged version of all of this and a little bit more of how this might work in a classroom. But if you are an educator or you know someone who's an educator who might be interested please share the link far and wide. We would love to get folks involved and that will be a little bit more focused on the greater Portland area this year. That's just in terms of where we could get larger kits to but if you know someone who's up in the county and wants to get involved you know they can still get in contact and we can see how we can help them out. So these are just some some more photos of our volunteers out in the field searching for critters and then this is some of my I love getting the we've got some great drawings and photographs and stories from volunteers were out in the field and we are really appreciate all of those things and it's wonderful to see the creativity of a lot of folks come out. And then again this is just some some more great photos of what you might be looking for and and again mentioned that we will be expanding again this year both in geographic area so again if folks are way up north and want to get involved we love it and then also including our educators in schools as well. And this is just a thank you so a lot of those photos were for by our volunteers and also shared by organizations and then a lot of the images were also edited by Tom's daughter so we want to thank her as well for for helping out with that. And finally so this is this is how you get involved so you've done the first step you're here at the webinar you've joined the webinar. The next thing to do would be to sign up for a one of the workshops the in-person workshop slot if you're interested again that is not a requirement but if you're interested we would love to have you and then figure out where you want to sample. So again is that is that some place in your town or is that someplace that DEP has said yeah me and I can help you find a place and you're going to use that link up top there my email there can serve at Maine Audubon and I will send all of this out to everyone as well. So you're going to sample and then you're going to input your data into Survey123 or mail me your paper data form and then we will say a big big thank you because you've helped us and you've helped DEP and you've helped mainstream to kind of figure out what's going on. So with that being said I'm going to stop sharing my screen and it looks like Doug's there hi Doug. If you just want to quickly we're going to actually pass it over to Tom but if you want to quickly introduce yourself that would be great. Sure Doug Souter also with Maine DEP and I'll be showing you the how the app works after Tom's done. All right Tom so I think we're going to pass it over to you. All right let me know when it pops up. It's there perfect. Okay great well welcome everybody I'm so happy to have a year three of stream explorers and it's exciting to see lots of folks online so I'm going to talk about sorry there we go. So tonight I'll talk about the instructional materials how to collect samples and how to sort macro invertebrates and then tomorrow night we'll talk a lot more about the what aquatic macro invertebrates are and an overview of the types that you'll be seeing in main streams doing the stream explorers program. So macro invertebrates are animals that do not have backbones that you can see without magnification and so this is some macro invertebrates in a healthy stream and without even knowing what they are you can see that there's a lot of different kinds in a healthy stream so there's a lot of diversity and the ones in blue are ones that are generally sensitive to pollution they need cold clean water and then the ones with the green are ones that are little they still need really good water quality but they're a little more tolerant to disturbance and and then if you had a stream that was not very healthy it might look like this where the sensitive macro invertebrates can't live there anymore because of maybe it could be salt in the water or bad habitat to the water might be too warm and but you still have some of the more like intermediate tolerance the ones in green but the communities really shifted over to these tolerant organisms such as these little fly larvae called midges and amphipods which are these like little shrimp-like fellas and but you can see compared to the previous slide there's a lot of diversity and not much diversity and so the purpose of the stream explorers is to help main DEP and get more information about the water quality around the state as Hannah mentioned the DEP can only monitor a certain number of streams a year doing a very detailed comprehensive surveys but the volunteers can cover a lot of sites and they can then provide information that would help the department prioritize where to go to look at nice healthy streams or ones that might need help and so the stream explorers has these guides keys and field sheets and so this year we have three volumes to the stream explorers there's an introduction in sampling instructions volume two is a basic macro vertebrate guide so folks who are return have done stream explorers in the past will notice that we have a simplified macro vertebrate guide and then we have what was the regular guide is now called the expanded macro vertebrate guide but we're finding that the some folks were struggling with so many choices and learning that many macro vertebrates and we thought it would be easier to start with a more basic macro vertebrate guide and then people can work their way up to the expanded one and each of the guides has these tax taxa keys that will help you decide what type of macro vertebrates you have in your tray in your sample and so the the basic guide only has two pages now as opposed to six pages in the expanded guide and so there's this page and then there's a second page where the first page were animals that had jointed legs and and this second page are animals that do not have jointed legs and so we'll talk a lot about all of these macro vertebrates tomorrow but I just wanted to show what the what materials we have for you to learn and then when you get to a certain critter on the the key then each of them has a page similar to this where it has pictures of the organisms it says if it's a sensitive a intermediate or somewhat sensitive or tolerant organism and it has pictures of the different types that would be in that group gets into the diagnostic characteristics behavior environmental sensitivity and then down at the bottom you'll have these little scale bars showing what sizes they may be out in real world so you can see that a lot of these macro vertebrates will they're not all the same size they can as they are young they'll be smaller and as they mature they'll get bigger and then we have these paper field sheets for keeping track of what types of macro vertebrates you're finding and a dug suitor who's been very kind to work on the survey 123 forms so they can be entered electronically so you have your choice you can do paper in the field you could do the survey 123 on your tablet or your phone in the field or you could do the paper and bring it home and then enter the stuff on to the survey 123 on your your phone tablet or computer at home afterward so there's lots of options for folks so the in the first volume of the guide is the introduction and sampling instructions and it gets into you know what type of place you would ideally like to sample and so as Hannah mentioned this slide says that project coordinators will give you direction to a sample location this is an older slide I need to update that you there are some sites that Hannah has a list of where if you don't know where to go we can help find a site for you but you're not respected to those either you can go to any stream you want and usually the sample team would have two or more people just for it makes it easier to sample and it's more fun to have someone out there with you and as Hannah mentioned you can have up to six locations now to sign out a kit of sampling equipment and you have these various items in the kit and then when you are at the stream there are a couple target habitats that would be good to sample and and in order of preference the best areas would be areas where you have rocks on the bottom of the stream with several inches of water flowing over the rocks it the next best option would be an area where the water has carved out and eroded a little area under the bank so you have what's called an undercut bank and sometimes you'll have tree roots and stuff there so the different macro invertebrates will often hang on to those tree roots and find that as a good place to live the next habitat would be logs and branches that are submerged underwater and several inches of flowing water and then the last target habitat would be where you have plants growing in the water and so when you approach a site you would look for those types of habitats and you would target at least four samples in the highest priority habitat type and then if you want you could allocate one or two samples to another target habitat in the stream it it's perfectly fine to do all six samples in the highest priority habitat it's really flexible so here's an example of a stream that is up in the china area and in this stream there's a lot of rocky you can't really see but in the bottom of the stream there's a lot of rocks and it's a lot and there is a good flow nice gentle flow but it's a constant continuous flow there's also some overhanging alder bushes with roots in the water so in this stream I might do four samples where the rocks are and then two samples where the overhanging alder bushes are so for the rock samples you have the net and typically it's easiest if you have one person hold the net and then the second person would squat down and would kind of have an imaginary box in front of the net about 18 inches in front and you would pick up a rock and wash off the material and have the the stuff float into the net and so the you want to have the net facing where the water is flowing into it and so you would pick up a rock and hold it near the front and kind of be like a raccoon and gently wash the critters off of the rock with your hands and the all that stuff will then float into the net while you're doing this you might want to just keep an eye for things that are trying to crawl back out of the net sometimes in particular these stone flies which we'll talk about more tomorrow they will often try to crawl out of the net but you should just push them back in and so you would pick up a rock clean it and then set it to the side pick up another rock clean it set it to the side and this could take you know three to five minutes of doing that and then afterward if it's not too sandy you could just kind of agitate the substrate under the rocks ideally it's easiest to process the samples later and to find the bugs if you don't have a lot of sand so if it's a sandy stream then I might avoid that last step of agitating underneath the rocks for the root samples you do something similar where you hold the net where the water is flowing into the net and in this case you would hold the opening of the net right where the tree roots are and the branches are in this case these alder trees will have twigs and and also some roots coming off of it and so you can hold the net there and then the other person would go in and gently agitate the and wipe off the the you know the bark and the roots and try to have stuff float into the net the branches so in this case this is a sample where where you have the submerged branches and logs say pretty much the same idea you hold the net where the water is flowing into it and then you have the second person like wipe the surface of the branches and logs and have things then float into the net and for the for the rocks typically the rocks surveys you typically will leave the net in one place and just have you work in front of it for the roots and the the branches you might have to move the net while the other person is cleaning it so it just so things are floating into the net so you so you have to kind of work with your teammate and then finally if the fourth target habitat were these plant samples so this is where there are these emergent grasses, sedges, rushes, or hookerweed, or in this case you got a brewery, you could same idea as the other ones you just would have one person hold the net and the other person would gently wipe and rub off the plant surfaces to get stuff to float into the net and again in this type of situation you might have the person with the net you know move as to follow more closely where the person is cleaning to try to maximize the amount of critters that are captured by the net so in general you want to do have six samples per site and you'd have these three trays these white trays or sometimes they might be different color but you have these three plastic trays and in general you'd have two samples in each tray and so you would do you do your first sample you do your first sample empty it out into the tray where that works that works best where you have some water in the tray already and then you would turn the net inside out and then have it dip into the water to help get the stuff that was inside of that out into the tray of water and then you would go collect your second sample that would go into tray number one also and then samples three and four would go into tray number two and samples five and six would go into tray number three and so spreading out the samples into the three trays will make it much easier to to first see the macro invertebrates and then to pick them out and identify them as I mentioned earlier the less sediment or sand you have the easier it will be for you to see the macro invertebrates a lot of these macro invertebrates are designed to not be seen and some of them are quite small so once you have them in a tray of water you would generally want to let it just sit for a little while and you would want to just watch it and just stare at this tray and it and you'll start seeing things moving and the longer the more experience you have in doing this but you'll just see more and more and more so it's a little harder at your first time out because you'll there'll be things that you or you'll be surprised that they're that small or that you'll be surprised that they that's a bug because it doesn't look like one but it gets easier every time you do it it also helps if you're new to try to go with someone who has some more experience and if you are interested in going with someone who's more experienced you could contact Hannah and she might be able to to match you up with somebody so once you have the macro invertebrates in a tray we have the spoons brushes and the pipettes to help remove them from the tray and into these other holdings places and sometimes it's helpful to use the brush and the spoon together so you so if you use just the spoon when you sometimes when you pull the spoon out of the water as you're pulling it out the water is coming out and the critter might also flow out of the spoon but sometimes you can use the brush to help kind of put it push it into the spoon and then to help keep it in the spoon as you take it out of the water and then once you have it out of the water we have these petri dishes or ice cube trays and you fill fill those a little bit of water and you can you can put the invertebrates into those either ice cube dishes ice cube trays or petri dishes and match them up with similar kinds that make it easier to count them later so plan on if you can it probably not like an hour or more you could it's amazing how fast it can take or how fast time goes by while you're doing this because it's quite fun and once you start looking at the critters it's it's enjoyable and you can spend a lot of time looking for them and identifying them so you might want to plan for about an hour or more if you're really fast and you're in a hurry you could probably get it done in 45 minutes but you could also easily spend two hours depending on how much fun you're having but anyways once you have the critters into the petri dishes and ice cube trays you can use your keys and guide to identify macrovertebrates I'm pretty sure each of the the kits will have laminated keys so they'll be able to get wet and not get damaged and so those are really helpful and then you can enter an abundance code for each kind so once you match out you've gone through the key and you think you know what you have then you would have this abundance code on the field sheet or on the survey one two three form of a few common or abundant if you are if you would like to count them and actually put a number in then that would be great too and also if you are a teacher and you want to do some activities with your kids later on it could be very helpful for the kids to count them and have numbers and then you could do some fun things like make bar graphs of the different kinds of organisms and compare sites and it just makes it more interesting for the kids and it's a sneaky way to teach them to help let them practice their math skills and then once you have counted the different kinds I'm sorry the numbers of individuals in each kind then you would count the number of kinds by their sensitivity group so you'd have on the field sheet there's a spot where you can say the number of different kinds of sensitive macrovertebrates and then the number of different kinds of moderately sensitive and the number of different kinds of tolerant macrovertebrates and those can be very helpful when trying to get a quick overview of the condition of the stream and I'm going to just back up to the first up here so this is the basic field sheet and so if you were pretty sure you had a mayfly or then you would you would type in the the abundance category there so if you had like six to 25 mayflies it would be a c for common and then you could even put in the number there and then you do that for each of the types of critters that you have in your sample and then on the front of the field sheet these are the ones that are sensitive to pollution and then on the back of the field sheet these organisms here are moderately sensitive and then we have a group of tolerant organisms and so in addition to putting an abundance value for each of the ones you find then you would count up all right I got you know three different if you had a mayfly stone flies and catas flies then maybe put in a three here for sensitive and maybe you had two of these you put a two over there for tolerant and and so again this would provide a very good information about the health of the stream so for this healthy stream we had some nice sensitive organisms and there's a nice diversity of them and there's another nice diversity of the green ones that are the moderately sensitive and there's also some tolerant ones even healthy streams will have tolerant organisms the town tolerant organisms aren't bad they're just tough so if they but if you had a stream and you visited and you didn't have any sensitive organisms and you had mostly tolerant ones then that would be a sign of potentially that it's not very healthy and so both of those types of situations can be helpful information to provide to main Audubon our partnering organizations and to main DEP and then main DEP could follow up with if there's a really nice stream and DEP has never been there before then it might be a very good to document that that as a very nice stream in it with the DEP's methods also and if it's if if the volunteers are finding something like this then that might be a site where the department might want to go back and to confirm if it's healthy or not and so that's part that's it for my section and so I'll stop sharing my screen or maybe Hannah are there any questions yes yeah we do have a couple questions okay um let's be here so we've got one question so how was it established how do we know which macrovertebrates are sensitive to water quality and which aren't yeah so the the there's a lot of information about some groups like mayfly stoneflies catas flies they're they're commonly viewed as being sensitive to pollution and needy cold clean water and so some of these ones here in blue and but I also took the step of going through the main DEP's like long history of biological monitoring that goes back to 1983 and went and saw what are the organisms that we found most often in the healthy streams based on our surveys and so you know for the in the basic field sheet the these ones here were ones that were most often found in the nice quality rivers and streams based on the DEP sampling and this this coincides if you went to other parts of the of this country it'd be the same groups primarily and similarly the ones that are tough and that can survive and even like an urban stream that has a lot of salt and it's warm and it doesn't have a lot of good habitat the ones they're the toughest are these ones here on the bottom and so the so I selected representative critters that we're we are found in Maine to be in high quality streams or the ones of the the last ones to hang on in the bad streams as the tolerant and so forth so so the especially the expanded guide is really tailored to Maine. We have another question here if the stream may dry up in the summer would you still want it sampled I'm assuming before before it dries up. Yeah so sure so the the department primarily samples in the summer but with the stream explorers program you would have the options pretty much sample when you want and you can find shifts in the different kinds of macro vertebrates depending on the time of year but in general if you're in a nice stream you will find sensitive organisms in the spring summer or fall the one tricky thing about streams that dry up in the summer is that sometimes those streams may not have as abundant they might not the macro vertebrates may not be as abundant in those than in a stream where they're wet all year round so if you went in the spring and sampled them you just might have to you be really careful when you're sorting through your trays or even collecting a double sample just to try to get enough critters to to you know make it worthwhile and then kind of just off of that I'm going to jump to this question because it relates a little bit. Does this sampling apply only to streams or are vernal pools also a part of the program? Yeah so this this guide is designed for streams and if there is interest in the future I was I was thinking of doing a similar guide for ponds so like and that would probably work for vernal pools too but it's a there there are the what you would find in like a marsh or pond or vernal pool you might find some of the same critters but there's really a shift in where you'd find some critters and streams and not in a pond and there'd be vice versa you'd find some things in a pond that may not be in a stream. I should also mention that if you are sampling areas like underneath the roots on the stream bank or like an area on the side of the stream where there's plants you could get some things that you might find normally find in a pond and so don't be surprised if you find in your tray there are things that aren't on this guide aren't on this field sheet or aren't in the guide so those are still really cool fun critters and if you and you can learn more about them and if you're not sure what they are you can take a picture and you can send me a picture and I could help you let you know what they are and I believe the Vochel guide to macro macrovertebrates the book is that in the kits yeah so some of those pond critters would be in that book for sure and so don't be surprised if you find things that aren't in the guide or on these field sheets but you can just make a note of them and but they won't count for the stream explorers stream edition. We have quite a few questions here I'm just going to do one more before we pass it over to Doug and then we will get to the rest of these questions like I will type the answer to some of them then any that I don't we'll get to at the end but Hilary is asking what is the frequency of sampling each stream? Yep so it's up to the volunteers so for most streams will be once a year if you are really interested in the stream it might be interesting to go out more than once to see you can start seeing some seasonal shifts and it's really that's really fun to learn about that too so we find that the one of the really fun aspects of stream explorers is not just that it provides information but it's really just a it can be an enriching experience for everybody who's interested in the outdoors and the more you look the more you learn the more you appreciate and the more questions you have and it just it kind of can get out of control. And I think I can't remember if that was on your slide or not but we do ask folks to commit to between one and three streams over the season so that you know between May and October if we would love it if you could get out to one or three streams that could be three different streams if you want to do three or it could be the same stream three times but we are looking at that. And I also wanted to mention that if you I don't know if the questions are about the critters but tomorrow's night talk we'll we'll get into the critters a great deal and I'll try to look at the questions that we can't get to tonight to try to answer them tomorrow while doing that presentation. Okay thanks Tom that was wonderful so I'm going to have you stop sharing your screen perfect and then we are going to pass it over to Doug who is going to show you the survey one two three app and how you would get that on your computer or tablet. Hey let's see so while I'm figuring this out I should mention in my introduction I left out that I am a main Audubon chapter board member from Mary meeting Audubon so I want to share the screen voila mainstream explorers so yeah so this is mostly going to be based on how to get the electronic app onto either your phone your tablet or your laptop like Tom mentioned you can go out in the field using the phone or tablet or you can write it down on the paper and you can bring it back in and enter it all in on your computer or you can enter it once you get home on any of these devices. So if you're using a phone or tablet it's pretty simple Android has one way you go through the Google Play Store and you just search so first thing you want to do is probably load the survey one two three app onto the phones or computers before getting any further so like I said with the Android go ahead and the Google Play Store with an Apple based iPad or iPhone you go to the app store and search for survey one two three for ArcGIS install that if well we'll come back to this so once it's installed it'll bring you to this screen which we'll show you again in just a moment so if you're working with a computer you're going to have to use Google to kind of find the app so you'll search for the app get survey one two three and Google will bring you to this page here so there's going to be three possible options so don't do these ones with the red X avoid those so for the computer if you have a MacBook or Apple tower you go to the app store if you're Microsoft based you hit this bottom link below and this will go ahead and install the field app for you and this is still with the computer so you'll get to the field app it'll bring get survey one two three like I said this is the center section that we're showing the file will download onto your computer into your downloads then you'll have to go to your download folder double click on the thing and it will install for you so once you have these apps you'll uh you can Hannah's going to send this out so you can aim your phone tablet at this goofy looking thing and it'll bring you to our app or you can just click on the link here and this on your computer you'll probably just shoot the link here you click the link and this will open up the tablet or this will open it up on your computer sorry this is the tablet of the phone and it'll pop open here so looking at it as if you're on a computer you'll get this little option here so open in a browser or open in the field app so it will work in either of these if you open in the browser it just won't look as good it's got some weird html features about it that show up funny in the browser but look good in the app and I guess I'm not smart enough to figure out how to get it to code better so it looks good in the browser and yet but maybe we'll figure that out but try it in the app that's what I recommend so once you click on that app that link say I open it in the app it'll pop this little window open says open an ArcGIS survey 123 you could collect this select this button if you hit this little checkbox here before you'll never have to see this again it'll just automatically open and then looking at it'll kind of bring you to this screen so just you can sign in if you have an account with ArcGIS online they do offer free accounts you can sign in but you don't need to you can continue without signing in I recommend that it's probably the easiest way of doing things and then you're off to go so I'm going to bring it over here so this so I've clicked on the app so I want to open it in the field app here we are with the open field app open survey 123 and that link that we showed you before will bring you to the stream explorers app so because I've already logged in it didn't show me that open without the account screen so so this is how it opens up in the app so we have your location is the start so you're going to decide whether you're going to use the basic or the advanced survey first and Tom quick question for you so or tonight are we just covering the basic or um you could do primarily if you could do the basic I want to show both but yeah but um if you have time to do both that'd be awesome yeah let me go just quickly show the advanced and then we'll come back to the basic well no sorry all right never mind so we're going basic first so you pick your base so we're going to do the basic here so you put in your stream name so you have so these little stars these are mandatory you can't submit your data without having filled these out by clicking either the basic or advanced it will determine what options show up further in the survey so you put in your stream name your town you just click the down button select the town you have to put it in the date you have to click on it to get it to show up date and the time and then say you're uh if you're using the tablet in the field it will auto populate to where you are but if you've collected your data while you're out and about and you want to come back to your office or back to your home to put in where you sampled you just kind of zoom in on the map where you think you are you're somewhere near the back you say okay and this will populate it'll put the pin on the map populate your coordinates and then we were suggesting you take an upstream and a downstream photo and we've put in the option to select up to eight photographs so if you've got a funny looking critter that you can't quite identify feel free to try and take a picture through a the best picture you can get of it if you want to take additional photos of the site go ahead and take pictures if you i'll show you in a moment here but if you want to write down the numbers of species in addition to abundance codes you can take a picture of your notes so you're allowed up to eight photos so all you have to do to add a new photo is hit this little additional photo yes button and then it gets to eight and you're done so from your computer so if you're again sorry I should mention this so using your tablet you click on the little photo button if you're home at the computer and you've already taken the pictures on your phone and you put them on your computer you hit this little folder and it lets you navigate to the folder where your photos are are contained and then it just associates it with the app and it uploads them so you describe moving on you describe the sample location you can put in the name of the collectors here your minutes at the stream again mandatory so we were in a hurry so we did it 45 minutes well we sorted for 45 minutes we played around in the stream for a hour and a half two hours because it was fun we sampled two rocks two trees you didn't mention logs but logs count too was this the well never mind yeah and plants as well which you kind of handle as as if tree roots so you got carried away you sampled more than you needed to sample but you're having fun so it's okay in this case tom will correct you later so this is the basic it opens up you're here you're sensitive species so the basic form it has everything open so we have our mayflies we had good collection of mayflies we had a few stone flies it's nice sight quite a few catas flies so you just go through and you select your abundance code for each of these and while you're going along it keeps track of how many you saw yeah i had a single water snipe fly crawling around but a whole bunch of these free living catas flies oh that's unrealistic a good a good feel then it keeps going down to the moderately sensitive and see any of those there are tons of these things as usual they're fun dragon flies you had a few of those they're fun gotta have a damsel fly because they're cool black flies uh it's main so yeah so you keep cruising through this thing it gives you a couple examples of beetles and the beetle larvae but there'll be some different looking ones as well water pennies that tom will talk more about the beetles and such to our crayfish want them bit you paid attention to him he snuck up while you were playing around with the rocks and this was a pretty nice sight you had maybe a stale or two which is interesting but so then once you get to the end of this thing so it's kept track of this for you so we're going to go ahead and i'm going to submit well we're going to come back to this but so once you get to the end of the survey you'll hit this check button here and it will submit your survey for you so you can send it now send it later so if you want to just like well i'm entirely sure what that was if you took a photo of it you're going to ID it later you can hit send layer it'll send later it will save it on your computer or your tablet and you can come back and correct your ID if you want or something of the sort so but we're going to i'm going to hit continue for just a second so i can go back up and show you the advanced here but we're going to come back and submit the state at a moment so doing the same with advanced so what advanced does if you click the advanced tablet advance tab it goes through the same stuff until you hit the location now the the boxes are closed there's just a few more species so this is where Tom will get into this a little more tomorrow with the different species so this is where your ID skills have to be a little higher level so you're going to work your way into these probably for the most part so you pick the different species and it's the same principle you just go through them select them and it keeps track expand the boxes and the tolerant species are actually the same for both so we're going to go ahead and submit that basic form so we would hit the submit so i didn't change anything with the advanced one so we're going to give it a stream name too all right so so it's got our what we recorded for these oh no we lost them oh well sorry yeah by clicking the advanced tab i lost what i put in before one leech yeah scary come to get you so we're going to send it now and off it goes so that data has now been sent off to the cloud these are our different apps so going back to our power point here hopefully you're now seeing my power point again so this is the map so the map should now populate live so here's the link to our map we click on this thing and it opens up which i need to refresh the map to see this point that i just entered and here we are here's our new sebec point so here's our sebec stream that we just entered so this that gives you your listing of sensitive types the moderate types tolerant types so this is the arc gis online project that's open and available for everybody to look at to view you can play around with this quite a bit there's nothing you can do to break it so feel free to play with it as much as you like so it has a number of options so basically i start with the layers over here so it's showing last year's data as well as this year's data if you want to see something you go over to the you hit this little layer button to see different layers and you poke it in the eye if you want to turn it off or you want to turn it back on you poke them in the eye which is a weird way of doing it but that's what they came up with so so we're going to look at some of these layers so like the sensitive so it's kind of map now so i have sensitive and moderately tolerant species minus the tolerant species is kind of how it's showing so the bigger the purple dot the more sensitive and tolerant species are the bigger the orange dot the more more tolerant species there were so you can filter on these data so if you so you've clicked on your layer over here i'm going to poke the other ones in the eye i'll turn them off so we're just looking at this one so we have this thing on so we're going to there's all these different tools you could play with you could start and this is where hannah will send out some additional instructions so teachers will be able to work with their classes to do you can even do some plotting and graphs in this in this project now so we'll set up a filter first so say you just want to see we want to build an expression i just want to see what i entered this year what i entered last year so i'm going to go to stream name and i'm going to replace that you have oops sorry do you have all these different options of the data that's collected you want to see that but we're going to go down to the names of the people so the names of the collectors so i want to build something that says anything where i've been out about something so i'm going to put in a couple of these are the sites i went out and did last summer oh come on tug oh come on arc map embarrasses you every chance it gets all right sorry so yeah so you can get lost doing this quite easily but like i said there's nothing you can break and it has a lot of options that you could play with so right now i'm showing any site that i went to hey dug yes tom so could you if you were interested in a certain like stonefly you could put it that exactly see where it is yep yep yeah so yeah you just change this to whatever you want so if you want to see just where aquatic dance fly was found or if somebody at dp is interested in kind of coming around to try and sample sites where they where we find a more sensitive species or sites where we have a particularly tolerant species where we want to know or even crayfish say we want to find rock rusty crayfish and this would be a good way for us to start looking for well there's crayfish found at these different sites and we know rusty or tend to be in sites that are well they're in pretty nice sites so wouldn't work that way but yep so you can play with it that way they have pop-up boxes so once you brought it up you can bring the site to where you are you can see this site had seven sensitive nine moderately tolerant moderately sensitive and we're gonna change that terminology too tolerant you could page down see the photos like at this site we were collecting the actual number of species so I took a photo of my uh my note sheet keeping track of everything page through them see different pictures of the sites you get the stream photos in here did you click on you get there's a nice site oh go back it's hidden by the zoom screen so yeah so like I said play with the map as much as you want there's nothing you can really do to break it once you've built your expressions you cancel them and you get back to the original data poke them an eyeball again you can see the other thing so the newer sites one more thing yeah so the new sites we're gonna show up under the stream explorer is 2022 ones so we'll have a we'll have a form just for the advanced what's submitted under advanced and what is submitted under basic under the basic forms and under last year's data I kind of pre-built this thing it'll show you I built in just places where the larger the dot the more species were found so where the tolerant species were found where there were some sensitive species found again the larger the dot the more though there were and moderately sensitive so it gives you quite a quite an option to play with the data and see where everything showed up that's really about that like I said you can't break it so feel free to if you shut it down with a filter on or something like that that's just fine but I think you've just issued a challenge people are going to try so the one thing you can't get pop-ups on these so most of them you click on them so you got to have the layer on in order to see the data for it so once you turn the data on it'll give you the pop-ups the photos and so on and so forth so I think that's about all I've got to say unless Hannah has something to remind me to add this is great this is really exciting to have this this is a wonderful so people can see everybody's survey oh do you need some help to stop sharing yeah it says it's new share I don't want a new share no there we go we have just two of the same questions so people are saying they've downloaded the app they got there and now what's the step to get to the actual stream explorers so that there was a link and this link is going to be available both on our website and in documents that I send out to you so there'll be an actual link and then there will also be a QR code which is that funny little black and white design thing if you're on your smartphone you can use your photo your camera to take to use to get to the QR code which will take you to the stream explorers page or you can click from your browser the link and that will take you there so I'm gonna put that I'm just gonna put that link in the Q&A there but then again that will be on our website and it will also be sent out to everybody as well we'll make sure you get it on multiple multiple ways yeah so the chat so oh perfect thank you Doug here's the oh can you always set that directly to you I think you do one more time to everybody yes um so Doug is putting the link straight in the chat there and then what I am also going to do right now is add two more links so we've got the link to register for tomorrow night's training so that's part two of this one where Tom is going to deep dive into the the critters you're looking for and then there's also going to be a link to the educator webinar which is on May 12th and again please feel free to share that with any educators that might be interested be here okay so you've got those two links in the chat as well so with that being said we that's kind of the the end of our first night if there are folks that have questions we have a couple options now you are welcome to put them into the Q&A you're also welcome if you want there's the option of raising your hand on a webinar and I can actually unmute you and you're welcome to ask a question or or anything that way as well we'll have more opportunities of course to ask questions tomorrow and if I remember correctly from last year I think the questions there are quite a few bit a few more questions than nights that we went over the critters because there are a lot of them and I know Tom said this at one point but but just to emphasize as well some of these are quite small and we know that and they can be hard to find this is why we we have definitely labeled this a treasure hunt so don't worry if some of these you know you're not quite getting them at the beginning with practice and a little bit of time time you'll get there and you'll start seeing you'll look like there's nothing in here there's nothing in my water nothing's happening and then as you look things start moving and then you'll start seeing more things moving so so you will get there it just takes takes a little bit of practice and we are available throughout the season to help as well and there's a question if the recording for tomorrow's session will be sent to everyone and yes so tonight's recording as well as tomorrow night's recording will be on the website probably first thing next week and then we will also email it out to everyone as well as a lot of the the documentation that we've talked about and the different materials that will go out to everybody um Tom yes one other thing is I forgot to mention my daughter was helping make a video of of me collecting stuff in the field and so hopefully that will be posted up on the website eventually too it's hard to get a teenager to finish something sometimes very enough um that would be great Doug can you just pop also the link to the map viewer in the chat as well I just did oh perfect thank you it should be there double check that yes you did I see that perfect great yeah the qr code would not go through the zoom chat doesn't quite um support that would be my guess yeah but that link did work the pre the earlier link will bring you to the same thing as the qr code um so are there if there are no other questions um and again if you think of something afterwards or there isn't either something we haven't covered or you need some clarification on please feel free to reach out my email address is um I'm going to well I'm just going to pop that in the chat as well if you have any questions please feel free to to send an email um to conserve at main autobahn.org um any questions feel free to reach out and then we will hopefully see everybody back here tomorrow night but um I want to say thank you so much to everyone who joined us um on this you know spring evening um and we will see you tomorrow and thank you to to tell them and Doug as well for all of your work and thank you and all of your help getting ready for this thank you for coordinating all right everybody have a great night


Card number 10, Reno Corva and Filippe Vidal, Ocean Hunter. Reno Corva and Filippe Vidal, CIA Assets, CIA Assets, card number 10, Reno Corva and Filippe Vidal. Reno Corva and Filippe Vidal are members of Brigade 2506, veterans of an earlier CIA created Contra Army, the 1961 Bay of Pigs invasion force. As CIA man John Hall's lieutenants, C-card number 12, they oversaw the recruitment of UCLAs, a CIA acronym for unilaterally controlled Latino assets for the Southern Front, thus providing a link between Miami Cuban Exiles and the Contras. They had other duties as well. According to dissident Contra leader, Eden Pastora, Corva and Vidal robbed our helicopter and promoted desertions among our comrades in order to destroy us militarily because we didn't want to be CIA soldiers. They have been implicated in the La Pena bombing, C-card number 9. When Joe Fernandez, CIA chief of station in Costa Rica, admitted in secret testimony before the Iran Contra commitment that some of our people had a problem with drugs but we had to protect them, he was referring to Corva and Vidal. Corva, known as the Poison Dwarf, is a business partner of Medellin Cartel Associates Francisco Paco Chains and the Gaborto Nuez, C-card number 11. Vidal code named Morgan is a hitman who has been arrested seven times on gun and drug trafficking charges. Most recently in 1986 Corva and Vidal oversaw the deliveries and shipments of Medellin Cartel cocaine on John Hall's ranch using weapons deliveries as a cover. The company which fronted for the drug and gun smuggling operations was called Ocean Hunter and was owned by Paco Chains. Wow. Web. You know that name.


So our second speaker today is CJ Calvo, our second-year retina fellow, and he has an interesting title. Is there a doctor on board? Thanks, Ryan. All right. Good morning, everyone. I'm CJ Calvo, one of the retina fellows, and I'm excited to give this talk to you about something that has absolutely nothing to do with ophthalmology, and I'm excited to give that to us because as ophthalmologists, I think we really need the help of all people. So the title, the title of my talk is Is there a doctor on board? And I'm going to be talking about something that we very often may encounter, or already have encountered, is the topic of in-flight medical emergencies, and there's going to be a time that you probably will get that overhead page on a plane and have to decide what to do. And so someone gave this talk to me when I was a resident, and I thought it was just really educational about what can you do on a plane? I don't know. You know, what tools are there? What, who can help you? So I think that this will be helpful for us because we are a very subspecialized field, and it's probably been a while since we dealt with a heart attack. How many people here would you say fly more than three times in a year? More than five times in a year? More than ten times in a year? Okay, so there's a lot of frequent flyers in this room. So worldwide, almost three billion people fly every year on a commercial flight. And so we know that in-flight medical emergencies actually pretty common. It's one in 600 flights, or there's about 44,000 in-flight medical emergencies worldwide every single year. Fortunately for patients, I think medical people are pretty well-traveled because in three quarters of all of these medical emergencies, there is a healthcare professional, like a physician or a nurse or an EMT or someone on board that's able to help them. So my objective for this talk is I want to better understand what's the nature of these emergencies, what you're likely to see, and I want to give you some education on what tools and resources are available for you when you respond to an emergency. And then we'll review some of the more common ones because like I said, it's been a while since we've dealt with these things as we're all ophthalmologists. Fortunately, most in-flight emergencies are simple problems. They're self-limited. The flight can go on to its normal journey without being disrupted. And a very serious illness is really rare. And death is particularly rare, you know, less than a point three percent of emergencies. Aircraft diversion, and what that means is say you're flying from New York to LA, diversion means that they need to change the path of that flight. They need to land in Kansas because there's a medical emergency that is time-sensitive and but that's a very rare occurrence. That means seven percent of all cases of medical emergencies have a flight diversion. So you can deal with most of these without diverting the plane. The types of problems that these people have, the majority of them are pre-existing problems. So someone already has COPD. They already have CHF and then they just have an exacerbation or an issue when they're on the plane.  But most of these are pre-existing problems. Medical problems are likely to happen in an airplane because of this interesting physiologic environment that you're in. So planes cruise at about 30 to 40,000 feet. The cabins are pressurized to about 5,000 or 8,000 feet. So about 11 PSI. So that's, you know, if you live in San Diego, you know, it's nothing for us. But if you live in San Diego, that's a big difference in in cabin pressure. And so the reduced partial pressure of oxygen in a healthy resting individual in an airplane is about 93 percent. So if you're someone that has CHF, COPD and then you get it and say you live in, you know, at sea level and then you get in an airplane, you're going to have a significantly decrease in your O2 saturation. And then this pressurization in the cabin is going to lead to expansion of closed gas spaces. So like your sinuses in your middle ear and that could lead to like a lot of discomfort and pain. And then as we know from retina surgery, non-physiologic gases will expand in that environment. Dehydration is a big issue that exacerbates problems in planes. The air is very dry in an airplane. So the airplane draws in air from the dry high altitude air and then it's dehumidified by cycling through the engine compartments. So it's very, very dry air. The recycled air also, you know, you're going to increase exposure to airborne illnesses and allergens. So that may trigger some respiratory diseases in the plane. And then as we know, we know about clotting and DBTs in planes, you know, so you have prolonged sitting, you have high poxemia. And then this may this may activate the systemic inflammation and platelets. And so in high risk individuals, they have a 5% risk of developing a lower limb thrombosis during a flight. So here's a list of there's a study that I'm that I am referencing a lot. It was published in New England Journal of Medicine last year where they looked at about 12,000 medical emergencies worldwide that came in through a call center. So it's like five international and domestic airlines. And you can see that the most common things are syncope, respiratory symptoms, nausea, vomiting and cardiac symptoms. OK, so we're going to talk a little bit about those later in the presentation. So what can we do when you get that overhead page? Is there a doctor on board? So what can we do? Well, the first thing you could do is do nothing. That is that is always a choice that you have. You could just do nothing at all. That is up to you. That is fine for you to do that. There's no legal obligation to assist on a flight. And I'll talk a little bit more about that. But you have to ask yourself, is there a moral and a professional obligation for you to help someone if there's no one else that's raising their hand? Or you can do something. So and we'll talk about those that want to do something and what's available for you. So this picture, I think is from the Moran flight to Hawaii and I is a popular one. So what equipment is available for you? There's an emergency medical kit available on almost every commercial flight that's regulated by the FAA. So if that airplane and then also if that airplane has at least one flight attendant, the FAA mandates that there is an automated external defibrillator. That's not the case in other places of the world, even in European airlines. It's not mandated for there to be an AED. So I want to go over this is the the minimum contents of the emergency medical kit. We're going to go through these.  And they have a self inflating like a bag mask that's available as well. There's IV sets with tubing. You have protective gloves. There's needles for IVs or to administer medications. You have syringes to administer meds. You have analgesics. So they have acetaminophen and aspirin on the plane. They have an anesthesia, benadryl, oral and injectables. They have atropine, which is used for cardiac arrest. Aspirin, they have bronchodilator like albuterol inhaler. They have D50 dextrose solutions. And they have epinephrine, one dosage for like an epi-pin for anaphylaxis. And then another one for cardiac arrest like an ACLS scenario. Lidocaine as well. You have nitroglycerin tablets. You have normal saline. And then there's some basic instructions in the kit on how to administer this drugs. OK, so another thing that's really helpful and this isn't required.  But the consulting physicians on the ground are becoming a big resource. And airlines are starting to use these more and more.  And I'll talk about that later. And they don't want to divert the plane unless they absolutely have to. So they're going to consult with physicians on the ground that they do this all the time and they're going to be able to tell you what you should do. And so that could be a big resource for, you know, someone like me. I'd love to talk to another physician on the ground. So here's an example of this. This is a company called Medair. They are emergency room physicians that are located inside the emergency room of Vandergoot Samaritan in Phoenix and have ER physicians 24-7. And they are very experienced. You know, they're not just ER physicians that are getting thrown in there.  So they're really going to be helpful to you. So you're not going to have a phone to talk to them directly, but they're going to you're going to be able to communicate through the flight attendance and the pilot to the staff on the ground. Flight diversion, as I said, it's not common. It only happened in seven percent of flights, but it's a it's a really complicated thing. So they have to decide, are you going to save any time by, you know, diverting in Kansas or can we just book it another three hours and get to LA where we're going? If we stop in a small airfield in Kansas, are they going to have medical services nearby that are going to be able to take care of it? Is the weather safe? That's going to be another consideration for them. And then also like airplanes aren't always, you know, they may not be safe to land immediately after takeoff. If they have a large load of fuel, they may have to jettison this fuel to a fuel drop in order for the plane to be safe to land. And then it's a huge cost. So twenty thousand to three quarters of a million dollars for an airline to to vert a flight, because they have to now. Figure out this whole plane of people. We have to have them go somewhere. They have to get there if they have housing and then all the other flights down the down the line that that plane was going to go on. So it's a huge cost. So the airline definitely does not want to do that if they don't have to. Unfortunately, most people do fine without it. Liability is something that we think about a lot. And that's definitely, you know, it would be a concern of a volunteer health care provider and especially in a field that we're not very familiar with. And so there's no legal obligation to assist in the United States, Canada, England and Singapore. But in some countries like Australia and some European, it is required for you. So I don't know how they'd figure out that you were there. But apparently there have been legal precedent that that it is required. There's a 1998 Aviation Medical Assistance Act, which has a good Samaritan provision that protects passengers that offer medical assistance, you know, other than gross negligence or willful misconduct in. So in most states, you know, in the United States, you're not protected by the good Samaritan law. If you accept payment for your care. So, you know, if I, you know, see someone, but I bill for it, then you're no longer a good Samaritan. However, you know, it's very common for airlines that they want to give you points or they want to upgrade you or give you drink vouchers or something if you help. And it seems that that does not prevent you from being covered by the good Samaritan laws. However, the aviation experts say that that's something that makes you really nervous. Just avoid accepting any gratuities. And then you'll kind of eliminate that concern for you. There's only been one case in the United States where a physician has been sued for assisting in an in-flight emergency, but that case was dismissed. So it's a very, very low personal legal risk to assist in an in-flight emergency. And this practice is supported by experts in aviation medicine. So you really have a lot of people backing you up.  I think that's been in the news quite a bit. There have been scenarios where there's an in-flight medical emergency, but there was a female physician, particularly females of color. And they asked for a doctor and you have like a female anesthesiologist or ER doctor and the flight attendants have bias and say, no, we don't want your help. We have like a male pharmacist. We'd rather him help us. And so these have been in the news. So I bring this up because you may consider caring with you. You're like hospital badge or I know many state medical licensees that give you like a wallet version to have in there. So if you want to help, you could have we bring a credential with you. And that can really allow you to get in there and help if the if the airline is giving you some resistance. So the most common in-flight emergencies, as we said, there's syncope, respiratory, GI and cardiac symptoms. I'm going to talk about some of them that I think may be the most difficult to deal with. We'll first talk about syncope. So when you first evaluate someone with syncope, and this is common in an airplane, people are dehydrated, you have altitude changes, people are nervous or cramped. It's just, you know, they may be hot, you know, so it really predisposes people to passing out. You know, when you're going to go and try to awake this patient, you have to understand that very often syncope patients are unresponsive. And when you check their vitals early on, they may be hypotensive as well. And so this should improve. So, you know, in most patients, they can improve just with oral treatments. They don't require IVs, but if they have persistent alter mental status, you need to start thinking about something else like an MI or a stroke. And so what you should do in these, confirm breathing impulse, move the patient to the aisle or the galley and then place the patient in a supine position, their legs raised and then provide oxygen for them. You're going to want to continue to check vital signs. As I said, patients are going to be hypotensive immediately after the episode. If the patient has diabetes or if you're concerned, check the blood sugars either with the kid or fine one on the plane. And then most patients, if it's just syncope, they're going to respond in a couple of minutes spontaneously. And if the patient, for some reason, cannot take oral fluids, you know, you need to consider doing an IV and giving them the normal saline. Cardiac symptoms, you know, these are the ones that are probably some of the scariest on the airplane. But thankfully, with aspirin, nitrates and oxygen, you can really manage most of these yourself without diversion. In most cases where an MI or if you're if you're suspecting an MI or an arrhythmia, the AED would be a really helpful tool. You can put the AED pads on the patient and they have an analysis mode. And that can tell you, you know, some may actually show you a strip. Most of them won't. But it will tell you the patients in, you know, ventricular tachycardia, ventricular fibrillation, and that will give you a sense of what the patient's kind of disposition is. Are they in normal sinus rhythm? If so, AED will tell you do not shock. And if it tells you they should shock, then this is a lot more severe than you thought it was. So you can use AED as a monitoring device. The survival rate of cardiac arrests on airplanes is, you know, very different, you know, Carrie Fisher, the actress she died from a cardiac arrest on an airplane, but about half of these, the flight actually did not diverted in this series of the 12,000 flights or 12,000 emergencies over two years. None of the 920 non-arrest cardiac cases resulted in death. So like I said, you could manage these patients pretty well. And then they use the AED or they apply the AED to 137 patients, but only five of them, thank you, only five of them received a shock so you can see how it's helpful to use the AED as a monitoring tool. So you're going to want to check vital signs. You're going to want to provide oxygen to them. If your history suggests that the chest pain is cardiac in origin and consider giving them aspirin, nitroglycerin, sublingual nitroglycerin can be given every five minutes, but you want to make sure the patient's systemic blood pressure is greater than 100 to prevent them from getting hypotensive with that dose. You want to check their blood pressure after everyone. We talked about using the AED for its monitoring capabilities. And then, you know, ground-based consultation is very helpful with these. So there's a paper that also talks about this in JAMA and they have these cards that are in the paper. And so, you know, GI, stroke, seizure, obstetric emergencies, they have these like quick reference cards. So I think I'm going to probably take like a screenshot of this and keep it in my phone in that event. But if any of you guys are interested in having it, just let me know and I'll email you the paper. I think it could be a good thing to keep in like the photos of your phone to have like a reference sheet if you needed to have some help. So in conclusion, you know, it's a pretty common thing. So a lot of people here fly, if you fly more than 10 times over a year throughout your life, you know, there's a high likelihood that you're going to have a medical emergency. So I think that we should all be prepared in these scenarios. We are ophthalmologists, but we are physicians and people are going to expect you to your physician. You know, you need to be able to have some basic physician knowledge and medical service.  Thankfully, most of these in-flight emergencies are self-limited. The plane will proceed on its normal journey. And then there is minimal personal liability and offering assistance. And like I said earlier, if you were the only physician on board, some medical care is better than no medical care. Any questions? All right, thanks everyone.