All right, folks, any questions or comments about what we've discussed already? No questions? Go ahead, for naloxone. So, you know, it costs money, right? So, Charles will get into the cost of these medications, but if people are on Medicaid or Medicare or even private insurance, very minimal cost, very minimal. Like, some of the ones that he'll talk about are covered by Medicaid, and a lot of our folks are on Medicaid, a lot of us, a lot of our folks are, so a lot of this is on the Texas Medicaid formulae. So, you can go in and access it, yes. Yeah, Texas is a little slow on the uptake. We're working on it. So, right now, the Texas Pharmacy Association, what is it a private? So, H.E.B. is getting ready to come on board. And so, honestly, H.E.B. will be our biggest distributor in the state of Texas. And that's interesting you say that, because I was telling Mark last week in my neighborhood in Austin, I just, last Sunday, I just said, well, let me try this. I went to Walgreens and had some difficulty because they didn't know about it, and I went to local H.E.B. and they're like, oh, yeah, yeah, they don't care. We're looking really forward to it. We already have it here and we're going to be getting more, but we're going to be getting more education about it. So, I think it depends on the region. And I think it's moving that direction. It just hasn't made all the way around yet. That's a good question. The officer? They are. And so, and so, one of the things that we, I've worked with a lot of law enforcement around this, and as I'm sure you're aware, a lot of law enforcement around the country have this medication in their first eight hits. A lot of them. Yeah. Yeah. Many, many, many, many, many. I've trained a lot of law enforcement. They're not on mics, so you have to repeat the question. Oh, this is a lot more work than what you've done to us. So the question was, is law enforcement carrying the medication for emergency purposes? Oftentimes, as we know when 911 is called, officers show up on the scene. And so, in many parts, almost the whole East Coast right now, if you're a police officer on the East Coast, you're carrying naloxone. Yeah. You're looking at me like you don't believe me. You don't believe me?  Where are you going to get the officers? Who? Officers or regular people? Officers. You're going to have to work with your police force in order to access it if they want it. They don't, nobody has to have it. It's not mandated. It should be. But you have to work with your particular medical director and your chief in order to get this. This has become such a large national initiative by law enforcement that I can't understand why everybody wouldn't be doing it. And there's been about 1200 rescues just by law enforcement nationally with Narcan.  You know, I worked in the Northeast and I'm going to tell you that it has changed the dynamic of community policing in some communities. I'll give it to you when you're okay. Yeah. And don't tell the cops, but if anybody needs naloxone, I will send it anywhere in the state of Texas. Just don't tell the cops. And if you have something you don't want, we will come get it in the state of Texas. Kind of work. It's legal. So I can't. So I just very quickly. Um, you know, Charles and I have been doing this around the state over the last number of months over the last couple years. And I can't begin to tell you how important and influential like not only this work has become, I think for people to be able to do some really effective work, people that watch that video last night on Fox 29 here in San Antonio and saw what CHCS is doing would be rather impressed about how they're engaged and with the community and the lives that have been saved. Charles and I first started doing this and CHCS was our first real training to providers and we gave them I guess around 300 or 400 doses of naloxone and they have done an amazing job with putting protocols into place and all that. I am a very fortunate guy to be able to travel around the state of Texas with Charles. He's become my brother. And you know, when you're away from family, um, having somebody close to you that not only has your back in your work, but in your personal life is critically important. So I'll let Charles take you through the interesting stuff of the training. Thank you, Mark. Thank you, Mark. We've been told to stand a little closer here. So if I'm not loud enough, somebody raise your hand in the back if you haven't trouble hearing me, okay? I just wanted to have a few announcements before we get going once. How many of you like to drink water? Yeah, a lot of hands. How many of you's heard of clean water? One hand. Okay, I'm gonna read this to you. 50% of profits support recovery from alcohol and drug addiction. Clean cause water. Look forward in your grocery store. If you don't have it, ask the manager to get it. Go online. Go online. You can get it online. Mark shared some stories. There's folks that are struggling with addiction, wanting to live in stable, sober living environments. And these folks have been really, really good about helping folks do that and other things. So the other thing market calendars, August the 31st is International Overdose Awareness Day on the south steps of the capital. We're gonna have the third annual International Overdose Awareness Day. Mark talked about the Peterson brothers. They're gonna be providing entertainment. You should Google those guys. There's some up and coming little blues specialists, really great musicians. This is real good. We've had folks that show up to have lost loved ones to overdose and honor those folks. So come check it out. There's handouts over here. Scare me. It's gonna be on one of our slides. Stimulate call 911 airway. It's really, really good handout. Something good to sit and have discussions with your clients, your family members, or whoever and use these as handouts after you've had that discussion with folks. Okay, so what we're gonna do on this next little part is we're gonna kind of start talking about the causes of overdose and basically how to recognize, respond and evaluate. Okay, so what are opioids? Okay, heroin, morphine, delotted oxycontin, oxycodone. Mark talked a little bit about the 5% of the world's population, 80 to 90% of the opioid consumption. I watched something on TV the other day and it said there were enough opioids being prescribed at one point here in the last few years that every American in the whole country could have a whole prescription sitting in their counter. Okay, so now locks on North Canada is what we're talking about that reverses opioid overdose. It only works on opioid. It does not work on soma, Xanax, benzos, alcohol, it doesn't work for any of those things. It only works to reverse overdose from opioid. Okay, folks have asked us that question quite a bit. Are all opioids created equal? In some ways, yep. Some ways or not. Okay, they all come from the opium poppy plant, or they are created to be like the ones that come to synthetics that come from the opioid poppy plant. Okay, they all work on the same part of the brain to cause the overdose. And we're going to talk about this more in detail. Basically, opioid overdose is caused because from respiratory depression.  And the person that do too much opioids stop breathing die. Okay, so they all have the same effect on the same part of the brain. And they cause the overdose in the same way. Okay, if too much is used. So how are they different? They're different in the variations of strength. And what's really important here is their difference in how long they last. Okay, and this is going to be really important, especially when you're talking, talking to clients and talking to family members. And when I've talked about talking to family members and clients, I'm talking about anybody, you know, I'll tell a little story where there was a friend that lived with a grandmother and the grandmother got education and nor can and when somebody went out at the house and grandma ended up giving Narcan so anyone can can use this medication folks Senate bill 1462 allows for that. Okay. Narcan is a short acting medication. So that's why it's going to be really important whenever you're talking to folks and educating them about how long these opioids last. That's going to be very important. So methadone 24 to 32 hours. Oxycontin 12 hours. heroin, morphine, the codeine, demoral, your average in three to four hours. Okay. And when we're talking about fentanyl here, I was talking to gentlemen and I said break, we're talking about the fentanyl patch can last up to three days. Okay. But just straight fentanyl across two hours, we're talking about pharmaceutical fentanyl here. Okay, because later on, we're going to be talking about fentanyl is being produced in the clandestine lavatories. Mark talked a little bit about it. The hundred pounds of pure fentanyl that was seized. That's not the fentanyl patch of the pharmaceutical. This was fentanyl that was made in in laboratories. Okay. You may want to write this down. I know some of you said you from the south. So you may understand it. It's called a naked truth. Mark said death by fentanyl. And Mark said if you're from the east coast, that means the naked truth. Okay. So naked truth. It's a it's on YouTube now on our station at home. It's channel 1206 I saw it was a it was on again the other night. And it it's a lady goes into into Mexico and she's interviewing some of the cartels that are manufacturing some of these drugs. And she was particularly asking this guy about fentanyl. He said he paid someone from Columbia $50,000 to come in and show him how to make it. And she said how much of the heroin going into United States? Or you guys put in fentanyl and he said all of it. And it kind of long story short, he talked about competition. If this guy's putting fentanyl in his heroin to make it a little stronger, they're going to want to buy his and not mine. So therefore I have to put some in mine when he puts a little more to make his better. I have to compete. And that's what we're seeing. That's part of what we're seeing. So, you know, that's part of what's driving this thing. So and remember when we talk about durations of effects, just because demoral may last two or four hours if a drug users using these drugs, the biggest fear for a drug user is what? Withdrawal. Hope your drug user does not want withdrawal is not a pleasant situation. Okay, so the last thing someone wants to do is go into withdrawal. So even though the duration of the drug may be six to eight hours, that doesn't mean the person is going to wait six to eight hours before they use again. What happens is they keep using it keeps building up in the system. And that's where you go and you start increasing the risk for overdose as well. Why do people use opiates? Mark talked a little bit about it. They work. Basically, pain relief before you where are they coming from? And again, this epidemic is being fueled by prescription drugs. But what we're seeing is we're seeing an uptick. You know, law enforcement's response to this has been work on shutting some of the pill mills down. You know, there was a difference in scheduling for hydrocodone went from schedule three to schedule two back in October 2014. So all those things are effective things. There's a prescription drug monitoring program. There's a drug take back program. But I'm here to tell you not a prescription drug take back program. Not many opiates are showing up. Okay. But they are somewhat effective. So all those things put together can really make a difference. But most of the drugs that we're seeing coming in or coming from Mexico, South America, Southwest Asia, Southeast Southeast Asia, where I was going with that a while ago, it's like shutting down some of the pill mills. What's happened is what we're seeing is the uptick in heroin use as people that were getting prescription medications for whatever reason, can't obtain those as easily anymore. And they go to street heroin's more available. It's cheaper. It's easier to get. Okay. So we are seeing a rise. What's the different number? What's 60? 6040 6040 some parts of the state. Yeah, still about 60% prescription drug. You know, we've never seen more opioids at a higher purity and a lower cause than we are seeing today. In this country, more available. Yeah. Ever. You had a question? Are you seeing with that arise with the increase in heroin arise in HIV and Hep C? It's a great question. Good question. We're seeing a rise in HIV and Hep C. Remember what what happens is even if someone starts off with the prescription drug use, taking pills, what at least I've seen my experience in working with with users through the years has been people maybe graduate over starting heroin. Eventually, the majority of times people end up using an intervention. And with that usually comes sharing equipment, sharing syringes and increased risk for HIV and Hep C. I mean, Hep C is running rapid in IV drug using community has been for a long time. And so we are seeing an uptick in both HIV and Hepatitis C. Texas is an interesting state where there's very limited if any access to clean injection equipment. And yet we're seeing the number of injectors increase. What's going to happen is we're going to see the number of Hepatitis C and HIV increase, health care costs are going to increase, need for services are going to increase. And we could have spent seven cents on a clean injection equipment. So nobody wakes up in the morning because there's a clean needle and say, Hey, think I'll start shooting dope today. It's not all works. Yeah. And we hear the argument with Narcan some folks that say, Well, if you're going to make Narcan available, won't people use more? Overdose is not a pleasant experience, but I haven't met anybody yet that says I'm going to try to do enough to overdose today because I know you have Narcan. It's just not a pleasant experience. It really isn't. How many? Some of you raised your hands about working in substance abuse treatment. How many licensed counselors in the room? Quite a few? Any LCDCs? Yeah? How many of you remember an LCDC school where they set you down and talk to you about this? They didn't have it? Yeah, you sound like you went through a I can I can relate. Yeah, first test. I took us for KDAC. What? LCDC training school and being ready to start another one and I do teach them about this. Good. Great. That's great. So teaching it in the LCDC training, that's great, because we rarely hear this, folks. The bottom line is what I remember is, you know, you need to get a relapse plan with your client at the beginning of the process when you develop a treatment plan, individualized agreed upon treatment plan, objective strategies, goals with the client that's agreed upon. But nowhere do I remember anybody telling me to talk to your client about using safer if they go back out, talk to your client about not overdosing if they go back out. That was not part of the conversation. We really need to be changing the way we do and things we really, really do. When we have clients come in the door, it'd be really nice to know that they're all going out and they're going to stay clean and sober and hop down the recovery trail is just not happening. Now there's treatment work. Absolutely. I'm not saying it doesn't. But we need to be talking to folks about what happens if it doesn't. We need to keep them alive. I don't know about you folks. I haven't seen any dead people walk in a 12 step meeting yet. Yes, ma'am. And access to syringes. There's still a problem in Texas with access and syringes. This lady is shaking her head yes. So I was go ahead. So I will tell you, there's a number of municipalities in the state of Texas. God, this ought to go over big in this room. HB 10 was passed a number of years ago, which allowed people you guys in San Antonio should be intimately aware of this that allowed for municipalities to do syringe exchange. The district attorney here in in San Antonio didn't really like what was happening and kind of close it down and that never came to fruition where people that injected narcotics, I had access to clean injection equipment. Honestly, that though that HB 10 is still on the books. So potentially, you could be doing syringe exchange in San Antonio. And there are some movement in that direction. I will tell you that legislators are not against this per se, right? There's a lot of proof now nationally. Listen, Mitch McConnell is backing the needle exchange. Okay, I mean, people know what Mitch McConnell is right? Okay, maybe not. So here's the thing. Is it moving in the right direction? Yes. Is there still an incredibly lack of access to clean injection equipment in the state of Texas? Yes. We have really, really high rates of hepatitis C in the state really and there's treatment for help see for folks in treatment if you want more information on that, we can give it to you after the training as well. This is where the drugs are coming in. Okay, what do they look like? Mexican black tar heroin pictured here, the brown Mexican brown, more so in the past, we China white we saw on the east coast again, the fentanyl that we're seeing hitting the streets now we're seeing more and more and more of it. You know, I have some of the questions we get asked some time that's quite frequently people have said why would someone want to get up? Why would someone want to use it? They know it's that if it's that's potent, it's killing folks. They don't know what they're getting folks. The drug they may get today looks like the one on the bottom of the white and it's hair mostly heroin. And they'll go back to the same connection or different connection or whatever. And it looks just like the stuff they got last week. But it's got fentanyl in it. And bam, they're out.  So folks don't know. And again, the cut mark talked a little bit about the cutter a while ago. I don't know how many of you can see this probably can't see that measured in micrograms. Okay, some of the fentanyl think about granules of sugar. Three granules can be lethal. Fentanyl and clandestinal laboratories 100 times more potent than morphine. 50 to 60 times more potent than heroin. We got a Mark Center article yesterday showing up in some crack cocaine. They're actually manufacturing pills that look like Norco or Viking have fentanyl in it. It's crazy. Okay. Fentanyl dose almost invisible. Okay, how does overdose work? talked about the cause. Okay. So there's the opioid. Here's the brain receptor. Basically how it happens. You put opioids in, the opioid lays on the brain receptor, it lays on the brain receptor that tells the body to breathe. So you see folks going into heavy nod, the breathing slows, the more opioids you put in, the heavier it sets on the brain receptor tells the body is slow, slow, slow on the breathing. You do too much. It says stop. The person stops breathing and end up dying. Okay. It fits exactly on on the brain receptor. Who's at risk? The very folks that we are working with some of you that raise your hands, the folks coming out of treatment, those very folks that we do that relapse plan with that we say, Oh, call your sponsor, work the steps, read the literature, go to meetings. Does that stuff work? It does for a small amount of people. We need to be talking to folks and say, when you go back out, what's the plan if you start using again? Okay, if Mark and I talked about the hypothetical of us going out and use again, I may not want to share my drugs with Mark. But I need to tell Mark, when I go over in this room, if I'm not out in two or three minutes, you need to come check on me. We need to be educating clients about that. You need to have a plan with your using friend. If you're living with family or friends, you need to have nor can you need to educate them, the family and tell them how this works. You need to let folks know when you're using and where you're going to be using. Okay, homelessness. Very big increase in risk of overdose, incarceration, folks that have not used in a while whether it be voluntary or involuntary, or at higher risk for overdose. And we'll talk a little bit about tolerance and stuff. So entering and exiting your treatment programs. persons with comorbidities, COPD, asthma. Talk about the story about the lady that goes in has COPD gets some kind of minor minor surgery happens, the doctor gives her a prescription for 30 60 narcos doesn't say anything, no education whatsoever. About overdose. Talk to a gentleman last week that was here. said had a friend went in and got a toothbrush got 60 narcos. No education. Nothing about overdose. Okay, it's crazy. Sure. So one of the things who's working in criminal justice system people are okay. So what just really briefly one of the things that we found really effective. So you come in the lockup, you get an assessment, right? You usually do a pretty good assessment around people's histories, so on and so forth. Opioid use comes up in those assessments oftentimes, right? You flag it. When people are going through their their stint in lockup, they're in jail or in prison. During their later stay, we start to educate them around overdose prevention and education. We actually train them around what an overdose looks like how to respond how you evaluate, they take a test, they get certified in this. When they get ready to leave lock up, they get a certification, right?  They have a certificate that shows they're certified in overdose prevention. They are given a bus pass or whatever in directions to a community health provider. In Austin, it's the Austin Travis County Internal Care. They go to ATCIC, they present their certificate, they are given the lock so good stuff, right? The other good thing about that is is that they get directly connected to services, right out of the joint. We have vast data that shows the quicker we connect with folks out of the joint, less recidivism, less overdose deaths. Very simple and you have you have the resource in your community. Mark talked about many times Center for Healthcare Services way ahead of the game on this stuff folks way ahead of the game. There's been six reversals I think as a result of their work just in the last few months. That's that's a lot. Talking about some of the specialized outreach programs I know in Austin, there's been over 60 reversals in Austin from specialized outreach programs been doing this work again, headed again. So, you know, the folks in the community, the ones that have going to have to be doing this and you are the folks in the community. So people living with HIV, Hep C, running rapid 75% higher risk of overdose than someone that doesn't have it. Yes, ma'am, we're going to talk about that. That's a good that's a really good question if there's somewhere in Texas that that's funding that it's really depending on individuals and agencies and how to be creative and do that. How many of you in here have contracts with Department of State Health Services to do substance abuse treatment? How many of you know that it's been in your statement of works in September the first 2014 that you should have already be doing this with clients? No hands go up. That's what I thought. That went into statements of work September one FY beginning of FY 15. I was still an employee at Department of State Health Services should be in your contracts. Every client coming in for services gets education on overdose prevention and information on access to naloxone at entry and again prior to discharge. And we put it in there like that because we wanted to make sure if they came in and went AMA that they they would get it at least either on the front end the back end or both. So and I'm not up here calling people out saying you should be doing I'm just saying there's the majority of folks what we've seen edgy going through the state doing this work is the majority of folks that have those contracts weren't aware it's in there. Anyway, check it out. And one of the things we talk about how to purchase it I encourage you to get with your DSHS folks and ask them some creative ways on how to purchase this. Many people coming out of jail mark brought up a good point. You know, same way with treatment programs folks, those folks in your programs are the highest risk folks there are for overdose. They're the highest risk folks not on their tolerance going down the strength of the drugs is probably changed since they went out a lot of people go in thinking I can go back out and use the same amount I used for I came in it just doesn't work. Lots of tolerance, the regular use. Folks continue. The next one's a big one mixing drugs. Okay, alcohol, opioids, and benzos is almost equals overdose. Okay, we need to educate folks again. That's another thing that you know that we need to educate clients about persons may be on benzodiazepine maybe for long term use or whatever. And they, you know, have again have a toothache or will for whatever reason go to the doctor get a prescription for opioids and want to have a couple glasses of wine tonight. Those are going to put you at high risk. So educating folks is very important. You know, there's one of the little videos that we show at the end. I don't know if we'll show that one today. But the guy kind of talks about, you know, when it comes to mixing these drugs, you know, one and one doesn't equal to necessarily one and one might equal for when you start mixing them together. And I'm sure everybody's got the prescription that says alcohol may intensify and all this good stuff. Using alone. That's a big one. You know, I have a son is 25 years old and he's lost a couple of friends and and the story was kind of the same. The friends they go to a party and and somebody starts nodding out or looking like they're really high and all that. So the, you know, what are we going to do? We're going to pick them up and put them in the back room, let them sleep it off. They find them dead. Okay, again, a strong education piece. Educate clients if you're at a party and people are using don't put them in a room by theirself. That's the last thing you want to do. You got to stay with the people you got to watch them. Okay. Don't tell them don't use alone. Or if you do let someone know where you're going. The variation the strength of the street drugs we talked a little bit about that. Okay, educating folks tell them to do it. Test shot or whatever. Again, with the fentanyl. It's a very high risk if you don't know what you get. Possible cause what happened? Someone overdose is going to depend on the kind of drug that they use. Okay, so what does overdose look like? Anybody here ever actually witness actual overdose? Yeah, a couple of people. Okay. Remember, people are trying to get their breath turn in blue, purplish. Okay, the loud to call it the death gurgle, real loud snoring, both these folks are trying to breathe. Okay, they can't breathe. They're trying to catch their breath. So it may be the bluish may be underneath the fingernails. Okay. The breathing is slowed down. Lips turning purple. I think it's important to Charles. So most overdoses take one to three hours to occur. So we have time to respond folks. Right. Yeah, what we see on TV is somebody usually see lovers of person sticks kneeling their arm down, they fall over dead. Okay. We're kind of seeing some of that with the fentanyl. But in most cases, we got one, two to three hours. So what does that mean for us? That means we have time for intervention. Okay, we have time to intervene. And we can keep people alive long enough to get them some help. Okay. Yes. Talk about beef and arpey. Suboxone subutex. Yeah, benzos is increased risk. Kind of same concept with the opiates. Yeah, good point. So yeah, you know, and we've seen, seen that, you know, Prince just died from an opioid overdose. So we've definitely seen with with benzos. Yeah, it's like, well, most overdoses actually are in combination. Yeah. I said you're very, very huge increased risk when you start mixing those. Okay. Yes, ma'am. No minimum age for naloxone. Good question. Yes, ma'am. Exactly. So someone can go to pharmacy, pick it up and carry it like an EpiPen for allergy. That that's exactly right. Right. It's legal. So right. Right. That's correct. Yes, anyone, doctors, anyone. I'm a licensed counselor. I can do it. Senate Bill 1462 covers you under that. Okay. That's a good question. Yes. Great question. If it's not an overdose, you give it to him. What happens? The love of my life. I'm gonna tell you her name. Penelope. Four years old. She has my heart. If Penelope comes in my house, which she does all the time, my granddaughter, and she sees my North can laying around and decides to inject it or drink it or whatever. Nothing happens. Zero. It will not hurt Penelope at all. So the only thing this drug can do, folks, is save people's lives. They cannot do any harm. Okay, these are all great questions. Okay. So what are we doing? We see these persons? Okay, they're nodding out. They're doing all this stuff. Blue lips, the death gurgle. Okay, tap them on the shoulder. If you know their name, yell their name, pull their ear, pinch their hand. Okay, you want to do a sternal rub? You can try it on yourself. Put your fist like this, put it right here on your chest bone and rub real hard. Okay, if there if there, there's a fine line between being real high and go and be in an overdose.  Okay, if they're in overdose, they're not going to respond.  Okay, you've done the sternal rub, you've determined they're probably in overdose here. So next thing to do is gonna be called 911. What's some of the reasons folks won't call 911? Mark, I sure like you a whole lot, but I don't want to go back to the walls unit. I'm on parole. I don't want to call 911. That's another education piece, folks. You know, I know I worked when I worked at the community based level doing work with active users on the street, we used to talk about that stuff. What's gonna happen if you one of your friends go out? Well, I don't know. I'm on parole. I'm on probation. How about if you call 911, and you stay with the person until you see the lights get there and then you go or whatever just having the conversation means a whole lot. Okay, so start those conversations. The primary barrier folks not calling the spirit of being arrested. Just a little bit information. Mark and I, we were working on some of this legislation stuff in the last session, there was a house bill 225 that had a good Samaritan piece. Okay, and it also had access to naloxone. The good Samaritan piece was going to give immunity to someone more than I was out using illegal drugs. He goes out. I call 911. I don't have to get worried. I have to worry about getting arrested because I was using illegal drugs because I call it an emergency situation. If there was a good Samaritan law, it did not pass. It got vetoed. Okay, so call 911. Soon as you've done the sternal rub, yell, all this good stuff. Begin rescue breathing. Have you ever done any rescue breathing? Good deal. A few hands went up. I forgot to say, Mark and I, we wasn't aware of this was gonna be a film. So we got kind of excited because last week someone told us we had the perfect faces and bodies for radio. So we said, man, we're gonna be in front of TV now. This is really cool. So anyway, rescue breathing. What you want to do is put the person on her back. Okay, you've already called 911. So when you get him on her back, as gently as possible, use your hand. Put on the forehead under the chin, lifting the head up, making sure you keep the mouth open. Okay, pinch the nose and give two slow really long breaths. And then a breath every five seconds, one 1000, two 1000, three 1000, four 1000, five 1000 another breath. Okay, you want to watch the chest cavity to make sure there's no blockage. Okay, place your ear. See if you can feel air coming in and out or whatever, or watch the chest to make sure that they're there breathing that the air passage is open. Some folks when they went in and overdose may have had food in their mouth. I know some of the dealers when I worked the streets in Austin used to carry the heroin in balloons and they kept them in their mouth. That way if law enforcement came up, they would swallow. They went to jail two hours later to go to the bathroom. They had their dope back. So there was a lot of reasons people had stuff in their mouth, people that injected may have the syringe cap in their mouth. So you want to make sure that that airways opening at the air is getting in. Okay, it's very important. Okay, pinch the nose. We talked about taking a deep breath, the two slow breaths. Now rescue breathing is not hard to do, but it's hard to keep up. So again, educated tell folks if there's more than one of you there, you can swap off. Care for opioid overdose. And this is important folks. Even if you don't have Narcan. This education is important to give the folks because you can keep someone alive long enough for medical emergency care to get there. Okay, rescue breathing alone can keep them alive. Okay, so the real cure for opioid heroin overdose is air oxygen. If you have to leave the person for any reason, remember you have them on their back. You want to put them in the recovery position of the rescue position we call it on their side arm over and leg over.  Now lock song. Yeah. The other thing it's important to get medical attention there in particular with some of the new synthetic opioids that are coming into place. I don't know if long for have you guys seen any of the w 18s and all here is there been any arrest with the new synthetic w 18 here? You know, you know of any. So the reason I say this that what what's happened is people are getting chest rigidity syndrome would chest right. And if we don't get medical attention there, even doing rescue breathing may not be enough. So what happens is that this stuff is so powerful that it almost anesthetizes your lungs where it won't receive air, right? Gotta get medical attention there. You just have to have very good. I'm glad Mark brought that up. We're talking to gentlemen from CDC last week that was telling me about the chest rigidity syndrome where someone was trying to put the nasal norcan up someone's nose and they couldn't it wouldn't go up because of the chest rigidity because of the kind of drugs that they'd use it was so potent. And he said being creative that instead of pinching the nose and trying to push air in the mouth, they put the medicine in the nose and covered the guy's mouth and blew up the nose and got it in. So it's like, man, I don't know if I thought of that. But yeah, very good point. So we're going to talk a little bit about the norcan and now lock song. Okay. Remember, it works for opioids. Thank you, Mark. It's an antidote for any opioid. Got a high penalty. It's set on the brain. Now, here is the important part. I talked about the duration of how long some of those drugs were oxycontin 12 hours heroin 68 hours. Okay, methadone 2432 hours. So remember, that's how long those drugs are sitting on that brain receptor and telling the body telling the brain receptor not to breathe. Okay, nor can 30 to 90 minutes, folks, short acting. Guess what the first thing someone's going to want to do when you give them nor can they're going from overdose to withdrawal.  Okay, don't let them use again. And we're going to talk a little bit a bit more about that. So the opiates have said on the brain receptor, what nor can does it comes in, it kicks the opioid off the receptor tells the body you can breathe again. Okay, that's what it does. Very, very short action 30 to 90 minutes. This is one form of the nasal. And it kind of looks like this at birth. And then when it's assembled, it looks like this from Mountside Medical. And this has got an atomizer. Okay. And the atomizer screws on looks like this. One thing that's important. The atomizer is meant to insert the nose to inject. If you have this type of nasal nor can and you don't have the atomizer, it will still work without the atomizer. Okay. So that's important. And it screws on atomizer screws on like this. The medication is in a vial. Looks like this.  And it also screws in. Okay, one CC each nostril. Happen one nostril, happen the other. Okay, we'll talk about cost, and how you can get this stuff here in a minute. The newest on the market. This one has four milligrams. Adapt is the pharmaceutical company. Okay, and inserted in the nostril, just one nostril and pushed all of the medicine in. Okay, any questions on those two? It will work for the opioid. Good question. If they're mixing opioid and stimulants would still work. It will work for opioid. It will do nothing for the stimulus. You know, it's pretty hard to overdose on stimulus, to be quite honest. Yeah, it's much less likely to overdose on a stimulants. However, people think that a stimulant and so we'll probably show them that move. People think stimulants and depressants even things off and they don't. Yeah, that's not the way it works.  And it doesn't quite work that way. But folks will tell you that. The next one, I call this one the Cadillac model when we get to the prices. You guys know what I'm talking about. This is the drug company Kaleo K a l e o. Okay. Great company. This one is a trainer. It says on top of this, it says trainer. This medication comes in. I think I have a box comes in a box. It looks like this. Okay. The box has two doses of medicine. The medicine is LSU colors, of course. Okay, everybody's a tiger fan, right? Except more. Two doses of medicine that comes with a trainer and the trainer talks to you. Maybe you can hear this. Life's safe. Okay. FZO. About Kaleo. That's the one everybody kind of wants because they're kind of cute. Like you were talking about the EpiPen model. Yes, ma'am. Good question. Question is, which one should the pharmacies have? Do they have all three? It's going to depend on the pharmacy. And to be quite frank, if you have insurance, it's going to depend on the insurance company. I sat and looked up my insurance last week and looked and they cover the one that I'm about to talk about. And then I went to HEB and they had the nasal. They didn't have the one that my insurance comes. So again, I think that's going to be conversations that we're encouraging you to start having with your local pharmacies on if you want some, nor can what which ones are they going to carry which ones do you want? And we'll talk about pricing to that's going to probably have some to do with. So that's a really good question. Okay, the injectable intramuscular comes in a vial one CC already measured out. Okay, also comes in a bottle with 10 CC actually get 10 doses out of this. The syringe that we recommend to be used with the with the intramuscular. I call it kind of the animal syringe in the region. I call it that one that you can find them in feed stores or online. But this has a really long needle. Okay, that will reach the muscle. There's been some concern folks say, Well, if we leave these around drug users will use this I worked with active users for a lot of years. I never met anybody that used illicit drugs with a needle this big. I'm not saying it hasn't happened. I haven't seen it. Okay, take the take the needle, put it into the bottle, draw up one C on CC, hit him in the arm, the thigh or the booty. Okay. Now, doing education with drug users are with folks that may have a syringe is not this type of this long intramuscular. Lot lot of users use you 100 insulin syringe. I have a really short needle. If it can hit him in the tongue, inject in the tongue.  They're gonna be alive folk. They're gonna be happy to be pretty happy their sons or daughters or brothers or sisters be really happy they have that sore tongue. I'm here to tell you. Okay, do not put the cap back on. And we're being filmed. So I'm putting it on because we're gonna use it for training again. But it's not recommended to put the cap back on. Okay, dispose of it in a sharps container. Okay, anybody have any questions on any of the types? We're gonna talk about pricing. Oh, everybody needs to have a t shirt like this, right? We went, we went what was in some burger joint last week. I don't remember what city was in Houston, maybe? Or Dallas, Houston, and the barbecue place.  I'm like, Hey, look, and they got the naloxone shirt, but it replaced barbecue. And they probably came first. But anyway, we like this. No effect other than opiates. Can't hurt you. It's not a scheduled drug. It has no potential for abuse. To be quite honest, it would be nice one day that it's not even a prescription. But so that everybody understands because I know people have come up and asked questions. Open script means you can go in a drugstore and get it without going to the doctor. We were riding around. We did the training in Dallas. And we passed by drugstore and it was like flu shots here. And it reminded me of it. It's like, okay, I can get flu medications as prescription. I normally have to go to my doctor to get it. But because there's an open script, I can go to Walgreens or CVS and get it. Same thing at naloxone. Open script, the script's there. You just go get it. Okay. And some instances, if someone has done enough opiates or with some of the stronger opiates we're seeing on the street, it may take more than one shot of Narcan. That's why it's important to stay with the person. Remember, you recognize sternal rub, call 911 rescue breathing, then the two big breaths, give Narcan and go back to rescue breathing. Okay, you may have to give takes three to five minutes for the Narcan to start working, folks. It's important. Three to five minutes. So if you give Narcan and they don't come out of it 10 seconds because it hadn't started working three to five minutes for it to start working. Okay, last 30 or 90 minutes. You continue to give breath. Absolutely. Good question. Remember, you've called 911, you got medical intervention coming. Okay. It's not a pleasant situation for somebody waking up. So again, another reason you want to stay with them, they wake up and they see you there. They see a mess there. They remember these these folks are going from overdose into total withdrawal. Okay. So it can be it can be a pretty traumatic deal for someone. Here's a couple of videos if you want to write this down. The first one is www.get now locks on now.org. You can go to this link. You can go through a series of questions, take a test and you complete it will actually spit out a certificate you can print out a certificate saying you've completed the training. Okay, this is the one mark was referring to folks being incarcerated go in they take this test to get the little certificate and they get the voucher. They go to communities for recovery or Austin Travis County integral care here would be Center for Healthcare Services or whoever you can work with. The other link is www.prescribe to prevent.org. This link has some really good videos one we're probably going to be showing you here in a second. And also if you're a medical professional doctor, a PA nurse, you can go here and take a little test and questions asking you can actually get free CEU. Okay. Great videos on here to show family members after you've had that discussion with them. You know, I'm not recommending or suggesting that you just get the person and sit them in the room and say here we're going to put this video on so you'll learn all about overdose prevention. And have a nice evening. Yes, ma'am. Yes, ma'am there's several videos on there and we're going to be showing one. But there's there's videos on there. But again, I encourage you to have conversations with your clients or family members or whatever and then David also show the video. Yeah, so we're going to talk about how can we access this stuff? Okay. One philanthropy if you can find some some folks that just want to, you know, make their mark in the world and make this a better place to live keep people alive. That's a real good way to do it. Medicaid reimbursement mark touched on this. All of this is on Medicaid formulary. However, this one is not preferred. It's non preferred. Now, if any of you familiar with Medicaid plans, there are certain instances where you can do single case agreements and other stuff and talk to your Medicaid plan if you can work something out where they'll pay for whichever one that's fine have that conversation with your Medicaid plan but the inter muscular and the nasal are on the formulary as preferred. Okay, federal funding block grant dollars can be used to purchase naloxone. If you're receiving block grant dollars, have those conversations with your funders. Okay, how do I purchase naloxone? There's been conversations with the state on providers purchasing this and I was told that it needed to be a line item. Start having conversations about how to make it a line item. We need to start problem solving figuring out how to do this folks. Pharmaceutical donations. Kaleo talked a little bit about have been very, very generous to mark and I we've been able to distribute quite a bit of medication in state of Texas. A lot of lives have been saved. And Kaleo's played a huge part in that. But the block grant dollars started having those conversations. Currently have Texas standing orders. Now locks on train overdose responder enrollment forms. There are forms that if you're going to be working with folks, information can be gathered. So many specialized programs we talked about that are working with folks on the streets or in certain settings that ask information doesn't ask for name, but just demographic stuff on who's being reversed so we can collect data. Okay, adapt has a record of use form the nasal. Any questions so far? Yes, ma'am. Okay, if they're mixing anything, let's say if they're taking Xanax and narcos and nicotine, I think you mentioned our alcohol, you give Narcan, it will reverse what the opioids doing, but it won't do anything for the rest. So the main contributor to respiratory depression is going to be the opioid, right? Even though some of the other drugs the gentleman was talking about benzos and alcohol work on the same part of central nervous system, what it's going to do is it's going to kick the opioid off, which will allow you to start breathing again. Here's a story I'm going to share I shared with this gentleman in the audience a while ago and this is a story it was told to us. It's like, okay, I'll use myself an example. I have insurance. Okay. And I'm going to talk about the price of this but I can go in with my insurance. I can purchase this for $10 the one CC. Okay, that's my copay or whatever they call it. Alright, I have a cousin that's using opioids. Living with his roommate. And I know my cousin that's using even if he had $10 in his pocket, he's probably not going to go buy a norcan with it. He's struggling with addiction issues or whatever the case may be. I can purchase this naloxone. I can go give it to my cousin's roommate and educate him and tell him if my cousin goes out, please administer this to him. So there's ways that we can figure out how to get this in the hands of folks. Now the cost okay, the cost of this about $28 for CC if you're buying it out of pocket. Okay, most of this stuff is recommended to get at least two doses. The nasals are sold in a minimum of two doses for the reason I talked about sometimes you have to give someone more than one dose. Okay, so about $28 a dose for one CC out of pocket that that four milligram two doses about 150 bucks. Okay, like a lot of things, demand and supply and demand the price of this medication is skyrocket or spokes especially on the East Coast working with the former pseudicles try to bring the cost down. The nasal mountain side medical two doses somewhere around 6575 bucks. Kaleo out of pocket about $4,000. Again, these folks have been very, very generous with the patient assistance program. Okay, with insurance, about 20 bucks. I heard a sigh of relief. Again, that's between your and your insurance company and the drug, you know, is the insurance company gonna want to pay for something that costs this much versus pay for that. But I wanted to say with these two here law enforcement, there is a program for law enforcement, where you will receive these. If you want that information, I can get it to you. So law enforcement is usually provided either free medication or a very, very reduced rate of these two in particular. Any other questions about the pricing or how to get it? Yes, ma'am, then I'll come to you. $28 for the for the intramuscular and the 4,000 and the 75 and 65 is someone with no no insurance, no coverage whatsoever. That's walk in and out of pocket. With insurance is gonna it's gonna be whatever your insurance covers if they covered if it's on the formula, I have the health select or whatever and it covers the the intramuscular. It's okay. There it goes, man. Everything we made today is down the drain. So this for me was 10 bucks with insurance. If I wouldn't have insurance, it'd been about $2830. Yes, ma'am. Good question. Is there a difference in the reaction type? No, there's a different kind of in the formulation. And you know, some folks have come up and said, Well, I have that the intramuscular and I use it as nasal, you probably don't want to do that. It's got a different formulation. But the response is going to be the same. It's all going to work the same way I talked about. It's going to get in, you know, the act. Obviously, the nasal is going to go in and work on the mucous membrane. Folks that say, Do they have to be breathing? It's like, No, they're not breathing. But it gets absorbed through the mucous membrane, but they all work the same. They go in and it knocks the opioid off the receptor and gives the person a chance to breathe. It's safe for pregnant women. I know one thing that's not safe for pregnant women. Over there. Not good for the baby either. Yeah, folks have asked that. I don't know that there's been a lot of studies. But what we know is if the if if the mom's going into an overdose, her and the baby could both going to die. Bottom line. And this has been used on pregnant women. And there's been no reports of it having adverse effect. And the lock zone is given to newborns often that are in situations where opioids are used. Someone actively using it may have been I was saying that someone actively using may not go in and purchase it. A chest rigidity. Well that the chest rigidity things for the drugs Mark was talking about the real, real strong drug we're seeing mostly on the East Coast now that comes in and they get they get rock solid. People do rescue breathing and it won't let it in. It's just like solid here. So people are being creative. The guy that I talked to last week from CDC said somebody had the chest rigidity syndrome and the guy was trying to do rescue breathing and he would blow into the mouth and it wouldn't go in. And he started freaking out. He didn't know what to do. And all he had was nasal Narcan. So he shot the nasal Narcan and the person's nose and it started running out. It wasn't going in. He's like, Now what do I do? I'm supposed to be blowing in the mouth and holding the nose, right? But I'm blowing the mouth. I can't get air in. So he kind of freaked out. And he said he put the medicine in the nostrils and he put his hand over the person's mouth and blew up their nose. And it blew through. And the person started a few minutes later, first started breathing again. But I said, Well, I don't know if I would have thought of that. It's why it's really important to get medical attention. Yeah, it's really, really important because, you know, there may be something that that else is going on that medical people need to be there. The majority over 85% of all rescues are done by laypeople, meaning other people, friends, family members, people that are not trained medical providers. And so that's how easy this medication is to administer. Another good education piece, you know, because we when we start thinking overdoses like who's going to save these people, the police, EMS, not let you folks in the audience, the people you work with, or you folks sitting in these audience, you don't necessarily have to be a professional to use this anybody can use it. Uh, how many folks working criminal justice? Part of you? Do you folks want to see something with got folks coming out of jail, or around overdose prevention or overall pain medications and, and other opioids. It's a video that goes through all of that. And what it looks like, it's like 1050, not even 15 minutes. Which one? Make a choice, folks. Okay, coming out of jail, raise your hand. Okay, we'll show the other one. Nobody wants to go to jail today. I don't blame you. And on this presentation, one of the last slides we have is that little scare me handout. And it's also got a place on the side you could actually add local resources. And if anybody wants this presentation, we have a few business cards up here. If you want our information, please come get them and come join us August 31, folks in Austin, if you get a chance. Or if you want to hold your own event here, we'll be glad to help. Can we dim the lights? Or is that against the movie rule? To severe pain, some common opioid pain medications include hydrocodone, which includes brand names like Lorset and Vicodin, oxycodone, which include brand names like Percocet. There are also longer acting opioid medications like oxycontin, MS content, methadone. And there's one in a patch called fentanyl or dirgeizic. Opioid medications can cause a number of side effects. In the short term, we often see nausea. Longer term, we see constipation as a common side effect. Some people will also have some sedation or sleepiness. Fewer people will have itching or rash. Those need to be brought to the attention of your physician immediately. There's a couple of things that are really important that you need to know about this medication. If your doctor wants to go up on your dose, be real careful with that. You know, especially the first couple of days, if you jump into a dose that's too hot, it can cause that respiratory secretion to and can cause overdose. The most serious risk for taking opioid medications is the risk for overdose. If you take more than your body can handle for whatever reason, it can depress the breathing centers of the brain and you could actually stop breathing. What would put you at more risk for an unintentional overdose would be starting a new opiate medication or switching to a newer, especially a long acting version. Other conditions might be certain medical conditions like chronic lung disease or kidney problems or liver problems. Your body adjusts to opioid medications and develops a tolerance over time. Taking these medications, you need more of a medication to achieve the same pain relief result. It's very important that if for some reason you're off of your pain medication for a period of time, like you're in the hospital or you're ill and can't eat or drink very much, that you not go back to your previous level of use. As that tolerance has gone down, your body will be more sensitive to the medication and you'll be more at risk for an overdose. If your pain is not adequately controlled by your current medicine dose, it's important that you stay in close contact with your physician so that he or she can help you adjust your medications. Particularly with long acting opiates like methadone or Oxy Contin, increasing pills even by one pill can put you at increased risk for overdose. Other substances can combine with the opiates to make you more at risk of an overdose as well. If you take certain medications, especially like Valium or Ativan, alcohol or recreational drugs, even at low levels of use, taking them along with opiates can increase your risk for overdose death. This is a lot boxed for my medications. I have two young grandchildren. That is a lot of the medicine I have, so there won't ever be that chance of getting into the wrong hands. Good noon. It's really good to see you again. And I know we're working really hard with you to manage your pain as you go through this. We've increased the pain medicine a bit. So I want to talk to you today about one of the scarier things that can happen rarely, but sometimes with these medicines, which is an overdose. So I'm going to teach you how to recognize one and what to do. Do you have any idea what an overdose might look like? They can't wake up? You've got the most important part. When people overdose, they're breathing, they stop. I'm not hearing anything. I don't see the chest going up and down. So I don't think they're breathing. They're breathing maybe really slow. They may be snoring in a strange kind of way or gasping. They may begin to turn a little blue around their fingernails and around their lips. These are all signs to be watching out for. But the key point is that you can't wake them up. They take my knuckles and rub them up and down on your breastbone like that. It hurts. Right. So if somebody sleeps through that, whatever's going on, it's an emergency. And what do you do in an emergency? You call 911. Right. And it's very important to say that the person's not breathing or struggling to breathe and they'll make that their top priority in coming. And so now, if they're having trouble breathing or they're not breathing, then we're going to breathe for them.  Check in the mouth and make sure there's nothing in there.  Okay. Want to give it a try? Sir, I'm ready. Nothing's happening. We're opening up the airway. That's great. Hold in the nose. Tight seal over the mouth. His chest is going up. That air's getting in there. 1001, 1002, 1003, 1004. Excellent. Now you're going to keep that up until you get to your next step or he tells you to stop or the EMS folks come. Now you've got the ambulance on the way. You've given your friends some oxygen. Now we're going to talk about a medicine called Naloxone or Narcanth. This is a life-saving medicine that just blocks the effects of whatever opiates are in the brain. It can be injected into somebody that's having an opioid overdose and within minutes they're going to wake up when we talk to them. Now it doesn't block the effects of alcohol or other tranquilizer somebody might have taken. It does block the opiate, which is what makes people stop breathing. Very safe medicine if I give it to somebody that's unconscious for some other reason. It does absolutely no harm. Naloxone comes in a couple different ways. There's a whole dose right here. Now this is what we expect you to get but sometimes pharmacies have a larger bile of it and we'll say on here just give one cc. It's the same dose. Here's your Naloxone. Here's your needle. Have a good fight. Grab off of the Naloxone. Take the cap off the needle. Put the needle into the deepest part of the liquid. Hold the plunger up. Push a little air out but air is not dangerous to inject into the muscle. And it wants to go right into the arm or into the leg. Whenever this person's unconscious they're not going to feel a thing. Perfect. Now don't put a cap back on the needle because that's a really easy way to get a needle stick. Keep doing the rescue breathing because you need to keep that oxygen flowing. That's what's really keeping them alive while you're waiting for the ambulance while you're waiting for this to work. Now just in case this one dose doesn't work we're going to give you a second dose to have on hand. If in three to five minutes they haven't begun to rouse and to breathe you can go ahead and give them a second dose. I'm also going to show you how to use the intramasal form of Naloxone. This starts up the nose instead of being injected. It takes effect even if the person's not breathing because it's absorbed through the nose. So the box like this comes with the tube and this is the medicine and it's got a little nasal applicator.  I'm going to drop it in this tube gently and then turn it very gently until it's just barely tight. That means it's ready to go. Now we'll take the nasal applicator and hold on to these plastic wings here. One side is about half of the medicine. The other side precise about it. But you want to get all the medicine in there. You want to try it? Sure. One nostril. Half of the other nostril. Then you'll go back to your rescue breathing while you wait for it to take effect. There's two doses just in case that first one doesn't work. Rescue position is on one side, usually the left side with a left arm above the head. This helps them to breathe more clearly. This is the position that you want to keep the person until EMS arrives. Even if you get the Naloxone and the person who has overdosed becomes conscious, it's still important to get EMS to the scene as soon as possible. The opiate that had been in their system relieving their pain is no longer working. Therefore, they might have pain. They could have some symptoms of opiate withdrawal and they may be very uncomfortable. You think it can teach us at home? Great. Do you feel comfortable teaching your mother and sister about it? I feel much more reassured that I can go home and tell my family how to respond, what to do in the worst case scenario. And if folks want flyers for overdose awareness day, they're up on the table here by the camera, please take some, put them in your office. Thank you.


proudly we hail from New York City where the American stage begins here is another program with a cast of outstanding players public service time has been made available by this station for your army and your Air Force to bring you this story as proudly we hail Major Dana Stacy US Air Force our story is entitled the old pro the story of a daring jet fighter pilot as proudly we hail Major Dana Stacy of the US Air Force and all the officers and men of the 25th fighter interceptor squadron and the 51st fighter interceptor group our first act curtain will rise in just a moment but first young man take your place in the new jet age as an Air Force aviation cadet you'll get 18 months of intensive training learn all about jet operation and you'll be surprised how easy jets are to fly and how safe to aviation cadets graduate as Air Force lieutenants with earnings of over $5,000 a year to qualify you must be between the ages of 19 and 26 and a half single and have at least two years of college visit your nearest United States Army and United States Air Force recruiting station for details and now your army and your Air Force present the proudly we hail production the old pro you're a jet fighter interceptor your name is Major Dana Stacy you're called back to your squadron in South Korea after rest and recuperation leave in Tokyo leave that was cut in half because your squadron wanted you back fast something big in the wind so you look out the window of the C-47 down at the dark blue flatness of the Sea of Japan below and you talk to the war correspondent Kogan on the bucket seat next to you and then you doze off dreaming of the lead you until you feel a hand shake you major major Stacy wake up what's matter we're almost at the field thought you'd want to know we are supposed to fasten safety belts all right hey you will really pout in your ear dreaming beautiful dreams Kogan but leave in Tokyo I didn't get the finish tough say what do you suppose your squadrons got scheduled they need you back in such a rush how long have you been a war correspondent Kogan about a year why well then you want to know I couldn't tell you even if I knew I'm sorry how long you've been in the service major since 42 not counting a few years as a civilian after the big war and you ought to be used to these things happening yeah you're right Kogan I'm sorry you didn't exactly flip it's just that after you've been at it for a while getting back to your squadron isn't the kick it used to be old are you major 29 real old timer the kind they call the old pros huh yeah that's what these buck lieutenants call us flew in the last war yeah at late 15th Air Force P-51s I used to think they were hot ships I'll say we're about to land any minute for the landing pattern now what made you come back in major didn't like civilian life oh I guess you've heard all the standard answers to that one but for me once you've flown a combat ship nothing else is quite enough wanted to climb into a jet and see what made it tick something like that all I needed was a reason and this career business that was the reason I needed what's this all about Colonel Payton you'll get brief but I can tell you this much now tomorrow we're gonna clobber a new red airfield this side of the yellow maximum effort by the group huh yep hey what's that looks like someone's in trouble spot in states yeah there is Jeff that f-86 on the approach to runway 1 7 what's the matter with him he's coming in dead stick well isn't he coming in too steep he's got to he needs to speed yeah he's leveling off now he's got the runway made right easy boy level those wings that's it that's it not just pull her back a little that's it I put her down hey thought for a minute he was gonna undershoot it yeah we need that boy in his plane for tomorrow man it is one devil of a sight you were sweating think about that boy they come in dead stick like that very often whenever it happens that's too often must be some trick to make a landing like that without any power you only get one shot at the runway and if they foul up they usually don't they can't ever make a dead stick landing in a jet major not yet Colgan and I just assume put it off for a while how's that for a meal Dana better not sukiyaki yeah yeah except the sukiyaki's in Tokyo now there's six weeks and we'll hit Japan together a boy oh good deal they mean while clue me in on tomorrow's mission with you yeah well it's strictly max effort and with everything we got against everything they've got hey lieutenant summons yes tell Major Stacy here what happened to your flight yesterday man that was some hairy old dog fight what happened well there were these eight migs in a ragged formation like when the new boys you know first trip out so we tore into them turned out they were anything but new they fought us down to the deck and back up again using every trick in the book and it was rough toxin rough yeah but I mean stays oh excuse me the old man's way but yes but the next time I see one of those jokers I won't be caught with my flaps down I'll clobber him for sure lieutenant you're sure one fire-eating fly boy I don't have to be a world war two vet to know I can bounce a jet around the sky as well as anyone and I mean anyone a real hot pilot no one ever got on my tail including combat instructors except one make and he didn't stay there long kid you got a lot to learn don't you know there's always someone somewhere who can outfly it no one in this man squadron including the fellas with world war two air medals and DFC's old pros old schmose well we may be old schmose buddy but we learn how to fly wing first meaning what meaning when you left your leader's wing last month to go after a mig oh hara told you huh yeah and more how he had to jeopardize his entire flight to save your neck when another flight of migs bounced you I'm not the only one who's done that summers the minute you left oh hara's wing you jeopardize the life of a guy who was depending on you and the quicker you learn that a wingman is supposed to fly wing to protect his leader and himself the better off we'll all be and I'll tell you this buddy you ever leave my wing I'll see a court marshal I'm not planning to fly your wing major well I hope you don't you'd really get a workout are you kidding flying wing on a cautious old pro is the safest work there is that's good duty your man wanted to know how many airplanes will have in commission well you get major states to hear the word lieutenant the ungarbled word colonel the straight cadet school poop the lieutenant doesn't know it Jeff but someone's gonna fix his wagon one of these days in the air or on the deck hey anything wrong no no no well are you leaving lieutenant yes sir right away sir good night sir major sir colonel what's that all about stays smart buck lieutenants what makes these kids so almighty cocky stays ten years ago we were the same way and you were worse than any of us yeah I guess you're right well I'll see in the morning right in the ready room at briefing Jeff right look at that flight board what's up state well I'm still leading a flight but look who's on my wing oh that kid's summer not my doing says but this summer's Jeff I have no use for him or he for me sorry buddy really I am but he's your wingman today as colonel Vargas just pointed out moving into this new field at Kawangpo this out of the yellows part of the reds try for airs premacy our fighter bomber the new version of a pain new field coming a hundred miles closer than their nest across the river almost but he sharp and once they set up shop it'll be rough rooting them out of there so today we've got to stop them all that's going to stop the 800 or so makes that they throw against us is our hundred and fifty sabers fly on top cover for the fighter bomber now Mr Stacy yeah back here call sign for your flight will be doctor right station will be 40,000 feet right about here see what I'm putting on a map in the bend of the river just west of Kawangpo grid coordinates are Uncle Roger 2170 got it yeah angels 40 Uncle Roger 2170 got it take off time for dr. flight 0900 you'll see you're in and out courses here on the map don't forget to check operational control center punch drunk before you cross the bottom line and control ship blackjack after you're across now captain remain your flight will follow the colonel's flight you're strapped in the cockpit of your f-86 saber jet now home your earphones are plugged into the radio and your oxygen mask fits tightly over your face your jet engine is idling impatiently behind you and you're ready to leave you glance at the others in your flight then you call the tower tower this is dr. flight with four patients taxi and takeoff instructions please doctor this is tower clear to runway 17 altimeter 29.92 wind south southeast at 15 Roger tower and out so you swing out to the taxiway your flight strung out behind you in single file up ahead you see a leader and his wingman rushing down the runway in the twin snorting tail-up charge lifting eagerly into the air then climbing sharply away and beautifully paired precision suddenly there's silhouettes and you are ready for takeoff the glance at summers and he's right at your wing tip tower this is dr. are we clear to roll cleared for takeoff dr. you slowly open the throttle holding the brakes as hard as you can and release the brakes and feel a slam of power as you're banged back into your seat now you're rolling gradually picking up speed seeing summers out of the corner of your eye almost a breast of you off your wing then your controls take hold as the air speed indicator rises you pull back in the stick and your airborne you trim for a long straight climb and wait for your other two boys taking off 30 seconds behind you to join up 40,000 feet now heading north the four of you in a tight shiny V with you at the head you're approaching the bomb line a red jagged line on your map that separates you and forces from the commies so you contact the operational control center punch drunk this is dr. how do you read me over dr. that read you loud and clear over punch drunk this is dr. with four patients heading north over Roger dr. and now you've punched in for work and when you put in your time as long as your fuel punch out on the way home you look off your right wing tip at summers he's still in there close ahead big alley no man's land smack in the middle of it 40,000 feet big altitude below the broad mouth of the Yalu River empties into the yellow sea far off on the horizon across the river is on tune the migs biggest nest time to call into the control ship blackjack this is dr. how do you read me over dr. blackjack am on station at angels 40 standing by over Roger dr. standing by waiting for makes waiting for blackjack to tell you radars picked up make bandits heading your way staring into the sky waiting for one telltale gleam of silver knowing their radars picked you up by now and the fighter bombers who are now winging into plastic kawanko waiting doctor this is blackjack over go ahead blackjack enemy aircraft departing station Roger blackjack and out so you call your boys dr. flight they're on their way keep your eyes peeled they'll be above us Roger dr. Roger dr. five minutes later or is it five seconds later dr. this is blackjack bandits three o'clock high three o'clock high Roger blackjack radar tells blackjack which way you're pointed and that the migs are above you to your right but radar can't get in the cockpit and spot them for you so you have to eyeball it yourself eight pairs of eyes are riveted on three o'clock high when three o'clock very high eight of them doctor blackjack we have bandits inside out turn into them dr. flight here we go fly boy turning now stick close doctor this is blackjack more enemy aircraft departing station you are listening to the proudly beheld production the old pro will return in just a moment for the second act college men you can learn to fly the latest and fastest jets easily and safely as an air force aviation cadets aviation cadets get 18 months of tough concentrated jet training leading to a lieutenants commission in the air force and earnings of more than five thousand dollars a year your future is unlimited to qualify you must be between the ages of 19 and 26 and a half single and have at least two years of college visit your local United States Army and United States Air Force Recruiting Station now you are listening to proudly we hail and now we present the second act of the old pro this is it a dog fight not a one-pass brush with the reds running for cover but a big old hairy dog fight your formation meshes with theirs closing at 1,000 miles per hour and you answer the red-winking cannons from their noses with your fifties then suddenly you're through their formation turning sharply to avoid a collision twisting to get another bandit in your sights for a split second then rocking your ship around in a seat have a stomach pulling turn ready for the next pass deal with you doctor let's go get them doctor three where are you bandit nine o'clock busy over here doctor can't rejoin you doctor this is blackjack enemy aircraft departing today now the sky is full of twisting turning rolling screaming hammering planes yours and theirs could be every man for himself but summers hangs on to you moon wolf below dr. shall we negative bandits coming in at six diving with you let these new boys make their past and we'll go help tiner read me Roger doctor here we go and this new flight of migs barrels in another eight sleek cannon platforms pouring hot embers at you as you turn sharply into them and then you break tiner where are you have him in sight doctor three o'clock low alone doctor three get on up here fast looking for four he's gone doctor he's got trouble on his tail two of them breaking down fast to help him stick summers with you all right over on your back and down there stay in the sights big boy you've got him doctor oh thanks doctor joining you hurry it up doctor have you inside joining you when you've been wing man shaking off a bandit then clobbering got yourself a big me lucky back off the chatter here they come again coming in on your tail doctor turning into him turning with you wow and as the firing make flashes past you turn to look at summers who've been protecting your tail and time to see another make pulling up in a steep recovery from a run a firing pass that ripped off half of summer's wing summers how bad is it can't you see I only got half a right wing can you stay with it not very long buddy you okay can you jump all right trimmer up the best you can and point south while I check my map Roger doctor I've already got as much left rudder as I can hold a compensate for the wing keep your head swiveling in your eyes open your easy meet to these migs now buddy Roger Roger Roger as far as I can figure we're not too far from the bomb line you stay up till we get over our lines losing altitude steadily but I think I can have other ideas I'll run you interference boy you got enough fuel to stick with me toxin fuel fat with it don't kid me my fuel counter say you want to return the base I can handle myself look you got a wingman now to keep the big bad migs from picking on you company ready three o'clock high toxin man you jerk your head up in there they are for slim migs jockeying for position to start their runs this should be cold meat for them one limping saber with only you to protect him summers can you turn into them when they make their runs negative you'll spend well then hold your course I'll do the turning cardinal rule for fighter pilots always turn into your attacker don't let him get on your tail but summers can't turn so it's up to you you have to always be between summers and the migs and turn into each pass they make the hair on the back of your neck bristles but suddenly you know what it is to be target and then it starts summer's dives you turn into the first big meeting him head-on for a breathless instant you face each other his nose winking brightly as he lobs cannon shells out to your 50s pouring into any flashes over you big and ugly but now is lagging wingman flits into your gun sight for only a moment and you fire a burst turning sharply deleted and pieces of metal spray from his plane before he's gone which have no time for relation as you scream in a tight whistling turn into the next big and the next firing when they flash through your gun sight swiveling your head frantically trying desperately to keep those four migs off summers and off your tail and then a mix stands big and fat in your sight thinking he's got a clear shot at summers not knowing you're on his tail so you pour your 50s into him it against smoking and then a brilliant blast scanners him all over the sky you pull up into his wingman and fire again while on your back in a roaring turn suddenly it's all over there isn't another plane in the sky except summers down below they gone summers yeah see any good down so you join up on summers again feeling like you've just gone ten rounds against a team of Dempsey's your glove palms wet pools of hate and fear icy sweats stinging your eyes clamming the flight suit against your heaving sides your mouth tasting of pennies you're completely whipped and you're still hundreds of miles from home yeah looks like no sweat I told you look summers worth 12,000 now you get the 5,000 make a slight bank and bail out but fast you know maybe I could take this baby in with half a wing gone you'd clobber yourself could be done you bail out boy once you down safely I'll call a helicopter for you 5,000 you ready okay out you go aim for that clearing Roger see you around campus buddy punch drunk this is Dr. Leader four entered one returning two already returned that right doctor repeat two already returned is that correct affirmative punch drunk have a man down south of bomb line can you get a helicopter to him Roger doctor have a chopper in vicinity what are your coordinates let me see oboe Baker 59 18 got it oboe Baker 59 18 Roger doctor returning the pigeon now punch drunk Roger doctor and out returning out of base if you're lucky your fuel counter shows you couldn't fly more than five minutes and you've got several hundred miles to go so what do you do you make a decision it'll be tricky maybe first climb up to where you don't eat fuel up so fast climb 40,000 feet now a little faster rate of fuel consumption distance to travel a lot of fuel left altitude and the answer always comes out the same not enough fuel if you want to have power to land with you've got to do without power now more arithmetic and here's an answer you like without power you can glide maybe a hundred miles then start your engine and land with power simple well it might be done so you cut your switch the quiet is eerie you pop your stick forward slightly pushing the nose down now you're committed to the arithmetic that your life is dependent upon somewhere off on the horizon as you feel you're high now but your ultimate a hand is turning counterclockwise relentlessly as you steadily lose altitude in your desperate glide and then suddenly too suddenly you're at 8,000 feet time for an air start now or never you flip your air start switch and the engine sings you check your instruments then cut in your fuel the spark is there with a fire now now now before you lose any more altitude and it does catch slamming your back in your seat with its sudden power you climb again to serve fuel the head you can see the field but in your cockpit the fuel counter says you only have 10 gallons barely enough for a landing tower this is doctor emergency low on fuel request straight in approach over cleared for straight in landing runway 1 7 over 10 miles from touchdown now it's going to be close Roger doctor we're standing by you better clear the mayday tower may day I'm dry engine just cut out Roger tower pretty as dead stick I ever saw state Jeff I was sure I undershot it skillful execution as the old man would say I still say one dead stick landing one too many big day for you buddy you know successful air start and dead stick landing two minks and a probable it looks like I'm not the only one to nail a make I never saw a mess all so happy have a big day for everyone the squadron the group the wing the fighter bomber boys plastered that field and we took care of the mix and unqualified success as the old man seen summer states no no no last last time I saw him you're sitting on a rock this side of the bomb line someone says he's back there he is bouncing into the mess hold on I thought I told you to stay on my wing you beat up major you how'd you get back trust tf-86 this beautiful glide ratio yeah well you know that helicopter you got just delivered me those choppers aren't bad considering they got no way last time I saw you boy you were missing half a way hey boys boys let me clue you about the major wasn't for him I wouldn't be here shot down too big mix he did and chase the others away that were picking on poor little defenseless me as he did and he knew all the time he didn't have the fuel to afford to stay with me when I tell a wingman to stick with me I see that he sticks oh that's the ungarbled word sure couple are really lucky boy oh you know with our luck summers we ought to find ourselves a poker game I'm with your buddy all the way hey what is this I thought you didn't like the major yeah you and Stacey had no use for each other are you kidding Stacey's my buddy that's a straight poop why he's an old pro young man if you had two years of college are single and otherwise qualified there's a future for you as an aviation cadet in the US Air Force you'll receive 18 months of the world's finest flight training fly the latest jets easily and safely and graduate as an Air Force lieutenant with earnings of more than $5,000 a year the aviation cadets of today will be the leaders of the jet age be one of them visit your nearest United States Army and United States Air Force recruiting station today this has been another program on proudly we hail presented transcribed in cooperation with the station proudly we hail is produced by the recruiting publicity center for the United States Army and United States Air Force recruiting service this is Kenneth Banghart speaking and inviting you to tune in the same station next week for another interesting story on proudly we hail


Hi everyone, this is Sarah from System Dynamics and today I want to share with you some do's and don'ts for crafting your online presence. It is undeniably true that the internet has revolutionized the way we communicate, interact and do business. So it's important that you are staying up to date with the latest business strategies including online marketing. A solid foundation to online marketing is an effective online presence, which is what I'll be helping you with today, so let's get started. Online marketing can sometimes feel like shouting into the void, but an easy way to combat that feeling is to nail down your target audience. Once you figure out who it is you're trying to reach, do some research to find out what interests your audience and content that they may want to see from you. Consider your customers' needs, wants and pain points to create a content strategy that speaks to them. Knowing how to communicate your services to your potential clients can help increase your visibility and sales. When designing your website, email blasts, or any other communications that may be going out to potential customers, keep it simple. Of course you want your online presence to look great, but keeping everything user-friendly is even more important. You can have the prettiest website on the internet, but if a potential customer can't figure out how to use it, it's useless. This also applies to your text or copy. Avoid using too much industry jargon, potential clients may not always be aware of industry specific terms, so it's best to keep your content simple and accessible. Ease and efficiency should always be the most important thing when it comes to designing your online communication. From profile pictures to social media handles, your online presence and brand identity should always be consistent. Brand identity is an essential part of any successful business or organization. It is the combination of visuals, content and messaging that together create a cohesive and distinctive representation of you or your company. It's what makes customers recognize and remember you instantly. A unified brand identity can help create a greater sense of credibility and transparency, as well as make it easier for potential customers to find information about your business through both search engines and social media. Curating your brand identity is a feat in and of itself, and honestly warrants its own video. We are always working on more videos like this to help you boost your brand and your business. If you're interested in learning more about how to succeed online, be sure to subscribe to System Dynamics. Social media is an inherently authentic platform, so taking the easy way out when it comes to content and engagement can be detrimental to your online presence. Avoid buying followers or likes. Most social media platforms have a built-in algorithm that looks for spam or spam-like behavior, so buying followers and likes may get you flagged. This applies to plagiarizing content as well. Copyright policies on most social media sites are really strict, and breaking those rules could result in suspension or termination of your account, so make sure your content is authentic to you to optimize your success. Measuring your success online is vital to the growth of your online presence. You should monitor the engagement metrics of both your website and your social media accounts. Some of the important metrics to look out for are going to be the reach of your posts, how long people are engaging with your content, and any feedback that you receive, whether through reviews or in the comments section. Social media can be a bit of a trial and error, so knowing the performance metrics of your online presence will help you adjust your strategies and improve your conversion rates and visibility. Let's recap. In order to ensure your online presence is effective, you need to understand your audience, develop a consistent brand identity, and measure your success. You also need to avoid over-complicating your websites and social media platforms and create content that is authentic and belongs to you. Those are all the tips I have for you today, but if you learned something, make sure you give us a like and drop a comment down below. To stay up to date on our latest videos, be sure to subscribe to our channel. See you next time.