Medical

The Occupy Boston Health Team (formerly known as the "Medic Team") brings together a diversity of skillsets and services to provide care to Occupiers at by our Health Tent in Dewey Square and on Occupy Boston marches and rallies. We embrace and are composed of volunteers with training in first aid, EMS, hospital and clinic medicine, complementary therapies (massage, reiki, acupuncture, etc), mental healthcare, social work, and public health.

= Donations & Supply Requests =

We post updated donation requests on Twitter: @OccupyBos_Medic

You might notice that there aren't that many requests. That's true! We've been overwhelmed with generosity! Thanks y'all!!

Donations we DO NOT accept
[to be expanded]


 * prescription medication and controlled substances (including asthma inhalers)
 * items containing ingestible alcohol (including mouth wash and over-the-counter cold medicine)
 * hypodermic needles
 * injectable medication(s)

= Contact Info =

You can reach the Occupy Boston Health Team at our Health Tent (marked by a big red cross flag) or via e-mail at occupybosmedic@gmail.com

Are you working with a Health or Medic Team at another Occupation? We'd love to talk to you about our experiences organizing our health tent and hear your stories, suggestions, and problem-solving. Email occupybosmedic@gmail.com and we can get back to you by phone or e-mail.

Are you repping some kind of media? Please *don't* contact us by e-mail. We are organized horizontally and without 'representatives' so no person can speak for the entire health team except for the few policies which we have collectively consensed upon (listed below). Some medics do agree to do interviews, but they do so as individuals and speak from their own beliefs, experience, and individual perspective, not as representative of the Health Team.

How to Volunteer
We ask all volunteers to have at least a recent Red Cross (or equivalent) First Aid/CPR certification or a competency in mental health, social work, complementary therapies, or public health.

While we do occasionally offer extended first aid trainings, we ask that you not volunteer with us until after you've received one. Trainings open to non-medics will be announced on the Occupy Boston calendar. You can also take a class with the Red Cross.

To volunteer, please e-mail 'occupybosmedic@gmail.com 'with you name, contact info, and an explanation of you experience and skillset.

= How we organize ourselves =

This is a short guide to how the Health Team works, put here for transparency within Occupy Boston and as a resource for other Occupy health teams. It's just a summary-- when you volunteer with us, we'll get you all the details so you can plug in!

E-mail L istserves
We have a main Health Team listserve + a few working groups have their own lists. We use e-mail listserves for lots of stuff, including:


 * Nearly nightly health tent scheduling e-mails
 * Announcements (trainings, clinics, etc.)
 * Problem-solving, debating, and hashing out policies and protocols before our weekly meetings
 * Sharing useful resources

Meetings
Weekly, off-site team meetings to debrief, discuss protocols, bring up issues, crises, and kudos.

Liaisons Group
A group of medics acts as the "Liaisons Group," handling administrative tasks like scheduling, supply requests and refills, answering the group e-mail address, and interacting with other Occupy Boston working groups.

Logbook
We keep a paper logbook in the Health Tent to pass on important information between medics over time. See "logbook protocols" below for more information on how we strive to maintain patient privacy.

Technology
We use a radio to communicate with the Safety Team at Dewey, and a trackphone that is kept at the Health Tent at all times for medics to communicate with whoever's at the Tent.

Trainings
We try to hold both internal trainings to share skills amongst ourselves as well as workshops on first aid, mediation, and emotional skills for Occupy Boston.

We urge all Occupy Boston health workers to learn "street medic" skills. "Street Medics" are protest medics with specific protocols, tactics, and ethics developed over decades of practice, debate, and creativity at protests in the US and abroad. We try to hold regular bridge trainings for health professionals (2-4 hours) as well as some more in depth street/clinic first aid trainings for lay people (6-20 hours) to learn first aid skills. Check out Medic Wiki for more on street medics and street medic protocols.

The Health Tent
We are currently running a health tent at Dewey Square which is staffed 24-hours and also a DIY First Aid table filled with stuff like cough drops, safer sex supplies, and bandaids.

Health Tent staffing goals:


 * We strive to have two medics 'on duty' staffing the Health Tent at all times for each other's safety, to be able to treat multiple patients, and to be able to leave the tent to do rounds.
 * Our ideal pair includes someone with a higher level of medical training (WFR, EMT, RN, etc.) and someone with mental healthcare skills

Scheduling
We use two calendars to schedule shifts (usually 4 hours or 8-hour overnights). One is a paper calendar in the Health Tent for medics on-site to know who is on-duty, and the other is online, using an internet calendar service that is updated by a liaison. We try to sync the online google calendar and the paper calendar in the tent every day.

On shift
On Health Tent shifts, be sure to:


 * Pass on the phone, radio, and pertinent patient information (including expected follow-up needs) to the next medic
 * Fill in the logbook (see logbook protocol below and on the logbook cover]
 * Request supply refills from our off-site overstock location from the Supply Liaison
 * Put donations in the overflow plastic bins to go to storage at our off-site overstock location
 * Organize and label the hell out of everything. Goal: anyone can find anything.

Marches & Demonstrations
We invite first aid folks, especially those with Street Medic training, to check out the Occupy Boston calendar for march details and come by with a packed first aid kit.

= Health Team Protocols & Policies =

The following Protocols and Policies have been consensed on by the Health Team at our weekly meetings. All decisions are welcomed to be revisited, edited, and changed as needed through consensus process at meetings, or in the case of smaller decisions, over e-mail.

Health Tent Standards of Care
General guidelines for all Occupy Boston Medics:


 * Wear gloves

Regardless of whether you are dealing with or expect to deal with bodily fluids


 * Ask for consent from the person seeking care

We respect the rights of people to make decisions for their own bodies and treatment.


 * Stay within your Scope of Practice

Do not provide treatment outside of or above what you are trained to do. Get help: refer the patient elsewhere or call for an Occupy Boston medic with more training.


 * Follow “Do No Harm” protocols

Restrict your treatment to practices with effects that can only be neutral or helpful to patients given your training and experience. Remember we are a phone call from 911. See Medic Wikifor more information and examples.

Health Tent Intake and Assessment Protocol
Guidelines for all care at the Occupy Boston Health Tent:


 * Introduce yourself and identify your skill level to the person seeking care

My name is X and I am an EMT/RN/First Aid certified/Social Worker, etc.


 * Ask for consent

“Is it ok if I treat you?”


 * Ask open-ended questions to figure out what the issue is, how the person seeking care would like to treat the issue, and if there are underlying or hidden issues at play:
 * “What’s your name?”
 * “How would you like me to refer to you (name, gender pronoun)?”
 * “What’s going on?”
 * “Tell me what happened”
 * “Has this happened before?”
 * “How do you treat it usually?”
 * “Is there anything else we should know about you before we treat you?” (pre-existing condition; recent substance use; support system; fears or anxiety)
 * “Have you eaten, drank, slept, kept warm, gone to the bathroom in the past 12 hours?”
 * “What’s been going on for you in the last 24 hours?”
 * “Do you have any allergies? Are you allergic to any medications?”


 * Explain treatment options and ask them what they prefer.

Again, ask for consent if you plan to treat them (think about referrals and your own level of training; ask for help if needed)


 * If they consent, provide treatment
 * Fill in the log book

Intake and Assessment Protocol for Mini-visits
When people are just popping in for a medication, band aid, cough drop, still be sure to ask:


 * “Are you allergic to any medications?”
 * “Have you taken this medication recently? When and how much?”
 * If necessary, educate the person seeking care about dose and possible side effects of the medication

Health Tent Logbook Protocol
All logbook entries should follow this format:


 * Patient identifiers:
 * First initial of patient*
 * age (optional)
 * gender (optional)
 * Condition that was treated
 * Type of treatment provided
 * Notes/concerns
 * Need for follow up
 * Name of person who provided care and their phone number.


 * Avoid using specific identifying information for patients (don’t use full name or specific descriptions)

THE LOGBOOK MUST REMAIN IN THE MEDIC TENT AT ALL TIMES Explanation: The goal is to ensure both patient privacy to the highest degree while still allowing future medics to have the information necessary to treat returning patients.

Health Team Neutrality Guidelines

 * On marches, medics marked with a red cross will act "tactically neutral"

They will support the march by their presence but refrain from engaging in the tactics of the march (like chanting or carrying banners). If you are 'on duty' (i.e. wearing medic markings), you are a medic first. Feel free to carry first aid supplies without identifying yourself as a medic if you want to be ready to help but also engage in the protest.


 * Get consent before engaging in political, emotional, and counseling-type discussions amongst medics, and refrain from doing so while patients are present

Respect each others' diverse viewpoints, stress levels, and desires by asking before plowing into any charged discussions while 'on duty' (in the Health Tent, running as a marked medic). Keep this stuff just between medics, so as not to alienate folks seeking care (again, only applies while 'on duty').


 * Political signs/clothes/etc: While 'on duty' (marked as a medic, in the Health Tent), be conscientious of the impact these may have on folks seeking care

Dress and act in ways that are approachable and do not exclude people from care. We respect that this is a political event and many of us are here for specific political reasons. Use your judgment.

Health Tent Media Policy

 * No media of patients (even with their consent) or care
 * No media inside the tent; keep the area outside the tent relatively clear & accessible
 * To interview an offduty medic, get consent and do it in a different location

Explanation:

The purpose of the media policy is to ensure the Health Tent space is kept clear and accessible for patients and care. Even if everyone currently at the tent consents to media, we do not know who is choosing to stay away because of media's presence. In an emergency, extra bodies and equipment add distraction, crowding, and invasion of privacy-- best to keep them away entirely. Note this policy does NOT interfere with medics/health folks giving interviews, but do it only while someone else can cover the tent, and do it in a different location.

Scope/purpose of the Accountability Process
How do we take responsibility for our role as caregivers and ensure we hold each other accountable for the safety and wellbeing of each other and the Occupiers who look to us for care? How do we address Health Team members who act in a way that we feel endangers a patient, another medic, or the movement via a gross violation of our consensed upon protocols or basic medical ethics? How do we do handle this behavior in a way that affirms the humanity of the person who acted this way but is still efficient, firm, and fast enough for safety?

Unacceptable Behavior
We identified 4 types of behavior that we feel are egregious, unacceptable behavior for the Health Team that automatically trigger the accountability process described below. Other behavior may still merit some form of follow up or accountability, from a private conversation to a full accountability process (described below), but these 4 MUST be responded to and addressed.

These acts automatically trigger the accountability process:

1. Being intoxicated while on duty as an Occupy Boston healthcare provider

2. Bringing illegal substances to the Health Tent

3. Doing harm to patients and/or committing a major violation of one's scope of practice

4. Violence or sexual harassment towards patients or medics

Please understand that each of these 4 behaviors were discussed at length, and we understand that there can be nuances and extenuating circumstances. That's why the Accountability Process is designed to facilitate discussion and thoughtfulness. What triggers that process should be broad and vague enough for fellow Health Team members to exercise their judgement-- start the process if you are uncomfortable!

Accountability Process
Flow chart form. "You" witness the incident. "The medic" commits the incident.

1. You WITNESS an incident.

"Incidents" include the 4 behaviors above, as well as any acts in violation of our Health Team protocols (http://wiki.occupyboston.org/wiki/Medical) or basic medical ethics. It can also include any behavior that seriously concerns you.

2. If you are comfortable and able, directly speak to the medic to STOP the behavior.

If serious enough, ask the medic to LEAVE the Health Tent.

''You are always empowered to ask someone to leave the Health Tent if you personally are uncomfortable with their presence there. If they refuse to leave, try to get help; if you feel unsafe, remember that you can also leave the space.''

3. Discuss the incident with another Health Team member and get FEEDBACK.

A) Minor incidents: If you both agree the incident was minor, and it did not violate the 4 Unnacceptable Behaviors listed above, feel empowered to decide on an alternative way to address the incident, like speaking to the medic privately. THE PROCESS ENDS HERE.

B) Major incidents: If you both agree the incident was a major problem and/or it violated the 4 Unacceptable Behaviors listed above, THE MEDIC IS AUTOMATICALLY NO LONGER WELCOME IN THE HEALTH TENT AND AS A MEMBER OF THE HEALTH TEAM. The Accountability process will proceed to decide if the medic will be welcomed back.

C) Disagreements: If you and the person you speak to do not agree, THE ACCOUNTABILITY PROCESS PROCEEDS though the medic remains a part of the health team; the process may ask them to leave later.

''You are always empowered to ask someone to leave the Health Tent if you personally are uncomfortable with their presence there. If they refuse to leave, try to get help; if you feel unsafe, remember that you can also leave the space.''

4. You (or someone you ask to do this) ANNOUNCE AN ACCOUNTABILITY MEETING

In the e-mail...

- NAME the medic (so others with concerns or support know they should come)

- DO NOT DESCRIBE THE INCIDENT (all descriptions of incidents should remain OFFLINE. repeat: do not write this stuff in an e-mail!!!)

- STATE A TIME AND PLACE for the meeting

5. Accountability Meeting

A. WHO? The following people must be present:

- The medic in question

- An outside mediator (like from the Occupy Boston mediation team; must be mutually agreed upon)

- At least 3 other Health Team members

- Goal: at least one person with Mental Healthcare skills

B. WHAT? At this meeting...:

- Folks talk about the specific incidents and behaviors in question

- Folks bring up mitigating circumstances

- Folks discuss and consent upon (NOT) WELCOMING THE MEDIC BACK to the Health Team if the incident was major

(or some other requests/demands/sanctions for the medic if the incident was minor)

C. WHY? how come we default to not welcoming someone, and then vote them back in instead of voting to kick them out

- This process errs on the side of safety. It prevents a medic's best friend from blocking their expulsion (technically it prevents the medic from blocking their own expulsion). If means that if someone blocks a consensus vote to welcome the medic back, the blocker is literally saying "i will leave the team if so-and-so is welcomed back" (this is the meaning/seriousness of a block), thereby reducing the likelihood that just one lone grudge will prevent someone from being welcomed back.

- Voting someone in is a positive process and therefore avoids the socially awkward pressure some may have not to kick someone out.

6. COMMUNICATE the results (positive or negative) of the meeting via e-mail and at the next Sunday meeting

- Remember, DO NOT DESCRIBE THE INCIDENT on the internet. Just say who it was and the results of the meeting.

7. Health Team members are welcome to REVISIT these decisions at any Sunday meeting

allowing those who couldn't be present at the Accountability Meeting to have input later.

= Resources for Health Team Members =

[links, handouts, referals, etc etc... more coming soon!]

"How-to" guides for medics at protests:


 * Medic Wiki- invaluable resource for street medics including protocols, injury aftercare, and some history of the protest medic movement
 * Medics 4 Tahrir - downloadable "how-to" guides in English, French, and Arabic, collected and translated for the Arab Spring uprisings. Consider contributing a translation if you are able.
 * Northeast School of Botanical Medicine (herbal medicine) - Herbal first aid guides from a teacher and practitioner of herbalism, and experienced protest medic
 * StreetMed - Under construction, but will become a good resource for medics at many kinds of political actions (street protests, wilderness campaigns, etc.)

How to treat trench foot: 1 and 2

= Resources for All Occupy Boston Participants =

[links, handouts, referrals, etc etc... more coming soon!]

Staying Healthy and Safe at Protests
The City of Boston Public Health Department (!) created a Tip Sheet for Occupiers (pdf).

Medic Wiki is an incredible in-depth resource for protest first aid and healthcare. Some specific pages of interest to Occupy Boston protesters include:


 * Health and Safety guide for protesters
 * Health and safety at arrestable actions
 * Documenting injuries (after police brutality)
 * Injury care and prevention
 * hypothermia (if you get too cold)
 * sexual assault(this guide includes how to be a good active listener, and is useful for many different kinds of emotional crises)
 * Injury Aftercare - Self-care instructions for follow-up treatment of common injuries from protests, including:
 * blisters
 * coughs
 * emotional stress
 * chemical weapons like pepper spray or tear gas
 * handcuff injuries (see this in-depth guide also)
 * wounds
 * sprains
 * head injuries
 * Role and Ethics of "street medics," medics who provide care at protests

The BALM Squad (Boston-Area Liberation Medics) website, though no longer updated, is a great resource for handouts on protest safety, emotional care, links, and other resources.

"Excited Delirium: A Protester's Guide to 'Less Lethal' Police Weaponry" is a zine explaining some common (and not so common) police weapons like pepper sprays and tazers, as well as some information on protecting yourself.

Anti-Oppression Resources
Resources to learn anti-oppression skills:


 * Notes from an Occupy Boston Anti-Oppression training

Thoughtful critique of privilege and oppression within the Occupy movement:


 * Occupy the Hood - Articles about community speakouts and anti-police brutality events connecting income inequality to racism in Boston
 * DisOccupy- Collection of criticisms of race in Occupations around the US
 * Racialicious- This very active blog on the intersection of race and pop culture ran a series looking into race in the Occupy movements (see in particular "So Real It Hurts: Notes on Occupy Wall Street")

Referrals
The Health Tent, while totally awesome, is simply a first aid space for minor medical and mental healthcare, as well as a triage space for larger emergencies. Here are a few other sources of healthcare in Boston you may want to check out:


 * Sidney Borum Clinic - 130 Boylston Street - Provides "quality, open care to young adults ages 12–29 who need a health center that really gets them," with specialties in respectfully providing care to LGBTQ and homeless youth
 * Fenway Health - many locations - Provides complete care to anyone, but with specialties in LGBTQ and low-income people, including help applying for MassHealth, free or cheap STI testing, and low-cost or free dental care