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CEN learner - Certified Emergency Nurse Updated: 2023

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CEN Certified Emergency Nurse

The CEN test is for nurses in the emergency department setting who want to demonstrate their expertise, knowledge and versatility in emergency nursing.

Killexams is the only source for emergency nursing professionals and their employers to obtain recognized certification with proven results for greater knowledge and performance. Enhance your knowledge, your career, and patient care with specialty certification in emergency nursing.

One of the more common questions we get from our customers is about the difference between a certification and a certificate. Here is the difference in a nutshell:

A certificate comes from an educational program where a certificate is awarded after the individual successfully completes the offering. Examples of certificates are Advanced Cardiac Life Support (ACLS) or Trauma Nursing Core Course (TNCC).

A certification, like the Certified Emergency Nurse (CEN) is an earned credential that demonstrates the individuals specialized knowledge and skills. Certification is awarded by a third-party organization, such as Board of Certification for Emergency Nursing. Individuals receive their certification after meeting strict eligibility requirements and successfully completing the required examination. In addition, certifications have ongoing requirements that must be meant to maintain the credential, ensuring the holder has maintained their level of expertise in the specialty area. Certifications are nationally recognized and are often utilized as part of the earners signature.

Earning professional certifications such as the CEN, CPEN, CFRN, CTRN and TCRN offered by BCEN, and completing certificate programs such as ACLS, PALS, ENCP and TNCC, are critical to the work emergency nurses do, but there are significant differences.
1. Cardiovascular Emergencies 20
A. Acute coronary syndrome
B. Aneurysm/dissection
C. Cardiopulmonary arrest
D. Dysrhythmias
E. Endocarditis
F. Heart failure
G. Hypertension
H. Pericardial tamponade
I. Pericarditis
J. Peripheral vascular disease (e.g., arterial, venous)
K. Thromboembolic disease (e.g., deep vein thrombosis [DVT])
L. Trauma
M. Shock (cardiogenic and obstructive)
2. Respiratory Emergencies 16
A. Aspiration
B. Asthma
C. Chronic obstructive pulmonary disease (COPD)
D. Infections
E. Inhalation injuries
F. Obstruction
G. Pleural effusion
H. Pneumothorax
I. Pulmonary edema, noncardiac
J. Pulmonary embolus
K. Respiratory distress syndrome
L. Trauma
3. Neurological Emergencies 16
A. Alzheimer's disease/dementia
B. Chronic neurological disorders (e.g., multiple sclerosis, myasthenia gravis)
C. Guillain-Barré syndrome
D. Headache (e.g., temporal arteritis,migraine)
E. Increased intracranial pressure (ICP)
F. Meningitis
G. Seizure disorders
H. Shunt dysfunctions
I. Spinal cord injuries, including neurogenic shock
J. Stroke (ischemic or hemorrhagic)
K. Transient ischemic attack (TIA)
L. Trauma
4. Gastrointestinal, Genitourinary, Gynecology, and Obstetrical Emergencies 21
A. Gastrointestinal
1. Acute abdomen (e.g., peritonitis, appendicitis)
2. Bleeding
3. Cholecystitis
4. Cirrhosis
5. Diverticulitis
6. Esophageal varices
7. Esophagitis
8. Foreign bodies
9. Gastritis
10. Gastroenteritis
11. Hepatitis
12. Hernia
13. Inflammatory bowel disease
14. Intussusception
15. Obstructions
16. Pancreatitis
17. Trauma
18. Ulcers
B. Genitourinary
1. Foreign bodies
2. Infection (e.g., urinary tract infection, pyelonephritis, epididymitis, orchiitis, STDs)
3. Priapism
4. Renal calculi
5. Testicular torsion
6. Trauma
7. Urinary retention
C. Gynecology
1. Bleeding/dysfunction (vaginal)
2. Foreign bodies
3. Hemorrhage
4. Infection (e.g., discharge, pelvic inflammatory disease, STDs)
5. Ovarian cyst
6. Sexual assault/battery
7. Trauma
D. Obstetrical
1. Abruptio placenta
2. Ectopic pregnancy
3. Emergent delivery
4. Hemorrhage (e.g., postpartum bleeding)
5. Hyperemesis gravidarum
6. Neonatal resuscitation
7. Placenta previa
8. Postpartum infection
9. Preeclampsia, eclampsia, HELLP syndrome
10. Preterm labor
11. Threatened/spontaneous abortion
12. Trauma
5. Psychosocial and Medical Emergencies 25
A. Psychosocial
1. Abuse and neglect
2. Aggressive/violent behavior
3. Anxiety/panic
4. Bipolar disorder
5. Depression
6. Homicidal ideation
7. Psychosis
8. Situational crisis (e.g., job loss, relationship issues, unexpected death)
9. Suicidal ideation
B. Medical
1. Allergic reactions and anaphylaxis
2. Blood dyscrasias
a. Hemophilia
b. Other coagulopathies (e.g., anticoagulant medications, thrombocytopenia)
c. Leukemia
d. Sickle cell crisis
3. Disseminated intravascular coagulation (DIC)
4. Electrolyte/fluid imbalance
5. Endocrine conditions:
a. Adrenal
b. Glucose related conditions
c. Thyroid
6. Fever
7. Immunocompromise (e.g., HIV/AIDS, patients receiving chemotherapy)
8. Renal failure
9. Sepsis and septic shock
6. Maxillofacial, Ocular, Orthopedic and Wound Emergencies 21
A. Maxillofacial
1. Abscess (i.e., peritonsillar)
2. Dental conditions
3. Epistaxis
4. Facial nerve disorders (e.g., Bells palsy, trigeminal neuralgia)
5. Foreign bodies
6. Infections (e.g., Ludwig'sangina, otitis, sinusitis, mastoiditis)
7. Acute vestibular dysfunction (e.g., labrinthitis, Ménière's disease)
8. Ruptured tympanic membrane
9. Temporomandibular joint (TMJ) dislocation
10. Trauma
B. Ocular
1. Abrasions
2. Burns
3. Foreign bodies
4. Glaucoma
5. Infections (e.g., conjunctivitis, iritis)
6. Retinal artery occlusion
7. Retinal detachment
8. Trauma (e.g., hyphema, laceration, globe rupture)
9. Ulcerations/keratitis
C. Orthopedic
1. Amputation
2. Compartment syndrome
3. Contusions
4. Costochondritis
5. Foreign bodies
6. Fractures/dislocations
7. Inflammatory conditions
8. Joint effusion
9. Low back pain
10. Osteomyelitis
11. Strains/sprains
12. Trauma (e.g., Achilles tendon rupture, blast injuries)
D. Wound
1. Abrasions
2. Avulsions
3. Foreign bodies
4. Infections
5. Injection injuries (e.g., grease gun, paintgun)
6. Lacerations
7. Missile injuries (e.g., guns, nail guns)

8. Pressure ulcers
9. Puncture wounds
10. Trauma (i.e., including degloving injuries)
7. Environment and Toxicology Emergencies, and Communicable Diseases 15
A. Environment
1. Burns
2. Chemical exposure (e.g., organophosphates, cleaning agents)
3. Electrical injuries
4. Envenomation emergencies (e.g., spiders, snakes, aquatic organisms)
5. Food poisoning
6. Parasite and fungal infestations (e.g., giardia, ringworm, scabies)
7. Radiation exposure
8. Submersion injury
9. Temperature-related emergencies (e.g., heat, cold, and systemic)
10. Vector borne illnesses:
a. Rabies
b. Tick-borne illness (e.g., Lyme disease, Rocky Mountain spotted fever)
B. Toxicology
1. Acids and alkalis
2. Carbon monoxide
3. Cyanide
4. Drug interactions (includingalternative therapies)
5. Overdose and ingestions
6. Substance abuse
7. Withdrawal syndrome
C. Communicable Diseases
1. C. Difficile
2. Childhood diseases (e.g., measles, mumps, pertussis, chicken pox,
3. Herpes zoster
4. Mononucleosis
5. Multi-drug resistant organisms (e.g., MRSA, VRE)
6. Tuberculosis

8. Professional Issues 16
A. Nurse
1. Critical Incident Stress Management
2. Ethical dilemmas
3. Evidence-based practice
4. Lifelong learning
5. Research
B. Patient
1. Discharge planning
2. End of life issues:
a. Organ and tissue donation
b. Advance directives
c. Family presence
d. Withholding, withdrawing, and palliative care
3. Forensic evidence collection
4. Pain management and procedural sedation
5. Patient safety
6. Patient satisfaction
7. Transfer and stabilization
8. Transitions of care
a. external handoffs
b. internal handoffs
c. patient boarding
d. shift reporting
9. cultural considerations (e.g., interpretive services, privacy, decision making)
C. System
1. Delegation of tasks to assistive personnel
2. Disaster management (i.e., preparedness, mitigation, response, and recovery)
3. Federal regulations (e.g., HIPAA, EMTALA)
4. Patient consent for treatment Performance improvement
6. Risk management
7. Symptom surveillance
a. recognizing symptom clusters
b. mandatory reporting of diseases
D. Triage
Certified Emergency Nurse
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Certified Emergency Nurse
Question: 1
An elderly female client presents to the ED with complaints of chest pain and a history of angina.
After the initial triage, what would be the next appropriate interventions?
A. cardiac monitor, oxygen, and sublingual nitroglycerin
B. cardiac monitor, sublingual nitroglycerin, and Foley catheter
C. cardiac monitor, IV, oxygen, and sublingual nitroglycerin
D. oxygen, sublingual nitroglycerin, and Foley catheter
Answer: C
Question: 2
A 7-year-old child is brought to the emergency department after multiple bee stings about 30
minutes previously. He complains of itching, swollen lips, and difficulty breathing. Wheezing
and stridor are heard. What is the most immediate treatment required?
A. epinephrine 0.1 mg intramuscularly
B. intravenous corticosteroid
C. intravenous antihistamine
D. broad-spectrum antibiotic
Answer: A
Question: 3
After an auto accident, x-rays of the patient's leg show a transverse fracture of the midfemur with
several bone fragments surrounding the fracture site. The skin of the leg is intact. This type
fracture is called:
A. compression fracture
B. comminuted fracture
C. avulsion fracture
D. open fracture
Answer: B
Question: 4
A cancer patient is seen in the emergency department with high fevers and malaise for 2 days.
She received chemotherapy about 10 days ago. Her physical test is not revealing but her
temperature is 103F A CBC shows a hemoglobin of 10 g/dL, WBC 4000 with 10% polys, 5%
bands, 70% lymphs, 10% monos, and 5% other white or unidentified cells. Platelets are
60,000/mm3. Which of the following is NOT immediately appropriate?
A. blood cultures from different sites
B. electrolytes, liver and renal function tests
C. eask if she has been receiving granulocyte colony-stimulating factor (G-CSF)
D. white blood cell transfusion
Answer: D
Question: 5
Which statement best describes acute respiratory distress syndrome (ARDS)?
A. ARDS is caused by trauma only.
B. ARDS is sudden, progressive, and severe.
C. ARDS is caused by an illness only.
D. ARDS never results in lung scarring.
Answer: B
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Medical Certified learner - BingNews Search results Medical Certified learner - BingNews Certified Medical Billing and Coding Specialist Training

Medical Insurance, Billing, and Coding learning course are essential to student success in all healthcare programs. This course introduces health insurance and reimbursement and familiarizes students with the health insurance industry, legal and regulatory issues, and differences in reimbursement methodologies. Students will learn about the principles of medical billing related to proper claim form preparation, submission, payment processing, and the follow-up process. The MBCC course is the second of the four courses taken for the Medical Billing and Coding Certificate.

This course prepares students for the NHA Certified Billing and Coding Specialist (CBCS) certification test and provides insurance training essentials, including:

Assigned Modules 60 hrs

  • Roles of an Insurance Billing Specialist
  • Privacy, Security, and HIPAA
  • Compliance, Fraud, and Abuse
  • Basics of Health Insurance
  • The Blue Plans, Private Insurance, and Managed Care Plans
  • Medicare
  • Medicaid and Other State Programs
  • Tricare and Veterans' Health Care
  • Workers' Compensation
  • Disability Income Insurance and Disability Benefit Programs
  • Medical Documentation and the Electronic Health Record
  • Diagnosis Coding - ICD-10CM
  • Procedural Coding -CPT/HCPCS Books
  • The Paper Claim CMS -1500
  • The Electronic Claim
  • Receiving Payments and Insurance Problem Solving
  • Collection Strategies
  • Ambulatory Surgery Center
  • Hospital Outpatient Billing

The MBCC course provides students with foundational knowledge for learning the essentials to gain proficiency using various medical coding systems. The ability to translate medical record documentation into the appropriate diagnosis and procedure’s universal alphanumeric codes and report them on the national medical claim forms for reimbursement. Students learn the skills to manage all phases of the health insurance revenue cycle for government and commercial payors, ensure accuracy and aid in the insurance claim payment process. Students learn employer sought problem-solving and customer services skills needed to work in a clinic, outpatient, and inpatient settings.

Tue, 01 Nov 2022 19:06:00 -0500 en text/html
RIT Certified

RIT Certified is expanding our institutional reach through a new portfolio of programs for a new audience of learners who are looking for non-credit training and development opportunities.

We will join together with companies to fill crucial skills gaps for employers, individuals, and the job economy as a whole. Our programs will emphasize user-centered learning, meeting individuals where they are. These offerings will be aligned with job growth, and will dynamically reflect industry changes in real time. RIT Certified learners will earn credentials that recognize the skills they’ve acquired, signaling clear value to employers.

Who is the target audience?

A new and growing audience of learners who are not in the market for graduate or undergraduate degrees. Some of our learners will want to sustain their current job, some are seeking a promotion and need to define what upward mobility could look like, some will want to advance their career in ways education hadn’t imagined when they were in school, and some will want to switch fields. Our programs will support and enable the multiple job and career transitions demanding the acquisition and demonstration of new skills throughout an individual’s life.

Tue, 03 May 2022 04:21:00 -0500 en text/html
Non-FMLA Medical Leave of Absence


This policy identifies the conditions under which eligible Professional Staff Members may take a medical leave of absence not covered under the Federal Family Medical Leave Act of 1993 (FMLA).


This policy applies to all benefit eligible Professional Staff Members, excluding any Professional Staff Members governed by language in their collective bargaining unit agreement.


Implementation of this policy is the responsibility of the Department of Human Resources in conjunction with the Designated Third-Party Administrator.


The Executive Vice President, Treasurer and Chief Operating Officer is the Drexel University official responsible for the administration of this policy.


  1. Professional Staff Members may request a Non-FMLA Medical Leave of Absence for up to 12 weeks of continuous leave in a rolling 12-month period for their own or a family member’s serious or chronic medical condition(s).
  2. Professional Staff Members may request a Medical Leave of Absence for up to 90 calendar days in a 12-month period for one or more of the following reasons:
    • a Professional Staff Member's own chronic health condition, including disability due to pregnancy and/or post-partum;
    • the birth and care of a Professional Staff Member's newborn child (leave must conclude within 12 months after birth);
    • the placement of an adopted son or daughter or a foster child with a Professional Staff Member (leave must conclude within 12 months after placement);
    • the care of a Professional Staff Member's immediate family member with a serious health condition;
  3. Non-FMLA Medical Leave is available only to Professional Staff Members that are not eligible for FMLA Leave.


Benefit Eligible refers to full-time or part-time Drexel University Online Professional Staff Members who are eligible to receive Drexel University Online paid benefits (e.g. medical coverage, leave accrual, etc.). Full-time Professional Staff Members are regularly scheduled to work 40 hours per week. Part-time Professional Staff Members are regularly scheduled to work at least 20 hours per week but less than 40.

Designated Third-Party Administrator is the Drexel-chosen provider for Non-FMLA Medical Leave administration.

Health Care Provider is defined as a doctor, podiatrist, dentist, clinical psychologist, optometrist, nurse practitioner, nurse midwife, clinical social worker, physician assistant, Christian Science practitioner or a chiropractor.

Professional Staff Member is defined as an individual employed in any non-faculty category by Drexel University, including an individual who is deemed to be either exempt or non-exempt under the provisions of the Fair Labor Standards Act (FLSA) and/or applicable state law.

Serious Health Condition is defined as an illness, injury or impairment, or physical or mental condition that involves either inpatient care or continuing care by a health-care provider. Continuing care can include:

  • a period of incapacity requiring absence of more than three calendar days that involves continuing treatment by a health care provider;
  • pregnancy and time needed for prenatal visits;
  • a chronic health condition, such as asthma or diabetes;
  • a long-term condition such as Alzheimer's; or
  • multiple treatments by a health care provider for a condition that likely would result in incapacity of more than three consecutive days if left untreated (such as physical therapy for a back injury).

Spouse refers to any individual who is lawfully married to an employee.


The Non-FMLA Medical Leave of Absence is administered by the Office of Human Resources in conjunction with the Designated Third-Party Administrator.

Request for Medical Leave of Absence

  1. Eligible Professional Staff Members may apply for Non-FMLA Medical Leave by contacting the Designated Third-Party Administrator to initiate their claim.
  2. Professional Staff Members seeking a Medical Leave of Absence are required to provide, at least 30 days prior, written notice of the proposed leave. When advance notice is not possible, such as in the event of a medical emergency, notice should be provided as soon as practicable. Failure to provide advance notice where foreseeable may delay or postpone the commencement of the leave.
  3. When an eligible Professional Staff Member contacts the Designated Third-Party Administrator to apply for a Medical Leave of Absence, the Administrator will request any necessary information and will also send the medical certification form to the Professional Staff Member for completion by their health care provider.
  4. Once a medical certification is requested by the Designated Third-Party Administrator, the Professional Staff Member must provide it within 15 business days. Failure to provide requested medical certification will result in denial of the request. Denied requests cannot be reopened for the same condition.
  5. Employee Notices

    1. If the request is approved, the Professional Staff Member must notify their immediate supervisor of the impending leave and the expected duration. However, the Professional Staff Member is not required to reveal or discuss the details of the medical condition. It is recommended that Professional Staff Members only discuss medical details with the professionals at the Designated Third-Party Administrator or a member of the Human Resources department.


    1. Medical certification from a health care provider will be required. Failure to provide such certification may result in a delay of the Professional Staff Member's leave.
    2. The medical certification must be provided within fifteen (15) calendar days of the Designated Third-Party Administrator's request. Drexel University Online reserves the right to require recertification of a medical condition every 30 days. When a Professional Staff Member learns of a change in the anticipated length of an approved leave, the Professional Staff Member must notify the Designated Third-Party Administrator within three (3) business days of learning of such a change.
    3. Drexel University Online reserves the right to obtain a second opinion by a certified health care provider at any time that is chosen by Drexel. Should the two opinions conflict, Drexel University Online may require that the Professional Staff Member obtain the opinion of a third health care provider paid for by Drexel. The third health care provider will be designated or approved jointly by Drexel and the Professional Staff Member. The decision of the third provider will be final. Failure to submit to a request for a second opinion or to attend the independent medical examination may result in a delay of approval or denial of the leave and/or revocation of currently approved leave.
    4. The Professional Staff Member is required to provide medical clearance from the treating healthcare provider stating that the Professional Staff Member is fit to return to work.

    Duration of Medical Leave

    1. Eligible Professional Staff Members may request up to 12 weeks of unpaid medical leave during any rolling 12-month period. The period from the previous twelve months will be examined and any Non-FMLA Medical Leave taken during the previous twelve-month period will be subtracted from the current 12 weeks of Non-FMLA Medical Leave entitlement. For example, if the Professional Staff Member requests a medical leave scheduled to start on October 1, 2020, the time period from September 30, 2020 back to October 1, 2019 would be examined. If the Professional Staff Member has not taken any Non-FMLA Medical Leave during the prior twelve months, they are entitled to up to 12 weeks of Non-FMLA Medical Leave. If the Professional Staff Member took 4 weeks of Non-FMLA Medical Leave during the prior 12 months they would be entitled to only 8 weeks more of leave.
    2. When both spouses are employed by Drexel University Online, they have the same rights and obligations under this policy as any other eligible Professional Staff Members. Each spouse is entitled to 12 weeks of Medical Leave for the birth and care of their newborn child, or for the care and placement with them of a child for adoption or foster care. Leave for the birth and care, or placement and care of a child must conclude within 12 months of the birth or placement of the child.
    3. While employees are on an approved Medical Leave, they are relieved of all work duties and are not required to perform any duties for the duration of their leave. There will be no punitive action taken against a Professional Staff member as a result of time taken under the Non-FMLA Medical Leave of Absence.

    Compensation for Professional Staff Members when using Paid Leave

    1. When a Professional Staff Member takes Non-FMLA Medical Leave they are required to use all of their available paid time during the Medical Leave before going into an unpaid status. The Professional Staff Member will be required to exhaust all available paid time in the following order: sick time, then vacation time, then personal time at the beginning of the leave.
    2. Professional Staff Members who have elected short-term disability will use their available sick, vacation and/or personal time to satisfy their elimination period in accordance with their short-term disability election. Should the Professional Staff Member exhaust their accrued sick, vacation and personal leave time, and there is no short- term disability election, the remainder of the leave, if any, will be unpaid.
    3. Paid time off will run concurrently with Non-FMLA Medical Leave time.
    4. Professional Staff Members who remain on Drexel University Online payroll while using their available sick, vacation and/or personal time will be considered in an “active pay status” and will continue to accrue sick and vacation time.
    5. Professional Staff Members who are not being paid by Drexel University Online (e.g., receiving short-term disability payments from the Designated Third-Party Administrator, or have exhausted their paid leave) are considered to be in an “inactive pay status” and accruals for sick and vacation time will cease.

    Benefits During Leave

    1. During the Non-FMLA Medical Leave, Drexel University Online will maintain the Professional Staff Member's health insurance with the same coverage that would have been provided if the Professional Staff Member had been continuously employed during the entire leave period. Drexel University Online and the Professional Staff Member will each continue to pay their portion of the benefit costs.M/li>
    2. If a Professional Staff Member goes into an unpaid pay status by exhausting available sick, vacation and/or personal time, Drexel University Online will recover the unpaid premiums from the Professional Staff Member when they are reinstated into active pay status.
    3. Drexel University Online may recover premiums from the Professional Staff Member paid to maintain health coverage for a Professional Staff Member who fails to return to work from a Medical Leave.
    4. Drexel University Online-paid life insurance, personal accident insurance, accidental death and dismemberment, and long- term disability insurance will continue in effect for the duration of the Medical Leave.
    5. A Professional Staff Member who was participating in a dependent-care or health-care reimbursement account may continue to participate in accordance with policy provisions. No contributions can be made while the Professional Staff Member is on any unpaid part of a Medical Leave.
    6. Retirement plan contributions will continue in accordance with the provisions specified in the respective retirement plan documents.

    Return from Leave

    1. Following the exhaustion 12 weeks of Non-FMLA Medical Leave, failure to return to work without communication from the Professional Staff Member to their immediate supervisor may be considered voluntary termination of employment.
    2. Professional Staff Members returning from the Medical Leave will be required to provide the Designated Third-Party Administrator medical clearance from their treating physician certifying their fitness to return to work, and are required to notify their immediate supervisor of their anticipated return date. Professional Staff Members who are unable to return to work at the end of the leave should notify Human Resources and their immediate supervisor as soon as possible.
    3. Use of the Medical Leave will not be counted against the Professional Staff Member as an "occurrence" under Drexel University Online Attendance Policy.


    Notwithstanding anything to the contrary stated in this policy, nothing herein is intended to alter the at-will status of any Professional Staff Member. Drexel University Online at all times retains the right to terminate any Professional Staff Member at any time for any lawful reason, or for no reason at all.

Sat, 11 Nov 2017 01:53:00 -0600 en text/html
North West learner, 19, arrested for stabbing another learner will have bail hearing next week

Johannesburg – The 19-year-old learner arrested by the North West police for stabbing another learner at the Rustenburg Bus Rank will be appearing in the Rustenburg Magistrate’s Court next for a formal bail application.

Blessing Dintle Tladi appeared briefly in thecourt earlier on Monday after he was arrested on Friday for fatally stabbing 18-year-old Lethabo Mojalefa Sibanda and injuring another learner following a squabble between the two groups.

Police spokesperson Captain Sam Tselanyane said Tladi appeared in court and was formally charged with murder and attempted murder.

Tselanyane said the matter was postponed to next Monday for a formal bail application to proceed.

According to the police, preliminary investigations revealed that the victim was stabbed with a sharp object in his throat.

According to bystanders, the victim, who comes from a high school in Rustenburg, allegedly fought with Tladi, who in turn recruited a group of other learners to attack the victim's group.

The two groups allegedly gathered at the bus rank, leading to a fight and the eventual stabbing of Sibanda, who was later certified dead at the scene.

Another learner, who was also stabbed, was transported to a local hospital by the Emergency Medical Rescue Services (EMRS).

North West Education spokesperson Mphata Molokwane said that the Education MEC had visited the deceased learner's family on Monday and that the department had already dispatched counselling support services to the school following the incident.

Tladi is expected to appear in court again on June 12.

The Star

Mon, 05 Jun 2023 05:00:00 -0500 en-ZA text/html
Is It Possible to Become Compulsive About Stress?

In the final episode of The Marvelous Mrs. Maisel, Midge Maisel a standup comic with a long and successful career, is meeting with her staff. She asks them: “Ok, what is on the schedule for next week?”

One of her staff answers, “Well, Monday you have a showcase, Wednesday you’re flying to Vegas, Thursday through Saturday you have a limited run at the Bellagio, Sunday you fly back.

“What about Tuesday, Midge asks?”

Gleefully, the staffer replies, “Tuesday you rest.”

Midge looks astonished, then clearly annoyed. In response, the entire staff looks frantically at their electronic devices, scrambling to find something for their boss to do. Clearly, Midge does not know what to do with herself when she is not busy or stressed. Surprisingly, she is not alone.

According to a 2015 study by the American Psychological Association, 24 percent of Americans experience extreme stress regularly, and stress levels have been steadily increasing over the last decade.

“Stress addiction isn’t a diagnosis,” according to Michael McGrath, M.D., a psychiatrist who is board certified in addiction medicine. It is not recognized in the current edition of the Diagnostic and Statistical Manual. However, it is still possible to develop a compulsion toward stress or stressful situations. Such behavior affects the networks of the brain’s risk-reward system. It’s a disorder involving a pattern of repetitive and compulsive actions that aren’t related to the use of a specific substance.

Stressful situations, like learning you have a serious medical diagnosis, preparing for a final exam, or giving a presentation to an auditorium full of strangers, have an effect on brain chemicals like cortisol and dopamine. Some people enjoy the feelings these hormones produce, particularly the dopamine effect. This increases the likelihood that the behavior will be repeated.

Why Is Dopamine So Special?

Source: Alice Vacca Adobe Shutterstock

Dopamine is a neurotransmitter. Made in your brain, it acts as a chemical messenger, communicating messages between nerve cells in your brain and the rest of your body. It plays a role in the brain’s “reward center as well as in many body functions, including memory, movement, motivation, mood, and attention. Abundant research has documented the important role that dopamine plays in promoting recurrent behavior.

For example, a study published in Science described research in an animal model that proved Thorndike’s law of effect. This law states that actions that lead to reinforcements tend to be repeated more often. Reinforcement relies on dopamine activity in an area of the brain that causes animals to shape their behavior to receive dopamine stimulation.

In humans, dopamine is known as the “feel-good” hormone. It gives you a sense of pleasure and enhances your motivation to engage in behaviors that cause you to feel pleasure. From an evolutionary standpoint, dopamine rewards you for doing things you need to do such as eat, drink, and reproduce.

On the other hand, some maladaptive behaviors also cause a surge in dopamine, making it more likely those behaviors will be repeated and sometimes become deep-rooted. Junk food and sugar trigger the release of a large amount of dopamine into your brain, which gives you the feeling that you’re on top of the world and you want to repeat that experience. Some of the maladaptive repetitive behaviors that we treat in psychiatry are also tied to the pleasurable release of this hormone. Other examples are compulsive gambling, porn use, video gaming, and over-exercising.

How Does This Explain Stress?

Hans Selye defined stress as “the body’s nonspecific response to any demand, whether it is caused by or results in pleasant or unpleasant stimuli.” Once a stress response is activated (by a threatening or even non-threatening stimulus), our body pumps cortisol, adrenaline, and dopamine into our system to help us survive what feels like a life-or-death situation. It summons our body to turn off nonessential functions to route essential resources into our muscles and brain. Imagine you were being chased by a man-eating tiger—an elevation in body temperature, blood pressure, and heart rate would assist you in fleeing from danger. But, for some of us, the stress response becomes so habitual we seek more and more stress, such as overworking, to achieve that heightened state. Because stress isn’t just a mental reaction but also a physiological one, the “high” that stress causes can become compulsive.

Neuroscientist Jim Pfaus opines, “By activating our arousal and attention systems, stress can wake up the neural circuitry underlying wanting and craving—just like drugs do.” Once we become accustomed to a higher degree of stress, it may seem necessary to feel that way all the time. The brain will seek out more of the “feel good” chemicals to maintain the same stress level, which may require ever greater amounts of stimuli over time.

In their excellent book (in press) Raising A Kid Who Can, Catherine McCarthy, M.D., and colleagues write: “Experiencing stress may actually have positive correlations with life span. Stress can prime the brain for action, attention, learning, or retrieval, and researchers at the University of California at Berkeley have shown that moderate stress levels can increase cell growth in an area of the brain called the hippocampus.”

However, too much stress can cause significant risks to health. According to researchers at the Mayo Clinic, long-term activation of your stress response system and overexposure to cortisol and other stress hormones can have a negative impact on almost all your body's processes, which puts you at increased risk of significant medical conditions such as anxiety and depression, gastrointestinal disorders, headaches, muscle tension and pain, cardiovascular disease, obesity, and sleep disorders. It also places you in the higher risk category for other problems such as eating disorders, substance abuse, and alcoholism.

Clues That You May Have a Problem

  • If you can’t sit still or relax, it may be a sign. You feel like you’re always chasing the next high or find yourself constantly seeking out new or exciting experiences.
  • If you constantly feel anxious, overwhelmed, or on edge, it’s a sign that stress has overtaken your life.
  • If you’re constantly tired, even after a good night’s sleep, it may be a sign that your body is struggling to cope with stress in your life. To concentrate, you rely on more caffeine to get through the day.
  • You’re sick more often: Chronic stress can weaken your immune system, making you prone to illness. If you already have a medical condition, particularly an autoimmune disorder, you may notice a worsening of your symptoms and find it harder to recover from any new illness you experience.

What You Can Do

I treat my patients holistically and have developed the following pneumonic which has proven useful: MENDS.
M=medication when indicated. Individuals suffering from chronic stress may benefit from various types of anti-anxiety medicine or low-dose antidepressants. This would require a consultation with a psychiatrist.
E=exercise. Exercise decreases anxiety and depression. In a November 2022 post on this blog, I reviewed some of the positive effects of exercise on mental health. They include an increase in your sense of self-worth, self-confidence, sleep quality, and life satisfaction. Exercise has anti-inflammatory effects. The antidepressant effects of exercise are associated with neurogenesis—the process by which your brain increases the number of brain cells. In addition, exercise is positively associated with increased neuroplasticity—the ability of the brain to form new connections and pathways and change how its circuits are wired. Exercise decreases stress hormones. The more your fitness improves, the better your body becomes at dealing with physical stress. This means less cortisol will be released during exercise and, more importantly, in response to emotional or psychological stressors.
N=nutrition. A healthy diet can reduce stress in several ways. Comfort foods, like a bowl of warm oatmeal, boost levels of serotonin, a calming brain chemical. Other foods can cut levels of cortisol and adrenaline, stress hormones that take a toll on the body over time. A healthy diet can help counter the impact of stress by reinforcing your immune system and lowering blood pressure.
D=Dhyana. Taken from Hindu, it means contemplation and meditation. According to an article in the American Psychological Association, researchers reviewed more than 200 studies of mindfulness among healthy people and found mindfulness-based therapy was especially effective for reducing stress, anxiety, and depression. Mindfulness can also help treat people with specific problems including depression, pain, smoking, and addiction.
S=sleep. Prioritize your sleep: Disturbed sleep can negatively affect many medical conditions, including cardiovascular health. Studies show short sleep duration or poor sleep quality is associated with high blood pressure, elevated cholesterol, and atherosclerosis. Habitual short sleep increases the chance of cardiovascular events. Stress and sleep disturbance are intimately linked. When you are stressed, your sleep quality is disturbed, or you may not sleep enough. The opposite is true as well. If you sleep poorly, it will worsen your stress level. Go to bed and wake up at the same time every day, weekends included. The American Heart Association recommends sleeping in a dark, quiet place set at a comfortable temperature. It is important to ban electronic devices from your bedroom and avoid caffeine, alcohol, and large meals before bedtime.

Mon, 05 Jun 2023 07:43:00 -0500 en-US text/html
Halifax Certified Medical Aesthetician Course, Learn-From-Home For Moms Update No result found, try new keyword!The Dermysk Medical Aesthetics Academy has made several updates to its course structure to make its medical aesthetician training programs more accessible to single parents, or students working their ... Sun, 04 Jun 2023 07:54:00 -0500 Family and Medical Leave Policy for Staff

In accordance with the Family and Medical Leave Act of 1993 (FMLA), it is the policy of the university to grant up to 12 weeks of family and medical leave (FMLA leave) to eligible employees during any “rolling” 12-month period, measured backward from the date an employee uses any FMLA leave. The leave may be paid, unpaid or a combination of paid and unpaid, depending on the circumstances.

It is also the policy of the university to grant an employee up to 26 weeks of leave in a single 12-month period to care for a current member of the armed forces with a serious injury or illness incurred in the line of duty. The 12-month period begins on the first day the employee takes such leave. The leave may be paid, unpaid or a combination of paid and unpaid, depending on the circumstances.

An employee is responsible for ensuring that his/her supervisor and department are kept apprised of any absence from work, whether paid or unpaid.


In order to be eligible for FMLA leave under this policy, the employee must have been employed for 12 months (not necessarily consecutive) or more in a benefits-eligible position and have worked at least 1,250 hours over the previous 12 months before the leave commences. An eligible employee will be granted up to 12 weeks of FMLA leave during a 12-month period, counted backward from the onset of the requested time away.

Type of Leaves Covered

FMLA leave must be for one of the following reasons:

  1. The birth and care of a newborn child of the employee.
  2. Placement with the employee of a child for adoption or foster care, and to care for the newly placed child.
  3. To care for an immediate family member (spouse, child or parent) with a serious health condition. A child is defined as a biological, adopted or foster child, stepchild or a legal ward who is under 18 years of age, or 18 or older and incapable of self-care because of mental or physical disability at the time that FMLA leave commences.
  4. Personal medical leave when the employee is unable to perform the essential functions of his/her own position because of a serious health condition (may include job-related illness or injury of a serious nature that is covered by workers’ compensation).
  5. Because of a qualifying exigency arising out of the fact that the employee’s spouse, child or parent is a covered military member on active duty (or had been notified of an impending call to active duty) in support of a contingency operation.
  6. To care for a covered service member with a serious injury or illness if the employee is the spouse, child, parent or next of kin of the service member.
  7. Due to incapacity caused by pregnancy, for prenatal care or for the mother’s serious health condition following the birth of a child. A spouse is entitled to FMLA leave needed to care for the pregnant spouse under any of these circumstances.

Definition of Serious Health Condition

A serious health condition under the Family Medical Leave Act is defined as an illness, injury, impairment or physical or mental condition that involves (1) inpatient care in a hospital, hospice or residential medical care facility, or (2) a period of incapacity requiring an absence of greater than three days and continuing treatment by a health care provider. Continuing treatment is defined as (1) two or more visits to a health care provider within 30 days of the first day of incapacity, or (2) a single visit that results in a regimen of continuing treatment under the supervision of the health care provider. The visits must be in person, and the first visit must occur within seven days of the first day of incapacity. For chronic conditions, visits to a health care provider at least twice a year are required.

Length of FMLA Leaves

Employee’s or Family Member’s Serious Health Condition

Based on medical certification, an eligible employee may be approved for a maximum of 12 weeks of FMLA leave in a 12-month period. For purposes of this policy, a “rolling” 12-month period will be used, measured backward from the time an employee uses any FMLA leave. FMLA leave may be taken as follows:

  1. A continuous leave.
  2. An intermittent leave (defined as a schedule of individual days or partial days off in increments of at least an hour for medically necessary treatment, etc.) may be taken when medically necessary to care for a seriously ill family member, or because of the employee’s serious health condition.
  3. A reduced schedule leave may be taken when medically necessary to care for a seriously ill family member, or because of the employee’s serious health condition.

Care for a Service Member

An eligible employee may be approved for a maximum of 26 weeks of leave in a single 12-month period to care for a current member of the armed forces with a serious injury or illness incurred in the line of duty. The 12-month period begins on the first day the employee takes such leave.

Qualifying Exigency

An eligible employee may be approved for a maximum of 12 weeks' leave in a 12-month period, calculated on a “rolling” basis. Qualifying exigencies include short-notice deployment; military events; child care and school activities; financial and legal arrangements; counseling; rest and recuperation; postdeployment activities; as well as other circumstances. Employees are advised to consult with human resources regarding eligibility.

Birth, Placement or Adoption of a Child

An eligible employee may be approved for a maximum of 12 weeks' leave in a 12-month period, calculated on a “rolling backwards” basis.

Conditions for Intermittent or Reduced Schedule Leaves

The employee must try to schedule intermittent or reduced schedule leave so as not to disrupt the department’s operation. Whenever possible, the employee and manager should reach agreement on a leave schedule before intermittent leave or a reduced schedule begins. If FMLA leave is for care of a newborn or newly placed adopted or foster care child, use of intermittent leave is subject to the approval of the employee’s supervisor and must conclude within 12 months of the birth or placement. The university may temporarily transfer an employee to an available alternative position with equivalent pay and benefits if the alternative position would better accommodate the intermittent or reduced schedule.

Spouses Who Are Both Employed by the University

Spouses who are both employed by the university are entitled to a combined total of 12 weeks of FMLA leave for the birth and care of a newborn child, for placement of a child, for adoption or foster care and to care for the newly placed child, and to care for a parent who has a serious health condition.

Procedures for Requesting FMLA Leave

A request for FMLA leave shall be made to the benefits unit of the Office of Human Resources at least 30 days prior to the leave or, under emergency circumstances, the employee (or the employee’s representative) should provide Brandeis as much notice as practicable (within one or two business days of learning of the need to take FMLA leave). Employees are also required to inform their immediate supervisor of their need for FMLA leave; however, they are not required to provide the medical reason for the leave to the supervisor.

In the case of planned medical treatment, an employee should make a reasonable effort to schedule treatment in order to avoid disrupting the work of his/her department.

Applications for FMLA leave are available from the benefits unit of the Office of Human Resources. Employees must provide satisfactory medical certification with a request for FMLA leave. A “certification of health care provider” form must be completed and submitted with the employee’s application for FMLA leave within 15 days of the request, or a reasonable explanation for the delay must be provided. Forms must be submitted to the Office of Human Resources for review. Failure of the employee to comply with the medical certification request may result in the denial of the leave.

If there are deficiencies in the medical certification, the university will explain in writing what additional information is needed, and the employee will have seven days to provide the requested information. If questions still remain after receiving information from the employee or the employee does not provide the requested information within seven days, the university’s Office of Human Resources may contact the employee’s health care provider for clarification and/or confirmation of the authenticity of the medical certification. In these situations, employees must sign a HIPAA release form (the federal law restricting release of medical information) permitting the human resources office to contact their health care provider, or leave may be denied.

Except in cases involving service members, the university has the right to request a second medical opinion. The university will pay for the employee to see a second health care provider who is not employed by the university, which the university will select. If the second opinion differs from the first, the university may require, at its own expense, a third final and binding opinion from a heath care provider designated and approved jointly by the university and the employee.

Response to Employee’s Request for FMLA Leave

The Office of Human Resources will provide initial notice, either verbally or in writing, responding to the employee’s request for FMLA leave within five business days (absent extenuating circumstances). If the initial notice is given verbally, a written notice will follow. The notice will inform the employee of eligibility for FMLA leave. It also describes the employee’s rights and responsibilities under FMLA and includes specific expectations and obligations of the employee and the consequences for failing to meet these obligations.

After submitting an application requesting FMLA leave and supporting medical documentation to the Office of Human Resources, an employee will receive a written notice that describes whether the request for FMLA leave is approved and designated as FMLA leave. If additional information is needed to make the determination, the employee will be notified in writing.

Recertification of Medical Condition

Except in cases involving service members, employees on leave for their own serious health condition are required to provide periodic documentation no less frequently than once a month to the Office of Human Resources regarding the status of the medical condition and intent to return to work.

An employee on leave to care for an immediate family member with a serious health condition (unless that person is a service member) is required to provide periodic documentation no less frequently than once a month to the Office of Human Resources regarding the status of the medical condition.

Use of Sick, Vacation or Personal Leave During FMLA Leave

  • If the leave is for an employee’s pregnancy and birth of a child, available sick leave benefits may be used during the portion of the leave Checked by medical certification of need (generally up to eight weeks of sick leave benefits may be used). In addition, accrued vacation and personal time may be used during the leave. When this time is exhausted or if an employee elects not to use sick, vacation or personal leave, the employee will be placed on an unpaid status.
  • If the leave is for care of a newly placed adopted or foster care child, employees may elect to use their accrued sick, vacation and personal time balances during their leave. When this time is exhausted, the employee will be placed on an unpaid status. (Up to 12 accrued sick days may be used by full-time employees for the purpose of adoption. Leave will be prorated for part-time employees.)
  • If the leave is for an employee’s own serious health condition, available sick leave benefits must be used during the portion of the leave Checked by medical certification of need. Once sick leave benefits are exhausted, an employee may use vacation and personal time balances. When this time is exhausted, the employee will be placed on an unpaid leave status.
  • If the leave is to care for an immediate family member with a serious health condition, up to five accrued sick days may be used (if available). In addition, an employee may use accrued vacation and personal leave balances. When this time is exhausted or an employee elects not to use available sick, vacation or personal leave, the employee will be placed on an unpaid leave status.

Status of Benefits During FMLA Leaves

The university will continue an employee’s medical and/or dental coverage during both paid and unpaid FMLA leaves, provided the employee continues to pay his/her portion of the premiums (payroll deductions will continue to be taken during a paid leave). Employees should make arrangements with the benefits unit of the Office of Human Resources to continue the premium payments during an unpaid leave.

Group Basic Life Insurance and Long-Term Disability Insurance

Group basic life insurance and long-term disability insurance will continue at no cost to the employee during an approved FMLA leave. If the employee is enrolled in the supplemental life insurance, the premium deductions will continue through payroll during a paid leave. Employees should make arrangements with the benefits unit of the Office of Human Resources to continue the premium payments during an unpaid leave.

Retirement Plan

Retirement plan contributions will continue during a paid FMLA leave based on eligible salary received. Under IRS rules, retirement plan contributions cannot be continued during an unpaid leave.

Vacation, Personal and Sick Leave

Vacation, personal and sick leave will continue to accrue during a paid FMLA leave; however, these leave accruals may not be used until the employee returns to work. Note that an employee receiving the 60% paid extended illness benefit will accrue vacation, personal and sick time at a 60% rate. Vacation, personal and sick leave will not accrue during an unpaid FMLA leave. Vacation leave accrued during FMLA leave will not be paid out if the employee does not return to work.

Flexible Reimbursement Accounts

Deductions for employees who participate in either the university’s dependent care or health care reimbursement accounts will stop immediately upon the beginning of the unpaid portion of the leave. An employee may continue to submit claims for covered expenditures during the leave and continues to be responsible for expending the account in accordance with plan provisions or risk losing an unused balance.

Tuition Reimbursement

Tuition benefits cannot be used or paid while on leave. However, upon return to a benefits-eligible position, eligibility is reinstated immediately. Eligible employees must be actively at work while taking an approved course at the time of reimbursement to receive this benefit.

Reinstatement and Employee Status After FMLA Leave

Employees are expected to contact their supervisor and the Office of Human Resources at least one week prior to their return-to-work date. If the FMLA leave was for the employee’s own serious health condition, a “fitness for duty” form/letter completed by his/her health care provider will be required, certifying that he/she is able to return to work and perform the essential functions of his or her position. The letter/form should also indicate what accommodations, if any, are recommended. The letter/form must be submitted to the Office of Human Resources prior to the employee’s return to work. The university may deny reinstatement until such fitness for duty certification is provided.

At the completion of the approved period for FMLA leave, an employee will be reinstated to his or her former position or a position with equivalent status, pay, benefits and other employment terms.

Failure to Return to Work After an Approved FMLA Leave

Employment will be terminated if an employee does not report to work within 30 days of the expiration of an approved FMLA leave. Engaging in other employment while on leave without the approval of the university will result in termination of employment.

The university will recover its cost of health and dental insurance premiums paid to maintain coverage during the unpaid portion of the leave for employees who accept other employment or who do not return to work due to reasons under the employee’s control. Deductions will be made from any payments due to the employee, such as vacation leave or unpaid wages. The university also reserves the right to take any other legal action necessary to recover any amount due.

Fri, 07 Aug 2020 03:42:00 -0500 en text/html
May HealthBeat: Resources for health, learning, support and more

Red Cross Babysitter's Training for ages 11 – 15 is 9 a.m. – 4 p.m. May 30 at the Pelham Falls Clubhouse in Greer. The cost is $115 each and includes certification card and book. For details and registration, visit

Safe Sitter for ages 11 – 13 is 8:30 a.m. – 3:30 p.m. June 9, June 16, June 30 or July 14 at Bon Secours St. Francis Eastside. The cost is $65 per child. Safe Sitter is a one-day course that covers information on how to handle emergencies, major and minor. Students listen, practice, and role play to learn about safety precautions, rescue breathing techniques, recognizing emergencies, and calling for emergency help. Safe Sitter also covers childcare basics. Register online at or call 864-675-4400.

Learn Infant and Child CPR at 6:30 p.m. May 10 at Bon Secours St. Francis Eastside. Register online at or call 864-675-4400.

Red Cross Adult and Pediatric CPR/First Aid/AED class is 2:30 – 7 p.m. May 31 at the Pelham Falls Clubhouse in Greer. The cost is $115 each and includes certification card (valid for 2 years.) For details and registration, visit

Safe Harbor offers survivor support groups and classes for survivors to learn more about the cycle of violence and how to parent their children in the wake of domestic violence. Safe Harbor employs multiple bilingual staff, with outreach available in English, Spanish and Arabic. For details, visit

Child Passenger Seat Safety Inspection from Safe Kids of the Piedmont and Spartanburg Medical Center is offered monthly at Spartanburg Medical Center, 101 E. Wood St., Spartanburg. For details, visit or call 864-560-6845.

Facts of Life for Mothers And Daughters is at 6:15 p.m. July 26 at Bon Secours St. Francis Eastside. The cost is $20 per mom/daughter. The class focuses on the emotional and physical changes during puberty for the 9 – 11-year-old female and her mother or female support person. Register online at or call 864-675-4400.

Just Say Something offers parenting courses for parents of young children, adolescents and teens. For more information, contact Lynn Hooper at 864-467-4099 or

Julie Valentine Center's Online Support Group (OSG) is an anonymous online group chat that allows members of the community who have been affected by sexual violence to connect with one another. OSG can be a great support for caregivers and loved ones of children who have experienced child abuse and/or survivors of child abuse and/or sexual assault. OSG is offered from 7 – 8 p.m. Mondays and noon – 1 p.m. Wednesdays. Access the group at these times online at Registration is not needed. For more information, contact Jamika Nedwards at 864-331-0560 or

Triple P – Positive Parenting Program, offered by Greenville First Steps, is a parenting and family support system designed to prevent – as well as treat – behavioral and emotional problems in children and teenagers. Learn more at

Triple P – Positive Parenting Program is offered by Just Say Something. Parents of young children can enhance their parenting skills and gain confidence as a parent. Call 864-467-4099.

This article originally appeared on Greenville News: May HealthBeat: Resources for health, learning, support and more

Mon, 05 Jun 2023 04:14:00 -0500 en-US text/html
Rustenburg learner arrested for stabbing and killing another learner

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Disaster Day training teaches high schoolers to save lives items in first aid kit © Provided by KPTV Portland items in first aid kit

PORTLAND Ore. (KPTV) - ) Ida B. Wells High School in Southwest Portland partnered with PPS, AMR and Portland Fire will put 80 students through medical field exercises to earn their Teen Community Emergency Response Team (CERT) Certification.

It’s a program for students to get hands-on experience to learn and better prepare for any disaster they may encounter.

The exercises were made up of four stations: cribbing, when a patient may be trapped, fire suppression, stop the bleed and triage.

“Our medical students have to go in, and they have to search and clear the room and sort out those patients based on their priority and urgency,” says Aaron Olsen, Health Science Teacher. “The idea Is that the students because they have been learning medical principles and medical skills that they can actually be resources to their own community.”

Senior Emma Hayes says it’s a rare opportunity for kids to learn life-saving skills.

“Understanding that you can have these skills and you can learn more of it, is really helpful in high school to understand what you wanna do after high school,” says Hayes.

During her free time, Emma is also part of the Multnomah County Search and Rescue Team.

“We go up into the gorge and look for people,” says Hayes. “It’s an amazing opportunity that I don’t think high schoolers usually get it’s kind of unique to our county that it’s so youth led.”

Olsen says he never wants kids to have to use these skills but wants them ready, if they should need to.

“Unfortunately, I hear stories about once a year, just out and about or in a lot of vehicle incidents and things when they’re out,” says Hayes. “I kind of just celebrate them that hey yeah you’ve gone through the training.”

Mon, 05 Jun 2023 13:34:00 -0500 en-US text/html

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