The URL can be used to link to this page

Home My WebLink AboutItem C03 C3 BOARD OF COUNTY COMMISSIONERS COUNTY of MONROE Mayor James K.Scholl,District 3 The Florida Keys Mayor Pro Tern Michelle Lincoln,District 2 Craig Cates,District 1 David Rice,District 4 Holly Merrill Raschein,District 5 Board of County Commissioners Meeting September 10, 2025 Agenda Item Number: C3 2023-4448 BULK ITEM: Yes DEPARTMENT: Fire Rescue TIME APPROXIMATE: STAFF CONTACT: Chief Colina N/A AGENDA ITEM WORDING: Approval for issuance (renewal) of a Class A Certificate of Public Convenience and Necessity (COPCN) to Islamorada Village of Islands - Fire Rescue for the operation of an Advanced Life Support(ALS) and Basic Life Support(BLS) transport ambulance service for the period October 1, 2025, through September 30, 2027. ITEM BACKGROUND: On September 20, 2023, a Class A COPCN was issued to Islamorada Village of Islands - Fire Rescue to operate an ALS and BLS transport ambulance service. The current COPCN expires on September 30, 2025. In view of the foregoing, Islamorada Village of Islands - Fire Rescue has applied to renew this Class A COPCN which, if approved, will become effective October 1, 2025. This will enable Islamorada Village of Islands - Fire Rescue to provide inter-facility transports only. PREVIOUS RELEVANT BOCC ACTION: 09/27/17 BOCC approved renewal of Class A COPCN for the period 10/01/17 through 09/30/19. 09/18/19 BOCC approved renewal of Class A COPCN for the period 10/01/19 through 09/30/21. 08/18/21 BOCC approved renewal of Class A COPCN for the period 10/01/21 through 09/30/23. 09/20/23 BOCC approved renewal of Class A COPCN for the period 10/01/23 through 09/30/25. INSURANCE REQUIRED: Yes CONTRACT/AGREEMENT CHANGES: The renewal will cover the period of October 1, 2025 through September 30, 2027. STAFF RECOMMENDATION: Approval. DOCUMENTATION: Class A COPCN Application Islamorada Village of Island Fire Rescue—Redacted l.pdf 88 Isla morada—Class—A—COPCN-1 0.0 1.2025to09.30.2027.pdf FINANCIAL IMPACT: Effective Date: 10/01/25 Expiration Date: 09/30/27 Total Dollar Value of Contract: N/A Total Cost to County: N/A Current Year Portion: N/A Budgeted: N/A Source of Funds: N/A CPI: N/A Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: N/A Revenue Producing: N/A If yes, amount: N/A Grant: N/A County Match: N/A Insurance Required: Yes, per Statutory Requirements 89 Uc%r i TfflCage of IsCands �r �+ Department of Fire ReSCLIe V lI" Office of the FIRE CHIEF July 31, 2025 R.L. Colina Monroe County Fire Chief 7280 Overseas Hwy. Marathon, FL 33050 Re: APPLICATION RENEWAL FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY Dear Chief Colina. Please find enclosed the application for renewal of the Certificate of Public Convenience and Necessity for the delivery of Emergency Medical Service for Islamorada, Village of Islands. The insurance coverage expires October 1, 2025, and will be renewed prior to that date. We will then furnish you with the updated certificate of insurance. Islamorada, Village of Islands respectfully requests this item be put before the Monroe County Board of County Commissioners' agenda for the August 2025 meeting. If you have any questions or need additional information, please contact me at your earliest convenience. Thank you! IS MO RADA FIRE RESCUE Terry L. Abel Fire Chief 868000VERSEAS HIGHWAY.I"FLOOR•ISLAMORADA,FLORIDA 33036 OFFICE.305-664-6490 FAX.305-852-5195 E-MAIL:fdjnfa ftLSLta[L �orada fl Lai 90 MONROE COUNTY, FLORIDA APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY (COPCN) CLASS A EMERGENCY MEDICAL SERVICE _.________________________________________________________________________________________________________________________________e (PRINT OR TYPE) ❑ INITIAL APPLICATION-$950.00 ® RENEWAL APPLICATION-S475.00 IF RENEWAL, PLEASE LIST NUMBER OF PREVIOUS CERTIFICATE: # ........... 23-08 ........................................................................................................................-.................._ 1. NAME OF SERVICE Islamorada Village of Islands Fire Rescue . I" Floor, Islamorada, FL 33036 BUSINESS MAILING ADDRESS 86800 Overseas Hwv,,, BUSINESS PHONE NUMBER 305-664-6490 EMERGENCY PHONE NUMBER 305-664-6490 2. TYPE OF OWNERSHIP(i.e.Sole Proprietor,Partnership,Corporation,etc.) Municipal-ity DATE OF INCORPORATION OR FORMATION OF THE BUSINESS ASSOCIATION December 31 1997,____ ...........................................................................�.......... 3. LIST ALL OFFICERS,DIRECTORS,AND SHAREHOLDERS(use separate sheet if necessary): ______________ _______.._______.__ ........ ......... ....................................................... NAME AGE ADDRESS TELEPHONE# POSITION/TITLE Sharon Mahoney w Hwy, F.L 33036 305-664-6400 Mayor 68� 86800 Overseas Hw Islamor Don Horton 70 86800 Overseas Hwv, Islamorada, FL 33036 305-664-6400 Vice Mavor Deb Gillis 74 86800 Overseas Hw , Islamorada, FL 33036 305-664-6400 Council Member ............................................................................................................................................................................................v:...................................................................................... .................................................................................. Anna Richards 50 86800 Overseas Hwy,Islamorada,FL 33036 305-664-6400 Council Member ................................................................................................................................................. .................................................................................................................................................................................................................................................................................................................... ...................................................................................................................................................... Steve Freidman 54 86800 Overseas Hwv, Islamorada, FL 33036 305-664-6400 Council Member 4. LEVEL OF CARE TO BE PROVIDED: ❑ BLS or ® ALS IF ALS: ®TRANSPORT or ❑ NON TRANSPORT 5. DESCRIBE THE ZONE(S)THAT YOUR SERVICE DESIRES TO SERVE. (Use separate sheet if necessary.) From the West end of the Channel Two Bride a roxintately mile marker 72a6 to the West en, ,_ ,f.t, ,e,;,Ta,v,,,em,i,er,;;,;;;,;;;,;;,;;,;;; Creek Bridge-(approximately mile marker 90.8). including the entire island of Plantation Key, Wind ley Key,Upper_ atecumbe e Lower Matecambe Kg . and Teatable Ke, ,and all land tilled in between the islands all connected b _._.................................................................................Ya................................................................................................................................ .............................................................................................Y.......................................................................................................................,.,,..,,,.mm.,,,,.,,..,,,,,,,,,..,.,,,,.,..............!L....m................................,v, m Q_Smm One-Overseas,Hi he way. all of themITabove-withinITlslamorada.Village of Islands. Florida. ZONE 3) 6. LIST THE ADDRESS AND/OR DESCRIBE THE LOCATION OF YOUR BASE STATION AND ALL SUB-STATIONS. (Use separate sheet if necessary.) BASE STATION Islamorada Fire Rescue Station 21 UmS.One_&MM M.8.....86800 0vurseas I I��y. f�� 1=loor. Islamorada. wL 3303L SUB-STATION Islamorada,,,,,Fi,re,,,,,Re„sgq.e,,Stat,i,P.n 2,0„__wwww___U.wSw_.One& MM 81.5 81850 Overseas Hwy. lslamorad FLµw3,3036www Islamorada Fire Rescue Station 19 U.S. One& MM 74 74070 OverseaswwHwv_, Islamorada,FL 33036 .... Page 1 of 7 91 7. DESCRIBE YOUR COMMUNICATION SYSTEM (Attach copy of all FCC licenses): �_. FREQUENCIES CALL NUMBERS #OF MOBILES #WOFWPORTABLES Monroe County Public Safety Communications System 800 mhz radio system 12 50 8. LIST THE NAMES AND ADDRESSES OF THREE (3) U.S. CITIZENS WHO WILL ACT AS REFERENCES FOR YOUR SERVICE. ........................... NAME _ ADDRESS Frank Derfler ...._.�_��_....��...... 8800m......��..___�.�..._..�.__.. _... ._.__.. .., 5 Overseas Hwy., 10-120, Islamorada, FL 33036 ................... _....... _..._..__..........._........__._, Cheryl Culberson 161 Leoni Dr., Islamorada,FL 33050 - .............. __ ....-... ....................:................................................................_ ..._.. . .........-�...... .. Joe Roth 127 Valencia Dr, Islamorada, FL 33036 9. ATTACH A SCHEDULE OF RATES WHICH YOUR SERVICE WILL CHARGE DURING THE COPCN PERIOD. 10. PROVIDE VERIFICATION OF ADEQUATE INSURANCE COVERAGE DURING THE COPCN PERIOD. 11. ATTACH A COPY OF YOUR SERVICE'S CONTRACT WITH A MEDICAL DIRECTOR. 12. ATTACH A COPY OF ALL STANDING ORDERS AS ISSUED BY YOUR MEDICAL DIRECTOR. 13. ATTACH A CHECK OR MONEY ORDER IN THE APPROPRIATE AMOUNT, MADE PAYABLE TO THE MONROE COUNTY BOARD OF COUNTY COMMISSIONERS. I,THE UNDERSIGNED REPRESENTATIVE OF THE ABOVE NAMED SERVICE, DO HEREBY ATTEST MY SERVICE MEETS ALL OF THE REQUIREMENTS FOR OPERATION OF AN EMERGENCY MEDICAL SERVICE IN MONROE COUNTY AND THE STATE OF FLORIDA. I FURTHER ATTEST THAT ALL THE INFORMATION CONTAINED IN THIS 7AP, ICATI TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. SIGNATURE OF APPLICANT AUTHORIZED REPEL"` "NTATIVE KAtLLIE MICH4ELLE TARV33 'ES Notary Public•State Of Flomlda a�nrralsslan 1#VI I3153 NOTARY SEAL awr« . y cc;m.Expires Jan 23,20V '"Eonded through National Notary Assn. NOTARY SIGNA I DATE Page 2 of 7 92 PERSONNEL-PARAMEDICS NAME PARAMEDIC CERTIFICATION First,.Middle,Last SOCIAL SECURITY# CERTIFICATION# _ EXPIRATION DATE Te Lee Abel 205452 12/1/26 545121 /26 Mohammed Fareed Abukahok.... _.. ..... _............... ......-......�.........._.....��. 12/1.. .._ 12/1/26 AlaynmAlons.°...................._._.................��............��......��................................................................................. ...Sm447.3. ..........................�...._........... �.� . Andres Fel e Ardila......... ...................................................�_ 5264.11..__...___...... 12/1/26 Jason Christian Brvant 511516 12/1/26 Adrian Castellanos 526853 12/1/26 Marcio Cemin 523649 12/1/26 Michael Benj.amm 540545 12/1/26 Cortina ... _ ..._ 5 .� Anwar Elias Cure-Twede 535002 12/1/26 Keith Thomas En elme er 538279 12/1/26 Alexander Kristopher Franklin 533734 12/1/26 Michael Jeremy Kimes 523643 12/1/26 Anthony Loboguerrero 539709 12/1/26 Jason Alan Luna 519294 12/1/26 Charles Walter Mather 12240 12/1/26 Steven Cesar Mejia 531833 12/1/26 Erica Bastos Oliveira 520615 12/1/26 Misael Alejandro Oropesa 536349 12/1/26 Christian Orozco 546141 12/1/26 ..._.�.............................................................................................. ........._ _ __._..�..__................ ..............................................................�.... ._._._............_..............._.........................__..... StephenAlan Pollock......__.._.._.._ _....._.._................_.....�_..... ... .�_..___................517032._.....__..........._______.._.... ... ......................... Michael Anthony Rodriguez 522249 12/1/26 James Philli Ruggles 520868 12/1/26 Jorge Luis Sanchez 534270 12/1/26 Daniel Patrick Self 519016 12/1/26 Fil wIv lov Todorov.......... ........... ...524782.................................... .w....2/1/2.6........... Lester Robert Young 514855 12/1/26 �...... .............................................................��_. ON-CALL PERSONNEL PARAMEDIC CERTIFICATION PARAMEDICS CERTIFICATION# EXPIRATION DATE Warren Harding Long 533049 12/1/26 Page 3 of 7 93 ......... ...................... .....................................................................................................................I.............. ............... ................. PERSONNEL—EMERGENCY MEDICAL TECHNICIANS NAME EMT CERTIFICATION First,Middle,Last SOCIAL SECURITY# CERTIFICATION# EXPIRATION DATE Ronald Carl Jacobs 308660 12/1/26 Tavler Holman Russell 572960 12/1/26 James David Griffeth 300527 12/1/26 Cristian Peter Berry 577668 12/1/26 Edward Thomas Booth 577454 12/1/26 Christopherr Dvlan Cash 579991 12/1/26 .Christopher Benj,,amin Freitas-Kamal._._. _._................... 588223 12/1/26............................................................................................. Victor Hernandez 584089 12/1/26 ...Michael AnthOny�.................... /26 S oan ...575379........................�....... .12....1.............................�.... ......................._.._.._ Arian Montes de Oca 579970 12/1/26 Michael Jav Venezia 586782 12/l/26 ON-CALL PERSONNEL-EMT Heidi Leeann Hunan vvvvvw 523330 12/l/26 Page 4 of 7 94 w 0 A Z O d a a I 1"I'"T" I' l"'ITT I---IT w ...... _ ...... .. k LTy W O U cC � cd c� cc1 cd cC cC cC cG cC cd cC cC cC cC cC c� cG cC c� c� cC c� ca cC cC cC cC c� cG cC cd cd c� cd cC c� c� cC W Z ;o -o •o _o -o_ -c_ -o o o_ b_ -_o _c -o_ b_ o_ v_ -�_ -�s -o_ o_ Ts -o_ -o o_ _o b_ -o_ -�_ b_ -o_ b_ b_ -o -cs •o o_ •o -v b_ -b_ d O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O ram. w u. ri [% rs. u. ri. ram. rs. ram. ci. ri. rJ. wram. ri. cL. rJ. ram. ram. ram. r� cs., [i r1., ram. W z w U W a a A w A z a o m a O w H d A > F O U W d Ui O Cd rn ° cG N CIStf W y '�dZ "ma Q Qtr.bL. G •d-,....... +O+ �°'CUL oo Ua�i aL� c '❑L V.bL, N i°.,.1s0. �oO ca 'aiL yca�.....'��d....O° o o W ZC cC 5. O w ^ , U o 0 , q❑ o c O O u E O > 0 Q � Ox U Q >U Cd o � xE =� o o E- � QQUW =llUQ � � Q � Qu 'C', � Qcu =� Uv� QW � Uv� � �; F- ° G1 � i� � JOx3 ___......... .. .. .._..._ ... _... .._ _ ..... _.... 95 � ry NW p 1R N � K LL M N O w LU y 3o'EE � 6 o a F ^m 7 � � Q Q z 1 O ° F � O w z z a ° ° w Q z m o > Q ° w Qz = Q F a w F Q W � Z 3p w O �T w N o o-. 0 �= I N F F fx W = x Q c Lz. v � .O mW w O U C7 ° rT. 96 r w 0 o wG4 � o 0 0 0 0 CL z wa� c c zz F cC p Fz _ ._.... LA �m �+ Q c� '' ''.............. & rV. z x X X N U U U U U Oo v. dM' � O � 3 o a Gn z Q x ti o CA 00 x �t o U Q 2 Q w w Q M M C,M .,,.. ._.��.�.�.. .�.�. _._. ... .� .... ............� .... ......... ..........._..._.. ..........._._-CD .�,. TJ 00 W A." N W a O oo �n o 0 0 0 0 u N N N N N Ito G1S 0 tx« w F W � U o O w d T F- 97 Islamorada Village of Islands Fire Rescue EMS Fee Schedule 2025 Ambulance mileage (A0425) $12/mi ALS 1 (A0426) $547 - $647 non-resident ALS 1 E (A0427) $547 - $647 non-resident BLS (A0428) $500 - $600 non-resident BLSE (A0429) $500 - $600 non-resident ALS2 (A0433) $811 - $911 non-resident A0999 extrication- $250 98 lrDp DATE(MM/DD/YYYY) as CERTIFICATE OF LIABILITY INSURANCE 9/13/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ,IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT World Risk Management PHONE"' Jenny Jellnlngs FAk 20 N. Orange Ave„ (Al ,t?,,. t}. Q7t45?414 d „N®y 407-445-2868 ... Suite 500 E-MAIL ADDrss �r1n�,pcl�raimolg��wrr�T�klc. �1n� Orlando FL 32801 _ mm ..__INSUIRER(SIAfFORDING COVERAGEAIG 1 t! INSURE _ na ement of FL RA: Public Risk Ma ._ ..9 (. , x, 1111 INSURED ISLAMOR-01 INSURER B Islamorada, Village of Islands 86800 Overseas Highway INsuRERc. _ Islamorada FL 33036 INSURERD; INSURER E; h INSURER F: COVERAGES CERTIFICATE NUMBER:1826083592 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _.. ..... ,,. INT R ---.... ....TYPE OF INSURANCE .. WVDSUahk" .._------- POLICY NUMBER. �� ...�MMdr3D"MYYk" PMl DY EX� LIMITS A X COMMERCIAL GENERAL LIABILITY PRM024-011-083 10/1/2024 10/1/2025 EACH OCCURRENCE .... a $2,000,000 tAMAGE T RElT ES CLAIMS-MADE occuR occurrewey $2 000 000 MED EXP(Any one person) $EXCLUDED n,. I w.. m® V PERSONAL&ADV INJURY $2,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO. LOC PRODUCTS COMP/OPAGG $ 1 01 HER, .. $ AUTOMOBILE PRM024-011-083 10/1/2024 10/1/2025 COMBINED SINGLE I.Rk+BI r $2,000 000 A AU C._1Fa Rs,ddgMJ. X -------------ANY AUTO --_- _ ,„.... BODILY INJURY(Per person) $ X OWNED SCHEDULED . adept} 1 HIRED X AUTOS PROP�ER'0YDAMvlAGE �,_ _ AUTOS ONLY AUTOS ONLY AUTOS ONLY U BODILY 1 g F. INJURY(Per a „ T-11'"'I""E""D APO yp APD DEDUCTIBLE $5,000 UMBRELLA LIAB OCCUREACH OCCURRENCE EXCESS LIAB CLAIMS MADE AGGREGATE $ V G RETENTION$ $ A WORKERS COMPENSATION PRM024-011-083 10/1/2024 10/1/2025 X PER bTH- 'AND EMPLOYERS;LIABILITY Y/N ___,STATUTE .,_ER ....................... _ _ ANYPROPRIETORIPARTNER/EXECUTIVE E.L EACH ACCIDENT $1,000 000 OFFICERIMEMBER EXCLUDED? N/A ---- (Mandatory in NH) E L.DISEASE-EA EMPLOYEE:.s 1,000,000 If yes,describe under ._......._._... ._.___ .-....-.._...._ DESCRIPTION OF OPERATIONS below '..E,L.DISEASE-POLICY LIMIT $1,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FL Department of Health Bureau ACCORDANCE WITH THE POLICY PROVISIONS. of Emergency Mgmt Oversight EMS Section Bald Cypress Way BIN A22 AUTHORIZED REPRESENTATIVE Tallahassee FL 32399-1722 f - - ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 99 D(ILusign EnWope ID:3BE43DBB-B99C-412A-BBCD-906885D3D215 AGREEMENT BETWEEN ISLAMORADA, VILLAGE OF ISLANDS, FLORIDA AND TGM MEDICAL CORP. FOR MEDICAL DIRECTOR SERVICES This is an Agreement between Islamorada, Village of Islands. Florida. a municipal corporation organized and existing under the laws of the State of Florida. its successors and assigns, hereinafter referred to as the "VILLAGE" AND TGM Medical Corp (hereinafter referred to as the -CONSULTANT"). whose principal place of business is 105030 Overseas Hwy, Key Largo. FL 33037 and who is represented by Dr. Thomas Morrison. In order to establish the background, context and form of reference for this Agreement and to generally express the objectives, and intentions, of the respective parties herein, the following statements.representations and explanations shall be accepted as predicates for the undertakings and commitments included withfii the provisions which follow and may be relied upon by the parties as essential elements of the mutual considerations upon which this Agreement is based. WHEREAS, the VILLAGE. as a provider of Emergency Medical Services to its citizens. is required by Chapter 401, Florida Statutes, to contract with a licensed physician to serve as the VILLAGE'S -MEDICAL DIRECTOR", also referred to as the "FIRE DEPARTMENT PHYSICIAN". and WHEREAS. the VILLAGE prepared and advertised a Request for Proposals ("RFQ 24- 16") for EMS Medical Director Services, (RFP-24-16), a copy of which is attached hereto and incorporated herein by reference; and WHEREAS. the CONSULTANT meets the qualifications necessary to provide Medical Director services to the VILLAGE and the VILLAGE desires to utilize the services of the CONSULTANT-, and WHEREAS, On October 8, 2024, the VILLAGE accepted the proposal from CONSULTANT and authorized the proper VILLAGE officials to enter into an agreement with CONSULTANT to render die services more particularly described herein below. NOW, THEREFORE, hi consideration of the mutual terms and conditions. promises. covenants and payments set forth below, the VILLAGE and the CONSULTANT agree as follows: a. 100 D&usign Envelope ID:3BE43DBB-B99C-412A-B8CD-908885D3D215 1.1.9 Possess a DEA registration. to provide controlled substances to the VILLAGE. DEA registration shall include the address at which controlled substances are stored. Proof of such registration shall be maintained on file with the VILLAGE and shall be readily available for inspection. The Village will forward all renewal documents as received to Medical Director to assure continuous registration and will reimburse Medical Director for cost of such registration. 1.1.10 Ensure and certify that security procedures for medications, fluids and controlled substances are in compliance with Chapters 499 and 893. Florida Statues. and Chapter 64F-12,Florida Administrative Code. 1.1.11 Assist and coordinate with the Fire Chief written operating procedures creating, authorizing and confirming adherence to rules and regulations regarding all aspects of the handling of medications, fluids and controlled substances by the VILLAGE. 1.1.12 Notify the Department of Health in writing, when applicable, of each substitution by the VILLAGE of equipment or medication. 1.1.13 Assume direct responsibility for the use by an EMT of an automatic or semiautomatic defibrillator, the performance of esophageal intubation by an EMT; and on routine inter-facility transports, the monitoring and maintenance of non-medicated IV's by an EMT. The Medical Director shall ensure that the EMT is trained to perform these procedures, shall establish written protocols for the performance of these procedures; and shall provide written evidence to the Department documenting compliance with provisions of this paragraph. 1.1.14 Review and approve a 40-hour EMT and Paramedic continuing education. 1.1.15 Complete a minimum of ten (10) hours per year of continuing medical education related to prehospital care or teaching or a combination of both. 1.1.16 Coordinate, approximately four (4) hours per month of in-service education to include classroom teaching and review of EMT and Paramedic performance, ARTICLE 2 METHOD OF PAYMENT 2.1 The VILLAGE agrees to pay the CONSULTANT as fill compensation for the services described in Article I, a fee of$67,200.00 to be paid to the CONSULTANT in twelve equal monthly installments of S5,600.00. The CONSULTANT shall be entitled to a fee increase of four percent(4%) annually, during the terns of this Agreement and subsequent renewal years hereunder, if the Agreement is renewed under Article 6. This fee includes all costs and expenses of CONSULTANT. 3 101 Docusign EDivelope ID:3BE43DBB-B99C-412A-B8CD-906885D3D215 4.3 Through the term of this Agreement, the Medical Director shall possess and maintain current registration as a Medical Director with the U.S. Department of Justice. Drug Enforcement Administration ("DEA"), to provide controlled substances to the VILLAGE. A copy of the registration shall be provided to the VILLAGE prior to execution of this Agreement. 4.4 CONSULTANT shall maintain active participation hi a regional or statewide physician group involved in prehospital care. 4.5 The CONSULTANT shall perform such other duties and responsibilities as now are imposed or may be imposed during the term of this Agreement by Florida law, including but not limited to the applicable provisions of Chapters 252 and 401.Florida Statutes, and Rule 64E- 2. Florida Administrative Code, as may be amended from time to time. 4.6 Inter-facili Transfers: CONSULTANT will develop BLS and ALS medical evaluation and treatment protocols and approve operating procedures as related to BLS and ALS inter-facility patient transfers. CONSULTANT will provide training for EMT's related to monitoring BLS and ALS patients during inter-facility transfers. CONSULTANT will develop a patient care quality assurance system for inter-facility patient transfers. CONSULTAN f is not responsible and assumes no liability for the choice or appropriateness of the receiving facility. CONSULTANT is not responsible and assumes no liability for the medical treatment provided to patients by physicians and/or other medical personnel at the sending and/or receiving facilities. CONSULTANT is not responsible and assumes no liability for any complications or negative patient outcome before, during or after the inter-facility transfer. ARTICLE 5 VILLAGE OBLIGATIONS 5.1 The VILLAGE shall assist the CONSULTANT by placing at its disposal all available information pertinent to the services to be performed by the CONSULTANT. 5.2 The VILLAGE shall provide for the CONSULTANT'S use during the term of this Agreement, a Medical Director's identification badge, and appropriate administrative support services as approved by the Fire Chief. ARTICLE 6 TERM 6.1 This Agreement shall commence on November 1. 2024, and shall continue through October 31, 2027, unless terminated earlier under Article 7. The VILLAGE shall have the option to renew this Agreement for two (2) additional two-year terms subject to the same terms and conditions, by providing the CONSULTANT with written notice to renew no less than thirty(30) days from the expiration date. ARTICLE 7 102 Dubusign Envelope ID:3BE43DBB-B99C-412A-B8CD-906885D3D215 expenses, including attorneys' fees, demands and claims for personal injury, bodily sickness. diseases or death or damage or destruction of tangible personal property or loss of use resulting therefrom, arising out of any errors, omissions, misconduct or negligent acts of the CONSULTANT, its officials, agents, employees, volunteers or subcontractors in the performance of the services of the CONSULTANT under this Agreement. ARTICLE 9 MISCELLANEOUS 9.1 presentative of the VILLAGE. It is recognized that questions in the day-to-day conduct of this Agreement will arise. The VILLAGE designates the Fire Chief or his designee, as the person to whom all comununications pertaining to the day-to-day conduct of this Agreement shall be addressed. 9.2 Ownership OwneLship of Oocuz ientsMeliverables, Any files, documents, studies. nun reports, training curriculum and other data prepared by the CONSULTANT in connection with this Agreement are and shall remain the property of the VILLAGE, and shall be delivered to the VILLAGE no later than seven(7)days after termination of this Agreement. 9.3 Public Records. VILLAGE is a public agency subject to Chapter 119, Florida Statutes. To the extent that CONSULTANT is acting on behalf of VILLAGE pursuant to Section 119.0701. Florida Statutes. CONSULTANT shall: a. Keep and maintain public records that ordinarily and necessarily would be required to be kept and maintained by VILLAGE were VILLAGE performing the services under this agreement; b.Provide the public with access to such public records on the same terms and conditions that the County would provide the records and at a cost that does not exceed that provided in Chapter 119. Florida Statutes, or as otherwise provided by law; c. Ensure that public records that are exempt or that are confidential and exempt from public record requirements are not disclosed except as authorized by law; and d.Meet all requirements for retaining public records and transfer to VILLAGE,at no cost. all public records in possession of the CONSULTANT upon termination of this Agreement and destroy any duplicate public records that are exempt or confidential and exempt. All records stored electronically must be provided to the VILLAGE. 9.4 No Contingent Fee. The CONSULTANT warrants that lie/she has not employed or retained any company or person other than a bona fide employee or agent contractor working solely for the CONSULTANT to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual or firm, other bona fide employee working solely for the CONSULTANT any fee, commission, percentage. gift, or other 103 D'ocusign Envelope ID:3BE43DBB-B99C-412A-BBCD-906885D3D215 287.135, F.S. Pursuant to Section 287.135. F.S., the City may immediately terminate this Agreement at its sole option if CONTRACTOR , its affiliates, or its subconsultants are found to have submitted a false certification; or if CONTRACTOR, its affiliates, or its subconsultants are placed on the Scrutinized Companies with Activities in Sudan List, or Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or engaged with business operations in Cuba or Syria during the term of the Agreement. 9.9.3 CONTRACTOR agrees to observe the above requirements for applicable subcontracts entered into for the performance of work under this Agreement. 9.9.4 As provided in Subsection 287.135(8), F.S., if federal law ceases to authorize the abovestated contracting prohibitions then they shall become inoperative. 9.10 E-Verify. CONTRACTOR shall comply with Section 448.095, Fla. Stat.. "Employment Eligibility,"including the registration and use of the E-Verify system to verify the work authorization status of employees. Failure to comply with Section 448,095, Fla. Stat. shall result in termination of this Contract. Any challenge to termination under this provision must be filed in the Circuit Court no later than 20 calendar days after the date of termination. If this Agreement is 9.11 Notices. Whenever either party desires to give notice to the other,it must be given by written notice, sent by certified United States mail with return receipt requested addressed to the party for whom it is intended, at the place last specified, and the place for giving of notice in compliance with the provisions of this paragraph. For the present, the parties designate the following as the respective places for giving of notice, to wit: For the VILLAGE: Terry L. Abel, Fire Chief Islamorada Fire Rescue Islamorada,Village of Islands 86800 Overseas Hkvy Islamorada,Florida 33036 Telephone: (305) 664-6490 Facsimile: (305) 852-5195 With a copy t John Quick,Village Attorney Islamorada,Village of Islands 86800 Overseas Hwy Islamorada,Florida 33036 Telephone: (305)664-6418 Facsimile: (305) 504-8989 9 104 Dc usign Envelope ID:3BE43DBB-B99C-412A-B8CD-906885D3D215 ()ac,gasluprur.?,d by. Mamie McGrath, Vu1tKrge Clerk A P ROVED AS TO FORM AND SUFFICIENCY: s8gpnQd by: John Quick, Vitlage Attorney (`0 ti Lj:T4'X- 1. r , witne sti;: �_ .. Name: C Print Name _-a ... . .._._ .._�.._a ,.._.. , _._.. Print Ia[rre: - 105 I 321f1.LVN01S 335N3011 — 1 d aiQ�e NOSIHMOW r, oz I 9ZOZ`6£AavnNVr:e1ea uallealdx3 NNalS.0 SVWOHi I I I. %l 'VORIOIJ d0 31V15 3Hl 30 S3inu ONV SMVI 3H1 pt d0 S1N31n13211MON 11V 13H SVH MO139 03WVN I 1 OZ`ZAilVfIN W 3H1 I OS!'iE9B 9066E 3W Zl�0001VO10 I I nmo uu,. yr I 'ON IOILLN00 'ON 3SN3011 3.LV0 II 1 30NvNnssd kinvnD IVOIQ3W 30 NOISIAIa 1 I H1T/3H 30 1N3VWtJ dd3❑ VG180l3 30 3.Lvis I I I I � 1 � o I N �I � (D 3:Z: I 4 i c 1, >. c I F= ILw o 1 0 m F I O L) ° W a � c w .a a CCU 0 I ZZ CY m o � � �a N �p c Ern 0 I w gl �. c U c 0 ° cc I � — Q wI DLL c°i c0a I W� V Q a � �, I FQ w Cl) o }I O M CL_ ZLJL N 3 v� m .0 c s I w µ. LL N d l 0 > — V 0 w 0 �I N 42 w C a I a w � 3 n to I 4 w c as N N OI F Z G I v LLJ INaw Q LLIg Na� � � `gym I aQ � _' F- Z � � I w t o (D Q fl I � ' 0 0 a c Z 1 Qom — ,, m I a. °� gCO w rs m `- tea � � Ciro I as ° JU) L oC � a z Ix ai (D 0) � c c io m I _ .. _. p O p 0 l � a v5, o0m 3F=aE ora a1 00 a}a 0 m aa 00) Luw a F , �aw ° I I L — — — — — — — — . — A 106 DEA REGISTRATION THIS REGISTRATION FEE qCONTROLLED SUBSTANCE REGISTRATION CERTIFICATE NUMBER EXPIRES PAID UNITED STATES DEPARTMENT OF JUSTICE 01-31-2027 $888 V DRUG ENFORCEMENT ADMINISTRATION WASHINGTON D C 20537 SCHEDULES BUSINESS ACTIVITY ISSUE DATE I 2,2N,3, PRACTITIONER 09-04-2024 13N.4.5 Sections 304 and 1008 (21 USC 824 and 958)of the Controlled MORRISON,THOMAS Substances Act of 1970, as amended, provide that the Attorney ISLAMORADA FIRE RESCUE General may revoke or suspend a registration to manufacture, 86800 OVERSEAS HWY distribute,dispense,import or export a controlled substance ISLAMORADA, FL 33036 THIS CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF OWNERSHIP,CONTROL,LOCATION,OR BUSINESS ACTIVITY, AND IT IS NOT VALID AFTER THE EXPIRATION DATE. CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE UNITED STATES DEPARTMENT OF JUSTICE DRUG ENFORCEMENT ADMINISTRATION WASHINGTON D C.20537 DEA REGISTRATION THIS REGISTRATION FEE NUMBER EXPIRES PAID IFM4688151 01-31-2027 SCHEDULES BUSINESS ACTIVITY ISSUE DATE 2,2N,3, PRACTITIONER 09-04-2024 3N,4,5 MORRISON,THOMAS Sections 304 and 1008(21 USC 824 and 958)of the ISLAMORADA FIRE RESCUE Controlled Substances Act of 1970, as amended. 86800 OVERSEAS HWY provide that the Attorney General may revoke or ISLAMORADA, FL 33036 suspend a registration to manufacture, distribute, w dispense,import or export a controlled substance 0 E 8 THIS CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF OWNERSHIP,CONTROL,LOCATION,OR BUSINESS ACTIVITY, u- AND IT IS NOT VALID AFTER THE EXPIRATION DATE. 107 �, BOARD OF COUNTY COMMISSIONERS County ofMonroe Mayor James K.Scholl,District 3 The Florida Keys Mayor Pro Tem Michelle Lincoln,District 2 Craig Cates,District 1 David Rice,District 4 - Holly Merrill Raschein,District 5 Monroe County Fire Rescue ° 7280 Overseas Highway Marathon,FL 33050 Phone(305)289-6004 r MEMORANDUM TO: Nicole Lyons FROM: Cara Johnson SUBJECT: Check for Deposit-COPCN DATE: August 13, 2025 Attached please find dated July 31, 2025 in the amount of$475.00 to be deposited in revenue account 141-342000-RC 00345.This check has been issued for the renewal application of a Class A Certificate of Public Convenience for Islamorada Village of Islands Fire Rescue. Thank you, Cara Johnson 108 ISLAMORADA VILLAGE OF ISLANDS * CT.N77 rv9M9AL OPERATING ACCOUNT 86800 OVERSEAS HIGHWAY ISLAMORADA, FL 33036 ISLAMORADA,FLORIDA 33036 (305)664-6400 07/31/2025 PAY TO THE ORDER OF MONROE COUNTY BOARD OF COUNTY COMMISSIONERS*********************************` $ 475.00 —Four Hundred Seventy Five Dollars and 00/100 Cents--- DOLLARS MONROE COUNTY BOARD OF COUNTY COMMISSIONERS FINANCE DEPARTMENT 500 WHITEHEAD ST ' KEY WEST, FL 33040- MEMO TWO SIGNATURES REQUIREDrrr,G+, I ISLAMORADA VILLAGE OF ISLANDS VENDOR.0101 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS 07/31/2025 7/30/2025 COPCN FEE 2025-202 Renew MoCo Cert-Class A Medical Service 475.00 CHECK TOTAL 475.00 109 CD C., C.) M. zm, M 131 UO) CX1 - M. 01 nil TO '0 m A in -4--1 �a z :13 "1 0 0 m p z c)0 8 im C, M3 z ;1 xx M> 33 > M 0 G) 0 m -u M> M 33 X Ca 0 C) M 33 M Tin z- 0 --1 m 33 03 0 Z m z :-Z :z m Z CD mC7 Wrcy Z 0 6 mA cz,z ayt I o 0 2 x M fD r m m A 00 0 33 M m I en < C) > m z im :02 m 5 - 6 M— - U� o o z x 00 C-) --i cm in,g M, m .c 0 P >m Z Z -n (n 0 m 5E --q M C7 C M m 0 m .4 0 33 U) M sn 110 N_ LU n O U U)LU z OC w U o LU ,Ae U) Q OV, V_J OWN LL cn 0 � O o U 0 50 w J C� N Ln N :1, N � � H H i O 3 3 U L •� � � d 4J r m Q U GJ Q 'y U H m w GJ s CC L r_ m : U H m GJ U •i L r i O GJ tv L c� .N CC +-a.+ .L 4- m i LL H ._ m H i 0 s mO v O O O E Q .v m U m .E t�: L 3 O m o s O i LU S M H M O O O O O O O O O O O O O Ol Ol Ol Ol I I I I I I I I N luu�llllllllp 0 U � O O �- 0 O O O O O a to O U �- U U O _ O _ O p p O a p U ^` O O O O N LA U n U L L L Q O p O a to a a p O y/ illl um Q U U •O ^O IIlultllll IM (� LIp l, IIII U LU>' to O U (6 U O O N (D A O N O) ( L O O N O O Q N m 0- L U Q N O L Q E (U W U) UO N 0 a •O n I Q U O L N L (6 N Q W CSC Q U W a Q C�IIIIIIIIIIII ulllllllllll. rn O �' N .� N m � � rn �' N cv n n cif cif cif ci m f IIIIIIIIIIIIIIIIIIIIIII N N m m d O O O O O O O O N N O O N \ \ \ \ \ \ \ \ \ \ \ \ \ luu�llllllllp c-I c-I c-I c-I c-I c-I c-I c-I O O c-I c-I O III'° 0 0 0 0 0 0 0 0 0 0 U) �. 'N O p a p 0 p 70 _ U) - U L U) U (6 70 U O >, O L O O p) O N O O U Q UO U O O) O_ O CC N � > 0 �- L L G L n � O U) O � IIIIIIIIIIII a O � a U O a L III 7 L U) U) a N O p N N (6 70 O L O U) N p„„.. a m m (6 Q L m (6 U i N W � U a a C� O c6 U) 4O Q U � U N m U (6 'N Z > U) > U) Q G > 0 a 70 Q iL GJ a CC c� ) > Q Q U muuuuu IIIIIIIIIIII m �n �o N N 00 �' 00 LO Vu�w N N N N N N N N N N N N N \ \ \ \ \ \ \ \ \ \ \ \ \ r- 00 00 00 00 00 00 00 00 00 00 00 00 luu�llllllllp O O O O O O O O O O O O O III'° 0 0 0 0 O U _ O O X O a 0 CU OU U L N O a O O �+ .N pl a Cn O CU CU a dy O OL O LO CU C>U + - 0 O O UU > Z.0 CU U O CV N 6 N� _06L Q �a Q L IM OO L O UUU W N CU . U U H N O V -0I E E L I Q N 0 O Q U U U Q CU E 0 L (6 O ) Q O .s E L CU .0 O Q CU L L L 0 0 a A �/� 06 _0 O IM Z a L •� ) Ca L L O 0 �, U L W °°�°IIIIY Cuuuuuu uuuuum. m rI N m W 00 m Ol O r-1 �l m � ri ri ri ri ri ri 00 00 00 IIIIIIIIIIIIIIIIIIIIIII � � � � II cfl III I pul��u N N N N N N N N N N N N N \ \ \ \ \ \ \ \ \ \ \ \ \ 00 00 00 00 00 00 00 00 00 00 00 00 00 luu�llllllllp O O O O O O O O O O O O O L O L Q Q 70 0 ^^Q N Q l U Ilultllll o i LN0 aL a U U)Q � a3 -Le-+ U Q Q a _ Q L yI= ' ' � U N -0 U 12- I L L Q > Q +� X -0 W Q U)U Q N L U — W N M M N U L Q M N U U to (6 U � U D M N M M U N � 0) J � � cU6 Q U N i .� IAU W W Q a -0 •— Y m U �. E > Z U) o U > E a a L a� _Q n U) L L ^Q LL 6�°Illlp pll„ II, I Cuuuuuu uuuuuul. O N 00 O N � 00 00 00 00 � lfl III II I"01" ti T-1 T-1 N N N N N N N Lr) Lr) N N Vu�w N N N N N N N N N N N N N \ \ \ \ \ \ \ \ \ \ \ \ \ O O 00 00 00 00 00 00 00 I- r- 00 00 luu�llllllllp r-I c-I O O O O O O O O O O O III'° .L o ° ° ° L a� O U o Q 0 0LAf ° O O Oo o°3 M °o °3 °NLL U 0- 0 > V ° °m LL U O 70 m O O L III L — — E O O _00 Q >, 0 N j W Q .p Q op ��S v °° W ° L ) N L N U O Z Ln muuuuu. ro r1 N m 1n N rn 6 6 `� N N m m III 00 co Vu��w N N N N N N N N W W W W W W r- r- uu�llllllllp O O O O O O O O 0 U O O U a O O � Q O L � Cn O LA U U vo �� O O U �• L II O D E fn Q O >O a .v, U O N a� U (D C: (6 IIIII O N \ 0' _ _ OL U) LU N L CO U �, U) c N Q L U N N a> �- U p Q 70 0) o o Cn N po„ C�uuuuuu uuuuum N m 0 oo IIIIIIIIIIIIIIIIIIIIIII N � ri N M Q c-I mi N M L. l0 Q c-I N M IT L1 -? Il OP Ql O c-I N M -:t Ln l0 I, w m 00 c-I cN-I c-I c-I c-I c-I c-I c-I N N N N N N N N N N N M M M M M M M M M W W W N N N W U Z W W W } 0 c tv v) Q O O O c E Q E 41 N O d w 'O W aJ o U cn E N ,v„ u Z c v, c \ � c - Z v CO W O UD .0 4 J > U — H C7 •+_ _ cv W 4� 4 Q a OC CO pJ +J O ro Z c pi c c 0 :� N W aj YO ao CW w = O O +J oC c N V c G Q Q .0 W O � 2 u 4J W .� cn C pJ = p S: E Q '� �J �J _ W c + W U + -a — d pJ N J tl0\ m C } C +� C7 ro O pJ U u 40 N u u N � = Q pJ C0 dp \ O cv O z0° a Q 0 � vas za 'C � � � o ap 'o0 \ C cn Q v c U� Q c CIM I W \ ' >a,aco O — Q . Q) ) � � a 4-1 N cX x ° O Z Lu v Nv uc Clj � v° � oU °v v ° UE EL Q Q ap OC c> v 4, > V)v > v) v) O O c � •— s > v Q Q Q Q Q U Q Q Q m U U U a a a a H > W Q U C) w Lu cn S S z o a 0 N Ln tc Z Z Z O cI N M ITL� l0 1� OP Q cI N M ITL� l0 Q cI N M ITL� l0 1�1 0o Ql O cI N M :Im Ln V Ln Ln Ln Ln Ln Ln V l0 l0 l0 l0 l0 l0 l0 l0 l0 l0 l0 l0 l0 l0 l0 W W W N N N c O c N O = W O V c w Z D W C7 O v1 'a W 4� G O N Z }' QJ =3 J (B 'kjj .e'. Qj ::; O O — Q tv _0 U O CO LA 0 on co z W N \ >_ >_ N U O > iri � U +J N W O } N N m Q N t o ro +J U t o N W Q .� .0 } N U co co ty J c c p .2 Q cQj c N c i C7 +J C7 c Q U r O cv v v) _ O w Z U ; +J rla WCO C d Q U `J° `J° N fN ,,.k;Y,J P;J 7 O N rr'. N ;Y,J tv cO U v O CO v W oc . . a u H > cv u o v v v v r:::r r r Q > v \ a _UQ _ r.. •_ ,J > v U x r:::r.. v) 4 J v) i — a, H � � � aE � Q ° � E � E 'a N 00 7 N U N O N - - - N W 'O NO N N V N 'a 7 i W a J > •— i — — — N 4- co co 7 — U I L (9 > v� N + an d O i W c v) i N 7 O 7 N + u i O � < < uzoacncn oauuuaa a a amcDcDZaaCLLnLn H > z _ q _ O � � O � ® g m 7 m 3@@ q q q E § § o ® E � > V § .2 § < ° f N Q E � k ° / § - ° d 2 ° ® � ƒ / m w — u � E § � E 2 / ° g fa < L E k • 2 § < kLU m R � � q � k �E 'E D •§ 0 0 .g ° g E E E E \ \ m k 2 < E E G (Dz Q / # # # � Q � � q q _ oo e & m m e » I c o e D e & m m e » I c o e e e e e e \ e e e e & & b $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ LLI LU q 2 2 \ u ±_ / - \ - f \ to < E • e £ '/ " _ > > 2 / 2 f = E E •\ u _ \ \ \ \ \ o / 2 < + o \ •= 9 .o £ / 7 ® ) ) k 0 x = > } _\ \ / k % \ \ � / w k 2 E - 2 5 .g - A = y o e k = E / E mo 7 \ \ t § 7 2 .g ,u u@ = Q = + E ® k § \ f / \ 2 ¢ u } \ / / ( 5 £ \ ° k 2 U k y E = 2 2 e / e / .s o % CL CL 2 y g e / g A y / @ •\ •\ ± 2@ 5 E 2 / / / § 2 / x \ Q .E A g 'E _ _ \ 3 2 / A R a U U U 2 LU w w w ± �:e —j 2 2 m m m m + + 12 + M N cn Q c-I N M l.rl l0 I� 00 Ql c-I N M 'n l0 i i i i i i i i i Q1 Q1 Q1 Q1 Q1 Q1 Q1 Q1 Ql Ql Q1 Q1 Q1 Q1 Q1 Q1 W N O Z 0 06 U 4• 4. 4 f9 fB — — N Q -0 N N 'a Q d O_ a� —i N N i.� > -O N N O U U Q t o t o 4J 4J N o_ o_ N O O 4- ate-.+ (� N N E N cn cn 7 v� (9 ro CO CO N N a-.+ (9 (9 C7 aJ U U U •— � � 'E '� Y U C - O N N O U (9 (9 Y 'a a U U U W C O E N a- N U C O 4- (B N U 0 U U Wcli i N 'O 2 2 � 4J w C U O N > N - O N N FO cn Q ro O C W -O E (9 (9 = t9 M E E N O O N N N N N N W aJ v m LL 4-1 p " " E E OC c I 0 0 0 w C7 C7 OC OC OC (n (n (n H H H Iq q _ O � � O 2 2 m f 7 7 0 w g m m w r, w m 0 w g m m w @ 0 0 0 0 0 0 0 0 ® ® w ® ® w w w ® w g q q N q q q q q w w w w ® w w w 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 � w w w w w w w w ® w w w w w w w w w w � C fa ¢ > \ - < fa 2 ƒ O � k 3 N @ t o 2 P fa u ƒ _ / J ƒ _ % ° u q � / 2 2 / O f fa ° 2 ° E 2 0 ƒ 5- � \ 2 D - x u U # $ § m E ' x 0 � 2 # o @ / / ƒ = � 0 0 § ° / ƒ a 2 f o f t fa fa m E ° » C : E # � $ ƒ � C k w o w w ƒ q D .g @ � q ° o P 2 o o ® ° k \ > / z D % % o k N m C § m m m E .[ .E § r a f § f ° 'K / § ( 2 .g .§ .§ E ) 0 � / ( 2 § § E 2 % D 2 'k o o u # ƒ � 2 / / 3 § k U 3 E § @@ a C § � E M � .� .@ o D a a % $ m ° o k 2@ < < < < 7 7 U c c c c 0 w w LL � 2 2 2 o m w » LO N LU CD M U v, U) w LU z t� Lu z LU w m � c� I j 5 z Q w LL III`" � � f °�irtirP°rr G i 0 Q � 5 W J C) (D N O h ........................ � r v „gm Q z eL C. 0 v 0 IIII a i� � ' 'ilii MIND � C u uuuull fE`iiii, CC +a f6 o N O a t � U 1 L ,;,, ,:,,I fEfEfEfEfEf,, ;; ,,,,, EEEEE„,,,, [[[[[;; �� !!!!'"•,"""" ,,,,,, E Mill ; r.l _ 70 lit O a v �s c � ulllllll uu ui L a CD 010 LL {Ff i G °Illall O CL Z Aco Cu co U ♦ CL 015 U) E 1P� `_ Vo c�11 N 0 y � cr 0 as �a �, IIIIIIIIIII�IIIIIIIIIIII Z g m� a IL — G7 ' zz ` o IIII0 cin co co m Q e- to o o w EOf C q � . LL o m i 8 -2 � � O � .E U) > q? E c o y IL12 LO m ♦ cam E x Q) 7 aEi O _o) Ln U) E a) < U) � Cry ao V _ � o U Q E ) Q D O LU LLID 1 -1 ti N N Cf I N mCD N G9 U _ L C O tf iiii � H N r J O 0 U uu O � � IIIIIII�II�IIm — � CID U U N III N N I O 0 w 4r � mIII •— m-uuuuuu �✓ � ,� ( « m a ul C �a N as 2 � � � � N U o2S `o ELLJ � � U C Nw� N L IIIII ++ N W W Iuu r 0 tnw u l IIIII O O ♦ 0 u "Y� Y w > Y"7 O _ Q V m r u > 0 (� of � ^/ O O dh.r ri V d E . U II of � � Q 0 � O U E -0 U E L m O ILL i — M C c >, m E U U m a ' p urn" +�—, v O m in m de w LU p V a � � U' z a> m � Y �._ Eck w w ate; CL SE ac_ aL� OU U Q Tm a C OFOE a) O E a> m Q > O m E 4- E C � O a O O aOom a) v Es ._ _ w a— > UmUQLL � � mmmzn � w U � C W � CW � � � � � L� mm � _2 CIO CM 0 �N O C N �L 0 CCO O C Q E V R o � s O V 0 E cr U CD Q Q L 0 N (6 w 0 �O O Oo co Q O') 0 0 a O U d O O �• '� ,O i O D L E w O \ O O y O C1 � O OQ '++ (� C� O = O L � ) O O LL d U tv c� N 11114 Q p N tq i O 'D O (�6 IM III � > O •� O E > ;Y 0 _ (D V! C � a L N u Cy E m (� Q O V O LO > .� O N O C O N N LJJ O re O O O O N O N QO D Q ''kl k Q U O `MmmE O 70 0 OU �� a L _ � a O (6 Q o (D Q o Y , toEL a� c}a �� N QZ i H m i m > x w a in 1 -3 0) N N O L VI V 4 3 m Q p t) O N V v O L > OL V as ' '� ° � a �' � ° o N a' Q L O o o ayi N o ari L) a CL > 0 ~ O N `� f/) N O E N w J 2 w O rL CD O i' i>,z d y y y '> `o Ct +, w X C > _ > O • O O J Y d „Yf„r d a� cn Irr' V! r, U N _ >, / ,++ Z a / o / t X U / / a / / / / , / / / / / / / / / / co /.�,rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr, / / / / / air / / r / / // / »...... .rrrr / , f�... v / / MWEE/ / / / / // / / / / V! Y, / / [[[[iim�',,,,,,/ / O / rrrrr, // / r LL / w / / ' �� ..:/fEfEExxYYYYYYYY ,/ a / rrrrrrrr, / Y � . / �a 10 rr,i� /rrrrrrrr, , ... .rrrrrrrr, ,/ t�� .. ,,,,,,,,,,,,,,,, .. rir ,�,,,,,,,,,,,,,i ,. €"rr`.... iiiiiiii;, ,,,,,,,,i � ,,,, iiiiiiiiiiiirr� /iiii ,,,,;;;,.: c / [[,,, rrrrrrr ..„r yr €€> r � u ��[[ °��„ O . • / [[ off ,/ ,,,,,,,,, d r i I r as r r;;, ,,,,,,,,,,.. ,/ ,,,,,,,,,,, ,.a•,� r / i i / r /[[ /� , / /%%,. / r ,,,,,,,,;> ,/,, ,,,, , ii / / / / / / / / / / rrrrrrr, , i�/ ,rrrrrrrr> �� rrrrr / / / / r/ r / / / / / i «.,.... / / / / I / / / / �j r i / N i l ��/ O O N H O O O r W N � c3 X ++ N O Q w O O 1 -4 0 M LO C 'A tq t % CD 0 O N r OR + x N LL' ►" s G O CL Im E, 0 0, 0 "V p W H V) .w N U 4 O O 0 0 Q ( srJ +' v�� G + Im = uY v 773 0 -6 d V A d E U vc tY o2 4 O t! c CL o) .0t Cam? V V) y N co QI ++ r O Q C _o O C N r2 U zL. lC ` E O O O CL N CL V) O — L. r N f2 t31 N d h N y '� _ o N V C W - X O O % N O _ O CJ °vm�»»»»»»»»»»>r (Q G! N O J Y D N m Y L aI L L f2 dcm co Q d lC OfAUaOW > LOB O 2 L 'a C L • . . . . . . . N W L O > C L. > .N N Q Q O O M > O a' a n a a O N 0 X 4) O Q U O � LL LU O I aI a fC N L 2 Q N W R r E m4 LL .7D -00 L N E of y O M rn a a a) o E tom)) N V O r R —� m —� rn .E N U a.— chi 3 CO „gnu n "° d N O M O m W Q x u° o gnu O a O y '":) Q gnu a d U P I L 0 U 1 -5 T- M U) N r L (11) U) 70 U cu U Ucu cu EO >, cu CD U O cu U cu O c a) �? a) >cu O1 Q i cu cu U > O 4- cB `� N L O cu � I_- a) Q Q Z) O) a) O ca a) L R _ L >1 E 0) ?� � a) L U �. O O O Q t 7 0)� � N U cu O o cu H 0 Q a� CU >1 Q X cB a) a) o) 0 U a3 U c U > L U a) U O O U E �_ a) ccn CU 0) _ (u n� cn Q cn cu Q nW a) iL Q 0) a) cn cn 4m, L.I.J a) cu cn cn cu O4- a) ° 0).Cu � U) � L Qcn C cucu 3: Q O Q cB cu U) O� Q �_ a)a) IZZcu O �'C) w cn cu N �. U L U a) (� L La) cu cu cu 0 U LL U �/�/ a) J a) E o cu a) �_ EF a) U � — L L Z) N 70 O O U _ N U o �. Q a) L � N a) L a) o cn o �. Q o 0 v u OQ 0 ) cu Q cB ) a) N O a) L L N � a (nU O a) a001. a .� U V yp CM U • • • • • • • • � p 0 p ^i L 0 CL Lm LL cL i c° 0 cu p 'a U d U m >' a) cu E _ L L — 0 U C: �_ o > Ln ++ W fn cu � a 70 N 0 0 U) Q - - O) • N Q U a) = cn z L O �. a) L Ln ui L U =p 3 0 d N O Q _ � Q a) a i U � O> i, Q L Q a) a) •� cm cu O a) III '� O cu cu _ O 570 �• — U � � O) Q C "U N O 0 _ * VZ > a) CID ycn E a x � O �� w � � � o .� a) — c0 a) c0 � C �CU cu Qc Za � m E T CU � cu Q 070 O vLL om � i OoL cu o o (A o :3 •— Z O W LU N 0cu om 0) EcB p Q L Cfl yam_+ � cB n O Q O1 O 00 > c3 amQ `= � ca U .� Z U Cn 2= ca W • • • • d • • • • • • • • E 1 -6 N M LU CD M U U) LU � U LU p W ol LL W 50 ryll' r i j N 0 Q J C) M M h w w � Vl I N 0 N N C 10 �C O y V L 0 � L O R rr Q a1 E C O •� O 70 CL t k H u L ii Q Oil III p a0 .. •_ mCO ojf U E N CD4 U) J p O _ — U N �� a O MM � y Cl) to 00 � o 0 0 L 3 7 U U 04 o I wi* -0 U oI LL a00 L. © c No L +OO o :ara LL � U N o D - >` m N O E N z Q 0-2 �+ Q U) U d :c a) Q .� x .� co © L �. O 0 �� C O U) co N O "6 O E c 2 N � O � UU = c C� c O O E x O U (V 0 0 D d 0 0 0 0 0 °t3 L o U 0 0 U C -0 -0 (o Q0 a) O U) U) U a-• U N 'O Q E E E E ') 0 O >' N c E 0 0 p O Q U a a) N Q CD IM 0 N � � � � � � a) U) 0 U O N U fn L E Ln c Q co V O d U a� 0 .� U m U J N Q E /� U 2 co 0 Coca J 7 7 YO O ?� E a E a) > C L0 0 o .2 w� > U •� O 0 OL W O O 0- 0--a Q Q Q � _ _ _ _ _ _ 2-1 dq M N 0 CDE N »»»»,,,,,;, 3 n� , ri / / o � co -� c0 04 1 c0 0 " err C "a C O LL c0 / 4 O U O O �n / >r O c0 L EEEEEE„ �,,,, x" ,,,,,,,, ,,,,,,,,;,, C (n m Hµ �uuuu — // O w IIII H / (n CU U N C L� fA 0 -2 -0 iillllllllilcu 0 U (0 cu Y Va L O •U O U Q ti (U? N t N 00 N _ N (� wn > Cs p C c U IIIIII um *�J . -0 L E r cw _ OU W u—oi 2 t EE cu -0 a�i N cu cu Q C) l m c� a 0 C O Q ° III° ° sx c E -_ - a LL a O wlllll 2 `�' y LL c cu c 0 lum '6""" U cu _C x 7 N ' N C "O O O a-aU) O m CU aE 0 Nz00 V m cu U) Z CU O CD � � �c cu i E o ._ .y — C o p o Y �+ E C w H o L o c� a� a C O > o c Q .>_ — o > a) m E co 0) E p O A LID -00 M A a� c) E dcu U) ICI m E cncu cn N U 2 c o a y _ Ecu • E > O o U v +J '— 1 N A a ppN (>3 O U I(11 NCD III L UO C d W m p LL C Y I C U O N E w co oz2 > "rm— gym E hd � OIIIIIIW C O N Y a:+ cU c 0 E O O _ �I� 0- o � co C U ~Z C U ( Z UJ x U =JU LL• oo2 w � Ex W � � � 0 _ 21- Cn - Cn aCO x t x �C5 UOCD u� DUI > X u) 0- U Q < U) O QOwaO `= Q 0 0 0 0 2.2 LO M CM N E a E a, W N � = o o n E E c a E y moco 0 .O R m co O s N L � C � N E N c � co L N CD Q co +J V O _ N O 0 a O N Q C c Y 0 mO ! O 'a lC to •� C Z3 co p i v Ncn U � � N U NC N N( Q E z o O p L V CD0) 0 ._ CD 6 0 0 (D `C C) . L O Q N o U L a� w J to O (6 to k H W to C U, >,U N 0 — a O oQ w z co L> (o (o Q L fn � � N O N Q � U (� < O „ C (6 D p U) (D 0 aD II III co O L Z o � to (D U — 'U) (6 p U _ o 0 m Q O p O J co Q m i V Q O E O p > N Y Q U to (D u) >,Cn J Y O p U 0 QZ V E (n LL Q a a O Q E a Q o z L ° o w 2-3 cfl M co T a 0 U m 0 0 N CD co 0 0 2 U Lo � }, N O 0 E Ell! � N d o C/) O 0 O Y m EL O OLL 0 cooU L Z0All 4— V! ii 0 ur .+�+ H O III�IIIIIII U) U + p crj Q N � U) � 9,n� cco cn O IIIW o u'' ' O ,o IW� � ';lip � � 0 L U 00 iiM E N W } N co 2 E Z co a O i y U m co O O > Q ""' � CU Cn CO �+ ,L O CU L > (o m � a` W j U � O 2 N D � ° N � ° O N LL Z Q „ i »» Q h'u rn �,yy >> to — III I � �u O IIII QOMNI N 00 Y O 02SI IIINrp r.� O 02S '� I� r nu. U Vn (o Z O I d •� all (� y-- o0 p co> > p X i � J 2-4 ti M LO N 0 � N O C O V! �L L CO C V! N R U O m m CO o U U � O N N 'm o ; O > LLL � a V O y 4-1 cy� wOJ �, ° a rw O CL L y N O O ri c� y t tv Gl - OnN ri y ++ ++ O N LL O C W > X m O 0 O J Y N Y aI a ++ >CL L z L t Of E 3 r LO ocanva0w > ++ LL L a a Q, n. +� N � a LL � r � w � A � +� E o G� W C V O —► —► m —► O O d U O •� R 0 „gnu n O p O 0 m Q O y Q — o V X Qu° o gnu a o E a ] as ao a v > a o c i Ln O L ,� � m o +�+ o > v r1 E an LL f6 � f6 N G/ V') R W 2-5 co M �s 2 N li a �l C: O N .� IIIIIIIII W (►� � .p _ ❑III QL (! o CL sr. s (o o 0 Q w- N III f2 0) 76 O) X O co Q U p s L ❑ m�uuu m�uuu uuuuuum uImIIIII co co ,5 a, O O N L.L E a O [[ , N N HUI O 0 D4-0 L Oco (n cn U iiiia ti ++ lCLU `o %/ L 0 Z �' '� CL vJ U Z ' 'a m Z o ++ N E E OCD N N — Z oo i O p co i W ��, > y Y Q 4-0 cn oC Nt (Dcn O a U N C o III N � L3 Q co O 70 c O O � o O (o O co _Q C/) O O O (o 0) O co U1 Q i N 3 0 O cn — (n co 7 i m Q (D 0 (n � U) p E U) 0 Q ++ Z � om m E- c � U) � Q LD � O oO o �U1 Y v L Q u N cn O —O V N O m O � � 0 7 U II :u U � Q ,� y 2-6 M I N O T O C O V! �L L CO C V! R O s H L 0 O . a N � LL N � amnia a CL 2 .2 _ a° 2-7 0 w w CIO N M N N i c c U io Y O 0 N N R a1 rr Q > O 70 CL s t k H ii Q,( Vl 10 Q � o � ui ui :.., CU cr N �,,,,,, J p o Q a — U O� ++ O•,i.r ,,,,,,,,,, �oi�iiiiiw U) 4Z Co EV U U � oQ Z O 3 � U � III U) Lo N Q� L (_U6 .N m D E > C — a) � m �� v 0 m LL d Q C a Q 0 O LL Q W O �. � ri V (n • • • • U N a Z :a N C/) Q +� E V z 0 N � LV U) N E L U) w a) 0 a T N ►"' x S co � co © L CC >_ �� 2 Co o U) a W (D 0 0 0 E a? c d N M O = UUd c C� c o UQ O U c cn cn u W (V o a c 0) }. CU O 0 d (0 0 o a� 0 L o U D O O Cn O C 0 (o L O N O U) U) U �� U� U a) ° a E E E E 2 — — U L o o > � c E 0 0 = o o Q U a o N O OI-e coco CD N � � 1 a) a) Y U p O N O U Ln Q ~ O d U o 06 L co aa) U J N Q E U a) o U)= ca c 0 O YO .� •� c o ?� E a E > L •� O O N O O Q � _ _ _ _ _ _ 2-8 d � � N y L L O � � O � 70 O R o N O Q O o (D O2>2 c6 7 � C O v � O U O ++ cnU N E O cn E cn O a N co a - U — cn cn cn o NZ3 O c� n = p Q 04 O U Q a N 4O cn o U O cn _ ° O O ZUm (L a a o Cl) L C W LL V 0) E O E v) � E U � � � u y � a0 w U o a m Q Q Q Cc C/) cn 4— o Q O C: cn I U ._ � L � N to 0 0 to O U E N U() m cn — _0 O � r > Qoo � mo � > � Y � 0cn a cn cn oZ 4— c ccnn > cn w a 2-9 N d' N N N O r � allGli •� •� jn ,M a o ❑ L Ohl 7 7 7 0 N o yji�l111p = 0 R a�' 3 ++ c Q plum N L a' ,rh O�OOO . O N y O O O V ( m /)Cl) fn fn fn O E Q O N O 0)Y a_0i C/) L cn Z 0 — O � U) p a V �€€€€ Al „7r L jj�I1�� IIII ,.,,,,,,.i Y� ,q; EEEEEEEEEEEEEE � ..........:....iiiiii � V „ i' iiiiii Lo U- a 06 /� 6 I..L L ..., U) s< i . W . (13 J L Q Co cc0 co Q �• C O ffo�, (Oj U) � N O O 0O O CIDW L ' Z j IIIW .L IIIW Of N i w C Q N (� L co Q "w > . w f 0 Of �O c0 co 2-10 M d' O w O k I s Z ;. CD „� -► 0 X© s w Op k c a� a rL r' a C.) ❑ co 0 EO C9O p > j ui a Co O +r Q : 4 O O x r. o �- O 0 a L y = � Cn O' w z iris o +r r:+ tn i o N � � w .. ", , p ,'�'4 `p f _ Q ca a) — O III O c a ' N N 7 U U li _ U) Cn ODa O � (U (U >+O O III IIILL E Z (V (V Cl) • • • • O Cn Cn V c O � U � 0 1 © ° co �c� c 0 0 � 2 o — � LL O E c5 8 W Dn > � cUU (L � m CL E a) cn cn O E C d E "i c- ° a E E co o .= O V) U) U) c cm c E 0 0 w m E (D CD U c U) ) OD N 0c nY U o o+I +I V) � c co co O ♦ O a L o c � N Q a) U ac°i O I"ri"',G m co a) Y L c co U) -a N `1 > 0 > U _L a) c co O o co � ��- Q co LLJ m N �j E a) c o � _ _ _ _ _ _ L� 2-11 dq d� LU CD M U U) LU I.L Q LU w KIP LL �r ryll' r i j W CM 50 Q J C) LO d CM i 0 � N 70 O R C� o CID O 0 - _ 0 ;= C�1cr 0 CD O') N O O(L6 +r N O •� O M � O •O •Q O Q N (O N N O O O ° a CU 0 w O O d O O 0) _ E o Q +r a� - •3 •> rn CID Um (L �. U U Q) U) ") (� 1 O OL � CU O CIDQ III � .� � O � N y �^ � O O •� O O (�6 "' U E N LU Q N U a '> N O vJ � � � � � CU E m O� J (�' O O O O a - a U Q W )CU LU U ._ to Cn N O - O _ m t � O CU N Q U to _ Q III a CL O O O O _ O N(u II III III O O a O III O W O_ _ > vT (u y M Q o y a cu U O = mi O III L kl0 >> rn > L U) Q U > (Q CID i M > x w a in 3-1 to d• L co o co c x O c O cm a) M E co co L co O - co fC U) �= U O E L C 4' O co x +_' O a) — O o co U) > O Co U) C ^ co Y O co a) N co "a co `� - Co > O Q Co p ° C E z L O O C co >_ Co +LJ O 4— EO E Q a) L O +J o E L u) O O N } O O = cco co co Qii'" O U C U O O 0 -O co O O Co fn cUn N '� L OC co p) co N O Co o O Q a) > .2 O O co O N O co O co O U +�+ Q a) O O N y L a) lC j --. +J . - co CY)O U D) C O co C L O C V! O >N Oco >+ co° = U E O O ` co +_ OL a) C L O y O N ° ° a) = C. a) O O E > U) Co n ( Y O Cod a)EO co a Co O N a) L Q cn o y — cn cn L U) — caa)) co - � U °� - 03: co 'a dLo c cco cv a O Q a? H a +� o +J O iri ......III.. cn y 0 j ui co U cn N e d O '� co a) O '� co Y r a) co c +) N O U O0Z p c}n a�i a) °� -oa O a�i a�i E u) U o o a o � co � .Q .Q .� o � O ° E co a c a�i Q� °c ate) ,o a) - •- Q� g O L V c O U) _ c o aa)) .o Q o a) > y o CoL c a) � — ° U a) c° Y o co a) co - O c E .U) c c ,o x °o °� ° �I co � �Lp Co o y coE o 3 a) °cco E E — _ _ a N O O a) TQ i W (na0 � U �- c c � � O 4+ co >,,cn cco a) O O L O O V ..�.� O a) co +J Y L a) ° U N O o 2 U E + > > O p U U Y c c 10 a) > cu ° a) E O OC V V V a m 2 > cu a)V a W � U) O (D y C + O H co a` ca � 2cu o cn G� Y m ca coi O N cn a) coi V) C N cu O) to 70 T (1) x u) U U 0 m N O cn 4- � N > E E U o L O co c 70 E cu - +m70 L a) C: O)j- O a) w co 0) V L O a) N aof a) co W a) co co m cB z �. p OU U•L 70 co a Q co OL Z) o a) 70 co U) LO MEO a) C13C: 0 7 co C:- �. �. _ E N cu � a x co ~ O L 70 70 cn Y U co � a �� U �. �czoo0 �� o � x co O 70 UE o cc:o > LU) m " EL 0 0 0 o u? 0 v a) E Y L �Ln C: o `n E c? 70 � Z) a) > 0 7 ,E O w n � o �� E o Qz � Ox 0) 0 ° � 70 a) waa2d > as > a 7 � 0 o cn C: a) W • • • • • • a • • • • = CU a) a) cu >, O x � �5 a) 3-2 ti d• CM ° N U) U) 4- ` J CD C N UO) ❑ O L � . V) "� N a) E 0 CD tu O LL a) c L a) E U i O O cu + ❑ L) p a) ❑ cB w O i N a) a) N p O (1) O � — U > N cB � O Q >N U ❑ cB 3 E Q Q to 0 c cB U) ro FJ5 L a) tea) 4- W O > ° o O c L cn o a) CU V ca ca U U a)0 0) 0 70 > a) a) ) .0 70 E, L c om u w N .N CU Z) U) maV) .L U L �+ O L a) 4- Q� U) N O Q a) � cn Q a) O a) U) a) O > ° cn > +J Q a) N cB a) U) OV O 1 E O cu L > N U) L)a) o a) N U 'ii O E Dd :t! 0 (/JUDdO z0coU) 0 � 0d00 O Ny • • • • • • • • • • • • • • • • • • • • • • O V L N 0 a cC d O) •a cC a) cB CD V_ a) U) 4- U) Y d L o L) O 0 L cB (1) i 4- > v! ) 4- N O U) O0 U a L) N 7 s 4- cu 70 � •�_ O U cnE cu 70 a) t a) ❑ ❑ O U N a) _ Q o c p_ - E o > E 0 cu Q O Q a) p N O O Q O �. ,- ) U ; E Y O iii CU L m J OU IZ- c 0 70 J ❑ _ u L p w d N 70 a) C cB — L ca3) j3 Lµw 00 ` Wz O a) U O C) _E 4- E () p c QQ � ° � � wcD 4- ' ^ > ca ca L (B Q (� _ L '� _ m cB qu N N QIm a) 13.0 X O 5 � Z) +J cB L U O — A cuCL ^ L O O U) E E O U Q O U L O ) ++ E LL U) •� U) O Q C V a) O CO )' 7 Q V p E L Q co a) 7 >> O �. (� O U) 3 o w v_) Fu > E > � � � � a�i o a�i z III 2d > 0 cn� (n CUdcfl E d Q U � "< fn0 0 = z w a 3-3 co d IT i CM M � N O C O V! L CO C V! R E O s H L 0 W E U O U O O III N U x N U6 O1 O to(1) O a) p N U 0 W N � u NQ O E- 111111111111 I'll 0 Lo _0U 0 v _ N O > a N �. L O - „> y 0 � � -0L U >, O ) O � O M O U (6 •> > .� LL a Q L Q +r O L O O U N O U a O � N O O N .� U NU- ) L) N > 0 U) � U c6 N ' U O' ._ O L 0).- D Q( N OLOU L III - � Lo IIII �C' Q °Q (6 LO O W a OU C- UO O0-� O U L U � O O ) L �� 0 � � � °� o-0 QoQ> (1) LO � 0 0 0 � � Q U � � � N 0 � a � LL U ul _ m _ o _ N U cn >, c6 >, Cn L y U) UQcnao aQ � E m w m w a 3-4 d CU a) Ln cu C: �; Q cU a) U) cu U) -0 U) a) o L 0) cB c & U^` y W y� L L �W O N W N L X O N�w a) R U) � O �i W L 0 MI6 H O L C a) � (B p o cu a) U) U O c ,1 N U a) a) O 0 p a) w O ' �. Z) L Q ++ C cu N a) U .III 0 � cu N p a) CUL O L ��wi ilW '— O L � ) L O p Q " OU � Q cu O cw C14U � �� 3 U) L ° cn E L to x Q cu a) � Iriilii > � L O i CU p to U O �'W Q +� CL O _ L U) 2 a) � L � � E U O ++ L L cu cu a) O O �, oP""'u' _0 cu A � N � L) NN;N' (B U +' m cu cu cu Q U L U cn to u) cn E a) a-0 L a) E U O O L) �u a) U O�-2 0Wo ° �° CU Q > cu° � w � ) T -0 0) a a) cu Oa) M� N OcB Oa) �+ a) cn _ cB � L a)cn a) �� a) N Z) CU -0 .S .— .� U W to N E •� L a) CU0 U) o ww ca W o O > t � � Q rI � � � � � � �, < C: > 4.1 „, cu — L a cu c o ,� c ti a) 0 > ° W O a) _ a) cu cu to � J N U O II Q > (n z O U a) — — � in W cn � U O l cB U 0 ++ an d a) N O � a) E N'N'N' a O > O c N - a) •U 2 Q 'N'" O O � LO 'X 'li V � Y 0_ z CL Wd0O > D Q< 0� o � � � Y � call!°i d �> Y d a — a) L Q p o w a m cvn - a 3-5 0 LO T Cfl N U U co I y +J U) .�_ L (� cn N C C 7 co 0 O L L 0) L E LL Co a) E cm Co Q co L co C co > N "E5 N L L U +J U &0 L N N U) U L U Co U C C E co O �_ cn LU 0 U T"O O O O U co U) E CoN L co E c a� o '�•� c E ii O 4o C c— O `o L LU co o m c a Y ° o a�i U '� 0 O CL coa�i LU co O a� c U Z r> c > R ai CO c co 0 0 co co °� o °� E con L '1) om W o f E a N E - w CO cCU °� E °c ao o U L U — U) Ue •� > N i = U U Q U N L (o z Q U U)- > 0 N U CU 4- J O co O O +' co co O H Q O C + +' u A- o- } W N O a? O c 0 a? Q � Qc N � p cu O N_ _ 3 N •� co +a •� fn Y N co z L U T C U N — cn Q co 0 N E U a O U U O w CU cOi cn °� a� a� Y E E .N axi a E co o U V O o U) � � � � � a � U O 2 Cal Cal N N O ca � x�•,, � � �as � � U v I I ~ s _ s CL i4� vi •� 0 YY 11 a ._ L CL _ O E d /�u� m Cl) N L L v 72 a CL 3 o o 72 Cl) 0 � L co co L L Q 72 H Q ......._..,„„,gym ...,.-." 2 O %i Vmunim � 0 W, N E / V o m z 3-6 T- LO 0 cn U) 0 _ ai c Y E E a) U) c Co W a) (0 O a) L C Q = O " N C fA Ma O O L c M L a) U M +� L O M O N 0 a) E -- O O �\ Wco o c� 0 a a) Cu 5,6 U) a U) 0 c O � Cu 0 c •� cn >> a) cn ca c c ca E °� L O O a) L C U U) -C +J U a) C e N a) c +J > .� O N +J om O E p W L O O a) O O > (0 U) O) N_ Cu O U) ?� (0 — N c C Cu C N �Cu U) c U C >'a.., fn fn Q "� a) "� L -� r W a) E o .� 0 a a) a) °) E E w E E M o cU o wo o CU o E E ui Q M o> a) E '> °? c a) c E > Q Oa0) � � � U 00 °aaOia�Ei � " �Y " aa) °)Yo � °' � 0 R x c o a) Cu o 'U) a °a L E J co o C x E O a) m .N c O a) U - co >+.2 co 0 E c Cu a) E U) ° >' Y c c o E N a) 0 E 0 c ui °c -C o c co E a) 0 0 0 0 >1u_o) o o ° o 0 Q Cu Cu U 0 a W L ai cn o c a uS 0 E a) c 0 a) c 0 Cu m U ._ a) c uo Cu °)i a Y 0 'Q > = x" Ea) = c a) a = c o _ ECUa0i a0i 'a��i �° • a) U U • m m • O O O • L Cu L U) M C E � O N O 0 (0 V co a) E y = > O N O O y 0 C � Q Y O y t O L0 � � mO 0 6 �? a W d c .0 a om c � �0 � fC a) U > O U M O cB t� Cu C O � U) O E � a � •� L O O E O ) C +' f0 L CE U)O a) a) (Cu UC6 E a N p a Gyre U) L ) L z E Cu Q � Cu ,� c 0 c 0 0 c 0 O E = a Q co C a) a) a) a) x W Q a+J a) C 0 c) m O Cu Ea c o o O c c a) c a) E _ O ® O cn E � 0 om cna `. _ L U) Y U Q U) O U O O L a) O O O > a) N U) a) Cu U L L > ++ a) ^ O "O Ch a) x 0 O Cu C O N U E a N C L O a) U) p U a) a) O O U U U Cua) a) 01 LL C O co O _; O co L y a a) a) �M 0) MaN E aE a) Y Q E a) 0 O L0 (B Cuc) 0 O C O C O C E V. O E c c a�i 0 a) a) cn E a) E o c L 0 C Cu Y a) +J C a) Q c O O a) Q h OL +' Q O 0 L C } O) O a) N 0) O Q 0 E C > fCu A E O) a) 0 U a) m C '� U) (0 C w a) (0 c N m c o E u) Y m a) c co Q Z c co o o °) O o E a c o Q a o Cu 0 L o 0 Cu 0 E CU E 0 E � U O � U V) L (0 C L = C 0 +J V) >'W p) E >'W > +� (n L a) m •� •� = O = U) > a) E _ L +J (B O x o m ai a0i E E aa)) x Q Q u0i Q Q o ca a) L W C Cu 0 Cu O W U E CO Mo }_� O O O a U) C a) M L — O U Cu a U) U U) a) •V! U) aci E � E Q o Cu Loa °? Lo ac) ate) i > cn c o a m E > c > L — > +0 a) O O Q Cu O N L Q a) Cu O C E a) CO a C O C 4- C U) N a O)7 a) N a) — `-' v) Q O " — L Q O Q i fA a) c �_ c Q ti > > L 0 a) E o w a) E E o � E •� a) c 0 ° > ° � E o �,� •c0) c o � � � � } lC E > L � 0 i E � QC � � lC > a0 EY i > a) � 0 � L a) x O C M ++ O C Q 0 N L O Q L -O ++ O Q O > C lC • • • • lC • • L lC • • • • lC • • • • w = =I a = = 3-7 N LO a >' M cu o �. cu L L >' U U O M �. � cu � � Z) om � C � a) o 7— 70cu � a°)i a�i cn Q� o a) 70 o L) � cu L U ° Z) C (u cu 0 � � � .o CD70 , ° � c o z � ° cu LLB U o — ( U i 70 > o Z) O O 70 OM yONCU a) U a C " C,Z)W cuv aui c X 0 — > E v'� ua �w o EZ3:� cu 0 - T0S 0 Q0 /o) i cU —_ CUB V a) iL O E E L L WCU 0 � N O O o Q a) C o � LL Y � � �—>'I >' to �- LL (0 O (am > - 70 W o cu o f ° m cn 0 00( Q � cn O cu Q•— � Q ao cu Q c >� — >, cu a) arc " cuE rn , —a °? > a0L) a) .°� O �; � U � °o 0).L O a>i Q n a>i .� cu a) a) O cu O Q � � cOn cUn � � cu a) cu E N E >, a) Z) a) 0O O 70 >, 75 LL 70 Q U cu 2 U Q E (A U ) cu 7> N N 0 OC O O L Lo a LL a 7 ca c iu rn ca cu E ' 2 � � E ce) >> E Z cu c G� � � o N >' i O N U N 70 QL co cu N O a) E cu •� C N fu a) p a) cu C . cc L O CL p cu a) Q Q 70 U ) Q > c O >, U cu C.) z N j OL cc a) ( O C 0 0 > rn (1) p Q � N N >% N a) — cu c A y (1) — � o O u� U a)Q ) U CU •cto� &�_ x a) cn cu C� Q a) a) E a) � •� a) N U =3 cu cu cu E E 70 c O cu w U) Q cam O cu C cu c >+ N cc O vi 0 > ^. a) 0 O �cu 75 0 � � � V ON N o o a) � � c w E a) a) o o Q E Q Q ii o ao ao . a) Z) � L a) � �- cu U O L N N N a) a) cu i a) cu 0 O a) L 3 3 N � O O 70 L L N N O) M M O () 7 OO Z: a a O Q O Om Q a) a) a cu O O 70 —O a) O) is �2 >% a) L O C1 N z E O E L vj a) a) cu O O X N o Q LL � O c3 O . c N F- � ofd Q UO Q � LL (.0 � N U am vZ Q � • • • • • • • • cu • • 0 • y • Q • • 3-� w a LL M M U) ca O ❑ N (1) O a) y a) cL 0 R cu L O U cn i U ❑ N ) O L cu Q p) N a>) 0 0 .Q Lcu = ') 0 O cu V O 0 L IIII 04 O 3 Q o >, a N N cu i N O C Q U v > a) U) 00 L O .— — U- d � 4-- lC — — IIII > N III O� (B 0 N ca p ❑ o O CQ X O a) , OO > a] L L c a) 70 0— � � O a) O 0 � t„w' �cu � c� ° �' � cU � „III......." � 0) CU L 0 G , Q E •= uj a) cU Q o >, a) .� ca a �) TL) a) > N U) c� Q O > a > Y O LL C: — O N ;� �, m a) ca a) �. 4 — Q z � U III,,,, „ _ U a) O O ,II, > _ > N 70 E U w a a CU O > III I � Q U � in W fn 3-9 d' LO O CM U) N ❑ N O s c O U O C U c' y OU N O i Q O O (B ^0^` R W E C O H C O � L N E (B E ❑ 70 U O (B O � E 0 N N (B cn N "J C m Z3 O O � � N cu cU � N T cu U p N � O a) tU L O E �. L d a❑) C p u c C 0 v - III W 0 Lo � CU a O (B cu Q N 0) 0 O OS2 � O cn O a0 E w Q 0 (B � 0 v! 70 O N I3 Q i R3 70 O >N O C cu N O N pp O tU tU Z E (B p O N d U Q Q E Q N d 70 U a) ,0 CU CU � O Q O ?� �. O O a) p � O N O Q fIf ' cu c 70 Q cu U U U U N E E N � w j O -0 O N U (a Q cu O �. U Q cu N N N Q N C N i +- U (B to > U N p d 3 cu O to N C U 70 (B U L U tll T3 > N E 0 i C •— (B N '— .� a) C O (a E 00 O � 3 7 O to L L L to L -C C -C 70 ❑ N E a) > Q (a C (a C C O �. .— — N N O U O Z � � o � � ao arc) U) c) w 3-10 O a L a) M �_ 0 0) N O cu a CDN 0 L ❑ >, L 2 r L O �3 O cu 7 o O N 0 U ?� y L�+ O O 0 L > KIIIIIIL CL a N U O O .� cB cm N O cB z CIDcm E E U) cuL III Q cn N L V N s Cl) � cn � � Ir- Q O _ �I L O >' O N ~ �. W III U 7070 0 W U — U O O p O N 70 Q 0 to L �� L � 0 0 �9 W � � � � � � � Cn 0 0 c� 3 Q� a) U CM U) Q � ) U ) O N � Q V �W > O z i � J O cn > Q �. .— d a) � 7 W Q Q U 0 U Y 'N Q 1 N O �• O L Z) J a� O J p m ca Q 0 �, L E E o O .2 z ai N Q E E U 0 z V cn J O O N � z O Q � � � O cu000 } Co � c cn u°�i000 U 0 W (/) 0 (/J n U > ch CU > cu 0 z 0 z 0 • • • W • • • • • • • • () • • • • 0 a CnI Q � V � O L 0 Y^_ a ' L � O 2 V_ Cu cu E � � a �a 0 NN �! Iw N 0 CD 0 U C%1 N cB O CD a L 70 I � N N z O > N �'%„( W U � � 0 O h 0 U �' „ 111,111 O cB p p �u„( Q cu �� U E J O L cu y.+ "„ N L O N O CD CO m 0 E J to N O cu N to cu cu cu o (6 Q "� O 0 O � III' ' U cn X uj N 'IIIIIIIIII cCU aw Z) aa) Q N I�w Q _ a> CuQ Q = L c6 Q o l � 70 o NU — 7 l� 'iio c0i — cm a CD � o „„„ w cuo Uca 0 U m ma cn III'II w 7 O a) O CJ CD a) ' � � �w ul � w > a� c� U 0 CD 7o .L cD 'Fn o W a) E E a) O H w0-0-0 ilr aQ> C� in Q . . . . . . . . . . z 3-11 W a a (D LO N rn LD o U L C O >, > cu a) — L L •� cl cn 7 U O Om cu 0 CU M O O C a) cu U) '— a) L C a) N cu o a) _ cu a) E L cn a) O N Q L cn cu O y 7 CL p U O Q C j _ cu Q'y N L � _ O cu cu a) O Q a) 1 C v� t cu C Q E In d Q C C L E N Q) Co +-' 'C a) a) L L Q X L .Z � O 0 �' O a) O O O � cu (n Q N �_ Q) cu 70 V CU C 7 C.) H (TjN � R O L O O C O cu >,`� �' cu C E CL 0- In � — N Q CU N U c3 to > a) N C N to '� L a) �_ cn a) cn C E C L +N- fu 0 +. �+ a) O U > C N cn 0 L V a) a) C � .o � � � CU � � L) cu mac' � Q � � cM a) N E cn = rn -CU � � a) QX QQ Q� °� � d x � � c C: - > �� cu c � E cu a) C L V O O L C cu Q 7 0 c cu� � NN No m cn cu 4— �_ a) _ — o >. a�i O O c C N c o CU o V C � � L cn ( 'cn 0 cu +- N to L C U cu O U (Q /3 > C — a) cu > p a) cu a) O a) cu O X (1) W =3 2 s Q LM W c..) om C Q co U U W 7 � 4 � y Q O y O fi O L O 's3 m a) CU U ++ p C: cu E E � cQ C (u V O a) to N cn 4- a) a) > cn C � C U �=. a) 0cu L U (u � a) O O Q N � �_ to � � C U a) cu CO cu cn N OU O L U ()a) N � C NO OO `. cu Qa) CL Qa) C Q N O UO a7 0a) > O U Q E ( I' ma il O Q (om CU cu G� a L cu E X J N cn c cu m .0) a) m cu O a) v)O '� aE � - � aa)) cn cu � u� � .L � -- o .Qa�i >,III 'I'I' 0U70 cu : o C cuC QQO � C) oa) � cu � w > � a) � cu C cu Q U ) w U) "_ a Q .� Q E o a a)70 cn o (u O C U J cu .� N II N u � N U) O z) 1 P U ma C a) "- �,() cu cu n OV � o 0iC � L A CO a Q u o > ) ) Oo —CU cam ) O&- — Q cu a) .O cu = c0) d E g 70 Q.!!I„'' a) > � Q z U)i cu u0i C L X +� O cn ,� a) L a) Q of 9i E L O Q f O cn ma F- wao > � aQO � L .� Q � L a � Q >_ o � Qo w a I- LO LU CD M U U) LU OC LU U) W;. //gLu V LL W V UJ �10 "� W 50 J C) co LO i 0 � N 04 C O V! L L CO C V! R E O H c (Q C m ') � O O p -0 Q O - m a 70 70 O N E a� o N O E cr 0 _ O 0 Q � L � N � Q . O o Q (� 70 z p y � U p p w Q m W C a�i � m � 70 Q Q 0 > a _ a) m Ln o — 0 0 to U N }, c0 m O L>' -0 CO � E � N U a a N N C� N N +, O a) r Q - O � cn N 7 � O a CD > cf) > Z Z O C IL 2 p L }; E O Q \ p O c}n LL w a 4-1 0) LO L i L fn -�• (� p (O N U N 7 — 01 U N N O O 0 (U U N 0 a V j p O1 a) •U N O O (6 (O = O O U = >'� N N O Q (D rn O O U N O L U O O �' ❑ CIDr N C p O N N 7o O O O O U CD O 70 O L p oO C U O O w N� O O 6 a O O p O1 O >, y ,y = O i+ O U U .� +� U N O O f/) U O L y O L O O p Q O L O O U Q (6 N O fn ~ E a ° aD � aDu) Z (� O � O L V to to (6 L (6 N N L fn (6 (6 Q = .Q UH O a O U F- LU 3 U u. J J N N O O Z m 70 c o ) O L .O N O N (� L O QC14 O) N ii a 0 L O O lC U .. J _ N L Q N u N It: N 70 O c� N N to to U O Q i U O Ali O +�+ O W U 7070 EQ N N Q 70 cn �U I N U N �O 1 � .. : m OL L �O O ++ N OLLO > 0 O (U 7 L - - O ..... � > O O M .... O O a O O O V O Lf)D 70 L L 0 a O 0) c6 � .O LL Q L '��aP V E U uu�� X 70 (n 0 0 w 0 S � Q U (p C) O O O O N - •- •• Q Cn - O m � N � � O (D U N .O O L E L Q L N U t O m O �+ O 0 U .0 > O U (call O U O Z i ) O U O Q i ... .V ' — Q U p •— N �1 - _ CL_ � y vaaO > ) CD � 0Q c� LU a _ cn 4.2 0 cfl co 4 0 � N /1 c� N W C L N � U y R U o 70 70 0 o 0 p O N U 4- U � N N O E � N U d -0 N cn +- N N U j O O O -0 to O c Q E O ++ L O � ._ O � a N O N C a 2 .2 = 4- (U a L E N 0 m ra 70 .— m m� LU c� � Z a� o CU � cn c� LU4- o a� o O 0) c) cn Q E C: N O Q N - U O Q c U O Q U O tz L.cn cn .� O L Q O m : � a) �O N E m � - � � (� 7 N O W C� p Q Z � > >N2 m Q > U c� U U O �_ a� L �i �"� L E Ha02a > a w a 4-3 cfl 4 0 � N C O V! �L CO C V! R E O s H L 0 4 i M C' 4 2>2 CO c CO O c� v E o > O Cf) 70 LL ` 4— N � a ca � N '++ 2 N N _ c L O M d ^ L L O ' O1 CO E 2 E N C) Q (� � O Q. C/5 co L FLU (/) Q O U ' U p O c (/) m I Q O i *.p Q �} N '� V � am. M 'j a) 0) — j CO� .� z < > (DC7 to O +� (� G� O Z O W 0- CDL • • • • • A O > E LL Q > h w a 4-4 N tG LO O Q L a) cu o -r- 0 0) N c O cu o >> � L r ( N Q O c3 O cu N � O O O L > U O O O O Q 0 N O a) 1 y L R L Np o cu Z a) E U) cuL N V a) s a) cn Q _ _ cu L O >' O N ~ O W i Q ) U � E O W U — Q .0 O 0 70 0 p O N cn O L U L Q ojf O' cn = O La O N - cu — O P 7 cn H a) � cu a) a) d U d L = U J 3: a) fn O � a) H � O� � Q ?� � O a) � �� Q W � of J O cn � � 2 � a) = O a) V - O H N Q � p a p � 0 Q p p U N a o Y Z — — O J a) a) cu O J o CO cu ( � Q a) a) L E o O •2 Z � N Q 0 SEE U 03: z co J � O � a) � z p Q a) Z) cu o O } O � D o � Cn 0 0 0 0 V (� Lu 0- 0ch ) U OJ O I> cu 0 z 0 z O • • • W • • • • • • • • • () • • • • 0 a, L O a Wi Q y a a � V � O L O i ,E a` c6 cn iLn O U) C14N 2 L a) `O 'D c� EN) O d U U y 8W _0 N a) c6 N N (sl N E Z _0 cu 0 w O O O w Q L 0 � a) O 0 E � L E � J cu a) °' a0 1� (6U O 0 cu CU c6 Q O III III (6 W Z) a) Q � N N IIIIIII �wu�q� � Q U) Cn Mp�pM (1) -0 Q a -0 70 Q = L w (�6 _ U 00 N : LL kl Q O odu U cu i O) U p a) w cup V c6 E CL Oiil' ul c6 cUl O mL Q O — U r a) a) _ H = w ZUD U) o � Q0 E w -0- 05 cc aQ — C� )cn Cc Q • w m m a a Z 4 _5 M tG co I 4 O > O (� N N W C � � O t / N y/ LL C is V O R is O H fn o Om N � N Q E U Q � +p 70 N > to C O U C m E U � O O Z O 0 U y 4— � ii U 0 _ a o L N iu m fq cn L O 70 � — � L n N O �a LL a f N U � N � 70 >; O N 2 .2 70 2 � � � E p cn O U 0 m N Q E N to W fn N W m 20 t a 0 U a a C >+ w � a a--� O � C/j Qom ' U 70 Q Q Q .� � 0 N 70 N — N 7C3 > > Q 0 O U — Q Q N N O � O L N m 76 - Q O O> v 70 0 N E Y cn N 0 N to -0 .L N to c� >, (n U O v L C� w a a o 4-6 dq cfl i 4 0 � N 04 C O V! �L CO C V! R E O 2>2 H L 0 m'^ cn cn 2>2 m U � O U 4- L- O N J 0 IIILD � O _ U N N N O O O L o U E N a O ii cL O O Q Q a `o �a N � a Ljj N a E 0 O O E U � � i W cn W C H (C� Q +J N N � 'Q^ 7C3 Q 7C3 N C/) 7C3 - Q 0 O UQL EN U - L 4 U L U O O CIO u N W Q O > W N C� N Y ,,,,,,,,,,, O N 5 �+ � _� cn � o > 0- Q � � U° w a 4-7 LO cfl .................................................I 0 — 0 cli 0 a emm 0 00 UJ ZO < 7- In uj z Z z < Rj z t V5, < 0 0 7 a > . L UA -- L) C) 04 7 1 . u z u il 0 X z z ol 04 o o Cc) x 0 0 ul Z CD z o ir wi uj 0 z Z < V; 0 >U.1 z 0 L, z 0 0 o z z N LU 0 < 0 Z z < w 0 0 C nz z > 2 z Z< H M 0 E Z (jz CL Z 0 z z I 0 z 0 z x I z o 0 z z < 0 z > o z In ci CIO) m L o LL CD z 4mm ,I Lu cn Illy V) o ---- ------- to 75 z 4) A 0 ul , 0 0 cf) O L. tz Z Ila LLJ .................................................I 0 E U) Cu 0) 70 U) Cu 70 04 (1) 0 C) 0 70 0 0 Lf) C) 0 0- 0 > CIS) M E 0) C: LL a) —1 0 0 E 6 J N U (6 U (� �_ C - (D 0) < (D CO L 0 0 -�e M U) 0) E LU (D 0 Cu (1) C/) C: (D Cu (1) 0 v 1 U) 0 Cu(1)C/) L- DI) C� M E W" -00 cn 2 E Ll < 0) 0 0) C: _0 LU :4i:f X 70 U) F = Lu (D -2 < 70 0 M Cn E 2 C: (D -0 c 0 b w M E c: > (D (D 070 M U) Z- 0 E L) -0 < < IS(D Cu 70 M g- > S- E0-) E 1 0 Lr 'a . M u 0 0) — o > >>, (u (1) o c) 5 > 0 F- 763 0 m 0 > m 0 !��............... LL 0- 0- < LL c LU CL cfl cfl LU CD M U U) LU LU �� Cn U_ w U_ V LL LLB J W ft, ,, O CD r °�„ti�P°rr "MI r 0 CNN LLJ 50 O J C) ti cfl Lid C0 C O 0 0 L E Q � � Q N ' � N W tea` Q a C Q N � N I � U N O N ' � L N CU �• NO N O O •L ' -- L I �• L �, CU — X U � 1 O O N O U CU O 4-o E CU I, III •Q� � � � � �� Q L � a� � � '� U � �, III _ � •�, o 0 � p Q I C I III III O � O X X III O O O U CU L II > O U O uuum O — � O U O U oo oo Z Cn Q C/) ( Z Q C/) U- L Q Q a c� Q 5-1 co cfl L � a) OLO L L N a� o o o cU ) O c6 c6 0CD L � 0 70 Q 01 (U y (6 U o O (6 O (6 i U O O (1) U) a> p U Q a) O1 L O U E (D Z3U O 70 U O O O s (DO U - (Da> O (U O ( 0 Q U .L (D � = (D Q O '— > U L (D DO Q (DO) L U O O Zi p 70 Q O 0 4 Q O Q O (D O O(6 O� •U > �a>) O U O7�0 7(0�0 �> O O U m U OFQ L (n 6 L O > � cam (D O) E U 0 O m 70 O Z a) O .O �L ++ > N o � 0 O o .L o N a� U L a) N N J p m- E U E Q > Z O 0 } (D L O N 0 Q (D W � �_ o � � 7 0 W � � (6 � L O `er p y 0 O O O �' O Q W '0O W O Tam a U > O Q (6 o a) (6 L CL 0) > O J O_ Q a) to 70 _V -a �a W 2 T `� .� 2 J QFD0- m = � � = a) E � o .Q E � � � O �a m a J _ n3 _ _ � U N I (D 70 . U (j w N (D O D E V Q O ~ a) Q O N 0 W - U (6 �. v� LO O O o U L— O Q (6 LU (O6 . �a- )L a) O O 70 �Oa) �j (D O co (D (DU L) OW Qo O . U .. (DL a) O U W Q to ..0 L c6 — O O O o 0 0 0 E d 0) D E o 0 - •� ( o� o0) 0 m - >, FD a a) � _ _a � d o 0 (D cn � Q E p p a QQ H H Q • • • • • • • • Z m • • • • • W a a -J 5-2 cfl a� CM ° C: D >; LO Q c6 - ° E E (D ° o Q� 0 a� C CD E L U �M �_ x 0 y� > om W L L (U 0> 0 Z3 70 70 >1 (6 0 o 0 (6 �. V '� 0 L 0 R Q 0 (D (D (D Q r y--� 0 (6 0 W 0 to 0 y 0 (D (6 H 5 0 Q 0) -- p 0Eil� 0 (6 70 - fn >' 0 i O > U L L 0 W C C L O Q 0 0 ( �0/ X � O � � L O (6 70 L 0 F LL 0 0 L E 0 ,a 0 O N (6 U V 0 Qm mo ' N (6 � � � L .- � � � U0E (6zaa aaE � a a� 0 Ol L_ o LL cL (D L >_ (Dca o U) 7FD (6 i N U O 0 � U •� � J U O 0 O U to 0 70 0 (D I E N om Q L U y Q (D (D i 0 ° E U N V i (D (D0) W (D U U (D (6 L o �. (6 0 (6 Q — (6 U (6 (6 Q O 0 Z .0(6 (DD O (D N 0 � o c6 0 (6 E U — (6 70 (D ° � aD � 0 Na `- `- QU a �' O L E L 00 0 o) N (6 — (6 0 ° (6 C� ° N O O 'U i U 0) O (�6 m M 00 W H a0- 0"- cn aa (La a ° ate c6 cn ° w a 5-3 0 ti L6 � 1 CD � „ � ��t�� ✓U" �r u 41 f c C N i d� w Ir h MYw�'wti C7L r '%/ ❑ID 0 tl y nn ,,f„ow yyj fib i - rr ' �1 % O CL wr �L N L O Tam CL (U IA 1�w ,�IT1>Nir 1y rcf L �_ /6 fC a �� G ° f /r �✓" VI i C O .t 41 (n to Y U 3 W N C ////j �lfii� wl� // C fir S O 41 Mly�lff r✓� // '' F if r� - " r; Om 41 C �F v CL r f; U U L G v aA L (n O +� L z O 5-4 ti Lid i Lid ° N O C O V! L L CCO � C O y R O C N ~ O � L 7 7 ° N N a � (� � � `� 0 U Y -0 C/) cn O � N N O U 3 O m —CD 0 cc N ayi o N O O 2 �� N am_^^ a � ` > ii L- O O O O 2 E J � N � O L a O (� `� O O N O +� LLI to E 0) L - y Q UCD m -I.-, L (� Q N N cu U >� N N r_ _ U O � � N° NN IIIh � ) 'aE 0 a) - cn cn > +r Z O O(U ND 0 cnE Q O O cn 01 N O1 cu COm N� �� E �� W _ � � � M npO CL O� � „ o U CN CD- N Q w a 5-5 N ti Lid M � N 2 N O C O V! �L L CO C V! E O s H L 0 v^I L a a °' ) U 4- o w (D O 0 U) o .� 70 O a) a) U o 0 a NN 70 OQ `. QCL L p Q �" O N a) U to d LJJ � Z U C� J a) 3 U 0 O W CNC 70 U) _ ��> ') U (Q G .�j a) �� illy L •,A • �� /V.�, L O L! U N = a' W to L O zO 70 (n � •� i 00 U V - a) a _ W _ E (U U) � — O c � o � � E L (U6 _ y O1 OCL m O C O ( � O Ocm a) �• O 0 N m O W � i }+ N to N m IO0- 42 L N Y Q > (6 Z3 N (1) 42 N O') 5-6 M ti LU CD M U U) LU OC LU U U) w _ ,r LLJ c) z LL Q U) W 0 W (� i ILLJ uj W 50 J C) d ti i `0 Cfl W O E W N ++ N Go O E —• QO 0 CD Q >l �_ E '� W y -0 >+ E •� O ' O Q c v O a m :E wOa ca V y (6 V! - C LL d2 . v U '� L U N x UU O T U O N > O N N O U U mi Q '�'��'� ............III 4- (D � U N - �. L 70 >, O O Q y U L N 0 (6 O O O N ~ p N O Y x J (6 � U Z ) ,C 0 0 p N w U O O) U Zu W \ N � p O O >, L O E N O - (6 N O •L N Q O Q U III N CO N II _ a L Ie 0 Q O � � O L v C � U V CL O 70 U O � U � � � O C U to N Q_ > p L U �'� N > O O .� N O N •— O _ (6 O _ a 0 0 III MM O _ — •� >' III a � �_ a�i � . _ P" > CL N > O om • • • • • • L • • • • O Q � � << E 0- QUIIIIIIII 2 `� N N U M o • • o 6_ w a LL LL LO ti L ° O 70 Q � U n � � � �, a CD cn X U) N U ca ca c=o C O � p O L Z L �+ Q � U O)n 70 c cn ° N rL+ L- a) a) 0 ca O L ca ca U a) O O N ,a) O cB a) cB cn a) V O . O La) E ° CU c> 7 O 0Q a) Q X O � � � LM O a)O � 00 ca 0) C L O a) vi 70 ca a) O 0 cu (amU � CN NQ c O ) N ^.Q R a) O -- . L L Q _c r- O� _E Ir VCU . _ NE 0 U cn cB O) > y _ > U � Q � C: � N � o O Q L '� U O L> L N C w � O L ) Z � a) m 0 m L cB to a) � cn � a) � � � Q 0 U L O O) L �, 0 cu a) (B � N - cu •° L a) to 7 "-' a) L cn Rf y U0 � � � O) L � a � L n = � �0 a m0o 0 cu .ca� /� Q vI F C: �+ LO -0 cu 8- 0 o on o� Q-0 O CU a) C: L L) 0L L L B I^ W ° O 0- Z cB O L N o U cB ° � ° cu °C) Q0 � cQ Qa N nU D- 00 � mC------------- t� y cn U N O d 0 cm LLa 00 L (D O U N U Q R E U _ _ O Q N O CCL N Z) U O Q _ O m ® N 0 a) O V U LU N W U) U a) O Q ) CM O O M O a) cn O U m Q (1) a) a) ul 4 aa)) X O O L a) O O O O J N ._ U > O L 0 Q � 0 0 (7 C N ._ �M ww � 1 M. Qa) )ca NM 0 Q Q O O N Q v) 0- M �� Q a) E C: X x O C U cn c6 0- 0- > 0 ° U C V O M (6 m UCL U C� N y � a) i O O O Otm ~ a • • • • O • • O • co w a U 6-2 cfl ti CM 04 co CD MH N ��1� �� o OiiN5 Mill w, r R • „� c ,,,,,,,,,,,,, 0 I tr o L IIIII V! Q mm c c N L vW u ° -2 ° +' cu � � ) U d cn a) cu O p d U 'u°—i 'u°—i o NCLO ° s s co U) y oCli � O ° °a E E E — o c ...,, . . -tea �a O • U) ca 2 > 0 Li LD ° ° E `oy '� N c' E p ° � i E Q o O � � nu nu c>3 a y O 2 � oo � .E ?� E � 0 ova) N CU N N U U) O •� O W O N O O Q ) 7 W E O LL 222222 Lu c o d - 0 7 �wuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu ii O L,�� U 0 a i Cn O U o •� � cn w � � E cn a a) 0 p � 'cn ate) WoC C: — O) 0- (B O U O) a s °O C a) O ° t Q Y (6 p V)i O L O Q O C) O U) Q co W O 'a Q p N d cLo a Z �- M s a cn co �i u) O CU to 3 = O Co d co E ° � 2)— O Co m c bio ,+��+ d a) . . . a CC: CU Cn CO o m o m O C O +_ � a) X (� 3 '� C to E O m U O .N OO > O W a �, > —r •C ca /� CnO /a)) • • • • • • U • • • • • CA O L LL � � _ � C-0 70 0 © - k CD m � 2 ( _ 2 ( CL m % \ ) % o / k 0 \ } } $ 0- 0 m @ f \ § ƒ a 2 k 3 L o E E o ( > 2 / / CL/ 0 / ® \� % § § E $ { 2 0 ƒ \ k 3 § k a)k $ f 3 / % _0 m ) $ . kD z « m � E ¢ _0 E @ \ � U / 0 CL •� 2 2 0 E0 O � § E 0 E U C) ( � � '2 0 2 n E / E \ 2 % E U 2 E a a >s L 2 O \ m \ E E E 2 2 ( \ 7 L / E 2 a 0 ) 2 , E / - = o f 0- 0- o \ 3 r \ '� > n ¢ 3 ¢ § _ L R 0 ■ / ) 0 2 u \ u z z « m r 2 m s m o ¢ 2 2 > a % \ d \ \ L0 4- 0 m � § u = > E o m > n § § E 7 7 a § % § -0 q .§ = 2 \ 2 ¢ ¢ o 2 2 -0 E E . o ° \ a a 2 ¢ ¢ C4 ¢ ¢ r- E ¢ ■ E m / 2 2 2 s c _ 0 ® % ® ■ e s s s E ' 0 @ u u u o 2 \ \ \ { D N C4 L L L / - 6-4 co ti Lid (6 M � N c� N O O V! �L L CO C V! R E O s H L 0 W J W N J � „ c CD -a �a LV p p ca 2 V `O 'a Q E z V m p C/) y LV m N Z O _ _7C3i V V O u p u u u (7 7C300 , W CM N o as as z a 6-5 ti L L O 7 o �• N > N O m o CL O ~ 70 k rn U1 i W O •� E O y R Q Q Q U .6 N N O 0 Q U O W N O Y p LU 70 0) � 'O W o c cm Q >' O 3 c � � o a M H L i 'a �a p Q L a a� > c L Ica _ p w 4- (D (D ( o W O _ m � N N Q U Q V A Q m m Z 0) n Q O C O O N (6 U 70 L 'y (6 N U W 70L m y iJ Z3 N O V 70 � •� E U O m 0LO •� N o O W O }+ U O O N N U O N �. O p >_ (6 O) (6 O O m i V V Q Q '� 0 7070 Z � � c � a�i � M � (D � � � � � - � c 70 0 F _ U E Q O L _ 0 E > Q > Q > U Q J c 0 i a W a Za M 6-6 0 co ti Cfl N Y O 0 0 U U 0 v! ~ ON E O r 0 r-I � 77 � z y en e (6 co — M N R 4O a1 O C fa r O O W 1 0 C 4"i QCLr Q ui • • • CA CA a e 'C3O _ Qca _ N cn E ��acI MLa.A Hra ao ►-, E of� Ma '•a 0 E( � � 0 O > oT oO oNU Q O- - �O ....� a1 N N Qj '� Q O — j Q Z § i U ++ v� w p LW O 0 Q) CO (6 7 7 0 Q d 0 a: O u C \ L 0 Q �. CO u U m iL L. L U cn v ++ — + — r j > a p E Q Q y N a C� c E o c L U 0 c u a L L U > W C E O U c w a) L C Q o v o f O E O O ro O E o c 0 c — O ^ � O: U \ +� U N bD 7 V U a .� Q E E CL N J 7 w w of of of N � u uo m o � v a) bD N D ° °O 0 pzI r � � Ln o Q E E E E u O v c E o o ° u v v [r OC Q a j U Q O a1 v�i •v� LL I 0 ro a"i v s U N Q N Ln — 7 L' Ll L I 7 - - x °A ao o O o ° v +�+o o a av a a a 6-7 T- oo 00 (6 F a- ui (U C: p N L O Co (� 0 ++ O 0) o 0 U cv - q�j Q > O o Q N N i Q +r O N N Q 2-C, 6C �, •� O •— �. _ +, O 0 c — U ii a - LU •v > o N `O 'a E N a 0 N O v! U Qj i 0 N (D .55> 70(D O (6 L ++ O N U U Om a) O U) UU (1) -0 0) O OO Q+LNON ' Q O o L U U Z) � A Z)� � LL UO (0 U O 0- O _0 700 0) AU GN+� m O O — O N N m L L O U O m U O � 0 0 0 � � > 0O F7- O . :t� J) 0- (1) O O Z) (n N L L U O fn 0 � 0) L U N 01 to O c 0 M L L Z N U O 0 L O O E 0 O [r 6-8 N co . -1111111 .......... �f} {[ Cl) i, } N p U) o 0 o U co co 0 s _ c 0 0 0 0Eco8w o U U d o a� ° ° E C d ° o o 04 � ma ma co oW o U5 cm aa) co co � � 70 ch co O O� a co o N O ' E411111, ° v! [Y] U to sz E a) Q N U o c� o i L ++ L .> > x L ++ 0) _ O cn U 06U r— cl), y0 ED a � _ _ _ _ _ _ U v ca � `—' N N `� H E4) rn c � 0 > W _N 0 to N L' (o U N _ c � E >+ N0- OIIIIII o 5 Cl) M E U) o � o m U C > LL � � C L N � U U 'tn co c +1 O > U U N O O O > O — C C Q to o E a�i cn `� 0) ° E o E a) Y L a) > a) > E fC d U O +l a >1 CDa) CD +�� >+ - O to `o Y U m 0) -a Z N Y o Y Q '.1. (6 CDO W L��W CO O U Y E E U � E U C'J E U C'J E U E 0 0 .6 o cV — CD — CDU o .�5 U O o 0 NCL Ll o E _Q is Cc,co � O IIu L 6J IJ N ...u)..O o O 4c 6-9 M co o r C-0I � N IIII IIIIIIIIII p II ollllllllll N �L III 0 i ou ��//�� w 0 V/ L }� cc � V/\ u uuul uuuu m„ .- III llllllll ^� �uuuum 5W cc'�'^ cn cn li ulum2>1 (� U • � N � IIIIIIIIIIIIII OIIIIIII N 4— cnU N U ayi o cn c co N Z i -a N N +� L L ch U O O m E 2>2 III y N N .5 O N cn W ..IIIIIII J cn Cc 2 � Q N cu C/) .— ' Q cn Z3 U ZC: O III -123 = X U U cu �.�u..) L IIII N O � O N Q m IIII > _ _ � IIIIIII IIIIII IIIIIII IIIII > � C� cn cn U cn 7 •— " N — — O O O IIIIIII IIIIIII cn 2 m„>1 cn +-, U U C� � • • I�luum • • � w a 6-10 dq co L � L 7 L � (n O L- a) � O1 O O m (6 p CO mO 4mm O1 N O a) E L U) >, 0 70 (D 70 m O L O .0 > fn a) U N L O U (6 Q N a x O (1) O 01 to N 0) FD U .Ln L a) U N 2) U Q N (n O O v to (Uo U N Q to O a) Q J i O Q L 0) U) a) �� p W O O C U) ❑ L�O a --• Q � � ° 70 ° � m 0 cama , o nUm ° OL70 mO �(6 E Eo L Oo o (o 0) 0)0 O = � (n � �o o O° Q U � °� a U y � m Cn U o L a O 0 H 0 0- o c� a� N N � V LL a J co -tea �a (n co O 0 (D 70 a) O 70 v./ (6 _ C N Q a) 70ai Z .X Q U a> L — 0 >+ ro o y 0 a O L Q it 70 a) om a(D U 70 (n oa) 70 0 ((u OL U a) = O 04 a) CL — CO o L E � �, � U � ul � � > a) U Nam ._ N a) 0 m LU a 70 0, ca a E ��Lo aim° � )°� cm 04 m (6 Q U O >> C1 O L (6 O 70 �+ Q 70 O U- Q•. +� IJJ Q L (6 CL U�0 70 Cn \�' O U) III o LUO UU� O Q O 70 E > � L � .0 CO 0 .� a) N — o .N p O O � � (O 'tn � O 0) 70 . . . . . . . � 0x a) H O — m > M � Q � � O U Z (6 M ,w a LO co 3 O a O iiii ❑ C/) 0 0 c o 0 04 O Y U p Z >, ii'i " UP I R L 0 C to 0 p N to N (6 — _ L > W Q �IIIIII> p X O ❑ p J N „I.. N � p N a U) U Iu6„ N �- 0 to U ul„ X � U 5 Q � OUOwacnw CL °o E E a ,,, h N 000 N O „ O CO ll , U- a r 2 .2 O co > L V } m .LO p a co co ° Z co U cn N V! N O dB IN U 3 co C +- N a) co "O O O III L d O �_ L ul O O C m�uuuuu Q O Q Eco PII�I„ L co co o a) L6 a) oil N "ii iil (n d O I��III lu N co III�uI � � •> "161 U o ul o I� � � � I uuu 11,8 a a� — •y U) O Oco m a) +� � mII ➢ U Q V��m uuul C s= co C i III III L i L O °— a) > c a) > N +J m� � c � Nti a) > `� CD „ o L co It c O O p p .Q O Q , p o U A, ^� c �� W }, ry<M U) co ILL 2 �H 2 W a� a� a� O u cu IL.NLL 11T m °' 6-12 . a u (D co CM 70 o a ' CO a� o o C� Q o I a L CD � y I, W /� VI y 1 1L Q L U U o 0 E N N a (� i I E Z Li 0 v o N O O 70 a) a- y Q LL Q c cv J m OC/) 'L O E Lu W 0 c c �- W70 +� H (D70 � c Q 0 %- H W_ o c6 (D N „ Ny O m o W jLUn cv i O 42 E Z UD L O m � ii cL W o i—�° O +r cv •� m _ ,2 00 UI U L - c M ++ ° (Da5 c L o QL � y U E �- c o ° moo � Q -� ram ° N O 70 U) v! J O Q 2 O M M V) 01 (6 O U Q (/) OBE 2 00 � Q (D ca H ° E L Q L L C O OU O O m Nam. W O Q a ° a o o y ° 70UJ y cU O N Q 0 U O) m _ 70 E � LamL/ L O L L E r y70I C� 0 0 a O cn O N L H E G� U U U O (L6 O t� o o c_S Z a5 ° L cv 70 0 O � J 2 N 70 > N �� ._ Q O (D (6 (6 U � L L V (Q y� � aa W � C/) U- (D y E 010- IL W 0 6-13 ti co i Cfl N � N O C O V! �L L CO C V! R L / j n � o i O N LL a L � � ...... a LL 6-14 co co Lid i Cfl � N N Go M x C C N C O N Z x R L 000000 (U 0 N Cfl Cfl LO LO � m N (6 00000000000 U 0 (D + L Q y C Q U — cv + E .O „ 0) C (Q N 0 (Q 3 N Z 0000rl- (D oo0 0 m ,i o p � 000000 � � � O c N 0 0 0 0 0 0 0 0 0'� 0� to 00I` tiCOCO 0 N L �' C 0 L U a >, N U ,E a O OO a � m0000N � aoNmo � U V i Q � ._ � 000OCOtititiaoaornrn _ c L a N Q _ cn U U) C . L 0 Q +' U O LL t U O M Lo (1) E Y NLO 0MLO0LO00 U c V Cl) CO CO N N Cl) � 0 O O U, � to U_ O E U to N E E >, >, >, >, >, >+ N O L J Q a CO CO � N � CO CO � � 6-15 0) co LU CD M U U) LU OC LU Q �r D Z LL Q W ° roP°rr W 50 O J C) 0 ti M � N c� N O C 0 Q O O (6 '� m i ) U C/) a) E L E 0 N Z O N O') D O O w L a) O U U U N �' �+ 0 a) O X Q (6 -0U C� �. U N N U tq a) oNc O U (1) 3 4-0�oo QQ ao E � (D U a) O -Da U 6 O D iC 0 _ L '_ N � O ' 0 0- U N (6 O (6 m O w� •_ E o f c6 U O Q Q ) N U LL. � O (6 (6 U OC: 0 w CL � 0 O J O E 0- � a) O Q Q a) o Q E O L O O N �k O m N `L- O � U O O (6 U " . U - U C � Iw�Iw L (n F4 i'��111"I'll ull U 0 O O a) O a) O (O U > Q O O U N O) �- �. IIII m I C y- L U to O L E (6 O — (Q �: O a) O N D O U Q O > +�+ a� aD E a a o UL0) U 1 Q V _0 >, c/) O _i U�(D N Q > (DaD aD Z OC = U U U -,:- O Q 0 > U- XO (6 L Q O F- aOU < (D -0 a � 0 > (u a � U w a 7-1 N ti M � N c� O C O � N O O my U) Q O QH 0 u) E J O U 0 O O') i a O O Cu m O C� o o II O O Cu -0� N - n O 0- O O i v U N Q N � O N to a) .� Q c6 O L 0 O � CuL ii Cu 0. _ — re L t Cr C14 U c6 O L — Cu Q o — U O ° O ) N uj � O �. O �. c6 G� U a�i - ( 2 y Qa _ � o � � Q � a o v > o Q o = . .,Q m _0 U O 1° G Cu -6Z N �. N N �, O c O) ._ 0 O O N III 0 _aI L N O D O Q O Q N U) M OQ 0aa_ - 0 ul III NU Q O > � N E � 9 N >, cno Z � o o LL > u 0) C LL O oa O L 0 0- Q Ilh U � a000 � 0 > cv • • • c6 ILcu w a 7-2 N CM ti M � N c� N O O N co L sO V! IM 0 O U O H U) 0 U U E � I Q � 0 L O' O 0 �• IM 00 0 ilia x U) a N U (6 � a O � a) a) CM � O Cn U U c ra M W 0 N C �_ U O L N (6 a) N N L C O � O . O Z 0 0 '' Z a) Q. N a L U N (6 L U G to O J O C) (6 < 0 N U N l O Q `� O' i .� U a) U) (6 O U (6 a) U L a) •0) 70 � O O O Q7 L L ^ O) ` co LO, — U a> cn ) < O U) U O � > � � aI III co mo (6 (6 o E CO CD (D ) .�� cn a> E LD �= au) a) a .0 70 >, a) cn aLLo o x �: F .c o ma. Z oul� ''I11U 0- 00- Q > 0� Q E aQO� > U LU a 7-3 M O a) U � � a) W O :t: M U) N _ O O y U L L L O c O Z O E R N O 0 H r' O o O L u o C) ❑ ° � O C W IM Za) a) U m O _ L r L 4-1 O ., (D _ _ /�/� � v Z E U Z W L L J N Q M C) CL o v) U Q o Q a�i w J ,— ca t� > �> .� d W W' W cv Z ') � O °') p O O V V a) O ) L C O Z (/ O 4 N E lid E Cn �• O (B L i 4— U (� Ocu2 .2 � U O �� OO O') —NC U U CC W (a� W ) cu L U L (6 cn � Q 70 — > a 70 W U a) W a)) ca '4- M �L Om U oE O Q )ai ° > a o o O C o LU .—I a) Om T— L Z � ° Q u J X L � o 0 Q OOmcu _ Z _ _ U 6 u_ 0 o 0) 70 Cn O) W L > t a) a) ) � U U Z _ O 6 Lj cN CO 6 om O Q � cri U (n cu Ua � Zow a) U (6 caO 0 U O 0 >, O o O 025 �. L LLJ (6 Q Q j (Q Q O �> (6 N (6 (6 L W — ° L � � > � 000a ma maa) >, Z oE � � a '� a) ° � O ° - a�) n .n LLWU Q Cn o ° uc6 u zf o FuZO LL c; 0X �. Q O o Q� w 0aQ > QQ 0- UQ � � � ,- w . . . . . . a Q 7.4 d LO Ecn L X Q U N + N O U N Q M ❑ = O — CD � � y 4- O 70 O to 70 (1) C N 0 >, (1) C O o 0 0 o � O °� N ca >' O Z CD- � � Om o � �mZ E cn m X X O p N+ L `� a C U OT � •� N _� + N O O N O U -�e E � V� 06 O O � U m � O }' O N O Q=j CL > O O N •i 1 � }, c (� cn 42 C � Q C/) tf O N X O G� L N _N ," C N Q }' O = G� L � N O O Q U N O O O c a- ' O O (� EM - X O .NO � L (/5 N � U 4 + > > N N >, N N (� 9 U U U O N O N }>> }>> V m O N .N 2 2 O N Q Q 0 O O Q .No O Q 'O 0- 0 N N a °i a 7-5 p � _ � � 0 2 CD f / k 0 k / k § 7 - C \ / 7 ) E a co \ E § '7 \ 0 ; = o ° 2 CalE ƒ § o + \ ( \ E ° I E 3 S 7 ) - 2 � $ e ? a .@ 2 t # = 8 G ] � f e § A j \ ± 3 § 2 @ \ § W W _ n N § . \ co J k $ Q @5 e = m 2 � � 2 /\ ■ k co % \ f Z2 / § U 2E§ \\& 2 %\a2 0 � E g \m j_0 /k U ( / 2 - k & = 2 ® § •�� a k \ / % k\ \ � � 7 f \ O � � O m a / & / § \ a � E % , g U 3 > % \ \ e 2 2 ƒ 2 - g �& ® ) E§ ] \ / tmm © R @ \% O \ S -SQ �£e° / / /§- I / ƒ � »}\2E\_ 5®\ Z. aaaa 2 , G ® ® G§ e = [ o a8 2e .. /\ \ S2 � ea % � w = . o f 2i Sao , Et e § \ 3% o 2 8 § [ f \ ) \fo ® f a ® � � � « +7 / k km4 '§ ] 2 R o m ® ) a ( > § 2 I e a= o , o � e 0 o � at � 0 < �a w fog ter- L � ° m k { 0 § + e a 20 -0 g «km � m co } ( § k {a : 2 U)4 § \ § }k \ \ 0 . : Ff\ 2 ƒL\ } 2 2 .2 —22 S S { 0 2 § § § E 2 0 0 8 � ; .� 00 ■ � EEEo ) 0CL a Gem - s CL \ \ \ 2 t > a � oo a) ZEx2 ° { { { & ¥ Eon to = xo o 0 o e 2 uuup 2 / 3 / / p 2 Aj \ ƒ LUp _ n N _ Mi _ nN _ Cal &0 _ nN _ Cal CO &0 _ nN _ W 7-6 cfl In ti U 70 U 2 c C — O 4-- N O i CO 0) C '^ a) U c6 O _ O L U) N (D 'L N Q Q 0 D -o a) N O U) Q Z3 Cy (D O = 0 N • • • O O 4-0 a, O a La �J E 0) a ayi o O Ln = U � o ,t � E — L. c1r) LnLL W a L �.o ce)IM ''-1 �_ to CU N O V N U — � W (6 a) U) U) �• O N O � O > O •� L (6 _0 O N 0 E w Lo _ U) O to � U �O cu E y. O a) _ LO E •� L _ ryi�� L N Q (6 E O w N `t O N N a) c6 70 � � � C > a) Ln c3 N _ .— �. — N L N O) O W cu - E L ED N � '� U — O E70 Qa) O Qom_ U C � o f >, � � �. � � � cu (_6 (1) U � c6 III � � Z � acn (D �Lo QO Q O (6 U o � U)O O .) o C�m a Q p o � aD � O a) iO n Q a) nsoO NZ O) �ca cuQ_ U • • • • • • • i • • • • • • O tq • • • w a " • !t: 7-7 ti > 00 �. cu cn N C N a) _ > a) E �. E O C to U N O O O N L- U o O cn E Q cu N C c � s? N N � W y U � U W 7 C p cu cu 0 O 0) +O+ U) L O C J _� N LO ( N O C N L Q n E L E N > L Q to O C a) N O > N cu Q O Q cu >, 70 O i 0) E am cu O `L Q Z) cu W i U Ov Lu 0 70 cn cu Q - U) X 0 N 7 > C E a 0 Z �_ p 0 0 c o ca .� QO 70 � � J o � w � cCU � a) cucuU) U ca z �' U 0 d to m ca �. ca �. > �- a) C L Z) J m W W 0 N �70 L- � — 7 N > O O' n m 0 O W N cU C cB Q O E cu L > O — .�� N L 0 O Q H cu Q70 p E I Lp mo p) qT Q � oo � � ) W a) O � � '4- C: O � O 3 0 0 to E CO top Cq E cn LU N z to � L O � E ma � �• V cu 0 „ 0 M a CaJa � a z cn z QOf 0 2= N sz o • • • • m • • a • Off, • • • • • • a (L a LL p a `o 'a N � L L cu 0 � A cu _0 J cB to U N 70 a) N E 70 C L N a) to O O 2 L O > tv Q N `� N cv c"-) O 70 C U Z) Z) E to O cu C a) cu 7 >+ to 70 cu � L C (ll i U N cu C 2) cu O N 7 LO U Z) p U p O_ N cu cu N cucu L to L �� 0) L L to rr� 0 cu Q) CL L m •L U cu c O W O L (� H a) N L O Q C �_ N J to ,> — cB N N O fA N _ tll Q L E a o 0 +- (v o C O mo (v cucu (B U N U L O p_)+--� > C Q O C Z) cu O1 N E C cu — N 0 to +-' U O) C N a) C cu Q U C cB O 7 p N N cB 70 O U) C N N L 0 cu N L cn tll �+ L tll •N C 'C L) >, cu .O C 0 > to o U C O cn 70 ca Z) CmQ cu to O (D �. tv 0).� sZ _ L 70 cu to �-+ U rn rn � ��.., C >+ U N LL O tll �_ C E v) i 0) 70 — N Q � — +' O U O �_ cu SZ 3 CU C U O "' C O Q > "N- N •V p O O L C 7 N CU O U �. C to _ _ . O O m � � E a) C to cu 0 0) p O N O)= O o o L N N N N C 0) L_ cB U L C N O C U J C U •C p 2 0 > o tv 0) N o tv sZcn L (nd CdLUJ 50 o c Wn tom cu cu W t0) W cu W W Q cu 7-8 co 0) i � N O 70 O N L O � C0 V, C E CU o L 70 t L � 70 O U 0 U U ^ 0 7 N t� (6 U O to CU C Q U L N O O 0 U 70 a x CU to O CU OL � O) 70 CL O N 70 c c6 U v CU p O OU �••' N N O •y N N N70 L O E O U E Q (6 70Cn _ 2 LU O O O � O U �' x E N J E p V U 7 •U' 0 � CU T � �- (6 W N U (6 0 Q D Q (6 L (6 Q (6 O E CD > Cn O O CU x (6 m O Z_ O CU (6 m Q U N X L U O O Lm `- W' O 0 M � O 0 o -W 0 0 U O Q D m a) a � U (6 E- EO o L Q M p E U � p U U (6 U mo �. to D T > � 7 M (D 41 0�0 0 O L J L m N I V Q O FD Z c 70 0 _ 707co: o) E O �Y O � CU ` > Z0U ~ 0 0 �. L QML •y CU . . . . . a . . . o . U- M . . w 7-9 O 70 70 2) O c a� IL 0 O O N Q (O rrann � C O 0 V Q (i) y Q i+ O L Q y 70 U 0 0 Q N O E Q 0 cS Z LL 0 0 N � N N y N Q p � L L J (6 to mO E LU a LL D W C C O W � -W Lu LL vo U) C� W LL E 0 � O � � y � O 0 0 `- W O ayi o O a L 0 y 0 LL L Z Cn -a �a LL E 70 W U O `o � 0 0 m � c1) L3 o Q U � °' L E O 70 uS 0 - 7 C Q O E N � � cn 0) V m co 70 = Q C L A! _ L L o .L a M c� Q ca ~ c6 L �. cv CL O CU Q Q (D 0 0 0 0) O Q E D CU o Q 0 a � CD � � �' = 0 � Q cyav�i D V a 0) 0) � 0- � (DL (Dcc mC: c� 5EmM zE a) LU 70 CD a VO 0 0)0 m a Q O NN 7 E LL L 0 L Eme OI.fi () y-- r 0 70 xV U 0 CU 00 Q pQ Q U _ 7 L fn i z V a) N (L6 7 O 0 O � 0 Z CUB V O ~ 4 70 O rt.. O III Q J 2 CU c6 CU a 0 t 0 CD O ~ CU Cn L (6 U o O CU .O a .M H a> U c6 L J C� a W Cn H 0 a y E Q� 0 • • • _ • • • • Q CL a 7-10 0 0 N c eeeea o r o Q- .. „� E O ............ is I�Yuu " mr -O C ;;;; ,,,,, 0 '??? ,,,, ... N fn 'i a — , " ,,,,, ,,, m - - 0 Q „ �m 0 ,,,,,,,,,, LL �V� m a L 0 0 c -6 (IJI - Q a E =3 Ea (n U) o O co (D U) L- O co c n\ CD i UO i 6co L ". �.d u LL a Co Y N U U c r 0 U * U U cn O U Y O III L o _0 co U o 0 •- U cn o U U -0 i U o = 0 0 i Co fA U L to d Qj 0 co —► U (n O � .� O � t µilYtl 'a fC Z U U O C N (3 C �' U i6 2 .2 � U � N LL m o y > � 'm 0 N L U N LL N > O > > 7 0 — Q U) U O c U 0 ~ 0 Q w U 0 co c N 000 -0 -0- L Q? o ca 0 o O N 0) = U U d 0 0 p p d o o � `u o •° °aEEE Diu L U rn O � a> a � cE ° O � 04C) 0 N Oq c0 N c0 L L i U 0 U 06 Q � N H H H H H H 0 E 0 i Z I cn W06 U o 0 �� a� - _ 0L. 0 .— E oClo c a o •� j cu x °� V LL y 0 O ui ui U > 0 0 ° a) 0 0 • aa-p aaa � _____= 7-11 T- 0 N N ti � N O C O V! L L CO C V! R E O s H /� L V/ 0 Z 7 O O _ (6 U) N 0 0 75 U) N 0 C� coi = 0 o O O o 0 i a 0 cn >, 70 o o 0 o 0 E c6 m> 0 L L 0 0) 0 � LL /1 d (6 0 L ii fC Z LJ J L — p E W >O ull 4- W O v E J L N � ' U ° E cu 0 U 0) � m o cUo70 7oU Q Y cn E o cn c�w o (n >, Q >, v0 >,L U u) m °' 'O c6 c6 � L � QOQZ 0 70 � `M' as Q Q E _ a� o u, > c N Q 2C0EQ o � L . .- (u H c� N J 0) Q 0 (1) 0 .y O .y O L �(6 X - 0 Q E a cn0 > a LV • • • • • `� `� a 7-12 N O N LU CD M U U) LU OC U) LU � r 17, LL r � °�rrti�P°rr r �\ 00 S%-/ 50 J C) M O N r O0 W N M L L a--� 0 ' o L N (� 0 (A O Q L E E cn 0 " H N � U 70 70 O Q v C/) 0 m — O N 0 N 7070 o cn 0 x a M L70 0 a� m 0 -a �a U 0 t E 2 .2 j > m A Q N 0 U 0 0 E 0 _N N cn to N 0 0 L M 0) L � L L ` O L 'L Q L a) L }, N cn 0 Z N N E U v N 0 U M a C C 0 U m0 0 — 70 0 00C: C: 0 a� O N G� 0 Q N O G� L L 4ma � N � 0) M c O 0 Q L N 0 0 0 0 i N N a--� 70 ?j N +� m O �--/ _ L G� C� U � N U U N >, Q U r_ O N 0 a", .L cn MO 'D 12 cn Q_ 0 - aQ 0 � mca " '� OCLca Er • • • • • • • • • • p �..r W u) 8-,� d• 0 N N LO a) c Q O O y � L L O O cu O a) yr � U cu E X Q O a) 0 H O 0 O O ❑ - O a) c a) Z cu Q yam-+ O a) 0 i .0 �+ .� 2 O cu Q L }� E cu o N cn cu X Q •� a) a) cu cu cB a) ++ C _ N > C Q a) cu 70 Q p cu a) cu cu a) ++ Q N y -0 >+ O cu 7 m rn 0 _ CL 0 V (Dfu — O O > a) > fu a) 4-j y 0 1 'cu N N 2 a)L n � a) 0 0 0 y 0 O c cu c to cu co > a N _ 7 LL CD 0 O a) O � L �' >' U N N E +�+ •a cC cu O p Na) CU 0 cu O Q N Q i . cn 2 = c U O L—le .Q0 � � ECU U �_ 0 O 7 a) N � d to Q 0 vJ cp 0 n N � cu < U a) CD U N N O cu a) 7 fu U C a N o 7 Q o (D cu a) p c Q Q >> cu cn yr (D CU L L y+ r' • Q a) 0 a � = 0 � � a) � CL V 0 � rn o cu cn .� E a❑) aa) >' vvi O U E v CLc 0 > o a) i (D 0 c� 0 L a) o cu � .— _ > o CU cu O E Q cu o 'X o .L rn w E o �. cu co i 0 E — cu L O Q C cu w O a) a) CU C L O o � a� o � ❑in fu x o � o a� � ❑ p .. o a) 0 0 > y � L c O y 0 0 ' '— i s cu aD Q O a) L o o N " v cu - C w a) 70 LO Q U a) mo L O L L N 0 0 0 �+ p 0 cn L cu >_ 0 � cn a) N V O 0 Q O C +� Q cn O O p) ca a p 0 N cu cu N O Na CT 0 .� dC'm Q O O 0 O N 70 V! L X _ O p _ p 0 > O Qm >+ �+ O LM 0 V N d 1 70 cu U O 0 a) cu a cu VI O 0mr— O 0 0 0 /) 0 M cua) E r >1 � U L N V L N M O > N O cu O fu y+ L yam+ L LL cu L- O � N 0) N cu M o >�, co v�i a❑i > N a�i c c Q Q U Q a = c — •� aD c L '(D cu � o T o Q 70 70 • • O O cc mo ; m � Q `� � 0- QU) � UU0- 000Q UUQ CLQ � U • • • C • • • • • 0 • • • • • • • • • • _ • Q • • w U a U cn 8-2 LO 0 N CM ❑ N Gor O O V! �L CCO Ip�I C LL� t O t tl � j� 1 N � o Z 2 .2 C'D ^, m C A N N Q a a U iCL O N N .= N m CL ._ = N X m 0 :L-1 N U U) a CL 0 =_ a as x z U U U CIL 8-3 (D 0 N co � N O C O V! �L L CO C V! R O s H L 0 .iii. O 3 o a � ° O L� Lc a .. 2 .2 O 'D �y,�/%////////// •� REN EE, Q i` /// 8-4 I- C) N Lid � O co t � N N t n o Y C� c C O O i .� 00 U 0 N N L_ V! O T c N Q U Q G� O N N O T 4- x > O O U O N -0 'a � �_ � N 0 O OU U N L 0 C� Q 0 N 0 O (6 L > (6 N70 0 N Q C o a) y � a� cv 0 c6_0 0 O 0 L- a N (6 vlCJ N � �E 0 0 O 0C2 N , LL m Q N N > C Q O -0 N 0)0 > O) p Q U Q A X — pLU OUOU (6 O u) > N N = Q N N N � Q U0 _ O c6 L �. > >, O a� LU uJ to O L " o 0) Q U) o (D +r L o o a y n CL c 0 aD a i o Z L y y c� L c� m o — Q O > M _j \ N a) L to _0 L y •� N m •� c6 m o H � U � C C N L N to W U +L- p -0 to N O a) U O N O O 2 O O) O W N to O O 0 V = x = O O) W O) O) U -0 �. -0 >+ Q w C 0) Q Q H U o o U •c 0 Z Gj N x Q 0 � 0 M M 0 N W V 0 M L U 0 _0 V- O 0 U U N (-6 U •� O N 'a Q N a `t c6 N O c6 to to L `� c6 O U Q N N U 0 ma Q N C • • • • • • • • • • • • • • • a W n M c 8-5 co 0 N o c O ""'4444444444444444�444444444444444444444�m C Y4 N O j f s H � L ❑ �I �I N f i O V J d N E � O y U l � W I, f: wk. i 8-6 0) 0 N �/�/ ❑ 0 CD o cu CB O 0 N N 75 f cu 70 p �I 0 O U p N t N N CO -0 CB a O :5 L O N N N V � N � CB ci N > C6o L y 0 V L O C3 0- CB 2 ii a ° cn °f= 7 �a � FDcU Q L > L O M 0 70 0 O +� N " N > p) Q) U ❑ CB U O a)a) N _ 3 0O a N CB O N N N E d) >, L S= L U N U C3 QcnN L x O 2) a) U U Q W N U Q CU cu p L O N O CU a) O `� `gyp U CB u to O N -0 0 72 U CB i U a) CB CB CU L > (U N L cn O >> L6 C6 N •F cn +�+ O O U -0 L V Q O - +� N cn O O U) CU 'E �- O ° � c� E �- cn U O N U >, a°) °� a°) a� `� U) z Ca ) > � 0L) >, o sz c� a) a) cU O ° — ° a� CL s= ° L � O a � U L � U .s a) CB a- =� a � L o Ua U , a w 8-7 0 N L W O Q W E y co -O cu cu c N N U)CL C Q ram+ 0 a) O o C c0 O O aEi a °' L a? D Q ° Q r.l Q d 16 R a ° a) U '� > c a)O V) ° x — +� Q O N "Q `� C L ❑ 3 co >, +J W fA O L > 0 U N E a) O y N E U) O O + O N a) 0Lf� cuO 0 U) y L Q O a) N ° co U) Q co " w a, O V U cu y y O cuO N a O O V) U +� a a d 0 Q co Q cu � � L � � V) � •= Sri 3 CL O U U c0 fp O w cu VV) N 'O cu C aj a = +' O � L cu L 0 u O O O C (� N Q y �" ° 0 N 0 Q .i O) y a z o > L E +.1 co c 0 L o E Q Q co a cU M O a a m c o a Q y I-eL V) C y Q c0 Q y L +� C N N Q L G> N ° y o c'�a C � O o ocoLp cu cu ' E OIE5 cu N Q L Q C .� Q y Q + c E ° a) ma = Q 4 N E c U) E oCU N L N c0 O y L f+ L L cu y .2m C L0 = - yL �4 Loa "-_ p a � L a) o a) Esc ° Q � � � 0 v � x Ica ° ° - Q) N a o � Q aa) � cwaw a a) Qc � � ca W O30 W � c0o U U (B o O = N a Q En = V)cu o O OLu O O O N N Y Q Q r c0 C L O "a > E co O Y M ^ y L L t Q k N Q E c N c = 'a O i c0 M O y E O ++ a N O (B j y E ^ Lo u) Q C aQ-' > ° C Q E d Q" E x N L y L N O U N O ?> E 'a > Q Q L N Q C Q E + cu +� ° � •� o Q '° QUO = U W L cu }' (B Q E -� C M Q O U Q- Q Q (B L I o l O cm y t a? Q 3 a -a QLL E N Q = � Q — E a) y >, a) a '< Q H Q U) •� w co �.... N V) (B C y U f�C i U --' E Q (B c0 �ii'" M C O Q O L N Q a) +J �O y E cuo Q N C a- E L z N (B O C1 N O 0 U O a c0 Q CU N Q O N Q r+ C a)ulul Q O •O — ° c Q CU CU U) cu cu Q N > EO- = o o U 1600 - Lcu s_ U E x + a) "Q c0 O cc0 O 1_ cm Q — a)EL LLwdQ � _, om mU) L CL cn 3 3 p • • • y • • • 0 • • • • 0 • 0 • • • • • • a 4 U Cl) J J d 8_8 W .E N 4-0 00 C: � O 06 U Go f CD O L " Afq R L 6 r NO AW i w� r rrr ITV I �{ y 1/FI1�iUl I N i Um a` a, J 0 LU r r 9 ry , Army/,/iii%/O�� y IINN r r "Q ' , "Z �i 8-8 cont N T- N 00 " 9Pr ao " e CD` - PI' low LL r L LL L ,. r •> U 6 2 .2 c `14; CN r' 2 ru " v^,u. ; 41 8-9 M N 0 r 00 � N O C O V! �L L CO C V! R O s H L 0 v 0 ++ i O ,. LLa a 2 .2 m d N � � Y ..... /// 8-10 d N r Co o o U U) sei�N �J��W�j�j JI �/r N_ +' O co co U O U O C o U N co 0 E co c N co U U N Q or c a) N CO N N O U O co „� �o� ' �' > cn co O yr cn coO i L U) O _ O ' C L U) E +O p O _ N J U) R ��. o ° E O c i co cm +' J C U �. C O O co " N Co U co O co O > 0 L O co co E cn L U O O +' O C Q O i i L N S E N cn } O O 0 C N N U O C > CDa > O co + +' O + O C Q — (o i O N p) +' N U cn > U C c E C U) N > J O � O cn OU C i O N O C' Co a) i a) i a- E C } o a) L Q a� a) U Y a) O L dVayNi rN+ OOO N � +> co 0O O U) N �O> � O O cE0 nco co > O L J � O OU O a)Q co EaE � CoCoN `C _0 co co _ co O — c = om 0 a LL ++Oo EOO Q- E � c 0 0 c O O z co7 O N N _ On O O a0 n 0 :3 L N O O LL cL co fn O �a _ O E U _ Co o O O O n i 7 U O •C>� V Co 0 co N ~O C M�eE OL U +- coO Q :3 Coa) CoO N O Q Co co U > co � U) cm c AE c >OOOL d U) EO E N N N C� Q O N (oco N E U C co MLI om co co d L L L co N 0) o ° C c O +' cn O N J E cc E o U = °� ,py a� O a� co a) +J += co U > N J U +� - - W L Y > O +J �O N O Q O L C Q i C "O p C co � U O U c O O a_' ' W O 0 c N c Q O O C U O U > C 0 co N UC cLL Qaa� Q OOoO0 ++ '•a� �+caN' ++0aaJ� CU }O MQ co N CN o ° co c— c •o c Eo o O O c m 3 co 0E a ca cu 0 O c c O y d � O > n O _ � EN C a O C N = O N co O O O Q O O U co d0 O Q p a� — O O� O Q O co a O '- n '> cm co a) }0 a a > E O c coU o E ° oo ° U O w MOM cm ° a �o o O a c � a'U E U = c U) " � U) cu > CU o )Q5 n � n EE w w CU c O n On OO J co LU n U n O OO cli (o (o O cN c Q a) �W O WOC N E O(o C a)OQ OO J co a) E n ca + ON E N (o N ) O O U U O CU C CUicfnn •� Qa� 2 'E IL a U d 0 d U co H co a >- E LL N cli co -4 LO co P_: ao 0) T- LO T— N U N U m c U) co •� >, C o coco CD N Z Y O Q a) C a C a) U) yr N co V) cu i Q z Q co a) C E —0O m � U N c o x R (o K a) +J a) 0 C E U) Y s a) U) y co p V! +J a) ~ o Q i C C 0 V) Q a) > O L O 0 O co ` Ocu N — _ O V U > O (o N ) a) cu O O N a) can O O a) C N co 0 a) +' E � cu 7 V a) co E o a +` a)W a) o w L O a) �j O i N � O U) N V E N Q N N C U U) o ® c O yOy 4-0 � o +Vy+r LU " L ao Q �°a' aO U) � �o E 06 N ) C c V co V) cu o U)ma Q > (oV! N UO a) 0 co a) a) o O u CU " Y U) a)o co O L L U) U) a) > 2 C i (o 'p N V) .}°— C V) V a) o C W a) U a) W Q Q- a) 0 cu vJ C N (D U Q -°a N Q U O cu a y a a�i o c E o C� x a o uai C C Q C N a� o aUi U) co 0 +J C N C Q a) U) Q (1) fA O p 7 +OC +L(/+0 w � U > Q co O O o _ co >> >' oC ( oa c° o E >+ a) c U � a) a ° cu cu d ° 2 a� a? aa) E o a — co ° a a) a) co co L ~ x a°i o co — Q L a) i C E m w o }. V) L }� 0 •� M ° o co ° co o co o co ° ° cn ° N °a co � >� a� a) a� 0 cm a� - C a? ° CU ate aai c}n o �� cLo C x ma co M o E aa) ° > ca � CU _ E C u ul C o ca O co O >, co C m 0IN c0 j III....... (B U U Y o •� H ° Q E ° a°�i co c`o ° U) a a� ui ul ° a ° coo U U E w a� o � c}n � a� � E °� Q ca) oN ' � ccoow2 � a� � � � L ` � � 0 C o o Y a 2 CU � cn III....... -a a ° U �_ +± ° co �gy� L .� u C }, co c> z cm i a� (o o }, co C C L co O (B (B C a) o o z } C U +J a) co o d a) a } Q Q co C ° o a .� a� W L o mO E rr o O 7 co � — u ' N N +, Q+, Q III III P A C U V) ° � +' C O N +, ,a i — V1 N C V L Q L o > a a) o U p V) V! C N Q o w C—u ° " ° a) a) z 1 C III a� a) o 2 w o ca o U N (o (o o V) V) >+ co 7 co > > E +, +, 7 y a) U U fC > i m O C U U p O C > L a) i p co C t — � O L a) ��6� L L x a--� a) ��Ilf.. +J V) C +J •— '— •— ++ i O x a) O L 0 a)Q' +J U +J +J _E d (n O N 0 a) a) a) O a) a) O i a) j V! • • • (o 3 V • • • • • • • • • • • • • • • t • • tv co E a Zi omU) U) W0 4- 8-12 cfl N CM 00 O a� CD Q c C 70 U 0 (6 o L V Q U 7d 70 O O y R 70 C 1L C: O L (6 O 0 U1 O N N O E L U N ► o o o a� Q 0 Q E y ° ) 70 a �. 70 � O ca o o (D V U E (6 (6 to O,+ L — E y�--. y�--. V .Q L O 4- O O y y } L Q U L o L � o C: L a Ln (D as LLa O 4.4 O L �. Lu L (D � v y N O 0) .O L U V Q O �• (D 70 N O O �. OU (D O (D N G� O to O O (6 M U U (DM _ U) F O •O Q(D M (DU O 1.+ (7 E >, N O Z z M Q O E O m O Q N O U >+ Q •0 .y O (D O �' O L tp U O O O '`T (6 (DC E N � O m L •L m w O m O 4- O O QL U Q U (D o m N m N m to 70 L a .Ln � � > 4— N Z3 O � o — c� O O G� (6 co U 1 L i O ++ CO i C: .a O E > U O O a • • • • • • O • • • • • W � 8-13 ti N It /rrrrir r 00 O CD 1J ii r 0 4V' 'ri l✓/ // L yr r ��°� II�IIOIfI o (� /il/l/i/ N 5 0 O 0 70 t� y •N N � N v O -W 0 L Ncu d O O Q Ocu tq N Q � tv L +� O U N O N N c Q Q N N to +�+ �•+ +� � Q ++ N N c N -0 E O O N (� N V O Q a)O N to •Q E L O) � (B N cOn N O V) E "' — tn .E 4— O N c L U > 0 O O O N N O .� O :L� � � • (�B � O N t > cu � (B � -0( (6 i � O O O U (a a) >, i 0)Y N (B cu 7FD -0 0 — N O V Q U O U � VN1 _ C: -0 (j O U N ca Y U Q O � c3 CDc3 Q E N O) N O L O (6 c3 O O i C_ O .N c O N N �• -0a) �O J 0 O (B O U 0 � •N � � � U p O .0 U > E 4— cci _0 —CU -0N N p cn O 0 �W/ V Q Qcn _ D L CU L O Z v �_ ca ++ Q a) N cn m Q -0 � Q B N (E -0 N c3 N c3 >+ O >, >, 0 N U >, N N d O d E Qj N cUn cUn Q = Q Q N O +�+ � — U to oaaa aa � o � aa � DU) � a W W- Q cn 0- al) 8-14 co T- N O N r •� co Q U1 > U) O C N > C CD Z c 'M W (U 0) Q V! 0 Q Q V O c U1 O 0 Z Q Y NCL N o J U) c� .L0 ¢ I? U E W 4- 0 O O •� o Z y O O c Q ai o � Q W E E c y E O 70 0)C Q a ' O ca W o >% N N V U) E V 0 7 U o L C L O 0 L a a a �- O S U 7 p 0 V S= `o �t� � 'c� c W N � �' E 'L � o 70 0 t E ( O - - o a E z3 U y •E p E ( L) L v o s= a� 2 D ( a70 jp C C a) U c L CO 0 c U m Q•� U > O C: •C_ V L O M a) E to C ic OU N �• �' L ~ O cam �+ U •�_ Um p (6 C 0) QME — Z3o 0 Z (D m Q N L N -O =01 01 �+ C 6 6t � o p o O 0 Om 0- DDUQQU a� a� a w n a ° a 8-15 N i O 70 LO co o > _^ 0 N vI (6 U = CO O ~ � k o U1 i W N L p cv `o E O � C Q Q Q U i t}n v vp O 4 0 o 0) o 0 7 J U D 0 c Q U O W N 0 � � J � (D 0 � N 0 0 O Z U Y O c Q o .L t 70 > o >S O w o c Q >' O �_ 3 c _ � o a �a p Q L a a� > c L Ica _ O w U 4- (D (D ( o W O N > M Q U (D 0Q V A Q E 0 O >, m m Z N O Q = 0) cx Q O C 0 O N (6 U 70 L 'y O) (6 N U W 70L m C O U N O Z y iJ Z3 O U O y N O U .� (D •� O i E ,a (D I �--� L 0) �"� a a) ^ }+ U O O N O p >_ (6 O) (6 O O p Z c a�i o 4 c � 70 0 F _ U E Q O L _ 0 E > Q > Q U Q J a w a ° M 8-15a 0 N N r co O N N o Q � � o CL C 70 U O y .i o O to N N � Q i 0 N 0 a L - - - - •- a a N � 4— 4— 4— ' cn cn cn cn v '� � to to to to to O • .N LL (L Q V U (/� 72 `o •- N a m aw � y p _N _N _N _N C/) N O O O O i G� .N O O O O O to u LO O LO O � O L C: N t '� m O N U U O O O O rm O O O O 0 -0 -0 - v L L L cn U U U U E t 7 U � N N N N O cOn O O O O v N U c � •� � •� U U U U O � _0 Q c�a a) cn a) Q a) a = 8-16 CN CN 04 CD � d IN Y E E - E 8-17 N N N 00 U r N � � U O 00 O O C1 O 70 � 2 O Q Q O TS /� � N V W ,Q)v L / O (D y 0 (� 7 7 � o H (6 V Z3700 N D N +� j 70 U 0 _ 0 7 .0 (D v O 0 � a) 0 � Q (D = O O O m (D U O Q v./ a U 0) E N V 3 0) Q � V 70 0 �_ y y � U •?y (6 t (6 (6 LO O •(� L O L �• O O O a .L a (D 0 O 'DQ _ �' y W y 7070 N N N O 4 V Y Q V CI O U) L i m O N M m a)- E O (� Q O X O) m 0 C� U .m N C� Q j N O U O N C1 U \ M 7 N Q (6 Q L O O L 0 (Dm U U N Q C1 70 C O (6 O 0 > N O 0 0 V a) M U 70 L E M (D M L .� O N Q N CL U Q �, O O U m N (DN (70 U (O O L U U Q ++ U L U Z j _ �. (6 E o O (Q U U O U = w >, N O .y (06 N Z O N � Q 'i O U •U � W = N U V () O U O >' (6 O (6 00 O 0 Om U Q- O 70 O 0 O E (6 a w M N N U N CF) � N •� r N N 0 00 N N � � O — 70 >+ (6 O 2 N ' O O CD O O LU L 0 � U O U N O 1" (D N U R L Q 4- E_ 0) H U � O U � 0 00 U 0 Q U U 7 ° O �_ O) W (DU O L CD " D (6 Z3 D O (DU OU �, ° U o U (6 (6 (6 m O U U U E >, N V N (6 O Q N (D O 70 U > = L L }1 O Q = 0 = O L- 0) � a w c6 in O w W G� N v N O W cU6 N ° M N C Q O iai ara mO � Q ° OU) 0 � ° o o oo LU M Lm (D cU cU X N — to .N N N O 0 (6 L '' LU o U O LO O m L 0 m U N O Cfl (6 > O U O O (6 NN O W .0 U (DE •� N p -0 O N N 5 W~ N O O QN = � (U Q m (6 O W u Q CO Q -0 Q N L N O N '� O O N � O N O (6 -0 O -0 (U6 U U to ) to N O m - (6 O O (6 N > N O O Q O O U i O O D U to O U0 L N > D O U �. O X U N - O U NLUO L U L �' Q > O O) D L N (6 1 O C N •� 00 U OU O N O) o .L ° C U (D O N W -0 U CO -0 Q m U O C Q Q O U L _0 O O O to 0 m N 0 0 0 0 N U 0 0 �. N C� Z Q- N N N V ( 0 O O O O O M> � O N C Q O N L L L N �' N fn N O L 7 L O L ND O O O1 ° L N Z3 n O a ° Q a cn U O o ' Q wm a a . . . m 8-19 dq N N O N ❑ = 2 o c O tl! •L L CO C V! R E O s / / L ❑ W L 0 LLI c ai Q NN `- O U C U LL a O o a O U Q J E -0 - N O L y-. U O N N U L r n E ° o E o o o ° U O to U to Q (6 (6 N Z3 O O E M - U O U O � N O � O E L O N � 0 m � U � 00 N (6 N � U U N >' G� N O i O N -0 U C C (D N -0 N >, O _ E E V (6 L N Q O Q X �. O O) O O -0 Q i U U U E E Q .a Cn Z Z C W m 0 a n W Q 0- Q C LV . . . U . . CL LO CN CN 0) cu a <Its (1) e. 0 C2. Om CIO 0 E 0) Its C) a) E E cn C U) C1 Its U) 0 U) a) M 0 U) 04 C) a a)_0 m CO E -T >N > CD Its E _0 0 3 0 ryu E > WD C3) M I aryummi L) >� C3) U) 0) cu 4- C1 C: _0 cu E 0 -a C2 0 cu 0 0 IT C: E 0 > cu O 0 ."— a)0 4- CC 0) C: -E " -0 a a) 0 C: cu — cu L— -0 -E C: cq ±:1 C/) 0 0 0(a. -r— 0 cn 0 Its LU 0 0 0 C: Its L) M CU E Cf 0 a) Its :3 a) 0) C) z 0) C: L) > C: CU C/) E Z) Its a 3. o • C: -0 0) .5 C: 0) C3) C: mmm- AmJ ui -C Z) - U) 0) 0 0 C: 0 0 Its mmmmm, Its a) L) -�r— cu a) It m -r- a) - a) a) % -0 " cn a) cu C3) o C2. CU a) z E 75 _0 m mmm. AmJ cu 4- cu AmJ a -0 0 a) 0 CP 0 C:a) C: M cu a)C: -Fu -r- 0 0 :5 0 Emmm. 0 L) _0 Z- 0) Its Its 3: 0 0 U) mmes. Its M C: C: a) cn L) mr: 4mm. AmJ 0 >N 0) cu cu .2) Lam) cu cu E CU 0 L) -r— m70 L— 0 A Its Its wgy CD cu . 5 cl) " 0 C: C: cu 0) C2 - 0) E 0 0 E C: 0 a) E C: a) AZ — " 0 -r- C: M cu C6 mc) cu cn , L) -0 0 0 -0 cu cu a) :t:! C2. Its Its -0 -�:; 0 _0 .0 0 U) mki mmmm- a) C: C: " ca. E a) le mc) = o 0 Its cn 0 CU _0 0 C3) Emmm. C1 C2 a) 0 ca- 0 C: 0) a) cn cu a) C: Z) Its — 0 ca. C: > CP -0 cu 4- C: 0) Z) cu 0 a) 0 cu a) cu LU 0 -CZ -) _a Z) CU CU U) L -c- T a) C: cu C: a)CU cn 0 0 CI E a) 4mm Q% ts a)a) -0 0 I Z) L) _r -r- U) V a) Z) Its E -o E L- 4mm- 0 a) (1) 70 CP z CU L) 0 -0 0 a) a) Its > 0 0 > cu cu cn 4mm- 0 0) CU 0) M a) C: -0 a) E Z) 0 4mm- L) E E m 70 0 ca. cu C: cu cu a) a) C: a) Z) -0 cu a) 0) Its cn 0) cn 0) 0 Z) CU C: -0 _r 0 0) C: cu om � CU cu < 0 0) 0 a) ca. cu -C— CU — CU " a) >N C: -r- a) E �cO o " _r — M 0 '. u Z) a) 0) Its L) 0 — Z) - 0 E a) 0 a) a) cu FE a) ca. a) E E 0 _r 0 Its cm- Emmm. mm, -a 3: E cn z Its E C) 0 a) CU 0 0 A -0 'Z CU CU 0 C: -0 SM C3)Acmm" 0 4) U) 75 U) L) C: 0 4-- 0 a) C) C)wwww ww 0 T- a) cu a) 0 E 0 0 cu a) 0 C: L) CU a) Emmm. L) a) X a) 0 0 a) E cu -0 a) _q C) a) CU a a U) cu cu 0 X cn L- L- cy -r- C: U) (1) 0 (1) C) Z L) L) U) 0 0 U) C) a) > 0 0 cu 0 4-- a) CU E Z_j E a)CL 4- . . . . . . U) a) a- LU Of 0 o 8-2 0 L- III w S L) C-4 vi (L (D N N LU CD M U U) LU OC U) LU �e //%, LL "' r 1!r °�rrti�P°rr LL W fry 50 o O J C) ti N N r o c O V! L L CO C V! R E O U H w 0 ❑ •U .Q U) H > U Z 70 U O Z > w � H 70 � a o r � y LL O O v N 0 CU L L O — (6 E. m 10 �a N 2 .2 o 0 O L Y N — C� o y! O 0 0 0 _ ai U >70 0 (D U J m L 0 Cn N L r C L- m > O O .y `t � p O (6 0 ^CU O 0 Q L L I (.0 aD Q c >> Z3 > a) L- > L 70 Q C� O U .0 U O Q 0 0 U) O — 70 Z3 > > Cj Q 0 vOi (6 I JC4 70 U Q m U > Q 70 70 °Q c6 c6 0 O L 0 L N Q O CU >, O � Q Q O C� •O L m 70 0 O D U O U L O = Q N X X O J Q Cn L >, O Q >, >, CU � N 0 < L) < cn0- 200 Q » 0� CnIL • • • • • • • • • • • • • • • • • • • 10- 9-1 co CN CN F- CD 0 .T CO E O CS UZ, CL N - r AIM . r 2 L 0 0 LL .......... SIVIIA z 0 .1 c 3 i cn E LU > > LU C> cn > > > j U. ta ea 0 >0 0 Y 9-2 0) N N ° CM C/) (6 E 0 o D o y a� CD L 0 N o M 7 U Q U `o .� ° 4- ° a 76-3 ,y (DL (Do V n L M a) E ° 0 O LU .L -0 ° v p O O N Z3 _0 U 0 O U a) ° C 0 N U L Z Q (.0 U D 0')m _0 co U oES O a) p � (DU Q N C O (6 O N O -0 0 ° p t� 70 to to L 0 U 7 D O U O N Q -0 (D Q �a O (D O E a> x ° `� a) m : O 0 (D o _0 Q m O ( O U (D i U Q to O (D O to O �• z3 (D Q O O a) C O L —L N O-0 O1 6 0 E UO p Q (D p ° N �' L +�+ U L L U U_ (6 (D ,y J a) p L Q O Z Q i 0 N X p O � O > (D Q m p Q ° 0 Q _ ( -0 -0(D U ' (Q 4 a) O m _0 (6 .L (D O ° Z O 0Q p U Z O a) a) � O p U 'L Q Q > U U (6 U Q O O O 0 O O to U a) O a) 0) a) E O_ 0 co) W c v '� Cn 2 m m m N m cv 0 > 9-3 0 M N IT `� C�5 4�4 l�? ❑ o c O V! �L CO C R E O s H L ❑ U bl1 oIN 11Q O o LL i pON LL d O � — N E D ap ' N yMIo N Ct 9-4 M N Lid o c LL ""'4444444444444444�444444444444444444444�m C Y4 N O j f s H � L ❑ �I �I N f L O V J d N E � O y U l � W I, f: wk. i 9-5 q M q � � 0 2 CD f / k \ E / \ B \ k / k § 7 - C CL � ) E a co \ E E _ _ i / E / } \ _ � , o E ƒ § � o + \ ( \ E ° I E t , § .m 3 G 7 ) - o e . ) § U $ -E t # = 8 S A j \ 3 3 § 2@ \ SE CD W) _ n04 _ m � § . \ m � J k $ Q @5 e = m 2 ■ k cot * \ f Z2 / § g 2 §k � 2 j 0 2 •� ® 7 k � \ > \ O \ / & / § 3 > % \ \ e 2 2 - g � E ] t o @ Q � \ E 5 a) ® ) § me % % °£ O \ \ ° / } \ ® m © ® - Cl) 04 / § /\ /ƒ » 2 \ C/) G ® ® G§ e U = o a § }t / \ [\ ± ƒ5 a8 E@ \ 2 \ 2 \ /\ \ S2 2 , ¥ � _ .0 � ea % SZa w = t p 0) % [ 2 .@ � oe � < = aoo82 . o f 2i Sao , Et e § > 3% o 2 8 § [ f \ ) \f) ® f a ® � � � « +7 / k 2 R o m ® ) { ( > § 2 I e a= CL o e � \ o � at � � :3 w fog � e � o L � ° / k { § + e 2 \ 2w -0 gCL a) 7 ] C f { [ § {a : 2 \ \ fk » § ƒ § }k \ (n \ 0 . : F/\ 2 CL a) 2 20 - S S { ) 2 § § § E 2 0 0 8 � ; .� § w ■ � EEEo ) 0CL a Gem - s CL \ \ \ 2 t > � � � o E % E ° { { { & ¥ Eon to = x2 o 0 o e 0 uuup 0 / 3 / / p 2 Aj \ ƒ jp _ Cl) 04 _ _ _ nC _ _ &0 _ nC4 _ _ co &0 _ nC _ W 9-6 M M q 70 � 0 © - k CD m � y 2 & > \ g ; .. § E 2 ( _0 m ( CL m % \ ) % o / k 0 \ } } $ 0- 0 m @ f \ § 0 a 2 k 3 L o .� § S i ( 0 2 / / CL/ 0 / ® \� % § § E $ { 2 0 ƒ \ k 3 § k a)k $ f 3 / % _0 m ) $ . kD z « m � E ¢ _0 E @ \ � U / 0 CL •� 2 2 0 E0 O � § E 0 E U C) ( � � '2 0 2 n E a) E \ 2 % E U 2 E a a L 2 O \ m \ § E E 2 -0 2 ( \ 7 L / E 2 a 0 ) 2 , E / - = o f 0- 0- o \ 3 r \ '� > n ¢ 3 ¢ § _ L R 0 ■ / ) 0 2 u \ u z z « m r 2 m s m o ¢ 2 2 > a % \ d \ \ L0 4- 0 m � § u = > E o m > n § § E 7 7 a § % § -0 q .§ = 2 \ 2 ¢ ¢ o 2 2 -0 E E . o ° \ a a 2 ¢ ¢ C4 ¢ ¢ r- E ¢ ■ E m / 2 2 2 s c _ 0 ® % ® ■ e s s s E ' 0 @ u u u o 2 \ \ 0 a) D � C4 L L L / - 9-7 d M N m 00 W m E C W W O m O C U U 0 U U O O m N (6 O Q ❑ 0 C 0 tu a) N v) -O OU L O L H (1) o m 4-7 ❑ Q W O Y U a) O) O O U m O E C O N U 2 p) C Q O Q E O L O- O m a, N � o a) L z W o a Q N a) O E ?� O O a) O O Q V"! y M o o � x a v Q c ? m m y �m O o > m U m L O �_O > O w�. O X w ° oL -- O z ° ELL d O) C) COa) V m c s m W m a m E �a v �° Q °� m ° o a) c E C� L 'a N WV) m O- Y O ° y a) E c m U a� m m � s U L m min o m m o ° O 0) E m O co m m c U L Q W - W m U) CL m m ° > c - 0 _0 O O 0m Qm o � E > c0 oai E mcoW It _0 >aE oL a) O O c � o a) -0 - = °Q o !E 'i a � c mm +cir aiE a m W c U m_m E N aai Q U0 o3 f o - sE a - > m mc a) O a) m c !, o o �o U mO O E O M > `o > W a) Q o m c .m a) E O vi c `o m m 0 �_ o m -O m E U a) N O) 7t! 00 O p ate+ `O Z) � s m E m m m c U c 0 E ° E E E r m w c w U m v m o m c > m of m O o y .E O m 0o E y M oC: C-)°) m moam m• cm• c` o .m o � oT) E c o f Q U a) O c c a) > QE �' O a) O m ° V V E _ =°m•� W E -LDm m O Q W ) n ) ) 0 ao N Q U U O n '= X• V) V) V) m ; • • • • • • • Q• Q• QE • wv O —a) ° LL }, aUa a O iLL • g_g LO M N m �� w 0 c m = OF) c = m c o O o _ v a O = m O O o_ Q ' o o c a c O U E y L tf m C C O m = O > O a) a m N h y E a d R E V E rn = O c m s ) m E m m y ~ `o to O cl� > m m U) � O m c 0 O m m c E O N -o o °� O O h � _O O `o c Q o o O > c of m N O75 "r m m m o N a>i O Q " °' °� O m c 4 cf) m O s coo D Z 7 Q 0) 0 p a N Q ; N N ° c o O E o o O m 4 N Z) 0 L `o =c n a, a ow 0 N a) V > m O m o O N OL �+ y.+ O a) Q = V O d Q N O O O O O o w L v_ E 0 m - O m a o I� a i m- 4 C� E O U O — m .Q cx h ~ aa)iU) aoi W o _ tv 3 Q Z m a) c I� c N V O = m o � a � O a T � } Q O O m Q c O W > `° E 3 o a) a m Q a m ai'- a O N c �° of m E a> O o b Q h 2 0, 2 h O E V m- m °� 2 E _ O c O 0 m U E c c O m 0 m a -0 O h C O O m *a � � E .� m Z o m c � > L O � o N m Q z, m m o Q m E -0 m '.Q.)m�m o o O Q Q _0z mcmp� 0 IL m QO Q m 0)— >, a c' O E mLoO =o " O O OadC. 0 0) O m O m m Q m 7 m m mm mm E _0m �o O c -OL cm v c m mm om o mL -E -E O �D c cn m oa) m c E o O 0 Q o-o w mm m E� ovO c m a N -0 U yama a a) � o o � E m � c Q :: m o 3 x o � `'` L E m s E c T a> o o ++ -0 U) a p o m O Q Q Q O - - c to m h O O m m m O m s o O .m m a +r m m N m - a N m Q� m O m Qm = O s s s O s s s s s s x O o m c m m O w w E N m • • • _ • • • • • • • • • • • • — • • V d v o g 9_9 W M N Y Of6 07 u T� C O )E c 0 IIIIIIIIIIII (6 _L ¢ O'� � ID IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII � � � O m � """"II � ELI IIIIV�IIIIV� N � ❑ II uulluum � m c s �w� J ❑ �wn NNIm N O m (/� 0 L O IIIIIIIIII d LL ✓//l�� III � wuuuuuuuuuiww�w y�TM I x t +� o i LL M N 9-10 I- CV) CN 9r- 2 C-4 a I.- 0 CD 0 v- 04 ol 0 T- 0 T- 04 T 0 W z 0 0 0 Z) LU< ww, ui E o <cc a z z 0 < W z 0 ILI I 1 cy U- cc F) 0 ILI E w Lu W LL w o Z 1, cc WE LU w 8 LU < UJ CID < >0 u M 0 8 = IS z 0 0 V) ui u cc Z W 0 U"jl W 0 0 3� o > L" L) Z; 0 uj z 0 0 z 0 o LU W, LU < ul ul C) 0- LU uj 0 CL U�) uj V) , M CD 0 z uj > O V) it, 0 ul cl 0 z w 0 �: UM U- W 0 z z cy 0 Z U) < Ui 0 Cd uj 0 Lu LU LLJ u > U, Lo n < 0 0 0 < rr 0 cc z a x U z z LU < 91 < 'r Iuj 0 x 0 LU CC 0 RC � cc w UJI cc Z g - OZ z ll X z > m , = o o z , 0 0 0 0 0 w 03 z < z z z z < z < it. 81 0 10 < cr < < Z (D LL 0 L. LL CL .2 E O 'D m > 0 > Ln 0 -1.14 m E .2 w E CL 0 0 Z., 0 w m -w CL C: CCL CL 0 w 0 0 0 Ln 0 0 E 0 ca L- w i i 0 CL w 0 z +j a 0 0 0 +j 0 0 0 w -0 E CA CIL 0 0 E E u • E E ui 0 0 0 0 ui CL CL -a -0 -0 -a m U.1 CA 9-11 co M N N dF) W) �N O C O V! �L L CO C V! R E O s H L ioimooi � r � � Q eq r? w- ,may wW w. V a IIW .t 0 +C"' � � uj ",��. g; r y CX f U. zcfir""., ,:Y !1. Cc: ate. " � -I � W u 'a k ' z i w N cc N iIJ 1C 2 y Z � " ,w � r' CL a cu i It j .. W L mw ra N ry, WA 4 w W y Cd9 � iw 2 OP W CL P r w W c�Uy CL 0 w 911 G! GLMidt 9-12 0) M N r � N O C O V! �L L CO ra 9 O S 's fu Io t v I m r5an R 1 . 0 0 MJW I.i �I� ivy`. w v nei �eri� � a 1 _ Ili ! LIJ O 'D RIIIf LU y CIO uu un CIO UA VIC WiILA w lz - .�- co 0� 0 Iq N r Q N a0i co o o Lp O a) a) Co w a ❑ ° U CD E a) co ° c � co o 7 _ V! - O Q a--' U co u) V) O O a) y a Co ° O o a o N +' O C U Co N �O N i �O N C O �O O +J E 4 N "O -E ❑ O > N L Q C O N (o > cu co .. U N L L (o O N -6 cuW > L O 0 co V) > L 4 O N N N ^ O y O Q- C co u }, O co Q co ^ co O N O O U Q O V) C OU U) +O' N cu N "� V N cu 4— "a Co LZ C U y +�+ LL cu C cn Q ca N y -a a) N co O L _ LLJ N a O co co y C1 N N N '� O Q O W > '~ co O � O N 4-1cu " E O a) _ fCa .> Q C Z t+ t + Ep uuN)i +Q.,) Qo) ° C Oco O C .�L -Op E ° +� Q a) yC ad O > +y+ co 4 L O ° UO LO c d O a � OLL CLQ O _ ' co r .0 U > _ co ) ° L1 N U O (n O 3 W o � +° .�N a) a ,W E � U `o x a co ° L L � O N N ~ O O w a N O �= O N y O y N Cl) O cu — Q O L C y. ?) U > O ++ y 0 (V E U Q) V O W O + co ,� U 3 C U N L U) V) u) - U L U N O O U O cu 'O N "a W V fC L 0 Q•� O j, J L p �_ C N p U O O N N +O+ ' ° co Q co e N y c v a . � V) C tom/) V O O U (o Q) fC N C ° N O ca cn C d h N O +' O O L N a0 O) O D O) N V C > M O L • 'L U (n N Y p a-=• C O O a--• u - O y N � C L E 0 0 C N p U N D y `- d 0 Q U J O O N u) fC O N u) 3 .2 N Q) Q O N Q — O cu > Y .O 'a E N uco ) E a)d co ° rn > " O O O Wa o Co yo E ~c ° ° U) on o > Q) Cca +O+ '� - y 'E J O N N D cu > O U >� N 2 E D } Q N N N O + cu Q �I C o co a) C o - O .� +� °) O > E ,� E v o i W .r uj > O U) = OU U O t4 N O •c LCL V p N a N t E O .� — > co E E cn Y 'y Fu '� h 2 N N N O y co 0 L L N L° co O Z a)tNCco3i NO V E LL ° E W O Q- O •c O a) o oE j OOz = a u) a) o IQ) O a C — O C- = au UE O cuWO O C6 O) ; Q .ycu 4 U ZI L l ° °° E U F- o a? as W � z ,a azte o cu NaO uiLOca) Q' N ai .4 wi tD ti O 2 ao 6 T- Iq CN Lid CF) cE 0 CO E 0 11 Ll 0 ILI ILI ILI c to ILI IL� Ilj LU 0 LL U- a4 �rjj 0 'o w, > 0 A jj ILI ILI ILI > z EZ 15 << IL,IL, 1 < U U Ll, Z Z ILI 0 0 I U) "U f'I 1 lu IL LI I L, rj I IL�IL� ILI << , . . . . . . . . . 0 z 3 mo 1w 10 < u 9-15 CN Iq CN CF) CD 0 CO E 0 m I El rcA 4 E� OC CI --y r 'o u LL1 1 L 1� E E l m LL 0 E 11 o yr m u �Iy fi-I 1 "3 1 q o m w I 'o z 1121 0 J <z I -, y i, z om C) q F�: mE E Cc ... ... ... ... ... P -oo o'Aw'o-mm w w mE—w o'—w ww—8 < 'o z o -o -ovv0 u 9-16 M d' N N_ LU _ VJ 0 U U 0 0 U) LQL Fu LU Z3 � Q70 70 LU �e "0" 2 LL 0 � (6 � to 'h wr�Jw zk u (D V J 0 42 ` Q � 0 O U 50 a L Q a) a) J L 0 dq dq N r Adenosine Triphosphate (Adenocard°) o ACTIONS: Adenosine exerts its effects by decreasing conduction through the AV ❑ mode.The half-life of Adenocard (Adenosine) is less than 10 seconds.Thus c its effects, desired and undesired,are self-limited. `o � INIIIII :AIIIfNS: R ,� Adenocard is indicated for paroxysmal supraventricular tachycardia (PSVT), = including that associated with accessory bypass tracts (Wolf-Parkinson- o f r % White Syndrome). Adenocard is contraindicated in second-or third degree AV block and sick sinus syndrome(except in patients with a functioning artificial pacemaker), and known hypersensitivity to Adenosine. � WARNINGS: Adenocard may produce a short lasting first,second, or third degree heart block. In extreme cases transient asystole may result.At the time of conversion to normal sinus rhythm,a variety of new rhythms may appear (PVC's, PAC's, sinus bradycardia,sinus tachycardia,skipped beats,and varying degrees of AV block) and generally last only a few seconds without intervention. ....................................................... The effects of Adenosine are antagonized by methylxanthines such as caffeine and theophylline.Thus, larger doses of Adenosine may be required for Adenosine to be effective.Adenosine effects are potentiated by dipyridamole(Persantine).Thus, smaller doses of Adenosine may be effective.Adenosine may produce bronchoconstriction in patients with asthma. ADVERSE REACTIONS AND SIDE EFFECTS: Cardiovascular: Facial flushing, headache, and rarely:sweating, palpitations,chest pain,and hypotension. Respiratory:Shortness of breath,chest pressure,and rarely:hyperventilating,metallic taste,tightness in throat and head pressure. CNS: Light headedness and rarely:dizziness, blurred vision,tingling and numbness in extremities, apprehension. DOSAGE: Adii,m t m:lir:)sag� e- 6 mg rapid IVP immediately followed by 20 ml NS flush. Repeat in 2minutes at 12 mg IVP followed by 20 ml NS flush PRN. lIe liat n is cilosaael.ke: 0.1 mg/kg (maximum 6 mg) rapid IVP immediately followed by 5 ml NS flush. Repeat in 2 minutes, at 0.2 mg/kg(maximum 12 mg) rapid IVP followed by 5 ml NS flush PRN. lorm.uie/Actfii:)n Ill)m°r:..fflle- Onset mu:allk ftur�:tfiii:)n IV: immediate unknown 1-2 minutes 10-1 dq N N Albuterol (Proventil®, Ventolin®) CD o e- 0 i O V! R ACTIONS:NS: ° Albuterol is primarily a beta-2 sympathomimetic and as such produces bronchodilation. Because o of its greater specificity for beta-2 adrenergic receptors it produces fewer cardiovascular side effects and more prolonged bronchodilation than isoproterenol. INI'1IIICAf"IIII; NS: Albuterol inhaler is indicated for relief of bronchospasm in patients with reversible obstructive airway disease including asthma, and COPD. CI'' ImlI"I""III'°CAI IIII DI CA,.I""III I011ll'lmlI"!: Albuterol is contraindicated in patients with a history of hypersensitivity. WA �\l G Isisu:; Use cautiously in patients with coronary artery disease, hypertension, hyperthyroidism, and diabetes. In adults, do not give Albuterol if heart rate is > 150. Exception: If patient remains in sinus tachycardia and systolic blood pressure remains > 100 Albuterol treatments may be continued.The rationale must be clearly documented.The benefits must outweigh the risks. Administer cautiously to patients on MAO inhibitors or tricyclic anti-depressants. Beta-Blockers and Albuterol will inhibit each other. POSSIBLE A VEIR E REAcriONS AND SIDEEFFECT : ...................................................................................................................................................................................................................................................................... Cardiovascular:Tachycardia, hypertension, and angina. CNS: Nervousness, tremor, headache, dizziness, and insomnia. GI: Drying of oropharynx, nausea, and vomiting, unusual taste. Adult: 2.5 mg of Albuterol in 3ml of NS to nebulizer and flow oxygen 8 liters/min. Clhilld: If> 1 year or> 10 kg: 2.5 mg of Albuterol in 3 ml of NS (0.083%) to nebulizer and flow oxygen 6 liters/ min. If < 1 year or< 10 kg: 1.25 mg of Albuterol in 1.5ml of NS (0.083%) to nebulizer and flow oxygen 3 liters/min. (2.5 mg divided in half).Treatment will be delivered over approximately 5 to 15 minutes. III''lhmrme/Actuioin Purofuillle: Onset l::)ealk [)uiiratloin Inhaled: 5-15 minutes 60m90 minutes 3-6 hours 10-2 (D dq N CO Amiodarone (Cordarone) o ACTIONS: o � s Amiodarone suppresses recurrent VF, prolongs intranodal c � conduction and refractoriness, negative inotropic effect. `o R INDI-CATIRNS o Ventricular Fibrillation PulseL ess VT • PVC l s greater than 12 min with i.�o I :� r y ( i:rrow "ll�lll I�" �;ym��: ui�:...I. tl Ventricular Tach cardias Wide and Narrow) with a pulse Ai „�,i �� I I III, III ll��I „ i I]O1��" • Any known allergy • Cardiogenic Shock • Sinus Bradycardia • 2nd and 3rd degree AV blocks P SS1PLE AlI7YER51II lI.EAC"1C1 NS AND S11I71II IIII®1®IIICTS: ....................................................................................................................................................................................................................................................................................................... None in Ventricular fibrillation. Adult dosage: Pulseless Arrest: 300 mg IV/I0 May repeat with 150 mg IV/ I0 With Pulses: Infusion loading dose: 150 mg IV (150 mg in 100cc NS) infused on a macro drip over 10 mins1.5gtts/sec. III°e(Iti.9at� Iiiu.jiic I()sal;aue.n�� PulselessArrest: 5mg/kg IV/I0 may be repeated once. No single dose greater than 300 mg. (15mg/kg max) "Finie/Action I11:3rofile:, 0iiiset Pealk IIlaiii at!()iii IV/I0: Unknown Unknown Unknown 10-3 ti dq N Aspirin (Bayer, ° Bufferin°) o ACTIONS: NS: � � s Aspirin is an analgesic, anti-inflammatory and anti-pyretic, which also 0 appears to cause an inhibition of synthesis and release of prostaglandins. E Aspirin also blocks formation of thromboxane A- 2. (Thromboxane A - 2 f/ causes platelets to aggregate and arteries to constrict). Reduces overall o mortality from acute myocardial infarction. IN III CAPII0 NS. Aspirin is indicated in the Acute Coronary Syndrome setting to prevent � further clotting. „.. S: A�knolwnilla��IleIIrAitlll�"� �. allergy Aspirin (i.e. urticaria, dyspnia, etc.), active GI ulceration or bleeding, hemophilia or other bleeding disorders, during pregnancy, children under 2 years of age. PO II BIEA VEIR E IR ACTIION S A.YP S..11PEEI .FECT : GI: Nausea,vomiting, heartburn, and stomach pain. OTIC:Tinnitus. Hypersensitivity: Bronchospasm, tightness in chest, angioedema, urticaria, and anaphylaxis. Adult: 324 mg (4) 81mg chewable tablets for Acute Coronary Syndromes "1If'lhmrme/Actiioin IPurofuillle: Onset I::)ealk IDuirat6oii°: (Oral) PO: 5-30 minutes 1-3 hours 3-6 hours 10-4 00 dq N LO Atropine Sulfate as Cardiac Agent o ACTIONS: NS: ° � s Atropine is a potent anticholinergic (parasympathetic blocker, c V! parasympatholytic) that reduces vagal tone and thus increases automatically o the SA node and increases A-V conduction. V! R E O IN11111CATIONS: • Sinus Bradycardia accompanied by hemodynamic compromise, (i.e. ° hypotension, confusion, frequent PVC's, pale, cold, clammy skin). • In children (< 1 year) bradycardia of less than 60 beats/minute should be treated if symptomatic even if BP is normal. C1' 1ml ""1111'° A11111I1111CA"'11111' 1ml "!: .................................................................................................................... None in emergency situations WA I\l G S: Too small of a dose (< 0.5 mg) or if pushed too slowly, may initially cause the heart rate to decrease. Antihistamines and antidepressants potentiate Atropine. A in�i uxin,iu.unu fi ,)s��q� of 0.04 mg/kg should not be exceeded. For 2nd degree AV block type II and 3rd degree AV block, omit Atropine and go to external pacer. POSSIBLE A VEIRE REAcriONS AND SIDEEIFIFECT : ...................................................................................................................................................................................................................................................................... CNS: Restlessness, agitation, confusion, psychotic reaction, pupil dilation, blurred vision, and headache. Cardiovascular: Increase heart rate, may worsen ischemia or increase area of infarction, ventricular fibrillation,ventricular tachycardia, angina and flushing of skin. GI: Dry mouth and difficulty swallowing. Other: Urinary retention. Can worsen pre-existing glaucoma. Adult: Bradycardia: 0.5-1 mg IV/10, may repeat every 3-5 minutes until improved or total of 2mg is reached. 0.02 mg/kg IV/10 (minimum dose is 0.1 mg and iniaxinu iu n,i single dose is 0.5mg child, 1 mg adolescent). May repeat once. III''lhmrme Actiioum Purofuillle: Onset I::)eak 1'.)uirat6oii°: IV/IC: Unknown Unknown Unknown 10-5 0) dq N CO Atropine Sulfate as Antidote for Poisoning o ACTIONS: INS: o � � Atropine is a potent parasympatholytic that binds to acetylcholine receptors thus c o diminishing the actions of acetylcholine. 0 Sul�fate V! IN1' III, IIIONS- E 0 Mig 04 rmol i AntichoIinesterase syndrome poisoning such as; Organophosphate (e.g. Parathion, Malathion, Rid-a-Bug) and Carbamate (Baygon, Sevin and many o common roach & ant sprays). Signs of organophosphate poisoning are: Salivation Lacrimation Urination Defecation GI distress, Emesis,) Miosis (Pinpoint pupils, bradycardia, and excessive sweating. ��i��ll� ile� �ll ��Ill in ithe management of severe organophosphate poisoning. WA I l<G psis{: It is important that the patient be adequately oxygenated and ventilated prior to using Atropine as it may precipitate ventricular fibrillation in a poorly oxygenated patient. Even after Atropine is administered, the patient may require intubation and aggressive ventilatory support. POSSIBLE A VEIR E REAcriiONS AND II E EFFE r : ...................................................................................................................................................................................................................................................................... Victims of organophosphate poisoning can tolerate large doses (1000 mg) of Atropine. Signs of atropinization are the end point of treatment: flushing, pupil dilation, dry mouth, and tachycardia. Adult: 0.03 mg/kg IV/IO, repeat every 5-10 minutes until atropinization occurs. u r�lii uiu uu::: 0.05 mg/kg (maximum 3 mg) IV/IO, repeat every 5-10 minutes until atropinization occurs. 1If'lhmrme Actioin Purofuillle: Onset l::)ealk I::)uirat6oii°: IV/IO: Immediate 2-4 minutes 4-6 hours 10-6 0 LO N Calcium Chloride 10% o ACTIONS: CD o Calcium chloride increases the force of myocardial contraction; calcium c may either increase or decrease systemic vascular resistance. In normal o hearts calcium's positive inotropic and vasoconstricting effects produce a CALCIUM t predictable rise in systemic arterial pressure. c r I� 1 III IIIONS-gp o I. 1, I Calcium chloride is indicated during resuscitation for the treatment of hypocalcaemia and calcium channel blocker toxicity (i.e. Verapamil or Cardizem overdose) and Magnesium Sulfate overdose. It also protects the �� heart from hyperkalemia as may occur in patients with end-stage renal � disease. Cardiopulmonary arrest not associated with calcium channel blocker toxicity, hypocalcaemia or hyperkalemia. WA Calcium {chloride should not be administered in the same infusion with Sodium Bicarbonate, since calcium will combine with sodium bicarbonate to form an insoluble precipitate (calcium carbonate). Calcium chloride j should be given with extreme caution, and in reduced dosage, to persons taking digitalis because it increases ventricular irritability and may g g Y Y precipitate digitalis toxicity. IPOSSII LE ADVERSE REACTIONS AN SIDE EFFECTS: If the heart is beating, rapid administration of calcium can produce slowing of cardiac rate. Adult dosage: For hypotension following administration of calcium channel blockers (i.e. Cardizem,Verapamil): 4mg/kg IV slowly If patient is taking digitalis, 2 mg/kg IV slowly. Repeat every 10 minutes PRN. For calcium channel blocker overdose and hyperkalemia: 8-16 mg/kg IV slowly Asystole/PEA(if on calcium channel blockers) 1gm IVP 1If'lhmrme/Actiioin Purofuilllem Onset I::)ealk uira tIoin IV/IO: Immediate Immediate 2-5 hours 10-7 T- LO N 00 Cyanokit° o ACTIONS: NS: CD � IJ Hydroxocobalamin is an antidote to cyanide. It is marketed as c CYANOKIT° in the US. It removes cyanide directly from the blood without converting any of the hemoglobin and therefore does not 1 oxygen p Y interfere with ox en transport. It combines with the cyanide to form E cyanocobalamin which is a derivative of vitamin B-12. Both the L Hydroxocobalamin and B-12 are harmlessly excreted in urine. o p p Ex osed to products of combustion in an enclosed space Soot resent in their nose mouth or sputum p • Altered mentation i Does not meet trauma alert criteria • At least 18 >years old Common Signs & Symptoms include: Symptoms Signs Headache Altered Mental Status Confusion Seizures Dyspnea Mydriasis (dialated pupils) Chest Tightness Tachypnea (early) Bradypnea (late) Nausea Hypertension (early) hypotension (late) Cardiovascular collapse Vomiting CI' I� ""I"'III'°CAI III D III I .................................................................................................................... None WA],"i,J\flV�\IGS: Do not use the following medications in the same IV line: Diazepam Propofol Ascorbic acid • Dobutamine Thiopental • Fentanyl Sodium Nitrite • Nitroglycerin Sodium Thiosulfate • Pentobarbital Whole Blood DO NOT RELY ON PULSE OXIMETRY FOR ACCURATE READINGS Please refer to detailed infusion instructions located within the CYANOKIT° itself. or in protocol 3-2. Several multi-dose kits are carried in the Battalion Chiefs vehicle 10-8 N L0 N Dextrose 50 % and 25 % (d-glucose) o ACTIONS: CD o A monosaccharide, which provides calories for c 50 V! N � metabolic needs, spare body proteins and loss of o electrolytes. Readily excreted by kidneys producing "XTR i diuresis. Hypertonic solution. c n � InjectionPN)�� INI II A ION : • Hypoglycemia Coma of unknown origin. "' ICAIIII�' w ith r4 CI II I I'„intracranial orlilnt k raspinal hemorrhage (in a patient with normal BGL). w.� 0 Blood glucose Level > 60 mg/dl. IPO III�LE ADVEIR E IREACTIION AND I�I�TIDE EECT : • Cardiovascular:Thrombosis Sclerosing if given in m peripheral vein • Local:Tissue irritation or necrosis if infiltrates. • Others: Acidosis, alkalosis, hyperglycemia, and hypokalemia. Adult: (> 30 kg) 50 ml of a 50% solution; (25 gm) IV/10. (< 30 kg) 2 ml/kg slow IV/10 of a 25% solution. (< 10 kg or< 1 month of age) 5 ml/kg IV/10 of 10% solution (dilute D50 4:1 with NS). "11f'lhmrme Actiioin IRurofuillle: Onset l::)ealk I::)uilrafloin IV/10: < 1 minute Depends on degree of hypoglycemia 10-9 M L0 N 0 Diazepam Hydrochloride (Valium°) o CD � v >A' IfMfi�lll�fgh!� � , �gu�pll�uuiiuuiuouou ❑ r L CO C ACTIIONS- E A member of the benzodiazepine family, Diazepam, depresses the limbic system, thalamus, and hypothalamus s° resulting in calming effects. Diazepam produces a sedative effect and is also a muscle relaxant. ~ L ❑ II IN IID III CAII IIIONS- Status epilepticus, Premedication prior to cardioversion,Agitation due to acute alcohol withdrawal, Drug induced psychosis,Short-term relief of acute anxiety, Cocaine intoxication : :]'loN.l RAI II\I I":N:;A I'I:'''V .............................................................................................. • Alcohol Intoxication • Pregnancy(except for seizure control associated with eclampsia) • Neonates ...................................................... Do not mix Diazepam with any other drug, precipitates with almost all medications. When injecting IV administer slowly through the IV tubing as close as possible to the vein insertion. Do not administer into small veins such as those on dorsum of the hand—causes local irritation and possibly venous thrombosis in small veins. IIOIJS: • Pregnancy(except for control of seizures associated with status epilepticus or eclampsia) • Neonates. POSSIIBII..IE ADVERSE REACTIONS AND SIDE IEIFIFIECTS: ....................................................................................................................................................................................................................................... • CNS:Confusion, muscular weakness, blurred vision,drowsiness, respiratory depression, respiratory arrest, and slurred speech. • Cardiovascular: Bradycardia,hypotension,and cardiovascular collapse. • G.I.: Nausea,vomiting, abdominal discomfort and hiccups. • Respiratory: Respiratory depression. • Other: Potentiates MAO's, barbiturates,tricyclics and phenothiazines Potentiated by Cimetidine, ETOH and other CNS depressants. DOSAGE: Adu.wllIt- To be administered in 5 mg increments. Dosing ranges from 5-20 mg IV/IC/IM depending on specific protocol. The IV route should be administered slowly-no faster than 5 mg/min. IM 20 mg maximum dose per injection. IM injections are painful. If IM route used inject deeply into the deltoid for maximum absorption. I�Jl udiatric: Status epilepticus 0.2 mg/kg IV/IO slowly(max 5mg). Rectal Dose 0.5 mg/kg, may repeat either route x 1 in 5 mins. uurrne/Actiou°n IPirolfulle: Onset 1:1ealk l)u.uirafloiru (Sedation)IV/IO: 1-5 minutes 15-30 minutes 15-60 minutes IM: 15-20 minutes. 5-1.5 hours Unknown Rectal: Unknown 1-2 hours 4-12 hours 10-10 dq N r Diphenhydramine (Benedryl) o DRUG FORMULARY o = � s V! CO C V! R ACTIONS: c Diphen.hydiramine its an ar°ntntnr tare rna to arnttcnhrnaer u (drMg)and � sedative side effects.Antihistamines appear n a with histarnine foro yell receptor sites,on effector cells,Diphenhydrami prevents,but does not reverse histaminedated responses,partkularly histamine s on the sm th muscle of the I bronchial airways,gastrointestinal tract,uterus,and Ibloold vessels. A&Iergy ..�,.symptoms,ainaphylaxis.. Sedation of,violent patient, t. Dystanic reactions firom phenothiazine overdose(i.e.HaWol,Compazine, Thorazine,and tad-ariru ).. DiphentWdiramine is not to be used oirr newborn or premature intartts. Diphenhydramine is not to be used in patients w i h acute asthma attar: WARNIN§1 In iurrotar its and children especialk antihmamines in overdlose,may arse halludinations,convulrAons,or death.As in adults,antihistamines rimy dimmish mental alleriness sin children.In young children,they may pmduce excitation.Diphenhydirairmine has additive effects ter alcohol and other CNS depressants(1hy nr ti sw sedatives,train luau lln rs,et .). ntshistamin s airy more i cause,dizziness, 'atio n,„aria hypotewsion in the all eta(160 years or ok*r)patient ADVERSE RIAMONS,AW"ODE ECTS: CMS"Drowsiness,coaftism,kumnimi,headadike,w rya s( ally it the eWerliVj. sNm errs„r � ras�PVVs and hypowpon, spiir aWy Thkkenft of Ihsrrs N secremns,t s of the rhe,A wn's .a°ing,nasW stuffiness., aar.Maw"a,vom. . N rare( * and Gul Dysuria,urinary feterdim, pnmigi rrr n" 25-50 ffq IV110 at 50 mig d IM �s iv/0 or °s "irrraWAct r Prsrr'ar ' arras Peaik Duration /10; rapid amok, hows crap: s 14 gars a hows DighgnhydralmiM RLdrochiglide JlienadELW Dr, 0. . 10-11 L0 L0 N N Dopamine Hydrochloride (Intropin°) o AC" IONS- � i Dopamine stimulates dopaminergic beta-adrenergic and alpha-adrenergic CD receptors of the sympathetic nervous system. It exerts an inotropic effect on T r the myocardium resulting in an increased cardiac output. Dopamine produces o less increase in myocardial oxygen consumption than does Isoproterenol and y its use is usually not associated with a tachyarrhythmia. Dopamine dilates E renal and mesenteric blood vessels at low doses that may not increase heart 0 i rate or blood pressure. Therapeutic doses have predominant beta adrenergic receptor stimulating actions that result in increases in cardiac output without marked increases in pulmonary occlusive pressure. At high doses, Dopamine 10 has alpha receptor stimulating actions that result in peripheral vasoconstriction and marked increases in pulmonary occlusive pressure. INDICATIONS: To treat shock and correct hemodynamic imbalances, improve perfusion to vital organs and to increase cardiac output. C.�,�,.�'IINJ„'I'R IllNJ HCA III'll01N�I6- Dopamine should not be used in patients with pheochromocytoma or hypovolemic shock. Do not administer � ister Dopamine in the presence of uncorrected tachydysrhythmias or ventricular fibrillation. Do not add Dopamine to any alkaline diluents solutions since the drug is inactivated in alkaline solution. Patients who have been treated with monoamine oxidase(MAO) inhibitors will require substantially reduced dosage.MAO inhibitors include: furazolidone(Furoxone°), isocarboxazid (Marplan°), pargyline hydrochloride (Eutonyl°),pargyline hydrochloride with methyclothiazide(Eutron°), phenelzine sulfate(Nardil°), procarbazine hydrochloride(Matulane°), tranylcypromine sulfate(Parnate°). IPOSSIIIBII..E ADVERSE REACTIONS AND SIDE IFIFIFIFCTS: Cardiovascular:Tachycardia, palpitations,angina pain,ectopic beats, and hypotension GI: Nausea and vomiting Local: Necrosis and tissue sloughing with extravasations, use a large vein to reduce this incidence Other:Piloerection, dyspnea and headache. DOSAGE: Adult and II I'Jlediatric: Pre-mixed bag Begin infusion at 5 mcg/kg/min. and titrate to effect(Maximum dose 20 mcg/kg/min.) Vial(400 mg)To yield a concentration of 1600 mcg/ml mix 400 mg of Dopamine into 250 ml of D5W. uurrne/Actiou°n IPirolfulle: Onset 1:1ealk l..)u.uirafloiru 4 minutes 10-15 minutes Continuous with infusion 10-12 co L0 N M Duo-Dote" o (Atropine and Pralidoxime Chloride) � o ACTIONS:NS: ° N Blocks nerve agents effects and relieves airway constriction 0 wand secretions in the lungs and gastrointestinal tract. • Acts to restore normal functions at the nerve ending by c removing the nerve agent and reactivating natural function L INIXI lllllONS- Suspected or confirmed nerve agent exposure COPI I II AI 111 J D„CAI III 0 Pil��: il 4 Both medications in the kit should be used with caution P (but not withheld) in patients with preexisting cardiac disease, HTN, or CVA history. z POSSIBLE ADVERSE RE CTION AND SIDE EFFECTS......°.... Chest pain , .................. . . .......................................................................................................................... exacerbation of angina, Myocardial infarction, Blurred vision , Headache , Drowsiness , Nausea , Tachycardia , Hypertension, 08 Hyperventilation P DUODOTE TM — Each auto injector contains BOTH: Atropine 2.1 mg and Pralidoxime 600 mg Adult: For Nerve Agent Exposure (SLUDGE symptoms): Up to 3 auto injectors may be used for one patient based on signs (1-2 kits for self treatment— up to 3 for buddy treatment with severe symptoms) )ek,: tai k::: DuoDotes TM are not authorized for the use of children under the age of 9 years. 10-13 I- LO N .............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................. r Epinephrine 1:1,000 0 CD OC q �II f E i� 5 1 JJ1111111111 ��JJ»»l L AC;P lNS: Epinephrine is a sympathomimetic, which stimulates both alpha and beta-adrenergic receptors causing immediate bronchodilation, increase in heart rate and an increase in the force of cardiac contraction. Subcutaneous dose lasts 5-15 minutes. I N III IIICA"ll'IIIO NS: • Asthma • Anaphylaxis • Angioneurotic edema COINJ I RAlIINiDMCA"'111""IIUIP6- ...................................................................................................... None in the cardiac arrest situation. Hyperthyroidism, hypertension,cerebral arteriosclerosis in asthma. Caution should be used with Epinephrine administration when the patient is older than 40 years old or has a history of heart disease.The benefit must outweigh the risk. Do not administer Epinephrine if heart rate is> 150. WX IIJ�TV JGS: ........................................................ Epinephrine is inactivated by alkaline solutions- never mix with Sodium Bicarbonate. Do not mix Isoproterenol and Epinephrine- results in exaggerated response.Action's of catecholamine is depressed by acidosis-attention to ventilation and circulation is essential.Antidepressants potentiate the effects of epinephrine. IRGSSIIBII..IE ADVERSE REACTIONS AND SIDE EFFECTS: ....................................................................................................................................................................................................................................... • CNS:Anxiety, headache and cerebral hemorrhage. • Cardiovascular:Tachycardia,ventricular dysrhythmias,hypertension,angina and palpitations. • GI: Nausea and vomiting DOSAGE: Adujllt: SQ 0.1-0.3 mg(0.3 cc). Repeat every 3-5 minutes(Asthma/Anaphylaxis may repeat once in 15 minutes). IIe li alw'"Iric: IM 0.01 mg/kg up to 0.5 mg. 11innle/Acdoin IRurof llle: Onset Peak I)u ira lion SQ: 6-12 minutes 20 minutes 1-3 hours 10-14 00 Lf) C14 Lid ISLA,MORADA FIRE RESCUE 0 DRUG FORMULARY V_ o .............. CD 0 Epinephrine, 1:10,,000 T ............... 0 E 0 Epinephrine is a sym put vomimetic,which stimulates both Alpha and Beta- receptors,As airesult of Ks effects,myocardial and cerebirai bbod flow are ims"sed dun"wwRabon aind chest compression.Epmelphfine increaws systemic vascular resistance and thus may eMance defibirdfation. 110A] ARI Pubefess Arrest AsVstole Ventincular FibrWation unresponsive to defibriltation; PEA Other pediatric indwai hypotension in patierft with circu$atory wistabdity,,dry dycairdia(before Atropine) a I M UN kHz M;,,m lim Norie,in'the cardirac arrest situabion. Epinephrine is inactivated by alkaimesolutions-never mix with Sodium Bicarbonate,Do not immix Isopricrtererwi and Epinepitwine-resuft in e"ggerated response.AAftions of carechisfarndyes are depressed by acidicisis -att"tron to ventilation and criculation kis essential,Awritideprewants potentiate the effects of:epinephrine. CKS:Anxiety,headache and cerebral hemorrhage. Cardiavascutar:Tactrycardia,verarictdar dprin0mias,hypertirnsion,angifta and Palpitations. GA:Nausea and vmking, AW11ft- (1:10,0001)1,mg(10 ml)FV air,C,repeat every,3-5 minutes,Repeat every 36 minutes.N patient is in SEVEFUE anaphylaxis with ieta It terms" you may start an W and adri 3-S at of a 1:10,000 so4uticin 11,VP sJow over 2 minutes, P"fidatric: 0,01 YnLf kr,,(0.1 milft'r,IV or 101.Repeat every 35 n1kalste's. pedimric POST ARRUT:O.Lrivr4,jkg/min Mix Irrog of Elpi inbD I(Mint NS=Concentratimt of lirrwC/iml TimoJActitm PrafiW On"jit Peak Duration TV/10w Rapid 1-2 irri 20 ni Epinephrinell:10,000 Dir.SaMi 501weMMW,,D,0, 10-15 0) L0 N .............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................. r Fentanyl ' 0 N � N ACTIONS- � o C Fentanyl Binds with stereospecific receptors at many sites within the CNS, increases pain threshold,alters pain y �L reception, inhibits ascending pain pathways. Fentanyl binds to brain receptors, relieving pain. It decreases the Lo feeling of pain and a person's response to pain. Fentanyl is 50-100 times as potent as morphine; morphine 10 y mg I.M. =fentanyl 0.1-0.2 mg I.M.;fentanyl has less hypotensive effects than morphine due to minimal or no c histamine release. L 0 INI I A flll j�� ll�IONSw_ / rJ yN i�ii�ibo1ifl • Moderate to severe pain in patients>10kg • Acute Coronary Syndrome—Chest Pain (Adult) • Pain associated with isolated extremity fracture, renal colic, burns, etc. r. i C mIINII°RAWIINIAIC III II0II\6- • Epistaxis or bilateral blocked nares • Known hypersensitivity to fentanyl • MAOI use in past 2 weeks • Unstable hemodynamics or altered WX 11JVINGS: ........................................................ Use with caution in patients with bradycardia, hepatic, renal,or respiratory disease or those with increased ICP, head injuries,or impaired consciousness; patients must be monitored until fully POSSIBLE ADVERSE REACTIONS AND SIDE IEIFIFIE S: ....................................................................................................................................................................................................................................... • CNS: Drowsiness, sedation, increased intracranial pressure • Cardiovascular: Bradycardia,hypotension,peripheral vasodilation • GI: Nausea,vomiting • GU: Urinary tract spasm • Respiratory: Respiratory Depression • SLOW IV PUSH- Rapid push may cause chest wall rigidity decreasing,or eliminating ability to ventilate. DOSAGE: Adult. 1-2 mcg/kg IV/IO/IN (first initial dose 50-75mcg,followed by 50mcg doses 15 mins later if needed) or 100 mcg IM 714 P. II 1M III II u;'AU I Il&I°I a 7II°I dI`nII III IIA I..II3 Ilu .S II`Lfl I u 7 . II IJSI..I..IIVT'(71 IIeciliat is> aLQI<.G: 0.5 mcg/kg IV/10/IN/IM May repeat half the original dose administered 0.25mcg/kg 11inn�e/Act1oin Proflllle: Onset Peak 1)u ira lion IN: 2-10 minutes 30-60 mins IV: immediate 30-60 mins 10-16 FENTANYL C) W CN JSLMORADA FIRE RESCUE 0 DRUG FORMULARY o.................................................................................................. ftro 0 semide (L,asix@,) T 0 E 0 A suffonamide derivative and potent dikoetic.,which inihibits the reabsorpbon of sodium and chloride in the prommW a�nd distag renal tubulin as weff as in the I of Hleirdey.Kas a direct venodda tin g effect in acute pulmonaryy ederna With TV administration,onset of,venoditating is gmerally within 5-1,0 minutes;diuiresis will usuaffi/occuir in 20-30 minutes IN D4 CA 11,04145 m. Puimonary ederna Anuria,ShoWd be used in gwegnaincy only when bervefts clearly outweigh risks. WA,11 lrlhl N G S,,, Furosemide stwuld be protected from light.Dehydratwn and electrotyte irnbalance, can result friom excessive dosages,Rapid diuresis can lead to hyponension and thromboembork episodes, CNS-IMrziness,tinnAus,hearing I headache,blurred wisim and weakness W.Aniorexia,vomiting and nausea Cardiovascular:HVWension Othe,r-Pruritus,urticaria and musc*a'aimping. Adu,fc F.80mg W ordoublethe patient dose a pto max 101)rng. Cardiogenic Shock.40 mg IV slowtV over 2 minutes(If systok Wood pressure is thain 100 MM1Hg,j 'IFIfnefActionPraffle- Onset Ppak Wiration N/110- S minutes 30 minutes 2 hours Furosemide (LasixO) ter,Safta:"oMMM D,O, 10-17 cfl N 00 r ISLAMORADA FIRE RESCUE 0 DRUG FORMULARY o O Lgim,lbuterol x N L L CO C V! R E O A U Y S L agovist causiM bmnehocBstion and Wax Waxaftn of rra muscles of aill airways t.ist has a durabwup to 8 hours. TreatmeM for " HypersensOwAy to XOPeMK or raioemic AbuWol., a ;J Should be disooftnued#OT prokmgAbon,,ST segmeM depmssiom ra mp' bronchospasm or hypersens&vAy reacton occurs,such as taticaria,angioederns, ?J rash or,crap ro HeadNervousness,Seizzwe,Weakness,SyrkoopP-,'rre.ffxxs, airdic wascuW: Tachycardia,Chest pain.Palpftaborts, Hypokafernia, r- /// Hypotermiort ..................... .............. DO SAGE Adult., (*12 years,of age,)043 3mi mg aria nebukzer Q 11 ors 'age)0.31 1 ( )nV via nebulizer "fir" ,of 12 may nmeive t. ' : that has not responded to the in"" t e gat 0.63 Sarx1ra SchwenvM, " . 10-18 CN W CN CF) ISLAMOR,AD FIRE RESCUE 0 DRAG FORMULARY o CD a 0 Magnesium Sulfate T 0 MagnI to is or contrcis ccmvulssons by bixkift neummusI Uawrnnsan E 0 and decreaung the ansount af,"Vicholone liberated at the end-plate by tho ffwtor nerve,WWWse.magraWurn is said to h"e a depressaint, effect on the cer&al fterwous 7 system,boat k does rwt affed the aKicher,Fetus or neonate when used as diected in eclaoWssa and pre-eclampsia,Man mourn acts pan flIphef&I to Errand me vasoddatatim dserefore a dmp in PI OP is to bit antk*atetf, • Preveirtionand control of sezures,in eclangWa • rorsades de Powdes Suspected W(pomagnesernic state(te.chronk alcoholism and chrork use of diureficsj Refractory ventw4ar fitaillation Reftactory Asthma ZWMUWI12WLaUr& Parentieral admuistration of Ow drug is contraindicated in p0ents Wish heat Nock CK ntyccardaiJ darmge. tntmenous use of mapesium suffate should rux be g*wn to mothers With toxerria of pregnwxy with Ontrinent deOvery,mapiI Sulfate InI USP,50%must be, mad Ji* 14 dkited to a concentratm of 2,D%or Wn prior to IV infusion, for VV'Ima, Because an turn is rernmod from the Ibody saWy,by tho k Winers,Ove drug skKid.be used with caution,in patients with renai WMairamint.Monitorngtho Ipatie as dioI stators its esser"tea avonll the consequences of overdese in edaMsia.Calcium Chloride shoWd be kninteshately away laWe to counowact the poten"tiazards,of rnigrtemm mtoKkation in"Umpsis..Sqns of hypemsagrmsmm include resporalmy depression; abseme lot patelar rOlex,etc, Adverse effects of Magnesium sWfate ry we usuaNy the resuft of magnesium Womwissn, Signs of fob pemagnesemEra OKludw flushin&sweating,byWension,depresI of reflexes,flaccid Iparadlysic,hypothernt*,arid izimulArey collapse,dquession of cardiac function and centrad nervous system depressiw These symptoms can precede fatal Paralysis AfAtIt'. For edantirtki seizures�2 gm in 20 cc W over 2 miniates . F—Orignion Ol?.2in'111 InArefragMA11-2 gm(nixed in So rW oI wW adirriksutered over 1-2 minutes)fodovmd by a maintenance infusion(:l gm in 250"of NS adanristered at Act gtts,/minj, TknelAictwo Profilft. Onse"t Pleak Dgmaglan tv cq*u Im"W"e, lunknown, Miagnosium Sulfate, Dr.Sardla Sclwpemmef.0,0. 10-19 tG CN 0 ISLAMORADA FIRE RESCUE DRUG FORMULARY o ............................................................. CD Met4ylpredntsolone (Solu-Medrol,*.A, Methapred), 0 E 0 AC",110f,45,!� Decreases jinflamma for y,effects via its Went anti-inflarnmatory synthetic steroid. 111"OKAFIONS, Asthma 10" Ani,arphViaxis Head in' jury COPID Uincons6Dus with kniown Adldison's disease CONTRAINDICATMIS: J08W Ift 041440171 None in thie emergency setring, AW POSSIBLE ADVERSE REA(rlONS AND SSE EFFECTS- G1 hemorrhage,reduces ieukotrines of imrr une.system amid increases potemial for infectons. DOSAGE: Adull mg IN slow ovier 2 minuites Pediatric img/kg (max 1.25 mg)FV Maw over 2 minutes Time/Action lPrwmifie. Onset Peak Durahon �Wlo!� Unknown Unknown Unknown Methylpreldnisolone (Solu,-MedrolO,A Methapred) Dr.S"3,SdWA4WMl UO 10-20 d cfl N r N ISLAMORADA FIRE RESCUE0 IF UG FORMULARY � o Morphine Suffate �(MS) T L CO C f d01 WI�R�S4�DI6f1f6W (flK,�tf"6'G (i�fi, 'i'bP '° E O t G L 0 Moro Erna is a iaarcotic analgesic,which depresses the central nervous and respiratory system and sensithdty to pain.,Morphine also increases wersous capacdtarmcpw decreases venous return and pr ces mild peruptnerad vasodilatation, • Pain • Pain associated wttdn isolated extremity fracture,renal colic,drurrns,etc, ONtllAlddyt CAT IONS,,, • Head trauma • Acute astdmrrrra Known• hypersensitivitV to MS Morphine is rdetowifilend by the INwrr ,It is potentiated by akiifiot,antihistarviiines,bairbiturales,sedatives a beta ars. P0551 dd E ADVERSE REACVONS AND WE t'l d.CTSl CNS-Euphoria,drowsiness,pupOlWry constriction and reWiratory arrest,. Cardiowascutin:BradWarcha and Ihypotension. 'll.decreases gastric motility,nawrrsea:and ornitiun .. G,U: retention. Respiratory- rorwutdmotomirlr on and decrease cough reddemuv. D06W.: Ad uftr increments N stowty,Repeat every is minutes untd desired responw,is achieved (maximum dose ddl mg),Can be given N. 01 rng/kg lid slowly.Mllay resat the lrsklal dose X1 in 3-S minutes, ivaitriiwit; dd, mg/kg mg/kg pad slowly.Mawyr ant the initial dose 'dlrn 3-5 inimaes, `dlur Actiionm prr dlleu Onset Peak Duration lid. Rapid 20 minutes 4-S tmr Morphine Self S) r. arstra m w rawer.ID:,G 10-21 LO cfl N N N Naloxone Hydrochloride (Narcan®) o o � r ° 0 0 {rff0 ,,, ,,, / 1111111111f l E i „ r o L 0 ACTIIONS- Naloxone antagonizes the effects of opiates by competing at the same receptor sites.When given IV,the action is apparent within two minutes. IM or SC administration is slightly slower. III NIIDIIICAIIFIIIlONS: eNaloxone is indicated for the complete or partial reversal of central nervous and respiratory system depression secondary to opiate narcotics or related drugs such as, but not limited to: *Heroin, Meperidine(Demerol), Codeine, Morphine, Methadone, Lomotil, Hydromorphone(Dilaudid), Pentazocine(Talwin), Propoxyphene(Darvon), Percodan, Fentanyl (Sublimaze) (Known on the street as"White China") ''Vq i.i.RAi 11 i llDR A i'H'V 11 i;li: .......4................. Known hypersensitivity to Narcan. dN�� ll' i4llll i4llGS: ...................................................... Naloxone should be administered cautiously to persons including newborns of mothers who are known or suspected to be physically dependent on opiates it may precipitate an acute abstinence syndrome. If patient is intubated and airway is controlled do not administer Narcan (excludes cardiac arrest). May need to repeat Naloxone since duration of action of some narcotics may exceed that of Naloxone. Naloxone is not effective against a respiratory depression due to non- opiate drugs. Use caution during administration as patient may become violent as level of consciousness increases. IPOSSIIIRII..E ADVERSE REACTIONS AND SIDE IFIFIFIFCTS: ........................................................................................................................................................................................................................... CNS:Tremor, agitation, belligerence, pupillary dilation,seizures, increased tear production, sweating and seizures secondary to withdrawal. Cardiovascular:Hypertension, hypotension,ventricular tachycardia, pulmonary edema and ventricular fibrillation. GI: Nausea and vomiting. DOSAGE: Adu.wllIt. An initial dose of 2 mg may be administered IV/IN/IC/IM (outer thigh) PRN. If no response after 8 mg, then condition may not be due to narcotic. (Fentanyl overdose may require larger doses of Naloxone to reverse effects). I�Jl udiatric: 0.1 mg/kg IV/IC/IM/IN PRN. uurrne/Actiou°n IPirof lle: Onset Peak l)u irafloirn IV/IN/IC: 1-2 minutes unknown 45 minutes IM: 2-5 minutes unknown >45 minutes Naloxone Hydrochloride (Narcan°) 10-22 cfl cfl N M N ISLAMORADA FIRE RESCUEDRUG FORMULARY 0 o m......................................................................................................................................................................................................................................................................................................................................................................................................, o tivgycerin (Nitrostatg Nitrolingua,10Spray) y L ACTIOP, CO C V! f.. a O Nilrogtycehn is,a direct vasoddator,wh.ich acts principally mm the venous � system although it also produces direct coronairy artery vasoWatation as o well.There is,a decrease in venious r ttmrtm*wtkh decreases the rkl n d on the heart and thus,decreases ntVocardial a demand.Suiblingual nitrogtycerin is rapidly Ibsorbed. Pam relief occurs within one to two mutes and therapeutic effects can last uip to 30 minutes. lF4lllmICA1lm 1N u 0 µ west pain ordiscomfcwt associated with m sus ted MIL . Pulmonary edema with hypeftension., • Children undler 12 • Patients on ereafle dysfunictiion drugs that tall Umlrw time parameters(lute. hours) • Know hypersensitMty to the drug • Evidence mat a 1positive WR in the setting of an Inferiof wafl MI PRECAIJM0W Nitroglycerin tab4ets are inactivated by light,heat,air and moisture.Must be kept in amber glass containers with fight-fitting lids. IL a not ieave canon in container,Once opened„rmttr gt cerlmw his a shelf life,of 3 months.Do not shake Nitrofingual spray.Alcohol wmmmfl accentuate venodilating and hypotenswe effects, 2dLAUL Ul m IU eadawe,dizziness,filusnhimm .,nausea and vomiting. rurdU Umtrm HyWenswn,reflex tachycardia,and b�radytatdia. Adu ft 0.4 mg(I tablet or Ispray sublfimw a l),.May repeat i µa minutes PRN. fins/Ax,,,dawtm Profile. Onset Peak IFmw,ummariii n SL 1-3 minutes unknown 30 60 minutes Nitroglycerin ( situ uNitro in u1 Spray) r.Safta,SOVAemmer,D.O. 10-23 ti cfl N ISLAMORADA FIRE RESCUE DRUG FORMULARY o S 0 nitrous Oidde (N'ftronow O) ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ..... ..... ..... L CO C ACT V! R �� n r� CS perception of pain � has, a potent anakpsic effect � L IIIII� �f��"m ��„' 0 I C W I�n 14��'�yi�.lu Iu� u '�a u Pam martage t for traurna or medi al emergencies 1E,m real calculus,ABD Ipain, bums wlhMA rest,,tM invoNement,extrem, injunies where sin ten ion are not ms. Hypotens,ive AMI ., LOC such as FT ' I or dfug abuse COPD CHF Suspected mead Injury,falcial or chest trauma Any forM Of k or hypotenSion exCeI t AMI NEVER in, DIVE Emergencies al � Patients strotAd receive oxygen at 4[prn for 10 mnirnitmtes after disiconfinuance of Nitrous Oxidel ' OSSII L,F ADVERSE REM" HIM ND SIDE EFFECTS: Sedation,inausea&vomiffing, apnea,dirawsiftess DOSAGE: Adul Seff adminWeredi tvia a face mask,Wended mixture r 50% NArcus,Oxide and Oxygen, Sett istered: Raippd 2-3 nlnute Nitroglycerin (NitrostaM NttrofingualO Spray) u .MY03 zchftffmw0 10-24 00 W C14 Lid N ISLAMORADA SIRE RESCUE, DRUG FORMULARY CD 0 Oral Glucose (metaGlucose) T 0 E 0 o Gin w! ACT 1101116!k Increases blood gtucose tevels slov0y. 2W&W.K11 ul—I BS,'�N 60 rngdl,p,at*nts who ar ftered but alert enough to take t!he command to swallow, Patients unable to,swaltow or Stroke symptoms. PREt MYHQI,"IS� None when Ipatient cain swaftw,risk of aspiration if given improperly. ADVERSE REAC11ON5,AND SIDE EFFIECTS: 61* Naursea 22JAGE. Aduft. 1 tube I tube FrSnel&UM PTONO- Onset Peak Dunwhon 10 rninutes unknown Lk*rovon Oral Glucose (finsta Glucose) &M"SMW&Mwr DO, 10-25 cfl N N ISLAMORADA FARE RESCUE � DRUG FORMULARY � S Sodium Bicarbonate y 0 V! J / E lincreases Ffi to reverse addoses.. 7 DUv 11��a ,few„� r * iMetaboliIc acidosis iin�"ardiac arre,st 11 N N° . Tricyck overdoses with QRS>0.1 Ilctrrtcsr'timr * Hyperkafernia Methanol/Ethoeine gl,ycol toxiicfty Severe ketoaddoses CA N III lillAlNUllt A lllONS: rm ` CHF and Af0fatic states Excessive therapy inhibits oxygen release,reduces the ability to duu fibrilllart ,may prrvacm iitata other medicartions and administration should be guided by bloodl gases.Do not give concurren#V "'tam any other miedication,flush the fine Wdre and after administration Metabolic alkalosis,and may crystallize in III solutions. Aduly 1 imEW'kg IV push,then the dose,rl 10 mnuirrs,, 'l ct rrtions" 2 rrm ri N spar^,lu ura m°: 1-2 rnE dinned 50:50,wdth N r°mai Safine Tirmn l ctiion Profile-, blouse Peak D'Uranlruru [ 1 Unknown Unknown n Unknown Sodium te M Sam"setwoerNmr,co-. % 10-26 0 ti N N O TRANMc ACID (TXA) (CYKLOKAPRONj 0 ACTIONS: o c . � Antifibrinolytic hemostatic that competitively inhibits - the activation of plasminogen to plasmin,an enzyme that degrades fibrin ciot�s,fibrinogen,,aind other plasma a proteins. o 04100 % INDICATIONS* I AT'iONS* o Blunt or penetrating trauma,signs and symptoms of Acid x mo R hemorrhagic shock( BP< 0 mmHg and HR> 110, major i blunt or penetrating torso or pelvic fracture,one or more major amputations and/or evidence of severe bleeding), s external manual)efforts to control the hemorrhage have been instituted, < 3 hours since incident. "Oi °'fitAl l TIQ S: More than 3 hours post incident. '110 0m f10ml Patients taking estrogens,progestins,or oral tretinoin(a f 0 / Il chemotherapy agent used to treat leukemia) may have enhanced thrombogenc effects from TXA. Dose reductions are necessary in patients with severe renal)impairment. If TXA has been administered,ensure that the receiving facility its aware that the(patient has received TXA prior to arrivail. POSSIBLEADVERSE REACTIONS AND SIDE FF 5q Headaches, back aches, nasal sinus problems,abdominal pain,diarrhea, pulmonary embolism,deep vein thrombosis,anaphylaxis,visual disturbances. W.S.A.GIE.; Adult dosage.: 1 gram miixed in 100ml NS administered over ifs ruins. If TXA has been administered by the sending facility,continue or initiate an additional 1 gram of TXA at a rate to complete the 2na dose over 8 hours. Time/Action profile: Onset Peak Duration IV/10: 1-2 minutes 3-5 minutes T " `ANEXAMIC ACID (TXA) (CYKL.QKP "" SON) Dr.Sandra Schwemmer,D.O 10-27 ti CN 00 IS RADA ME RESCUE 0 DRUG FORMULARY o CD a 0 Versed (Midazol,am) T 0 0 Depresses CHS,musde retaxant,strong sedative,hypn,=,c,,and 7 HIINCATIM4S, Cointro$ of seizes,,sedation for cardioversion pacing,and sedation for awway manageirmnt, Respiratory depression Hypotension 01 EMIH and drugs R t J I',",i(,,,t 5 Mwitor patient for respratory aind CNS depression,and vital signs after administration- P(MIMEADVERSE RLACTIONS AND 9DE EFFECTS: CND. Retrograde arnnesia,alftered mentalstatus and dizziness Cardiovascular:Bradlycardia,hypotension,PVC"s,tactrgardia!and nodal r"hms Gl-nausea and vottviting,hiccoughs and coLoing Respira(M.Respiratory depression,lairyngospasm and bronichospasm AcIVII: 1,2 LLEX&Lagm 2.5-5 mg based on patient's weight up to 0 mg nvaix per"fiar"16c >I years of age(01 mg/kg)U="Mjpj=;o pediatric less than I year of age Time/k,,,tion Profile. Onset Peak Durationi tv 1-2.minutes, 3-5 minutes Weight diependent Midazolam (Vemed&) M.SarWa&Mwwnmw,D.0, 10-28 C ISLAMORADA FIRE RESCUE STANDARD OPERATING PROCEDURES Section: 700. EMERGENCY MEDICAL SERVICE S Subject: TRAUMA TRANSPORT PROTOCOLS m S.O.P. 701.00 Effective: 10/11/99 y Revised: 8/22/24 Page 1 of 13 oMorrison Approved r. Thomas Mo rrison �� s� rove � � Pa,�� d By: Terry Abel, Fire Chief Foams Required: .... .... ...... ... .. .... ........ __ ..... ........... . .. I. DISPATCH PROCEDURES Monroe County is unique in the State of Florida, in that it is comprised of a chain of islands stretching one hundred and thirteen miles in length, and connected by only one main highway. Islamorada Fire Rescue (IFR) ALS transport vehicles are located at strategic points throughout the Village of Islamorada, from MM 72 to MM 91.5 and are supplemented by numerous Fire/Rescue vehicles and one reserve ALS transport vehicle which are activated as first responder support for EMS personnel, and for secondary inter-facility transport if needed. 1. Calls are received via an enhanced 911 system (Monroe County Sheriffs Office Central Dispatch Center) located in Marathon, Florida. 2. The Dispatcher obtains information from the caller regarding: A. Name of person calling B. Nature of incident C. Type of injury D. Call back number E. Number of patients F. Location of incident G. Extent and severity of reported injury 3. The Dispatcher selects the EMS response vehicle(s) closest to the location of the incident. The Dispatcher immediately transmits the appropriate alert tone, followed by the command "Rescue (assigned unit), be en route to...", after which the nature, location, and known details of the call are transmitted. This information is transmitted via 450 mHz (UHF) pagers and 800 mHz radios carried by all EMS crewmembers, and all Fire-EMS Supervisory personnel. 4. Should all IFR units be actively engaged, the Dispatcher will call the closest geographically located ALS Fire Rescue unit(s) for "mutual aid". II. PRE-HOSPITAL REQUIREMENTS FOR TRAUMA CARE--64J-2.002 1. Islamorada Fire Rescue (IFR) shall ensure that upon arrival at the location of an incident, an EMT or paramedic shall assess the condition of each adult trauma patient using the adult trauma scorecard methodology to determine the transport destination, as provided in Rule 64J-2.004, F.A.C., and the transport destination of each pediatric patient by using the pediatric trauma scorecard methodology included in Rule 64J- 2.005, F.A.C 1 272 2. IFR shall transport, or cause to be transported, every trauma alert patient to a State Approved Trauma Center (SATC) or State Approved Pediatric Trauma Center (SAPTC) nearest to the location of the incident via the most readily available helicopter transport agency. A request for emergency air transport service to respond shall be made by the IFR Incident Commander or on scene Lead Paramedic on duty. If no helicopter agency is available, trauma patients shall be transported to the nearest medical facility. Pediatric trauma alert patients shall be transported to the nearest Level 1 SATC or SAPTC to the location of the incident. If a SATC or SAPTC further from the location of the incident has a special resource(s) that the nearest SATC or SAPTC does not have, such as burn center or hyper baric chamber, which is needed for the immediate condition of the trauma alert patient, the EMS provider may transport to the SATC/SAPTC having that special resource(s) even if the SATC or SAPTC is not nearest to the incident. 3. An Islamorada Fire Rescue Patient Care Report will be completed on every patient as defined in section 64J-1.001(17), F.A.C. by the IFR personnel that were on-scene. This form and a copy of run report will be forwarded to the receiving facility when completed. The field report will accompany every patient transported by air to the SATC/SAPTC. The IFR Patient Care Report will also be completed for all trauma victims found deceased on scene, 4. IFR will ensure that a pre-hospital "Trauma Alert" is issued upon determining that a trauma patient meets the requirements of Rules 64J-2.004 and 64J-2.005, F.A.C. The words "Trauma Alert" shall be used when notifying the trauma center, or hospital that EMS (or air transport) is enroute with a trauma patient. IFR medical director (Dr. Schwemmer) or the receiving physician at the trauma center (or hospital), are the only people authorized to change the trauma alert status (downgrade). IFR shall provide the receiving trauma center or hospital with information required under subsection 64J1.014(5), F.A.C., and the information listed below at the time the patient is transferred to the air medical crew, or the personnel at the receiving trauma center or hospital: A. Time of injury if different from the time of the call; B. Date of injury if different from day of call; C. County of injury; D. County of residence of patient; E. Cause of injury, F. Injury site/type, G. Trauma alert criteria if met as defined in Rule 64J-2.004 or 64J2.005, F.A.C., and H. Protective devices if motor vehicle crash, bicycle or marine crash. The information listed above shall be documented on the patient care record of the transporting unit that delivered the patient in accordance with the requirements of Rule 64J-1.014, F.A.C. 5. If the patient does not meet the trauma criteria, the EMT or paramedic can call a "Trauma Alert" if, in his or her judgment, the patient's condition warrants such action. Where EMT or paramedic judgment is used as the basis for calling a "TRAUMA ALERT", it shall be 2 273 documented as required in section 64J-1.014, F.A.C. and criteria met shall be noted as "Paramedic judgment based upon...". 6. Air Transport Guidelines: A. If the patient is considered a TRAUMA ALERT patient as outlined in Section III and Section IV and/or B. Blockage of the Main road or failure of the drawbridges, C. Extrication time greater than fifteen (15) minutes, D. If ground transportation is not available and is not expected to be available within a reasonable time, E. If a helicopter is needed to gain access to the patient or needed to transport the patient out of an inaccessible area, F. Possible MCI (mass casualty incident). III. ADULT TRAUMA ALERT CRITERIA-- 64J-2.004, F.A.C. 1. The EMT or paramedic shall assess all adult trauma patients using the following criteria (RED criteria) in the order presented and if any one of the following conditions is identified, the patient shall be considered a Trauma Alert patient: A. Airway: The patient requires active airway assistance beyond the administration of oxygen or has a respiratory rate of less than 10 or greater than 29 breaths per minute. 1. Drowning or near drowning patients. B. Circulation: The patient lacks a radial pulse or has a blood pressure of less than 90 mmHg or patients age 65 or older with a blood pressure of less than 110 mmHg. C. Disability: The patient exhibits a GCS score of 13 or less or exhibits the presence OF paralysis or there is the suspicion of a spinal cord injury or the loss of sensation. D. Soft Tissue: Patients exhibiting any of the following are considered Trauma Alerts: 1. 2nd or 3rd degree burns to 15 percent or more of the total body surface area; 2. amputation at or above the wrist or ankle; 3. any penetrating injury or GSW to the head, neck, torso or extremity; 4. chest wall instability or deformity (suspected flail chest); 5. crushed, degloved, mangled or pulseless extremity; 6. dislocations of the hip, knee or ankle. Superficial wounds of the torso, head or extremity, where the depth of the wound can be determined, are excluded. E. Longbone Fracture/ Skeletal: The patient reveals signs or symptoms of two or more longbone fracture sites. Long bone fracture sites are defined as the (1) shaft of the humerus, (2) radius and ulna, (3) shaft of the femur, (4) tibia and fibula. F. Mechanism of Injury: Patients exhibiting any of the following are considered Trauma Alert: 1. Severe facial injury/fractures with potential airway compromise; 2. Electrocution or lightning injury with loss of consciousness or visible signs of injury; 3. Blunt abdominal trauma or chest trauma in a patient with history of paralysis (paraplegia or quadriplegia); 4. Pregnant patients > 20 weeks with abdominal pain after blunt trauma. 2. Should the patient not be identified as a Trauma Alert using the RED criteria listed in (1) of this section, the trauma patient shall be further assessed using the BLUE criteria listed in this 3 274 section and shall be considered a Trauma Alert patient when a condition is identified from any two of the seven components included in this section: A. Circulation: The patient has renal failure and is on dialysis; B. Disability: The patient has head injury with loss of consciousness, amnesia or new onset of altered mental status; C. Soft Tissue: The patient has soft tissue loss from either a major de-gloving injury involving muscle and/or nerve, or a major deep flap avulsion greater than 5 inches. D. Long Bone Fracture/Skeletal: The patient has an obvious or suspected single long bone fracture due to MVC, or any patient with an obvious or suspected single long bone fracture on Coumadin or other"high risk" anticoagulants; E. Age: The patient is 55 years of age or older (special consideration should be given to patients age 65 and older exhibiting minimal signs/symptoms after traumatic injury); F. Mechanism of Injury: Patients exhibiting any of the following criteria: i. The patient has been ejected or thrown from an automobile, motorcycle, golf cart; ii. The patient has been ejected from a horse (with or without loss of consciousness) with suspected anatomical injury; iii. Blunt head, chest, or abdominal trauma in patients on Coumadin or anticoagulants with high risk of bleeding (see attached list, page 12, of Thinners with High Risk of Bleeding); iv. There is a traumatic death in the same passenger compartment of the motor vehicle; v. There is intrusion of more than 12 inches in the roof or occupant side of the motor vehicle or more than 18 inches intrusion into any site of passenger compartment; vi. Vehicle telemetry data consistent with high risk of injury (vehicle telemetry data, when available, collected at the time of the crash and relayed to dispatch to assist in predicting serious injury); vii. Falls from 10 feet or more; viii. Pedestrians or bicyclists that are struck, thrown, or run over by motorized vehicles traveling at speeds greater than or equal 20 miles per hour; ix. Motorcycle, golf cart or ATV crash at speeds greater than 20 miles per hour. 3. In the event that none of the conditions are identified using the criteria in (1) or (2) of this section in the assessment of the adult trauma patient, the EMT or paramedic can call a Trauma Alert if, in his or her judgment, the patient's condition warrants such action. Where EMT or paramedic judgment is used as the basis for calling a Trauma Alert, it shall be documented as required in accordance with the requirements of Rule 64J-1.014, F.A.C. The results of the patient assessment shall be recorded and reported in accordance with the requirements of Rule 64-J-1.014, F.A.C. 4. Islamorada Fire Rescue shall provide the trauma center or hospital with information required under subsection 64J-1.014(5), F.A.0 and the information listed below at the time the patient is transferred to the personnel of the receiving trauma center or hospital: A. Time of injury if different from the time of the call; B. Date of injury if different from day of call; C. County of injury; D. County of residence of patient; E. Cause of injury; F. Injury site/type; G. Trauma alert criteria if met as defined in Rule 64J-2.004 or 64J-2.005, F.A.C. H. Protective devices if motor vehicle crash, bicycle or marine crash. 4 275 The information listed above shall be documented on the patient care record of the transporting unit that delivered the patient in accordance with the requirements of Rule 64J-1.014, F.A.C. 5. An Islamorada Fire Rescue Patient Care Report will be completed as defined in section 64J — 1.001(18) F.A.C. by the Rescue personnel that were on-scene. Additionally, a hand written "Patient Care Field Report" containing information pertinent to the patient's identification, patient assessment, and care given will be provided by the EMS ground crew to accompany all Trauma patients transported by Trauma Star. A final ePCR report must then be sent to the receiving Trauma Center as soon as completed, or within 24 hours of the incident. A Patient Care Report will also be completed for all "dead on the scene" trauma patients, regardless of whether MFR transports the body. 5 276 Islamorada Fire Rescue Adult Trauma Scorecard Methodology The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person sixteen (16) years of age or older for the presence of at least one of the following three (3) criteria to determine whether to transport as a Trauma Alert.These four criteria are to be applied in the order listed,and once any one criterion is met that identifies the patient as a Trauma Alert,no further assessment is required to determine the transport destination: 1. Meets color-coded triage system(see below) 2. Meets local criteria(specify): 3. Patient does not meet the trauma criteria listed,but was transported to a trauma center due to EMT or paramedic judgment(reason for transport must be justified in run report). m,,. ... ., ..... .. ....... ........- --... _..... _- __ _ _ I1111 II1 BLUE AIRWAY A�:'1 VII ,AI11�L' AW W,yS11,:61+Ll UU II!' m IMIR �'10 oii 9 II!8 _.......... ......... ........ � �i n " '.tl r,IIh,L 110Ia NlI1JG GIIU tlEILAM II CIIt'OW1EJd1'4G, �tCUIL..A�IICY&� Au.,lh 4L1 II��AIA -- - --------- CO 1111 Sll: +aii 11°1 III uniiruVlq PATIENTS WITH RENAL FAILURE ON DIALYSIS oV°K:'tl II J VU' II'AI I'll I`J 1 OVIIl IIU 65`MEAIRS I' A ii N t i.... HEAD INJURY WITH LOSS OF CONSCIOUSNESS,AMNESIA oe�� II�IISAII£III..Ifllr' f�v(.:*_ 1,3 r:31" 111 ;R1''I`+IC"I Jal "' IFtll4l r, I„ c� E` II 1 4Uslt' SPINAI CO RI)II Mt of I tlSS 01:::: SEI'VSA I ION NEW ALTERED MENTAL STATUS _.., 'tl1iv roU IBSA SOFT TISSUE LOSS SOFT TISSUE i."III a'IIryIS�I�IuIIV� Ilru_uu'R li'r I�n , ��Ir111,11'4011 ,601,1I4VIA1110111 1,1 0111 AllIOAII: LIIIII wiiClhu1 u u 44111+,E11!!' ,�L14Y II%I ITII NRAHIN:I'u IIICVw1111Illv`d oii u::1VSW 110IItl11.LtlC,MEEK, IOIlUSO 111i IIX II II1 1`u`'' I)115d U CA 1111ION'01 111111 KI°JLII OR AIQ11+II E C111 III SI L'1 \I!!.11 INS VAIIIIIIIII11 `f 111 II�I::FO IIIIAII1o''0LAIII,�1HSIy CII$0,VSllllfld),II'0A1'1, ul II i:lY,11111 C_111 a_VI!'P`+OR V'"q,,,,,OLS 111 S,3 II 'X IIIBIIi',Ill fl _w m.1 SINGLE LONG BONE I SITE DUE T....LONGE30NE II V$,Ak:YIIwV111U��Dll�" f"�ktl„�r,:urrV'�PC�1lal-I.u';�I�1d�uId:YI'�1E.'!w"' OMVC° FRACTURE/ SKELETAL SINGLE LONG BONE FX IN PT ON COUMADIN or !ANTICOAGULANTS WITH HIGH RISK OF BLEEDING _._. y ..... --- _ __............................................,, AGE 55 YEARS OR OLDER Ydo1S(,°I IA :... OF II"�NWI � �� 11111IAS IIPCl0.PII'Vflfie II`J II^,lhlllll 1111.a ON WAVUILARIIJ(GO„��VVflADIld"h�ou � .... EJECTION FROM AUTOMOBILE,MOTORCYCLE, .... ....GOLF CART IFV.�UIftY A I'Q I ICOA nU.A AN 1S W111`II111 11 flG,111°1 III 01 I1:N II II-DIIING, OR HORSE WITH ANATOMICAL INJURY 111VI:R1II fACII�A111 IF,JIIUDII'VOII RAC UII111S WITH SS"111!III'^J111AI AI1143ACVy' BLUNT HEAD,CHEST OR ABDOMINAL TRAUMA IN PATIENTS U:d:7NII III MIIIAII,uL ON ANTICOAGULANTS WITH HIGH RISK OF BLEEDING IIII 1 CC1VUCw0,I I1 I1011 OR II..,IGII I11` 1III°eG III\Llk,flO,"Wll1 11°tl 11 OS n 0l: DEATH IN SAME PASSENGER COMPARTMENT 4 0.;WVLSCI 0l 0„INII SS OR VIISII1131 N:'::SI IIC3 01111II II U,IURIV,' INTRUSION INCLUDING ROOF>12INCHES OCCUPANTSITE; SII..U..1TJ 1 AIIJII)011`,411`,DV1I.oii CH1I; 1 tl1'�J II°A 1 dLI'fl° 1H IH >18 INCHES ANY SITE INTO THE PASSENGER HII,"'VI H'V OI I111AlIRAIII tl;',IS 4111AlIR AIAII II GV,m (NU\11"II J111_U iI p11�A" COMPARTMENT Bll il''lolf UAI"JU;"ri':�.TM,11 1 ?� A'"V 1 V U 111!wEU"VW�'tlVIVAL.II'"NII? AIU"ID IIIII.Lfl\H VEHICLE TELEMETRY DATA CONSISTENT WITH HIGH RISK OF 1CRAU.➢IIMA INJURY' FALL 10 FT or MORE AUTO VS,PEDESTRIAN/BICYCIST THROWN,RUN OVER or WITH IMPACT GREATER THAN 20 MPH MOTORCYCYLE CRASH>20mph Mtlliiia[L =any one(1)-transport as a trauma alert BLUE =any two(2)-transport as a trauma alert 1. Airway assistance includes manual jaw thrust,continuous suctioning,or use of other adjuncts to assist ventilatory efforts. 2. Crushed, major de-gloving injures, mangled extremity or deep flap avulsion(>5 in,) 3. Excluding superficial wounds in which the depth of the wound can be determined. 4. Long bone fracture sites are defined as the(1)shaft of the humerus, (2)radius and ulna, (3)femur, (4)tibia and fibula, 5. Vehicle Telemetry Data when available will be relayed to dispatch;the data can assist in predicting potential serious injuries from the data collected at the time of the crash. 6 277 IV. PROTOCOL FOR PEDIATRIC TRAUMA 1. Upon arrival at the location of an incident, the EMT or paramedic shall assess the pediatric trauma patient by evaluating the patient's status for each of the following components: Size, Airway, Circulation, Disability, Soft Tissue, Long Bone Fracture/Skeletal, and Mechanism of Injury. In assessing the pediatric patient, the criteria for each of the components in (2) and (3) of this section shall be used to determine the transport destination for pediatric trauma patients. 2. The EMT or paramedic shall assess all pediatric trauma patients using the following RED criteria and if any of the following conditions are identified, the patient shall be considered a pediatric Trauma Alert patient: A. Airway: If the patient requires active airway assistance including manual jaw thrust, continuous suctioning, or use of other adjuncts to assist ventilator efforts, has a respiratory rate of < 20 in an infant less than one year of age, or a respiratory rate of < 10 in children age 1-15 years old. 1. All drowning or near drowning patients. B. Circulation: The patient has a faint or non-palpable carotid or femoral pulse or the patient has a systolic blood pressure of less than 50 mmHg. C. Disability: The patient exhibits an altered mental status that includes: drowsiness, lethargy, the inability to follow commands, unresponsiveness to voice, totally unresponsive, or is in a coma or there is the presence of paralysis; or the suspicion of a spinal cord injury; or loss of sensation. D. Soft Tissue: The patient has a major soft tissue disruption, or major flap avulsion or 2"d or 3rd degree burns to 10 percent or more of the total body surface area or amputation at or above the wrist or ankle, or a major de-gloving injury. The patient exhibits a dislocation of the hip, knee or ankle. E. If there is any penetrating injury or GSW to the head, neck or torso or extremity (Superficial wounds where the depth of the wound can easily be determined are excluded from this criteria), F. Long Bone Fracture/Skeletal: There is evidence of an open long bone fracture or there are multiple fracture sites or multiple dislocations. Long bone sites are defined as the (1) shaft of the humerus, (2) radius and ulna, (3) shaft of the femur, (4) tibia and fibula. G. Mechanism of Injury: Patients exhibiting any of the following criteria will be Trauma Alerts: i. Electrocution or lightning injury with loss of consciousness or visible signs of injury; ii. Severe facial injury with airway compromise or potential airway compromise; ii. Penetrating injury to the extremity at or above the elbow or knee; iv. Blunt abdominal trauma or chest trauma in patient with history of paralysis (paraplegia or quadriplegia); v. Blunt head, abdominal, or chest trauma in patient with bleeding disorder or taking anticoagulants (see list page 12); vi. Auto versus pedestrian or bicyclist thrown, run over, or impact resulting from speeds more than 20 mph; vii. Ejection from automobile, ATV, golf cart or horse with visible signs of injury. 3. Should the pediatric patient not be identified as a Trauma Alert using the RED criteria listed in (2) of this section, the trauma patient shall be further assessed using the BLUE criteria listed in this section and shall be considered a Trauma Alert patient when a condition is identified from any two of the five components included in this section: A. Size: The patient weighs < 22 kilograms (44 pounds). 7 278 B. Circulation: The carotid or femoral pulse is palpable, but the radial or pedal pulses are not palpable or the systolic blood pressure is less than 90 mmHg. C. Disability: The patient exhibits symptoms of amnesia or there is loss of consciousness. D. Soft tissue: The patient sustains a dislocation of the upper extremity, excluding fingers. E. Long Bone Fracture/Skeletal: The patient reveals signs or symptoms of a single closed long bone fracture or dislocation. Long bone fractures do not include isolated wrist or ankle fractures. F. Mechanism of Injury: Pediatric patients exhibiting any of the following criteria: i. Ejection, partial or complete, from an automobile, ii. Death in the same passenger compartment, iii. Intrusion of more than 12 inches in the roof or occupant side of the motor vehicle or more than 18 inches intrusion into any site of passenger compartment, iv. Vehicle telemetry data consistent with high risk of injury, v. Fall > 10 feet or 2-3 times the length or height of the child, 4. In the event that none of the criteria in (2) or (3) of this section are identified in the assessment of the pediatric patient, the EMT or paramedic can call a "Trauma Alert" if, in his or her judgment, the trauma patient's condition warrants such action. Where EMT or paramedic judgment is used as the basis for calling a Trauma Alert, it shall be documented as required in accordance with Rule 64J-1.014, Florida Administrative Code. 8 279 Islamorada Fire Rescue Pediatric Trauma Scorecard Methodology The EMT or Paramedic shall assess the condition of those injured individuals with anatomical and physical characteristics of a person fifteen (15)years of age or younger for the presence of one or more of the following three(3)criteria to determine the transport destination per 64J- 2.005, Florida Administrative Code, F.A.C.): 1. Meets color-coded triage system(see below); 2.Meets local criteria(specify); 3. Patient does not meet the trauma criteria listed,but was transported to a trauma center due to EMT or paramedic judgment (reason for transport must be justified in run report). I tED BLUE WE WEIGHT<22 Kg ........._ AIRWAY A1;TI,VFAollPWA ASI, IIIISuAlaa,IL utlu ,u:nuWAVu NdlulJ10:A1,g1`-N1' u1 utlu:Au:nuW�auu � nP1uu11;o--wu�I;u u:I'^�.p°w�`uP 1�:aA°utl V1ROW11'w1PING OR I^411:AII3 IDIIIOW11,411I1NW G � N V NIL.II°All MOII A� II'"U VII,III.u:rui... CAROTID or FEMORAL PULSES PALPABLE,BUT THE RADIAL,118V";ULATIQ�I�P II NII111 i�u`PeVu',7 tlU_II tl +�II�d::�Vtlll�anu II II S113II:"„.50 IiVilM Ilq OR PEDAL PULSE NOT PALPABLE or SBP<90-mmHg DI SABILITy - 1�1II!!! ______-m-_. . ,.,,__,... ,m-.... -___--- _-______----------------- All AII!I I11311 II1 11I1111 All SA A U VJS,ruin P 1311J"F11,,11 11 OF II�"AI113 11 d IIS o; AMNESIA or LOSS OF CONSCIOUSNESS SN 6 11111IQ;IIOI1IN OF SININAII COR11:1 IN„JI1I11"V oii II OSS F11I' FIFI'NSA"AVu::NI �.... ... .. ........ . ....— ,,, _n,,,,,. SOFT AA,.pOI� SO11:T U I!S�4 VII':II'111A1113Ul11:1"1�JlN UPPER EXTREMITY DISLOCATION AI'^WA i°1IAll 'RAtlIIING INJURY 4 1IR a ,` W1 m tllu. HIIIIAID,NIJ tl:lK, U U';NIP$SO 0113 U'.:Y'111IFN1lT`e1 AIIAIPPU.VTATV01'1 AT 011::':C AI11311)VII V 11fl WHI .U.� i All ll<P.F IISI..W"CAU1ON All Ill 81111111II°.W„I+ulII' OR AVNdIIKII II'' L(�N _____ ... . ...... ___________.._ ____.... m........ ...,e_ BON I: 011��tl�1��C 11I VIIIJJI, iu IIMU11I.V l:111 II 0�8AI:,111 VO III SINGLE LONG BONE'FRACTURE SITE'or DISLOCATION G Ei�7NE A1tl"II IN TV"I�IrA II' FRACTURE/ SIu ES i)u IIVIiJ fll..TVII III IWIIS11 0CATI101`4 SI I IFS SKELETAL _ MI.Cu-IIV ISlwl�� II II II tl' rRUq:U„V"1"I10 y' 0113 IL 1G11 N tl lJvJV N G 8 tl 11 I<A'"DTI tl I 11,0S S EJECTION(PARTIAL or COMPLETE)FROM AUTOMOBILE OF INJI CONSCIOUSNIJISS 0II3 VI IB11 T,SIGINd ;oI III1 Jill J °r' DEATH IN SAME PASSENGER COMPARTMENT SII VILIIVU II ACIIAII III1 VUllllb"`' AIITII°N Atlll11" A"'a"'Q1NUV°VP;PIItfiV 11 INTRUSION INCLUDING ROOF>12 INCHES OCCUPANT SITE; U II'wUU!!',AAAII"IIII""llU'::ii ll�d llU..➢P1"°1' U1" 14PIIr III,"UIIPII!III'V'fIIU"u'+ tl +:rr�AeN+1 'lI, UHL >18 INCHES ANY SITE INTO THE PASSENGER COMPARTMENT I L10W oii II;INVII'IE VEHICLE TELEMETRY DATA CONSISTENT WITH HIGH RISK OF I1II..UNWTA111r111d:YN4111111IJ III oq CIflIJ l3M J111'4+A IIIINpPA�III I1I1tl W11 II INJURY' V Ili'"1"QFIIo1W OLiV'II'I''A`IIU+NII"1P"SV,W 0I1AII'UAII'°All Q-:IIN`re u:uu H DU VA11:111'CVII"VII GY'J�Ny FALL>10 FT OR 2-3 TIMES THE HEIGHT OF THE CHILD I!q L1Il"el II 1flIAII'.u,d IINII V,ABIC�u::11VIVII`4AL 1II1AU.flN11A III`";II°tl 1'1 VtlIIB I+IIIII 1V1`"dW 11'II"Fu RIl Illlid::`VR01N,IC(A1111M+111:M,I NII1tlOW;OA�"sUIYII,.°",INdtl;S VVII 11U 11NllGIIItl IMSK UVV 1B111..11 VII IIINIG11 ALI10 AS II :DIES U IIvII+"`mP'EII IISIIV`'N° 11I..IIS U 1 p-NIIroF"WINW,RUIN IN dF"dWFR oii W11 I I J11W NNC If GII 11 A tl 11:;;111 riiI MINI 2!0 I,111111° Ill:C�� II0111 II IIrd:111M AU II 0 ATV,V,01II II CAI13"1 OR I N l:iStl Wr' I Y 11 P SIGNS 011: IIIN„.IIU,➢II'R"`u Arpf,) .,any pril-trprIspgrt al trauma aliql BLUE =rsny,_tvuKa(2).. tr n pQrt a�.�;trp�F114 1,(�Ft 1. Airway assistance includes manual jaw thrust,continuous suctioning, or use of other adjuncts to assist ventilatory efforts, 2. Altered mental states include drowsiness, lethargy, inability to follow commands, unresponsiveness to voice,totally unresponsive. 3. Long bone fracture sites are defined as the(1)shaft of the humerus, (2)radius and ulna, (3)femur, (4)tibia and fibula. 4. Long bone fractures do not include isolated wrist or ankle fractures or dislocations 5. Includes major de-gloving injury. 6., Excluding superficial wounds where the depth of the wound can be determined. 7 Vehicle Telemetry Data,when available,can be relayed to dispatch;the data can assist in predicting potential serious injuries from the data collected at the time of the crash. 8, See list of Anticoagulants with High Risk of Bleeding. 9 280 V. EMERGENCY INTER-FACILITY TRANSFER OF TRAUMA PATIENTS There are no state approved trauma centers in Monroe County. The closest available service for air transport is Monroe County Trauma Star in Marathon, FL and will be used as first call. When Trauma Star is unavailable, back up air transport (Miami Dade Air Rescue or Life Net-Air Methods) may be utilized. Occasionally, when air transport is unavailable, a TRAUMA ALERT patient may be transported by ground to a local hospital for stabilization/treatment prior to transport to a SATC or SAPTC. Should air transport be unavailable, TRAUMA ALERT patients identified in the field may be taken to the nearest local hospital and should be stabilized and transported as expeditiously as possible to the nearest SATC/SAPTC. The initial receiving facility will arrange the most rapid air/ground transportation of the patient to the nearest SATC/SAPTC. IFR may be called upon to assist the local hospital in ground transportation of a trauma patient should expedient air transport not be available, and ground transport is approved by the IFR Operations Chief. Should supplemental personnel, such as medical or nursing staff, respiratory therapy staff, etc. be necessary to assist the EMS crew for optimal patient care during transport, the transferring hospital will coordinate the necessary personnel to accompany the EMS ground transport personnel. All cases of TRAUMA ALERT patients taken to local Hospitals will be reviewed by the IFR Medical Director. VI. TRAUMA TRANSPORT PROTOCOLS MEDICAL DIRECTOR APPROVAL 64J-2.003 These protocols have been submitted by Islamorada Fire Rescue and have the approval of the agency Medical Director, Sandra Schwemmer, D.O, FACOEP-D, FACER VII. APPROVED TRAUMA CENTERS AND INITIAL RECEIVING HOSPITALS Approved Trauma Centers and Pediatric Trauma Referral Centers 1. LEVEL 1 - Ryder Trauma Center, University of Miami/Jackson Memorial Hospital Medical Center Adult and pediatric trauma care 2. LEVEL 1 — Kendall Regional Medical Center, adult and pediatric care 3. LEVEL II —Jackson South Community Hospital 4. LEVEL 1 - Nicklaus Children's Hospital, pediatric trauma only 10 281 Local Critical Access Hospitals-Receivingi Facilities 1. Mariner's Hospital, Tavernier, FL 2. Fishermen's Hospital, Marathon, FL VIII. DISTRIBUTION OF TRAUMA TRANSPORT POLICY The SATC, SAPTC, and receiving facilities to which Islamorada Fire Rescue initiates trauma transport of TRAUMA ALERT patients have been provided a copy of the criteria which are used to determine trauma transport destination. 11 282 ANTICOAGULANTS High Risk of Bleeding: Trade Names: Generic names: Aggrenox (ASA+ dipyridamole) Anagrelide(Agrylin) Agrylin (anagrelide) Apixaban (Eliquis) Brilinta (ticagrelor) Cilostazol(Pletal) Coumadin (warfarin) Clopidogrel (Plavix) Effient(prasugrel) Dabigatran (Pradaxa) Eliquis (apixaban) Dipyridamole(Persantine) Jantoven (warfarin) Dipyridamole+ ASA (Aggrenox) Plavix(dopidogrel) Edoxaban (Savaysa) Persantine (dipyridamole) Pentoxifylline(Trental) Pletal (cilostazol) Prasugrel (Effient) Pradaxa (dabigatran) Rivaroxaban (Xarelto) Savaysa (Edoxaban) Ticagrelor(Brilinta) Ticlid (ticlopidine) Ticlopidine (Ticlid) Trental (pentoxifylline) Vorapaxar(Zontivity) Xarelto (rivaroxaban) Warfarin (Coumadin, Jantoven) Zontivity (vorapaxar) Injectables: Activase(alteplase) Aggrastat(tirofiban) Angiomax(bivalirudin) Argatroban Arixtra(fondaparinux) Fragmin(dalteparin) Heparin Innohep(tinzaparin) Integi in(eptifibatide) Iprivask(desirudin) Lovenox(enoxaparin) Reopro(abciximab) Streptokinase Tenecteplase(TNKase) Urokinase May 2023 12 283 August 22, 2024 To Whom It May Concern: There have been no changes in the March 2021 Trauma Transport Protocols for Islamorada Fire Rescue. I approve the TTPs submitted. Should ou require any further information, please contact me. r. Thomas Morrison Medical Director 305-923-3061 tgmmedicalcorp@gmail.com 13 284 Islamorada Fire Rescue Adult Trauma Scorecard Methodology The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person sixteen (16)years of age or older for the presence of at least one of the following three(3)criteria to determine whether to transport as a Trauma Alert. These four criteria are to be applied in the order listed,and once any one criterion is met that identifies the patient as a Trauma Alert,no further assessment is required to determine the transport destination: 1. Meets color-coded triage system(see below) 2. Meets local criteria(specify): 3. Patient does not meet the trauma criteria listed,but was transported to a trauma center due to EMT or paramedic judgment(reason for transport must be justified in run report). ................__ RFD a.uo: .. AIRWAY A IIM ,ut'.JAYASY lrAf',)0 „i Rk In,,, ,, BMA I>1,,WIN1119,ON N1 AR DROW1'JIIJs; :OfCQ UCAVIC➢N _................ ..... 4 AA h 01 RA,DW III`,C'.i o, RP 10 iiiiul'I, IIATIUNIS WI1IN fdFIVAI 4AV L.L.!I'CF ON DIALYSIS IW 10 IN 11N F/I111 (,NI OVI I, `1 AM .... .... —.. ""` --- .. .e.�. ... ..... CDINA191L11I y I h ur 111,1 ,l NJ li CII 1 Al4AL.'6I,,in,,IU IICI N Of .'i11I11JAI CORD INJURY WNPIr D IOVIURYf WITH LO v f.DF CON NC IOUSIVI S,FhdV 1NESIA,ai NI..W or MY,01 Y1T,A1I0IJ AIITIEREi.DMI INIAILSn ANUS NC)E1' If15°sCVE: 7'^ Olk 111DI I(l I I9lP,"IJ, 10 1"'Y,n Ir ARI "114'"A SOFT IFISSU1 LOW IVf,A IJ IA1aCCN A I 1 IN ABOVI I I-IF WKI"1 arr AN'1.1:. Ft1°d'f VI I'11_LrATIIA,)11'1JURY IIJ 1111J�W 1JI1:,16, 10 MO,OTF;'41III"AlI IA , d u AT1111°,I C)l I HIP, a1',I I Oli AIh(l I',: A I lff V,/A1..I II'T I/WI(..IIY,n M1 f:)hhA11 Y II L..A,11 CHFSI..) I'1MY 110,I',LAI'lr,l I',,Ul ,1OVI D,,1R JIM'�I I I ,I XTRI',:IrA I7V .. ... ,. __ _......____— LONG BONE I W THIO 01 DIVO ni,MOM 101311-I#I q,IP,l SlN&L LONG BONE fX VI P Mllf TO NAVC:' F II$A 11 lJ n1'I'.:::/ nlR I ..I I AV..,r W'90 l 11 1..OP ,Ilii u1911'P X IN III GIN u I I II/+'MIN ^t, 111 TIr;a0A0I l,A N I..1!:0 J,OIIIIIVId':M llll l+ill N ILIII,'.Y AGE ._._,.,.,,�,�.,a,.,.,.,�,. .... .... ......... .............. a,AI AIRS.,� ,,,,,,,,,,,. .. „..,,,,,,, ......... ,,,,,, _ .7R CI II dDH A 'AI7q IIV i71d dJ,01 JM I'1Dd ..,iVII YAI::III INt�D.:IDANl:�N1�Dt: 111 n1, uh/u,.11/v1 ul � � ... �c°rL.LD,C�CCLI c:ai . . r �y r n �'" , , p�'.:n' ... I dV::CaI"IC:D6'V I'h'&CYNFl ALPTC:IIV11fLh!40[.R,NVC.7uC7�n' . TII Cbl't I IG7 PD°'sP IMURX III WI I Ol-PHI IITK( WIIHANA1�01MICAJLIN.IUIRY 9il G }'I I,d1,rt;:.J 11V 81 III,pIRY/I V+ACI I II'125, NlW I'(.EOAl Cd l0V dl.lM1 Iryl'"'W .A " V:'. [LV ID IVIf I-fl li£CaI D�D.:I II f."ST�C.IR AII91::OMIlU"�I.]RAU14YA,IN PA�T1P§I'V1fS ON A,N016EOAGUTA,N I S WII I I IIIZI RISK 4lf fil CiE DIIIN C:6 I C`1 dui"i.:4..."1yl vL8 i iIC LIf�,AV I f Ifl f 3i tll''��I II II•�'Ir V161'fl.8..p..V I i i 111 :��E11 I,`l "B I:IG h�dl , I;I I'l VI llP 0 161'A, I II YIu,..I Ins"u, DEATH IN 9,AIMF PAR SE:NCEfR COMPIAR-11A41:N F BMW AHID011,4IIJA1� HI SI IRAUIVU' llN IIAIII bd11/dlIa-I I II'a10NY ICP i VLd1fIfDllSpC7V"A IIV CJ...LP C:bYV'X C.0 IdC7C71';•].P IIV^;IOV::.r OCC UPA,M�I]E;',J.B INCHES F'AlkAl `d'!,)1 AINAI'l1 MWI, i I"1I1,^I.>>I:,11 I[CIA) ANY`III: WO 114f::PA d NCIIFR COMI'dAIRTl'a1 CrilV.. I:,I?,I f,IJANC'f,, I,AIIV ANIJ Idl..l.lNf IRer,L..1PAA WHICIF FU MFI RY FWA,CXJINSISTEN1'W'ITFY difG31-d Pil";I€C.bF IVVJLIG3V� 1:A,L1..10 Graf ui,NA 0R7 ALylO VS 11l DESl RIA,IN/f31C:YCIS11..L.PiOCC)UUfU,fCUI°3 CDVV:ft car UVGa1..0-d Ofv1R84CD CRF.lA1fFR VHA,IN 20I111 MCNORCYC:YLE CRASH.,,20i,in�lph R 0 =any one(1)-transport as a trauma alert BLUE =any two(2)-transport as a trauma alert 1. Airway assistance includes manual jaw thrust,continuous suctioning,or use of other adjuncts to assist ventilatory efforts. 2, Crushed,major de-gloving injures,mangled extremity or deep flap avulsion(>5 in.) 3. Excluding superficial wounds in which the depth of the wound can be determined. 4. Long bone fracture sites are defined as the(1)shaft of the humerus, (2)radius and ulna, (3)femur,(4)tibia and fibula 5. Vehicle Telemetry Data when available will be relayed to dispatch; the data can assist in predicting potential serious injuries from the data collected at the time of the crash. 6. See list of Anticoagulants with High Risk of Bleeding. 285 Islamorada Fire Rescue Pediatric Trauma Scorecard Methodology The EMT or Paramedic shall assess the condition of those injured individuals with anatomical and physical characteristics of a person fifteen(15)years of age or younger for the presence of one or more of the following three(3)criteria to determine the transport destination per 64J-2,005, Florida Administrative Code, F.A.C.: 1.Meets color-coded triage system(see below); 2.Meets local criteria(specify); 3. Patient does not meet the trauma criteria listed,but was transported to a trauma center due to EMT or paramedic judgment(reason for transport must be justified in run report). -.m m. _...----- .... ... —.-------- ....... ...,..... RIFII:11 BLUE .. .,. SIZE WFIC VI1 22 Kg AIRWAY M rI A"I ,I,n , � /M L_, IIV Y,RAII:I: d O IVrli I11,11:AIN I Y"'P 1 6"U F"Al"1l:r tlit llyd 1l1-I1g1...0111 IN I'YI1— 1,1M _ I i1 VI 4IIINfa OR NI nlr CIV i'NVNII,IG II A11141 r I'+dfMI V,':U 1'1 W I C a1 OYII I; I11 1 VR 111"d M I 3Y Cp�RM II7 or I' MORAL P J1 rILS P RADIAL ...P.eee...eee CRC.I!..�"t..f..V(JN � � y`'�� r � PALPABLE,E,P§IJT tilll�RFV VIIFUI (1Fi PEDAL rR1', "0rvlIIJS PIlJQS1 N01 PALPA131...E or SBP<OC-rnml�iR t7V°ada,Bi I Il T I u L:,IG a 111 n �n 1a,r� I I (��l " 71 11 1 kIIiN Ia I o° I ;T+a )1 I u I��. `f Ittl Cvd6>I6l n� LOSS()I CONSCIOUSNESS F.'aS I11111"VO ( :!I'+II 1I111 MY )I 10 ri iE11,h'1101v1 SJ F,j...j..ISSUE 1vIAH71:',0f I II','Ill:DISR011110N,MAJI/Ik I)N1.ul i 1,11 ,INJ1,1111.. LJPF I R IXTREIIIY DISLOCATION,EXCLUDING ING F�I UUV(71_MES i MAJOR/,1,VI I I ,I/1 P,l 1TI r,I<I I',l' II14`'A :#II"l�lldl.7lkAIINIJI1rJ.u..11,rl71,/.::9/1UIr,rJv�114?AI1 P"M "',Il'Mr"U0fa >G AIr,ilIVll/1MIN/Y IIRAI,(iY/I 1111 WI7III or AI`d'1II:: DW,l f-AI ION r11 IIIILI-I II I1,1,411 )If ANIIJ " A(.IJI,JIoa' 7JIIIITIIIIf'I,/,�T11,T^,111 Sir-----------------_SIIINCUI LONGBONV::'FRAC.TUM ;IrE"or 170 n1(CATION ..... .... I_CYu\I(�LiG1C��ja ---- �(�III/1/'�ul;,r,,>rJ1 Ica AIn(rN P�IKA(Tl.1FtE:/ I Enlll Iu 1.1.r+^,I�11/flu,rr/,IILY SI(iiII.E f AIL MECHANISM HIM i:;IJIH N i lr I III I I Ir9I I i�l [KI HNII hll „i U CI V EJECTION F. _) ..irl,i htiflr;4111. F rg� .NJ6 ( Ii TYhdl.of C:C.1MY V F.IIE::)[ROM Ak.1T C.7 MI(3 F§II_E. IN.ILDIItY 01 ISI1"111 YGNIIi:/o-11'`dll.11w"P IJ I::.tl lfli I SA N4 E 4sA55E::NGER C:OVtq 6'6latT Mli::N(� I VI l,) I AC:IAV Ir1IV„UVY WI I I I AU",W,A l 01M1:II U IM1,P':I: INTRIJS10N INC1.J.JI::)ING R00F.•>1.2 M1C:11.S 0CCG J11AN1 1311E;:>ll.r';1 N CA I E S III I,dl WAIII'Ri IN11,11),10 Il 1 1 XTI+I MII'Al T of P 13 A/I. I IHI f B01A oi' ANY SIFF INTO THL F ASSCNGFR COMPAIRXMENr 10'1l I'::I:: VEHICLEIEILI NAETRY DATA CON.SUSTF:NI WITH IH IG IF♦I RISK OF:INJURY'I!'1111°J I AISI::1�rG,111`,I F#L..or(Ill 111iAl,ll'Jl ft IN F"A'711 I I l aN173-I lil J/II?(f;iP I'"AAIY',Q,{1/4RA 1�MoiritI,",I7MINI FAI..L>10FTOR1...:TT16VtlES THE HFUG'H"FIDIF Hl'CHVI_IG IEYUIUb'RI l:: . 0 A'A111 IIlMIFLAI..V1 o.I.Y I'VIA Irl III iNIIH 1FI 11111111:F p'YN_++�grl;l Id(:➢N ql :)"H/IAI ANT,VVIIH I-HIGH "I"IN Cil::: 14i11 I V DII life, f 11 1 I�III'1 1 ,r,l,rY�u� ,`I IIJ H10M,1N,RUN 0'0 R oq�A/I II�1k,11111,AC111. U0 All I1 WAIN 1 0 i1il FI II 1ItCHOI')f VAVAJY10,AIV,(,01f/'AJ [OP1101 I ,V111-1 ]/,Nl, :1l H I r%1,r RI I aarV„�anc{1) ,„trrrr perrtas,a,rtrt�rraw 9rrt fqt. E Orr:y,t ¢r,(2),-truf7�part_r atraaum"Izalcr't 1, Airway assistance includes manual jaw thrust,continuous suctioning,or use of other adjuncts to assist ventilatory efforts. 2. Altered mental states include drowsiness,lethargy,inability to follow commands, unresponsiveness to voice,totally unresponsive. 3, Long bone fracture sites are defined as the(1)shaft of the humerus, (2)radius and ulna, (3)femur,(4)tibia and fibula 4, Long bone fractures do not include isolated wrist or ankle fractures or dislocations. 5, Includes major de-gloving injury. 6. Excluding superficial wounds where the depth of the wound can be determined. 7. Vehicle Telemetry Data,when available,can be relayed to dispatch;the data can assist in predicting potential serious injuries from the data collected at the time of the crash. B.. See list of Anticoagulants with High Risk of Bleeding, 286 36% 64% 1 ,580 JI' 366 DAu� � VA, Counts 1)Sfru(Ii Are Fire r r 1 B (1 2)Fire In mobile:xp oerly used as a fixed s[tructure r T (13)Mobi P,property(vehide)fire 1 2 l 7 (14y I vageWIon fire f 1, 2 (15)0 coi de ruahish fire I 1 2 4 (16)Special outside Nire 2 1 1 4 (32)l:mergency medical senfice.(ERA)Incident. 79 104 119 92 85 73 lob FU 69 63 58 10 1,010 (35)Extncatmn,rescue 1 2 3 1 2 1 1 1 1 14 (36)Walei cm ice elaked rem.,ue 1 2 1 4 � Rescuo or EMS standby 2 3 a (4'1)Carnbusriblvelflarriffralbe spills&leaks 1 1 3 (42r Chernicai]release,reaction,or roxic condillon I 1 6 (43)Radioactive corI a 1 (44)ElediicW wrling/equipmenIt pi rabimn 2 3 4 3 3 3 3 2 26 14a:1)Accident,cosenkial icciden� 1 (51 1 Person in dIstmss 3 4 4 1 2 3 1 21 `52�Water problem 3 (53 Smake,adoi prob:em 1 2 (154)Ar:iMal problum ai rescue I 1 2 (5 P5 blic servIce assisisAnce 3 8 14 6 4 3 6 5 6 a 6 15 84 (57)Cover assignmrint,standby at fire siaI I up 3 1 2 2 3 3 1 3 5 4 3 29 (61)Dispatched and canceled an router 111 1 T 4 7 8 8 4 5 3 9 so Z62)\yfong lamatlon,no emeIu fond 1 3 )Controlled burning i (67)1 fazkilar release irrtresligalron w/no r lazMat (71 t Malicious,mischipmus talks slavirn 6 1 1 1 9 (73)Syslarn or dei actor mattAnakirin 10 4 6 3 4 6 8 7 a 5 4 67 l74)Unintentional sys(iontide(lector opaiarficin(no iron 11 14 a 6 12 13 6 18 17 27 16 17 '167 (9 1)Citizen complamf 1 1 1 1 1 5 UNK 9 4 s 6 UNK 1 1 Folal 128 149 1178 128 1119 116 l56 135 122 11&Y 99 132 1,580 287 REFERENCE COPY This is not an official FCC license. It is a record of public information contained in the FCC's licensing database on the date that this reference copy was generated. In cases where FCC rules require the presentation,posting,or display of an FCC license,this document may not be used in place of an official FCC license. 'Federal Communications Commission ' Public Safety and Homeland Security Bureau . RADIO STATION AUTHORIZATION LICENSEE: MONRO}E, COUNTY OF Call Sign File Number WQBK905 0011176849 Radio Service ATTN: COMMUNICATION MANAGER YE- MONROE,COUNTY OF PubSafty/SpecEmer/PubSaftyNtlPlan,806-817/851 2945 OVERSEAS HWY -862MHz,Trunked MARATHON,FL 33050 Regulatory Status PMRS Frequency Coordination Number FCC Registration Number(FRN): 0001802081 56YEAP14026277 Grant Date Effective Date Expiration Date Print Date 07-30-2024 07-30-2024 10-27-2034 07-30-2024 STATION TECHNICAL,,SPECIFICATIONS Fixed Location Address or Mobile Area of Operation Loc.1 Address: 1 KM SE OF OVERSEAS HWY US 1 AT MILE'MARKER 106 City: KEY LARGO County: MONROE State: FL Lat(NAD83): 25-10-01.4 N Long(NAD83): 080-22-29.2 W ASR No.: 1015970 Ground Elev: 1.8 Loc.2 Address: 88770 OVERSEAS HIGHWAY City:TAVENIER County: MONROE State: FL Lat(NAD83): 24-58-46.0 N Long(NAD83): 080-33-03.0 W ASR No.: 1030845 Ground Elev: 3.7 Loc.3 Address: 107 MI S OF OVERSEAS HWY US 1 LONG KEY City: LAYTON County: MONROE State: FL, Lat(NAD83): 24-49-17.5 N Long(NAD83): 080-49-05.9 W ASR No.: 1015977 Ground Elev: 1.5 Loc.4 Address: 2798 OVERSEAS HWY City: MARATHON County: MONROE State: FL Lat(NAD83): 24-42-44.4 N Long(NAD83): 081-05-51.6 W ASR No.: 1015975 Ground Elev: 1.5 Loc.5 Address: MM 32 N OF US 1 City:WEST SUMMERLAND KEY County: MONROE State:FL Lat(NAD83):24-39-04.0 N Long(NAD83): 081-18-35.0 W ASR No.: 1029593 Ground Elev: 0.9 Loc.6 Address: 5525 COLLEGE RD City:KEY WEST County:MONROE State:FL Lat(NAD83): 24-34-37.3 N Long(NAD83): 081-45-08.1 W ASR No.: 1207153 Ground Elev: 1.0 Loc.7 Area of operation Countywide: MONROE,FL Conditions: Pursuant to §309(h) of the Communications Act of 1934,as amended,47 U.S.C. §309(h),this license is subject to the following conditions: This license shall not vest in the licensee any right to operate the station nor any right in the use of the frequencies designated in the license beyond the term thereof nor in any other manner than authorized herein. Neither the license not the right granted thereunder shall be assigned or otherwise transferred in violation of the Communications Act of 1934,as amended. See 47 U.S.C. §310(d). This license is subject in terms to the right of use or control conferred by§706 of the Communications Act of 1934,as amended. See 47 U.S.C. §606, FCC 601-ULSHSI Page 1 of 6 August 2007 288 Licensee Name: MONROE,COUNTY OF Call Sign:WQ13K905 File Number: 00 1 1 176849 Print Date: 07-30-2024 Antennas Loc Ant Frequenck,�' Sta. No. No. Emission Output ERP Ant. Ant. Construct No. No. (MHz) CIS. Units Pagers Designator Power (watts) Ht./Tp AAT Deadline (watts) meters meters Date 1 1 000851.17500000 FB2 I 14KOF9W 100.000 339.000 95.1 90.5 07-15-2010 8KIOFIE 1 1 000852.175000001 112 1 14KOF9W 100.000 339.000 95.1 90.5 07-15-2010 8KIOFIE 1 1 000852.60000000 F8'2 1 14KOF9W 100.000 339.000 95.1 90.5 07-15-2010 8KIOFIE 1 1 000852.86250000 V112 1 14KOF9W 100.000 339.000 95.1 90.5 07-15-2010 8KIOFIE 1 1 000853.68750000 F1.12 I 14KOF9W 100.000 339.000 95.1 90.5 07-15-2010 8KIOFIF 2 1 000851.26250000 14KOF9W 100.000 347,000 85.2 89.0 07-15-2010 8K10F1E 2 1 000852.18750000 FB2 I 14KOF9W 100.000 347,000 85.2 89.0 07-15-2010 2 1 000852.61250000 FB2 I 14KOF9W 100,000 347.000 85.2 89.0 07-15-2010 W10F I E 2 1 000952,88750000 FB2 1 14 KO�'4W 100.000 347.000 85.2 89.0 07-15-2010 8K I 01"I L' 2 1 000853.31250000 FB2 i 14 KOF,9W 100,000 347.000 85.2 89.0 07-15-2010 81�16rl`E 3 1 000851.33750000 FB2 I 14KOf"9W �00.000 270.000 67.7 62.8 07-15-2010 8KI 01-"1 ii, 3 1 000852.21250000 FB2 I 14KOF9W 100.000 270,000 ()T7 62.8 07-15-2010 8 K 1 01"t 1;!. 3 1 000852.63750000 FB2 I 14KOF9W 100,000 270,0001 6T7 62.8 07-15-2010 8KIOFIE 3 1 000853.18750000 FB2 I 14KOF9W 100.000 270,000 67.7 62.8 07-15-2010 SK10FIE 4 1 000852.32500000 FB2 I 14KOF9W 100.000 364,000 617 62,8 07-15-2010 8K10F1E FCC 601-ULSHSI Page 2 of 6 August 2007 289 Licensee Name: MONROE,COUNTY OF Call Sign: WQ13K905 File Number: 00 11176849 Print Date: 07-30-2024 Antennas Loc Ant l{requencitl Sta. No. No. Emission Output ERP Ant. Ant. Construct No. No. (MHz) Cls. Units Pagers Designator Power (watts) Ht./Tp AAT Deadline (watts) meters meters Date 4 1 000852.71250000 FB2 1 14KOF9W 100.000 364.000 67.7 62.8 07-15-2010 8K10F1E 4 1 000853,20000000 F142 1 14KOF9W 100.000 364.000 67.7 62.8 07-15-2010 8KIOF1E 4 1 000853.70000000 VB2 p 14KOF9W 100.000 364.000 67.7 62.8 07-15-2010 8K10FIE 4 1 000851.83750000 #U2 1 14KOF9W 100.000 364.000 67.7 62.8 07-15-2010 8K10F1E 5 1 000852.03750000 F112 14KOF9W 100.000 449.000 112.8 107.3 07-15-2010 8K10F1E 5 1 000852.33750000 1'`1.12 1 14KOF9W 100.000 449.000 112.8 107.3 07-15-2010 8K10F1E 5 1 000852,83750000 FB2 1 14KOF9W 100.000 449.000 112.8 107.3 07-15-2010 8K1OV1E 5 l 000853.28750000 FB2 1 14KOF9W 100.000 449.000 112.8 107.3 07-15-2010 IVF 11", 5 1 000853.58750000 FB2 1 14K0,f9W 100.000 282.000 112.8 107.3 02-11-2016 &KI Or,It,, 6 1 000851.18750000 FB2 1 14KQFoW 100000 252.000 50.3 45.8 03-10-2012 8Ktt1F11 6 1 000852.16250000 FB2 1 14KOF9W 100,000 252.000 5.0.3 45.8 03-10-2012 8K10FIF 6 1 000853.36250000 FB2 I 14KOF9W 1011000 251000 50.3 45.8 03-10-2012 8K10F1E 6 1 000853.73750000 FB2 1 14KOF9W 10 000 252.000 503 45.8 03-10-2012 8K10F1E 6 1 000852.68750000 FB2 1 14KOF9W 100.000 252t0OO 50.3 45.8 02-11-2016 8KIOFIE 7 1 000808.70000000 MO 2600 14KOF9W 15.000 25.001t 07-15-2010 8K10FIE FCC 601-ULSSI Page 3 of 6 August 2007 290 Licensee Name: MONROE,COUNTY OF Call Sign:WQBK905 File Number: 0011176849 Print Date:07-30-2024 Antennas Loc Ant Frequencies Sta. No. No. Emission Output ERP Ant. Ant. Construct No. No. (MHz) Cis. Units Pagers Designator Power (watts) Ht./Tp AAT Deadline (watts) meters meters Date 7 1 000808 7125'0000 MO 2600 14KOF9W 15.000 25.000 07-15-2010 8K10F1E 7 1 000806.26250000 MO 2600 14KOF9W 15.000 25.000 07-15-2010 8K10FIE 7 1 000806.33750000 10 2600 14KOF9W 15.000 25.000 07-15-2010 8K10FIE 7 1 000806.93750000 Wfo 2600 14KOF9W 15.000 25.000 07-15-2010 8K1OF1E 7 1 000807.03750000 rVIO Z 6 0 0 14KOF9W 15.000 25.000 07-15-2010 8K10F1E 7 1 000807.17500000 mu" 1090, 14KOF9W 15.000 25.000 07 15-201 0 8K10F1E 7 1 000807.18750000 MO 2600„ 14KOF9W 15.000 25.000 07-15-2010 8K10FIE 7 1 000807.21250000 MO 2600 14KOF9W 15.000 25.000 07-15-2010 1i1 10F 11�: 7 1 000807.32500000 MO 2600 14K0179W 15.000 25.000 07-15-2010 K 1001 7 1 000807.33750000 MO 2600 14K,0F' W 0.000 25.000 07-15-2010 8K1.1)i"°1 E 7 1 000807.60000000 MO 2600 14KOF W 15.000 25.000 07-15-2010 8KIlrF 1 F 7 1 000807._61250000 MO 2600 14KOF9W 15�.000 25M0 07-15-2010 8KIOFIE 7 I 000807.63750000 MO 2600 14KOF9W 15,0100 25.000 07-15-2010 8K10F1E 7 1 000807.71250000 MO 2600 14KOF9W 15.000 25.000 07-15-2010 810F1E 7 1 000807.83750000 MO 2600 14KOF9W 15.000 25,000 07-15-2010 8KIOFIE FCC 601-ULSHSI Page 4 of 6 August 2007 291 Licensee Name: MONROE,COUNTY OF Call Sign: WQBK905 File Number: 00 11176849 Print Date:07-30-2024 Antennas Loc Ant Frequencies Sta. No. No. Emission Output E P Ant. Ant. Construct No. No. (MHz) Cls. Units Pagers Designator Power (watts) t./Tp AAT Deadline (watts) meters meters Date 7 1 000807 862,50000 MO 2600 14KOF9W 15.000 25.000 07-15-2010 8K10F1E 7 1 000807.88750000 N40 2600 14KOF9W 15.000 25.000 07-15-2010 8K10F1E 7 1 000808.18750000 tVJ0 2600 14KOF9W 15.000 25.000 07-15-2010 8K10F1E 7 1 000808.20000000 t 2600 14KOF9W 15.000 25.000 07-15-2010 8K10F1E 7 1 000808,28750000 M0 2600 14KOF9W 15.000 25.000 07-15-2010 8K10F1E 7 1 000808.31250000 N10 2600, 14KOF9W 15.000 25.000 07-15-2010 8K10F1E 7 1 000808.33750000 MO 2600 14KOF9W 15.000 25.000 07-15-2010 8K'1OF1E 7 1 000808.68750000 MO 2600 14KOF9W 15.000 25.000 07-15-2010 li;K101°'11�;. 7 1 000806.18750000 MO 2600 14KOFOW 15.000 25.000 03-10-2012 ,10F1.1:r 7 1 000807.16250000 MO 2600 1410f'9W 6�.5.000 25.000 03-10-2012 8'K101.1E, 7 1 000808.36250000 MO 2600 140F9W 15.000 25.000 03-10-2012 8K1OF11.'i 7 1 000808.73750000 MO 2600 14KOF9W 15,0110 25.600 03-10-2012 810F1E 7 1 000807.36250000 MO 2600 14KOF9W 15,000 25.000 03-10-2012 8K10F1E 7 1 000806.68750000 MO 2600 14KOF9W 15.000 25.000' 11-07-2012 8KlOF1E 7 1 000808.58750000 MO 2600 14KOF9W 15.000 25A00 02-11-2016 8K10F1E FCC 601-ULSHSI Page 5 of 6 August 2007 292 Licensee Name: MONROE,COUNTY OF Call Sign: WQ13K905 File Number: 0011176849 Print Date:07-30-2024 Antennas Loc Ant Frequencies,, Sta. No. No. Emission Output ERP Ant. Ant. Construct No. No. (MHz) Cis. Units Pagers Designator Power (watts) Ht./Tp AAT Deadline (watts) meters meters Date 7 1 00080T 68750000 MO 2600 14KOF9W 15.000 25.000 02-11-2016 8KIOFIE Control Points Control Pt.No.1 Address: 10600 AVIATION BLVD City:MARATHON County: MONROE State: FL Telephone Number:(305)289-6035 Associated Call Signs <NA>> Waivers/Conditions: Waiver of Rule 90.631 was granted by Order DA 04-325,1e 61 lf)"L8-04. Prior to commencing operations on any channel or channels s p iflied under this authorization,the licensee must provide at least 60 days written or electronic notice to Sprint Nextel Corporadotiefliat,j(intends to activate the channel(s)for testing or commencement of operations,Sprint Nextel must cease operation on t(ae diannel(s)specified in the notice by the intended date to the extent necessary to comply with the co-channel spacing requirements d`§90.621(b),after which the licensee may activate the channel(s). Sprint Nextel Corporation has established an email box to receive:these rm ific:ation,at 8OOmhzinterleavedspectrum@sprint.com FCC 601-ULSHSI ["age 6 of`6 August 2007 293 d N O UO O aj U a N � a N �' ) cd 4 U) U N N ~ cdO U co U O� U 4O � O O N . fJ1 pj p U .� pU11)j .0 � ,( � bO � � N � co N zt U N Ux w o N Cd '� Ucd O W Z U ,- Z,o� ° °Q) O U o o N Z, --^°3 w a U o o c C,) U O O O d Wz � o Z, 'Z ' � r,� °�' a) O U � a � N Cd M v Ut!) d a Z o co a co a x o x 44 U W co � CO o ,z a oCd P" U '� ~ V +�- � N z co Cl) co IL) s cd � , � °' ° ° cd cj cd � o � ° O U � OU co � Q , U QL)� � Q, � '� � WEB N ° N Nco z ° � � cd cd cd a N v o o 'co a? � Q) U cd d x U = 0 � U O N O � U O p W � W N �� '� (Q N p N F U p ® N N d O p p N Cd N Q �i 41 �i �i O �i U U p N C O LH r/1 cd W co u NNE 4° H � U ai co ai U a1 (n ai O O � N Cd �11 L� Liz Yongue From: Gomez-Krystal <Gomez-Krystal@MonroeCounty-FL.Gov> Sent: Thursday, September 4, 2025 3:35 PM To: Ballard-Lindsey; County Commissioners and Aides; Kevin Madok; Pamela Hancock; Senior Management Team and Aides; Liz Yongue; InternalAudit Cc: Shillinger-Bob; Williams-Jethon; Cioffari-Cheryl; Livengood-Kristen; Rubio-Suzanne; Pam Radloff; County-Attorney; Allen-John; Danise Henriquez; Hurley-Christine; Rosch- Mark; Gambuzza-Dina; Beyers-John; InternalAudit; Kevin Madok; Valcheva-Svilena; Powell-Barbara Subject: Item C3 BOCC 09/10/2025 REVISED ITEM WORDING BACKGROUND. Attachments: AIS 4448 REVISED BACKGROUND WORDING.pdf Good afternoon, Please be advised that the agenda item wording background has been revised for item C3. "Approval for issuance (renewal) of a Class A Certificate of Public Convenience and Necessity (COPCN) to Islamorada Village of Islands -Fire Rescue for the operation of an Advanced Life Support(ALS) and Basic Life Support(BLS) transport ambulance service for the period October 1, 2025, through September 30, 2027. " ITEM ACKG'ROlnlND: On Septenibeu,20, 2023, a A COK"N �tas, issued to Islau'uionad,,t Village o lshinds - IFore Rescue to operate an AiL;'S and BLS transport auuti:h uOance .,icr ^icc_ The curreat ("OK" expires w,,i September 30, 20,25- In view of the forego ing, lslainorada Village of lsku:u'1ds - Fire Rescue leas applied to rerww, this Class A COI,CN which, if approved, will became of efive October 1, 2025, Tlui�il� euu�u i Sincerely, Executive Administrator Monroe County Administrator's Office 1100 Simonton Street, Suite 2-205 Key West, FL 33040 (305)292-4441 (Office) (305)850-8694(Cell) Courier Stop#1 Notary Public w.r o n r y e c_ u�n1y:�:V_e.gpy PLEASE NOTE: FLORIDA HAS A VERY BROAD RECORDS LAW. MOST WRITTEN COMMUNICATIONS TO OR FROM THE COUNTY REGARDING COUNTY BUSINESS ARE PUBLIC RECORDS AVAILABLE TO THE PUBLIC AND MEDIA UPON REQUEST. YOUR EMAIL COMMUNICATION MAY BE SUBJECT TO PUBLIC DISCLOSURE. 1 2 C3 BOARD OF COUNTY COMMISSIONERS COUNTY of MONROE Mayor James K.Scholl,District 3 The Florida Keys Mayor Pro Tern Michelle Lincoln,District 2 Craig Cates,District 1 David Rice,District 4 Holly Merrill Raschein,District 5 Board of County Commissioners Meeting September 10, 2025 Agenda Item Number: C3 2023-4448 BULK ITEM: Yes DEPARTMENT: Fire Rescue TIME APPROXIMATE: STAFF CONTACT: Chief Colina N/A AGENDA ITEM WORDING: Approval for issuance (renewal) of a Class A Certificate of Public Convenience and Necessity (COPCN) to Islamorada Village of Islands - Fire Rescue for the operation of an Advanced Life Support(ALS) and Basic Life Support(BLS) transport ambulance service for the period October 1, 2025, through September 30, 2027. ITEM BACKGROUND: On September 20, 2023, a Class A COPCN was issued to Islamorada Village of Islands - Fire Rescue to operate an ALS and BLS transport ambulance service. The current COPCN expires on September 30, 2025. In view of the foregoing, Islamorada Village of Islands - Fire Rescue has applied to renew this Class A COPCN which, if approved, will become effective October 1, 2025. This will e islaffiefada Village of islands Fife Resette to pfavide intef f�eili�y tfanspefts only. PREVIOUS RELEVANT BOCC ACTION: 09/27/17 BOCC approved renewal of Class A COPCN for the period 10/01/17 through 09/30/19. 09/18/19 BOCC approved renewal of Class A COPCN for the period 10/01/19 through 09/30/21. 08/18/21 BOCC approved renewal of Class A COPCN for the period 10/01/21 through 09/30/23. 09/20/23 BOCC approved renewal of Class A COPCN for the period 10/01/23 through 09/30/25. INSURANCE REQUIRED: Yes CONTRACT/AGREEMENT CHANGES: The renewal will cover the period of October 1, 2025 through September 30, 2027. STAFF RECOMMENDATION: Approval. DOCUMENTATION: Class A COPCN Application Islamorada Village of Island Fire Rescue—Redacted l.pdf 1 Isla morada—Class—A—COPCN-1 0.0 1.2025to09.30.2027.pdf FINANCIAL IMPACT: Effective Date: 10/01/25 Expiration Date: 09/30/27 Total Dollar Value of Contract: N/A Total Cost to County: N/A Current Year Portion: N/A Budgeted: N/A Source of Funds: N/A CPI: N/A Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: N/A Revenue Producing: N/A If yes, amount: N/A Grant: N/A County Match: N/A Insurance Required: Yes, per Statutory Requirements 2