Workplace Preparation for Wildfire Smoke Health Concerns

On behalf of the Center for Occupational and Environmental Health and the California El Camino Real Association of Occupational Health Nurses I’d like to welcome you to our webinar Workplace Preparation for Wildfire Smoke Health Concerns presented by Anne Katten, MPH. At this time, I’m pleased to introduce Julia Buss, PhD, RN, and a member of CECRAOHN, who coordinated this webinar. Thank you so much. Thank you very much for hosting this webinar. So this time I’m very pleased to be able to introduce our presenter today for this important webinar. The pesticide and work safety Project Director of the California Rural Legal Assistance Foundation. She advocates for improved enforcement policy changes She holds a master’s in public health degree in industrial hygiene practices from University of California. So very pleased to have a knowledgeable advocate to chat with us today. Thank you for joining us. And I’d like to hand over to our presenter now. Hi, this is Anne. Hello. Hi, I’m Anne and thank you all very much for joining. And I have no conflicts to disclose on this matter. Today we are going to cover employer responsibilities for protecting employees from wildfires smoke exposure. Some background information about the Air Quality Index for small particles PM 2.5 which are the predominant pollutant from wildfire smoke. Appendix B Of the emergency standard and some guidance and how to recognize farmworkers concerns and special training needs when doing training. We California Rural Legal Assistance Foundation, along with the California Labor Federation and work safe petitioned the OSHA standards board last December. For development of a standard based on the Air Quality Index to protect outdoor workers from wildfire smoke. We did this because in recent years we saw farm workers day laborers construction workers working outside during the wildfires, and saw they needed protection, of course. The emergency standard was developed on a very, you know, as an emergency standard on on a very tight timeline. It was Put in place at the end of July, after a rulemaking process where comment input were taken from, you know, various stakeholders in this. You can find A copy of the proposed and final text here. This is a temporary standard it in current form, it will expire in the middle of January, unless it is renewed or a permanent standard is put in place It can be renewed up to one time. So in current form, it could be up to one year in place and then permanent standard would need to be in place and the outdoor heat standard was developed through the same process. The standard applies to workplaces where the Air Quality Index for fine particulate matter is 151 or greater, which is the level that is considered unhealthful for for All the population and This applies for workers who are exposed at least an hour a day and it applies to both indoor and outdoor workers. But if workers are working in a closed vehicle or building that has filtered air, they don’t have to be provided with respiratory protection. The standard is based on the PM 2.5 fine particulate Levels, because that is the predominant pollutant from wildfire smoke and because it is Readily It is constantly monitored at a lot of government stations, but we also, of course, recognize there are a lot of other pollutants in wildfire smoke that can have a health impact. And for more background, the Air Quality Index. Which is it’s an index that was developed by US EPA to provide a real time air quality information on ozone. Levels throughout the country. From a network of air monitoring stations and when there is a large wildfire in process additional mobile stations are generally added to the area. And the levels can be checked on a website called air by zip code. So it’s easy information to access and they are the, the current level is a rolling average I think based on 24 hours with a 24 hour rolling average with some weightings Okay. Other requirements. In the standard employers have to Check the levels of when when you are reasonable suspect that there is wildfire smoke in an area, they need to check levels before each shift and periodically during work shifts To see what the levels of PM 2.5 are and then exposures to wildfire smoke need to reduce to the extent feasible by relocating work to an enclosed building or vehicle where the air is filtered or to another outdoor location where the air quality is healthier. And if employers can’t reduce workers exposure adequately through these engineering and administrative controls. Then they need to provide respirators such as most commonly N-95 type respirator for all employees for voluntary use along with training on the requirements of the regulation health effects of exposure to wildfire smoke and how to safely use and maintain a respirator. And what the limitations of uses of respirators are When the air level for PM 2.5 during a fire reaches 500 which is the upper limit of the hazardous scale respirator use is mandatory. And the advocate, those of us who filed a petition, we feel that the level for a mandatory, you should be 300 which is the lower level of hazardous. But we can discuss that in more detail later. These are just examples of some types of in 95 respirators. The most common type used by outdoor workers would be the, the one on the right, but without a valve. The different styles of respirators fit different shapes of face better or worse. And for for voluntary use. There is not a set obligation to provide different multiple styles, but it’s really a best practice to make sure that everyone can have a Respirator, that is protective The wildfire smoke regulation has an appendix, that is intended to be used as a guide for training for the content for the training that’s required Simply, you know, providing copies of the appendix is not an adequate way to do training. Anyway, Content that is supposed to be included in training includes explaining the health effects of wildfire smoke exposure and Different health conditions that can make people more sensitive to wildfire smoke. The right of workers to obtain medical treatment without fear of reprisal and the responsibility for employers to provide prompt Transportation to medical treatment. How to find the AQI for PM 2.5 You know how to ask the employer for it if there isn’t any internet access at the work site. The general requirements of the regulation. The employer system for how they both Communicate information to workers as such if the Air level the smoke level is getting worse, or if workers perceive that the smoke level is getting worse or are experiencing symptoms. The methods that the employers Planning to use to control exposure you know relocation. To an indoor site or to another site further from the smoke or Respirator use And then finally, the part that really takes the most time in the training the benefits and limitations of using a respirator. And how to dawn the respirator when it needs to be changed. And How to To judge if you may not. It may not be helpful for you to wear a respirator. The appendix includes this graphic, which is a nice clear glass graphic that Shows You know some of the important things to consider about placement of the respirator in your face that it seals better if facial hair is shaven around a seal. And it in how to check in the face seal needs to be checked, of course, not all respire N-95 so having those clips. So that’s something to keep in mind. We also strongly recommend that people That workers are trained to check for the NIOSH seal. That’s generally on the middle of the respirator because some subcontractors and small employers. May be providing dust mask that are really respirators either out of ignorance or cost cutting. And so it’s really important for workers to know how to check whether they’re getting the genuine article that will be protective. The here I’ve provided a link to the regulation, which again includes the appendix. CalOSHA has translated the full regulation and the appendices into Spanish and they’ve translated the appendix B into Korean and they’re planning to translate into additional languages. The Davis Western Ag safety Center has also developed some handouts That include additional graphics and you know as a simpler explanation of the information in the Appendix B in both English and Spanish. If you’re doing training. These are intended for agricultural workers, but I think they would be useful for helping to plan training for for any workers. And of course, we work a lot with farm workers and day laborers and in working with a Population of immigrant workers who do a lot of seasonal work with, you know, different employers there anyhow. There are a number of things to keep in mind. The population is tends to be very low literacy and in any language. So it’s important to have oral training low literacy materials with a lot of graphics That are culturally relevant if possible and to have, you know, a real life demonstration, if possible, of how to put on the respirators. If that isn’t possible You know, we’re hoping that some short videos are going to be produced that could be used, maybe on a tablet out in the field for helping to explain how to use respirators. And this could be particularly important. For workers who speak the indigenous Mexican in Central American dialects, because those languages are just Are not used in written form by workers and there are multiple dialects, so You know we are hoping that some short videos can be developed in multiple dialects. For helping to train these working populations. There are also phone translation surfaces in some community groups that can help with training indigenous workers. And in training, it’s, of course, important to respect people’s cultural practices in agriculture, it’s, you know, very common to use a bandana to protect from the sun and from dust. And you know, it’s, it should be approached in a way which I think the Western tenders materials do where you explain that the the bandana will let the smoke come through. So that’s not why it’s not good for for this but but not trivializing the use of the bandana. It’s of course, important to have a clear explanation of how respirators are important for preventing inhalation of smoke but that they’re not safe for some people who have lung and heart problems. And you need to keep in mind. A lot of these workers unfortunately have limited medical care access. So they may not know they’re part of a sensitive population. It’s really important to explain how that N-95 can get clogged over time and needs to be replaced and shouldn’t be kept for days on end. And of course, it’s really important to encourage reporting of symptoms and explain the right to medical care for work related illnesses for these populations in particular. And I’ll go into examples of some of the air quality in past fires. This is just a look back in general about how for the Northern California area here. In particular, we see that the between 2016 and 2017 PM 2.5 exceeded the level unhealthy for sensitive groups went way up. This is, you know, due to the Fire in Santa Rosa area, most likely, and then some other fires in Los Angeles. It also there was the the fire complex in Los Angeles and Ventura And then Last year, of course, in November. There was the very terrible a fire the campfire in the paradise area and this is a breakdown of the air levels in Chico very close to the fire. And as you can see the Levels shot up to the hazardous level on the first day of the fire and then remained at the unhealthy level for most of us, for the most part for 12 days following And In other areas throughout northern California, as you probably all remember there were multiple unhealthy days in the throughout the Bay Area. As well as here in the Sacramento Valley from the smoke from the fire. And several in each area several days where the air quality was very unhealthy or hazardous. None of these levels went over 500 for 24 hour average, but in the Chico and viewing area. There were several one hour exceeding as a 500 And as I mentioned before, the temporary emergency regulation will expire in the middle of January. CalOSHA has already started the advisory committee process for developing a permanent regulation, an advisory meeting was held at the end of August, and a discussion draft is available comments were taken until the end of September. For the permanent rulemaking. CalOSHA Prepared a discussion draft with both some very minor clarifying edits and then edits that would lower the threshold for offering respirators for voluntary use to 101 level unhealthy for sensitive groups and would lower that threshold for mandatory respirator use where fit testing and medical evaluation. By a health care provider are required from 500 to 301 and We the petitioners are very supportive of both of those proposals because there are of course many people who are working, who are members of sensitive groups and they need to have protection and particularly for lower income workers. They may not know that they Have asthma or some other sensitivity that where they could benefit by use of a respirator at a lower Air level and you know they should be entitled to it, the proposal as written by OSHA would require workers to ask for a respirator. At the levels that are unhealthy for sensitive groups. And we think that it should be simplified, that they’re just provided for voluntary use at that level rather than having a distinction Then you know as a mentioned there. Some of the ongoing discussion is about you know how to best protect workers who are part of sensitive groups. The appropriate threshold for mandatory respirator use And when you read the regulation, you will notice that the workers who are involved in emergency response are exempt from the engineering and administrative control requirements and we are We have concerns at the way emergency work is Is defined is a little too broad. It should be work under the incident command we think, and there are some administrative controls that can be used for some emergency response work. So we think the exception is also too broad. There’s also work underway to try to figure out what the appropriate type of filtration is to be effective against Against wildfire smoke and indoor situations and also you know how often it needs to be made. Maintenance needs to be performed. And I think that is something that CalOSHA could use more input if anyone has special expertise in that And then finally, of course, when you’re involved in this, you’re going to need To look up the PM 2.5 air levels, as I mentioned, the air now website is a great place to look them up, it has both current and forecasted AQI levels. And air now also has an environment flash alert system. You could sign up for to get alerts when the air quality is unhealthful for sensitive groups or unhealthy or worse. Many local air districts also have email alert that you can sign up for and there are various private apps in around. But if you’re using one of those. You need to make sure they’re using reliable air monitoring data because some use the purple air monitors, which are not considered adequate for this purpose there. They haven’t been calibrated and they may not be sensitive enough for PM 2.5 Also whenever you’re checking the websites or alerts or apps, you need to keep in mind there are since there is AQI information available for ozone and PM 10 as well as people 2.5 you just need to make sure you’re looking at the right number, it’s usually pretty straightforward. Any. This is how you sign up for the environment and viral flash email or text alerts. It’s pretty simple. Just lastly It’s, you know, important to ensure that your employer is aware of the requirements under this regulation. And to review the appendix, especially the way for communication for the training requirements and to have a supply of N95 ready for voluntary use preferably A range of styles or several styles. It’s important to follow the AQI for PM 2.5 for your different workplace locations. Some of the apps may have a way to sign up for more than one location at once. And then, you know, of course, integrating wildfire preparedness into emergency preparedness plans is more and more critical and Another issue with the people who may be involved in evacuations, you know, an emergency response. We feel that the regulation should be Should include information on accounting for the whereabouts of those workers and So it’s important to keep that in mind when you’re developing any plans. And then also there, you know, there will be further opportunities to participate in the CalOSHA advisory committee process and You know, I provided the link where you can can look for sign up for information there. And I guess I went kind of quickly so we could Do Q&A now Thank you. Thanks. And I hope everybody can hear me a bit better. I apologize to my bad mic earlier on that, please do enter any questions you may have into the Q&A section of your zoom. And in the meantime, we have some questions that folks have already Shared. So while you’re thinking of some for now I’ll go ahead and go through some of these questions. The first one is in the rule. It says it applies when AQI is greater than 150 and up. There’s an anticipation of exposure to wildfire smoke. But what if the AQI is greater than 150 but there is no wildfire, do the rules still apply? No, the rule is intended to be limited to times when there is wildfire smoke. You know it the wildfire may not be responsible for the entire AQI level of PM 2.5 but it where it’s, you know, heavily influenced its, its rise. We have another question. About whether your slides can be shared and yes we are planning to share all the slides we will be able to email the slides out to everybody who attended and Then you’ll have the link To the materials. And then another question. Is somebody asked the training. Can we just give our employees Appendix B is that adequate. No, it’s not adequate. Training needs to include a presentation of the material and an opportunity for workers to ask questions and get them answered. And that that’s written into the regulation and, you know, and as I mentioned, you know, many farm workers and other low income workers have very low literacy so For them, the regular presentation and training is all the more important. There’s another question about the unit of measure for particulate matter. And I think the unit of measure for fine particulate matter PM 2.5 is micrometres Yes, I was going to include a slide like that. And I didn’t, but that these the levels will try to go back here. The levels here in the AQI in the index they correspond to certain ranges of micrograms per meter cubed. In the actual regulation, there’s a table that shows the levels they correspond to and if you if you go online. You know, it’s like everything else you know they have a conversion to um but Yeah. So, for example, for the Air Quality of 151 corresponds to PM 2.5 level of 55.5 micrograms per meter cubed and then A level of 301 The AQI of 301 corresponds to Pm 2.5 level of 250.5 micrograms per meter cute and that’s in the appendix A which I did not cover, but if it is possible for an employer to in instead of Relying on the air. Now, or air district data, it’s permissible to do your own monitoring of the PM 2.5 levels. If you have a monitor that you know if I’m have adequate quality and calibrated which those are fairly expensive, but they are available. Somebody else asked about, is there a range of N95 respirators to offer employees or is this the one particular brand. Okay, or do you know Well, for the voluntary use of the less high, shall we say, air AQI The provision of one model is acceptable, according to the standard itself, but You know, It is well recognized that people with certain facial shapes. If you have a narrow chin or particularly large face. You know, one model isn’t going to fit absolutely everyone, so it is good to have several sizes or models available to be sure that you’re, you can really protect workers from known hazard. It doesn’t necessarily have to be more than one brand just more than one Model You know, multiple shapes. Their foldable ones. They’re the duck bill ones and then they’re more standard ones, and I could go back to that. And do you know Say about somebody who’s with asthma. They have and that would they be able to use an N95 Yeah, many people it it would sort of depend on how severe your asthma is but many people who have asthma would benefit from use of an N95 and would really benefit more if it was provided at the, the lower the level that’s Unhealthy for sensitive groups. That’s, that’s what that advisory is is intended for So, you know, that’s why we think that threshold should be 101, and we would encourage people to provide you know make respirators available at that level. You know, and you have to keep in mind. Not everybody really understands, whether they have asthma and some people would feel funny asking for a respirator at a, at a lower Level. So, you know, we encourage just making them available at that lower level, but you also need to keep in mind that The best way to reduce exposure is to try to locate the work to a less hazardous area. Either you know indoors or you’re in an area where there’s less smoke. Because the, you know, some people with asthma can’t tolerate any smoke exposure or may have trouble with a brief breathing resistance from a respirator, and I Noticed in the standard, it says the employees with lung and heart problems consult a physician. I was wondering about barriers for farmworkers in accessing healthcare. Is a really big problems. So, that that is an area where You know it’s it’s a general general piece of advice that doesn’t really Isn’t really adequate so that’s why You know, we think that both providing respirators at a lower Air level, if possible, and then also encouraging people to report symptoms in taking them to medical care if they are You know, removing them from exposure. If they’re developing his symptoms is really important. We have another question asking about whether is their no requirement for fit testing new respirators and most models cannot be fit tested. Well, Um, the there is it once you get to the mandatory use level, then you are required to do fit testing and to administer the to have a full respiratory protection program, which would include fit testing and administering the question there to be evaluated by a health care provider, which, you know, looks at risk factors, people may have the could contra indicate using a respirator, like if they have a heart condition or COPD or something else like that. But when use is voluntary Those The fit testing and medical evaluation aren’t required and it is Harder to fit test a N95 then say, a alas numeric respirator because You know, the positive and negative test doesn’t really work, but it is possible to do fit testing is done with in Using like the saccharin spray method and In within 95, you know, part of the fit testing is figuring out if the standard model really fits your face or if you need to go to a duck bill model should go back to that again or or some of the folding models fit people better So you know that. So for people who use N95 You know, In healthcare settings or in some construction or pesticide application settings where it’s mandatory. They do have to be tested. So anyway, the first The first picture here on the left, this is the duck bill type and it’s supposed to be better for someone with an arrow chin. And the valves are really good for. It’s a little more comfortable and cooler, but they also don’t always fit where based on where the valve is located. They may not fit real well for some for someone who has a larger nose. So it’s just you know different you know one shoe doesn’t fit everyone And are the employers is fully responsible than for purchasing and providing the respirators for voluntary use and also replacing them as needed. Yes, the regulation clearly States that you need to have a sufficient number of respirators for all the workers, you know, so that all workers, excuse me, so if if all the workers on the crew on a shift want to use respirators, they will be able to So the employer definitely has to provide them once the air level is at The unhealthy level now and that may be reduced to the unhealthy level for sensitive groups due to wildfire smoke. And It’s certainly highly recommended if not required that the respirators, you know, these are disposable respirators, that you get a new one at the beginning of each shift You know, one a day for, and you also need to have a few extra around in case one of them gets Well, you should have quite a few extra around because you know they can get dirty for one reason or another. And Also, if the smoke level gets really high, they could get clogged before a full shift is done. And then they’re not only unprotected. They’re hard to breathe through that point. Do you know as well as wearing an N95 increased risk for heat exhaustion for these outdoor workers and is that something we should sort of be aware of It, it could to some degree increase the risk of heat exhaustion. We strongly recommend people increase the break frequency, the frequency for a rest breaks and also try to reduce the pace of work when respirators are used and we’ve advocated for an hour relief break while using respirators to have that added to the permanent standard So that is one way to address that. You have another question. How do you determine exposure dose for voluntary use I’m not sure I understand the question. How do you determine exposure. Does the voluntary use is moved work indoors. Sorry. Maybe that person could ask the question again, just not sure, unless you understand what that means Anne Well, I think. If someone is working indoors in a building without mechanical filtration, we really don’t have a good way of knowing what the, what the AQI, what the air, what the PM 2.5 level is in that environment. We just have to Assume that it is the same as outdoors. You know what the nearest Air Station. Which I I have not actually seeing the data, but I have heard that. In some cases the air levels could get even higher in a indoor location say where the bays are open in a warehouse or something because the smoke could kind of get trapped there You know, so the simple answer there is just you, you need to assume the air level is whatever the closest outdoor station level is, I believe And another question is what would you recommend for workers who don’t want to wear a respirator. Yeah, I mean, respirators are not comfortable. I completely understand It’s really important that they monitor their symptoms, you know, whether they are getting any symptoms from smoke exposure and You know, reconsider. If they are or report the symptoms. You know, of course, the better. Way to deal with this is to try to Reduce the number of people who are working in areas where the smoke levels are high to You know, to just the really central work. I remember that you’d said that the regulation applies to outdoor workers, farm workers and day laborers, but it does it also apply to Federal workers as well as state workers. Federal workers are not covered by CalOSHA standards because the are federal not state workers. But that said, they are covered by the general duty clause to protect them from known health effects. So it is not explicitly required, but it is highly advisable to give them protection because There have been Cases where someone has been a has, you know, made the case that they were not being protected from a known hazard, which they should have been under the general There’s a question about compliance, how will compliance be monitored. Well CalOSHA will respond if there are complaints, you know, from workers or people who who see situations where it looks like workers aren’t being protected. Outside And they also hopefully will have the resources to go out during smoky conditions in areas where the Levels of PM 2.5 are high and you know do checks to make sure workers are getting protection So I guess the CalOSHA workers will have to Be careful of that, wear their respirators too when they aren’t In their condition vehicles. Yeah, well I think they’ve mostly probably been tested. And so given the sort of way employment is with many subcontractors. Then Who gets held responsible for non compliance. And do you know what the penalty would be Um, well, the person Sometimes you have a joint employer situation because you may have a contractor who’s directly hiring the workers. But if, say, the grower is Saying you know directing you know you have to, you have to harvest this vineyard, even though it’s close to the smoke because we got to get in harvested, you know, then it would be a joint employer situation and either or both could be sited And I, I don’t know what the fine levels would be, but I Would think that some of these could be serious citations, because, you know, as we know. Inhalation of high level. Can increase the risk of A lot of lung and Heart Problems, because the PM 2.5 goes deep into the lungs and it’s absorbed into the bloodstream. We, we did hear reports of, you know, some of the workers outdoors during some of the height of the Extensive fires getting pneumonia and in just, you know, coughs that last have a long time. Do you know other AC filters and cause them to protect people from exposure. I think that is something that really needs to be researched more and I know CalOSHA was looking at You know whether the standard should be what is called a Merv filter, you know, for Buildings and and I don’t even know if those are available for cars, but No, I think that is a very good question. And it’s something that needs to be researched. There’s also the issue of If you’re doing work and you have to keep opening your window for some reason for safety, then That’s, you know, your car window that’s going to be an issue. And you should have, I think, you know, workers who have to drive around should at the very least, have a respirator available. They may not need to wear it all the time, but they should have it available. Just thinking generally about climate change and it is a prediction to increase wildfires frequency and intensity. What that it is likely that the standard will have to be updated or is. Does that happen with standards once written that they can be changed. Certainly. You know that the outdoor The standard for prevention of heat illness and outdoor workers has been modified several times to strengthen it and it, it definitely can can and does happen. It’s not always a super fast process but It does happen. And is there anyone who’s gets excluded from the regulation. Well, this regulation currently excludes the firefighting workers. They are covered under other regulations and then It has some exceptions for workers who were doing emergency response work. There is an issue that came up during the advisory meetings that utility workers. When they’re working near the live lines. There’s an there’s a hazard called arc flash and it’s You obviously shouldn’t be wearing a flammable respirator when you’re doing that work. You know, we think that the solution is just, you know, you should wear the respirator when when you’re doing other work and not when you’re doing that work. It’s also, it might be possible to wear a shield over a respirator but but that could be a real heat Heat stress issue. Otherwise, There, as I mentioned, there is an exception from the engineering and administrative controls for workers who were doing evacuations helping with evacuations and other emergency response and We think that is a little too broad. You know, That because, you know, you may be able to To cycle workers, sometimes you may not be able to. And you definitely need to have a system for accounting for workers. In that kind of situation. So in January when the temporary regulation expires. What, what happens Well, given that, you know, CalOSHA is hard at work on this. They’re there. I’m almost positive there will either be A permanent regulation, put in place at that point or the temporary regulation could get renewed while the final touches are being put on a permanent regulation in the next six months. What do you see as being the sort of biggest challenge to implementation. Um, well, getting the information out. We are working in making sure You know, the information reaches all workers, we are The labor occupational health program at UC Berkeley got a grant for developing a model program for field workers and we will be working with them to help develop and field test that program soon. It, you know, with any new regulation, it’s Sometimes there are unforeseen issues that have to be addressed. As they develop but you know I think this has gone through a really good review process I think the only final question is just, given that I’m not sure what percentage of this audience and nurses, but it may be higher than lower Do you have any particular kind of recommendation for the occupational health nurse that you’d like to share to them while you have a captive audience. Well, I think, to, you know, just to try to encourage reporting of symptoms and recording of symptoms. So we, you know, can get an idea of how well the regulation is working. The more health care providers who are trained in in how to Do the medical to do the evaluation of the questionnaires during the medical evaluation, you know, for respiratory protection program, you know, the better, and to do fit testing. I think those are all really important issues. And if you find in your work that there are certain respirators that seem to fit better than others. You know, it’s good to get that information back to maybe the DPH occupational health program or I’ve given my email. I, I welcome feedback so I can, you know, try to take into account as we move forward. Great, well thank you so much, and I hope that that will be able to continue this conversation. And have small webinars, maybe in follow up after the permanent standard comes into place and perhaps some examples from nurses and what they’ve done in their workplace, but so please everyone listening. Stay tuned for future Webinars and in the meantime, unless I don’t think there’s any other questions. So I just wanted to say. Thank you very much again to our presenter for Helping us in this great way and sharing all your expertise. It is very, very helpful and good opportunity for us to take a look at the standard and also thank you again very much to COEH for supporting us and hosting this webinar. Yeah, thank you guys so much for joining us. And again, thank you Anne for presenting and CECRAOHN for organizing this as well. If you want a recording of this webinar. We are going to make that available on the website. It’ll be at and we’ll also have it on our YouTube page. We will be sending out evaluations after the webinar. So make sure you check your email for that evaluation. Thank you all so much for for joining us today. I hope you have a wonderful day. Oh, and if you want a copy of the slides. You can email [email protected] again that’s [email protected] and we’re helping to distribute the slides. Thank you. Thanks everyone. Have a good day. Bye.

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