Know How to Avoid Heat-Related Illness when the Temperature Spikes This Summer

You’re at the beach on a 92-degree day with a friend when, suddenly, she seems confused. She says her head hurts, she feels dizzy and starts to vomit. Then she faints.  

Would you know what to do?  

Your friend is likely suffering heat exhaustion. If her symptoms don’t improve after moving her to a cool place, loosening her clothes, putting a cool cloth on her head and having her sip water, you should seek medical attention.   

From May through September 2022 in Virginia, 2,861 people went to emergency rooms or urgent care centers for a heat-related illness. Already this May, 75 people have sought medical help.  

Your body cools itself down by sweating, but when temperatures soar above average and you spend a lot of time outside, sweating might not be enough.  

Dehydration can happen if you lose too much water and salt from your body when it’s hot. If you have been sweating a lot or haven’t had any water, you can become dehydrated. Severe dehydration can be life-threatening.  

Heat cramps are painful, involuntary muscle spasms that can happen during heavy physical activity in the heat. You could feel cramps in your calves, arms, abdominal muscles and back. If you have heat cramps, find somewhere cool and out of direct sunlight (preferably inside), rest for several hours and drink clear juice or a sports drink with electrolytes. 

Heat Exhaustion symptoms also can include heavy sweating; cold, pale and clammy skin; a fast, weak pulse; muscle cramps and tiredness or weakness.  

Heat stroke is life-threatening and could lead to death. If you’re outside for a long time, doing physical activity in hot weather, you may stop sweating. Your body temperature could reach 106 degrees in as little as 15 minutes.  

You can avoid heat-related illness this summer with the following tips:  

  • Drink plenty of water. 
  • Stay inside an air-conditioned building, if possible. 
  • Wear light-colored, lightweight clothing. 
  • Limit physical activity. 
  • Wear a hat. 
  • Use sunscreen. 
  • Take frequent breaks when working outside. 

It’s helpful to learn the terms that weather forecasters use to talk about how hot it will be. An excessive heat warning means that higher temperatures than normal are expected in the next 36 hours. The heat index is how it feels outside when relative humidity is added to the air temperature. 

Be sure to check the back seat of your car to make sure children and pets are not left behind. A hot car with the windows up can quickly reach more than 150 degrees, leading to heat stroke or death. Leaving the window down is not enough to keep the car cool.  

It’s also a good idea to check on neighbors. People age 65 or older may suffer from heat-related illness and complications when the temperature and humidity are high. 

Infants and children, people with chronic conditions, athletes, people with lower incomes, outdoor workers and pregnant women are also more at risk of becoming sick when the temperature is high. 

Other things that could increase the risk of a heat-related illness:  

  • Obesity 
  • Fever 
  • Prescription drug use 
  • Heart disease 
  • Mental illness 
  • Poor circulation 
  • Sunburn 
  • Alcohol use  

You can have a fun and safe summer with a few simple steps that will help protect you and those around you.    

Learn more on the Virginia Department of Health and the CDC websites about heat-related illness, who is at greater risk and how to stay safe in extreme heat.

Emergency Medical Services Week Recognizes the Determination and Commitment of Virginia’s EMS Providers to Deliver Quality Prehospital Care and Save Lives

Virginia’s EMS providers respond to emergencies during our citizens greatest hour of need. The critical moments from the time a 911 call is received to the arrival at the hospital is where emergency care begins. Last year, EMS providers responded to more than 1.65 million calls for help in Virginia, which represents approximately 4,520 incidents per day.

As proclaimed by Governor Glenn Youngkin, May 21-27 is EMS Week in Virginia. This special week honors EMS providers’ commitment to respond to emergencies and provide critical care. EMS for Children Day, May 24, emphasizes the pediatric patient and their required specialized treatment. This year’s EMS Week theme is, “Where Emergency Care Begins,” and it highlights the importance of our first responders who assure quality prehospital care.

“Seconds count when a person is suffering a heart attack, is seriously injured in a wreck, or is having a life-threatening allergic reaction, stroke or other medical emergency. EMS teams provide pre-hospital, on-the-scene care that can make the difference between full recovery, prolonged disability, or death,” said State Health Commissioner Karen Shelton, MD. “EMS professionals, along with other first responders, are also on the front lines of the opioid overdose epidemic, saving lives by administering naloxone, giving people another chance at life and recovery. We appreciate their dedication to the communities they serve.”

“Virginia’s EMS providers are among the best in the nation due to their elevated focus on providing exceptional prehospital emergency care and maintaining their skills with continuing education,” said Gary Brown, director of the Virginia Department of Health Office of EMS. “Their ability to remain calm, treat injuries and save lives during harrowing incidents is truly remarkable. It is my honor to recognize and thank our EMS providers for their heroic efforts, dedication and determination to protecting the health and well-being of all people in Virginia, each and every day.”

During EMS Week, Virginia EMS agencies may host community activities, including first aid classes, health and safety fairs, open houses and more. These family-friendly events encourage citizens to meet and greet the first responders in their neighborhoods. Please check their websites or social media pages for additional information.

In recognition of Virginia’s fallen fire and EMS personnel, the Virginia Fallen Firefighters and EMS Memorial Service honors fire any EMS responders who died in the line of duty and those who risk their lives daily to serve and protect Virginians. The Annual Fallen Firefighters and EMS Memorial Service will be held June 3 at noon at the Richmond International Raceway.

To learn more about the Virginia Department of Health Office of EMS, visit www.vdh.virginia.gov/emergency-medical-services/.

Office of Vital Records Staff Knit and Crochet Cuddlies for Preemies

The crafters in the Office of Vital Records (OVR) have been busy! They have made: 

  • 28 hand-knitted and hand-crocheted baby blankets, 
  • 34 darling crocheted octopuses that are more than just plush toys, and, 
  • 15 hand-made incubator covers.
     

These items are for families of babies in neonatal intensive care units. OVR’s Field Services Team members always cross paths with birth registrars at hospitals. VDH staff train hospital staff on using software to register newborn births with the state properly. 

“We have always been looking for an outreach program for our birthing facilities, said Senior Field Service Representative Denise Cox. 

When Field Services Representative Lisa Cauthorne came across an article about the crocheted octopuses for preemies project, she shared it with her colleagues. 

“We thought it was a great idea because a lot of us are crafters,” Cox said. “We were excited just to give back. In those (neonatal intensive care units), it’s pretty traumatic for many of the mothers… talking with the birth registrars gave us a boost to start this project.” 

“We wanted to participate in something where we can help these children and these families that we affect. And I don’t mean from just a paper perspective, but from a personal perspective,” added Cauthorne. ”To show them we are not just governmental paper pushers.” 

Former OVR staff member Michelle Reid, who has retired, came up with the name “Granny’s Closet.” They kicked the project into gear in August 2022. The blankets and octopuses are made to specifications. The octopuses have a purpose other than being cute – the idea is that the tentacles provide the babies something to grab onto so they don’t grab and dislodge any medical tubing that might be attached to them. 

Meanwhile, Cauthorne reached out to area hospitals about donating the items. On May 10, they donated their first collection of hand-mades to the neonatal intensive care units at Bon Secours Southside Medical Center in Petersburg and to HCA Johnston-Willis Hospital in Chesterfield County. 

They hoped to make Mother’s Day a little brighter for families with babies in the NICUs. 

“We are already involved in these people’s lives through the registration of their birth certificate,” said OVR Director Seth Austin. “This is a way to drill down more of a tangible, personal way to help our staff connect with the work and people we are impacting every day.”

 

May is Lyme Disease Awareness Month: Don’t Let the Tick Get You Sick

It could start with a headache, fever, joint or muscle pain or fatigue.  

And then there’s the bull’s-eye rash, the tell-tale sign that a tick bite could have infected you with Lyme disease.  

Lyme Disease is a very serious disease in Virginia. It spreads to humans through a bite by the blacklegged tick, which is found in suburban areas in the northern and western regions of Virginia and in the higher mountain areas.  

May is Lyme disease awareness month, a time to learn about the seriousness of the disease. If Lyme is left untreated, it can lead to the following conditions:  

  • Severe headaches and neck stiffness 
  • Pain in the tendons, muscles, joints and bones 
  • Additional rashes on other areas of the body 
  • Arthritis with severe joint pain and swelling, especially in the knees and other large joints
  • Facial palsy (face drooping on one side)
  • Irregular heartbeat, dizziness and shortness of breath 
  • Inflammation of the brain and spinal cord 
  • Nerve pain and shooting pains, numbness or tingling in the hands and feet  

Not all blacklegged ticks carry Lyme disease and it’s possible to avoid infection if you find a tick right away and remove it from your body. If you do have symptoms right after the bite, it’s possible to cure the infection and avoid long-lasting conditions if it’s treated right away with antibiotics. 

It’s a good idea to check yourself over when coming inside from outdoors. If you find a tick on your body remove it right away. If you think the tick has been on you for more than two days, save the tick in rubbing alcohol (or clear alcohol like vodka). Watch for those early symptoms that include headache, fever, joint or muscle pain, fatigue or the bull’s-eye rash.  

If you notice these symptoms, contact your healthcare provider right away and bring the tick with you so that it can be identified. If your healthcare provider cannot identify the tick, you are welcome to send it to the Virginia Department of Health (VDH) through the Virginia Tick Survey. Please note that testing is not always the best indicator of the likelihood that you may develop Lyme or other tick diseases. 

To learn more about ticks, how to avoid them and the diseases they can carry, visit the VDH Tick Page. 

Here’s What You Need to Know for National Fentanyl Awareness Day

Every Virginian is affected on some level by the opioid crisis. You could know someone who has overdosed or know of someone whose life has been affected.  “We all know someone who has been devastatingly impacted by it,” State Health Commissioner Karen Shelton told Virginia Department of Health (VDH) staff last week. 

Drug overdoses are the leading cause of unnatural deaths in Virginia and illicit fentanyl is the driving force behind that. In 2022, more than 2,500 people died across the Commonwealth from drug overdoses. 

Illicitly – or illegally – manufactured fentanyl (IMF), a synthetic opioid, is a growing problem in Virginia and across the country. Fentanyl, whether it is made illegally or in a factory for medical purposes, is 50 times stronger than heroin and 100 times stronger than morphine. 

Virginia was making strides against drug overdose deaths, Shelton said. And then came COVID-19, which brought isolation, loneliness and fewer programs available to the people who needed them. 

And while some ground was lost during the pandemic, Shelton stressed that now is the time to gain it back by getting to work.  

Tuesday, May 9, is National Fentanyl Awareness Day, a time to learn more about opioids, overdoses and what you can do to help if you believe someone has overdosed.  

And there’s more that you can do.  

Learn the street names for illicit fentanyl:  

  • Apache  
  • Dance Fever 
  • Friend 
  • Goodfellas 
  • Jackpot 
  • Murder 8  
  • Tango & Cash 

Know the signs and symptoms of someone who has overdosed:  

  • Slow or no breathing 
  • Pale  
  • Clammy skin 
  • Unresponsive 

And learn what to do if you believe someone has overdosed:  

  • Call 911 
  • Give naloxone 
  • Provide rescue breathing  

Naloxone is a drug that temporarily reverses the effects of an opioid overdose – especially slow or no breathing. You may have heard of Narcan, a brand name for naloxone.    

You can learn how to give naloxone through the REVIVE training program, a Virginia Department of Behavioral Health and Developmental Services program taught by local health departments, and other public and private entities across the state.     

You can get naloxone without a prescription, but it may not be free. Contact your local health department to find out where to get naloxone free. You can also talk to your insurance company, your doctor and pharmacist to learn more.  

Shelton, a native Virginian and former health director for the Mount Rogers Health District, said her goal is to help give people the resources and tools they need to be able to combat the problem on a personal, local and state level. “Public health,” she said, “is a community effort.”  

To learn more about fentanyl and opioids, visit the VDH Opioid Homepage. To learn more about REVIVE training, visit the Department of Behavioral Health and Developmental Services REVIVE page. Visit www.fentanylawarenessday.org to learn more about National Fentanyl Awareness Day and how you can help.

COVIDWISE Exposure Notifications App to be Retired When the National Public Health Emergency Comes to an End

The Virginia Department of Health (VDH) announced today that the COVIDWISE Exposure Notifications App will be retired when the Association of Public Health Laboratories (APHL) disables the National Key Server as the National Public Health Emergency comes to a close on May 11.

More than 3 million users downloaded the COVIDWISE app and/or turned on COVIDWISE Express, an app-less version exclusively for iPhone users. COVIDWISE has alerted thousands of users if they have been in close contact with an individual who anonymously reported a positive COVID-19 test result. The app and COVIDWISE Express has used Bluetooth technology to quickly notify users likely exposed to COVID-19 with the goal of reducing the risk of infection and stopping disease transmission.

“COVIDWISE brought us cutting-edge technology as we responded to one of the biggest public health threats in modern times,” said State Health Commissioner Karen Shelton, M.D. “With this technology, public health agencies put information directly into the hands of citizens, providing them with a tool and information to protect themselves and others around them.”

The free COVIDWISE app, which launched in early August 2020, was the first exposure notifications app in the United States using the Google/Apple framework. No personal data has ever been collected, stored, tracked or transmitted to VDH as part of the app or Express version.

“We stated from day one that when COVIDWISE was no longer needed, VDH would take the app down,” says Jeff Stover, VDH Chief of Staff. “We are following through on that commitment to the public.”

COVIDWISE works across state boundaries, including Washington D.C. and more than 20 states that have similar exposure notification systems using the National Key Server. This has allowed users to receive exposure notifications from people in participating states or jurisdictions.

The app has been updated several times and has included options to help users find and schedule vaccine appointments and access other valuable vaccination-related information, including the user’s COVID-19 vaccine record.

Virginia’s public service video promoting use of exposure notifications, “Students for COVIDWISE,” won a silver Telly Award in 2021 and was nominated for two Emmy Awards in 2020.

When the app is disabled on May 11, users may simply delete it from their phones. COVIDWISE Express users can turn off exposure notifications in Settings.  Regardless, the Bluetooth technology that enables COVIDWISE to operate will no longer work for the app or COVIDWISE Express. The retirement of COVIDWISE does not impact COVID-19 surveillance activities, which will continue as part of VDH’s ongoing COVID response.

For more information on COVID-19 in Virginia, visit www.vdh.virginia.gov/coronavirus. To access your COVID—19 vaccine record, visit the COVID-19 Vaccine Record Request Portal.

Think you know about vaccines and childhood diseases? Test your knowledge with our latest quiz.

True or false: Children still receive the polio vaccine in the United States?  

If you said true, give yourself a gold star! In fact, the polio vaccine is on the Virginia list of School and Day Care Minimum Immunization Requirements

Polio is a disease that was eliminated in the United States with the vaccine, but still is a threat in other countries, according to the Centers for Disease Control and Prevention.  

Last week was World Immunization Week and National Infant Immunization Week. But it’s always a good time to talk to your healthcare provider and your child’s pediatrician about vaccines.  

It’s also a good time to test your knowledge of required vaccines for school and day care settings and diseases with associated vaccines that you may have forgotten about.

Take our quiz below to find out how much you know about the following diseases and vaccines, then check your answers below the quiz:


 

  1. Tetanus can be fatal without a vaccine.
    1. True
    2. False
  2. The Hepatitis A vaccine is not one of the school minimum immunization requirements in Virginia.
    1. True
    2. False
  3. What does DTaP stand for?
    1. Diptheria, Tetanus & Pertussis
    2. Diptheria, Tetanus & Polio
    3. Diptheria, Tetanus & Pneumococcal
  4. Hepatitis _____ is spread through blood or other bodily fluids and can be spread from an infected mother to child during birth.
    1. A (Hepatitis A)
    2. B (Hepatitis B)
  5. Rubella was once also called ______ measles. 
    1. Traveling measles
    2. German measles
    3. Eastern measles
  6. Pertussis is also known as:
    1. Ear, Nose and Throat Disease
    2. Breathing Fever 
    3. Whooping Cough
  7. Pneumococcal disease can infect the following parts of the body:
    1. Brain
    2. Lungs
    3. Ears
    4. Blood
    5. All of the above
  8. The MMR vaccine stands for Malaria, Meningitis and Rabies.
    1. True
    2. False
  9. Hib Haemophilus influenzae type b – can cause:
    1. Brain damage
    2. Deafness
    3. All of the above
  10. Chickenpox is also known as:
    1. Varicella
    2. Legionella
    3. Tarantella

 


 

Answers:  

1. True. The disease also can cause lockjaw and muscle stiffness. A vaccine for tetanus is included in the DTap vaccine.

2. False. Effective July 1, 2021, a minimum of two doses of Hepatitis A vaccine is required at Kindergarten entry. The first dose should be administered at age 12 months or older. 

3. A. It stands for Diptheria, Tetanus & Pertussis

4. B. The answer is hepatitis B. The Hepatitis B vaccine is part of the Virginia School and Day Care Minimum Immunization Requirements.

5. B. German measles. The vaccine for rubella is included in the MMR vaccine.

6. C. Whooping Cough. The DTaP vaccine includes pertussis and is part of the Virginia School and Day Care Minimum Immunization Requirements.

7. E. The vaccine is part of the Virginia School and Day Care Minimum Immunization Requirements.

8. False. MMR stands for Measles, Mumps & Rubella. The MMR is part of the Virginia School and Day Care Minimum Immunization Requirements.

9. C. The most common type of Hib disease is meningitis. The vaccine is part of the Virginia School and Day Care Minimum Immunization Requirements.

10. A. The vaccine is part of the Virginia School and Day Care Minimum Immunization Requirements.

 

Office of the Chief Medical Examiner Seeks Public Help to Identify Skeletal Remains

Yesterday, Virginia Department of Health’s (VDH) Office of the Chief Medical Examiner (OCME) released facial approximations of eight skeletal remains found in the Central Virginia region.  The facial images represent the eight men whose remains were found in separate locations between 1988 and 2020.

“Many of these cases have remained unidentified for decades,” said Lara Newell, the long-term unidentified coordinator for OCME. “The goal is to get the information and the likenesses out into the public in the hopes that they will be recognized, and eventually identified.”

The facial approximations were created from CT scans of the skulls and examinations of the remains by the FBI Forensic Anthropology and Forensic Imaging Units at no cost to OCME or law enforcement.

Photographs of the facial approximations have been entered into the case files of the National Missing and Unidentified Persons Systems (NamUs). NamUs is a web-based computer search engine funded by the National Institute of Justice to facilitate matching missing and unidentified persons.

Information on the unidentified individuals is as follows:

The skeletal remains of a White male, approximately 39-64 years old, were found in an overgrown area near a pathway in the City of Richmond on July 2, 2020. Cause and manner of death undetermined. The individual is approximately 5’2” to 5’7” in height and had healed fractures to nose, ribs and shoulder (clavicle). Fractures to nose would have caused deviation to the left. NamUs ID: 72826
The skeletal remains of a Black male, approximately 33-49 years old, were found in the rear yard of a residential area within the floodplain of the James River in the City of Richmond on March 7, 2016. Cause and manner of death undetermined. The individual is approximately 5’9” to 6’3” in height and had healed fracture of the right knee, may have walked with a limp/locked knee. May have been partially deaf in the left ear due to trauma (healing). NamUs ID: 14889
The skeletal remains of a Hispanic male, approximately 25-35 years old, were found in a wooded area in Highland Springs in Henrico County on January 28, 2014. Cause of death is homicidal violence of undetermined etiology, and the manner is homicide. The individual is approximately 4’8” to 5’3” in height and has had numerous dental restorations. NamUs ID: 12242
The skeletal remains of a Black male, approximately 50-70 years old, were found in an industrial area by construction crews in the City of Richmond on September 26, 2000. Cause and manner of death undetermined. The individual is approximately 5’2” to 5’9” in height and healed rib and lower left leg fractures. NamUs ID: 6148
The skeletal remains of a Black male, approximately 34-68 years old, were found in a residential area in the City of Richmond on October 23, 1995. Cause and manner of death undetermined. The individual is approximately 5’9” in height and had jaw fracture. NamUs ID: 903
The skeletal remains of a White male, approximately 45-65 years old, were found in a wooded area in Brunswick County by a hunter on January 1, 1990. Cause and manner of death are undetermined. The individual had healed facial and abdominal trauma, possibly from a car accident or another traumatic event, 15 years prior to death. NamUs ID: 6513
The skeletal remains of two white Hispanic males were found in a wooded area in Ruther Glen in Caroline County by hunters on November 10, 1988. The older male is approximately 35-45 years old and between 5’5” and 5’9” in height.  The younger male is approximately 17-25 years old and is approximately 5’6” in height.  DNA indicates a possible parent-child relationship. Cause death was blunt force injury to the head and the manner is listed as homicide. NamUs IDs: 6507 (older) and 6301 (younger)

The facial approximations are online at www.vdh.virginia.gov/medical-examiner/looking-for-a-missing-person/.

Anyone with any information about the possible identity of any of these cases is asked to call the Central District – OCME at (804) 786-3174 or email at OCME_CENT@vdh.virginia.gov.

Currently, Virginia has 224 unidentified remains statewide, with some remains dating back to 1948.

Governor Glenn Youngkin Announces a Commonwealth Milestone: Over 100 Doulas Certified a Year After the Establishment of the Commonwealth’s Certification Program

Governor Glenn Youngkin announced today that 107 individuals have become state-certified community doulas in the Commonwealth and are now providing services to Virginia’s women and their families. The achievement of this important milestone highlights the successful collaboration between the Virginia Department of Health (VDH) and the Virginia Department of Medical Assistance Services (DMAS) and comes just one year after VDH established the requirements for doula state certification on January 6, 2022, and the launch of the Virginia Medicaid Community Doula benefit.

Last week, Governor Glenn Youngkin was present at the grand opening of the new Urban Baby Beginnings maternal health hub in Petersburg. “I continue to be committed to improving maternal and infant health outcomes in the Commonwealth,” said Governor Glenn Youngkin, who was present at the health hub’s grand opening. “The new maternal health hub truly exemplifies the Partnership for Petersburg, bringing together many state and community partnerships to make this possible.”

The maternal health hub, located at 1965 Wakefield Street in Petersburg, VA, was created through a three-year, $825,000 grant from the Anthem Blue Cross and Blue Shield Foundation.

“As we prioritize maternal health from pregnancy to life with a newborn, the maternal health hub is a helpful resource for Virginia families, especially mothers,” said First Lady Suzanne S. Youngkin. “The Petersburg maternal health hub, along with several other hubs operating in the state, offer a community-based model of care to enhance maternal and child health outcomes.”

Urban Baby Beginning will support pregnant and postpartum mothers and offer supportive services to doulas. Currently there are 107 state-certified doulas within the Commonwealth, 57 of which are also Medicaid doula providers. Engagement efforts have been ongoing within the state to bring awareness about doulas, doula state certification, and the new Medicaid doula benefit.

“We must continue to build on our collective work to ensure mother and baby receive critical prenatal and postpartum care.” says Virginia Secretary of Health and Human Resources John Littel. “The wrap-around services and doula support provided by Urban Baby Beginnings will help ensure mothers and babies are healthy and supported.”

“Through the Partnership for Petersburg and the doula benefit, we have committed to enhancing access to care for the over 300 Petersburg women who give birth through the Virginia Medicaid program every year.” says DMAS Director Cheryl J. Roberts. “The Urban Baby Beginnings maternal health hub aligns well with these goals, and we are excited to continue to collaborate in providing services to this community.”

Doulas are trained, non-medical professionals who provide continuous physical, emotional, and informational support, including childbirth education and lactation support, to pregnant mothers before and throughout pregnancy, during labor and delivery, and up to one year after birth. Doulas also provide a connection to local community resources and referrals for health or social services such as food, transportation, and housing. The availability of state-certified doulas within the Commonwealth who are now eligible for Medicaid reimbursement means greater access to advice, care, and support with the goal of improving maternal and infant health outcomes.

“Doulas play an important role in supporting pregnant moms before, during and after delivery. Expanding the use of doulas across the Commonwealth will lead to improved birth outcomes such as lower preterm birth rates and other benefits including the reduced likelihood of a cesarean birth and higher likelihood of breastfeeding initiation,” said VDH Acting State Health Commissioner Parham Jaberi, MD, MPH.

To become a state-certified doula, individuals must complete all education and training requirements which include 60 hours of training in core competency areas and submit a state-certified doula application to the Virginia Certification Board (VCB). Doulas who become state-certified through the VCB are then eligible to apply to become Medicaid Doula Providers through the DMAS. Once approved, these providers can begin providing doula services to Medicaid’s 36,000 pregnant, and postpartum members.

Doulas have shared some of the reasons why they do this work is because it is “rewarding,” “powerful,” and “life changing,” and for the positive impact they feel they are having in supporting pregnant mothers before, during, and after delivery.

“We are pioneers. We are saving lives,” said Larissa Joos, a Medicaid Doula provider.

More information is available about doulas, the state certification process, and the Medicaid doula benefit, on the VDH website and the DMAS website.