Dovidjenja

Goodbye Croatia.

Sitting in the Zagreb airport awaiting our flight home. Our entire team has been very pleased with the success of our trip.

Last Night in Croatia

Our last night to a very successful trip. We have made connections and built relationships that will last for years. We are all very excited to have our new friends and colleagues come visit us in MN. We will be asking those of you reading this blog to join us in welcoming them and we are sure that as we have, you too will develop lasting friendships and professional affiliations. 

Zagreb

This morning we left the scenic slowed-pace beaches of Zadar and traveled to the capital city of Zagreb. The two cites have a very distinct look and feel. Zagreb is a busy urban city of approx. one million people with crowed streets and heavy traffic. One can clearly sense the energy of the city as celebrations are already underway to mark the occasion of Croatia joining the European Union, which officially occurs Monday. We've been cautious not to make much of the entree into the EU as it's been obvious it is a political issue here, with some people welcoming the new partnership and a larger role on the world stage, and others expressing some trepidation.

Soon after we arrived in the city we were welcomed to the national emergency management center (DUZS)'for a briefing about their system. This included a tour of the dispatch (112) center. A gentlemen from the US Embassy joined us for the meeting, and it turns out that he is from Woodbury MN, stationed here in Zagreb.

Afterward, two of our three Croatian hosts left to return to Zadar - a sad parting, as they have been so gracious to all of us. Tomorrow morning we'll leave Croatia to return home.

We look forward to our partners visiting Minnesota in September.

Farewell Dinner In Zadar

The Deputy Governor of Zadar County hosted our team for a farewell dinner this evening. As you can see we shared a meal and great conversation on the shores of the Adriatic Sea.

As has been previously mentioned, the sunsets of the Dalmatian Coast are among the most spectacular in the world, and tonight was no exception.

We are all feeling melancholy about leaving this beautiful place inhabited by such warm and genuine people. At the same time each of us are looking forward to returning home and seeing our own families whom we have missed.

We are already making preliminary plans to host an EMS team from Zadar in Minnesota come mid-September.

This has been an extraordinary experience. Tomorrow morning, it's a three hour drive on to Zagreb for a series of meetings. Then On Friday, Paris, Atlanta and Minneapolis.

The Pathology is the Same....the Umbrella's are Not

One of the things we have learned is that the pathology which Croatian EMS providers encounter is no different than what we treat in the US. However, the equipment used to treat patients is often quite different. For example every ambulance in Zadar has an advanced ventilator with a digital display. They can perform volume control ventilation in both assist control and SIMV modes. CPAP is also available but only for intubated patients as NIPPV masks are not routinely available. It turns out the Umbrellas are quite different too! The operation captured in the attached picture almost resulted in several "112" calls. Have you heard the joke " a doctor, an emergency manager and a hospital administrator try to put up a beach umbrella......"

Long Distance Transports

Just like in the United States the EMS transport times from the scene to a hospital can vary considerably throughout Zadar. One of the ways in which the Zadar EMS system addresses this variability in transport times is by adjusting the medications available to the physicians and nurses on the long distance ambulances. For example, EMS providers on the island of Preko have access to intravenous antibiotics including gentamycin which are not routinely available in other ambulances in the county. Research has demonstrated that the time to antibiotic administration in septic shock directly affects the mortality of the patients so decreasing the time to administration by providing antibiotics to front line providers in remote areas makes sense. This is but one of the many examples of things we have learned from our exchange which we may incorporate into our EMS practice back home.

Describing E.M.S. in the U.S.

On Monday afternoon a few of us had the opportunity to present how E.M.S. works in the U.S. and in particular, Minnesota. In attendance were nurses, technicians, and a physician from area ambulance bases in Zadar County. Those who were present were excited to learn about the similarities (and differences) that our two systems share, albeit from 5,000 miles away.

The presentation allowed for an idea on how the development of pre-hospital care in the United States came to be. Through the history of the first, "Battlefield Medic" and exposure to the Television show, "Emergency" with firefighter/paramedics, "Johnny and Roy", we also guided the presentation into our current system of operations and the ongoing development that the E.M.S. industry has experienced these past 40 years. Other topics discussed were definitions of EMT's and paramedics, along with the education requirements and scope of practice that each level of provider is allowed to perform under the direction of an emergency physician. The information was well received by all and brought about some fantastic observations that identified similarities and differences in our systems.

What was clearly apparent and unmistakably similar, was the desire to care for people; keeping them healthy, safe, and recipients of the best care that each of our services can provide to them. Within the room of the presentation, there was no doubt that we all recognized that we are members of a nobel and prideful profession. No matter the language that was spoken, or the land upon which we stood, EMS providers shared in a common bond that we will ALL forever hold in high regard.

Last night in Zadar

With one night left in Zadar, we are all reminiscent of the spectacular success of this event.

ZADAR EMS COMMUNICATIONS

One of the challenges faced by Zadar EMS is communicating between widely dispersed fixed medical stations and mobile ambulance teams. They do not have a county-wide EMS radio communications system, and currently rely on cellular telephones for much of the communications with their mobile ambulance teams.

Zadar County extends from the west to the east across the entire country of Croatia. The County's terrain is diverse, extending from coastal plains in the West, through fertile mountain valleys, across a high central mountain range, and on to the border in the East. Compounding this already challenging topography are more than 120 islands scattered off the coast of Zadar County.

Law enforcement uses a nation-wide TETRA radio system, consisting of a digital system in the 400 MHz band. TETRA is the European standard for digital radio systems. EMS, Fire, and Mountain Rescue agencies have not fully transitioned the system. Zadar County EMS plans to join the system in the future, and looks forward to having more reliable, consistent mobile communications after the transition.

Our Team Leader

Our team Leader Rick Larkin (St. Paul, Emergency Management Director) has done a tremendous job at being our diplomatic spokesman.  

Here Rick presents the chief of the Zadar Police department the City of St. Paul Coin.  Rick has done a great job at keeping us on task, and organized.  

Today we met with Mayor of Starigrad, who hosted us for lunch in a villa on the side of a mountain.  To describe it as amazing would be a gross understatement.

We have been treated so well here!!!    

MVA Drill

Today we had the opportunity to witness a multi-discipline exercise that involved all of the emergency response agencies of Zadar County - EMS, Fire, and Police.

The drill was staged just outside the Zadar County Team Two Site of Seline. They drilled a response to a simulated one-vehicle crash with one-patient. The terrain in this area includes winding two-lane switch-back roads packed with tourists on their cars, bicycles, motorcycles, and on foot - with absolutely no shoulder on the roads. It's not difficult to imagine such a crash occurring on roads like this.

Generally, the drill was very similar to what we might have seen the USA. Police arrived first with the ambulance right behind, followed by the fire department who took charge of the extrication. Procedures and techniques were nearly all very familiar to us American observers.

One key difference of course, is the fact that the women in the photo with the stethoscope around her neck is a physician, representative of their staffing model here. Everyone enjoyed being able to witness this drill.

Afterwards, we were treated to a tour of the near-by mountain rescue headquarters in a National Park. More on that below.

Croatian Mountain Rescue at Paklencia National Park

We are just returning from an amazing visit to the Croatian mountain rescue brigades at Paklenica National Park. This is an area where visitors from all over the world come to rock and Mountain-climb. Even with the use of appropriate safety harnesses, ropes and helmets there are still multiple injuries that this team encounters every week. Unfortunately they even had a fatality in the last week.

This team has taken some standard EMS equipment and modified it for better use in the unique environment in which they practice. For example they have modified a Stokes basket by breaking into two distinct pieces each of which can be carried by a single rescue climber. After reaching the patient the two rescuers can combine each of their pieces to form a single Stokes basket which is then used either to lower the victim to the ground or to attach to a helicopter pulley system and lift the patient up. These advanced technical rescuers apply their medical knowledge in an environment which contains unique challenges and operational hurdles. Their innovative approaches to addressing these challenges were impressive and we think there are aspects of their extrication systems which may have a role in our (very vertically challenged) EMS operations in Minnesota.

Operations

Greetings all!  We’ve spent a great deal of time to better understand the EMS system in Croatia.  We’ve discussed and continue to learn about their response system, procedures and protocols.  In some ways they have advantages over our system in the US.  The have national EMS legislation that drives what is being termed EMS reform.  This gives the leaders the ability to determine best practices and deploy them across the entire nation.  This will take a period of years, as the reform just began in 2009. 

 

We have seen some good equipment.  Having one voice for EMS across a country has tremendous strength.  They will be able to move quickly as they learn from successes and failures while they grow.  Imagine if EMS in the US began with things like good diagnostic equipment, GPS, strong physician leadership and a unified voice.

 

One striking difference is that they do not respond to all calls. In fact nearly 80% of callers do not get an ALS ambulance response. They might be referred to a wheel chair and/or general transportation option. Additionally, because they staff the ambulance with doctors, often citizens will simply show up at the all ambulance bases where a doctor can treat them right there is they choose to do so.  It would be like having a clinic at your base. 

 

You call an ambulance by dialing 194 for an ambulance or 112, which is a European standard for calling Police, Fire, or EMS.  194, in Croatia is a one call number for an ambulance.  Calls route to what would be similar to our PSAP, and then transferred to the ambulance dispatch.  So how can they not respond to all call?  Good question! 

 

The Croatians use a process similar to our EMD, where they question the caller.  If it’s determined that their medical condition doesn’t require an ambulance then they explain where they can go to get the help they need, and an ambulance is not dispatched.  They color code their responses, and if it’s a yellow or red the ambulance goes.  There are 10-ambulances for the Zadar County.  There are 21 Counties in Croatia.  

 

In the city of Zadar there are only 2 ALS ambulances for a population of just over 90,000.  I’m sure you’re scratching your head wondering how that’s possible.  We did too...  For you EMS folks, consider what our call volume would look like if we spoke to most of those that needed an ambulance?  Then triaged the calls, and only responded to what would be in our system would only be considered Delta or Charley calls?  It would be considerably less responses. 

 

We explained that in the US we have no choice, and anyone can call an ambulance for any reason and we must respond.  “Dr. Turbo-Skeeter” asked with a strong Croatian accent: (think Grew from Despicable me accent) “so, if I have a mosquito bite and I call an ambulance then you must take me to hospital?” We explained that although our crew may try and discourage such a request, if the patient adamantly wanted to go to the hospital, then yes we would have to do so!  Dr. Turbo said, “well that is stupidest thing I ever heard.”  We all laughed and agreed. 

 

As we continue to learn the operation we are looking for areas we can collaborate, and learn from one another.  They are a wonderful group of professionals here!    

 

 

This message contains information that is confidential and may be privileged. Unless you are the addressee (or authorized to receive for the addressee), you may not use, copy or disclose to anyone the message or any information contained in the message. If you have received the message in error, please advise the sender by reply e-mail and delete the message.

Zadar Police Department

Today we had the privilege of visiting the main Zadar Police Department headquarters. There are several different police agencies that respond to calls in the County of Zadar; however unlike law enforcement agencies in the US where responsibilities are divided by geography (local, sheriff, state patrol) the police departments in Croatia have their responsibilities divided by call classification. One type of department will respond to in progress crimes while another will function as more of an investigative unit for crimes which have already been completed. While the law-enforcement officers have access to firearms they may not carry them on their person at all times. In our discussions with both the medical and law enforcement professionals we have met here in Croatia, it appears that there is approximately one gunshot victim in Zadar county every three months. This is in contrast to the several gunshot victims who routinely arrive at regions Hospital every week.

A Sobering Reminder of the War

Looking out the main entry to the Zadar EMS Institute there is a home that serves as a reminder of their war. I look at this every time I walk out. My friend Zeljko Muic, when asked quickly dismissed it. I am not a weapons expert or a war damage assessor. In my opinion it may have been a RPG, Rocket Propelled Grenade hit.

Inter-facility Ambulance

Outside our hotel this morning an Austrian Interfacilty BLS Ambulance arrived to pick up an Austrian citizen who was to be repatriated back to that neighboring country.

The Austrian Ambulance Technician posed with Dr. RJ Frascone and Pat McCauley. The technician was very excited to photographed with the Americans and asked that we e-mail him the picture!

Team Station - Policnik

This is a picture of a team station. It is a little bit like a ambulance posting location. The difference is that there is a room there for the treatment of patients who walk up. The place is staffed by the ambulance crew( MD, Nurse, Driver), but that is all. If they are sent on a call (intervention), then the place is locked and there is no service for those who walk up.
Imagine waiting your turn and suddenly the whole team walks out to the ambulance and drives away. I guess your condition can wait longer.

If you look closely, you can see the credit card machine where you will pay for your non-urgent care. There is a list of conditions and treatments on the wall with their cost. If you really want to be seen for your sore throat, then you can pay cash or card.

Team Dynamics

Matt Simpson, Kevin Miller, Brian LaCroix and Dr. Paul Satterlee at a rest stop as we travel between two cities.

Generally, our days have been filled from wake up until well into the night. Our hosts are doing a great job at helping us gain a comprehensive appreciation for Croatian EMS, and Croatia itself. Team Leader Rick Larkin reminds us often of the need for Semper Gumby (always flexible). In what some might consider a challenging job, Rick has been skillful at leading a group of senior leaders from four different Emergency Service organizations. We are enjoying the camaraderie and spirits are high.

Sunday is our one and only free day. Some are seeking adventure and others simply looking forward to a little downtime.

Medicine as a career

I talked to one of our hosts for a while about the path that took him to EMS.
Medical school here is 6 years after high school. They are required to do an internship year and then they are free to work, or they can do a residency if they can find one. Dr. Kozar spent 3 years as a primary care physician in a small village but got frustrated with paperwork and the volume of patients he was expected to see. He decided to transition to the EMS role, which is traditionally done by new grads with very little experience.
He is going to apply for a spot one of the new EM residencies. I am sure he will get in, I just hope he will stay involved in the reformation of Croatian EMS.

I find it interesting that some of his concerns are the same ones doctors are facing in the US. Less time for patients, more focus on administrative work.

Food

The food here has been great. Our hotel has a great seafood menu for those who want it.
Our hosts have been treating us to wonderful meals with a lot of grilled meat, all kinds.
The fruits and vegetables are what you would expect to see in a mediterranean salad; cucumbers, tomatoes and olives.


prosciutto and goat cheese

Klamath Motovun

A group of A cappella singers called Klapa Motovun, fill a chamber with resonating voices in Roman ruins of Diocletian's Palace in the City of Spilt, Croatian.

The ruins of Diocletian's Palace, were built between the late 3rd and the early 4th centuries. The palace represents the most valuable example of Roman architecture on the eastern coast of the Adriatic.

Sent from my iPad

Croatian Ambulance Design

Croatian ambulances are a single chassis van design. There are three seats in the back, one at the head and two on the side. Unlike ambulances in the US there is no bench seat. One standard piece of equipment on ambulances in Zadar is a ventilator. Their specific model can preform standard volume control ventilation as well as SIMV and CPAP. There is a digital readout and easy to adjust parameters (TV, RR, I:E, pressure alarm etc).

Research in Croatia

Today we had the great opportunity to travel to the town of split in Croatia and visit one of the country's medical schools. Interestingly the medical school is starting a new curriculum that will be completely in English throughout all of the classes. This may present a very interesting opportunity for us to partner with our Croatian colleagues and share our training of medical professionals. In addition to the medical school there is also a nursing school radiology technology school and other allied health professions.

One of the most exciting things we learned on our visit to the medical school was that a main area of research focus is cardiac arrest resuscitation. This is our main area of research interest as well! Dr. Ivica Grokovic, Professor and head of the dept of anatomy is studying post conditioning in a myocardial infarction model in rats. Their model is very innovative and unlike any that we are currently using in the US. After inducing anesthesia they gain access to the heart from below by by opening the abdomen and incising the diaphragm. Dr. Grokovic then places a suture across the left anterior descending coronary artery inducing the heart attack. One of the unique aspects of this approach is that they are able to directly visualize the heart as it develops ischemia.

The specific aspect of ischemic post conditioning which they are studying is the use of isoflurane anesthesia as a myocardial protectant. This is a topic which has recently been gaining attention with the Minnesota Resuscitation Consortium right here at home! It was very exciting for us to learn that half a world away researchers are developing techniques and studying methods of saving patients which we too are focused on right here in Minnesota!

Our Host

Lt. COLONEL (retired Croatian Army) Željko Muić demonstrates his observance of the no smoking sign at the medical school in Split, Croatia. As you can see Željko is a very big man. Not many people tell him what to do.

Actually, Željko is a gentleman in every sense of the word and has been our primary contact and facilitator during this trip.

Croatian Fire Service

St. Paul Fire Chief Tim Butler, and Deputy Chief Matt Simpson visit with the chief of Zadar County Fire.

Croatian 911

Today, among things we visited the 112 Center (911) of Zadar County, Croatia.

Most of their challenges are universal. However, besides the landlines they have one additional unique and large problem to deal with.

Because a large portion of the county includes beautiful coastline and stunning islands, tourists from across Europe (Asia as well), flock her in droves during the months of June, July and August. In some places to population increases by ten-fold!

Talk about surge capacity! You can bet, most EMS professionals do not get a chance for vacation during these months.

A Sobering Reminder of the War

This fire department member is pointing out the red-zone on their computer aided dispatch system. This shows the areas where there are land mines left over from the war.

Few, if any American EMS providers have to worry about hitting a land mine on their way to call. Here, it's an everyday occurrence.

You Can't Escape Paperwork!

One of the many things we found we have in common with our colleagues in Croatian EMS is the need to complete paperwork. It seems that no matter where in the world you practice EMS or by what names you call your medications, a common need is to document what you do. In Croatian systems this occurs both on paper as well as on the computer. However, since the billing system is much different here there is less of a need to document specific components of an exam as there is in the United States. (ie 8ROS and 10 physical exam to bill a level 5 visit). The need to fill out paperwork on every patient you treat is a common frustration that we share with our EMS colleagues in Croatia.

Preko Ambulance and EMS Meds

June 21, 2013
I had the pleasure to spend a shift on an ambulance with Dr. Maia Tomic in the city of Preko, Croatia. This beautiful island is a 10 minute speed boat ride from the main city of Zadar. The ambulance assigned to the island is staffed by a MD/RN/driver combination. Unique to their care delivery model is the need to deal with the isolation that accompanies practicing EMS on an island without a hospital. When a patient needs to be transported to a hospital they are brought to the dock, placed on a medical speedboat and accompanied by the medical team to the mainland. During my shift we transported an elderly male with fever and abdominal pain.

The medications carried by the EMS team are quite different than in Minnesota. This is in part due to the physical isolation of the island and in part to the physician staffing of the team. Some drugs not found in routine practice in MN but common in Croatian EMS include aminophillin, verapamil, gentamicin and injectable toradol. Looking foreword to going to the division of mountain rescue next!

Sunset in Zadar

Alfred Hitchcock wrote that of all the places in the world he has visited, Zadar has the most spectacular sunset.  Many gather each evening along the Zadar coast to watch the setting sun.  It was indeed spectacular.  It is just one of many, many beautiful intricacies here in Croatia. 

 

 

This message contains information that is confidential and may be privileged. Unless you are the addressee (or authorized to receive for the addressee), you may not use, copy or disclose to anyone the message or any information contained in the message. If you have received the message in error, please advise the sender by reply e-mail and delete the message.

The Croatian Sensation

Dr. “Turbo – Skeeter”

Dr, Kosar is a pre-hospital emergency physician in Zadar, Croatia. His is an energetic, vibrant person who is keeping us laughing. With his involvement, the future of Croatian EMS looks very bright.

This message contains information that is confidential and may be privileged. Unless you are the addressee (or authorized to receive for the addressee), you may not use, copy or disclose to anyone the message or any information contained in the message. If you have received the message in error, please advise the sender by reply e-mail and delete the message.

Observations of the Physician's Role in EMS

In Croatia, the model of emergency care is different than what we see in the US and in other western countries. Here, there is a physician on nearly every ambulance. When they go to a scene with the nurse ( no paramedics here), they determine if the patient can stay home or needs to go to the hospital. It is very common for them to treat the patient, with a shot or wound care, and then direct the patient to a clinic the next day. If they decide to take them to the hospital, they go to a large compound where there is no "catch-all" emergency department. There are small areas in the internal medicine clinic, surgery clinic, gyn clinic, and peds clinic that are set up to see these patients.
The clinics are staffed by nurses and physicians of various specialties that commit to managing the clinic emergency patients in between their in-hospital duties.

The reform of EMergency Patient care has mandated the establishment of Emergency Departments like we are familiar with in the US. THe one in Zadar will open in September and this is where all ambulance patients will go.

This has caused some concern, because they will then allow patients to self report to the ED/Hospital. The process to date is that the patients can only cone to the hospital if they are directed here by their clinic, or by an EMS physician who has seen them via the ambulance.

They are moving towards a system more like ours, with patients reporting to a centralized ED, and yet, with our experience, we see the value of their current system where patients are triaged and treated outside the ED for minor concerns.

We can learn a lot from each other.

From one combat medic to another

A poignant moment last night when Lt COL. (Retired) Al Glass pinned Dr. Vlatko Grković, Deputy of Director of The Zadar EMS Institute with the Combat Medical Badge.

Al began his service to his country as a combat medic in Vietnam where he served two tours and was wounded in the 1960's. Dr. Grkovic served his country as a combat medic in the war here in the 1990's. More on that from Al and Vlatko later.

Thursday

Meeting with the officials of Zadar County

Impressions

Editor Comment: There are ten of us here in Croatia from four different EMS groups in MN. The posts you will see here are from all of us. We have taken the approach of sharing our story through our impressions - with the physicians generally commenting on clinical medicine, the operations leaders on ops, etc. That said, we are one team and if we slip into "first person" language consider it coming from the entire team.

Here are some initial thoughts.

Our hosts have been extraordinarily hospitable. We spent our first full of work day sharing information about their system and ours at day-long meetings at the Zadar EMS Institute. Zadar is on the Dalmatian Coast in the south-west part of the country. The weather is warm if not downright hot (30 C, mid 80's to 90 F). They tell us there are two climates in the country, continental in-land, and Mediterranean here on the coast where we are.

Our EMS systems are difficult to contrast directly because we are at such very different points in our development. However, we can tell you that while we are very proud of many aspects of our system in MN, we definitely have things to learn from our Croatian colleagues. I'll let our operations folks comment further but here's a few things to consider.

Emergency Medicine is relatively new to Croatia - which they call the land of 1,000 Islands (1,246 in fact) 67 of which are inhabited and need EMS services.

EMS is under a significant government reform - much of it sponsored by the World Bank following the war that took place here less than 20 years ago - more to come on that later. Before reform the Croatians themselves describe the system as "lousy". Good in big cities but disjointed with many left out, no standards or supervision. Administration Reform started 2009 - operational reform in 2011.

By our first accounts we can tell you that they have made great strides in a very short time. The system is governed by the Federal Government - the Croatian Health Ministry.

Staff members of the ambulance are primarily Physicians, and Nurses and medical technicians. They do not yet have a paramedic level of practitioner comparable to the US.

Emergency departments have not always existed within Hopsitals but are now being developed in all hospitals in the country.

Did you know the Dalmatian Coast is indeed associated with the spotted dog? St. Paul Fire Chief Tim Butler is trying to figure out how to get one in his suit case when we return home.

The Neck Tie was invented here, and the inventor Tesla is a national hero. And even though Leonardo Divinci is credited with making the first known drawing of the parachute, it was here in Croatia that was actually built and tested (no word on the EMS response that followed that first jump).

Our days ahead are filled with numerous meetings, discussions, tours and yes some fun like site sighting tours to the islands, 911 center (194 here in Croatia) and formal meetings with government leaders.

We are honored to be representing Minnesota and building stronger bonds with our Croatians colleagues as well as with our MN partners.







Sent from my iPad
This message contains information that is confidential and may be privileged. Unless you are the addressee (or authorized to receive for the addressee), you may not use, copy or disclose to anyone the message or any information contained in the message. If you have received the message in error, please advise the sender by reply e-mail and delete the message.

Croatian Exchange Plaque

Sent from my iPad using Mail+ for Outlook

The American Team

Zadar EMS Staff

Sent from my iPad using Mail+ for Outlook

Wednesday

Post

Wednesday, June 19, 2013
Greeting from Zadar of the coast of Croatia!

Earlier this year Rick Larkin, the Director of Emergency Management in St. Paul, Minnesota, invited a group of MN EMS professionals to be part of a professional EMS exchange in the county of Zadar in Crotia. We are very grateful to our generous Croatian hosts who will help us better understand the EMS system in this beautiful country on the Adriatic Sea. Our team includes:
Rick Larkin and Al Glass from St. Paul Emergency Management
Dr. R J Frascone, Dr. Arron Burnett, and Pat McCauley from Regions EMS
Chiefs Tim Butler, and Matt Simpson from St. Paul Fire Department
Dr. Paul Saterlee, Kevin Miller, and Brian LaCroix from Allina Health EMS

Over the next two weeks or so we will share our experience on this blog site. Thanks, we hope we enjoy!

Sent from my iPad
This message contains information that is confidential and may be privileged. Unless you are the addressee (or authorized to receive for the addressee), you may not use, copy or disclose to anyone the message or any information contained in the message. If you have received the message in error, please advise the sender by reply e-mail and delete the message.