Summer 2013 - California Ambulance Association

24 Pages·2013·1.98 MB·English

Get Ready for the 65th Annual Convention – Sept. 24-27
Summer 2013
EMS Documentation | Contractor Audits | Criminal Background Checks
Summer 2013
CAA Vision
Assure delivery of excellent pre-hospital care to the
people of California by promoting recognized industry Table of Contents
best practices.
CAA Mission 1 | Chair’s Message | Helen Pierson
• Serve as the voice and resource on behalf of 2 | Executive Director’s Report | June Iljana
private enterprise emergency and non-emergency
ambulance services. 4 | Legislative Update | Chris Micheli, Esq.
• Promote high quality, efficient and medically 6 | Member News: Governor Brown Announces
appropriate patient care. Appointments; Hall Ambulance Service Names New
• Advocate the value that pre-hospital care provides Director of Media Services
in achieving positive patient outcomes.
7 | EMS Law: California EMS System Data Development
• Promote effective and fiscally responsible EMS
and Core Quality Measures | Dana Solomon
systems and establish standards for system design.
8 | CAA Elections: 2013 CAA Elections –
Slate of Candidates and Candidates’ Statements
CAA Leadership
12 | Feature Article: Independent Contractor Audits Are On
Board of directors the Rise – What Can You Do to Protect Your Company?
| Krista M. Cabrera, Esq.
Chair | Helen Pierson
Vice Chair | Alan McNany 14 | Feature Article: EEOC Issues New Guidance on
Criminal Background Checks | Spencer Hamer, Esq.
Secretary/Treasurer | Eb Muncy
Directors | Richard Angotti | Bob Barry 16 | Feature Article: Pregnancy Disability Leave 101
| Edward Guzman | Fred Sundquist, Jr. | Mari Bradford
Sergeant-at-Arms | Josette Mani 17 | Feature Article: Onward to the Next Generation of
EMS Documentation | Jonathon S. Feit, MBA, MA
staff
18 | 65TH Annual Convention: Schedule and Registration
Executive Director | June Iljana | [email protected]
Administrative Director | Kim Ingersoll | [email protected]
Legislative Advocate | Chris Micheli | [email protected] Editorial Information
Program Director | Dana Solomon | [email protected]
Accountant | Tricia Schrum, CPA | [email protected] Theviewsandopinionsinthearticleshereinarenottobetakenasofficialexpressions
ofthepublishersunlesssostated. Thepublishersdonotwarrant,eitherexpresslyorby
implication,thefactualaccuracyofthearticlesherein,nordotheysowarrantanyviewsor
California Ambulance Association opinionsofferedbytheauthorsofsaidarticles.Manuscriptsandqueriesshouldbedirected
2520 Venture Oaks Way, Suite 150 toEditor,theSirenattheaddresslistedbelow.
Sacramento, CA 95833 © Copyright 2013 California Ambulance Association. No material can be reproduced without
[phone] (toll free) the express written consent of the publisher.
[phone] (fax) CirculationamongCalifornia’sprivateambulanceproviders,electedofficialsandEMSA
www.the-caa.org administrators.
The Siren | Summer 2013
Chair’s Message
Never a Dull Moment
in the CAA
The California Ambulance Another element of the Association’s
Association has been providing value is that of education. This requires
value and benefits to members since keeping a vigilant eye on activity within
its inception in 1947. At various times in the industry to spot trends and potential
our history we have had to devote more impacts, maintaining relationships with
or less effort to different aspects of the other industry stakeholders and regulators
association to keep up with the ever-evolving to ensure that we keep abreast of news
Helen Pierson | Chair of the Board tide of issues our members face. Whether and, of course, providing information to
it’s Medicare’s change in administrative members that may impact how they serve
contractors, applying or reapplying for their communities. Whether through
accreditation, bidding on RFPs, keeping up the Siren, through our newly re-designed
with advancements in technology or fighting website, through member updates and alerts,
for your cause at the Capitol, we truly never through webinars, or through meetings and
have a dull moment. conventions, our goal is to ensure that our
members know what is happening in EMS
The most significant benefit is our advocacy outside their own areas. Our Education
on behalf of the private ambulance industry. Committee, led by Chairperson Jimmy
The majority of our effort is devoted to McNeal, and greatly aided by June Iljana,
identifying and addressing local, state and Kim Ingersoll, and Jennifer Blevins, is
national regulatory issues that affect the putting the finishing touches on our Annual
ambulance industry. When policies are Convention with some great speakers and
proposed that will make it more difficult topics. I look forward to seeing you all there.
for ambulance companies to serve their
communities, as is very often true, we collect One of the less frequently mentioned
information and make our case against them. benefits of membership in the CAA is access
In addition, we identify needs within the to discounts through our affiliates program.
ambulance industry and work proactively to The CAA has agreements in place that offer
see those changes made for the benefit of our savings to our members and benefits to the
members and their patients. association. Since 1967, CAA members
have been offered a 20% discount when they
Whether we are sponsoring legislation or work with I.C. System, Inc. for receivables
participating in committees and taskforces management. In addition, Ninth Brain EMS
at the state level, we make sure the voice of Management Software offers a 10% discount
our industry is heard and the impacts on for new CAA-member customers. Many
our members are known by policymakers. more partnerships are under development
Oftentimes our advocacy is successful, and including savings on data service, fuel,
sometimes we return to fight another day. printing, insurance, travel and more. For
A huge thank you to CAA Legislative & more information on the CAA affinity
Agency Relations Committee Chair, Carol program, contact our Executive Director,
Meyer, and Legislative Advocate, Chris June Iljana. She will be happy to tell you
Micheli for their work in guiding us through how you can take part in or take advantage
the list of Senate and Assembly bills related of these great offers and get the most out of
to our business this year. your CAA membership.
California Ambulance Association | 1
Executive Director’s Report
CAA Board Votes
to Approve Changes
to Membership Categories
In a move intended to streamline the provide or bill for emergency transports
June Iljana | Executive Director
Association and focus on our core except when emergency transport is
mission to represent private-sector required due to disaster, mass casualty
ambulance providers, the Board of Directors or mutual aid request. Entities that join
has voted to approve changes to the CAA under this category will have a reduced
Bylaws affecting the membership categories. rate for dues. They will be able to serve
They are: on committees and a committee will be
created to address issues specific to their
• The Out-of-State membership has been needs, but they will not vote or hold
merged into the Associate Member office. Non-emergency providers will still
category with no change to status or have the option of joining the CAA as
benefits. active members to receive full voting and
office-holding privileges.  
• Not-for-Profit Public Ground
Ambulance Services have been removed • A new category of membership has been
from the Associate Member category. created for Public Agencies. They will
This language was confusing in that pay full dues and will have access to all
it required non-profits to be public information and discounts and they will
agencies to qualify. As always, non-profit be able to serve on committees, but they
ambulance services are invited to join the will not have a vote or hold office. This
CAA as Active Members with full voting is consistent with the CAA’s mission
and office-holding privileges. Most to represent private-sector ambulance
already opt to do this. services.
• County or regional EMS agencies have • There will no longer be an Honorary
been added to the Associate Member Membership. Instead, persons who have
category. We welcome local EMS rendered distinguished service to the
agencies to take part in the CAA to science and art of ambulance service, and
both provide and receive information whose names have been recommended
important to effective administration of by or to the Board of Directors and
the EMS industry statewide.   approved by a vote of 2/3 of the board,
will receive Emeritus Recognition.
• A new membership category for Non- They will continue to receive the Siren
Emergency Members has been created for and will be recognized in the annual
services that are authorized or certified
by their local EMS agency that don’t Continuedonpage3
2 | The Siren | Summer 2013
Executive Director’s Update
Continued from page 2
membership directory, however they of support and opposition we’ve done this Alerts are posted for review.   In addition,
will not be members of the Association year.  We’ve also created a comprehensive we have added buttons enabling visitors
and won’t have a vote. They have the “Committees” section with a page for to send us comments, subscribe to our
option to join the CAA as an associate each committee including minutes of mailing list for general information, and
or active member if they are working past meetings for the past year or so and a link directly to the CAA Facebook page
in the ambulance industry and wish to upcoming agendas as available. In addition, where we post information of interest to
participate more fully in the CAA.  all past Member Updates and Member ambulance service providers.
All of these changes will be implemented
immediately for new members and in
January for renewing members. As always,
prospective members of the CAA are
reviewed by the Ethics & Professionalism
Committee which makes a recommendation
to the board for approval. We will be
contacting those who are affected by these
changes over the next several months to
facilitate the transition. The revised bylaws
have been posted on the CAA website.   
CAA Website is Up-To-Date
and More Useful Than Ever
Speaking of our website, if it’s been a while
since you looked at the CAA website, it’s
time to visit. We’ve renovated to make it
more organized, more updated, and more
useful. We’ve added industry news that
will be updated as frequently as news is
available. In the member’s only section
of the website, we’ve added a list of bills
the CAA is watching along with status,
summaries and links, plus all of the letters
CAA Statement on “Periodic Intervals”
for Ambulance Provider Contracts
The Board of Directors of the California Ambulance Association Health & Safety Code Section 1797.224, regarding competitive
has approved the following statement as the official position of processes, that the local EMS agency retain authority for
the CAA regarding the “periodic interval” for competitive processes contracting in a way that, consistent with state law, best supports
as required by Health & Safety Code Section 1797.224: the goals and needs of the local EMS system and effectively meets
the needs of the persons served. Therefore, CAA does not support
“The California Ambulance Association believes the state establishing a universal regulatory time limit on local contracts
Emergency Medical Services Authority has an important role in but rather supports counties determining a contract duration or
oversight of local competitive processes for emergency ground periodic interval that most responsibly meets the needs of their
ambulance transportation services to ensure that those processes system, provides for competition, and ensures that providers will
support further development of an integrated statewide EMS be encouraged to invest in infrastructure improvements that are
system, as is consistent with their legislative responsibility. However, necessary to produce improvements in service delivery and quality
the CAA believes it was the intent of the legislature in creating patient care.”
California Ambulance Association | 3
Legislative Update
Still a Long Way to Go
Chris Micheli | CAA Legislative Advocate
The CAA has been busy on behalf of sustained great bodily injury as a result of to have the bill provide some level of
the membership in the legislative conduct arising out of and in the course immunity to employers when an employee
and regulatory arenas during the of the police, sheriff, fire department, or provides voluntary emergency medical
first half of 2013 and we expect continued emergency medical service dispatch. This services, including, but not limited
activity through the Fall to conclude the bill would require, upon conviction, to, cardiopulmonary resuscitation, in
2013 Legislative Session.  There have been that the person shall also be liable for response to a medical emergency.
many bills and the state budget activities all reasonable costs incurred by any
that have consumed our advocacy efforts unnecessary emergency response. This AB 902 (Gaines)
in Sacramento and we have worked bill would exempt from its provisions Existing law requires a person driving
diligently to promote and protect CAA’s telephone calls made in good faith. CAA a vehicle on a freeway approaching a
members’ interests. has been supporting this bill because stationary authorized emergency vehicle
the author agreed to our requested that is displaying emergency lights, a
amendment to include EMS providers in stationary tow truck that is displaying
Medi-Cal Provider Rates
the bill. flashing amber warning lights, or a
As in the past few years, our primary focus stationary marked Department of
this spring has been on efforts to increase AB 355 (Cooley) Transportation vehicle that is displaying
Medi-Cal provider rates. This issue has had Existing law establishes the Emergency flashing amber warning lights, to
its ups-and-downs this year because of the Medical Services Authority in the Health approach with due caution and, before
legal, legislative and budgetary hurdles. For and Welfare Agency to administer passing in a lane immediately adjacent
example, the federal courts have effectively a statewide system of coordinated to one of those specified vehicles, absent
upheld the State’s 10% provider rate emergency medical care, injury prevention, other direction by a peace officer, either
reduction. Anticipating this outcome, we and disaster medical response. CAA proceed to make a lane change into an
joined a large coalition of providers pushing is supporting this bill to appropriate available lane not immediately adjacent
for AB 900 (Alejo) and SB 640 (Lara). Both $1,000,000 from the General Fund to to one of those specified vehicles, or slow
of those measures had specific language to the EMSA to continue the Mobile Field to a reasonable and prudent speed that
prevent the 10% provider rate reductions Hospital program. is safe for existing weather, road, and
from taking effect. We anticipated that vehicular or pedestrian traffic conditions,
these measures would lead to serious as specified. CAA is supporting this bill
budget negotiations to reverse or mitigate AB 633 (Salas) to increase the fine for a violation of this
those rate reductions. Unfortunately, the Existing law provides that a health care law to a fine of not more than $100.
Administration’s strong opposition derailed provider is not liable for professional
these efforts to stop the provider rate negligence or malpractice for any AB 911 (Bloom)
reductions. We will work with DHCS on occurrence or result solely on the basis The Warren-911-Emergency Assistance
implementation of these reductions. that the occurrence or result was caused Act requires every local public agency
by the natural course of a disease or to establish and operate a telephone
condition, or was the natural or expected system that automatically connects a
Legislation
result of reasonable treatment rendered person dialing “911” to an established
AB 47 (Gatto) for the disease or condition. CAA has public safety answering point through
Under the bill, the person responsible for been working for several months with normal telephone service facilities. CAA
a “swatting” call is guilty of an offense the author, opposition, several provider is supporting this bill which would,
punishable by a fine not exceeding groups, the Civil Justice Association, and commencing January 1, 2019, establish
$10,000, by imprisonment in a county the California Chamber of Commerce
jail not exceeding one year, if any person on amendments to this bill, in order Continued on page 5
4 | The Siren | Summer 2013
Legislative Update
Continued from page 4
various requirements regarding 911 to exercise the option to rescind the EMS providers in this state. This bill
emergency call technology that would contract. would prohibit a person, firm, corporation,
be applicable to operators of multiline or association that is a nongovernmental
telephone systems (MLTS). SB 191 (Padilla) entity and contracts to perform labor or
Existing law establishes the Maddy services for a public entity from displaying
AB 1333 (Hernandez) Emergency Medical Services Fund, and on a vehicle or uniform a seal, emblem,
Existing law authorizes the legislative authorizes each county to establish an insignia, trade, brand name, or any other
body of a city, county, or district to EMS fund for reimbursement of costs term, symbol, or content that reasonably
enter into contracts for various services. related to EMS. Existing law, until could be interpreted as implying that the
CAA actively opposed this bill and January 1, 2014, authorizes county boards labor or services are being provided by
helped defeat the measure in the Senate of supervisors to elect to levy an additional employees of the public agency, unless the
policy committee. It would have penalty, for deposit into the EMS Fund, in vehicle or uniform conspicuously displays
required a contract or memorandum of the amount of $2 for every $10 upon fines, a specified disclosure.
understanding with a total annual value penalties, and forfeitures collected for
of $250,000 or more between a private criminal offenses. CAA is supporting this
party and a city, county, city and county, bill to extend the operative date of these
or district that contains an automatic provisions until January 1, 2021.
renewal clause, the legislative body of the
city, county, city and county, or district SB 556 (Corbett)
to, on or before the annual date by which CAA has been working in opposition
the contract may be rescinded, adopt a to this bill because it would impose
resolution that either exercises or declines unnecessary costs and burdens on private
— Thank You Sponsors —
California Ambulance Association | 5
Member News
Governor Brown Hall Ambulance Service
Announces Appointments Names New Director of
Media Services
Dan Burch, 47, of Turlock, has been appointed to the California
Commission on Emergency Medical Services. Burch has been Mark Corum Brings Wealth of
administrator at the San Joaquin County Emergency Medical
Experience to New Position
Services Agency since 2005. He was a coordinator at Tuolumne
County Emergency Medical Services Agency from 1997 to 2005
and a quality improvement coordinator at the Alpine, Mother Lode,
Hall Ambulance Service Founder and President, Harvey L. Hall,
San Joaquin Emergency Medical Services Agency from 1991 to 1997.
is pleased to announce the appointment of Mark Corum as
Burch was a hospital corpsman 3rd class in the United States Navy
Director of Media Services.  Under this newly developed position,
from 1984 to 1986. He is president-elect of the Emergency Medical
Corum will take responsibility for carrying out Mr. Hall’s vision
Services Administrators’ Association of California. This position
with respect to Hall Ambulance’s media relations and internal/
does not require Senate confirmation and there is no compensation.
external communications effort. 
Burch is a Republican.

Corum brings over 25 years of media and strategic communications
David Rose, 48, of Livermore, has been reappointed to the
experience to his position including advertising, graphic arts, web
California Commission on Emergency Medical Services, where
design, and media relations. 
he has served since 2010. Rose has served in various positions at
the Santa Clara County Fire Department since 1991, including
Corum previously served 12 years (1996-2008) as Hall Ambulance’s
fire captain-paramedic. He is a member of the California
Public & Media Relations Director, where he received nationwide
Professional Firefighters and is a former president of the Santa Clara
recognition for his passion to tell the story of emergency medical
Firefighters, IAFF Local 1171. This position does not require Senate
confirmation and there is no compensation. Rose is a Democrat. services.  This devotion led to him being honored with the County of
Kern EMS Department’s Outstanding Performance in EMS Award
Eric Rudnick, 52, of Red Bluff, has been reappointed to the in 2007. 
California Commission on Emergency Medical Services, where
he has served since 2010. Rudnick has been medical director at In 2008, Corum ventured out on his own to start a communications
Northern California Emergency Medical Services Inc. since 2010 business serving a select clientele that included Hall Ambulance
and a consultant at the Rural Response Group since 2008. He has Service, several ambulance companies outside of Kern County, and
been medical director at the Santa Clara County Emergency Medical a few public safety associations.  He also worked as a consultant for
Services Agency Division of Public Health and an independent the California Ambulance Association (CAA) where he coordinated
emergency medicine consultant since 2005. Rudnick served in state-wide media coverage of the Association’s Annual Stars of Life
multiple positions at Shasta Emergency Medical Group Inc. at the St. event; and produced the Siren newsletter.
Elizabeth Community Hospital from 1996 to 2004 and at the Mercy
Hospital Medical Center from 1993 to 2004. He is a member of the “I am honored to be given the opportunity to return to Hall
Emergency Medical Directors Association of California. Rudnick Ambulance Service, where I will be responsible for promoting and
earned a Doctor of Medicine degree from the Medical College of protecting the Hall Ambulance Service brand throughout Kern
Wisconsin. This position does not require Senate confirmation and County.”
there is no compensation. Rudnick is a Democrat.
Founded in 1971, Hall Ambulance Service, Inc. is the 9-1-
1 paramedic provider of emergency medical services of these
Pending Members incorporated cities: Arvin, Bakersfield, California City, Maricopa,
Shafter, Taft, Tehachapi, and the communities of Lamont, Frazier
Park, Mojave, Rosamond, and Boron.
Ramos Oil Co., Inc. Mercy Ambulance
Cover photo credit: Mark Corum, Hall Ambulance Service, Inc.
Commercial Member Active Member
Hall Ambulance Service, Inc. provides emergency medical
transportation services for 87% of Kern County, California,
Comments or questions about membership applications
including: 9-1-1 paramedic provider, critical care transport, and
should be directed to: Kim Ingersoll: [email protected].
air ambulance services.
6 | The Siren | Summer 2013
EMS Law
California EMS System Data Development
and Core Quality Measures
Dana Solomon | CAA Program Director
The California EMS Authority nation and serves as the primary impact of vendors are already preparing for
(EMSA) is charged with collection this project.” NEMSAS 3.3.1. This year we hope to
and evaluation of statewide have several vendor’s at our California
prehospital care data (CCR, Title 22, Div. The California Ambulance Association Ambulance Association Convention in
9, Ch. 4, Section 100147, 100169, 100170). was an active participant in this process September in Anaheim.
EMSA is required to assess each EMS area, as a member of EMSA’s Core Measures
• Be sure you and your LEMSA are on
utilizing regional and local information, Task Force consisting of prehospital EMS
the same page. I can’t stress enough
for “the purpose of determining the need providers, medical directors, local EMS
how important this is! Remember, they
for additional emergency medical services, agencies, hospitals and EMSA staff. The task
are working through some adjustments
coordination of emergency medical services force was asked to:
and upgrades as well.
and the effectiveness of such services” (HS
1. Assess the capacity of the California
1797.174). The LEMSAs are required to • Make sure that you send your Clinical
Emergency Medical Services
plan, implement, and evaluate their local Care Coordinator, Quality Assurance
Information System (CEMSIS) to
systems (HS1797.204). LEMSAs must Officer or whomever is responsible for
deliver core performance measures.
submit data annually to EMSA as part your data collection and submission
of their EMSA-approved EMS Quality 2. Create a formal data system profile and to one of several data system change
Improvement program. written analysis to identify areas for rollout sessions in September. These are
data quality improvement and form an the dates and areas so far.
In April 2012, EMSA received a grant from action plan to address the issues.
the California Health Care Foundation to 3. Work to reveal opportunities for San Francisco > Thursday, September 5th
review the existing California Emergency both short-term and long-term data Sacramento > Monday, September 9th
Medical Services Information System improvement plans. San Diego > Wednesday, September 11th
(CEMSIS), develop a set of EMS Core
4. Focus on achieving reliable measures Los Angeles > Thursday, September 26th
Measures, and engage local EMS agencies in
that are high value and feasible within a
working towards uniform reporting metrics. Bakersfield > Monday, September 30th
short-term time frame.
The timeline for completing the grant project
was one year plus a three month extension 5. Define and publish core measure sets for, EMSA will also attempt to have one, along
granted by CHCF to enable more LEMSA’s clinical, response and transport for the the central coast and another in Northern
to submit data. The final report was due to entire state of California. California. Specific times and Locations
CHCF by July 31, 2013. 6. Submit data to the National EMS will be posted on the EMSA website.
Information System (NEMSIS)
“This process has allowed EMSA to make Finally, when you review the final report
7. Conduct three training workshops for
short and long term changes to our EMS to the California Heath Care Foundation,
LEMSAs, EMS providers and Vendors.
data and information, to begin moving remember the data collected was all
towards implementing new National EMS retrospective and collected in a variety of
How can you make sure that the
Information Systems (NEMSIS) data different ways. Thus, it is very difficult to do
information gathered in your response area
standards, and to position EMS to meet any kind of verification or comparison with
is accurate?
the challenge of integrating with electronic this retrospective analysis. The goal here is to
healthcare information systems,” said EMSA • Electronic Pre Hospital Care reports have everyone on the same page, submitting
Chief Deputy Director Dan Smiley. “The (ePCR). If you are still using the hand the same data, using the same core measures
development and implementation of EMS written PCR, you will need to upgrade and doing it in a much timelier manner.
Core Measures was the first of its kind in the or continue to fall behind. Most ePCR Please be proactive in this endeavor!
California Ambulance Association | 7
CAA Elections
2013 CAA Elections
Slate of Candidates
CAA active members have received
their official ballots for the 2013-2014
California Ambulance Association California Ambulance Association
elections. Active members are eligible to 2013-2014 CAA Elections
vote for candidates seeking election as
Officers of the Association, Directors of — SlAtE of CAndidAtES —
the Board and members of the Ethics &
Professionalism Committee. NomiNees for the Board of directors
(four positions, two-year terms):
In accordance with the bylaws, elections
are conducted by mail only no later Helen Pierson Medic Ambulance Service, Inc. Vallejo, CA
than August 27, 2013 with any ties being Alan McNany American Legion Post #108 Sutter Creek, CA
broken by the Active membership in Ambulance
attendance at the Annual Membership Richard Agotti St. Joseph’s Ambulance San Rafael, CA
Meeting that will be held on September Service
26, 2013 at the Disneyland® Hotel, Bob Barry Care Ambulance Service, Inc. Orange, CA
Anaheim, CA. This gives every active
member the opportunity to exercise
their right to vote whether or not they NomiNees for the ethics &
are present at the Annual Membership ProfessioNalism committee
Meeting. (two positions, two-year term):
Byron Parsons First Responder EMS, Inc. Chico, CA
We encourage you to review the
enclosed statements prior to making Rick Roesch Mercy Medical Transportation, Mariposa, CA
Inc. & &
your decision. McCormick Ambulance Hawthorne, CA
NomiNees for officer PositioNs
Following are nominees for election (one-year term for each position):
to serve the CAA during its 2013-
2014 operating year. Candidates CHAIR:
were formally ratified by the Board of *Helen Pierson Medic Ambulance Service, Vallejo, CA
Directors during a conference call held Inc.
on August 22, 2013. Results will be
VICE CHAIR:
announced during the Annual Meeting *Alan McNany American Legion Post #108 Sutter Creek, CA
of the Membership which will be held on Ambulance
September 26, 2013 at the Disneyland®
Hotel, Anaheim, CA. SECRETARY/TREASURER:
*Eb Muncy Desert Ambulance Service Barstow, CA
* Must be elected to the Board of Directors to be qualified to hold the position of
officer of the Board of Directors.
Thank you for your time and
participation in the CAA!
Continued on page 9
8 | The Siren | Summer 2013