Medic

[N Harmon]

As a final thought, I do not see cap needing people certified beyond first aid through CAP since there is a definite policy against cap members performing schedule aid stations, or rending other then life saving first aid.

Is this true? I am quite sure I read in our MOU with the American Red Cross something about CAP agreeing to provide personnel to man aid stations under ARC supervision.

edit:
According to National Headquarters, "The MOU with the American Red Cross expired 07 May 2002 and has not been replaced. Historically, most if not all mission support for the ARC has been through state and federal missions and existing mechanisms for employment. We expect that will continue into the future. Both organizations hold one another in great esteem and serve America well without an MOU."

[JayT]

Here's a question: does CAP consider an EMR an EMT? Some paperwork I've dealt with for my state and nremt licensure have referred to it as EMT-FR... not trying to push the limits, just curious. My assumption is no, but maybe others have dealt with this before.

It's really not considered an 'EMT' in most states. Depending on the state, the CFR-D/EMR may not even be commonly taught. Around Long Island, the only time they really run the class is before the FDNY Academy class goes in, because it's a requirement upon entry.

[Krapenhoeffer]

Be careful with the ARC Emergency Response class. In my neck of the woods, legally, it's just Super Advanced First Aid (now with BP, Oral and Nasal airways, and packaging!).

There are some things that I've heard of Cadets being taught that just frightens me. From what I understand, AL wing teaches Cadets how to "properly" use a C Collar.

About a day later (this was at NESA), these cadets when faced with the scenario "My plane crashed, and I'm cold and I'm thirsty. Also, I'm pale" they gave the simulated patient something to drink.

IMHO, having Medical First Responders (or above) in CAP serves a good use in CAP. First, they can recruit more EMTs for the local Vollie Bus. And, they can keep the Basic First Aid people from doing incredibly stupid things.

[sarmed1]

From what I understand, AL wing teaches Cadets how to "properly" use a C Collar.

you know its not like it requires a degree in rocket science....

Also, I'm pale" they gave the simulated patient something to drink.

I alsways love this one; can anyone explain to me why its a bad thing.  As a blanket statement to cover the least competant or lowest trained provider I understand.  Sure there are a few instances where you may be compounding the problem:  abdominal injury where stomach contents or intestinal contents may be leaking interanlly; adding increased volume or pressure there could worsen the injury.  Impending surgical intervention you want to avoid something in the stomach that may come back out under ansthesia.
Current military doctrine allows oral rehydration for traumatic injuries if there is a reasonable anticipation of delay to surgical intervention (just as there would likely be in a plane crash scenario).  So to me this is not the absolute no no it once was.... (just like tourniquets, c-spine clearing in the field etc etc)

mk

[SARTAC Medic]

Cap will never be an EMS agency. 

Even if they did, they would need a national level medical director to cover the protocols needed, and there would need to be local medical direction for the field providers.   

Seeing as the country as a whole cannot get their heads out of the ground when it comes to a national level of EMS certification (NREMT aside, which still cannot let you be portable across state lines) I think trying to make CAP members anything other then advanced first aiders is a moot point.

I can see however, having a cap specialty rating as a "field medic" or some other term that will not twist knickers which is essentially a standardized first aid program with some wilderness/remote aspects incorporated.    As far as ground teams goes, this would be compatible with wilderness search and rescue AND some of CAP up coming (in my opinion) disaster relief role as pertains to natural disasters.   There is no reason why a cap ground team cannot be deployed to assist the red cross in an area where a tornado, hurricane, or other natural disaster has hit to do damage assessment and other CERT type missions.   

As far as cervical collars goes.... I see no reason to not include proper training in this.  Even if we are not transporting or moving patients there is no reason we cannot give members training to help limit morbidity of crash victims or other aided cases we may find during cap missions.   A ground team out on a ramp search who comes across a car accident could potentially cause more damage trying to "help" the victims then if they were properly trained to hold stabilization until rescuers respond. 

Being pale, does not alone indicate being in a state of profound hypo-perfussion.     The only reason we are trying to limit oral intake on a "shock" patient is so they do not aspirate their gastric contents if they vomit, and to allow them to be rushed into surgery if needed.   With that said, if someone in a crash is compensating decently with their low level hypo-perfussion, why let them die of dehydration awaiting rescue 4 hours away.   

I know this is a hot button issue with all the EMS and fire people out there, so Im going to not get on a soap box here (or step down if I have stepped up).

[N Harmon]

Cap will never be an EMS agency. 

Never? Ever? Not in a thousand years? That's a mighty definitive statement you're making.

I think it is safer to say we will not be an EMS agency for the foreseeable future, barring any major nation-wide changes to our mission and/or structure.

[SARTAC Medic]

Im going to stick by my "never ever" policy.

But i will conceid that CAP may eventually have some sort of standardized field medic program. 

The main obstacle i forsee is a lack of standardization nationwide in the current EMS system.  Its not like cap could say "OK Folks, If you are a certified EMT outside of CAP you can apply to be an EMT for CAP." There simply isnt a homogeneous system in place for EMT training. 

Also, anyone in EMS knows that even BLS providers operate under a medical director.  I also cannot forsee CAP getting a medical director who will allow sooooo many EMT's to operate at large without a massive nation wide academy for EMT's.  This is why I think that CAP may choose to have a standardized First Aid Program based on some of the already nationally recognized First Aid Program.  The one problem with this is that in some areas of the country it is difficult, if not impossible to find one of the "alphabet" oranizations.   American Red Cross (ARC), American Heart (AHA), National Safety Council (NSC), etc....  We would need a mass instructor train the trainer course so each wing would have instructor trainers, who then would have instructors trained at the local level, who woudl finally train the local members to be providers.   CAP could become a national training organization for any of the groups, much like NOLS has nation wide centers.   

Another option i forsee is a splintered program where national recognized the need for BLS (maybe) and allows members who are doctors to sign a crap load of forms to be local medical directors and then authorize their local members to operated under that medical director with a specific set of BLS protocols (maybe a national set, which can only be used if there is a medical director)   I think that these protocols would be simple... Bleeding control, splinting, spinal immobalization, stuff along those lines.     

ALS protocols are waaaaaaay down the road if this were to even come to fruition.   There are loads more considerations what i dont think will ever never ever never, allow cap to be an ALS program...

[Major Lord]

From what I understand, AL wing teaches Cadets how to "properly" use a C Collar.

you know its not like it requires a degree in rocket science....

Also, I'm pale" they gave the simulated patient something to drink.

I alsways love this one; can anyone explain to me why its a bad thing.  As a blanket statement to cover the least competant or lowest trained provider I understand.  Sure there are a few instances where you may be compounding the problem:  abdominal injury where stomach contents or intestinal contents may be leaking interanlly; adding increased volume or pressure there could worsen the injury.  Impending surgical intervention you want to avoid something in the stomach that may come back out under ansthesia.
Current military doctrine allows oral rehydration for traumatic injuries if there is a reasonable anticipation of delay to surgical intervention (just as there would likely be in a plane crash scenario).  So to me this is not the absolute no no it once was.... (just like tourniquets, c-spine clearing in the field etc etc)

mk

In many ways, its misleading to compare military protocols to civilian protocols. Civilian EMS is married to the "Golden Hour" where timely  Pre-Hospital care and rapid transport is known to result in significantly higher shock/trauma survival rates. I think that the idea of keeping trauma patients NPO stems from the old days, when adding water to your guts just made the the fluids migrate even more efficiently through the peritoneum. This resulted in a blanket order for nothing by mouth the only sensible thing to do in penetrating peritoneal or thoracic injuries ( typical war wounds) To give water (beer, whiskey, gatorade or anything else) to a patient with a hole in their trunk is just an awful idea.

So now the question of why not give a drink to a person who in the described scenario gave a text-book signs and symptoms description of shock? Partially, for the reasons above, i.e, transporting fluids around and reducing the survivability of the patient due to peritonitis. The nature of a high impact event like a plane crash ( the Mechanism of presumed injury) suggests a high likelihood of internal injury, so shock protocols are prudent. (especially since your patient was kind enough to read you their triage tag for the exercise) Secondly, giving shocky patients anything by mouth will almost certainly result in vomiting, especially when they have a gut injury. Naturally, this will also happen as their level of consciousness declines, so you will now be left with a patient who will almost certainly aspirate their vomitus. ( your water plus stomach contents, blood, other icky fluids) This leaves you with a patient who will require airway management, taking one EMS provider out of the game and unable to deal with other patients.

In the military pre-hospital care environment, treatment may be delayed past the point of a rational expectation of survival. If so, I suggest you euthanize your patient with morphine or a pistol rather than drowning them with your canteen. Giving water to a patient who is in shock, will probably require surgical intervention, or require advanced airway management is just a bad idea. That is why you learn to start IV's. Making a judgment call in the field  to give water by mouth is one that is unlikely to help the patient, and will be one you will have to live down if things go wrong, and defend even if everything goes right.

Major Lord

[Eclipse]

Cap will never be an EMS agency. 

Never? Ever? Not in a thousand years? That's a mighty definitive statement you're making.

Never.  Ever.  Never.

[Larry Mangum]

Another side tracked topic.  A cadet asked a question concering the wearing of a badge and about a position that does not exist. NESA does not have a medic couse, it simply offered a wilderness first aide course.

[Krapenhoeffer]

Honestly, the "golden hour" will still apply to any patient we likely stumble across.

I don't know about where you live, but where I live, the Flying Bus is only half an hour away (at max) at any given point in the State, and they carry heavy rescue equipment on-board...

I can say for certain that CAP will never ever be a ALS provider... I mean, you can't provide ALS to civilian standards without a rig. However, I wouldn't mind seeing individual wings certified to the EMR-FR level, provided that those First Responders have their own insurance...

[Eclipse]

Honestly, the "golden hour" will still apply to any patient we likely stumble across.

How do you figure?  We don't even deploy within the golden hour.

It starts when you get injured, not when the ES resources are called, and in most of our searches, ground or air,
it takes longer than that just to decide CAP will be involved.  Even during SARSAT days it was usually at least two passes
before AFRCC would start waking people up.  That's 2-4 hours, easy.

[Krapenhoeffer]

Precisely.

Any patient we have will likely be part of our own teams.

A plane crash victim is either 1) walking wounded or 2) deceased by the time we reach them.

Second: The Golden Hour, isn't. Basically, it's a phrase that sounds cool (and is misunderstood by everyone), that means "shortest amount of time possible."

[Eclipse]

For some of our pilots, the golden hour refers to how long they can fly before they have to go potty...

[Krapenhoeffer]

... Which is why the Jumbo Mega Coffee (with extra Caffeine) is to be drank at least 45 minutes prior to wheels up. Gives the aircrew PLENTY of time to take care of biological needs...

[SARTAC Medic]

I dont know how to quote posts yet, so Im not going to.


There is no way that you can say that any victims that CAP stumbles across will be within the golden hour.  I mean honestly.  There are plenty of times where in the response system where I work that  we don't get to real 911 calling patients within the golden hour.... AND I OUR AVERAGE RESPONsE TIME IS 6 MINUTES!!

If i were planning a CAP field medic course... (BTW, Im teaching the last class room session of my Field Medic Course today in about 2 hours) It would most certainly be centered around the idea of self and team aid.   Giving the students the correct information about shock, head injury, spinal trauma, joint and bone injuries, cold and heat emergencies, and GI distress is the back bone of the course.  It also gives them some ORM to deal with wilderness trips, and some more indepth hands on then the standard first aid class.   The most important aspect of this program is dispelling the idea that there is always an ambulance 10 minutes away, and that some of the old wisdom "old wives tale" and folk remedies (butter on a burn) are worthless.  My students may not be qualified EMT's but we are working to make then compitent first aiders who can assess the need to make a slow or fast evacuation and have the proper information gathered for rescuers.   Its alot more about critical thinking and the thought process then it is about treating individual wounds.   

Ill beat this pony till the apocalypse,  CAP WILL NEVER EVER NEVER be an EMS agency and as soon as we accept that and stated to train accordingly we will have a good program.   

I was never involved with the NESA field medic program or the hawk program, but my co-author of the LIGSAR field medic program was.   He said that NESA was a pretty decent program as far as information provided and that hawk was about similar. 

Training to the level of first responder, which encompasses a wilderness/remote and delayed help block would be appropriate.   It would give people the know how to start to mitigate emergencies, minimize life threats, and recognize when there needs to be someone more trained to deal with the problems.   

[Krapenhoeffer]

And that's what I like about the ARC Emergency Response course. Legally, it's just Not-So-Basic First Aid (at least where I live), and with the exception of oral and nasal airways, nothing in the curriculum would make Lawyers get angry.

But what I really like about the First Responder curriculum is that it has two big things: Patient assessment, and treatment of life threats. Not to mention that it goes into the "why?"

Back in my high school days, when I was just Basic First Aid man, my instructor didn't bother telling us why we do things, they just said do it. And when my High School offered the ARC Emergency Response class, my big thing was that they explained, in detail, why Chest Compressions are a good thing for unconscious choking patients, why giving oral fluids to a shock patient is a bad idea: Things like that.

Buddy Care is important, as it makes up at least 90% of any medical situation we come across, but occasionally, we do get distress finds.

Ideally, we like to find our patients alive, and being able to speak the language, and get patient assessments done before the Flying Helicopter Bus arrives is important.

The stethoscope isn't a bad thing, when wielded by persons who know when and how to use it. Granted, if I see a cadet wearing one around their neck, I'll tell them why it is a stupid idea away from a clinical environment, and why they should be kept in their nice storage case.

[JohnKachenmeister]

Small SIPS of water to relieve the discomfort of dehydration... OK.

Drinking the whole canteen... Bad.

CAP will never, ever be an EMS agency.  Never.  Niemand. No Way.  Not Gonna Happen.

Our "Medics" exist to provide aid to our own guys who might get hurt.  When we find a civilian in need of medical care, we call a civilian EMS agency.

In the police academy, after the extensive first aid instruction, the instructor asked "How do you treat a stab wound victim with multiple stabs in  his abdomen and who has lost a lot of blood?  The correct answer (after a few of the suck-ups described a whole medical treatment regimen) was:

1.  Press the microphone button on your radio.

2.  Say:  "Dispatcher, send me medical here."

3.  Release the microphone button, and continue to do YOUR job. 

[SARDOC]

Bringing this back to the original uniform thread as it was intended....Does anyone know why Vanguard sells the EMT Badges with the Senior and Master ratings although there is nothing in the regs that allows it?  Do they know something that we don't...are there pending changes to the reg?

[Eclipse]

If they do it has been double-secret.

Most likely this, like the HSO badges, was/is in anticipation of a published spec that has yet to be decided (and may never).