Health Services Specialty.

[flyerthom]

While all the discussion of the medical fields is interesting, I want to know How does a Doctor advance from a Tech rating to a Senior rating in the Medical Officer specialty track?  Or is it not possible? I'm not concerned about promotions at thsi time, just sepcialty track level advancement.

The direct answer is the progression track is in limbo due to legal concerns therefore it is awaiting final approval from the Board. There is a cap yahoo group for health services. It was formed by memebers of the Health Services working group but is open to all HSO's.  Currently there is no formal method of advancement.

[chiles]

At any Encampment that I serve as the Nurse Officer, I insist on a document going out that certifies self medication or, more to the point, that they cannot self medicate. I also talk to parents in order to get the real deal if it's needed. Otherwise, we talk to the cadets, and often the parents, during in processing to go over what's needed and confirm that all our information is correct. From there, I take the data from the meeting, form and Rx bottle and check it against what I had in my spreadsheet. The spreadsheet is broken out by flight and includes all cadets on medications. For those that self medicate, the lines where a TAC initials that a dose was given is greyed out with the words "SELF ADMINISTER" in them. The only stuff I keep in the medical bay are those medications requiring refrigeration and those that the parent has specifically requested I give. Like the self medication, the line on the spreadsheet is greyed out with the words "REPORT TO MED BAY @ [INSERT TIME]". If that medication needs to travel with the cadet to activities, we load a small tote cooler with ice and send it with the TAC. The process exists and it can be done safely, it just requires some forethought and a little effort on the HSO.

As for the legal bits, most states have some type of "Summer Camp" clause that allows the dispensation of medication by a trained professional during a summer activity. Each state's law is different and requires varying levels of supervision.

[Ned]

As for the legal bits, most states have some type of "Summer Camp" clause that allows the dispensation of medication by a trained professional during a summer activity. Each state's law is different and requires varying levels of supervision.

When I was working on the NHQ committee on this issue, we found that some states do indeed have "camp nurse" laws.  And they sure vary.  Anecdotally, they appear to be a "East Coast" thing, but nobody has done a 52-wing survey on just how widely the laws vary.

But, of course, any law that requires a certificated medical professional to dispense medications is problematic.  If it truly requires an HSO to do it, then the HSO is likely performing the kind of routine medical care (dispensing medications as a professional) that the regulation seems to prohibit.  And TACS and other in loco parentis adult volunteers rarely qualify as medication dispensers under the state law.

Self medication (where not prohibited) avoids both Scylla and Charybdis.


And my lawyer brain is a little worried about detailed medication logs as described.  I certainly understand that any medical professional worth his/her salt will document everything they do; and this is especially true concerning patient care.  And while CAP is not subject to HIPPA, the existence of medical documents that contain cadets names and specific medications taken (or missed) is a little scary.  All sorts if privacy and litigation issues arise.

What are the record retention and storage protocols?  IOW, who keeps these logs after encampment and for how long?  Who gets to see them?  Does higher headquarters know of their existence?  (If NHQ is served with a subpoena for all documents related to a cadet, they would probably know to check the local unit, but would they know to call the encampment HSO from two years ago to see if he still has those logs in his garage?)

While HSOs are critical to the CP and encampments for their advice, planning expertise, and training skills, I think it is unwise to design or adopt specific policies that require an HSO to be present at encampment, even for mundane duties like medication management.

First, although it may well vary by wing, there simply aren't enough HSOs of the right flavor (probably LVN and above) available who can donate the 10 days a year necessary for an encampment.  (Yes, the week could be covered by several different HSOs taking it in turn, but the problem remains.)  If we require an HSO to be in attendance at an encampment, then a lot of encampments are simply going to be cancelled.  And that would be A Bad Thing.

Second, it has been my experience that "if you give a sick call, they will come."  (Apologies to Kevin Costner.)  And conversely, if you don't, they won't.  IOW, if you put out that the Encampment Medical Officer will conduct Sick Call at 0700 daily, I guarantee that you will have customers.  And probably a line.  But if you allow the TACS to take care of the routine "boo-boo" care (in consultation with Mom as necessary) then everyone is taken care of and still gets to class on time, with the added bonus of not tempting any HSO to engage in the non-emergency care prohibited by the regulation.

But it is certainly interesting how widely practice in these areas varies amongst the wings.

[chiles]

The commander at the time was aware and the system was fully disclosed to cadet parents so that they knew it was being tracked. I had a conversation with the TACs about privacy. I know, this doesn't satisfy the HIPAA (for those who don't know, it's the Health Insurance Portability and Accountability Act) regulations. I think that the idea of TACs administering is a bit concerning. TACs are supposed to carry and safeguard. The cadets are supposed to dispense their own while the TAC notes that they got their med. Having just taken over the Wing NO position, I need to have a discussion with the Wing legal guru about how we can show that medication was given while maintaining legal privacy. My immediate inclination is that records should be kept in a sealed envelope in the Wing HSO's office (work area, closet, etc) in a locked filing cabinet. It goes against everything I've been trained not to document medicine dispensing (by the cadet or otherwise) and I think we expose ourselves if we give a TAC a bag of drugs and they don't record when something was given, particularly for a controlled substance.

Edited for grammar

[brasda91]

No emergency = no medical care.  Period.

Not exactly.  If I have a team member twist their ankle while working a mission, this is not an "emergency".  But if it is a benefit to them we apply ice to reduce the swelling and keep them in the game, I'm going to do so.

It's pretty simple.  There's no need to read everything through a lawyers eyes.  National does not expect the members of CAP that have advanced medical training to give less patient care than they are trained to do.

Now if anybody does not agree with this, you should call National yourself.  I'm simply trying to convey what John told me.

[Ned]

 
It's pretty simple.  There's no need to read everything through a lawyers eyes.  National does not expect the members of CAP that have advanced medical training to give less patient care than they are trained to do.

Sir, with respect I simply cannot let that go unclarified.

That is only true when treatment is authorized in the first place -- i.e. an emergency

Otherwise your exception eats the rule.  "Hey, I'm an MD and my buddy John at NHQ says I can "give all the patient care I am trained to do," so I am gonna conduct an encampment sick call and diagnose various chronic ailments that present themselves."

I think we agree on more than we disagree here.  In an (genuine) emergency, CAP HSOs can certainly give care within their training and experience.

But just as importantly, CAP members simply CANNOT perform non-emergency routine medical care, regardless of their qualifications.  On this point, the regulation could not be more clear.

Now if anybody does not agree with this, you should call National yourself.  I'm simply trying to convey what John told me.

John can say whatever he wants.  But no one at NHQ makes policy -- that is reserved for our volunteer leaders on the NB and NEC.  And that policy is expressed in the regulations adopted by those bodies.

No one can contradict that policy, regardless of where they work.

Ned Lee

[SAR-EMT1]

For the time being I just look at the Health Services Track like I do the
" Specialty Track"  for unit commanders.

Its an identifier, nothing more or less, not something you progress in.

Question: are there different 'levels' for Chaplains? - Tech, Sr, Master?

I am not talking about MLO's.

[Snake Doctor]

I was looking to advance a member in the HSO Specialty Track to the Senior Level, from the Technician level so. I can put him in for his Level III (Loening).

I guess he'll have to get into another Specialty Track.

[IceNine]

There is an issue with your account settings somewhere....

I just played and put a member in for senior and approved it then put in for master and approved it, it worked fine and shows on his member search page?

[Pace]

You can "advance" the health services track in anyone's account, but you're not supposed to use that for PD levels and promotions (because there is no published specialty track that establishes it as part of the professional development program).  It's just a designator to keep track of medical professionals in CAP.

[mikeylikey]

It's just a designator to keep track of medical professionals in CAP.

That begs the question as to why?  Why keep track if these people can't even advance in that field.  Why keep it if they can't do more than bandages and moleskin at Encampments?!?!

[Pace]

I dunno.  I gave up on this entire line of thought about a page back when legal and operations couldn't find a comfortable middle ground.  I'll pick this one back up when I finish my degree.  For now, back to my labs...

[BlueLakes1]

HSO's don't require PD advancement for promotion, they only require time in grade and command approval. Ref: CAPR 35-5, Section E, Paragraph 24.

While the PD track advancement is "nice" (my old Sq/CC gave me a HS rating some time ago), it's not needed to promote, and is really kind of pointless. It was nice to get the third silver star, though.

[Pace]

HSO's don't require PD advancement for promotion, they only require time in grade and command approval. Ref: CAPR 35-5, Section E, Paragraph 24.

Apples and oranges.  The discussion was over using health services specialty track designations in e-services' online PD module to advance members' PD level and promote them farther than a professional appointment promotion (or whatever it's called) would get them.  Hopefully someday the HS specialty track will be published and medical personnel will have a way to continue to advance past their professional appointment grade in a specialty that takes advantage of their skill set.

While the PD track advancement is "nice" (my old Sq/CC gave me a HS rating some time ago), it's not needed to promote, and is really kind of pointless. It was nice to get the third silver star, though.

The health services inclusion in the specialty track module should have no bearing on professional development or uniform accessories.  There are no completion standards to establish credit for any level of effort in the track.  It's the same line of thought for members with "command" in the specialty track records.  Even if someone put "master" in their command specialty, they shouldn't use it for Level 4 or add a silver star to their leadership ribbon.

[RiverAux]

Why can't health services people accept their initial appointments based on their professional qualifications and then follow the same rules as everybody else in regards to promotions?  Why is there a need for a specialty track for this? 

[Pace]

If you're going to bring in medical professionals and give them an advanced promotion based on their medical degrees/qualifications, you might as well give them a clear set of duties to perform and give them credit for that effort.  Bring them in as health services officers, promote them initially, then allow them to continue to promote based on duty performance in a medical capacity.

Makes sense to me.

[SARMedTech]

I've been on ground team almost since I joined in 2002.  I do understand the need for medical personnel; however, it is my experience that most of the skills that medical personnel possess cannot legally be used.  CAP members are only authorized the use of basic first aid for stabilization, regardless of advanced medical training.  160-1 even defines the intent of "emergency care" as CPR and first aid.  I mean no offense in any way, but a non-medical person with first aid training can (not necessarily will, but can) possess the same level of medical treatment ability allowed to be used legally by CAP.  On the flip side, I also know that it is abundantly beneficial to have a medically trained team member for when crap hits the fan.

1-21f. First Aid and Emergency Medical Care. CAP is not an emergency medical care or paramedic organization and should not advertise itself as such. CAP will not be the primary provider of medical support on missions or training events though qualified personnel can be used to support such activities. The only type of medical aid that should be administered by CAP personnel or by any other person at CAP's request is reasonable first aid deemed necessary to save a life or prevent human suffering and executed by a person qualified to attempt such medical care within their skill level.

What?  Most of the skills that medical personnel posses cannot legally be used?  CAP members are only authorized the use of basic first aid for stabilization, regardless of advanced medical training.  160-1 even defines the intent of "emergency care" as CPR and first aid.  I don't know how you came up with that.  I'm a state certified EMT and I can tell you that if I don't perform up to my level of training, I can be held negligent.

Regarding your quote from 60-3, no we are not an emergency medical care or paramedic organization and should not advertise itself as such. CAP will not be the primary provider of medical support on missions or training events though qualified personnel can be used to support such activities.  What that means, is we will not be called to be the "medical team", even though we have members that are EMTs, Paramedics, nurses, and doctors.  The biggest reason we need f/a and cpr training is for our own members.  No one is going to call CAP to a scene to take the place of an ambulance service.

And the last statement "to save a life or prevent human suffering and executed by a person qualified to attempt such medical care within their skill level".  Once again, my skill level is higher than someone with basic f/a and cpr.  It is expected of me to do more, simply by state laws.

Brasda-

youre way off here. If you are at a CAP function, you are obviously not on duty as an EMT or Paramedic. If you are not on duty, you are not functioning under the license of the medical director of your region and therefore cannot perform any more emergency interventions than the average good samaritan. In fact, when not on duty, thats all you are. Ive seen off duty EMTs at all levels carrying around huge jump kits when off duty, enough to support a fire team in the field for a month. Fact is, you can use bandages, skin strips, make a sling, do CPR, use direct pressure to staunch bleeding, sit there for an hour and hold C-spine while EMS tries to find you. But you break out that combi or ETT (which you cannot possess legally if you are not on duty) and it so much as touches the lips of your "patient" and thats when you need to worry about going to jail or losing your license. I agree that the CAP regs are vague and ambiguous. They are intentionally that way to keep CAP from being legally responsible if one of its members does something dumb. They can say "see...we only told them to do first aide." About a year or so ago when I started on this forum, I had the same idea you have. But then I decided i would like to keep my license. Oh...remember that you cannot be held negligent by a court of competent jurisdiction unless you had a duty to act and did not. Unlife LEOs, EMS personnel do not have a duty to act when off duty and hence cannot be found to be negligent if they do nothing. I understand that you may have a license, but if you arent on duty or currently working in the EMS field, you may as well use it as a book mark cause that is about how much good its gonna do ya.

[arajca]

Which is why the legal folks got involved. There are at least 50 different versions of when EMT's are on/off duty and what they can do. This does not include the numerous local medical controls that may have their own ideas. For the best answer, I recommend contacting YOUR wing's legal officer for guidance. Thet should be familiar enough with the state laws to give you the correct information. I also recommend contacting YOUR medical control about their views.

National can only give general guidance because they are most likely not famiiar with the particular laws and restrictions in every instance.

[brasda91]

Brasda-

youre way off here. If you are at a CAP function, you are obviously not on duty as an EMT or Paramedic. If you are not on duty, you are not functioning under the license of the medical director of your region and therefore cannot perform any more emergency interventions than the average good samaritan. In fact, when not on duty, thats all you are. Ive seen off duty EMTs at all levels carrying around huge jump kits when off duty, enough to support a fire team in the field for a month. Fact is, you can use bandages, skin strips, make a sling, do CPR, use direct pressure to staunch bleeding, sit there for an hour and hold C-spine while EMS tries to find you. But you break out that combi or ETT (which you cannot possess legally if you are not on duty) and it so much as touches the lips of your "patient" and thats when you need to worry about going to jail or losing your license. I agree that the CAP regs are vague and ambiguous. They are intentionally that way to keep CAP from being legally responsible if one of its members does something dumb. They can say "see...we only told them to do first aide." About a year or so ago when I started on this forum, I had the same idea you have. But then I decided i would like to keep my license. Oh...remember that you cannot be held negligent by a court of competent jurisdiction unless you had a duty to act and did not. Unlife LEOs, EMS personnel do not have a duty to act when off duty and hence cannot be found to be negligent if they do nothing. I understand that you may have a license, but if you arent on duty or currently working in the EMS field, you may as well use it as a book mark cause that is about how much good its gonna do ya.

I agree.  But we were not talking about a run of the mill CAP function.  We were talking about GT's not being able to use their EMT's skills on missions.

Naturally, while at a CAP function were an ambulance service can be contacted, they should be.

Can we please move on?

[SARMedTech]

I know this horse has been flogged and I have been part of some of the most complex and bizarre conversations regarding this subject. Part of MS degree work is trying to develop a national protocol for all levels of EMS provider. I am from Illinois and here, its like being in 50 different states as you move from one EMS region to another. Up here near the Wisconsin border, Basics can do cram and slam intubations (combitube) give epi, glucagon, etc. Down in region 7 where a friend of mine is an EMT they cant do any of that...they can only give aspirin and oxygen and both of those have to be at the order of the supervising paramedic. So there is that to deal with in each Wing and then regionally when  said EMT might go to another state, etc. But here is the stituation as it stands:

1. We could be CCPs and only give "basic stabilizing first aide." Now we could chose to follow the American Red Cross standard for what first aide is, but I guarantee that NHQ would leave us twisting in the wind when something went wrong.

2. We have no more medical authority on scene that average "civilian" and even if we stand back and start giving people orders as to what to do, our fat is still in the fire.

Basically, the EMS bling is a merit badge. And with the way we attack things like the whole ABU controversy, we out to see some changes in terms of some kind of medical specialties, oh...about 1500hrs next millennium, however, I still wear my insignia on my blues because chicks dig bling.