First Aid Responder

[aveighter]

Oh, I don't know about Bob having an issue with medical officers, doc.  If he ever gets a toothache at a sarex I'm sure you will be at the top of his list of new best friends.

But if you really want to help, learn to fly. 

[Dustoff]

What I am proposing is teaching a first responder skills that adults and youth could easily learn and put to use at home or at CAP functions.  Basic things like dealing with burns, applying a bandage to a minor cut, removing a splinter, dehydration avoydence, understanding hypothermia, insect sting treatment, CPR, etc.  Many people will not chose to be on a ground team and will not go out with those teams.  Why not have some cadets that know these skills and can use them in other areas.  You never know when someone will get a Minor injury at a CAP function or just a routine training day.  Wouldn't it be great if they knew they had a cadet to turn to for help?  For ground teams they can be very handy for the minor accidents to ground team members or other first responders at an incident.

Gee, that almost sounds like CERT!!

[Eclipse]

Bob, it sounds like you have an issue with medical officers.  I would hate to be in your squadron where you don't value the talents of others.

That's a troll if I have ever seen one. 

Medical Officers don't have any FUNCTION within CAP, our conservative NHQ and the lawyers have seen to that. I have photos from the Nat Geographic that show CAP members hanging IV's in the field, that was then, this is now, and we have 9-1-1.

This isn't an issue of respect, this is an issue of reality and our mission.

And if I get a toothache at a SAREx that is bad enough to not be able to knock back with Advil, I'll GO HOME.

That's how it works, we're not the Delta force and the world will go on without me. 

Despite the overt acceptance that we have no outward-facing medical capabilities, we continue to talk about and actively recruit medical professionals, especially first-responder types, then we can't figure out why they get frustrated and quit.

[DNall]

Medical Officers don't have any FUNCTION within CAP, our conservative NHQ and the lawyers have seen to that. I have photos from the Nat Geographic that show CAP members hanging IV's in the field, that was then, this is now, and we have 9-1-1.

This isn't an issue of respect, this is an issue of reality and our mission.

Our mission is to go into the field & ve prepared to address anything we find there. It is unfortunate lawyers have screwe dup the law & it has to be fixed, but that'll happen soon enough, you can relax till then. When it does, I think you'll find medical personnel cn be forced to duty just like chaplains can now.

And if I get a toothache at a SAREx that is bad enough to not be able to knock back with Advil, I'll GO HOME.

See that's fine, but if you just get bored & leave... well in Texas you can go to jail. Just like if you're an EMT & refuse to render aid at a car wreck. No one is delta force, not even CAG is the delta force. You still have a moral & legal obligation to use your training to help people.

Despite the overt acceptance that we have no outward-facing medical capabilities, we continue to talk about and actively recruit medical professionals, especially first-responder types, then we can't figure out why they get frustrated and quit.

FEMA requires EMTs on ground teams at a certain level, so we will be tapping those people, but there isn't a lot of need for other types of medical folks. I can envision deploying medical teams, our SDF here has something like that but I don't know much about it, but that too would be held up till congress gets the law fixed for FEMA.

[SAR-EMT1]

This is a bit off topic, but Id be interested to see anything on this Article National Geographic did on us in the old days.

[Eclipse]

This is a bit off topic, but Id be interested to see anything on this Article National Geographic did on us in the old days.

The article is at the hut, I'll grab it an scan the pics for a future post.

Its titled "Minutemen of the Civil Air Patrol" May 1956, and its regularly available on eBay, though I can't seem to find it right now...

[flyerthom]

There are several roles that HSO's can do that have not yet been suggested.

One that has been around is preventive medicine. I've had or Stroke nurse come in and talk about CVA's. I've done talks about flu shots and pneumonia shots. I need to do one on the President's challenge. I also did one on CBNRE awareness.

Two is Aero Medical issues. I've done one on the FAA and medications. Over the counter medications is also a good topic. The handout from that one was put into the squadron's pilot read and sign book. I've done another based on the AOPA Pilot article on regaining your medical after open heart surgery. A good yearly topic along with Safety is IMSAFE.

A good aerospace ed and HSO cross topic is Air EMS. I'm going to try and arrange for our local helicopter EMS to come in and show off their bird and talk about things like helicopter safety and setting up LZ's. We had them scheduled for last fall but a maintenance issue came up and left the short of birds. I also work per Diem fixed wing so I'm going to see about getting our King Air to come in.

As for actual and SAREX mission skills, the HSO should be the expert on local EMS and Fire emergency response. Inter agency liaison is the mission niche HSO's should be called upon to perform. The HSO hand in Hand with Safety should be writing the ICS 206. Who else should have the knowledge of who the EMS agencies are, where the nearest hospital is, what are the capabilities, etc.? We work in the system. We can (and maybe should) be the person who interacts with the medical branch in a distressed find or mass casualty incident.

There are non clinical roles the HSO can and should fill. And, at the risk of sounding cynical, I do CPR, start IV's bind wounds, apply splints every day. Can't I do something else 

[arajca]

There are several roles that HSO's can do that have not yet been suggested.

One that has been around is preventive medicine. I've had or Stroke nurse come in and talk about CVA's. I've done talks about flu shots and pneumonia shots. I need to do one on the President's challenge. I also did one on CBNRE awareness.

Two is Aero Medical issues. I've done one on the FAA and medications. Over the counter medications is also a good topic. The handout from that one was put into the squadron's pilot read and sign book. I've done another based on the AOPA Pilot article on regaining your medical after open heart surgery. A good yearly topic along with Safety is IMSAFE.

Sounds like general informational issues. Nothing truly HSO specific.

A good aerospace ed and HSO cross topic is Air EMS. I'm going to try and arrange for our local helicopter EMS to come in and show off their bird and talk about things like helicopter safety and setting up LZ's. We had them scheduled for last fall but a maintenance issue came up and left the short of birds. I also work per Diem fixed wing so I'm going to see about getting our King Air to come in.

ESO?

As for actual and SAREX mission skills, the HSO should be the expert on local EMS and Fire emergency response. Inter agency liaison is the mission niche HSO's should be called upon to perform. The HSO hand in Hand with Safety should be writing the ICS 206. Who else should have the knowledge of who the EMS agencies are, where the nearest hospital is, what are the capabilities, etc.? We work in the system. We can (and maybe should) be the person who interacts with the medical branch in a distressed find or mass casualty incident.

I actually brought this idea up, and I have been deafened by the incredible silence from higher ups. I wrote and submitted the SQTR and the necessary tasks, but so far National hasn't bitten. There are no treatment requirements in it, just coordination by a knowledgeable professional who happens to be a CAP member.

There are non clinical roles the HSO can and should fill. And, at the risk of sounding cynical, I do CPR, start IV's bind wounds, apply splints every day. Can't I do something else 

That's a problem CAP has when it gets new seniors. We ask them to do what the do for a living and generally don't listen to what they want to do, or place it as a secondary choice.

[Ned]

Medical Officers don't have any FUNCTION within CAP, our conservative NHQ and the lawyers have seen to that.

It is not all that mysterious or technical.  It has very little to do with NHQ or the evil lawyers.

Health professionals who practice medicine need to have malpractice insurance.  Not a very "CAP-specific" issue, as it is necessary for every single doctor or nurse who puts their hands on patients in any organization in the US.  Ask any health professional and they will tell you about their insurance and how much it costs.

Since CAP cannot afford to carry malpractice insurance for our health professionals,  they cannot anything other than emergency care.  A malpractice policy to cover errors and omissions for our various MDs, DOs, RNs, and the supporting professionals so they could perform routine care in all 50 states for not only our members, but members of the public as well would literally cost hundreds of thousands of dollars a year from any reputable malpractice carrier.

Go ahead -- price it out. 

So if we good find a rock-bottom price for, say, $600,000 a year it would add about $100 per year to each of our dues.

Is it worth more than doubling our dues?

And there really isn't any practical alternative.

Good Samaritan laws do not cover members of an organization treating other members of the same organization, nor routine care given to members of the public.

Ned Lee
Former CAP Legal Officer

[RiverAux]

If it was part of an Air Force mission, then CAP the AF would be backing up their actions just like they back up our pilots and everyone else in regards to insurance.  So "liability" could be covered that way.  However, I'm assuming the AF hasn't been willing to take on the potential for such liability by allowing us to provide more medical care, even on actual SAR missions or we would already have done it. 

[DNall]

Medical Officers don't have any FUNCTION within CAP, our conservative NHQ and the lawyers have seen to that.

It is not all that mysterious or technical.  It has very little to do with NHQ or the evil lawyers.

Health professionals who practice medicine need to have malpractice insurance.  Not a very "CAP-specific" issue, as it is necessary for every single doctor or nurse who puts their hands on patients in any organization in the US.  Ask any health professional and they will tell you about their insurance and how much it costs.

Since CAP cannot afford to carry malpractice insurance for our health professionals,  they cannot anything other than emergency care.  A malpractice policy to cover errors and omissions for our various MDs, DOs, RNs, and the supporting professionals so they could perform routine care in all 50 states for not only our members, but members of the public as well would literally cost hundreds of thousands of dollars a year from any reputable malpractice carrier.

Go ahead -- price it out. 

So if we good find a rock-bottom price for, say, $600,000 a year it would add about $100 per year to each of our dues.

Is it worth more than doubling our dues?

And there really isn't any practical alternative.

Good Samaritan laws do not cover members of an organization treating other members of the same organization, nor routine care given to members of the public.

Actually I'm pretty confident the price would be a good bit more than that. There's also the issue of deploying outside the state in which you're licensed & the other state recognizing your credentials to practice, which is not universal & varries even between different kinds of licenses.

There are two kinds of alternatives currently being considered by Congress, but the details, side issues, & loop-holes are signigicant & time consuming to overcome. One is that volunteer medical workers requested to deploy by the federal govt would be covered by the govt during the mission.

Supplementary to that is the idea of restructuring the HSO career field so that medical professionals are recallable like chaplains are, which may serve to extend coverage beyond formal missions to routine CAP activities, but that gets complicated.

Yet another option is to tie in with DMATs as reserve PHS officers, or to create a similiar structure subordinate to DoD. That too is rather complex as I'm sure you can imagine.

It will be worked out, it just takes time. Be patient, we'll be back hanging IV bags in teh field in no time.

River, the liability coverage of CAP, both on & off mission, is very limited and excludes the kind of limits that would be necessary to legally provide medical care. Likewise there are many state laws requiring that care in emergencies with varrious hold harmless arrangements. HSOs should be highly familiar with these distinctions & take extreme care as to what situations they allow themselves to end up in.

[RiverAux]

Granted I'm not up to date on exactly how CAP's insurance works, but as I understand it we have one policy to cover CAP-specific activities but that there isn't any insurance policy for AF-Aux activities and that we are included in the federal government which is "self-insured".  I'm sure the problems with providing medical care while on "CAP-time" would be insurmountable, but I don't see that it would be overwhelming to make it possible for care to be given while on AFAMs. 

[DNall]

What we have on AFAMs isn't the same kind of coverage & wouldn't extend to medical malpractice at all, much less in the amounts necessary for required coverage. That coverage is spelled out pretty well if you want go track it down. The insurance policy for the rest of the time is basically the same level of coverage but covered by a private company, and that policy is paid by the AF as required by Congress.

If the amount is actually only 600k, then write the justification statement to AF to add that policy as an appropriated item, and when making that request explain how much easier it would be if congress extended govt self-insured coverage to CAP medical personnel on AFAMs in accordance with the FEMA request, or if AF helped find another way to deal with it under their jursidiction, then let them lobby on. It'll get taken care of.

[desert rat]

I would be in CAP regardless of being a medical officer or not.  I would still offer my services to train others in CPR and first aid as a certified instructor (many CAP medical officers do this), A medical officer is a highly trained individual that can do alot for a squadron and wing.  One of the major roles of a medical officer is that of being an advisor. 

A good commander would utilise all the tootls he/she has available to him/her.  One of those tools is seeking out advice from a medical officer, or chaplain, or flight crews etc.  Not listening to advisors is a definate sign of a commander being ill trained and ill fit for a command position.  I uderstand command because I was trained to command in the military and in CAP.

CAP does place a value on having medical officers in their membership.  They do not expect us to go out and do field trauma.  Many of us (even dentists) have been trained for this and could to it, but we are not looking for the opportunity.  Like most other health professionals, I see blood and trauma daily.  I do not need to see more on my days off. 

Getting pissed of and leaving CAP over not being able to save lives in the field is not really going to happen with most medical officers.  CAP is more than that.  This is the same reason why pilots who lose their pilots license don't just up and walk out.  I think within CAP there are so many opportunities to volunteer that a person can always find interest.

By the way, don't call a person a troll unless you know what you are talking about.

[DrDave]

Interesting topic.  Glad to see so many health service officers, medical officers, and nurse officers leading this discussion.  (That was sarcasm.)

I'm a physician and I joined CAP not to further my trade in the healing arts, but to serve my community and country.  To put my enthusiasm, selflessness, and considerable personal and financial energy to work for good causes.

I looked over CAP for a full month before joining.  Looked the web site up and down, checked out local units, googled multiple CAP topics, even bought and read "Aerospace: The Journey of Flight" before joining (yep, Yeager award was my first accomplishment).  Looking over what CAP did impressed me.  I wanted to join to help out.  And I liked the cadet programs where I felt I could be a good role model and mentor to cadets while also imparting some good health advice that might stick.

Did I join to be a "trauma-rama" hotshot at crash sites?  No.  Am I here for the bling and prestige (you know we go right to Captain as a licensed physician, then Major after only a year ...)?  Nope, already have that as a doctor.  Am I here for the big bucks?  Yeah, right.

I'm here as a volunteer to help any way I can.  That's probably the main reason any health professional joins CAP.  Yes, we know we can't practice medicine (the regs are pretty clear on that), but there are so many other reasons for being a part of this organization.  And many more things medical officers – and health services officers – can do for your squadron and members.

Many topics have already been discussed, where HSO's are an asset to CAP.  Health and Safety briefings being a very important one.  I've done them on color-blindness, hypoxia, smoking, meningitis vaccine (recommended for our young adults), lightning strike injuries, blood borne pathogens, etc.  Sure they can be done by others.  I hope I bring more experience and insight to them rather than a layperson doing a canned PowerPoint presentation. 

And our role as advisors is not an insignificant one.  Probably one of the most important.  Extreme environment advise, can Johnny do PFT with that ankle injury, reviewing all medical forms and informing the squadron commander about what possible problems may lay ahead during the upcoming activity or weekend event, drug interactions, which meds will make Johnny dehydrate faster out on the parade ground, who's blood sugar needs to maintained, illicit drug information, etc.  HSO interaction with cadets and participation in the cadet program is probably where HSO types can do the most good in CAP.  And as many of you know, we instituted a volunteer senior member physical fitness program in the Missouri Wing last year ("GetMOCAPfit").

I'm a Group Commander.  I'm a Wing R&R Officer, Assistant Wing Med Officer, and Assistant Wing PAO.  Was awarded last year's Wing PAO of the Year for Missouri.  I've got specialty ratings in six specialties, none of which are health services.  Yes, I know that none of these duties are as a medical officer (well, the Asst. Wing MO is, of course) – but what if I hadn't joined?  Medical types bring much enthusiasm in with them, they truly want to reach out and help others.  My continuing accomplishments are a direct outcropping of this phenomenon.  We have such a retention problem in this organization already, why are we trying to make it worse?

Are medical officers REALLY worthless in CAP?  Shouldn't we be welcoming any one who wants to participate to join CAP?

Is the negative tone of this discussion thread part of the solution or part of the problem?

[DNall]

They are by no means worthless, there is just very little function within their specialized skill set that is critical to keeping the Sq operating, a lot of nice to have elements but not critical, and even at that we don't have enough to keep them as busy as our critical positions have to be. You have to be creative to make best use of HSOs, and while I know we're capable of that, most units are pre-occupied keeping their heads above water to accomplish the minimum based on teh massive administrative load they shove down on us.

The growth area for medical skills in CAP is with EMS types working on GTs. FEMA is requiring that at a certain level & we'll be working to meet it with a few teams. Certainly a lot of medical personnel aren't going to be qualified or interested in that work, and that's fine. We're also going to need people at the next level to administer those personnel, and we're still going to need all the things that medical officers can do for us now. Anything beyond that would require some significant changes.

[SAR-EMT1]

Interesting topic.  Glad to see so many health service officers, medical officers, and nurse officers leading this discussion.  (That was sarcasm.)

.....
I'm a Group Commander.  I'm a Wing R&R Officer, Assistant Wing Med Officer, and Assistant Wing PAO.  Was awarded last year's Wing PAO of the Year for Missouri.  I've got specialty ratings in six specialties, none of which are health services.  Yes, I know that none of these duties are as a medical officer (well, the Asst. Wing MO is, of course) – but what if I hadn't joined?  Medical types bring much enthusiasm in with them, they truly want to reach out and help others.  My continuing accomplishments are a direct outcropping of this phenomenon.  We have such a retention problem in this organization already, why are we trying to make it worse?

Are medical officers REALLY worthless in CAP?  Shouldn't we be welcoming any one who wants to participate to join CAP?

.....

My hat is off to you Doctor. I couldnt have said it better.... lo that I am merely a simple trauma monkey... 

Stood in the hallway for 2 hours today with a MVC victim before a PA would admit her...
Anyway... Just curious sir; what is your field?

[SJFedor]

The growth area for medical skills in CAP is with EMS types working on GTs.

Don't know if this topic came up yet, I scanned over the topic, so forgive me if this has already been mentioned.

As another trauma monkey, there's one big question I have. Everyone is shouting "Let the EMT's and Paramedics and RN's do what they're trained to do!"  Great, absolutely. But there's many problems with that.

Insurance and liability has been raised already. Someone has to pay when someone screws up in the field, big brother blue doesn't want to, NHQ doesn't want to, so it's not happening.

Second, and more concerning, is medical control. Who's going to serve as the medical control for any person working as a CAP member? Last I checked, EMT's, paramedics, RN's, all of them require orders from a licensed physician before they can render anything beyond basic first aid. In the field, there's standing protocols at different levels that allow EMS personnel to do their job (advanced airway, drugs, etc), and they STILL have a medical control that they can contact and clarify or recieve orders from. RN's in the hospital have an MD they can contact for orders, or can execute standing orders. But, and I emphasize, NO EMT, Paramedic, or RN can do anything without a form of order. Even flight nurses on HEMS crews or fixed wing have protocols and medical control to contact.

I'm glad there are doctors out there commenting on this, and I'm very glad we have you all as members. I'm not sure how many are Emergency Medicine or Trauma/Surgical Critical Care doctors, but despite the training doctors DO have, just because the person is a doctor does not make them the end all know all in the field. Dentists, podiatrists, infectious disease specialists, optometrists, internal medicine doctors, all of them had training at one point or another in what to do when patients go south. Most, if not all, at least hold ACLS certification. Awesome. And most want to help, in or out of the hospital, which is great as well. Doesn't make them the best consult, or even a consult you may want, in the field during an emergency. Granted some is better then none, but I've seen MDs in the field, trying to help the EMS crew, get in the way, and almost hurting people (doc tried to roll ejected MVC patient w/o someone holding c-spine, paramedic almost tackled him.)

So, to the doctors that are members out there, who would like to serve as medical control during a mission? Cuz god knows no hospital will do medical control for an unlicensed and unregulated ad-hoc ES organization who just so happens to have a few EMTs and Medics in the mix. Too risky, too much liability.

What I think should happen is that squadrons and wings that are active in missions need to make contact with the state and county EMA's, along with the EMS response services. If you have a downed aircraft that's missing and you're looking, your best bet is to get them involved, and perhaps have them assign a medic crew to your ground team, wherein if a find is made, a trained, licensed, and LEGAL EMS team is already there to begin care. Not saying our members cannot help if needed, but you have people who are properly licensed, operating within protocols under med control, and have insurance.

Or, just do what we continue to do and call 911 when you hit the scene. Unless you're way out in the boonies, they're usually not too far away. Besides, once you say you have the find, every EMA, sherriff, police officer, EMT, fire department, and boy scout troop within 30 miles is going to be converging on that location. Keep the patient still, stabilize them within first aid training and protocol, and wait for the calvary.

Bottom line, first aid, maybe first responder, is all anyone in CAP is ever going to be permitted to do. Anything that anyone trained beyond that level does is outside the scope of their operations as CAP members. No health care provider wants to be standing in court before the judge while he's asking why you did such an such a thing while not duly authorized to do so. What FEMA wants is not really the scope we're under. Yeah, we work with them sometimes (Katrina, other DR activities). But does FEMA have a lot to do with most GSAR operations for missing aircraft, persons, or other small, localized missions? AFRCC handles it, not FEMA. They do the tasking, they call the proper people out as they see fit.

And to the HSOs out there that help out with everything in CAP: thank you. You guys are an invaluable asset, and your expertise and knowledge helps keep us all safer.

[DrDave]

SAR-EMT1: I'm a family physician in private solo practice in southwest St. Louis County, Missouri (suburban practice).

[DNall]

SJF,
I understand where you're coming from, but the issues must be addressed for the future, not based on what we have right this second.

The liaiblity situation must be addressed by either AF-funded malpractice coverage or congressional action to include that in the federal coverage extended to us, both of which are currently under consideration, I don't know about the insurance, but the federal coverage is going to pass eventually.

Far as control & administration, those are different things:
The SOP would be established by AF surgeon general, who we are working with already.

The administration of the people & policies would probably need to be done by HSOs on our end, but would have to be accountable to AF seperate from the CAP chain of command.

The controlling authority you mention in detail already exists & always has. You know they have an trauma surgeon on duty or on call at AFRCC 24hrs a day expressly for that purpose? Cause they do. And they have a direct hotline to all kinds of specialized AF medical resources that they'll put on a conference call right into your cell phone out there in the sticks, all you have to do is ask. You'll find that
to be the same system PJs call for medical orders in stateside deployments.


Far as FEMA, there's isn't a them & us. There's a system all emergency responders have to comply with or go home & not get any federal funding, and it doesn't matter if FEMA is in charge or not. CAP is not exempt & NB has voted to comply. That means all GTs will become WSAR teams. Now at type III & below you rely on local EMS (type III is them tagging along, type IV is them on call). At type I&II you need an EMT on the team (type I is EMT per team, type II is EMT per 48 person task force). Every GT will not be type I&II, the large majority will be the kind of work we do now, which is type III&IV, but on the Wg & Reg levels there will be pre-set type I&II teams listed so that if we need to send such people to Katrina or whatever they'll be ready to go.