What are the limits of teaching First Aid/CPR?

[SJFedor]

Now, you're not going to teach a 12 year old cadet to reduce a fracture or even use QuickClot products.  But different ways to immobilize a fracture, insert an NPA, or how to backboard an injured person, I ask why not?

Ehhh. Splinting, no real big deal. But inserting an NPA and spinal immobilization (using c-collar, etc) is one of those "restricted to sale by or on order of a physician" kinda things, and I don't think AHA first aid or CPR covers the use/performance of them, except at the healthcare provider level, which is geared towards those who are, well, healthcare providers. Having the "healthcare provider" card doesn't make you one. Airway adjunct placement and spinal immobilization are part of the First Responder/EMR curriculum.

Now, with that being said, you can teach a monkey to put in an NPA in like 45 seconds. It's good to be able to do that, as it can sometimes be a quick fix to a potentially life threatening airway issue. But, if you're going to be placing an airway adjunct, you also need to be able to support that airway via BVM or other means.

But, in the reality of things, beyond your example of boarding a team member w/ an injured ankle or something to facilitate removal from the woods, there's really no reason why any CAP member should be doing spinal immobilization on a victim, let alone removing them from a site. With very few exceptions, there should be EMS, professional SAR, SO, or any other amount of organizations involved that should be able to swoop in and handle patient care.

I'll use backboarding a patient as an example.  If you conducted training at the squadron for your ground team in backboarding an injured person for extrication from the woods (call him a fellow cadet who twisted an ankle).  There is no reason why the ground team couldn't backboard the patient to transport him.  Just because it wasn't covered in "Heartsaver First Aid/CPR/AED" class, that gave you a cool card, doesn't mean you can't do it if you got trained on it.

This is true, but is it "formal training" or is it "SM Jimbob watched an episode of "Emergency!" last night and showed us how to use a LSB". Because that's what a lawyer is going to ask if they even have an inkling that using the LSB (a piece of medical equipment) may have contributed to the worsening of a spinal cord or other injury. Which is very hard to prove that it didn't, since CAP is not a medical agency, and therefore a proper assessment on the patient's neuro/motor status wasn't performed by a licensed/credentialed provider prior to utilizing that piece of medical equipment.

[ProdigalJim]

This:

"This is true, but is it "formal training" or is it "SM Jimbob watched an episode of "Emergency!" last night and showed us how to use a LSB". Because that's what a lawyer is going to ask if they even have an inkling that using the LSB (a piece of medical equipment) may have contributed to the worsening of a spinal cord or other injury. Which is very hard to prove that it didn't, since CAP is not a medical agency, and therefore a proper assessment on the patient's neuro/motor status wasn't performed by a licensed/credentialed provider prior to utilizing that piece of medical equipment."
:clap:  :clap:  :clap:

And every time I get asked this sort of question in my home unit, as an ALS provider I respond with: "Before I answer, can you tell me who CAP's Medical Director is?"

Hint: this is a trick question...

[Eclipse]

These examples are exactly why CAP wants an outside organization to provide this training, as while it may not absolve them of liability,
it makes the lines much less clear.

As to "extra" training - it's a double-edged sword.  In a real no-poop scenario, you want Cadet John Gage and SM Roy DeSoto on the team, and
if a cadet goes down during encampment, I want Maj House as my HSO (assuming he's not in jail and available).

But a lot of our members pursue extra training like First Responder and EMT and expect, and sometimes demand, to use it in a CAP context, which then just causes friction.

I had to deal with one fairly experienced Senior, who knew the score in CAP, that decided to pursue EMT as a career - good on him, except he
started showing up to ELT missions with a backboard and oxygen (along with a medical go pack that was straight out of Rampart General).  His
nose was basically out of joint from that point forward, until his rhetoric about how "messed up CAP was" got to the point where he needed to
be reprimanded several times and he ultimately quit. 

At some point he decided CAP needed to be something it wasn't, and then it was "our fault" for not stepping up.

[Garibaldi]

It might have just been a wing or squadron requirement, but I would think a minimum age requirement of 15 would be a good idea. Allow any cadet to train for ground operations, but I wouldn't put a cadet onto a ground team under the age of 15, no I'm not saying I will personally tell them no they can't go under the current regulation. I just think it would be a good idea to keep the younger cadets who aren't physically or emotionally developed enough from the harsh reality of finding a dead mutilated corpse in a crashed plane, or a missing person who has had lord knows what happen to them, decaying in the woods.

As far as I can tell from trying to find the answer on age to administer an AED shock, there isn't an age requirement.

I had a cadet flat out tell me that if he wasn't allowed to be the senior cadet on the ground team (age 15) then he wasn't going to a SAREX. He had a lot of training but a lot of arrogance that comes with that age, feeling that he should be able to teach everyone else, including seniors, what he knows. He said he was told by the head of NGSAR that he was authorized to teach and lead, which I immediately disproved thanks to CAPTALK. Hated to lose that kind of knowledge but that arrogance was intolerable. He's no longer very active in the unit.

[FDLT19]

The more likely scenario is that the person renders the aid as required by his mandates, and if liability were an issue, CAP would simply disavow coverage and ask to be removed from the case based on actions of the member outside his scope within CAP. If you have a "duty of care", the shirt you are wearing isn't going to matter once you're aware of the need.

Eclipse is correct, CAP would be called in to court; however, once proven that CAPR prohibit advanced life support without medical oversight, The liability would fall on the provider, and CAP would remove them selves from the suit, as they can prove through CAPR that the provider was acting outside the defined regulations, and as an independent provider with no medical control or over site.

I worked as a Paramedic, at the same time I was on the Ground Teams; I was limited to basic fist aid and CPR when on mission. Regardless of the situation, I had no medical protocols to function under, as a paramedic, i.e. there was no Wing Medical Officer who listed protocols out for me to utilize Advanced Life Support (ALS) measures while on scene.  There were no problems with me working in a Basic Life Support (BLS) capacity, as most of the injuries I saw were to cadets and senior member getting blisters and bruises while on mission, plus I had none of the equipment necessary to function in my skill set. 

In response to your question about training, I am in firm agreement that cadets under a given age do not need to be exposed to a traumatic incident, while this is unavoidable, precautions should be taken to mitigate it from happening.   

I would offer American Heart Basic Life Saving or AHA for the Health Care Provider course to the cadets; this program has a basic first aid component that should cover the entire mission needs for CAP. Beyond that I would check with your ES director, as Allison went through my Advanced First Aid course.

There is no reason to exempt cadets from this training due to age, as the American Heart Assoc, teaches CPR in Schools programs at the sixth and seventh grade level. 

Hope this helps, if not have Bob give you my number and we can talk off line.

[FDLT19]

Check with the curriculum developer for the program that you are teaching to see what is the minimum recommended age.  If I recall the instructions issued by the AED in an Emergency have to be in English at a Fourth Grade Level...So the age of the cadet may vary with maturity and comprehension.  The same is true for First Aid and CPR.

Agreeded, The maturity level is a huge factor when teaching these course.  So it could be argued to tempo the course to those who are most likely to comprehend the information. 

Good Point...

[John Bryan]

As an American Red Cross instructor I can tell you there is no "age limit". There are watered down first aid classes for elementry school and cub scouts but as for 12 and older I'd say Standard First Aid and CPR with AED. AED is a very simple skill, I believe a caveman could do it.

You are correct maturity level is a huge factor ...I would say if you think your cadet does not have the maturity level for CPR and First Aid.... DO NOT approve him/her for doing Emergency Services. Remember not every cadet needs to do ES.

Some young people in and out of CAP do have the maturity level needed to handle emergencies. You can become a certified life guard at 15....look at most public parks, water parks and beaches...a lot of teenage life guards. Many have training beyong CPR/First Aid...some are even Emergency Medical Responders (formerly called EMS First Responders). Not saying CAP needs to go beyond First Aid/CPRjust pointing out some young people have the maturity level to work emergency response.

[a2capt]

As an American Red Cross instructor I can tell you there is no "age limit". There are watered down first aid classes for elementary school and cub scouts but as for 12 and older I'd say Standard First Aid and CPR with AED. AED is a very simple skill, I believe a caveman could do it.

[FDLT19]

One of the major problems, I see, in going above and beyond simple first aid, is the fact that we, CAP, provide no medical oversight to our personnel.  Simply put, there are no national medical protocols, for us to function under as Basic or Advanced Life Support providers, beyond simple first aid. 

When I was a cadet I would have argued differently, as I had the stare of life and wanted to save the world with gauze and oxygen.  Now I have been a paramedic for the last twelve years and have dealt first hand with limited trained responders.  It is my experience that those trained in simple first aid do better for the patient then those who have attended an advanced first aid training course.  I attribute this to the fact that those who have limited training rely on what they know, and tend to approach the pt with a less is better mentality, as opposed to those who have been through a advanced first aid course. 

What I have seen is that those persons who have a rudimentary understanding of advanced first aid, are attempting to make decisions based, often times, on limited information and demonstrate a lack of understanding of the injury or disease process.

I had the rare opportunity to respond to a call where two senior cadets stopped and rendered aid in the form of comfort and calling 911.  These two cadets were able to calm the patients down and had the fore sight to let the medics do the medicine.  I have also been on scenes where those trained as first responders acted so wildly out side of the scope of practice; they actually made the injury worse, no CAP cadets were involved in this one. 

While I don't disagree with training cadets as first responders, in fact that was one of the major factors in my decision to become a paramedic and firefighter, it must be emphasized that the senior members that taught that course made very clear that, "We were not paramedics, EMTs, or subject to the magical powers of medicine, just because we attended a course."  Those senior members were there to reinforce what was learned, and made sure that we continued learning.  I never functioned as a "Medic" on a ground team, and this was due in large part to the senior member oversight that ensured that we understood "our place."  If the squadron does not have senior member that have the ability or want to temper and teach, I would not even peruse this type of training.

[lordmonar]

Personally I think we all need to be NOLS Wilderness First Aid certified....in stead of this vague "First Aid Course" we currently have....but I agree with John.....if an individual cadet/senior member has maturity issues....we just don't let him train for the specialty.

[BillB]

My Community College offers a First Responder Course and graduates are Certified First Responders. I'd say about a third of the course included what NOT to do at an incident. The course instructors were all EMTs so they provided information on First Responder activities that could be negatives at an incident. While we learned CPR etc. we also learned the legal limits of first responders and what not to do till EMS arrived.

[docbiochem33]

I tend to agree with FDLT19 that those with little training are sometimes better.  I remember combat lifetakers, I mean savers, when I was on AD.  They would walk around and tell people that they were combat medics and that they knew all this great stuff.  It was always fun when they were bragging and then you pop in and correct them on the combat medics thing and then tell them you are a medic.  We had one show up at the hospital and start bragging about his qualifications until one of the ICU nurses started quoting a list of qualifications that was like an alphabet.

People with little training tend to stay limited in focus and tend not to want to hurt people and so they do little.  People who get a lot of a little training want to do too much.  I used to argue with a guy in our unit because I would just ice down an ankle and not wrap it and he would immediately want to go to the wrap and then ice.  He would say, "You old timers really make things look bad.  Within about 2 years he was with me and waiting to wrap a cadets ankle complaint.  He started to realize that 99% of the "my ankle hurts" situations came when it was time for the PT test run.  Sure, he was going by his training, but I was going by both training and also years of service.  I had seen it before and knew what was happening.

This is part of the problem that I have had with people who get a little extra training.  They don't always realize that going hog wild is not the best. 

[EMT-83]

Reminds me of the time I was at a dinner function, and someone across the room was choking. Sitting at my table was a paramedic, a nurse and an ER doc.

By the time we got to the patient, all was well. A guy with basic first aid training had removed the obstruction and had the patient resting comfortably. He didn't need alphabet soup following his name to get the job done.

That's all we really need; folks who can remain calm and render basic care.

[manfredvonrichthofen]

Being able to keep calm is the most important factor when it comes to emergency care. If you are all hyped up you are going to make them uncomfortable, and if there are any indicators of shock, you are going to make it worse. And when you are all hyped up you are more likely to make mistakes. You aren't more likely to make mistakes, you will likely make more mistakes. Persons making medical decisions, especially in the emergency situation need to be solid decision makers, so if you have a slack off cadet in any aspect they are likely a poor candidate for any advanced emergency care, I use the term emergency care to engulf any possible training scheme over bfa. If they slack on promotions, or initiative, or pt, especially if they slack off on school, they would likely be a poor candidate. The biggest identifier would be school grades. If they are a great cadet, but are poor at school they might be the kind that think you won't find out about school, and a slacker that tries to hide it is the worst person you want giving emergency care.

I would suggest that if you do want to give training above bfa, you look at each person's report. Their CAP record, school grades, and see what their parents say after you explain to them what you are looking for. Every parent wants to put their child on a pedestal, but if you tell them you are looking to train some on advanced emergency care they are more likely to give the truth about their kids and their abilities. Also I wouldn't offer the training to anyone in CAP unless you have known them over two years. Just gives time to know eachother and build rapport.

[Garibaldi]

A coupleof months ago I cut the living shizz out of my finger. My female coworker freaked out and I had to calm her down in order to explain what she needed to do to help me because a) it was my good hand and b) obviously cleaning and bandaging was a two-hand job that I was incapable of doing. I felt like I was in a bad movie.t
"OK. You're going to have to take this stuff and apply it directly to my fingers."
"OhmyGodohmyGodohmyGodit'sbleedingalloverholycrap!"
"You can do this. Put on one of those gloves and wipe the blood off."
"HolycrapohmyGodI'mgonnapassout!"
"You got this. Now, i need you to HOLY CRAP THAT STINGS!"
"I'msorryi'msosorryi'mgonnafaintIcan'tdothis!"

Five minutes later all was well.

[NavLT]

I am a Paramedic and instuctor for BLS/FA/ACLS/PALS.

I have found that setting an arbitrary age for training is idiotic.  I have adults that cannot handle the training, the panic of an actual crisis or the potential after affects of traumatic issues.  I have had 12 year olds that did well in the training and handled the panic of crisis and dealt with the pressures and shock afterword better than adults.

All training weither it is medical or ES SQTR specialties need to have candidates for training based on evaluation of the individual. 

V/R
Lt J