What roles do MD, RN, EMT have in CAP

[armyguy]

What are some of the functions that MD's, RN's & EMT's have in CAP?  My understanding is that they do not function with-in the scope of their practice but rather serve as advisors to the commander. 

[Eclipse]

On paper - "advise commanders on matters of health".

In practical reality?  None.

Sprinkle on a dusting of NHQ looking the other way when it encourages medical professionals to join,
makes a point of the fact that CAP is not a health care provider, and then hopes to the FSM that
they intervene in a crisis (internal or external), while knowing it will disavow any liability.

Kinda fun.

[Ned]

Don't undersell the "advice" role.  When it is my turn in the bucket as an encampment commander, I find it invaluable to have an appropriate HSO review the medical part of the applications to advise me of potential limitations and concerns so I can pass along necessary concerns to the FTO and flight cadre as the situation warrants.

Me: "OMG, this cadet says he has Osgood-Schlatter disease.  That's bad, right?"
HSO:  "Meh.  Normally not a big deal, but let me check with Mom for any limitations during volleyball."

I use HSOs to instruct cadre and adult leaders on avoiding heat and cold injuries, and to assist me in my ORM matrix for an activity.

In the squadron, I have used HSOs to interpret and coordinate with a cadet's health providers to determine the appropriate physical fitness category for new cadets or cadets who develop issues during their membership.

At NHQ, we have a dedicated doc to review Spaatz applicants in Categories III or IV.

I do NOT use HSOs to conduct "sick calls" or decided whether a cadet with a twisted knee should go to Urgent Care.  HSOs, like all CAP members, can only provide direct medical care in a bona fide emergency.

I normally do not have a full time HSO at encampments or NCSAs, but I sure know how to reach one when I need advice.

It would be difficult to run a vigorous and challenging cadet program without the assistance of our terrific HSOs.

Ned Lee
National Cadet Program Manager

(Edit-spelling)

[Eclipse]

I do NOT use HSOs to conduct "sick calls" or decided whether a cadet with a twisted knee should go to Urgent Care. 

Unlike the myriad encampments that still do exactly that.

[Jester]

I've used them at encampments to treat blisters that were too much for the training officer to handle.

[Capt Thompson]

At NESA the HSO's called out weather conditions and gave direction on hydration and hot weather injury prevention, let us know when the chiggers were particularly bad, and helped determine if a student needed to come out of the field due to indications of heat exhaustion, dehydration etc.

As a GTL, I was once asked at a training mission if a victim with a head injury was ok to be moved. I replied that I'm not qualified to make that assessment and called for another team that had an actual EMT on the team to come in for a better assessment. He determined the patient could be moved, ended up instructing the Cadets on field expedient litters and how best to moved the victim onto the litter while avoiding further injury. He didn't technically provide any more medical care than I did, but was there to give a professional opinion when I wasn't qualified to do so.

[Eclipse]

^^^ And that "professional opinion" is where the issues potentially start.

If he's wrong at an FD job, he's likely to have qualified immunity and the protections
of departmental policy and treatment doctrine.

If he's wrong in CAP, he gets the "we told you not to, good luck with that..." letter.

[TheSkyHornet]

I'll take a licensed M.D. as my advisor over the "I delivered all the babies in the community 40 years ago" wannabe any time.

In my experience, most HSOs are more of an annoyance because they're seen as the expert of all things, which we know just isn't true. Being a registered nurse does not mean that you're an outstanding consultant on cadet fitness activities. Being a doctor doesn't mean that you're the know-it-all on COVID-19.

But in lieu/lack of, I'd rather have an HSO present than to wing it on my own. Am I first aid trained? Yes. But I'm the first one to consult someone with more training than me before I make a boneheaded decision. And yes, I'll consult a doctor on whether or not this is an urgent care matter or if it's something that can be dealt with there on-site.

I couldn't tell you if someone has a tummy ache because they ate something wrong, they're dehydrated, they're constipated, or the fact that their medical form says they have Crohn's disease.

I do think, though, that we tend to employ a lot of overzealous folks who truly don't know much more than I do, and they run around like combat rangers quick to save the day. We can find that attitude in a lot of areas in CAP, though.

[Spam]

Love my (qualified, licensed, experienced) MDs et al, in CAP.  I first really appreciated having one at a 1992 encampment when I had a female cadet present during the obstacle course on base with severe abdominal cramps, and as the deputy commander I sought the opinion of our MD, on site. He kept me from making the call of heat cramps, and ruled out a burst appendix... turned out to be rupturing ovarian cysts. THANKS DOC.

I am not so enamored with the wanna bes that CAP attracts that try to gain CAP MO/HSO designation in order to gather yet more fruit salad. I've sought backup for my refusal to frock applicants with chiropractor certificates or "doctor of life skills" dubious mail-order degrees, and thankfully CAP *real docs do continue to perform that gatekeeper function. Just like chaplaincy endorsement/validation, and like check pilots for aircrew, right?

So I hope that that we've got the right folks (the real degrees/experience, not the fake "studies" degrees) advising on policies and reasonable accommodation for medically related issues (COVID and gender dysphoria being current examples). For the former, my feel is that we've used our MDs/HSOs fully and properly to help navigate our way out of COVID. However, I just got some feedback from upset parents that we had a male cadet with the latter problem who was housed in female barracks at an activity last summer (just hearing about this now, they are wondering if this is medical policy now to put these males in with females and vice versa). If we had an HSO/MO at the activity I would hope they stood up on the issue.

R/s
Spam

[AirDX]

^^^ And that "professional opinion" is where the issues potentially start.

If he's wrong at an FD job, he's likely to have qualified immunity and the protections
of departmental policy and treatment doctrine.

If he's wrong in CAP, he gets the "we told you not to, good luck with that..." letter.

And there's not a prehospital provider out there that doesn't understand that. We are well versed in the medicolegal aspects of our profession, which is why I carry a substantial professional liability policy and have my attorney's card in my pocket. Not that I've ever had to use either.

Any provider worth their salt has had that internal conversation at some point... "What will I do?" And most of us, regardless of time or place, are going to react to provide life-saving care to the limit of our training and available equipment.

CAP doesn't, and can't, provide the structure that prehospital providers need to function as providers wearing a CAP hat. Anything beyond basic first aid requires medical control, signed protocols, training and quality control, approved equipment, etc. CAP isn't going to provide that or try to play in that arena, and that is a good decision. It's expensive and time-consuming. We have enough to do in our own sandbox. I serve as an EMT in a system that crosses a state border, and the hoops that our med control jumps through to satisfy TWO state EMS authorities are many. Imagine trying to satisfy 50.

So let's all understand that CAP will never be a prehospital medical provider beyond the basic first aid level. Let's also understand that individual providers will very likely go beyond that level in emergency situations on their own recognizance, and that's just what will happen.

[AirDX]

In my experience, most HSOs are more of an annoyance because they're seen as the expert of all things, which we know just isn't true. Being a registered nurse does not mean that you're an outstanding consultant on cadet fitness activities. Being a doctor doesn't mean that you're the know-it-all on COVID-19.

Let someone become injured or ill, and who does everyone turn to stare at? Those annoyances.

[Eclipse]

Let someone become injured or ill, and who does everyone turn to stare at? Those annoyances.

Which is not fair to them in the extreme.

[Fubar]

Love my (qualified, licensed, experienced) MDs et al, in CAP.  I first really appreciated having one at a 1992 encampment when I had a female cadet present during the obstacle course on base with severe abdominal cramps, and as the deputy commander I sought the opinion of our MD, on site. He kept me from making the call of heat cramps, and ruled out a burst appendix... turned out to be rupturing ovarian cysts. THANKS DOC.

This is precisely the scenario NHQ says it doesn't want to see happen, people providing medical evaluations and diagnoses. Obviously it's great that your cadet got the appropriate medical care she needed, but your doctor could have easily been wrong. Severe abdominal cramps mean a phone call to parents to see what they'd like to see done, can't reach the parents than urgent care it is.

But hey, I just got an email saying NESA is looking for medical officers, so if NHQ isn't following the various regulations that say don't provide medical care, why should anyone in the field?

[TheSkyHornet]

CAPR 160-1:

1-6.
b. Medical care within CAP is limited to emergency first aid and may be provided only
by members with appropriate training and experience. Such care shall continue only until
professional medical care can be obtained

1-6.
d. CAP members providing emergency first aid will inform first responders, like
emergency medical services, what they have done so that further care is not hindered.

Most individuals couldn't even tell you the difference between first aid and emergency first aid.

[AirDX]

Let someone become injured or ill, and who does everyone turn to stare at? Those annoyances.

Which is not fair to them in the extreme.

We're used to it. Same thing happens in the other 95% of our lives.

[Eclipse]

Let someone become injured or ill, and who does everyone turn to stare at? Those annoyances.

Which is not fair to them in the extreme.

We're used to it. Same thing happens in the other 95% of our lives.

Which is even more reason CAP should not set its members up this way.

Complicating things even more are the medical professionals and law enforcement personnel
(among others) who have a "Duty to Act".  CAP's welcome gift is making sure these
members know that they do so under their own auspices with no support from the corporation or the USAF.

[Pace]

Utilizing healthcare professionals in an advisory capacity is non-trivial. As stated, they are perfectly suited to help plan for and mitigate health related concerns during operations and cadet activities.

Most medical professionals also have training that is necessary in life-saving situations. From a personal medicolegal standpoint, using those skills in CAP carries the same level of liability as it does when I stop at a vehicle accident and render aid. Specifically, I am protected by the Good Samaritan Law that every state has enacted, and in some states I may have civil or criminal liability if I fail to act. The law doesn't define the level of response required or the scope at which I must practice; however, it would be prudent and appropriate to render basic first aid/BLS until an ambulance arrives. I could act beyond that scope, and I might if the situation required it (unlikely). However, acting at a level that requires professional licensure (performing a cricothyrotomy on a patient with an obstructed airway or a pericardiocentesis on someone with trauma-induced cardiac tamponade) and not simply a certification course is a tricky animal, and I would be exposing, at a minimum, my license to adverse action by a state board. At that point the devil would be in the details, and I had better be absolutely right and be able to defend my choices.

Rendering CPR and using an AED is likely the extent of the actions necessary in emergency situations and is clearly protected by BLS/first aid and good samaritan laws. CAP needs no official policy, exemption, or medical liability insurance for that.

[Eclipse]

Rendering CPR and using an AED is likely the extent of the actions necessary in emergency situations and is clearly protected by BLS/first aid and good samaritan laws. CAP needs no official policy, exemption, or medical liability insurance for that.

It also doesn't need Health Care Professionals for it either.

Which is frankly the core of most of these issues and discussions.

CAP members are barred, by regulation and design, from doing basically anything
that requires any skill beyond that of a well-rounded member of the general public,
even when they actually possess skills and experience beyond that of a well-rounded
member of the general public.

Lawyer?  That's nice.  Yeah, a handful at higher HQ will get to assist
with contracts for banquets and hangar use, the rest will just get a badge.

MD?  That's nice. Yeah, a handful at higher HQ will get to advise on
hot weather safety, and how long to run the water to expunge covid, the
rest just get a badge.

EMT?  Badge for you, too.  Leave the backboard and oxygen at home, we don't do that here.

If CAP spent more time understanding how important well-rounded members of the general public
actually are, and less time trying to emulate military and civilian models it can never aspire to,
a lot more would get done, and a lot more members would be satisfied with their time spent.

(Of course if you're an Army E4, you're the savior of CAP and we need you
to get in here now and start doing exactly the same thing as everyone else, but I digress).

[Fubar]

Rendering CPR and using an AED is likely the extent of the actions necessary in emergency situations and is clearly protected by BLS/first aid and good samaritan laws. CAP needs no official policy, exemption, or medical liability insurance for that.

The regulations clearly state performing life saving aid is specifically allowed, in fact it looks a lot like your average Good Samaritan statue. CAP is within their rights to tell their members what they can and can't do, even if licensed or certified to do so and in this case, CAP is saying go right ahead.

It's the "Medical Officer" at encampment that is there to do a lot more than stand around in case that emergency situation arises. They do triage, assess patients and determine course of treatment from take ibuprofen and put some moleskin on that foot to get this person to the hospital stat. That is contrary to our internal regulations and policies yet happens at a lot of cadet and emergency services activities.

As stated before, this continued ignoring of the rules puts both the members and CAP, Inc at risk, but NHQ engages this behavior so why shouldn't the membership?

I get creating duty positions and bling probably had good intentions around recruiting, but it's created an cadre of members who really want to open temporary medical practices at activities instead of being a phone number folks can call for advice.

[Pace]

It also doesn't need Health Care Professionals for it either.

I never said it did. I'm only stating that CAP doesn't need to actively support medical professionals any more than they already do.