What are the limits of teaching First Aid/CPR?

[Garibaldi]

Our DCC asked me tonight what the limits are on what sort of first aid we should teach younger cadets. Specifically, what should they learn and not be taught, like should a 12 year old be taught how to use a defib unit or take a first responder course? What are CAPs limitations regarding the Good Samaritan Act? I had answers but I want to see what others think before I post them.

[docbiochem33]

I don't think that it is a problem if you stick with the basic courses that the American Red Cross has.  Both Adult and child.  Infant can be good because they may babysit younger siblings or kids they know.  The defib is not a problem since you are teaching them with an AED and not the old fashioned type I learned on many moons ago.  The AED's will not do anything if there is no reason to shock. 

I don't think you should go into advanced first aid stuff as one may not be covered under Good Samaritan laws.  Sure, I know how to deflate a chest, perform an emergency breathing tube procedure, and can start an IV, but I am not covered.  Cadets don't know how to do these things and most seniors don't.  As I have learned with the Combat Life Savers Course, once a few people learn a few skills they think they can do it all.  I remember one RN from our ICU telling me that she had a guy telling her about all his skills and how he was a CLS person in his unit and knew all the stuff medics knew.  His jaw dropped when she dropped her alphabet soup of credentials.  A little conservative training is sometimes better than teaching a lot of advanced skills.

[Brad]

We always did the American Heart Association Basic First Aid for Healthcare Providers....which is basically the same thing the AMR teaches, it just has a bit more standing in some legal circles is all. Basic wound care, very simple splinting, shock, temperature extremes, CPR Adult/Child/Infant + AED

[Stonewall]

I look back to my first ARC Standard First Aid and CPR course I took in CAP in 1987.  It started at 1800 on Friday at Camp Blanding, FL and wrapped up with a full blown scenario on Sunday at around 1500 that lasted at least an hour.  Seriously, 25 years later, me and a couple of my best friends still talk about that weekend.

I think it was a combined 24 hours of training.  I'm not sure what ARC's time requirements were, but the dude that taught us was a combat medic from Vietnam and was still serving as a 1Sgt for the local Army Reserve "MASH" unit with his civilian job as a flight medic on the local life flight. I'm sure the curriculum called for 12 hours of training, but we practiced and practiced until we got it right, and then he taught us some "cool" ways to make things work.

This is the way I look at still today.  Regardless of what the curriculum is for a specific course, call it "community first aid" or "standard first aid", there really is no reason to stop at that curriculum.  The course may call for teaching the old sling & swathe to immobilize an injured arm, but if you're the instructor and you know of a valid, practical, and proven way of enhancing that specific task, go for it.  Simply say "hey, this is not on the test, nor will you have to demonstrate it, but it's a good-to-know tool for your toolbox."  Things like that.

One of the things we fail to do is simply continue practical and realistic medical training, regardless of a qualification.  You can teach a "non-qualified" cadet/senior to simply stop bleeding.  Just because they aren't getting a cool card after the block of training, doesn't mean you shouldn't continue adding to their medical toolbox.  No need to rubber stamp the first aid requirement and stop once the card is issued.  Add scenarios and hip-pocket-training that cover medical skills regardless if it's something covered in their particular level of certification. 

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?

[Garibaldi]

This is basically what I told her. In the scope of CAP, we really can't act any further than our training. She was concerned about legal issues, which I think we covered in our discussion. Basically, I said that our first aid card has enough information on it, and anyone concerned can look it up as to which course was given, the content, and who taught it. A lawyer should, in the course of his investigation, get all this information anyway if needed. Course content isn't a big secret; anyone can call or google the information themselves and find out what was taught, and at what level. A 12 year old cadet on a UDF or ground team (extreme case, I know, but our unit is seeing more and more 12 and 13 year olds joining) will have an adult on hand to take the responsibility for administering first aid, but in real life a 12 year old with first aid or cpr training may or may not have the maturity to administer aid. And in the event a victim is conscious, they do have the option to refuse aid if offered. I may or may not decline if approached by a young kid who claims to know first aid.

We both kind of agreed that there should be levels of training depending on age and maturity. Seniors and senior cadets (age 17-21) should be eligible for advanced training like defib, setting broken limbs, etc., cadets in the age range of 12 to 14 should be given basic, such as burns, blisters, and sprains, and those in the mid range can have intermediate, like slings, penetrating trauma to the eye, CPR, etc.

Still don't know how CAP and the Good Samaritan law interact as well as I should. For some reason, and this goes back to my cadet days, we always said that if there was a conflict between training we had and CAP rules, that the qualified person(EMT or paramedic) would "resign" by taking off their uniform blouse and handing over their CAPID, while the team leader quickly wrote out a note saying this person resigned effective etc etc, thus negating CAP culpability, but this isn't a valid defense, is it?

[SARDOC]

It really depends on your state as far as the Good Samaritan act.  First Aid is one of those things in my state that you don't need to be certified to do.  The only reason to do it is just to document the training for organizational requirements. 

Good Sam does apply to us as we don't have the duty to respond as a medical provider.  We train our membership in certain Emergency Services Specialties but we don't require our membership to provide medical care...When reading the policy we actually limit the care provided to Emergency Care within the training and qualifications of the person providing the care but don't actually have a legal duty to respond.  I would say we have an ethical duty to provide what care we can but we'd be protected by Good Sam because we don't have the legal duty to respond. 

Make an Inquiry through your chain to the Wing Legal Officer to find out how Good Sam works in your state.

[Eclipse]

The requirements for First Aid training are spelled out fairly well in 60-3 (Page 17):

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 treatment deemed
necessary to save a life or prevent human suffering.  This treatment must be executed by a person
qualified to attempt such medical care within their skill level.  When first aid or higher medical
training is required for qualification in a particular specialty, the expectation is that the
qualification course includes both knowledge and practical skills training; first aid courses taken
on-line only are not acceptable; though members are not considered employees when supporting
operations, courses are expected to meet the National Guidelines for First Aid in Occupational
Settings available at  http://ntl.bts.gov/lib/24000/24700/24757/ngfatos.pdf or ASTM F 2171-02,
Standard Guide for Defining the Performance of First Aid Providers in Occupational Settings.
CAP medical personnel are not provided supplemental malpractice insurance coverage, and any
care provided is at the members own risk.  Though medical supplies and equipment are not
normally provided to responders, any reasonable supplies used on training or actual missions
may be submitted for reimbursement as long as sufficient justification is provided.

In nearly all cases, this limits the "who" to professional instructors certified by organizations such
as ARC, AHI, Green Cross, etc., not members (even medical professionals), nor the local fire department,
or "mom who is a nurse".  This type of training is sometimes referred to as "Community-level First Aid".

While you can make the argument that "no knowledge is bad knowledge", in the case of medical
treatment, some knowledge is potentially dangerous, especially when not practiced on a regular basis.

Your best bet is to have them attend a local class outside CAP and leave it at that.  CPR is no longer
required and while attending a CPR/AED orientation class isn't a "bad" idea, per se, the likelyhood
of it ever being needed are pretty slim, especially for a cadet.

Make an Inquiry through your chain to the Wing Legal Officer to find out how Good Sam works in your state.

+1

[Eclipse]

Still don't know how CAP and the Good Samaritan law interact as well as I should. For some reason, and this goes back to my cadet days, we always said that if there was a conflict between training we had and CAP rules, that the qualified person(EMT or paramedic) would "resign" by taking off their uniform blouse and handing over their CAPID, while the team leader quickly wrote out a note saying this person resigned effective etc etc, thus negating CAP culpability, but this isn't a valid defense, is it?

No.  Nor is it likely to fly in the way a coffee-house lawyer thinks it would.  For starters, since the average GTL is not a corporate officer (and in fact not even Wing CC's are any more), this "field resignation" wouldn't be valid anyway, nor would a judge or jury likely just ignore how the person got to the scene to start with.

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.

I >have<, however advised members who are not comfortable with this situation to simply not put themselves within mission scenarios where
it could become an issue - i.e. "maybe being on a ground team isn't for you..."

[coudano]

Hmm, is there an appropriate age limit to operate an AED?

[Garibaldi]

The requirements for First Aid training are spelled out fairly well in 60-3 (Page 17):

*snip*

In nearly all cases, this limits the "who" to professional instructors certified by organizations such
as ARC, AHI, Green Cross, etc., not members (even medical professionals), nor the local fire department,
or "mom who is a nurse".  This type of training is sometimes referred to as "Community-level First Aid".

While you can make the argument that "no knowledge is bad knowledge", in the case of medical
treatment, some knowledge is potentially dangerous, especially when not practiced on a regular basis.

Your best bet is to have them attend a local class outside CAP and leave it at that.  CPR is no longer
required and while attending a CPR/AED orientation class isn't a "bad" idea, per se, the likelyhood
of it ever being needed are pretty slim, especially for a cadet.

Make an Inquiry through your chain to the Wing Legal Officer to find out how Good Sam works in your state.

+1

Yeah we looked at it and it didn't answer as many questions as we'd hoped. We'll pursue it up the chain if necessary. Thanks to all who responded

[Eclipse]

Yeah we looked at it and it didn't answer as many questions as we'd hoped. We'll pursue it up the chain if necessary. Thanks to all who responded

I've personally discussed this with John Desmaris and others at NHQ, and the basic answer was that they don't want to define it any tighter
because they don't want to limit which organizations can provide the training, while at the same time maintaining that is generally needs to
be an outside organization and that the certifications expire and require retraining.

Anything more specific should be approved by your Wing CC, as he is the person who ultimately approves all the ES quals in your wing.

[manfredvonrichthofen]

Personally I wouldn't have young cadets ( under age 16) using an AED.

I am a trained EMT licensed in Indiana, what I am saying is based on what I know and understand, but it does not reflect law or regulation in any capacity.

I would keep young cadets under 15 to the basic first aid and CPR, this shouldn't be any issue, as far as CAP goes, cadets under 16 can't operate missions anyways.

At age 15 introduce healthcare provider level CPR and AED . It's good stuff to know and start getting used to more technical items.

Age 16+ more advanced first aid style training, deeper thought into trauma systems, assisting EMS, spinal immobilization, treating shock and the differences between hypovolemic shock and septic, or neurogenic, or anaphylactic shock, what triggers it, how to treat the different kinds of shock until further treatment can be sought. I know you go over it in basic first aid, but it can be taught in greater detail, about immobilizing foreign objects, traumatic eye injuries, and burn injuries, basic first aid barely touches these issues.

[Eclipse]

cadets under 16 can't operate missions anyways.

How do you mean?

There are no age restrictions within CAP for ES.  A properly trained and qualified cadet can act in a number of operational roles as equals to
senior members, not the least of which is Ground Team and UDF, where they would most commonly be called upon to use First Aid.

[manfredvonrichthofen]

cadets under 16 can't operate missions anyways.

How do you mean?

There are no age restrictions within CAP for ES.  A properly trained and qualified cadet can act in a number of operational roles as equals to
senior members, not the least of which is Ground Team and UDF, where they would most commonly be called upon to use First Aid.

I was pretty sure there was an age requirement to be GTM3 qualified of 16yrs old.

[coudano]

There are no age restrictions within CAP for ES. 

Some specialties do have 18 years old as an age limit (of course that doesn't necessarily inhibit all cadets, as cadets over 18 can do those jobs)

I was pretty sure there was an age requirement to be GTM3 qualified of 16yrs old.

Nope.

[Garibaldi]

The only age restrictions I am aware of are that you have to be 16 to get your solo wings, 18 to be a GTL and 21 to be a driver. Personally, I wouldn't use any cadets under 16 for a ground team mission involving a missing plane but that's just me. I have no problem training a 12 year old to do anything if they are willing to learn and be serious, but I wouldn't call them to go out unless I had no choice. Not emotionally equipped to handle mission stress and whatnot.

[Eclipse]

The only age restrictions I am aware of are that you have to be 16 to get your solo wings, 18 to be a GTL and 21 to be a driver. Personally, I wouldn't use any cadets under 16 for a ground team mission involving a missing plane but that's just me. I have no problem training a 12 year old to do anything if they are willing to learn and be serious, but I wouldn't call them to go out unless I had no choice. Not emotionally equipped to handle mission stress and whatnot.

18+ to be aircrew.
18+ but under 21 may drive COVs but not passengers or trailers.  18+ to drive golf-cart-type vehicles.

I wouldn't necessarily disagree with the rest. 

[manfredvonrichthofen]

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.

[Stonewall]

Personally I wouldn't have young cadets ( under age 16) using an AED.

I'm an AHA BLS/CPR/AED/FA instructor.  In the past, I was an ARC CPR/AED/FA instructor.  I've also been a first responder and EMT.

As quoted by AHA the target audience for Heartsaver FA/CPR/AED is "anyone without formal medical training...".  It does not give a minimum or maximum age, anywhere.

In my current capacity at work, we don't teach first aid, just CPR/AED, so I'm not up on time requirements for the FA part.  But I found it interesting after my original post above, that the combined time requirement for all 3, CPR/AED/FA is roughly 7 hours total.  It actually says 5 to 7 hours.  I can teach a monkey to use an AED in like 10 minutes.  CPR and AED, in 30 minutes. 

I think it's cool how (in my original post) that as a 14 year old cadet, I spent a solid weekend Friday through Sunday evening, learning First Aid/CPR.  Actual classroom and hands-on training was at least 24 hours worth.  And NONE of that was AED because they didn't exist for non-paramedic types.

Here's the question that should perhaps be posed to a lawyer type (although I don't much care for them), but what is important?  "Scope of training" or "scope of certification". 

Just because you're not a card carrying member of "how to do CPR", does that mean you shouldn't try, especially if you've been "certified" in the past?

What if you don't have a "FIRST AID CARD", but you read an article and then practiced how to splint a fracture on your own, without formal training?  Is splinting a fracture "outside your scope of training?"

Personally, I think, while yes, we do need to have an official "card" that says we're qualified to earn our GTM rating in CAP, I strongly believe that our training should NOT stop at the curriculum for said "first aid card".    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.

[SARDOC]

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.