ICS Courses

[JC004]

Only for Type I and II teams. Type III and IV require local EMS support. Realistically, CAP would only be fielding Type III or IV teams.

Absolutely agree.  Given the requirements, we will be Types III/IV.  But even to accomplish that, we have to seriously look at how our ES team system is organized.

Agreed.

Any such examination must be done by a group diverse enough to transcend any parochialism or tribalism currently found within the organization.

[DNall]

I see that in 60-3. Funny that it never made it into the SQTRs. It never was an issue for me since Scanner was the first specialty I finished.

SQTR makes it look like noth are required:
Planning Section Chief - Prerequisites
AOBD - Air Operations Branch Director         
GBD - Ground Branch Director

[JC004]

I see that in 60-3. Funny that it never made it into the SQTRs. It never was an issue for me since Scanner was the first specialty I finished.

SQTR makes it look like noth are required:
Planning Section Chief - Prerequisites
AOBD - Air Operations Branch Director         
GBD - Ground Branch Director

Wonderful, aren't they?  You'd think they could get this together.  Hell, if they'd let me, I'd go in and fix all the mistakes myself.

[DNall]

Firstly one could argue that when on an AF assigned mission status, state law does not apply as we are an AF instrumentality, hence need not meet state requirements as far as lincensure or scope of practeice. 

First of all, those AFAMs are under state jurisdiction. Remember the states have responsibility for SaR, and the AF is the designated federal agency to provide air spupport to them when they have a need they can't fill on their own. CAP's SAR mission is to take the bulk of that, particularly the non-distress work, and keep it off the AF's plate.

In otherwords, you do have to comply with state requirements, because it is the state that decides if CAP gets called by AFRCC or not, and under what limits. Not that it matters, those requirements are supposed to be replaced by the standardized FEMA requirments, which we clearly have no choice but to get compliant with.

When I was in the nasty guard, we had a similar predicament, medics could not operate using the Army standard unless they were on Federal status, unless they held an equivilent state certification.

91W is an EMT-B

Secondly, that "scope of care" that FEMA is looking at is pretty minimal.  I think EMT or Wilderness FR is more for the knowledge level rather than a specific skill set.  In that aspect it is level of competency that CAP could easily achieve.

If you'll look at how the teams are shaped, you're talking about one EMT back at base with the command & control element of 48 people in the field. My understanding is they are there for triage & to provide support to field teams.

[BillB]

What law puts SAR under state jurisdiction??? In some states SAR is placed under County control. In others, no mention of what agency has jurisdiction. A missing aircraft search has, under the Inland SAR regulations always been a USAF controlled activity. Maybe in Texas there is a law that transfers control to the state, but that law doesn't appear in other state statutes.
In Florida a missing person search falls under the County Sheriffs jurisdiction, or in many local seaches under the City Police Department. But large area searches are conducted thru AFRCC. There have been few (a VERY few) search missions where the Sheriffs helicopters were asked to stand down due to USCG or CAP Search operations.

[SAR-EMT1]

While all 91W's attain the National Registry at the Basic Level, they have the option of retesting for The "D" / Basic-Extra tag...
Also Combat Lifesavers  can certify at  Nat. Reg. First Responder -Extra
- I keep saying "extras" because thats the common term I hear at the station or in the ER. The cards Ive seen actually Say "D" - but thats IL.

[DNall]

What law puts SAR under state jurisdiction??? In some states SAR is placed under County control. In others, no mention of what agency has jurisdiction. A missing aircraft search has, under the Inland SAR regulations always been a USAF controlled activity. Maybe in Texas there is a law that transfers control to the state, but that law doesn't appear in other state statutes.
In Florida a missing person search falls under the County Sheriffs jurisdiction, or in many local seaches under the City Police Department. But large area searches are conducted thru AFRCC. There have been few (a VERY few) search missions where the Sheriffs helicopters were asked to stand down due to USCG or CAP Search operations.

The national search & rescue plan, which is the US portion of an international treaty.

All inland SaR, including missing aircraft, is a state responsibility. States can then in use thier own laws to delegate that responsibility to counties if they wish. That tends to be the case for missing persons, but not far beyond that. Aircraft searches are generally under a state dept of aviation/transportation/state police/something like that. Ours is under the aviation division of DPS (state police).

AFRCC is not in charge!!! They are much like FEMA in that they are there to coordinate federal support to an outside effort. They are in charge of that federal support, and to the extent states may choose thru MOU to hand over that authority thru an assistance request, in some narrow situations.

My point being, it's not a federal HLS mission in which the state has no interest or authority. The state is legally the governing agency for all inland searches, and the AF is secondary. Our part is as one inexpensive tool in a full box of federal resources that AFRCC can call on to provide aid to states in fulfilling their obligations. So, we most certainly would have to meet any state mandated qualifications & such, or the state can and will freely cut us out of SaR missions. And there are limitations in some states (Colorado & Nevada I believe are examples) based on our qualificatiosn, and extra requirements in other states (Washington I believe for example).

While all 91W's attain the National Registry at the Basic Level,

That's what I said. So obviously they can practice under that license while on state active duty & acting as an instermentality of the state. The problem would be (and is w/ CAP) one of acting in a federal capacity while only holding a state license, which isn't a problem within your state, but is an issue going outside to stuff like Katrina. I believe the FEMA standards state national certification, at least at the type I level, but that's going from memory.

The bigger deal though is what I said about their capacity & duties. They are basically the missions medical officer for a GBD/CUL supporting 48 GTL/Ms, NOT a field medic. The standard of care we're talking about is still GTL/M w/ first aid & an EMT on the other end of a radio (be that local EMS or otherwise). Having an actual EMT on the team itself would be nice, but that's overkill.

[stillamarine]

Not for nothing,

But if I remember correctly (it's been a couple years since I've let my NREMT-P expire) but an EMT is required to work under a Medical Director. 

I like the idea of an EMT on a ground team, but you would have to figure out who is going to be that Director.

Now, I don't think MFRs or WFRs are required to have an oversight. True they can't provide all that an EMT can, but there is plenty they can do to accomplish the mission.

I think you would have to look at how often you are putting ground teams into rural areas where local EMS systems are not readily available. This includes hospitals. I lived in the Northwoods of WI once and in the winter time getting to the hospital by ambulance could take almost an hour. I know. I drove it A LOT. Up there we required all of our FFs to get MFR as soon as possible and we also payed anyone interested to get at least their EMT-B.

If your in an area where you have EMS readily available, then it may not be as important to you.

[DNall]

All full-time FFs in our state have EMT-B as a prerec, not that it matters to the conversation, but it's real useful.

On a type I/II incdent, there would be a medical officer with the IC staff that oversees your organic EMT, who in turn oversees your field operators. I'm not really an expert, but there's an EMS response plan just like thre is a SaR one, that's where I'd direct my question. The kind of supervision you're talking about, like authorization for drugs & such, should rarely ever be an issue, but where it is there are AF emergency physicians avail 24hrs on-call to AFRCC. It's ashame we don't practice it, but they will put such a person on the phone that will supervise care.

[isuhawkeye]

just a point for this thread

The national registry is simply a testing entity.  this entity is very widely recognised, but not all states accept national registry status. 

Secondly the national registry certification does not allow you to practice medicine.  All states require a state issued licenser or certification in order to function.

These are mutual aid procedures in most states which allow out of state health care providers to function during times of emergency

[sarmed1]

In regards to 91W (or bravo at the time) EMT-B does not allow a Military Medic to start IV's or administer any medications even thou 91W are at the EMT-I level of skills they are not certified there, under the NG rule they could only perform those skills if the held an equivilent state certification (EMT-I, CRT, EMT-Advanced or Paramedic depending on where you live)

Yes Medical direction is still a requirement at the EMT-B level, other wise you are operating as a first responder (kind of super first aid). Dont do EMT-B skills, ie assisted medications, oral glucose, activated charcoal etc etc, without having some kind if in writting physican oversight (based on how your state does taht sort of thing).
The AFRCC fligh surgeon is a nice idea, I have never tried to call as a CAP person, we tried once from a C-130 on an aeromedical evac training mission and it took forever to get patched thru.  If this is an area you feel strongly about I would pursue it with either the wing medical officer or your home volunteer/paid medical director.  When I lived in Texas our service medical diretor told us that if we were ever out and about and needed to be covered for something not at work, call him.

[Nick]

EMT-B does not allow a Military Medic to start IV's or administer any medications even thou 91W are at the EMT-I level of skills they are not certified there, under the NG rule they could only perform those skills if the held an equivilent state certification (EMT-I, CRT, EMT-Advanced or Paramedic depending on where you live)

[snip]

When I lived in Texas our service medical diretor told us that if we were ever out and about and needed to be covered for something not at work, call him.

Hey Mark, long time ...

That limitation on administering IVs doesn't apply to saline, right?  I mean, I see CLS' running around with bags of it all the time... and they're not even EMT's.

As for that medical director... that's some pretty [darn] good support right there.   I think an AFRCC on-call medical director (or even a joint service RCC medical director; perhaps at that level it could be a 24/7 standby medical director) would be ideal.  Of course, then that enters into a whole new wide world of "what are the limitations of a CAP EMT?"  I can't see them toting drugs or anything else requiring medical direction.

[DNall]

I can't speak for other states, but the way I understand it here is TX or fed test is good enough to get you a state license. So all our guard folks are state licensed if they like it or not. They are further acting on governor's orders, and that trumps licensure requiremnts as the governor has power over that. I believe that's also the case when deployed to another state at that governor's orders. We're also reciporicle with other states to a degree, though I don't know details on that for EMT.

I'm with Nick in thinking very little medical direction is actually required. The med kit carried should be fairly limited to minimal stabalization. I can see cases where it would be very helpful to have a doctor on call, but more as a practical consultant than a formal medical director. In a real ICS situation there would be a medical director in that chain that you'd have your organic EMTs reporting to for those matters. I don't really see any of this as all that complicated.

[PA Guy]

You have hit on part of the problem. Licensure/certification can vary widely from state to state. For instance, in CA EMS certification is a county function. An EMT must be certified in each county they work. The EMS standardized procedures can also vary from county to county.

Medical direction is required and all legend meds, supplies and equipment must be approved by the medical director. If you are going to do ALS you must be prepared to do it completely, there is no such thing as partial ALS. The cost of medication, supplies, equipment and training/sustainment to provide ALS would be prohibitive for CAP. Therefore the best CAP could  supply would probably be BLS. There would also have to be some sort of  credentialing process for all providers and a quality assurance program.

The show stopper is tort liability. If you are providing a BLS service as an organization the Good Sam laws won't protect you. So, who is going to provide the protection? CAP doesn't have the money. Most states won't, since many won't cover their NG medics when in IDT status. That leaves the feds and they show no inclination. So until this is resolved all the discussions of levels of service, medical control etc. is not going to go anywhere.

[sarmed1]

Saline still falls under IV's... 
DNall, your NG folks are only licensed in Tx if they submit for reciprocity.  The  state governmental entities are not exepmt from state law/requirements unless specifically exempted by that law.

Medical direction is still required, be it on line (direct contact) or off line (ie  protocol)

Sure there is such a thing as partial ALS, states that have intermediate levels, they are limited ALS providers and by law are only allowed certain skills/medications.  Equally a medical director could limit what even paramedics are capable of doing, again it depends on how your state laws regarding EMS and provisions of prehospital care are written.

[PA Guy]

Sure there is such a thing as partial ALS, states that have intermediate levels, they are limited ALS providers and by law are only allowed certain skills/medications.  Equally a medical director could limit what even paramedics are capable of doing, again it depends on how your state laws regarding EMS and provisions of prehospital care are written.

You're right. My bad. When I wrote that I was thinking of ACLS. The point I was trying to make was that if you are going to do ACLS you must have all of the training, medications, supplies and equipment to do ACLS. You can't have bits and pieces.

Approved ALS procedures can and do vary from jurisdiction to jurisdiction.

[sarmed1]

either way ACLS intervention, as it applies specifically to cardiac arrest is a waste of time in a wilderness environment.  The time to definitive care is longer then you would likely be able to maintain meds needed to resucutate somebody.  After 15 years of EMS very few prehospital arrests survive even to the ER, and thats with good bystander CPR, early defibrillation and ACLS medications, in the wilderness environemnt, not likely.  Non-arrest ALS interventions are much more useful and likely to be needed in the wilderness environment:  treatment of diabetics, allergic reactions, heat injury/dehydration, pain management for trauma, seizures, asthma attacks and early cardiac management..ie asa, nitro.

mk

[SAR-EMT1]

just a point for this thread

The national registry is simply a testing entity.  this entity is very widely recognised, but not all states accept national registry status. 

Secondly the national registry certification does not allow you to practice medicine.  All states require a state issued licenser or certification in order to function.

These are mutual aid procedures in most states which allow out of state health care providers to function during times of emergency

Not so...
In IL, for example the National Registry IS the test, certification/ licensing body.
The reason behind this is because we had a problem with the Chicago FD stealing the answer keys to the old state tests and passing them out to new hires.  So, we no longer have a state test and just go through the NR

... I hate Chicago.. and all it stands for...
Needs to be a seperate state. lol
i kidd I kidd....

[isuhawkeye]

Iowa is the same way.  the test is administered under the direction fo the national registry, but that card doesnt meen anything with out your state cirt.  I still hold my Illinois card. 

[stillamarine]

FL is the opposite, NR is not recognized. Sort of. You can challenge the FL test but you still have to be FL certified.