CAP Talk

As most of us know, CAP has tried its best to devise language that makes it pretty clear that we're not here to provide medical care for anyone, but at the same one of our reasons for being here is responding to emergencies  that have the potential need for CAP members to provide care for those who have been injured.  Personally, I don't think they've come up with a rational approach to this whole situation, but lets look at a specific example that cropped up on VolunteerNow: http://www.capvolunteernow.com/news.cfm/nev_cadets_call_on_emergency_skills_at_scout_expo?show=news&newsID=7619

In this case, dozens of CAP members performed a roving "safety patrol" at a Boy Scout encampment and apparently had "first aid response teams" that were called when needed.

Does this sound like a proper duty for CAP members given our regulations regarding first aid?  In this case we're looking at a planned non-CAP event where CAP members were tasked with being first responders in incidents where first aid might be necessary. 

That is worlds apart from happening to be at someone else's event and spontaneously responding to an emergency which I think is what CAP would really prefer.

The applicable langauge from 60-3 would seem to be this:

QuoteCAP 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.

One might claim that CAP was just supporting the camp nurse and therefore would be covered, but that would be a close call in my book.

To be clear, I actually think CAP should be able to provide advanced medical care and I think this sort of thing is a great mission for CAP, but it seems to me that it goes against what CAP wants us to do, yet here it is being trumpeted by our PA folks. 

Incidentally, shouldn't the Boy Scouts have had plenty of their own folks with First Aid merit badges walking around?

Quote from: RiverAux on May 13, 2010, 07:42:12 PM
Incidentally, shouldn't the Boy Scouts have had plenty of their own folks with First Aid merit badges walking around?

As I read that all I could think was how many noses were out of joint that CAP was the responder in that situation.  I know I'd have an
"opinion" if Boy Scouts were helping CAP members at an airshow or something - it doesn't really make any sense.

I don't think they were really over the line, but I don't understand why we were there to start with.

Reminds me of that deal when the CAP cadets were driving around assisting stranded motorists a couple of years ago. I think some people just want to help way to much.

Yeahhhh. That's a huge liability right there. Ambulance services can provide standby EMS crews for these types of events, who are licensed and insured to provide these services. Not a good call.

"Emergency First Aid Response Teams" sounds like an emergency medic or paramedical response.

Or maybe a PAO is just a little too good at trying to write an exciting news story...

CAP is very clear about what we can and cannot do.  There is no mixed message except in the minds of people who don't want to be restrained in their actions.

Might have evolved out of a combination CAP/BSA squadron??

Quote from: Short Field on May 13, 2010, 11:45:14 PM
Or maybe a PAO is just a little too good at trying to write an exciting news story...

Well, I don't entirely discount that as a possibility, but in this case they would have had to radically mistate or make up the statements of concern.

QuoteCAP is very clear about what we can and cannot do.  There is no mixed message except in the minds of people who don't want to be restrained in their actions.

By this do you mean that you believe that having CAP members specifically tasked to be available to perform first aid at a non-CAP event falls within our regulations? Or are you saying that it was clearly not allowed and they messed up by taking on that task?

Quote from: RiverAux on May 14, 2010, 12:31:09 AM

Quote from: Short Field on May 13, 2010, 11:45:14 PM
Or maybe a PAO is just a little too good at trying to write an exciting news story...

Well, I don't entirely discount that as a possibility, but in this case they would have had to radically mistate or make up the statements of concern.

QuoteCAP is very clear about what we can and cannot do.  There is no mixed message except in the minds of people who don't want to be restrained in their actions.

By this do you mean that you believe that having CAP members specifically tasked to be available to perform first aid at a non-CAP event falls within our regulations? Or are you saying that it was clearly not allowed and they messed up by taking on that task?

Having CAP memebers specifically tasked with "emergency first aid responders" is pretty clearly against the regulation.

Quote from: JThemann on May 14, 2010, 01:22:33 AM
Having CAP memebers specifically tasked with "emergency first aid responders" is pretty clearly against the regulation.

Especially considering that neither of the cadets had first aid training, BCUT, or any of the FEMA courses.  One cadet did have his GES qualification.  This is from Ops Quals.

Quote from: RiverAux on May 14, 2010, 12:31:09 AM
but in this case they would have had to radically mistate or make up the statements of concern.

Oh, someone passes out, a distress call goes out, and the CAP command post sends out a C/AIC and a C/SrA to take care of the situation - neither of whom has any first aid training. No CAP adult supervision was provided?  The cadets made an initial medical assessment and then called a nurse?  The nurse is asking the cadets "What should you do next?".   Yep, you are right, this had to have happened exactly as written without any exaggeration at all. 

Sure sounds like two cadets responded without any adult members with them. With the way I understand what CAP does not want us to do this doesn't sound right at all. I'm not saying it might not be a good mission for CAP but they don't want us doing this for our own people why would they let cadets do it for anybody else? And then to put it up on a web page for all to see

I noticed that the PAO was from the same squadorn as the Sq. CC and wrote this:  "Capt. David Henderson, commander of the Jim Bridger unit, led the 36-cadet safety team with organization and precision."   I agree with an earlier poster that this is a lot of extra hype; you would have thought Capt. Henderson was preparing for an OER.

My big question:  Why the heck did VolunteerNow even publish this news given how far agianst regulations it was?  I have more of a beef with that then I do the original "story."

I don't think anyone blames the cadets as in this case they were pretty clearly doing what they were told to do. 

I'm pretty impressed with the First Aid Response Team acronym.  What would the patch look like?

Motto could be, "There she blows". hehe..

Lots of clouds and lighting bolts on the patch?

Brown clouds, maybe.  >:D

Brown is ok but they need to make sure they don't put a torch on the patch to help light the way...

Torch would actually be good if they have a long blue flame on the other side.

I felt that I had to post something on this seeing as I'm a member of both organizations. I work as a lifeguard and as an assistant to the nurse at a Boy Scout camp in Oregon. I can tell you that most Boy scouts are going to have more medical experience and training when compared to cadets (especially since as pointed out earlier neither of the responding cadets had any medical qualifications. looking at this line out of the article


Under the nurse's guidance, the cadets were allowed to take more medical information, and they discovered a history of hypertension and diabetes. Asked by the nurse, "What should you do next?" they responded without prompting: "Call 911 for emergency medical help."

First off "Discovered"!!!! like oh my gosh we discovered!!!  ::)
it seems like a situation where the Nurse was just letting the cadets play along and think that they where actually doing something important. Even if CAP has the write or authority to provide roaming safety patrols shouldn't they have some sort of medical training? Looks to me like a case of cadets and seniors wanting to feel important. The article writes them up like the where PJs jumping out of helos in order to save this persons life when in all actuality they where un-trained cadets asking basic questions and applying ice packs under the supervision of a nurse. Huge exaggeration and I agree completely with those who said they where disappointed to see Volunteer publish this. 

Quote from: coolkites on June 21, 2010, 08:52:58 PMI can tell you that most Boy scouts are going to have more medical experience and training when compared to cadets

By what measure?

Quote from: Eclipse on June 21, 2010, 09:45:54 PM

Quote from: coolkites on June 21, 2010, 08:52:58 PMI can tell you that most Boy scouts are going to have more medical experience and training when compared to cadets

By what measure?

Because the first aid they are required to know for advancement to First Class Scout is more advanced than the Basic First Aid class taught by the Red Cross. If they actually have the First Aid Merit badge, they have even more training.

Quote from: cap235629 on June 22, 2010, 12:13:11 AM

Quote from: Eclipse on June 21, 2010, 09:45:54 PM

Quote from: coolkites on June 21, 2010, 08:52:58 PMI can tell you that most Boy scouts are going to have more medical experience and training when compared to cadets

By what measure?

Because the first aid they are required to know for advancement to First Class Scout is more advanced than the Basic First Aid class taught by the Red Cross.

Not by a long shot.

Quote from: cap235629 on June 22, 2010, 12:13:11 AM
If they actually have the First Aid Merit badge, they have even more training.

Now we are talking roughly equivalent training. But I'd rather have a cadet with an ARC card than a scout any day because I can be reasonably sure of the quality of the ARC training. I know exactly what kind of first aid training scouts get.

Quote from: davidsinn on June 22, 2010, 12:27:55 AM

Quote from: cap235629 on June 22, 2010, 12:13:11 AM

Quote from: Eclipse on June 21, 2010, 09:45:54 PM

Quote from: coolkites on June 21, 2010, 08:52:58 PMI can tell you that most Boy scouts are going to have more medical experience and training when compared to cadets

By what measure?

Because the first aid they are required to know for advancement to First Class Scout is more advanced than the Basic First Aid class taught by the Red Cross.

Not by a long shot.

Quote from: cap235629 on June 22, 2010, 12:13:11 AM
If they actually have the First Aid Merit badge, they have even more training.

Now we are talking roughly equivalent training. But I'd rather have a cadet with an ARC card than a scout any day because I can be reasonably sure of the quality of the ARC training. I know exactly what kind of first aid training scouts get.

Sorry to burst you bubble Mr. Sinn but I am an ARC instructor.  The first aid requirements for advancement to First Class Scout cover more than Basic First Aid.

I am also a 25 year scouter and have been teaching the First Aid Merit badge for 20.  Over the years, first aid training has been more prevalent in the rank advancement process.

here is just an excerpt:
# Demonstrate bandages for a sprained ankle. and for injuries on the head, the upper arm, and the collarbone.
# Show how to transport by yourself, and with one other person, a person:

    * from a smoke-filled room
    * with a sprained ankle, for at least 25 yards.

# Tell the five most common signals of a heart attack. Explain the steps (procedures) in cardiopulmonary resuscitation (CPR).

Here is waht they do for second class (which is before 1st, not after for you non scouts)
   1. Show what to do for "hurry" cases of stopped breathing, serious bleeding, and ingested poisoning.
   2. Prepare a personal first aid kit to take with you on a hike.
   3. Demonstrate first aid for the following:
          * Object in the eye
          * Bite of a suspected rabid animal
          * Puncture wounds from a splinter, nail, and fishhook
          * Serious burns (partial thickness, or second degree)
          * Heat exhaustion
          * Shock
          * Heatstroke, dehydration, hypothermia, and hyperventilation

and before they can advance to 2nd Class, they have to pass the Tenderfoot requirements:

#

   1. Demonstrate how to care for someone who is choking.
   2. Show first aid for the following:
          * Simple cuts and scrapes
          * Blisters on the hand and foot
          * Minor (thermal/heat) burns or scalds (superficial, or first degree)
          * Bites and stings of insects and ticks
          * Venomous snakebite
          * Nosebleed
          * Frostbite and sunburn

Quote from: cap235629 on June 22, 2010, 12:36:38 AM
and before they can advance to 2nd Class, they have to pass the Tenderfoot requirements:

#

   1. Demonstrate how to care for someone who is choking.
   2. Show first aid for the following:
          * Simple cuts and scrapes
          * Blisters on the hand and foot
          * Minor (thermal/heat) burns or scalds (superficial, or first degree)
          * Bites and stings of insects and ticks
          * Venomous snakebite
          * Nosebleed
          * Frostbite and sunburn

Yes I know. I have a scout hand book too. More than one in fact. I also have this little silver bird on a red, white and blue ribbon. At what point does a scout become more knowledgeable than a first aider? We did all of that in my ARC class and then a whole lot more.

then you didn't take the Basic First Aid Class.  The syllabus does not include half of what I just listed.

That's all basic, community level first aid.

Nothing more, nothing less.

Quote from: Eclipse on June 22, 2010, 01:19:45 AM
That's all basic, community level first aid.

Nothing more, nothing less.

Yes it is, but the scouts have to know more than what is taught in the ARC Basic First Aid class, that was my whole point.

Quote from: cap235629 on June 22, 2010, 01:06:07 AM
then you didn't take the Basic First Aid Class.  The syllabus does not include half of what I just listed.

I didn't take an advanced course. I have a basic first aid card. I'm also an Eagle Scout. I'll take the cadet with a first aid card over a scout any day of the week.

Quote from: cap235629 on June 22, 2010, 01:20:59 AM

Quote from: Eclipse on June 22, 2010, 01:19:45 AM
That's all basic, community level first aid.

Nothing more, nothing less.

Yes it is, but the scouts have to know more than what is taught in the ARC Basic First Aid class, that was my whole point.

Back to the article, the heart of the matter is if you don't have trained, certified, and equiped medical personnal, you're exposing yourself to a huge risk. Scouts or Cadets, it doesn't matter. I was a gung ho basic first aider when I was a cadet....then I took my EMT class and got a job on an ambulance....then my advanced EMT class....and now I start paramedic school in a month.

There's nothing wrong with helping cadets develop an intrest in emergency medicine, but if I rolled up to the scene of a big camp out and had fifty fourteen year olds swarming around someone, I would be in my hot tub with a tasty adult beverage about twelve minutes after the end of that particular tour of duty.

Quote from: cap235629 on June 22, 2010, 01:20:59 AM

Quote from: Eclipse on June 22, 2010, 01:19:45 AM
That's all basic, community level first aid.

Nothing more, nothing less.

Yes it is, but the scouts have to know more than what is taught in the ARC Basic First Aid class, that was my whole point.

No, the scouts who progress know about the same as our cadets who take the basic class.  I don't know where you're taking ARC/FA, but its nearly identical.

Our cadets not active in ES don't necessarily know anything about first aid, and those who are likely know more than the "average" boy scout.  But to make the assetion that one organization is inherently better trained than the other doesn't fly.

Further, ES is a mandate and a mindset of CAP, it's literally what we do and why a majority of the adults join (either as a whole or in part).  While community service is certainly a part of the BSA its by no means on the level that CAP is involved in ES, or charged by many agencies as a significant resource.

Quote from: Eclipse on June 22, 2010, 02:14:20 AM
I don't know where you're taking ARC/FA, but its nearly identical.

I am an ARC INSTRUCTOR.  I TEACH the class.  It is NOT nearly identical.

For starters, ARC is not the only FA trainer in the market, I took mine form ASHI, and I can tell you everything above was covered.

Nothing above is earth shattering or beyond basic first aid.

If you look at my posts, I confined my responses specifically to the ARC Basic First Aid class.  I did not imply that all classes were created equal.  I responded to Mr. Sinn's ascertation that the ARC Basic First Aid class was more in depth than the first aid requirements to advance in Scouting.

Whatever, I don't even know what the heck we're arguing about.

CAP and BSA are both worthy organizations with different missions and focus.

I went and looked up the requirements directly, and frankly its probably a wash.

The BSA simply requires demonstration of the skill, no certification required, but demonstration is - they don't care where you figure out a tourniquet, just that you know how to use it.  I also like the fact that FA is required as a matter of course for progression, which means it is more integrated into the fabric of the program.  The odds of ever using
those skills, though, are much lower, and CAP requires a lot of demonstation of actual skills before you can ever get into a real-world mission environment.

Unless, apparently, if you're supporting a BSA activity, in which case all our rules go out the window and any random cadets can go and "render aid".    ::)

I'm more irked at the article stating that the nurse seemed to think that an emergency situation was a good teach opportunity...

"What do you do next." Call 911... right. If 911 needed to be called, the nurse probably should have done that as soon as the "tightness in the chest" part was mentioned. Not have the cadets ponder the merits of calling 911.

As for the cadets providing the first aid, I don't really have a problem with it. I think it would be far worse publicity for cadets to sit there and watch a woman collapse to the ground without providing some degree of care for the sake of protecting CAP's heiny than to risk screwing up and possibly having to take advantage of Good Samaritan. And since none of the BSA people seemed to intervene in taking care of their leader, I'm going to assume that nobody there had the appropriate training, or was not confident enough to feel the need to relinquish the two cadets of their intervention.

A point of clarification. 

Are we comparing cadet snuffy to scout snuffy, or we comparing scout snuffy with a cadet who participates in CAP's Emergnecy services mission.  I think there is a difference as First aid and Emergnecy Services training are not requirments of the cadet program. 

These were cadets without Basic First Aid. Acting as part of a "Emergency First Aid Response Team." Now, first CAP shouldn't even be there. They should have paid for off duty EMTs, as this was a totally planned event. Besides, an EMT is going to have a direct link to the rest of the EMS system, and doesn't have to work through the 911 dispatcher (love them, but I never like having to call them. Their lists are far to annoying. Rather use my radio).

Not to mention, I'd take the Boy Scout over a ARC certified first aid-type person any day. (Hint: The new ARC Wilderness First Aid was based off the Boy Scout curriculum). I mean, the latest first aid/CPR classes don't even teach patient assessment anymore.

Now, the Boy Scouts in my neck of the woods had to practice on Mr. Plastic Man, not just explain how they would do it.

If this was a CAP activity, I would be Mr. EMT man in my CAP uniform, because my wing's interpretation of 60-3 (and my insurance company) say I can. Since this is a BSA activity, I would be in my EMS uniform, as my wing's interpretation of 60-3 say I can't.

"If this was a CAP activity, I would be Mr. EMT man in my CAP uniform, because my wing's interpretation of 60-3 (and my insurance company) say I can. Since this is a BSA activity, I would be in my EMS uniform, as my wing's interpretation of 60-3 say I can't."

I am sorry, do you mean to say that your wing allows you to act as an EMT while on CAP activities?

Major Lord

Let me explain. 1st. I'm usually not just sitting around waiting for someone to get hurt. I'm usually busy doing something else CAP-related, until somebody gets injured. Then, thanks to the fact that I'm technically on duty 24/7 (and that comes with my insurance as well). I have the authorization of the State to act. The Wing's interpretation of 60-3 is more or less "You have insurance? Good. Go do stuff." And then I do stuff. Every case I've handled was resolved at the scene (that will likely change now that the bees are out, and the summer influx of new members...). If somebody needed transport to the hospital, my lovely radio has the dispatch frequencies (personally owned), and I call for the rig.

At a BSA activity, I would likely just be sitting around. Bored. Maybe working on a project or something. But I'd be in my cool white aviator shirt and BBDU trousers! And I would likely have the rig out with me.

Yes, of course you can go do "stuff", however the minute you start "stuff", and for the duration of "stuff" you are not acting as a CAP member, and if you implied you were, you'd be on thin ice at best.

CAP provides members liability protection and resources for activities and actions within its scope.  Advanced medical care is out of scope.
Its no different than if I decide to "help" the ARC during a mission setup their network infrastructure or troubleshoot a database.  If things start smoking or anyone gets hurt, CAP, Inc. will not cover the costs, regardless of which shirt I am wearing, because technology support
is not within CAP's scope.

Quote from: Krapenhoeffer on July 01, 2010, 03:24:16 PM
Let me explain. 1st. I'm usually not just sitting around waiting for someone to get hurt. I'm usually busy doing something else CAP-related, until somebody gets injured. Then, thanks to the fact that I'm technically on duty 24/7 (and that comes with my insurance as well). I have the authorization of the State to act. The Wing's interpretation of 60-3 is more or less "You have insurance? Good. Go do stuff." And then I do stuff. Every case I've handled was resolved at the scene (that will likely change now that the bees are out, and the summer influx of new members...). If somebody needed transport to the hospital, my lovely radio has the dispatch frequencies (personally owned), and I call for the rig.

At a BSA activity, I would likely just be sitting around. Bored. Maybe working on a project or something. But I'd be in my cool white aviator shirt and BBDU trousers! And I would likely have the rig out with me.

As if I was not frightened enough for the future of CAP.

It bears repeating that you absolutely may not - under any circumstances - render medical care to members or non-members while you are at a CAP activity in anything but a genuine "life or limb" emergency.  (In an genuine emergency, you can and should do what needs to be done up to the level of your training.)

It simply doesn't matter if you have insurance or not.  It doesn't matter if the state thinks you are "on duty 24/7" or not.

You can't do it, period.  That's what the regulation says.  Honest, take a moment and read it.  You won't find any exceptions for members covered by their own insurance or if they happen to be on duty for another entity, or even if they have their own rig hidden under a bush.

Members who render non-emergency care to anyone risk the very existence of CAP, Inc.

So don't do it.


Ned Lee
Former CAP Legal Officer

Contrary to what most people believe (even those in the profession) you are not required to be on duty 24/7.  Most of what that is, is people putting that requirement on themselves.  A lot of LE officers claim that as well, when in reality, when I am off, I am off and not required in any capacity to act.
Morally is a different story, legally is another thing.  I am an EMT.  Nobody can force me to render aid when I am on my personal time just because I happened to take an EMT course.  I dont owe my life or my personal time to the Counties EMS authority. 
As far as CAP, if something happens, act if you need to.  Otherwise, call an ambulance.  If you are on duty at a CAP activity and happen to be a CAP member, then fine.  But its your EMS position you are acting under, not that you are a CAP member who is also an employed EMT in your day job.

Quote from: Flying Pig on July 01, 2010, 06:10:51 PM
If you are on duty at a CAP activity and happen to be a CAP member, then fine.  But its your EMS position you are acting under, not that you are a CAP member who is also an employed EMT in your day job.

Robert,

No.  It is not fine for a CAP member at an activity to render non-emergency aid ever.  There is no provision in the regulation for "dual status" members who are wearing a CAP uniform but claim to be acting under the authority of their EMS employer/police agency employer/USAFR status or whatever.

As a practical matter, the victim is not going to care what sort of clothing the person saving their life is wearing.  The flip side of that is if something - God forbid - should go wrong and there is a non-optimal outcome, the court is not going to sort out any sort of dual-status and CAP, Inc is going to be on the hook for what the "state licensed EMT1 employed by the Barney Ambulance Company but who happened be be dressed as a CAP Capt at a CAP activity" did or didn't do that resulted in the non-optimal outcome.

(Sure, there could be litigation following the judgment where CAP and the Barney Ambulance Company fight it out, but it will still result in a judgment against CAP, Inc for which we have no insurance coverage.  It only takes a couple of million dollars in malpractice awards before we are simply out of business.)

So, the bottom line is that the regulation is unambiguous and binding:  CAP members at an activity may not under any circumstances render first aid in anything other than a genuine life or limb emergency. 

Things like self-insurance, "dual status", "on duty status" are simply irrelevant distracters to the discussion.

Ned Lee
Former CAP Legal Officer

EDIT- Added the word "first" before the word "aid" in the penultimate sentence.  My bad.

Quote from: Ned on July 01, 2010, 06:32:09 PM

Quote from: Flying Pig on July 01, 2010, 06:10:51 PM
If you are on duty at a CAP activity and happen to be a CAP member, then fine.  But its your EMS position you are acting under, not that you are a CAP member who is also an employed EMT in your day job.

Robert,

No.  It is not fine for a CAP member at an activity to render non-emergency aid ever.  There is no provision in the regulation for "dual status" members who are wearing a CAP uniform but claim to be acting under the authority of their EMS employer/police agency employer/USAFR status or whatever.

As a practical matter, the victim is not going to care what sort of clothing the person saving their life is wearing.  The flip side of that is if something - God forbid - should go wrong and there is a non-optimal outcome, the court is not going to sort out any sort of dual-status and CAP, Inc is going to be on the hook for what the "state licensed EMT1 employed by the Barney Ambulance Company but who happened be be dressed as a CAP Capt at a CAP activity" did or didn't do that resulted in the non-optimal outcome.

(Sure, there could be litigation following the judgment where CAP and the Barney Ambulance Company fight it out, but it will still result in a judgment against CAP, Inc for which we have no insurance coverage.  It only takes a couple of million dollars in malpractice awards before we are simply out of business.)

So, the bottom line is that the regulation is unambiguous and binding:  CAP members at an activity may not under any circumstances render aid in anything other than a genuine life or limb emergency. 

Things like self-insurance, "dual status", "on duty status" are simply irrelevant distracters to the discussion.

Ned Lee
Former CAP Legal Officer

Right....Thats what I meant.  I meant on duty as an employed EMT at a CAP activity.  Meaning that for some reason, the CAP activity asked for the local Ambulance to stand by at an activity for whatever reason.  In that case, you are there as an EMT.  Your CAP membership status is of no consequence.  On the flip side of that, just because you happen to be an employed EMT in your day job does not give you authorization or coverage to act as a "CAP EMT" (If there were such an animal) as a CAP member.  Basically, the CAP EMT/MD or Nurse badge does nothing to protect you or CAP from liabilty nor give you the authority to provide medical care AS a CAP member.  Your screwed should something go wrong.     As  a CAP member, Nobody expects you to watch a cadet die while choking on a hot dog.  Call an ambulance, render the necessary aid, stabilize and then step back. Clear as mud?

Added Later  I think we should do away with the Medical badges totally.  All they are is ego boosters anyway.  Lets make a badge for members who are cops also while we are at it.   It just adds confusion.  If you recognize peoples skills, they expect you want them to use it.  We DO NOT have medical services, just like we don't have LE services.  Heck...at least we actually have a counter drug program and work with LE agencies.  We dont have medical services and we dont work with medical providers.
We have lawyers and Chaplain badges because we have lawyers and Chaplains.  Why do we have Medical Badges or give advanced promotions for skill sets we dont use?

Listen to Ned.  There is no wiggle room here.  And, yes, if you are an employee of an Ambulance company/medical facility hired by the activity to provide support, your membership in CAP is not a factor in doing the job you are hired to do.

That is not however, what the regulation is addressing.  CAP members (acting as such) DO NOT provide routine or non emergency medical care to members (or non members) at a CAP activity (unless you wish to become one of the many "former" members of CAP >:D ). End of story.

so if im working an airshow etc and some one has cardiac arrest, am i gonna get kicked outta cap for providing CPR?

(i am CPR/AED/1ST AID cert)

what if some one is hit by a car near me when working in assistance with LE on a large event?

Um... Before I bleed out from the vicious attacks of the CAPTalk hounds, I would like to add (I just realized that this might not be self-apparent), that the rule of thumb in non-life or limb cases is to "help the patient help themselves."

Lets say for instance that Cadet Snuffy has a nosebleed. Cadet Billy, who just got Basic First Aid wants to jump all over this case. Senior Member Bob, not wanting a potential cadet disaster, decides to call me over. I see Cadet Snuffy with his nosebleed. I'm not going to touch him. I know how Battery works. So instead, I pull out some gauze, and direct Cadet Snuffy in the ways of stopping his nosebleed. To make Cadet Billy feel useful, I tell him to fetch me a bag of ice. When he gets back, I tell Snuffy where to put the bag of ice. Behold the vast majority of CAP "medical emergencies."

Oh, and Sabre17, you're going to get 911 on the phone first, before you EVEN THINK of doing anything.

Quote from: SABRE17 on July 01, 2010, 07:25:33 PM
so if im working an airshow etc and some one has cardiac arrest, am i gonna get kicked outta cap for providing CPR?

(i am CPR/AED/1ST AID cert)

what if some one is hit by a car near me when working in assistance with LE on a large event?

By Flying Pig
As  a CAP member, Nobody expects you to watch a cadet die while choking on a hot dog.  Call an ambulance, render the necessary aid, stabilize and then step back.

well of course, except 911 for me at events is the radio in my hand to the command post where my unit cc is usually standing next to the guy in charge of what ever real medical service is there.

Quote from: SABRE17 on July 01, 2010, 07:25:33 PM
so if im working an airshow etc and some one has cardiac arrest, am i gonna get kicked outta cap for providing CPR?

(i am CPR/AED/1ST AID cert)

what if some one is hit by a car near me when working in assistance with LE on a large event?

Is cardiac arrest routine or non-emergency? No. Same with someone being hit by a car.

Someone who trips and scrapes their knee is a non-emergency.

Quote from: Ned on July 01, 2010, 06:32:09 PMCAP members at an activity may not under any circumstances render aid in anything other than a genuine life or limb emergency.

Exactly how far down the aid continuum does this go?  For example:

- Cadet participates in CPFT.  Gets a little light-headed during the mile run.  Senior member walks cadet back to a bench, provides him with some water, keeps an eye on him while he recovers.  Is this a violation of CAP regulations?

- Cadet trips and falls.  Scrapes hand, but doesn't have a first aid kit.  Asks for a band aid.  Are we to bring him to the ER to administer the band aid?  Or drive him to Wal-Mart to buy his own?

- Cadet gets blisters at encampment, doesn't have moleskin.  Do we send him home?

I know CAP members aren't going to be stitching up wounds or doing open heart surgery at a CAP activity, but what is the threshold for something being considered medical care?

Gentlemen, there is a distinction between "First Aide" and "Medical Care".  I think you all can figure out the difference and can make reasonable decisions when the time comes to act. 
But, then again, this is Cap Talk.... ;D

It's not my fault that Ned uses the terms "aid" and "medical care" interchangeably.  Or maybe he really means to say that CAP members cannot provide a band aid to a cadet with a skinned knee.  I figured I would get some clarification on that.

I know, common sense and all that, but when someone who signs their posts "Former CAP Legal Officer" says "thou shalt not provide non-emergency aid of any kind, period", I'd like to have a better idea of what that means.  I don't think that's an unreasonable request.

And of course, virtually anything that isn't life or limb can be treated with Basic First Aid. I mean, the most medically severe situation I've ever had to deal with in CAP was a cadet who passed out from locking his knees (despite the best warnings of the cadet staff to not do that). That involved all of, I think, 5 seconds of Basic Life Support (assessments are part of Basic Life Support), until he responded to my voice. Called parents, cadet went home early. Badabing, badaboom. All without having to physically make contact with the Cadet.

Last time I checked you are more likely to be sued for not providing first aid than for providing it. And I consider anything we teach Cadets to be first aid.

And for Life/limb situations, well, that's what separates me from a first aider (hence the title EMERGENCY medical technician).

Now, for the "stabilize and do NOTHING else." That's kind of what an EMT does. Not to mention that you can't step back once you start stabilizing... You have to keep stabilizing. Anything beyond stabilizing can't be done without the Ambulance. And if the ambulance is undermanned, and they need me to go with, I'll just deblouse (literally and figuratively, those things get hot really quick).

And if I'm so far from civilization, that I have to, God forbid, break out Wilderness protocols... A lawsuit or a 2b is the least of my worries.

EDIT: And I will add that there are huge discrepancies in what is being said by up top. I mean, there is a "Health Services" specialty track now... But back to my main point. I define routine care as the EFARTs at the BSA camp, or a MD who happens to be a CAP member acting as a MD in a CAP capacity.

Now, during a Briefing conducted by National, they told us that CAP can be hit with liability for not providing basic first aid on a non-routine basis. After all, our MOUs state that we only field ground personnel with at least basic first aid, and that we function to that standard of care. Not to mention that since basic first aid, or whatever care they can provide is what "a reasonable person in similar circumstances" would do, we have to do it, or else we (CAP) can get hit for NOT providing care.

Remember, pretty much anything that CAP does, ES-wise, is non-routine.

Quote from: dwb on July 01, 2010, 07:43:51 PM

Quote from: Ned on July 01, 2010, 06:32:09 PMCAP members at an activity may not under any circumstances render aid in anything other than a genuine life or limb emergency.

Exactly how far down the aid continuum does this go?  For example:

- Cadet participates in CPFT.  Gets a little light-headed during the mile run.  Senior member walks cadet back to a bench, provides him with some water, keeps an eye on him while he recovers.  Is this a violation of CAP regulations?

- Cadet trips and falls.  Scrapes hand, but doesn't have a first aid kit.  Asks for a band aid.  Are we to bring him to the ER to administer the band aid?  Or drive him to Wal-Mart to buy his own?

- Cadet gets blisters at encampment, doesn't have moleskin.  Do we send him home?

I know CAP members aren't going to be stitching up wounds or doing open heart surgery at a CAP activity, but what is the threshold for something being considered medical care?

My rule of thumb has always been that anything beyond mom and chicken soup kind of care is outside our scope.  In a life or limb situation activate the EMS system and provide care until they arrive.  Conducting a daily sick call with the laying on of hands, routinely dispensing OTC or legend meds, giving injections or assisting in giving injections, these are the types of things I would consider medical care.  Handing out band aids, moleskin and having someone rest for few mins. I don't consider medical care.

Quote from: Krapenhoeffer on July 01, 2010, 08:53:49 PM
And for Life/limb situations, well, that's what separates me from a first aider (hence the title EMERGENCY medical technician).

Now, for the "stabilize and do NOTHING else." That's kind of what an EMT does. Anything beyond stabilizing can't be done without the Ambulance. And if the ambulance is undermanned, and they need me to go with, I'll just deblouse (literally and figuratively, those things get hot really quick).

And if I'm so far from civilization, that I have to, God forbid, break out Wilderness protocols... A lawsuit or a 2b is the least of my worries.

I appreciate your skill set however, the regulation would keep you from providing any other care; in or out of the ambulance.  As a CAP member, IMO, you would be taking our collective posteriors with you if you determined that the ambulance was "undermanned" and made decisions which may adversely effect the (now) patient.

This regulation, BTW, was authored by two very respected physician members of CAP.  One is our chief HSO and the other the chief of EM at a large metropolitan hospital.  Yes, our lawyers were involved too.  We live in very interesting times....

Quote from: PA Guy on July 01, 2010, 09:13:53 PMMy rule of thumb has always been that anything beyond mom and chicken soup kind of care is outside our scope.  In a life or limb situation activate the EMS system and provide care until they arrive.  Conducting a daily sick call with the laying on of hands, routinely dispensing OTC or legend meds, giving injections or assisting in giving injections, these are the types of things I would consider medical care.  Handing out band aids, moleskin and having someone rest for few mins. I don't consider medical care.

What about the NCSAs that have sick calls run by CAP members... It happens people, and CAPTalk wannabee lawyers aren't going to stop it. Is it incorrect, yes. Is it happening, yes. Do the regs need to change, yes.

Quote from: FW on July 01, 2010, 09:21:33 PM
I appreciate your skill set however, the regulation would keep you from providing any other care; in or out of the ambulance.  As a CAP member, IMO, you would be taking our collective posteriors with you if you determined that the ambulance was "undermanned" and made decisions which may adversely effect the (now) patient.

This regulation, BTW, was authored by two very respected physician members of CAP.  One is our chief HSO and the other the chief of EM at a large metropolitan hospital.  Yes, our lawyers were involved too.  We live in very interesting times....

Allow me to explain, when I say figuratively deblouse, I mean to say that I would be signed out. That has always been my idea. And I wouldn't be the one determining if the ambulance is undermanned. The crew chief of the ambulance does.

If and when I board the ambulance, I'm not SM Krapenhoeffer, CAP. I'm Asst. Crew Chief Krapenhoeffer, <insert my municipality here> EMS.

Quote from: dwb on July 01, 2010, 07:43:51 PM

Quote from: Ned on July 01, 2010, 06:32:09 PMCAP members at an activity may not under any circumstances render aid in anything other than a genuine life or limb emergency.

Exactly how far down the aid continuum does this go?

Good catch.  I forgot the word "first" in front of aid.  I went back and edited my post.

By definition, "first aid" is "emergency care given before professional medical care can be obtained.

CAP members can always render aid in an emergency, and I hope nothing I have said would discourage anyone from trying to save a life or limb.

The problems come when members - in good faith - try to push the boundaries of "first aid" to stretch it to cover any possible medical assistance in any situation.

So let's use your examples and take a look:

Quote
  For example:

- Cadet participates in CPFT.  Gets a little light-headed during the mile run.  Senior member walks cadet back to a bench, provides him with some water, keeps an eye on him while he recovers.  Is this a violation of CAP regulations?

Giving someone some water and watching them is not "medical care" nor first aid.  On these facts alone, there is no emergency in any event.

Quote- Cadet trips and falls.  Scrapes hand, but doesn't have a first aid kit.  Asks for a band aid.  Are we to bring him to the ER to administer the band aid?  Or drive him to Wal-Mart to buy his own?

Similarly, a minor scrape is not an emergency under anyone's definition.  Handing someone a Band-Aid  Brand adhesive bandage (tm) is neither medical care nor first aid, and is perfectly acceptable.

Quote- Cadet gets blisters at encampment, doesn't have moleskin.  Do we send him home?

I'm not sure why anyone would get sent home for blisters, so maybe I'm not following your question.  But handing someone a piece of Dr. Scholl's Molskin adhesive padding (tm) is not medical care nor is it first aid.

Quote
I know CAP members aren't going to be stitching up wounds or doing open heart surgery at a CAP activity, but what is the threshold for something being considered medical care?

Part of the problem is that there is never going to be a bright line definition that will work for every possible factual situation.  That's one of the reasons that common sense is needed in abundant supplies by our members and leaders.

Most folks define "medical care" as professional treatment given for an illness or injury.  Diagnosing, prescribing, or treating illnesses and injuries normally requires a medical license of some sort in every state.  There are common-sense exceptions for things like first aid and conditions that do not require medical care, which includes things like blisters, insect bites, bumps and bruises, etc.

No medical license is required for a Mom or Dad to put a Band-Aid (tm) on a minor cut, take a child's tempurature, or decide when it is time for a trip to the doctor.

Similarly CAP members with responsibility for the care of minor cadets can do similar sorts of things - and it simply isn't medical care.

But it isn't hard to thing of hypotheticals that get closer and closer to the line.  And while 99.9% of the situations we are faced with will have an obvious answer about what is or is not acceptable, sometimes - in that tiny percentage of cases - we will need to rely on our trained leaders to make a common sense decision.

Quote from: Krapenhoeffer on July 01, 2010, 09:32:37 PM

Quote from: FW on July 01, 2010, 09:21:33 PM
I appreciate your skill set however, the regulation would keep you from providing any other care; in or out of the ambulance.  As a CAP member, IMO, you would be taking our collective posteriors with you if you determined that the ambulance was "undermanned" and made decisions which may adversely effect the (now) patient.

This regulation, BTW, was authored by two very respected physician members of CAP.  One is our chief HSO and the other the chief of EM at a large metropolitan hospital.  Yes, our lawyers were involved too.  We live in very interesting times....

Allow me to explain, when I say figuratively deblouse, I mean to say that I would be signed out. That has always been my idea. And I wouldn't be the one determining if the ambulance is undermanned. The crew chief of the ambulance does.

If and when I board the ambulance, I'm not SM Krapenhoeffer, CAP. I'm Asst. Crew Chief Krapenhoeffer, <insert my municipality here> EMS.

Krapenhoeffer, I think that you are reading to much into some things, and too little into others.

The fact of the matter is, and you know, is that an AEMT cannot practice their skills without ALS equipment. I'm a good EMT, but without a Zoll, a drug bag, a narcs kit, a tube kit, a trauma bag and an airway bag....there's really not much I can do, is there? I don't know about your state, but in New York, an ALS provider can only provide BLS care if they buff a call unless they contact medical control and are authorized to provide ALS care in that county ahead of time.

What situations do you think you are going to come across that requires anything beyond BLS stabilization? No one is saying that you can't provide emergency stabilization.

Quote from: Krapenhoeffer on July 01, 2010, 09:22:41 PMWhat about the NCSAs that have sick calls run by CAP members... It happens people, and CAPTalk wannabee lawyers aren't going to stop it.

But commanders, staffers, and any officer having genuine concern for the future of CAP can and should stop it.

Quote
Do the regs need to change, yes.

Non-concur.

The regs are written the way they are for simple and practical reasons.

CAP cannot be in the business of providing non-emergency medical care for the simple reason that we are not a medical provider.  Medical providers have things like standards, training, protocols for treatment, an adequate infrastructure to provide for oversight and quality assurance in all 52 wings, and most importantly, errors and omissions insurance to cover the inevitable errors that are made by all human beings, including medical officers (and lawyers).

Feel free to price out an insurance plan with any broker that would cover all of our health professionals in all 52 wings (and our overseas units.)  Be sure to tell the broker that you will need to cover not only physicians, PAs, and nurses, but also various kinds of medics ranging from Advance First Aid card holders through paramedics (with a lot of variety in between).  While reasonable minds will vary, I suspect that CAP, Inc will need at least $10-20 million in liability coverage (about a mid-range award for, say, a tragic mistreatment of a cadet rapelling accident that resulted paraplegia).

Tell me what the price you find is, but the last time NHQ checked, we were quoted something like a quarter of million dollars a year.  Which is another way of saying "a substantial dues increase for every single member."

(And, BTW, if I found an extra quarter of a million dollars in CAP's budget, I would probably spend it on other things.  Like cadet scholarships, o-rides, and travel money for basic encampments.  To start.)

Once you have found us some inexpensive insurance, take a moment and think about the infrastructure necessary to provide training and supervision for all of our HSOs in 52 different jurisdictions.  That's a lot of record-keeping and doctrine creation.

Finally, take an additional moment and price out the standardized equipment necessary for all of our medical folks to meet the minimum standards of care in each state.  Things like AEDs, oxygen sets, extraction collars, splints, litters, cardiac monitors, etc.  Don't forget to price out routine maintenance and upkeep, including rotation of supplies.

NHQ is not a cabal of evil people trying to think of ways to deprive you of opportunities to serve your community.  Indeed, it is quite the opposite.  But NHQ and the National Staff do have the responsibility to think policies through carefully, examine the costs and benefits, provide that data to our volunteer leadership that makes the final decisions.

Which they have - the result is a clear, unambiguous regulation that forbids members to render medical care except in genuine emergencies.

And in an emergency, CAP members can and should render all possible care within their resources and training.

Ned Lee
Former CAP Legal Officer
Former EMT

Ned, what are your thoughts on the incident that prompted this thread?

Quote from: RiverAux on July 01, 2010, 09:59:17 PM
Ned, what are your thoughts on the incident that prompted this thread?

Hard to say.  The only two factoids in the Volunteer article were "roving safety patrols" - which seems fine on it's face assuming adequate senior supervision, etc. - and " first aid teams."

If the teams are truly responding to genuine emergencies and providing first aid ("emergency care given before regular medical attention can be obtained"), then I don't see a problem with the regulation.

In the only actual medical incident described, the cadets passed out a cold compress or two and immediately summoned professional medical help (the nurse) .  That doesn't sound like rendering medical care or first aid to me.

And I must say I agree with your impression that it seems a strange mission for BSA to request external assistance from CAP.  Expecially since the BSA apparently had professional medical folks (at least the one nurse) on site.  The Volunteer article did not address the background or history of the situation.  But stranger things have happened in CAP . . .

@JThemann: That's kind of what I've been trying to say... I don't know how it is possible to go beyond BLS without an ambulance... Well, except for that really gung ho paramedic I met long ago, and his Truck of Doom... Regardless, I know that I'm never going to have to activate ALS, or be able to for that matter, when playing CAP.

Second thing I'm trying to say. Pretty much any non-life or limb situation can be treated with a bit of basic first aid + common sense. Now, as a matter of habit, whenever I'm dealing with such situations, I don't make physical contact with the patient. I'll just talk the patient through treating his/her self. I don't count that as being "medical care."

If there is a pre-planned CAP activity, where more dangerous things such as repelling or firearm practice are going on, we're going to be on a military installation with its own medical facilities.

In an ES situation, I would be going no further than BLS stabilization, until the ambulance/aeromedical evacuation shows up. If I'm not in my home "trauma region," (the name was pre-white papers) I contact the "Regional Trauma Center" medical director, and get permission to perform BLS in the region. I sign out before doing anything, and I don't introduce myself as a CAP member.

Like I said, you're kinda worrying over nothing.

Quote from: Ned on July 01, 2010, 10:24:04 PM

Quote from: RiverAux on July 01, 2010, 09:59:17 PM
Ned, what are your thoughts on the incident that prompted this thread?

Hard to say.  The only two factoids in the Volunteer article were "roving safety patrols" - which seems fine on it's face assuming adequate senior supervision, etc. - and " first aid teams."

I guess I'm more interested in your take on whether or not providing first aid teams goes against this:

QuoteCAP 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.

Quote from: Ned on July 01, 2010, 09:52:52 PM

Quote from: Krapenhoeffer on July 01, 2010, 09:22:41 PMWhat about the NCSAs that have sick calls run by CAP members... It happens people, and CAPTalk wannabee lawyers aren't going to stop it.

But commanders, staffers, and any officer having genuine concern for the future of CAP can and should stop it.

Quote
Do the regs need to change, yes.

Non-concur.

The regs are written the way they are for simple and practical reasons.

CAP cannot be in the business of providing non-emergency medical care for the simple reason that we are not a medical provider.  Medical providers have things like standards, training, protocols for treatment, an adequate infrastructure to provide for oversight and quality assurance in all 52 wings, and most importantly, errors and omissions insurance to cover the inevitable errors that are made by all human beings, including medical officers (and lawyers).

Feel free to price out an insurance plan with any broker that would cover all of our health professionals in all 52 wings (and our overseas units.)  Be sure to tell the broker that you will need to cover not only physicians, PAs, and nurses, but also various kinds of medics ranging from Advance First Aid card holders through paramedics (with a lot of variety in between).  While reasonable minds will vary, I suspect that CAP, Inc will need at least $10-20 million in liability coverage (about a mid-range award for, say, a tragic mistreatment of a cadet rapelling accident that resulted paraplegia).

Tell me what the price you find is, but the last time NHQ checked, we were quoted something like a quarter of million dollars a year.  Which is another way of saying "a substantial dues increase for every single member."

(And, BTW, if I found an extra quarter of a million dollars in CAP's budget, I would probably spend it on other things.  Like cadet scholarships, o-rides, and travel money for basic encampments.  To start.)

Once you have found us some inexpensive insurance, take a moment and think about the infrastructure necessary to provide training and supervision for all of our HSOs in 52 different jurisdictions.  That's a lot of record-keeping and doctrine creation.

Finally, take an additional moment and price out the standardized equipment necessary for all of our medical folks to meet the minimum standards of care in each state.  Things like AEDs, oxygen sets, extraction collars, splints, litters, cardiac monitors, etc.  Don't forget to price out routine maintenance and upkeep, including rotation of supplies.

NHQ is not a cabal of evil people trying to think of ways to deprive you of opportunities to serve your community.  Indeed, it is quite the opposite.  But NHQ and the National Staff do have the responsibility to think policies through carefully, examine the costs and benefits, provide that data to our volunteer leadership that makes the final decisions.

Which they have - the result is a clear, unambiguous regulation that forbids members to render medical care except in genuine emergencies.

And in an emergency, CAP members can and should render all possible care within their resources and training.

Ned Lee
Former CAP Legal Officer
Former EMT

Ned,

A very very well put. I had never put that much thought into it before.

Yes a very thorough explanation.  Thank you, Ned.  These are the things that help keep the membership happy .  I know that technically NHQ doesn't have to give reason for anything they do, but, it definitely improves morale when they do.  Since I am not getting a paycheck from (actually I give my paychecks to) CAP, it does help having things explained.  It is a leadership principal I follow with my subordinates – I always try and explain why I decided to do something one way or another, unless there just is not the time to do so (like when I have a gunman holed up in a house w/ a hostage).

It is too bad that we can't train to do more, but it is understandable.

Then in all honesty and concern, we need to revise the ES Training manuals, and taskbooks.

I realize that every member needs First Aid.  But if we are to abstain from emergent care in the field, then advanced knowledge should be deleted.

Also the task of stretcher carry, should be deleted.  If you don't have knowledge on how to stabilize the c-spine, then you should not carry someone out of the field.

Delete from the regs the EMT Badge.  If you wear one, you are advertising that CAP has the ability to care for prople in the field.

I am half joking and half serious.  The joke is that many people join CAP for the illusion that we search and THEN rescue people.  Rescue by definition means to provide care and transportation from point of rescue to point of care.  The serious part is that because CAP has no medical direction, there is to large of a liability to have emergent rescue crews to work in the field.

If you truly want to save someone, join a rescue service. Otherwise good sam laws are your only protection from lawsuits.  Better know your skills and be very proficient in those skills.

Quote from: CadetProgramGuy on July 05, 2010, 07:59:52 AM
Rescue by definition means to provide care and transportation from point of rescue to point of care. 

Rescue is not synonymous with providing advanced medical care.  If we find 2 people sitting by their crashed plane and walk them out of the woods back to civilization, we have "rescued" them.  If we find a a lost 3 year old who has been gone for an hour and is happily picking wildflowers, we have "rescued" them.  Most definitions  revolve around freeing someone from danger. 

But, I tend to agree with the thrust of your other points (hence why I started this thread), that CAP continues to send a lot of mixed messages about both emergency and non-emergency medical issues within the organization. 

Quote from: RiverAux on July 05, 2010, 01:21:40 PM

Quote from: CadetProgramGuy on July 05, 2010, 07:59:52 AM
Rescue by definition means to provide care and transportation from point of rescue to point of care. 

Rescue is not synonymous with providing advanced medical care.  If we find 2 people sitting by their crashed plane and walk them out of the woods back to civilization, we have "rescued" them.  If we find a a lost 3 year old who has been gone for an hour and is happily picking wildflowers, we have "rescued" them.  Most definitions  revolve around freeing someone from danger. 

But, I tend to agree with the thrust of your other points (hence why I started this thread), that CAP continues to send a lot of mixed messages about both emergency and non-emergency medical issues within the organization.

IF you look at the CAP driver liability issues (e.g. make a minor mistake/accident and you pay for it (not gross negligence), you have you answer on this. >:(  Mixed messages means DON'T touch anyone, call in the nearest public safety or others that have current emergency medical response training.  Why take the personal monetary liability chance :(

In the lost child found by CAP'ers, I'm willing to bet there's is a public safety medical unit at the scene that will evaluate the child, before letting the kid go home.

I don't think too many people walk away from aircraft crashes in the woods.  As another issue with responding ground teams, If there's entrampment in the aircraft, CAP has no cutting tools etc to "rescue" them.  I think we have a great responsibility upon identification of a definite crash site find (by air) to ensure we have a proper interdisciplinary team, which likely will be non CAP members skilled in "rescue/extracation" & the highest possible medical care possible when responding to the scene.   

As far as non emergency care, frankly at encampments CAP should be contracting with an appropriate health care provider (likely either a physicians assistant or primary care nurse practioner, qualified in emergency care) to be on site.  IF there's any medical issues that occur, they will make the determination if a higher level of medical intervention is necessary.

Again there's absolutely no incentive for any senior member to place themselves in a potential liability situation.  Any medical issue (especially with cadets), call 911 and get the individual evaluated by appropriate medical specialist.
RM

Quote from: RADIOMAN015 on July 05, 2010, 04:11:33 PMI don't think too many people walk away from aircraft crashes in the woods.

People do wander away from crash sites in the woods, for various reasons. Some are looking for help, and some are just in a daze (think shell shock) and don't know what they're doing. That's why it's my responsibility as a GTL arriving on a fresh scene to try to account for the individuals on board (using passenger manifest or whatever other means we have available), to make sure I don't need to send out hasty teams to find someone.

Quote from: RADIOMAN015 on July 05, 2010, 04:11:33 PM
In the lost child found by CAP'ers

Please stop using that term, it's insulting.

Quote from: RADIOMAN015 on July 05, 2010, 04:11:33 PM
As far as non emergency care, frankly at encampments CAP should be contracting with an appropriate health care provider (likely either a physicians assistant or primary care nurse practioner, qualified in emergency care) to be on site.  IF there's any medical issues that occur, they will make the determination if a higher level of medical intervention is necessary.

And who, exactly, is going to pay for that?  CAP doesn't pay anyone else for their services - pilots, technicians, managers, but we should pay for unnecessary medical staff?  Tax dollars are already providing emergency care via 911 - no onsite medical staff is called for, certainly not at member expense.

If your activity is so high risk that you need onsite medical staff, or are away from 911, the ORM numbers are too high (but we've already said that about 1000 times).

Quote from: Eclipse on July 05, 2010, 05:24:11 PM

Quote from: RADIOMAN015 on July 05, 2010, 04:11:33 PM
In the lost child found by CAP'ers

Please stop using that term, it's insulting.

I knew someone else would notice- and I, personally, promise not to use the term anymore.

Quote from: Eclipse on July 05, 2010, 05:24:11 PM

Quote from: RADIOMAN015 on July 05, 2010, 04:11:33 PM
As far as non emergency care, frankly at encampments CAP should be contracting with an appropriate health care provider (likely either a physicians assistant or primary care nurse practioner, qualified in emergency care) to be on site.  IF there's any medical issues that occur, they will make the determination if a higher level of medical intervention is necessary.

And who, exactly, is going to pay for that?  CAP doesn't pay anyone else for their services - pilots, technicians, managers, but we should pay for unnecessary medical staff?  Tax dollars are already providing emergency care via 911 - no onsite medical staff is called for, certainly not at member expense.

If your activity is so high risk that you need onsite medical staff, or are away from 911, the ORM numbers are too high (but we've already said that about 1000 times).

I do believe we had a Nurse Practitioner at our encampment, though I couldn't confirm. I agree that they should be able to perform their skill set just as the others do, free of charge if they so choose.

Last year at encampment, we had Dr. (Maj) Wilson, who is a general surgeon (who also does family practice) as our Medical Officer.  It was absolutely fantastic.  All med issues were handled, all fakers were put back into drill, and all meds were distributed in an orderly fashion.

Quote from: DakRadz on July 05, 2010, 05:53:13 PM

Quote from: Eclipse on July 05, 2010, 05:24:11 PM

Quote from: RADIOMAN015 on July 05, 2010, 04:11:33 PM
In the lost child found by CAP'ers

Please stop using that term, it's insulting.

I knew someone else would notice- and I, personally, promise not to use the term anymore.

Quote from: Eclipse on July 05, 2010, 05:24:11 PM

Quote from: RADIOMAN015 on July 05, 2010, 04:11:33 PM
As far as non emergency care, frankly at encampments CAP should be contracting with an appropriate health care provider (likely either a physicians assistant or primary care nurse practioner, qualified in emergency care) to be on site.  IF there's any medical issues that occur, they will make the determination if a higher level of medical intervention is necessary.

And who, exactly, is going to pay for that?  CAP doesn't pay anyone else for their services - pilots, technicians, managers, but we should pay for unnecessary medical staff?  Tax dollars are already providing emergency care via 911 - no onsite medical staff is called for, certainly not at member expense.

If your activity is so high risk that you need onsite medical staff, or are away from 911, the ORM numbers are too high (but we've already said that about 1000 times).

I do believe we had a Nurse Practitioner at our encampment, though I couldn't confirm. I agree that they should be able to perform their skill set just as the others do, free of charge if they so choose.

Have you read any of this thread?

1. Without proper equipment, supplies, diagnostic tests, and support, an EMT, an AEMT, a Paramedic, a surgeon, a physician, a nurse practitioner, a physicians assistant, a registered nurse, an LPN, etc etc, is little better able to provide comfort and treatment to someone then your average lay person. This equipment cost money. A lot. And how much do you need to cover the entire US?

2. Who's going to provide medical direction and control? Insurance? Depending on what state your in, an NP or PA may or may not be able to practice on their own. RN's and LPN's are even more limited to what they can do offline. EMT's and AEMT's operate essentially exclusively under the direction of some doctor somewhere.

3. Is every encampment and activity going to have a medical section? What sort of liability are you exposing yourself too if you don't have a medical section are your encampment?

Quote from: JThemann on July 05, 2010, 09:11:52 PM

Have you read any of this thread?

1. Without proper equipment, supplies, diagnostic tests, and support, an EMT, an AEMT, a Paramedic, a surgeon, a physician, a nurse practitioner, a physicians assistant, a registered nurse, an LPN, etc etc, is little better able to provide comfort and treatment to someone then your average lay person. This equipment cost money. A lot. And how much do you need to cover the entire US?

2. Who's going to provide medical direction and control? Insurance? Depending on what state your in, an NP or PA may or may not be able to practice on their own. RN's and LPN's are even more limited to what they can do offline. EMT's and AEMT's operate essentially exclusively under the direction of some doctor somewhere.

3. Is every encampment and activity going to have a medical section? What sort of liability are you exposing yourself too if you don't have a medical section are your encampment?

Yes,  I understand what you are saying -- when I'm talking about emergency medical personnel I mean NON CIVIL AIR PATROL personnel, from either paid or volunteer EMS units. 

It seems to me that for a professional EMT/Paramedic, who also volunteers in CAP this is a "mine field" to stay away from.  IF a liability problem arise. CAP isn't going to help you, based upon the guidance that is given.

Perhaps it would even be better to stay away from ANY ground team involvement, instead spend your time in the air as a scanner/photographer, observer, or maybe something back at mission base.

BTW in my state, EMT's/paramedics are not covered by the Good Samartian law at all  -- which I think is not good either, especially if they are off duty and happend to be driving on the interstate and come upon a serious vehicle accident.  Strange things sometimes happen in our state house and senate. >:(
RM

   

Quote from: High Speed Low Drag on July 05, 2010, 07:33:15 PM
Last year at encampment, we had Dr. (Maj) Wilson, who is a general surgeon (who also does family practice) as our Medical Officer.  It was absolutely fantastic.  All med issues were handled, all fakers were put back into drill, and all meds were distributed in an orderly fashion.

You have the right to remain silent. Anything you say can and will be used against you in a court of law. You have the right to an attorney. If you cannot afford an attorney, one will be appointed to you. Do you understand these rights as they have been read to you?

Major Lord

Why?  He took cadets to the ER as he felt necessary, ensured the cadets that were trying to get out of drill were medically fit, and dispensed the meds in accordance with wing policy (before the proposed change came out).  What is the issue?

Quote from: High Speed Low Drag on July 06, 2010, 08:52:33 PM...and dispensed the meds in accordance with wing policy...

Plaintiff's Attorney:  "The Civil Air Patrol dispensed medications?  Isn't that specifically against regulations?"

Defendant:  "No...um...what I meant to say was that we "secured" the meds..."

(See how this game is played?)

Point -

The medical officer provided the cadets, whom had brought medications to the encampment, an oppurtunity at the appropriate times to take their medications as directed by their personal physcians.

Better?

And watch for the new CAPR 160-2 to implement that NB's policy directive that the default position will be that cadets retain their own medications at encampment.

Coming soon to an internet near you.

Quote from: Ned on July 07, 2010, 12:27:07 AM
And watch for the new CAPR 160-2 to implement that NB's policy directive that the default position will be that cadets retain their own medications at encampment.

Coming soon to an internet near you.

Isn't it already in force from a policy perspective?  I thought 1 Jan 2010 was the start...

Quote from: High Speed Low Drag on July 06, 2010, 09:00:29 PM
Point -

The medical officer provided the cadets, whom had brought medications to the encampment, an oppurtunity at the appropriate times to take their medications as directed by their personal physcians.

Better?

Oh its way too late for that kind of backpeddling.....Its also a non-starter defense. You will have to be sacrificed  to satisfy CAP, Inc. Sorry......Take one for the team and just have your whole staff commit Seppuku now.

Major Lord

@High Speed Low Drag: The Lawyer Overlords demand your firstborn, with which they shall impress him into the Legal Nazgûl, where he shall wander the earth endlessly, drawn by the power of the regs, to secure all power for Mordor Maxwell AFB.

But the regs are clear: Stay away from something that can look like routine treatment. Now, I can't remember the exact AFI, but if I'm not mistaken, Air Force medical personnel can hold sick calls for people of CAP persuasion (I personally think that's more obnoxious than "CAP'pers" I'll keep it), as long as they are billeted on an Air Force facility. Same goes for Army medics on Army posts, etc...

And as for routine prescribed medications, my rule of thumb is that if somebody can't administer their own medication away from home, they need to steer clear of CAP overnights. As for Epipens, I ensure that everyone in my squadron is very familiar with their use and operation, and that if a member carries one, that they make sure that somebody nearby always knows where it is.

For over the counter medications, we have a squadron supplement for 24-hr gear that requires some basic pain killers, anti-diarrhea, and allergy medication. Then I have a list of recommended items. You're going to be eating Lt. Col. Bob's cooking for 4 days, I would advise you to carry the family size Tums with your gear. And I can't give you anything, because that would first involve me calling your parents, and then getting permission from the hospital, and then I have paperwork. So no, I will not give you a Tylenol. You must bring your own.

Quote from: Krapenhoeffer on July 07, 2010, 02:03:57 AMBut the regs are clear: Stay away from something that can look like routine treatment. Now, I can't remember the exact AFI, but if I'm not mistaken, Air Force medical personnel can hold sick calls for people of CAP persuasion (I personally think that's more obnoxious than "CAP'pers" I'll keep it), as long as they are billeted on an Air Force facility. Same goes for Army medics on Army posts, etc...

That would be AFI 10-2701, which is the Instruction that outlines the organization of CAP and provides the structure and authorization for
a numbers of areas of military and base support, including emergency medical care.  In cases where the activity or billeting is on an non-USAF facility, the AFI is provided as guidance for the host service with an expectation of care and Space-A support under their similar reciprocal agreements and protocols.

In the case of medical care, it does not specifically authorize Airmen, etc., to provide care as such, but instead references AFH 41-114 (MHSS Matrix), and dictates that CAP personnel on an AFAM are entitled to limited emergency care, and that during other activities CAP Personnel will be provided care via the same system as any civilian.

In nearly all cases on an active military base, that means dialing their equivalent of 911 and being treated by the base's version of EMS.  It does not authorize base personnel to provide routine medical services to CAP members, nor even emergency treatment outside the normal base SOP for EMS.  If Airmen are coincidentally driving the ambulance as part of their duty, you might meet them, but increasingly it is either civilian contractors, or EMS from the local community.

If you hit your head on an AFAM while on base, Uncle Sam pays for the care.  If you hit your head during an encampment, Uncle Sam stabilizes you, but cannot admit you to a military hospital (at least not on a Navy base, BTDT), and you are then either discharged, or transported to a civilian facility as soon as you can be moved.  All on your personal insurance.

Quote from: Ned on July 07, 2010, 12:27:07 AM
And watch for the new CAPR 160-2 to implement that NB's policy directive that the default position will be that cadets retain their own medications at encampment.

Coming soon to an internet near you.

This year we had a FF/First Responder be our primary medic and I (EMT from a looooooong time ago) was back-up medic when he wasn't available.  We were talking about the reg coming soon to an encampment near you.  I was absolutely astounded at the number of cadets that were on antidepressants / mental health drugs.  Floored.  Taken aback. 3/4 of the meds that were "secured" were if these types.  Handing the meds out took at least 45 minutes at morning & evening chow.

Ned - I was originally opposed to the idea of not "securing" the meds.  From an operational standpoint, I am now a believer.  However, I am still concerned about the meds finding their way to other cadets.  This year we found a cadet huffing AXE deodorant - what are they going to do with the meds in the hands of the cadets?  Or do we just say "Nothing I can do" and let the kids (which we wouldn't detect 99% of them doing it) do what they do?

Quote from: High Speed Low Drag on July 08, 2010, 01:30:52 AM
Ned - I was originally opposed to the idea of not "securing" the meds.  From an operational standpoint, I am now a believer.  However, I am still concerned about the meds finding their way to other cadets.  This year we found a cadet huffing AXE deodorant - what are they going to do with the meds in the hands of the cadets?  Or do we just say "Nothing I can do" and let the kids (which we wouldn't detect 99% of them doing it) do what they do?

When the committee was writing (and rewriting and rewriting . . .) the policy proposals we looked really, really hard to find evidence of this problem and we came up blank.  We looked through all the mishap records, all the AARS and encampment reports, and pretty much everywhere we could think to look and did not find a single instance of medication-swapping.  Nor could we find anyone with first-hand knowledge of such an event.

Sure we found lot's of rumors and stories, but no confirmed reports.  Obviously, given the thousands of encampments and hundreds of thousands of attendees since WWII I wouldn't be surprised if it had happend on rare occasions.  But it does not appear to have been a significant problem in the past.

And, of couirse, we are watching for any problems or trends with the new policy. 

But we did find multijple occurances of "cadet urgently needing medication in one place and medications secured somewhere else."  Ultimately it will be a "lesser of two evils" analysis, I suppose.

But I am confident that our experienced and trained CP leaders will be vigilent and concerned for our cadets' health and well being.

Ned Lee

Ned, I would like your opinion on the following:

I am a Paramedic and plan on being the Medical Officer at an activity inovlving a large number of cadets and senior members. 

I percieve my duties to be the following: 1) Advise the commander of any members participating in the activity that may have medical issues that will affect the activity or CAP, 2) monitor the most common illnesses/injuries, advise the director of those issues and what we may do to prevent them, and 3) transport members to the appropriate medical facilty for evaluation if they complain of illness/injury and, within the limits of HIPPA, advise the commander of their status.

I'm kind of the substitute TAC Officer to transport members to local medical facilities to determine "fitness for duty" so the TAC Officers can remain with the rest of their cadets.

On at least one occasion, I have consulted with the activity director and strongly recommended that a member get a medical evaluation to determine their capability of continuing with the activity and not trying to "push through the pain, man up, etc".

I am strongly against being the caretaker, dispenser, or responsible person for anyone else's medications.  I will, and I will advise TAC Oficers,  to remind cadets and/or seniors to take their medictions as prescribed.  I will also keep a supply of moleskin, Band-Aids (tm), ice packs, and a quiet loaction for breaks.

Sound kosher?

Maybe we need a very explicit fact sheet on what CAP members can do at encampments and on missions in regards to medical care.

For example:
"During performance of Emergency Services duties, CAP members who have completed a First Aid Course may do the following to care for persons in medical distress:
1.  Apply direct pressur
2. ...."

"During performance of Emergency Services duties, CAP members with First Responder, EMT, MD or other advanced medical training may do the following and still be covered by CAP's insurance....."

Quote from: RiverAux on July 08, 2010, 03:20:29 AM
Maybe we need a very explicit fact sheet on what CAP members can do at encampments and on missions in regards to medical care.

For example:
"During performance of Emergency Services duties, CAP members who have completed a First Aid Course may do the following to care for persons in medical distress:
1.  Apply direct pressur
2. ...."

"During performance of Emergency Services duties, CAP members with First Responder, EMT, MD or other advanced medical training may do the following and still be covered by CAP's insurance....."

There's no way they'd want to put that in writing. That would be very close to creating a medical protocol, and you start walking a fine line on that. Just saying "to meet the extent of the emergency, within the scope of your training" means it puts it in the member's hands as to what they should or should not be doing, and especially ones with higher medical training should already know what they should or should not be doing.

Not to mention, not all of the first aid provided is on ES activities. Encampments, weekly meetings, other activities all have times when first aid is required.

Quote from: Redbird Leader on July 08, 2010, 03:10:04 AM
Ned, I would like your opinion on the following:

I am a Paramedic and plan on being the Medical Officer at an activity inovlving a large number of cadets and senior members. 

I percieve my duties to be the following: 1) Advise the commander of any members participating in the activity that may have medical issues that will affect the activity or CAP,

This is the perfect job for an HSO.  Commanders truly benefit from advice on what to expect from dosclosed medical conditions and how to reasonably accomodate persons with limitations.  Further, HSOs can train the staff on how to care for minor but significant issues like blisters and hydration.  And of course, HSOs can help plan for things like sleep plans and environmental risks like heat injuries and risk assessments for things like obstacle courses, etc.

Quote[2) monitor the most common illnesses/injuries, advise the director of those issues and what we may do to prevent them

"Monitor" is a squishy word, so be careful here.There is no problem with noting trends and pointing out that multiple cases of blisters could bernefit from more frequent sock rotations, Moleskin, and/or a post-shower preventative blister check.  Or counseling a better hydration plan (pee charts, whatever) after a spike in heat injuries.

But if "monitor" means that you are personally assessing cadets, then problems start to present.  That begins to look and feel like diagnosing individual illnesses and injuries, which is problematic.

Quote3) transport members to the appropriate medical facilty for evaluation if they complain of illness/injury and, within the limits of HIPPA, advise the commander of their status.

I guess I have no problems with transporting cadets to "Doc in the Box", but it doesn't really require medical knowledge to drive there and sit around for a couple of hours.  (I use chaplains for this duty whenever possible.  8) )

And it bears mentioning that since CAP is not a medical provider of any kind, HIPPA does not apply to us in any way.  If it applies to you as a medical provider, that suggests that you are performing some sort of medical provider role, which again tends to cross over into the danger zone.

QuoteOn at least one occasion, I have consulted with the activity director and strongly recommended that a member get a medical evaluation to determine their capability of continuing with the activity and not trying to "push through the pain, man up, etc".

This worries me.  It sounds like you are using medical knowledge to make medical decisions about what should or shouldn't be done in a given situation.  That could easily wind up being deemed diagnosing and treating in a non-emergency situation.

QuoteI am strongly against being the caretaker, dispenser, or responsible person for anyone else's medications.  I will, and I will advise TAC Oficers,  to remind cadets and/or seniors to take their medictions as prescribed.  I will also keep a supply of moleskin, Band-Aids (tm), ice packs, and a quiet loaction for breaks.

Concur.  (And thanks!)

Quote from: Ned on July 08, 2010, 03:40:13 AM

Quote from: Redbird Leader on July 08, 2010, 03:10:04 AM
2) monitor the most common illnesses/injuries, advise the director of those issues and what we may do to prevent them

"Monitor" is a squishy word, so be careful here.There is no problem with noting trends and pointing out that multiple cases of blisters could bernefit from more frequent sock rotations, Moleskin, and/or a post-shower preventative blister check.  Or counseling a better hydration plan (pee charts, whatever) after a spike in heat injuries.

But if "monitor" means that you are personally assessing cadets, then problems start to present.  That begins to look and feel like diagnosing individual illnesses and injuries, which is problematic.

Quote3) transport members to the appropriate medical facilty for evaluation if they complain of illness/injury and, within the limits of HIPPA, advise the commander of their status.

I guess I have no problems with transporting cadets to "Doc in the Box", but it doesn't really require medical knowledge to drive there and sit around for a couple of hours.  (I use chaplains for this duty whenever possible.  8) )

And it bears mentioning that since CAP is not a medical provider of any kind, HIPPA does not apply to us in any way.  If it applies to you as a medical provider, that suggests that you are performing some sort of medical provider role, which again tends to cross over into the danger zone.

QuoteOn at least one occasion, I have consulted with the activity director and strongly recommended that a member get a medical evaluation to determine their capability of continuing with the activity and not trying to "push through the pain, man up, etc".

This worries me.  It sounds like you are using medical knowledge to make medical decisions about what should or shouldn't be done in a given situation.  That could easily wind up being deemed diagnosing and treating in a non-emergency situation.

QuoteI am strongly against being the caretaker, dispenser, or responsible person for anyone else's medications.  I will, and I will advise TAC Oficers,  to remind cadets and/or seniors to take their medictions as prescribed.  I will also keep a supply of moleskin, Band-Aids (tm), ice packs, and a quiet loaction for breaks.

Concur.  (And thanks!)

OK - based on the above conversation, if a cadet comes in and says "I have a headache," what is CAP's position that we should do.  Do we take them to the ER for a headache, or a stomach ache, or what?  Where do we draw the line and how do we draw the line?  We are all aware that the most of the aches and pains come from 1) not wanting to do drill or PT, 2) stress, 3) typical minor, temporary ailments.  When do we go to the ER (and potentially cost the parents $100 or more co-pay) and when do we say, "What do you take at home for these things? - OK here you go."  We have to be mindful that we can't & shouldn't take 20 kids to the ER everyday if they complain of something.  This is especially true of the cadets that have some complaint everyday,

Correct me if I am wrong, but since we are acting in loco parentis [sp], with the appropriate release, do we (CAP staff) not have a right to full disclosure of the diagnosis so we can make the determination as to the continued participation of the cadet?

Quote from: High Speed Low Drag on July 08, 2010, 04:20:34 AM

Quote from: Ned on July 08, 2010, 03:40:13 AM

Quote from: Redbird Leader on July 08, 2010, 03:10:04 AM
2) monitor the most common illnesses/injuries, advise the director of those issues and what we may do to prevent them

"Monitor" is a squishy word, so be careful here.There is no problem with noting trends and pointing out that multiple cases of blisters could bernefit from more frequent sock rotations, Moleskin, and/or a post-shower preventative blister check.  Or counseling a better hydration plan (pee charts, whatever) after a spike in heat injuries.

But if "monitor" means that you are personally assessing cadets, then problems start to present.  That begins to look and feel like diagnosing individual illnesses and injuries, which is problematic.

Quote3) transport members to the appropriate medical facilty for evaluation if they complain of illness/injury and, within the limits of HIPPA, advise the commander of their status.

I guess I have no problems with transporting cadets to "Doc in the Box", but it doesn't really require medical knowledge to drive there and sit around for a couple of hours.  (I use chaplains for this duty whenever possible.  8) )

And it bears mentioning that since CAP is not a medical provider of any kind, HIPPA does not apply to us in any way.  If it applies to you as a medical provider, that suggests that you are performing some sort of medical provider role, which again tends to cross over into the danger zone.

QuoteOn at least one occasion, I have consulted with the activity director and strongly recommended that a member get a medical evaluation to determine their capability of continuing with the activity and not trying to "push through the pain, man up, etc".

This worries me.  It sounds like you are using medical knowledge to make medical decisions about what should or shouldn't be done in a given situation.  That could easily wind up being deemed diagnosing and treating in a non-emergency situation.

QuoteI am strongly against being the caretaker, dispenser, or responsible person for anyone else's medications.  I will, and I will advise TAC Oficers,  to remind cadets and/or seniors to take their medictions as prescribed.  I will also keep a supply of moleskin, Band-Aids (tm), ice packs, and a quiet loaction for breaks.

Concur.  (And thanks!)

OK - based on the above conversation, if a cadet comes in and says "I have a headache," what is CAP's position that we should do.  Do we take them to the ER for a headache, or a stomach ache, or what?  Where do we draw the line and how do we draw the line?  We are all aware that the most of the aches and pains come from 1) not wanting to do drill or PT, 2) stress, 3) typical minor, temporary ailments.  When do we go to the ER (and potentially cost the parents $100 or more co-pay) and when do we say, "What do you take at home for these things? - OK here you go."  We have to be mindful that we can't & shouldn't take 20 kids to the ER everyday if they complain of something.  This is especially true of the cadets that have some complaint everyday,

Correct me if I am wrong, but since we are acting in loco parentis [sp], with the appropriate release, do we (CAP staff) not have a right to full disclosure of the diagnosis so we can make the determination as to the continued participation of the cadet?

Well here's the thing. If someone holds a medical licensure or certification, are they acting in loco parentis or are they acting as a medical provider? How do you distinguish the difference, and moreso, how does the law distinguish the difference? For example, parent signs authorization form for as needed ibuprofen, aspirin, pepto, the normal simple stuff. A CAP member who's, lets say, an EMT, administers this in loco parentis, and the cadet has an adverse reaction. When the parents sue, is the court gonna say "as an EMT, it's not within your state protocols to administer this medication, and you didn't have a medical control or physician order to do so" and subsequently fry the CAP member.

I guess what I'm trying to say is, where's the line for medical providers between acting in loco parentis and being medical providers?

Sir,

There will never ever be a bright line in these matters.  Senior members will simply have to use their abundent common sense and worldly experience.

I did not take my kids to the hospital every time they said they had a headache or a tummyache.  This was particularly true if the headache coincidentally developed the morning of the math final. 

(I did take my daughter to the hospital when she complained of severe and persistent abdominal pain that turned out to be ovarian cysts.)

Adults have been taking care of minors and each other for a couple of million years at this point, and most of us have a pretty good sense of what is going to require professional medical care and what does not.  But I will be the first to acknowledge there is no "-10 manual" that will tell you what to do in every possible circumstance.

If after talking with the kid and "looking at the boo boo" (if appropriate), make the call.  If you are unsure, talk about it with the other officers.  Sometimes a quick phone call home can work wonders.  ("Mom, Sally says she has a headache, but I am concerned that she really is afraid she will let the flight down at the drill comp.  Do you have any insight for me?  ( . . .)  Can I have your OK to give her a Tylenol and send her to the drill comp, or would you prefer I take her to the clinic? Can I answer any questions for you?)

When I have been an encampment commander, I have used a variety of methods to help me with this sort of low-level triage.  I have had USAFR medics and nurses on mandays who had protocols from a USAF medical officer to help make the calls.  I have used a non-CAP "camp nurse" (actually the wife of a member) and bought an insurance policy that covered the nurse and CAP, Inc.

But most years, we simply use the common sense and wisdom God gave us.  If we need to send a troop to the urgent care clinic, we do.  Sometimes a couple a day.  (We have eaten hundreds of dollars of costs for uninsured cadets.)

And sometimes cadets get sent home to "recover" with Mom and Dad.

But the bottom line is simply adults making fairly routine adult decisions about the care and welfare of the cadets placed in their charge.  Nothing very mysterious or technical - just common sense.

(Standing by for the "but what if X happens . . . . hypotheticals that would torment and ER physician.)

Ned - Exactly.  I would say that others would argue with you (if you weren't who you are) that you were violating the regs - while others agree with you and say that (like you) it is common sense.  It all stems from what was written earlier and the bright line that the regs suggest.  Here, you sent mixed messages.  Earlier you cautioned against "using medical knowledge to make medical decisions about what should or shouldn't be done in a given situation.  That could easily wind up being deemed diagnosing and treating in a non-emergency situation." - but then you talk about "If after talking with the kid and "looking at the boo boo" (if appropriate), make the call."  And please understand - I'm not trying to ding you - I am confused. (Which is why I am asking questions)

Out of curiosity, how much did that insurance cost you to cover the "camp nurse"?  I think I am going to make the recommendation that next year we have the Medical Group send a nurse over for sick call.  I would also recommend the NHQ draft a medical release statement to reflect the new policy but still provide some latitude for OTC medications to be dispensed to those cadets that did not bring any Tylenol.  (Ex:  we had a lot of female cadets begin "that time of the month" and did not have anything to mitigate the issue.  Being able to provide OTC (w/ express parent consent through release) would have been nice to be able to do).

My question is simply the liability aspect for the member in acting in loco parentis when theyre a qualified medical professional. I was hoping you might be able to give some insight as the legal guru of the board :)

A couple of quick responses since it is getting late.

Standard caveat.  I am not a currently licensed attorney and cannot give legal advice to anyone.  And if you take anything you read for free on the internet as personal legal advice, you are a fool, my friend.

But I can try to explain some legal concepts, so here we go.

Adults who supervise minors (acting in place of the parents or in loco parentis for those who love their Latin) are held to the standard of care of a reasonable person in the same or similar situation.  IOW, if you act with the care and caution of a person with ordinary prudence in the same or similar situation (even if you are wrong), you will not be acting negligently and thus generally not liable.

Medical professionals, however, are held to a higher standard of care - that of a licensed medical professional with the minimum training required for their profession.  This is one of the reasons that - in my opinion - tactical officers (and similar officers in charge of the cadets) can actually do more of the routine personal care (blisters, tummyaches, etc) than CAP medical folks can do.

This is a little hard to understand, so bear with me.  If I - as a ordinary tactical officer - run across a 13 year old troop complaining of a stomach ache right before PT, I'm gonna ask a few questions ("when did it start?  How bad does it hurt?  Are you gonna throw up? Has this happened to you before?  How are you enjoying encampment?  Doing OK at PT?, etc.)  and then make some sort of decision.  As long as I am act reasonably, I will be fine (and hopefully the troop will be, too.)  My actions will be judged against what any other reasonable adult would do in the same or similar situation.

But if I were a doc, and I have a cadet patient complaining of abdominal pain, the standard of care is going to call for at least a limited physical examination before reaching any conclusions.  My actions will be judged against the standard of care of a licensed physician.

Medical professionals cannot be judged by lay standards, which makes sense because otherwise no one would ever win a malpractice suit.  Doctors cannot call a "time out" and say "well, I was treating this minor as a lay person, not as a physician so I cannot be held to the higher standard of care of a medical professional."

This is another way of saying that medical professionals cannot act in loco parentis  - medical professionals always have to act as medical professionals, which is a higher standard of care that we put on parents (or those acting in loco parentis.)

Clear as mud?

I'm going to bed now.

Quote from: Ned on July 08, 2010, 06:16:20 AM
A couple of quick responses since it is getting late.

Standard caveat.  I am not a currently licensed attorney and cannot give legal advice to anyone.  And if you take anything you read for free on the internet as personal legal advice, you are a fool, my friend.

But I can try to explain some legal concepts, so here we go.

Adults who supervise minors (acting in place of the parents or in loco parentis for those who love their Latin) are held to the standard of care of a reasonable person in the same or similar situation.  IOW, if you act with the care and caution of a person with ordinary prudence in the same or similar situation (even if you are wrong), you will not be acting negligently and thus generally not liable.

Medical professionals, however, are held to a higher standard of care - that of a licensed medical professional with the minimum training required for their profession.  This is one of the reasons that - in my opinion - tactical officers (and similar officers in charge of the cadets) can actually do more of the routine personal care (blisters, tummyaches, etc) than CAP medical folks can do.

This is a little hard to understand, so bear with me.  If I - as a ordinary tactical officer - run across a 13 year old troop complaining of a stomach ache right before PT, I'm gonna ask a few questions ("when did it start?  How bad does it hurt?  Are you gonna throw up? Has this happened to you before?  How are you enjoying encampment?  Doing OK at PT?, etc.)  and then make some sort of decision.  As long as I am act reasonably, I will be fine (and hopefully the troop will be, too.)  My actions will be judged against what any other reasonable adult would do in the same or similar situation.

But if I were a doc, and I have a cadet patient complaining of abdominal pain, the standard of care is going to call for at least a limited physical examination before reaching any conclusions.  My actions will be judged against the standard of care of a licensed physician.

Medical professionals cannot be judged by lay standards, which makes sense because otherwise no one would ever win a malpractice suit.  Doctors cannot call a "time out" and say "well, I was treating this minor as a lay person, not as a physician so I cannot be held to the higher standard of care of a medical professional."

This is another way of saying that medical professionals cannot act in loco parentis  - medical professionals always have to act as medical professionals, which is a higher standard of care that we put on parents (or those acting in loco parentis.)

Clear as mud?

I'm going to bed now.

That's about what I thought. Thanks for the info.

Thanks, Ned.  That answered my questions and concerns.

Quote from: Ned on July 08, 2010, 06:16:20 AMAdults who supervise minors (acting in place of the parents or in loco parentis for those who love their Latin) are held to the standard of care of a reasonable person in the same or similar situation.  IOW, if you act with the care and caution of a person with ordinary prudence in the same or similar situation (even if you are wrong), you will not be acting negligently and thus generally not liable.

Frankly this all gets down to your personal risk management and what you want your exposure to be.  You can be legally right and bankrupt yourself (OR your organization) defending that you are right.

If it isn't cost effective to defend, a settlement will be in order.

Frankly, IF a cadet at an encampment or other CAP activity has pain or has an injury, bring them to a medical professional to get evaluated.  There's no incentive to you the senior member to personally take ANY chances >:(  and you really don't know when the various levels of CAP'ers start second guessing you on your decision (not to bring to professional medical treatment), what the overall implications will be.

RM

Quote from: RADIOMAN015 on July 08, 2010, 11:52:36 PM
Frankly, IF a cadet at an encampment or other CAP activity has pain or has an injury, bring them to a medical professional to get evaluated. 

Taking every hangnail and blister to the ER is just as silly as telling a cadet with a 104-degree fever to "suck it up" and get out there for PT.

Both extremes are an abdication of the common sense required of all of our adult leaders.

This really isn't all that exotic or mysterious; which is why we have had a vigorous and challenging encampment program for over 60 years without a single senior member ever being sued for exercising common sense supervision over our cadets.

(Notice I said "never been sued" which is even better than "never paid a nickel".)

Cadets are not some sort of IED waiting to go off in your face.  If you are not comfortable exercising common sense in supervising a youth-oriented leadership program, you should consider belonging to another organization.

I guess in the end, it really comes down to what my MedicoLegal instructor hit on.

"What would a prudent person do in this situation?"

I think we have to look at this from a EMT-Basic or a common Lay Person.

I choose EMT - Basic level for these reasons: 

1.  It takes effort to kill a patient.  Grossly ignoring a blister will not kill your cadet.
2.  When you are over your head in a situation, you are taught to call for additional resources, (call 911)
3.  Bandage and transport the bleeders or stay and play while calling 911
4. EMT - B's cannot give medications other than Oxygen, and assist Patients with their own Aspirin, inhaler, Nitro.

You get my drift.

On the meds issue....Just don't think we have the liability to dispense meds.  I do believe that as prudent persons (in loco parentis) we should secure them and herd the cadets to have them open, take out, consume, and resecure the original container.  All we should do is handle the container.

Quote from: CadetProgramGuy on July 09, 2010, 04:13:03 AM
I guess in the end, it really comes down to what my MedicoLegal instructor hit on.

"What would a prudent person do in this situation?"

I think we have to look at this from a EMT-Basic or a common Lay Person.

I choose EMT - Basic level for these reasons: 

1.  It takes effort to kill a patient.  Grossly ignoring a blister will not kill your cadet.
2.  When you are over your head in a situation, you are taught to call for additional resources, (call 911)
3.  Bandage and transport the bleeders or stay and play while calling 911
4. EMT - B's cannot give medications other than Oxygen, and assist Patients with their own Aspirin, inhaler, Nitro.

You get my drift.

On the meds issue....Just don't think we have the liability to dispense meds.  I do believe that as prudent persons (in loco parentis) we should secure them and herd the cadets to have them open, take out, consume, and resecure the original container.  All we should do is handle the container.

How much effort?

Quote from: CadetProgramGuy on July 09, 2010, 04:13:03 AM4. EMT - B's cannot give medications other than Oxygen, and assist Patients with their own Aspirin, inhaler, Nitro.

You get my drift.

Which goes back to one of the big issues here in terms of different laws and jurisdictions.

Our EMT-B's can give albuterol, aspirin, and EpiPens on standing order. Some states allow their EMT-B's to administer Nitro on standing.

Even our career field can't establish a very basic certification across different states. How can we expect CAP to establish any sort of medical program across 50 states?

And for the record, it takes a lot to kill a patient. I've met EMT's who I swear are government trained assassins who haven't managed to do it yet.

Quote from: JThemann on July 09, 2010, 11:30:34 PM

Quote from: CadetProgramGuy on July 09, 2010, 04:13:03 AM4. EMT - B's cannot give medications other than Oxygen, and assist Patients with their own Aspirin, inhaler, Nitro.

You get my drift.

Which goes back to one of the big issues here in terms of different laws and jurisdictions.

Our EMT-B's can give albuterol, aspirin, and EpiPens on standing order. Some states allow their EMT-B's to administer Nitro on standing.

Even our career field can't establish a very basic certification across different states. How can we expect CAP to establish any sort of medical program across 50 states?

And for the record, it takes a lot to kill a patient. I've met EMT's who I swear are government trained assassins who haven't managed to do it yet.

;D :clap: ;D :clap:      >:D

I have seen plenty of medical people put patients with COPD on high flow O2 and cut off their respiratory drive, occasionally resulting in a death. Killing a patient by accident can be remarkably easy. Ditto with Nitro. My rig partner had a patient killed by a helpful citizen performing CPR......

Major Lord

Quote from: Major Lord on July 10, 2010, 02:13:11 AM
My rig partner had a patient killed by a helpful citizen performing CPR......

Something tells me this patient didn't need CPR? Kinda tough to kill a dead guy.

Quote from: Major Lord on July 10, 2010, 02:13:11 AM
I have seen plenty of medical people put patients with COPD on high flow O2 and cut off their respiratory drive, occasionally resulting in a death. Killing a patient by accident can be remarkably easy. Ditto with Nitro. My rig partner had a patient killed by a helpful citizen performing CPR......

Major Lord

Me: "Umm, Jack, this guy has rigor....."
FTO: "What? The cops put another dead guy in my bus!"

Quote from: Ned on July 09, 2010, 03:22:43 AMCadets are not some sort of IED waiting to go off in your face.  If you are not comfortable exercising common sense in supervising a youth-oriented leadership program, you should consider belonging to another organization.

I think every senior member will just have to decide for themselves what they want their personal risk exposure to be in regards to cadets .  There's nothing in a CAP regulation that states that adult senior members need to emerse themselves into every aspect of the cadet program.  I'm sure there's some that never have contact with cadets

Your explanation about why we shouldn't have qualified medical personnel onsite at encampments & other activities, is the EXACT reason why I would limit myself in these cadet activities.   

RM   

Quote from: RADIOMAN015 on July 10, 2010, 04:19:34 AMI think every senior member will just have to decide for themselves what they want their personal risk exposure to be in regards to cadets .  There's nothing in a CAP regulation that states that adult senior members need to emerse themselves into every aspect of the cadet program.  I'm sure there's some that never have contact with cadets

The cadet program is the largest part of CAP.  Indeed, the majority of our members primarily work directly in or primarily support CP.  You may well be correct that there could be some W.C. Fields-like seniors out there who actively avoid cadets. 

But the point is that there is effectively no significant "risk" in working with cadets.  No senior has ever paid a nickel in damages while exercising reasonable care while working with cadets.

QuoteYour explanation about why we shouldn't have qualified medical personnel onsite at encampments & other activities, is the EXACT reason why I would limit myself in these cadet activities.   

All CAP personnel - including "qualified medical personnel" are welcome onsite at encampment.  We have a critical need for trained folks to work with our cadets as tactical officers, communicators, HSOs, etc.  HSOs have a vital role to play in reviewing applications, advising commanders on safety and environmental risks, and training the staff and cadets.

In fact the only thing HSOs cannot do is to perform non-emergency medical care.

Quote from: HGjunkie on July 09, 2010, 11:17:44 PM

Quote from: CadetProgramGuy on July 09, 2010, 04:13:03 AM
I guess in the end, it really comes down to what my MedicoLegal instructor hit on.

"What would a prudent person do in this situation?"

I think we have to look at this from a EMT-Basic or a common Lay Person.

I choose EMT - Basic level for these reasons: 

1.  It takes effort to kill a patient.  Grossly ignoring a blister will not kill your cadet.
2.  When you are over your head in a situation, you are taught to call for additional resources, (call 911)
3.  Bandage and transport the bleeders or stay and play while calling 911
4. EMT - B's cannot give medications other than Oxygen, and assist Patients with their own Aspirin, inhaler, Nitro.

You get my drift.

On the meds issue....Just don't think we have the liability to dispense meds.  I do believe that as prudent persons (in loco parentis) we should secure them and herd the cadets to have them open, take out, consume, and resecure the original container.  All we should do is handle the container.

How much effort?

Remember we are talking about Basics's here.....

Hi Flo O2 on COPD will do it in an hour......
Ignoring allergic reactions will do it.....
Ignoring your patient will do it.....

Like I said it takes effort......

In my limited experience it is hard for EMTs and below ti inflict negative outcomes on patients by their actions.  Generally at this level negative outcomes are a result of inaction.  Paramedics and above on the other hand can inflict serious harm by their actions. 

Never underestimate the killing power of an enthusiastic EMT! I am sure the Medical people among us will know the rules of "The House of God" and know that its treatment that kills patients, not diseases. Trauma on the other hand, is a horse of a different color.

Major Lord

Quote from: Major Lord on July 11, 2010, 02:14:46 AM
Never underestimate the killing power of an enthusiastic EMT! I am sure the Medical people among us will know the rules of "The House of God" and know that its treatment that kills patients, not diseases. Trauma on the other hand, is a horse of a different color.

Major Lord

Rule No. 13.