CAP and EMT's

[SJFedor]

So, is this a NIMS resource typing question, or a thread about medical directors for EMS providers.  Either way we have hashed both issues to death many many times

We have??

This topis relates to CAP and EMT's on the teams.  Is there a time where we can deliver aid in the field to our targets, or are we opening our selves to lawsuits?

That is the major reason there is not a program for HSOs to progress through. Read CAPR 160-1 for more details.

Does Good Sam laws relate to EMT's?

Varies from state to state. Check with your wing HSO or Legal Officer.

Also I don't understand where I was in-correct.  My statement was about needing EMT's or FR or higher to be type I certified.  Thats what NIMS states in your link as well.  Can you elaborate where I am wrong?

A Type I team requires EMT, ACLS, BTLS, not FR. A Type II team requires EMT or Wilderness First Responder. which is a specific skill set not covered in the generic First Responder certification.

As for elaboration,

So in the world of NIMS and MINS compliance we need a FR or higher on our ground teams to act as a Type I Team.

FR doesn't cut it for Type I teams.

Couple of problems here:

1. BTLS is no longer called BTLS. It has been changed to ITLS or International Trauma Life Support. Its semantics by the company that basically holds the monopoly but it behooves us in such conversations to get our terminology straight.

2. If an EMT (meaning an EMT-B) is required for a Type I team, the ACLS does not come into play. ACLS involves the use of not only synchronized defibrilation (a technique not generally allowed for use by Basics), it also involves the use of cardio-verting drugs, which are definitely out of bounds for basics, unless your state considers ASA a cardioverter and allows its administration by Basics.

BTLS, ITLS, PHTLS, they all work. 

And to my knowledge, no state in the union allows their Basics to provide ACLS care. Heck, there's a lot of states that don't even let their basics start IVs (PA, unless it's changed since I moved).  Just for gits and shiggles, where does it say in the FEMA/NIMS stuff that a Type I team needs an EMT with BTLS and ACLS skillsets? Cuz if it does, they probably need to rewrite their verbage to have it say EMT-P.


And, just a moment of zen for you medical professionals out there....

[cap235629]

Just for gits and shiggles, where does it say in the FEMA/NIMS stuff that a Type I team needs an EMT with BTLS and ACLS skillsets? Cuz if it does, they probably need to rewrite their verbage to have it say EMT-P.

http://www.fema.gov/pdf/emergency/nims/508-8_search_and_rescue_resources.pdf

pay particular attention to pages 24-27 (mountain SAR) and 39-41 (wilderness SAR)

[SJFedor]

Just for gits and shiggles, where does it say in the FEMA/NIMS stuff that a Type I team needs an EMT with BTLS and ACLS skillsets? Cuz if it does, they probably need to rewrite their verbage to have it say EMT-P.

http://www.fema.gov/pdf/emergency/nims/508-8_search_and_rescue_resources.pdf

pay particular attention to pages 24-27 (mountain SAR) and 39-41 (wilderness SAR)

Hm. Ok then. I'm guessing they're alluding to this person being an EMT-P since they do make the differential between an EMT-B and an EMT-P on Page 31, simply by saying that ACLS is required = EMT-P, not just a Basic.

[sarmed1]

There is technically nothing that prevents an EMT from taking ACLS.....they just are not allowed to perform ACLS level care in most situations.  The military is the one example I can think of, the 3 services only require their medics to hold an NRMET-B basic certification, but can be allowed to delivers ACLS meds in certain situations...


mk

[sarmed1]

we also don't invest in extraction stuff.  Not that there's anything wrong with that - but when you say "We do Search and Rescue" to someone you know that the image you just put in their head doesn't match what CAP really does.

It is interesting how CAP seems to have eliminated most references to "rescue" in relation to GT operations.  Given the old 101 trainnig program just had a broad training catagory covering "rescue training" but even in the past couple of years, litter tie-in has been removed as well as knot tying.

Facilitating rescue (ie I'll call the Fire Department and tell them where to come to) is good enough it seems.....I have to agree CAP is seemingly mis-represeting its capabilities.

mk

[Eclipse]

Facilitating rescue (ie I'll call the Fire Department and tell them where to come to) is good enough it seems.....I have to agree CAP is seemingly mis-representing its capabilities.

Where, specifically?

I think you may be confusing the actions of members with the corporate policy.

[isuhawkeye]

THe "EMT" in the verbiage was written as a generic place holder.  in many states an EMT-I (99) can function at the ALS (ACLS) level.  Some states have special certs for WIlderness (ALS) Other states have cardiac technicians that can fill the ALS component.

I dont read it to mean that an EMT-B needs ACLS.  

[JayT]

THe "EMT" in the verbiage was written as a generic place holder.  in many states an EMT-I (99) can function at the ALS (ACLS) level.  Some states have special certs for WIlderness (ALS) Other states have cardiac technicians that can fill the ALS component.

I dont read it to mean that an EMT-B needs ACLS.  

New York actually has a level of care above EMT-I but below full EMT-P that can do ACLS and almost all other Paramedic skills (I have that class tonight!)

[NC Hokie]

Facilitating rescue (ie I'll call the Fire Department and tell them where to come to) is good enough it seems.....I have to agree CAP is seemingly mis-representing its capabilities.

Where, specifically?

I think you may be confusing the actions of members with the corporate policy.

This might be an appropriate example:
http://www.cap.gov/visitors/about/our_programs/operations.cfm

[Eclipse]

Facilitating rescue (ie I'll call the Fire Department and tell them where to come to) is good enough it seems.....I have to agree CAP is seemingly mis-representing its capabilities.

Where, specifically?

I think you may be confusing the actions of members with the corporate policy.

This might be an appropriate example:
http://www.cap.gov/visitors/about/our_programs/operations.cfm

The only thing on the line would be the litter, otherwise,


its just SDIS and a member picking up "stuff".




Nothing in the text even hints at a paramedic capability.

Helping move a victim is still well within our capabilities and operational authorization.  The problem is that a lot of members carry enough equipment to transplant a kidney or do dialysis on the poor guy between the place he got hurt and the ambulance, and get all bent when we say "no".

I'll grant that someone seeing CAP for the first time, might get the impression we render emergency medical care as part of the mission, however seeing some of our press releases and other web sites, potential members might also think we're an active component, drive hummers and C-130's, and have an SF component that does nighttime combat ops (look hard enough and you can find plenty of members in cap uniform wearing face paint with weapons in their hands).

Once they actually shake hands with someone at the unit-level, they should be receiving the right idea.  If a "bill-of-goods" is being presented, that's the local Unit CC's fault, Not CAP, Inc.

Regardless, emergency medical care is not something CAP, Inc. is "selling" to anyone officially, and to believe that it is requires filling in the gaps using incomplete information because you want to believe that we do.

[NC Hokie]

Eclipse,

I agree that CAP is not and should not position itself as an emergency medical provider, but I don't think that's what sarmed was talking about.  My understanding of his post is that CAP, Inc. seems to be distancing itself from the rescue side of Search and Rescue.  With that being the case, it is misrepresentation to advertise CAP's search and rescue capabilities, as half of those capabilities are simply no longer supported.

To be blunt, it's much more accurate to label CAP emergency services as any of the following:

Fly and Find
Drive and Disable
Aid and Comfort

There's nothing wrong with any of those missions, but the fact remains that none of them are remotely close to the common understanding of Search and Rescue.

[Ned]

Absolutely.  But contrary to your assertiions, sometimes saving lives does indeed involve running shelters, filling sand bags, and handing out food/water.

It is important and worthy work.  We are privileged to perform it when needed and requested.

But that critically important work isn't as flashy or fun as pulling victims out of collapsed buildings.

It is important and worthy in the same way the finance guy back here at home makes sure I get paid when I'm downrange in contact. It's not what you engage highly trained, experienced, line personnel to do. That's a huge waste of resources.

Non-concur.

I spent a lot of years in the Guard, arguably as a "highly experienced line person" (MOS qual infantry and military police), and my troops and I personally were called upon to:

1.  Fill thousands of sandbags and patrol levees in severe floods.

2.  Drive trucks while supporting firefighters in major wildfires.

3.  Support a homeless shelter being run out of my armory.

4.  Transport and pass out pallets of water and food to persons displaced by earthquakes.

(Sure, we also did some MOS-appropriate tasks like suppress major riots.)

And while watching people suffer, I don't ever remember any of my soldiers say that our deployments were a "huge waste of resources."  Even though we were highly trained and equipped for other possible state and federal missions.

How is CAP any different?


(OK, in the interest of full disclosure, we were never really in love with the homeless shelter mission.  But we did what we were told.)

You were an infantry officer with PL & CO time. I don't know if you ever had to do a rotation as S1 or 4 or anything like that, but I'm sure you know fellow officers that did. When that's a quality line officer in that role. You know darn well how they feel about it.

I was both a Bn 1 and a 4.  And as a former company commander I can tell you that there is a reason we use line officers in those roles at the battalion level.  And that's because the line guys understand how their work impacts the companies in ways a non-line guy never could.  I also learned a whole lot more about logistics and personnel than I ever would have if I had just done PL and CO time.  And that made me a much better field grade officer, I believe.


Again, how is CAP any different in this respect?

[sarmed1]

Where, specifically?

I think you may be confusing the actions of members with the corporate policy.

RESCUE:  Definition:
 
1. transitive verb remove somebody from danger: to save somebody or something from a dangerous or harmful situation

Given an aircradft that spots a downed aircraft or a ground team that finds the distress ELT is an integral part of the SAR process, but that would be like saying I saw the bank robbers getaway car and claiming I was part of the arrest of wanted felons.

I agree that you are not going to land the aircraft nearby and hike to the crash site with a load of medical gear and extrication equipment PJ style and pull out the crew.  But a ground team that hikes overland to do the same and is unable to at least provide rudimentery emergency medical care or limited extrication/evacuation capability is a toothless animal.

but i digress, rescue capability of CAP SAR units would be a cause for a differant topic....this is about medical capability.

mk

[DNall]

Absolutely.  But contrary to your assertiions, sometimes saving lives does indeed involve running shelters, filling sand bags, and handing out food/water.

It is important and worthy work.  We are privileged to perform it when needed and requested.

But that critically important work isn't as flashy or fun as pulling victims out of collapsed buildings.

It is important and worthy in the same way the finance guy back here at home makes sure I get paid when I'm downrange in contact. It's not what you engage highly trained, experienced, line personnel to do. That's a huge waste of resources.

Non-concur.

I spent a lot of years in the Guard, arguably as a "highly experienced line person" (MOS qual infantry and military police), and my troops and I personally were called upon to:

1.  Fill thousands of sandbags and patrol levees in severe floods.

2.  Drive trucks while supporting firefighters in major wildfires.

3.  Support a homeless shelter being run out of my armory.

4.  Transport and pass out pallets of water and food to persons displaced by earthquakes.

(Sure, we also did some MOS-appropriate tasks like suppress major riots.)

And while watching people suffer, I don't ever remember any of my soldiers say that our deployments were a "huge waste of resources."  Even though we were highly trained and equipped for other possible state and federal missions.

How is CAP any different?


(OK, in the interest of full disclosure, we were never really in love with the homeless shelter mission.  But we did what we were told.)

Your full unit did those things. What was the lowest or even average qualification level of all personnel assigned? MP & Infantry units are going to do just those kind of tasks, as well as security details.

I'm in an apache unit BN. It's even called an "Attack Reconnaissance BN," but we have no meaningful role in disaster response. We send out an enlisted task force for the same sort of security/grunt work, and many of our staff officers move up to Bde to support overall aviation ops, but a lot of people just stay home.

I wasn't talking about the whole unit though, or MOS related work.

CAP in the big picture does and will continue to do all those lesser but still worthy/important tasks - shelter mgmt, hand out supplies, etc, etc. That's what cadets do. That's what type III/IV qualified GTM/Ls do when the environment calls for type I/II teams. I'm not saying at all that those tasks are below our very best front line operators, but neither do you assign an SF unit to manage a homeless shelter unless things are REALLY desperate. If/when you do that, you can expect to piss off those folks (be it CAP, guard, or civilian) who train their ever-lovin-butts off to be qualified for more significant missions, and then they walk away at the first opportunity.

You were an infantry officer with PL & CO time. I don't know if you ever had to do a rotation as S1 or 4 or anything like that, but I'm sure you know fellow officers that did. When that's a quality line officer in that role. You know darn well how they feel about it.

I was both a Bn 1 and a 4.  And as a former company commander I can tell you that there is a reason we use line officers in those roles at the battalion level.  And that's because the line guys understand how their work impacts the companies in ways a non-line guy never could.  I also learned a whole lot more about logistics and personnel than I ever would have if I had just done PL and CO time.  And that made me a much better field grade officer, I believe.

Again, how is CAP any different in this respect?

While you can use an AG or QM officer in those roles, of course it's better to put a line officer there that actually understands the mission. It does develop that line officer for higher command, and it does deliver better support to the line companies.

That said, you can fill those posts with your best up & coming guys that you want to groom for future BN cmd with that short-term broadening experience, or your taking the guys that you don't want to ever command a BN & stuffing them into a staff billet, preferably out of a line BN.

You understand my example though. You don't willingly put your very best front line operators on BS work, or you don't for long have front line operators.

Which again... how do I retain my best operators, and keep them dedicated to ES, when they see a massive disaster & don't get to do what they joined CAP to do. They're spending a lot of time & money to build up & maintain those skills. If they think it's a waste of time, they're gone.

^ that being an issue, cause these FEMA standards say we need medics to field top end teams, which puts my better operators out of business till we solve that issue.

Facilitating rescue (ie I'll call the Fire Department and tell them where to come to) is good enough it seems.....I have to agree CAP is seemingly mis-representing its capabilities.

Where, specifically?

I think you may be confusing the actions of members with the corporate policy.

Try this picture gallery: http://ngsar.homestead.com/home.html
Or this one: http://www.pawingcap.com/hawk/

I'd say we're misrepresenting to our own members, and I don't mean potential recruits. While at the same time having national policy that runs contrary to all of that.

[Eclipse]

Try this picture gallery: http://ngsar.homestead.com/home.html
Or this one: http://www.pawingcap.com/hawk/

I'd say we're misrepresenting to our own members, and I don't mean potential recruits. While at the same time having national policy that runs contrary to all of that.

You wouldn't get any argument from me on that, both are part of the problem, namely we're purporting to train our own people for missions we're not allowed to execute.

But that's got nothing to do with what we sell externally, nor should it muddy the understanding of members who attend.
By the time you are capable and eligible to go to Hawk or NESA, you know the score.

[SARMedTech]

Try this picture gallery: http://ngsar.homestead.com/home.html
Or this one: http://www.pawingcap.com/hawk/

I'd say we're misrepresenting to our own members, and I don't mean potential recruits. While at the same time having national policy that runs contrary to all of that.

You wouldn't get any argument from me on that, both are part of the problem, namely we're purporting to train our own people for missions we're not allowed to execute.

But that's got nothing to do with what we sell externally, nor should it muddy the understanding of members who attend.
By the time you are capable and eligible to go to Hawk or NESA, you know the score.

One should not have to wait to "know the score" until a given amount of blingage is earned. This is emergency services (ostensibly), not the friggin boy scouts. Members, new or otherwise, should know the score the first time they strap on the BDUs cause the friggin score should be posted at the beginning of the game.

Oh, and in IL, its illegal for anyone who is not directly involved (as a provider, supervisor, dispatcher, etc) in emergency medical services to  display or wear the star of life. Im sure this is true in other states. Should we all be taking the "blue star and wings" off our shirts?  Probably.  Being an EMT in CAP entitles you to clutter up your uniform with another patch or pin. It is NOT an actual function as defined under any accepted definition.  So for your GTLs...next time you say to a crash victim or lost person "I'm going to have my EMT take care of you" stop and think exactly what that means. EMS is more than "aide and comfort" and regardless of what anyone things, CAP, Inc is trying to say without really saying that it has EMS personnel who can function within the full scope of that occupation in its ranks. Its trying to give them an "MOS" that looks good to the public and draws membership.

Here in IL, we have a disaster medical team, an urban search and rescue team, a technical rescue team, etc. All seperate organizations run by the state. The only common denominator is medical care. The medical team I am a part of here provides the medical personnel for all those seperate teams. And we operate with a medical director with standing orders, etc and we never deploy without that MD medical director with us. CAP needs to stop selling what it cant provide. Its beyond semantics at this point. These are peoples lives in disaster situations we are talking about. CAP does not, nor can it, provide more medical care than the average boy scout and shouldnt even hint that it can. Given the nature of what it claims to do, it should have a fully functioning and supervised medical component, but it doesnt and  never will.

As for the definition of rescue...so you remove someone from a dangerous situation. Then what do you do with them. So you take them out of the mess that used to be a plane. They should never be moved without a c-collar. Do you have one? Probably not and if you did you have no standing orders for its use.

SAR is a complex and highly skilled avenue of endevour. It is highly different from point to the bad thing and get out of the way. CAP is sort of like a hunting dog: it points to what is being looked for and then stays out of the way of the guys with the big guns. Ive worked on SAR teams that have a full medical component. CAP just isnt one of them and doesnt have the training or the assets or the liability coverage to be. We need to move on from this discussion and back to important ones...like where to get BBDUs because those seem to be the things important to National.

[Eclipse]

So for your GTLs...next time you say to a crash victim or lost person "I'm going to have my EMT take care of you" stop and think exactly what that means.

What it would "mean" in this case, is that the GTL is violating CAP regs.

[MIKE]

5 pages going nowhere because it can't go anywhere.