Ground Team composition

[davedove]

Far as 101 though, since FEMA is moving to doing the credentialing, I think there might be a point soon thereafter where the 101 is redundant. At some point on past that I'd think they'd drop all that info onto your handy dandy scanable combination picture ID & membership card. Hey what do I know though.

Don't be silly.  You know we'll have to keep the 101, as well as any FEMA credentials, plus some other card that no one has developed yet.   All just to describe the same thing.

[DNall]

I know you're joking, but in the begining you're probably not wrong at all. Eventually though it'll be obselete at least mostly. I'm sure there still some info we need on the CAP end, currency dates for pilots & such, but that'd all fit nicly on the inside of a single photo ID/mbrshp card - show up to base, scan, thanks you're signed in & we have a log of all you quals w/ currency dates & emergency contact info. NIMS card to make the govt happy, alright go in there & standby for a gear check & brief.

[SAR-EMT1]

I glanced - briefly- at the regs for the Wilderness SAR training quals. But does anyone know how the required gear compares to our 12/24/72 hr gear? Or if there IS required gear? ....

[Pace]

^ Temp policy till the legal issues get sorted out, which is a bigger than just CAP. These are FEMA requirements, not ours. If they say an EMT has to be on the team or you can't work the mission, then you need to find one even if they aren't allowed to practice their trade

I get that, and I agree with having a licensed "medic" (EMT, nurse, doctor) on the team.  What I'm saying is why do we need to put their professional qualifications into a completely new rating just for the 101 card when all they have to do is wear their EMT/nurse/doctor badge (or not) and be there?  FEMA's happy that they're there and no need to add more stuff to the 101 card.

which by the way I think watching the guy die & quoting CAP regs is probably going to get your license jerked & charges filed.

More than that, it's downright immoral.

[DNall]

^ Temp policy till the legal issues get sorted out, which is a bigger than just CAP. These are FEMA requirements, not ours. If they say an EMT has to be on the team or you can't work the mission, then you need to find one even if they aren't allowed to practice their trade

I get that, and I agree with having a licensed "medic" (EMT, nurse, doctor) on the team.  What I'm saying is why do we need to put their professional qualifications into a completely new rating just for the 101 card when all they have to do is wear their EMT/nurse/doctor badge (or not) and be there?  FEMA's happy that they're there and no need to add more stuff to the 101 card.

The badge don't mean nothin, not to them or anyone else. The only good it'd do on a 101 would be that your actual license has been checked, as well as actual quals on everythign else, andyou can consolidate all that to this one card rather than carrying a box with you. 101 doesn't mean anything to FEMA either though, so it really doesn't matter except to make it easier for us internally to account for it (you know those badges aren't mandatory). Especially if we eventually go to one ID card that you scan & has all that info on it at one shot. That's where we're eventually going to be, it's jsut going to be a good while.

which by the way I think watching the guy die & quoting CAP regs is probably going to get your license jerked & charges filed.

More than that, it's downright immoral.

Sure, but "immoral" never stopped CAP frm 2b'ing someone. The fact that the reg contradicts the laws of every state is something of a motivator to find a middle ground, at least till Congress extends federal coverage. I understand the issue is just that our insurance won't cover you, but you are required by law to do what you can.

[Pace]

^ Temp policy till the legal issues get sorted out, which is a bigger than just CAP. These are FEMA requirements, not ours. If they say an EMT has to be on the team or you can't work the mission, then you need to find one even if they aren't allowed to practice their trade

I get that, and I agree with having a licensed "medic" (EMT, nurse, doctor) on the team.  What I'm saying is why do we need to put their professional qualifications into a completely new rating just for the 101 card when all they have to do is wear their EMT/nurse/doctor badge (or not) and be there?  FEMA's happy that they're there and no need to add more stuff to the 101 card.

The badge don't mean nothin, not to them or anyone else.

That's why I put "(or not)" after "wear their...badge".  The fact that they're on the team should satisfy FEMA.

The only good it'd do on a 101 would be that your actual license has been checked, as well as actual quals on everythign else, andyou can consolidate all that to this one card rather than carrying a box with you.

As a licensed medical specialist you'll have to carry your license anyway to legally practice, so I'm not seeing the argument for that one.

101 doesn't mean anything to FEMA either though, so it really doesn't matter except to make it easier for us internally to account for it (you know those badges aren't mandatory). Especially if we eventually go to one ID card that you scan & has all that info on it at one shot.

Being a GBD and an aspiring IC, I can appreciate that.  I would say leave it up to the GTLs and Sq/CCs to know if they have an EMT, nurse, or doctor (which usually they will tell you whether you ask or not), but for accountability the 101 idea is not bad.  Maybe instead of having GTM-E or something associated specifically with GT, why not have an independent specialty qual like CISM, ARCHER, GRM, ARM, etc.  Call it MED for medical or medical specialist.  Heck, you can even make it multi-level (MED3 for EMT, MED2 for nurse, and MED1 for doctor).  Let's not split hairs over different levels of EMT or anything else because I know of 3 levels of EMT and 4 (possibly 5) levels of nurse (LPN, RN ASN, RN BSN, RN MSN, and I think they're in the process of making an RN PhD).

which by the way I think watching the guy die & quoting CAP regs is probably going to get your license jerked & charges filed.

More than that, it's downright immoral.

Sure, but "immoral" never stopped CAP frm 2b'ing someone. The fact that the reg contradicts the laws of every state is something of a motivator to find a middle ground, at least till Congress extends federal coverage. I understand the issue is just that our insurance won't cover you, but you are required by law to do what you can.

Booting someone for trying to save a life would be detrimental to CAP's PR.  If I got a 2b after trying to save a person in distress (whether successful or not), I would be writing letters to every media outlet and legislator I could get contact info for.  Hell, maybe that kind of national negative coverage is what it'll take for Congress to afford CAP protection under the law.

[DNall]

I don't know for sure, but I'm pretty sure nurses & doctors don't automatically qualify on this. I think you have to be certified for ER - forget what it's called. My little brother's an RN ADN in ER with that certification. A dermitologist is going to be pretty useless to me in a field rescue situation though. Well maybe not useless exactly, but not what they're looking for. They do make a distinction in the requirments between levels of EMT, so we would need to know that on our card, even if it's jsut the two levels they care about.

Booting someone for trying to save a life would be detrimental to CAP's PR.  If I got a 2b after trying to save a person in distress (whether successful or not), I would be writing letters to every media outlet and legislator I could get contact info for.  Hell, maybe that kind of national negative coverage is what it'll take for Congress to afford CAP protection under the law.

Sure it's messed up, and I doubt they'd do it if you saved someone's life, but might if you did something in-between, citing insurance & regs all the way. It's not like you didn't know the rules & you broke them anyway. You granted you don't by law have a choice, but the court will say you did have a choice to be on that team where you knew it might come up. Granted it's bad PR, but seems like everyone that gets 2b'd writes letters & ends up in NOTF crying about some BS, true or not. Some of it is really serious stuff, and no one cares. That's the kind of thing that AF doesn't have the power to fix so ti keeps going & going, which is what prompted the changes in 2000. More of it won't be a good thing. FEMA is working on it for disaster volunteers & they know we need coverage for missions. It's in the works, it's just time consuming.

[Pace]

I don't know for sure, but I'm pretty sure nurses & doctors don't automatically qualify on this. I think you have to be certified for ER - forget what it's called. My little brother's an RN ADN in ER with that certification. A dermitologist is going to be pretty useless to me in a field rescue situation though. Well maybe not useless exactly, but not what they're looking for. They do make a distinction in the requirments between levels of EMT, so we would need to know that on our card, even if it's jsut the two levels they care about.

I'm pretty sure there's no special ER certification for nurses (mom's an RN), and I've never heard of one for doctors.  Sure there are experience levels that certain agencies look for or require, but any nurse can work in ER.  Maybe you're thinking of ACLS???  Or maybe I'm wrong, and it's just that none of the hospitals in Louisiana use the certification you're thinking of.

I see your point on doctors.  I made a flawed assumption in thinking that a doctor on a GT would be capable of emergency medical treatment, which as you pointed out is not the case.  As for EMT, I have little knowledge of their different capability levels and FEMA's requirements so I'll defer to you on that one.  My original line of thought was whatever we put on the card (assuming eventually we do), not to tie it in with GT.  Make it just a broad specialty rating like we do for other specialty skills since those skills aren't specifically tied to GT.  Plus, if we need to separate it into different levels we can (i.e. MED-E2, MED-E1, MED-N, MED-D).

Sure it's messed up, and I doubt they'd do it if you saved someone's life, but might if you did something in-between, citing insurance & regs all the way. It's not like you didn't know the rules & you broke them anyway. You granted you don't by law have a choice, but the court will say you did have a choice to be on that team where you knew it might come up. Granted it's bad PR, but seems like everyone that gets 2b'd writes letters & ends up in NOTF crying about some BS, true or not.

I didn't mean NOTF.  That's the quickest way to get your name discredited in CAP circles.  I was thinking more along the lines of FOX News, CNN, or even a talk show (Jerry, Jerry, Jerry!!!).  In reality, though, it's a personal decision to either try to save a life if you see it's going to require more than first aid to save the victim or try to sleep at night knowing you let someone die over some words on a piece of paper.  Personally, first aid and CPR are all I have so there's not much I can do to a critically injured person, but my mom's an RN with ER and ICU experience and training...and she's a GTM1, and I know several other GTMs and GTLs who might be put in this situation.

The one distress mission I've been on, EMS was 1/2 mile away from the area the aircraft was believed to be located in.  Had we needed them, they could have been on scene within a few minutes max.

[sardak]

Regarding FEMA credentials replacing the 101 card, please see question 8 of these FAQs.
http://www.fema.gov/pdf/emergency/nims/credent_faq.pdf

Here are the medical requirements for ground SAR teams.
FEMA Radio Direction Finding Team (1 per team)
Type I - EMT
Types II and III - none

FEMA Wilderness SAR Team (1 per field team, Type I and II teams must have multiple field teams)
Type I - EMT, ACLS, BTLS
Type II - EMT-B or Wilderness First Responder (WFR)
Types III and IV - none, supported by local EMS

FEMA Mountain SAR Team (1 per team)
Type I - EMT, ACLS, BTLS
Type II - EMT-B or advanced WFR, BTLS
Types III and IV, First Responder or WFR, BTLS

Colorado Wilderness Search Crews (1 per crew)
Type I - EMT-B, First Responder, or "Outdoor" equivalent (WFR is not the only choice)
Types II and III - first aid and CPR

The Mountain Rescue Association (MRA), NASAR and ASTM SAR standards (all referenced in the FEMA/NIMS SAR credentials "job titles" document) address only personnel requirements and not field teams.

MRA Policy 106 is a list of medical capabilities a team should be able to provide a patient.  Specific team and personnel requirements are left to the agency having jurisdiction and the team's medical adviser to determine.

NASAR SARTECH III has no medical requirements.  SARTECH II has a list of required first aid topics, but there is no specific medical (first aid) requirement.  SARTECH I requires Advanced First Aid or higher.

ASTM standard F-2209 "Training of a Level I Ground Search Team Member" has a list of required topics, but leaves the specific medical requirements to the agency having jurisdiction.

Mike

[sardak]

Regarding my last post, the NIMS SAR credentialing document actually references MRA Policy 105.1.  This requires that MRA personnel wanting to comply with NIMS credentialing must have at least basic first aid or equivalent.  Policy 106 still applies but is not referenced.

I glanced - briefly- at the regs for the Wilderness SAR training quals. But does anyone know how the required gear compares to our 12/24/72 hr gear? Or if there IS required gear? ....

FEMA RDF, Wilderness and Mountain teams require "Appropriate level of PPE for working environment."

FEMA RDF team typing has no other requirements for personal equipment.

FEMA Wilderness SAR teams are required to be self-sustaining for a given number of hours (depending on type) in local wilderness environments.  There are no other specific personal equipment requirements.

FEMA Mountain SAR team typing lists specific personal equipment requirements, but nothing out of the ordinary.  These teams are also expected to be self-sustaining for some length of time in certain environments, again depending on team type.

Colorado Wilderness SAR crew typing requires "appropriate clothing, equipment and PPE for the given environment."  There are also requirements for length of time to be self-sustaining and able to conduct field operations, depending on team type.  There are no specific personal equipment requirements.  [Note: there are other state SAR typing documents, but currently the NIMS credentialing document only references the Colorado document.  No offense directed to other states which have similar typing documents.]

NASAR SARTECH II has a list of required equipment.  SARTECH I is the same list but with increased quantities of some items, since a SARTECH I is also qualified as a crew leader.

ASTM standard F-2209 requires clothing, equipment and PPE suitable for the environment and task, leaving the specifics to the agency having jurisdiction.

F-2209 includes as an appendix (non-mandatory material) a list of suggested items for a 24 hour pack, base camp kit and personal first aid kit.  The lists were compiled from the equipment lists of 20 SAR teams taken from across the US, including NASAR.  Copyright restrictions prohibit posting ASTM (and NFPA and OSHA) standards.

However, as I was the original compiler of the lists, I have made the lists available for download.  In addition, I've posted the FEMA/NIMS SAR resource typing and credentialing documents, MRA Policy 105.1, SARTECH documents, the Colorado WSAR Crew typing document, and a compilation of the equipment and medical requirements from these documents.

They are available at:
http://www.m2ei.com/nims_wsar/

Mike

[flyerthom]

I don't know for sure, but I'm pretty sure nurses & doctors don't automatically qualify on this. I think you have to be certified for ER - forget what it's called. My little brother's an RN ADN in ER with that certification. A dermitologist is going to be pretty useless to me in a field rescue situation though. Well maybe not useless exactly, but not what they're looking for. They do make a distinction in the requirments between levels of EMT, so we would need to know that on our card, even if it's jsut the two levels they care about.

Booting someone for trying to save a life would be detrimental to CAP's PR.  If I got a 2b after trying to save a person in distress (whether successful or not), I would be writing letters to every media outlet and legislator I could get contact info for.  Hell, maybe that kind of national negative coverage is what it'll take for Congress to afford CAP protection under the law.

Sure it's messed up, and I doubt they'd do it if you saved someone's life, but might if you did something in-between, citing insurance & regs all the way. It's not like you didn't know the rules & you broke them anyway. You granted you don't by law have a choice, but the court will say you did have a choice to be on that team where you knew it might come up. Granted it's bad PR, but seems like everyone that gets 2b'd writes letters & ends up in NOTF crying about some BS, true or not. Some of it is really serious stuff, and no one cares. That's the kind of thing that AF doesn't have the power to fix so ti keeps going & going, which is what prompted the changes in 2000. More of it won't be a good thing. FEMA is working on it for disaster volunteers & they know we need coverage for missions. It's in the works, it's just time consuming.

WARNING: More about nurses than you really wanted to know:

ER nursing does not require specialty certifications but many Er's pay a differential for it (wish mine did). The nurse hierarchy is sort of NCO like.

1) Certified Nurse Assistant (about a 3 month course) very basic.
2) LPN/LVN (may be an associates degree). Pass meds, basic care, limited IV scope with additional training.
3) Registered Nurse; Assessments, Invasive procedures with orders, Medications, IV use. May be an ADN, BSN, MSN, PhD. The additional degrees do not add to scope of practice unless it's a specialized program.
3a) Speciality certifications such as CEN (certification Emergency Nursing) CCRN (ICU certification) CNOR (OR certification) - not a boost in scope but an acknowledgement of skills, knowledge base and time in practice. These are voluntary national and Non governmental certifications. Personal pride as well as marketability drive these. The tests are hard. Think of them as the National Staff College of nursing.
3a.1 Most critical care specialties require additional training such as Advanced Cardiac Life Support, Pediatric Advanced Life Support, Trauma Nurse Core Curriculum Provider that don't show up as initials behind your name.
3b) enhanced scope such as nurses trained to work in EMS (PHRN, MICN, EMS RN) at the paramedic level (only a few states have certifications and licenses for this), oncology nurses, PICC nurses. These are regulated at the state level
4) Advanced practice Nurses. Most are Msn's. This includes Nurse Midwives, Nurse Practitioners (best analogy is they are similar to PA's)

Pulling a nurse out of QI or Neonatal ICU and thinking they could reasonably meet a Ground Teams need for first aid could get you burned. We still need to train them ES wise and focus the skills and knowledge already there.

We also need to know who's out there so we can utilize the resource most effectively.

Capt Thomas J Cooper
RN, CEN, EMS RN
Las Vegas NV

[Pace]

Very informative.  Thank you.

So if we tacked some sort of medical specialty rating on the 101 card, would it be easiest/best to limit the rating to those who can provide proof of competency/certification in emergency life-saving procedures (ACLS, etc.) instead of all licensed nurses and doctors?

[SAR-EMT1]

I don't know for sure, but I'm pretty sure nurses & doctors don't automatically qualify on this. I think you have to be certified for ER - forget what it's called. My little brother's an RN ADN in ER with that certification.
I'm pretty sure there's no special ER certification for nurses (mom's an RN), and I've never heard of one for doctors, but any nurse can work in ER.  Maybe you're thinking of ACLS???  

OK, couple of things: its trauma- or shock trauma
ACLS and ETLS advanced cardio life support, Emergency trauma Life support.  CEN (certification Emergency Nursing) CCRN (ICU certification) CNOR (OR certification), PALS And yeah docs have equivalents. Finally as far as any nurse working ER... I one saw a CNA and an RN both put a nursing home resident on a NRB at about 4 liters a minute. Then when the guy was out cold, hypoxic, and seizing they called us (EMS) While they waited for us they kept the O2 at same low level. .....
I HATE NURESES        ...  except for Flight Nurses 

Sorry... didn't mean to rant off topic. Apologies.
Continue previous thread> 

tags fixed -DCP

[flyerthom]

Very informative.  Thank you.

So if we tacked some sort of medical specialty rating on the 101 card, would it be easiest/best to limit the rating to those who can provide proof of competency/certification in emergency life-saving procedures (ACLS, etc.) instead of all licensed nurses and doctors?

Competency in BCLS, current license and previous/current field experience. I too, like the other poster have gone into nursing homes and have had patients on the wrong O2 settings or even cardiac arrests where no one is doing CPR or can give a patient report.
The field medic courses that some wings do could fill the cross training role nicely.

[SAR-EMT1]

Also had them doing CPR on a guy who is trying to push them off 
We get there, pull her off and then the nurse starts attacking us .....

Id also at the least require that any EMS position in the field be required to carry a level 3 BLS kit at the least. (in terms of gear)

Tell me more about this Wing field medic program.

[flyerthom]

Also had them doing CPR on a guy who is trying to push them off 
We get there, pull her off and then the nurse starts attacking us .....

Id also at the least require that any EMS position in the field be required to carry a level 3 BLS kit at the least. (in terms of gear)

Tell me more about this Wing field medic program.

As a caveat, I'm not the biggest Hawk Mountian supporter but the field medic program is well established. As for the rest, if we start swapping war stories we'llbe here all night...

[SAR-EMT1]

Im jsut asking what the "field medic" training course /  position is. Ive never heard of such a thing (in CAP)

[flyerthom]

Im jsut asking what the "field medic" training course /  position is. Ive never heard of such a thing (in CAP)

Should be something on the Hawk Mountain web page:

http://www.pawg.cap.gov/hawk/summer.htm

[arajca]

Id also at the least require that any EMS position in the field be required to carry a level 3 BLS kit at the least. (in terms of gear)

What is a Level 3 BLS kit? 13 years as an EMT-B and never heard of it.

[arajca]

Very informative.  Thank you.

So if we tacked some sort of medical specialty rating on the 101 card, would it be easiest/best to limit the rating to those who can provide proof of competency/certification in emergency life-saving procedures (ACLS, etc.) instead of all licensed nurses and doctors?

Competency in BCLS, current license and previous/current field experience. I too, like the other poster have gone into nursing homes and have had patients on the wrong O2 settings or even cardiac arrests where no one is doing CPR or can give a patient report.
The field medic courses that some wings do could fill the cross training role nicely.

Basic Cardiac Life Support?! Overkill.