First Aid Responder

[floridacyclist]

What I am proposing is teaching a first responder skills that adults and youth could easily learn and put to use at home or at CAP functions.  Basic things like dealing with burns, applying a bandage to a minor cut, removing a splinter, dehydration avoydence, understanding hypothermia, insect sting treatment, CPR, etc.  .....

Gee, that almost sounds like CERT!!

Yes, it does sound a lot like CERT, which is why we're using the CERT textbooks at our next Ranger School in March. Disaster Medical Operations pts I and II, plus Light SAR with emphasis on how the concepts of Light Urban SAR (sizeup, damage assessment etc) can be used on the scene of a crash in order to ensure team and victim safety. To me, the concepts of CERT and how we might have to react in a worst-case scenario (traumatic injuries with medical care enroute but not expected immediately) are very similar. NHQ has a policy on First Aid training that you can read at http://capnhq.custhelp.com/cgi-bin/capnhq.cfg/php/enduser/fattach_get.php?p_sid=t_N87lvi&p_accessibility=0&p_redirect=&p_tbl=9&p_id=1309&p_created=1088005402&p_olh=0. We would like to train at this level, but it's not going to happen over a weekend school, so for now we're going to concentrate on immediate post-find actions.

As far as liability, Florida has the Good Samaritan Law.
Good Samaritan Act; immunity from civil liability.—

(1) This act shall be known and cited as the "Good Samaritan Act."

(2)(a) Any person, including those licensed to practice medicine, who gratuitously and in good faith renders emergency care or treatment either in direct response to emergency situations related to and arising out of a public health emergency declared pursuant to s. 381.00315, a state of emergency which has been declared pursuant to s. 252.36 or at the scene of an emergency outside of a hospital, doctor's office, or other place having proper medical equipment, without objection of the injured victim or victims thereof, shall not be held liable for any civil damages as a result of such care or treatment or as a result of any act or failure to act in providing or arranging further medical treatment where the person acts as an ordinary reasonably prudent person would have acted under the same or similar circumstances.

[SJFedor]

SJF,
I understand where you're coming from, but the issues must be addressed for the future, not based on what we have right this second.

The liaiblity situation must be addressed by either AF-funded malpractice coverage or congressional action to include that in the federal coverage extended to us, both of which are currently under consideration, I don't know about the insurance, but the federal coverage is going to pass eventually.

Far as control & administration, those are different things:
The SOP would be established by AF surgeon general, who we are working with already.

The administration of the people & policies would probably need to be done by HSOs on our end, but would have to be accountable to AF seperate from the CAP chain of command.

The controlling authority you mention in detail already exists & always has. You know they have an trauma surgeon on duty or on call at AFRCC 24hrs a day expressly for that purpose? Cause they do. And they have a direct hotline to all kinds of specialized AF medical resources that they'll put on a conference call right into your cell phone out there in the sticks, all you have to do is ask. You'll find that
to be the same system PJs call for medical orders in stateside deployments.


Far as FEMA, there's isn't a them & us. There's a system all emergency responders have to comply with or go home & not get any federal funding, and it doesn't matter if FEMA is in charge or not. CAP is not exempt & NB has voted to comply. That means all GTs will become WSAR teams. Now at type III & below you rely on local EMS (type III is them tagging along, type IV is them on call). At type I&II you need an EMT on the team (type I is EMT per team, type II is EMT per 48 person task force). Every GT will not be type I&II, the large majority will be the kind of work we do now, which is type III&IV, but on the Wg & Reg levels there will be pre-set type I&II teams listed so that if we need to send such people to Katrina or whatever they'll be ready to go.

I'll be honest, I wasn't aware that AFRCC had that type of on call staffing.

I've got a pretty good beat on how the civilian world EMS works, and how we'd need to have our people licensened in each state they intend to practice in, but how does that work for persons under a federal entity, like PJ's or Field Medics activated in a federal disaster/emergency? I know that they usually have them get the NREMT certification and registry exams, but are they exempt from state EMS regulations when it hits the fan?

And it's good to know they have a nice med staff like that who you can call. But I'll be honest, and most field personnel would agree, I'd rather be getting consultation from the trauma surgeon I'm 10 minutes out from dropping this patient on then one that's 500 miles from me in an office. And doing over-the-phone triage is a PITA to begin with. You need to have our personnel with the advanced skillset and protocol to do them (chest tubes, advanced airway, cric, needle decompression, central lines), as well as providing the training and CE to keep them in line with that protocol. Medics that run with a rural ALS unit aren't going to have that kind of protocol, and keeping them trained and proficient would be a real big undertaking, financially and logistically.

I'd be curious if we could get individual wings with the licensed personnel registered as a standby EMS company for activation during emergencies? That way the state EMS board is on board, they'd have established protocol and local medical control, and I think it would improve relations with the other EMS/EMA communities in the state, or at least, make yourselves known to them.

[floridacyclist]

Realistically, we're not going to be dealing with severe trauma that much...either the folks have died or else their injuries were light enough to let them survive until we reached them.

That said, I'm still a big fan of this type of training, not only for how the cadets may be able to use it in CAP, but how it may be used in real life or even the career field they may choose to go into. There are other things to consider as well.

A year ago, my stepson had dropped out of CAP after a year in. He had let his hair and clothing go and was in danger of being kicked out of school; we were concerned that he wouldn't be able to pass a drug test if he tried.

Since then, he has rejoined CAP, been to HMRS, been accepted onto Ranger Staff (they asked him if his school grades were good enough to be one of them during the staff selection board and he brought them up to As and Bs afterward) and is in serious contention for the Florida Wing Honor Society. Now he wants to be a paramedic.

All this because somewhere along the line, he learned that it was possible to makea difference in someone's life, and for the first time in his life realized that there was more important stuff to do than take care of Number One.

[SJFedor]

Send him over to www.flightweb.com

There's actually an interesting conversation re: paramedic vs RN. Paramedic is good for the glory ~5% of the time, the rest it's scoop and run. Unless you're on a CC transport team or a flight team.

Helicopter and FW EMS is where the party is at. If he wants the $$ and the fun, tell him to take the 2 years he'll dedicate to his EMT-B and EMT-P, get his associates in nursing, get into an ER/Trauma center, do his bachelors online, do the paramedic cert while you're working as nurse (and making the nurse $$$, which isn't that great, but it's better then a medic salary, unless you're with a major FD), and get onto the choppa!

That's if he REALLY wants to be all into the action and all. Street medics are awesome, and we'd be lost w/o them, but if he wants the real hardcore stuff, just tell him to think about who the paramedics call when it's really going down hill and they're not close to an appropriate facility.


Totally off topic, but some good advice I've picked up over the years. I'd be glad to get him in contact with people in both career fields if he's interested.

[DNall]

I've got a pretty good beat on how the civilian world EMS works, and how we'd need to have our people licensened in each state they intend to practice in, but how does that work for persons under a federal entity, like PJ's or Field Medics activated in a federal disaster/emergency? I know that they usually have them get the NREMT certification and registry exams, but are they exempt from state EMS regulations when it hits the fan?

Military EMTs (including PJs) are fedally licensed, I think DoT still runs that. The dotors & nurses are too, as are PHS & DMAT personnel. All those licenses are universally recognized by every state. As you know the rules are a bit more quirky for some state licenses going to other states, in general though, you're talking about people that are going to be licensed in & operating in-state. I wouldn't be against assistance to upgrade to federal licenses though. Maintaining your skills (including logistics & cost) is part of your day job. CAP didn't train you to be an EMT or pilot, they are just using you for that outside specitization that we need on our team or we can't go.

I'd be curious if we could get individual wings with the licensed personnel registered as a standby EMS company for activation during emergencies? That way the state EMS board is on board, they'd have established protocol and local medical control, and I think it would improve relations with the other EMS/EMA communities in the state, or at least, make yourselves known to them.

That's over my pay grade & out of my field. You'd have to spend some time with the HSO community to figure that out. I'd tell you that we may e able to come up with the EMTs, but we'll never come up with internal emergency physicians to oversee the program.

When you deploy on a FEMA mission, you're going to e comming from out of area with your EMTs holding a license recognized in the state you;re deploying to & federally provided malpractice coverage. There will be a whole medical branch in that IC structure that they link in with & will go thru for field consults & such. Where you take any patients you come up with may be a tent in a walmart parking lot, or it may be loaded to trafitional or helo EMS. For the most part you're talking about triage, and stablization for someone else to transport.

[flyerthom]

Send him over to www.flightweb.com

There's actually an interesting conversation re: paramedic vs RN. Paramedic is good for the glory ~5% of the time, the rest it's scoop and run. Unless you're on a CC transport team or a flight team.

Helicopter and FW EMS is where the party is at. If he wants the $$ and the fun, tell him to take the 2 years he'll dedicate to his EMT-B and EMT-P, get his associates in nursing, get into an ER/Trauma center, do his bachelors online, do the paramedic cert while you're working as nurse (and making the nurse $$$, which isn't that great, but it's better then a medic salary, unless you're with a major FD), and get onto the choppa!

That's if he REALLY wants to be all into the action and all. Street medics are awesome, and we'd be lost w/o them, but if he wants the real hardcore stuff, just tell him to think about who the paramedics call when it's really going down hill and they're not close to an appropriate facility.


Totally off topic, but some good advice I've picked up over the years. I'd be glad to get him in contact with people in both career fields if he's interested.

Only one problem with that, the $$ aren't that wonderful. I do part time fixed wing, part time ground EMS and full time ER. The ER job has much better pay and bennies. If I did OT there rather than the two other jobs I'd do far better cash wise. 
That being said, the Air EMS jobs still don't have trouble recruiting  due to the nature of the work. You get to fly, you get challenging cases, you get to fly and did I mention you get to fly. While most want adds say they want 2 years experience it's really closer t0 5 years critical care experience and a specialty cert like CEN or CCRN, previous EMT experience and ACLS, PALS, and TNCC and/or PHTLS.

TC
RN CEN EMS RN

[thefischNX01]

I'm currently an EMT-Trainee in MD.  The way it looks to me is that national certification would be ideal for anyone in CAP.  I could easily break down how I would organize a Civil Air Patrol Medic Program, but that's for another time. (When it's not the middle of the night)

Realistically, we're not going to be dealing with severe trauma that much...either the folks have died or else their injuries were light enough to let them survive until we reached them.

True, sir. However, I'm thinking about what other missions might be available in the future.  Mostly, when I think of a CAP Medic I go to Midway Six's post on his Hurricane Katrina experiences.  (Found at: http://capblog.typepad.com/capblog/2006/08/stop_screwing_t.html) In it, he says "Our Teams were the first uniformed responders that 80% of the people we encountered had seen after the storm".  This statistic caught me off guard, even after reading the Katrina AAR.  Given this statistic, I believe that a CAP Medic would serve a greater purpose than simply deployment in SAR missions.  We should add Disaster Relief and Recovery ops to thier mission assignments.

Granted, Katrina was a once-in-a-generation type of disaster, but given the recent news of tornados all over the east coast, wouldn't it be prudent to have a means to assist on the ground as well as the air?

[PA Guy]

I've got a pretty good beat on how the civilian world EMS works, and how we'd need to have our people licensened in each state they intend to practice in, but how does that work for persons under a federal entity, like PJ's or Field Medics activated in a federal disaster/emergency? I know that they usually have them get the NREMT certification and registry exams, but are they exempt from state EMS regulations when it hits the fan?

Military EMTs (including PJs) are fedally licensed, I think DoT still runs that. The dotors & nurses are too, as are PHS & DMAT personnel. All those licenses are universally recognized by every state. As you know the rules are a bit more quirky for some state licenses going to other states, in general though, you're talking about people that are going to be licensed in & operating in-state. I wouldn't be against assistance to upgrade to federal licenses though. Maintaining your skills (including logistics & cost) is part of your day job. CAP didn't train you to be an EMT or pilot, they are just using you for that outside specitization that we need on our team or we can't go.

I'd be curious if we could get individual wings with the licensed personnel registered as a standby EMS company for activation during emergencies? That way the state EMS board is on board, they'd have established protocol and local medical control, and I think it would improve relations with the other EMS/EMA communities in the state, or at least, make yourselves known to them.

That's over my pay grade & out of my field. You'd have to spend some time with the HSO community to figure that out. I'd tell you that we may e able to come up with the EMTs, but we'll never come up with internal emergency physicians to oversee the program.

When you deploy on a FEMA mission, you're going to e comming from out of area with your EMTs holding a license recognized in the state you;re deploying to & federally provided malpractice coverage. There will be a whole medical branch in that IC structure that they link in with & will go thru for field consults & such. Where you take any patients you come up with may be a tent in a walmart parking lot, or it may be loaded to trafitional or helo EMS. For the most part you're talking about triage, and stablization for someone else to transport.

Sorry about the prev. post.  I hate this laptop.

Military docs do not have a medical license issued by the Fed. Govt.  They are required to be licensed in one to the states and maintain that license.  They are credentialed by the military which is a records verification for the most part.  I have been on a Type I DMAT for over 10 yrs and I don't have a license issued by the Fed Govt.  All I am required to do is maintain my licensure in a state.  The Fed. Govt. does not issue licenses to health care providers they only conduct the credentialing process.

[DNall]

The credentialing process is all we care about here. Obviously everyone has to pass an appropriate board. Our focus is if we can take state licensed people up out of one state & apply them directly into operations in another w/ no paperwork or permission. That's not universally the case with all qualifications. So, figuring out how to make that workable is one of the issues we have to work out.

What we're looking for down the road is not door-to-door surveys a week or two after the fact & outside the critical area. What we want to work towards for hurricane response is a combined air/grd assessment team with organic command & control & one EMT for triage & support (as required by FEMA); be at the impact point within 12 hours of coming ashore & shooting back imagry that llows the fed govt to determine their response; absolute tip of the spear.

We're more caoable for that than anyone else, and that's what NIMS compliance opens up for us, that & following Florida's example on this one.

[floridacyclist]

True, sir. However, I'm thinking about what other missions might be available in the future.  Mostly, when I think of a CAP Medic I go to Midway Six's post on his Hurricane Katrina experiences.  (Found at: http://capblog.typepad.com/capblog/2006/08/stop_screwing_t.html) In it, he says "Our Teams were the first uniformed responders that 80% of the people we encountered had seen after the storm".  This statistic caught me off guard, even after reading the Katrina AAR.  Given this statistic, I believe that a CAP Medic would serve a greater purpose than simply deployment in SAR missions.  We should add Disaster Relief and Recovery ops to thier mission assignments.

I understand your point, which is why I said usually. As shown in my own post at http://www.nettally.com/captlh/charley-aar.pdf, that is not a unique experience. That said, in our case, our job was to perform reconnaissance, find out how much infrastructure was left, and do whatever it took to get the information (photos and reports) back to Tallahassee so that help could be sent where it was needed the most. We were not to perform rescues or first aid unless it was of an immediately life-threatening nature as doing so would have detracted from our primary and overall more important job. Other jobs might operate under different parameters, but are usually sent into areas later after even more outside help has arrived.

Under these circumstances, it was possible that we might find someone in need of life-saving first aid, but given the fact that this is still several hours after the winds have stopped howling, they are probably not too severely injured if they are still alive.

A more likely scenario might be coming across someone that was injured in a car crash or from their chainsaw, but even then if our job is to perform RECON, we don't want to get too far down in the weeds treating this person beyond the ABCs. At this point, we do have a very powerful tool at our disposal that the civillians don't have and that is our radio (or satphone in some cases). If we made it to where this person is, so can others and in the immediate aftermath of an event there will be lines of mutual aid EMS teams looking for work; in addition to making sure that they're breathing, not spurting blood and treating for shock, calling the EOC or our mission base and requesting advanced medical help is the single best thing we can do so that we can get back to our primary job of RECON. For this reason, we are training all of our team members to the CERT level of care, although I wouldn't turn down a First Responder class if it came our way; actually, I'm working on the FD Training Officer to let us sit in on one.

Looking at it this way also underscores the importance of good communications, which is precisely the issue I'm trying to address in our next Ranger School by spending an entire week working on (mostly tactical) comm.

[DNall]

speak of the devil. 

[SARMedTech]

What it all boils down to is CAP not wanting to take the responsibility/liability and to shell out the money for liability coverage. As for finding medical direction, I have experience with this and it can easily be done by contacting your Squadrons local ER attending. The fact is that having EMTs/Medics, etc out there on SARs is a valuable resource, and one which would be made even more valuable if they could do more than first aide and advise. There may not be a whole lot of times when full blown EMS is needed before a municipal or private crew can get there, but theres going to be an awful lot of wailing and nashing of teeth the one time that someone does need a combitube to maintain a patent airway and they die in respiratory failure because CAP didnt want to go the extra mile. The fact is that EMS is a vital part of SAR. Now alot of what we need to do can be covered within CAPS current "stabilizing first aide" regs. But what about nasal and oral airways? C-spine motion restriction with more than just hands? What has happened in the past is irrelevant. What matters is whats happening now. Im going to feel pretty rotten the day that I can treat someone's burns at a crash site, but when they crunk on me all I can do is stand there and look at them while I listen to EMS trying to find its way to us with sirens wailing miles away. First aide only gets you so far. CAP needs EMS assets that can function in more than advisory capacities. And there is talk about bee or other stings or bites which would cause anaphylaxis. Now we were talking about the use of epinephrine and airway adjuncts either for a CAP member or a found person. Under the current regs, whaddya gonna do. Nothing, because you cant. I have and continue to gain more experience in Mass Casualty Incidents, triage, etc. Wouldnt it be nice if I could use it, just in case it were needed. And what if I start triaging patients and then one of them crunks, its my neck on the block. What it comes down to is CAP wanting those medical officers out there in the field during SAR/EXs but not wanting to do what is necessary to allow them to fully function. The liability insurance for an EMT-Basic is minimal. Hell, work out a system where I can pay for it myself and I will. What we have here is a private, non-profit corporation who claims that it specializes in SAR but has no real ability to provide in depth medical treatment when it is necessary. Mark my words, some day, that will change us from Search and Rescue to Search and Recovery...of a dead body because there are people of competant training out there as ground pounders who have life saving training and skills who cant use them for fear of losing their license or going to jail. Am I thinking in the extreme...[darn] right, but thats what EMS and SAR is about...hoping for the best and planning for the worst. Unless CAP gets its act together in this regard, those of us who wear the EMS badges or patches might want to start carrying the nice big black zipper bags cause as sure as good made little green apples, one day we will need them. Being able to treat someone with burn gel is great and may decrease the extent of their injury and their pain. Being able to provide a patent airway when their trachea swells shut may save their lives. Im getting ready to go to disaster medical specialist training in a few months, but unfortunately CAP has tied my hands so that I wont be able to use what I learn. Its hard to find another non-profit SAR group out there (we have lots of them where I used to live in NM) that doesnt have a useable medical asset (read as EMT or Medic) on their team. It simply doesnt make sense. Yes this is a pet peeve of mine but I have had patients die in my hands when I have been covered with liability and medical direction and its about the hardest thing a medical care provider can go through. Now imagine what it would feel like to have it happen simply because CAP wont get off its duff and take some action to move us into the 21st century of SAR.

[arajca]

Most SAR teams in CO do not have organic EMS. The local fire or EMS agency provides that function. The SAR team members usually only do first aid. NIMS requirements for Type III and IV Wilderness SAR teams state that EMS and technical rescue capablilites are not required to be organic.

SARMedTech, you underestimate the problem of getting a system that will agree to provide physician advisor (PA) for CAP members. There is alot more than just "contacting your Squadrons local er attending." Unfortunetely, in todays society, you need to get the lawyers involved before any physician in their right mind will sign on as PA. Also, you're assuming there is a local er near the unit. get out of the city and you'll find them becoming rarer. Remember the golden hour? In most of CO, we don't even think about it because there is no way to get the patient to a trauma center within 90 minutes - even with Flight fo Life.

Another issue is the differing protocols states use. Colorado is, from what I have heard from my PA, in the minority of states using the exact same protocols statewide in several different and competing medical systems.

An effort was made to get the AF Surgeon General to provide PA service for CAP, but it fell through.

[sarmed1]

As mentioned in this and other posts the issues still rest in that every state has differant requirements for the authority to practice as an EMT, or Paramedic and sometimes even as a first responder.  It would be difficult at best to create a national policy that addresses all of the particulars each state has.  However it would be nice if CAP could create an exception just like they have for other GT specialty areas.  An in writting approval that meets at minimum x, y, z type requirements kind of clause would go a long way in keeping them in the middle of the liability highway than the far right they are risking themselves in now.

mk

[SARMedTech]

Most SAR teams in CO do not have organic EMS. The local fire or EMS agency provides that function. The SAR team members usually only do first aid. NIMS requirements for Type III and IV Wilderness SAR teams state that EMS and technical rescue capablilites are not required to be organic.

SARMedTech, you underestimate the problem of getting a system that will agree to provide physician advisor (PA) for CAP members. There is alot more than just "contacting your Squadrons local er attending." Unfortunetely, in todays society, you need to get the lawyers involved before any physician in their right mind will sign on as PA. Also, you're assuming there is a local er near the unit. get out of the city and you'll find them becoming rarer. Remember the golden hour? In most of CO, we don't even think about it because there is no way to get the patient to a trauma center within 90 minutes - even with Flight fo Life.

Another issue is the differing protocols states use. Colorado is, from what I have heard from my PA, in the minority of states using the exact same protocols statewide in several different and competing medical systems.

An effort was made to get the AF Surgeon General to provide PA service for CAP, but it fell through.

First off all, I am befuddled by your use of term organic when referring to EMS. Ive been around it awhile and have never heard this term used.

I do not underestimate the difficulties of getting a doctor to act as what you call a PA which is medical parlance stands for Physicians Assistant, not Physician Advisor. All hospitals have an attending physician or physicians on staff at all times who function as medical control or medical direction for EMS crews in the field. If CAP were willing to pry open its wallet, it could get liability for the EMTs and Medics, since the Physician would already be covered by his own malpractice insurance and the liability coverage of the hosptial. Furthermore, since its not like we are going to be running to the doctor, asking a question and then running back on foot, but rather calling by cell or satphone, it wouldnt matter if the physician was 9, 90 or 900 miles away as long as he can be reached by phone.

Finally the problem of differeing protocols in different states would not present any more of a problem than in does for private EMS agencies. The Medical Director would be familiar to the enth degree with the protocols of the state regarding the level of provider he was directing, thus avoiding this problem. Im not sure what your involvement in EMS is, but you seem to have a fundamental misunderstanding of how EMS operates. A friend of mine is a medic in W. Virginia and her medical director is 90 minutes away from the closest call in her reponse area. As long as you can maintain a clear connection, there is no problem. Im not talking about each Wing having a single medical director, but more likely a group of Squadrons in relatively close geographical proximity to each other such that if they were "civilian" EMS they would likely be using the same medical direction. You obviously fail to see the need for trained EMS personnel in the field being able to legally operate to the extent of their training. Without knowing it, CAP inadvertantly allows this through the regs which allow for stabilizing first aide to the extent of the medical professionals training. Of course a medics will be different than mine and mine will be more advanced than a first responder or someone with his CPR certificate only. Its ironic that there is a 10 page thread on arming CAP officers with guns and why it should be done, but no one can see the more clear and present need for a trained and liability covered EMT/Medic on SAR sorties in the field.

[sarmed1]

Organic is a term used in a new FEMA type/sourcing document:  Simply meaning a medic type who is part of the SAR unit (organic) vs one supplied from an outside agency to support the SAR unit (non-organic)

You need to get out and travel some.  Every state (and sometimes even within the state) though similar is still differant in regards ot medical direction and protocols. For example when I lived in Texas each individual service had its own medical director, that medical director was responsible for defining the specific protocols for the agency they worked with.  In one he wanted to be called on his cell phone for every point where it said contact medical control, and another worked it out that the ER doc at a specific hospital could provide medical control.  Both though had the same levels of provider's each had very differant drug lists and procedures for their ECA's, EMT's Intermediates and medics.

Yes they do leave that little back door open for within the scope of care based on your level of training caluse, but its also countered by 60-3 which specifically prohibits CAP form being the lead agency for their own medical support for SAR operations.  Its a catch 22.  I know one of the Military Docs who supports Hawk Mountain is working with national legal to look to clarify the loopholes and gray areas, and hopefully get some exceptions ok'd to allow medical personnel a little more room to operate.

mk

[SAR-EMT1]

Much as I would love to see CAP have EMS officially considered as part of ground teams I know it probably wont happen.
As far as being able to treat out of state the best thing to do is join a DMAT. The closest stopgap is to pass the National Registry.
Now, I DO wish CAP could use its medical talent to Augment with AF medical services much as I can do with the Coast Guard through its Aux.

I wear the EMS badge on my uniform, and I have a Buttback full of BLS materials for missions. Anything else, Im going to be forced to rely on the local EMS teams. Which - for most of us is ok- its CO, AK and the like that worries me.

I do have one question though... Arajaca posted that at one time the AF Surgeon General was approached about providing CAP with oversight. When did this take place?

[arajca]

I do not underestimate the difficulties of getting a doctor to act as what you call a PA which is medical parlance stands for Physicians Assistant, not Physician Advisor. All hospitals have an attending physician or physicians on staff at all times who function as medical control or medical direction for EMS crews in the field. If CAP were willing to pry open its wallet, it could get liability for the EMTs and Medics, since the Physician would already be covered by his own malpractice insurance and the liability coverage of the hosptial. Furthermore, since its not like we are going to be running to the doctor, asking a question and then running back on foot, but rather calling by cell or satphone, it wouldnt matter if the physician was 9, 90 or 900 miles away as long as he can be reached by phone.

PA is the term MY system uses for the physician advisor, which is different from medical control. The PA is at the central hospital location in Denver and the medical control is at the local hospital (part of the same system) in Frisco. The issue that occurs is that the EMT's practice under the PA's license and any problems that occur can cause him to lose his license.

Finally the problem of differeing protocols in different states would not present any more of a problem than in does for private EMS agencies. The Medical Director would be familiar to the enth degree with the protocols of the state regarding the level of provider he was directing, thus avoiding this problem. Im not sure what your involvement in EMS is, but you seem to have a fundamental misunderstanding of how EMS operates. A friend of mine is a medic in W. Virginia and her medical director is 90 minutes away from the closest call in her reponse area. As long as you can maintain a clear connection, there is no problem. Im not talking about each Wing having a single medical director, but more likely a group of Squadrons in relatively close geographical proximity to each other such that if they were "civilian" EMS they would likely be using the same medical direction. You obviously fail to see the need for trained EMS personnel in the field being able to legally operate to the extent of their training. Without knowing it, CAP inadvertantly allows this through the regs which allow for stabilizing first aide to the extent of the medical professionals training. Of course a medics will be different than mine and mine will be more advanced than a first responder or someone with his CPR certificate only. Its ironic that there is a 10 page thread on arming CAP officers with guns and why it should be done, but no one can see the more clear and present need for a trained and liability covered EMT/Medic on SAR sorties in the field.

1. I've only been an EMT for 14 years in a rural environment. I am quite familiar with the EMS system I work in.
2. I know the need for organic EMS in CAP ground teams, but a significantly higher priority is to get teams NIMS compliant and listed so they will be able to be called out. Until you reach the upper level (Type I and II) teams, medical is not an organic requirement. Most of CAP's  ground teams will fall into the Type III and IV categories.
3. Even private EMS companies have training periods employees must go through is the change states. Some even have to if they change areas in a state.

[Hoser]

Dr Dave said it all. I joined CAP to help out where I can. I have 30 years experience in EMS/Fire, both civilian and military. When I joined, my Squadron Comanader thought my experience as a paramedic would be an asset to the squadron, and I have used my skills, not in managing death and dismemberment, but as Dr Dave has done, in an advisor role and in providing oversight on multiple activities. As to using my skills for real in CAP I would have to say that is dependant on the situation. No matter how unlikely it may be, if facing an immediate life threat I am going to do what I can for the patient, I really don't care what the regs say. While I didn't take a Hippocratic type oath, I have a moral obligation to provide care to someone who needs it and I simply am incapable of standing by while someone slips away beause CAP regs prohibit me from using all my skills to help out. If I get my hiney pinched by CAP, so be it. I am not a "Randy Rescue" and would not take that type situation lightly, but I would do it.  I also am of the opinion that even though I am not a First Aid instructor, CPR instructor etc etc etc I am still qualified to teach what needs to be taught, all the certifications associated with EMS are merely initials and having them does not make one more qualified than one who does not. Ability is not measured by the number of letters after one's name. As Dr Dave I assume would agree, there is a difference betwen having a paramedic license and being a paramedic. Yes I took ACLS, PALS, PHTLS becuase I had to and because it was CEU hours, but did those classes make me a better medic? I don't know. All I know is I will do what I need to do to save someone's life if it is within my power to do so. Just because something is against the regulations does not make it wrong.
That is my opinion, I could be wrong


Mark Anderson, Capt
ARCHER Operator
MO Wing

[arajca]

Immediate care to save a life is permitted. "Routine" type care is not.