EMS Protocols

[arajca]

In CO, medical direction/oversight/control is provided by the hospital system your agency works with following general guideline from the state. Most hospital systems in CO use the same protocols for legal reasons - doing so takes a tool away from the sharks lawyers (Why don't you allow YOUR EMS personnel to do XYZ like ABC Hospital Corp. does?). Some provide coverage anywhere/anytime in the state, some just when your on duty with your agency.

[Eclipse]

I am allowed to use all of my fun protocols when I'm in my home county.

Not in a CAP uniform.

[SJFedor]

EDIT: I forgot to mention how Medical Oversight works in WI. Online Medical Oversight is provided by the receiving hospital. Don't know if it's different elsewhere, but that's the situation in WI.

Yeah, it changes from place to place. Here in Louisville, all our OLMC is done through UofL for adult patients and Kosair Childrens for peds. Nashville is the same, with Vanderbilt providing med control for NFD EMS.


And the fact that there wasn't a med unit on standby somewhere was a massive failure on the part of the incident commander. If we're looking for an aircraft in a county, I'd definitely wanna be on the phone with the county EMA and EMS, and have fire, technical rescue, and EMS standing by and ready to roll. We're not the end all be all, we're only the first link in the chain, and some IC's forget to remember that and make sure they have additional resources ready.

Shock doesn't always kill someone, there's 3 stages of shock, and all but the last one can be fixed. Had this patient had a significant MOI (as she did) along with significant injuries, then the only way that patient would have a chance is to have pre-hospital transport readily available.

And lets be realistic. By the time we get the call, mobilize, get to the field, and find the person, the golden hour was up a long, long time ago.

[Krapenhoeffer]

I am allowed to use all of my fun protocols when I'm in my home county.

Not in a CAP uniform.

Thanks, I'll take a 2b from CAP, rather than lose my license and watch my patient die.

[Eclipse]

I am allowed to use all of my fun protocols when I'm in my home county.

Not in a CAP uniform.

Thanks, I'll take a 2b from CAP, rather than lose my license and watch my patient die.

I didn't make the rules, nor do I necessarily agree with them, but if you find yourself in a "duty of care" situation because of your CAP service, you need to be fully aware that you will most likely not be covered by CAP liability insurance, etc., when you hang the IV.  A 2B might be the least of your worries if someone dies because you made a mistake and your professional insurance says "talk to CAP about this..."

You haven't discovered anything "new", or "problematic" - this is the official stance of CAP, Inc., and has been for a long time.
Either you can work within that or you can't, and a CAP GTL would be well within his CAP authority to tell you to knock it off, or sign you out of the mission on the spot if you start doing something beyond the scope of CAP's mandate and authorization.

[cap235629]

or sign you out of the mission on the spot if you start doing something beyond the scope of CAP's mandate and authorization.

Is this one of those Eclipse regulations that aren't really there?  Where does a GTL get the authority to sign anyone but him/her self in or out of a mission?

[sarmed1]

Thanks, I'll take a 2b from CAP, rather than lose my license...

Not likely, CAP is no differant than any other not Ambulance job.  If I am working for walmart and someone collapses in front of me and dont do anything because I am just the greeter despite being a paramedic, I wont be in trouble because I had no duty to act (morally maybe but that's usually not a legal or certification loosing issue)

Would you loose your license for not giving O2 to a trauma patient on your way home from the store because you dont carry your own O2 in the car...or AED...or traction splint??  All protocols and expected standard of care?

As far as a first responder requirement a good idea but not relaly problem solving; I work with a number of "pro" first responders (police, fire dept, industrial etc) and unless (and even then) they are riding the ambulance on a regular basis their skills are usually substandard (they put oxygen on 15LPM do CPR and everything else is a little rusty).  My point is its not about more initial training, its about keeping up their skills; and the basic first aid skills that CAP people have is a fine starting point for the mission they do; medical folks need to keep everyone else updated and up to speed; that would go a much longer way than everyone taking a 40+ hour course

otherwise if going down the road of medical types doing more than advising and emergency care:
Personally I like the following option for medcial care in CAP...it solves the cost and liability issues (of course there is some coordination and details that need to be worked out)
Two words  Air Force.  If the USAF covers all of CAP liability and Tort issues for USAF mission why cant medical care on the same missions be covered?  (both for care to members or search victims)  I would imagine in order for USAFMS to take on the "risk" CAP members would have to meet realtively the same training and maintainig standards as their USAF counterparts, someone would have to keep track of all of that as well. 
I think that is a better plan than trying to develop something that wont likley work in all 52 wings and will cost CAP a butt load of money in insurance

mk

[Eclipse]

or sign you out of the mission on the spot if you start doing something beyond the scope of CAP's mandate and authorization.

Is this one of those Eclipse regulations that aren't really there?  Where does a GTL get the authority to sign anyone but him/her self in or out of a mission?

GTL's are the final authority in the field for a ground team - they aren't there just to "drive the cadets".  You obey them or you go home.

[Eclipse]

Thanks, I'll take a 2b from CAP, rather than lose my license...

Not likely, CAP is no differant than any other not Ambulance job.  If I am working for walmart and someone collapses in front of me and dont do anything because I am just the greeter despite being a paramedic, I wont be in trouble because I had no duty to act (morally maybe but that's usually not a legal or certification loosing issue)

On this it really depends on the state - some have pretty strict regs regarding duty to act by medical professionals.

[Krapenhoeffer]

@sarmed: I carry my jump pack in my POV, of course minus the O2, and the AED, because I can't afford those nice things. As for splints, in a wilderness setting, potential splints can be found anywhere one looks.

Maybe try recruiting more EMTs from the real world, than trying to raise them up in-house?

And as for not providing care: Yes, I know that technically one cannot have their license revoked, but in practice... There was an EMT I knew, not well, but knew, and he was at a school football game, and one of the players on the other team went down, unresponsive, the EMT said to the parents of this child "I would help, but he's on the other team, so I think it would be inappropriate." And stood there. And did nothing. Not even AABC. His boss found out, and magically he never seemed to be on the rig anymore. When the time came to re-certify, he wasn't considered "active" so he lost his license.

@Eclipse: I can't get sued as long as I stay within my scope of practice. Which means not obtaining IV access until I'm directed by online medical control to administer intravenous medication. And I think you will be hard pressed to find a GTL who would tell an EMT to knock it off, especially after I'm directed to drop an IV (no longer CAP responsibility anyway, responsibility for patient transfers to St. Mary's Hospital).

[Eclipse]

And I think you will be hard pressed to find a GTL who would tell an EMT to knock it off, especially after I'm directed to drop an IV (no longer CAP responsibility anyway, responsibility for patient transfers to St. Mary's Hospital).

Really - well here's one.  For starters you wouldn't be bringing that stuff to insure you didn't get "tempted".

Second, the millisecond you are directed by someone to hang an IV, you are literally no longer on that mission, and are taking direction
from a different agency.  At that point I could not care less what you do, I notify the GBD that you're off the mission and go back to securing the scene.

I'm not going to risk my house and future so you can play Squad 51.  If its that important, leave the turn out gear on and stay with the FD.

Why would we recruit more EMT's? So we can have more of these conversations?  Until CAP changes their tune, we don't need them as medical responders - their general abilities, understanding of the nature of ES, and certainly their warm bodies, yes, but from a medical perspective they might as well be florists.

[High Speed Low Drag]

Is there a Legal Officer in the house??

[Spaceman3750]

I am allowed to use all of my fun protocols when I'm in my home county.

Not in a CAP uniform.

Thanks, I'll take a 2b from CAP, rather than lose my license and watch my patient die.

Kapen raises an interesting point. CAP regulations don't take account for the fact that a licensed medical professional (EMT, RN, MD, etc) is required by law (at least in IL) to take actions up to his level of licensure if required. Are we basically asking medical professionals to put their license on the line because CAP insurance doesn't cover medical care?

[Eclipse]

Kapen raises an interesting point. CAP regulations don't take account for the fact that a licensed medical professional (EMT, RN, MD, etc) is required by law (at least in IL) to take actions up to his level of licensure if required. Are we basically asking medical professionals to put their license on the line because CAP insurance doesn't cover medical care?

No - what we tell them is that if they encounter a "duty of care" situation, they have to perform that duty within the bounds of whatever
agency or license is forcing the issues.  (i.e. they take their figurative blouse off).

Its cilla and caribdus for our members, no question, but that doesn't change things.

[Krapenhoeffer]

And I think you will be hard pressed to find a GTL who would tell an EMT to knock it off, especially after I'm directed to drop an IV (no longer CAP responsibility anyway, responsibility for patient transfers to St. Mary's Hospital).

Really - well here's one.  For starters you wouldn't be bringing that stuff to insure you didn't get "tempted".

Second, the millisecond you are directed by someone to hang an IV, you are literally no longer on that mission, and are taking direction
from a different agency.  At that point I could not care less what you do, I notify the GBD that you're off the mission and go back to securing the scene.

I'm not going to risk my house and future so you can play Squad 51.  If its that important, leave the turn out gear on and stay with the FD.

Why would we recruit more EMT's? So we can have more of these conversations?  Until CAP changes their tune, we don't need them as medical responders - their general abilities, understanding of the nature of ES, and certainly their warm bodies, yes, but from a medical perspective they might as well be florists.

Then tell me, why does CAPabilities brag about how many EMTs and First Responders that CAP has?

Why do we have a badge awarded to those with such skills, if we don't use them?

You know, I'm glad that I live and work in a State and Wing that values are uses the training of the medically trained personnel who volunteer their time to fulfill the mission of Search and Rescue: So That Others May Live

Now, I came to ask about modifications and improvements for a proposal that has yet to be submitted. Not to get into useless flamewars.

[JayT]

@sarmed: I carry my jump pack in my POV, of course minus the O2, and the AED, because I can't afford those nice things. As for splints, in a wilderness setting, potential splints can be found anywhere one looks.

Maybe try recruiting more EMTs from the real world, than trying to raise them up in-house?

And as for not providing care: Yes, I know that technically one cannot have their license revoked, but in practice... There was an EMT I knew, not well, but knew, and he was at a school football game, and one of the players on the other team went down, unresponsive, the EMT said to the parents of this child "I would help, but he's on the other team, so I think it would be inappropriate." And stood there. And did nothing. Not even AABC. His boss found out, and magically he never seemed to be on the rig anymore. When the time came to re-certify, he wasn't considered "active" so he lost his license.

@Eclipse: I can't get sued as long as I stay within my scope of practice. Which means not obtaining IV access until I'm directed by online medical control to administer intravenous medication. And I think you will be hard pressed to find a GTL who would tell an EMT to knock it off, especially after I'm directed to drop an IV (no longer CAP responsibility anyway, responsibility for patient transfers to St. Mary's Hospital).

Who's responsbility is it then? Yours? Who's providing the medicine? (What medicine is used to magically make trauma patients better by the way? Unless you're packing O-Neg...)

How are you contacting medical control? Via a CAP radio? How are the medicines being stored? What if you're out of your county? In NY at least, ALS is a county level thing, not a state (ie, you can be state certified but if you're not registered with the county, you're BLS with an AEMT patch.)

There's nothing stopping you from providing good BLS care, and frankly, that's what a trauma patient needs. The "golden hour" stuff is a bunch of unscientific nonsense, it should be "as soon as possble." Work on developing a plan with your local medivac service.

The regulation says that you are able to provide care up to your level of certification, but recognize that CAP will not pay out malpractice insurance.

As I said before, there's forty different grades of prehospital provider in the US, and hundreds or thousands of different protocols. You cannot expect a national organization to operate as a medicine provider unless they have their own high level MAC.

Practically too, its almost a moot point, as I doubt you can find more then a handful of cases where a plane crash victim died because they didn't get the "life saving IV" or an amp of thamine.

It's not a flame war. Trust me, I'm a young (extremely young) ALS provider that wants to slam a trauma bore into everyone and hang a dopamine drip three or four times a tour, or conduct hypothermic therapy (I AM LITERALLY RUNNING ICE WATER INTO YOUR VEINS!)
But this is also my career. Its my job. And you don't want to risk it because you broke the rules and got your entire team sued.

[Eclipse]

Then tell me, why does CAPabilities brag about how many EMTs and First Responders that CAP has?

I have no idea.

Why do we have a badge awarded to those with such skills, if we don't use them?

No idea - we have "Medical Officers", too - that can't do anything, either.  They can wear the Caduceus, so what.  We also have people
wearing CIB's, Maintainer Badges, and everything else in between - doesn't change what we do, this is simply recognition of service outside CAP.

Now, I came to ask about modifications and improvements for a proposal that has yet to be submitted. Not to get into useless flamewars.

You and every other new EMT who joins CAP - use the search function and see just how old an issue this is.  If you think a message board that disagrees with your perception by stating facts is a "flame war", you may wish to  close your AOL account.

[Krapenhoeffer]

As I said before, there's forty different grades of prehospital provider in the US, and hundreds or thousands of different protocols. You cannot expect a national organization to operate as a medicine provider unless they have their own high level MAC.

That's why I'm only proposing this up to the Wing level. In WI, standards and levels of care are set by the state. Depending on where you are in the state determines which hospital you go to, and the receiving hospital provides online medical control, and each hospital does things a little bit differently, but not too differently, or the state will award contracts to different hospitals.

And even though we have EAA AirVenture in WI (Berets aren't allowed outside of Oshkosh usually, WIWG still has operational control over the entire mission), we end up with more missing person searches than plane searches. To be more precise, I've never been on an actual ELT hunt. Plenty of training missions, but that's just the idea of how rare they are.

But for missing person searches, the State Patrol is the lead agency, so it will either be via Mr. Cell Phone (like back in real EMS world), or State Patrol frequencies on a CAP radio.

Now, I don't know about other Wings/States, but in Wisconsin, we're getting more missions. The state and county EMAs love us, and the Governor just signed a bill into law that provides essentially the same job protection to CAP members as to Nat'l Guardsmen.

[RiverAux]

You may only be proposing it to Wing, but depending on exactly what you're asking for you are either going to need to get NHQ to approve a Wing supplement or to have them passively approve of one (some regs you need pre-approval to modify and some you don't, but NHQ can still make you change them if they don't like them).

[Eclipse]

That's why I'm only proposing this up to the Wing level. In WI, standards and levels of care are set by the state.

Which means you literally don't understand the issue.  The state of Wisconsin may set care levels for professionals they license,
but they literally have no say about what CAP will do.

This is an issue which sits squarely at the national level, and won't be changed until NHQ decides a change is warranted.

You will never get a local supplement to supersede the national policy on emergency medical care.  Period.