Main Menu

Medical Sections

Started by Hawk200, June 10, 2007, 01:06:17 AM

0 Members and 1 Guest are viewing this topic.

Hawk200

In the Army Guard, most units have their own medical sections, usually with enlisted medics and on occasion, a nurse. Does anyone know if there is any similar concept for CAP operations?

I know that some encampments have a doctor, maybe a nurse or two, and a few medics to provide some basic routine medical care (such as runny noses, or mild "boo-boos"). Is there ever a similarly staffed section for large activities, such as SAR-EX's, missions or other activities of similar size? I know there are people that would like CAP to provide a First Responder type of medical care, but what about routine care for our own members?

Don't know if this would be the right section to put this post in, but it didn't seem to be exclusively ES related.

Ned

Quote from: Hawk200 on June 10, 2007, 01:06:17 AM
In the Army Guard, most units have their own medical sections, usually with enlisted medics and on occasion, a nurse. Does anyone know if there is any similar concept for CAP operations?

I know that some encampments have a doctor, maybe a nurse or two, and a few medics to provide some basic routine medical care (such as runny noses, or mild "boo-boos"). Is there ever a similarly staffed section for large activities, such as SAR-EX's, missions or other activities of similar size? I know there are people that would like CAP to provide a First Responder type of medical care, but what about routine care for our own members?

Don't know if this would be the right section to put this post in, but it didn't seem to be exclusively ES related.

Most activities don't have a medical section for the fairly simple reason that is of very limited utility.

Becasue CAP medical folks, by regulation, simply cannot perform routine medical care.  Especially routine care that you described -- the ordinary runny noses, tummy aches, and sore knees.

HSOs are important in their advisory and training roles.  For example, they are essential to review medical information on applications to advise commanders and leaders on member's medical limitations.  They are also crucial trainers; they can help train encampment tactical officers about heat stress and basic first aid.

But they absolutely cannot run a "sick call" or treat anything except a true emergency that endangers life or limb.

Some units and activities choose to ignore the regulation, and this is very, very dangerous to the individuals and to CAP, Inc itself.

Since CAP does not have medical malpractice insurance, a single error treating a cadet at encampment could result in a civil judgment that could literally end the corporation.

"Friends don't let CAP medical personnel endanger the corporation, they point out the pertinent regulations."

Ned Lee
Former CAP Legal Officer

Hawk200

Pretty much answers my questions. Thanks.

lordmonar

You know what the funny part is...Malpractice Insurance (at least for EMTs) is relatively inexpensive!

PATRICK M. HARRIS, SMSgt, CAP

PHall

Quote from: lordmonar on June 10, 2007, 03:49:35 AM
You know what the funny part is...Malpractice Insurance (at least for EMTs) is relatively inexpensive!



Okay, how's this? 

If you wish to use your EMT skills in CAP then you will provide Proof of Malpractice Insurance.
No insurance, then it's nothing but Band Aids for you.

Does that sound semi reasonable? 


DHollywood

Quote from: PHall on June 10, 2007, 06:48:33 AM
Quote from: lordmonar on June 10, 2007, 03:49:35 AM
You know what the funny part is...Malpractice Insurance (at least for EMTs) is relatively inexpensive!



Okay, how's this? 

If you wish to use your EMT skills in CAP then you will provide Proof of Malpractice Insurance.
No insurance, then it's nothing but Band Aids for you.

Does that sound semi reasonable? 



Sure, except for a doctrine called "respondeat superior."  In a nutshell, CAP might be held liable for anything you do at a CAP activity, in uniform, in connection with your service to CAP, that constitutes negligence.  The master is responsible for the torts of his servant....

At our last statewide FTX there were outside agency EMS on site.  That said, when a cadet had a potentially serious allergic reaction there were Nurse Practitioners and paramedics with Epi pens in hand.  Fortunately, it wasn' that severe.

account deleted by member

SARMedTech

Quote from: DHollywood on June 10, 2007, 07:10:47 AM
Quote from: PHall on June 10, 2007, 06:48:33 AM
Quote from: lordmonar on June 10, 2007, 03:49:35 AM
You know what the funny part is...Malpractice Insurance (at least for EMTs) is relatively inexpensive!



Okay, how's this? 

If you wish to use your EMT skills in CAP then you will provide Proof of Malpractice Insurance.
No insurance, then it's nothing but Band Aids for you.

Does that sound semi reasonable? 



Sure, except for a doctrine called "respondeat superior."  In a nutshell, CAP might be held liable for anything you do at a CAP activity, in uniform, in connection with your service to CAP, that constitutes negligence.  The master is responsible for the torts of his servant....

At our last statewide FTX there were outside agency EMS on site.  That said, when a cadet had a potentially serious allergic reaction there were Nurse Practitioners and paramedics with Epi pens in hand.  Fortunately, it wasn' that severe.



And, EMS response agencies do not issue insurance cards to their responders. The policy covers malpractice on the part of all responders, not each one individually. And the doctrine of respondeat superior refers back to what I said in the other thread about CAP and EMS that CAP not covering EMS personnel who may be in its ranks and be participating in an exercise or sortie when a member or other person gets hurt may end up being responsible anyway in situations where there may be a medic or EMT standing right there but not able to do anything because of CAPS regulations, or more accurately, significant lack thereof. And CAP says that EMTs or other responders will provide stabilizing first aide to the extent of the their training and licensure which is inconsistant with "emergency stabilizing first aide" since the extent of a medic's training and licensure includes things like intubation and needle decompressions of collapsed lungs. Is this another instance of when the reg reads specifically it is intended to be interpreted specifically and literally and when it is vague and general it is intended to be interpreted broadly? (And no, I am not turning this into another CAP EMS thread;)
"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

lordmonar

My point is was that CAP could get liability insurance to cover some limited medical operations (EMT, general practice) fairly cheaply but they have chosen not to do so.
PATRICK M. HARRIS, SMSgt, CAP

Flying Pig

If Im not mistaken, dont EMT's, paramedics and nurses have to practice under some sort of authority from an MD?  I mean as far as employment, not as a citizen just doing the right thing. When I was a SWAT member, I was the teams EMT.  When we started branching into having Paramedics, they needed to be under some sort of covering from an MD.

Im not seeing a need for CAP to get into medicine.  Im all for medically trained members, but without all of the equipment and drugs, your not going to do much except call for an ambulance.

As far as routine care for CAP members, by CAP members?  Could you imagine the paperwork nightmare that would become!?  I dont see my insurance recognizing CAP as my primary care doctor.  I dont think CAP has the infrastructure to get into the medical care business.

Hey, if Im out in the sticks...feel free to do what you can.  Short of me squirting blood from my femoral artery.. call in LifeFlight and send my to the ER so I dont get slaped with a $6000 helicopter ride!

Ned

Quote from: lordmonar on June 10, 2007, 03:44:45 PM
My point is was that CAP could get liability insurance to cover some limited medical operations (EMT, general practice) fairly cheaply but they have chosen not to do so.

Patrick,

I honestly don't think any such insurance could be had for less than several hundred grand a year, and probably more if wanted to cover "routine care" for members at encampments, etc.

As others have pointed out, EMTs, medics, RNs, etc work under protocols approved by physicians.  So the EMT (only)insurance is pretty cheap, because any lawsuits are gonna be directed at the deep pocket decision maker who approved the protocol that was presumeably followed and produced the complained injury.

And because CAP would need to cover itself as well.  Medical malpractice insurance that covers corporations is simply not cheap.

Again, I would really, really like the realities of the situation to be different.  You know I am a CP guy, and having routine care available -- if for no other reason than "triaging" tummyaches and sore knees at encampment -- would be a huge force multiplier.

Sigh.

SARMedTech

What the folks who dont see EMS as a possible part of CAP keep doing is changing the subject. No one, least of all myself, has ever talked about "routine medical care." Im not talking about members, senior or cadet, coming to me for a follow up during an encampment after they have seen their doctor about migraines and want my opinion. While I have about 160 hours of medical school level studies in addition to my EMT license and training, Im not a primary care physician. All I have ever talked about is the fact that CAP owes it to its members and those lost people that may be recovered to have medical care on scene--pre-hospital emergency care--and that it ought to make it possible for those who are qualified to offer such care to do so. Of course there are arguments to be made against it. But there are far more to be made for it. And as far as calling in a med-evac, I cant do that in the field and neither can anyone else (Perhaps a CAP physician but even that is iffy). You have to call 911, who then dispatches EMS who decides whether or not a dust off is needed. I cant simply called and say "Im an EMT  with the Civil Air Patrol, send me a chopper to the following co-ordinates." Thats not how it works. Frequently, the decision to call for med-evac is not made until a ground crew is on scene. More time wasted.

The fact remains that many of the places we will go will take quite some time for ground EMS to arrive and when a trauma is severe enough, minutes, heck even seconds, matter. Thats why I am for putting together medical teams to work in the field and giving them the tools they need to do things appropriately. If CAP wants us to perform first aide, then it should look at the International Red Cross's list of conditions which it considers in need of first aide and what it recommends doing about them. Could it be expensive to field EMS teams. Yes, it could. But when you ask people to do things which inherently carry a level of danger and risk of injury and to not get paid for doing it, it seems the least that could be done is to provide them some sort of medical care in the field. In the mean time, if what CAP wants is "stabilizing first aide" from those of us qualified to give it, I am happy to do so. That doesn't mean that I dont think the standard should be higher and that CAP members deserve more.  Maybe if CAP cut back on all the patches and uniform variations, there might be a little left over for some things that could be more consequential
"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

Ned

I agree that you haven't been addressing routine medical care.

But that was the initial inquiry in this thread, and something of far more importance to CP folks like myself than SAR EMS.  I clearly understand that the latter is your focus and that you are not addressing routine care at other types of CAP activities.  And that's fine.  Separate missions create separate priorities.

But neither type of medical care can really be discussed in a vacuum.  Because the issues and needs overlap considerably and probably cannot be realistically separated.

I think I understand why SAR EMS is important to you (and the potential vctims who might benefit from that care.)

But medical care (or lack thereof) also greatly impacts CP at major activities like encampments and NCSAs.  It is a critical drain on staffing resources to run a bunch of cadets to "doc in the box" (the local urgent care clinic) every day to deal with the inevitable borderline injuries and conditions that arise at any challenging activity.  (Think volleyball ankle injury/rule out fx situation.)

Or assisting young persons with chronic medical conditions who might be away from home for the first time.

Or simply maintaining secure custody and providing necessary storage conditions for the literally hundreds of prescription medications at a large activity like a TX, FL, or CAWG encampment (the usual mixture ranging from contrulled substances to medications requiring refrigeration) while documenting adminstration for minors.

God, I would love to have an RN, PA, or even a doc at a large CAWG encampment with 250 bodies living in open-bay barracks.

Or at least one that could actualy treat non-emergent patients and do some good.

But until we can figure out a realistic way, we are both stuck looking at the wrong side of our HSOs.

For both of our missions.

Peace.

Ned Lee
CP Kind of Guy

capchiro

Along Ned's lines, at the last SER encampment, they had a young male cadet that was homesick and decided he wanted his parents to pick him up and take him home.  They had the Chaplain talk to him and the Chaplain told him that he had seen this same thing many times and that it was a response to caffeine (Coca cola) withdrawal and that he was authorizing the cadet to drink one Coke a day and they would see if this helped.  Strangely, it worked and a Chaplain, playing Doctor?? saved the day!!  A lot of time the cadets need someone to talk to that hasn't yelled at them all day and that they are afraid of??  And actually you are both right, as far as the need for care, and at different levels, but, the Reg's just don't support the idealistic ways of doing things.  Perhaps in the future and with discussions like this maybe, attention will awaken the desire of the powers to be.
Lt. Col. Harry E. Siegrist III, CAP
Commander
Sweetwater Comp. Sqdn.
GA154

arajca

Quote from: SARMedTech on June 10, 2007, 10:21:25 PM
And as far as calling in a med-evac, I cant do that in the field and neither can anyone else (Perhaps a CAP physician but even that is iffy). You have to call 911, who then dispatches EMS who decides whether or not a dust off is needed. I cant simply called and say "Im an EMT  with the Civil Air Patrol, send me a chopper to the following co-ordinates." Thats not how it works. Frequently, the decision to call for med-evac is not made until a ground crew is on scene. More time wasted.
I don't know what system you're in, but I can easily call in to dispatch, id myself as an emt and get a chopper headed to my coordinates - if they are within range of the chopper. BTDT. Especially if you inform them that you're on a SAR mission.

Typically, if you're doing a live person search, the requesting agency should have notified the local medivac folks as to the potential for them to get called. So all it should take is a call to the appropriate center - could even be a CAP communications unit - and the chopper is on the way. Tell the chopper where they are going and who to contact on the ground and they'll be there.

SARMedTech

Quote from: arajca on June 11, 2007, 01:39:23 AM
Quote from: SARMedTech on June 10, 2007, 10:21:25 PM
And as far as calling in a med-evac, I cant do that in the field and neither can anyone else (Perhaps a CAP physician but even that is iffy). You have to call 911, who then dispatches EMS who decides whether or not a dust off is needed. I cant simply called and say "Im an EMT  with the Civil Air Patrol, send me a chopper to the following co-ordinates." Thats not how it works. Frequently, the decision to call for med-evac is not made until a ground crew is on scene. More time wasted.
I don't know what system you're in, but I can easily call in to dispatch, id myself as an emt and get a chopper headed to my coordinates - if they are within range of the chopper. BTDT. Especially if you inform them that you're on a SAR mission.

Typically, if you're doing a live person search, the requesting agency should have notified the local medivac folks as to the potential for them to get called. So all it should take is a call to the appropriate center - could even be a CAP communications unit - and the chopper is on the way. Tell the chopper where they are going and who to contact on the ground and they'll be there.

Well therein lies the problem. Yes, as an EMT working for a recognized EMS agency, I might be able to get on scene (to modify my earlier position) and tell them I need a chopper dust off. Youre right. Even up here in Northern IL where EMS is a cluster-fluff we can do that. What I was trying to get at was that if you call dispatch as an CAP EMT out in the field (first of all, how do you contact emergency medical dispatch...You can call 911 and try to get them to put you through to helo dispatch) you ARE going to have a more difficult time. If you get lucky, and the EMD (emergency medical dispatcher) has heard of CAP, you might be able to say "This is Lt. So-and-so with the Civil Air Patrol and I need a helicopter to med-evac a severely injured patient." It might actually work. But I have been on scenes where we needed a chopper as a non-CAP EMT and been told that the helicopter is on standby for another flight, etc. What I should have said is that its going to be very difficult to get it done when you are not operating with an EMS agency that alot of people have heard of and that dispatch is familiar with.

As far as EMTs performing more routine things and assisting with more routine situations at encampments, etc, I am all for that. I would happily work in concert with an MD, nurse, etc to help make sure that folks get their meds, to be the custodian of those meds and to assist the physician in running a "sick bay." I think that could be a very useful function for EMS personnel out there in a "tent city." Im not against it at all. Also, when you have 10 cadets coming to you at the same time, an EMT is taught triage and can act as a triage officer and know that someone bitten by a spider and having difficulty breathing goes ahead of a tummy ache or home-sickness. Thats really one of the most constructive uses of our services that I have heard thus far. We can be out there putting mole skin on blisters, skin closers on cuts that dont need sutures, cleaning up skinned knees and elbows, getting sets of vitals from cadets and seniors who "just dont feel right" and keeping records of who we see, what they are seen for, what the outcome was, whether or not they needed to be evacuated or sent home. I really thank you for that suggestion. I dont know why I hadnt thought if it previously because when I work EMS on industrial sights up in the great white north of Canada thats alot of what I do. So yeah, I am willing to play "Umm, Lt. I got noticed this welt on by leg, is this a spider bite?" Excellent idea. We can keep sick bay logs, etc and as I say I think it would be a great use of the skill-set when the EMT in question is not doing his other stuff as a GTM or whatever.  Bravo Zulu for the good thinking!
"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

SJFedor

I'm not a total expert, but this is what I've seen in PA.

They usually have a medical section, headed up by an ER MD. They usually have an ER RN or two in the bay, and usually an EMT assigned to each squadron to travel with them, moreso as a personal safety officer then anything else. They have keen eyes to watch for dehydration or anything they feel is unsafe, and if something bad happens (cadet billy falls off the OC and has a bleeder on his head) then the EMT can at least apply a bandage, and either get the local EMS rolling, or if it's something like a splinter or something minor (confirmed minor, not suspected minor), can be taken to the med shed and have the same care given that mommy would do at home.

I never participated in the process, but as a cadet back in PA, it's kind of what I saw. People from there can fill in more.

But having emergency trained professionals simply adds more safety to the first aid. Refer back to cadet billy falling off the OC with the bleeder on his head. Normal non trained person is going to go "oh darn", put a compress on his head, let him walk it off, and go to the med shed or the urgent care facility. The EMT or other emergency trained professional is going to start considering things like a closed head injury, spinal fracture, etc etc. A lot of time these things can be zebra's.

Zebra= medical expression used to think logically about differential diagnoses. When you hear hoof beats, you think of horses, not zebra's. Zebras are those things you don't think of, but still could be.

Oh well, it's just more of the corporate mentality, and what's good for the corporation is going to come before what's good for the member.

Steven Fedor, NREMT-P
Master Ambulance Driver
Former Capt, MP, MCPE, MO, MS, GTL, and various other 3-and-4 letter combinations
NESA MAS Instructor, 2008-2010 (#479)

Eclipse

Quote from: Hawk200 on June 10, 2007, 01:06:17 AM
In the Army Guard, most units have their own medical sections, usually with enlisted medics and on occasion, a nurse. Does anyone know if there is any similar concept for CAP operations?

I know that some encampments have a doctor, maybe a nurse or two, and a few medics to provide some basic routine medical care (such as runny noses, or mild "boo-boos"). Is there ever a similarly staffed section for large activities, such as SAR-EX's, missions or other activities of similar size? I know there are people that would like CAP to provide a First Responder type of medical care, but what about routine care for our own members?

Don't know if this would be the right section to put this post in, but it didn't seem to be exclusively ES related.

Yes.  911.  Anything else is all but essentially prohibited by regs.  Please feel free to argue about it...

"That Others May Zoom"

SARMedTech

Quote from: Eclipse on June 11, 2007, 02:00:45 PM
Quote from: Hawk200 on June 10, 2007, 01:06:17 AM
In the Army Guard, most units have their own medical sections, usually with enlisted medics and on occasion, a nurse. Does anyone know if there is any similar concept for CAP operations?

I know that some encampments have a doctor, maybe a nurse or two, and a few medics to provide some basic routine medical care (such as runny noses, or mild "boo-boos"). Is there ever a similarly staffed section for large activities, such as SAR-EX's, missions or other activities of similar size? I know there are people that would like CAP to provide a First Responder type of medical care, but what about routine care for our own members?

Don't know if this would be the right section to put this post in, but it didn't seem to be exclusively ES related.

Yes.  911.  Anything else is all but essentially prohibited by regs.  Please feel free to argue about it...

I dont want this thread to get locked down, but... the regs say emergency stabilizing first aide up to the level of training and licensure of the provider and this is also the the stance of CAP Health Services. First Aide is a big area to cover and in fact could be considered almost any emergency care which is non-invasive. Many members have made it pretty clear that CAP is not a paramedical orgranization, not a health care organization, but if they fall and get hurt, get bitten/envenomated by something, cut themselves or break a bone, they are going to want anybody and everybody with licensed medical training their working on them. I will just wear my EMT patch/badge, and do what the regs allow until they can be changed by an administration that is truly worried about the safety and well-being of its members. If you want emergency first aide, emergency first aide is what you shall get.  ;D
"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

capchiro

Due to the definition in the Reg's CAPR 160-1, if one wants to render more aid, one needs to raise their level of training and qualification.  Unfortunately, EMT's fall within the same domain as occupational therapist, diet therapist, blood and cell therapist, orthotic techs, and opticians.  According to the Reg's, a Medical Officer, being a doctor, can render a higher level and more emergency care than a Health Services Officer because of their level of training and qualifications.  This would seem to make common sense and be a good thing.  It would seem that a likely answer to our dilemma would be to recruit more doctors and especially emergency room physicians to work with us in the field and at encampments.  Unfortunately, I don't know too many that are willing to donate their time to the degree that we need them.  The Reg's further mention "the next higher level of care".  This is a common term in Emergency Medicine and means that a care giver will recognize and submit to the next higher level of care and will not turn over the patient to a lesser level of care without assuming some liability for doing so.  Now, what happens in the field if you are a EMT-I and the civilian that turns up is an EMT-B?  Do you turn the patient over to him?  If you are a Nurse or Doctor in the field, do you turn over the patient or stay with him to the hospital?  Basically the Reg's say that we will provide stabilizing "First Aide" up to our level of expertise, but I think they are attempting to limit it to basic first aide and not the battle field amputations that some may consider necessary first aid or cracking some guys throat with a pocket knife to provide an airway.  Now, to go even further, the Reg states that the health personnel will espouse the Air Force health style, etc.  So, I guess we can't recruit 300 pound EMT's, Opticians, or Doctors?  JMHO as usual
Lt. Col. Harry E. Siegrist III, CAP
Commander
Sweetwater Comp. Sqdn.
GA154

SJFedor

Quote from: capchiro on June 11, 2007, 10:33:58 PM
Due to the definition in the Reg's CAPR 160-1, if one wants to render more aid, one needs to raise their level of training and qualification.  Unfortunately, EMT's fall within the same domain as occupational therapist, diet therapist, blood and cell therapist, orthotic techs, and opticians.  According to the Reg's, a Medical Officer, being a doctor, can render a higher level and more emergency care than a Health Services Officer because of their level of training and qualifications.  This would seem to make common sense and be a good thing.  It would seem that a likely answer to our dilemma would be to recruit more doctors and especially emergency room physicians to work with us in the field and at encampments.  Unfortunately, I don't know too many that are willing to donate their time to the degree that we need them.  The Reg's further mention "the next higher level of care".  This is a common term in Emergency Medicine and means that a care giver will recognize and submit to the next higher level of care and will not turn over the patient to a lesser level of care without assuming some liability for doing so.  Now, what happens in the field if you are a EMT-I and the civilian that turns up is an EMT-B?  Do you turn the patient over to him?  If you are a Nurse or Doctor in the field, do you turn over the patient or stay with him to the hospital?  Basically the Reg's say that we will provide stabilizing "First Aide" up to our level of expertise, but I think they are attempting to limit it to basic first aide and not the battle field amputations that some may consider necessary first aid or cracking some guys throat with a pocket knife to provide an airway.  Now, to go even further, the Reg states that the health personnel will espouse the Air Force health style, etc.  So, I guess we can't recruit 300 pound EMT's, Opticians, or Doctors?  JMHO as usual


And some of that is very open ended. A doctor may have more school then an EMT, but not necessicarily qualifications, especially in the emergency field. Who would you rather have, the EMT with 2 years of 911 experience, or the MD  that may have 30 years of experience, but is a podiatrist?

And honestly, you don't have to worry about EMT-Ps and MDs doing a cric on someone with an airway problem. They wouldn't do it unless it was A) absolutely necessicary, and B) they knew what they were doing, and were willing to stake their licenses on it. It's the non licensed person who has basic first aid, watches too much ER, Greys Anatomy, and MacGyver that you really hafta worry about.

Steven Fedor, NREMT-P
Master Ambulance Driver
Former Capt, MP, MCPE, MO, MS, GTL, and various other 3-and-4 letter combinations
NESA MAS Instructor, 2008-2010 (#479)