Medical squadrons

[ALORD]

Is it just me or does anything ALORD posts sounds negative.   Even when he is agreeing with you?

You probably just have an overly suspicious and cynical nature; Would you like to talk to the Chaplain son? And it is remotely possible ( No, don't try and stop me, I can take it!) that my dark and dry sense of humor does not make its way through everyone's video screen. ( Turn of Irony filters in Windows setup) One recent example may have been the irritation I experience when I mentioned that CAP members have to "Take off the jacket" of CAP if they feel the need to try and save a person, on the ill-founded theory that CAP can't get into trouble if one of its "Medical Officers" or members gives a cadet an aspirin or sticks a tube in his chest, or something equally icky or dangerous.  It's just plain sophistry. Starfleet's Reg posting shows I was right on target...basic first aid only....unless you have to treat the patient by law, a rare circumstance. ( FYI, do sex therapists have a duty to act?... Just wondering....) We medical peeps care a smidge more about life ( At least the good guys lives) than we do about our CAP "Career" ( I laughed like a Hyena when I first heard someone say that out loud!) I have and always will treat my teammates like they were family, even if it means a having the  patches torn from my uniform, branded with a hot iron,  and my saber broken is disgrace ( Well, the USAF Officers sword is not a Saber, but the principle is the same) and drummed out of the Corp.

Another of my favorites is the 900-3, which states among other things that CAP members may not be deputized. In California, not coming to the aid of an LEO by accepting deputization is a crime! CAP has no exemption, except this: The second you obey the lawful demand for assistance from a LEO,  you are no longer acting as a CAP member, You have to go to "CAP-OFF" state! ( Taking off your jacket is optional) I also think that disarming lawfully armed CAP members, police included, is just about as un-American as refusing to assist an LEO. Whose side are we one? So it's possible that I am a little cynical and suspicious of CAP's motives in certain regards. I sure hope you did not take these as personal attacks.....as far as I know, I don't even know you, but if you find yourself around Travis AFB, or Napa, Where I live,  I will be happy to buy you a beer and wipe the bitter taste of my words from your mouth!

[PA Guy]

So enough about EMT's, how about doctors??  How far can they go??

According to the previously-cited regulation, up to their level of training and licensure.

Non concur. All CAP members are restricted to first aid regardless of skill level. CAPR 160-1:

"1-6. Medical Care Policy.
a. CAP is not a health care provider, and CAP members are not permitted to act in the role of health care providers during the performance of official CAP duties. Consequently, CAP members are not permitted to function as pharmacists, physicians, nurses, or in any other role that would permit the administration and dispensing of drugs under various federal and state laws and regulations."

With the exception and caveat of...

c. Any member can assist another member in distress in order to save the life of the
member. Members are encouraged to inform activity leadership, health service officers, those in
direct contact with the member of their condition, and critical information for support that may
be needed. Should any CAP member be required by law to render aid by virtue of his or her
professional credential or state license (such as a paramedic or emergency medical technician,
for example), such CAP member in complying with his or her legal obligations shall be deemed
to be doing so either as the agent of his or her employer or as an agent of the state agency that
issued his or her license, but in no event as the agent of CAP.

This refers to the miniscule, MN is the only one I can find, number of states that have an off duty legal Duty to Act requirement.

[Holding Pattern]

It might be a good opportunity for any medics to suggest a rule change to read:

c. Any member can assist another member in distress in order to save the life of the
member. Members are encouraged to inform activity leadership, health service officers, those in
direct contact with the member of their condition, and critical information for support that may
be needed. Should any CAP member having active professional credentials or state licenses
(such as a paramedic or emergency medical technician, for example) render aid
beyond the limits set for in para b., such CAP member shall be deemed
to be doing so either as the agent of his or her employer or as an agent of the state agency that
issued his or her license, but in no event as the agent of CAP.

Thoughts?

[Holding Pattern]

It's also worth mentioning that many states have laws written like this:

TITLE 31. HEALTH
CHAPTER 11. EMERGENCY MEDICAL SERVICES
ARTICLE 1. GENERAL PROVISIONS

O.C.G.A. § 31-11-8 (2007)

§ 31-11-8. Liability of persons rendering emergency care; liability of physicians advising ambulance service pursuant to Code Section 31-11-50; limitation to gratuitous services
(a) Any person, including agents and employees, who is licensed to furnish ambulance service and who in good faith renders emergency care to a person who is a victim of an accident or emergency shall not be liable for any civil damages to such victim as a result of any act or omission by such person in rendering such emergency care to such victim.
(b) A physician shall not be civilly liable for damages resulting from that physician's acting as medical adviser to an ambulance service, pursuant to Code Section 31-11-50, if those damages are not a result of that physician's willful and wanton negligence.
(c) The immunity provided in this Code section shall apply only to those persons who perform the aforesaid emergency services for no remuneration.

[Fubar]

According to CAP, I'm not allowed to do anything medically, regardless of my training or expertise unless it's to save a life. Big bad CAP isn't trying to get all you stethoscope jockeys from getting your life-saving ribbons, so please stop worrying.

What CAP would really like everyone to do is to drop the "medics" that show up at the camp-outs and encampments with a fully stocked ALS kit who spend the duration of the activity in scrubs diagnosing everything from sprained ankles to common colds. That's what's going to get us sued out of existence someday.

Otherwise, keep lugging your kits around, nobody, especially CAP is going to keep you from a attempting to save someone's life. If you do find yourself saving someone's life, CAP only asks that you limit yourself to what you've been trained to do (most state EMS and good samaritan laws say something like that as well).

[AirAux]

I liked the cadet that brought a full suture kit to encampment.  When asked if he was trained to use it, he replied, "No, but my Dad is a Doctor".  I guess that takes care of that.......

[ALORD]

I liked the cadet that brought a full suture kit to encampment.  When asked if he was trained to use it, he replied, "No, but my Dad is a Doctor".  I guess that takes care of that.......

Perhaps he was planning on sewing on new stripes with sutures and surgical ties? That would be within his scope of practice as a "Cadet Medic" ( Whatever that is...) Since blood pinnings are a thing of the past, I guess he could not use his surgical staples to staple his new stripes or bling right through his shirt into his skin. That would be almost as cool as getting your Wing Patch tattooed on your shoulder!

[Al Sayre]

^^
And almost as smart as ironing your shirt while you're wearing it...

[AirAux]

It's called the Good Samaritan Law:

"It's also worth mentioning that many states have laws written like this:

TITLE 31. HEALTH
CHAPTER 11. EMERGENCY MEDICAL SERVICES
ARTICLE 1. GENERAL PROVISIONS

O.C.G.A. § 31-11-8 (2007)

§ 31-11-8. Liability of persons rendering emergency care; liability of physicians advising ambulance service pursuant to Code Section 31-11-50; limitation to gratuitous services
(a) Any person, including agents and employees, who is licensed to furnish ambulance service and who in good faith renders emergency care to a person who is a victim of an accident or emergency shall not be liable for any civil damages to such victim as a result of any act or omission by such person in rendering such emergency care to such victim.
(b) A physician shall not be civilly liable for damages resulting from that physician's acting as medical adviser to an ambulance service, pursuant to Code Section 31-11-50, if those damages are not a result of that physician's willful and wanton negligence.
(c) The immunity provided in this Code section shall apply only to those persons who perform the aforesaid emergency services for no remuneration."



 

[Ned]

Folks,

We've talked about this before, of course.

There are a lot of compelling reasons why CAP does not permit members to provide medical services to anyone except in a genuine life-or-limb emergency.

Much of it does indeed center around liability issues - CAP does not carry "errors and omissions" (essentially medical malpractice) insurance that would cover medical issues.  There are several reasons for this, one is that we would have to cover everyone from EMTs to physicians, with a lot of licensees in the middle like paramedics, RNs, LVNs, etc., all of which have different license requirements and scope of practice restrictions based on their states.  And they vary. A lot.  Throw in places like Puerto Rico and the overseas units and it gets complicated quickly.

But mostly because malpractice insurance to cover the member and CAP inc. would cost literally hundreds of thousands of dollars a year.  Every year.

Which we simply do not have.  Sure, we could raise every single member's dues $10-15 dollars per year.  But there simply is not that kind of money floating around NHQ to spend on insurance.  (And frankly, if we did have a an extra couple hundred thousand dollars, I could find much better ways to spend it.)

Without insurance, it a single misdiagnosed tummyache at encampment could simply end CAP as we know it.

And Good Samaritan laws do not offer much help in this area.  First, they vary a great deal from state to state.  Second, and more importantly, they would only cover the individual offering the aid, and not CAP, Inc.  Any lawyer in a medical bad outcome case is going after "the deep pocket" to recover damages.  That is almost never going to be, SM Bob, hardworking family man with two kids and a mortgage, but CAP, Inc. a large 501(c) corporation with hundreds of millions in assets.  (The fact that most of those assets belong to Uncle Sam is going to be lost on most attorneys.)

CAP Friends don't let CAP friends offer medical aid in anything but a genuine life and limb emergency. 


Ned Lee
Former CAP Legal Officer

[THRAWN]

Folks,

We've talked about this before, of course.

There are a lot of compelling reasons why CAP does not permit members to provide medical services to anyone except in a genuine life-or-limb emergency.

Much of it does indeed center around liability issues - CAP does not carry "errors and omissions" (essentially medical malpractice) insurance that would cover medical issues.  There are several reasons for this, one is that we would have to cover everyone from EMTs to physicians, with a lot of licensees in the middle like paramedics, RNs, LVNs, etc., all of which have different license requirements and scope of practice restrictions based on their states.  And they vary. A lot.  Throw in places like Puerto Rico and the overseas units and it gets complicated quickly.

But mostly because malpractice insurance to cover the member and CAP inc. would cost literally hundreds of thousands of dollars a year.  Every year.

Which we simply do not have.  Sure, we could raise every single member's dues $10-15 dollars per year.  But there simply is not that kind of money floating around NHQ to spend on insurance.  (And frankly, if we did have a an extra couple hundred thousand dollars, I could find much better ways to spend it.)

Without insurance, it a single misdiagnosed tummyache at encampment could simply end CAP as we know it.

And Good Samaritan laws do not offer much help in this area.  First, they vary a great deal from state to state.  Second, and more importantly, they would only cover the individual offering the aid, and not CAP, Inc.  Any lawyer in a medical bad outcome case is going after "the deep pocket" to recover damages.  That is almost never going to be, SM Bob, hardworking family man with two kids and a mortgage, but CAP, Inc. a large 501(c) corporation with hundreds of millions in assets.  (The fact that most of those assets belong to Uncle Sam is going to be lost on most attorneys.)

CAP Friends don't let CAP friends offer medical aid in anything but a genuine life and limb emergency. 


Ned Lee
Former CAP Legal Officer

With that in mind....what then is the rationale behind medical officers at encampments, "medic" training in the foothills of Pennsylvania, or even a regulated HSO program?

[Ned]

With that in mind....what then is the rationale behind medical officers at encampments, "medic" training in the foothills of Pennsylvania, or even a regulated HSO program?

I'm not sure I fully understand the question, but let me give it a try.

HSO's are a critical part of CAP, and especially useful to CP.

As a former encampment commander at the wing and region level, as well as an NCSA Activity Director, I rely on HSOs for crucial services, advice, and information:

1.  I have them review the medical information provided on the applications to let me know what to expect and best practices to help the cadet to succeed.  (Me: "Hey, Doc, this kid says she has something called "Raynaud's phenomenon" - that's bad, right"  HSO: "No, not really.  It's very manageable, let me call Mom and see if there will be any restrictions . . ." ).  Then I can alert the FTO and necessary staffers for their situational awareness.  Ditto for something like a peanut allergy.  (Me:  "Doc, is this like a peanut allergy or a PEANUT ALLERGY where we can't even use the same pots and pans that we use for everyone else.  I need to tell the dining hall something."  HSO:  (Based on the information here, it looks like we are going to need to have this cadet eat separately . . . ")

2.  I absolutely include them in RST to provide risk information on hot weather or other environmental factors, dehydration, etc, based on local factors.  I can't imagine doing an effective RST for something like an encampment without them.

3.  HSO's are great at providing training to staff members on things like foot care, watching for signs of excessive stress, and hydration issues.

4.  (and a lot more I can't think of right now.)

At the national level, I absolutely get HSO input on CP policies like sleep requirements, medication storage issues, CPP risk factors.


Now, I don't generally support a requirement that there be a "medical officer" at encampment, as I don't think there are enough of them to go around, and often there isn't enough work during the encampment for an HSO in any event, since we are obviously not conducting anything resembling a "sick call" or providing routine medical treatment.  When we have an emergency, we dial "9-1-1" just like every one else on base and get good service from the first responders.

Was there something else I could address?

[Spaceman3750]

With that in mind....what then is the rationale behind medical officers at encampments, "medic" training in the foothills of Pennsylvania, or even a regulated HSO program?

I'm not sure I fully understand the question, but let me give it a try.

HSO's are a critical part of CAP, and especially useful to CP.

As a former encampment commander at the wing and region level, as well as an NCSA Activity Director, I rely on HSOs for crucial services, advice, and information:

1.  I have them review the medical information provided on the applications to let me know what to expect and best practices to help the cadet to succeed.  (Me: "Hey, Doc, this kid says she has something called "Raynaud's phenomenon" - that's bad, right"  HSO: "No, not really.  It's very manageable, let me call Mom and see if there will be any restrictions . . ." ).  Then I can alert the FTO and necessary staffers for their situational awareness.  Ditto for something like a peanut allergy.  (Me:  "Doc, is this like a peanut allergy or a PEANUT ALLERGY where we can't even use the same pots and pans that we use for everyone else.  I need to tell the dining hall something."  HSO:  (Based on the information here, it looks like we are going to need to have this cadet eat separately . . . ")

2.  I absolutely include them in RST to provide risk information on hot weather or other environmental factors, dehydration, etc, based on local factors.  I can't imagine doing an effective RST for something like an encampment without them.

3.  HSO's are great at providing training to staff members on things like foot care, watching for signs of excessive stress, and hydration issues.

4.  (and a lot more I can't think of right now.)

At the national level, I absolutely get HSO input on CP policies like sleep requirements, medication storage issues, CPP risk factors.


Now, I don't generally support a requirement that there be a "medical officer" at encampment, as I don't think there are enough of them to go around, and often there isn't enough work during the encampment for an HSO in any event, since we are obviously not conducting anything resembling a "sick call" or providing routine medical treatment.  When we have an emergency, we dial "9-1-1" just like every one else on base and get good service from the first responders.

Was there something else I could address?

This may be published somewhere and I've missed it, but is there a recommended practice on how to handle the types of issues that mom and dad might handle at home, that don't rise to the level of an emergency, and therefore don't rise to the level of a hospital/clinic trip or ambulance ride? Examples include headache, upset stomach, routine twisted ankle, blisters, etc? I'm not trying to be confrontational or have an opinion either way, I'm just curious if there is a recommendation or required way to handle it.

EDIT: It would seem that under regs, the answer is we don't; however, it would also seem like someone needs to deal with it. Do we have encampments calling parents for this stuff? I'm genuinely curious. I don't think CAP should be in the medical business either, but we do need to take care of our cadets at activities somehow.

[THRAWN]

With that in mind....what then is the rationale behind medical officers at encampments, "medic" training in the foothills of Pennsylvania, or even a regulated HSO program?

I'm not sure I fully understand the question, but let me give it a try.

HSO's are a critical part of CAP, and especially useful to CP.

As a former encampment commander at the wing and region level, as well as an NCSA Activity Director, I rely on HSOs for crucial services, advice, and information:

1.  I have them review the medical information provided on the applications to let me know what to expect and best practices to help the cadet to succeed.  (Me: "Hey, Doc, this kid says she has something called "Raynaud's phenomenon" - that's bad, right"  HSO: "No, not really.  It's very manageable, let me call Mom and see if there will be any restrictions . . ." ).  Then I can alert the FTO and necessary staffers for their situational awareness.  Ditto for something like a peanut allergy.  (Me:  "Doc, is this like a peanut allergy or a PEANUT ALLERGY where we can't even use the same pots and pans that we use for everyone else.  I need to tell the dining hall something."  HSO:  (Based on the information here, it looks like we are going to need to have this cadet eat separately . . . ")

2.  I absolutely include them in RST to provide risk information on hot weather or other environmental factors, dehydration, etc, based on local factors.  I can't imagine doing an effective RST for something like an encampment without them.

3.  HSO's are great at providing training to staff members on things like foot care, watching for signs of excessive stress, and hydration issues.

4.  (and a lot more I can't think of right now.)

At the national level, I absolutely get HSO input on CP policies like sleep requirements, medication storage issues, CPP risk factors.


Now, I don't generally support a requirement that there be a "medical officer" at encampment, as I don't think there are enough of them to go around, and often there isn't enough work during the encampment for an HSO in any event, since we are obviously not conducting anything resembling a "sick call" or providing routine medical treatment.  When we have an emergency, we dial "9-1-1" just like every one else on base and get good service from the first responders.

Was there something else I could address?

Wouldn't those things fall under "providing medical services"? As for the "field medic" training in PA, how is that justified under the 160 regs as well as the 60-3 reg?

[Holding Pattern]

With that in mind....what then is the rationale behind medical officers at encampments, "medic" training in the foothills of Pennsylvania, or even a regulated HSO program?

I'm not sure I fully understand the question, but let me give it a try.

HSO's are a critical part of CAP, and especially useful to CP.

As a former encampment commander at the wing and region level, as well as an NCSA Activity Director, I rely on HSOs for crucial services, advice, and information:

1.  I have them review the medical information provided on the applications to let me know what to expect and best practices to help the cadet to succeed.  (Me: "Hey, Doc, this kid says she has something called "Raynaud's phenomenon" - that's bad, right"  HSO: "No, not really.  It's very manageable, let me call Mom and see if there will be any restrictions . . ." ).  Then I can alert the FTO and necessary staffers for their situational awareness.  Ditto for something like a peanut allergy.  (Me:  "Doc, is this like a peanut allergy or a PEANUT ALLERGY where we can't even use the same pots and pans that we use for everyone else.  I need to tell the dining hall something."  HSO:  (Based on the information here, it looks like we are going to need to have this cadet eat separately . . . ")

2.  I absolutely include them in RST to provide risk information on hot weather or other environmental factors, dehydration, etc, based on local factors.  I can't imagine doing an effective RST for something like an encampment without them.

3.  HSO's are great at providing training to staff members on things like foot care, watching for signs of excessive stress, and hydration issues.

4.  (and a lot more I can't think of right now.)

At the national level, I absolutely get HSO input on CP policies like sleep requirements, medication storage issues, CPP risk factors.


Now, I don't generally support a requirement that there be a "medical officer" at encampment, as I don't think there are enough of them to go around, and often there isn't enough work during the encampment for an HSO in any event, since we are obviously not conducting anything resembling a "sick call" or providing routine medical treatment.  When we have an emergency, we dial "9-1-1" just like every one else on base and get good service from the first responders.

Was there something else I could address?

Wouldn't those things fall under "providing medical services"?

No. Rendering medical services is pretty clearly defined as in the areas we just quoted earlier. What Ned is referring to is clearly outlined in 160-1:

1-7. General Duties of Health Service Personnel. CAP health service personnel are
responsible for advising CAP commanders and unit personnel on the health, fitness, disease and
injury prevention and environmental protection of CAP members relevant to CAP activities, with
special emphasis on those members involved in flying, emergency services and disaster relief
activities, field exercises, encampments and special activities.

As an aside, this conversation has given me a chance to read through the 160-1 and also discovered that there is apperantly no pamphlet for that specialty track.

[THRAWN]

Starfleet, thanks. A little clearer but it still seems like two sides of the same coin.

[Holding Pattern]

Think of it this way: Health Services provides medical specific ORM for activities.

All individuals with a CPR/First Aid card can render that level of care.

All individuals credentialed beyond that level of care can't go beyond that except in a life-saving situation (which if someone needs "beyond first aid," it seems likely that it has become a life saving situation, but we'll skip the nuances of that for now, I think we beat that to death earlier.)

In the circumstance of 1-7, would advising on how to help cadets succeed ever be considered "medical care" above the call of "first aid"? Not that I can see. Further details of 1-7 go into even further detail on drawing the line between advise to commanders and rendering medical care such as here:

e. Advise members to obtain necessary physical examinations from non-CAP health care
sources when required by the activity commander. CAP health service personnel will not
perform such examinations as part of their CAP duties.

A lot of the key words in 160-1 with regards to duties are: Advise, educate, promote, assist, and report.

[Ned]

This may be published somewhere and I've missed it, but is there a recommended practice on how to handle the types of issues that mom and dad might handle at home, that don't rise to the level of an emergency, and therefore don't rise to the level of a hospital/clinic trip or ambulance ride? Examples include headache, upset stomach, routine twisted ankle, blisters, etc? I'm not trying to be confrontational or have an opinion either way, I'm just curious if there is a recommendation or required way to handle it.

EDIT: It would seem that under regs, the answer is we don't; however, it would also seem like someone needs to deal with it. Do we have encampments calling parents for this stuff? I'm genuinely curious. I don't think CAP should be in the medical business either, but we do need to take care of our cadets at activities somehow.

For stuff like blisters, mild sunburn, the odd cut and bruise, etc., we rely on the senior members supervising the cadets to provide support and advice.  Just like Mom and Dad would do at home.  Because that kind of stuff is not medical care; it's just the routine stuff of life.  As a FTO at encampment (something like 25 times so far), I can say and do things like "Cadet, we need to make sure that blister doesn't get any worse.  Here's some Moleskin (tm).  Want me to show you how to put it on?"  Or "Hmmm, got a headache?  Let's see if Mom pre-authorized us to give you a Tylenol (tm) according to bottle directions.  If not, I'll give her a call and let her decide.  In the meantime, why not lie down over there for a few minutes to see if you feel better."  Or, "Tell me about your twisted ankle, cadet.  Hmmm, maybe we should take you to the local Urgent Care Center to see what they think.  Let me call Mom and see what she thinks and then we'll decide what to do."

So, yes, I call parents before any OTC medications are given to the cadet and try to get their consent in writing.  (They can take their own if they want.)  And I always call parents before I take a cadet to see a doc.  I want to make sure they are onboard, and also to warn them that they are on the hook for any costs.

It's really just common sense when it comes to the ordinary bumps and bruises of an active and challenging cadet program.  Most adults are pretty good at assessing when something might be serious enough to be seen by a professional.  If you're not sure, talk about it with the other experienced CP volunteers at the activity, as well as Mom and Dad.

But giving a troop a BandAid (tm) is not medical care in anyone's definition.  But sometimes it is just part of good leadership - taking care of your people.

Take a look at the Cadet Encampment Guide for specific guidance on the OTC medications at encampment and the role of the Training Officer generally.


Thank you for your work with our cadets.

Edited to correct semi-humorous typo - "thank you for your work with out cadets."   

[Fubar]

CAP Friends don't let CAP friends offer medical aid in anything but a genuine life and limb emergency.

Slap a ™ on that bad boy and start printing the bumper stickers...

[Mitchell 1969]

With that in mind....what then is the rationale behind medical officers at encampments, "medic" training in the foothills of Pennsylvania, or even a regulated HSO program?

I'm not sure I fully understand the question, but let me give it a try.

HSO's are a critical part of CAP, and especially useful to CP.

As a former encampment commander at the wing and region level, as well as an NCSA Activity Director, I rely on HSOs for crucial services, advice, and information:

1.  I have them review the medical information provided on the applications to let me know what to expect and best practices to help the cadet to succeed.  (Me: "Hey, Doc, this kid says she has something called "Raynaud's phenomenon" - that's bad, right"  HSO: "No, not really.  It's very manageable, let me call Mom and see if there will be any restrictions . . ." ).  Then I can alert the FTO and necessary staffers for their situational awareness.  Ditto for something like a peanut allergy.  (Me:  "Doc, is this like a peanut allergy or a PEANUT ALLERGY where we can't even use the same pots and pans that we use for everyone else.  I need to tell the dining hall something."  HSO:  (Based on the information here, it looks like we are going to need to have this cadet eat separately . . . ")

2.  I absolutely include them in RST to provide risk information on hot weather or other environmental factors, dehydration, etc, based on local factors.  I can't imagine doing an effective RST for something like an encampment without them.

3.  HSO's are great at providing training to staff members on things like foot care, watching for signs of excessive stress, and hydration issues.

4.  (and a lot more I can't think of right now.)

At the national level, I absolutely get HSO input on CP policies like sleep requirements, medication storage issues, CPP risk factors.


Now, I don't generally support a requirement that there be a "medical officer" at encampment, as I don't think there are enough of them to go around, and often there isn't enough work during the encampment for an HSO in any event, since we are obviously not conducting anything resembling a "sick call" or providing routine medical treatment.  When we have an emergency, we dial "9-1-1" just like every one else on base and get good service from the first responders.

Was there something else I could address?

As to point 4, the stuff you can't remember:

4.A - Remind people only to eat fruit that can be peeled, and then only after washing it;

4.B - Give advice on where to dig latrine facilities in relation to the tents;

4C - Remind personnel not to urinate upstream;

4D - Inspect government beef for signs of maggots and rotting;

4E - Keep medicinal spirits securely under lock and key;

(OK, so it came from a VERY old manual )