USPHS Auxiliary

[wingnut]

Put your health-related training into practice with the Commissioned Corps. To qualify for the Commissioned Corps, you must:

Be a U.S. citizen
Be less than 44 years of age
Be medically qualified
Have a current, unrestricted professional license (if applicable)
Have a qualifying degree or a higher degree from an accredited institution (varies depending on occupation)

All Commissioned Corps officers must meet several basic qualifications: you must be a U.S. citizen, be less than 44 years of age, and pass a physical examination. Degree and training requirements for public health officers will vary depending on the area of practice. To be a health services officer, you also need the following:

qualifying degree from a program that, at the time the degree was conferred, was accredited by the acceptable accrediting body for your discipline
A current, unrestricted, and valid license (if applicable) in any of the 50 States; Washington, DC; the Commonwealth of Puerto Rico; the U.S. Virgin Islands; or Guam may be required.

I did some work with The USPHS and they are all graduates from colleges with  a BS, or an MD and licensed to practice medicine or the required certifications from a "real"(Nationally recognized) school.

Sceptical big time of any discussion of making an EMT a 'Warrant Officer" no way that will ever happen, a licensed LVN is equivalent to a medic in the military, indeed many states allow some medics to take the LVN exam after their discharge.  The US Military requires a BS to be a Commissioned Nurse Corp officer, so does USPHS. Physician Assistants all have a BS and Nurse Practitioner's have an MS.

I think the Pay is a big issue for many people going into the USPHS and the Military medical Corps. Some of you may not remember but we had to draft Medical personnel into the military well through 1973, I worked with lots of those guys and they hated the military, the uniforms, saluting, it was like MASH all the time.

I work with lots of college kids who "want to get into medical school and when you ask them why usually they reply  because Dr's make $200,000 per year etc, etc.

the USPHS also sends their staff to places that many medical staff will not go to (Appalachia, Indian reservations) its a noble deed, but when you talk to some of them they want out bad, its hard on the family, poor schools for their kids. I think we have a real problem with people just are not willing to help their fellow man, it's about greed. Like Nip and Tuck.

Oh one comment about working at the Federal Prison, I worked for the federal Government in Law Enforcement, and let me say one thing about Shooting a Federal Prisoner. Yes, the Federal Regulations say you may shoot an escapee (often without warning) but just remember this, the Federal Government will not supply you with an attorney when the family Sues you in Civil,Court for depriving the family of the bread winner (I mean Drug smugglers).

[JCW0312]

You'll find that most EMTs are not in it for the "greed". I don't know of too many of them that make enough money that they can afford to avoid overtime, second jobs, etc.

[JCW0312]

 Also, military medics can take the National Registry EMT exam upon discharge in some cases (depending on the amount of training they received in the military). I'm still confused as to why LVNs were brought up. Nursing and EMS are two different ballgames. Even emergency nursing is different in most cases, due to the fact that most of the time it takes place in a definitive care setting.

In Tennessee (and most other states), a paramedic straight out of school can do way more than an RN (with very few exceptions, such as foley catheters).

[wingnut]

as a former Medic and an EMT , I don't think that the USPHS is going to make an EMT a warrant officer. You can be an EMT with a 3 month class. Warrant officers make $4,000 per month, W/O allowances.

If you look at the bottom line here the U.S. Government is trying to put together a reaction force to a disaster or an attack. If you have a group of medical personnel that can be activated ( Federalized) they can respond. The military is hard pressed keeping up with enough medical staff for the military.

I think a USPHS reserve corp is an excellent idea, it makes great sense to train out own kids in school, but, these people will be working in their skill area after graduation and we are back to what is happening in Iraq, the Guard and reserve are at maximum deployment. Think about a Dr. who gets federalized and is now making 25% of what he was making in private practice. he will be bankrupt in 5 months.

I think we need to expand the Guard and reserve,  say maybe double it, give tuition reimbursement for a 6 year enlistment in the reserve. But lets make it mandatory, a reserve and Guard draft. Freedom cannot be free, ( free for the rich maybe). Membership in CAP should be part of it too.

If it pops off in Iran, we will have big problems

[wingnut]

I agree, as a combat field medic I should have been given my RN license, thats something that the Military should consider to get people in. A 2 year medic school should be fully accredited. We had to go back and take an EMT course because the Govt. would not allow us to pick up civilians unless we were certified.

A military Medic can take the LVN test in some states, once you have that some colleges have a 1 year LVN to RN school. State exam requirements to be an RN are strict, same thing to be a Doctor or any State approved program to get a medical license of any type.

[PA Guy]

In Tennessee (and most other states), a paramedic straight out of school can do way more than an RN (with very few exceptions, such as foley catheters).

Are you referring strictly to procedures? Or are you referring to the practice of nursing in general?  If that is the case why aren't paramedics employed in ICU, OR, OB, Med Surg, Mental Health, Nurse Practitioner, Nurse Midwife or other areas instead of the RNs?  I think you are trying to compare apples and oranges. Paramedics are the greatest thing since sliced bread in the pre hospital setting but have a limited role beyond that.

[JCW0312]

In Tennessee (and most other states), a paramedic straight out of school can do way more than an RN (with very few exceptions, such as foley catheters).

Are you referring strictly to procedures? Or are you referring to the practice of nursing in general?  If that is the case why aren't paramedics employed in ICU, OR, OB, Med Surg, Mental Health, Nurse Practitioner, Nurse Midwife or other areas instead of the RNs?  I think you are trying to compare apples and oranges. Paramedics are the greatest thing since sliced bread in the pre hospital setting but have a limited role beyond that.

I'm referring to procedures for both straight out of school. I'm also referring to the emergency medical side of things (including emergency rooms). I know that nursing overall (OB, Med Surg, Midwife, etc.) encompasses many specialties that nurses can go into, but I'm thinking along the lines of medical responders to mass casualty incidents and other disasters (which I assume reserve WO's would be called on for if they came into existence).

Most nurses who work in an emergency room are great at emergency medicine. However, many nurses who work in other specialties are not up to par in emergency medicine. If you don't believe it, ask any medic who has had a nurse show up to help on the scene of a car crash. You can tell those who don't work in an ER! I had a nurse on a motorcycle crash (trauma full arrest) tell me to stop pumping on the guy's chest because she could feel a pulse. Well, yeah... that's what pumping on a chest does. Come to find out, she was an OB nurse for one of the local hospitals.

I'm not trying to knock nurses in any way. Most I have run across are great at what they do. I'm just trying to say that if you need medical responders for something, don't discount them just because EMS is offered in certificates instead of degrees. (Of course, some schools are offering degrees now)

[wingnut]

Yes and when I  went to Medic school they shot a goat and we got to practice, but if I touched a civilian including one in a disaster and I was not certified or licensed in that State. "Medical Malpractice Lawsuit here I come"

This is a well beaten path, Medical Li censure is a fact of being in the Health Care world, If your Licensed and come upon an accident and do anything beyond your 'Scope of Practice", expect to be sued if anything goes wrong,  be prepared to be charged criminally if they die. We in CAP for the most part are not even recognized as an entity that does medical EMS, we can wear an EMT badge if "Still Current" in certification", but really how many squadrons can field enough guys to carry one fat guy on a stretcher. I would say 98% of our members don't even have a Red Cross CPR card.

I think its great anyone who is a volunteer can sit through an EMT class, but if you want to use your skills for that you should maybe also be a member of a volunteer fire Dept. or a rescue squad.  If you have been staying current in the Latest of Defibrilation Techniques the studies are showing that Paramedics maybe should not be doing that at all, they found that if you pack them in Ice and use some new IV meds in the ER you can save a much larger percentage than shooting 320 Joules through their heart.

Scoop and Scoot

More to come on that you will see

[JCW0312]

I doubt too many CAP EMT's went to EMT school just for their role in CAP. Most of us come from an EMS background. Like you said, we're not an EMS organization, so it would be a waste of a lot of time.

I agree that we need to expand the CPR program for members. I think it should be required for all members to be current with either an ARC or AHA CPR cert. Many hospitals now require all employees  (including the custodial staff) to complete CPR classes every 2 years.

[alice]

Last June, the former national commander of CAP with the approval of the NEC held some "exploratory" talks with representatives of the Office of the Secretary of Defense and USAF in Rosslyn, Virginia.  The point from the OSD and USAF's perspectives was to see if CAP leadership was interested in giving CAP volunteers in the field more support from OSD and more flexibility in performing federal instrumentality non-military emergency services. 

OSD was then more than willing to have CAP as the first operational part of a brand new civilian volunteer reserve corps.   There was real intent to try to get such legislation into the big Defense appropriation bill going though Congress this year.  It would be very much like the USPHS Aux and  the USCG Aux.  As of last June, the only equivalent civilian reserve force the Department of Defense had is civilian linguists.

The whole idea is we all know the DoD gets tasked to do lots of missions, often on short term notice with staffing needs they can never always have on hand - such as lots of Arabic speakers when the first Gulf War started.  This week we see Congress and the US President dickering over the DoD budget such that the Sec Def says today he must furlough 200,000 paid civilian employees next month.

Here are some of the features OSD agreed to last June tenatively if the CAP volunteer and paid leadership agreed, too:

1.  A CAP civil reserve would be strictly volunteer -- no one could be forced to go on a mission.
2.  While on duty - whether for a daylight one-day SAREx or on a mission away from home more than a day, the civil reservist would be paid at least a per diem if not more as if holding equavalent GS rank.  FECA benefits would no longer max out at 50% of equivalent GS claims.
3.  Local CAP units would not need to pay out of their own personal pockets for local phone, rent, and utilities, since they would be like any other part of the US government -- GSA or DoD would give them the status to rent as if a fed instrumenality.  Thus, a unit could get in line for space at fed facilities the same as any other fed agency, not as if CAP were the Boy Scouts of America as is presently the legal situation.
4. RON - at normal government rates and reimbursement procedures.  No more of this RON "only if asked" or things get desparate to get volunteers on long missions such as the Steve Fossett search; or waiting months and months for a F108 to be processed through endless CAP channels.
5.  All CAP corporate aircraft would be treated like public aircraft and CAP pilots as public pilots. No more biannual FAA waiver song and dance or moving target.  Already USAF has a lien on each CAP aircraft for its full value.  Let's admit it.  The government already effectively owns those planes!  So treat them like full public aircraft.  Let them be serviced anywhere a US public aircraft can be serviced like a local Air National Guard maintenance shop.
6.  Dept of Justice is happy as clams to give CAP volunteers all these new fed instrumentality supports and benefits if USAF or OSD make CAP as fully accountable and transparent as any other operational agency is which gets as much money from Congress as CAP gets now.
7.  CAP corporate HQ personnel would get direct transfers to GS jobs, thus ending the double dipping for CAP-USAF retirees who get CAP, Inc salaries and pensions.
8. Some or all of the CAP volunteer national leadership would similarly be transfered to direct GS status and pay.
9.  The BoG would have no more reason to exist.
10.  CAP-USAF would have no more reason to exist.
11.  Cadet program would stay looking the same it is now to cadets in the field.  Same uniforms.  Same program.
12.  OSD fully supported the idea of CAP having MOUs with fed instrumentality status with State ES agencies to do all sorts of ES training and response from SAR to disaster response up to a certain dollar amount since such training and response for local and state emergencies fits with CAP's Congressional charter purposes of national and local emergency response and also falls under the rubric of "readiness" for federal needs.
13.  How any OSD or DoD civil reserve force would fit with DHS remained to be decided.  But the model for how the National Guard can easily switch back and forth from state to fed status was discussed.

What are the downsides?  Well, some CAP leadership might not be eligible for such GS rank.   Some might call this an "Air Force takeover" since they could no longer control as much as they do now though "corporate games".  But in return for getting more money, missions and flexibility to the volunteers in the field should not CAP leadership demonstrate some more flexiblity and creative thinking?  And, DoD might not need so many full time paid civilian employees when so many in CAP are willing to do much more than we are asked to do or able to do now.

I've sat through CAP legal officer college banquets for the last ten years where we've heard high level USAF JAGs talk about a shortage of JAGs in the field while the volunteer CAP legal officers raise their hands offering to help at local military legal offices.   So short handed are they, the JAG speaker this year in Boston talked about how USAF JAGs have to carry guns in Baghdad to guard their prisoners in the Green Zone when the JAGs are escorting them to criminal trials there.   

An offer of CAP help as a civil reserve to DUSAF has only been made to the USAF chaplain and accepted by CAP chaplains. Why is that??

And, why is there a new national policy memo on MOUs which seems to indicate the idea of AFAM (federal instrumentality) status for state missions is dead?   What happened to the idea of "readiness" for a civil defense reserve corps?

[SAR-EMT1]

So let me get this straight... If something like this happened, we might get to do more, might even get paid, but we would cease to exist as the USAF Auxiliary?
No thanks.

[alice]

SAR-EMT1:  What *exactly* does "existing as the USAF Aux" mean to you?

FWIW:  CAP got that USAF Aux "name" merely as part of the old 1950's era federal Supply Bill for CAP in order to enshrine in USAFs' mind that CAP's primary federal overseer and benefactor is USAF.

Many times CAP's status as "USAF Aux" has been used by some in the USAF JAG offices - and even NorthCom's legal office and the Sec AF legal office, too -  as an excuse to treat CAP as if it is only part of the active duty USAF rather than part of the greater federal world - as well as part of the state and local emergency response world as the Congressional charter dictates.  For example, the Air Force as a spin-off of the Army is subject to posse comitatus laws while the Navy and USCG never have been.  Often in the past ten years, people in USAF think CAP should never do anything on the ground looking like the Army or anything over water looking like Navy or USCG.  Think how hard it has been for some wings to continue their sundown patrols for boaters and to do any ground ops like radio work during the first 72 hours after major disasters -- the typical time it takes for the fed world to spin up and respond.

There is no reason a DoD, OSD or even a DHS civilian defense reserve corps could not have a branch which looked just like the current CAP, with USAF style uniforms, a cadet program, and all.  This thread started to discuss what the Surgeon General is doing about creating a Public Health Service Aux.  We already know the Public Health Service has lots of plain clothes GS civilians, as well as uniformed "officers" who sometimes don't wear their Navy-style uniforms.  They are all still part of the large organization working for the Surgeon General, just as CAP could be a real integral part of the DoD, USAF, OSD and/or DHS.

If CAP were truly a real USAF Auxiliary, we would already have long Help-Wanted listings from every Air Force and Air National Guard base to our local squadrons of tasks they would like us to do as CAP chaplains do now for Air Force bases. 

Tell me this:  should CAP be flying on an A-funded or B-unfunded AFAM, or a C-corporate flight release (maybe or maybe not reimbursable based on unwritten policies about C flights) when flying CAP aircraft marked "USAF Auxiliary" to and from an air show at an Air Force base?  If killed while doing such core recruiting activities for a USAF Auxiliary, should the CAP members' surviving spouses get FECA coverage or just the bare-bones C-corporate "charity" coverage paid for out of member dues not taxpayer dollars?  (Yes, the late NVWG CC and PACR DO were on "just" a C flight release when they were killed in the line of duty while shuttling a CAP corporate bird to the Nellis AFB air show for CAP, the USAF Auxiliary; as well as traveling to and from a state-wide unit meeting.)

Should CAP continue to wear USAF uniforms and fly federally paid-for aircraft in this kind of grossly underfunded corporate vacumn for our active members in the field while we continue to play games with A, B or C missions and play an unnerving footsie with our state ES agencies about whether we are fed instrumentality or corporate while performing ops?

[mikeylikey]

Very Intersting.  What happened......why did it not make it into the bill?  Who held it up, NHQ (TP) or CAP-USAF (USAF)?

[alice]

Mikey Likey:  It's a mystery why discussion stopped.  All I know for sure is the former CAP CC told the NEC something along the lines of this-is-a-takeover-attempt by USAF and/or OSD the same week as the discussions in Rosslyn.  Haven't a clue if any national CAP or CAP-USAF leadership ever heard the whole unvarnished story from anyone at OSD or USAF since this proposal is totally different than the Spring 1999 legislative proposal by USAF since OSD was so involved this time and since DoD and DHS have found themselves overwhelmed after Iraq/Afghanistan and Katrina recognizing a real need for more civilian volunteers to be on call for emergency services duties.

[arajca]

Question: OSD?

[flyerthom]

I agree, as a combat field medic I should have been given my RN license, thats something that the Military should consider to get people in. A 2 year medic school should be fully accredited. We had to go back and take an EMT course because the Govt. would not allow us to pick up civilians unless we were certified.

A military Medic can take the LVN test in some states, once you have that some colleges have a 1 year LVN to RN school. State exam requirements to be an RN are strict, same thing to be a Doctor or any State approved program to get a medical license of any type.

Combat Medic does not cover some major topics that nursing curriculum's do:
Pediatrics, OB, Maternal Child Heath, Neonatal and nursery care,  Developmental Psychology / Growth and Development, Geriatrics, (non trauma) Critical care, non trauma Psychiatric care, Community Health, in depth pharmacology, home health care, long term care etc. This is why combat medics are not given the clearance for the NCLEX exam.

Most nursing programs do not cover things like movement restrictions (used to be spinal immobilization till the attorneys got involved), vehicle extrication, rapid transport, aeromedical concerns,  advanced airway procedures, CBNRE response etc.   

They really are two different beasts. There are post graduate cross overs like prehospital RN and critical care paramedics but neither is a fresh out of school program.

Combat medic is an extremely challenging specialty - but it hardly prepares one for the NCLEX or med surg floor or even the ER. It is geared for dealing with trauma - to mostly younger and healthier clients.

Likewise a new RN is not prepared for mass casualty, START triage ( or triage period), adverse conditions, and dealing with protocols.


Both require their own trainings and don't train th the others license requirements.
They are both valuable - and should have equal pay - but viva la difference!

[dogboy]

Medical Reserve Corps Support
There are Medical Reserve Corps Units located in and near each of the
RDF cities. Volunteers from these Units can be recruited to support the
RDF Teams in a broad variety of roles.

I'm confused. What's the difference between Medical Reserve Units and Disaster Medical Assistance Teams (DMAT) except that MRU are directly under the USPHS (which is in the US Department of Health and Human Services) while DMATs are under Office of Preparedness and Emergency Operations (also in DHHS)?

Is this just a turf war?

[wingnut]

I think that the CAP members receive little if any National support for what we do, Like Alice has said time and time again the US Government and the People of the  United States need an organization that goes beyond the CAP corporation, the corporation needs to die and go away, CAP needs to be reorganized similar to the USCG AUX, directly under the command of the National Guard,
as for the two CAP senior leaders who  died if they are only authorized a $10,000 dollar death benefit we need a Congressional Investigation of CAP.

The paying members need to vote more on important aspects of CAP. As for not flying  missions  the Guard and the reserve should get the Aircraft where CAP pilot refuse to fly missions because of the way they are treated (Not getting paid for 5 to 6 months after an SAR mission. I feel like we are rotting from within.

And the Guys who think we should be doing paramedic work in the field, grow up, the Air Force has Paramedics that do that and the extract using a Helicopter. Most or I dare say 90% of CAP can barely put 2 or three UDF teams in an area and 3 or 4 aircraft maybe more if its a weekend. Unless the CAP id given the same Leave Status as the National Guard and the Reserve we will be hard pressed to do much in the next 5 to 10 years.

You know what some people are calling us "The Diaper Patrol" or the 'Depends patrol", what is the average age of our pilots now?, and what causes the younger pilots to quit?

how many Parmedics and EMTs are in CAP? Nurses? how about people with a CPR card? or someone  with a CERT certificate?

How many squadrons have food and water to support 3 aircrews for two weeks, in case of a disaster? how about 1 aircrew, how about one person? it seems that people blog mostly about a patch, or blue uniforms vs green uniforms, color guard etc etc.

I digress, I think I am sick of the blog for awhile, mostly sick of some of the information I am finding out about our leadership at NHQ, blocking requests for help. Making us the 100 pound weakling on the beach, as one current Presidential candidate puts it maybe CAP has become just another federal Pork Barrel Project.

[PA Guy]

Medical Reserve Corps Support
There are Medical Reserve Corps Units located in and near each of the
RDF cities. Volunteers from these Units can be recruited to support the
RDF Teams in a broad variety of roles.

I'm confused. What's the difference between Medical Reserve Units and Disaster Medical Assistance Teams (DMAT) except that MRU are directly under the USPHS (which is in the US Department of Health and Human Services) while DMATs are under Office of Preparedness and Emergency Operations (also in DHHS)?

Is this just a turf war?

In Jan '07 the DMATs were moved from FEMA back to DHHS where they started.  The DMATs are more highly organized than MRCs.  A Type 1 DMAT is able to deploy a 35 person team with a cache that allows them to be self sufficient for 72 hrs.  The cache  has a medical component capable of treating 200 casualties/day to include medications and lab. The comm. component of the cache has radios including satcom and IT. They carry their own tents, personal equipment, generators, sanitation, water, water  purification unit and vehicles. The team is composed of medical, comm, admin and log personnel

DMAT personnel have undergone a background check, been credentialed, issued a govt. travel card, DHHS ID, current immunizations and assigned a GS rating commensurate with their position on the team.  When activated they are considered intermittent federal employees with USERRA protection.  At any given time there are several DMATs on alert in the US with a fully rostered team capable of deploying with their cache in 8-12 hrs.  There are several specialty DMATs in surg, burns, peds, mental health and WMD Ops.

My experience with the MRC is that they are more informal in  organization and  personnel requirements and lack things like USERRA protection.  It is just my opinion, but I think alot of the MRC push happened during the time the DMATs were in FEMA and DHHS was left without there own surge medical component.  Prior to the move to FEMA DMAT personnel wore a USPHS tape on their uniforms.  Hope that helps. 

[BillB]

OSD= Office of the Secretary of Defense