Health Services Specialty.

[Snake Doctor]

What ever happened to the Health Services Specialty Track Pamphlet?

[IceNine]

IIRC there was never a guide for HSO, it is simply covered in 160-1, which says once appointed you are to keep up with professional continuing ed.

[arajca]

There isn't an HSO pamphlet. One was proposed, but until the legal and HSO folks at National work out some issues, there won't be one.

[flyerthom]

There isn't an HSO pamphlet. One was proposed, but until the legal and HSO folks at National work out some issues, there won't be one.

Isn't there an unapproved draft on the yahoo group?

[Snake Doctor]

How does one advance in the specialty then?

[Pace]

Since the HSO is primarily advisory in nature, why should there be an entire track for medical professionals?  Their advancement (if any) will have nothing to do with CAP, and we can't use most of their skills anyway (and only their knowledge of prevention and safety).

Seriously, I don't get it.  What direction was the committee that put together the draft pamphlet going with this?

[arajca]

How does one advance in the specialty then?

You don't.

There was a long discussion on the HSO Yahoo! group about promotions for HSO's and the consensous was that the only requirement for HSO's to promote is TIG.

[Snake Doctor]

I'm more interested in advancement in specialty track levels in the HSO track.

[IceNine]

You have to achieve a higher level professional rating.

So EMT's, P-Gods, etc are Techs

Nurses, and similar are Senior

MD, DO, DS, DD, Etc are Master

Again, Only if memory serves me correctly

[arajca]

You have to achieve a higher level professional rating.

So EMT's, P-Gods, etc are Techs

Nurses, and similar are Senior

MD, DO, DS, DD, Etc are Master

Again, Only if memory serves me correctly

There are no ratings in HSO. There is no HSO track. It is used only to identify those who are serving as HSO's. No ratings, no progression in a track that does not exist.

For promotions, however, see CAPR 35-5

CAPF 2 on health service personnel recommending appointment to an appropriate grade, as outlined below. The member's qualifications will be evaluated by the wing health service program officer, who will provide his or her comments and recommendations to the wing commander prior to approval. (Specific qualifications for medical personnel are outlined in CAPR 160-1.)
1) Second Lieutenant. Licensed practical or vocational nurse, paramedic, or other health technician.
2) First Lieutenant. Registered nurse, physician assistant or other health professional with a bachelors or masters degree as outlined in CAPR 160-1.
3) Captain. Licensed physician, dentist, or other health professional with an earned doctorate degree in a health care discipline.
4) Major. Licensed physician appointed a unit health service program officer in accordance with CAPR 160-1 who has served 1 year time-in-grade as a captain.

for initial appointment grade and

24. Training Requirements. Professional personnel must complete Level I and CPPT prior to appointment to CAP officer grade. Health Service personnel, legal officers, professional educators serving as aerospace education officers and financial professionals serving as finance officers are exempt from all other training requirements prescribed for promotion to additional grades. Completion of CAPP 221 is required for all chaplain promotions after initial appointment. Chaplains are exempt from all other training requirements prescribed for promotion to additional grades.

emphasis mine
for subsequent promotions.

Also, CAPR 160-1

11. Training and Professional Growth: All health service personnel are expected to receive annual continuing education in their professional discipline and are encouraged to participate in the CAP Professional Development Program as outlined in CAPR 50-17.

Absolutely nothing about HSO specialty track or professional development ratings.

[SARMedTech]

You have to achieve a higher level professional rating.

So EMT's, P-Gods, etc are Techs

Nurses, and similar are Senior

MD, DO, DS, DD, Etc are Master

Again, Only if memory serves me correctly

Actually, I believe EMTs (Basic, Intermediate and Paramedic) also qualify for Technician, Senior and Master hence the three different wing blings with the SOL in the middle.

[arajca]

You have to achieve a higher level professional rating.

So EMT's, P-Gods, etc are Techs

Nurses, and similar are Senior

MD, DO, DS, DD, Etc are Master

Again, Only if memory serves me correctly

Actually, I believe EMTs (Basic, Intermediate and Paramedic) also qualify for Technician, Senior and Master hence the three different wing blings with the SOL in the middle.

The EMT badges are NOT the same as the specialty track ratings, which do not exist.

[SARMedTech]

Since the HSO is primarily advisory in nature, why should there be an entire track for medical professionals?  Their advancement (if any) will have nothing to do with CAP, and we can't use most of their skills anyway (and only their knowledge of prevention and safety).

Seriously, I don't get it.  What direction was the committee that put together the draft pamphlet going with this?

Yet another person who doesn't understand the need for medical personnel in the field. I thought we beat this horse to death months ago. So if my position is advisory, can I tell someone how to stabilize a tib-fib fx in the field, I just cant do it myself? I'll tell a pilot. They can do anything  .

[SARMedTech]

You have to achieve a higher level professional rating.

So EMT's, P-Gods, etc are Techs

Nurses, and similar are Senior

MD, DO, DS, DD, Etc are Master

Again, Only if memory serves me correctly

Actually, I believe EMTs (Basic, Intermediate and Paramedic) also qualify for Technician, Senior and Master hence the three different wing blings with the SOL in the middle.

The EMT badges are NOT the same as the specialty track ratings, which do not exist.

No they are specialty insignia, IIRC since we are splitting hairs on this non-issue again.

[chiles]

Doctors, nurses and EMT's don't need to lay a hand on a patient to apply their experience to CAP. Here is a list of some things us HSO's do:
1) Train members in CPR, 1st Aid, Bloodborne Pathogens, etc
2) Monitor expiration dates of the above training and set up refresher courses
3) Assist with teaching safety issues
4) Teach courses on health issues relevent to unit issues
5) Mentor cadets in nutrition and exercise to help them become healthier and do better in their PT tests
6) Assist the squadron commander and deputy commander for cadets in cadet medical issues (e.g. cadets with disabilities)
7) Maintain the squadron's 1st aid kits
Counsel cadets (And seniors) interested in entering the medical field
9) Serve as medical staff at cadet events such as encampments
10) Assist parents with documentation required for cadets with disabilities

The proposed system that's currently being re-re-re-reviewed by legal has personnel advancing based on their service above. There are various subtracks, the biggest being training. The major concern is liability but the proposed program track has nothing to do with seeing patients.

The need to advance in your degree to become a higher rank in CAP is a myth. If an HSO completes Level 1 and then acts as an HSO at any level, all they need is time in grade. Having said that, as a Wing Nurse Officer, I'm supposed to review promotion requests before they pass to the Wing Commander. One of the things I look for is what type of activities they have participated in and what duties have they filled in their unit. Nobody should get a free pass but the idea that the position need only be one of an adviser is a waste of talents. There's a lot to be said for prevention and mitigation, let alone training. The HSO position is really what the HSO makes of it. I choose to get more involved and try to show my superiors and contemporaries that health professionals bring more to the table than a box of bandaids and a stethescope.

[Pace]

Yet another person who doesn't understand the need for medical personnel in the field. I thought we beat this horse to death months ago. So if my position is advisory, can I tell someone how to stabilize a tib-fib fx in the field, I just cant do it myself? I'll tell a pilot. They can do anything  .

I've been on ground team almost since I joined in 2002.  I do understand the need for medical personnel; however, it is my experience that most of the skills that medical personnel possess cannot legally be used.  CAP members are only authorized the use of basic first aid for stabilization, regardless of advanced medical training.  160-1 even defines the intent of "emergency care" as CPR and first aid.  I mean no offense in any way, but a non-medical person with first aid training can (not necessarily will, but can) possess the same level of medical treatment ability allowed to be used legally by CAP.  On the flip side, I also know that it is abundantly beneficial to have a medically trained team member for when crap hits the fan.

1-21f. First Aid and Emergency Medical Care. CAP is not an emergency medical care or paramedic organization and should not advertise itself as such. CAP will not be the primary provider of medical support on missions or training events though qualified personnel can be used to support such activities. The only type of medical aid that should be administered by CAP personnel or by any other person at CAP's request is reasonable first aid deemed necessary to save a life or prevent human suffering and executed by a person qualified to attempt such medical care within their skill level.

Doctors, nurses and EMT's don't need to lay a hand on a patient to apply their experience to CAP. Here is a list of some things us HSO's do:
1) Train members in CPR, 1st Aid, Bloodborne Pathogens, etc
2) Monitor expiration dates of the above training and set up refresher courses
3) Assist with teaching safety issues
4) Teach courses on health issues relevent to unit issues
5) Mentor cadets in nutrition and exercise to help them become healthier and do better in their PT tests
6) Assist the squadron commander and deputy commander for cadets in cadet medical issues (e.g. cadets with disabilities)
7) Maintain the squadron's 1st aid kits
8 ) Counsel cadets (And seniors) interested in entering the medical field
9) Serve as medical staff at cadet events such as encampments
10) Assist parents with documentation required for cadets with disabilities

The proposed system that's currently being re-re-re-reviewed by legal has personnel advancing based on their service above. There are various subtracks, the biggest being training. The major concern is liability but the proposed program track has nothing to do with seeing patients.

The need to advance in your degree to become a higher rank in CAP is a myth. If an HSO completes Level 1 and then acts as an HSO at any level, all they need is time in grade. Having said that, as a Wing Nurse Officer, I'm supposed to review promotion requests before they pass to the Wing Commander. One of the things I look for is what type of activities they have participated in and what duties have they filled in their unit. Nobody should get a free pass but the idea that the position need only be one of an adviser is a waste of talents. There's a lot to be said for prevention and mitigation, let alone training. The HSO position is really what the HSO makes of it. I choose to get more involved and try to show my superiors and contemporaries that health professionals bring more to the table than a box of bandaids and a stethescope.

Thank you.  That's what I was trying to figure out.  Although it is still more knowledge than skill based in application, at least in this way it is directly used to benefit the membership instead of just throwing together a status report every few months and sitting back.  The only one of those scenarios you listed that remotely describes a situation where a medical professional could use their training for its original intended purpose is at encampment, and to the best of my understanding (again from a legal standpoint) there is very little that a medical professional can personally do for other CAP members.  In fact, it is my understanding that a gas station station clerk can provide more medical assistance for minor injuries than a medical professional can at a CAP activity.


As a side note, isn't a physician's assistant an MSN level certification much like CRNA is?

[chiles]

Thank you.  That's what I was trying to figure out.  Although it is still more knowledge than skill based in application, at least in this way it is directly used to benefit the membership instead of just throwing together a status report every few months and sitting back.  The only one of those scenarios you listed that remotely describes a situation where a medical professional could use their training for its original intended purpose is at encampment, and to the best of my understanding (again from a legal standpoint) there is very little that a medical professional can personally do for other CAP members.  In fact, it is my understanding that a gas station station clerk can provide more medical assistance for minor injuries than a medical professional can at a CAP activity.


As a side note, isn't a physician's assistant an MSN level certification much like CRNA is?

I disagree with the assertion that training and prevention aren't original uses for my nursing license. Having been both a public health and ER nurse, I can tell you that education is one of my primary jobs. That goes for CAP as well. I may not be legally allowed to push cardiac medications on a senior member having a heart attack but I can certainly teach them how to avoid one in the first place! And that is very much part of my nursing career and license.

To answer your question, a physician's assistant is a masters level degree. Depending on the state, it can be equivalent to any nurse practitioner. State laws vary, though. In Maryland, an NP can hang a shingle but a PA must work under a physician. I know in other states, this isn't the case and a NP must work under a doctor and a PA can have their own practice. From a practical standpoint, PA's can come from virtually any background. They must have a bachelors but it can be in anything. Most PA programs require medical experience and patient time, though. An NP student must have a bachelors in nursing. Some programs exist, for example at Johns Hopkins Nursing School, that take you from a freshman in college all the way through to your NP license. Other programs require you have a few years experience as a nurse under your belt. Either way, an NP certification program is also masters level. Hope this helps.

[Pace]

I disagree with the assertion that training and prevention aren't original uses for my nursing license. Having been both a public health and ER nurse, I can tell you that education is one of my primary jobs. That goes for CAP as well. I may not be legally allowed to push cardiac medications on a senior member having a heart attack but I can certainly teach them how to avoid one in the first place! And that is very much part of my nursing career and license.

I stand corrected.  I guess I'll pick that up later this year once I start nursing school.

To answer your question, a physician's assistant is a masters level degree. Depending on the state, it can be equivalent to any nurse practitioner. State laws vary, though. In Maryland, an NP can hang a shingle but a PA must work under a physician. I know in other states, this isn't the case and a NP must work under a doctor and a PA can have their own practice. From a practical standpoint, PA's can come from virtually any background. They must have a bachelors but it can be in anything. Most PA programs require medical experience and patient time, though. An NP student must have a bachelors in nursing. Some programs exist, for example at Johns Hopkins Nursing School, that take you from a freshman in college all the way through to your NP license. Other programs require you have a few years experience as a nurse under your belt. Either way, an NP certification program is also masters level. Hope this helps.

Again, thank you.  I've never completely understood the difference between PA and NP.  Although you gave me more than I was asking for (which is most appreciated), the reason I was asking is I noticed a proposed PA badge in the health services yahoo group.  I didn't understand why it had a badge but other MSN level certifications didn't, but your explanation makes sense.

[chiles]

Welcome to the nursing world  ! If you need any help, let me know. I'll PM you with my contact information. Good luck with it and rest assured your clinical instructors won't let you kill anyone... at least until your senior year...

[brasda91]

I've been on ground team almost since I joined in 2002.  I do understand the need for medical personnel; however, it is my experience that most of the skills that medical personnel possess cannot legally be used.  CAP members are only authorized the use of basic first aid for stabilization, regardless of advanced medical training.  160-1 even defines the intent of "emergency care" as CPR and first aid.  I mean no offense in any way, but a non-medical person with first aid training can (not necessarily will, but can) possess the same level of medical treatment ability allowed to be used legally by CAP.  On the flip side, I also know that it is abundantly beneficial to have a medically trained team member for when crap hits the fan.

1-21f. First Aid and Emergency Medical Care. CAP is not an emergency medical care or paramedic organization and should not advertise itself as such. CAP will not be the primary provider of medical support on missions or training events though qualified personnel can be used to support such activities. The only type of medical aid that should be administered by CAP personnel or by any other person at CAP's request is reasonable first aid deemed necessary to save a life or prevent human suffering and executed by a person qualified to attempt such medical care within their skill level.

What?  Most of the skills that medical personnel posses cannot legally be used?  CAP members are only authorized the use of basic first aid for stabilization, regardless of advanced medical training.  160-1 even defines the intent of "emergency care" as CPR and first aid.  I don't know how you came up with that.  I'm a state certified EMT and I can tell you that if I don't perform up to my level of training, I can be held negligent.

Regarding your quote from 60-3, no we are not an emergency medical care or paramedic organization and should not advertise itself as such. CAP will not be the primary provider of medical support on missions or training events though qualified personnel can be used to support such activities.  What that means, is we will not be called to be the "medical team", even though we have members that are EMTs, Paramedics, nurses, and doctors.  The biggest reason we need f/a and cpr training is for our own members.  No one is going to call CAP to a scene to take the place of an ambulance service.

And the last statement "to save a life or prevent human suffering and executed by a person qualified to attempt such medical care within their skill level".  Once again, my skill level is higher than someone with basic f/a and cpr.  It is expected of me to do more, simply by state laws.

[Snake Doctor]

While all the discussion of the medical fields is interesting, I want to know How does a Doctor advance from a Tech rating to a Senior rating in the Medical Officer specialty track?  Or is it not possible? I'm not concerned about promotions at thsi time, just sepcialty track level advancement.

[Pace]

What?  Most of the skills that medical personnel posses cannot legally be used?  CAP members are only authorized the use of basic first aid for stabilization, regardless of advanced medical training.  160-1 even defines the intent of "emergency care" as CPR and first aid.  I don't know how you came up with that.  I'm a state certified EMT and I can tell you that if I don't perform up to my level of training, I can be held negligent.

Regarding your quote from 60-3, no we are not an emergency medical care or paramedic organization and should not advertise itself as such. CAP will not be the primary provider of medical support on missions or training events though qualified personnel can be used to support such activities.  What that means, is we will not be called to be the "medical team", even though we have members that are EMTs, Paramedics, nurses, and doctors.  The biggest reason we need f/a and cpr training is for our own members.  No one is going to call CAP to a scene to take the place of an ambulance service.

And the last statement "to save a life or prevent human suffering and executed by a person qualified to attempt such medical care within their skill level".  Once again, my skill level is higher than someone with basic f/a and cpr.  It is expected of me to do more, simply by state laws.

I'm taking a step back from this discussion 1) because I tend to think CAP's limits on use of medical personnel is a little back asswards [although I do understand why it is], and 2) CAP regulations clearly state that the maximum extent of medical care that any CAP member may provided is "reasonable first aid" (which you selectively omitted in the quotation in your last paragraph).  I wonder what NHQ's definition of "reasonable first aid" is.

If your state law conflicts with CAP regulations, it seems that acting in the capacity of a medical professional on CAP time puts you in a precarious situation.

While all the discussion of the medical fields is interesting, I want to know How does a Doctor advance from a Tech rating to a Senior rating in the Medical Officer specialty track?  Or is it not possible? I'm not concerned about promotions at thsi time, just sepcialty track level advancement.

After reviewing the draft material, specialty track advancement would be based on participation as a Health Services Staff Officer at different echelons with CAP specific knowledge and performance requirements for each track level.

Those in the loop, is this draft dead in the water, or is it being reviewed by NHQ?

[Snake Doctor]

The specialty won't go to the Senior level in e-services.

[Pace]

If you mean it won't right now, that's because the Health Services "specialty track" designator doesn't coincide with a published specialty track.  It's just used to identify health services personnel in CAP, much as the command "specialty track" just tracks those personnel in command positions in CAP (although I haven't figured out the usefulness of that one yet since e-services tracks all current commanders).

[Snake Doctor]

Indeed, there are some goofy things in e-services. 

Thanks to all for all the input.

[chiles]

Yeah, the e-services thing can be changed at the whim of the squadron commander. In reality, there is only draft material and no current way to advance in the rating. Hopefully there will be some movement on this in the future and the track will be approved. If it is approved as the draft is set now, you can go a few ways to go up the ratings ladder. You can focus on training (teaching CPR, 1st Aid, BBP, etc), activity (supervising encampments, handling activity medication issues) or CISM. This is all from the draft version and is subject to change, cancellation, expungement, destruction and denial of existence. If you want to get all the latest and greatest, check at the Yahoo group CAP_Health_Services. It requires member verification so be patient.

[capchiro]

Gentlemen and Ladies, e-services has me listed at the master level in the Health Services as of July 1, 2002.  I think it has to do with the level of your certification as mentioned before, doctor = master, etc.  I can think of no other good reason.  It is like the requirement to be a Health Services Officer, one must be a doctor, otherwise, one can be a Health Services Nurse or Technician.  Any thoughts??

[Pace]

Gentlemen and Ladies, e-services has me listed at the master level in the Health Services as of July 1, 2002.  I think it has to do with the level of your certification as mentioned before, doctor = master, etc.  I can think of no other good reason.  It is like the requirement to be a Health Services Officer, one must be a doctor, otherwise, one can be a Health Services Nurse or Technician.  Any thoughts??

Back on July 1, 2002, someone in your chain of command input the "health services identifier" by your name on the PDR.  While doing so, since they couldn't find any guidance on track levels (because it doesn't exist), they assumed that MD should be listed as a master level.  Just a guess...

For now, any track level associated with HSO means squat for the purposes of promotion and PD Levels.

[chiles]

Whoever put you in as a HSO made you a master rating. It's not automatic. The proper terminology for the positions are Medical Officer (doctors), Nurse Officers (nurses) and Health Services Officers (pharmacists, physical therapists, EMT's, etc).

As for using those levels in the future, I support the idea of a rating being given based on what you do in the program rather than your starting point. A doctor who does nothing is less useful to CAP than an EMT who goes through the trouble of becoming a CPR instructor and trains CAP personnel. Nobody should get a free pass in terms of rating. Everyone starts at the basic level and gives to the program in order to work their way up.

[capchiro]

How would your theory apply to initial appointments?  Would a doctor still come in as a captain?  How does any of this compare to the legal officers and chaplains??

[chiles]

Initial appointment is already spelled out in  CAPR 35-5, Section E, Figure 6 . HSO's are appointed based on their education level. We're talking about a specialty track not promotions. Though they are related, anyone can climb up the professional development program without being a certain rank. For example, a Captain can hold a masters rating in cadet programs but not qualify for promotion due to time in grade. According to the CAPR 35-5, HSO's only need to complete time in grade after their level 1 training to promote. Adding the specialty track would help change this to something more concrete and allow HSO's to advance like any other specialty. I think it'd also reduce the likelihood of those working their way up the ranks without actually doing any work at all.

As for legal officers and chaplains, I'm not really sure and will refrain from comment until I can properly look it up but it should be in the 35-5 as well.

[brasda91]

2) CAP regulations clearly state that the maximum extent of medical care that any CAP member may provided is "reasonable first aid" (which you selectively omitted in the quotation in your last paragraph).  I wonder what NHQ's definition of "reasonable first aid" is.

I didn't omit it on purpose.  "Reasonable first aid" for an EMT is going to be a higher level of patient care than someone with basic f/a and cpr.

[brasda91]

I wonder what NHQ's definition of "reasonable first aid" is.

I just got off the phone with John DesMarais and he said National does not expect an EMT, Paramedic, etc. to drop their level of patient care down to that of basic f/a and cpr.  If you have the protocols, tools and ability to provide advanced care, you are allowed to do so.  The reason National states the "reasonable first aid" is because they cannot control from one gt to another, what the qualifications of the members are.  They do not maintain your certification as an EMT, Paramedic, etc.  Therefore, go forth and save lives!!   

[sarmed1]

John DesMarais and he said National does not expect an EMT, Paramedic, etc. to drop their level of patient care down to that of basic f/a and cpr.  If you have the protocols, tools and ability to provide advanced care, you are allowed to do so

I would be interested in seeing John put that in the form of a policy letter concurrent with the legal officer.


mk

[Ned]

If you have the protocols, tools and ability to provide advanced care, you are allowed to do so. 

You should probably include the phrase "in a genuine medical emergency" in that sentence so that people are not misled.

No emergency = no medical care.  Period.

And the definition of "medical emergency" is pretty standard and normally involves immediate threat to life or limb and that requires treatment by a medical professional to avoid death or permanent damage.

(See definitions of "medical emergency" here.)

Ned Lee
Former CAP Legal Officer

[chiles]

I honestly never doubted that CAP wouldn't restrict my response to an emergency. It would cause them to be liable just as much as I would be for negligence. The real issue is the practice of medicine, in whatever form, at events where life and limb are not at risk. Taking a literal interpretation (as we should) of the regulations, every time a cadet twists their ankle, has stomach pain, etc at an encampment, they should see a doctor. There is a certain lack of practicality there. But, as has been said before many times, CAP holds no liability insurance and so, if you think stomach pain is constipation and keep the cadet at the activity and it turns out he perfed his appendix, they're screwed when the parents sue. Of course, a nurse in MD shouldn't be 'diagnosing' anything, but you get the picture. This isn't going to change any time soon. And there have been other ways around it, such as picking up liability only for encampments and NCSA's. The insurance is expensive, even for a select few days in a year.

On the other hand, there's nothing that says you can't practice prevention and mitigation. Watch how the cadets take care of themselves. Check feet for blisters. Headoff rashes when you catch them. Talk to cadets and cadet leaders about signs and symptoms of common injuries and illnesses. Knowing what's going on may not stop the injury completely but it may stop it from becoming an event ender for the cadet. I think that my constantly harping on cadets for running in the barracks saves more ambulance trips than anything else.

The other issue is that of medication. Parents send kids in with their medication all the time. Some have prescription, others OTC, some a combination of both. We take over that care in the absence of the parent. The problem is that the sheer amount of drugs brought to encampment make for a daunting task. In the past, I have discussed with parents which medications their cadets can take on their own. A large amount of cadets can handle their own diabetes equipment and asthma equipment. The rest we split up and give to the TAC's with a spreadsheet that causes them to only pick out when cadet and follow across a line to see the drugs they take and when. They sign off in the box for the date and time taken and we can move on.

Pardon the rant, just got started and didn't want to stop the flow of thought.

[sarmed1]

The thing I find most interesting when I talk to people about "medical care", the life and death catagory is what they most worry about.  This is by far though the most drastic, the least common occurance durring CAP activites.  I think I can count on one hand the number of 1st or 2nd person major medical emergencies that have occured at CAP activities over the past 18 years I have been in.  It's all of the other "problems" that are more common, and thus prohibited by 160-1. (which as chiles pointed out can be headed off with good preventitive care)

Ned, whats your take on Johns quote, "...If you have the protocols, tools and ability to provide advanced care, you are allowed to do so" (so assuming we add in "in a genuine medical emergency"?

Kosher or not?

mk

(ps I am still going to wait for the policy letter to come out before I start throwing around the tubes, drugs and IV's)

[pixelwonk]

...The real issue is the practice of medicine, in whatever form, at events where life and limb are not at risk.

ie; a nasal airway is not the solution for belligerent FBO linemen who won't let you into the hangar to silence the ELTs they set off from rough tugs.

...not even if it works.

......and it will. 

[Ned]

Ned, whats your take on Johns quote, "...If you have the protocols, tools and ability to provide advanced care, you are allowed to do so" (so assuming we add in "in a genuine medical emergency"?

Kosher or not?

I think once you have a genuine emergency, the regulation clearly permits first aid and stabilization within your skills and abilities.  And that coincides with your moral responsibility as well.


Responding to another post, I think the routine collection of medication by CAP folks is probably a bad idea, and is clearly illegal in some states.

(To be fair, it apparently is may well be required in some states -- the law varies widely here.)

Sure, if you have some 12 year-old who cannot administer their own meds, we may need to help and monitor, but normally the cadets have been living with their medical conditions for a long time, whereas some TAC with a spreadsheet is an invitation to a missed dose.

I certainly sympathize with the comment about the number of meds arriving at encampment these days.  WIWAC there were maybe 2 or 3 cadets in a flight who has asthma meds or maybe bee-sting kits, but now the prevalence has increased by several orders of magnitude and it is not unusual for some poor TAC to be lugging around 20-30 medications for her charges.

But I would strongly urge setting the default to leaving the medications with the cadets for whom they were prescribed (with exceptions on a case by case basis after talking with Mom) for a couple reasons:

1.  In most states it is illegal to possess prescription medications unless you are the prescribee, a pharmacist, or maybe Mom or Dad.  Not many exceptions  for adult volunteer youth group leaders.

2.  Once you have some poor TAC lugging around a couple of dozen pill bottles for the cadets, the odds of the TAC and a particular cadet being separated at pill time increase geometrically.  Think about cadets on KP, or at encampment HQ for honor boards, or whatever.

3.  Some of the widespread ADD/ADHD drugs are taken "as needed."  A cadet may be reluctant to admit to the TAC that she/he "needs" their meds and will foolishly attempt to gut it through.  We have already had several incidents of this type because the cadet felt intimidated to admit to an adult that they needed their meds.

4.  Although most seniors will tell you that they are fearful that cadets will abuse and/or swap medications if these are left in their possession, I was unable to find a single verified incident of this occurring.  The fear seems unfounded.

5.  We really don't belong in the medication storage business.  Proper storage of medications probably requires training, locked containers, and possibly refrigeration (depending on the medication).  We don't need to go there.

I would go so far as to require that all cadets be required to certify that they can "self-medicate" before coming to a CAP activity, with exceptions for younger and medically fragile cadets on a case by case basis.



The whole "sick call" routine with Nurse Ratchet dispensing medications in little paper cups is very dangerous.

[sarmed1]

I used to be a firm believer in the collect them all let tacs hand them out.  But I have of late agreed that except for some very rare circumstances cadets should self medicate and self storage (if they cant they may not be mature enough for the activity)  substances like your assorted 'pams (more for the theft potential rather than the misruse potential)

Part of that though is that TACs should have a listing of all of the who takes what when and why. If its not an as needed medication they should be reporting to their tac when they have taken their medication (so the adult supervision can be sure that they are at least in theroy taking their medicines)

HSO's at encampment can be the focal point of preparing said lists and educating the TAC's on the whats whys and watch out fors of their respective charges....

If its an over the counter parents need to send a supply of their prefered OTC and instructions on what for and how much (that should be communicated to parents as part of the encampment paperwork game); otherwise its the 2am phone call telling mommy that jonny has a tummy ache, what would you like us to do?

mk

[flyerthom]

While all the discussion of the medical fields is interesting, I want to know How does a Doctor advance from a Tech rating to a Senior rating in the Medical Officer specialty track?  Or is it not possible? I'm not concerned about promotions at thsi time, just sepcialty track level advancement.

The direct answer is the progression track is in limbo due to legal concerns therefore it is awaiting final approval from the Board. There is a cap yahoo group for health services. It was formed by memebers of the Health Services working group but is open to all HSO's.  Currently there is no formal method of advancement.

[chiles]

At any Encampment that I serve as the Nurse Officer, I insist on a document going out that certifies self medication or, more to the point, that they cannot self medicate. I also talk to parents in order to get the real deal if it's needed. Otherwise, we talk to the cadets, and often the parents, during in processing to go over what's needed and confirm that all our information is correct. From there, I take the data from the meeting, form and Rx bottle and check it against what I had in my spreadsheet. The spreadsheet is broken out by flight and includes all cadets on medications. For those that self medicate, the lines where a TAC initials that a dose was given is greyed out with the words "SELF ADMINISTER" in them. The only stuff I keep in the medical bay are those medications requiring refrigeration and those that the parent has specifically requested I give. Like the self medication, the line on the spreadsheet is greyed out with the words "REPORT TO MED BAY @ [INSERT TIME]". If that medication needs to travel with the cadet to activities, we load a small tote cooler with ice and send it with the TAC. The process exists and it can be done safely, it just requires some forethought and a little effort on the HSO.

As for the legal bits, most states have some type of "Summer Camp" clause that allows the dispensation of medication by a trained professional during a summer activity. Each state's law is different and requires varying levels of supervision.

[Ned]

As for the legal bits, most states have some type of "Summer Camp" clause that allows the dispensation of medication by a trained professional during a summer activity. Each state's law is different and requires varying levels of supervision.

When I was working on the NHQ committee on this issue, we found that some states do indeed have "camp nurse" laws.  And they sure vary.  Anecdotally, they appear to be a "East Coast" thing, but nobody has done a 52-wing survey on just how widely the laws vary.

But, of course, any law that requires a certificated medical professional to dispense medications is problematic.  If it truly requires an HSO to do it, then the HSO is likely performing the kind of routine medical care (dispensing medications as a professional) that the regulation seems to prohibit.  And TACS and other in loco parentis adult volunteers rarely qualify as medication dispensers under the state law.

Self medication (where not prohibited) avoids both Scylla and Charybdis.


And my lawyer brain is a little worried about detailed medication logs as described.  I certainly understand that any medical professional worth his/her salt will document everything they do; and this is especially true concerning patient care.  And while CAP is not subject to HIPPA, the existence of medical documents that contain cadets names and specific medications taken (or missed) is a little scary.  All sorts if privacy and litigation issues arise.

What are the record retention and storage protocols?  IOW, who keeps these logs after encampment and for how long?  Who gets to see them?  Does higher headquarters know of their existence?  (If NHQ is served with a subpoena for all documents related to a cadet, they would probably know to check the local unit, but would they know to call the encampment HSO from two years ago to see if he still has those logs in his garage?)

While HSOs are critical to the CP and encampments for their advice, planning expertise, and training skills, I think it is unwise to design or adopt specific policies that require an HSO to be present at encampment, even for mundane duties like medication management.

First, although it may well vary by wing, there simply aren't enough HSOs of the right flavor (probably LVN and above) available who can donate the 10 days a year necessary for an encampment.  (Yes, the week could be covered by several different HSOs taking it in turn, but the problem remains.)  If we require an HSO to be in attendance at an encampment, then a lot of encampments are simply going to be cancelled.  And that would be A Bad Thing.

Second, it has been my experience that "if you give a sick call, they will come."  (Apologies to Kevin Costner.)  And conversely, if you don't, they won't.  IOW, if you put out that the Encampment Medical Officer will conduct Sick Call at 0700 daily, I guarantee that you will have customers.  And probably a line.  But if you allow the TACS to take care of the routine "boo-boo" care (in consultation with Mom as necessary) then everyone is taken care of and still gets to class on time, with the added bonus of not tempting any HSO to engage in the non-emergency care prohibited by the regulation.

But it is certainly interesting how widely practice in these areas varies amongst the wings.

[chiles]

The commander at the time was aware and the system was fully disclosed to cadet parents so that they knew it was being tracked. I had a conversation with the TACs about privacy. I know, this doesn't satisfy the HIPAA (for those who don't know, it's the Health Insurance Portability and Accountability Act) regulations. I think that the idea of TACs administering is a bit concerning. TACs are supposed to carry and safeguard. The cadets are supposed to dispense their own while the TAC notes that they got their med. Having just taken over the Wing NO position, I need to have a discussion with the Wing legal guru about how we can show that medication was given while maintaining legal privacy. My immediate inclination is that records should be kept in a sealed envelope in the Wing HSO's office (work area, closet, etc) in a locked filing cabinet. It goes against everything I've been trained not to document medicine dispensing (by the cadet or otherwise) and I think we expose ourselves if we give a TAC a bag of drugs and they don't record when something was given, particularly for a controlled substance.

Edited for grammar

[brasda91]

No emergency = no medical care.  Period.

Not exactly.  If I have a team member twist their ankle while working a mission, this is not an "emergency".  But if it is a benefit to them we apply ice to reduce the swelling and keep them in the game, I'm going to do so.

It's pretty simple.  There's no need to read everything through a lawyers eyes.  National does not expect the members of CAP that have advanced medical training to give less patient care than they are trained to do.

Now if anybody does not agree with this, you should call National yourself.  I'm simply trying to convey what John told me.

[Ned]

 
It's pretty simple.  There's no need to read everything through a lawyers eyes.  National does not expect the members of CAP that have advanced medical training to give less patient care than they are trained to do.

Sir, with respect I simply cannot let that go unclarified.

That is only true when treatment is authorized in the first place -- i.e. an emergency

Otherwise your exception eats the rule.  "Hey, I'm an MD and my buddy John at NHQ says I can "give all the patient care I am trained to do," so I am gonna conduct an encampment sick call and diagnose various chronic ailments that present themselves."

I think we agree on more than we disagree here.  In an (genuine) emergency, CAP HSOs can certainly give care within their training and experience.

But just as importantly, CAP members simply CANNOT perform non-emergency routine medical care, regardless of their qualifications.  On this point, the regulation could not be more clear.

Now if anybody does not agree with this, you should call National yourself.  I'm simply trying to convey what John told me.

John can say whatever he wants.  But no one at NHQ makes policy -- that is reserved for our volunteer leaders on the NB and NEC.  And that policy is expressed in the regulations adopted by those bodies.

No one can contradict that policy, regardless of where they work.

Ned Lee

[SAR-EMT1]

For the time being I just look at the Health Services Track like I do the
" Specialty Track"  for unit commanders.

Its an identifier, nothing more or less, not something you progress in.

Question: are there different 'levels' for Chaplains? - Tech, Sr, Master?

I am not talking about MLO's.

[Snake Doctor]

I was looking to advance a member in the HSO Specialty Track to the Senior Level, from the Technician level so. I can put him in for his Level III (Loening).

I guess he'll have to get into another Specialty Track.

[IceNine]

There is an issue with your account settings somewhere....

I just played and put a member in for senior and approved it then put in for master and approved it, it worked fine and shows on his member search page?

[Pace]

You can "advance" the health services track in anyone's account, but you're not supposed to use that for PD levels and promotions (because there is no published specialty track that establishes it as part of the professional development program).  It's just a designator to keep track of medical professionals in CAP.

[mikeylikey]

It's just a designator to keep track of medical professionals in CAP.

That begs the question as to why?  Why keep track if these people can't even advance in that field.  Why keep it if they can't do more than bandages and moleskin at Encampments?!?!

[Pace]

I dunno.  I gave up on this entire line of thought about a page back when legal and operations couldn't find a comfortable middle ground.  I'll pick this one back up when I finish my degree.  For now, back to my labs...

[BlueLakes1]

HSO's don't require PD advancement for promotion, they only require time in grade and command approval. Ref: CAPR 35-5, Section E, Paragraph 24.

While the PD track advancement is "nice" (my old Sq/CC gave me a HS rating some time ago), it's not needed to promote, and is really kind of pointless. It was nice to get the third silver star, though.

[Pace]

HSO's don't require PD advancement for promotion, they only require time in grade and command approval. Ref: CAPR 35-5, Section E, Paragraph 24.

Apples and oranges.  The discussion was over using health services specialty track designations in e-services' online PD module to advance members' PD level and promote them farther than a professional appointment promotion (or whatever it's called) would get them.  Hopefully someday the HS specialty track will be published and medical personnel will have a way to continue to advance past their professional appointment grade in a specialty that takes advantage of their skill set.

While the PD track advancement is "nice" (my old Sq/CC gave me a HS rating some time ago), it's not needed to promote, and is really kind of pointless. It was nice to get the third silver star, though.

The health services inclusion in the specialty track module should have no bearing on professional development or uniform accessories.  There are no completion standards to establish credit for any level of effort in the track.  It's the same line of thought for members with "command" in the specialty track records.  Even if someone put "master" in their command specialty, they shouldn't use it for Level 4 or add a silver star to their leadership ribbon.

[RiverAux]

Why can't health services people accept their initial appointments based on their professional qualifications and then follow the same rules as everybody else in regards to promotions?  Why is there a need for a specialty track for this? 

[Pace]

If you're going to bring in medical professionals and give them an advanced promotion based on their medical degrees/qualifications, you might as well give them a clear set of duties to perform and give them credit for that effort.  Bring them in as health services officers, promote them initially, then allow them to continue to promote based on duty performance in a medical capacity.

Makes sense to me.

[SARMedTech]

I've been on ground team almost since I joined in 2002.  I do understand the need for medical personnel; however, it is my experience that most of the skills that medical personnel possess cannot legally be used.  CAP members are only authorized the use of basic first aid for stabilization, regardless of advanced medical training.  160-1 even defines the intent of "emergency care" as CPR and first aid.  I mean no offense in any way, but a non-medical person with first aid training can (not necessarily will, but can) possess the same level of medical treatment ability allowed to be used legally by CAP.  On the flip side, I also know that it is abundantly beneficial to have a medically trained team member for when crap hits the fan.

1-21f. First Aid and Emergency Medical Care. CAP is not an emergency medical care or paramedic organization and should not advertise itself as such. CAP will not be the primary provider of medical support on missions or training events though qualified personnel can be used to support such activities. The only type of medical aid that should be administered by CAP personnel or by any other person at CAP's request is reasonable first aid deemed necessary to save a life or prevent human suffering and executed by a person qualified to attempt such medical care within their skill level.

What?  Most of the skills that medical personnel posses cannot legally be used?  CAP members are only authorized the use of basic first aid for stabilization, regardless of advanced medical training.  160-1 even defines the intent of "emergency care" as CPR and first aid.  I don't know how you came up with that.  I'm a state certified EMT and I can tell you that if I don't perform up to my level of training, I can be held negligent.

Regarding your quote from 60-3, no we are not an emergency medical care or paramedic organization and should not advertise itself as such. CAP will not be the primary provider of medical support on missions or training events though qualified personnel can be used to support such activities.  What that means, is we will not be called to be the "medical team", even though we have members that are EMTs, Paramedics, nurses, and doctors.  The biggest reason we need f/a and cpr training is for our own members.  No one is going to call CAP to a scene to take the place of an ambulance service.

And the last statement "to save a life or prevent human suffering and executed by a person qualified to attempt such medical care within their skill level".  Once again, my skill level is higher than someone with basic f/a and cpr.  It is expected of me to do more, simply by state laws.

Brasda-

youre way off here. If you are at a CAP function, you are obviously not on duty as an EMT or Paramedic. If you are not on duty, you are not functioning under the license of the medical director of your region and therefore cannot perform any more emergency interventions than the average good samaritan. In fact, when not on duty, thats all you are. Ive seen off duty EMTs at all levels carrying around huge jump kits when off duty, enough to support a fire team in the field for a month. Fact is, you can use bandages, skin strips, make a sling, do CPR, use direct pressure to staunch bleeding, sit there for an hour and hold C-spine while EMS tries to find you. But you break out that combi or ETT (which you cannot possess legally if you are not on duty) and it so much as touches the lips of your "patient" and thats when you need to worry about going to jail or losing your license. I agree that the CAP regs are vague and ambiguous. They are intentionally that way to keep CAP from being legally responsible if one of its members does something dumb. They can say "see...we only told them to do first aide." About a year or so ago when I started on this forum, I had the same idea you have. But then I decided i would like to keep my license. Oh...remember that you cannot be held negligent by a court of competent jurisdiction unless you had a duty to act and did not. Unlife LEOs, EMS personnel do not have a duty to act when off duty and hence cannot be found to be negligent if they do nothing. I understand that you may have a license, but if you arent on duty or currently working in the EMS field, you may as well use it as a book mark cause that is about how much good its gonna do ya.

[arajca]

Which is why the legal folks got involved. There are at least 50 different versions of when EMT's are on/off duty and what they can do. This does not include the numerous local medical controls that may have their own ideas. For the best answer, I recommend contacting YOUR wing's legal officer for guidance. Thet should be familiar enough with the state laws to give you the correct information. I also recommend contacting YOUR medical control about their views.

National can only give general guidance because they are most likely not famiiar with the particular laws and restrictions in every instance.

[brasda91]

Brasda-

youre way off here. If you are at a CAP function, you are obviously not on duty as an EMT or Paramedic. If you are not on duty, you are not functioning under the license of the medical director of your region and therefore cannot perform any more emergency interventions than the average good samaritan. In fact, when not on duty, thats all you are. Ive seen off duty EMTs at all levels carrying around huge jump kits when off duty, enough to support a fire team in the field for a month. Fact is, you can use bandages, skin strips, make a sling, do CPR, use direct pressure to staunch bleeding, sit there for an hour and hold C-spine while EMS tries to find you. But you break out that combi or ETT (which you cannot possess legally if you are not on duty) and it so much as touches the lips of your "patient" and thats when you need to worry about going to jail or losing your license. I agree that the CAP regs are vague and ambiguous. They are intentionally that way to keep CAP from being legally responsible if one of its members does something dumb. They can say "see...we only told them to do first aide." About a year or so ago when I started on this forum, I had the same idea you have. But then I decided i would like to keep my license. Oh...remember that you cannot be held negligent by a court of competent jurisdiction unless you had a duty to act and did not. Unlife LEOs, EMS personnel do not have a duty to act when off duty and hence cannot be found to be negligent if they do nothing. I understand that you may have a license, but if you arent on duty or currently working in the EMS field, you may as well use it as a book mark cause that is about how much good its gonna do ya.

I agree.  But we were not talking about a run of the mill CAP function.  We were talking about GT's not being able to use their EMT's skills on missions.

Naturally, while at a CAP function were an ambulance service can be contacted, they should be.

Can we please move on?

[SARMedTech]

I know this horse has been flogged and I have been part of some of the most complex and bizarre conversations regarding this subject. Part of MS degree work is trying to develop a national protocol for all levels of EMS provider. I am from Illinois and here, its like being in 50 different states as you move from one EMS region to another. Up here near the Wisconsin border, Basics can do cram and slam intubations (combitube) give epi, glucagon, etc. Down in region 7 where a friend of mine is an EMT they cant do any of that...they can only give aspirin and oxygen and both of those have to be at the order of the supervising paramedic. So there is that to deal with in each Wing and then regionally when  said EMT might go to another state, etc. But here is the stituation as it stands:

1. We could be CCPs and only give "basic stabilizing first aide." Now we could chose to follow the American Red Cross standard for what first aide is, but I guarantee that NHQ would leave us twisting in the wind when something went wrong.

2. We have no more medical authority on scene that average "civilian" and even if we stand back and start giving people orders as to what to do, our fat is still in the fire.

Basically, the EMS bling is a merit badge. And with the way we attack things like the whole ABU controversy, we out to see some changes in terms of some kind of medical specialties, oh...about 1500hrs next millennium, however, I still wear my insignia on my blues because chicks dig bling.   

[isuhawkeye]

Not to derail the conversation, but there is a national scope of practice.  Iowa for one is working very hard towards its development.  Under the national scope there will be 4 recognised levels. 

Trainign curriculum, and text books should be out by this fall, and the national registry is *planning* on changing over the tests by 2013
http://www.soundrock.com/sop/pdf/SoP_Final_Draft_4.0.pdf

[BlueLakes1]

Not to derail the conversation, but there is a national scope of practice.  Iowa for one is working very hard towards its development.  Under the national scope there will be 4 recognised levels. 

Trainign curriculum, and text books should be out by this fall, and the national registry is *planning* on changing over the tests by 2013
http://www.soundrock.com/sop/pdf/SoP_Final_Draft_4.0.pdf

Now if we could scrap the NREMT and get a federal entity to maintain the tests, and issue the licenses/certs (at least to verify core competencies), we'd be a lot better off. I can't stand the NREMT.

[arajca]

Not to derail the conversation, but there is a national scope of practice.  Iowa for one is working very hard towards its development.  Under the national scope there will be 4 recognised levels. 

Trainign curriculum, and text books should be out by this fall, and the national registry is *planning* on changing over the tests by 2013
http://www.soundrock.com/sop/pdf/SoP_Final_Draft_4.0.pdf

But each state and system sets its own scope of practice, within the DOT EMT practices.

[isuhawkeye]

andrew.  expect to see federal funding tied to the iniative much like nims or the federal highway legislation.

otherwise don't forget nremt is nothing more than a private company.  they hold no special power or authority.  states choose to use them to manage testing.

[SARMedTech]

Not to derail the conversation, but there is a national scope of practice.  Iowa for one is working very hard towards its development.  Under the national scope there will be 4 recognised levels. 

Trainign curriculum, and text books should be out by this fall, and the national registry is *planning* on changing over the tests by 2013
http://www.soundrock.com/sop/pdf/SoP_Final_Draft_4.0.pdf

Thats an awful lot of maybes, especially in the EMS world. There currently is NO national scope of practice, and to say one is under development is to be overlly optimistic. Even if Iowa came up with a draft that needed no revision, you still have to get 49 other states' Boards of EMS to approve it and enact it. 2013? try 2025. And when talking about the NREMT "planning" anything perhaps we should have an accurate representation of how slowly actual and substantive change occurs in that particular organization. A national protocol, let alone a scope of practice is quite some distance off.

[isuhawkeye]

You clearly haven't reviewed the source material.  This initiative is coming form the federal DOT.  The curriculum for 4 standardized EMS levels will be out in the fall, and the National registry of EMT's will transition to the new tests fall of 2010. 

Im sure all states will NOT adopt this standard, but the goal is to at least create a standard. 

[John Bryan]

On a side note.....the one task that the US Air Force Surgeon General has given CAP to help the AF with , many HSO, Nurses and Medical Officer don't take part.

This "mission" I refer to is DDR..... I wish more of our HSO's, Nurses and Medical Officers would work on getting on to bases and into communities and building this program.

Instead of complaining about what we can't do , why not work in the areas we can. I also think the SG would be more likely to support more AF use of our Health Services folks if he saw us working hard on the project already given to us.

HS folks should be working hand and hand with DDR, safety, CISM and other depts....not trying to creat are own empire.

Just my 2 cents.

[flyerthom]

On a side note.....the one task that the US Air Force Surgeon General has given CAP to help the AF with , many HSO, Nurses and Medical Officer don't take part.

This "mission" I refer to is DDR..... I wish more of our HSO's, Nurses and Medical Officers would work on getting on to bases and into communities and building this program.

Instead of complaining about what we can't do , why not work in the areas we can. I also think the SG would be more likely to support more AF use of our Health Services folks if he saw us working hard on the project already given to us.

HS folks should be working hand and hand with DDR, safety, CISM and other depts....not trying to creat are own empire.

Just my 2 cents.

Inter agency liason is another area. Who better to interface with EMS, Fire and other SAR units then those who work in those fields? We know who to talk too, what they need from US what we need from them.

[SARMedTech]

Not to derail the conversation, but there is a national scope of practice.  Iowa for one is working very hard towards its development.  Under the national scope there will be 4 recognised levels. 

Trainign curriculum, and text books should be out by this fall, and the national registry is *planning* on changing over the tests by 2013
http://www.soundrock.com/sop/pdf/SoP_Final_Draft_4.0.pdf

But each state and system sets its own scope of practice, within the DOT EMT practices.

Can we please stop saying that EMS personnel have scopes of practice. They dont now, never have and never will. What they have is protocol. Scopes of practice implies that somehow they can hang out a shingle and set up medical shop on their own, which they cant because the only person with the scope of practice is their medical director, under who license they operate. And this children, is why CAP doesnt have EMT-Bs or paramedics that do anything other than say "that bandaide should be tighter." Heck, as it stands right now, a "CAP EMT" could probably get litigated to death if they put a latex bandaide on a kid with latex allergy.

[isuhawkeye]

Can we please stop saying that EMS personnel have scopes of practice. They dont now, never have and never will.

cough er ehem
http://www.idph.state.ia.us/ems/common/pdf/scope_of_practice.pdf

For the record that document is off of the Iowa department of public health bureau of EMS web site.
The scope of practice is a way to designate what skills a medical director can legally include in a protocol.  with out this document medical directors could legally train and allow first responders to intubate, give drugs, or preform other ALS skills.

And now back to your regularly scheduled rant

[BlueLakes1]

Can we please stop saying that EMS personnel have scopes of practice. They dont now, never have and never will.

...And currently in the approval process with the NHTSA, http://www.naemse.org/SoP_Final_Draft.pdf .

Incidentally, in EMS here in Kentucky, we commonly speak of things within our scope of practice. Of course, Kentucky paramedics hold licenses rather than certifications, so that might factor into the terminology.

YMMV.

[isuhawkeye]

wow someone else who reads national level documents.  I am impressed

[SARMedTech]

wow someone else who reads national level documents.  I am impressed

REDACTED AND TAKEN TO PM DUE TO POINTLESSNESS OF ARGUMENT AND TOTAL LACK OF RELEVANCE TO CAP.

As an MS student in Emergency Services, my book shelves are full of national level documents. I have not had time to read this 4.0 version of a National Scope, but since you were so kind as to post it, I will do so. However, lest we think we are breaking new ground, the national scope argument has been going on since the late 1960s when ambulances made from converted hearses painted white and stenciled with red crosses roamed the earth. Why, you may ask, is this document in its 4.0 version?  Because, dear reader, the NHSTA has turned it down in its previous forms. As much as I would like to have a national scope/protocol (by the way, I will give you +1/-1 and myself +1/-1 for the argument of protocol vs. scope. If the Oxford English Dictionary is used, these terms mean pretty much the same thing), its not anywhere on the horizon for American EMS in the next 20 years. Its just not going to happen. The closest thing to it is the EMAC (emergency mutual assistance compact) which exists between states and allows DMATs (or whatever your state calls them...does Iowa have a DMAT?  I dont remember that it did last time I checked) to move from state to state offering medical assistance in time of disaster. For example, IMERT works closely with the Missouri DMAT-1. If they need us (or vice versa) their governor calls our governor and the EMAC is enacted by executive order. Then we can go to their state and practice EMS at whatever level we are licensed just as if we were in our own state. Im sorry, but this is about as far as its going to get.

One thing that would have to happen is that all regions within a state would need to align their protocols. For example, here in IL, I am in EMS region 1, which takes in most of the area west of Chicago over to the Mississippi. In my region as a BLS/BTLS provider, I can use a combi-tube, administer epi, etc. Same goes for Chicago which I believe in region 7. However, down in the area of Peoria, students are required to learn this skill and test off on it, however combitube set ups are not carried on BLS rigs. Even within a given city, protocols vary within agency. Until and unless all of this can change, the NREMT, NAEMT and NAEMSA can wish in one hand and spit in the other till the cows come home for a national scope/protocol, it aint nebba gonna happen, GI. One of my professors at AMU sits on a national scope board for NHTSA and what they agree on is that they cant agree on how a national scope would work, but they are for it, so they write these little white papers (notice its called a model and has been submitted to the NHTSA 3 previous times) and keep going through the motions. For the record, I am all for it and lobby for a national scope. But its not going to happen while I can still carry a litter. Ill look over the white paper on the proposed national scope over the next couple of days. Heck I may write an opinion paper on it for school. But lets do the rest of the CAPsters who couldnt give a tinkers [darn] a favor and take it to PM. The only place that this issue has less relevance than in EMS is in CAP which has no EMS. Believe me, I like wearing my little wing and star sewn onto my BBDUs (Im 20 pounds overweight...so shoot me...I still have my camos and will be back in them before summer encampments). But its is meaningless. The only place being an EMT is more meaningless is the USCGAUX but at least there you can get what amounts to an MOU for the duration of an op or op-ex which allows you to function as an EMT with the controlling stations medical officer operating as your medical control.

(Wrestling topic back on track)...seriously, if you want to practice EMS in an austere field environment, do it the right way:shell out alot more of your own cash for khakis and gear and join a DMAT or start your own CERT or join the MRC or something. NHQ has made it plain that there is no place for legitimate use of EMS personnel in CAP and there isnt going to be for the near future, which after all, is what this poor misguided thread started off to be about. ANd if there is an ounce of mercy in the souls of the admins, someone please slap a padlock on this sucker.

[SARMedTech]

Can we please stop saying that EMS personnel have scopes of practice. They dont now, never have and never will.

...And currently in the approval process with the NHTSA, http://www.naemse.org/SoP_Final_Draft.pdf .

Incidentally, in EMS here in Kentucky, we commonly speak of things within our scope of practice. Of course, Kentucky paramedics hold licenses rather than certifications, so that might factor into the terminology.

For my edification, can you please advise what state's responders do not hold licenses but rather only certifications?

[arajca]

Colorado, for one. All levels of EMT (B, I, P) hold certificates, not licenses.

On the protocol issue, Colorado has standardized all systems using the same protocols. As it was explained to me, the reasoning was to avoid legal problems - "ABC system allows their EMT-B's to push D50. The patient suffered needlessly because your EMT-B on scene could not push D50 per your protocols. Why should you not be held responsible for this person's suffering when such a simple thing could have avoided it?" By having the same protocols state-wide, that argument is largely voided.

[brasda91]

I'm an EMT in Kentucky.  I'm from the old-school EMT's (read not National Registry).  I have never called myself licensed.  I am a state-certified EMT.  I think the difference may be a person is "licensed" if they go before a medical board, just the same as PA's, Doctors, Nurses, etc..  Maybe Paramedics have to do that, don't know.  As an EMT renewing my "certification" all I have to do is submit my re-application to the state.  I do not have to be interviewed by a medical board.

[BlueLakes1]

Kentucky EMTs are certified, but Kentucky Paramedics are licensed. When I first became a paramedic, we were also certified, but that changed around 2000 or so, IIRC. Oddly enough, when paramedics in KY were certified, the certification came from the KY Board of Medical Licensure; it changed when we switched to the KY Board of EMS. One benefit for us here was that licensure made it possible for hospitals to hire us to actually work as paramedics in ERs, rather than to just use us as ER Techs.

(Brasda, I'm old school too...37389/1701-P. If you hadn't heard, there's a bill in this session to scrap NREMT and begin state testing again. I hope it passes!)

All levels of EMS providers in Indiana are certified. I know that Texas used to allow paramedics to be either certified or licensed, but I'm not sure what they're doing now. I couldn't find a definitive list on the 'net of which states use certification over licensure, but it seems that licensure (at least for paramedics) is becoming more prevalent.

[Hawk200]

I couldn't find a definitive list on the 'net of which states use certification over licensure, but it seems that licensure (at least for paramedics) is becoming more prevalent.

While I was in Alaska, the state didn't recognize a position of paramedic. I knew a couple of people that went to Washington and took the tests. Don't know if it helped them in any way professionally or not.

It would be interesting to see if they did at present, or will in the future.