Health Services Specialty.

[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