CAP Talk

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

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

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

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

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

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

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

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

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

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

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

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

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

Ned Lee
Former CAP Legal Officer

Pretty much answers my questions. Thanks.

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

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

Okay, how's this? 

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

Does that sound semi reasonable? 

Quote from: PHall on June 10, 2007, 06:48:33 AM

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

Okay, how's this? 

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

Does that sound semi reasonable? 

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

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

Quote from: DHollywood on June 10, 2007, 07:10:47 AM

Quote from: PHall on June 10, 2007, 06:48:33 AM

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

Okay, how's this? 

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

Does that sound semi reasonable? 

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

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

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

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

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

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

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

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

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

Patrick,

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

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

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

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

Sigh.

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

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

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

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

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

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

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

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

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

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

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

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

For both of our missions.

Peace.

Ned Lee
CP Kind of Guy

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

Quote from: SARMedTech on June 10, 2007, 10:21:25 PM
And as far as calling in a med-evac, I cant do that in the field and neither can anyone else (Perhaps a CAP physician but even that is iffy). You have to call 911, who then dispatches EMS who decides whether or not a dust off is needed. I cant simply called and say "Im an EMT  with the Civil Air Patrol, send me a chopper to the following co-ordinates." Thats not how it works. Frequently, the decision to call for med-evac is not made until a ground crew is on scene. More time wasted.

I don't know what system you're in, but I can easily call in to dispatch, id myself as an emt and get a chopper headed to my coordinates - if they are within range of the chopper. BTDT. Especially if you inform them that you're on a SAR mission.

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

Quote from: arajca on June 11, 2007, 01:39:23 AM

Quote from: SARMedTech on June 10, 2007, 10:21:25 PM
And as far as calling in a med-evac, I cant do that in the field and neither can anyone else (Perhaps a CAP physician but even that is iffy). You have to call 911, who then dispatches EMS who decides whether or not a dust off is needed. I cant simply called and say "Im an EMT  with the Civil Air Patrol, send me a chopper to the following co-ordinates." Thats not how it works. Frequently, the decision to call for med-evac is not made until a ground crew is on scene. More time wasted.

I don't know what system you're in, but I can easily call in to dispatch, id myself as an emt and get a chopper headed to my coordinates - if they are within range of the chopper. BTDT. Especially if you inform them that you're on a SAR mission.

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

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

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

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

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

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

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

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

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

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

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

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

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

Quote from: Eclipse on June 11, 2007, 02:00:45 PM

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

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

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

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

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

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

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

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

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

Amen, but it's not open ended as it states level of training and qualifications so that means that a podiatrist shouldn't engage in the same level of care that an ER doctor could, but you've got the problem of EMT's that have done nothing but transport sick people versus those that have worked active MVA'S and seen trauma on a daily basis.  However, that same EMT may not have seen a Strep throat or Pink eye in years.  There is so much diversity and experience among certifications that I guess we have to go with the lowest level, or rely on each person to stay within their level of expertise?  Unfortunately, just as some cadets think they are Rambos', some EMT's think they are battlefield medics and they are not.  We are often judged by the worse of us and CAP has been known to attract some bad eggs because of little if any standards for enlistment/joining.  As a commander, someone that seems too enthusiastic, is sometimes someone I need to watch closely.  I have had people attempt to join as both medical personnel and Chaplains with advanced rank that didn't have the documentation to back there qualifications up, but I digress..

re-sent as a personal message.

Quote from: SARMedTech on June 11, 2007, 07:49:17 PM

Quote from: Eclipse on June 11, 2007, 02:00:45 PM

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

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

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

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

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

There is a big difference between providing first aid for stabilization, and staffing a "medical section" with cadets walking around wearing stethoscopes (as many encampments have).

In Armageddon scenarios (which most members seem to think should be the basis of our OPSLANS and training), anyone will take assistance from anyone.

During encampments, etc., (in all but the most extreme cases), this is almost completely unnecessary.

Screening test for medical personnel at encampments:
Medical Personnel Evaluation (http://www.weathergraphics.com/tim/disease.htm)

Mike

When I was in AZ they had a huge problem they year before with medical problems.  They did like many people here advocate, they called 911 for everything.  The base EMS got real tired real fast for showing up 2 or 3 times a day for a week for what we in EMS kindly term "BS" calls.  As a paramedic they wanted me to help them solve their problem.  My solution was in place medical support (the same as the military does) Citing CAPs restricvtive regs and the lack of medical direction or insurance we were at a little bit of an impass.  The solution we came up with was military medical personnel (myself as a NG medic) and an actiuve duty RN I conned into going permisive TDY. (I had one or two other nurses and techs come down and help out during some busier times)  We had established assessment guidelines, routine and emergency treatment protocols approved by and signed off by a base physician.  ( Limited ALS level care and the usual tums, motrins and benadryls etc) We coordinated with their clinic (non emergency room) for duty hours evaluation and follow up and with an off base urgent care for after hours.  We provided our own transport via military ambualnce for routine and used 911 for ALS level emergencies. 
We did all of the other expected mecical support stuff, monitor water intake, ensure extra water at outdoor activites on site standby for things like PIR and obstacle and Land Nav course.  We went from something like 2 dozen transported cadets with a similar number sent home the previous year  to only 2 patients sent for serious care (spider bite & ear infection) and none sent home.  The biggest argument I hear is the liability CAP would have, either in the outlay for insuracne or the cost of lawsuit payment if something goes wrong.  Look at the amount of money we potentially saved the corportation with our medical support operation.  The average EMS ride costs about $500-$700 (theres $12000 to $17000 right off the bat), and whats the average doc in the box visit cost $100-$300 ish? (so another 3 or 4 grand) The only outlay they had was for the limited amount of supplies we used...maybe $50 to $100 in over the counter meds and some other boo boo supplies. 

In my CAP time I have seen more serious illness and injuries at encampment type activites than I have ever seen doing SAR missions.  This is definetly one area that CAP needs to get its head above water in regards to medical support.  Be it an internal exception or a requirement for some type of military support.  Most encampment activities are held on a military base of some kind (they usually have some kind of medical support or a higher headquarters that has it) and somewhere in a wing there is at least one active duty, guard or reserve medical type person who is also a CAP member.  It takes more work than your state director asking for a medic or a nurse or even a PA but if you are serious about solving the problem and staying legal about it the resources are out there.

mk

Mark, the magic words were "signed off by a base physician".  Therein lies the rub.  It is hard to get any physician to sign off on such items.  The fact that you are an NG medic and had active duty nurses participating goes a long way to help when we want to do something like this.  This was an unusual situation and not one that is easily or consistently able to be done.  I applaud you for your efforts and successes, but, don't get everyones hopes up that such can be done everywhere.  I personally wish it could, but alas, t'ain't so universally and if something did go wrong, the Reg's would be of no help to you.  This world doesn't work on common sense anymore.  I don't know why.  Life used to be easier and we used to get all of our encampments on Air Force bases and they used to shower us with support.. But I digress..

Essentially, the base accepted responsibility for this situation.

I assume you had a Wing CC sign the authorizations, as they are the only commanders who are legally allowed to sign contracts.

I can't even imagine the mess this would have been if someone had died or been seriously hurt.

Too bad if the EMTs didn't like the "BS" calls - that's what they are there for.

I have had shifts where the same people go to the hospital three or four times in a 24 hour period in civilian EMS and we had to finally give them some "education" about abusing the 911 system and how their continued calls (often when they had signed out AMA the time before) could well prevent us from responding in a timely fashion to a trauma or mass casuality incident. But many, many shifts are consumed with "BS" calls, a term which I personally dont use. If a person calls 911 or calls our post for a direct call out, we go. If its an old person who is scared in the middle of the night because their tummy hurts, or someone who cut their finger eating a bagel at 2am or the ever popular "I just dont feel right" these are all the duty of EMS. As much as I like to be challenged by a call, you will never hear me talk about a BS call or a BS patient. Fact is, most people are reluctant, if not embarrased, to ask for medical assistance. Yes, I would like to be covered and have medical direction for the big things that could happen, but while I work to try to change that so those of us who are licensed do have those things, I am happy to care a better than average first aide kit and stock of OTC meds and remedies. I personally think it would be a good feeling to be able to give a cadet or senior for that matter who feels like they are getting a cold some alka-seltzer, take a temp and basically play medical mommy. That might well be the difference between losing a team member on a search because they feel rotten enough to want to go home, or a cadet not being able to finish out an encampment because what they really need is some attention and someone to give them something for dysentary. Like I say, I think a CAP medical corps would be a great thing a prove to do alot of good, but until it happens (and it will) I am more than happy to help out in whatever way I can within the regs. And remember folks...stabilizing first aide is an awfully broad term.

The important part is to coodrinate with the State Director, they are the POC for coordinating military support for CAP needs.  (of course they were still called the liason officer at that time).

QuoteI can't even imagine the mess this would have been if someone had died or been seriously hurt

Bob, for who?  CAP is not in a liability positon here, its military members providing medical care during an AF authorized activity.  (there is a whole CAP reg citing the authoriztion of military medical care) The medical support is no differant than getting billiting, mess facilities using the obstacle course or use of buses or O flight's on C-130's. 

The important part (which is where many people go wrong) is that there is no  dual shirting here, you are either there as a military member on orders or you are there as a CAP memeber.  Not both when it suits your convenience.

mk

Quote(there is a whole CAP reg citing the authoriztion of military medical care)

Could you please site that reg? I would be interested to read it in its entirety. Thanks.

I have commanded a number of large CAP encampments (200-300 pax), and have used the following medical support models:

a.  "Doc in the Box."  Under this model, TACs perform in loco parentis type care (band aids, blisters, hoarse voices, mild sunburn, etc) while members who have more severe symptoms who need to be seen by professionals are taken as needed to the local urgent care center.  True emergencies = 9-1-1.

Advantages:  No "medical overhead" in the sense that we don't have CAP HSOs on staff.

Disadvantages:  Some cadets are uninsured, leading to significant costs.  Significant time for staff to transport and monitor cadets at the urgent care facility -- usually 6-8 manhours/day. 

b.  "Camp Nurse".  In this model, we "employ" a non-member RN who volunteers his/her time (usually the spouse of a member).  The RN gets protocols from a local urgent care clinic in exchange for the overflow business.  We buy a commercial "camp nurse" malpractice policy to cover the nurse with CAP, Inc as a named insured.  (Cost - about $10/head).  TACS still cover the blisters and band-aids.

Advantages:  The nurse works for us -- a tremendous advantage when it comes to communicating potential restrictions for activities.  Huge savings in staff time (many fewer trips to urgent care clinic.)

Disadvantages:  Some minor logistical concerns about housing a non-member on military base, cost of policy ($2-3k), and availability of non-member nurse is not assured.

c.  "The Military is Your Friend."  Here, we get a Guard/Reserve/AD medic/nurse/PA to work some mandays during the encampment.  The military person performs triage and routine care (well, the TACS still do band-aids and blisters).

Advantages:  Little/no cost.  Cadets get good care.  Staff avoids urgent care runs.

Disadvantages:  Sometimes the military person does not fully understand the encampment program and tends to be rather conservative about marking cadets for "quarters."  The SD may not have mandays to support this option.

Of the three, the clear choice is having a military medical support.  This is what has worked well in CAWG for the last several years.

We still have issues with uninsured cadets -- but that is a good topic for another thread.

Needs and resources will, of course, vary among the wings.

But the only "wrong" model is the one with CAP personnel performing routine medical care.  This happens in several wings each summer.  And it is very frightening.

And it bears repeating, such illegal actions threaten the very existence of CAP.

Ned Lee
Encampment Guy and Former Legal Officer

SarMedTech,
I don't think there is a whole CAP reg that sites such.  However, in CAPM52-16, Cadet Programs, under encampment, there is an Air Force Reg mentioned that applies in some situations to on base military health care:

b. Government Medical Care. See AFH 41-114, Military Health Services Systems Matrix, for guidance on using military medical care facilities during an encampment.

I haven't read it in a long time and if you do, please post and let us know the gist of it.  Thanks, 

Here's the lowdown from my experience with medical staff at encampments.

1) 'Medic' Cadets: These cadets focus on making sure the cadets have water available.  They also carry around some band-aids, glucose tabs, and watch for heat related injuries.  They carry a radio to call for aid if something outside that happens.  All of these cadets were EMT-B's.

2) TACO's: These wonderful people don't carry around anything with them, but at night perform blister checks to head off any blisters that may be forming (hot spots).  They also aided in checking for ticks and performed tick removal.  Ensured that cadets were showering regularly and eating regularly.  Carried a radio to call for aid if needed.

3) Encampment Nurse: Licensed nurse, ran the medical bay in day to day operations.  Maintained a good supply of Gatorade powder, glucose tabs, simple OTC medications (Tylenol, aspirin, Advil, alka-seltzer, pepto, etc) as well as a more complex first aid kit with bandages, dressings, compression bandages, etc.  She also maintained prescription medications and ensured the cadets got them every time they were supposed to.  She treated blisters, headaches, dehydration, and other simple 'first aid' type injuries.

4) DOCTOR: The last encampment I went to had all the above as well as a licensed orthopedic surgeon.  He aided the nurse when nothing was going on, but handled more complicated injuries.  Sprains, twists, etc.  He was vital in determining if something needed to go to the hospital or could be handled at the encampment.  In a pinch, if a cadets medication ran out or treatment needed a prescription medication, after consultation with the parents and consent- BAM prescription written and filled.  He carried his own liability and malpractice insurance.

There was never in the last 10 encampments I've been to a need for any true 'emergency' care at encampment, and things that merited a hospital visit were brought and someone else dealt with it. What I have seen the need for is someone trained to recognize the symptoms of things and the proper course of action to take.

I do think that every major CAP activity should have assigned medical personnel. 

[TRUE STORY]
For instance, I was at an NCSA (won't say which one or when), but a cadet showed up with flu like symptoms.  He was lethargic, slept frequently, had glazed eyes and was perspiring.

They kept an eye on him for the first day.  The next morning, the cadets symptoms had worsened.  The AD didn't want to take him to a hospital or urgent care facility saying he only had a cold.

Two seniors present (not medically trained in any way) made the decision to take him, even though the cadet had no insurance (sorry, was 'self-insured'), and didn't want to go.  They brought him to an Urgent Care facility and the nurse took a look at him and told the seniors to get him to the emergency room as fast as they could.

Upon arrival at the emergency room the two seniors handed the paperwork to the nurse at the front desk of the emergency room, looked it over and quickly rushed the cadet to a room.

This cadet had developed juvenile diabetes and had a blood sugar of over 700.  They could smell the sugar coming out of his pores. (for those of you who don't know, blood sugar of 120 is normal).  Had that cadet gone untreated for even a few more hours, he may not have made it home alive.
[/TRUE STORY]

So that is why I think they should have trained medical personnel at a lot of CAP activities.  I'm not sure if this cleared or muddied the conversation, but if it helps, great.

Quote from: sardak on June 12, 2007, 05:10:19 PM
Screening test for medical personnel at encampments:
Medical Personnel Evaluation (http://www.weathergraphics.com/tim/disease.htm)

Mike

Whew...I'm glad I can diagnose Ebola and Typhus, but I am a 'Surgeon General' according to that quiz, I don't have any med quals except 1st/CPT/BBP...

Quote from: SARMedTech on June 13, 2007, 03:51:25 AM

Quote(there is a whole CAP reg citing the authorization of military medical care)

Could you please site that reg? I would be interested to read it in its entirety. Thanks.

AFI 2701 indicates USAF / Military support of CAP.

Specifically,

Quote from: AFI 2701, section 3.15
3.15. Use of DoD Medical Facilities. CAP personnel incurring an injury or illness during an AFAM are
entitled to limited military medical care in accordance with AFH 41-114, Military Health Services System
(MHSS) Matrix. CAP personnel participating in an official function on a military Installation may be entitled
to emergency medical care, like any other civilian, in accordance with AFH 41-114.

Note the use of the word "may".

For all intents and purposes we are civilians in this regard.

Quote from: jimmydeanno on June 13, 2007, 12:49:54 PM
For instance, I was at an NCSA (won't say which one or when), but a cadet showed up with flu like symptoms.  He was lethargic, slept frequently, had glazed eyes and was perspiring.

They kept an eye on him for the first day.  The next morning, the cadets symptoms had worsened.

There shouldn't have been a "next morning" he's that ill "looking" he goes home.  This is not BMT.

We had a similar situation this year at Spring with a cadet who had a history of seizures and "forgot" his meds.  Mom says "let him lie down in a quiet spot and give him some Advil..."

Mom picked him up from the ER that night.  Our people are not paid for, trained for, or protected against this kind of thing.  Why should I, as a CC, put them at risk?

I also don't want cadets "passing out glucose tablets" - they give a couple to someone with a sugar imbalance and that cadet and it can be as much trouble as low blood sugar.

^Except 'home' was 2000 miles away and even if they sent him home immediately, the next plane wouldn't have left until the next day anyway.  Then you have a cadet with this illness wandering through airports for connector flights <--that's so much better...

Quote from: jimmydeanno on June 13, 2007, 01:35:57 PM
^Except 'home' was 2000 miles away and even if they sent him home immediately, the next plane wouldn't have left until the next day anyway.  Then you have a cadet with this illness wandering through airports for connector flights <--that's so much better...

No, you have a cadet who is the care of local EMS, with a senior from the event as chaperone, with parents enroute to pick them up.

Cadets who are ill enough to need EMS go home.  Period.

Ummm...I thought I said they brought them to the hospital and he was admitted.  Sorry for not specifically saying..."the parents were notified, the seniors stayed until the parents arrived two days later and he went home..."

and just because a cadet needs to go to the hospital doesn't mean they need to go home.  They may have cut their finger or sprained an ankle, that sometimes requires a hospital visit, not necessarily a go home though. 

One encampment I was at had a cadet with epilepsy and mild retardation.  About three times a day he'd have a siezure, we didn't send him home and guess what, he actually completed the encampment.

The story of the cadet with diabetes and a BGL of 700 is exactly why medical staff of whatever level are needed in CAP and need to be able to render a certain level of care and also to examine a cadet or senior who is not feeling well. An EMT is qualified to take a BGL with a glucometer, (by the way, normal human blood glucose level is between 90 and 120, therefore 120 is at the high end of the medically acceptable level) and had someone done so on the first night the cadet did not feel well, they would have seen his BGL was sky-rocketed and that in fact he was in diabetic ketoacidosis,  a form of potentially fatal shock which very well could have ended that cadets life as he slept slept on his first night. This story only serves to bolster my assertion that EMS personnel are necessary for CAP. If we do nothing but do field medical assessments, its worth it. Obviously, there was no one who looked at this cadet and said "something aint right" or he never would have been allowed to go without medical attention overnight. A simple finger stick would have sent him to the hospital immediately. Given the signs of symptoms of this cadet, a BGL check would have been just about the first thing I did. There are many who seem to think that EMTs only want to be at CAP activities  for the major stuff, and they can be. But there are also those of us who know that when you put a bunch of kids out in the field or anywhere away from home for an extended period of time, you should have health care and assessment available on scene. And there are those who say the treatment for true medical emergencies is 911 and of course that is true. But when members, either cadet or senior, are operating or on exercise somewhere where EMS may be 45-60 minutes away, the ill or injured person may be decompensating so you have a much worse situation by the time "civilian" EMS arrives. Again I say that what this comes down to is finances. There is really no logical argument to be made that and EMS presence at CAP activities is a good idea and I have heard plenty of non-sensical arguments against it. Make no mistakes folks, its about the money. I am willing to bet that if tomorrow CAP said we are going to insure and provide medical directions for CAP EMTs, everyone would be for it. So when it comes down to a matter of money, people need to start pressing command to make a change. I really would like to see some statistics about medical and traumatic cases at CAP events. By shear law of averages, they occur. Just saying they dont doesnt make it so. At auto races, marathons, etc EMS is standing by for the just in case type scenarios. Why should CAP be any different? Of course in the case of serious trouble you want EMS inbound...but what happens to the sick or injured cadet or senior in the mean time could make all the difference in the world. (Climbs down from soap box, puts on fire suit).

PS-there is alot of talk about cadets being certified first responders. There is a big difference between a first responder and an EMT and in most states, you must be at least 18 years old to even train as an EMT.

Quote from: jimmydeanno on June 13, 2007, 02:05:50 PM
Ummm...I thought I said they brought them to the hospital and he was admitted.  Sorry for not specifically saying..."the parents were notified, the seniors stayed until the parents arrived two days later and he went home..."

and just because a cadet needs to go to the hospital doesn't mean they need to go home.  They may have cut their finger or sprained an ankle, that sometimes requires a hospital visit, not necessarily a go home though. 

One encampment I was at had a cadet with epilepsy and mild retardation.  About three times a day he'd have a siezure, we didn't send him home and guess what, he actually completed the encampment.

These kinds of stories only serve to support the need for onsite medical personnel. If you had a cadet who was seizing three times a day and no one had the good sense to send him home, that proves that there was some skewed medical judgement, perhaps by someone not qualified to assess and make the stay or go situation. Seizures are not little things like hiccups that happen and then go away...there are lingering neuro effects some times for days and whoever decided that a cadet in a state of status epilepticus (periods of seizures with no significant recovery post-ictal time) should stay made a very dangerous call. Firefighters and lots of other occupations have medical parameters and if you fall outside of them, you are done until you are stable. A cadet seizing three times a day at an encampment is NOT stable. Was he medically checked out each time he had a seizure for things like a lacerated tongue or contusions? Was he given a neurological assessment each time he seized? Im guessing not. All of these stories only serve to make my point for the necessity of liability covered, medically directed EMS in CAP. Im pretty sure that a cadet seizing three times a day could have wound up costing CAP alot of money if any one of this 3 a day seizures had had long lasting effects. You dont mention if he had his meds (usually dilantin and barbituates), if its was insured that he was taking them properly, etc. You also dont say who decided he should stay until the end. I would have sent him home on a medical "discharge" for the duration of the event.

Steven, this is the problem for commanders with the current system.  I may trust you, as I have come to know a little about your medical background and depth of knowledge, but another EMT or medical person of some type comes to a Georgia encampment from Florida and becomes the "medical person" and then tells the commander that a cadet with multiple seizures is okay to stay at encampment.  This creates a liability for the sick cadet, for other cadets around him, for the "medical person" if something happens and a big problem for the commander if something happens.  nothing like having a cadet on an orientation flight on a Blackhawk or climbing a rope bridge and having a seizure.  The stress and dehydration that accompanies encampments can only exacerbate any epileptic type disorder.  We need the "proper" medical personnel at CAP stuff and until we can insure that we have it, it's almost better to err on the side of caution. JMHO

I don't know all the details of this specific cadet as I was not privvy to all his medical needs, not being someone who would have been able to meet them.

We had a RN and licensed physician on site.  As a staff member we were told that the cadet has seizures several times a day normally and to just make sure the nurse was present when they occured.  We were told of the signs to watch for when they are about to occur.  The nurse just made sure the cadet didn't hurt himself, gave him time to recover and he went on his merry way.

Also, I was witness to a few of these seizures, and from what I understand there are different "types" of seizures that range from violent twitching and spasming to what appears to be a loss of conciousness with little movement.  His were the latter.

The decision to even allow him to come was made by the Wing Commander and Encampment Commander, above my paygrade.

So I really don't see it as an issue since the cadet was aware of how to take care of himself on the onset and recovery of his seizures, the parents were aware of the medical capabilities of the staff, the nurse and doctor were aware of and had experience in handling this disability and all were willing to attend to the needs of the cadet when they arose.

Some may call it a liabilty, I call it a success story.

Quote from: jimmydeanno on June 13, 2007, 12:49:54 PM
Here's the lowdown from my experience with medical staff at encampments.

(. . .)
3) Encampment Nurse: Licensed nurse, ran the medical bay in day to day operations.  Maintained a good supply of Gatorade powder, glucose tabs, simple OTC medications (Tylenol, aspirin, Advil, alka-seltzer, pepto, etc) as well as a more complex first aid kit with bandages, dressings, compression bandages, etc.  She also maintained prescription medications and ensured the cadets got them every time they were supposed to.  She treated blisters, headaches, dehydration, and other simple 'first aid' type injuries.

4) DOCTOR: The last encampment I went to had all the above as well as a licensed orthopedic surgeon.  He aided the nurse when nothing was going on, but handled more complicated injuries.  Sprains, twists, etc.  He was vital in determining if something needed to go to the hospital or could be handled at the encampment.  In a pinch, if a cadets medication ran out or treatment needed a prescription medication, after consultation with the parents and consent- BAM prescription written and filled.  He carried his own liability and malpractice insurance.

There was never in the last 10 encampments I've been to a need for any true 'emergency' care at encampment, and things that merited a hospital visit were brought and someone else dealt with it. What I have seen the need for is someone trained to recognize the symptoms of things and the proper course of action to take.

I'm certainly glad that everything went well at these activities and that cadets and seniors had access to professional care.

But in telling us the staff coverage I wish you had mentioned that the nurse and the doctor were not CAP members (or that the encampments occurred a long time ago before the current restrictions on our HSOs were enacted.)

Because if they were members, then the set-up you described would not be permissible under current regulations.  Because, according to your description, both the doctor and the nurse engaged in prohibited "routine care" including administering medications, diagnosis of injuries and illnesses, and prescribing medications.

Similarly, I am hopeful that  the non-member doctor treating cadets (with parental permission, of course) had placed CAP, Inc as a named insured on his malpractice/liability insurance.   Otherwise, the corporation would have had horrific exposure in the event of a bad healthcare outcome.

Again, I'm glad it went well, but we should make sure that we provide complete descriptions to ensure that other activity commanders do not mistakenly allow CAP HSOs to perform any medical care beyone first aid in true emergencies.

Ned Lee
Encampment Guy
Former CAP Legal Officer

Quote from: capchiro on June 13, 2007, 03:28:27 PM
Steven, this is the problem for commanders with the current system.  I may trust you, as I have come to know a little about your medical background and depth of knowledge, but another EMT or medical person of some type comes to a Georgia encampment from Florida and becomes the "medical person" and then tells the commander that a cadet with multiple seizures is okay to stay at encampment.  This creates a liability for the sick cadet, for other cadets around him, for the "medical person" if something happens and a big problem for the commander if something happens.  nothing like having a cadet on an orientation flight on a Blackhawk or climbing a rope bridge and having a seizure.  The stress and dehydration that accompanies encampments can only exacerbate any epileptic type disorder.  We need the "proper" medical personnel at CAP stuff and until we can insure that we have it, it's almost better to err on the side of caution. JMHO

Harry-

I agree that a physician trumps an EMT in training and diagnostic as does a nurse (though nurses technically do not diagnose and EMT-Ps do regularly perform field diagnoses). I think my point was more that it was really completely reckless to allow a cadet who was seizing several times a day to remain at an encampment. Here is a situation where there were medical folks there, and they failed. All of the factors you mentioned (dehydration, fluctuating blood sugar, fatigue, the effects of strenuous activity in heat) can cause some with epilepsy to go into a period actively seizing. And while I think that the CAP cadet program should be kept open to all young folks who can and want to participate, a thorough look needs to be taken at that cadet's physical condition and quite frankly, I would question the wisdom, not of allowing anyone with epilepsy at an encampment, but rather a person who is prone to status epilepticus in the first place. Many epileptics go years between seizures and many have them each day and while this runs afield of the current topic, its a little (read alot) irresponsible to allow a cadet with that condition to be out on an encampment. I would love for all of them to be able to participate in all activities, but thats just not the way it goes. And I agree fully with what you say about the variance between qualifications and knowledge/skill set, so we do need to be careful in that regard. And in the situations you list above, the O-ride and climbing a rope bridge, even a petit mal seizure (of the sort described by the above poster) could be potentially very dangerous. While the last thread on this sort of topic got locked out, it is something that really needs to be worked on and talked about constructively.

To both of these, this is the problem with these topics - people ask / tell what they can do today under current regs, and people start discussing what SHOULD be done.

These are the times in which we live.  I have photos of ILWG members hanging IV's in the field.

That's not going to happen ever again...

While we may discuss it here, nothing will change until someone makes a proposal to the appropriate CAP authorities. There are many folks here with strong opinions about how things should be done, but, so it seems, few do more than argue here. If you really want change, do the research and submit a well developed, thought out proposal. Sending a note complaining will not change anything. Arguing here will not change anything. Do the work.

Quote from: Eclipse on June 14, 2007, 02:48:56 AM
To both of these, this is the problem with these topics - people ask / tell what they can do today under current regs, and people start discussing what SHOULD be done.

These are the times in which we live.  I have photos of ILWG members hanging IV's in the field.

That's not going to happen ever again...

I'd love to see those photos and know about when they were taken. And whether they were taken in the 1950's or the 1980's it shows at one point that CAP medical officers were trusted to do more than say "i think that cadet might be sick" and then stand around wringing their hands. I know, I know, we live in an era of frivolous law suits. I havent been with my squadron very long, but I am working to change the way the medical regs currently stand. Things take time to change and NEVER is a long time. Im sure there were those who thought a portable hospital would never be able to pull up in front of your house and begin treating you before you ever saw a doctor. And the fact that there are photographs of medical officers hanging IVs would seem to be documentation that CAP engages in activities in which field medical care could become necessary. Maybe the discussions of CAP medical regulations will bump uniform discussion out of the top three and could actually prove more productive.

Quote from: sarmed1 on June 12, 2007, 10:56:42 PM
When I was in AZ they had a huge problem they year before with medical problems.  They did like many people here advocate, they called 911 for everything.  The base EMS got real tired real fast for showing up 2 or 3 times a day for a week for what we in EMS kindly term "BS" calls.  As a paramedic they wanted me to help them solve their problem.  My solution was in place medical support (the same as the military does) Citing CAPs restricvtive regs and the lack of medical direction or insurance we were at a little bit of an impass.  The solution we came up with was military medical personnel (myself as a NG medic) and an actiuve duty RN I conned into going permisive TDY. (I had one or two other nurses and techs come down and help out during some busier times)  We had established assessment guidelines, routine and emergency treatment protocols approved by and signed off by a base physician.  ( Limited ALS level care and the usual tums, motrins and benadryls etc) We coordinated with their clinic (non emergency room) for duty hours evaluation and follow up and with an off base urgent care for after hours.  We provided our own transport via military ambualnce for routine and used 911 for ALS level emergencies. 
We did all of the other expected mecical support stuff, monitor water intake, ensure extra water at outdoor activites on site standby for things like PIR and obstacle and Land Nav course.  We went from something like 2 dozen transported cadets with a similar number sent home the previous year  to only 2 patients sent for serious care (spider bite & ear infection) and none sent home.  The biggest argument I hear is the liability CAP would have, either in the outlay for insuracne or the cost of lawsuit payment if something goes wrong.  Look at the amount of money we potentially saved the corportation with our medical support operation.  The average EMS ride costs about $500-$700 (theres $12000 to $17000 right off the bat), and whats the average doc in the box visit cost $100-$300 ish? (so another 3 or 4 grand) The only outlay they had was for the limited amount of supplies we used...maybe $50 to $100 in over the counter meds and some other boo boo supplies. 

In my CAP time I have seen more serious illness and injuries at encampment type activites than I have ever seen doing SAR missions.  This is definetly one area that CAP needs to get its head above water in regards to medical support.  Be it an internal exception or a requirement for some type of military support.  Most encampment activities are held on a military base of some kind (they usually have some kind of medical support or a higher headquarters that has it) and somewhere in a wing there is at least one active duty, guard or reserve medical type person who is also a CAP member.  It takes more work than your state director asking for a medic or a nurse or even a PA but if you are serious about solving the problem and staying legal about it the resources are out there.

mk

If it is at all possible could you PM me with the details of how you worked this thing out and what your treatment plans etc were like?

Quote from: Eclipse on June 14, 2007, 02:48:56 AM
To both of these, this is the problem with these topics - people ask / tell what they can do today under current regs, and people start discussing what SHOULD be done.

These are the times in which we live.  I have photos of ILWG members hanging IV's in the field.

That's not going to happen ever again...

Would you mind posting those pics? As a historical reference.

... Once upon a time, California and several other states even had MASH units under the Control of WING.

They are discussed briefly in several books about CAP. One by C.A. Mobley -sp?- comes to mind.

Quote from: SAR-EMT1 on June 14, 2007, 04:47:25 AM

Quote from: Eclipse on June 14, 2007, 02:48:56 AM
To both of these, this is the problem with these topics - people ask / tell what they can do today under current regs, and people start discussing what SHOULD be done.

These are the times in which we live.  I have photos of ILWG members hanging IV's in the field.

That's not going to happen ever again...

Would you mind posting those pics? As a historical reference.

... Once upon a time, California and several other states even had MASH units under the Control of WING.

They are discussed briefly in several books about CAP. One by C.A. Mobley -sp?- comes to mind.

50's - 1956, I believe. 

The pics are from the infamous National Geographic article I keep threatening to scan and post.  I'm going to have to wreck my copy to scan, so I have been debating.

Looking again, and based on the terrain, they probably aren't from ILWG, but they are absolutley CAP, in the old green fatigues.  Show CAP frogmen as well.

Ah the good old days of frogmen and field medicine. Makes one long for a by-gone era.

I'm sorry but I did not read all three pages of the thread.  I thought I would add Iowa's 2 cents worth

At each Iowa WTA we set up a first aid station. 

a "Medic" (I know the term is controversial) staffs the station.  they are responsible for having a plan for medical emergencies, and for assisting the safety officer with hydration, and other health services needs.

Yeah...funny about the word "medic."  If youre out on a SAR or SARex or some other CAP activity and know you have an EMS responder with you, hollering "Medic!" is probably going to bring any level of responder running. Its just most EMS folks, I must admit myself included, are touchy about the term medic because it indicates a whole different level of licensure and about 1000 hours of clinical and classroom. I may be old-fashioned but as you can see from my signature line, I am a fan of "Corpsman." In the early days of field medicine, a corpsman could be anything from a stretcher bearer to an ambulance driver to the unit's "medic." If Iowa and Illinois ever work together and I am there, if you yell "Corpsman Up!" youre guaranteed to get my attention. Ive often thought that perhaps Corpsman is a term that could be used by CAP but then i think that maybe the Navy's medicos might take offense.

Quote from: Ned on June 13, 2007, 08:57:51 PM

Quote from: jimmydeanno on June 13, 2007, 12:49:54 PM
Here's the lowdown from my experience with medical staff at encampments.

(. . .)
3) Encampment Nurse: Licensed nurse, ran the medical bay in day to day operations.  Maintained a good supply of Gatorade powder, glucose tabs, simple OTC medications (Tylenol, aspirin, Advil, alka-seltzer, pepto, etc) as well as a more complex first aid kit with bandages, dressings, compression bandages, etc.  She also maintained prescription medications and ensured the cadets got them every time they were supposed to.  She treated blisters, headaches, dehydration, and other simple 'first aid' type injuries.

4) DOCTOR: The last encampment I went to had all the above as well as a licensed orthopedic surgeon.  He aided the nurse when nothing was going on, but handled more complicated injuries.  Sprains, twists, etc.  He was vital in determining if something needed to go to the hospital or could be handled at the encampment.  In a pinch, if a cadets medication ran out or treatment needed a prescription medication, after consultation with the parents and consent- BAM prescription written and filled.  He carried his own liability and malpractice insurance.

There was never in the last 10 encampments I've been to a need for any true 'emergency' care at encampment, and things that merited a hospital visit were brought and someone else dealt with it. What I have seen the need for is someone trained to recognize the symptoms of things and the proper course of action to take.

I'm certainly glad that everything went well at these activities and that cadets and seniors had access to professional care.

But in telling us the staff coverage I wish you had mentioned that the nurse and the doctor were not CAP members (or that the encampments occurred a long time ago before the current restrictions on our HSOs were enacted.)

Because if they were members, then the set-up you described would not be permissible under current regulations.  Because, according to your description, both the doctor and the nurse engaged in prohibited "routine care" including administering medications, diagnosis of injuries and illnesses, and prescribing medications.

Similarly, I am hopeful that  the non-member doctor treating cadets (with parental permission, of course) had placed CAP, Inc as a named insured on his malpractice/liability insurance.   Otherwise, the corporation would have had horrific exposure in the event of a bad healthcare outcome.

Again, I'm glad it went well, but we should make sure that we provide complete descriptions to ensure that other activity commanders do not mistakenly allow CAP HSOs to perform any medical care beyone first aid in true emergencies.

Ned Lee
Encampment Guy
Former CAP Legal Officer

This post has some dust on it, but I thought it might be helpful to add one point about the treatment of cadets who have not reached the age of majority. Under the  laws which give a medical professional of whatever sort the authorization to treat a  minor, there is the issue of implied consent. It applies to people with altered mental status and also to children. If a cadet does something...say gets a nasty laceration and is taken to the nearest ER he can and will be treated under implied consent which essentially says that if his parents cannot be reached by phone or however else you might contact them, the ER doc essentially becomes the minor's guardian ad litem meaning that he has the authority to treat the child under the assumption that the cadet's parents or legal guardian would want him treated and cared for to the best extent possible. Its the same with EMS. If someone is not mentally capable of making to decision to accept or decline care or is a child who cant legally make that decision for themselves, we can report that we treated under implied consent and there is really very little concern about liability in such a situation.

Quote from: SARMedTech on June 26, 2007, 03:33:28 AM
This post has some dust on it, but I thought it might be helpful to add one point about the treatment of cadets who have not reached the age of majority. Under the  laws which give a medical professional of whatever sort the authorization to treat a  minor, there is the issue of implied consent. It applies to people with altered mental status and also to children. If a cadet does something...say gets a nasty laceration and is taken to the nearest ER he can and will be treated under implied consent which essentially says that if his parents cannot be reached by phone or however else you might contact them, the ER doc essentially becomes the minor's guardian ad litem meaning that he has the authority to treat the child under the assumption that the cadet's parents or legal guardian would want him treated and cared for to the best extent possible. Its the same with EMS. If someone is not mentally capable of making to decision to accept or decline care or is a child who cant legally make that decision for themselves, we can report that we treated under implied consent and there is really very little concern about liability in such a situation.

You may well be correct in your state.  But in most states (including my state of California) "implied consent" laws are designed for emergencies and situations where delay will entail substantial risk of permanent and substantial injuries.  Such laws do not apply to routine care.

As you undoubtedly know far better than I, most lacerations requriing  closure by stitches or staples have a window of several hours before the tough choices set in.  As a practical matter, any doc or emergency department will spend pretty much whatever time it takes to reach a legal guardian before suturing.

Again, these laws are very much a creature of state law, and vary somewhat across the 50 states, so you are probably correct for your state.  But that is also part of the problem.  Many CAP activities involve participants who cross state lines, and it becomes almost impossible for CAP, Inc to set out a uniform system of rules that could reasonably apply wherever we have members.

Finally, we again reach the problem that the emergency provider may well be covered for actions taken to ensure the good health of a minor patient, but even under optimum conditions, implied consent laws do not cover CAP, Inc for its decisions and actions.  Even if (and perhaps especially if) Mom and Dad cannot sue the doc or the EMS provider following a perceived bad outcome, they will surely come after the deep pocket; CAP, Inc.  Mom will argue that we delayed, or took the kid to the wrong facility, or lost the paperwork with their cell number on it so Mom could have been contacted before treatment, or whatever.

Bottom line is that implied consent laws -- however useful they are to ensure that patients are cared for and providers are relatively free of liability -- do not really help us in protecting CAP, Inc or somehow making it easier for HSOs to provide appropriate care within their scope of practice.

Ned Lee
Former Legal Officer

I think there may have been some misunderstanding. I was only ever a paralegal and now do some medical-legal consulting on the side which basically involves interpretation of medical documents for lawyers and occasionally working as an expert witness in cases involving EMS. I didn't mean to indicate that it would be a CAP provider carrying for our hypothetical lacerated cadet. Here's my thinking: a cadet is climbing on something made of metal...I don't know what it would be...remember I am a nubie.  He slips and aside from destroying his brand new camos, he acquires a 10cm lac on his thigh. (we'll pretend that CAP wouldn't be liable for the injury because thats not what we're dealing with). This 10cm lac is bleeding severely. The sharp, eagle-eyed TAC officer calls 911. 911 arrives where the extraordinarily well trained and wise EMT assesses that this lac will have to be sutured. Now of course there is a window before the wound MUST be stitched. Based on experience thus far, I wouldn't say that I would like that window to remain open for hours. Perhaps and hour or two assuming that a health officer has controlled the bleeding with direct pressure from a fabulously well-stocked first aide kit. Now this laceration, because of its size, is considered a trauma which makes it emergent. Cadet gets to the ER, where every effort is made to contact the parents as the TAC officer is also trying to call the parents with his list of contact numbers. At this point, say 90 minutes post trauma the doctor will make the decision that he needs to close the wound because he is getting clotting where he doesn't want it and the tissue around the wound is looking quite pail. Here is the kind of thing I was talking about...the ER doc can make the decision (and I am keeping in mind that we are in different states) to go ahead and stitch because he rightly assesses that the parents would want their child to receive the best care he can. I have not been able to find any case law or statue through Find Law that says he cannot assume medical guardianship (ad litem) and treat the cadet. Further, if he didn't do this he could very well be deemed negligent by not meeting the mandated standard of medical care. Understand I'm not talking about a cadet getting something in his eye and going to the ER. I'm talking about a trauma. While California medical law has some twists and turns that don't exist in any other state, I cannot fathom that any court of compatent jurisdiction would day anything other than that the doc acted in the best interest of the child. So I'm not talking about about little injuries and not talking about a cadet that slips into a diabetic coma. I'm talking about the sort of thing that send young people to the ER everyday because, well, because they are kids and they get hurt. I do of course defer to an attorney's legal knowledge, but the National Registry of Emergency Medical Technicians which bases its protocol on California medical laws because they are some of the most stringent in the country, says that this would be a case of implied consent. You can tell I have worked in the legal field because I just typed forever and didn't say much. I would love to hear feedback because I appreciate "getting schooled" when it helps me be better at what I do. Honestly, I don't mind being proven wrong.

No, your scenario is almost certainly correct.  Under those circs the doc can and probably would treat and close because to do otherwise carries substantial risk of permanent scarring or worse.

The problem from the point of the thread ("medical sections") is that it is not very helpful one way or another since neither the doc nor the EMT as you've described are CAP members and you have excluded CAP liability from the discussion by definition.

So, yeah, the doc and the ems provider would almost certainly be free and clear.  But I don't want anyone thinking that a CAP doc or a CAP medic would be free and clear under either CAP regulations or state law for doing what your independent doc and medic did.

Some of my scariest nightmares come from hearing about CAP "medical sections" where cadet "medics" carry gear around and treat various issues at encampments and/or CAP HSOs treat members for anything other than a bona fide emergency.

That is a unspeakable risk to the corporation.  Such scenarios threaten our very existence.

And they happen almost every summer at some wings' encampments.

It must stop.

I agree with everything you said, and my saying that is something that has evolved over time. Until and unless CAP gets a Medical Corps, which I have to say I do want to see, we have to be mindful. Sure, Im gonna help that cadet out with tending to that monster blister because he didnt think to take off his boot when his heal started burning like it was on fire. And if someone burns themselves (or gets a sunburn) or has a minor laceration that needs no stitching, Im gonna help clean them up, make sure that lac isnt dirty, find out what they cut it on and think about whether we need to be thinking about a tetnus booster, put a 4x4 and some cling tape on that thing and send them back out. Im not going to let someone be in pain or sick if there is a one-shot way I can give them aide to help them. And I carry gear so that if there is a major trauma, we can go high speed. I dont carry anything I am not proficient in using or licensed to use and Im not gonna go berzerk and think I can fix anything in the field. But I will wade into a trauma up to my neck and take full responsibility for what happens if me not doing so means a very bad outcome. The basic thing, is that as HSOs or EMTs or whatever in CAP, we are there largely to monitor for dehydration, symptoms of exposure to heat and cold, etc. And in the absence of a full EMS team on standby, truth be told CAP wants me and people like us there.  Do I carry quite a bit of medical battle rattle? You bet your boots. But 99.5% of it is to keep people comfortable, healthy, hydrated and happy. If a handful of TUMS is going to keep an officer happy,Ive got him covered or if a cadet gets stung or sun burnt with blisters, Im your go-to guy. But the rest of my gig is to do what needs to be done to assess, triage and stabilize whatever might happen until we can evacuate the cadet or officer or until the lights and sirens come up the road. As a CAP newbie and a hardcore EMS junkie, its taken me a while to get the concept. But now that I have it, I can settle into what I am there to do, keep folks in one piece so we can carry on with the operation or exercise and if the spit hits the spam I hold things together as best I can until the ambulance or helo comes in.

this is why we get permission slips, and telephone numbers. 

In five years of being a "Medic" at CAP activities I have never had an issue with getting approval for emergency treatment

administering cadet's prescription/OTC meds is an entirely different story.

Here's my point and I want to make it as uncomplicated as I can because I fear the more I talk the less I am understood: in "street" EMS there is a concept called load and go or stay and play. Basically this defines whether we hang around on scene and do all of our assessments and diagnostics and then make a decision as to how to proceed or whether the situation is serious enough that we slide a back board under the person, run to the back of the ambulance, and as the doors are closing, we are already running code three. I am willing to say that the vast majority of things that could happen to a cadet or officer out in the field are "stay and play" situations. But in those situations where that is not the case, I would like to have someone on scene who has the training and experience to say, for instance "that cadet is in shock, they can sue me later if they want and we are sliding into the back seat of the nearest truck and going like Hades. This is all I am saying and is really all I have been saying all along. As a side note, shock can occur for any one of a hundred reasons. I want someone standing over me when/if it happens who knows the severity of what just happened and whether or not we have time to stand around putting wet cloths on that persons forehead and waiting for them to be able to remember their own name. I want someone who knows the difference between compensating and decompensating shock and who knows that to do about both and the fact is that someone who spends a week at Hawk Mountain or similar facility and then wear the title "medic" is not that person. If a person falls and hits their head and is unconscious, does that "medic" know that the first thing you do is have someone clamp onto that persons head, hold it in line with the rest of their spine and not let go until that person is collared and taped down to a long board. Do they know how to take a blood pressure and determine to a fair degree of certainty from the numbers on the gauge whether or not that person has an internal head injury?  I dont think that they do having examined some of the "medic" programs curriculum. I dont even want someone putting a c-collar on my who has less than 6 months training to know when you should do that and when you shouldnt and when you do, which part of the persons head gets taped to the long board last and why. These are not issues of liability. These are issues of getting puffed up because someone hands you a certificate and calls you a "medic" and someone who has advanced anatomy and physiology, diagnostics, etc and has been able to pass a national exam that tells them when the medical spit is hitting the spam. How often does a cadet fall off a rope ladder and get hurt..I dont know because know one has been able to produce those statistics for me. But lets have a CAP officer answer this one: if thats your cadet who falls off that rope ladder or slips in the mud and smacks his head on a rock, do you want a "medic" or do you want someone with an emergency medical license issued by an authorized state department of public health and signed off by an MD to take care of your cadet?  It really IS that simple. Because in matters of life or death, liability is or at least should be and after thought and the fact is that that "medic" has a far greater liability than someone who has trained for a year or so to make these assessments. Can that "medic" explain in a court of law why he decided to get a couple of the brawnier cadets to pick that head injured cadet up and carry him to his bivvy and lay him down and let him rest rather than having him immediately assessed by someone who knows what in blazes they are looking at? I doubt it. I would love to be proven wrong and anyone who wants to pay for me, at 33 years old, to observe at Hawk Mountain or any similar program is welcome to do all they can to prove me wrong. It aint gonna happen.

Before Hawk Mountain instructors and graduates get out the flamethrowers, I want to say this definitavely: My posts about EMS getting involved with CAP and EMTs vs "Medics" has nothing to do with my ego or anything of the sort. It has do entirely with how best to keep our members safe as they do what can be dangerous work. I didnt get into EMS because I enjoy trying to beat the life back into someone with CPR or getting my uniform soaked in someone else's blood from a pumping artery. I got into it because I have something of a facility for medicine and because I genuinely want to help people when they need it most.

I will now stand down and prepare copious numbers of burn dressings.

Quote from: SARMedTech on June 28, 2007, 05:44:32 AM
Before Hawk Mountain instructors and graduates get out the flamethrowers, I want to say this definitavely: My posts about EMS getting involved with CAP and EMTs vs "Medics" has nothing to do with my ego or anything of the sort. It has do entirely with how best to keep our members safe as they do what can be dangerous work. I didnt get into EMS because I enjoy trying to beat the life back into someone with CPR or getting my uniform soaked in someone else's blood from a pumping artery. I got into it because I have something of a facility for medicine and because I genuinely want to help people when they need it most.

I will now stand down and prepare copious numbers of burn dressings.

FWIW, no flames from here.

I think you are right on.

SARMed, I see your point and have a very easy, quick solution - dial 9-1-1, and let the pros do it.

If the event is SOOOO rugged and "Leet" that its in accessible to EMS, contract a pro.

Either way, it provides the services needed, without risk to a members liability.

What if that member IS who 9-1-1 would have sent, if he wasn't at the event?

If they operating as part of CAP, they are not part of the 911 system, even if they are normally part of it. I don't think any EMS system is so hard pressed that they only have one person to send out.

Now, if you are there and sign out of the activity and lose the CAP uniforms, then feel free to act as the outside EMS personnel.

A slightly diferent perspective: I am a volunteer Haz Mat Tech. At work, I have no haz mat tech level duties. When an incident occurs at work, unless my boss tells me to go, I do nothing. I have discussed it with the company legal folks and the decision was that I could, IF I where to be willing to assume FULL liability for anything that happened as a result of my actions. However, if I punched out and responded as part of the haz mat response, I would not be considered an employee and the liability concerns are not an issue. BTDT.

Quote from: Eclipse on June 30, 2007, 03:57:10 AM
SARMed, I see your point and have a very easy, quick solution - dial 9-1-1, and let the pros do it.

If the event is SOOOO rugged and "Leet" that its in accessible to EMS, contract a pro.

Either way, it provides the services needed, without risk to a members liability.

First of all, I am a "pro".  EMS is what I do for a living. And youre not going to be able to get an EMS crew, contracted or not, to sit at a week long cadet encampment 24 hours a day. As I have said so often, its not an issue of liability. Its an issue of CAP leadership not wanting to spend money. They have it to spend, we have been over how little it would cost to cover me and just yesterday I was having lunch with a trauma doc friend, and he informed me that all CAP would need to do would be to contact the local trauma center where the event was going to be covered, say we have a liability covered EMT as our health officer out here and the ER would just assign whoever was going to be on duty as the medical point of contact, which by the way, is what they do anyway. People keep talking about medical direction and supervision. Each and every EMS region in the country has its own medical director under whose license all EMTs and Paramedics in that region operate. However, it is not that single doctor who an EMT or Medic calls when they need a question answered or orders for a drug, procedure, etc. They call the local ER and whoever answers what is usually called some variant of the "MedLine" which is who ambulances call when they are inbound with a patient, and they get whoever answers the phone. Often this is a nurse and if a doctor is needed, she goes and gets one. Ive written several posts lately saying Im willing to operate as an EMT within CAPs current regulations until and unless the organizations is willing to pony up the cash for liability. Its the people who seem to be afraid of having an EMT out there, like we are going to deprive you of the opportunity to use your first aide skills, that keep sqwalking. Fine. The horse is dead. All I have continued to say is that if a cadet or officer is seriously hurt, I am going to do what is necessary to take care of them regardless of liability and if the State DOPH wants to pull my license after a due and proper hearing and investigation, then they can go write ahead and do it. It really is the non-medically trained among us or those who have not done the research that I have into this issue that are doing all the hollering. Do you want to wait for an EMS team to arrive. Fine. If you are the officer in charge, you may tell me so and to avoid getting 2b'ed I will stand down and let a persons condition deteriorate until EMS arrives.

Quote from: arajca on June 30, 2007, 05:19:08 AM
If they operating as part of CAP, they are not part of the 911 system, even if they are normally part of it. I don't think any EMS system is so hard pressed that they only have one person to send out.

Now, if you are there and sign out of the activity and lose the CAP uniforms, then feel free to act as the outside EMS personnel.

A slightly diferent perspective: I am a volunteer Haz Mat Tech. At work, I have no haz mat tech level duties. When an incident occurs at work, unless my boss tells me to go, I do nothing. I have discussed it with the company legal folks and the decision was that I could, IF I where to be willing to assume FULL liability for anything that happened as a result of my actions. However, if I punched out and responded as part of the haz mat response, I would not be considered an employee and the liability concerns are not an issue. BTDT.

Again, I dont remember what your EMS status is. But talking EMS and HazMat is apples and oranges. HazMat is not medical, except insofar as they keep a hazardous problem from affecting peoples health by containing it. Since we arent likely to need the glow worms at an encampment, I fail to see where this is relevant, but if a cadet spills his MRE on himself and it starts to eat his uniform, rest assured I will give you a call. All along what I have been talking about, it caring for the run of the mill injuries and assisting in the event of a major trauma should one occur until an EMS unit can be summoned and arrive. And when you start using the word "any" you are in dangerous territory. We have an volunteer EMS system just down the road from me in a rural area, that has no response vehicles and there "EMS" crews are all first responder certified, only, because thats all their community would pay for. In the middle of the night, they literally respond about half the time in their pajamas with their first aide kits, some of them walking to the scene, and waiting the two hours until a full crew can arrive. There has been more than one instance where they have transported someone in the bed of a pickup. Is this what you want for cadets or anyone else you may in charge of. I have said over and over, especially recently, I will abide by what CAP regs say and what the NHQ boys and girls want. And then, as far as liability, its not going to be my neck on the block if someone with an allergy to bee stings dies in anaphylaxis waiting for EMS. Its going to most likely first be the Wing commander explaining to a judge and jury why there was no one in a camp full of cadets or on an operation that was taking care of people. "Well your honor, its like this. We just really didnt want to pay for liability. Actually there was an EMT there and he acted to the fullest extent of our regulations by packing ice on the sting and he did give CPR when the cadet stopped breathing, but you know, without oxygen and an AED which we just didnt want to pay for, the cadet died despite that big chunk of ice that our EMT did such a good job of holding on the cadets leg. I really dont undertand why that cadet died."  People have said that CAP cannot be held medically liable. Fact is, when you have people's kids out there, or some officer with a heart condition, the judge is going to want to know why no one was willing to assume such liability. And when the Wing commander tells the judge and jury "we didnt want to pay $104/year for EMT liability" and we didnt do the research into having medical direction available for that EMT" the judge is going to say, well now you can pay the liability out of your wing funds and then the wing just goes away because its bankrupt.  Am I talking worse case scenario, yes I am, because that is what EMS is about. And we just recently had a entire school district almost go bankrupt because it had only one nurse who floated around to about 15 schools and the resulting damages levied against them and for the parents of a child who didnt get his diabetic meds on time were so enormous that that district now has know extra curriculars of any kind so that they can pay out their installments of the judgement and punitive damage each month to this family and to the diabetic research group that the judge ordered the school district to contribute to. The school district appealed in federal court, and lost. Do you really think that a judge will hesitate to levy the same kind of judgement against CAP. He is going to want to know why do you have medical officers and nurse officers and health services officers and no liability to cover them? We could have a trauma doc as the physician officer out there with cadets or whomever and if he is away from the hospital for which he works, his liability isnt going to cover him either, same with the nurse.

Quote from: SARMedTech on June 30, 2007, 10:23:04 AMI will abide by what CAP regs say and what the NHQ boys and girls want.

And then, as far as liability, its not going to be my neck on the block (. . .)

Its going to most likely first be the Wing commander explaining to a judge and jury  (. . .)

but, without oxygen and an AED which we just didnt want to pay for, (. . .)

People have said that CAP cannot be held medically liable. Fact is, when you have people's kids out there, or some officer with a heart condition, the judge is going to want to know why no one was willing to assume such liability. And when the Wing commander tells the judge and jury "we didnt want to pay $104/year for EMT liability" and we didnt do the research into having medical direction available for that EMT" the judge is going to say, well now you can pay the liability out of your wing funds and then the wing just goes away because its bankrupt. 

. Do you really think that a judge will hesitate to levy the same kind of judgement against CAP. He is going to want to know why do you have medical officers and nurse officers and health services officers and no liability to cover them?

Gosh, just a page or so ago you indicated that you understood, and while you disagreed with the resource/policy issues inherent in the decision not to have HSOs perform routine care, you were going along.

And then you write this.

I'm (almost) speechless.

I think I may have mentioned that I am a former cop and a lapsed EMT.  Indeed, my basic EMT rating is well over 20 years old.  I would be far out of my depth in commenting on specific medical condictions and procedures.  Like many former EMTs, I undoubtedly think I know more than I do and may well be dangerous in an emergency.

And while I appreciate that you have some legal knowledge, may I respectfully suggest that you may be equally out of your primary area of expertise in discussing the legal exposure of the corporation based on our policy.

For example, Wing Commanders do not talk to judges and juries.  That's why we have lawyers. 

Who know the law, and how to talk to juries.

But in your scenario (bad outcome bee sting), it is not actually very important guessing who is going to talk to the jury, since nobody is going to have to.  Lawsuits just don't happen like you are suggesting.

Really.

(Hint:  A huge difference between us and the unfortunate school district you described is that they DID offer limited routine medical care, but then did not deliver on their promise when someone relied on it.  We are in an entirely different position in CAP.  And deliberately so.)

Remember, we agree that we that having routine and emergency care available to members is a very good thing. 

But medical care is not free, and we simply don't have the resources to implement it as you have suggested.  If you recall, I shared with you how I had actually contracted with a local urgent care center for protocols for an encampment nurse (who was a non-member).  I know this can work.

But you are inconsistent in your projections of low cost.  While the basic liability policy for an EMT may well be a very reasonable $104/yr, we have discussed that that policy does not cover CAP, Inc.  And without corporate coverage, it just doesn't matter how much the EMT policy is.  It could be free, but the very existence of CAP, Inc is at risk.

And then, using your scenario, we are gonna need a $1k AED and a couple thousand dollars of oxygen equipment and trauma gear for each activity.  Which has to be maintained and kept up to date.

Anyway you look at this it amounts to hundreds of thousands of dollars a year, which we just don't have.

Finally, remember that all CAP members can and should aid each other in emergencies, like the bad outcome beesting you so vividly described.


Ned Lee
Former CAP Legal Officer

Quote from: RogueLeader on June 30, 2007, 04:51:32 AM
What if that member IS who 9-1-1 would have sent, if he wasn't at the event?

?

Ned-

I had this big long post prepared in response to your latest and then decided to pair it down.

1. I understand and will abide by the "emergency stabilizing first aide" regulations set forth by CAP.

2. Because of the nature of the operations and exercises carried out by CAP cadets and CAP officers, there will be a time, if it has not happened already, where "emergency stabilizing first aide" will not be enough.

3. In the instance I gave of the beestung cadet going into anyphalactic shock, minutes mean the difference between having an airway and a heart beat and not having one. Those minutes are gained by the administration of an auto-injecting ampule of epinepharine (adrenaline).

4. Under CAP regs, I cannot do this, nor would I have the epinepharine in the first place due to CAPS regs.

5. You mentioned the cost of CAP outfitting all of these supplies. Most of us who are EMS trained already have our own "jump kits" full of trauma supplies which I suspect we would be willing to donate the use of just as we donate so many other resources when we sign up to volunteer. No, I am not paying for an AED/oxygen, but CAP should.

6. You have spoken about people working within their areas of expertise. I have spoken with many EMS providers within and outside of CAP. I think the consensus is if your certification is 20 years lapsed (no offense intended) but theres alot of new information and skills you might not have, just as I dont have your level of legal expertise (I assume you are a lawyer). You'll forgive me if I ask you just to hand me bandages when the spit hits the spam. Again, I would even ask my retired LEO father whose EMT card expired about the same time yours did to step aside.

7. Regardless of what it may seem, my whole motivation behind all of this is to keep you, other officers and cadets safe and when they arent safe to keep them for getting worse or God forbid, dying. I should think that would be something CAP could get behind. Because even if CAP wasnt found legally liable in a wrongful death, for instance (51% liable) the publicity, all of it bad, would certainly cause a problem.

My kit is packed with advanced first aide gear. I have one I would use for CAP, and one for the rest of the world. I will not excede CAP regs because I am a good and loyal member (read with a little sarcasm).

Son,

I really think we agree on more than we disagree.

We agree that it would be better if CAP members had better access to routine and emergency care at activities.

And I think we also agree that current CAP regulations absolutely prohibit HSOs from providing anything other than true emergency care.

And I also think we agree that the primary reason for the current situation is legal liability for our HSOs and CAP,in, and the associated costs for providing liability insurance.  (There are some other significant problems like nation-wide standards and certifications as well as status during federally assigned missions -- but we'll leave those for other threads.)

And I further understand that you wished there were some way to magically change that and allow you and other highly-skilled folks help our members.

I get that.  I really, really do.


But, you keep acting like these are some beauracratic rules designed to keep you from your True Calling in Life -- Savng Lives.

I appreciate the fact that you have worked as a legal assistant and researcher.  That's a great foundation for anything you would like to do in life.

The problem is that you are pretty much wrong on the law as it applies in this situation, and that is leading you to some false conclusions.

Quote from: SARMedTech on June 30, 2007, 06:28:13 PMCAP does not carry medical liability insurance. It would in fact, still be liable for a tortious action, that is an action causing damages other than physical ones. 

I'm not sure what you are trying to say here.  CAP is, and always has been, liable in tort for any civil wrongs committed by the corporation or its members in the course and scope of their duties.  CAP is not, and never has been liable in tort, for members acting outside their course and scope. 

But we cannot be liable for the tort medical malpractice if we do not engage in medical care (save emergencies.)

We can of course, be liable for negligent supervision (or something like that) if we negligently allow a cadet to come to harm.  But the standard is that of a reasonable, prudent person.  An ordinary lay person.

And most decidedly NOT the standard of a medcal professional.

Quote
As for the AED, there is no liability necessary for them since they sit now in cabinets in shopping malls and are virtually impossible to misuse. No license or certification or liability is necessary. As for maintaining it, well, just turn it on and run a ddiagnostic on it before carrying it along to whatever the event. Maintenance is not carried out by any medical person but rather by the company that sold the AED and usually involved putting in a new battery.

Yep, all you need is the thousand dollars or so to buy it, and then you have one.  You do, or course, need to maintain it.  How much does that battery cost?  How often does it need to be replaced?  How many AEDs do we need to buy to cover all simulaneous activities in all 52 wings, plus a few spares?

Oh, how about all the other trauma gear, like the oxygen set up you mentioned was needed? 

Honestly, how much would we need to spend to equip an EMT with minimum gear needed  for an activity like a 200-person cadet encampment?  How much of that needs to be checked, replaced, and rotated when that EMT is back at her/his home unit?

Quote
Ive been able to show where liability expenses come from...what we havent seen is this mystery number of hundreds of thousands of dollars.

Look back a page or two and you'll see it (again.)

After we buy about a hundred AEDs (less than two per wing) and spend that intitial hundred grand, we are gonna need that pesky liability insurance to cover CAP, Inc for medical malpractice.  Go ahead and price that one out for me.  Check with any large broker.  Tell them it covers a couple hundred medical professionals ranging from EMTs to docs and has to cover 52 jurisdictions and should probably have a 20-50 million dollar coverage.

Go ahead.  I'll wait. . . . .


Does that couple of hundred thousand really seem so unreasonable?

Quote
I can assure you that if someone died because CAP has no emergency medical team, it would go to court, with the lawyers, and I can also assure you that various wing commanders and squadron commanders would be called as witnesses and when a lawyer asks why there was no medical care and the lawyer for CAP or whoever says there was but we didnt provide them with liability...well the parent of the aforementioned cadet is going to own alot of airplanes and trucks and comms equipment.

As Ronald Reagan said, "there you go again" telling us about who can sue who for what.  And you are incorrect.

Tragically, this organization has already lost a number of our members.  Even more sadly, some have died of conditions like MIs or trauma where indeed a full-fledged medical team standing by might have made a difference.

But so far, there has not yet been a significant recovery against the corporation for failing to have such a team standing by in all conceivable locations.

IOW, we've lost over a dozen cadets at encampments since WWII, and parents do not yet "own a lot of airplanes and trucks and comm equipment."

And what I'm trying to tell you is that is because we do not pretend to offer medical care that we do not have the resources to do adequately.  Not because we have been "lucky."

Quote
When someone prevents me from carrying out what I am trained to do by not having appropriate liability in place, the judge is going to say well that EMTs hands were tied, he couldnt do anything.

I know something about judges, and I can predict with some certainty that the judge will say nothing of the sort.

Because judges follow the law.

QuoteIf you think I am giving worst case scenarios to jolt someone into action, I am, and will continue to until someone listens or someone dies from a lack of action, whichever comes first.

Like I said at the begining, we can both agree that it would be a good thing if members had better access to both emergency and routine care.

Now, let's talk about solutions . . .

Ned-

See now I cant respond angrily because you called me "Son." ;)

Somehow this posting got up when I had erased it before it was posted and replaced it with a much more productive one. Wait, that is the one I meant to post...whats up here.....Oh well.

I dont think that its actions being taken to keep me from my true calling. I live my true calling on a rotation of 24 hours on, 48 off, 52 weeks a year.


The kit I recommend be at all events and stowed with the Squadron, not taken home by the individual EMT, is called a S.T.A.R.T kit (Simple Triage and Rapid Treatment). It costs about $200.  Its very inexpensive to keep the kit current, stocked and maintained and in the hands of someone trained to use its contents could do alot of good.

I totally understand what your saying and defer to your greater legal knowledge. You say lets come up with some solutions. Im all ears, "Pop."  ;)

As I have said before the only viable solution to this problem is to come under the Fed umbrella for tort protection.  With at least 52 different jurisdictions, varying protocols and standardized procedures and a variety of licensure, certifications and skill levels I don't see anyother way out.  We need something along these general lines:  http://ndms.dhhs.gov/teams/dmat.html

Logically, I can only think of two alternatives:

1.  Locate a bucketload of money (say a million or so for equipment, training, and insurance)., or

2.  A legislative fix that would serve as a sort of federal Good Sam law that would specfically protect volunteer medical providers working in and for non-profits. 

Beyond the normal hurdles that any leg program faces, this one would have the additional burden of likely being opposed by two huge lobbying groups -- both the AMA and the trial lawyers.  For both groups it is a simple pocketbook issue; for the AMA, any care provided by volunteers is probably care that would otherwise have been provided on a fee-for-service basis by one of their members.  For the trial lawyers, well, they  would simply oppose any limitations on liability in medical malpractice situations.  Lawyers make a lot of money on these kinds of cases.

Frankly, I'm not very optimistic about either option.  I'm hoping that the rest of you have some better ideas.

Thoughts?

PA guy was headed in the right direction.  But, we don't need to duplicate DMAT. Why reinvent the wheel? We need an MOU with them. We then train with them; giving us medical coverage and them increased transport and recon capability. It also trains both for better inter agency interoperability. If the MOU gave HSO's Federal Coverage we're golden. If it doesn't - at least our members would have a covered medical team on hand. And if they supplied EMT's to our ground teams -we'd be closer to NIMS or NASAR standards.
Cost would be minimal. And we may just get more disaster relief missions.
It's at least worth a look.

(modified for grammar error)

Another alternative might be something along the lines of the USCG Aux Health Services program.  In this program liability is assumed by the feds and credentialing is done through the USCG along with supervision.  Do I see the USAF doing this in my life time? Not really.

Quote from: flyerthom on July 01, 2007, 03:04:19 AM
PA guy was headed in the right direction.  But, we don't need to duplicate DMAT. Why reinvent the wheel? We need an MOU with them. We then train with them giving us medical coverage and them increased transport and recon capability. It also trains both for better inter agency interoperability. If the MOU gave HSO's Federal Coverage we're golden. If it doesn't - at least our members would have a covered medical team on hand. And if they supplied EMT's to our ground teams -we'd be closer to NIMS or NASAR standards.
Cost would be minimal. And we may just get more disaster relief missions.
It's at least worth a look.

I wasn't suggesting CAP set up a DMAT.  I was thinking more along the lines of fed tort protection and the licensure/certification issues. 

Quote from: PA Guy on July 01, 2007, 03:13:23 AM

Quote from: flyerthom on July 01, 2007, 03:04:19 AM
PA guy was headed in the right direction.  But, we don't need to duplicate DMAT. Why reinvent the wheel? We need an MOU with them. We then train with them giving us medical coverage and them increased transport and recon capability. It also trains both for better inter agency interoperability. If the MOU gave HSO's Federal Coverage we're golden. If it doesn't - at least our members would have a covered medical team on hand. And if they supplied EMT's to our ground teams -we'd be closer to NIMS or NASAR standards.
Cost would be minimal. And we may just get more disaster relief missions.
It's at least worth a look.

I wasn't suggesting CAP set up a DMAT.  I was thinking more along the lines of fed tort protection and the licensure/certification issues. 

That would be ideal. Getting that by congress is the curve ball. An MOU would bypass that and give things to both. Either way is a solution.

Quote from: PA Guy on July 01, 2007, 03:07:29 AM
Another alternative might be something along the lines of the USCG Aux Health Services program.  In this program liability is assumed by the feds and credentialing is done through the USCG along with supervision.  Do I see the USAF doing this in my life time? Not really.

To my knowledge, no such animal as the USCG Aux Health Services exists. When I looked into joining, one of the reasons I did not join was that they have no program even in place to deal with EMS personnel and have basically what we have except with minimal (and I do mean minimal) coverage. However, it is so minimal, that trying to get them to approve an AED on board a facility is almost impossible. They still are not covered for providing any serious medical emergency care. Theyre pretty much in the same position we are. They do not recognize any health care professionals even to the extent that CAP does. There are no identifying insignia, etc. The only difference is that on an operation, they allow a flotilla crew that might have an EMT, nurse, doctor, etc aboard to call a land based hospital for minimal medical direction. Their first and primary course of action is to get a USCG AD vessel, helo, medical team, etc to evacuate the person from your facility. They dont even provide for Auxies to perform water rescues if it involves much more than dragging someone on board with a boat hook and they do not allow for something like assisting a distressed motorist by helping them fight a fire aboard their vessel. They have the same report and keep clear policy as we do. The only difference is they are willing to cut members some slack and pick up any slopped over liability if a member acts outside of regs. BTDT.

PS- the only time that your professional credentialling as a health care provider comes into play is you meet the exceptionally high security clearances to work as a force augmenter aboard a USCG facility or station.

Quote from: Ned on July 01, 2007, 01:04:20 AM
Logically, I can only think of two alternatives:

1.  Locate a bucketload of money (say a million or so for equipment, training, and insurance)., or

2.  A legislative fix that would serve as a sort of federal Good Sam law that would specfically protect volunteer medical providers working in and for non-profits. 

Beyond the normal hurdles that any leg program faces, this one would have the additional burden of likely being opposed by two huge lobbying groups -- both the AMA and the trial lawyers.  For both groups it is a simple pocketbook issue; for the AMA, any care provided by volunteers is probably care that would otherwise have been provided on a fee-for-service basis by one of their members.  For the trial lawyers, well, they  would simply oppose any limitations on liability in medical malpractice situations.  Lawyers make a lot of money on these kinds of cases.

Frankly, I'm not very optimistic about either option.  I'm hoping that the rest of you have some better ideas.

Thoughts?

My thoughts are that it would take one heck of a legislative fix. By definition, good samaritan laws do not cover licensed health care providers unless they are not acting as health care providers. IE if I decide to stop and help at an auto accident scene and am not working, I would be covered. As soon as I step into my EMT boots, good Sam no longer applies.

I think that what will end up being the fix is to have providers out there who are there for their knowledge and their ability to provide "emergency stabilizing first aide" above an beyond what the average laymen can provide. For example, an untrained person might be able to do CPR. But a trained person, acting as a layman knows how to do CPR with Sellicks maneuver if the head tilt chin lift or modified jaw thrust dont work. While a layman may know how to provide direct pressure for a wound, someone with EMT licensure and training would know what to do, within the bounds of first aide, when that direct pressure doesnt stop the bleeding. Honestly, there is alot of grey area here, and alot of it depends on the outcome. If I take some "extraordinary measures" that are a direct result of training and knowledge as an EMT, some judge or court might be willing to overlook it if the person lives. If the person dies and its ruled that its because of what I did, its the hanging tree for me and my license, which I will never get back in any state. The question is, am i willing to take that risk to keep someone from dying.

Quote from: SARMedTech on July 01, 2007, 07:36:00 AM

Quote from: PA Guy on July 01, 2007, 03:07:29 AM
Another alternative might be something along the lines of the USCG Aux Health Services program.  In this program liability is assumed by the feds and credentialing is done through the USCG along with supervision.  Do I see the USAF doing this in my life time? Not really.

To my knowledge, no such animal as the USCG Aux Health Services exists. When I looked into joining, one of the reasons I did not join was that they have no program even in place to deal with EMS personnel and have basically what we have except with minimal (and I do mean minimal) coverage. However, it is so minimal, that trying to get them to approve an AED on board a facility is almost impossible. They still are not covered for providing any serious medical emergency care. Theyre pretty much in the same position we are. They do not recognize any health care professionals even to the extent that CAP does. There are no identifying insignia, etc. The only difference is that on an operation, they allow a flotilla crew that might have an EMT, nurse, doctor, etc aboard to call a land based hospital for minimal medical direction. Their first and primary course of action is to get a USCG AD vessel, helo, medical team, etc to evacuate the person from your facility. They dont even provide for Auxies to perform water rescues if it involves much more than dragging someone on board with a boat hook and they do not allow for something like assisting a distressed motorist by helping them fight a fire aboard their vessel. They have the same report and keep clear policy as we do. The only difference is they are willing to cut members some slack and pick up any slopped over liability if a member acts outside of regs. BTDT.

PS- the only time that your professional credentialling as a health care provider comes into play is you meet the exceptionally high security clearances to work as a force augmenter aboard a USCG facility or station.

You might want to check out this link: http://www.cgaux.info/g_ocx/missions/action/healthcareskills.html
I augment at a CG clinic as a member of the CG Aux and the background check wasn't that big of a deal.

The reason I offered this suggestion was not that it applied directly to EMS but to show that it is possible to  cover aux members to practice. I wanted to show that mechanisms do exsist to do what we are talking about. The fact that it doesn't pertain directly  to EMS wasn't the point I was trying to make, only that liability, credentialing and supervision could and has been extended to members of an aux.

PA Guy-

I misread your original intent and think that you might have a good idea.

The problem with a DMAT type of coverage is that we are not a US instrumentatlity except when they use us that way ( the whole on/off aux thing) that would be great for USAF mission, but at least 1/2 if not more of our activites that really require medical coverage are non AF operations...encampment type avctivites come fore front to mind.  There we would need some type of corporate coverage (or some fancy way to have the medical support approved as an AF mission, and I see that as coplicated)

The easiest solution I can forsee is CAP corporate finding out what $$$$$ there is just to cover the corporations butt.  Individual HSO that want to participate must show proof of thier own liability coverage, and then just like other ES specialties not covered under 60-3 (ie mountain rescue, K-9, equestrian SAR) , must provide all their own equipment.  As well as a reg change defining areas such as physican oversight to non provider HSO's, recommended equipment standards and support guidelines for activites and any limitations on HSO's.

Insurance is really not that hard.  As a paramedic I have 1mil/3mil (and a bunch of other little coverages) that covers me on or off duty anywhere in the world, (lawsuit has to filed in the US or Canada) all for a whooping $147 a year.
I dont know what the company level coverage would be because its a mail in/fax quote request for that.  I am sure its a little hefty though.

Like SARMEDTECH said most of the HSO types out here have most of their own equipment or can readily acquire it.

Like most instances of "we should do this".....there is no reason in the corporate eye.  Like Ned said no one has tried to sue CAP foir NOT having adequate medical coverage (yet).  So in the corporate mind it wont be something we need to solve until their butts are on the line for it.  Then I am sure a solution will be had overnight.

mk

Revived from the dead:
After a wek of HMRS we beat this one up an down (actually discussions with the PA Wing CC, National Legal officer, CAP-USAF commander & TP himself.)

One of the discussion our Doc pointed out a case he was involved in (doing medical discovery stuff for a lawyer) involving the BSA.

Short version they had a MD working with them while cadets were doing rappeling.  Scout got his hand caught in the device, the doc rappeled down, started a line and a few other little things.  Kid lost a finger and got a nasty infection in the arm.  Sued the Doc and BSA for injuries.  BSA said not our fault, we dont have Doctors, he did that all on his own, the Doc's insurance coverd the cost of damages.  The Doc turned around and succsefully sued the BSA for putting him in a postion to be sued by asking him to be there due to his superior medical knowledge (just in case) yet limiting him by regulation in what he can and cant do, because they dont carry insurance to cover that type of thing (medical care)

mk

Quote from: sarmed1 on July 18, 2007, 05:40:39 PM
Revived from the dead:
After a week of HMRS we beat this one up an down (actually discussions with the PA Wing CC, National Legal officer, CAP-USAF commander & TP himself.)

One of the discussion our Doc pointed out a case he was involved in (doing medical discovery stuff for a lawyer) involving the BSA.

Short version they had a MD working with them while cadets were doing rappelling.  Scout got his hand caught in the device, the doc rappelled down, started a line and a few other little things.  Kid lost a finger and got a nasty infection in the arm.  Sued the Doc and BSA for injuries.  BSA said not our fault, we don't have Doctors, he did that all on his own, the Doc's insurance covered the cost of damages.  The Doc turned around and successfully sued the BSA for putting him in a postion to be sued by asking him to be there due to his superior medical knowledge (just in case) yet limiting him by regulation in what he can and cant do, because they don't carry insurance to cover that type of thing (medical care)

mk

This brings two seemingly contradictory points to light as concerns CAP:

1. The doctor should have had no grounds for a suit because he could have refused to act per BSA regs.

2. See why the regs concern health and medical services for CAP needs to change. Kind of makes you rethink the notion that EMS isn't necessary in the field for CAP doesn't it.

"A well-trained medical section being necessary to the maintenance of a safe Civil Air Patrol, the right of CAP EMTs to render necessary emergency care shall not be infringed." 

Two ways to look at this one, one from the anti-CAP medical section crew and one from the pro-medical section crowd.

1. The doctor should have known better. He did the best job he could, but he should have known that if anything went up the spout he would get sued or worse lose his license, regardless of the fact that he may have kept the Boy Scout from dying of shock.

2. Had the BSA lived up to its obligation to provide liability covered medical care rather than relying on back alley first aide (ala CAP) the doctor may well have been able to do more to assist this poor Boy Scout and in the end, the BSA wouldn't have found itself in a pot of boiling water.

Ive said it before and i will say it again, CAPs sole reason for not having a medical section is financial and financial only. The BSA incident related in this post only serves to underscore the need for competent, insured emergency, pre-hospital care givers in the field who are covered for doing more than first aide. And to those of you who say CAP wont get in trouble for not providing competent insured EMTs and Medics...see the above story. The BSA i believe is a larger organization than CAP. It would take one law suit for someones child or husband or wife dying in the field because the EMT or medic standing couldn't do what needed to be done and CAP will fold after a massive tort action. And yes, I recently ran this past a tort attorney and he informed me that if CAP has medical care givers in the field, but ties their hands with regulations so that they cannot do ALL that needs to be done, the could well and probably would find themselves on the butt end of a tort suit. The "we isn't responsible cause we ain't got no EMTs" argument isn't going to fly. It didn't work for the monolithic BSA and it wont work for CAP. I'm sort of waiting to see what happens when a cadet gets shot during marksmanship training and the EMT standing there cant provide life support rather than first aide. I guess we can all have a party at NHQ to burn our membership cards, cause they will be worthless when it happens cause there wont be any CAP to be a member of.

I think the premise he won the suit on was that the BSA never told him he wasnt an instrumentatlity of the BSA. "...you told me you wnated me there in case anything bad happened.  So you knew it was a dangerous activity and didnt want to pay for real coverage.  You (the BSA) put me in a bad spot and thats why I got sued"

I have been asked to look into how to fix the medical coverage problem for CAP.  They were very impressed with the medical operation we run at HMRS, specificaly the prevention of injury and illness and would like to see something similar available for all CAP activites (at least the NCSA/encampment type anyway)

Two possabliites were discussed
a-either a National or Regional Medical unit that when activated sets up medical operations at a particular activity.  Insurance being purchased just to cover the providers for that duration of activity.  This would I imagine include a relevant reg change.  I am not sure how this would effect USAF missions but it was discussed that 60-3 woudl need change as wel;l and that woudl have to be coordinated with the USAF.

b-The previous mentioned brining CAP medical folks under the USAF umbrella similar to the chaplin program.  Medical personnel would meet the same initial and the continuing training requirements as AF medical service.  Be availble to support AF missions if requested, CAP missions and activites would be sanctioned as an AF mission. 

The impression I got was that option a would be easier to do (just on the CAP side) as a coporate thing.  Hopefully if successful leading to an adoption of optiopn be by the USAF once CAP can prove that it can manage such a program.....

mk

Quote from: sarmed1 on July 19, 2007, 02:04:44 PM
I think the premise he won the suit on was that the BSA never told him he wasnt an instrumentatlity of the BSA. "...you told me you wnated me there in case anything bad happened.  So you knew it was a dangerous activity and didnt want to pay for real coverage.  You (the BSA) put me in a bad spot and thats why I got sued"

I have been asked to look into how to fix the medical coverage problem for CAP.  They were very impressed with the medical operation we run at HMRS, specificaly the prevention of injury and illness and would like to see something similar available for all CAP activites (at least the NCSA/encampment type anyway)

Two possabliites were discussed
a-either a National or Regional Medical unit that when activated sets up medical operations at a particular activity.  Insurance being purchased just to cover the providers for that duration of activity.  This would I imagine include a relevant reg change.  I am not sure how this would effect USAF missions but it was discussed that 60-3 woudl need change as wel;l and that woudl have to be coordinated with the USAF.

b-The previous mentioned brining CAP medical folks under the USAF umbrella similar to the chaplin program.  Medical personnel would meet the same initial and the continuing training requirements as AF medical service.  Be availble to support AF missions if requested, CAP missions and activites would be sanctioned as an AF mission. 

The impression I got was that option a would be easier to do (just on the CAP side) as a coporate thing.  Hopefully if successful leading to an adoption of optiopn be by the USAF once CAP can prove that it can manage such a program.....

mk

Im for option b myself, but either would be better than what we have now. Chaplains get the souls and we get the bodies....makes ALOT of sense...whicih is probably why it wont happen that way.

Quote from: sarmed1 on July 19, 2007, 02:04:44 PM
a-either a National or Regional Medical unit that when activated sets up medical operations at a particular activity.  Insurance being purchased just to cover the providers for that duration of activity.  This would I imagine include a relevant reg change.  I am not sure how this would effect USAF missions but it was discussed that 60-3 woudl need change as wel;l and that woudl have to be coordinated with the USAF.
mk

I think this would be a licensing/credentialing nightmare.  How would they handle a PAWG EMT going to NMWG to cover say PJOC and going as basically a corporate employee? Sure it can be done,  locum tenems companies do it all the time but they have the infrastructure to get it done and make big money in the process. It might be cheaper if NHQ just went to a locum company and hired EMTs etc. for things like NCSAs and encampments.  Coverage for ES would be a 'nother ball of wax.

Quote from: PA Guy on July 20, 2007, 12:04:59 AM

Quote from: sarmed1 on July 19, 2007, 02:04:44 PM
a-either a National or Regional Medical unit that when activated sets up medical operations at a particular activity.  Insurance being purchased just to cover the providers for that duration of activity.  This would I imagine include a relevant reg change.  I am not sure how this would effect USAF missions but it was discussed that 60-3 woudl need change as wel;l and that woudl have to be coordinated with the USAF.
mk

I think this would be a licensing/credentialing nightmare.  How would they handle a PAWG EMT going to NMWG to cover say PJOC and going as basically a corporate employee? Sure it can be done,  locum tenems companies do it all the time but they have the infrastructure to get it done and make big money in the process. It might be cheaper if NHQ just went to a locum company and hired EMTs etc. for things like NCSAs and encampments.  Coverage for ES would be a 'nother ball of wax.

The solution is simple as pie...you dont send a MNWG EMT to a NM event of if he goes, he does not function as operational EMT. For that, you use NM licensed EMTs. And by the way, if youve ever hired a private EMT agency to sit around all weekend or week, you know that they will cost you and arm and a leg more than properly equipped CAP EMTs. The private agencies have to jack up their prices sky high for standby because they arent running as many expenive trauma calls which are their money makers.

I dont know where folks got this idea that we send EMTs from one wing to work in another. Protocols are different, the two states may not offer each other reciprocity thus rendering the EMTs from another state useless because they cant touch a patient outside their state of licensure. Thats why we should start recruiting EMTs and Medics at the wing/group  level, getting them into Squadrons and take care of things properly.I talked to a very nice woman whose title I didnt catch at Maxwell today by phone and mentioned beefing up medical sections and she seemed to think it was a good idea. She even say AJP thinks likes the idea, which I sort of doubt of doubt since if he did, he probably would have written new regs by now and thrown another uniform into the mix.

So many of the stumbling blocks thrown up by anti-CAP EMT crowd have no bearing in how the EMS system works in the US, let alone wing to wing. Illinois responders take care of their squadrons, NY takes care of theirs and you can even farm an EMT out from squad to anther when that squad isnt doing something where onsite CAP-EMS is ncessary for them at that time. You have lots less chance needing them on an ELT shutoff hunt than you do at an encampment or other mass activity. Come on kids, as sarmed1 said, he is being asked to do some legwork on this and I plan to help him when as much as I can because CAP EMS is an idea whose time has arrived. 3-4 years tops. I mean hell, the NREMT is already making subdued patches for field uniforms and BDUs and SWAT teams so they dont stick out like a sore thumb with the current red, white and blue patch I wear to work everyday. Is there a reg that would prevent me from putting an NREMT patch in my BDUs? I have seen some photos of CAP officers using them BDU blouse pockets and I saw one fellow with one on his ALICE pack. While on the subject, is there a reg that says that I couldnt sew a NREMT patch or tape that says "EMT" or  "MEDICAL"  or health services on the assault bag I use as my jump kit. Just kind of an identifier when your in the field. Other than the EMS wings and star insignia/badge is there a Health Services insignia or patch. Im assuming not since HS isnt a specialty track. I guess my real question is can I put a name tape or anything else for that matter (say another ES patch) on my packs?  Thanks.

Quote from: SARMedTech on July 20, 2007, 05:31:51 AM

Quote from: PA Guy on July 20, 2007, 12:04:59 AM

Quote from: sarmed1 on July 19, 2007, 02:04:44 PM
a-either a National or Regional Medical unit that when activated sets up medical operations at a particular activity.  Insurance being purchased just to cover the providers for that duration of activity.  This would I imagine include a relevant reg change.  I am not sure how this would effect USAF missions but it was discussed that 60-3 woudl need change as wel;l and that woudl have to be coordinated with the USAF.
mk

I think this would be a licensing/credentialing nightmare.  How would they handle a PAWG EMT going to NMWG to cover say PJOC and going as basically a corporate employee? Sure it can be done,  locum tenems companies do it all the time but they have the infrastructure to get it done and make big money in the process. It might be cheaper if NHQ just went to a locum company and hired EMTs etc. for things like NCSAs and encampments.  Coverage for ES would be a 'nother ball of wax.

The solution is simple as pie...you dont send a MNWG EMT to a NM event of if he goes, he does not function as operational EMT. For that, you use NM licensed EMTs. And by the way, if youve ever hired a private EMT agency to sit around all weekend or week, you know that they will cost you and arm and a leg more than properly equipped CAP EMTs. The private agencies have to jack up their prices sky high for standby because they arent running as many expenive trauma calls which are their money makers.

I dont know where folks got this idea that we send EMTs from one wing to work in another. Protocols are different, the two states may not offer each other reciprocity thus rendering the EMTs from another state useless because they cant touch a patient outside their state of licensure. Thats why we should start recruiting EMTs and Medics at the wing/group  level, getting them into Squadrons and take care of things properly.I talked to a very nice woman whose title I didnt catch at Maxwell today by phone and mentioned beefing up medical sections and she seemed to think it was a good idea. She even say AJP thinks likes the idea, which I sort of doubt of doubt since if he did, he probably would have written new regs by now and thrown another uniform into the mix.

So many of the stumbling blocks thrown up by anti-CAP EMT crowd have no bearing in how the EMS system works in the US, let alone wing to wing. Illinois responders take care of their squadrons, NY takes care of theirs and you can even farm an EMT out from squad to anther when that squad isnt doing something where onsite CAP-EMS is ncessary for them at that time. You have lots less chance needing them on an ELT shutoff hunt than you do at an encampment or other mass activity. Come on kids, as sarmed1 said, he is being asked to do some legwork on this and I plan to help him when as much as I can because CAP EMS is an idea whose time has arrived. 3-4 years tops. I mean hell, the NREMT is already making subdued patches for field uniforms and BDUs and SWAT teams so they dont stick out like a sore thumb with the current red, white and blue patch I wear to work everyday. Is there a reg that would prevent me from putting an NREMT patch in my BDUs? I have seen some photos of CAP officers using them BDU blouse pockets and I saw one fellow with one on his ALICE pack. While on the subject, is there a reg that says that I couldnt sew a NREMT patch or tape that says "EMT" or  "MEDICAL"  or health services on the assault bag I use as my jump kit. Just kind of an identifier when your in the field. Other than the EMS wings and star insignia/badge is there a Health Services insignia or patch. Im assuming not since HS isnt a specialty track. I guess my real question is can I put a name tape or anything else for that matter (say another ES patch) on my packs?  Thanks.

Just a moment please.  The orig. post said that the "A" proposal was for a Natl or Regional medical unit.  I took that to mean natl or regional in a CAP sense in that CAP members of various wings or regions would be assigned to cover activities on a natl or region basis.  If that isn't the case then let the author tell me that.

You seem to think that just because someone doesn't agree with you that they are "anti CAP EMT".  For starters many of us have been arguing and fighting this battle long before you came to CAP. And the issue is more than how it affects EMTs, it involves CAP health care providers in general and how to insure members at activities are properly cared for should they need it. Many of us have a depth of experience in CAP that you don't have yet that allows us to see many of the problems involved in setting up a CAP Health Care Program not just a CAP EMT program.  Most of us would do hand stands to see a viable program that would provide quality care,protect the provider and CAP, Inc.  Many of us have just as much health care experience as you and recognize the problems and hazards inherent in some of our activities and the need to change.  To change all of this isn't just a matter of the Natl. Commander writing a new reg. as you suggeted. It involves many, many people in CAP and the USAF all buying into the program. Myself and many others wish sarmed 1 nothing but the best and also would be willing to assist him in any way possible.  You are not the Lone Ranger here.

Wear of the CAP uniform is governed by CAPM 39-1.  If it isn't in the 39-1 it can't be worn.

What you sew/attach to your personal gear should not be a problem as long as it is in good taste.

PA Guy-

First off, you may want to consider dialing back the snot factor a couple degrees. I never claimed to be the Lone Ranger of what I hope will become over whatever period of time is necessary a sleek, efficient and high speed CAP Medical Section that can not only serve the emergency and general medical needs of CAP officers and cadets, but also for the public as well. If CAP is to move into the 21st century and ever hope to get better and stronger, alot changes will need to be made. For my part, I hope to work alongside people like yourself, sarmed1 and any and all other members interested in creating a CAP Medical Section. I never claimed to have the brand on this hope or the work it will take, but since my involvement in CAP, I have written hundreds of pages of research notes over just what it will take to make a CAP-HS work.

While a CAP Nat'l Health Service should be the goal,  option A of a National or Regional program would be a nightmare and an enormous stumbling block. If for no reason, it would take changing the way that the entire American medical system works, ie federally (as opposed to state) licensed EMTs, PAs, nurses, doctors, etc. The professional organizations that govern have all at one time or another considered such a tasking, but if you think getting EMTs federally licensed is a nightmare...it would require an overhaul the likes of which none of us can even imagine. It would take instituting federal board exams, like the NREMT, for each of the health professions and those boards would have to not only be a paper tiger certifcation like the NR but would require that in all 50 states, PR, Guam and the US Virgin Islands that all medical protocols and laws for all medical professions be mane identical. There may be alot of us who want to see a great CAP HS, perhaps even see it be our fourth mission along with CP, AE, and ES or perhaps be a wing (notice the small "w") but as you rightly point out, we arent just talking about EMTs here. I dont know if the PA in your handle stand for physician assistant or Pennsylvania, but I think we would all like to see HS as a specialty track and take in docs, nurses, EMS responders, etc. But for the reasons above, making it National, or even regional so that CAP HS members from one state could go to another state to carry out their CAP medical duties would not simply require an overhaul of CAP but of the entire American medical system and I dont think any of us or group of us, no matter how dedicated, is prepared to make that happen or could even fathom how.

I also have to disagree that getting liability coverage for medical professionals by the event as opposed to standing coverage would be like rolling and unrolling and giant ball of yarn each time you wanted to utilize a HS members services. Quite simply, it would be reinventing the wheel for each and every CAP event where HS personnel were required or desired. I think you can see how that is not a viable option, no matter how much we may admire the work that sarmed1 has done so far and the great initiative he has taken. Like him, I spoke with several folks as Maxwell/NHQ myself over the last couple of days. The task we face is daunting indeed. Its going to involve changes in regs, huge amounts or research, CAP HS planning conferences on huge scales, the writing of position papers from different points of view and on and on. However, I believe that our first and most attainable goal with a time frame of 3-5 years is a CAP EMS which can then serve as a model for a CAP HS. I think you would agree that that makes the most sense as a starting point. Its also going to take re-envisioning the way we view the first aide training of  our cadets. We need to take how they are taught in the CP and an HMRS and expand and improve it. We need them not only to be taught first aide, but for each and every cadet, or at least those who wish to be involved in HS, to at least be trained and certified to the level of Medical First Responders at the NREMT level with all that entails. If this is going to work, we are also going to need the assistance of the dedicated professionals at HMRS. That will be vital. Without that linch pin, its going to be much harder to get the CAP HS grenade to go off.

So before you come charging at me with admonitions of "just a minute please" you might have first found out what my health care qualifications among the rest of my qualifications are. So here they are....

I hold an AA degree in health and human services and a BA degree in social sciences. I have in excess of 190 hours of medical school level health sciences course work including A and P, diagnostics, trauma medicine, wound care, pediatrics and disaster medicine. In addition, before a near fatal auto accident, I attended medical school for two years and served a fellowship in Integrative Medicine along with a 1 year clinical internship in that field. I started with my Medical First responder cert and am now and NREMT-B and Illinois Licensed EMT-B/D with additional training in cardiac and cerebro-vascular care. I am an EMT (holding a license in IL and WI) and certified fire fighter  rehab specialist with two large metropolitan fire departments in the Chicago area. I am a command EMT with a muncipal medical rescue squad and an EMT supervisor with a volunteer non-profit EMS agency. I am certified in extreme climate and tactical EMS and hold a certificate and work as a "care under fire" tactical team medic for a private medical/security contractor. I have completed in excess of 100 hours of combat life-saver course work and as part of my care under fire training have been trained and certified in the use during a tactical medical emergency of smoke-flash diversion devices, the H and K MP-5 subgun, the Sig229 and the M870 tactical shotgun as well as being a competative long distance marksman with both .223 and .50 caliber rifles. I am certified in high angle, confined space, swift and standing water rescue. I have been a SAR, USAR and WSAR operator for 5 years and served on CERT teams that responded to the WTC attack and spent 4 weeks performing SAR, CERT and EMS operations in the Gulf Coast after Katrina after which I spent close to two months in  intensive care for a respiratory infection contracted from working in the diseased waters of New Orleans. Finally I am the team leader and founder of an urban CERT team and a member and instructor in the Medical Reserve Corps and an American Red Cross First Aide and advanced first aide instructor as well as an AHA health care level instructor in CPR and AED.  I am currently simultaneously completing the qualifications for an MS/MPH degree in disaster medicine as well as the coursework for licensure as a trauma care physicians assistant. I am also a certified operator of the EZ I/O rapid fluid delivery system as well as an instructor in its use.

I give you my curriculum vita not to impress you or anyone else. If you get into health care for glory you will burn out quickly. I offer you my qualifications so that you may understand that while I am a CAP SMWOG grade and the only two blings I have so far are my EMT "wings and star" and membership ribbon and I defer to your superior and extended experience in CAP, I am not some Johnny Come Lately to medicine who has no idea what it takes to make a CAP HS work or who hasnt "earned a few stripes" when it comes to medicine and medical care. My only interest in developing a CAP HS is to better serve CAPs membership, my community, my country and my fellow citizens. I have no chip on my shoulder, or grudge against you nor do I think that I alone will be responsible for developing CAP HS. I look forward to working with you, sarmed1 and all of the other CAP officers and cadets who have far more CAP experience and knowledge than I have and some f them who not only have more CAP time, experience and knowledge than I will ever have, but who have also served their country bravely and heroically in the various branches of the American Armed Forces. I am truly in awe of people who not only gave of themselves to keep our country free but now still have the honor to don the CAP uniform and continue to serve. I thank you for the information that you gave me in your post and hope that you will accept my apology as I seem to have unintentinally insulted you and perhaps other members. Again, if that is the case, I ask that you forgive me for any offense I may have given. Finally, thanks to all the CAP members who let me speak my mind by putting up with my long winded posts and to all those on this forum who have taken me as I am into their beloved CAP and have offered me the benefit of their infinite counsel, guidance and experienced wisdom. Thank you, Semper Vigilans and Long Live the Civil Air Patrol.

PS- Could you please fill me in on how the USCG AUX handles the "credentialling" of its health services personnel. I recently received a letter from the USCG Health Services director informing me that the USCGAUX offers no credentials to Auxiliary EMTs or other health professionals and that they do not even recognize them in the  basic way that CAP recognizes Physican and Nurse Officers or HSOs. To my knowledge, the do not even have an insignia of any kind for Auxies indicating their health service status.

Hmmm, where to start. I believe the orig. issue was a discussion over the possible two options for enhancing medical care within CAP. I said I was in favor of option "B" and listed a couple of reasons why I thought option "A" would be a problem. My response was based upon my understanding of the terms natl. and regional in a CAP context. Your lengthy reply inferred I didn't know what I was talking about.

You went over your CV to demonstrate your background. Just so you know where I am coming from I will give you mine.

I have been a member of CAP as a cadet and SM for 45yrs. I have completed Level 4 and held sqdn and group commands. I have been a Wing DCP and did a stint as a Wing Dir. of Gnd. Ops. I am a GTL and MO. I have 7 distress finds, all ground and one save.

Yep, you guessed it I'm a physician assistant (PA). I've been a PA for 30yrs. I have a MPAS from U. of Neb and a MPH in Health Admin. I am NCCPA certified and  completed the US Army Medical Dept. Officer Basic Course. I  worked as an EMT in the bad old days prior to NREMT. I spent 5 yrs working for a large county EMSA, pop. 4.5 million covering >7200 sq. mi.,  doing training and credentialing. I have spent 15 yrs. assigned to a Type I NDMS/DMAT. I have deployed to such places as the WTC, Katrina/Rita, Hurricane Andrew and Northridge. I am semi-retired and instruct part-time in a natl. WMD/EMS program that comes under the Dept. of Homeland Security/Off. of Domestic Preparedness. I also spent 31 yrs as a CA POST certified Level I Reserve Officer in a 300+ officer dept where I wrote the proposal and helped establish their TAC/Med program.

You wrote that you are doing course work to become a "trauma physicians assistant" Are you in a PA program or did you mean you are completing the perquisites to apply?

CG Aux health care providers are credentialed by the Armed Forces Inst. of Pathology, Dept of Legal Medicine. A complete description of the program can be found in COMDTINST 6010.2B dtd 22 Feb 07 at this link http://www.uscg.mil/hq/g-w/g-wk/wkh/pdf/COMDTINST%206010-2B_Revision_10_06_MOS_RECENT.pdf At this time there is no bling authorized for Aux health care providers, besides who needs it.

So let's just chalk this up to a personality conflict and move on. I apologize in advance to the other readers for the length of this post.

TP was in favor of a NHQ medical squadron or at least regional programs.   I didnt interupt at the point to discourage his enthusiasm for the idea by pointing out the problems of state to state differances in licensure/certification requirements.  Figured I'd save that for a point paper where following that option I'd recommend a Wing managed program.

I am much more in favor of the USAF option as it eliminates the need to conform to each states licensure/certification requirement.  The problem of course is getting the AF to play along anytime in the near future. 

Full time insurance as pointed out previously would be a huge financial burden tot he organization, especially to not have a use 90% of the year.  At HMRS our Doc gets a policy that just covers his 9 days at the school.  Much less expensive. 

mk

Quote from: sarmed1 on July 20, 2007, 07:57:29 PM
TP was in favor of a NHQ medical squadron or at least regional programs.   I didnt interupt at the point to discourage his enthusiasm for the idea by pointing out the problems of state to state differances in licensure/certification requirements.  Figured I'd save that for a point paper where following that option I'd recommend a Wing managed program.

I am much more in favor of the USAF option as it eliminates the need to conform to each states licensure/certification requirement.  The problem of course is getting the AF to play along anytime in the near future. 

Full time insurance as pointed out previously would be a huge financial burden tot he organization, especially to not have a use 90% of the year.  At HMRS our Doc gets a policy that just covers his 9 days at the school.  Much less expensive. 

mk

I agree that the USAF option is the better way to go. 

If your doc gets a special events rider on his ins. how do you square that with CAPR 60-1? Does he attend the activity a CAP member? When CAWG approached NHQ about this approach we were told that the provider couldn't be a CAP member. So the way we went about it was to have a non-member spouse RN fill the slot and the encampment paid for her special events coverage. We then went to a local urgent care center and in exchange for our business they provided medical direction for the RN.

If you guys have a MD that solves the medical direction issue but what would you do if the MD wasn't available. You are fortunate that you have a MD that is willing to take on the task but as I'm sure you realize that is a rarity.

Thanks for your efforts. At least now we know the Natl. Commander has at least heard of the prob.

Quote from: sarmed1 on July 20, 2007, 07:57:29 PM
TP was in favor of a NHQ medical squadron or at least regional programs.   I didnt interupt at the point to discourage his enthusiasm for the idea by pointing out the problems of state to state differances in licensure/certification requirements.  Figured I'd save that for a point paper where following that option I'd recommend a Wing managed program.

I am much more in favor of the USAF option as it eliminates the need to conform to each states licensure/certification requirement.  The problem of course is getting the AF to play along anytime in the near future. 

Full time insurance as pointed out previously would be a huge financial burden tot he organization, especially to not have a use 90% of the year.  At HMRS our Doc gets a policy that just covers his 9 days at the school.  Much less expensive. 

mk

I agree that wing managed makes the most sense, practically and logistically. Im not sure what you mean when you say that full time insurance wouldnt have a use 90% of the year. I dont see that as the case, perhaps because as I say I dont understand what you mean by it (sorry for uncorrected typos...i have a 4 year old Dell laptop and the warranty just ran out and you know thats when they start breaking down..my keys are falling off making typing difficult...off topic but does anyone have a good suggestion for reattaching them without getting superglu into the guts of the laptop).

The reason I say I dont knw what yu mean is that other than meetings and conferences, there is virtually nothing we do that wouldnt benefit from having CAPs own "in house" medical personnel. Maybe I can list how I see them being used:

1. they can generally take care of their squadron/group during operations, exercises, etc.

2. They can have more latitude in being able to make medical judgement calls, ie "Ive taken this officers vital signs and he is really beyond acceptable parameters to continue on this operation. I recommend (to the GTL) that he stand down for health reasons."

3. Im speaking for EMTs because that is what I am, but we would have the latitude to be able to give emergency-necessitated meds and perform lifesaving interventions appropriate to our protocol, ie combi/ET intubating, needle decompressions, traceostomies, starting IV lines, giving cardioverting drugs, running full on codes...you see what i mean.

4. Assisting with tending to crowds at airshows, etc where the public is present.

5. a Medical section done legally would allow us to have some form of ambulances, rescue vehicles, thus cutting down on time when minutes count because we dont have t wait for EMS because CAP EMS is there.

You see where Im headed I know because you are in favor of a medical section.

Expensive: Yes, but its not going to bankrupt us. We have the third largest airforce in the world which I think has to be quite expensive.

We say its all about the planes since we are the Civil AIR patrol well, our "parents" are the AIR Force but they have entire hospitals and medical centers (I was born at Ellsworth AFB and was in their PICU for a month).

Of course our medical section would be a scale version of the AF because 1. We are a scale version of the AF and 2. we arent combat oriented.

It seems odd to me that we have emergency services, but we are leaving out a huge chunk of what emergency services is...medical response. State Guard units have entire medical battalions. We do search and rescue...a large part of the time, an "actual" is going to involve some medical necessities.

We are responsible for peoples children...nuff said? We may have them sign a hold blameless but we still have an ethical obligation.

Theres a huge financial consideration...we are a rather large non-profit...we can raise money. Imagine taking money out of our constant fashion designing and putting it to practical use.

THe logistics of all this are surmountable by people who know what they are doing. And the finances are not impossible its just that people run scared when you say the word money.

I dont see this as some high speed luxury, just so we can say we have it deal. We do work for the American public, work which is often dangerous and often involves the public we serve requiring medical assistance. we have an Inspector General for crying out loud...internal affairs investigators, but we cant figure out a way to keep our members safe and healthy and to provide the absolute best standard of service we can to those who task us and those we serve.

I tell you what. If you PM me, I will give you my email address. I will help you however you want me to. I dont have a need to be in charge of this thing...in fact i really dont like most aspects of the command assignments I have outside of CAP as it is. I will stay in the shadows and do the &*^% work and then just work as a EMS provider in the field.  Being in charge isnt my issue. Being the best we can be is and finding a way to overcome things is. There may be those who dont approve of MG AJP but when the NC of a uniformed service organization says he is interested in something...shouldnt we investigate it and play it out to the bitter end. If it fails it fails but how can we claim that we are Semper Vigilans if we dont exhaust every avenue to try to make ourselves better Its not about lights and sirens and the adrenalin of field medicine...its about doing what we know we need to do and not being deterred by those who say it cannot be done. I do believe there were a lot of people who said man would never fly....and now we are in outerspace. I serve at the pleasure of CAP and the USAF...Ill serve however anyone orders me too...Ill go t Maxwell on my own dime if someone tells me too.  Sorry for the length and I dont intend to keep up with these long posts...its just that this is too important to throw up our hands and say it cant be done. I want to say to sarmed1 and PA Guy THank you for hearing me out and really all I want to do is serve. Tell me how, when and where and I will show up.

CAP typically on a mission works under another agency's authority.  I have never had an issue getting an air ambulance by calling the air ambulance dispatcher directly.  Most services work under a MOU with the county or state authority that allows any bonafied public agency and specified private (hospitals) agencies to request the air ambulance.  Their only concerns is who to make radio contact with and landing location.  However, it is wise that the person that lands the airship understands what is required for a safe LZ.  I wouldn't recommend this for a T/C along the urban freeway.

EMT's in California can't legally do much more than anyone else: Provide basic first aid, transport patients to the hospital, etc. ( okay, they can also shut off IV's and administer positive pressure O2, but so can a First Responder or a CNA!) I have fortunately never had a life threatening event (medically at least) involving CAP personnel on CAP business, every medical scenario I have been involved in could be handled with ordinary (parental-level) care. I think if you are worried about liability, you should not (publicly) espouse your feelings that you think it is a good idea to violate the Corporations policy. If you render any kind of aid, expect all your words to be crammed into all of your multiple orifices (orifi?) I am confident that Ned will back me up on this, having probably fed people handfulls of their own excrement in civil suits before.... As a Private Investigator, I would google the bejeepers out of you if you were on the opposite side in a civil suit, and have every position you have ever taken here as hard copy.

Would I use extraordinary medical procedures to keep someone alive, even if it violated CAP policies? For the record, no. CAP has presumably weighed the cost/benefit values and decided that a certain number of deaths and complications of late treatment are worth risking rather than allowing helter-skelter (which legally, is one step before "willy-nilly", help me out on this, Ned.) treatment of CAP members by fellow CAP members. My understanding of the Corporate policy is that, for instance, in the case of a life-threatening bee sting, I should only offer basic ABC support, and not pull out my own Epi pen and try to save the life of the victim in a way contrary to CAP's policy.

Operating within CAP's policies is the only protection we have against civil liability, and it is imperfect even then. If a patient dies under your care, expect to be sued. CAP will at least be a bigger target than we would personally. When I received combat-medic training, they used a phrase that I think every EMS person in the world has heard at least once: "You can't save anyone if you are dead!" To paraphrase this for CAP, "you can't save anyone if you are 2B'd!"

If in the event of an actual life threatening medical emergency you choose to violate CAP's policies, you do so not only at your own risk, but you imperil the entire corporation (which is to say, us!) You had better draw that epi pen with the same care you would draw your gun, knowing that someone may die, that you may have caused it, and that everything in your life has been put at risk with a single motion. It better be worth it....

Capt. Lord

First off, I do not advocate giving someone my epi via auto-injector in the field, nor do I advocate, as a few have on this topic, giving someone a blast from an OTC inhaler if they are in anaphylaxis. That being said, that person with an allergy to a bee-sting or something they have never eaten before may well die in the field from complications secondary to anaphylaxis.

Im not going to say what I might or might not due that falls outside the realm of first aide because as you said, if and when I were to get vetted for a law suit, its likely that some hypothetical that I posted on a relatively obscure forum would come back and get me. CAP leaves itself open when it says "emergency stabilizing first aide to the level of the providers training and licensure." What they are saying is that we want you to act, but we dont want to be responsible for you in any way, so we will give you a term which we really dont define and you do as you will.

So...how much is a human life worth? Is it worth me getting sued? Is it worth me losing my license? Is it worth taking CAP down when someone acts outside of a nebulous regulation.  That being said, Im not going to speculate on hypotheticals in which I might do this or I might do that. What I carry in my pack replicates what a combat lifesaver carries, leaving out things that I am not licensed to use under any circumstance in my state. I dont carry oxygen, as some here have stated they do since in IL it is classified as a controlled substance in terms of medical useage and something that I can only give when operating under standing medical orders from a medical director. I dont carry IV caths or setups or any other sharps besides sheers, safety pins and lancets for BGL testing. So my solution is to carry what I am trained to use and know how to use and to use them to the extent that any person without a license could. Its a stupid way to have to take care of someone when I have much more advanced training. Its a stupid way when the Red Cross has a list of "first aide-able" injuries and illnesses ranging from sunburn to a collapsed lung.

Would I risk my license and livelihood and perhaps my freedom to save someone in imminent danger of death if I did not act? All I can say is that there are moral and ethical standards which carry more weight than legal ones. I dont intend to let someones 14 year old son or daughter die if its in my power to stop it. That is a decision would make whether or not I was an EMT. If I felt so strongly that I needed to act outside of some very hazy parameters that I decided to do it regardless of the consequences rather than let someone die, before I acted i would let any CAP personnel present know what I was about to do and advise that they might wish to walk about a hundred yards away and not watch me work. Not for my protection because they couldnt see what I was doing but because I dont have the right to put others at legal risk as a result of my actions. Since CAP "orders" carry no legal weight other than me possibly getting 2b'd, I would listen closely to what my superiors had to say and then act based on my judgment of the situation at hand.

The fact is that EMS personnel get sued even when legally covered and medically directed. We recently had an EMT that I work with get sued for cracking a persons ribs during CPR which is a common and accepted risk with the procedure. The person whose ribs he broke is alive and kicking like an Army mule because he broke them. Never mind being an EMT, I am a human being and if knowledge and skills that i have can save someone, anyone from dying, then I have a MORAL DUTY TO ACT and will have to suffer the consequences of my actions. I understand and respect that you would not use extraordinary lifesaving measures that violate CAP regs. Its good to know where you stand. But my training as an EMT says my safety comes first, then my partner, then the patient. Thats SAFETY, not my backside. And rest assured that not only do I use epi when my protocols allows it with the same seriousness with which I draw my duty weapon, I also use that same gravity of responsibility in making the decision to even take my pack off my back and put my hands on someone.

Thanks for your input. Rest assured that I will take it under serious advisement and considering the source have a great deal of respect for it. As to whether it is worth it, the test for that is do I believe that I have better than a 50 percent chance of a favorable outcome. If the answer is yes...well, we will have to see what happens because that is that point at which it is said, "thus ends theory, let us begin the fact."

Quote from: SARMedTech on July 01, 2007, 07:36:00 AM
To my knowledge, no such animal as the USCG Aux Health Services exists.

Actually it does exist!

There are Coast Guard instructions outlining the program and I was almost a part of the program until my real military obligations cut into my volunteer time. Give me some time and I can cite the instructions.

Quote from: SARMedTech on July 01, 2007, 07:36:00 AM
When I looked into joining, one of the reasons I did not join was that they have no program even in place to deal with EMS personnel and have basically what we have except with minimal (and I do mean minimal) coverage. However, it is so minimal, that trying to get them to approve an AED on board a facility is almost impossible. They still are not covered for providing any serious medical emergency care.

Then you looked in the wrong direction!

Quote from: SARMedTech on July 01, 2007, 07:36:00 AM
Theyre pretty much in the same position we are. They do not recognize any health care professionals even to the extent that CAP does.

Negative. The USCG Aux is actually far ahead of CAP in utilizing healthcare personnel. Augmentation is done through local sectors with healthcare clinics. In order to work you must have credentials verified through the USCG and the gurus who run the healthcare augmentation program.

Quote from: SARMedTech on July 01, 2007, 07:36:00 AM
There are no identifying insignia, etc.

Not needed.

Quote from: SARMedTech on July 01, 2007, 07:36:00 AM
The only difference is that on an operation, they allow a flotilla crew that might have an EMT, nurse, doctor, etc aboard to call a land based hospital for minimal medical direction. Their first and primary course of action is to get a USCG AD vessel, helo, medical team, etc to evacuate the person from your facility. They dont even provide for Auxies to perform water rescues if it involves much more than dragging someone on board with a boat hook and they do not allow for something like assisting a distressed motorist by helping them fight a fire aboard their vessel. They have the same report and keep clear policy as we do. The only difference is they are willing to cut members some slack and pick up any slopped over liability if a member acts outside of regs. BTDT.

Sorry, you really don't know your USCG Aux capabilities. I submit that they are far advanced from CAP.

Quote from: SARMedTech on July 01, 2007, 07:36:00 AM
PS- the only time that your professional credentialling as a health care provider comes into play is you meet the exceptionally high security clearances to work as a force augmenter aboard a USCG facility or station.

Well, there you go! You made my point. The USCG Aux is actually a part of the USCG and the high application standards must be met. There are auxiliarists that are in sensitive positions requiring secret, maybe top secret, clearences. In contrast, look at our Civil Air Patrol...tell me what is wrong. I'm sure you can go on for days. Just check out the threads already posted on CAPTalk.

/r
LT

Quote from: PA Guy on July 20, 2007, 07:39:59 PM
Hmmm, where to start. I believe the orig. issue was a discussion over the possible two options for enhancing medical care within CAP. I said I was in favor of option "B" and listed a couple of reasons why I thought option "A" would be a problem. My response was based upon my understanding of the terms natl. and regional in a CAP context. Your lengthy reply inferred I didn't know what I was talking about.

You went over your CV to demonstrate your background. Just so you know where I am coming from I will give you mine.

I have been a member of CAP as a cadet and SM for 45yrs. I have completed Level 4 and held sqdn and group commands. I have been a Wing DCP and did a stint as a Wing Dir. of Gnd. Ops. I am a GTL and MO. I have 7 distress finds, all ground and one save.

Yep, you guessed it I'm a physician assistant (PA). I've been a PA for 30yrs. I have a MPAS from U. of Neb and a MPH in Health Admin. I am NCCPA certified and  completed the US Army Medical Dept. Officer Basic Course. I  worked as an EMT in the bad old days prior to NREMT. I spent 5 yrs working for a large county EMSA, pop. 4.5 million covering >7200 sq. mi.,  doing training and credentialing. I have spent 15 yrs. assigned to a Type I NDMS/DMAT. I have deployed to such places as the WTC, Katrina/Rita, Hurricane Andrew and Northridge. I am semi-retired and instruct part-time in a natl. WMD/EMS program that comes under the Dept. of Homeland Security/Off. of Domestic Preparedness. I also spent 31 yrs as a CA POST certified Level I Reserve Officer in a 300+ officer dept where I wrote the proposal and helped establish their TAC/Med program.

You wrote that you are doing course work to become a "trauma physicians assistant" Are you in a PA program or did you mean you are completing the perquisites to apply?

CG Aux health care providers are credentialed by the Armed Forces Inst. of Pathology, Dept of Legal Medicine. A complete description of the program can be found in COMDTINST 6010.2B dtd 22 Feb 07 at this link http://www.uscg.mil/hq/g-w/g-wk/wkh/pdf/COMDTINST%206010-2B_Revision_10_06_MOS_RECENT.pdf At this time there is no bling authorized for Aux health care providers, besides who needs it.

So let's just chalk this up to a personality conflict and move on. I apologize in advance to the other readers for the length of this post.

Hey you sound like I guy I ran into a while back...are you H. J. J. ?  or J. J. w/ SBPD?

Well, there you go! You made my point. The USCG Aux is actually a part of the USCG and the high application standards must be met. There are auxiliarists that are in sensitive positions requiring secret, maybe top secret, clearences. In contrast, look at our Civil Air Patrol...tell me what is wrong. I'm sure you can go on for days. Just check out the threads already posted on CAPTalk.

/r
LT
[/quote]I have been at the AFRCC at Langley and they let me right in the door, I went to the USCG SAR operations center and they wouldn't let me in the door as CAP.   I should them my other government (non military) ID and they cheerfully let me in.  Maybe they just wanted to keep the rest of the team out!

SAR MED...  I know you like to question my qualifications and others but if I am right...and what a small world...PA Guy and Ned are two guys I spent some time with.   Without blowing anyones cover...   Ned (Sir or better yet "You Honor") and PA Guy (as well as officer) are two very experienced and long standing members of Civil Air Patrol.   I think we all under estimate the knowledge and experience of many of our members.  If I am correct about these two,  both have way understated their qualifications and experience.  Your honor...care to render a verdict?  (am I right?)
PA Guy, didn't you spend some time in the south?

Quote from: SARPilotNY on July 25, 2007, 02:44:22 AM
SAR MED...  I know you like to question my qualifications and others but if I am right...and what a small world...PA Guy and Ned are two guys I spent some time with.   Without blowing anyones cover...   Ned (Sir or better yet "You Honor") and PA Guy (as well as officer) are two very experienced and long standing members of Civil Air Patrol.   I think we all under estimate the knowledge and experience of many of our members.  If I am correct about these two,  both have way understated their qualifications and experience.  Your honor...care to render a verdict?  (am I right?)
PA Guy, didn't you spend some time in the south?

Correct on both counts.

Quote from: SARPilotNY on July 25, 2007, 02:21:57 AM
I have been at the AFRCC at Langley and they let me right in the door, I went to the USCG SAR operations center and they wouldn't let me in the door as CAP.   I should them my other government (non military) ID and they cheerfully let me in.  Maybe they just wanted to keep the rest of the team out!

I don't know what to tell you. DoD vs. DHS. AFRCC recognizes CAP people, USCG doesn't.

CAP has a lot of great volunteers. I feel the CAP structure as it is now doesn't recognize the great pool of contributers it has within it's ranks. CAP is too focused on cadets and "aerospace education" in my opinion...it's too "touchy-feeley". Maybe I'm missing the point of CAP, I don't know. Let's spin up operational assignments and let the cadet/areospace program fall off to those "touchy-feeley" types who want to be in charge of kids.

SARPilot-

Im going to try to address you from now on as a fellow professional and hope that you will return the courtesy. It has been pointed out to me that I have been less than respectful in many of my posts and the message has been received by me 5x5. So please take my questions with the intent with which they were given.

During my EMS training, I worked with a private EMS agency. I worked many, many shifts with them, many mass casualty incidents including a hard landing of an out of state evac helo. When I left and then tried to go back, the agency had received DHS funding for BCNR (biological, chemical, nuclear, radiological) and WMD training and readiness. As such, they are partially under an MOU with DHS. I walked to the door, showed by photo ID to the duty medic and was turned away because I had shown up unannounced. Did you expect that the USCG SAR facility would just let you walk onto the station because you wanted to  be there.

This thread has drifted so a little more wont kill it. AE is important and the CP is very important. But in ES, everything we do, everything we train for carries the possibility of someone ending up dead if we do not do our jobs properly and with absolute excellence and professionalism on a par with our non-military auxiliary counterparts. The fact that the first flights to orbit over Ground Zero were CAP flights should tell us all something. We  are respected and trusted. Now it is time for us to earn the right to be revered and take our place among the best ES agencies in the world. The fact that we all volunteer is of no consequence to me. Training and educational standards must be stepped up. There are qualifications within CAP that should be as selective and rigorous as AFRCC Inland SAR school. Our operators must be trained to function as perfectly in extreme environments as they can on a table top. Our pilots must look at the GT and see professionals carrying out well planned and well executed operations. Our ground crews must know that the "primacy of the air: attitude is gone and has been permanently replaced the attitude of seamless interoperability adopted by most of our pilots.

We all have to work together. I see the need for more team building work for the SMs as we have with the cadets. My hope is that one day you and I will work an operation together and you will be able to look down from your plane as see a ground team utilizing the information you provide in the absolute best way that we can and that we can look up and know that we have pilots not worried about finds or saves, but rather about functioning as a team. An airplane is nothing more or less than a tool. Its an operational platform. We ground pounders carry and wear our platforms. Neither is better, neither is worse. If you tell me you need more color to see me, I need to learn to listen. If I ask you to trust that I am a capable and dedicated ground SAR pperator, I need you to do so. With out these aspects, CAP could well be on its way to being an expensive flight club and that would be the sad day when we ceased to serve our country in the best way we know how.

Darn...I spent over an hour writting a great response ...it  was time out and lost!
Sar Med...no hard feelings.  I have only been on this board a short while but in CAP for a long time.  I find it interesting reading these topics what a small world it is.  There are some really neat old dogs as well as some great new members.  I was correct as to who PA Guy and Ned are.  I have found a couple more that I have worked with both professionally and in CAP in a couple other postings.  Their knowledge base is huge!  I throw stuff out often to invoke dialogue so we can all learn and exchange ideas.  Our organization is far from perfect but I think we all would like to see some productive change.  Your EMS issues are the same we had when I started in the program and as an EMT.  Little has changed.
Keep the gloves (boxing) on...