CAP Talk

On the Yahoo CAP Health Services site we have been discussing training as medics.  Hawk mountin already offers this training, but we have no recognition as a medic for cadets or non medical personell.

Since we already have the authorization of a CPR/first aid patch for the BDU uniform I am proposing we have an ES tital of First Aid responder FAR , or EFAR Emergency First Aid Responder, and IFAR instructor First Aid Responder.  This would allow wing to know who all has had first aid training and who is current.  This would be helpful on missions, Sarex, encampments etc..  Afterall on missions the most we would normaly do is firt aid response and not much more.  We don't need a new badge or tital, or ribbon.  We already have the patch.  All we need to add is the ES qualification in the NiMMS.

How do you all feel about this.  It gives us medical officers some training to administer and helps take the load off us for encampments, missions etc.  It also helps to encourage youth to explore medical fields.

I would like to have a west coast version of Hawk Mountin Medic training to get cadets and seniors qualified as First Aid Responder or instructors.  I would be happy with the help of others at setting this up in Nevada or Northern AZ.  We could also look into getting medical professionals to discuss their professions at the training as well.

sounds cool  but maybe we could hve one for ems/emt training too

MIMS already tracks this qualification as a task (denoted on SQTR's as "Complete Basic First Aid Training or Equivalent").   Since you need it for several different ratings, like Ground Team Member 3, if you have that rating, it's already known that you've completed First Aid training. 

As for EMTs and Paramedics, they already receive proof of their training and currrency from the state.  No need to duplicate.

What First Aid patch? I know CPR patches are authorized, but I haven't seen anything in CAPM 39-1 or subsequent policy letters authorizing a First Aid patch.

CPR is the correct patch, but some CPR training comes with first aid and so the patch lists them both.  I have also seen people wearing CERT patches.   there is even a mountin first aid/CPR patch available.

I was not aware that Nimms had the first aid listed.  I know for ground teams it is part of the training, but so is many things that you would never see others having knowledge of it.  I think it would be better visible if it were an ES specialty and on the 101 cards.

It would be great if people were more known as a first aid responders and when the qualifications expired.   You can be ground team member and have first aid training expired.  It would also encourage cadets to look into medical occupations.  The oversight of the first aid resonder could fall upon wing medical officer and passed down to squadron medical officer and training done by instructor first aid responders.

Give the current legal paranoia over lawsuits, I don't expect to really see anything changing.

One problem CAP has with NIMS (National Incident Management System) is CAP's instance on unique qualifiers and positions. Gradually, this is changing. I recommend going to the NIMS (http://www.fema.gov/emergency/nims/index.shtm) website to review what is happening. There separate typing documents for EMS Resources (http://www.fema.gov/pdf/emergency/nims/508-3_emergency_medica_%20services_%20resources.pdf), Incident Management Resources (http://www.fema.gov/pdf/emergency/nims/incident_mgmt.pdf), and Search and Rescue Resources (http://www.fema.gov/pdf/emergency/nims/508-8_search_and_rescue_resources.pdf). These are how the feds, states, tribes, etc classify and order resources. There is no point in creating more CAP specific titles because they aren't going to be ordered, and, despite how we train and what some members think, CAP is not going to the lead agency on a mission. CAP will eventually either become compliant or become irrelevant.

As for the CERT patch, it is not authorized in CAPM 39-1 or subsequent policy letters. It is also not something wing or region commanders can authorize, per CAPM 39-1.

As for medical oversight, you're looking for a Physician Advisor (PA). I don't see any CAP medical personnel volunteering to put their license and livelihood on the line by becoming a PA for their wing, region, or CAP. Nor would I expect them to. There have been discussions with the AF and the Surgeon General of the AF's office about the AF taking on that role, but so far nothing has come of it. Another item is who does the continuing education? And who tracks it? At the unit level, the staff is usually on the verge of being overwhelmed by just keeping the unit functioning that anything that involves additional records, training, etc, especially for only a small number of members, will most likely be dropped as soon as no one is looking or merely be given lip service to placate higher ups. Add to that, most unit don't have Medical Offiers, Nurse Officers, or Health Services Officers.

I've been an EMT-B for 14 years, a fire fighter for 10, and a haz mat tech for 15, so I have some idea of the problems with running an EMS program, which is exactly what you're proposing.

ps. "tital" is not a word. The word you are looking for is "title".

pps. What is Nimms?

Exactly - what we need is a mission for which we train to respond, not training for a mission we don't have.

We can make more patches later.

The health services forum, as well as the myriad people are well-intentioned, but I am amzed at how much blingage credit people want for non-CAP skills.

As volunteers with no response commitments or espectation of on-call status, we can never be a first responder agency.  That's ok, it one of the  reasons CAP exists.

But since our core mission does >NOT< contain legal or training support for first responder skills, and some states require people with certain skills TO respond regardless, first responder training becomes more of a liability than an asset.

I don't mean this in the "what if we find a victim,then we'll show you, spirit", I mean this in the same quandries some LEO's find themselves -
their department requires they carry a weapon at all times, CAP forbids it - pick one.

Well, we do have response committments, & are organizationally on-call, that just doesn't filter down to the individual in the traditional way it does with paid folks. You call for a team though & one will show up in a reasonable time.

I understand that point about state laws, but the issue there is they are all different. Mine isn't so specific as to define quals. It say sif you have any qualification whatever that could prevent damage to life or property & refuse to render aid when the opportunity p[resents itself then you are criminally & civily liable. Basic first aid does fall under that, as does the ability to use a DF, or a cell phone for that matter. In a lot of states we're over that liability line already & cannot be otherwise, so you can;t just run from the training & risk that goes with it.

Anyway, I would agree that the liability situation currently restricts us form further involvement, at least until congress takes action to extend further coverage to activated volunteer medical personnel in federal service.

I would also agree that first aid is a requirement of even being in the field, so there is no purpose to an additional qualification. At some point the teams rise to the level of requiring an organic EMT, and even at that point you're talking about too many widespread people to manage at the unit level. All this jsut seems like a non-starter.

Quote from: arajca on February 23, 2007, 03:52:45 AM


I've been an EMT-B for 14 years, a fire fighter for 10, and a haz mat tech for 15, so I have some idea of the problems with running an EMS program, which is exactly what you're proposing.

ps. "tital" is not a word. The word you are looking for is "title".

pps. What is Nimms?

You were chasing glowing monkeys before becoming involved in EMS or Fire Suppression?  Ive never heard of that before ...Who were you involved ?

PS- Spell check is always your friend.

Actually, I was in a fire fighter before haz mat or ems. When my fd changed from vol to career, I got out. I kept my hm and ems current as the hm team is volunteer.

Back to topic... Desert Rat-
CAP has an insignia for Certified EMS personnel
EMT-Basics get the tech badge, Intermediates get the Senior and Paragods get the Master rating.
It has a BDU cloth counterpart and that allows an IC or GTL to know at a glance, that he has a trained pro ready to take action.
~ Now as for a suitable EMS Jump Kit that you can pack into the wilderness, I posted some links on a previous thread on GT equipment/ composition

As for CADETS... no offense to anyone, but unless you are a cadet who is 18+ and a certified EMT-B or a CFR, I would not utilize you in a medical role (basic first aid aside)   

I am familiar with the Hawk "medics"  but they just don't come close. Its not an accepted certification either outside of PAWG or in the courtroom.

Quote from: SAR-EMT1 on February 23, 2007, 06:35:10 PM
Back to topic... Desert Rat-
CAP has an insignia for Certified EMS personnel
EMT-Basics get the tech badge, Intermediates get the Senior and Paragods get the Master rating.
It has a BDU cloth counterpart and that allows an IC or GTL to know at a glance, that he has a trained pro ready to take action.
~ Now as for a suitable EMS Jump Kit that you can pack into the wilderness, I posted some links on a previous thread on GT equipment/ composition

As for CADETS... no offense to anyone, but unless you are a cadet who is 18+ and a certified EMT-B or a CFR, I would not utilize you in a medical role (basic first aid aside)   

I am familiar with the Hawk "medics"  but they just don't come close. Its not an accepted certification either outside of PAWG or in the courtroom.

Interestingly enough, a number of folks who go through the HMRS program either have or obtain not long thereafter various certifications that are recognized in the real world.  The Mike-squadron program at HMRS seems to be a jumping-off point for those who have or develop an interest in health professions - quite a few physicians, nurses, PAs, paramedics and EMTs have come from within the program.

^ that's nice & evrything, but we aren't the Civil Medical Patrol. There's nothing about our organization that involves exploration of medical fields. BSA has a medical explorer program for that. It's fine that they provide that inspiration, but it's not a focus of CAP that we're supposed to pursue.

We do on the other hand need more EMTs, and I'd favor tailored recruiting programs to attract them as well as scholarship programs to make some (preferably in exchange for a number of years service - yes I know how problematic that is).

Quote from: DNall on February 23, 2007, 09:17:01 PM
^ that's nice & evrything, but we aren't the Civil Medical Patrol. There's nothing about our organization that involves exploration of medical fields. BSA has a medical explorer program for that. It's fine that they provide that inspiration, but it's not a focus of CAP that we're supposed to pursue.

We do on the other hand need more EMTs, and I'd favor tailored recruiting programs to attract them as well as scholarship programs to make some (preferably in exchange for a number of years service - yes I know how problematic that is).

On one hand you're saying that CAP needs EMTs within its ranks, but on the other you're saying that it's wrong to encourage our cadets to become EMTs [or any other sort of health professional]. That's a bit of a disconnect, to put it mildly. I've encountered some top-flight health-care professionals both in and out of the organization that came up through our cadet program and were inspired to their career choices by their cadet experiences. Are you honestly going to tell me that there's something wrong with that?

Before you go and start comparing HMRS' Mike-squadron track [or any equivelent program] to BSA's Explorer program, I strongly suggest that you pick up a bit more knowledge-in-depth on the program.

I agree strongly that CAP could use more EMTs. Scholarship programs may be a viable way to fill this need. However, unless and until NHQ comes up with a better overall recruiting strategy, niche recruiting of EMS personnel probably wouldn't be productive.

The program does not need more EMT's as a concept.

There is little to no place for their specific skills within the existing ES operational abilities and allowed activities.

The general "emergent mindset" of most EMT's, yes, but not their actual skills, anymore than we need doctors or helicopter pilots.

Quote from: CAPR 60-31-21. f. First Aid and Emergency Medical Care. CAP is not an emergency medical care or paramedic organization and should not advertise itself as such. CAP will not be the primary provider of medical support on missions or training events though qualified personnel can be used to support such activities. The only type of medical aid that should be administered by CAP personnel or by any other person at CAP's request is reasonable first aid deemed necessary to save a life or prevent human suffering and executed by a person qualified to attempt such medical care within their skill level.

Do we need EMTs for CAP missions? Do we need medical officers?  A medical officer is an advisor to the commander.  Can they administer medical exams on CAP people? No, Can they ground a pilot? No, Can they do much of any medical skill?  What they do is help train others in medical minimal skills like first aid etc.  They also help encourge others to seek out medical educations etc.

Do we need baloon pilots or glider pilots or drill instructing on an ES mission?  No, but we still see a value in what they have to teach us.  We even allow people to wear pilots wings for those aviation skills.  The youth learn rocket, and wear a rocket badge, yet that is not an ES mission skill.  The list goes on.

What I am proposing is teaching a first responder skills that adults and youth could easily learn and put to use at home or at CAP functions.  Basic things like dealing with burns, applying a bandage to a minor cut, removing a splinter, dehydration avoydence, understanding hypothermia, insect sting treatment, CPR, etc.  Many people will not chose to be on a ground team and will not go out with those teams.  Why not have some cadets that know these skills and can use them in other areas.  You never know when someone will get a Minor injury at a CAP function or just a routine training day.  Wouldn't it be great if they knew they had a cadet to turn to for help?  For ground teams they can be very handy for the minor accidents to ground team members or other first responders at an incident.

Recognizing a skill like first aid responder with a patch goes a long way towards keeping youth involved in CAP.  It motivates them to learn more and help out.

I was lucky to have been an HPSP (Health Professional Scholarship Program) recipient.  The Army paid my way though dental school.  Most people have no idea about the severe shortages of qualified medical personell in the military.  The services spend alot of money each year recruiting and training officers and enlisted for medical careers.  Most youth do not know of all the opportunities that are available for further training in military medical careers.  We have an opportunity to set up a special program encouraging youth to seek out the training to become a medical specialist for the services.  They may even seek out to become flight nurses or doctors.  An introductory national training event would allow us to expose cadets to a field they may not know they could do.  It may help the military branches fill the growing need for medical help.  If professional volunteers are willing to staff this event then I say, do it.  Why not give out a ribbon and a cadet recognition like, red baret, or badge, or patch so that we keep kids motivated and excited about CAP and military opportunities.  When these youth and seniors come back from a medical national encampment they could be an awsome resource for their squadrons.

Quote from: desert rat on February 23, 2007, 11:01:48 PM
Do we need baloon pilots or glider pilots or drill instructing on an ES mission?  No, but we still see a value in what they have to teach us.  We even allow people to wear pilots wings for those aviation skills.  The youth learn rocket, and wear a rocket badge, yet that is not an ES mission skill.  The list goes on.

All of the above can fully participate using their skills within the program, without modification to any regs, dialing-down their abilities, or "fudging the line".

Medical professionals cannot.

And just because yo are an EMT or MD, does not mean you are certified to train people in First Aid or anything else.  In most cases the inverse is true.

Do we want medical professionals in CAP?  Yes.  Shoudl we recruit them based on their medical skills, no.

I can recruit a pilot, and he will fly. A Dr., who expects to use his skills in CAP will just get frustrated.

Bob, it sounds like you have an issue with medical officers.  I would hate to be in your squadron where you don't value the talents of others.

I wouldn't recruit any member based on their occupation or licenses.  I would recruit them based on their desire to serve, and commitment, and morals.  I would want good adults and youth, not pilots or doctors.

Many doctors are pilots.  The number 1 killer of doctors is flying. (probably because so many can afford a plane and don't fly enough to stay proficient)  You would be amazed as to how many medical professionals are trained as CPR instructors and also first aid instructors.  they are also qualified to give continuing medical and dental education much more in detail than a first aid course.  Take a poll sometime and look at all the skills your medical personel bring.

As a medical officer I don't get frustrated because I can't use the skills I use all day at my job.  I actually hope I never ever have to be involved in a CAP rescue.  I will however render first aid to any CAP member at any function I am involved with.  I have also registered myself and my office to be used by the Gov. in the event of an emergency, like a national disaster or epidemic.  I have also recieved CDC training in epidemics and disasters, and FEMA training.  In the State of Nevada dentists and other medical professionals are required to learn how to deal with bioterrorism.   Much of the medical officers in CAP have been militery trained and can command and offer help in other areas outside medicine.

I like to train in some ES, I also like working with cadets and mentoring them.  I am in a continued state of learning and hope to gain much broader skills with CAP and to gain more friendships.  It is not all about being just one thing or another.  I would however help cadets and senior members understand about the opportunties available to them.

I've run across a lot of doctors in CAP and not one of them has ever taught a First Aid class, done any ground team "medic" work or anything along those lines.  One of them does flight exams as part of their practice and has occassionaly piped up on medical-related issues during squadron meetings, but as a general rule their professional background has not been of any specific use to CAP.  I'm not saying that this is the case everywhere, just my own experience. 

Oh, I don't know about Bob having an issue with medical officers, doc.  If he ever gets a toothache at a sarex I'm sure you will be at the top of his list of new best friends.

But if you really want to help, learn to fly.  ;)

Quote from: desert rat on February 23, 2007, 11:01:48 PM

What I am proposing is teaching a first responder skills that adults and youth could easily learn and put to use at home or at CAP functions.  Basic things like dealing with burns, applying a bandage to a minor cut, removing a splinter, dehydration avoydence, understanding hypothermia, insect sting treatment, CPR, etc.  Many people will not chose to be on a ground team and will not go out with those teams.  Why not have some cadets that know these skills and can use them in other areas.  You never know when someone will get a Minor injury at a CAP function or just a routine training day.  Wouldn't it be great if they knew they had a cadet to turn to for help?  For ground teams they can be very handy for the minor accidents to ground team members or other first responders at an incident.

Gee, that almost sounds like CERT!!

;D

Quote from: desert rat on February 24, 2007, 12:01:21 AM
Bob, it sounds like you have an issue with medical officers.  I would hate to be in your squadron where you don't value the talents of others.

That's a troll if I have ever seen one. 

Medical Officers don't have any FUNCTION within CAP, our conservative NHQ and the lawyers have seen to that. I have photos from the Nat Geographic that show CAP members hanging IV's in the field, that was then, this is now, and we have 9-1-1.

This isn't an issue of respect, this is an issue of reality and our mission.

And if I get a toothache at a SAREx that is bad enough to not be able to knock back with Advil, I'll GO HOME.

That's how it works, we're not the Delta force and the world will go on without me. 

Despite the overt acceptance that we have no outward-facing medical capabilities, we continue to talk about and actively recruit medical professionals, especially first-responder types, then we can't figure out why they get frustrated and quit.

Quote from: Eclipse on February 24, 2007, 02:38:08 AM
Medical Officers don't have any FUNCTION within CAP, our conservative NHQ and the lawyers have seen to that. I have photos from the Nat Geographic that show CAP members hanging IV's in the field, that was then, this is now, and we have 9-1-1.

This isn't an issue of respect, this is an issue of reality and our mission.

Our mission is to go into the field & ve prepared to address anything we find there. It is unfortunate lawyers have screwe dup the law & it has to be fixed, but that'll happen soon enough, you can relax till then. When it does, I think you'll find medical personnel cn be forced to duty just like chaplains can now.

QuoteAnd if I get a toothache at a SAREx that is bad enough to not be able to knock back with Advil, I'll GO HOME.

See that's fine, but if you just get bored & leave... well in Texas you can go to jail. Just like if you're an EMT & refuse to render aid at a car wreck. No one is delta force, not even CAG is the delta force. You still have a moral & legal obligation to use your training to help people.

QuoteDespite the overt acceptance that we have no outward-facing medical capabilities, we continue to talk about and actively recruit medical professionals, especially first-responder types, then we can't figure out why they get frustrated and quit.

FEMA requires EMTs on ground teams at a certain level, so we will be tapping those people, but there isn't a lot of need for other types of medical folks. I can envision deploying medical teams, our SDF here has something like that but I don't know much about it, but that too would be held up till congress gets the law fixed for FEMA.

This is a bit off topic, but Id be interested to see anything on this Article National Geographic did on us in the old days.

Quote from: SAR-EMT1 on February 24, 2007, 06:14:39 PM
This is a bit off topic, but Id be interested to see anything on this Article National Geographic did on us in the old days.

The article is at the hut, I'll grab it an scan the pics for a future post.

Its titled "Minutemen of the Civil Air Patrol" May 1956, and its regularly available on eBay, though I can't seem to find it right now...

There are several roles that HSO's can do that have not yet been suggested.

One that has been around is preventive medicine. I've had or Stroke nurse come in and talk about CVA's. I've done talks about flu shots and pneumonia shots. I need to do one on the President's challenge. I also did one on CBNRE awareness.

Two is Aero Medical issues. I've done one on the FAA and medications. Over the counter medications is also a good topic. The handout from that one was put into the squadron's pilot read and sign book. I've done another based on the AOPA Pilot article on regaining your medical after open heart surgery. A good yearly topic along with Safety is IMSAFE.

A good aerospace ed and HSO cross topic is Air EMS. I'm going to try and arrange for our local helicopter EMS to come in and show off their bird and talk about things like helicopter safety and setting up LZ's. We had them scheduled for last fall but a maintenance issue came up and left the short of birds. I also work per Diem fixed wing so I'm going to see about getting our King Air to come in.

As for actual and SAREX mission skills, the HSO should be the expert on local EMS and Fire emergency response. Inter agency liaison is the mission niche HSO's should be called upon to perform. The HSO hand in Hand with Safety should be writing the ICS 206. Who else should have the knowledge of who the EMS agencies are, where the nearest hospital is, what are the capabilities, etc.? We work in the system. We can (and maybe should) be the person who interacts with the medical branch in a distressed find or mass casualty incident.

There are non clinical roles the HSO can and should fill. And, at the risk of sounding cynical, I do CPR, start IV's bind wounds, apply splints every day. Can't I do something else  :D

Quote from: flyerthom on February 25, 2007, 06:21:06 AM
There are several roles that HSO's can do that have not yet been suggested.

One that has been around is preventive medicine. I've had or Stroke nurse come in and talk about CVA's. I've done talks about flu shots and pneumonia shots. I need to do one on the President's challenge. I also did one on CBNRE awareness.

Two is Aero Medical issues. I've done one on the FAA and medications. Over the counter medications is also a good topic. The handout from that one was put into the squadron's pilot read and sign book. I've done another based on the AOPA Pilot article on regaining your medical after open heart surgery. A good yearly topic along with Safety is IMSAFE.

Sounds like general informational issues. Nothing truly HSO specific.

QuoteA good aerospace ed and HSO cross topic is Air EMS. I'm going to try and arrange for our local helicopter EMS to come in and show off their bird and talk about things like helicopter safety and setting up LZ's. We had them scheduled for last fall but a maintenance issue came up and left the short of birds. I also work per Diem fixed wing so I'm going to see about getting our King Air to come in.

ESO?

QuoteAs for actual and SAREX mission skills, the HSO should be the expert on local EMS and Fire emergency response. Inter agency liaison is the mission niche HSO's should be called upon to perform. The HSO hand in Hand with Safety should be writing the ICS 206. Who else should have the knowledge of who the EMS agencies are, where the nearest hospital is, what are the capabilities, etc.? We work in the system. We can (and maybe should) be the person who interacts with the medical branch in a distressed find or mass casualty incident.

I actually brought this idea up, and I have been deafened by the incredible silence from higher ups. I wrote and submitted the SQTR and the necessary tasks, but so far National hasn't bitten. There are no treatment requirements in it, just coordination by a knowledgeable professional who happens to be a CAP member.

QuoteThere are non clinical roles the HSO can and should fill. And, at the risk of sounding cynical, I do CPR, start IV's bind wounds, apply splints every day. Can't I do something else  :D

That's a problem CAP has when it gets new seniors. We ask them to do what the do for a living and generally don't listen to what they want to do, or place it as a secondary choice.

Quote from: Eclipse on February 24, 2007, 02:38:08 AM

Medical Officers don't have any FUNCTION within CAP, our conservative NHQ and the lawyers have seen to that.

It is not all that mysterious or technical.  It has very little to do with NHQ or the evil lawyers.

Health professionals who practice medicine need to have malpractice insurance.  Not a very "CAP-specific" issue, as it is necessary for every single doctor or nurse who puts their hands on patients in any organization in the US.  Ask any health professional and they will tell you about their insurance and how much it costs.

Since CAP cannot afford to carry malpractice insurance for our health professionals,  they cannot anything other than emergency care.  A malpractice policy to cover errors and omissions for our various MDs, DOs, RNs, and the supporting professionals so they could perform routine care in all 50 states for not only our members, but members of the public as well would literally cost hundreds of thousands of dollars a year from any reputable malpractice carrier.

Go ahead -- price it out. 

So if we good find a rock-bottom price for, say, $600,000 a year it would add about $100 per year to each of our dues.

Is it worth more than doubling our dues?

And there really isn't any practical alternative.

Good Samaritan laws do not cover members of an organization treating other members of the same organization, nor routine care given to members of the public.

Ned Lee
Former CAP Legal Officer

If it was part of an Air Force mission, then CAP the AF would be backing up their actions just like they back up our pilots and everyone else in regards to insurance.  So "liability" could be covered that way.  However, I'm assuming the AF hasn't been willing to take on the potential for such liability by allowing us to provide more medical care, even on actual SAR missions or we would already have done it. 

Quote from: Ned on February 25, 2007, 06:55:07 PM

Quote from: Eclipse on February 24, 2007, 02:38:08 AM

Medical Officers don't have any FUNCTION within CAP, our conservative NHQ and the lawyers have seen to that.

It is not all that mysterious or technical.  It has very little to do with NHQ or the evil lawyers.

Health professionals who practice medicine need to have malpractice insurance.  Not a very "CAP-specific" issue, as it is necessary for every single doctor or nurse who puts their hands on patients in any organization in the US.  Ask any health professional and they will tell you about their insurance and how much it costs.

Since CAP cannot afford to carry malpractice insurance for our health professionals,  they cannot anything other than emergency care.  A malpractice policy to cover errors and omissions for our various MDs, DOs, RNs, and the supporting professionals so they could perform routine care in all 50 states for not only our members, but members of the public as well would literally cost hundreds of thousands of dollars a year from any reputable malpractice carrier.

Go ahead -- price it out. 

So if we good find a rock-bottom price for, say, $600,000 a year it would add about $100 per year to each of our dues.

Is it worth more than doubling our dues?

And there really isn't any practical alternative.

Good Samaritan laws do not cover members of an organization treating other members of the same organization, nor routine care given to members of the public.

Actually I'm pretty confident the price would be a good bit more than that. There's also the issue of deploying outside the state in which you're licensed & the other state recognizing your credentials to practice, which is not universal & varries even between different kinds of licenses.

There are two kinds of alternatives currently being considered by Congress, but the details, side issues, & loop-holes are signigicant & time consuming to overcome. One is that volunteer medical workers requested to deploy by the federal govt would be covered by the govt during the mission.

Supplementary to that is the idea of restructuring the HSO career field so that medical professionals are recallable like chaplains are, which may serve to extend coverage beyond formal missions to routine CAP activities, but that gets complicated.

Yet another option is to tie in with DMATs as reserve PHS officers, or to create a similiar structure subordinate to DoD. That too is rather complex as I'm sure you can imagine.

It will be worked out, it just takes time. Be patient, we'll be back hanging IV bags in teh field in no time.

River, the liability coverage of CAP, both on & off mission, is very limited and excludes the kind of limits that would be necessary to legally provide medical care. Likewise there are many state laws requiring that care in emergencies with varrious hold harmless arrangements. HSOs should be highly familiar with these distinctions & take extreme care as to what situations they allow themselves to end up in.

Granted I'm not up to date on exactly how CAP's insurance works, but as I understand it we have one policy to cover CAP-specific activities but that there isn't any insurance policy for AF-Aux activities and that we are included in the federal government which is "self-insured".  I'm sure the problems with providing medical care while on "CAP-time" would be insurmountable, but I don't see that it would be overwhelming to make it possible for care to be given while on AFAMs. 

What we have on AFAMs isn't the same kind of coverage & wouldn't extend to medical malpractice at all, much less in the amounts necessary for required coverage. That coverage is spelled out pretty well if you want go track it down. The insurance policy for the rest of the time is basically the same level of coverage but covered by a private company, and that policy is paid by the AF as required by Congress.

If the amount is actually only 600k, then write the justification statement to AF to add that policy as an appropriated item, and when making that request explain how much easier it would be if congress extended govt self-insured coverage to CAP medical personnel on AFAMs in accordance with the FEMA request, or if AF helped find another way to deal with it under their jursidiction, then let them lobby on. It'll get taken care of.

I would be in CAP regardless of being a medical officer or not.  I would still offer my services to train others in CPR and first aid as a certified instructor (many CAP medical officers do this), A medical officer is a highly trained individual that can do alot for a squadron and wing.  One of the major roles of a medical officer is that of being an advisor. 

A good commander would utilise all the tootls he/she has available to him/her.  One of those tools is seeking out advice from a medical officer, or chaplain, or flight crews etc.  Not listening to advisors is a definate sign of a commander being ill trained and ill fit for a command position.  I uderstand command because I was trained to command in the military and in CAP.

CAP does place a value on having medical officers in their membership.  They do not expect us to go out and do field trauma.  Many of us (even dentists) have been trained for this and could to it, but we are not looking for the opportunity.  Like most other health professionals, I see blood and trauma daily.  I do not need to see more on my days off. 

Getting pissed of and leaving CAP over not being able to save lives in the field is not really going to happen with most medical officers.  CAP is more than that.  This is the same reason why pilots who lose their pilots license don't just up and walk out.  I think within CAP there are so many opportunities to volunteer that a person can always find interest.

By the way, don't call a person a troll unless you know what you are talking about.

Interesting topic.  Glad to see so many health service officers, medical officers, and nurse officers leading this discussion.  (That was sarcasm.)

I'm a physician and I joined CAP not to further my trade in the healing arts, but to serve my community and country.  To put my enthusiasm, selflessness, and considerable personal and financial energy to work for good causes.

I looked over CAP for a full month before joining.  Looked the web site up and down, checked out local units, googled multiple CAP topics, even bought and read "Aerospace: The Journey of Flight" before joining (yep, Yeager award was my first accomplishment).  Looking over what CAP did impressed me.  I wanted to join to help out.  And I liked the cadet programs where I felt I could be a good role model and mentor to cadets while also imparting some good health advice that might stick.

Did I join to be a "trauma-rama" hotshot at crash sites?  No.  Am I here for the bling and prestige (you know we go right to Captain as a licensed physician, then Major after only a year ...)?  Nope, already have that as a doctor.  Am I here for the big bucks?  Yeah, right.

I'm here as a volunteer to help any way I can.  That's probably the main reason any health professional joins CAP.  Yes, we know we can't practice medicine (the regs are pretty clear on that), but there are so many other reasons for being a part of this organization.  And many more things medical officers – and health services officers – can do for your squadron and members.

Many topics have already been discussed, where HSO's are an asset to CAP.  Health and Safety briefings being a very important one.  I've done them on color-blindness, hypoxia, smoking, meningitis vaccine (recommended for our young adults), lightning strike injuries, blood borne pathogens, etc.  Sure they can be done by others.  I hope I bring more experience and insight to them rather than a layperson doing a canned PowerPoint presentation. 

And our role as advisors is not an insignificant one.  Probably one of the most important.  Extreme environment advise, can Johnny do PFT with that ankle injury, reviewing all medical forms and informing the squadron commander about what possible problems may lay ahead during the upcoming activity or weekend event, drug interactions, which meds will make Johnny dehydrate faster out on the parade ground, who's blood sugar needs to maintained, illicit drug information, etc.  HSO interaction with cadets and participation in the cadet program is probably where HSO types can do the most good in CAP.  And as many of you know, we instituted a volunteer senior member physical fitness program in the Missouri Wing last year ("GetMOCAPfit").

I'm a Group Commander.  I'm a Wing R&R Officer, Assistant Wing Med Officer, and Assistant Wing PAO.  Was awarded last year's Wing PAO of the Year for Missouri.  I've got specialty ratings in six specialties, none of which are health services.  Yes, I know that none of these duties are as a medical officer (well, the Asst. Wing MO is, of course) – but what if I hadn't joined?  Medical types bring much enthusiasm in with them, they truly want to reach out and help others.  My continuing accomplishments are a direct outcropping of this phenomenon.  We have such a retention problem in this organization already, why are we trying to make it worse?

Are medical officers REALLY worthless in CAP?  Shouldn't we be welcoming any one who wants to participate to join CAP?

Is the negative tone of this discussion thread part of the solution or part of the problem?

They are by no means worthless, there is just very little function within their specialized skill set that is critical to keeping the Sq operating, a lot of nice to have elements but not critical, and even at that we don't have enough to keep them as busy as our critical positions have to be. You have to be creative to make best use of HSOs, and while I know we're capable of that, most units are pre-occupied keeping their heads above water to accomplish the minimum based on teh massive administrative load they shove down on us.

The growth area for medical skills in CAP is with EMS types working on GTs. FEMA is requiring that at a certain level & we'll be working to meet it with a few teams. Certainly a lot of medical personnel aren't going to be qualified or interested in that work, and that's fine. We're also going to need people at the next level to administer those personnel, and we're still going to need all the things that medical officers can do for us now. Anything beyond that would require some significant changes.

Quote from: DrDave on February 26, 2007, 10:08:50 PM
Interesting topic.  Glad to see so many health service officers, medical officers, and nurse officers leading this discussion.  (That was sarcasm.)

.....
I'm a Group Commander.  I'm a Wing R&R Officer, Assistant Wing Med Officer, and Assistant Wing PAO.  Was awarded last year's Wing PAO of the Year for Missouri.  I've got specialty ratings in six specialties, none of which are health services.  Yes, I know that none of these duties are as a medical officer (well, the Asst. Wing MO is, of course) – but what if I hadn't joined?  Medical types bring much enthusiasm in with them, they truly want to reach out and help others.  My continuing accomplishments are a direct outcropping of this phenomenon.  We have such a retention problem in this organization already, why are we trying to make it worse?

Are medical officers REALLY worthless in CAP?  Shouldn't we be welcoming any one who wants to participate to join CAP?

.....

My hat is off to you Doctor. I couldnt have said it better.... lo that I am merely a simple trauma monkey... 

Stood in the hallway for 2 hours today with a MVC victim before a PA would admit her...
Anyway... Just curious sir; what is your field?

Quote from: DNall on February 26, 2007, 10:25:35 PM


The growth area for medical skills in CAP is with EMS types working on GTs.

Don't know if this topic came up yet, I scanned over the topic, so forgive me if this has already been mentioned.

As another trauma monkey, there's one big question I have. Everyone is shouting "Let the EMT's and Paramedics and RN's do what they're trained to do!"  Great, absolutely. But there's many problems with that.

Insurance and liability has been raised already. Someone has to pay when someone screws up in the field, big brother blue doesn't want to, NHQ doesn't want to, so it's not happening.

Second, and more concerning, is medical control. Who's going to serve as the medical control for any person working as a CAP member? Last I checked, EMT's, paramedics, RN's, all of them require orders from a licensed physician before they can render anything beyond basic first aid. In the field, there's standing protocols at different levels that allow EMS personnel to do their job (advanced airway, drugs, etc), and they STILL have a medical control that they can contact and clarify or recieve orders from. RN's in the hospital have an MD they can contact for orders, or can execute standing orders. But, and I emphasize, NO EMT, Paramedic, or RN can do anything without a form of order. Even flight nurses on HEMS crews or fixed wing have protocols and medical control to contact.

I'm glad there are doctors out there commenting on this, and I'm very glad we have you all as members. I'm not sure how many are Emergency Medicine or Trauma/Surgical Critical Care doctors, but despite the training doctors DO have, just because the person is a doctor does not make them the end all know all in the field. Dentists, podiatrists, infectious disease specialists, optometrists, internal medicine doctors, all of them had training at one point or another in what to do when patients go south. Most, if not all, at least hold ACLS certification. Awesome. And most want to help, in or out of the hospital, which is great as well. Doesn't make them the best consult, or even a consult you may want, in the field during an emergency. Granted some is better then none, but I've seen MDs in the field, trying to help the EMS crew, get in the way, and almost hurting people (doc tried to roll ejected MVC patient w/o someone holding c-spine, paramedic almost tackled him.)

So, to the doctors that are members out there, who would like to serve as medical control during a mission? Cuz god knows no hospital will do medical control for an unlicensed and unregulated ad-hoc ES organization who just so happens to have a few EMTs and Medics in the mix. Too risky, too much liability.

What I think should happen is that squadrons and wings that are active in missions need to make contact with the state and county EMA's, along with the EMS response services. If you have a downed aircraft that's missing and you're looking, your best bet is to get them involved, and perhaps have them assign a medic crew to your ground team, wherein if a find is made, a trained, licensed, and LEGAL EMS team is already there to begin care. Not saying our members cannot help if needed, but you have people who are properly licensed, operating within protocols under med control, and have insurance.

Or, just do what we continue to do and call 911 when you hit the scene. Unless you're way out in the boonies, they're usually not too far away. Besides, once you say you have the find, every EMA, sherriff, police officer, EMT, fire department, and boy scout troop within 30 miles is going to be converging on that location. Keep the patient still, stabilize them within first aid training and protocol, and wait for the calvary.

Bottom line, first aid, maybe first responder, is all anyone in CAP is ever going to be permitted to do. Anything that anyone trained beyond that level does is outside the scope of their operations as CAP members. No health care provider wants to be standing in court before the judge while he's asking why you did such an such a thing while not duly authorized to do so. What FEMA wants is not really the scope we're under. Yeah, we work with them sometimes (Katrina, other DR activities). But does FEMA have a lot to do with most GSAR operations for missing aircraft, persons, or other small, localized missions? AFRCC handles it, not FEMA. They do the tasking, they call the proper people out as they see fit.

And to the HSOs out there that help out with everything in CAP: thank you. You guys are an invaluable asset, and your expertise and knowledge helps keep us all safer.

SAR-EMT1: I'm a family physician in private solo practice in southwest St. Louis County, Missouri (suburban practice).

SJF,
I understand where you're coming from, but the issues must be addressed for the future, not based on what we have right this second.

The liaiblity situation must be addressed by either AF-funded malpractice coverage or congressional action to include that in the federal coverage extended to us, both of which are currently under consideration, I don't know about the insurance, but the federal coverage is going to pass eventually.

Far as control & administration, those are different things:
The SOP would be established by AF surgeon general, who we are working with already.

The administration of the people & policies would probably need to be done by HSOs on our end, but would have to be accountable to AF seperate from the CAP chain of command.

The controlling authority you mention in detail already exists & always has. You know they have an trauma surgeon on duty or on call at AFRCC 24hrs a day expressly for that purpose? Cause they do. And they have a direct hotline to all kinds of specialized AF medical resources that they'll put on a conference call right into your cell phone out there in the sticks, all you have to do is ask. You'll find that
to be the same system PJs call for medical orders in stateside deployments.


Far as FEMA, there's isn't a them & us. There's a system all emergency responders have to comply with or go home & not get any federal funding, and it doesn't matter if FEMA is in charge or not. CAP is not exempt & NB has voted to comply. That means all GTs will become WSAR teams. Now at type III & below you rely on local EMS (type III is them tagging along, type IV is them on call). At type I&II you need an EMT on the team (type I is EMT per team, type II is EMT per 48 person task force). Every GT will not be type I&II, the large majority will be the kind of work we do now, which is type III&IV, but on the Wg & Reg levels there will be pre-set type I&II teams listed so that if we need to send such people to Katrina or whatever they'll be ready to go.

Quote from: Dustoff on February 24, 2007, 01:54:10 AM

Quote from: desert rat on February 23, 2007, 11:01:48 PM

What I am proposing is teaching a first responder skills that adults and youth could easily learn and put to use at home or at CAP functions.  Basic things like dealing with burns, applying a bandage to a minor cut, removing a splinter, dehydration avoydence, understanding hypothermia, insect sting treatment, CPR, etc.  .....

Gee, that almost sounds like CERT!!

;D

Yes, it does sound a lot like CERT, which is why we're using the CERT textbooks at our next Ranger School in March. Disaster Medical Operations pts I and II, plus Light SAR with emphasis on how the concepts of Light Urban SAR (sizeup, damage assessment etc) can be used on the scene of a crash in order to ensure team and victim safety. To me, the concepts of CERT and how we might have to react in a worst-case scenario (traumatic injuries with medical care enroute but not expected immediately) are very similar. NHQ has a policy on First Aid training that you can read at http://capnhq.custhelp.com/cgi-bin/capnhq.cfg/php/enduser/fattach_get.php?p_sid=t_N87lvi&p_accessibility=0&p_redirect=&p_tbl=9&p_id=1309&p_created=1088005402&p_olh=0 (http://capnhq.custhelp.com/cgi-bin/capnhq.cfg/php/enduser/fattach_get.php?p_sid=t_N87lvi&p_accessibility=0&p_redirect=&p_tbl=9&p_id=1309&p_created=1088005402&p_olh=0). We would like to train at this level, but it's not going to happen over a weekend school, so for now we're going to concentrate on immediate post-find actions.

As far as liability, Florida has the Good Samaritan Law.

---

Good Samaritan Act; immunity from civil liability.—

(1) This act shall be known and cited as the "Good Samaritan Act."

(2)(a) Any person, including those licensed to practice medicine, who gratuitously and in good faith renders emergency care or treatment either in direct response to emergency situations related to and arising out of a public health emergency declared pursuant to s. 381.00315, a state of emergency which has been declared pursuant to s. 252.36 or at the scene of an emergency outside of a hospital, doctor's office, or other place having proper medical equipment, without objection of the injured victim or victims thereof, shall not be held liable for any civil damages as a result of such care or treatment or as a result of any act or failure to act in providing or arranging further medical treatment where the person acts as an ordinary reasonably prudent person would have acted under the same or similar circumstances.

Quote from: DNall on February 27, 2007, 07:32:15 PM
SJF,
I understand where you're coming from, but the issues must be addressed for the future, not based on what we have right this second.

The liaiblity situation must be addressed by either AF-funded malpractice coverage or congressional action to include that in the federal coverage extended to us, both of which are currently under consideration, I don't know about the insurance, but the federal coverage is going to pass eventually.

Far as control & administration, those are different things:
The SOP would be established by AF surgeon general, who we are working with already.

The administration of the people & policies would probably need to be done by HSOs on our end, but would have to be accountable to AF seperate from the CAP chain of command.

The controlling authority you mention in detail already exists & always has. You know they have an trauma surgeon on duty or on call at AFRCC 24hrs a day expressly for that purpose? Cause they do. And they have a direct hotline to all kinds of specialized AF medical resources that they'll put on a conference call right into your cell phone out there in the sticks, all you have to do is ask. You'll find that
to be the same system PJs call for medical orders in stateside deployments.


Far as FEMA, there's isn't a them & us. There's a system all emergency responders have to comply with or go home & not get any federal funding, and it doesn't matter if FEMA is in charge or not. CAP is not exempt & NB has voted to comply. That means all GTs will become WSAR teams. Now at type III & below you rely on local EMS (type III is them tagging along, type IV is them on call). At type I&II you need an EMT on the team (type I is EMT per team, type II is EMT per 48 person task force). Every GT will not be type I&II, the large majority will be the kind of work we do now, which is type III&IV, but on the Wg & Reg levels there will be pre-set type I&II teams listed so that if we need to send such people to Katrina or whatever they'll be ready to go.

I'll be honest, I wasn't aware that AFRCC had that type of on call staffing.

I've got a pretty good beat on how the civilian world EMS works, and how we'd need to have our people licensened in each state they intend to practice in, but how does that work for persons under a federal entity, like PJ's or Field Medics activated in a federal disaster/emergency? I know that they usually have them get the NREMT certification and registry exams, but are they exempt from state EMS regulations when it hits the fan?

And it's good to know they have a nice med staff like that who you can call. But I'll be honest, and most field personnel would agree, I'd rather be getting consultation from the trauma surgeon I'm 10 minutes out from dropping this patient on then one that's 500 miles from me in an office. And doing over-the-phone triage is a PITA to begin with. You need to have our personnel with the advanced skillset and protocol to do them (chest tubes, advanced airway, cric, needle decompression, central lines), as well as providing the training and CE to keep them in line with that protocol. Medics that run with a rural ALS unit aren't going to have that kind of protocol, and keeping them trained and proficient would be a real big undertaking, financially and logistically.

I'd be curious if we could get individual wings with the licensed personnel registered as a standby EMS company for activation during emergencies? That way the state EMS board is on board, they'd have established protocol and local medical control, and I think it would improve relations with the other EMS/EMA communities in the state, or at least, make yourselves known to them.

Realistically, we're not going to be dealing with severe trauma that much...either the folks have died or else their injuries were light enough to let them survive until we reached them.

That said, I'm still a big fan of this type of training, not only for how the cadets may be able to use it in CAP, but how it may be used in real life or even the career field they may choose to go into. There are other things to consider as well.

A year ago, my stepson had dropped out of CAP after a year in. He had let his hair and clothing go and was in danger of being kicked out of school; we were concerned that he wouldn't be able to pass a drug test if he tried.

Since then, he has rejoined CAP, been to HMRS, been accepted onto Ranger Staff (they asked him if his school grades were good enough to be one of them during the staff selection board and he brought them up to As and Bs afterward) and is in serious contention for the Florida Wing Honor Society. Now he wants to be a paramedic.

All this because somewhere along the line, he learned that it was possible to makea difference in someone's life, and for the first time in his life realized that there was more important stuff to do than take care of Number One.

Send him over to www.flightweb.com

There's actually an interesting conversation re: paramedic vs RN. Paramedic is good for the glory ~5% of the time, the rest it's scoop and run. Unless you're on a CC transport team or a flight team.

Helicopter and FW EMS is where the party is at. If he wants the $$ and the fun, tell him to take the 2 years he'll dedicate to his EMT-B and EMT-P, get his associates in nursing, get into an ER/Trauma center, do his bachelors online, do the paramedic cert while you're working as nurse (and making the nurse $$$, which isn't that great, but it's better then a medic salary, unless you're with a major FD), and get onto the choppa!

That's if he REALLY wants to be all into the action and all. Street medics are awesome, and we'd be lost w/o them, but if he wants the real hardcore stuff, just tell him to think about who the paramedics call when it's really going down hill and they're not close to an appropriate facility.


Totally off topic, but some good advice I've picked up over the years. I'd be glad to get him in contact with people in both career fields if he's interested.

Quote from: SJFedor on March 02, 2007, 07:41:13 AM
I've got a pretty good beat on how the civilian world EMS works, and how we'd need to have our people licensened in each state they intend to practice in, but how does that work for persons under a federal entity, like PJ's or Field Medics activated in a federal disaster/emergency? I know that they usually have them get the NREMT certification and registry exams, but are they exempt from state EMS regulations when it hits the fan?

Military EMTs (including PJs) are fedally licensed, I think DoT still runs that. The dotors & nurses are too, as are PHS & DMAT personnel. All those licenses are universally recognized by every state. As you know the rules are a bit more quirky for some state licenses going to other states, in general though, you're talking about people that are going to be licensed in & operating in-state. I wouldn't be against assistance to upgrade to federal licenses though. Maintaining your skills (including logistics & cost) is part of your day job. CAP didn't train you to be an EMT or pilot, they are just using you for that outside specitization that we need on our team or we can't go.

QuoteI'd be curious if we could get individual wings with the licensed personnel registered as a standby EMS company for activation during emergencies? That way the state EMS board is on board, they'd have established protocol and local medical control, and I think it would improve relations with the other EMS/EMA communities in the state, or at least, make yourselves known to them.

That's over my pay grade & out of my field. You'd have to spend some time with the HSO community to figure that out. I'd tell you that we may e able to come up with the EMTs, but we'll never come up with internal emergency physicians to oversee the program.

When you deploy on a FEMA mission, you're going to e comming from out of area with your EMTs holding a license recognized in the state you;re deploying to & federally provided malpractice coverage. There will be a whole medical branch in that IC structure that they link in with & will go thru for field consults & such. Where you take any patients you come up with may be a tent in a walmart parking lot, or it may be loaded to trafitional or helo EMS. For the most part you're talking about triage, and stablization for someone else to transport.

Quote from: SJFedor on March 02, 2007, 05:27:15 PM
Send him over to www.flightweb.com

There's actually an interesting conversation re: paramedic vs RN. Paramedic is good for the glory ~5% of the time, the rest it's scoop and run. Unless you're on a CC transport team or a flight team.

Helicopter and FW EMS is where the party is at. If he wants the $$ and the fun, tell him to take the 2 years he'll dedicate to his EMT-B and EMT-P, get his associates in nursing, get into an ER/Trauma center, do his bachelors online, do the paramedic cert while you're working as nurse (and making the nurse $$$, which isn't that great, but it's better then a medic salary, unless you're with a major FD), and get onto the choppa!

That's if he REALLY wants to be all into the action and all. Street medics are awesome, and we'd be lost w/o them, but if he wants the real hardcore stuff, just tell him to think about who the paramedics call when it's really going down hill and they're not close to an appropriate facility.


Totally off topic, but some good advice I've picked up over the years. I'd be glad to get him in contact with people in both career fields if he's interested.

Only one problem with that, the $$ aren't that wonderful. I do part time fixed wing, part time ground EMS and full time ER. The ER job has much better pay and bennies. If I did OT there rather than the two other jobs I'd do far better cash wise. 
That being said, the Air EMS jobs still don't have trouble recruiting  due to the nature of the work. You get to fly, you get challenging cases, you get to fly and did I mention you get to fly. While most want adds say they want 2 years experience it's really closer t0 5 years critical care experience and a specialty cert like CEN or CCRN, previous EMT experience and ACLS, PALS, and TNCC and/or PHTLS.

TC
RN CEN EMS RN

I'm currently an EMT-Trainee in MD.  The way it looks to me is that national certification would be ideal for anyone in CAP.  I could easily break down how I would organize a Civil Air Patrol Medic Program, but that's for another time. (When it's not the middle of the night)

Quote from: floridacyclist on March 02, 2007, 05:04:09 PM
Realistically, we're not going to be dealing with severe trauma that much...either the folks have died or else their injuries were light enough to let them survive until we reached them.

True, sir. However, I'm thinking about what other missions might be available in the future.  Mostly, when I think of a CAP Medic I go to Midway Six's post on his Hurricane Katrina experiences.  (Found at: http://capblog.typepad.com/capblog/2006/08/stop_screwing_t.html (http://capblog.typepad.com/capblog/2006/08/stop_screwing_t.html)) In it, he says "Our Teams were the first uniformed responders that 80% of the people we encountered had seen after the storm".  This statistic caught me off guard, even after reading the Katrina AAR.  Given this statistic, I believe that a CAP Medic would serve a greater purpose than simply deployment in SAR missions.  We should add Disaster Relief and Recovery ops to thier mission assignments.

Granted, Katrina was a once-in-a-generation type of disaster, but given the recent news of tornados all over the east coast, wouldn't it be prudent to have a means to assist on the ground as well as the air?

Quote from: DNall on March 02, 2007, 11:15:44 PM

Quote from: SJFedor on March 02, 2007, 07:41:13 AM
I've got a pretty good beat on how the civilian world EMS works, and how we'd need to have our people licensened in each state they intend to practice in, but how does that work for persons under a federal entity, like PJ's or Field Medics activated in a federal disaster/emergency? I know that they usually have them get the NREMT certification and registry exams, but are they exempt from state EMS regulations when it hits the fan?

Military EMTs (including PJs) are fedally licensed, I think DoT still runs that. The dotors & nurses are too, as are PHS & DMAT personnel. All those licenses are universally recognized by every state. As you know the rules are a bit more quirky for some state licenses going to other states, in general though, you're talking about people that are going to be licensed in & operating in-state. I wouldn't be against assistance to upgrade to federal licenses though. Maintaining your skills (including logistics & cost) is part of your day job. CAP didn't train you to be an EMT or pilot, they are just using you for that outside specitization that we need on our team or we can't go.

QuoteI'd be curious if we could get individual wings with the licensed personnel registered as a standby EMS company for activation during emergencies? That way the state EMS board is on board, they'd have established protocol and local medical control, and I think it would improve relations with the other EMS/EMA communities in the state, or at least, make yourselves known to them.

That's over my pay grade & out of my field. You'd have to spend some time with the HSO community to figure that out. I'd tell you that we may e able to come up with the EMTs, but we'll never come up with internal emergency physicians to oversee the program.

When you deploy on a FEMA mission, you're going to e comming from out of area with your EMTs holding a license recognized in the state you;re deploying to & federally provided malpractice coverage. There will be a whole medical branch in that IC structure that they link in with & will go thru for field consults & such. Where you take any patients you come up with may be a tent in a walmart parking lot, or it may be loaded to trafitional or helo EMS. For the most part you're talking about triage, and stablization for someone else to transport.

Sorry about the prev. post.  I hate this laptop.

Military docs do not have a medical license issued by the Fed. Govt.  They are required to be licensed in one to the states and maintain that license.  They are credentialed by the military which is a records verification for the most part.  I have been on a Type I DMAT for over 10 yrs and I don't have a license issued by the Fed Govt.  All I am required to do is maintain my licensure in a state.  The Fed. Govt. does not issue licenses to health care providers they only conduct the credentialing process.

The credentialing process is all we care about here. Obviously everyone has to pass an appropriate board. Our focus is if we can take state licensed people up out of one state & apply them directly into operations in another w/ no paperwork or permission. That's not universally the case with all qualifications. So, figuring out how to make that workable is one of the issues we have to work out.

What we're looking for down the road is not door-to-door surveys a week or two after the fact & outside the critical area. What we want to work towards for hurricane response is a combined air/grd assessment team with organic command & control & one EMT for triage & support (as required by FEMA); be at the impact point within 12 hours of coming ashore & shooting back imagry that llows the fed govt to determine their response; absolute tip of the spear.

We're more caoable for that than anyone else, and that's what NIMS compliance opens up for us, that & following Florida's example on this one.

Quote from: thefischNX01 on March 03, 2007, 07:15:35 AM
True, sir. However, I'm thinking about what other missions might be available in the future.  Mostly, when I think of a CAP Medic I go to Midway Six's post on his Hurricane Katrina experiences.  (Found at: http://capblog.typepad.com/capblog/2006/08/stop_screwing_t.html (http://capblog.typepad.com/capblog/2006/08/stop_screwing_t.html)) In it, he says "Our Teams were the first uniformed responders that 80% of the people we encountered had seen after the storm".  This statistic caught me off guard, even after reading the Katrina AAR.  Given this statistic, I believe that a CAP Medic would serve a greater purpose than simply deployment in SAR missions.  We should add Disaster Relief and Recovery ops to thier mission assignments.

I understand your point, which is why I said usually. As shown in my own post at http://www.nettally.com/captlh/charley-aar.pdf (http://www.nettally.com/captlh/charley-aar.pdf), that is not a unique experience. That said, in our case, our job was to perform reconnaissance, find out how much infrastructure was left, and do whatever it took to get the information (photos and reports) back to Tallahassee so that help could be sent where it was needed the most. We were not to perform rescues or first aid unless it was of an immediately life-threatening nature as doing so would have detracted from our primary and overall more important job. Other jobs might operate under different parameters, but are usually sent into areas later after even more outside help has arrived.

Under these circumstances, it was possible that we might find someone in need of life-saving first aid, but given the fact that this is still several hours after the winds have stopped howling, they are probably not too severely injured if they are still alive.

A more likely scenario might be coming across someone that was injured in a car crash or from their chainsaw, but even then if our job is to perform RECON, we don't want to get too far down in the weeds treating this person beyond the ABCs. At this point, we do have a very powerful tool at our disposal that the civillians don't have and that is our radio (or satphone in some cases). If we made it to where this person is, so can others and in the immediate aftermath of an event there will be lines of mutual aid EMS teams looking for work; in addition to making sure that they're breathing, not spurting blood and treating for shock, calling the EOC or our mission base and requesting advanced medical help is the single best thing we can do so that we can get back to our primary job of RECON. For this reason, we are training all of our team members to the CERT level of care, although I wouldn't turn down a First Responder class if it came our way; actually, I'm working on the FD Training Officer to let us sit in on one.

Looking at it this way also underscores the importance of good communications, which is precisely the issue I'm trying to address in our next Ranger School by spending an entire week working on (mostly tactical) comm.

speak of the devil.  ;D

What it all boils down to is CAP not wanting to take the responsibility/liability and to shell out the money for liability coverage. As for finding medical direction, I have experience with this and it can easily be done by contacting your Squadrons local ER attending. The fact is that having EMTs/Medics, etc out there on SARs is a valuable resource, and one which would be made even more valuable if they could do more than first aide and advise. There may not be a whole lot of times when full blown EMS is needed before a municipal or private crew can get there, but theres going to be an awful lot of wailing and nashing of teeth the one time that someone does need a combitube to maintain a patent airway and they die in respiratory failure because CAP didnt want to go the extra mile. The fact is that EMS is a vital part of SAR. Now alot of what we need to do can be covered within CAPS current "stabilizing first aide" regs. But what about nasal and oral airways? C-spine motion restriction with more than just hands? What has happened in the past is irrelevant. What matters is whats happening now. Im going to feel pretty rotten the day that I can treat someone's burns at a crash site, but when they crunk on me all I can do is stand there and look at them while I listen to EMS trying to find its way to us with sirens wailing miles away. First aide only gets you so far. CAP needs EMS assets that can function in more than advisory capacities. And there is talk about bee or other stings or bites which would cause anaphylaxis. Now we were talking about the use of epinephrine and airway adjuncts either for a CAP member or a found person. Under the current regs, whaddya gonna do. Nothing, because you cant. I have and continue to gain more experience in Mass Casualty Incidents, triage, etc. Wouldnt it be nice if I could use it, just in case it were needed. And what if I start triaging patients and then one of them crunks, its my neck on the block. What it comes down to is CAP wanting those medical officers out there in the field during SAR/EXs but not wanting to do what is necessary to allow them to fully function. The liability insurance for an EMT-Basic is minimal. Hell, work out a system where I can pay for it myself and I will. What we have here is a private, non-profit corporation who claims that it specializes in SAR but has no real ability to provide in depth medical treatment when it is necessary. Mark my words, some day, that will change us from Search and Rescue to Search and Recovery...of a dead body because there are people of competant training out there as ground pounders who have life saving training and skills who cant use them for fear of losing their license or going to jail. Am I thinking in the extreme...[darn] right, but thats what EMS and SAR is about...hoping for the best and planning for the worst. Unless CAP gets its act together in this regard, those of us who wear the EMS badges or patches might want to start carrying the nice big black zipper bags cause as sure as good made little green apples, one day we will need them. Being able to treat someone with burn gel is great and may decrease the extent of their injury and their pain. Being able to provide a patent airway when their trachea swells shut may save their lives. Im getting ready to go to disaster medical specialist training in a few months, but unfortunately CAP has tied my hands so that I wont be able to use what I learn. Its hard to find another non-profit SAR group out there (we have lots of them where I used to live in NM) that doesnt have a useable medical asset (read as EMT or Medic) on their team. It simply doesnt make sense. Yes this is a pet peeve of mine but I have had patients die in my hands when I have been covered with liability and medical direction and its about the hardest thing a medical care provider can go through. Now imagine what it would feel like to have it happen simply because CAP wont get off its duff and take some action to move us into the 21st century of SAR.

Most SAR teams in CO do not have organic EMS. The local fire or EMS agency provides that function. The SAR team members usually only do first aid. NIMS requirements for Type III and IV Wilderness SAR teams state that EMS and technical rescue capablilites are not required to be organic.

SARMedTech, you underestimate the problem of getting a system that will agree to provide physician advisor (PA) for CAP members. There is alot more than just "contacting your Squadrons local er attending." Unfortunetely, in todays society, you need to get the lawyers involved before any physician in their right mind will sign on as PA. Also, you're assuming there is a local er near the unit. get out of the city and you'll find them becoming rarer. Remember the golden hour? In most of CO, we don't even think about it because there is no way to get the patient to a trauma center within 90 minutes - even with Flight fo Life.

Another issue is the differing protocols states use. Colorado is, from what I have heard from my PA, in the minority of states using the exact same protocols statewide in several different and competing medical systems.

An effort was made to get the AF Surgeon General to provide PA service for CAP, but it fell through.

As mentioned in this and other posts the issues still rest in that every state has differant requirements for the authority to practice as an EMT, or Paramedic and sometimes even as a first responder.  It would be difficult at best to create a national policy that addresses all of the particulars each state has.  However it would be nice if CAP could create an exception just like they have for other GT specialty areas.  An in writting approval that meets at minimum x, y, z type requirements kind of clause would go a long way in keeping them in the middle of the liability highway than the far right they are risking themselves in now.

mk

Quote from: arajca on May 30, 2007, 04:36:17 AM
Most SAR teams in CO do not have organic EMS. The local fire or EMS agency provides that function. The SAR team members usually only do first aid. NIMS requirements for Type III and IV Wilderness SAR teams state that EMS and technical rescue capablilites are not required to be organic.

SARMedTech, you underestimate the problem of getting a system that will agree to provide physician advisor (PA) for CAP members. There is alot more than just "contacting your Squadrons local er attending." Unfortunetely, in todays society, you need to get the lawyers involved before any physician in their right mind will sign on as PA. Also, you're assuming there is a local er near the unit. get out of the city and you'll find them becoming rarer. Remember the golden hour? In most of CO, we don't even think about it because there is no way to get the patient to a trauma center within 90 minutes - even with Flight fo Life.

Another issue is the differing protocols states use. Colorado is, from what I have heard from my PA, in the minority of states using the exact same protocols statewide in several different and competing medical systems.

An effort was made to get the AF Surgeon General to provide PA service for CAP, but it fell through.

First off all, I am befuddled by your use of term organic when referring to EMS. Ive been around it awhile and have never heard this term used.

I do not underestimate the difficulties of getting a doctor to act as what you call a PA which is medical parlance stands for Physicians Assistant, not Physician Advisor. All hospitals have an attending physician or physicians on staff at all times who function as medical control or medical direction for EMS crews in the field. If CAP were willing to pry open its wallet, it could get liability for the EMTs and Medics, since the Physician would already be covered by his own malpractice insurance and the liability coverage of the hosptial. Furthermore, since its not like we are going to be running to the doctor, asking a question and then running back on foot, but rather calling by cell or satphone, it wouldnt matter if the physician was 9, 90 or 900 miles away as long as he can be reached by phone.

Finally the problem of differeing protocols in different states would not present any more of a problem than in does for private EMS agencies. The Medical Director would be familiar to the enth degree with the protocols of the state regarding the level of provider he was directing, thus avoiding this problem. Im not sure what your involvement in EMS is, but you seem to have a fundamental misunderstanding of how EMS operates. A friend of mine is a medic in W. Virginia and her medical director is 90 minutes away from the closest call in her reponse area. As long as you can maintain a clear connection, there is no problem. Im not talking about each Wing having a single medical director, but more likely a group of Squadrons in relatively close geographical proximity to each other such that if they were "civilian" EMS they would likely be using the same medical direction. You obviously fail to see the need for trained EMS personnel in the field being able to legally operate to the extent of their training. Without knowing it, CAP inadvertantly allows this through the regs which allow for stabilizing first aide to the extent of the medical professionals training. Of course a medics will be different than mine and mine will be more advanced than a first responder or someone with his CPR certificate only. Its ironic that there is a 10 page thread on arming CAP officers with guns and why it should be done, but no one can see the more clear and present need for a trained and liability covered EMT/Medic on SAR sorties in the field.

Organic is a term used in a new FEMA type/sourcing document:  Simply meaning a medic type who is part of the SAR unit (organic) vs one supplied from an outside agency to support the SAR unit (non-organic)

You need to get out and travel some.  Every state (and sometimes even within the state) though similar is still differant in regards ot medical direction and protocols. For example when I lived in Texas each individual service had its own medical director, that medical director was responsible for defining the specific protocols for the agency they worked with.  In one he wanted to be called on his cell phone for every point where it said contact medical control, and another worked it out that the ER doc at a specific hospital could provide medical control.  Both though had the same levels of provider's each had very differant drug lists and procedures for their ECA's, EMT's Intermediates and medics.

Yes they do leave that little back door open for within the scope of care based on your level of training caluse, but its also countered by 60-3 which specifically prohibits CAP form being the lead agency for their own medical support for SAR operations.  Its a catch 22.  I know one of the Military Docs who supports Hawk Mountain is working with national legal to look to clarify the loopholes and gray areas, and hopefully get some exceptions ok'd to allow medical personnel a little more room to operate.

mk

Much as I would love to see CAP have EMS officially considered as part of ground teams I know it probably wont happen.
As far as being able to treat out of state the best thing to do is join a DMAT. The closest stopgap is to pass the National Registry.
Now, I DO wish CAP could use its medical talent to Augment with AF medical services much as I can do with the Coast Guard through its Aux.

I wear the EMS badge on my uniform, and I have a Buttback full of BLS materials for missions. Anything else, Im going to be forced to rely on the local EMS teams. Which - for most of us is ok- its CO, AK and the like that worries me.

I do have one question though... Arajaca posted that at one time the AF Surgeon General was approached about providing CAP with oversight. When did this take place?

Quote from: SARMedTech on May 30, 2007, 06:46:30 AM
I do not underestimate the difficulties of getting a doctor to act as what you call a PA which is medical parlance stands for Physicians Assistant, not Physician Advisor. All hospitals have an attending physician or physicians on staff at all times who function as medical control or medical direction for EMS crews in the field. If CAP were willing to pry open its wallet, it could get liability for the EMTs and Medics, since the Physician would already be covered by his own malpractice insurance and the liability coverage of the hosptial. Furthermore, since its not like we are going to be running to the doctor, asking a question and then running back on foot, but rather calling by cell or satphone, it wouldnt matter if the physician was 9, 90 or 900 miles away as long as he can be reached by phone.

PA is the term MY system uses for the physician advisor, which is different from medical control. The PA is at the central hospital location in Denver and the medical control is at the local hospital (part of the same system) in Frisco. The issue that occurs is that the EMT's practice under the PA's license and any problems that occur can cause him to lose his license.

QuoteFinally the problem of differeing protocols in different states would not present any more of a problem than in does for private EMS agencies. The Medical Director would be familiar to the enth degree with the protocols of the state regarding the level of provider he was directing, thus avoiding this problem. Im not sure what your involvement in EMS is, but you seem to have a fundamental misunderstanding of how EMS operates. A friend of mine is a medic in W. Virginia and her medical director is 90 minutes away from the closest call in her reponse area. As long as you can maintain a clear connection, there is no problem. Im not talking about each Wing having a single medical director, but more likely a group of Squadrons in relatively close geographical proximity to each other such that if they were "civilian" EMS they would likely be using the same medical direction. You obviously fail to see the need for trained EMS personnel in the field being able to legally operate to the extent of their training. Without knowing it, CAP inadvertantly allows this through the regs which allow for stabilizing first aide to the extent of the medical professionals training. Of course a medics will be different than mine and mine will be more advanced than a first responder or someone with his CPR certificate only. Its ironic that there is a 10 page thread on arming CAP officers with guns and why it should be done, but no one can see the more clear and present need for a trained and liability covered EMT/Medic on SAR sorties in the field.

1. I've only been an EMT for 14 years in a rural environment. I am quite familiar with the EMS system I work in.
2. I know the need for organic EMS in CAP ground teams, but a significantly higher priority is to get teams NIMS compliant and listed so they will be able to be called out. Until you reach the upper level (Type I and II) teams, medical is not an organic requirement. Most of CAP's  ground teams will fall into the Type III and IV categories.
3. Even private EMS companies have training periods employees must go through is the change states. Some even have to if they change areas in a state.

Dr Dave said it all. I joined CAP to help out where I can. I have 30 years experience in EMS/Fire, both civilian and military. When I joined, my Squadron Comanader thought my experience as a paramedic would be an asset to the squadron, and I have used my skills, not in managing death and dismemberment, but as Dr Dave has done, in an advisor role and in providing oversight on multiple activities. As to using my skills for real in CAP I would have to say that is dependant on the situation. No matter how unlikely it may be, if facing an immediate life threat I am going to do what I can for the patient, I really don't care what the regs say. While I didn't take a Hippocratic type oath, I have a moral obligation to provide care to someone who needs it and I simply am incapable of standing by while someone slips away beause CAP regs prohibit me from using all my skills to help out. If I get my hiney pinched by CAP, so be it. I am not a "Randy Rescue" and would not take that type situation lightly, but I would do it.  I also am of the opinion that even though I am not a First Aid instructor, CPR instructor etc etc etc I am still qualified to teach what needs to be taught, all the certifications associated with EMS are merely initials and having them does not make one more qualified than one who does not. Ability is not measured by the number of letters after one's name. As Dr Dave I assume would agree, there is a difference betwen having a paramedic license and being a paramedic. Yes I took ACLS, PALS, PHTLS becuase I had to and because it was CEU hours, but did those classes make me a better medic? I don't know. All I know is I will do what I need to do to save someone's life if it is within my power to do so. Just because something is against the regulations does not make it wrong.
That is my opinion, I could be wrong


Mark Anderson, Capt
ARCHER Operator
MO Wing

Immediate care to save a life is permitted. "Routine" type care is not.

Guys,

This isn't some sort of evil decision by the CAP Tri-Lateral Commission to diss you personally.

It's a pretty simple financial decision.

Go ahead and call a med mal carrier and get them to quote an errors and omissions policy for CAP.  Be sure to tell them that the licensed folks will be engaging in high-risk emergency procedures in SAR situations in potentially all 50 states (with differing scope of practice restrictions) and the odd Commonwealth or two.  Tell them we need coverage for MDs, RNs, DCs, DOs, PAs, LVNs, and various flavors of paramedics and EMTs.  Remind them that none of CAP folks will be covered by Good Samaritan exemptions.

Tell us what they quote you.

Any bets as to what the amount would be?  Hundreds of thousands of dollars, maybe?

For an organization with 60,000 members (in a good year.)

How much are you willing to raise the dues to cover the policy?

Which programs are you willing to eliminate to fund this?

If you want to blame someone, don't blame CAP, inc.

Blame the lawyers.  And their clients.  And the judicial system.

But don't go looking for some "secret" reason why CAP doesn't include EMS as part of our Missions for America.  It's as plain as it can be.

Quote from: desert rat on February 23, 2007, 12:30:05 AM
On the Yahoo CAP Health Services site we have been discussing training as medics.  Hawk mountin already offers this training, but we have no recognition as a medic for cadets or non medical personell.

Since we already have the authorization of a CPR/first aid patch for the BDU uniform I am proposing we have an ES tital of First Aid responder FAR , or EFAR Emergency First Aid Responder, and IFAR instructor First Aid Responder.  This would allow wing to know who all has had first aid training and who is current.  This would be helpful on missions, Sarex, encampments etc..  Afterall on missions the most we would normaly do is firt aid response and not much more.  We don't need a new badge or tital, or ribbon.  We already have the patch.  All we need to add is the ES qualification in the NiMMS.

How do you all feel about this.  It gives us medical officers some training to administer and helps take the load off us for encampments, missions etc.  It also helps to encourage youth to explore medical fields.

I would like to have a west coast version of Hawk Mountin Medic training to get cadets and seniors qualified as First Aid Responder or instructors.  I would be happy with the help of others at setting this up in Nevada or Northern AZ.  We could also look into getting medical professionals to discuss their professions at the training as well.

The problem here is that the Hawk Mountain program offers no licensure-meeting requirement for their "medics" nor do they provide many of the requirements necessary to sit for the various state and National Registy Examination. I think it would be great if they did, but they dont, so if a person goes through HM training and then tries to get their medics license, all they will have done is waste alot of time. And from what I have seen from the HM site, they dont make that really clear. It would be a great program to train CAP Medics, but it just doesnt get it done and even if it did, CAP is not willing to even investigate the idea. They do not yet grasp the idea that SAR missions often entail the need for emergency ground care beyond bandaides and iodine and that when we find a person it may be an hour or more (sometimes much more) away from the nearest EMS provider. Fact is, that the GS/EMS situation is broken and needs to be fixed. There will be those here that will tell you that CAP isnt in the business of providing EMS....I disagree. If you are in the business of finding people, often in downed planes, you need to be able to tend to them immediately and not wait for another asset to arrive. Im on your side here, but im nowhere near high enough up in CAP to make this change.

Quote from: Ned on May 31, 2007, 11:59:35 PM
Remind them that none of CAP folks will be covered by Good Samaritan exemptions.

CAP members aren't cover by Good Samaritan exemptions?  Is that true?  I have always been lead to believe we were, as long as we stayed within the bounds of our training.

Quote from: Ned on May 31, 2007, 11:59:35 PM
Guys,

This isn't some sort of evil decision by the CAP Tri-Lateral Commission to diss you personally.

It's a pretty simple financial decision.

Go ahead and call a med mal carrier and get them to quote an errors and omissions policy for CAP.  Be sure to tell them that the licensed folks will be engaging in high-risk emergency procedures in SAR situations in potentially all 50 states (with differing scope of practice restrictions) and the odd Commonwealth or two.  Tell them we need coverage for MDs, RNs, DCs, DOs, PAs, LVNs, and various flavors of paramedics and EMTs.  Remind them that none of CAP folks will be covered by Good Samaritan exemptions.

Tell us what they quote you.

Any bets as to what the amount would be?  Hundreds of thousands of dollars, maybe?

For an organization with 60,000 members (in a good year.)

How much are you willing to raise the dues to cover the policy?

Which programs are you willing to eliminate to fund this?

If you want to blame someone, don't blame CAP, inc.

Blame the lawyers.  And their clients.  And the judicial system.

But don't go looking for some "secret" reason why CAP doesn't include EMS as part of our Missions for America.  It's as plain as it can be.

There are many flaws in your argument.

1. You are trying to quote a number that would include every single member of CAP being covered by liability insurance as an EMT/Medic. I doubt that every member has an interest in EMS. What most of those of us who desire to see this change are proposing is a CAP medical corp.

2. There are EMS malpractice insurers who operate in all 50 states. The cover EMTs of all sorts based on the protocols in those different states.

3. All EMTs and Medics provide high risk procedures. I have done riskier things in the back of a moving ambulance than I would ever do in the field and quite frankly, having a patient on a drag stretcher and trying to drop and breathing tube is much easier

4. The "dues" you might need to raise to cover what we will for now call the CAP medical corps would not have to be paid by everyone, just those who wished to provide emergency medical care in the field.

5. Any doctor that would be involved (say as a remote medical director) would have his own insurance and I seriously doubt that we need chiropractors in the field, so that particular argument is moot. We're not talking about treating people for sciatica here, we are talking about saving lives through EMS. Youre comparing apples and oranges. Also, while perhaps their might be a need for an RN in the field, LVNs are not the most common practitioners of emergency medicine.

6. If it wished to do so, the USAF could cover CAP EMTs and Medics during the time that we are operational for them.

So here is your scenario...You are say 60 miles away from a hospital when you discover the downed plane you have been looking for. One passenger is dead. The other passenger and the pilot are in schock from broken bones and burns and the pilot can barely protect his own airway. What do you do? First aide isnt going to cut it. They are going to need airways and fluids, two things not covered by first aid.

Its not lawyers fault that we dont have these kinds of Corpsman in the field. That rest squarely with CAP. They are not willing to form an investigative committee to even examine this situation and the need for EMS personnel in the field. We train cadets how to splint legs and given then wire or SAM splints. Do you know what happens if you splint a femur fracture improperly, you either tear or occlude the femoral artery. Now the EMS help you need is still 60 miles away and then they have to find you and your downed aircraft once they get that 60 miles covered. You know what you have if you have two people in non-compensating shock for 60 minutes....Two dead people. All EMS is high risk. It developed from the same military model that CAP did. The only argument you make that rings true is cost. Im not meaning to jump down your throat but these are the same arguements that everyone who says that CAP-EMS cannot work and they simply dont hold water.

Quote from: ELTHunter on June 01, 2007, 01:56:19 AM

Quote from: Ned on May 31, 2007, 11:59:35 PM
Remind them that none of CAP folks will be covered by Good Samaritan exemptions.

CAP members aren't cover by Good Samaritan exemptions?  Is that true?  I have always been lead to believe we were, as long as we stayed within the bounds of our training.

Good samaritan laws cover those people who assist in accidents, etc but have no medical training. On its face, the Good Samaritan Law, which doesnt exist in all states, is not intended to cover EMS personnel.

Quote from: SARMedTech on June 01, 2007, 02:19:43 AM

Quote from: ELTHunter on June 01, 2007, 01:56:19 AM

Quote from: Ned on May 31, 2007, 11:59:35 PM
Remind them that none of CAP folks will be covered by Good Samaritan exemptions.

CAP members aren't cover by Good Samaritan exemptions?  Is that true?  I have always been lead to believe we were, as long as we stayed within the bounds of our training.

Good samaritan laws cover those people who assist in accidents, etc but have no medical training. On its face, the Good Samaritan Law, which doesnt exist in all states, is not intended to cover EMS personnel.

If you're a GTL with Wilderness First Aid, not ant EMT, I wouldn't think you would be considered "EMS" personnel.  I think in every Red Cross class I have had, the instructor has told me that we would be covered (In Tennessee) as long as we are performing within the scope of our training.

Good samaritan laws do not apply to profesional responders.  They cover you primarily whie out and about helping of your own good neighborly type of behavior.
CAP SAR personnel are looked at as proffesional responders.

On insurance.  Any proffesional providing medical care would need to be covered.  Unless CAP writes things as inclusive only to EMT and  Paramedice.....which would be dissing a be excluding a big part of our community.

An average 3mil/4 mil liability for an EMT or Paramedic runs about $100 per year.  That is for an individual, I imagine even with that coverage the corporation would require its own coverage also.

I doubt coverage for all 50 states would be needed.  In my 17 years of CAP I have operated outside of my home state maybe 2 or 3 times  The complexities of operating outside of your primary state of licensure or certification are even more complicated than the insurance requirements.

On HMRS what exactly do you expect out of an 8 day course?  The shortest paramedic class I have seen is 6 months, as a Full time student.  First Responder is the best you could pull out of that, and when we did run that program they were eligible for state reciprocity.  Currently the course provides Wilderness first aid certification, CPR certification.  Students are also trained in field sanitation and preventitive medicine as it relates to the wilderness/remote environment.  That level of training is more useful to a CAP GT and more in line with the current standing on medical care.

mk

Quote from: SARMedTech on June 01, 2007, 02:16:34 AM
There are many flaws in your argument.

1. You are trying to quote a number that would include every single member of CAP being covered by liability insurance as an EMT/Medic. I doubt that every member has an interest in EMS. What most of those of us who desire to see this change are proposing is a CAP medical corp.

Actually, most of us desire to see CAP accepted as true player in the SAR field. It's a matter of priorities. First and foremost, get accepted and established at a basic level - WHICH DOES NOT INCLUDE BECOMING AN EMS PROVIDER. Visit the several threads here discussing the National Incident Management System (NIMS). That is where emergency services - including SAR, EMS, Fire, LE, etc. are going. CAP hasn't found the turn yet, let alone started down the road. After becoming established and credentialed, then we can look at adding EMS to our services.

Quote2. There are EMS malpractice insurers who operate in all 50 states. The cover EMTs of all sorts based on the protocols in those different states.

True, and they have differing rates depending on the state and level of coverage. Most large multistate companies are self insured. Meaning they have a multi million dollar fund sitting to cover incidents. They usually have an underwriter to back them up and they pay for that as well.

Quote3. All EMTs and Medics provide high risk procedures. I have done riskier things in the back of a moving ambulance than I would ever do in the field and quite frankly, having a patient on a drag stretcher and trying to drop and breathing tube is much easier

It's a matter of environment. If I have someone collapse with a heart attack in the middle of the wilderness, and EMS is more than 30 minutes away, they're dead. If the same person collapses in the middle of town, they have a much better chance of survival. It may sound callous, but that's life.

Quote4. The "dues" you might need to raise to cover what we will for now call the CAP medical corps would not have to be paid by everyone, just those who wished to provide emergency medical care in the field.

And if I, as an EMT elect not to provide my services to CAP, do I still have to pay the extra dues? CAP is already an expensive activity. Increasing dues on those few members that are EMT's, etc will most likely end in no EMT's in CAP. Or no EMT's willing to contribute their skills to CAP.

Quote5. Any doctor that would be involved (say as a remote medical director) would have his own insurance and I seriously doubt that we need chiropractors in the field, so that particular argument is moot. We're not talking about treating people for sciatica here, we are talking about saving lives through EMS. Youre comparing apples and oranges. Also, while perhaps their might be a need for an RN in the field, LVNs are not the most common practitioners of emergency medicine.

Insurance rates are also based on where you practice. If you are serving as a PA, you get hit with additional charges to cover the EMT's under your license. When an EMT makes a mistake - or not - the PA gets sued since he is the 'supervisor' of the EMT.

Quote6. If it wished to do so, the USAF could cover CAP EMTs and Medics during the time that we are operational for them.[/qoute]
True, but to date it hasn't wished to do so.

So here is your scenario...You are say 60 miles away from a hospital when you discover the downed plane you have been looking for. One passenger is dead. The other passenger and the pilot are in schock from broken bones and burns and the pilot can barely protect his own airway. What do you do? First aide isnt going to cut it. They are going to need airways and fluids, two things not covered by first aid.[/quote]
1. The SAR medics I know carry some of these things. If it's going to be a long evac, they'll play God.
2. The SAR medics are not part of any SAR team, they are part of the ambulance service. When they're needed, they get called out. Which is not on every SAR mission.
3. Change the plane to a cliff and the injuries to trauma, and you've described a typical SAR mission in the mountains of CO, except the hospital is usually 100+miles away.
4. CAP is usually not the lead agency on searches. The lead agency typically has the local medical helicopter service on stand by.
5. I'm one person. Who lives and dies depends on the extent of their injuries. I've dealt with this in haz-mat (15 years).

QuoteIts not lawyers fault that we dont have these kinds of Corpsman in the field. That rest squarely with CAP. They are not willing to form an investigative committee to even examine this situation and the need for EMS personnel in the field. We train cadets how to splint legs and given then wire or SAM splints. Do you know what happens if you splint a femur fracture improperly, you either tear or occlude the femoral artery. Now the EMS help you need is still 60 miles away and then they have to find you and your downed aircraft once they get that 60 miles covered. You know what you have if you have two people in non-compensating shock for 60 minutes....Two dead people. All EMS is high risk. It developed from the same military model that CAP did. The only argument you make that rings true is cost. Im not meaning to jump down your throat but these are the same arguements that everyone who says that CAP-EMS cannot work and they simply dont hold water.

Actually, CAP used by an ambulance provider service, but that went away after some lawyers got involved. So, yes, it is the lawyers fault. Before you start claiming CAP isn't willing to investigate this, I suggest you contact Lt Col Kay McLaughlin, CAP HSD. Currently, we can't even establish a specialty track for HSO's because the lawyers won't let us. That project has been in the works for several years now. For more info, see the CAP Health Services Yahoo Group (http://groups.yahoo.com/group/CAP_HEALTH_SERVICES/). How do propose getting something that involves real patient care past the lawyers?

On the Good Sam laws topic, in some states, you can be covered if you are not serving in an EMS organization at the time you render aid. However, if you are outside of your PA's area, you can loose your certs. Seen it happen. EMT did everything right but the patient died anyway, but the incident was outside of his PA's area. He survived the lawsuit - the judge ruled the Good Sam applied because, in this state, the EMT did not have a duty to act. The state reviewed the case and pulled his cert because he was practicing without PA guidance because the EMT was outside the PA's area. Are you willing to put your livelihood on the line like that?

Here are some other things to think about:

Even at the first responder level:  a person must be 18 to get this level of certification. Thats DOT/DHTSA regs.

So out of the 60k members, you could elminate those cadets who are too young. The you can eliminate those that have no interest in EMS. Then you can elminate those that for whatever reason cannot meet the physical requirements necessary for an EMS license (generally being able to lift 150 pounds by youself). The you can eliminate those folks who are not ground pounders, IE those who work in misson bases.  So the 60k number (IE certifying and insuring the entire membership) is a falacy. Also, as I say, MDs have their own malpractice which covers them when they are working as medical directors and medical directors are not generally in the field. Many RN's work under the liability of whatever organization, hospital, hospice they work for and quite frankly, other than flight nurses (CAP has no aircraft equipped for accute trauma transport that I know of) or nurses who are also EMTs of one level or another, this number is relatively small. As I also said, you can take Chiros out of the equation because i have yet to see a chiropractor work a trauma scene with me. Same the DO's. I could go on and on, but I think you are getting the point. Nobody is talking about making everyone in CAP an EMT, but rather  covering those who are and developing a "CAP Corpsman" program so that the badges and patches we wear actually mean something instead of just being more shiny bling.

How much are gliders and hot air balloons used for SAR activities or transport time sensitive materials? Perhaps there could be some cuts in those programs. I have nothing against either of them, I just wonder how practical they are.

Here is something else to think about - In most of the country CAP is not seen as a viable emergency services entity because CAP still insists on playing by its own rules and not the rule everyone else plays by.

Until that situation is fixed, CAP-EMS isn't a viable option.

The glider and hot air ballon programs serve the AE  and CP missions of CAP, not the ES mission. Contrary to what some members think, ES is not the end-all, be-all of CAP.

Quote from: ELTHunter on June 01, 2007, 02:22:43 AM

Quote from: SARMedTech on June 01, 2007, 02:19:43 AM

Quote from: ELTHunter on June 01, 2007, 01:56:19 AM

Quote from: Ned on May 31, 2007, 11:59:35 PM
Remind them that none of CAP folks will be covered by Good Samaritan exemptions.

CAP members aren't cover by Good Samaritan exemptions?  Is that true?  I have always been lead to believe we were, as long as we stayed within the bounds of our training.

Good samaritan laws cover those people who assist in accidents, etc but have no medical training. On its face, the Good Samaritan Law, which doesnt exist in all states, is not intended to cover EMS personnel.

If you're a GTL with Wilderness First Aid, not ant EMT, I wouldn't think you would be considered "EMS" personnel.  I think in every Red Cross class I have had, the instructor has told me that we would be covered (In Tennessee) as long as we are performing within the scope of our training.

Covered by whom for what? The problem is that Wilderness First Aide is a certification, not a licensure to practice.

Quote from: arajca on June 01, 2007, 04:23:46 AM
Here is something else to think about - In most of the country CAP is not seen as a viable emergency services entity because CAP still insists on playing by its own rules and not the rule everyone else plays by.

Until that situation is fixed, CAP-EMS isn't a viable option.

The glider and hot air ballon programs serve the AE  and CP missions of CAP, not the ES mission. Contrary to what some members think, ES is not the end-all, be-all of CAP.

Ive never said ES is the end-all, be all of CAP, but it is an important part and there is agaping hole in it without EMS. Ive done some searching of private, non-profit SAR organizations across the country and virtually all of them have liability covered EMS personnel. This is the problem with CAP being a non-profit and working for the AF at the same time. It wants what it sees as the best of both worlds and because of this, leaves gaping wholes in alot of the services it provides. The fact is that the ability to provide EMS is an intergral part of SAR and SAR is an integral part of CAP ES as stated by CAP itself. Perhaps its time to clear the decks and find some more progressive minded leadership.

Quote from: SARMedTech on June 01, 2007, 04:34:30 AM

Quote from: ELTHunter on June 01, 2007, 02:22:43 AM

Quote from: SARMedTech on June 01, 2007, 02:19:43 AM

Quote from: ELTHunter on June 01, 2007, 01:56:19 AM

Quote from: Ned on May 31, 2007, 11:59:35 PM
Remind them that none of CAP folks will be covered by Good Samaritan exemptions.

CAP members aren't cover by Good Samaritan exemptions?  Is that true?  I have always been lead to believe we were, as long as we stayed within the bounds of our training.

Good samaritan laws cover those people who assist in accidents, etc but have no medical training. On its face, the Good Samaritan Law, which doesnt exist in all states, is not intended to cover EMS personnel.

If you're a GTL with Wilderness First Aid, not ant EMT, I wouldn't think you would be considered "EMS" personnel.  I think in every Red Cross class I have had, the instructor has told me that we would be covered (In Tennessee) as long as we are performing within the scope of our training.

Covered by whom for what? The problem is that Wilderness First Aide is a certification, not a licensure to practice.

I believe he would be refering to the Good Samaritan Act

Quote from: SARMedTech on June 01, 2007, 03:32:03 AM
Here are some other things to think about:

Even at the first responder level:  a person must be 18 to get this level of certification. Thats DOT/DHTSA regs.

So out of the 60k members, you could elminate those cadets who are too young. The you can eliminate those that have no interest in EMS. Then you can elminate those that for whatever reason cannot meet the physical requirements necessary for an EMS license (generally being able to lift 150 pounds by youself). The you can eliminate those folks who are not ground pounders, IE those who work in misson bases.  So the 60k number (IE certifying and insuring the entire membership) is a falacy. Also, as I say, MDs have their own malpractice which covers them when they are working as medical directors and medical directors are not generally in the field. Many RN's work under the liability of whatever organization, hospital, hospice they work for and quite frankly, other than flight nurses (CAP has no aircraft equipped for accute trauma transport that I know of) or nurses who are also EMTs of one level or another, this number is relatively small. As I also said, you can take Chiros out of the equation because i have yet to see a chiropractor work a trauma scene with me. Same the DO's. I could go on and on, but I think you are getting the point. Nobody is talking about making everyone in CAP an EMT, but rather  covering those who are and developing a "CAP Corpsman" program so that the badges and patches we wear actually mean something instead of just being more shiny bling.

How much are gliders and hot air balloons used for SAR activities or transport time sensitive materials? Perhaps there could be some cuts in those programs. I have nothing against either of them, I just wonder how practical they are.

No EMS Agency in CA has a physical capacity requirement for certification. Physicians in solo practice have their own malpractice but would have to add a rider for CAP that would drive up their premium. Physicians in group practices are generally covered by the group policy only while working directly for the group. This also applies to RNs, PAs etc. Their hospital, hospice or whatever only covers them when they are on the hospital, hospices clock. So to be covered those folks would need a seperate policy through CAP. Even if only 600 people in CAP wanted to participate in the program it would still be a sizeable chunk of change by the time all the EMTs, Physicians, Nurses and others were included. That would only include the personal liability it wouldn't include the corporate liability.  Remember, they aren't just going to sue you they will also go after CAP, Inc.

The only way CAP will ever be involved in EMS is if they are taken under the federal umbrella like the DMATs. And I don't see that happening anytime soon.

Quote from: PA Guy on June 01, 2007, 07:11:57 AM

Quote from: SARMedTech on June 01, 2007, 03:32:03 AM
Here are some other things to think about:

Even at the first responder level:  a person must be 18 to get this level of certification. Thats DOT/DHTSA regs.

So out of the 60k members, you could eliminate those cadets who are too young. The you can eliminate those that have no interest in EMS. Then you can eliminate those that for whatever reason cannot meet the physical requirements necessary for an EMS license (generally being able to lift 150 pounds by youself). The you can eliminate those folks who are not ground pounders, IE those who work in misson bases.  So the 60k number (IE certifying and insuring the entire membership) is a fallacy. Also, as I say, MDs have their own malpractice which covers them when they are working as medical directors and medical directors are not generally in the field. Many RN's work under the liability of whatever organization, hospital, hospice they work for and quite frankly, other than flight nurses (CAP has no aircraft equipped for acute trauma transport that I know of) or nurses who are also EMTs of one level or another, this number is relatively small. As I also said, you can take Chiros out of the equation because i have yet to see a chiropractor work a trauma scene with me. Same the DO's. I could go on and on, but I think you are getting the point. Nobody is talking about making everyone in CAP an EMT, but rather  covering those who are and developing a "CAP Corpsman" program so that the badges and patches we wear actually mean something instead of just being more shiny bling.

How much are gliders and hot air balloons used for SAR activities or transport time sensitive materials? Perhaps there could be some cuts in those programs. I have nothing against either of them, I just wonder how practical they are.

No EMS Agency in CA has a physical capacity requirement for certification. Physicians in solo practice have their own malpractice but would have to add a rider for CAP that would drive up their premium. Physicians in group practices are generally covered by the group policy only while working directly for the group. This also applies to RNs, PAs etc. Their hospital, hospice or whatever only covers them when they are on the hospital, hospices clock. So to be covered those folks would need a separate policy through CAP. Even if only 600 people in CAP wanted to participate in the program it would still be a sizeable chunk of change by the time all the EMT, Physicians, Nurses and others were included. That would only include the personal liability it wouldn't include the corporate liability.  Remember, they aren't just going to sue you they will also go after CAP, Inc. The only way CAP will ever be involved in EMS is if they are taken under the federal umbrella like the DMATs. And I don't see that happening anytime soon.

Well, first off, at least one EMS provider in CA has a physical requirement...An agency called AMR. They require their EMTs to be able to lift 150 lbs by themselves and 225 with the aide of their partner. I also happen to know that the medics that work for LAFD have this requirement except I think their weight requirements are higher.

First off, doctors in hospices, etc are not going to be providing medical control for EMS providers. Each EMS region throughout the country has a Medical Director who supervises and shuffles the paper for what goes on in that EMS region. The medical control comes from doctors, often hospitalists, who work only in the emergency room and pick up the phone when a crew is coming to their facility and needs permission to push a certain drug, perform a certain procedure, etc...many of which are covered by standing orders and do not require permission. Physicians in group practices do not (read are not allowed in IL) to provide EMS medical control. The physician providing this assistance to the crews has to be board certified in Emergency/Trauma Medicine.

To give you an idea...we have a new ambulance company here in my home town that was started by two medics in an old airplane hanger. The got registered with dispatch and they get medical assistance by calling into the hospitals and saying "hey we need a doctor." I think one thing you fail to understand is that I am not talking about EMTs out their putting burr holes in peoples skulls, what I am talking about is EMTs on GTs performing within their scope of practice (actually no EMT or Medic has a scope of practice as this would indicate that they operate autonomously, which they do not...rather they have protocols.)  I'm talking about EMTs on GTs performing BLS/BTLS within their protocols to effectively AND safely stabilize a patient  and be able to monitor that patient and report findings ACCURATELY  until the main EMS agency arrives.

You say some people live and some people die...I am keenly aware of this. I had a patient die in my hands on March 24th. But that doesn't mean that when there is an option to prevent this from happening that there shouldn't be a system in place to stabilize that patient, which after all, is what EMS does in the first place. Its a fallacy that EMS practices emergency medicine. We provide emergency medical interventions and there is a huge difference. I'm talking about things like when a cadet goes into anaphylaxis from a bee sting, that we could start a nasal pharyngeal airway and give low does epinephrine.....both stabilizing measures which might save that patient until a full blown EMS crew gets there. Or the possibility of being able to place a dual lumen airway in the patients throat to provide them with an airway. I know money is a concern. Money is a concern in any situation. But do you think that SAR cant open CAP up to liability when someone says "Hey, why wasn't my wife put in a c-collar before you put her in that basket stretcher to carry her to the road?" See what we have here is a situation where CAP members are going to provide first aide that are not licensed to put their hands on patients, they're going to go too far and thats where CAP will get in trouble.

As for NIMS/ICS...they have very little to do with the practice of EMS from a medical standpoint. They are designed as organizational systems in the event of a mass casualty incident. Very little of what NIMS does other than establishing triage, has anything to do with the actual medicine. And its not spreading at the rate you think it is because some agencies refuse to use it because it is still in its infancy and will probably take at least another 5-10 years before it is a viable management system. The fact remains that SAR agencies, like those that CAP worked along side of on Mt. Hood last Christmas are EMS capable and ready to go. They have to be. Its not a matter of people not wanting to pay more dues. Its a matter of SAR meaning Search and Rescue and Rescue inherently carries with it a medical component. If you have a patient in the wreckage or a plain, you better think twice about moving them without a EMS component on your GT. 

Your arguments are all over the place. All of CAPS literature says that CAP performs 85% of SAR missions for the Air Force on inland sorties. How can you say that CAP has yet to perfect their SAR capabilities. If they save 500 lives a year as its stands now, how many would they save if they could provide on scene stabilization. Lets here the statistics of how many people are reached by CAP GTs and then die before they can be gotten to a medical facility. The fact is that CAP touts medical as one of its specialties and doesn't deliver. Giving hygiene and anti-drug lectures to cadets and seniors isn't where the real medical dollars need to be spent.

For the sake or argument, let's assume that CAP develops an organic medical system for ground teams. CAP then advertises said capability. How do you ensure that each and every ground team has an EMT on it?

Quote from: arajca on June 01, 2007, 01:53:56 PM
For the sake or argument, let's assume that CAP develops an organic medical system for ground teams. CAP then advertises said capability. How do you ensure that each and every ground team has an EMT on it?

It has never been my contention that each and every GT has an EMT or Medic, only that those who already exist and may join in the future are covered by liability insurance and have medical direction so that they can do what they are trained to do. This has been brought up a few times and its not what I ever said. And Im not talking about ambulances and med-evac choppers and the like, Im simply talking about putting into place a program where those who have worked hard and trained to a level to be able to help those who are injured or experience sudden medical problems.

Im not saying that one day I hope to see ambulances going down the road in every state that say  "CAP EMS" on them. And as far as one of the other posters talking about NIMS and saying that CAP has to get that down first before it can even be a true SAR player, NIMS doesnt even have NIMS down yet. For proof of this, reference the days after hurricane Katrina. NIMS has nothing to do with there being one or two EMTs in a squadron in Minnesota and one in a squadron in Florida. Just as not all Squadrons deal with Cadets or even Seniors for that matter, every Squadron does not have to be able to do everything. Getting back to NIMS/ICS, this was a system developed in large part by FEMA and well, we can see how well they do at executing plans. NIMS isnt necessary for EMS when you arrive on a crash site and you have one person with a femur fracture and one person with eschar burns over 50% of their body. Here two EMS responders can manage this until private or municipal EMS arrives. The mistake that people often make is that NIMS=EMS. NIMS is being hammered out for situations like Katrina and 9/11 when the scale is so big that a command structure has to be set up. Of course you have to have a command   structure at a crash site and there is already in place within CAP Incident Commanders, etc, NIMS is designed for Mass Casualty Disasters and not everything that CAP will respond to fits that bill. And more than likely, if we show up on a system that requires NIMS to "kick in", the Air Force, National Guard, FEMA and Red Cross are going to be running the show and we will be taking orders from them.

Im talking about a system where when a person is found who hasnt had water for several days, someone can decide by examination whether they should be given a canteen to drink out of or should only have sips of water...should they be given any  food. You have a cadet with asthma and his albuterol isnt working...the next step is an airway adjunct of some kind or epinephrine.  Who's going to do that? Another cadet who's had a few hours of first aide and been shown how to make a tourniquet out of a stick? If CAP doesnt have a medical component, then it should stop recruiting saying that it does. If its not up to speed with the way that SAR operations are run, it shouldn't so  frequently say that it conducts 85% of the inland SARs for the USAF. Its time to live up to what we say we can do. If we say we can do it, the other organizations we work with will be expecting us to and relying on us for it and its going to be a big problem when we show up and dont have the slightest clue what to do.

Just out of curiosity, who would pay for all the equipment and meds that all of them are hauling around.  Even if stuff goes unused, a lot of it has shelf lives and need to be replaced "just because."  Add this maintenance cost onto the cost of insurance premiums, etc, and I think the cost would be rather substantial...

Quote from: jimmydeanno on June 01, 2007, 05:53:34 PM
Just out of curiosity, who would pay for all the equipment and meds that all of them are hauling around.  Even if stuff goes unused, a lot of it has shelf lives and need to be replaced "just because."  Add this maintenance cost onto the cost of insurance premiums, etc, and I think the cost would be rather substantial...

Not really a valid argument. My assumption would be that since CAP makes its members pay for so much of their own gear, equipment and uniforms now, including the contents of the little "1 gallon ziploc bags" it recommends for cadets, that it would probably expect the EMTs to pay for their own gear. Secondly, as far as equipment goes, it doesn't need to be replaced, just because: bandages, kurlex tape, cling tape, Israeli pressure bandages ,air splints, a pulse oximeter, a stethoscope, BP cuff, etc don't have expiration dates. As for the bandages I mentioned, they are good pretty much indefinitely unless they are opened. Things like 2x2s and 4x4s are good for a very long time unless they are just left rolling around loose in the EMTs pack.

As far as meds go, if we were talking about what an EMT would carry: Quik Clot has a very long shelf life as do instant cold packs, cold spray, aspirin is virtually indefinite  if its is stored properly. Nitro and Epi pens would need to be replaced about every 18 months, longer for the nitro if its in spray form since the liquid is more stable than the tablets. Glucagon is also good for 18 months to two years. Sealed activated charcoal is good until it is used as would be nasal and oral airways, combitubes, etc. You know its funny that I don't hear anyone asking how often and how expensive it is to maintain plane parts or the wings on gliders which have a "stress use life" measured in hours.

Lets get down to brass tacks: CAP isn't familiar with what it would take to have an EMT Corps...so because they don't have facts in front of them, they assume the worst and that it cant be done, as apparently, do alot of members of this board. I'm not trying to make enemies by pressing this issue, but hey, lets streamline the production of uniforms and patches and badges and other bling and see how much money that saves. This lack of understanding is shown by the very regs that govern health services. Health Services officers shall provide emergency medical care and stabilizing first aide to the extent of their training and licensure. First of all, I cant get my hands on things like epinephrine and glucagon unless they are supplied to me my an EMS agency or one sort or another. And even if I could, CAP doesn't provide the liability for me to operate the extent of my licensure and training so anything I do that is above what Joe Smith off the street could do is illegal and practicing without a license. CAP getting sued has been mentioned. The regs as they exist now would get CAP and me sued if I followed them. So if I happened to carry a nasal airway in my pack, if I put it down and tore the nasal mucosa, further compromising the airway, while CAP says it wants me to provide care to the extent of my training, I would lose my license and get sued and CAP would stand to lose alot more money than I would. While the CGAUX operates under largely these same policies, at least it would cover me if I functioned within my licensure protocols.

What CAP wants is for people with the license and training to stick their necks out to help someone in need, but doesn't want to take any responsibility. They cant have it both ways. They make it clear that they want EMTs in the field, but do nothing to back us up.

Quote from: SARMedTech on June 01, 2007, 05:24:13 PM
If CAP doesn't have a medical component, then it should stop recruiting saying that it does. If its not up to speed with the way that SAR operations are run, it shouldn't so  frequently say that it conducts 85% of the inland SARs for the USAF. Its time to live up to what we say we can do. If we say we can do it, the other organizations we work with will be expecting us to and relying on us for it and its going to be a big problem when we show up and don't have the slightest clue what to do.

CAP doesn't say anything about having a medical component in any of the recruiting material that I can recall.  Maybe individual members or squadrons are saying such a thing, and if so they shouldn't.  What we do say, as you mentioned, is that we perform inland search & rescue for the USAF, and we do that.  How are we not living up to that commitment?  As far as I know, CAP has never declined to search for any missing aircraft when we have been requested through proper channels to do so.

What I do see is some people identifying an expertise that they have and wanting that expertise recognized and integrated into what CAP does.  EMS is only one area of emergency services that has been mentioned in the past.  Others have wanted to incorporate other skill sets into CAP ES.  There isn't anything wrong with having those discussions.  I think the question we need to ask ourselves is what are CAP's ES missions, what skill sets are required for those missions, and are those missions something CAP can do better than other organizations.  There are other specialties that CAP could integrate into our operations, the question is can the USAF be convinced that there is a need for CAP to perform them.

Quote from: ELTHunter on June 01, 2007, 07:37:50 PM

Quote from: SARMedTech on June 01, 2007, 05:24:13 PM
If CAP doesn't have a medical component, then it should stop recruiting saying that it does. If its not up to speed with the way that SAR operations are run, it shouldn't so  frequently say that it conducts 85% of the inland SARs for the USAF. Its time to live up to what we say we can do. If we say we can do it, the other organizations we work with will be expecting us to and relying on us for it and its going to be a big problem when we show up and don't have the slightest clue what to do.

CAP doesn't say anything about having a medical component in any of the recruiting material that I can recall.  Maybe individual members or squadrons are saying such a thing, and if so they shouldn't.  What we do say, as you mentioned, is that we perform inland search & rescue for the USAF, and we do that.  How are we not living up to that commitment?  As far as I know, CAP has never declined to search for any missing aircraft when we have been requested through proper channels to do so.

What I do see is some people identifying an expertise that they have and wanting that expertise recognized and integrated into what CAP does.  EMS is only one area of emergency services that has been mentioned in the past.  Others have wanted to incorporate other skill sets into CAP ES.  There isn't anything wrong with having those discussions.  I think the question we need to ask ourselves is what are CAP's ES missions, what skill sets are required for those missions, and are those missions something CAP can do better than other organizations.  There are other specialties that CAP could integrate into our operations, the question is can the USAF be convinced that there is a need for CAP to perform them.

Check the specialty listing on the Prospective Member Information Pamphlet sent out by HQ

Quote from: SARMedTech on June 01, 2007, 02:16:34 AM

There are many flaws in your argument.

1. You are trying to quote a number that would include every single member of CAP being covered by liability insurance as an EMT/Medic. I doubt that every member has an interest in EMS. What most of those of us who desire to see this change are proposing is a CAP medical corp.

I'm sorry I wasn't more clear.  I was referencing the number of CAP members to show the size of the "dues base" available to pay the malpractice insurance for our medically licensed folks.  I certainly agree that only a few % of our members are licensed medical folks.

Quote from: SARMedTech
2. There are EMS malpractice insurers who operate in all 50 states. The cover EMTs of all sorts based on the protocols in those different states.

Exactly.  But it is more expensive to cover someone for multiple states than for a single state due to differing licensure and scope-of-practice issues.

Quote from: SARMedTech

3. All EMTs and Medics provide high risk procedures. I have done riskier things in the back of a moving ambulance than I would ever do in the field and quite frankly, having a patient on a drag stretcher and trying to drop and breathing tube is much easier.

While all medics by definition do emergency work, that is certainly not true for docs and nurses.  (Which, BTW will be the most expensive part of the policy, not the medics.)

The malpractice premiums for physicians vary widely among specialties and locations.  THe difference between an OB-GYN in NYC and a GP in Montana is hundreds of thousands of dollars a year.

Quote from: SARMedTech
4. The "dues" you might need to raise to cover what we will for now call the CAP medical corps would not have to be paid by everyone, just those who wished to provide emergency medical care in the field.

Ouch.  I suspect that would severely limit the number of docs who'd volunteer if they knew their dues could be tens of thousands of dollars a year more than mine.

Quote from: SARMedTech

5. Any doctor that would be involved (say as a remote medical director) would have his own insurance and I seriously doubt that we need chiropractors in the field, so that particular argument is moot. We're not talking about treating people for sciatica here, we are talking about saving lives through EMS. Youre comparing apples and oranges. Also, while perhaps their might be a need for an RN in the field, LVNs are not the most common practitioners of emergency medicine.

Ahh, but as others have pointed out, most docs are not sole practicioners these days.  Most practice for a group or a corporation.  And those malpractice policies are almost always limited to the practice of the entity paying for it.  Which makes sense.  Why would the Smalltown Physicians Group, Inc. pay for a malpractice rider for one of their docs so she/he could be part of the CAP EMS?

And the discussion is wider than just field medicine.  Cadet Programs folks would love to have a medical professional at encampments or NCSAs to help triage and treat the inevitable injuries and illnesses that arise at any challenging activity.

That's where your podiatrists and DCs come in.

Quote from: SARMedTech

6. If it wished to do so, the USAF could cover CAP EMTs and Medics during the time that we are operational for them.

Yup, they sure could.  But this leads to all sorts of problems with the whole AUX ON/AUX OFF thing as well as USAF oversight and licensing.  If I were the USAF, I doubt I'd cover any medical professional unless I'd had a chance to train or at least evaluate their training periodically.  A whole new CAP beauracracy . . . .

I hope I've addressed the "flaws" in my post.   ;)

Quote from: Ned on June 01, 2007, 09:38:46 PM

Quote from: SARMedTech on June 01, 2007, 02:16:34 AM

There are many flaws in your argument.

1. You are trying to quote a number that would include every single member of CAP being covered by liability insurance as an EMT/Medic. I doubt that every member has an interest in EMS. What most of those of us who desire to see this change are proposing is a CAP medical corp.

I'm sorry I wasn't more clear.  I was referencing the number of CAP members to show the size of the "dues base" available to pay the malpractice insurance for our medically licensed folks.  I certainly agree that only a few % of our members are licensed medical folks.

Quote from: SARMedTech
2. There are EMS malpractice insurers who operate in all 50 states. The cover EMTs of all sorts based on the protocols in those different states.

Exactly.  But it is more expensive to cover someone for multiple states than for a single state due to differing licensure and scope-of-practice issues.

Quote from: SARMedTech

3. All EMTs and Medics provide high risk procedures. I have done riskier things in the back of a moving ambulance than I would ever do in the field and quite frankly, having a patient on a drag stretcher and trying to drop and breathing tube is much easier.

While all medics by definition do emergency work, that is certainly not true for docs and nurses.  (Which, BTW will be the most expensive part of the policy, not the medics.)

The malpractice premiums for physicians vary widely among specialties and locations.  THe difference between an OB-GYN in NYC and a GP in Montana is hundreds of thousands of dollars a year.

Quote from: SARMedTech
4. The "dues" you might need to raise to cover what we will for now call the CAP medical corps would not have to be paid by everyone, just those who wished to provide emergency medical care in the field.

Ouch.  I suspect that would severely limit the number of docs who'd volunteer if they knew their dues could be tens of thousands of dollars a year more than mine.

Quote from: SARMedTech

5. Any doctor that would be involved (say as a remote medical director) would have his own insurance and I seriously doubt that we need chiropractors in the field, so that particular argument is moot. We're not talking about treating people for sciatica here, we are talking about saving lives through EMS. Youre comparing apples and oranges. Also, while perhaps their might be a need for an RN in the field, LVNs are not the most common practitioners of emergency medicine.

Ahh, but as others have pointed out, most docs are not sole practicioners these days.  Most practice for a group or a corporation.  And those malpractice policies are almost always limited to the practice of the entity paying for it.  Which makes sense.  Why would the Smalltown Physicians Group, Inc. pay for a malpractice rider for one of their docs so she/he could be part of the CAP EMS?

And the discussion is wider than just field medicine.  Cadet Programs folks would love to have a medical professional at encampments or NCSAs to help triage and treat the inevitable injuries and illnesses that arise at any challenging activity.

That's where your podiatrists and DCs come in.

Quote from: SARMedTech

6. If it wished to do so, the USAF could cover CAP EMTs and Medics during the time that we are operational for them.

Yup, they sure could.  But this leads to all sorts of problems with the whole AUX ON/AUX OFF thing as well as USAF oversight and licensing.  If I were the USAF, I doubt I'd cover any medical professional unless I'd had a chance to train or at least evaluate their training periodically.  A whole new CAP beauracracy . . . .

I hope I've addressed the "flaws" in my post.   ;)

Forgive me if I dont address what youve said in as orderly a fashion as you did:

Medical Directors for EMS are required to be established ER physicians working in a hospital or trauma center, not in Smalltown Medical Group. They are covered when advising us just as if they were treating the patient themselves. Their premiums do not go up because they are authorizing EMTs to do things in the field.

I am not suggesting that EMTs in CAP would practice in multiple states. That would involve the EMTs themselves holding multiple licensures.

Perhaps podiatrists, since there are lots of sore feet at encampments and exercises, but I see very little need for chiropractors in those settings or in the emergent medical setting of a live SAR sortie.

Doctors already have medical malpractice insurance and licenses. EMTs and Medics operate under that doctors ( the aformentioned medical directors) license, which is why EMT malpractice insurance is relatively inexpensive, especially when provided for an agency, rather than for a specific EMT.

As far as AUX on Aux off, I have suggested repeatedly that these EMTs would operate as EMTs and be covered only when acting as " force augmenters" for the AF. And the regs already say that medical professionals like EMTs are already credentialled and licensed and that no further credentialling by the AF or CAP would be necessary, merely a record of that EMS providers licenses and certificaions.

Quote from: SARMedTech on June 01, 2007, 10:08:47 AM

Quote from: PA Guy on June 01, 2007, 07:11:57 AM

Quote from: SARMedTech on June 01, 2007, 03:32:03 AM
Here are some other things to think about:

Even at the first responder level:  a person must be 18 to get this level of certification. Thats DOT/DHTSA regs.

So out of the 60k members, you could eliminate those cadets who are too young. The you can eliminate those that have no interest in EMS. Then you can eliminate those that for whatever reason cannot meet the physical requirements necessary for an EMS license (generally being able to lift 150 pounds by youself). The you can eliminate those folks who are not ground pounders, IE those who work in misson bases.  So the 60k number (IE certifying and insuring the entire membership) is a fallacy. Also, as I say, MDs have their own malpractice which covers them when they are working as medical directors and medical directors are not generally in the field. Many RN's work under the liability of whatever organization, hospital, hospice they work for and quite frankly, other than flight nurses (CAP has no aircraft equipped for acute trauma transport that I know of) or nurses who are also EMTs of one level or another, this number is relatively small. As I also said, you can take Chiros out of the equation because i have yet to see a chiropractor work a trauma scene with me. Same the DO's. I could go on and on, but I think you are getting the point. Nobody is talking about making everyone in CAP an EMT, but rather  covering those who are and developing a "CAP Corpsman" program so that the badges and patches we wear actually mean something instead of just being more shiny bling.

How much are gliders and hot air balloons used for SAR activities or transport time sensitive materials? Perhaps there could be some cuts in those programs. I have nothing against either of them, I just wonder how practical they are.

No EMS Agency in CA has a physical capacity requirement for certification. Physicians in solo practice have their own malpractice but would have to add a rider for CAP that would drive up their premium. Physicians in group practices are generally covered by the group policy only while working directly for the group. This also applies to RNs, PAs etc. Their hospital, hospice or whatever only covers them when they are on the hospital, hospices clock. So to be covered those folks would need a separate policy through CAP. Even if only 600 people in CAP wanted to participate in the program it would still be a sizeable chunk of change by the time all the EMT, Physicians, Nurses and others were included. That would only include the personal liability it wouldn't include the corporate liability.  Remember, they aren't just going to sue you they will also go after CAP, Inc. The only way CAP will ever be involved in EMS is if they are taken under the federal umbrella like the DMATs. And I don't see that happening anytime soon.

Well, first off, at least one EMS provider in CA has a physical requirement...An agency called AMR. They require their EMTs to be able to lift 150 lbs by themselves and 225 with the aide of their partner. I also happen to know that the medics that work for LAFD have this requirement except I think their weight requirements are higher.

First off, doctors in hospices, etc are not going to be providing medical control for EMS providers. Each EMS region throughout the country has a Medical Director who supervises and shuffles the paper for what goes on in that EMS region. The medical control comes from doctors, often hospitalists, who work only in the emergency room and pick up the phone when a crew is coming to their facility and needs permission to push a certain drug, perform a certain procedure, etc...many of which are covered by standing orders and do not require permission. Physicians in group practices do not (read are not allowed in IL) to provide EMS medical control. The physician providing this assistance to the crews has to be board certified in Emergency/Trauma Medicine.

To give you an idea...we have a new ambulance company here in my home town that was started by two medics in an old airplane hanger. The got registered with dispatch and they get medical assistance by calling into the hospitals and saying "hey we need a doctor." I think one thing you fail to understand is that I am not talking about EMTs out their putting burr holes in peoples skulls, what I am talking about is EMTs on GTs performing within their scope of practice (actually no EMT or Medic has a scope of practice as this would indicate that they operate autonomously, which they do not...rather they have protocols.)  I'm talking about EMTs on GTs performing BLS/BTLS within their protocols to effectively AND safely stabilize a patient  and be able to monitor that patient and report findings ACCURATELY  until the main EMS agency arrives.

You say some people live and some people die...I am keenly aware of this. I had a patient die in my hands on March 24th. But that doesn't mean that when there is an option to prevent this from happening that there shouldn't be a system in place to stabilize that patient, which after all, is what EMS does in the first place. Its a fallacy that EMS practices emergency medicine. We provide emergency medical interventions and there is a huge difference. I'm talking about things like when a cadet goes into anaphylaxis from a bee sting, that we could start a nasal pharyngeal airway and give low does epinephrine.....both stabilizing measures which might save that patient until a full blown EMS crew gets there. Or the possibility of being able to place a dual lumen airway in the patients throat to provide them with an airway. I know money is a concern. Money is a concern in any situation. But do you think that SAR cant open CAP up to liability when someone says "Hey, why wasn't my wife put in a c-collar before you put her in that basket stretcher to carry her to the road?" See what we have here is a situation where CAP members are going to provide first aide that are not licensed to put their hands on patients, they're going to go too far and thats where CAP will get in trouble.

As for NIMS/ICS...they have very little to do with the practice of EMS from a medical standpoint. They are designed as organizational systems in the event of a mass casualty incident. Very little of what NIMS does other than establishing triage, has anything to do with the actual medicine. And its not spreading at the rate you think it is because some agencies refuse to use it because it is still in its infancy and will probably take at least another 5-10 years before it is a viable management system. The fact remains that SAR agencies, like those that CAP worked along side of on Mt. Hood last Christmas are EMS capable and ready to go. They have to be. Its not a matter of people not wanting to pay more dues. Its a matter of SAR meaning Search and Rescue and Rescue inherently carries with it a medical component. If you have a patient in the wreckage or a plain, you better think twice about moving them without a EMS component on your GT. 

Your arguments are all over the place. All of CAPS literature says that CAP performs 85% of SAR missions for the Air Force on inland sorties. How can you say that CAP has yet to perfect their SAR capabilities. If they save 500 lives a year as its stands now, how many would they save if they could provide on scene stabilization. Lets here the statistics of how many people are reached by CAP GTs and then die before they can be gotten to a medical facility. The fact is that CAP touts medical as one of its specialties and doesn't deliver. Giving hygiene and anti-drug lectures to cadets and seniors isn't where the real medical dollars need to be spent.

Maybe a claification of terms is needed. In my neck of the woods a EMS Agency is the govermental entitiy that regulates and certifies EMS providers. EMS Providers are the entities that provide EMS services, such as AMR and LAFD.  Providers are free to determine physical capacity requirements. The agencies are not.

You state that physicians who provide medical control are required to be certified in emergency medicine. Not so, I know of areas in the country where family practitioners moonlight in ERs. I live part time in a rural area of the country where the Medical Director for the local EMS Agency is a family practitioner in a group practice and the FP that I go to for care moonlights in an ER. Neither is certified in emergency medicine. Heck, the whole state only has one Level I Trauma Center. And yes, ER docs do work in groups. In CA one of the largest ER doc groups is Pacific Physician Services. Most ER docs in CA belong to a medical group that contracts with the hospital to provide physician coverage to their ER and those docs are either MDs or DOs.

The point of all of this is we can't even agree on common terms and how the  various EMS agencies and providers do business in all parts of the country. How would we run a coherent CAP EMS program based on local policy and regs. Being covered under the federal umbrella is the only way it could work in my view and the political will to do that doesn't exsist right now. You are going to drive yourself to distraction trying to change the current regs, but hey, they are your windmills.   

Quote from: SARMedTech on June 01, 2007, 02:16:34 AM
6. If it wished to do so, the USAF could cover CAP EMTs and Medics during the time that we are operational for them.

Hate to tell you, but the military can't get enough medical personnel to cover their own needs, much less reach out and cover CAP too.

Quote from: PHall on June 02, 2007, 05:27:16 PM

Quote from: SARMedTech on June 01, 2007, 02:16:34 AM
6. If it wished to do so, the USAF could cover CAP EMTs and Medics during the time that we are operational for them.

Hate to tell you, but the military can't get enough medical personnel to cover their own needs, much less reach out and cover CAP too.

I think he ment...."cover" as in "liablity coverage" not "cover" as in provide USAF personnel to cover the requirment.

Heck CAP could cover them....we would just have to pay for it....standardise the training requirments and enforce the standards.  I just did a quick quote for malpractice insurese.  It cots only $104 per year for $1M per claim (up to 3 claims a year).

Heck that's cheaper than I thought!

That is what I meant when I said cover and while I realize that $104/year is more expensive than current dues and would have to paid for somehow, it hardly comes up to the millions of dollars that previous posters have indicated.

Here in IL, MDs providing medical direction to EMS providers must be board certified in Emergency Medicine. And talking about a corporate group of emergency physicians (which we have here too) is different than talking about a little group of rural physicians. Of course differences exist but they are the exception rather than the rule. And there is no federal organization of EMS providers. This is what the NREMT had hoped to become and has failed at miserably for more than 20 years. I agree it would be the best thing that could happen to EMS, but we're not likely to see it any time soon, nor do I believe it is the only way that EMS personnel could work with CAP on more than a first aide level.

Also, another poster said the EMS personnel are required to render care if they are licensed. Not so. If I am licensed (which I am) but am off duty, I can see someone bleeding to death on the street and walk right by them. If I am not on duty, I have no "duty to act" and therefore cannot commit the crime of medical abandonment or failure to render medical care.

I think we have beaten this poor horse into glue. There are those of us who believe that it is possible and doable and those who dont. The only thing preventing it from being done are the current policies and ways of thinking at Corporate. If CAP were the full time AUX for the Air Force and not a non-profit corporation, the decision and process would be greatly streamlined. The only body with the authority to certify EMS personnel to practice in any state at any time is the US Military, though I have never mentioned have CAP EMS folks licensed to practice in all 50 states. The chances of me, an EMT from IL being asked to go to California and work with CAP on  something like SAR/DR is so miniscule as to be non-existent.

I was interested to see that Lordmonar had actually gained some real information and that it sort of disproves the idea that it is prohibitively expensive to cover CAP EMTs. I bet flight insurance costs more than $104/year. My final thoughts are if you are going to do something, do it right. Dont give medical personnel the uniform bling so that they can easily be recognized and then not give them the "tools" they need to do the job in emergent care situations.

Oops. Sorry. One more thought. Not only does CAP list medical as one of the ways that people can get involved in their recruitment literature, when you fill out the request for information at CAP.gov, it asks what your interests are and one of the little boxes to check is "medical."

Quote from: SARMedTech on June 02, 2007, 07:24:38 PM
Oops. Sorry. One more thought. Not only does CAP list medical as one of the ways that people can get involved in their recruitment literature, when you fill out the request for information at CAP.gov, it asks what your interests are and one of the little boxes to check is "medical."

Quote from: SARMedTech on June 01, 2007, 08:24:45 PM
Check the specialty listing on the Prospective Member Information Pamphlet sent out by HQ

Interesting, I hadn't realized that before.  While I am still a little skeptical about the need for a full fledged medical program in CAP (I think we (CAP) need to look at exactly how we fit into the ES world, and what our niche is versus the capability already existing in other agencies), I understand where you're coming from.  I agree that the organization shouldn't be presenting itself to members and/or potential members while limiting them in the performance of the very areas they might be recruited for.

I also believe CAP does write things into the reg to protect the Corporation while at the same time they probably expect that people will violate those regs to perform their work on occasion.  That's not right.  Although those other cases probably do not carry as much risk to the member as the medical case.

Quote from: SARMedTech on June 02, 2007, 07:19:35 PM
.
I was interested to see that Lordmonar had actually gained some real information and that it sort of disproves the idea that it is prohibitively expensive to cover CAP EMTs. I bet flight insurance costs more than $104/year. My final thoughts are if you are going to do something, do it right. Dont give medical personnel the uniform bling so that they can easily be recognized and then not give them the "tools" they need to do the job in emergent care situations.

But there are more than EMTs interested in this. Are you saying that all of the other providers should be excluded?  As a PA in CA my malpractice runs about 6K/yr. If I decided to participate in a CAP EMS program I would have to add that to my malpractice and the premium would rise accordingly. It's not just about EMTs.

Quote from: SARMedTech on June 02, 2007, 07:24:38 PM
Oops. Sorry. One more thought. Not only does CAP list medical as one of the ways that people can get involved in their recruitment literature, when you fill out the request for information at CAP.gov, it asks what your interests are and one of the little boxes to check is "medical."

Looking at the online "Civil Air Patrol New Membership Information Request Form (https://creports.capnhq.gov/prospmbr/prospmbrinfo.asp), I don't see where the medical check box is.

The Prospective Member Information Package lists "Medical" in with the specialty tracks available. It also lists "Legal". Both of these are advisory positions. From CAPR 20-1,

QuoteMedical Officer
Responsible for advising CAP commanders and units on the health, sanitation and hygiene of CAP members relevant to CAP activities. (See CAPR 160-1 for policy on emergency medical treatment). They shall:
Assists the ES Officer in arranging or providing training in first aid and emergency lifesaving measures to include medically recognized cardiopulmonary resuscitation (CPR) techniques.
Provide bloodborne pathogen protection training including preventive measures.
Report bloodborne pathogen exposures and ensure that those members exposed obtain appropriate follow-up medical care from non-CAP sources.
Advise members to obtain necessary physical examinations from their personal physicians and to complete emergency treatment consent forms where required by regulation to participate in various Civil Air Patrol activities. NOTE: Under no circumstances will CAP medical personnel perform physical examinations as part of their Civil Air Patrol duties.
Arrange for necessary medical training materials. Supplies and equipment for unit missions or special activities.
Maintain first aid kits for medical emergencies. (See CAPR 160-1 for policy on emergency medical treatment.)
Generally advise commanders and unit personnel on preventive medicine matters relevant to CAP activities.
Plan conferences and meetings pertaining to special affairs.
Medical officers should be familiar with all CAP directives in the 160 series and applicable portions of CAPRs 55-1, 50-15, 52-16, 50-17 and 62-2.

emphasis mine

H*** no I am not saying that other health care providers should be excluded. The whole idea of all of this has been to provide cadets, SMs and the people we work with in the field competent and effective medical care. If a PA, doc or nurse wants to volunteer their time to hump an M3Alpha through the field with the EMTs, welcome to it. Im talking about EMTs because thats what I am. Because CAP says it wants us and does nothing to cover us from liability. They expect us to volunteer, give alot of our meager incomes to be able to do so and then not cover our butts when the spit hits the spam. If you want to be part of a GT medical team and helping to get CAP to create such an entity, I say "lets go."

Quote from: arajca on June 03, 2007, 03:50:49 PM

Quote from: SARMedTech on June 02, 2007, 07:24:38 PM
Oops. Sorry. One more thought. Not only does CAP list medical as one of the ways that people can get involved in their recruitment literature, when you fill out the request for information at CAP.gov, it asks what your interests are and one of the little boxes to check is "medical."

Looking at the online "Civil Air Patrol New Membership Information Request Form (https://creports.capnhq.gov/prospmbr/prospmbrinfo.asp), I don't see where the medical check box is.

The Prospective Member Information Package lists "Medical" in with the specialty tracks available. It also lists "Legal". Both of these are advisory positions. From CAPR 20-1,

QuoteMedical Officer
Responsible for advising CAP commanders and units on the health, sanitation and hygiene of CAP members relevant to CAP activities. (See CAPR 160-1 for policy on emergency medical treatment). They shall:
Assists the ES Officer in arranging or providing training in first aid and emergency lifesaving measures to include medically recognized cardiopulmonary resuscitation (CPR) techniques.
Provide bloodborne pathogen protection training including preventive measures.
Report bloodborne pathogen exposures and ensure that those members exposed obtain appropriate follow-up medical care from non-CAP sources.
Advise members to obtain necessary physical examinations from their personal physicians and to complete emergency treatment consent forms where required by regulation to participate in various Civil Air Patrol activities. NOTE: Under no circumstances will CAP medical personnel perform physical examinations as part of their Civil Air Patrol duties.
Arrange for necessary medical training materials. Supplies and equipment for unit missions or special activities.
Maintain first aid kits for medical emergencies. (See CAPR 160-1 for policy on emergency medical treatment.)
Generally advise commanders and unit personnel on preventive medicine matters relevant to CAP activities.
Plan conferences and meetings pertaining to special affairs.
Medical officers should be familiar with all CAP directives in the 160 series and applicable portions of CAPRs 55-1, 50-15, 52-16, 50-17 and 62-2.

emphasis mine

You are very right, in this case the mistake was mine. I thought I remembered checking "medical" in the online form. My apologies for the error. The fact remains, however, that on the Prospective Member Information Pamphlet  says "Medical" which is not followed by "advisory." The regs also say that medical personnel should render emergency, stabilizing first aide to the extent of their training. Im trained to put a tube down somebody's throat and give epi. Do you suppose CAP has my back if I do? Thats what all of this is about.

OK heres the policy I was looking at when we had a similar discusion for HMRS.  PA wing actually carries additional suplemental insurance for it rope and rappeling operations so this wouldnt be that much differant (except there is a waiver policy for that in the regs, this topic needs something similar!)
EMT's, Intermediates and Paramedics are $100 /year (a EMS volunteer is only $75, guess that means like first responders) and an LPN & RN is $89.  Quotes for PA's are not available without submitting a detailed form, same for a agency/firm type policy.  One point I thought was nice that we addressed here is it does cover you worldwide. 

QuoteFeatures and Benefits
Up to $1,000,000 per claim professional liability coverage
Your coverage protects you for settlement of a claim or damages awarded up to $1,000,000 each claim.
Up to $3,000,000 aggregate professional liability coverage
Your coverage protects you with up to $3,000,000 aggregate liability protection. This is the maximum limit available to protect you against multiple claims within the policy year.
HPSO offers other liability limit and coverage options.
Please contact us if you'd like to learn more about these options.

Occurrence Coverage
Protects you regardless of when a claim is filed, provided the policy was in force at the time the covered medical incident occurred.
Defense Attorney Provided
An attorney will be provided to represent you personally, when necessary. Legal fees will be paid for covered claims, in addition to your liability limit - WIN OR LOSE.
Deposition Representation
Reimburses you up to $5,000 aggregate, up to $2,500 per deposition for attorney fees as a result of your required appearance at a deposition that arises out of professional services.
Defendant Expense Benefit
Reimburses you up to $10,000 aggregate for lost wages and covered expenses incurred when you attend a required trial, hearing or proceeding as a defendant in a covered claim.
License Protection
· Reimburses you for your defense of license or disciplinary action and other covered expenses arising out of a covered incident, up to $25,000 aggregate, up to $10,000 per proceeding.
Worldwide Coverage
You are protected 24/7 anywhere in the world for covered medical incidents, provided claim is brought against you in the United States, its territories, Puerto Rico, or Canada.
In addition, HPSO provides the following benefits:

Assault Coverage*
Covers your medical expenses or reimburses you for damage to your property, up to $25,000 aggregate, up to $10,000 per incident if you are assaulted at work or while commuting to and from your workplace.
Personal Liability coverage
Protects you, up to $1,000,000 aggregate for liability damages for covered claims resulting from incidents at your residence, unrelated to your work.
Personal Injury coverage
Protects you, up to the applicable limits of liability, against covered claims arising from charges of privacy violation, slander, libel, assault and battery, and other alleged personal injuries committed in the conduct of your professional services.
First Aid Expense
You will be reimbursed for expenses you incur in rendering first aid to others- up to $2,500 aggregate.
Medical Payments
Pays up to $100,000 aggregate, up to $2,000 per person for reimbursement of medical expenses to others injured at your residence or business premises.
Damage to Property of Others
Pays up to $10,000 aggregate, up to $500 per incident for damage caused accidentally by you to the property of others at your residence or workplace.

mk

OK, now we have some numbers to begin to work with.

We do need a quote for MDs, DOs, and PAs to really get  a handle on this.

But the biggest problem is that while the policy you have researched does cover EMTs, it does not cover CAP, Inc. for the liability of its medical personnel.

And that's a show-stopper.

And of course, where the lion's share of the cost is going to be.

Keep up the good work.

"Hate to tell you, but the military can't get enough medical personnel to cover their own needs, much less reach out and cover CAP too."

That statement is so bad.  The military can't get medical/dental people because a doctor can make many times more income without a cost of going to war by being a civilian doctor.  the military carries too much risk with too little compensation for a doctor/dentist.   Cap on the other hand does not comit anyone to anything, and there is no chance of being forced into war.  With proper liability coverage I believe doctors/dentists would be more than happy to donate time and talants to CAP.  I know I am a dentist.

I would imagine, that in the case of CAP being covered vs the individual EMS personnel being covered, that CAP has insurance in place for liability,indemnity, etc. It has a legal department, it has insurance, etc. Where we run into the problem is that in case of a medical situation where an EMT, Medic, etc take aggressive action (say I place a breathing tube and damage the lining of the trachea...something that happens relatively frequently) even if that person does not die and suffers no permanent deficit or disability...Im screwed. Juries tend to side with the injured party. There ears suddently close when it gets to the part where a medical expert is testifying that if EMT Smith hadnt placed the ET tube when he did and secured an airway, Cadet Jones would have died in full cardio-pulmonary arrest. They dont hear that. What they hear is the other sides medical expert asking EMT Smith how many tubes he has placed in people throats in his career, how many of them would he classify as difficult, how many of the attempts to intubate have failed. The jury is also going to lose their hearing again when they are being told by a trauma physician that some damage to the trachea (or espophagus in the case of a dual lumen tube) is an understood complication and is considered an "acceptable outcome" given the alternative which is our aforementioned Cadet dying in full arrest. So then that jury turns around and awards a gigantic sum of cash to the Cadet's family, my license is pulled and CAP merrily on. They are covered. Its the providers that they are asking to perform "emergency stabilizing first aide" to the extent of their training that need to be covered. When you hear first aide, everyone thinks bandaides and iodine. Ive got news for you, its more than that. If you have a cadet or SM who falls over an embankment and breaks their femur and tears the femoral artery, then the "first aide" i need to perform just went up and I would hope that it could include a medic there able to gain IV access. Right now, with the way things stand, that cant happen.

To those who think this is all a fool's errand or that well-trained, well-insured EMS responders arent really all that necessary think about this situation: You are on a sortie or exercise and you get pains in your chest. At first they arent that bad so you ignore them and push ahead. Then they radiate down your arm and into your neck. Youre having a heart attack. You collapse and are pulseless and breathless. Do you want and EMT and  Medic right there on scene who can attempt through interventions, drugs, etc to revive you, or would you like us to perform basic first aide for the 60 minutes it takes a ambulance to reach you. Im guessing that everyone that volunteers their time would like to know thta in the event that they become hurt or ill or just dont feel right, that there is a team (hopefully an EMT and  Medic) on your ground team that can tend to your right then and there and if you need to be evac'd out, can begin to set that process in motion, all the while continuing to care for you. What about your children that are cadets? Do you want them to have instant medical care, or do you want them to wait? What about someone that we might find in an aircraft that is in shock, would you go home from that sortie feeling better that there was an immediate response by your squadron's medical officers that tried to help that person or would you lose some sleep because those medical officers could have helped, but were limited by the fact they are not covered from liability and do not have access to emergency medical direction.

As an EMT, I am willing to carry an entire Medics pack in addition to my alice pack to be prepared for as many eventualities as we can. Im willing to schlep the extra gear and setups into the field and then carry it back unused because nothing happened on that sortie. I am trained, willing and able to help in first aide AND emergent care situations, but Im not going to be as aggressive as perhaps I might need to be if I know that if something goes wrong, Im going to get left twisting in the wind by the same CAP who gave me that EMT bling for my BDUs. Im willing to be a volunteer EMT for CAP, but not if they dont have my back. They want it both ways...they want the service, but they dont want to have to pay anything for it. Im not saying that they should pay me, but pay for coverage, pay for some of the expendable supplies or reimburse me for them and give me some liability insurance. Its not a difficult concept...perhaps its just not as important  over at NHQ as what badge goes where on what uniform.

Quote from: desert rat on June 05, 2007, 06:09:57 AM
"Hate to tell you, but the military can't get enough medical personnel to cover their own needs, much less reach out and cover CAP too."

That statement is so bad.  The military can't get medical/dental people because a doctor can make many times more income without a cost of going to war by being a civilian doctor.  the military carries too much risk with too little compensation for a doctor/dentist.   Cap on the other hand does not comit anyone to anything, and there is no chance of being forced into war.  With proper liability coverage I believe doctors/dentists would be more than happy to donate time and talants to CAP.  I know I am a dentist.

'Doc', spell check comes in handy every now and again.  ::)
Aside from that, how would a Dentist be of direct MEDICAL benifit to CAP Emergency Services? - Im not saying a Dentist isnt of use to CAP, just not as a dentist "in the field" - I cant see CAP allowing Crown Repair on a mission, insured or not. 

Quote from: SARMedTech on June 05, 2007, 06:42:53 AM
I would imagine, that in the case of CAP being covered vs the individual EMS personnel being covered, that CAP has insurance in place for liability,indemnity, etc. It has a legal department, it has insurance, etc. Where we run into the problem is that in case of a medical situation where an EMT, Medic, etc take aggressive action (say I place a breathing tube and damage the lining of the trachea...something that happens relatively frequently) even if that person does not die and suffers no permanent deficit or disability...Im screwed. Juries tend to side with the injured party. There ears suddently close when it gets to the part where a medical expert is testifying that if EMT Smith hadnt placed the ET tube when he did and secured an airway, Cadet Jones would have died in full cardio-pulmonary arrest. They dont hear that. What they hear is the other sides medical expert asking EMT Smith how many tubes he has placed in people throats in his career, how many of them would he classify as difficult, how many of the attempts to intubate have failed. The jury is also going to lose their hearing again when they are being told by a trauma physician that some damage to the trachea (or espophagus in the case of a dual lumen tube) is an understood complication and is considered an "acceptable outcome" given the alternative which is our aforementioned Cadet dying in full arrest. So then that jury turns around and awards a gigantic sum of cash to the Cadet's family, my license is pulled and CAP merrily on. They are covered. Its the providers that they are asking to perform "emergency stabilizing first aide" to the extent of their training that need to be covered. When you hear first aide, everyone thinks bandaides and iodine. Ive got news for you, its more than that. If you have a cadet or SM who falls over an embankment and breaks their femur and tears the femoral artery, then the "first aide" i need to perform just went up and I would hope that it could include a medic there able to gain IV access. Right now, with the way things stand, that cant happen.

To those who think this is all a fool's errand or that well-trained, well-insured EMS responders arent really all that necessary think about this situation: You are on a sortie or exercise and you get pains in your chest. At first they arent that bad so you ignore them and push ahead. Then they radiate down your arm and into your neck. Youre having a heart attack. You collapse and are pulseless and breathless. Do you want and EMT and  Medic right there on scene who can attempt through interventions, drugs, etc to revive you, or would you like us to perform basic first aide for the 60 minutes it takes a ambulance to reach you. Im guessing that everyone that volunteers their time would like to know thta in the event that they become hurt or ill or just dont feel right, that there is a team (hopefully an EMT and  Medic) on your ground team that can tend to your right then and there and if you need to be evac'd out, can begin to set that process in motion, all the while continuing to care for you. What about your children that are cadets? Do you want them to have instant medical care, or do you want them to wait? What about someone that we might find in an aircraft that is in shock, would you go home from that sortie feeling better that there was an immediate response by your squadron's medical officers that tried to help that person or would you lose some sleep because those medical officers could have helped, but were limited by the fact they are not covered from liability and do not have access to emergency medical direction.

As an EMT, I am willing to carry an entire Medics pack in addition to my alice pack to be prepared for as many eventualities as we can. Im willing to schlep the extra gear and setups into the field and then carry it back unused because nothing happened on that sortie. I am trained, willing and able to help in first aide AND emergent care situations, but Im not going to be as aggressive as perhaps I might need to be if I know that if something goes wrong, Im going to get left twisting in the wind by the same CAP who gave me that EMT bling for my BDUs. Im willing to be a volunteer EMT for CAP, but not if they dont have my back. They want it both ways...they want the service, but they dont want to have to pay anything for it. Im not saying that they should pay me, but pay for coverage, pay for some of the expendable supplies or reimburse me for them and give me some liability insurance. Its not a difficult concept...perhaps its just not as important  over at NHQ as what badge goes where on what uniform.

I too have humped BLS gear into the woods with an Alice on a SAREX.
However, while I wear the EMT badge on my uniform- for comraderie with other EMS types-Im a far cry from carrying an Ambulance on my back.
(Im 140lbs)
I dont hump in O2, I dont have a KED or Longboard, though I do have a plastic tarp-esc liter, and while I do have a C-Collar I dont have an AED....
There are limits to the extras I can bring in and still remain "mission effective" - remember i still have a GT pack on my back.

Nor do I carry a long board, though a KED wouldnt be a bad idea as a substitute though I admit it would be bulky as all get out. And one c-collar, unless its adjustable for size isnt gonna do it, but I see what you mean. I wasnt talking about carrying an ambulance. Obviously, we cant carry one of the most needed things into the field, which is 02. When I talk about carrying extra gear, Im talking about a medics pack in addition to my alice gear, something along the lines of the new M3Alpha would help or a SWAT alice pack add on. We could take a big lesson from the new step child of EMS which is tactical medicine. It solves alot of the problems of size of items, etc that we need. Also looking at research on field medicine will help to down size and also help an EMT to carry equipment that has more than one purpose.

CAP is NOT a paramedical organization.

What are the approved medical protocols for EMT's and paramedics in CAP?  There are none.  That means that EMT's and Paramedicas are simply highly qualified and experienced first aiders.

CAP's cadet program is designed to teach leadership and aviation, not medicine.  While I would certainly NOT discourage a cadet from learning and exploring a career on his own, CAP is not set up to train wannabe doctors.

Hawk Mountain team medic training focuses on first aid for other team members. 

Quote from: SARMedTech on June 05, 2007, 06:42:53 AM
I would imagine, that in the case of CAP being covered vs the individual EMS personnel being covered, that CAP has insurance in place for liability,indemnity, etc. It has a legal department, it has insurance, etc.

Nope. 

And that's the whole point of this discussion.

CAP, Inc. is NOT covered for medical malpractice by its members.  Our general liability insurance specifically excludes medical malpractice, among other things.  And for a very good reason.

You certainly described a vivid situation where juries might tend to find for the plaintiffs in civil actions against CAP and the CAP medic who performed some medical function.  Heck, I'm not a medical professional (I'm just a "lapsed" EMT), so you are probably right.

And that is why medical malpractice insurance that covers CAP, Inc would be so darn expensive.  And as I mentioned above, I suspect it would be literally hundreds of thousands of dollars a year to cover the corporation.

Again, as a CP guy, I would love to have medical folks who could do more than advise and train.

But I'm not prepared to risk the entire cadet program by allowing medics to do anything that might result in a multi-million judgment against the corporation.

So, until we can figure out a way to cover the corporation at a reasonable cost, this discussion is pretty much done.

Ned-

simply because you dont know how a certain obstacle wold be overcome, doesnt mean that the discussion needs to be concluded. The free exchange of ideas is how problems get solved. The membership discussing an idea and talking over possible solutions to it are how things get done. For CAP its really a catch 22---if something happens to a cadet or SM and no medical assistance is available immediately on scene where it should be, CAP is going to get sued and sued big. If there is medical care there and something goes wrong CAP is going to get sued. It is my opinion, however, that when you have volunteers performing missions for the United States Military and there are no provisions made for pre-hospital emergency medical care in the field, you open yourself up far more that you would if you had those folks covered, yourself covered and something were to occur. One of the biggest instances I can thinking of is a severe fall. Without giving medical officers the tools and coverage they need to render care, CAP opens itself wide to a huge liability. They are responsible for the safety of cadets and officers while they are functioning in an official capacity for CAP, and no waiver form signed is going to hold up, I can tell you that from experiece. Nothing that says "I hold CAP, Inc totally and wholely blameless for any injuries or illnesses that I may incur in its service" is going to mean diddly squat in front of a jury. So if its a matter of where would Corporate get slapped around the worst, its by not having provisions for the best possible medical care available to its members. Heck, rock concert venues are required to have EMS standing by as are car races and air shows. Theres not a military operation that would occur anything like what CAP asks its members to do that would not have a medic along in the field. If it hold the line and doesnt make the necessary changes, its only when, not a matter of if, CAP will collapse under the weight of a huge liability lawsuit. A rather silly way to go under after 60 years.

Quote from: JohnKachenmeister on June 06, 2007, 12:17:43 AM
CAP is NOT a paramedical organization.

What are the approved medical protocols for EMT's and paramedics in CAP?  There are none.  That means that EMT's and Paramedicas are simply highly qualified and experienced first aiders.

CAP's cadet program is designed to teach leadership and aviation, not medicine.  While I would certainly NOT discourage a cadet from learning and exploring a career on his own, CAP is not set up to train wannabe doctors.

Hawk Mountain team medic training focuses on first aid for other team members. 

First of all, what HM produces are not truly medics. People who complete the program are not qualified to sit for the board exam of the NREMT which licenses medics and it is doing a disservice by calling people that complete the program medics. They are not. I have looked at the programs. They are training non-licensed first aiders. It takes a minimum of about 150 hours to qualify as an EMT-Basic and a couple thousand hours to be eligible to take the NREMT medic exam. HM is not producing medics.

Quote from: SARMedTech on June 06, 2007, 02:41:40 AM
Ned-

simply because you dont know how a certain obstacle wold be overcome, doesnt mean that the discussion needs to be concluded. The free exchange of ideas is how problems get solved. The membership discussing an idea and talking over possible solutions to it are how things get done. For CAP its really a catch 22---if something happens to a cadet or SM and no medical assistance is available immediately on scene where it should be, CAP is going to get sued and sued big.

Feel free to keep discussing "pie in the sky" scenarios if you wish.  It sure can't hurt anything.

But make no mistake, CAP does not incur any liability for NOT providing medical care.  IOW, the notion that we will somehow be sued for not allowing medics to engage in medical operations simply is not born out by the last 20 years of experience.  For better or worse, there is no significant liability for relying on conventional EMS.

If a cadet falls at encampment and is seriously injured, we render first aid and call 911 just like everyone else in the country. 

Like I said earlier on, this is a fairly simple economic decision.  We could easily go out and buy insurance, but the money has to come from somewhere.  Maybe Uncle Sam will kick down a couple hundred thousand in extra appropriated funds.  Maybe the membership wouldn't object to doubling or tripling of our dues.  Or maybe we could find a place to cut a couple of hundred thousand out of our budget.

But until then, our HSOs are gonna be restricted to providing advice and training.

No matter how much we might wish otherwise.

Quote from: SARMedTech on June 06, 2007, 02:45:04 AM

Quote from: JohnKachenmeister on June 06, 2007, 12:17:43 AM
CAP is NOT a paramedical organization.

What are the approved medical protocols for EMT's and paramedics in CAP?  There are none.  That means that EMT's and Paramedicas are simply highly qualified and experienced first aiders.

CAP's cadet program is designed to teach leadership and aviation, not medicine.  While I would certainly NOT discourage a cadet from learning and exploring a career on his own, CAP is not set up to train wannabe doctors.

Hawk Mountain team medic training focuses on first aid for other team members. 

First of all, what HM produces are not truly medics. People who complete the program are not qualified to sit for the board exam of the NREMT which licenses medics and it is doing a disservice by calling people that complete the program medics. They are not. I have looked at the programs. They are training non-licensed first aiders. It takes a minimum of about 150 hours to qualify as an EMT-Basic and a couple thousand hours to be eligible to take the NREMT medic exam. HM is not producing medics.

I know that.

They are trained to be the primary first aider if a team member goes down.

Look, guy, I'm with you, except that I'm not up on all the latest government rules on emergency medical care.  When I started in the medical thing it was 1967, and I was a Navy hospital corpsman.  The idea of trained medics at emergency scenes was a brilliant new idea pioneered by us guys in the military in Vietnam.  Now, civilian helicopter dustoff is rountine.  In 1968, it did not exist.  In in 67-68, if you were involved in a wreck, there was no extrication, no EMT's, no fluid replacement, there was only an ambulance, operated by the FUNERAL DIRECTOR, who would hire a guy with a Red Cross standard first aid card to drive you to the hospital.

While the inspiration for modern EMS did, in fact, come from the military, particularly during the Korean and VietNamese conflicts, the development of modern EMS in the United States, that is bringing medicine to the scene, was developed by the Department of Transportation and the National Highway Traffic Safety Administration in the early 1970's to deal with the increase of fatalities from highway and freeway accidents, particularly in California. Things have changed alot since then. We can and should be providing certain kinds of care, especially to volunteers for the US military that we could not have even imagined then. We have AED's the size of a couple loaves of bread and entire trauma kits that can fit in a duffle bag. All I am saying is that if CAP passes this off as a purely financial issue, it is one of not wanting to spend the money and not of not having it or being able to get it or being able to establish a better line of continuity with the USAF and get the change made. I understand that its not as cheap as carrying a KMart first aide kit in your pack, but dont our members deserve better than that anyway? Folks dont need to keep repeating the expense of it all. But you know where the bulk of the expense for an EMS agency comes from...purchasing and maintaining EMS vehicles and no one can say I ever said I thought that was what should be done. Ive worked with SAR organizations in several states with much smaller budgets than the SAR budget for CAP and they managed to have EMTs for the sake of both their members and the public they were helping. If CAP put half the thought and money into these kinds of efforts as it puts into new uniform development, we just might be able to get this done.

I can tell you first hand what the HMRS program teaches and why.   And it was hit hard on the head above, they primarily do care and support for the SAR team.  I can tell you with a high degree of certainty that even though HMRS medics are only at the first aid level of emergency medical care for thier initial level of training, the other parts of the program are the important things that a team in the field needs, none of which are a part of any stock EMT or paramedic program.  I see EMT's come up there all the time, with an extra rucksack full of emergency gear, , yet they cant find you a band aid or an ace wrap.  In over 17 years of SAR experience only a handful of occasions can I remember needing my EMT or paramedic level emergency care skills, and it was usually not in the field, mostly at a base camp setting.  J as an FYI, except in a few states all EMT's Paramedics are unlicensed first aiders, they are only certified,  same as anyone else with a firstaid card, just with a bigger bag of tricks and accountability an accountability to the state.

Also as you may not be aware it is a multi step course, just like the rest  of the Ranger aining trprogram, the course that most people complete is the basic (initial entry course)

QuoteMedic Second Class
M2 is the initial qualification for HMRS medics.  They have completed the basic course, hold a Wilderness First Aid Certification and Adult CPR certification.  They primarily operate under the supervision of a Medic 1st class or Senior Ranger Team commander.
They are awarded the Green Scarf and the Green Medic Tab.

Medic First Class
M1's are considered fully qualified medical personnel.  They operate independently with their respective teams.  They have completed an additional year of continuing medical education, advanced SAR skills, and hold Wilderness First Aid or higher certification (First Responder or EMT-B) and Professional Rescuer CPR certification.    They are awarded the Red Scarf and the red Medic Medic Tab.

Senior Medic
Senior medics are considered to be Operational Medical Specialists.  They are qualified to manage medical support operations for CAP SAR/DR missions as part of a single team up thru a multi-agency mission base.  Senior medics also are qualified to manage HMRS medical operations in the absence of a qualified medical officer.  They are 18 years or older and have been M1 for at least 2 years.  They hold EMT-B (or higher) and PHTLS certification.  They are well versed in the following areas: emergency medical care and treatment, general sick call/clinic operations, routine and emergency evacuation procedures, medical mission planning, Incident Command System, Triage/Mass casualty operations, Preventative medicine & field sanitation and hygiene, Search and Rescue Operations and Techniques
They area awarded the Red Senior Medic Tab, and wear the red scarf.

Master Medic
Master medics represent the leadership of the medic program.  They are experienced medical providers usually with years of experience both within the HMRS program and the civilian community.  They hold multiple instructor ratings in the medical field and are responsible for guiding the growth of the medic program.  In addition to filling the same role of the senior medic, they are responsible for the training of the other levels of medic ratings.
They are awarded the Gold/Red Master Medic tab, red pistol belt and wear the red scarf

. 

Quote from: sarmed1 on June 07, 2007, 02:57:33 PM
I can tell you first hand what the HMRS program teaches and why.   And it was hit hard on the head above, they primarily do care and support for the SAR team.  I can tell you with a high degree of certainty that even though HMRS medics are only at the first aid level of emergency medical care for thier initial level of training, the other parts of the program are the important things that a team in the field needs, none of which are a part of any stock EMT or paramedic program.  I see EMT's come up there all the time, with an extra rucksack full of emergency gear, , yet they cant find you a band aid or an ace wrap.  In over 17 years of SAR experience only a handful of occasions can I remember needing my EMT or paramedic level emergency care skills, and it was usually not in the field, mostly at a base camp setting.  J as an FYI, except in a few states all EMT's Paramedics are unlicensed first aiders, they are only certified,  same as anyone else with a firstaid card, just with a bigger bag of tricks and accountability an accountability to the state.

Also as you may not be aware it is a multi step course, just like the rest  of the Ranger aining trprogram, the course that most people complete is the basic (initial entry course)

QuoteMedic Second Class
M2 is the initial qualification for HMRS medics.  They have completed the basic course, hold a Wilderness First Aid Certification and Adult CPR certification.  They primarily operate under the supervision of a Medic 1st class or Senior Ranger Team commander.
They are awarded the Green Scarf and the Green Medic Tab.

Medic First Class
M1's are considered fully qualified medical personnel.  They operate independently with their respective teams.  They have completed an additional year of continuing medical education, advanced SAR skills, and hold Wilderness First Aid or higher certification (First Responder or EMT-B) and Professional Rescuer CPR certification.    They are awarded the Red Scarf and the red Medic Medic Tab.

Senior Medic
Senior medics are considered to be Operational Medical Specialists.  They are qualified to manage medical support operations for CAP SAR/DR missions as part of a single team up thru a multi-agency mission base.  Senior medics also are qualified to manage HMRS medical operations in the absence of a qualified medical officer.  They are 18 years or older and have been M1 for at least 2 years.  They hold EMT-B (or higher) and PHTLS certification.  They are well versed in the following areas: emergency medical care and treatment, general sick call/clinic operations, routine and emergency evacuation procedures, medical mission planning, Incident Command System, Triage/Mass casualty operations, Preventative medicine & field sanitation and hygiene, Search and Rescue Operations and Techniques
They area awarded the Red Senior Medic Tab, and wear the red scarf.

Master Medic
Master medics represent the leadership of the medic program.  They are experienced medical providers usually with years of experience both within the HMRS program and the civilian community.  They hold multiple instructor ratings in the medical field and are responsible for guiding the growth of the medic program.  In addition to filling the same role of the senior medic, they are responsible for the training of the other levels of medic ratings.
They are awarded the Gold/Red Master Medic tab, red pistol belt and wear the red scarf

. 

First off, your mixing apples and oranges. Medic in the "civilian" world means Paramedic, with a specific skill set and knowledge base, specific protocols and specific licensure, none of which exist in CAP.

Second, if you have licensed EMTs carrying a ruck sack full of gear and they cant find their first aide gear such and alcohol and band aides, thats someone with pour organizational skills as an individual and someone who should not be in the field as a medical responder.

Its my belief that HMRS should change what they call their so-called certifications to "corpsman." In the real world, outside of exercises, medic is short hand for paramedic which again is someone who holds a license from the state board of health in which he/she is licensed.

I notice that you say that you have 17 years of SAR experience and as has been often pointed out, SAR does NOT equal EMS. A first responder is someone who knows CPR and ultra-basic first aide. They are not trained in triage, assesment other than the ABC's or any other field necessitated medical skill.

Your biggest mistake, which I think demonstrates a lack of knowledge is when you say that EMTs and Paramedics are nothing more than "certified" first aiders with a bigger back of goodies. This clearly points to the fact that you are not familiar with the EMS system.  An EMT has on average 5-6 months of training comprised of 150-200 hours of classroom and clinical time.  A paramedic has between 12-18 months of training covering about 1500 hours of clinical and classroom time. There is no such thing as a "certified" paramedic. The term "certified" in the 21st century has come to mean any who has staid awake long enough to pass a little test a get their certificate. EVERY state in the US requires that Basic, Intermediate and Paramedic level EMTs sit for a at least the state board of health exam to acquire a license, not a certificate. Many states, like my home state of Illinois, also require the National Registry of Emergency Medical Technicians Exam also be taken before that EMT of whatever level can receive his state license.

What HM produces and calls medics are in fact not medics in the real EMS world, nor would they pass as medics in a true military situation. Im seeing 16 year old kids in HM and they are not even old enough to take a class in most states to get a basic EMT license. Before you start throwing around information like saying that EMTs and Paramedics are really just first responders with more toys, you need to know what youre talking about. The EMS profession in the US is overseen by the DOT and NHTSA which together develip and the curriculum and standards for EMTs at all levels working in the field. No EMT can operate in any state without a license as you seem to think. I honestly cannot tell from your posting if you are involved in professional EMS, but if you are, you need to go back and do some refresher work because you are truly misinformed about the education and requirements necessary to work in the field.

Semper Vigilans!

Since we are defending certifications or licenses or bling or whatever, I just want to hop in and state for the record that EMT and Paramedic training are not equivalent to military medic training and EMT and Paramedics do not have the training nor skills to compete with military qualified medics.  Now, having said that and to get back to the regular discussion, Our job (CAP) is to find and stabilize victims if possible.  Very few of our searches end in injured personnel, they are usually deceased and that is that.  We are to locate them and direct rescue personnel to the site.  Our ground crews are more for search and security than they are for medical treatment.  Just as we don't carry weapons on missions, we also don't carry field surgical gear.  Perhaps one mission in a thousand we might run across a rattle snake that needs killing or we might run across a victim that needs to have their arm amputated prior to the A/C bursting into flame.  That having been said, the liability of said items far outweighs the possible good from them.  the best we can hope for is to train our personnel to stop massive blood loss and prevent shock in the few cases we reach in time and all that requires is basic first aid.  Flame Suit On..

Quote from: capchiro on June 08, 2007, 11:23:10 AM
Since we are defending certifications or licenses or bling or whatever, I just want to hop in and state for the record that EMT and Paralegal training are not equivalent to military medic training and EMT and Paralegals do not have the training nor skills to compete with military qualified medics. 

Paralegals!? Who said anything about paralegals? Perhaps you mean ParaGodsmedics?

OMG..I can't believe that I did that.  I hope I got it modified okay.  Perhaps it was a fraudian slip or something.  I know that the legal profession has as much fun with paralegals as the medical profession does with paramedicals.  I do like both paramedics and paralegals, but sometimes they think they know more than the professionals they work for (and sometimes they do, but not as often as they like to think). 

Capchiro,

As a recently retired (01JUN07) Paralegal (oops) MEDIC --with nearly 30 years in EMS as paid-professional, volunteer, and instructor-- I wonder why, if as you proffered, "... EMT and Paralegals [sic] do not have the training nor skills to compete with military qualified medics" does the USAF require its PJ candidates to both obtain National Registry EMT-Paramedic certification (and, in so doing, ride out with civilian EMS personnel, principally in Albuquerque) as a part of their training "pipeline"? Why, too, does the USCG certify its Rescue Swimmers to EMT-B level and most of its corpsmen as EMT-P's?

Your assertion seems incongruous to history. EMS (and the EMT-B's and EMT-P's and LPs) had its genesis in a 1966 white paper that compared and disparaged the state of street-medicine to the field medicine in Viet Nam. A wounded person's "chances" of survival were far better in combat in Southeast Asia than in Southeast Birmingham, for example.

The resultant EMS program in the US (and copied worldwide) was based upon military combat medics. Many of the first EMT's and, a bit later, paramedics,  were recently returned Viet Nam combat medics.

Later, as the civilian EMS sphere grew and matured, its certifications were adopted by the military (albeit with some combat-specific, additional skills and techniques). Although, there are number of places in the civilian EMS world that external threats can rival combat ... and without the "additional skills and techniques" for combat nor the safety equipment, e.g. body armor, etc. available to the combat medic.

As to a civilian medic's ability to --as you put it-- "compete" with a military medic, I would ask --also-- compete in what way? I, for one, would put my patient care skills, my assessment skills, etc. up against any military medic's. In fact, I would go so far as to suggest that most civilian medics SHOULD measure up quite well in care-related skills with their military counterparts (whether at the basic life support EMT-B level or the ALS paramedic level).

Likewise, I'd hope (and frankly expect) that comparison extends to other healthcare personnel as well, e.g. MD's, RN's, RRT's, and so forth. I would add to that expectancy, this last fact ... the military regularly sends its MD's to civilian hospitals to stay current on trauma (especially blunt and penetrating) as the civilian world --even in wartime-- sees more of it than the military.

"I do like both paramedics and paralegals, but sometimes they think they know more than the professionals they work for (and sometimes they do, but not as often as they like to think)." 

... and you KNOW this how?

Having been both a Army medic and an EMT, I assure you that my skills and training in battlefront medicine were far superior in the military than in EMT training.  A lot, if not most EMT and Paramedics do nothing more than transport sick people to and from places of care.  Some respond to cases of heart attacks and low blood sugar.  Some, but not all work acute injury sites.  Military medics are trained in battle field amputations and the litany of battle field trauma that happens and that require their immediate attention.  In the old days, any military medic was qualified and recognized as a first aid attendant for employment purposes.  Not all first aid attendants were recognized as medics.  Now, If I suffer a traumatic injury, I would rather have a military medic attend me than I would an EMT or Paramedic.  There are levels of care and there are levels of training and having had both, I say, and not in a shy way, the military medic is tops.  Basic Medical Corpsman school used to be over 800 hours of training and then you went to speciality school.  That was back in the days of Nam.  I have heard that it far exceeds that now.  Green Beret medical training was 50 weeks when I was in.  Almost all of this was advanced training.  heart attacks, CPR and low blood sugar were covered and then considered to be learned and most of the time was spent on how to save the life of a wounded comrade, not how to transport someone that weighed 350 pounds with congestive heart failure.  So I have been there and done that and have several advanced certifications and degrees to support me.  However, this is all JMHO.. As usual..

 Don't paint all civilian EMS with the same brush; there's been a great deal of evolution and diversification over the years. It's not all about hauling the 350-pound CHF patient down three flights of steps to the bus anymore...

The good Colonel has little competition, or equal, in stereotyping and condescension skills.

Oh well, back to the rocking chair and another morning spent recalling  --with fondness-- 29 years of EMS service where apparently I did "... nothing more than transport sick people to and from places of care ... [and] ... respond to cases of heart attacks and low blood sugar," like "most EMT and Paramedics" ... to say nothing of the paralegals!

Way to go, Colonel, you sure KNOW EMS ... amazing!

Quote from: capchiro on June 08, 2007, 11:23:10 AM
Since we are defending certifications or licenses or bling or whatever, I just want to hop in and state for the record that EMT and Paramedic training are not equivalent to military medic training and EMT and Paramedics do not have the training nor skills to compete with military qualified medics.  Now, having said that and to get back to the regular discussion, Our job (CAP) is to find and stabilize victims if possible.  Very few of our searches end in injured personnel, they are usually deceased and that is that.  We are to locate them and direct rescue personnel to the site.  Our ground crews are more for search and security than they are for medical treatment.  Just as we don't carry weapons on missions, we also don't carry field surgical gear.  Perhaps one mission in a thousand we might run across a rattle snake that needs killing or we might run across a victim that needs to have their arm amputated prior to the A/C bursting into flame.  That having been said, the liability of said items far outweighs the possible good from them.  the best we can hope for is to train our personnel to stop massive blood loss and prevent shock in the few cases we reach in time and all that requires is basic first aid.  Flame Suit On..

Wow, did you ever completely miss the point...I was pointing out that what HMRS turns out are not medics, either in a military or civilian context.  And if you would rather have a military medic work on your than a civilian EMT or medic, please feel free to hang a tag around your neck next time you are on a SAR or automobile accident so that we dont waste our time working on someone who doesnt want our help. You really cannot compare battlefield emergency medicine with civilian EMS. They are two totally different fields of endeavor and contrary to what you may have been lead to believe, my colleagues and I are trained to treat traumatic injuries in general. If a bone is sticking out where it shouldnt be, it really doesnt matter what caused it, now does it. If a patient, military or civilian has no airway, the procedure is the same. The reason that military medics or corpsman are trained in field amputation is because it is necessary since they may not be able to get that patient back to a CSH in time to keep them from dying. This particular skill is not required in urban EMS since we are usually 10-20 minutes away from a trauma center. And regardless of what you may think or what your ego may say, the job of a medic or EMT, civilian or military is the same...stabilize and transport. Why are heart attacks and cardiac and vascular accidents trained on so much in the civilian world? Because they are the #1 cause of death in the home outside of traumatic injury. The USCG currently takes people through recruit training and then sends them to A school where they are trained as...wait for it...EMT-Basics, as has already been pointed out. That training lasts approximately 6 weeks whereas I had 20 weeks. Working in urban an industrial settings, I have and do treat in the field GSWs, stabbings and person inflicted trauma of all kinds. I also have advanced training in cardiac care. I now work primarily in industrial medicine 6 months of the year near the Arctic Circle where I treat injuries and traumas of all kinds in temperatures of more than -40f. And having been trained by a VietNam era medic, I can tell you that school was not fifty weeks long. There training was fast, dirty and into the field. And, like you, I have two advanced degrees, multiple certifications and more than 160 hours of medical school level training and anatomy and physiology, diagnostics and trauma care and the very first patient I ever rolled on was a chemical burn over 60 per cent of body surface area and the next one was a basilar skull fracture.  But as I say, if you would like to wait for a military medic to come along next time you are out on a SAR, just stick a note around your neck and Im sure we will be glad to move along to treat others. Seeing who can pee farther is hardly productive at all to this conversation. Just out of curiosity, how much time have you spent as a civilian EMS responder?

As usual , the prominent flamers are the ones with pseudonyms and not their actual signatures, but I digress.  The 50 week school was the green beret special forces medic training and not the standard military medic training.  I made that clear in my post.  I am always amazed at how people get their feelings hurt when they feel challenged.  I also mentioned that not all, but a lot of EMT's and Paramedics, spent their time transporting and carrying for non-life threatening cases.  That being said, I also noted that there are some that handle vehicle and injury cases.  I don't know why the Chaplain, if he actually is one, felt so threatened.  If you are one of the ones that handled nothing but emergency and trauma cases for 29 years, congratulations.  If not, perhaps the shoe fits.  There are a few outstanding EMT's and Paramedics out there.  There are also some 300 pound EMT's trying to transport 350 pound patients.  Pick which group you belong to.  Also, I said I would prefer to be treated by a Military medic.  Let me qualify that, I would prefer not to need treatment and if I do, my first preference would be an Emergency room trauma doctor and then the military medic and then other medics, etc.  I am entitled to my preferences and if you are truly a EMT, you should treat me if I need it.  Now, I am not attacking Hawk Mountain or the program.  I suspect that it is a great program and trains young people to the level they need for our mission.  It probably also helps direct young people into a medical field or profession, which is also what we are about (helping our cadets).  And for Chaplain Don's information, I am an attorney and a doctor, so perhaps I do know what I am talking about.  You don't get to be a gray hair without some experience.  I also passed the national registry for EMT and can tell you that it was not the same as the exit examinations we had to pass in the military.  I don't know why so many people on this board want to attack the military or put it down, especially since so many are military wannabe's.  Perhaps that is why, they just didn't have what it took to serve their country in uniform?  Now, stop with the personal attacks and go lick your wounds.. JMHO

Lock... To let you guys cool off some.