Ground Team composition

[SARPilotNY]

I seem to be losing power here...I will try it again...
Read JAMA or call the AHA, ABCs  w/o a defib has little value, that is why there has been a push for defibs all over the place. Than one still need ALS to keep the heart going.  You may be shocked, but I served on the Board of Directors for the AHA...another hat without a ribbon or uniform.
As far as resigning...I don't think so.  Is what we do important?  Yes.  Is how we do it important?  Yes.  Is this a contest, no, you challenged my credentials, I am standing by them.  As far as a team...you have no idea what my qualifications  are as a team player.  

[RogueLeader]

I do believe that the reason you are losing steam or "power" is that your posts show that your attitudes do not seem to mesh with what we all to know as CAP Culture.  It may not be that way where you are located, but we represent much more diverse aspect. To be blunt, sir; your posts have been not been in a positive manner.  While that is your right, it is not endearing.

[SARPilotNY]

To SARPilotNY: Since when are we allowed search and recover?  As having been told numerous times, when it is KNOWN that the subjects are beyond rescue, we are pulled off, and others take over.

Air search and rescue?  How does CAP pull that one off?  When a crash is located and there are no survivors, it is now a recovery operation.  We often assist the local agencies in recovering  the deceased.  We don't put them in the body bag, but we can help carry them out.  The USCG as an example will change a search and rescue mission into a search and recover mission once there is little chance for survival.  The AFRCC will typically not order a helicopter for a body recovery as it is too risky.  It is terminology used as we wind a mission down  and allow for the troops, family and media to wind down too.  My point was most of our missions result in locating a crash with no survivors...we are more often search and recover vs. search and rescue.  

[SARPilotNY]

I do believe that the reason you are losing steam or "power" is that your posts show that your attitudes do not seem to mesh with what we all to know as CAP Culture.  It may not be that way where you are located, but we represent much more diverse aspect. To be blunt, sir; your posts have been not been in a positive manner.  While that is your right, it is not endearing.

There are those that see change as good as well as diverse thought.  And than there are those that like the status quo.  Columbus would never gone to the new would if he had listened to others.  Many say CAP is flat, I say with some exploration we can find some new opportunities.

[arajca]

I seem to be losing power here...I will try it again...
Read JAMA or call the AHA, ABCs  w/o a defib has little value, that is why there has been a push for defibs all over the place. Than one still need ALS to keep the heart going.

Having an AED means nothing in a trauma situation. On a search, if an AED is needed, it was needed well before anyone got to the victim because the victim is dead. There is a relatively small window of opportunity to use an AED before the heart goes into an unshockable rhythm. By the time a SAR team gets there, the AED is dead weight. In the city, AED's everywhere can make a difference.

ABC's are CRITICAL for trauma. Not every medical incident requires an AED, but every one requires ABC's. That is what emergency medicine is based on.

You may be shocked, but I served on the Board of Directors for the AHA...another hat without a ribbon or uniform.

Then you should realize that AED"s have limitations.

[SARPilotNY]

I know AEDs have limitations, next thing everone will want them on ground teams...better saved for conferences and bases.  But with any successful save with, or without CPR, is airway management.  Suction anyone?  Shouldn't go there either, next we will have everyone wanting ET or Combi tubes.  I have seen a few end results of AEDs w/lay rescuers, seems that nobody touched the airway or in another case kept the airway clear.  Barf!

[SARMedTech]

I know AEDs have limitations, next thing everone will want them on ground teams...better saved for conferences and bases.  But with any successful save with or without CPR is airway management.  Suction anyone?  Shouldn't go there either, next we will have everyone wanting ET or Combi tubes.  I have seen a few end results of AEDs w/lay rescuers, seems that nobody touched the airway or in another case kept the airway clear.  Barf!

Sir, your posts really arent  consistent with someone familiar with SAR operations or to any great extent EMS or field emergency medicine. You say with or without CPR, airway is key. That statement doesnt make any sense. Without CPR, you can have a clear airway, but if your not compressing and actively ventilating a patient, that clear airway on someone who is pulseless and breathless is useless. Most people who code do not spontaneously regain pulse and respirations.

Im not sure either about your concern over suction?  Ever hear of a V-Vac? Its virtually impossible to do airway damage with manual suction, especially since if a person is carrying the thing, he is probably trained in its use.

You are concerned about combitubes in the field. Thats where they belong. They were originally designed as a combat field (read as blind) intubation option of last resort. Their use and evolution has moved forward now such that if a patient has no gag reflex, is over 5 ft tall (there are now combis that allow for shorter patients) and has no visible sign of esophageal or tracheal trauma, a combitube is a viable asset. I have put down several in the field and can say that they were the only thing that allowed for successful ventilation of a patient in many cases. I have the process down to about 45 seconds once CPR is halted. However, this is a moot conversation since, with CAP regs as they currently stand, we are not operating as EMS and therefore do not have combitubes available to us. These cannot be purchased by individuals without authorization. They must be purchased by agencies OR individuals operating with a licensed EMS agency. Since CAP is neither, we wont be seeing these little gems in the field anytime soon. 

As for AEDs, they are getting smaller and lighter and if they can be afforded, there really isnt any reason that they shouldnt be carried in the field. Since there is no mandatory certification for their use and since they are designed for the lay person to use with NO training, I dont see the problem. In the hands of a trained user, we are going to clear the airway and provide two minutes (the AHA now says at least one) of continuous CPR before attempting to provide a shock. An AED wont allow a shock that is ill-advised, but they do allow for shocks to rhythm which might not be shocked in a hospital setting since there may be no other alternative.

You seem to be getting a bad reaction all the way around and perhaps it is not because you are challenging the way things are done, but you are not offering VIABLE alternatives. Its useless to pick apart what someone else is saying without offering an alternative plan.

As for someone being dead, thats for the coroner to decide. Absent obvious signs of death (ie decapitation, etc) we dont make that call. Thats not our job. One of the cardinal rules of EMS is that if you arrive on scene and find a pulseless and breathless patient who is still warm without any presumptive signs of death, as mentioned above, you proceed as if that patient "coded" just before you got to them until you can determine otherwise. Since we dont have equipment to measure liver temp or other means to establish time of death other that lavidity and rigor, we assume we have a patient who just now stopped breathing. Now obviously if there is sign of animal damage, decomp, etc, we can assume otherwise since we can be reasonably sure that a living person capable of movement would not allow themselves to be chewed on by a passing coyote. In any case, as has been said, we simply get the call and activate a search. We do not PRESUME that a search has become a recovery operation and frankly, neither does AFRCC since they may be hundreds of miles away from the scene and other than an ELT ping and location, they have no information as to the situation. Now we may believe that due to weather, etc that its likely that a person not yet found may be dead, and we may even think that, but that call is not ours. We keep searching, as does any SAR organization, until we are called off or the search becomes impossible. There are also times where to continue searching would put the ground team in harms way, and then a command decision may be made to call it off, but that is still not made by the members of the team. that is a COMMAND decision. As a SAR operator, I assume that I am looking for a living human until someone higher up the operational chain tells me to change that assumption.

If you have been at this 30+ years, I would say you still have a lot to learn. I can suggest a few SAR operations in the desert southwest that can provide you with some valuable experience and facts.

PS- AEDs are designed with the "lay rescuer" in mind.

[SARPilotNY]

OK Sar Med Tech...I will get down to your level.

The quote"...with any successful save with or without CPR is airway management."

I really thought since your are an expert that you would have known  that many non breathing patients just require the A and or  B of CPR.  NO, we do not need to compress on everone's chest.  You should Always assess the ABCs before assuming somebody is a non breather or in full arrest.  Many patients only need the airway opened, managed or maintained without breathing or circulation.  And yes,  the AFRCC does award Saves to rescuers that locate people that did not need CPR.  I know that, I have a few and been on many missions where saves were earned.  Non of those saves received CPR.
My concern over suction is that a clean airway will give the victim their best chance of survival.  Basics in most CPR classes as well as EMT.  Any fluids that get into the victim's lungs will more than likely cause a very nasty pneumonia later in an already weakened and ill patient.  Mostly preventable.  Did they teach you that or are you forcing vomit with your PPV devices?    V-Vac...great... my point is when carring a stokes with a patient, it is difficult and time consuming keeping up with suction and an ambu bag.  I have done it, not easy, but in your flat world on the city streets and desert, I am sure it is a cinch.  Maybe some will believe you just how easy it is as an expert, maybe some will believe me, maybe not since you seem to have a need to show just how smart (or not) you are.
AEDs are a wonderful tool, and just that.  Without good skills and airway management , the odds of it being effective are decreased.  You say Combi tubes belong in the field, we use them in the ER too, there great as a second choice for us in the field.  But, not for CAP.  Want them???...maybe, but not for everyone and to say or infer they belong in CAP is wrong, and possibly illegal.  Most states would require I'm sure at least 4 to 8 hours ADDITIONAL MINIMUM training before having it added to anyones scope.
We can't get most people in CAP to take a CPR or First Aid class...let alone an EMT course.
AEDs in the field?  I doubt by the time we arrive as CAP to a crash victim that an AED will provide any value (as in near 0%),  Maybe as I said it would serve a better purpose for use on our own membership at mettings and conferences.  The equipment still is not cheap, requires some periodic checks and TLC.  Maybe having team members fit in the field should be a PRIORITY.  As for determining death.  In every state that I have been in over the past few years, they have allowed me, my partners and even EMTs to pronounce a death, no coroner if the family MD waives and just LE to write paper.  Even after we have performed CPR, under standing orders.  I guess  many states place a high level of confidence in their first responders training, I guess just not yours.   
After 30 plus years I still learn lot of new things.  I have had the opportunity to work in the Southwestern deserts, having been assigned to the border from San Diego to Nogales to Flagstaff, and even trained with "N.E.L.T."  from New Mexico.  Are you on that team too?  Seems like you have had the luxury to work from the back of an  air conditioned ambulance with an old fashioned biocom where you get permission from the BSH/BSP for everything. (Squad 51 calling  Rampart, come in Dixie)  Our guys run on standing orders, have poor or no direct radio communications with any hospital that requires skills above and beyond most.  Our closest hospital or trauma center is often hours away by the time we secure a patient, get him to the helo or ambulance and transport them to the hospital.   As far as the SW goes, I have been stuck on the ground due to WX that closed in that required an 8 hours litter haul, up and down washes and ravines that was followed by a two hour drive to the hospital.  Didn't turn my back on that one either.  We did that with myself and my partner, all ALS, all standing orders on a trauma patient, and a few volunteers from the local fire department in a very used type 3, un airconditioned van.  Again, if you want to go head on with me, one on one with the old man, bring it on!
I normally am a team player, but I will still beat you!  Or if you want to go one on one with medals and ribbons, I am sure I will beat you there to. Just don't try one on one with a Glock...you will lose!  (unless you have an M-16)
Words of wisdom  (police)  Don't bring a knife to a gun fight!
                             (fire)  don't bring a squirtgun to a fire!
                             (EMS) don't go in where there are weapons...unless its the cops with the guns...remember...be nice to the cops because they have the gun!

[pixelwonk]

Isn't it about time this little peeing contest is taken to PM?

[SARPilotNY]

Isn't it about time this little peeing contest is taken to PM?

I tried...but he just wants to show...well you know.   I even complimented him on several postings but, I am not worthy!  My original point to this post was to demonstrate the need for fast and professional responses to missions and agree to what SARGUY said and wham...we both got blasted.  So much for offering an opinion.
Back to my original point...
better not!
Good thing I have some time to do this, wx won't let us fly, paperwork is caught up and the boss is out of town!

[SARMedTech]

Isn't it about time this little peeing contest is taken to PM?

I tried...but he just wants to show...well you know.   I even complimented him on several postings but, I am not worthy!  My original point to this post was to demonstrate the need for fast and professional responses to missions and agree to what SARGUY said and wham...we both got blasted.  So much for offering an opinion.
Back to my original point...
better not!
Good thing I have some time to do this, wx won't let us fly, paperwork is caught up and the boss is out of town!

Im not going to continue with these postings, going toe to toe with the Good Doctor, since there is obviously no end to his skill and the depth of his experience. I am but an EMT. The only thing that I do disagree with because I think its important to point out an error for those who may need to use CPR. Cardio-pulmonary resusitation is really a misnomer. What we are attempting to do is to function as a human heart/lung machine for our patient. The American Heart Association places the likelihood for actually "bringing someone back" at between 0-7%. That likelihood goes up when you add an AED to the mix to something like between 0 and 13%. Make no mistake, this machines save lives, especially newer models like the Phillips MRX which not only monitors 12 leads simultaneously but interprets them and offers treatment possibilities, records events like the administration of cardioverting drugs, filters out artifact from bumpy roads, etc. In any case...

Again I apologize to all members for having allowed myself to be taken down to the level of discourse in which I have engaged in this post. What I can bring to the CAP table in my experience in emergency services (and not just in the back of an air conditioned ambulance) and in EMS in particular. Though the role of an EMT in CAP is different than for an EMS provider, all of the members that I have met so far that are EMS certified to one level or another can add a great deal to any team they are on, particularly in being able to take care of the other team members, monitor for dehydration and exposure, etc. I have allowed myself to sink the level of personal comments against the SARPilot and I regret that. Regardless of how I may feel, I generally pride myself on not attacking someone personally, so I apologize to him and to all for that as well. I think that when we get down to talking about facing off with numbers of saves, and ribbons and commendations and even our abilities as marksman (I have no idea where that came from) I think we have gotten pretty pathetic and that serves as a wake up call for me that thats not the level of discourse I wish to participate in and will no longer do so.

I had forgotten something here in lowering myself to SARPilots level which is that the person in a situation like this who can refrain from personal attacks will always come out the winner. Where I felt it necessary to challenge certain things was in the area of field medicine where i feel that SARPilot, regardless of what type of physician he is, has made errors and stated things incorrectly which could be costly if someone chose to follow his advice in the field when assisting medically. We all makes mistakes, make errors based on faulty information, etc. Fortunately, those errors have not cost me the life of any of my patients so far.

So I am going to chose to take my own advice and focus on the positive aspects of CAP, which I believe I have also done a great deal of in this forum so far. SARPilot seems to want to focus on whats wrong with the organization and I chose to try to focus on whats right about it. The fact is, that though CAP may not be primarily a SAR organization, it does rank among one of the premier organizations of its type in the country...actually thats a hard comparison to make because there is no other organization that has the diversity of assets and capabilities that CAP does and as we continue to bring in new generations of cadets and officers from more diverse fields, we will only grown and get better.

So I apologize to you SARPilot for any personal attacks I have made or anything that you perceived as a personal attack. You may well have a great deal to offer CAP, but its hard to get past your negativity and fault finding and I would encourage you to do what I am going to attempt to do which is to be the best I can at what I have to offer CAP and constantly increase my skill set so that I may better serve others, because, when all is said and done it isnt about ribbons, or grades or titles, its about how we serve our country. If we maintain that focus, its hard to go wrong.

[SARPilotNY]

10-4  10-8  10-19

[pixelwonk]

Regardless, this forum isn't a place for Roy and Johnny to argue over whose CombiTube is bigger.
Nobody gives a flying squirrel what you feel you have to point out anymore because you're both acting like raging babies.

Since you guys can't help yourselves, even while admitting you're done, I'd simply invoke Godwin's Law by calling you both Nazis and ask for a lock.

[MIKE]

^  Die thread, die!  Lock.