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Started by Hawk200, June 10, 2007, 01:06:17 AM

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SARMedTech

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

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

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

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

SARMedTech

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

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

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

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

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

Thoughts?



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

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

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

PA Guy

#82
Quote from: SARMedTech on July 01, 2007, 07:36:00 AM
Quote from: PA Guy on July 01, 2007, 03:07:29 AM
Another alternative might be something along the lines of the USCG Aux Health Services program.  In this program liability is assumed by the feds and credentialing is done through the USCG along with supervision.  Do I see the USAF doing this in my life time? Not really.

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

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

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

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

SARMedTech

PA Guy-

I misread your original intent and think that you might have a good idea.
"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

sarmed1

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

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

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

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

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

mk
Capt.  Mark "K12" Kleibscheidel

sarmed1

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

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

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

mk
Capt.  Mark "K12" Kleibscheidel

SARMedTech

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

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

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

mk

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

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

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

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

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

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

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

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

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

sarmed1

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

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

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

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

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

mk
Capt.  Mark "K12" Kleibscheidel

SARMedTech

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

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

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

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

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

mk

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

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

PA Guy

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

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

SARMedTech

Quote from: PA Guy on July 20, 2007, 12:04:59 AM
Quote from: sarmed1 on July 19, 2007, 02:04:44 PM
a-either a National or Regional Medical unit that when activated sets up medical operations at a particular activity.  Insurance being purchased just to cover the providers for that duration of activity.  This would I imagine include a relevant reg change.  I am not sure how this would effect USAF missions but it was discussed that 60-3 woudl need change as wel;l and that woudl have to be coordinated with the USAF.
mk

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

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

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

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

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

PA Guy

Quote from: SARMedTech on July 20, 2007, 05:31:51 AM
Quote from: PA Guy on July 20, 2007, 12:04:59 AM
Quote from: sarmed1 on July 19, 2007, 02:04:44 PM
a-either a National or Regional Medical unit that when activated sets up medical operations at a particular activity.  Insurance being purchased just to cover the providers for that duration of activity.  This would I imagine include a relevant reg change.  I am not sure how this would effect USAF missions but it was discussed that 60-3 woudl need change as wel;l and that woudl have to be coordinated with the USAF.
mk

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

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

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

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

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

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

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

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

SARMedTech

#92
PA Guy-

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

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

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

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

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

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

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

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

PA Guy

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

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

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

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

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

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

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


sarmed1

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

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

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

mk
Capt.  Mark "K12" Kleibscheidel

PA Guy

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

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

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

mk

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

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

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

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

SARMedTech

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

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

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

mk

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

SARPilotNY

CAP typically on a mission works under another agency's authority.  I have never had an issue getting an air ambulance by calling the air ambulance dispatcher directly.  Most services work under a MOU with the county or state authority that allows any bonafied public agency and specified private (hospitals) agencies to request the air ambulance.  Their only concerns is who to make radio contact with and landing location.  However, it is wise that the person that lands the airship understands what is required for a safe LZ.  I wouldn't recommend this for a T/C along the urban freeway.
CAP member 30 + years SAR Pilot, GTM, Base staff

Major Lord

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

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

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

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

Capt. Lord
"The path of the righteous man is beset on all sides by the iniquities of the selfish and the tyranny of evil men. Blessed is he, who in the name of charity and good will, shepherds the weak through the valley of darkness, for he is truly his brother's keeper and the finder of lost children. And I will strike down upon thee with great vengeance and furious anger those who would attempt to poison and destroy my brothers. And you will know my name is the Lord when I lay my vengeance upon thee."

SARMedTech

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

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

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

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

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

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

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."