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CAP Talk  |  Operations  |  Emergency Services & Operations  |  Topic: Where does it say we obey the law?
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Author Topic: Where does it say we obey the law?  (Read 4643 times)
Geber
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Posts: 68

« on: December 19, 2017, 07:19:33 AM »

I would certainly expect that if there is a conflict between a CAP procedure and a federal, state, or local law, we should ignore the CAP procedure and obey the law. But is there a CAP policy that states this?

A case in point would be a medical professional who is obliged to follow the standard of care and state-mandated protocols. These may conflict with, and be more up-to-date, than CAP procedures such as the task guide "Ground and Urban Direction Finding Team Tasks". This guide, for example, states that sweating is a sign of heat exhaustion while dry skin is a symptom of heat stroke. But the Vermont EMS Protocols (2015) state sweating (or lack of sweating) is an unreliable guide to the severity of heat illness.
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RiverAux
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« Reply #1 on: December 19, 2017, 08:35:54 AM »

Why would there be a need for such a statement in CAP regs?

As to your example, answering a question on a quiz for an ES qual doesn't have anything to do with following standards of practice.  It may be out of date, but giving the CAP-preferred but possibly outdated answer doesn't violate a law.  Perhaps actually acting based on the outdated answer might.   
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Eclipse
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« Reply #2 on: December 19, 2017, 09:40:43 AM »

The Big Sweat Lobby has been fighting this in Vermont for years.
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JayT
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Posts: 1,335

« Reply #3 on: December 19, 2017, 11:08:32 AM »

I would certainly expect that if there is a conflict between a CAP procedure and a federal, state, or local law, we should ignore the CAP procedure and obey the law. But is there a CAP policy that states this?

A case in point would be a medical professional who is obliged to follow the standard of care and state-mandated protocols. These may conflict with, and be more up-to-date, than CAP procedures such as the task guide "Ground and Urban Direction Finding Team Tasks". This guide, for example, states that sweating is a sign of heat exhaustion while dry skin is a symptom of heat stroke. But the Vermont EMS Protocols (2015) state sweating (or lack of sweating) is an unreliable guide to the severity of heat illness.

EMS protocols are not laws.
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"Eagerness and thrill seeking in others' misery is psychologically corrosive, and is also rampant in EMS. It's a natural danger of the job. It will be something to keep under control, something to fight against."
Pace
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« Reply #4 on: December 19, 2017, 11:57:59 AM »

Quote
EMS protocols are not laws.
No, but they do establish standards of care for a person's license.


I haven't kept up to date on regs, so please correct me if this has changed. No member is to provide medical care except to prevent loss of life or limb. Even then, the care provided must be within the scope of your certifications. If you exercise your full scope (and it's higher than basic first aid), it truly needs to be life or death. If you use your skills to the standard established for your practice and it truly is life or limb, good Samaritan law typically protects you; however, CAP does not cover your liability. Most likely your employer doesn't, either. If you use your skills inappropriately or negligently/poorly, you're opening yourself up to quite the lawsuit. At least that's my understanding.
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Lt Col, CAP
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lordmonar
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« Reply #5 on: December 19, 2017, 12:07:37 PM »

I would certainly expect that if there is a conflict between a CAP procedure and a federal, state, or local law, we should ignore the CAP procedure and obey the law. But is there a CAP policy that states this?

A case in point would be a medical professional who is obliged to follow the standard of care and state-mandated protocols. These may conflict with, and be more up-to-date, than CAP procedures such as the task guide "Ground and Urban Direction Finding Team Tasks". This guide, for example, states that sweating is a sign of heat exhaustion while dry skin is a symptom of heat stroke. But the Vermont EMS Protocols (2015) state sweating (or lack of sweating) is an unreliable guide to the severity of heat illness.
There would be no policy that states that......as it is understood.   As for what rules do you follow.    If you are teaching CAP Ground Team Task.  You follow CAP protocols and use the materials provided.  If you are teaching an EMT class in Vermont, you teach Vermont EMT Protocols.

Should not be a problem....unless you are CAP member in Vermont and Also an EMT in Vermont.   In which I would suggest that you get with your Wing Legal Officer and the Legal Officers at your EMT service and see which protocols apply to you and when. 
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PATRICK M. HARRIS, SMSgt, CAP
Pacific Region
JayT
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Posts: 1,335

« Reply #6 on: December 19, 2017, 12:11:31 PM »

Quote
EMS protocols are not laws.
No, but they do establish standards of care for a person's license.


I haven't kept up to date on regs, so please correct me if this has changed. No member is to provide medical care except to prevent loss of life or limb. Even then, the care provided must be within the scope of your certifications. If you exercise your full scope (and it's higher than basic first aid), it truly needs to be life or death. If you use your skills to the standard established for your practice and it truly is life or limb, good Samaritan law typically protects you; however, CAP does not cover your liability. Most likely your employer doesn't, either. If you use your skills inappropriately or negligently/poorly, you're opening yourself up to quite the lawsuit. At least that's my understanding.

They're still not laws. Also, Good Samaritian Laws do not apply to trained EMS staff in some states. In New York, if I stop at a medical incident outside of my primary area preform care above the basic life support level, I'm on the hook. My supervising physician will probably cover for me the best he can, but I'm still going to take a rip, even if the patient has a good outcome.
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"Eagerness and thrill seeking in others' misery is psychologically corrosive, and is also rampant in EMS. It's a natural danger of the job. It will be something to keep under control, something to fight against."
JayT
Salty & Seasoned Contributor

Posts: 1,335

« Reply #7 on: December 19, 2017, 12:15:17 PM »

I would certainly expect that if there is a conflict between a CAP procedure and a federal, state, or local law, we should ignore the CAP procedure and obey the law. But is there a CAP policy that states this?

A case in point would be a medical professional who is obliged to follow the standard of care and state-mandated protocols. These may conflict with, and be more up-to-date, than CAP procedures such as the task guide "Ground and Urban Direction Finding Team Tasks". This guide, for example, states that sweating is a sign of heat exhaustion while dry skin is a symptom of heat stroke. But the Vermont EMS Protocols (2015) state sweating (or lack of sweating) is an unreliable guide to the severity of heat illness.
There would be no policy that states that......as it is understood.   As for what rules do you follow.    If you are teaching CAP Ground Team Task.  You follow CAP protocols and use the materials provided.  If you are teaching an EMT class in Vermont, you teach Vermont EMT Protocols.

Should not be a problem....unless you are CAP member in Vermont and Also an EMT in Vermont.   In which I would suggest that you get with your Wing Legal Officer and the Legal Officers at your EMT service and see which protocols apply to you and when.

Our legal officer would start a deep and highly authentic belly laugh that would last well after we got up and laughed. Unless CAP is willing to high medical directors, write protocols, and establish literally thousands of invidiual mutual aid agreements, there is no place for CAP to provide medical care.
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"Eagerness and thrill seeking in others' misery is psychologically corrosive, and is also rampant in EMS. It's a natural danger of the job. It will be something to keep under control, something to fight against."
Pace
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« Reply #8 on: December 19, 2017, 12:21:35 PM »

They're still not laws. Also, Good Samaritian Laws do not apply to trained EMS staff in some states. In New York, if I stop at a medical incident outside of my primary area preform care above the basic life support level, I'm on the hook. My supervising physician will probably cover for me the best he can, but I'm still going to take a rip, even if the patient has a good outcome.
It probably is state and license dependent. There has been at least one lawsuit that I've been informed about where a nurse failed to provide care who was on scene and was held civilly liable in a wrongful death lawsuit related to failure to reasonably act.
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Lt Col, CAP
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NIN
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« Reply #9 on: December 19, 2017, 12:40:11 PM »

Non-health care professional's opinion here: where there is conflict between a private organization's in-house training training materials, nationally-recognized standards of care or procedures, and local/state standards on the matter, I would think that its first a tussle between the national & local standards (ie. what certifying body are you governed by, go with that), and the "organizational training" should be considered last, especially if its in direct conflict or 180 degree opposition to the current thinking.

We've see this for years with CPR & First Aid. The standards evolve from ABC (Airway, Breathing, Circulation) to "Check, Call, Care" and then "No breaths, just chest compressions," etc.  Every time you take the class or, sometimes, who you take it with, there's something different. And you're probably not wrong if you're doing it the way the certifying body told you to do it. 

A great example in my other job as a instructor: I'm governed by a nationally recognized training program that my local outfit, thru its affiliation with the national training and certifying organization, has vowed to follow. And for the most part, I/we do.  There are some minor inconsistencies in "how we teach it here" vs "the national standard," mostly related to locally available equipment, but at all times, I can point to the "what is different and why," and its reasonable accommodation to local conditions. We even have a couple "higher than the national standards" requirements, mostly in the name of safety, that we can also point to as "not uncommon" and "prudent and necessary."   It gets down to the point, however, when the stuff hits the fan, as to whether you were acting in line with the established national standards. Especially after an accident when someone comes noodling around for lawsuit. 

"Well, Mr. Ninness, the national association's training standard say that you're supposed to teach subject A, B & C at this point. Why did you teach A, B, C & D?"  or "The national standard is that you do procedure X, then Y, then Z.  You did V, X, Y & Z. Why is that?"   

I mean, you're really up a creek when procedure X is called for, but you're off doing procedure One because you thought you had a better idea and knew way better than the national body.

But if you can say "Sorry, here in my state, the standard of care is this, evolving from the national standard of this.  The organizational guidance is related to x year old standards that my certifying body has discarded as outdated because of evolving standards and information."





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Darin Ninness, Lt Col, CAP
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The contents of this post are Copyright © 2007-2018 by NIN. All rights are reserved. Specific permission is given to quote this post here on CAP-Talk only.
Pace
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« Reply #10 on: December 19, 2017, 12:52:00 PM »

I just realized after reading NIN's post that I completely missed the point of the OP.


CAP is not a medical certifying body and defers to the National Guidelines for First Aid in Occupational Settings for basic first aid training and standards. If your professional certification conflicts with CAP's task guides, go with the professional medical training standards. As for signing off those tasks as an evaluator, that's a great question to send to the knowledgebase for clarification.
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Lt Col, CAP
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Former this & that
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JayT
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Posts: 1,335

« Reply #11 on: December 19, 2017, 01:15:49 PM »

They're still not laws. Also, Good Samaritian Laws do not apply to trained EMS staff in some states. In New York, if I stop at a medical incident outside of my primary area preform care above the basic life support level, I'm on the hook. My supervising physician will probably cover for me the best he can, but I'm still going to take a rip, even if the patient has a good outcome.
It probably is state and license dependent. There has been at least one lawsuit that I've been informed about where a nurse failed to provide care who was on scene and was held civilly liable in a wrongful death lawsuit related to failure to reasonably act.

Nurses and PA's have no legal authority to operate outside of their specific workplace beyond low level basic care. I've told multiple nurses, inculding ones I've known personally, to go pound sand when they attempt to interfere with patient care in the pre hospital setting.
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"Eagerness and thrill seeking in others' misery is psychologically corrosive, and is also rampant in EMS. It's a natural danger of the job. It will be something to keep under control, something to fight against."
JayT
Salty & Seasoned Contributor

Posts: 1,335

« Reply #12 on: December 19, 2017, 01:23:45 PM »

Non-health care professional's opinion here: where there is conflict between a private organization's in-house training training materials, nationally-recognized standards of care or procedures, and local/state standards on the matter, I would think that its first a tussle between the national & local standards (ie. what certifying body are you governed by, go with that), and the "organizational training" should be considered last, especially if its in direct conflict or 180 degree opposition to the current thinking.

We've see this for years with CPR & First Aid. The standards evolve from ABC (Airway, Breathing, Circulation) to "Check, Call, Care" and then "No breaths, just chest compressions," etc.  Every time you take the class or, sometimes, who you take it with, there's something different. And you're probably not wrong if you're doing it the way the certifying body told you to do it. 

A great example in my other job as a instructor: I'm governed by a nationally recognized training program that my local outfit, thru its affiliation with the national training and certifying organization, has vowed to follow. And for the most part, I/we do.  There are some minor inconsistencies in "how we teach it here" vs "the national standard," mostly related to locally available equipment, but at all times, I can point to the "what is different and why," and its reasonable accommodation to local conditions. We even have a couple "higher than the national standards" requirements, mostly in the name of safety, that we can also point to as "not uncommon" and "prudent and necessary."   It gets down to the point, however, when the stuff hits the fan, as to whether you were acting in line with the established national standards. Especially after an accident when someone comes noodling around for lawsuit. 

"Well, Mr. Ninness, the national association's training standard say that you're supposed to teach subject A, B & C at this point. Why did you teach A, B, C & D?"  or "The national standard is that you do procedure X, then Y, then Z.  You did V, X, Y & Z. Why is that?"   

I mean, you're really up a creek when procedure X is called for, but you're off doing procedure One because you thought you had a better idea and knew way better than the national body.

But if you can say "Sorry, here in my state, the standard of care is this, evolving from the national standard of this.  The organizational guidance is related to x year old standards that my certifying body has discarded as outdated because of evolving standards and information."

Nin

The short answer is, it's very complicated, and honestly sometimes it comes down to who raises the issue. Ultimately (in my states) we are licensed by the state, but our authority to operate comes from the county level. The "national level" standards for EMS are functionally suggestions from the Department of Transportation, nothing more. There have been incidents where crews have followed local protocols and still gotten successfully sued. There has also been cases where crews flagrantly violated protocols, and are still working (the pair in New Jersey who preformed a successful C-section in a trauma arrest patient.)

The long and short of it.....national organizations shouldn't get involved with medical care unless they have their own army of doctors and lawyers.
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"Eagerness and thrill seeking in others' misery is psychologically corrosive, and is also rampant in EMS. It's a natural danger of the job. It will be something to keep under control, something to fight against."
Pace
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« Reply #13 on: December 19, 2017, 01:33:07 PM »

They're still not laws. Also, Good Samaritian Laws do not apply to trained EMS staff in some states. In New York, if I stop at a medical incident outside of my primary area preform care above the basic life support level, I'm on the hook. My supervising physician will probably cover for me the best he can, but I'm still going to take a rip, even if the patient has a good outcome.
It probably is state and license dependent. There has been at least one lawsuit that I've been informed about where a nurse failed to provide care who was on scene and was held civilly liable in a wrongful death lawsuit related to failure to reasonably act.

Nurses and PA's have no legal authority to operate outside of their specific workplace beyond low level basic care. I've told multiple nurses, inculding ones I've known personally, to go pound sand when they attempt to interfere with patient care in the pre hospital setting.
You're making this personal, which it is not. Please also refrain from insulting your fellow medical professionals. You can disagree without being rude.


This entire situation predicates that there is no official responder on scene yet. Once you're there, it's your show and I walk away. Have fun. But until you get there, an off duty medical professional may be on scene. This is not a issue of authority, but an issue of acting vs not acting to provide life saving care. Most of the time that care will fall into BLS, but if I fail to provide advanced care and the patient dies, that's on me and my license.
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Lt Col, CAP
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JayT
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Posts: 1,335

« Reply #14 on: December 19, 2017, 01:35:58 PM »

They're still not laws. Also, Good Samaritian Laws do not apply to trained EMS staff in some states. In New York, if I stop at a medical incident outside of my primary area preform care above the basic life support level, I'm on the hook. My supervising physician will probably cover for me the best he can, but I'm still going to take a rip, even if the patient has a good outcome.
It probably is state and license dependent. There has been at least one lawsuit that I've been informed about where a nurse failed to provide care who was on scene and was held civilly liable in a wrongful death lawsuit related to failure to reasonably act.

Nurses and PA's have no legal authority to operate outside of their specific workplace beyond low level basic care. I've told multiple nurses, inculding ones I've known personally, to go pound sand when they attempt to interfere with patient care in the pre hospital setting.
You're making this personal, which it is not. Please also refrain from insulting your fellow medical professionals. You can disagree without being rude.


This entire situation predicates that there is no official responder on scene yet. Once you're there, it's your show and I walk away. Have fun. But until you get there, an off duty medical professional may be on scene. This is not a issue of authority, but an issue of acting vs not acting to provide life saving care. Most of the time that care will fall into BLS, but if I fail to provide advanced care and the patient dies, that's on me and my license.

That's fine, but if you're on seen and talking over me, getting in my way, and making a nuisance of yourself, you're the one causing the problem, not me. And you will be told to go pound sand.
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"Eagerness and thrill seeking in others' misery is psychologically corrosive, and is also rampant in EMS. It's a natural danger of the job. It will be something to keep under control, something to fight against."
abdsp51
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« Reply #15 on: December 19, 2017, 01:43:01 PM »

Me thinketh... tick tock....
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NIN
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« Reply #16 on: December 19, 2017, 02:12:32 PM »

The long and short of it.....national organizations shouldn't get involved with medical care unless they have their own army of doctors and lawyers.

Yeah, no disagreement there.

I think the regulation even says that.
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Darin Ninness, Lt Col, CAP
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I like to have Difficult Adult Conversations™
The contents of this post are Copyright © 2007-2018 by NIN. All rights are reserved. Specific permission is given to quote this post here on CAP-Talk only.
kwe1009
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« Reply #17 on: December 19, 2017, 02:17:28 PM »

CAP is not in the medial care business in any way, shape or form.  HSO's in CAP are not authorized or licensed to perform any medical care beyond emergency (read: risk of losing their life) first aid.  Anything above that (including putting a bandaid on a person's cut leg) is not authorized.  For people in the EMS and medical fields, you probably are not covered by liability or malpractice insurance outside of your job so you would be acting on your on accord if providing higher levels of medical care.   

CAPR 160-1 para 1-6 I states that they really can't do anything except render emergency first aid.  That includes any medical professionals that are CAP members.  They are not authorized to perform any routine medical services. 
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Ned
Resident Philosopher

Posts: 2,193

« Reply #18 on: December 19, 2017, 02:36:27 PM »

Interestingly, there isn't even a law that says "you have to obey the law."

A typical statute simply describes a particular procedure, or perhaps forbids a particular action, and then states what will happen if the procedure is not followed or the prohibited action occurs.


Ned Lee
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TheSkyHornet
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Posts: 1,278

« Reply #19 on: December 19, 2017, 02:55:18 PM »

CAPR 1-2:
Quote
2.1. The Board of Governors (BoG), United States Air Force (USAF), or law shall establish policies in
accordance with the Constitution and Bylaws of Civil Air Patrol.

I found this statement odd. It should read along the lines of: "The Board of Governors (BoG), shall establish policies in accordance with the Constitution and Bylaws of Civil Air Patrol, to include standards set by the United States Air Force (USAF)." Laws do not establish policies in accordance with CAP. CAP must operate in accordance with law.

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