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Author Topic: Where does it say we obey the law?  (Read 2788 times)
Geber
Recruit

Posts: 33
Unit: NER-VT-009

« 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  It may be out of date, but giving the CAP-preferred but possibly outdated answer doesn't violate a law.  Perhaps actually acting based on the outdated answer might.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: 1,328

« 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: 1,328

« 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
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Posts: 1,328

« 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 © 2017 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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JayT
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« 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
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Posts: 1,328

« 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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« 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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The contents of this post are Copyright © 2017 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
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« 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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« 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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Pace
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« Reply #20 on: December 19, 2017, 03:28:43 PM »

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.
PM sent.


Warning 1. Keep the discussion respectful please.
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Lt Col, CAP
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« Reply #21 on: December 19, 2017, 04:30:12 PM »

For those who may be confused: if you're out hiking and the guy in front of you is feeling the heat, get him some water and find some shade.
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Chaplaindon
Seasoned Member

Posts: 233

« Reply #22 on: December 19, 2017, 06:54:50 PM »

Speaking as a retired paramedic and flight paramedic (and CAP GTL and IC), there sure seems to be a lot of sand pounding going on ... must be some sort of new ACLS protocol. Personally, I suggest TITRATING sand to the patient's B/P and LOC.
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Rev. Don Brown, Ch., Lt Col, CAP (Ret.)
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« Reply #23 on: December 19, 2017, 07:02:15 PM »

Anyone else still confused as to why CAP will remain a non-medical provider and that
is never, ever going to change, despite the superhero wishes of many members?

An organization that can't even issue a correct, nor update their uniform manual would
be incapable of establishing the protocols, procedures and recurrent training necessary to assume that liability.
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arajca
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« Reply #24 on: December 19, 2017, 07:36:39 PM »

Another issue is the variety of laws covering medical services, especially EMS. Not to mention the different protocols many areas have.
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Fubar
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« Reply #25 on: December 19, 2017, 09:29:35 PM »

Another issue is the variety of laws covering medical services, especially EMS. Not to mention the different protocols many areas have.

Is there such a thing as a nationwide medial service? I can't imagine trying to come up with policies that apply everywhere.
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etodd
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« Reply #26 on: December 19, 2017, 11:14:04 PM »

When in the last 5 years or so has a CAP SAR team been the first responder to a scene where any type of medical attention was needed and or required? Does this happen often, that we are there first waiting for others to arrive?
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kwe1009
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« Reply #27 on: December 20, 2017, 12:39:23 AM »

Anyone else still confused as to why CAP will remain a non-medical provider and that
is never, ever going to change, despite the superhero wishes of many members?

An organization that can't even issue a correct, nor update their uniform manual would
be incapable of establishing the protocols, procedures and recurrent training necessary to assume that liability.

It is also incapable of being able to afford the liability or malpractice insurance.
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Mordecai
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« Reply #28 on: December 20, 2017, 02:31:20 AM »

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.

That would be redundant. Read the Constitution and Bylaws for details.
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Geber
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« Reply #29 on: December 20, 2017, 09:37:36 AM »

When in the last 5 years or so has a CAP SAR team been the first responder to a scene where any type of medical attention was needed and or required? Does this happen often, that we are there first waiting for others to arrive?

The chances of CAP being first on the scene with the surviving subject of a search are slender indeed. But there is a not-so-slender chance of a CAP member needing medical attention, especially the milder forms of heat and cold injuries.
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Live2Learn
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« Reply #30 on: December 20, 2017, 11:47:28 AM »


The chances of CAP being first on the scene with the surviving subject of a search are slender indeed. But there is a not-so-slender chance of a CAP member needing medical attention, especially the milder forms of heat and cold injuries.

Odds might be "slender indeed" for a CAP member to offer necessary medical attention on a search, but we have many other activities where injuries from heat/cold, falls, accidents might occur in locations where the organized EMS network isn't likely to arrive onsite any time soon.  For example, a CAP orienteering course may be on the backside of some mountain half an hour or more from town... where (shock, shock!) cell coverage is nil.  Or, a van of CAP SM and cadets might encounter an auto accident or even a train wreck while enroute to some out of town event.  There are LOTS of places in western states where cell phones are useful paperweights... at least for substantial parts of any journey.  :)
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kwe1009
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« Reply #31 on: December 20, 2017, 12:06:48 PM »

I'm not sure why so many CAP members believe that medical treatment must be close by for any activity.  I was involved in Boy Scouts for years and I don't recall such concern for having EMS/medically trained personnel either on site or very close.  We just made sure that we had a good first aid kit and went camping, hiking, zip lining, etc.  Yes, scouts did get hurt but they survived even without an on site doctor.

What is CAP doing that is so different that so many people believe that we need to have a more capable medical mission?
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NC Hokie
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« Reply #32 on: December 20, 2017, 12:48:59 PM »

What is CAP doing that is so different that so many people believe that we need to have a more capable medical mission?

IMHO, there are two answers to this question.  First, CAP advertises search and rescue both internally and externally, implying some level of medical capability.  Second, there is the Health Services Officer position which grants advanced rank to appropriately credentialed members but does little to actually utilize their expertise.  Some of what you see is simply members trying to make that expertise relevant to CAP.
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William Hess, Maj, CAP
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« Reply #33 on: December 20, 2017, 12:52:30 PM »

Another issue is the variety of laws covering medical services, especially EMS. Not to mention the different protocols many areas have.

Is there such a thing as a nationwide medial service? I can't imagine trying to come up with policies that apply everywhere.

The Veterans Administration is about as close as we come to a Nationwide Medical Service and that's stretching it.
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Geber
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« Reply #34 on: December 20, 2017, 01:26:50 PM »

I'm not sure why so many CAP members believe that medical treatment must be close by for any activity.  I was involved in Boy Scouts for years and I don't recall such concern for having EMS/medically trained personnel either on site or very close.  We just made sure that we had a good first aid kit and went camping, hiking, zip lining, etc.  Yes, scouts did get hurt but they survived even without an on site doctor.

What is CAP doing that is so different that so many people believe that we need to have a more capable medical mission?

Speaking only for myself, I wouldn't say CAP must have a more capable medical mission. People hike in the woods and go for mile runs every day without having an EMS person along. Searches by various agencies routinely use state troopers, firefighters, and spontaneous volunteers, with no EMS person attached to each team.

I would say it is counter-productive to have Task Guides that would require EMS personnel to recite outdated answers to questions. This is particularly the case since the more serious hyperthermia and hypothermia cases are few and far between. It's enough of a struggle to flush the outdated information out of one's mind when new protocols come out, without having to rememorize and reforget the information to be a member of a CAP ground team. The person conducting the evaluation should be permitted to judge a candidate on the current protocol in the area where the evaluation is conducted, provided the candidate provides the evaluator with a copy of the protocol.
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Eclipse
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« Reply #35 on: December 20, 2017, 01:51:10 PM »

I would say it is counter-productive to have Task Guides that would require EMS personnel to recite outdated answers to questions.

The task guides do not require "EMS personnel to recite outdated answers to questions", it requires members wishing to be
qualified as CAP Ground Team Members, to learn, understand, and execute the CAP standard as written and presented.  It makes no distinction
for "EMS personnel", since they are not specifically called out as a qualification.

This is particularly the case since the more serious hyperthermia and hypothermia cases are few and far between. It's enough of a struggle to flush the outdated information out of one's mind when new protocols come out, without having to rememorize and reforget the information to be a member of a CAP ground team. The person conducting the evaluation should be permitted to judge a candidate on the current protocol in the area where the evaluation is conducted, provided the candidate provides the evaluator with a copy of the protocol.

That's not how a national standard works. 

The answer is for anyone with a conflict of rating or understanding to disengage that particular CAP duty or qualification
until such time as the personal, subjective calls regarding a given policy or procedure can be properly reconciled
with the respective CAP policy, procedure, or curriculum.

No one requires a member to be a GTM.  I advise members all the time that if they can't abide by the curriculum,
for whatever reason, just find a different way to be of use.

There is no spoon.  Accepting that is much better then wasting money on bandages for your forehead.


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EMT-83
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« Reply #36 on: December 20, 2017, 01:54:30 PM »

Anyone want to discuss wet vs dry dressings for burns?
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sarmed1
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« Reply #37 on: December 20, 2017, 02:18:23 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.

Quote
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.


That is often very state dependent.  My wife had been told at one point years ago (Sorry I cant find the specific reference) but generally in our state, the Nursing Practice Act holds a RN accountable to the standards of the act at all times.  Even though they may not be "working" or have a "hands on" level of intervention, they are expected to conform to the states standards of practice, care, behavior, advocacy etc etc at all times. (hence why they can loose their license for things like DUI, drug offenses etc even if it doenst happen at work) So an RN witnessing a Paramedic performing inappropriate care or dangerous interventions could still receive disciplinary action from the state board of nursing for failing to attempt to intervene at the time (ie at minimum telling said EMS provider they are/may be in the wrong)

Again, much like the problem of "national" protocols, every state is different in what you can and cant do and when you are or are not held to a certain level of accountability; EMS provider, RN or physician.

mk
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Mark Kleibscheidel
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sarmed1
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« Reply #38 on: December 20, 2017, 02:31:49 PM »

Anyone else still confused as to why CAP will remain a non-medical provider and that
is never, ever going to change, despite the superhero wishes of many members?

An organization that can't even issue a correct, nor update their uniform manual would
be incapable of establishing the protocols, procedures and recurrent training necessary to assume that liability.

It is also incapable of being able to afford the liability or malpractice insurance.

Personally I think the bigger concern is the difficulty to manage the system and the people that makes sure you don't need to worry about having to kick in your liability and malpractice insurance.  I see very little reason that CAP personnel couldn't be additionally covered under the same liability and malpractice that covers DoD medical personnel now for when they perform civilian care. (that whole instrumentality of the USAF when performing on authorized missions etc etc.  But I am just a medical guy, not a lawyer or policy expert)

mk
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Mark Kleibscheidel
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Eclipse
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« Reply #39 on: December 20, 2017, 03:01:02 PM »

Again, much like the problem of "national" protocols, every state is different in what you can and cant do and when you are or are not held to a certain level of accountability; EMS provider, RN or physician.

And to press this point further, what about when a member from one state deploys to another?

That happens far too often these days for disasters, and on a regular basis for NCSAs, encampments, SARExs,
O-rides, etc., etc.
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Ned
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« Reply #40 on: December 20, 2017, 06:02:47 PM »


I see very little reason that CAP personnel couldn't be additionally covered under the same liability and malpractice that covers DoD medical personnel now for when they perform civilian care. (that whole instrumentality of the USAF when performing on authorized missions etc etc.  But I am just a medical guy, not a lawyer or policy expert)

We've talked about this before in several threads. 

And I think that you are right --  that assuming our medical folks can meet the license/training requirements for their Federal counterparts, then there is little reason they could not be used on AF-authorized missions, where the government is essentially serf-insured.  Just like pilots and others on AF-assigned missions.  Underlying that assumption is that we would have to invent and maintain a system like the Feds, that records and tracks the certifications and training.  Which would also include mandated yearly professional training to maintain currency.  Which may or may not be what your state licensure requires.  And if it is more, then the HSO would have to fund and attend the training on their own.  And of course, our AF colleagues would have to agree to oversee the certification and training requirements before the DoD would consider moving forward.  And that would likely require a lot of persuading since they are pretty happy with the status quo.

Perhaps even more importantly, even if we could finagle all that (which is certainly possible), it would only cover AF-assigned missions, which would leave out something like 97% of what CAP does.  We still would not have any sort of care for cadets or seniors not on AF-assigned missions.  Still no coverage for care given on corporate missions or routine activities like encampment, NCSAs, unit meetings, or during CAP PD classes.

But it is not impossible during times we have instrumentality status.


Ned Lee
Former CAP Legal Officer
Former CAP Policy Guy
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etodd
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Posts: 1,002

« Reply #41 on: December 20, 2017, 10:58:31 PM »

in the thread regarding drones, I mentioned that any pilot with their Part 107 who has a drone, and is interested in using it for SAR, should put on their civilian clothes and go help any of the many agencies that could use their services. Do it outside of CAP.

Seems that idea may work here as well. If you are an EMT or similar and want to use those skills, then put on your civies and go help out. The Red Cross and other agencies would be happy I'm sure.

You can help CAP in some areas and also help other agencies with other skill sets.

Its a good thing.  :)
« Last Edit: December 20, 2017, 11:03:00 PM by etodd » Logged
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Brad
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Unit: MER-SC-020

« Reply #42 on: December 21, 2017, 01:02:54 AM »

To the OP, I'm curious if you have (re?)read CAPR 60-3 lately. All your concerns are addressed from what I can tell, and in terms of conflicts and which takes precedence, that's a call for Legal to make I would say:

Quote
1-17. Ground Operations. Ground teams may be used in virtually all phases of a mission.
Ground operations are governed by state and local laws as well as by CAP regulations and
policies.

1-24. Legal Issues of CAP Operational Missions. Title 10, USC § 9442 identifies CAP as an
auxiliary of the Air Force when carrying out a mission assigned by the Secretary of the Air
Force. This happens when CAP provides services to any department or agency in any branch of
the Federal government, including the Air Force. CAP is deemed to be an instrumentality of the
United States while carrying out missions assigned by the Secretary. This provides both legal
benefits and restrictions on what members can do on AFAMs. There are certain legal issues and
principles of which CAP members should be aware to protect themselves and the Corporation
from legal liability. While it is impossible to have specific rules which will be valid in all the
states and territories, several general principles of law can decrease the risk of individual and
corporate liability. The legal officer of each wing should review state laws and suggest ways to
avoid legal liability arising out of CAP activities.

f. First Aid and Emergency Medical Care. CAP is not an emergency medical care or
paramedic organization and should not advertise itself as such. CAP will not be the primary
provider of medical support on missions or training events though qualified personnel can be
used to support such activities. The only type of medical aid that should be administered by
CAP personnel or by any other person at CAP's request is reasonable treatment deemed
necessary to save a life or prevent human suffering. This treatment must be executed by a person
qualified to attempt such medical care within their skill level. When first aid or higher medical
training is required for qualification in a particular specialty, the expectation is that the
qualification course includes both knowledge and practical skills training; first aid courses taken
on-line only are not acceptable; though members are not considered employees when supporting
operations, courses are expected to meet the National Guidelines for First Aid in Occupational
Settings available at http://ntl.bts.gov/lib/24000/24700/24757/ngfatos.pdf or ASTM F 2171-
02(2009), Standard Guide for Defining the Performance of First Aid Providers in Occupational
Settings. CAP medical personnel are not provided supplemental malpractice insurance coverage,
and any care provided is at the members own risk. Though medical supplies and equipment are
not normally provided to responders, any reasonable supplies used on training or actual missions
may be submitted for reimbursement as long as sufficient justification is provided.
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Brad Lee
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« Reply #43 on: December 21, 2017, 08:15:48 AM »

Brad:

CAPR 60-3 seems to cover what I was looking for better than anything else I've found. The language is pretty much repeated in CAPR 160-1 OPERATION OF THE CAP HEALTH SERVICE PROGRAM.

The wording in these regulations seem much better than the language in Ground & Urban Direction
Finding Team Tasks
. For example, the task guide mentions as a step in patient care "transport the person to a medical care facility". CAPR 160-1 puts it differently: "Medical care within CAP is limited to emergency first aid and may be provided only by members with appropriate training and experience. Such care shall continue only until professional medical care can be obtained." The latter wording makes it clear that once the patient is turned over to "professional medical care" then those care providers are responsible for medical decisions (even if they were functioning as CAP members just before they started using their professional medical skills). CAP members who are acting as CAP members needn't feel responsible for medical decisions up to the point where the patient arrives at a health care facility, only up to the point where the patient comes under the care of a qualified medical professional.

CAPR 160-1 also lists as a responsibility of a health services officer "b. Provide or arrange for the provision of training in first aid, CPR and other life-saving measures by a certifying agency (American Red Cross, American Heart Association, American Safety and Health Institute, National Safety Council, etc.)." Since this is a regulation, while the  Ground & Urban Direction Finding Team Tasks is merely a guide, it would not be unreasonable for an evaluator to accept answers to questions that disagree with that guide but conform to up-to-date information from one of the certifying agencies that health services officers are allowed to select from when arranging first aid training. Really no different than an evaluator allowing a candidate to equip herself with an LED flashlight even though a guide was written before LED flashlights were generally available.
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RiverAux
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« Reply #44 on: December 21, 2017, 06:04:23 PM »

Passing the CAP task is different from obtaining one of the outside First Aid qualifications.  The CAP answer is the right one at least as far as passing the task. 

Also, keep in mind that a HSO or anyone else teaching First Aid doesn't necessarily have the qualifications to be evaluating someone working on a CAP ES task anyway. 
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Mordecai
Salty & Seasoned Contributor

Posts: 1,136
Unit: SI

« Reply #45 on: December 26, 2017, 10:30:13 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?

I do solemnly swear (or affirm) that:
I understand membership in the Civil Air Patrol is a
privilege, not a right, and that membership is on a
year‐to‐year basis subject to recurring renewal by
CAP. I further understand failure to meet
membership eligibility criteria will result in
automatic termination at any time.
I voluntarily subscribe to the objectives and
purposes of the Civil Air Patrol and agree to be
guided by CAP Core Values, Ethics Policies,
Constitution & Bylaws, Regulations and all applicable
Federal, State, and Local Laws.
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SarDragon
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« Reply #46 on: December 26, 2017, 11:13:26 PM »

Asked, answered, ended.

Click.
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Dave Bowles
Maj, CAP
AT1, USN Retired
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CAP Talk  |  Operations  |  Emergency Services & Operations  |  Topic: Where does it say we obey the law?
 


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