EMS Protocols

[Krapenhoeffer]

So, I was doing a review of a missing person search (successful) that happened last fall. And the medical care given by the GT that found her, was, well... Wrong. Now, I have read in places here on CAPTalk about how an incoming EMT could use their department protocols. After doing some research, I discovered that you can't. You can't even use all of BLS technically in CAP. So, my two ideas surrounded getting protocols made, and more First Responders in GT work.

Proposal 1: Recruit an emergency room physician in each wing as a Medical Director to help develop protocols for:
a) First Responder
b) EMT-B
c) EMT-IVT (IV Technician, the WI version of intermediate)
d) EMT-Paramedic
c) RN (seeing as we have quite a few RNs in WIWG)

Proposal 2: Find a way to get more Ground Team members to at least First Responder
a) Target older (17+) cadets first, as they can devote some summer time to taking a first responder class
b) Train other GT members in at least basic assessment (SAMPLE, DOTS, etc...)
c) Make CPR for the Healthcare Provider mandatory for GTMs
d) Have your new First Responders act as liaison between CAP and local EMS.

Any critiques of my ideas and or new ideas would be great.

[RADIOMAN015]

So, my two ideas surrounded getting protocols made, and more First Responders in GT work.

Proposal 1: Recruit an emergency room physician in each wing as a Medical Director to help develop protocols for:

Proposal 2: Find a way to get more Ground Team members to at least First Responder

Any critiques of my ideas and or new ideas would be great.

I don't think that CAP's mission policy wise is more than basic first aid (and frankly if there's other medical personnel available generally let them do the emergency care & CAP would just assist e.g. holding the IV tube, carrying the stretcher, etc).

I'm not sure how much of a difference there is between a Basic First Aid Course & First Responders training.

I do think it is important for both cadet & senior members to be trained in first aid, even if they are not part of an ES response team.
RM

[Eclipse]

Nope.

[arajca]

1. CAP is NOT an EMS organization.

[High Speed Low Drag]

Maybe it's time that we did put more emphasis on medical.  Are we not trying to make ourselves more marketable to potential potential customers?  What would be wrong with taking it to at least a First Responder level?

[Eclipse]

Maybe it's time that we did put more emphasis on medical.  Are we not trying to make ourselves more marketable to potential potential customers?  What would be wrong with taking it to at least a First Responder level?

Our liability costs would go through the roof, our training requirements would go through the roof, and yet our missions would not.
We are not a first responder agency, therefore we do not need first responder training.

Low ROI.

[JayT]

So, I was doing a review of a missing person search (successful) that happened last fall. And the medical care given by the GT that found her, was, well... Wrong. Now, I have read in places here on CAPTalk about how an incoming EMT could use their department protocols. After doing some research, I discovered that you can't. You can't even use all of BLS technically in CAP. So, my two ideas surrounded getting protocols made, and more First Responders in GT work.

Proposal 1: Recruit an emergency room physician in each wing as a Medical Director to help develop protocols for:
a) First Responder
b) EMT-B
c) EMT-IVT (IV Technician, the WI version of intermediate)
d) EMT-Paramedic
c) RN (seeing as we have quite a few RNs in WIWG)

Proposal 2: Find a way to get more Ground Team members to at least First Responder
a) Target older (17+) cadets first, as they can devote some summer time to taking a first responder class
b) Train other GT members in at least basic assessment (SAMPLE, DOTS, etc...)
c) Make CPR for the Healthcare Provider mandatory for GTMs
d) Have your new First Responders act as liaison between CAP and local EMS.

Any critiques of my ideas and or new ideas would be great.

Let me give you an example.

First off, there's over forty levels of EMS providers accross the country. I'm an EMT-Critical Care. Two counties over, EMT-CC's don't exist, but EMT-I's do. I can't work as an ALS provider there, but an EMT-I can operate under my supervision in my county.

Also in New York State, it's very rare to find RN's operating in the field.

Who's going to pay for the equipment? What good is a medic, RN, or MD without a monitor, drug kit, or intubation kit, in terms of providing ALS skills.

Who's going to provide online medical control?

[SJFedor]

its a good idea in theory, but A) you'd have a hard time finding an ER doc willing to donate all that time to be a medical director for something like that, and B ) the cost on certification and liability insurance would be through the roof.

There's the caveat in the regs that you can provide "initial care and stabilization up to the level of your training", and there's not a whole lot as a FR or EMT-B that you're gonna do to really overstep what you should be doing anyway. In the aircraft crash, is there an immediate life threat which warrants immediate extrication of the patient from the wreckage? If so, do it, if not, leave the patient be. C-spine management, bleeding control, and airway management. Beyond that, that's about all we'd be called on doing anyway. We don't need to be running around throwing c-collars and doing extrications on everyone, plus, how often would the skills be used? Not nearly enough to warrant all the training and recurrency of all the personnel.

And as for proposal 1, as much as I love and adore them, I wouldn't try and include RN's into this anyway. ER or pre-hospital RNs are fabulous, but jim bob RN who works on the med/surg unit isn't gonna have the training or experience needed to manage a scene.

And as far as my job is concerned, my job has always had a clause that if I act within protocols and scope, i'm covered under their liability insurance 24/7 in the state. They do that to encourage us to "stop and help", moreso in-county, but all over as well, if something is going on. And, to keep us under liability while we do that, we're considered "on duty" the moment we roll up, i.e. I get paid to do it 

And no, I do NOT drive around looking for wrecks for extra money. Lord knows I get enough overtime as it is.

[Major Lord]

Krapenhoeffer, I wish you had gone back and read through the posts here and on other CAP boards. Aside from uniform issues, this is one of the most contentious issues under discussion in CAP. Its a good thing that the number of times CAP personnel have been called upon to actually provide life saving medical treatment have been so few, compared to how often we discuss and argue about it at least! You can't even give a Tylenol to a Cadet with a boo-boo, let alone practice to your level of medical training routinely.

If you ever need to actually provide first aid in CAP, be prepared to swing from the Yardarm. CAP has made it abundantly clear that they don' t want us to provide anything more than the minimal level of lifesaving aid that is within our level of training and scope of practice. You will be very, very frustrated if you try to change the CAP HQ collective conscience on this subject.

Major Lord

[Slim]

And then, there's the trust factor.....

At least here, every county (and most private services) has a Physician Medical Director (PMD) who establishes protocols, has a staff to monitor compliance and standard of care.  Some PMDs, like mine, are very visible and active in the EMS community.  They need to be, as we all essentially operate under their license.  If I do something stupid in the field, I'm going to answer for it; if I do something good, I'm going to be recognized for it.  As a result, we all try to do our best to earn and keep the trust of our PMDs.  The PMD my company uses is also the county medical control authority PMD.

You'd be hard pressed to find any physician-let alone an ER/trauma doc-willing to put their license on the line for a couple hundred minimally trained (first responder is entry level here) and inexperienced people (unless your average ground team member is a trauma trooper, running around looking for MVAs and such, they aren't going to be all that confident in their skills because they hardly ever use them).  And these would be people the PMD might not even know.  Again, because my PMD knows me, and sees me on a regular basis, she's much more likely to give me a Gibbs smack on the back of my head if I do something stoopid.

If the stuff hits the fan, I know that I can do what I need to do to save a life, up to the level of my license, and not risk running afoul of CAP regulations.  No need to try and make us into something we aren't equipped to be.

[Eclipse]

We're all much better off just concentrating on finding the guy and then doing this:



and letting a pro go from there...

[N Harmon]

I think there is a LOT of room between the basic first aid/CPR that ES folks receive, and emergency medical care that requires a physician authority monitoring care. And it is in here that I think CAP really needs to pick up the ball.

I really like the NOLS courses. I would like to see CAP adopt either Wilderness Advanced First Aid or Wilderness First Responder as the GSAR requirement.

I don't see anything in there that would involve increased liability, or medical control.

We're all much better off just concentrating on finding the guy and then doing this:

and letting a pro go from there...

Yeah, that'll earn us all sorts of good press when the survivor of a plane wreck tells the media "the CAP team who located me wouldn't help me out of the plane because they said CAP is NOT an EMS organization. They even mentioned that NOT was in capital letters"

[Eclipse]

Yeah, that'll earn us all sorts of good press when the survivor of a plane wreck tells the media "the CAP team who located me wouldn't help me out of the plane because they said CAP is NOT an EMS organization. They even mentioned that NOT was in capital letters"

That's not how it works and you know it.

If their lives are in danger, i.e. fire, major bleeding, etc., then we are allowed to provide care and get them out.  If not, better to call in EMS and let them handle it.

The press isn't any better when you cut someone down from the straps and then find they have a broken neck and are now dead.

[RiverAux]

At one point we were requiring GTLs to have "advanced first aid", which was never specifically defined in the regs but somewhat official guidance from NHQ said was a 40-hour course - in others words, what is now known as Emergency Medical Responder (formerely First Responder).  Unfortunately, this particular course (or previous versions doesn't seem to be widely available. 

Having taken this course, I don't actually see a lot in it that CAP members would be likely to use in the field.  A large percentage of it is in dealing with medical emergencies rather than trauma.  The one big thing that EMRs can do that those with basic first aid can't do (and this probably varies by state) is administer oxygen.  Since we're not going to be lugging around those tanks, it would be useless to us.

Now, I have taken Wilderness First Aid and think it is a decent step up and would be appropriate for us without going off the deep end.  It does go some more into patient evaluation, which I think is an important for CAP members.  We need to be able to do some basic assessments so that the highly trained folks know what to expect.  The other part of the course is the same sort of basic trauma treatment found in EMR (pressure points, splints, etc.). 

[Eclipse]

At one point we were requiring GTLs to have "advanced first aid", which was never specifically defined in the regs but somewhat official guidance from NHQ said was a 40-hour course - in others words, what is now known as Emergency Medical Responder (formerely First Responder).  Unfortunately, this particular course (or previous versions doesn't seem to be widely available. 

When?  Not in the last 10 years.

[RiverAux]

I'm pretty sure it went away when the 2004 version of the task guide came out.  It is a requirement on the old 101T-GTL from 2001. 

[Eclipse]

I'm pretty sure it went away when the 2004 version of the task guide came out.  It is a requirement on the old 101T-GTL from 2001.

OK, that may be right.

[isuhawkeye]

Krapenhoeffer it sounds like the real issue here is the first aid training, and the application of those skills.  Adding an extra level of complexity does not seem to be the solution here.  If the ground team did not preform basic first aid appropriately then that should be addressed first.

Just my $.02

[a2capt]

2004 did kill it.

[Krapenhoeffer]

Okay: RNs are out. (Although the former USAF PJ turned Civilian RN will be saddened)

However, to address the belief that CAP just finds and turns over to the pros, in the particular mission that prompted this proposal-in-progress, the CAP GT was 2 miles away from the nearest roadway, over a iron deposit, where compasses don't work. Fortunately, the patient was a RN (and Girl Scout troop leader) herself, and knew how to not get killed, so she was fine.

But, Basic First Aid doesn't cover situations that CAP members would find themselves in. I read a criticism about trauma not being covered excessively in First Responder. Trauma isn't covered at all in basic First Aid. Signs and symptoms of shock are never discussed, and immobilization (although it is covered in CERT), don't get me started. The CAP GT immediately gave her food and water. Now, if we had a First Responder there, he or she would have been able to rule out shock, or if not, called for MedFlight. We were two hours away from a BLS ambulance. If this patient had shock, she would have died, as the golden hour had passed an hour before we left the wilderness.

I am allowed to use all of my fun protocols when I'm in my home county. However, I've never done a CAP mission here in Dane Co. WI.

I'm not for making a requirement of anyone to take advanced medical training, I'm just saying we should encourage it more.

I'm pretty sure that an 18-year old ES freak Cadet, would be more than overjoyed to be working on a volunteer BLS rig when away from CAP.

EDIT: I forgot to mention how Medical Oversight works in WI. Online Medical Oversight is provided by the receiving hospital. Don't know if it's different elsewhere, but that's the situation in WI.