Medical squadrons

[Pace]

Don't forget the narcan. With epi and narcan, you're sure to get the HR and SBP above 200. More is better, right? 

[LTC Don]

From 2011 --
Click the SCRIBD link, and also, there is or was a good picture of the ParaNurses doing their thing:
http://captalk.net/index.php?topic=12475.0

[Holding Pattern]

( I would almost bet you we have a few instructors who would do the training for free if you fed them and  treated them nicely)

It's worth remembering that with CAP, as a general rule, the better you treat instructors, the lower the long term costs and availability will be.

Always remember to write the thank you card!

[ALORD]

Don't forget the narcan. With epi and narcan, you're sure to get the HR and SBP above 200. More is better, right? 

Pace,

You are right! In fact, with CAP-Corporate, Narcan should be the first round drug of choice in any situation. I forgot one major problem, though: For Epi to be very effective, you would have to have a heart....Although it is an axiom of Emergency Medicine that with enough Epi and electricity, you can get a rhythm out of a baked potato... and yes, the Cap-Medical Allergy thing was a metaphor. I have not been taught to tap a Corporation's chest, although I can deliver a 300 Joule shock if called upon to do so!

On the issue of level of training, Paramedicine requires a Medical Director as an "overseer",  so irrespective of your level of training, you may not be able to ( lawfully) carry out life-saving procedures in your off-duty role as a private person ( Other than basic first aid, CPR, Heimlich, etc, the level to which many laymen are trained, and probably save more lives than advanced procedures in the field) An MD can initiate on his own authority and within his scope of practice. If a Cadet is stung by a bee, paramedical personnel should call for help, and wait for the Cadet to stop breathing so they can do ceremonial CPR....off duty, they have no authority to stick that Epi pen in your leg. ( Our instructors always said "You can help them do it, nudge, nudge, wink, wink! In reality, if you are not present when the bee stings or they eat the peanuts, you are probably too late for Epi anyway) Watching people die while we withhold treatment is within our scope of off-duty practice......and CAP policy ( Gosh, you guys better treat your Paramedical folks really nice, so we might be willing to bend the rules a little bit as opposed to watching you turn blue and flop around and stuff.) Cadets attending Public Schools in CAWG and other certain other areas should probably learn about the care and feeding of gunshot wounds...

We had a well known Nurse in CAWG ( You may remember her from the OJ. Trial) who was a First Responder Instructor, but I believe she has left this veil of tears. Any of you guys still out there?

[gcreager]

While my reading of the regs indicates anything more than bandaids is too much, there's also the rather prickly "duty to act" where a trained professional can't really sit aside, CAP regs, or lack of a medical director notwithstanding, and watch someone die.

Personally, I like the idea of treating corporations (and this isn't limited to CAP) to narcan, sufficient epi to make said baked potato palpitate, and dual-chamber pacing using a 1980's era external pacemaker, but I doubt we'll ever see consensus recommendations supporting it.

[lordmonar]

While my reading of the regs indicates anything more than bandaids is too much, there's also the rather prickly "duty to act" where a trained professional can't really sit aside, CAP regs, or lack of a medical director notwithstanding, and watch someone die.

Yep.....and because of the prickly differing set of rules in each jurisdiction....CAP has opted out of the health care business.  Acting as a health care professional and a CAP member to save a life or reduce suffering is compatible with the regulations so there are no conflicts.

[PA Guy]

While my reading of the regs indicates anything more than bandaids is too much, there's also the rather prickly "duty to act" where a trained professional can't really sit aside, CAP regs, or lack of a medical director notwithstanding, and watch someone die.

Personally, I like the idea of treating corporations (and this isn't limited to CAP) to narcan, sufficient epi to make said baked potato palpitate, and dual-chamber pacing using a 1980's era external pacemaker, but I doubt we'll ever see consensus recommendations supporting it.

How many states have Duty to Act laws?

[THRAWN]

While my reading of the regs indicates anything more than bandaids is too much, there's also the rather prickly "duty to act" where a trained professional can't really sit aside, CAP regs, or lack of a medical director notwithstanding, and watch someone die.

Personally, I like the idea of treating corporations (and this isn't limited to CAP) to narcan, sufficient epi to make said baked potato palpitate, and dual-chamber pacing using a 1980's era external pacemaker, but I doubt we'll ever see consensus recommendations supporting it.

How many states have Duty to Act laws?

Off hand, if I remember right, it's in the area of 10. Most of the "laws" are nothing of the sort. They're taken from department or agency specific rules and regs that say that you have a moral obligation to act, not a legal one and are mostly ties to the Good Samaritan laws in the state.

[PA Guy]

Spaceman,

"In other words, you may act up to your skill level (level of training) in order to save a life or prevent human suffering. So in your given example, assuming you are a licensed medical provider at some level (it sounds like you are), you are well within CAP regulations to provide care up to your skill level, not "clutch the regs and watch them die" as you put it. CAPR160-1 also has a similar line about "providing first aid within your level of training", and if your "level of training" happens to be EMT-P level, then that's how high you can act."


CAPR 160-1 para 1-6 a, b does not mention skill level. It only requires that a responder be trained to render first aid. Regardless of skill level a member of CAP is limited to first aid.

[PA Guy]

While my reading of the regs indicates anything more than bandaids is too much, there's also the rather prickly "duty to act" where a trained professional can't really sit aside, CAP regs, or lack of a medical director notwithstanding, and watch someone die.

Personally, I like the idea of treating corporations (and this isn't limited to CAP) to narcan, sufficient epi to make said baked potato palpitate, and dual-chamber pacing using a 1980's era external pacemaker, but I doubt we'll ever see consensus recommendations supporting it.

How many states have Duty to Act laws?

Off hand, if I remember right, it's in the area of 10. Most of the "laws" are nothing of the sort. They're taken from department or agency specific rules and regs that say that you have a moral obligation to act, not a legal one and are mostly ties to the Good Samaritan laws in the state.

Although somewhat dated this link might help.  http://emtlife.com/threads/duty-to-act-info.5673/ This applies to off duty only.

[Spaceman3750]

Spaceman,

"In other words, you may act up to your skill level (level of training) in order to save a life or prevent human suffering. So in your given example, assuming you are a licensed medical provider at some level (it sounds like you are), you are well within CAP regulations to provide care up to your skill level, not "clutch the regs and watch them die" as you put it. CAPR160-1 also has a similar line about "providing first aid within your level of training", and if your "level of training" happens to be EMT-P level, then that's how high you can act."


CAPR 160-1 para 1-6 a, b does not mention skill level. It only requires that a responder be trained to render first aid. Regardless of skill level a member of CAP is limited to first aid.

I would argue that "emergency first aid" is emergency care/aid by the first person on the scene, with appropriate training and experience, to save a life or prevent human suffering. While there are organizations that teach "first aid" classes, a paramedic who is the first on scene, providing aid to someone within their level of training, is still providing "first aid".

The spirit of the regulations at play is that "CAP is not a medical care provider". That means we should not be running around providing checkups, giving immunizations, and generally purporting to be a health care provider or EMS service; not that we should have our rescuers who are highly trained in other professions ignoring or limiting their response to a life-threatening emergency. And, absent further interpretation from a relevant commander, my reading of the regs and your reading of the regs don't mean anything.

EDIT: This argument does become kind of moot when you consider that most EMTs are not running around with an ambulance in their backpack, and in order to be fully effective, they kind of need all of the stuff that you would find in one. My point, is that when people say "I guess I will have to watch the person die because I think the regulation of a non-profit corporation says that I must.", it scares the hell out of me, because to me it represents a complete disregard for human life.

[AirAux]

So enough about EMT's, how about doctors??  How far can they go??

[Spaceman3750]

So enough about EMT's, how about doctors??  How far can they go??

According to the previously-cited regulation, up to their level of training and licensure.

[Pace]

All the regulatory bantering aside, I would act within the full scope of my practice if someone were dying in front of me up to and including intubation, cricothyrotomy, pericardiocentesis, and tension pneumo decompression. I wouldn't be able to sleep at night if someone in my care died and I had not done everything in my power to keep them alive.

[lordmonar]

All the regulatory bantering aside, I would act within the full scope of my practice if someone were dying in front of me up to and including intubation, cricothyrotomy, pericardiocentesis, and tension pneumo decompression. I wouldn't be able to sleep at night if someone in my care died and I had not done everything in my power to keep them alive.

+1
2b or allow a death?    Where do I sign?

[ALORD]

All the regulatory bantering aside, I would act within the full scope of my practice if someone were dying in front of me up to and including intubation, cricothyrotomy, pericardiocentesis, and tension pneumo decompression. I wouldn't be able to sleep at night if someone in my care died and I had not done everything in my power to keep them alive.

+1
2b or allow a death?    Where do I sign?

Maybe you have to take off your jacket and declare yourself "Of duty" before initiating advanced care. Aside from a few boo-boo and owies ( Stop me if I get too technical here) I have not had to render very much care to cadets ( Aside from there-there therapy) I received parental permission on the phone, via the Wing Commander to administer one 220 mg Naproxen/Pseudoephedrine to aid a cadet at encampment with a sinus infection, and I administered O2 to a female Cadet at encampment who had a prolonged seizure and was postictal ( What, you don't carry O2, an AED, suction, and airway kits in your car?) In California, once I stepped in, I had a duty to act, and to care for the patient as well as I could until relieved by higher medical authority. To treat and run is "Patient abandonment", which is a bad thing. If there are Uniforms as the scene of a medical, just put on your blinders and keep driving! ( I never did find out how that CAWG cadet faired with her seizure issue. I hope she is healthy and happy)

[lordmonar]

Is it just me or does anything ALORD posts sounds negative.   Even when he is agreeing with you?

[PA Guy]

So enough about EMT's, how about doctors??  How far can they go??

According to the previously-cited regulation, up to their level of training and licensure.

Non concur. All CAP members are restricted to first aid regardless of skill level. CAPR 160-1:

"1-6. Medical Care Policy.
a. CAP is not a health care provider, and CAP members are not permitted to act in the role of health care providers during the performance of official CAP duties. Consequently, CAP members are not permitted to function as pharmacists, physicians, nurses, or in any other role that would permit the administration and dispensing of drugs under various federal and state laws and regulations."

[Holding Pattern]

So enough about EMT's, how about doctors??  How far can they go??

According to the previously-cited regulation, up to their level of training and licensure.

Non concur. All CAP members are restricted to first aid regardless of skill level. CAPR 160-1:

"1-6. Medical Care Policy.
a. CAP is not a health care provider, and CAP members are not permitted to act in the role of health care providers during the performance of official CAP duties. Consequently, CAP members are not permitted to function as pharmacists, physicians, nurses, or in any other role that would permit the administration and dispensing of drugs under various federal and state laws and regulations."

With the exception and caveat of...

c. Any member can assist another member in distress in order to save the life of the
member. Members are encouraged to inform activity leadership, health service officers, those in
direct contact with the member of their condition, and critical information for support that may
be needed. Should any CAP member be required by law to render aid by virtue of his or her
professional credential or state license (such as a paramedic or emergency medical technician,
for example), such CAP member in complying with his or her legal obligations shall be deemed
to be doing so either as the agent of his or her employer or as an agent of the state agency that
issued his or her license, but in no event as the agent of CAP.

[Spaceman3750]

So enough about EMT's, how about doctors??  How far can they go??

According to the previously-cited regulation, up to their level of training and licensure.

Non concur. All CAP members are restricted to first aid regardless of skill level. CAPR 160-1:

"1-6. Medical Care Policy.
a. CAP is not a health care provider, and CAP members are not permitted to act in the role of health care providers during the performance of official CAP duties. Consequently, CAP members are not permitted to function as pharmacists, physicians, nurses, or in any other role that would permit the administration and dispensing of drugs under various federal and state laws and regulations."

With the exception and caveat of...

c. Any member can assist another member in distress in order to save the life of the
member. Members are encouraged to inform activity leadership, health service officers, those in
direct contact with the member of their condition, and critical information for support that may
be needed. Should any CAP member be required by law to render aid by virtue of his or her
professional credential or state license (such as a paramedic or emergency medical technician,
for example), such CAP member in complying with his or her legal obligations shall be deemed
to be doing so either as the agent of his or her employer or as an agent of the state agency that
issued his or her license, but in no event as the agent of CAP.

I missed that, good catch.