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.

[arajca]

In CO, medical direction/oversight/control is provided by the hospital system your agency works with following general guideline from the state. Most hospital systems in CO use the same protocols for legal reasons - doing so takes a tool away from the sharks lawyers (Why don't you allow YOUR EMS personnel to do XYZ like ABC Hospital Corp. does?). Some provide coverage anywhere/anytime in the state, some just when your on duty with your agency.

[Eclipse]

I am allowed to use all of my fun protocols when I'm in my home county.

Not in a CAP uniform.

[SJFedor]

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.

Yeah, it changes from place to place. Here in Louisville, all our OLMC is done through UofL for adult patients and Kosair Childrens for peds. Nashville is the same, with Vanderbilt providing med control for NFD EMS.


And the fact that there wasn't a med unit on standby somewhere was a massive failure on the part of the incident commander. If we're looking for an aircraft in a county, I'd definitely wanna be on the phone with the county EMA and EMS, and have fire, technical rescue, and EMS standing by and ready to roll. We're not the end all be all, we're only the first link in the chain, and some IC's forget to remember that and make sure they have additional resources ready.

Shock doesn't always kill someone, there's 3 stages of shock, and all but the last one can be fixed. Had this patient had a significant MOI (as she did) along with significant injuries, then the only way that patient would have a chance is to have pre-hospital transport readily available.

And lets be realistic. By the time we get the call, mobilize, get to the field, and find the person, the golden hour was up a long, long time ago.

[Krapenhoeffer]

I am allowed to use all of my fun protocols when I'm in my home county.

Not in a CAP uniform.

Thanks, I'll take a 2b from CAP, rather than lose my license and watch my patient die.

[Eclipse]

I am allowed to use all of my fun protocols when I'm in my home county.

Not in a CAP uniform.

Thanks, I'll take a 2b from CAP, rather than lose my license and watch my patient die.

I didn't make the rules, nor do I necessarily agree with them, but if you find yourself in a "duty of care" situation because of your CAP service, you need to be fully aware that you will most likely not be covered by CAP liability insurance, etc., when you hang the IV.  A 2B might be the least of your worries if someone dies because you made a mistake and your professional insurance says "talk to CAP about this..."

You haven't discovered anything "new", or "problematic" - this is the official stance of CAP, Inc., and has been for a long time.
Either you can work within that or you can't, and a CAP GTL would be well within his CAP authority to tell you to knock it off, or sign you out of the mission on the spot if you start doing something beyond the scope of CAP's mandate and authorization.

[cap235629]

or sign you out of the mission on the spot if you start doing something beyond the scope of CAP's mandate and authorization.

Is this one of those Eclipse regulations that aren't really there?  Where does a GTL get the authority to sign anyone but him/her self in or out of a mission?

[sarmed1]

Thanks, I'll take a 2b from CAP, rather than lose my license...

Not likely, CAP is no differant than any other not Ambulance job.  If I am working for walmart and someone collapses in front of me and dont do anything because I am just the greeter despite being a paramedic, I wont be in trouble because I had no duty to act (morally maybe but that's usually not a legal or certification loosing issue)

Would you loose your license for not giving O2 to a trauma patient on your way home from the store because you dont carry your own O2 in the car...or AED...or traction splint??  All protocols and expected standard of care?

As far as a first responder requirement a good idea but not relaly problem solving; I work with a number of "pro" first responders (police, fire dept, industrial etc) and unless (and even then) they are riding the ambulance on a regular basis their skills are usually substandard (they put oxygen on 15LPM do CPR and everything else is a little rusty).  My point is its not about more initial training, its about keeping up their skills; and the basic first aid skills that CAP people have is a fine starting point for the mission they do; medical folks need to keep everyone else updated and up to speed; that would go a much longer way than everyone taking a 40+ hour course

otherwise if going down the road of medical types doing more than advising and emergency care:
Personally I like the following option for medcial care in CAP...it solves the cost and liability issues (of course there is some coordination and details that need to be worked out)
Two words  Air Force.  If the USAF covers all of CAP liability and Tort issues for USAF mission why cant medical care on the same missions be covered?  (both for care to members or search victims)  I would imagine in order for USAFMS to take on the "risk" CAP members would have to meet realtively the same training and maintainig standards as their USAF counterparts, someone would have to keep track of all of that as well. 
I think that is a better plan than trying to develop something that wont likley work in all 52 wings and will cost CAP a butt load of money in insurance

mk

[Eclipse]

or sign you out of the mission on the spot if you start doing something beyond the scope of CAP's mandate and authorization.

Is this one of those Eclipse regulations that aren't really there?  Where does a GTL get the authority to sign anyone but him/her self in or out of a mission?

GTL's are the final authority in the field for a ground team - they aren't there just to "drive the cadets".  You obey them or you go home.

[Eclipse]

Thanks, I'll take a 2b from CAP, rather than lose my license...

Not likely, CAP is no differant than any other not Ambulance job.  If I am working for walmart and someone collapses in front of me and dont do anything because I am just the greeter despite being a paramedic, I wont be in trouble because I had no duty to act (morally maybe but that's usually not a legal or certification loosing issue)

On this it really depends on the state - some have pretty strict regs regarding duty to act by medical professionals.

[Krapenhoeffer]

@sarmed: I carry my jump pack in my POV, of course minus the O2, and the AED, because I can't afford those nice things. As for splints, in a wilderness setting, potential splints can be found anywhere one looks.

Maybe try recruiting more EMTs from the real world, than trying to raise them up in-house?

And as for not providing care: Yes, I know that technically one cannot have their license revoked, but in practice... There was an EMT I knew, not well, but knew, and he was at a school football game, and one of the players on the other team went down, unresponsive, the EMT said to the parents of this child "I would help, but he's on the other team, so I think it would be inappropriate." And stood there. And did nothing. Not even AABC. His boss found out, and magically he never seemed to be on the rig anymore. When the time came to re-certify, he wasn't considered "active" so he lost his license.

@Eclipse: I can't get sued as long as I stay within my scope of practice. Which means not obtaining IV access until I'm directed by online medical control to administer intravenous medication. And I think you will be hard pressed to find a GTL who would tell an EMT to knock it off, especially after I'm directed to drop an IV (no longer CAP responsibility anyway, responsibility for patient transfers to St. Mary's Hospital).

[Eclipse]

And I think you will be hard pressed to find a GTL who would tell an EMT to knock it off, especially after I'm directed to drop an IV (no longer CAP responsibility anyway, responsibility for patient transfers to St. Mary's Hospital).

Really - well here's one.  For starters you wouldn't be bringing that stuff to insure you didn't get "tempted".

Second, the millisecond you are directed by someone to hang an IV, you are literally no longer on that mission, and are taking direction
from a different agency.  At that point I could not care less what you do, I notify the GBD that you're off the mission and go back to securing the scene.

I'm not going to risk my house and future so you can play Squad 51.  If its that important, leave the turn out gear on and stay with the FD.

Why would we recruit more EMT's? So we can have more of these conversations?  Until CAP changes their tune, we don't need them as medical responders - their general abilities, understanding of the nature of ES, and certainly their warm bodies, yes, but from a medical perspective they might as well be florists.

[High Speed Low Drag]

Is there a Legal Officer in the house??

[Spaceman3750]

I am allowed to use all of my fun protocols when I'm in my home county.

Not in a CAP uniform.

Thanks, I'll take a 2b from CAP, rather than lose my license and watch my patient die.

Kapen raises an interesting point. CAP regulations don't take account for the fact that a licensed medical professional (EMT, RN, MD, etc) is required by law (at least in IL) to take actions up to his level of licensure if required. Are we basically asking medical professionals to put their license on the line because CAP insurance doesn't cover medical care?

[Eclipse]

Kapen raises an interesting point. CAP regulations don't take account for the fact that a licensed medical professional (EMT, RN, MD, etc) is required by law (at least in IL) to take actions up to his level of licensure if required. Are we basically asking medical professionals to put their license on the line because CAP insurance doesn't cover medical care?

No - what we tell them is that if they encounter a "duty of care" situation, they have to perform that duty within the bounds of whatever
agency or license is forcing the issues.  (i.e. they take their figurative blouse off).

Its cilla and caribdus for our members, no question, but that doesn't change things.

[Krapenhoeffer]

And I think you will be hard pressed to find a GTL who would tell an EMT to knock it off, especially after I'm directed to drop an IV (no longer CAP responsibility anyway, responsibility for patient transfers to St. Mary's Hospital).

Really - well here's one.  For starters you wouldn't be bringing that stuff to insure you didn't get "tempted".

Second, the millisecond you are directed by someone to hang an IV, you are literally no longer on that mission, and are taking direction
from a different agency.  At that point I could not care less what you do, I notify the GBD that you're off the mission and go back to securing the scene.

I'm not going to risk my house and future so you can play Squad 51.  If its that important, leave the turn out gear on and stay with the FD.

Why would we recruit more EMT's? So we can have more of these conversations?  Until CAP changes their tune, we don't need them as medical responders - their general abilities, understanding of the nature of ES, and certainly their warm bodies, yes, but from a medical perspective they might as well be florists.

Then tell me, why does CAPabilities brag about how many EMTs and First Responders that CAP has?

Why do we have a badge awarded to those with such skills, if we don't use them?

You know, I'm glad that I live and work in a State and Wing that values are uses the training of the medically trained personnel who volunteer their time to fulfill the mission of Search and Rescue: So That Others May Live

Now, I came to ask about modifications and improvements for a proposal that has yet to be submitted. Not to get into useless flamewars.

[JayT]

@sarmed: I carry my jump pack in my POV, of course minus the O2, and the AED, because I can't afford those nice things. As for splints, in a wilderness setting, potential splints can be found anywhere one looks.

Maybe try recruiting more EMTs from the real world, than trying to raise them up in-house?

And as for not providing care: Yes, I know that technically one cannot have their license revoked, but in practice... There was an EMT I knew, not well, but knew, and he was at a school football game, and one of the players on the other team went down, unresponsive, the EMT said to the parents of this child "I would help, but he's on the other team, so I think it would be inappropriate." And stood there. And did nothing. Not even AABC. His boss found out, and magically he never seemed to be on the rig anymore. When the time came to re-certify, he wasn't considered "active" so he lost his license.

@Eclipse: I can't get sued as long as I stay within my scope of practice. Which means not obtaining IV access until I'm directed by online medical control to administer intravenous medication. And I think you will be hard pressed to find a GTL who would tell an EMT to knock it off, especially after I'm directed to drop an IV (no longer CAP responsibility anyway, responsibility for patient transfers to St. Mary's Hospital).

Who's responsbility is it then? Yours? Who's providing the medicine? (What medicine is used to magically make trauma patients better by the way? Unless you're packing O-Neg...)

How are you contacting medical control? Via a CAP radio? How are the medicines being stored? What if you're out of your county? In NY at least, ALS is a county level thing, not a state (ie, you can be state certified but if you're not registered with the county, you're BLS with an AEMT patch.)

There's nothing stopping you from providing good BLS care, and frankly, that's what a trauma patient needs. The "golden hour" stuff is a bunch of unscientific nonsense, it should be "as soon as possble." Work on developing a plan with your local medivac service.

The regulation says that you are able to provide care up to your level of certification, but recognize that CAP will not pay out malpractice insurance.

As I said before, there's forty different grades of prehospital provider in the US, and hundreds or thousands of different protocols. You cannot expect a national organization to operate as a medicine provider unless they have their own high level MAC.

Practically too, its almost a moot point, as I doubt you can find more then a handful of cases where a plane crash victim died because they didn't get the "life saving IV" or an amp of thamine.

It's not a flame war. Trust me, I'm a young (extremely young) ALS provider that wants to slam a trauma bore into everyone and hang a dopamine drip three or four times a tour, or conduct hypothermic therapy (I AM LITERALLY RUNNING ICE WATER INTO YOUR VEINS!)
But this is also my career. Its my job. And you don't want to risk it because you broke the rules and got your entire team sued.

[Eclipse]

Then tell me, why does CAPabilities brag about how many EMTs and First Responders that CAP has?

I have no idea.

Why do we have a badge awarded to those with such skills, if we don't use them?

No idea - we have "Medical Officers", too - that can't do anything, either.  They can wear the Caduceus, so what.  We also have people
wearing CIB's, Maintainer Badges, and everything else in between - doesn't change what we do, this is simply recognition of service outside CAP.

Now, I came to ask about modifications and improvements for a proposal that has yet to be submitted. Not to get into useless flamewars.

You and every other new EMT who joins CAP - use the search function and see just how old an issue this is.  If you think a message board that disagrees with your perception by stating facts is a "flame war", you may wish to  close your AOL account.

[Krapenhoeffer]

As I said before, there's forty different grades of prehospital provider in the US, and hundreds or thousands of different protocols. You cannot expect a national organization to operate as a medicine provider unless they have their own high level MAC.

That's why I'm only proposing this up to the Wing level. In WI, standards and levels of care are set by the state. Depending on where you are in the state determines which hospital you go to, and the receiving hospital provides online medical control, and each hospital does things a little bit differently, but not too differently, or the state will award contracts to different hospitals.

And even though we have EAA AirVenture in WI (Berets aren't allowed outside of Oshkosh usually, WIWG still has operational control over the entire mission), we end up with more missing person searches than plane searches. To be more precise, I've never been on an actual ELT hunt. Plenty of training missions, but that's just the idea of how rare they are.

But for missing person searches, the State Patrol is the lead agency, so it will either be via Mr. Cell Phone (like back in real EMS world), or State Patrol frequencies on a CAP radio.

Now, I don't know about other Wings/States, but in Wisconsin, we're getting more missions. The state and county EMAs love us, and the Governor just signed a bill into law that provides essentially the same job protection to CAP members as to Nat'l Guardsmen.

[RiverAux]

You may only be proposing it to Wing, but depending on exactly what you're asking for you are either going to need to get NHQ to approve a Wing supplement or to have them passively approve of one (some regs you need pre-approval to modify and some you don't, but NHQ can still make you change them if they don't like them).

[Eclipse]

That's why I'm only proposing this up to the Wing level. In WI, standards and levels of care are set by the state.

Which means you literally don't understand the issue.  The state of Wisconsin may set care levels for professionals they license,
but they literally have no say about what CAP will do.

This is an issue which sits squarely at the national level, and won't be changed until NHQ decides a change is warranted.

You will never get a local supplement to supersede the national policy on emergency medical care.  Period.

[Major Lord]

There are lots of reasons you might have a conflict with CAP in either a moral or legal sense. 900-3 for instance, prohibits CAP members from being deputized. Unfortunately, (or fortunately, depending upon your perspective I suppose)  this law has no actual  legal effect, and if you refuse to join the Posse Comitatus, being a CAP member is not going to be a valid legal defense. One school of thought is that if you are not prepared to watch someone die a slow agonizing death in order to fulfill your oath of membership, you should not in good conscience join CAP. The other school of thought is that you give the Corporate regulations due regard, and if you are called upon to arrest a bad guy or start an IV as a necessary measure in the preservation of life, you weigh the legal and membership consequences against your own conscience, and do the right thing. Once again, CAP has made its position abundantly clear over a very long period of time, so no one should be surprised, outraged, or even frustrated by the Reg's and policies of CAP, Inc.

Major Lord

[cap235629]

or sign you out of the mission on the spot if you start doing something beyond the scope of CAP's mandate and authorization.

Is this one of those Eclipse regulations that aren't really there?  Where does a GTL get the authority to sign anyone but him/her self in or out of a mission?

GTL's are the final authority in the field for a ground team - they aren't there just to "drive the cadets".  You obey them or you go home.

Show me where ANYONE but the member who signed themselves in to a mission has the AUTHORITY to sign them out of a mission.  You have a great theory but it is not backed up by regulation.  And I would refute the GTL being the final authority.  Ever here of a GBD? OSC? IC?.  GTL's are the FRONT LINE LOWEST LEVEL OF SUPERVISION, not the "final authority".

Please educate me on the regulation you base your assertions on....

[cap235629]

The state of Wisconsin may set care levels for professionals they license,
but they literally have no say about what CAP will do.

Tell that to California.  Also, whoever pays the bills calls the shots.  Are you sure you are in the same CAP I am?

[Eclipse]

or sign you out of the mission on the spot if you start doing something beyond the scope of CAP's mandate and authorization.

Is this one of those Eclipse regulations that aren't really there?  Where does a GTL get the authority to sign anyone but him/her self in or out of a mission?

GTL's are the final authority in the field for a ground team - they aren't there just to "drive the cadets".  You obey them or you go home.

Show me where ANYONE but the member who signed themselves in to a mission has the AUTHORITY to sign them out of a mission.  You have a great theory but it is not backed up by regulation.  And I would refute the GTL being the final authority.  Ever here of a GBD? OSC? IC?.  GTL's are the FRONT LINE LOWEST LEVEL OF SUPERVISION, not the "final authority".

Please educate me on the regulation you base your assertions on....

If the GTL of the team you are on decides you are done, you are done.  Period.  That's how it works.  For the purposes of the team and that sortie, he is your direct commander.

[PHall]

or sign you out of the mission on the spot if you start doing something beyond the scope of CAP's mandate and authorization.

Is this one of those Eclipse regulations that aren't really there?  Where does a GTL get the authority to sign anyone but him/her self in or out of a mission?

GTL's are the final authority in the field for a ground team - they aren't there just to "drive the cadets".  You obey them or you go home.

Show me where ANYONE but the member who signed themselves in to a mission has the AUTHORITY to sign them out of a mission.  You have a great theory but it is not backed up by regulation.  And I would refute the GTL being the final authority.  Ever here of a GBD? OSC? IC?.  GTL's are the FRONT LINE LOWEST LEVEL OF SUPERVISION, not the "final authority".

Please educate me on the regulation you base your assertions on....

The IC can do it.

[sarmed1]

....Also, whoever pays the bills calls the shots

I think thats more the bottom line.  Technically no one but CAP dictates what CAP members will or wont do.  Look at 60-3 (please correct me if I am wrong, but as I remember) on multi juristictional missions CAP assets remian under the control of CAP; a CAP incident commander will report thru the overall incident commander. (or some such verbage)
The only time those type of things change (ie caltrans uniform, or over 18 only etc etc) is when someone (the bill payer basically) says "...in order for you to play; you will do this....." CAP still says yes or no. I am sure if down the road if someone says your people will have XYZ medical capability or training CAP will way the benefit's of that mission package and mandate the requirement (even if its only locally) or say sorry we wont play.

as far as your emt at the football game expample....first thats a really bonehead sto atement to make...I'd try to screw....err have his cert reclaimed too; but if he was working as the janitor at the game he is no position to provide emergency care because the school says as a representtive of the district thats the school nurse, athletic trainer etc etc not the janitor's  otherwise he's there as a private citizen....the whole good samaritan thing (barring if your state, locality or agency says you are on duty all the time such as some law enforcement agencies....but in that case they agree to back you.) 

But just like last months discussion on firearms carry; I think you would be hard pressed to find a lengthy list of agencies out there that will say you WILL do this on or off duty or suffer disciplinary action.  (if the opposite is true then a better and more likely succesful route would be to force a reg change that stipulates that as an exception rather than a "new reg")

mk

[Eclipse]

Tell that to California.  Also, whoever pays the bills calls the shots.  Are you sure you are in the same CAP I am?

It doesn't sound like it.

The state of California does not decide the capabilities or risk tolerance of CAP.  They "contract" (for want of a better term), the services offered within CAP's scope, and either take them or not.  You don't expect PD to put out fires or FD to enforce traffic laws.

Last I checked CAP was a National organization which is federalized in certain circumstances, which means states (or wings) don't extend the capabilities of the organization locally just because they feel like it.

We do what we do and nothing more - I 100% guarantee you no authorized mission in CAWG has ever gone beyond the reasonable scope of standard CAP capabilities and mission.

[cap235629]

or sign you out of the mission on the spot if you start doing something beyond the scope of CAP's mandate and authorization.

Is this one of those Eclipse regulations that aren't really there?  Where does a GTL get the authority to sign anyone but him/her self in or out of a mission?

GTL's are the final authority in the field for a ground team - they aren't there just to "drive the cadets".  You obey them or you go home.

Show me where ANYONE but the member who signed themselves in to a mission has the AUTHORITY to sign them out of a mission.  You have a great theory but it is not backed up by regulation.  And I would refute the GTL being the final authority.  Ever here of a GBD? OSC? IC?.  GTL's are the FRONT LINE LOWEST LEVEL OF SUPERVISION, not the "final authority".

Please educate me on the regulation you base your assertions on....

If the GTL of the team you are on decides you are done, you are done.  Period.  That's how it works.  For the purposes of the team and that sortie, he is your direct commander.

Again show me the reg!  I agree that if you don't play nice you go home, I am taking issue with your oppressive view of authority you tend to espouse.  YOU CAN'T DO HALF OF WHAT YOU SAY!

The IC can do it.

Show me where in the regs it says you even have to sign in?

[cap235629]

Tell that to California.  Also, whoever pays the bills calls the shots.  Are you sure you are in the same CAP I am?

It doesn't sound like it.

The state of California does not decide the capabilities or risk tolerance of CAP.  They "contract" (for want of a better term), the services offered within CAP's scope, and either take them or not.  You don't expect PD to put out fires or FD to enforce traffic laws.

Last I checked CAP was a National organization which is federalized in certain circumstances, which means states (or wings) don't extend the capabilities of the organization locally just because they feel like it.

We do what we do and nothing more - I 100% guarantee you no authorized mission in CAWG has ever gone beyond the reasonable scope of standard CAP capabilities and mission.

Since you can't apparently avail yourself to read the regulations let me post them the relevant sections for you with emphasis added for clarity:

From the latest rewrite of CAPR 60-3:

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.

And specific to rendering aid:

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://www.ngfatos.net/ or ASTM F 2171-02, 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.



So I just don't see you getting away with all your Gung-Ho it's my way or the highway crap.  CAP does indeed fall under State and Local control as well as National regulations.

 
As far as giving care, treat at your own risk and CAP will take the credit and pay for your supplies.  WIN WIN!

[Eclipse]

^ Yes, of course, meaning CAP can't do something not allowed by the state, or the state may require extra licensing, etc., for CAP to operate.

It doesn't, however, dictate capabilities.  Period.

As to the other, no point in going there, if you're seriously asking us to quote chapter and verse on how CAP ES operates or who is in
command of what, there's no point to it on my side.

[cap235629]

Eclipse,

I have a profound respect for you as you make an excellent debate opponent.  Please understand that I am in no way trying to flame you, I enjoy the discourse.  We don't agree and that is OK.  The purpose of a debate is to get your opponent to rethink their position.  Not change it, just get them to think.

I know your interpretation of the regs wouldn't fly in Arkansas Wing so I am trying to point out some of the differences throughout all of CAP

I enjoy a good debate and unfortunately I am on medical leave and bored out of my mind so I find my self in many at the moment   Please just keep me engaged!
Hope you feel the same!

[Eclipse]

I know your interpretation of the regs wouldn't fly in Arkansas Wing so I am trying to point out some of the differences throughout all of CAP
just keep me engaged! Hope you feel the same!

Of course, I'm the same way in person, you can throw a coffee mug at me and I'll just throw it back...

OK, so on topic.

Are you saying you don't have to be signed into a mission in Arkansas (what about the 109?), or that neither the GTL or the IC can send you home?

[cap235629]

no I am saying that the 109 isn't mentioned in 60-3

[Short Field]

no I am saying that the 109 isn't mentioned in 60-3

Check here -

CAPR 60-3 para 1-17b(3). Ground Operations:  ...Ground resources will not self-dispatch; they must be properly released, even remotely via phone or other means if necessary, and noted appropriately on mission documents. Signatures are not required on the CAPF 109, Ground Team Clearance, but the CAPF 109 must note who briefed and released the crew accordingly.

As to who is in charge? 

CAPR 60-3 para 1-12. Organizing Resources.  ...The CAP IC exercises full authority over all CAP personnel for matters pertaining to the mission;...

While a GTL might not have the authority to sign a member off a mission, one radio call to the IC would take care of it.  Full authority is full authority.

Now for the requirement to sign-in. 

CAPR 60-3 para 1-13.  Common Responsibilities of all CAP Mission Personnel. There are certain common responsibilities or instructions associated with an incident assignment that everyone should follow. Following these simple guidelines will make your job easier and result in a more effective operation.  Checklists, forms and training materials are provided on the NHQ CAP/DOS website, and evaluation guides are provided in CAP-USAFI 10-2701.

CAP-USAFI 10-2701 Page 86, para 2. states: 

Were all personnel signed in and a method established to ensure that all personnel could be accounted for? Were the qualifications and credentials of all personnel checked and verified?

You can claim all you want that sign-in is not required but 60-3 specifically references 10-2701 as a guide.  The USAF also uses that guide to evaluate CAP and failure to sign-in members is a down-check.  That sort of makes it required as far as USAF is concerned.

[PHall]

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Waiting for the "AFI's do not govern CAP" arguement.

Because you just know somebody will try to use that arguement.

[Krapenhoeffer]

Yeah, unless the 900 series regs were changed really recently (i.e. within the last couple weeks), my understanding was that we didn't have injury coverage unless we were signed in. I know that WI requires members to be signed in, don't know if that is Nat'l policy.

Now, my understanding of 60-3, endorsed by everyone at home that I've asked is that CAP allows EMTs and whatnot to treat patients, as long as we stay within the law (duh), with the understanding that CAP will not provide liability coverage, but pay me back for my supplies that I expend. State Law says I can use my happy fun protocols when off duty (i.e. not near my ambulance), and to encourage bystander intervention, protects me by saying I can't be sued as long as I use good judgment, and stay within my protocols. Easy for me to do, as I have not the slightest idea how to do things outside of my scope of practice, and never would want to until I've been trained to do so. So I'm not going to break protocols.

Now, BLS protocols are almost universal throughout the state (with the slightly major controversy about Cardiocerebral resuscitation, but that's not going to be an issue for a CAP ground team). The problem is with Intermediate and Advanced Life Support protocols, which vary across counties.

Yes, I know that CAP isn't an EMS organization. I think the whole EFART thing in Voluntold was idiotic. But in WI, there are high schools, with EMTs on staff, that have their own protocols. One doesn't need to be an EMS organization to have EMS protocols. That's what I'm basing my idea off of. It wasn't too difficult to get an ER physician to review the protocols, and set things up with the local fire departments. Frankly, having our own protocols would allow someone above EMT-B access to their ILS and ALS protocols away from their home counties.

And yes, Basic First Aid is wonderful, and should be a requirement for all CAP members, but an 8 hour class cannot do the fundamentally necessary job of correcting human instincts for treatment. Human instinct tells me that when somebody pale in the face is crying out for water, I should give it to them. My brain tells me that the patient is in shock, and shouldn't be given anything to drink or eat. Back when I had only my basic first aid, I would have gone with my instinct.

The other important thing about having more advanced medical personnel in field, is that we speak the language, and we can do assessments. If I stumble upon a search target, who insists that they're fine, I'm still going to do an assessment, to include vitals. Yes, I carry around a BP cuff and a stethoscope, and if I see that this guy has a really low blood pressure, I'm not going to walk him out, I'm going to treat for shock and summon MedFlight.

If you stumble across a very lucky plane crash victim, the earlier splinting is performed, the less injury the patient is going to do to themselves.

[Short Field]

Waiting for the "AFI's do not govern CAP" arguement.
Because you just know somebody will try to use that arguement.

I guess that argument would work right up until you fail your USAF evaluation.

[RADIOMAN015]

Yes, I know that CAP isn't an EMS organization. I think the whole EFART thing in Voluntold was idiotic. But in WI, there are high schools, with EMTs on staff, that have their own protocols.

And yes, Basic First Aid is wonderful, and should be a requirement for all CAP members, but an 8 hour class cannot do the fundamentally necessary job of correcting human instincts for treatment.

The other important thing about having more advanced medical personnel in field, is that we speak the language, and we can do assessments. If I stumble upon a search target, who insists that they're fine, I'm still going to do an assessment, to include vitals. Yes, I carry around a BP cuff and a stethoscope, and if I see that this guy has a really low blood pressure, I'm not going to walk him out, I'm going to treat for shock and summon MedFlight.

If you stumble across a very lucky plane crash victim, the earlier splinting is performed, the less injury the patient is going to do to themselves.

The AF evaluation checklist item is "basic first aid" and call in EMS via 911 or via mission base (and we don't want to get into whether mission base really has a good phone number to contact EMS in the area the team is in and AF inspectors have not done a good job on following up/verifying on this ).   

Perhaps the best way to approach this is to look for qualified EMS folks that can work with you in a joint agency operation, rather than CAP doing it alone.   I think the old way  "we can do it all" is slowly transitioning to a joint operations.  This even includes things like snow mobile clubs, off road vehicle clubs,  friendly folks that have ATV's, etc.

Also with CAP IF you aren't using any skill very much (e.g. including radio ops, which is relatively easy; versus first first aid which is more difficult) you tend to loose proficiency. 

I'm sure your are frustrated by the regulation, but the bottom line is it is there to protect the average CAP'er GT members that has very little or no medical/first aid training, but are very skilled in wearing their BDU's & shining their black boots for show and tell back at mission base

RM

[RiverAux]

Now, my understanding of 60-3, endorsed by everyone at home that I've asked is that CAP allows EMTs and whatnot to treat patients, as long as we stay within the law (duh), with the understanding that CAP will not provide liability coverage, but pay me back for my supplies that I expend.

Good luck with getting paid back.

[EMT-83]

Now, my understanding of 60-3, endorsed by everyone at home that I've asked is that CAP allows EMTs and whatnot to treat patients, as long as we stay within the law (duh), with the understanding that CAP will not provide liability coverage, but pay me back for my supplies that I expend. State Law says I can use my happy fun protocols when off duty (i.e. not near my ambulance), and to encourage bystander intervention, protects me by saying I can't be sued as long as I use good judgment, and stay within my protocols. Easy for me to do, as I have not the slightest idea how to do things outside of my scope of practice, and never would want to until I've been trained to do so. So I'm not going to break protocols.

I don't know the exact wording of the Wisconsin statute, but as a general rule, you can be sued by anyone, at any time, for anything. Putting any faith in a Good Samaritan or similar law is risky business.

[arajca]

In general, all the Good Sam statutes do is give you some cover from incidental damages PROVIDED you were not negligent in your care, i.e. you gave someone CPR and broke their ribs.

They also do not provide cover from other actions. There are cases where EMTs rendered aid outside their system, were commended for it, then had their certifications pulled becuase they were practicing outside their system. the Good Sam laws didn't apply because the EMT violated the statutes regarding praticing in a system. They did not have a legal duty to act, so they are no longer EMTs.

[Krapenhoeffer]

And they can get sued for breaking out ALS protocols outside of their home counties.

However, WI has the broadest scopes of practice for all levels. And I get my idea from an EMT-IVT I know, who is a volunteer EMT in Iowa Co., but works at a school in Dane Co. After some legal wizardry and help from the Madison Fire Dept., he was able to get protocols for the school that allowed him to use his ALS protocols that IVTs are allowed in Dane Co. I think that everyone can agree that a school is not an EMS agency, but clearly they can have their own protocols.

And we had it hammered into our brains from Day 1 that an EMT can only be sued if they are on the state's dime. When I'm off duty (CAP missions are considered off duty, I checked), I can't be sued for providing care. And so, the Paramedics made it very forcefully clear that they want us to have our jump packs with us at all times. So I just modified mine to accept ALICE clips, and it goes with me on missions. I don't carry an AED or O2, because those things are either a) expensive or b) heavy or some combination of the two. They live on the ambulance. When I'm on a CAP mission, or if I'm driving or anything, my first priority is to get the patient to an ambulance. Now, if the ambulance gets there, and they're undermanned, I'll go on, and then I'm on the state's dime.

[Eclipse]

And we had it hammered into our brains from Day 1 that an EMT can only be sued if they are on the state's dime. When I'm off duty (CAP missions are considered off duty, I checked), I can't be sued for providing care.

Do you seriously believe that?

[a2capt]

Probably, if what you do falls within the vail of the good samaritan laws.

[darn]ed if you do, [darn]ed if you don't some ambulance chaser will figure out you knew how to do more and didn't, in their opinion... and sue you for that too. The whole thing just sucks.

[PA Guy]

The Good Sam laws do not prevent you from getting sued. They provide you with a defense of your actions. You will still be out the time and money going to court to prove that your actions fell within the scope of the Good Sam law. 

[sarmed1]

I wouldnt count on good sam laws to protect your butt.  I personally think it would be difficult to prove in a civil court that CAP time is covered under the good samaritan laws.  The belief or reasonable expectation; I have a badge that identifies me as _________ (EMT, Paramedic, Nurse, Doctor)  & CAP has provided me with an "official" duty status as the same.  Medical care is expected (and identified as a skill..ie First Aid) for members engaged in search and rescue.  (Just because CAP says that WE dont provide "paramedic care" doesnt mean that's the industry satandard, which I imagine is what the "public expectation" is based off of.... ie FEMA resource typing document, NFPA 1670, NASAR etc) That sounds dangerously close to a duty to act, so if something goes wrong in your emergency stabilization and care up to your level of training ( ie the expectations of someone of the same level of certification) and injury results I am guessing there is a good potential for a negligence suit. (especialy if someone finds one of those sue happy TV injury lawyers)

mk

[Eclipse]

^ Yep...

...and...

The final verdict from a civil perspective would be determined by a jury, one likely not to draw the line as close as someone doing mental
yoga to internally justify an action which is clearly against the published regs in both spirit and function.

The mere fact that you are disavowed by the very agency you are working "for" will probably get you half way to cooked.

[SARDOC]

And we had it hammered into our brains from Day 1 that an EMT can only be sued if they are on the state's dime. When I'm off duty (CAP missions are considered off duty, I checked), I can't be sued for providing care.

Do you seriously believe that?

I know in Virginia Malpractice three things must be proved for Malpractice.

1) The Provider Must have the "Duty to Respond" (on duty for Volunteers and Being paid a wage for Career members)
2) The Action Taken by the Provider Was GROSSLY Negligent. (Another Similarly trained Provider finds completely unreasonable)
3) The Action Taken by the Provider actually was the Direct Cause for Substantial Harm to the Patient.

If I am Off Duty I am covered by the Good Samaritan Act which has an exemption specifically for Off Duty EMS providers to provide care.  If I'm off duty I can't be sued for malpractice...it's in the code.  That being said I can still be sanctioned by my agency or the Board of EMS rules and regulatory committee.

[PA Guy]

Good Sam laws vary from state to state as well as EMS rules and regulations.

[ol'fido]

Way back in the late '80's, it was required for a GTL to be Advanced First Aid qualified. This meant generally through ARC. At the time, I was going to school at SIUC and the health ed department was offering Basic FA and Advanced FA courses for credit. The course not only qualified you but also gave you instructor certification which was handy in training the other members of the GT. However, as I understand it the Adv. FA course went away and was not really replaced with anything else. Also, CAP regs have never really caught up with this change either.

At SARCOMP '88 in Alpena, MI, I got the high score on the FA written test even though other teams had EMTs and Paramedics on them. This is because the USAF Flight Surgeon that put together and graded the test had done it from a Basic FA perspective. The EMTs and paramedics went through their protocols instead of giving the ABC type answers that the test called for.

Our GT philosophy was the FA training was mainly for internal team use. A team member gets hurt or has a sudden illness/environmental injury, we could take care of it. We felt that more than likely our team would be used to lead or guide in regular EMS units, not provide it ourselves. Also, there was the consideration of exposing team members to BBPs.  While I do not think that we would ever do anything that was not covered by the Good Sam law, I wouldn't want to try it either.

This is one of the many elephants in the living room that NHQ refuses to deal with.

[Ned]

This is one of the many elephants in the living room that NHQ refuses to deal with.

I'm sorry, but are you referring to here?

Our regulations are pretty unambiguous when it comes to medical care provided by CAP members to other members or the public.  We don't do it in anything other than a genuine bona-fide emergency.

And then we do it withing the limits of our skills, abilities, and resources.

I'm not sure what the 52 different Good Samaritan Laws that CAP operates under has to do with the subject at hand.

[ol'fido]

Referring to the FA requirement for GT. The ARC dropped the Advanced FA course long ago but CAP apparently didn't realize this for some time. I don't expect perfection from NHQ but at least can we agree that there are many areas where the regs and manuals have not kept up with developments? This is especially confusing since we went to the online regs and manuals which was supposed to better facilitate this. This may not be your experience in working with HQ but from my perspective out in the field it is. Perception is reality.

[Eclipse]

What is confusing here?  CAP only requires basic First Aid.  Defined by our wing as the "Community Level".

[ol'fido]

Read what I said. What is confusing is that regs have not kept up with other developments even though the online paperless regs were supposed to be more easily edited and changed. We go on about it constantly with 39-1.

[commando1]

Disagree with me if you wish, but the way I view a bona fide emergency that requires medical attention is that unless they are going to die right in front of me I don't need to mess with it. Granted, I am not an EMT but I am working on my First Responder cert. If they are in the plane, don't touch them. If they are alive, talk to them. If the plane is on fire, then and only then, remove them. I am one of those guys who is completely obsessed with SAR. But if CAP prohibits me from doing something there is probably a reason. Not that I agree with all the reg's, but I try to respect them. If CAP reg's prohibit me from giving someone basic care and they will likely die as a result then I will tear off my CAP nametape and continue. I don't suggest that a 15 year old with basic first aid attempt to splint someones leg. But if they go into cardiac arrest right there I do suggest he begin CPR.

[IceNine]

Layman and professionals alike are trained to do everything we (CAP) should be doing.


 
CALL 911




Then while you're waiting....  ABC's

Body Substance Isolation- If it's not yours and it's wet, don't touch it (without gloves)
Scene Safety- Am I safe here now? Soon?  Is my crew safe here now?  Soon?  Is the victim safe here now? Soon?
# of pt's/victims - How many ambulances do we need?

Airway - If they cannot talk to you head tilt/chin lift OR modified jaw thrust.  EMS 101 while you're there ask politely that they not move their head, put your hands on either side of their head to remind them.

Breathing - Are they breathing? Check respirations for no more than 15 seconds, if nothing perform CPR

Circulation - Do they have a pulse?  If not perform CPR.  Are they bleeding LOTS?  If so, put pressure on it with a clean dressing, t-shirt, towel, etc.

If they were ok when you got there, start over and check ABC, ABC, .......  Until help get's there.


We will all choose to do those things differently depending on training.  We shouldn't be using anything we can't get at walmart to heal people.  The singular exception I can think of is if a BVM is available I will use that every time for CPR.  But you also don't have to be licensed to take CPR/PR.

[Eclipse]

CALL 911

http://www.youtube.com/watch?v=YkyhvCdJ_vM