Medical Staff @ Wing Encampments

[PhoenixDCC]

I am in the planning process for the 2010 MAWG Summer Encampment. Last November, during our follow up/debriefing meeting for the 2009 Encampment, I was informed that Nat'l HQ will no longer allow "Encampment Medical Staffing" at Encampments. We are a few months away from our Encampment and I have not heard any evidence of this. So my question is; Are (Qualified) Encampment Medical Staff allowed at Encampments?

Thanks

[capmaj]

Lengthy, but it may help.

The September 2009 National Board Minutes approved the policy below effective 1 January 2010.

September 2009 National Board Minutes (DRAFT)
AGENDA ITEM 6 ED Action
SUBJECT: National Policy on Medications at CAP Activities

PROPOSED NATIONAL BOARD ACTION:
That the National Board approve the implementation of the proposed policy below and that the National Board direct the National Headquarters to publish a new directive mandating this policy or include this policy as a part of an existing directive. Policy effective date as of 1 January 2010.
1. The possession, distribution and/or administration of illegal medications, or of legal medications obtained illegally, are prohibited at any CAP activity.
2. The administration of both legal prescription and legal non-prescription medication(s) is the responsibility of the CAP member and not the CAP Corporation.
3. The authority for members who have reached the age of majority to bring legal medications to CAP activities is vested with that member.
4. The authority for members who have not reached the age of majority to bring legal medications to CAP activities is vested with that member's parent or legal guardian.
a. Parents/legal guardians must inform CAP activity leaders, in writing, of the need for their minor members to take medication(s) during the application process for the activity.
b. CAP activity directors/managers must receive, in writing, a written statement from the minor CAP member's parent/guardian granting permission for the minor CAP member to take the medication(s) previously indicated as well as details of the timing and quantity of medication to be taken by the minor member. This written statement must be received no later than the arrival time of the minor CAP member at the activity.
c. Medication(s) brought to CAP activities by/for minor CAP members must be in the original manufacturer's container (over-the-counter products) or the original pharmacy container with the original label (prescription products).
d. A CAP senior member, after obtaining all the necessary information and written permission from the minor member's parent/ guardian, may agree to accept the responsibility of making sure a minor member is reminded to take any medication at the times and in the frequencies prescribed. However, no senior member will be required or encouraged to do so.
5. Except in extraordinary circumstances, CAP members, regardless of age, will be responsible for transporting, storing and taking their own medications. Members who require refrigeration for medications should carefully coordinate with activity officials well in advance of their attendance at the activity to ensure that refrigeration will be available.
6. If non-prescription medications are administered or furnished by an activity's staff, the senior member administering or furnishing such medications shall record the member's name and the date, time, and amount of such medications administered or furnished to the member in the activity medical log and the record shall be available to the parents/guardians of minor CAP members at the conclusion of the activity.
7. Wings may issue supplements to this policy only if state or local statutes mandate varying from this policy.

[Nathan]

From what it looks like, if anyone is interpreting this as a removal of the medical officer from encampment, I think that's a bit of an overreaction. There is nothing here that seems to prevent a CAP member from helping bandage, assessing heat stress, and providing basic first aid.

[Eclipse]

Medical care in excess of basic First Aid continues to require outside professionals (i.e. 911, 3333, or whatever your facility uses for those services). 

Triage, sick call, etc., continues to be a questionable practice at best.  Any cadet walking around with a stethoscope needs to be told to knock it off.

As a parent and concerned leader (from both a health and corporate CYA standoint) having medical professionals either on staff or in proximity, provides personal peace of mind, but is a challenge from the perspective of their being health professionals.  Why?  Because Nurses, Dr's, and EMT's, etc., want to treat people, which they really shouldn't be doing in a CAP context, and they are also sensitive to pushing people into the EMS response system unnecessarily.  The latter means doing some level of triage, which may ultimately delay 911 for treatment they can't provide anyway.

Encampments are not BMT - if you're sick or injured beyond light first aid, you should go home.  Period.  This idea that cadets can come with the flu and spend a few days in sick call, or twist an ankle and pull "light duty" is misguided and counterproductive.

Encampments and similar activities are inherently stressful environments - strangers telling you to set your bed, no television or internet, less sleep than you're used to, and this food...it is strange...fruit...vegetables...where's the processed sugar, corn syrup, and artificial colors?  And all this water!!! I'm supposed to be in the head all day long?

I have a tummy ache, I better see the HSE.  ((*sigh*))

Interestingly, when the specter of "home" rises, tummies feel better.  American parents take note - we have seen the enemy and he is US.  Turn off the TV, restrict the X-station, and delete the FaceSpace accounts!

CAP Health Safety / Service Officers are like nukes - you don't want to be without them if you need them, but if you ever really need them, things probably got so out of hand from an ORM standpoint that you have a lot of other issues as well.

What did change, though no particular regulatory guidance was provided, is the HSE/HSO's securing medications from cadets - some of
our leadership believed that this may be borderline "prescribing" and/or violate local laws regarding who may be in possession of another person's prescription medications.

Our solution for that this year was to have the cadets continue to report their medication and medical needs on their applications, but hold their own meds.  The HSE then has a schedule of who takes what, and those cadets must report to the HSE that they have taken their meds and initial a form to that effect.

Here's a shock - we had one or two who decided that this was the weekend to show mom they could "...do without them..."  to the detriment of their health and their encampment experience.

[Eclipse]

We also had several cadets with serious current or past serious health conditions which we were completely unaware of until they caused issues.

Unit CC's - if you know of a cadet who has "challenges", physical or psychological, its your duty to inform the respective activity commander, even if this information may preclude a cadet's participation.  Rubber-stamping Form 31's continues to be a problem.

When you sign the 31, you are attesting that you have checked over the information, its accurate to your knowledge, including omissions, and the cadet is prepared and capable of participating in the given activity.

[Ned]

In one of those "only on CT coincidences" the draft CAPR 160-2 that will implement the policy adopted by the NB has reached final draft stage, and will likely be approved and fielded shortly.

No big surprises await those who compare the policy and the final regulation.

And Bob, while I wholehearted agree with the majority of you post, I submit that we are in the business of accomodating disabilities at encampment and I would hesitate to send home a cadet with a twisted/broken ankle who could otherwise participate.  After all, we accomodate cadets with permanent mobility issues including wheelchairs, so unless the cadet has missed more than 20% of the training, I would be inclined to let them remain.

But it is always a local commander's call, or course.

Ned Lee
National Cadet Advisor

[Cecil DP]

Unit CC's - if you know of a cadet who has "challenges", physical or psychological, its your duty to inform the respective activity commander, even if this information may preclude a cadet's participation.  Rubber-stamping Form 31's continues to be a problem.

When you sign the 31, you are attesting that you have checked over the information, its accurate to your knowledge, including omissions, and the cadet is prepared and capable of participating in the given activity.

The parents are also signing medical forms attesting to their child's fitness and well being. Not being a physician or medical professional, we have to rely on Mommy and Daddy to make that final determination as to fitness.

[Eclipse]

I agree, and if you don't know, you don't know, but in many cases these conditions are made known to local staff who may not want to
say anything to avoid their cadet being turned down for a given activity.

My favorites, however, are when people feel that a block of text with BOLD, RED LETTERS saying "REQUIRED", become "not" if you usimply cross them out.

[mynetdude]

IIRC the CP uses a system to categorize what kinds of physical activities a cadet can be involved in and I believe there are 3-4 different categories.  Anyway, I know that HMRS and a few other significantly a ton more intense than encampment and some NCSAs require a better category to be eligible.

If I were running an encampment I'd want to know what cadets will have significant challenges as to accommodate them as such as we are required to for equal opportunity and non discrimination reasons. Without this information, I can't possibly know to accommodate this cadet.

I don't see any reason to prohibit/prevent a cadet from attending an encampment unless that cadet (or senior member) has significant challenges that could be disruptive to encampment or have an illness that can widely affect the activity attendees.

Other activities such as HMRS can limit cadets because of its more physically intense requirements could pose a safety risk to those who can't perform at the same levels.  I still see it a CC/DCC's responsibility to make sure that what they know about the cadet's challenges are known to the activity staff/directors not so that the cadet can be barred from attending regardless of whether or not a parent omits any information.

[Nathan]

In one of those "only on CT coincidences" the draft CAPR 160-2 that will implement the policy adopted by the NB has reached final draft stage, and will likely be approved and fielded shortly.

No big surprises await those who compare the policy and the final regulation.

And Bob, while I wholehearted agree with the majority of you post, I submit that we are in the business of accomodating disabilities at encampment and I would hesitate to send home a cadet with a twisted/broken ankle who could otherwise participate.  After all, we accomodate cadets with permanent mobility issues including wheelchairs, so unless the cadet has missed more than 20% of the training, I would be inclined to let them remain.

But it is always a local commander's call, or course.

Ned Lee
National Cadet Advisor

Agree completely. While I understand that there IS a difference between a sprained ankle and a Class III or IV restriction on a cadet, I don't necessarily see the reason we should automatically assume we need to treat them differently.

Where I would agree with you is when the "encampment medic" is used as an easy out for activities, or when a cadet is clearly not interested in being at encampment and either fakes or exaggerates a condition to spend as much time away from the activities as possible. In that case, if there is no way to get the cadet to WANT to participate again, then the option would be to send the cadet home.

However, a cadet who simply has a small injury or sickness can be "treated" and sent back out. For instance, I was at NESA in 2006 (WIWAC), and I was on a medication that caused me to dehydrate a lot faster than I thought. So, the obvious combination of being in the woods, being in the heat, and doing some light-to-moderate exertion caused me some issues that left me in the medic's area for a few hours. To me, I felt terrible and questioned going home, but after I was in the AC and putting myself into a fully hydrated state, I felt good enough to go back out. The only adjustment I made was to make sure to get a LOT more water, fill up on Gatorade whenever possible, and have some check-ins with the staff to make sure I was still functioning. I finished it out and graduated just fine.

In this case, it would have been easy to send me home, especially since in my dehydrated state, I was mentally willing to go. However, once the medical officers did their thing, I realized that I actually did want to stay, and I did. No problems.

It's the cadets like me that would make me worry about the mindset that we don't have any business dealing with "more severe" condition. Granted, my condition, while possibly having the chance of getting worse, wasn't really beyond the scope of normal first aid, but I think that I felt bad enough to compare with what many of the stressed out cadets may be feeling when they come to the medic complaining of feeling bad. Sometimes it's just the medic's job to supervise a thirty minute nap on the medical cot, and see if the cadet is ready to go again upon waking.

I still agree, though, that the medical officer should be responsible for ensuring that each cadet is taking the medication they need. I don't know if this is what Eclipse was implying, but if there are no legal issues with it, I would go one step further and have the medical officer actually watch the cadets put the pill in their mouth and swallow. It's not fool-proof, but that way, at least the senior member can say that they watched the cadet apparently take the medication they were supposed to in the dosage they were supposed to, and have a record initialed by both the cadet and the medical officer each time it happened. Not as much liability, and just as much accountability as the medical officer has ever had. Sounds like a win-win.

[Eclipse]

The regs say its not our problem, "duty of care", "loco-parentis", and general adult common sense say disagree.

Another Kobayashi Maru as payback for spending a whole week with no sleep trying to guide America's youth.

I don't understand why NHQ continues to allow these legitimately serious issues to sit in limbo with fingers crossed and eyes looking the
other way. 

If people wear an incorrect uniform, they look goofy.  If we screw up something health-wise they can die, and the responsible adults be
ruined financially and emotionally.  At any point in the regs where you put "may" instead of "shall", you leave things open to local decisions and potentially unprotected by NHQ.

[heliodoc]

Eclipse

You know why NHQ continues to leave issues in limbo...

No one down at Maxwell wants to step up to the plate UNLESS there is a platoon sized element of laaaaawwyers behind every decision

They can barely take seriously their outdated 39-1 let alone any other real serious issues unless its something about VAnguard donating to Hawk Mountain toys and rappel towers that no one else in CAP can have or attempt to have UNLESS it is them in PA representing the WHOLE  of CAP

Things are not taken too seriously down there and if it is....they (the "leadership") is frozen in making any sort of  decision in the med world

That is why their are pros in the medical field....good thing CAP is NOT in that decision making field.  They would know whether to dial 911 or treat a real issue at Maxwell

Regs and manuals that are outdated but lots of technology to brag  about in CAP.....just not REAL leadership or the ability to decide too may major things in 69 yrs.  The last 25....CAP has had a true leadership problem trying to decide if they are a corporation or some auxillary of the AF..trying to play that card

IF CAP had the AF running the program again...I am thinkin things would be a little different

Unprotected by NHQ???   Never knew we were "protected" by NHQ!

[CommGeek]

The letter only talks about medications....not medical care.     CAP cant tell an EMT/Paramedic what to to and how to do it.

[Ned]

I don't understand why NHQ continues to allow these legitimately serious issues to sit in limbo with fingers crossed and eyes looking the
other way. 

Then let me help you understand.

I've completed over 30 encampments as a cadet, senior tactical officer, commandant of cadets, and even commanded my fair share.  I've visited many different wing's encampments and probably over 25 NCSA iterations.  I've served as a wing and region DCP, and now as the principal CP officer on the national staff.

Please believe me when I say I fully understand the cadet medication problem from a practical, parental, command, and legal perspectives.

NHQ has been aggressively working this issue for several years.  I know because I'm the main instigator of change in this area, and have been working with the National Health Services officer, corporate counsel, the National Legal Officer and a boatload of others to develop useful guidance for folks in the field.

Like so many things, it turned out to be a lot harder than we thought to come up with useful guidelines, primarily because we are a national organization and state laws vary widely in this area (not to mention the overseas units and Puerto Rico Wing.)  Some states have no laws, some states have laws that make it a felony for persons to possess somebody else's prescription drugs, some states require camp nurses to safeguard and dispense medications at summer camps, etc.

I have spent a countless hours on conference calls, drafted and redrafted proposed regulations, called experts in other organizations and in state and local governments.  I have briefed the NB, NEC, and Gen Courter on this issue.

All while keeping all of the other CAP balls in the air.  Dr. McLaughlin has been working on this even harder than I have.

Ultimately we may be right or wrong on this issue.  I doubt there will ever be a full consensus on the best path among the folks like yourself who work hard in the field.

But we have given it our best shot and forwarded the draft to the NEC for approval.

We may be wrong, but we have not been "sitting in limbo with fingers crossed and eyes looking the other way. "

Hope this helps you to understand.

[davidsinn]

I don't understand why NHQ continues to allow these legitimately serious issues to sit in limbo with fingers crossed and eyes looking the
other way. 

Then let me help you understand.

I've completed over 30 encampments as a cadet, senior tactical officer, commandant of cadets, and even commanded my fair share.  I've visited many different wing's encampments and probably over 25 NCSA iterations.  I've served as a wing and region DCP, and now as the principal CP officer on the national staff.

Please believe me when I say I fully understand the cadet medication problem from a practical, parental, command, and legal perspectives.

NHQ has been aggressively working this issue for several years.  I know because I'm the main instigator of change in this area, and have been working with the National Health Services officer, corporate counsel, the National Legal Officer and a boatload of others to develop useful guidance for folks in the field.

Like so many things, it turned out to be a lot harder than we thought to come up with useful guidelines, primarily because we are a national organization and state laws vary widely in this area (not to mention the overseas units and Puerto Rico Wing.)  Some states have no laws, some states have laws that make it a felony for persons to possess somebody else's prescription drugs, some states require camp nurses to safeguard and dispense medications at summer camps, etc.

I have spent a countless hours on conference calls, drafted and redrafted proposed regulations, called experts in other organizations and in state and local governments.  I have briefed the NB, NEC, and Gen Courter on this issue.

All while keeping all of the other CAP balls in the air.  Dr. McLaughlin has been working on this even harder than I have.

Ultimately we may be right or wrong on this issue.  I doubt there will ever be a full consensus on the best path among the folks like yourself who work hard in the field.

But we have given it our best shot and forwarded the draft to the NEC for approval.

We may be wrong, but we have not been "sitting in limbo with fingers crossed and eyes looking the other way. "

Hope this helps you to understand.

Isn't this the kind of thing we have wing level JAs for? They should be able to provide you with the answers you seek. At least that's how it looks to a non-legal type like me.

[SarDragon]

Are you addressing Ned or Eclipse?

Just in case you didn't know, Ned's day job is Superior Court Judge up in NorCal. I think he's got a good handle on the situation. 

[davidsinn]

Are you addressing Ned or Eclipse?

Just in case you didn't know, Ned's day job is Superior Court Judge up in NorCal. I think he's got a good handle on the situation. 

I was addressing Col. Lee. I know he's in the legal profession but every state and territory is different as he pointed out. I was under the impression that the wing JAs job was to inform command of the differences in state laws. In other words he shouldn't have needed to spend a lot of time researching it as there should be someone in each wing that already knows the answer.

[Ned]

Isn't this the kind of thing we have wing level JAs for? They should be able to provide you with the answers you seek. At least that's how it looks to a non-legal type like me.

That's certainly one of the reasons.  Now imagine what happens when you send 52 separate emails to wing JAs to ask them to look into a fairly obscure area of law in their respective states.

The answer is that some respond promptly and comprehensively.  Some do not.  Now imagine how long it might take to corral those cats and formulate a response that will work in the 52 wings. 

Ultimately we designed the regulation with a "default" self-medication policy, with provisions that require wings in states that legally require a different policy to draft a wing supplement and make it available to members.

That should work.

[davidsinn]

Now imagine what happens when you send 52 separate emails to wing JAs to ask them to look into a fairly obscure area of law in their respective states.

Unfortunately I don't have to imagine. It's amazing what it takes to get a unit commander to respond to a request for names for cadet o-rides. One never did. His cadets lost out because of it. I feel your pain sir.

[Slim]

The letter only talks about medications....not medical care.     CAP cant tell an EMT/Paramedic what to to and how to do it.

Actually, they can.

6. Medical care policy.
a. Medical care within CAP is limited to emergency care, only (i.e., first aid and stabilization) within the training and qualifications of the person rendering such care, until such time that private professional or authorized military care can be obtained.

CAP is not a medical care provider, and any CAP member going outside of the codicils of this regulation are doing so at their own peril.  There are two disconnects between this regulation and reality.

First and foremost, "Duty to Act" laws vary by state.  In my state, as a private service employee, I only have a legal duty to act when I'm in uniform AND on duty (moral duty is something else).  Your, or another, state's law may be different.

The other disconnect lies in what constitutes "Emergency care".  Lets look at a common encampment injury, the turned ankle.  While splinting a possible sprained/fractured ankle may constitute emergency care and stabilization to me (as an EMT), or any reasonable person, it could be considered routine by a doctor.  While I'm doing it prior to either turning the patient over to EMS or transporting to the hospital by private vehicle, a nurse or doc on med staff may look at it, manipulate it, or otherwise assess whether an x-ray is needed.  Personally, I don't carry an x-ray machine in my pocket, so I'm going to treat it within my qualifications, while considering the restriction in the regs:  I'm going to wrap and splint it, apply ice and elevate, then put them in a CAP van and run them downtown to ER for an x-ray and treatment by a doc.  If it's something more serious than that, I'm going to do what my training and the regs allow, while waiting for local EMS (in my case, the base fire dept and an ambulance from the city fire dept) to arrive and take over care.

Ned and I have debated this topic more than once, and the consensus is that we agree to disagree on what truly constitutes "Emergency care and stabilization."  While I respect Ned's position on this (as an NHQ staffer, former Legal Officer, and fellow CP professional), I hope he respects mine as a medical professional.  I really don't wish to debate it again. 

What scares me are encampments that run a full-up clinic operation, with doctors and/or nurses, and 3-4 cadets, who may or may not have any real training or experience, running around with $500 trauma bags full of junk they'll never use and stethoscopes hanging around their necks.  Places that hold "Sick call" every morning, and have 10-15 cadets beached on beds "resting" until they feel good enough to go back and rejoin their flight.