This is for all you Ground Team Gurus.
Back in the day when I was interetsted in ES and ground team operations we organized our Ground Team in the following way. I was wondering how you guys organize your teams today.
We had the follwing personnel:
1 Ground Team Leader (a Senior Member)
1 Asst. Ground Team Leader (a Senior Member)
1 ELT operator
1 Radio operator
2 Medics
2 Engineers ( to move away debries and mrk off the crash site with the "Do not cross" Tape)
2 note takers ( Take pictures of scene, interview witnesses, and aw a sketch of the crashsite)
This was before the days of SARTECH and GTM1, 2 and 3. I dont know how its done today
1 Leader, 3 members - all trained the same (at least GT3).
We don't have medics anymore, and we don't have "asst GTL's".
Most ILWG teams are either all seniors or mostly seniors.
The paractical realities of waking up kids at 2am. or their ability to self-transport at that timeis self-limiting.
Considering we probably only have 100 people in the state that are actually current in Ground ops, putting 10 people per team is not going to happen.
See thats unusual for me in Atlanta. I hardly ever see Senior member ground team members.I am sure they are out there, but Idont see them very much. Its mostly cadets.
If most wings are like that then that may explain why you gys are so ES gung ho
Well, I don't know about gung-ho, but we do have the busiest airport in the world (I refuse to recognize ATL :D), and a LOT of larger GA airports.
I don't know how many the state gets total, but we probably get 2-5 ELTs a month in Group 22 alone.
We have a fair number of cadets involved in ES, but the vast majority are Seniors.
It might have something to do with the fact that we have a number of NESA staffers, too.
Most seniors I know joined for ES...
Quote from: flyguy06 on January 20, 2007, 09:38:18 PM
See thats unusual from wher eI am from. I hardly ever see Senior member ground team members. Its mostly cadets. We dont get a lot of misions at 2 am that require a GT either though.
If most wings are like that then that may explain why you gys are so ES gung ho
How can you have a ground team when you can't drive CAP vehicles?
I suspect that he meant that most of the GTMS are cadets with only a few seniors there to drive the van.
Quote from: Eclipse on January 20, 2007, 09:26:20 PM
1 Leader, 3 members - all trained the same (at least GT3).
We don't have medics anymore, and we don't have "asst GTL's".
Most ILWG teams are either all seniors or mostly seniors.
The paractical realities of waking up kids at 2am. or their ability to self-transport at that timeis self-limiting.
Considering we probably only have 100 people in the state that are actually current in Ground ops, putting 10 people per team is not going to happen.
Not to mention that it would take 2 vehicles to transport them and their equipment.
Ground Team composition is usually dictated by who is actually willing to answer their phone at 10PM....
Seriously though we don't get very specialized since you never know who will be on any particular ground team. Need to think of it like a Special Forces team in that everybody should be able to do almost everything in a pinch.
I was actually thinking about this problem the other day also. Obviously you can't always count on every person being there, but you can have a plan in place for which jobs you are going to fill. if you have 15 GT people on your active list and you have 6 jobs that need to be filled on every mission, i think you could find 6 out of 15 to go. And having people specialize on certain things could only help make us look better.
i was also working on having a set ground team for my squadron. Not just a pool of qualified people but a group of people that are dedicated to the idea of an actual set team. I was thinking of giving every one a job so that we could accomplish more. Have people be in charge of PAO, Logistics, Comm and so on. these jobs would be to maintain the team continually.
So i would love to hear from people about what jobs they feel are necessary for while being on a mission, and if you have any ideas off of the mission.
How many jobs do you need on the team?
Let's see. While on the road....a driver, and an observer. The observer helps navigate, monitor the ELT and operate the radio.
On the ground. Elt Operator and and a navigator.
You physicaly need 4 people on your team (5 by NIMS standards to include a medic) put how many actions do you need to do at the same time? Heck the GTL is can do everthing if he had enough hands. The other guys just have to look for the crash site.
Quote from: lordmonar on January 21, 2007, 02:30:43 AM
Quote from: flyguy06 on January 20, 2007, 09:38:18 PM
See thats unusual from wher eI am from. I hardly ever see Senior member ground team members. Its mostly cadets. We dont get a lot of misions at 2 am that require a GT either though.
If most wings are like that then that may explain why you gys are so ES gung ho
How can you have a ground team when you can't drive CAP vehicles?
The GTL or Asst. GTL (senior members) drive
Quote from: flyguy06 on January 21, 2007, 08:51:06 PM
Quote from: lordmonar on January 21, 2007, 02:30:43 AM
Quote from: flyguy06 on January 20, 2007, 09:38:18 PM
See thats unusual from wher eI am from. I hardly ever see Senior member ground team members. Its mostly cadets. We dont get a lot of misions at 2 am that require a GT either though.
If most wings are like that then that may explain why you gys are so ES gung ho
How can you have a ground team when you can't drive CAP vehicles?
The GTL or Asst. GTL (senior members) drive
I've seen this a couple times here, what, exactly is an "asst GTL".
If they aren't rated for ES, they don't go. If they are, they are just a GTM on the team.
It never hurts to designate somebody ahead of time to take over if something happens to the GTL.
Quote from: RiverAux on January 21, 2007, 09:24:01 PM
It never hurts to designate somebody ahead of time to take over if something happens to the GTL.
If something happens to the GTL, you come home. We're not the Green Berets.
Yes, but who is taking charge of the team in the meantime? Who is deciding where to take the GTL? Who makes the decision to go home? Highest rated ES person there? Highest rank? Highest current position of authority in the squadron?
That is why you decide ahead of time and make sure everybody knows.
Quote from: Eclipse on January 21, 2007, 08:59:45 PM
Quote from: flyguy06 on January 21, 2007, 08:51:06 PM
Quote from: lordmonar on January 21, 2007, 02:30:43 AM
Quote from: flyguy06 on January 20, 2007, 09:38:18 PM
See thats unusual from wher eI am from. I hardly ever see Senior member ground team members. Its mostly cadets. We dont get a lot of misions at 2 am that require a GT either though.
If most wings are like that then that may explain why you gys are so ES gung ho
How can you have a ground team when you can't drive CAP vehicles?
The GTL or Asst. GTL (senior members) drive
I've seen this a couple times here, what, exactly is an "asst GTL".
If they aren't rated for ES, they don't go. If they are, they are just a GTM on the team.
When i say Asst. GTL. I am referencing the make up of "my" previous GT organization structure. Asst. GTL is a postion not a qualification. You can have a 30 person Ground Team, but you can only have one leader. So, in my Ground Team, the GTL and Asst GTL are BOTH qualified GTL's but postion wise, one is the leader and one is the assistant. When the leader has to go away for some reason, the Asst GTL steps up. He is already a qualified GTL
The way my old squadron trained was have a 6-10 person team assigned as the primary ground team since invariably one or more people wouldn't be able to make it at 2 AM when the recall went out. The way we tried to operate was (from inside a CAP van from front to back, left to right with minimum quals in "[]"):
Front Row:
-Driver [GTM3] (no, not the GTL. NHQ took the CAP driver's license out of the GTL SQTR for a reason)
-GTL [GTL/GTM1]
2nd Row:
-Fixed DF'er [GTM3](for when the L'Per is tied into the van antenna)
-Radio Operator [GTM3/MRO]
-JAT [GTM1 or GTL trainee)("Jack of All Trades" used as needed as a comms record keeper, navigator, relief radio operator, relief DF'er - mobile or fixed, etc. but will not be the medic or IO)
3rd Row:
- (3) Mobile DF'ers [GTM3](for when the L'Per is used outside of the van - can switch with Fixed DF'er if necessary)
4th Row:
-Medic [GTM3/EMT, Nurse, Doctor, etc.](I know what CAP regs state, but if I find a survivor, I want someone who knows what the hell they're doing by virtue of their profession to assess and stabilize that person until EMS can take over)
-PAO [GTM3/IO](Keep your friends close and your enemies the media closer. It always helps to have someone trained to deal with the media on scene.)
The rest of the van space would hold gear.
Now before the flaming begins, I am well aware that a ground team operates only at the level of the least qualified member. Those requirements listed above (hopefully) serve as some sort of measure of experience. It wasn't necessary to fill all of those positions every time, but if you were on the team you knew exactly what your job was when it was assigned to you during the mission briefing. It always worked well for us since you have to assume that every overdue or ELT mission involves a crashed aircraft with survivors. Besides, the more involvement we had, the better morale and retention were.
Quote from: flyguy06 on January 20, 2007, 09:10:01 PM
This was before the days of SARTECH and GTM1, 2 and 3. I dont know how its done today
FYI, the current basic GT standard is a minimum of 3 ground team members (level 3) and a ground team leader.
Quote from: RiverAux on January 21, 2007, 09:44:26 PM
Yes, but who is taking charge of the team in the meantime? Who is deciding where to take the GTL? Who makes the decision to go home? Highest rated ES person there? Highest rank? Highest current position of authority in the squadron?
That is why you decide ahead of time and make sure everybody knows.
A 4-5 man team does not rate a convoluted chain of command!
We don't worry about assistant element leaders or anything like that. Although if you had large 20 man elements it would not be a bad idea.
If three guys in the field need to have a job title to make sure they can figure out what to do when their leader goes down.....then maybe these are not the guys you want in the field in the first place!
Quote from: dcpacemaker on January 21, 2007, 11:01:35 PM
Quote from: flyguy06 on January 20, 2007, 09:10:01 PM
This was before the days of SARTECH and GTM1, 2 and 3. I dont know how its done today
FYI, the current basic GT standard is a minimum of 3 ground team members (level 3) and a ground team leader.
Thanks, Like I said I am not into ES anymore. Ouguys are way more into than I ever was. I was just curious how you organize. Maybe I will get back into it.
Ok, I suppose I ought to put my 2 cents (and my ID tag ) into the mix.
NASAR, boy scouts, NIMS etc require a medic or EMT to accompany the team. It used to be a CAP requirment as well (maybe it was unofficial; but everybody did it...I dont know) I just think that in any non urban area - ae when you arent around O'Hare, but are in say...the backwoods of Idaho or Colorado, that if you dont have a medical asset on board you are just asking for trouble.
If it were me Id push for the reintroduction of a GTE- ground team ems position into our team makeup. ... no reason it cant replace one of the 3 GT member positions.
Well you have asked the $100K question.
CAP does not do medics because our insurance does not cover it.
It is simple as that.
NIMS requires a medic on the team to be typed.
There is no requirment for that medic to be a CAP medic......so there is our first out. We just have to find a supplier of medics who will be willing to work with us. On their insurance (We do this all the time....look at the repelling rules for cadets. You can repell under the BSA rules but not CAP....so if you get hurt....make sure you bill the BSA and not CAP).
Or...we can find an insurance carrier (ours currently sucks big time!) Or...we can require our medical personnel to purchase their own liabilty insurance as part of the credintaling process.
The bottom line....while the medical requirment (and the team member medical skills requirment) will cause us to examine our process and policies...they are not insurmountable.
I agree with you though....we should be taking an EMT with us out into the field for our own safety and the possibility of helping the victims.
If we were a first-responder agency, I would agree.
But we are not.
Is the poitn of ther thread this: FEMA-NIMS-NIC: WSAR (LINK - last three pages): (http://www.fema.gov/pdf/emergency/nims/508-8_search_and_rescue_resources.pdf)
excerpt medical capabilites...
Type I: Nat Standard EMT curriculun, ACLS, BTLS
Type II: Nat Standard EMT-B, or wilderness responder, BTLS
Type III & IV: None, supported (augmented with a member of) local EMS.
Virtually all GT missions we do are Type III/IV. The mississippi stuff in Katrina was in that range. Most REDCAPs in the woods are in that category. We do on occation cross into Type II, and very rarely but do sometimes cross into Type I. Now that's my judgement of what gets done on the substantial number of missions I've been on, not FEMA's who will be making the call on the situation & type level they require for it.
I believe we can easily adjust our task guide & add some training to meet type III/IV standards (LINK - pg 86). (http://www.fema.gov/pdf/emergency/nims/sar_jobtitle_111806.pdf) That should be just about priority number one in CAP right now. I think we can also support a fair number of Type II teams, at least one per Group/Wg. I think we MIGHT also be able to support a few type I teams, probably a couple per region. And yes, the medical specialist seems to be the greatest limiting factor in this. All I can say is that as we move up under NIMS over the next 2-3 years, it's a good idea to recruit a bunch of EMTs. It would be appropriate also for us to get some sort of EMT scholarship program going as well with a service obligation on it. That'll attract some young driven people to help us out.
How does everyone feel about that?
Also, the federal govt designates us a first responder, hence the issues, but states generally do not, which covers you under their good summaritan laws. This is one of those gray areas that is almost always going to come down on your side. The restriction though is temporary!!! In the long run it will probably remain in effect for corporate missions, but Congress is making the adjustment (not for us) to cover volunteer medical personnel serving federal agencies w/ medical liability that works the same as the other coverage we already have. That's taking some time to get the details worked out, but it's coming. We're waiting on the same legislation to put HSOs in augmentation roles w/ the AF just like we do with Chaplains now. There's one or two people on here that were involved in writing that spec track & understand the inner working of the situation better than I do. I can check into the progress on this though. Give me a couple weeks to get some other things off my plate & I'll see what I can do.
DNall.. Id appriciate if you could give me any/all info on any possible way I could vollunteer for this HSO specialty track... And/or serve as an EMS asset on base. ;D .. I already do that with the CG-aux.
The HSO track is pretty well done from what I understand, I don't have access to it. I'm not involved in that process, but I've heard from some who were, either directly or on the perifery. From what I understand, the hold up is witing for legislative change that FEMA is asking for, which will open up a few things. The options I've seen disucssed ranged from augmenting on base to DMAT style units for disaster response & everything in between. From what I understand they don't want to put out an interm spec track to get all our medical people working on & then change course mid-stream as soon as the stuff works its way thru. If it turns out to be delayed even further then it may come down to that, but I don't know. Like I said, I'll try to check into the progress on the legislation here ina couple weeks or so. I think it's kind of back burner & needs the details hammered out on standards & who's covered vs not & for what. It'll get done though, it just takes time.
Quote from: DNall on January 22, 2007, 10:55:15 AM
The HSO track is pretty well done from what I understand, I don't have access to it. I'm not involved in that process, but I've heard from some who were, either directly or on the perifery. From what I understand, the hold up is witing for legislative change that FEMA is asking for, which will open up a few things. The options I've seen disucssed ranged from augmenting on base to DMAT style units for disaster response & everything in between. From what I understand they don't want to put out an interm spec track to get all our medical people working on & then change course mid-stream as soon as the stuff works its way thru. If it turns out to be delayed even further then it may come down to that, but I don't know. Like I said, I'll try to check into the progress on the legislation here ina couple weeks or so. I think it's kind of back burner & needs the details hammered out on standards & who's covered vs not & for what. It'll get done though, it just takes time.
My God! Someone with a plan and a vision is actually working at CAP! That's unheard of! :)
I'm glad that they are working on this issue...it has been a long time in coming.
Where are we designated at the Federal level as First Responders?
Can you quote a reg or document?
Cannot quote a reg sir, but I believe the term is used to describe our ability to be called out after ELTs at 3am NOT as a medical reference.
And the group designating us as such at the federal level is probably AFRCC or CAP-USAF
National response plan, CAP is designated as a primary response asset. No other unpaid group is. That's always been the case. In varrious court cases we've been found to be an emergency response agency. You're certainly not a private citizen nor acting in that capacity when on a mission. The legal issue of medical liability is one that's never been a problem, & still shoud not be, just some silly lawyers making trouble where there's been none ever before.
Well hang the lawyers and give me a certification in Ground Team EMS! ;D
Quote from: SAR-EMT1 on January 22, 2007, 05:51:11 PM
Well hang the lawyers and give me a certification in Ground Team EMS! ;D
Better not call 'em
medics (even if quite a few here and there are) or some folks will have a conniption fit ;D
No, just call it what it is GTE - ground team EMS- 3 or 4 levels FR through paramedic.
I believe the official designation in this case is WSAR-M. Pretty sure the term ground team is going to disappear.
Couldnt call it WSAR-Medic because we arent all medics.
For the sake of the thread if I'll just call it GTE -ground team ems-
My question is this: If / when the HSO program gets off the ground does anyone else see value in adding an EMS qualification to the 101?
And if so, would the idea of 4 levels work out?
4: FR 3:EMT-B 2:EMT-I 1: EMT-P
Quote from: SAR-EMT1 on January 24, 2007, 11:11:25 AM
Couldnt call it WSAR-Medic because we arent all medics.
For the sake of the thread if I'll just call it GTE -ground team ems-
My question is this: If / when the HSO program gets off the ground does anyone else see value in adding an EMS qualification to the 101?
And if so, would the idea of 4 levels work out?
4: FR 3:EMT-B 2:EMT-I 1: EMT-P
I think it makes sense.
I think four levels could work; it seems to work just fine for Canada.
I believe it's WSAR-M for medical specialist, which covers the slot if it's a wilderness first aid course at the lower level or EMT-I/P at the top.
Quote from: SAR-EMT1 on January 24, 2007, 11:11:25 AM
Couldnt call it WSAR-Medic because we arent all medics.
For the sake of the thread if I'll just call it GTE -ground team ems-
My question is this: If / when the HSO program gets off the ground does anyone else see value in adding an EMS qualification to the 101?
And if so, would the idea of 4 levels work out?
4: FR 3:EMT-B 2:EMT-I 1: EMT-P
Forgive my bluntness here, but what exactly can they contribute without violating CAP regs? Making an ES certification is rather pointless in my book since there's no training CAP can give you that you can actually use on victims at missions. You can give first aid and stabilize (with training given by the Red Cross or the American Heart Association).
The training doesn't come from CAP, and CAP doesn't have (and shouldn't have) a program in place to test your proficiency since your certifying agency should be on top of that to cover their FPOC. If we're not doing the training, and we're not verifying proficiency, why do we need an ES qual for it? Wear the EMT, Nurse, or Doctor badge and be done with it. And I'm aware that radiological monitoring isn't normally training CAP provides, except there are no limitations on their skill usage in the field, and they don't get a cool badge (the patch is fugly) for their uniform.
^ Temp policy till the legal issues get sorted out, which is a bigger than just CAP. These are FEMA requirements, not ours. If they say an EMT has to be on the team or you can't work the mission, then you need to find one even if they aren't allowed to practice their trade - which by the way I think watching the guy die & quoting CAP regs is probably going to get your license jerked & charges filed.
Far as 101 though, since FEMA is moving to doing the credentialing, I think there might be a point soon thereafter where the 101 is redundant. At some point on past that I'd think they'd drop all that info onto your handy dandy scanable combination picture ID & membership card. Hey what do I know though.
Quote from: DNall on January 24, 2007, 08:02:37 PM
Far as 101 though, since FEMA is moving to doing the credentialing, I think there might be a point soon thereafter where the 101 is redundant. At some point on past that I'd think they'd drop all that info onto your handy dandy scanable combination picture ID & membership card. Hey what do I know though.
Don't be silly. You know we'll have to keep the 101, as well as any FEMA credentials, plus some other card that no one has developed yet. ::) All just to describe the same thing.
I know you're joking, but in the begining you're probably not wrong at all. Eventually though it'll be obselete at least mostly. I'm sure there still some info we need on the CAP end, currency dates for pilots & such, but that'd all fit nicly on the inside of a single photo ID/mbrshp card - show up to base, scan, thanks you're signed in & we have a log of all you quals w/ currency dates & emergency contact info. NIMS card to make the govt happy, alright go in there & standby for a gear check & brief.
I glanced - briefly- at the regs for the Wilderness SAR training quals. But does anyone know how the required gear compares to our 12/24/72 hr gear? Or if there IS required gear? ....
Quote from: DNall on January 24, 2007, 08:02:37 PM
^ Temp policy till the legal issues get sorted out, which is a bigger than just CAP. These are FEMA requirements, not ours. If they say an EMT has to be on the team or you can't work the mission, then you need to find one even if they aren't allowed to practice their trade
I get that, and I agree with having a licensed "medic" (EMT, nurse, doctor) on the team. What I'm saying is why do we need to put their professional qualifications into a completely new rating just for the 101 card when all they have to do is wear their EMT/nurse/doctor badge (or not) and be there? FEMA's happy that they're there and no need to add more stuff to the 101 card.
Quote
which by the way I think watching the guy die & quoting CAP regs is probably going to get your license jerked & charges filed.
More than that, it's downright immoral.
Quote from: dcpacemaker on January 24, 2007, 10:41:27 PM
Quote from: DNall on January 24, 2007, 08:02:37 PM
^ Temp policy till the legal issues get sorted out, which is a bigger than just CAP. These are FEMA requirements, not ours. If they say an EMT has to be on the team or you can't work the mission, then you need to find one even if they aren't allowed to practice their trade
I get that, and I agree with having a licensed "medic" (EMT, nurse, doctor) on the team. What I'm saying is why do we need to put their professional qualifications into a completely new rating just for the 101 card when all they have to do is wear their EMT/nurse/doctor badge (or not) and be there? FEMA's happy that they're there and no need to add more stuff to the 101 card.
The badge don't mean nothin, not to them or anyone else. The only good it'd do on a 101 would be that your actual license has been checked, as well as actual quals on everythign else, andyou can consolidate all that to this one card rather than carrying a box with you. 101 doesn't mean anything to FEMA either though, so it really doesn't matter except to make it easier for us internally to account for it (you know those badges aren't mandatory). Especially if we eventually go to one ID card that you scan & has all that info on it at one shot. That's where we're eventually going to be, it's jsut going to be a good while.
QuoteQuotewhich by the way I think watching the guy die & quoting CAP regs is probably going to get your license jerked & charges filed.
More than that, it's downright immoral.
Sure, but "immoral" never stopped CAP frm 2b'ing someone. The fact that the reg contradicts the laws of every state is something of a motivator to find a middle ground, at least till Congress extends federal coverage. I understand the issue is just that our insurance won't cover you, but you are required by law to do what you can.
Quote from: DNall on January 25, 2007, 02:32:30 PM
Quote from: dcpacemaker on January 24, 2007, 10:41:27 PM
Quote from: DNall on January 24, 2007, 08:02:37 PM
^ Temp policy till the legal issues get sorted out, which is a bigger than just CAP. These are FEMA requirements, not ours. If they say an EMT has to be on the team or you can't work the mission, then you need to find one even if they aren't allowed to practice their trade
I get that, and I agree with having a licensed "medic" (EMT, nurse, doctor) on the team. What I'm saying is why do we need to put their professional qualifications into a completely new rating just for the 101 card when all they have to do is wear their EMT/nurse/doctor badge (or not) and be there? FEMA's happy that they're there and no need to add more stuff to the 101 card.
The badge don't mean nothin, not to them or anyone else.
That's why I put "(or not)" after "wear their...badge". The fact that they're on the team should satisfy FEMA.
QuoteThe only good it'd do on a 101 would be that your actual license has been checked, as well as actual quals on everythign else, andyou can consolidate all that to this one card rather than carrying a box with you.
As a licensed medical specialist you'll have to carry your license anyway to legally practice, so I'm not seeing the argument for that one.
Quote101 doesn't mean anything to FEMA either though, so it really doesn't matter except to make it easier for us internally to account for it (you know those badges aren't mandatory). Especially if we eventually go to one ID card that you scan & has all that info on it at one shot.
Being a GBD and an aspiring IC, I can appreciate that. I would say leave it up to the GTLs and Sq/CCs to know if they have an EMT, nurse, or doctor (which usually they will tell you whether you ask or not), but for accountability the 101 idea is not bad. Maybe instead of having GTM-E or something associated specifically with GT, why not have an independent specialty qual like CISM, ARCHER, GRM, ARM, etc. Call it MED for medical or medical specialist. Heck, you can even make it multi-level (MED3 for EMT, MED2 for nurse, and MED1 for doctor). Let's not split hairs over different levels of EMT or anything else because I know of 3 levels of EMT and 4 (possibly 5) levels of nurse (LPN, RN ASN, RN BSN, RN MSN, and I think they're in the process of making an RN PhD).
QuoteQuoteQuotewhich by the way I think watching the guy die & quoting CAP regs is probably going to get your license jerked & charges filed.
More than that, it's downright immoral.
Sure, but "immoral" never stopped CAP frm 2b'ing someone. The fact that the reg contradicts the laws of every state is something of a motivator to find a middle ground, at least till Congress extends federal coverage. I understand the issue is just that our insurance won't cover you, but you are required by law to do what you can.
Booting someone for trying to save a life would be detrimental to CAP's PR. If I got a 2b after trying to save a person in distress (whether successful or not), I would be writing letters to every media outlet and legislator I could get contact info for. Hell, maybe that kind of national negative coverage is what it'll take for Congress to afford CAP protection under the law.
I don't know for sure, but I'm pretty sure nurses & doctors don't automatically qualify on this. I think you have to be certified for ER - forget what it's called. My little brother's an RN ADN in ER with that certification. A dermitologist is going to be pretty useless to me in a field rescue situation though. Well maybe not useless exactly, but not what they're looking for. They do make a distinction in the requirments between levels of EMT, so we would need to know that on our card, even if it's jsut the two levels they care about.
Quote from: dcpacemaker on January 25, 2007, 02:56:22 PM
Booting someone for trying to save a life would be detrimental to CAP's PR. If I got a 2b after trying to save a person in distress (whether successful or not), I would be writing letters to every media outlet and legislator I could get contact info for. Hell, maybe that kind of national negative coverage is what it'll take for Congress to afford CAP protection under the law.
Sure it's messed up, and I doubt they'd do it if you saved someone's life, but might if you did something in-between, citing insurance & regs all the way. It's not like you didn't know the rules & you broke them anyway. You granted you don't by law have a choice, but the court will say you did have a choice to be on that team where you knew it might come up. Granted it's bad PR, but seems like everyone that gets 2b'd writes letters & ends up in NOTF crying about some BS, true or not. Some of it is really serious stuff, and no one cares. That's the kind of thing that AF doesn't have the power to fix so ti keeps going & going, which is what prompted the changes in 2000. More of it won't be a good thing. FEMA is working on it for disaster volunteers & they know we need coverage for missions. It's in the works, it's just time consuming.
Quote from: DNall on January 25, 2007, 04:39:31 PM
I don't know for sure, but I'm pretty sure nurses & doctors don't automatically qualify on this. I think you have to be certified for ER - forget what it's called. My little brother's an RN ADN in ER with that certification. A dermitologist is going to be pretty useless to me in a field rescue situation though. Well maybe not useless exactly, but not what they're looking for. They do make a distinction in the requirments between levels of EMT, so we would need to know that on our card, even if it's jsut the two levels they care about.
I'm pretty sure there's no special ER certification for nurses (mom's an RN), and I've never heard of one for doctors. Sure there are experience levels that certain agencies look for or require, but any nurse can work in ER. Maybe you're thinking of ACLS??? Or maybe I'm wrong, and it's just that none of the hospitals in Louisiana use the certification you're thinking of.
I see your point on doctors. I made a flawed assumption in thinking that a doctor on a GT would be capable of emergency medical treatment, which as you pointed out is not the case. As for EMT, I have little knowledge of their different capability levels and FEMA's requirements so I'll defer to you on that one. My original line of thought was whatever we put on the card (assuming eventually we do), not to tie it in with GT. Make it just a broad specialty rating like we do for other specialty skills since those skills aren't specifically tied to GT. Plus, if we need to separate it into different levels we can (i.e. MED-E2, MED-E1, MED-N, MED-D).
QuoteSure it's messed up, and I doubt they'd do it if you saved someone's life, but might if you did something in-between, citing insurance & regs all the way. It's not like you didn't know the rules & you broke them anyway. You granted you don't by law have a choice, but the court will say you did have a choice to be on that team where you knew it might come up. Granted it's bad PR, but seems like everyone that gets 2b'd writes letters & ends up in NOTF crying about some BS, true or not.
I didn't mean NOTF. That's the quickest way to get your name discredited in CAP circles. I was thinking more along the lines of FOX News, CNN, or even a talk show (Jerry, Jerry, Jerry!!!). In reality, though, it's a personal decision to either try to save a life if you see it's going to require more than first aid to save the victim or try to sleep at night knowing you let someone die over some words on a piece of paper. Personally, first aid and CPR are all I have so there's not much I can do to a critically injured person, but my mom's an RN with ER and ICU experience and training...and she's a GTM1, and I know several other GTMs and GTLs who might be put in this situation.
The one distress mission I've been on, EMS was 1/2 mile away from the area the aircraft was believed to be located in. Had we needed them, they could have been on scene within a few minutes max.
Regarding FEMA credentials replacing the 101 card, please see question 8 of these FAQs.
http://www.fema.gov/pdf/emergency/nims/credent_faq.pdf (http://www.fema.gov/pdf/emergency/nims/credent_faq.pdf)
Here are the medical requirements for ground SAR teams.
FEMA Radio Direction Finding Team (1 per team)
Type I - EMT
Types II and III - none
FEMA Wilderness SAR Team (1 per field team, Type I and II teams must have multiple field teams)
Type I - EMT, ACLS, BTLS
Type II - EMT-B or Wilderness First Responder (WFR)
Types III and IV - none, supported by local EMS
FEMA Mountain SAR Team (1 per team)
Type I - EMT, ACLS, BTLS
Type II - EMT-B or advanced WFR, BTLS
Types III and IV, First Responder or WFR, BTLS
Colorado Wilderness Search Crews (1 per crew)
Type I - EMT-B, First Responder, or "Outdoor" equivalent (WFR is not the only choice)
Types II and III - first aid and CPR
The Mountain Rescue Association (MRA), NASAR and ASTM SAR standards (all referenced in the FEMA/NIMS SAR credentials "job titles" document) address only personnel requirements and not field teams.
MRA Policy 106 is a list of medical capabilities a team should be able to provide a patient. Specific team and personnel requirements are left to the agency having jurisdiction and the team's medical adviser to determine.
NASAR SARTECH III has no medical requirements. SARTECH II has a list of required first aid topics, but there is no specific medical (first aid) requirement. SARTECH I requires Advanced First Aid or higher.
ASTM standard F-2209 "Training of a Level I Ground Search Team Member" has a list of required topics, but leaves the specific medical requirements to the agency having jurisdiction.
Mike
Regarding my last post, the NIMS SAR credentialing document actually references MRA Policy 105.1. This requires that MRA personnel wanting to comply with NIMS credentialing must have at least basic first aid or equivalent. Policy 106 still applies but is not referenced.
Quote from: SAR-EMT1 on January 24, 2007, 10:15:12 PM
I glanced - briefly- at the regs for the Wilderness SAR training quals. But does anyone know how the required gear compares to our 12/24/72 hr gear? Or if there IS required gear? ....
FEMA RDF, Wilderness and Mountain teams require "Appropriate level of PPE for working environment."
FEMA RDF team typing has no other requirements for personal equipment.
FEMA Wilderness SAR teams are required to be self-sustaining for a given number of hours (depending on type) in local wilderness environments. There are no other specific personal equipment requirements.
FEMA Mountain SAR team typing lists specific personal equipment requirements, but nothing out of the ordinary. These teams are also expected to be self-sustaining for some length of time in certain environments, again depending on team type.
Colorado Wilderness SAR crew typing requires "appropriate clothing, equipment and PPE for the given environment." There are also requirements for length of time to be self-sustaining and able to conduct field operations, depending on team type. There are no specific personal equipment requirements. [Note: there are other state SAR typing documents, but currently the NIMS credentialing document only references the Colorado document. No offense directed to other states which have similar typing documents.]
NASAR SARTECH II has a list of required equipment. SARTECH I is the same list but with increased quantities of some items, since a SARTECH I is also qualified as a crew leader.
ASTM standard F-2209 requires clothing, equipment and PPE suitable for the environment and task, leaving the specifics to the agency having jurisdiction.
F-2209 includes as an appendix (non-mandatory material) a list of suggested items for a 24 hour pack, base camp kit and personal first aid kit. The lists were compiled from the equipment lists of 20 SAR teams taken from across the US, including NASAR. Copyright restrictions prohibit posting ASTM (and NFPA and OSHA) standards.
However, as I was the original compiler of the lists, I have made the lists available for download. In addition, I've posted the FEMA/NIMS SAR resource typing and credentialing documents, MRA Policy 105.1, SARTECH documents, the Colorado WSAR Crew typing document, and a compilation of the equipment and medical requirements from these documents.
They are available at:
http://www.m2ei.com/nims_wsar/ (http://www.m2ei.com/nims_wsar/)
Mike
Quote from: DNall on January 25, 2007, 04:39:31 PM
I don't know for sure, but I'm pretty sure nurses & doctors don't automatically qualify on this. I think you have to be certified for ER - forget what it's called. My little brother's an RN ADN in ER with that certification. A dermitologist is going to be pretty useless to me in a field rescue situation though. Well maybe not useless exactly, but not what they're looking for. They do make a distinction in the requirments between levels of EMT, so we would need to know that on our card, even if it's jsut the two levels they care about.
Quote from: dcpacemaker on January 25, 2007, 02:56:22 PM
Booting someone for trying to save a life would be detrimental to CAP's PR. If I got a 2b after trying to save a person in distress (whether successful or not), I would be writing letters to every media outlet and legislator I could get contact info for. Hell, maybe that kind of national negative coverage is what it'll take for Congress to afford CAP protection under the law.
Sure it's messed up, and I doubt they'd do it if you saved someone's life, but might if you did something in-between, citing insurance & regs all the way. It's not like you didn't know the rules & you broke them anyway. You granted you don't by law have a choice, but the court will say you did have a choice to be on that team where you knew it might come up. Granted it's bad PR, but seems like everyone that gets 2b'd writes letters & ends up in NOTF crying about some BS, true or not. Some of it is really serious stuff, and no one cares. That's the kind of thing that AF doesn't have the power to fix so ti keeps going & going, which is what prompted the changes in 2000. More of it won't be a good thing. FEMA is working on it for disaster volunteers & they know we need coverage for missions. It's in the works, it's just time consuming.
WARNING: More about nurses than you really wanted to know:
ER nursing does not require specialty certifications but many Er's pay a differential for it (wish mine did). The nurse hierarchy is sort of NCO like.
1) Certified Nurse Assistant (about a 3 month course) very basic.
2) LPN/LVN (may be an associates degree). Pass meds, basic care, limited IV scope with additional training.
3) Registered Nurse; Assessments, Invasive procedures with orders, Medications, IV use. May be an ADN, BSN, MSN, PhD. The additional degrees do not add to scope of practice unless it's a specialized program.
3a) Speciality certifications such as CEN (certification Emergency Nursing) CCRN (ICU certification) CNOR (OR certification) - not a boost in scope but an acknowledgement of skills, knowledge base and time in practice. These are voluntary national and Non governmental certifications. Personal pride as well as marketability drive these. The tests are hard. Think of them as the National Staff College of nursing.
3a.1 Most critical care specialties require additional training such as Advanced Cardiac Life Support, Pediatric Advanced Life Support, Trauma Nurse Core Curriculum Provider that don't show up as initials behind your name.
3b) enhanced scope such as nurses trained to work in EMS (PHRN, MICN, EMS RN) at the paramedic level (only a few states have certifications and licenses for this), oncology nurses, PICC nurses. These are regulated at the state level
4) Advanced practice Nurses. Most are Msn's. This includes Nurse Midwives, Nurse Practitioners (best analogy is they are similar to PA's)
Pulling a nurse out of QI or Neonatal ICU and thinking they could reasonably meet a Ground Teams need for first aid could get you burned. We still need to train them ES wise and focus the skills and knowledge already there.
We also need to know who's out there so we can utilize the resource most effectively.
Capt Thomas J Cooper
RN, CEN, EMS RN
Las Vegas NV
Very informative. Thank you.
So if we tacked some sort of medical specialty rating on the 101 card, would it be easiest/best to limit the rating to those who can provide proof of competency/certification in emergency life-saving procedures (ACLS, etc.) instead of all licensed nurses and doctors?
Quote from: DNall on January 25, 2007, 04:39:31 PM
I don't know for sure, but I'm pretty sure nurses & doctors don't automatically qualify on this. I think you have to be certified for ER - forget what it's called. My little brother's an RN ADN in ER with that certification.
I'm pretty sure there's no special ER certification for nurses (mom's an RN), and I've never heard of one for doctors, but any nurse can work in ER. Maybe you're thinking of ACLS???
OK, couple of things: its trauma- or shock trauma
ACLS and ETLS advanced cardio life support, Emergency trauma Life support. CEN (certification Emergency Nursing) CCRN (ICU certification) CNOR (OR certification), PALS And yeah docs have equivalents. Finally as far as any nurse working ER... I one saw a CNA and an RN both put a nursing home resident on a NRB at about 4 liters a minute. Then when the guy was out cold, hypoxic, and seizing they called us (EMS) While they waited for us they kept the O2 at same low level. .....
I HATE NURESES ... except for Flight Nurses ;D
Sorry... didn't mean to rant off topic. Apologies.
Continue previous thread>
tags fixed -DCP
Quote from: dcpacemaker on January 26, 2007, 12:46:00 AM
Very informative. Thank you.
So if we tacked some sort of medical specialty rating on the 101 card, would it be easiest/best to limit the rating to those who can provide proof of competency/certification in emergency life-saving procedures (ACLS, etc.) instead of all licensed nurses and doctors?
Competency in BCLS, current license and previous/current field experience. I too, like the other poster have gone into nursing homes and have had patients on the wrong O2 settings or even cardiac arrests where no one is doing CPR or can give a patient report.
The field medic courses that some wings do could fill the cross training role nicely.
Also had them doing CPR on a guy who is trying to push them off ;D
We get there, pull her off and then the nurse starts attacking us .....
Id also at the least require that any EMS position in the field be required to carry a level 3 BLS kit at the least. (in terms of gear)
Tell me more about this Wing field medic program.
Quote from: SAR-EMT1 on January 26, 2007, 03:52:48 AM
Also had them doing CPR on a guy who is trying to push them off ;D
We get there, pull her off and then the nurse starts attacking us .....
Id also at the least require that any EMS position in the field be required to carry a level 3 BLS kit at the least. (in terms of gear)
Tell me more about this Wing field medic program.
As a caveat, I'm not the biggest Hawk Mountian supporter but the field medic program is well established. As for the rest, if we start swapping war stories we'llbe here all night...
Im jsut asking what the "field medic" training course / position is. Ive never heard of such a thing (in CAP)
Quote from: SAR-EMT1 on January 26, 2007, 04:22:03 AM
Im jsut asking what the "field medic" training course / position is. Ive never heard of such a thing (in CAP)
Should be something on the Hawk Mountain web page:
http://www.pawg.cap.gov/hawk/summer.htm (http://www.pawg.cap.gov/hawk/summer.htm)
Quote from: SAR-EMT1 on January 26, 2007, 03:52:48 AM
Id also at the least require that any EMS position in the field be required to carry a level 3 BLS kit at the least. (in terms of gear)
What is a Level 3 BLS kit? 13 years as an EMT-B and never heard of it.
Quote from: flyerthom on January 26, 2007, 03:26:59 AM
Quote from: dcpacemaker on January 26, 2007, 12:46:00 AM
Very informative. Thank you.
So if we tacked some sort of medical specialty rating on the 101 card, would it be easiest/best to limit the rating to those who can provide proof of competency/certification in emergency life-saving procedures (ACLS, etc.) instead of all licensed nurses and doctors?
Competency in BCLS, current license and previous/current field experience. I too, like the other poster have gone into nursing homes and have had patients on the wrong O2 settings or even cardiac arrests where no one is doing CPR or can give a patient report.
The field medic courses that some wings do could fill the cross training role nicely.
Basic Cardiac Life Support?! Overkill.
regards credentialling, I know what the FAQ says, but rumor is they're pissed about some agencies picking & choosing standards then rolling out teams they stamp as NIMS compliant even though they aren't, then call for resources goes out & that team that may be perfectly fine w/ the slap dick stuff you do at home just can't do the job on a big time incedent. So, they're looking at the issues & it may come down to a FEMA certification card. Far as CAP is concerned, that threat should be important cause for the last few years we've been trying to weasle out way out of meeting these stadards & we need to get a drop dead order to do it or stay out of the way.
Quote from: arajca on January 26, 2007, 05:11:45 AM
Quote from: SAR-EMT1 on January 26, 2007, 03:52:48 AM
Id also at the least require that any EMS position in the field be required to carry a level 3 BLS kit at the least. (in terms of gear)
What is a Level 3 BLS kit? 13 years as an EMT-B and never heard of it.
OK works 2 ways: certification level and supplies-
Most "jump kits" are rated as to who may use the contents
You have jump kits that contain items authorized for BLS ILS ALS .
That said- A level three BLS kit would be well enough stocked to served the needs of a group: -SAY A GROUND TEAM?- At the BLS level for roughly 24 hours and with the minimum number of supplies. - I
think the standards are put out through National Registry; have to check on that.
For example it wouldn't have 30 Combitubes but it would have 1- adjustable C-Collar etc.
I'm sure I can dig up a list for a level 3 kit. OR- just look at the requirements for a Combat Life Saver Bag, and Add / Subtract as necessary
I'm not an EMT nor do I meet the WSAR quals right now (though I could get there quick if needed), but what I see is... the levels you need an EMT at require being out w/o support for 48-72 hrs before re-stock & go again. And, I'd be ready to walk up on 3-4 seriously injured survivors & need to pack them at at least to an LZ w/o outside help. Whatever supplies you need to do that. That's type II, really III & IV need to do that as well but w/ an outside EMT tagging along.
Quote from: arajca on January 26, 2007, 05:13:37 AM
Quote from: flyerthom on January 26, 2007, 03:26:59 AM
Quote from: dcpacemaker on January 26, 2007, 12:46:00 AM
Very informative. Thank you.
So if we tacked some sort of medical specialty rating on the 101 card, would it be easiest/best to limit the rating to those who can provide proof of competency/certification in emergency life-saving procedures (ACLS, etc.) instead of all licensed nurses and doctors?
Competency in BCLS, current license and previous/current field experience. I too, like the other poster have gone into nursing homes and have had patients on the wrong O2 settings or even cardiac arrests where no one is doing CPR or can give a patient report.
The field medic courses that some wings do could fill the cross training role nicely.
Basic Cardiac Life Support?! Overkill.
Having a CPR card is overkill?
Quote from: DNall on January 26, 2007, 04:14:28 PM
Regards credentialling, I know what the FAQ says, but rumor is they're pissed about some agencies picking & choosing standards then rolling out teams they stamp as NIMS compliant even though they aren't, then call for resources goes out & that team that may be perfectly fine w/ the slap dick stuff you do at home just can't do the job on a big time incident.
True. People with credentials showing up and not being able to do their job happens in other fields - wildland firefighting, certain organizations that issue cards to their members who do SAR...
The picking and choosing part is supposed to be eliminated by the standards and requirements in the latest credentialing ("job titles") documents for each discipline.
QuoteSo, they're looking at the issues & it may come down to a FEMA certification card.
FEMA issuing the card doesn't solve the problem though. Certificates and other proofs of training can be pencil whipped and submitted just as they are today. For FEMA to insure that having one of its cards is proof of meeting its standards, all training would have to be conducted and certified by FEMA. Some can be done online like IS-700 and 800, but the heavy duty stuff requires classroom and field training. That would require lots of FEMA qualified trainers and instructors.
QuoteFar as CAP is concerned, that threat should be important cause for the last few years we've been trying to weasel out way out of meeting these standards & we need to get a drop dead order to do it or stay out of the way.
CAP shouldn't wait for an order, it should just start doing it. If you want to run with the big dogs...
Mike
OK, this is more then a level three kit (I think this would be a level 2)
Took this off a FEMA page...dear lord don't ask me where :D
I spent some hours locating something like this.
As a personal note; the list doesnt include a glucometer but it does include meds.... seems odd. Id throw a small glucometer inside too.
------------------------------------------
The following is the reccommended standard for "Wilderness-Remote" Medical Personnel at the BLS / BLS-D level. This list is to be encouraged for those in the WSAR-M category.
The items are to be arranged in separate units as per function to be carried together in a large backpack or similar device by one individual. It is reccommended that the pack itself be comfortable, carry a hydration device, and allow for the passage of air between the pack and the back of the responder.
Trauma:
- (2) Field Dressings with Clotting Agent
-(1 Package) Band aids- various sizes
-(2) Vaseline Gauze
-(6) 2x2
-(6) 4x4
-1" tape
-2" tape
-1" transpore
-(2) Abdominal Pads
-(2) Eye patches
-Large Cling
-(2) Triangle Bandages
Instruments:
-Thermometer
-EMT Sheers
-Forceps
-Bandage Scissors
-Tweezers
-Penlight
-BP Cuff
-Stethoscope
-Large Trauma Dressing
-Large Burn Sheet
-C or D size aluminum bottle and toggle action
-regulator
-Adjustable C-spine Collar
-Sam Splint
-Manual Suction Device
Airway:
-Nasal Airway Kit
-Oral Airway Kit
-Pediatric Mask
-Adult Mask
-Nasal Canulla
-Extension Tubing
Medical:
IF ALLOWED IN SYSTEM:
-Insulin, Albuterol, Glucose, Epinephrine-Auto Injector, Pain Medication-Auto Injector
-Pediatric Kit, to include bottle
-Bag-Valve-Mask
-Emergency Blanket
-(2) Hot Packs
-(2) Cold Packs
-(2) PPE Kits: Mask, Gloves, Gown, Biohazard Bag
-(1) BASIC IV Start Kit, To Include 500cc Ringers Lactate, 500cc Saline
Other Accessories (highly reccommended)
-Kendrick Traction Device
-Emergency Stretcher Roll with Strapping
-Hydration Source For Patient with Dehydration Issues
-Emergency Blanket For Patient Hypothermia
---------------------------------------------
Alright my fellow trauma monkies, Have at thee.
Quote from: sardak on January 27, 2007, 05:50:26 AM
Quote from: DNall on January 26, 2007, 04:14:28 PM
Regards credentialling, I know what the FAQ says, but rumor is they're pissed about some agencies picking & choosing standards then rolling out teams they stamp as NIMS compliant even though they aren't, then call for resources goes out & that team that may be perfectly fine w/ the slap dick stuff you do at home just can't do the job on a big time incident.
True. People with credentials showing up and not being able to do their job happens in other fields - wildland firefighting, certain organizations that issue cards to their members who do SAR...
The picking and choosing part is supposed to be eliminated by the standards and requirements in the latest credentialing ("job titles") documents for each discipline.
QuoteSo, they're looking at the issues & it may come down to a FEMA certification card.
FEMA issuing the card doesn't solve the problem though. Certificates and other proofs of training can be pencil whipped and submitted just as they are today. For FEMA to insure that having one of its cards is proof of meeting its standards, all training would have to be conducted and certified by FEMA. Some can be done online like IS-700 and 800, but the heavy duty stuff requires classroom and field training. That would require lots of FEMA qualified trainers and instructors.
QuoteFar as CAP is concerned, that threat should be important cause for the last few years we've been trying to weasel out way out of meeting these standards & we need to get a drop dead order to do it or stay out of the way.
CAP shouldn't wait for an order, it should just start doing it. If you want to run with the big dogs...
No, you're right about all that. What I understand on FEMA issuing cards is they'd certify instructor/evaluators & those people would have to do the sign offs & be personally responsible. All that means is the agency sends their supervisor to a class & he has to do more paperwork, but at least that way the agency has to formally pencil whip it rather than just decide someone is good enough & let them fly like they didn't fully understand the standards.
I don't particularly care if FEMA does this or not. I can see the pro & the con to it. CAP though needs to take some kinds of whack in the head to understand it's way past time to get with the program. We're ready to take the hit & grow into a capable agency.
Thats a pretty darn good medic kit, but I would hate to gave to pack it in my backpack ( A "D" o2 cylinder? You must have donkeys for your ground team!) If it is car-borne, it is fairly complete. I personally think that most Ground team members should carry benedryl tablets, and over the counter inhaler (Bronotine mist) which is epinephrine. Sort of a poor mans anaphalaxis kit. In California, a snake bite kit is prudent, and if you are acutually going out on foot, an Adventure Wilderness foot care kit ( mole skin, etc.) I also carry a Lifepak auto defibrillator in the car, as well as an BVM ( or AMBU bag) since there is no way I am going mouthg to mouth on a dead stranger!
Quote from: CaptLord on January 27, 2007, 02:46:14 PM
Thats a pretty darn good medic kit, but I would hate to gave to pack it in my backpack ( A "D" o2 cylinder? )
C cylinder works too.
As for the rest... I dont see how its possible to get an AED in the woods...unless someone IS going to play donkey for the EMS person.
As for one person being able to carry it on on your back ...
http://www.rescuepacks.com/products.php
I found this site this afternoon and Im probably buying one...
This company made up a BLS package that fits inside a special backpack. Kinda expensive but then again in EMS what aint... The list of junk that can fit inside is almost word for word whats on the list I put up top. - see the accessories page. - Anyway, take a look, explore tell me what you think.
(Im not advocating this one company, but this IS the first apropriate BLS backpack kit Ive seen. Galls has them, but they cant carry any o2)
Looks kind of light duty to be rucking up & down the hill for 2-3 days at a time. Plus you know you still have to carry sustainment gear - water, food, cloths, shelter, sleeping stuff, etc. On a real team you'd divie the stuff up a bit & share the load, but in CAP, even if you deploy with a set team, that can change on the fly & fast. It wouldn't do to be seperated from your gear.
Thats why you still have the webgear, buttpack and all the cargo pockets on the pants. Ive done something similar in the past. BUT I think the greatest med pack ever is one that brigade QM offers. It just sells for 3 or 4 hundred is all :P Its big enough for all the gear carried by a 'real' army medic, plus his sleeping bag, and other basic mission gear. BIG mother..but it has to be to fit the crap. Has a hydro pouch too.
There is also a big pack called the CPF-90 Its basically a revamped large alice with a smaller pack that can be strapped to the top (about as big as 2 buttpacks) I say through your personal gear in the big one, and fill the smaller one with BLS gear.
I reckon thats the limiting factor- How big/strong are the EMS types going to be, since anyone under PT standards probably would have a hard time.
Blah... anyone else have any packs/kit ideas to offer up?
Or anyway we can get some buzz going before tossing this up the chain. ...
You need buzz on packs? or what med gear is required to meet the FEMA-WSAR standards for medical specialist on type I/II teams? Think you better rewind a bit & get CAP to accept that we have to comply w/ WSAR standards for GTM, then you can work the practical EMS angles within the HSO community.
GTL - SM
Asistant GTL - SM/cadet
medic team - 2 cadets, 1 with med pack and training, 1 with litter
reg. GT - prolly all cadets <10+ is good
comms team if needed - either SM or cadet <about 2
support team if needed - DF, resupply, etools or tools like that, etc <3-4 people
it works great for missing persons searches and even more so when u got a load of other agenecies. This setup used by one Sq can be used to support other underpowered Sq's or other agenecies
Well now we have
1 leader(At least 18 but does not need to be a senior member.)
1 Medic (but all qualified members are First Aid and have a first aid kit.)
1 Loger
1 Navigator
Then everyone works together in other tasks like DF and such.
Ahhh, i read some of the messages above my last about packs and gear, my favorite.
My web gear consists of a load bearing vest with pistol belt, a canteen on each side, and a mil-surplus (current issue) butt pack. For packs i have a couple options to pick from.
the built on mag pouches on my vest, and grenade pouches and butt pack, let me fit all 24 hour gear in a very secure way. Survival equipment involves alot of small stuff and i hate using my pockets for any of that, so its perfect. Throw a poncho in the butt pack with like a angle head flashlight and a watchcap. Throw small things in pouches in a squared away manner. There are many types of vests out there, so dont buy an assault type 1. Stay military surplus if possible. It helps cause then your gear is tuff and the cost is very very low.
Have an EMT on your GT who is carrying first aide and advanced first aide gear and supplies (if your EMS inclined I am putting together a list as I compile my 24 med pack).
Cadet twists an ankle, SM experiences chest pain, holler "Corpsman Up!" and worry no more. I carry my radio and cell phone on my belt so I can attend to the patient and talk to medical at the same time and/or call in a dustoff if its needed. Problem solved until the regs are fixed.
My Ground Teams usually consist of:
1 GTL
1 Navigator
1DF Operator
1 Radio Operator
If the team is only these four people, the GTL serves as tactician, the navigator works with DF to get bearing to target, establishes position and plots position and bearing and other notations on map. The DF operator takes DF readings. Radio Operator operates radio and keeps official team log.
If we have extra people, we have an assistant DF operator, or if possible, two DF units with two, two-man DF teams. In any event, DF signal and bearing to target are always verified by someone else.
Quote from: SAR-EMT1 on January 27, 2007, 11:01:55 AM
OK, this is more then a level three kit (I think this would be a level 2)
Took this off a FEMA page...dear lord don't ask me where :D
I spent some hours locating something like this.
As a personal note; the list doesnt include a glucometer but it does include meds.... seems odd. Id throw a small glucometer inside too.
------------------------------------------
The following is the reccommended standard for "Wilderness-Remote" Medical Personnel at the BLS / BLS-D level. This list is to be encouraged for those in the WSAR-M category.
The items are to be arranged in separate units as per function to be carried together in a large backpack or similar device by one individual. It is reccommended that the pack itself be comfortable, carry a hydration device, and allow for the passage of air between the pack and the back of the responder.
Trauma:
- (2) Field Dressings with Clotting Agent
-(1 Package) Band aids- various sizes
-(2) Vaseline Gauze
-(6) 2x2
-(6) 4x4
-1" tape
-2" tape
-1" transpore
-(2) Abdominal Pads
-(2) Eye patches
-Large Cling
-(2) Triangle Bandages
Instruments:
-Thermometer
-EMT Sheers
-Forceps
-Bandage Scissors
-Tweezers
-Penlight
-BP Cuff
-Stethoscope
-Large Trauma Dressing
-Large Burn Sheet
-C or D size aluminum bottle and toggle action
-regulator
-Adjustable C-spine Collar
-Sam Splint
-Manual Suction Device
Airway:
-Nasal Airway Kit
-Oral Airway Kit
-Pediatric Mask
-Adult Mask
-Nasal Canulla
-Extension Tubing
Medical:
IF ALLOWED IN SYSTEM:
-Insulin, Albuterol, Glucose, Epinephrine-Auto Injector, Pain Medication-Auto Injector
-Pediatric Kit, to include bottle
-Bag-Valve-Mask
-Emergency Blanket
-(2) Hot Packs
-(2) Cold Packs
-(2) PPE Kits: Mask, Gloves, Gown, Biohazard Bag
-(1) BASIC IV Start Kit, To Include 500cc Ringers Lactate, 500cc Saline
Other Accessories (highly reccommended)
-Kendrick Traction Device
-Emergency Stretcher Roll with Strapping
-Hydration Source For Patient with Dehydration Issues
-Emergency Blanket For Patient Hypothermia
---------------------------------------------
Alright my fellow trauma monkies, Have at thee.
This is a great list and is virtually everything I carry when I do industrial EMS in Canada. There is only one problem. This list pole vaults over the line from "emergency stabilizing first aide" and into BLS, BTLS, ILS, and ALS. With the restrictions that are placed on us by CAP regs, about half of the list would never make inspection and get into the field, and even if it did, it could not be used even by licensed EMT-B/D or Paramedic. First off, anything invasive is out since invasive moves you into Advanced Life Support. So any needles, IV set-ups and airways are strictly forbidden under CAP regs. Because we have no medical direction, and or standing orders, all meds including glucose and oxygen (yes, giving oxygen is giving a med under DOT/NHTSA standards) are out. Also, even though CAP EMTs or Medics cant start IVs, most systems have replaced Ringers Lactate with D5W. I assume when you said Kendrick Traction Device, you meant extrication device. This would be useful because it is the closest thing to a backboard we are really going to be able to hump into the field. Also I would recommend occlusive dressings, but only in the hands of someone that knows that its four side closure for neck wounds and three sides ONLY for chest wound. There is actually a new device out on the market that is an occlusive dressing that is about 10 inches in diameter and has a one way valve on it. You just peel of the tape, slap the dressing down and let the valve do the work instead of having to leave one side of your occlusive open.
As I say, this is a fantastic list and if we were allowed, this would be virtually exactly what I would carry into the field. However, since we are only allowed first aide even as EMTs or Medics, we could sufficiently lighten the load because many of the items we simply cannot use because of CAPs restrictive regs and lack of direction and liability coverage for EMTs. I would also add a military field tourniquet (as a method of last resort for hemorrhage control). The new ones being issued to CLSs can be placed and adjusted with one hand. The old boy scout stick and handkerchief method can be time consuming, frustrating and darn near impossible to maintain appropriate pressure with, especially when the adrenaline starts pumping. And remember to loosen those tourniquets at regular intervals kids (and watch out the for arterial spray.)
Also, as an after thought, we should probably stop calling the EMT a medic unless he actually is one. Could create some dangerous confusion when you call for EMS and say "our medic is doing xyz" and then EMS gets there and reads you the riot act because they were expecting a paramedic. In EMS "Medic" is always a paramedic, not anyone who is rendering care. EMT or perhaps even Corpsman might be the better word choice. I know it sounds persnickety but it could cause some confusion.
Sarmedtech,
The seal is called the Asherman chest seal. Good product, great for thoracic GSW's. On another note, I believe that liter flow O2, without demand valves, are within the scope of a first responder. and is not an ALS skill. For BLS wilderness meds ( yes, I know technically there is no such thing) you should have benedryl, Bronatine mist (an epinephrine inhale which can be as effective as an EPI pen and you can control the dose for little ones) and of course quikClot. ( vascular surgeons start screaming now....hey if they die on the table but make it out of the field, we still call it a save!)
I carry liter flow 02 with a mini C tank, and a BVM. Positive pressure uses up all your air fast.
Capt. Lord
Yes, absolutely QuikClot and let the surgeous scream. However, here in Illinois, Oxygen, however delivered is a med which requires a scrip or EMS agency licensure to give it. Under CAP regs, we cannot use it in the field. By definition, when you administer any substance to a patient by any method you are giving a medication (other than water of course which should be given very sparingly in the field). Though its stupid, with CAPR's as they now stand, we cannot give oxygen in the field.
Thanks for reminding me of the name of the Asherman. I know my medic friend in the Sandbox uses them all the time, I just couldnt remember the name and of course, Illinois EMS being what it is, alot of regional medical directors dont want to use them. I also carry the broncho-dilator inhalers to be used in lieu of epi, but how do you personally recommend adjusting the does (to dose equivalent epi of .15mg 1:1000). I dont mind giving an adult a full blast, but at not sure how you would accurately adjust the dose for a child with a metered dose inhaler. Please advise. Also, here in IL except in extreme emergencies, epi is a "patient assisted"medication, meaning we technically dont administer it, we "help them" and also we dont "technically" carry it on the rigs. Same with activated charcoal, which has in fact been taken out of the protocol in IL since it was "messing up the rigs" when it came back up which it does about 90% of the time.
Thank you, sir, and I look forward to your reply.
Semper Vigilans!
Quote from: SARMedTech on June 19, 2007, 05:25:36 AM
Though its stupid, with CAPR's as they now stand, we cannot give oxygen in the field.
I am not a medic/EMT, just have first aid; but if I had a patient that need 0
2 to live, Darn the regs, patient is getting 0
2.
1. I agree with you totally.
2. If a licensed EMT or medic gives 02 in the field with no standing orders or medical direction or liabilty coverage from CAP, said EMT will likely lose his license and find himself on the business end of a law suit.
3. The necessary changes can be made so that EMT and Medics enrolled in CAP can actually do what they are trained to do. Its a matter of money. A SAR organization where I lived in NM is a tiny fraction of CAPS size and they have medical staff, liabillity and medical direction. Simply put, there is no reason for CAP not to follow suit except for not wanting to spend the money.
4. Who among us wants to make the knock on the door in the middle of the night to say "Ma'am, on behalf of the US Civil Air Patrol, it is my duty to inform you that your son/daughter, husband, wife has lost their life while serving their country because adequate medical resources were not provided to our medical officers in the field. Im sorry...our hands were tied by antiquated regulations. Lets also get a working definitation of emergency stabilizing first aide and we might find that airway adjuncts, etc fit the bill and that would be a giant leap forward as would CAP EMTs and Medics being able to carry glucose, glucagon and epi...but I dont want to get ahead of myself.
Quite simply, we cant wait anymore, wringing out hands and saying it will never happen. It must happen. That being said, if there are those of you who are first responders, EMTs or Medics who work with GTs and would like to see these regs changed, please contact me via PM and lets see what we can do to get CAP to live up to its responsibility to its members the people it may find during a SAR actual. The time for waiting is over. The time for action is now. Thank you for listening and Semper Vigilans!
UH RAH!!
Quote from: SARMedTech on June 19, 2007, 05:45:41 AM
Thanks for reminding me of the name of the Asherman. I know my medic friend in the Sandbox uses them all the time, I just couldnt remember the name and of course, Illinois EMS being what it is, alot of regional medical directors dont want to use them. I also carry the broncho-dilator inhalers to be used in lieu of epi, but how do you personally recommend adjusting the does (to dose equivalent epi of .15mg 1:1000). I dont mind giving an adult a full blast, but at not sure how you would accurately adjust the dose for a child with a metered dose inhaler. Please advise. Also, here in IL except in extreme emergencies, epi is a "patient assisted"medication, meaning we technically dont administer it, we "help them" and also we dont "technically" carry it on the rigs. Same with activated charcoal, which has in fact been taken out of the protocol in IL since it was "messing up the rigs" when it came back up which it does about 90% of the time.
Thank you, sir, and I look forward to your reply.
Semper Vigilans!
The general thinking is that you need to administer 10-12 or so full oral doses with an OTC inhaler to reach (adult) EPI pen dose levels. The problem is, in actual anaphalaxis, the patient does not want to breath at all, so the question in acute anaphalaxis is moot. You need IV or Sub Q Epi at that point. For initial onset stages, when the patient has uticaria, dyspnea, and looks bad, start the patient on as many OTC inhalations as they can manage. (within reason) If they can still swallow benedryl, use it before they arrest.
For kids, start with a single dose unless the attack is so severe that respiratory arrest is likely. Listen to their lungs and titrate the dose as required. Status Asthamaticus can be dealt with in the same way.
Epi pen makes an adult and a Jr size. The administration of a full size adult dose of EPI to a child would be bad. On the other hand, to start with a small dose of epi on an adult is not a bad thing. If an adult has a bad heart, EPI can double-dog kill them ( stop me if I am getting too technical here) Starting with oral or IM benedryl is safe if you have EPI as a backup.
FYI, an EPI pen costs about $100.00 these days. You can buy EPI for horses, which is the same product in a brown bottle for about $3.00 an ounce....it would be wrong to use an unapproved product on a human, so try it with a Senior Member first. We have lots of Lt. Cols with shakey tickers...
On the O2 issue, those people who have not been trained in 02 therapy shoul dknow that O2 can diminish or eliminate the respiratory drive in certain patients ( COPD) and once you start o2 , you pretty much need to follow the case to the end.
There has been so much negativity about providing medical care of any kind in CAP, I would suggest that you just let your CAP member die in an orderly and proficient Air Force manner rather than actually rendering aid. We can always send out one of our highly trained and experienced Critical Incident Stress Counselors to help you deal with your guilt....
Capt. Lord
Tags - MIKE
There are places out there that O2 is considered a by stander item, in a local mall here in PA we have a number of AED cabinets that also have small o2 tanks in them, the tank turns on as soon as its removed from the case (so I hear, havent actually seen it happen) and starts flowing at 8LPM, with a simple mask pre- attached.
The Kendrick traction device is a tent pole looking kind of assembly that is used as a traction splint. It usues mechanical traction from tensioning up the foot strap to eaqual manual traction. When dis-assembled it fits in a 5 x 7 ish pouch. Packs nicely into your aid bag. Its a standard thing in most of the AFSOC bags, along with the asherman's, quick clot, chitosen dressings, CAT tourniquest and a much better fluid for volume replacement. Hextend...its a uber-cool hypertonic solution, that stays in the vcascular space much longer than saline or ringers (800 out of 1000ml after 2 hours vs 200 of 1000 LR in the same time frame if I remember correctly) Also we have switched to the Israli dressings over the battle dressings.
In the Spec Ops land we have these really cool BVM's that crunch down small and yet still pop back to normal size even after a long time in storage (just carry a pedi size mask and you're good to go)
Personal on the rest of the kit listing I would just carry 1 size tape, Duct for me peronally but in EMS land a roll of 2" would suffice (you can rip off 1" sections if you really need it) Also I woudl forgo the bandage scissors, EMT shears are good enough for all around use. I would add something like saline bullets for wound irrigation, easier on weight and space than the large bottles and doesnt eat up your supply of IV fluids.
mk
Quote from: sarmed1 on June 20, 2007, 03:52:59 AM
There are places out there that O2 is considered a by stander item, in a local mall here in PA we have a number of AED cabinets that also have small o2 tanks in them, the tank turns on as soon as its removed from the case (so I hear, havent actually seen it happen) and starts flowing at 8LPM, with a simple mask pre- attached.
The Kendrick traction device is a tent pole looking kind of assembly that is used as a traction splint. It usues mechanical traction from tensioning up the foot strap to eaqual manual traction. When dis-assembled it fits in a 5 x 7 ish pouch. Packs nicely into your aid bag. Its a standard thing in most of the AFSOC bags, along with the asherman's, quick clot, chitosen dressings, CAT tourniquest and a much better fluid for volume replacement. Hextend...its a uber-cool hypertonic solution, that stays in the vcascular space much longer than saline or ringers (800 out of 1000ml after 2 hours vs 200 of 1000 LR in the same time frame if I remember correctly) Also we have switched to the Israli dressings over the battle dressings.
In the Spec Ops land we have these really cool BVM's that crunch down small and yet still pop back to normal size even after a long time in storage (just carry a pedi size mask and you're good to go)
Personal on the rest of the kit listing I would just carry 1 size tape, Duct for me peronally but in EMS land a roll of 2" would suffice (you can rip off 1" sections if you really need it) Also I woudl forgo the bandage scissors, EMT shears are good enough for all around use. I would add something like saline bullets for wound irrigation, easier on weight and space than the large bottles and doesnt eat up your supply of IV fluids.
mk
The device you are talking about sounds like a Hair Traction Splint to me...maybe I am just misunderstanding. I like the chitosan dressings, but you need to make sure to ask your patient if they are allergeic to shellfish, since chitosan is derived from the shells and rubbery connective tissue of crabs, lobsters, etc and I have read studies about it triggering anaphylaxis.
Yes youre right about eliminating the bandage sheers. No real need for them if you are carrying trauma sheers. As a side note, I was given a pair of Big Shears (TM) as a gift. They are the super heavy duty buggers that will cut 1/2 leather, kevlar and have handles that are heavy and sturdy enough to break glass if need be. The only draw back is the cost: about $100 for 1 set. It sure seems worth it when you have to cut off a bikers full set of leathers though (you may also wish to carry a firearm as I have found that bikers do not wish to have their leathers cut...especially if they have their "club" colors on the back.
Obviously for EMTs in CAP, we arent carrying saline IVs. Do you know of a supplier for the saline bullets? My rig carries IVs, saline "bottles" for irrigation, and sterile water for irrigation. Any info you could give me on the "bullets" would be appreciated in a PM.
Is the Hextend available commercially?
I also carry Israeli dressings over battle dressings when i can get them.
Thanks for all of your suggestions. I would like to discuss them with your further in a PM if you dont mind.
Quote from: SARMedTech on June 20, 2007, 04:27:00 AM
The device you are talking about sounds like a Hair Traction Splint to me...maybe I am just misunderstanding.
The only similarity between a Hare(R) Traction Splint and a Kendrick Traction Device (TM) is the traction function. The third common type is a Sager(R) Traction Splint. The design of all 3 is different, with the Sager and KTD being similar to one another, but the function is the same.
The non-CAP SAR team I'm on has all three. The Hare doesn't leave the rescue trucks except for trainings where the truck is handy. There is a KTD in each of our med packs, since as mentioned, they collapse into a small pouch, and the Sager goes in the field often. We need traction devices several times a year.
Google each device to see the differences.
Mike
Mike...I say bring back the old half ring splint. Cheap, nothing moves, all you need is the multi purpose triangular bandage.
Just for clarity sake and (for once) not meaning to be a nit picker-
The idea that "nothing moves" in a splint, or in most field splints, is not really true. They certainly restrict motion, or unwanted motion of a broken bone, but they do not immobilize it entirely. This has also been noted in the names of our old friend the c-collar. The device and the technique of using it are no longer referred to as "spinal immobilization" but rather SMI or "spinal motion restriction" a name meant to reflect the best case scenario for use of the device. The reason for the change was that EMS agencies were getting sued as were manufacturers of various C-collars because they were making the claim of immobilization. Even the best collar, well applied and secured with either a head bed or towel rolls, etc allows for c-spine motion of fractions of an inch. The same is true of splints. As to what kind of splint, my favorite for SAR still has to be the time tested SAM. Lightweight, easy to carry, moldable and cuttable to a variety of circumstances and needs. I think I saw somewhere the recommendation for cadets was to carry the old wire splints, which in my experience, are just this side of useless. Fine in a pinch and certainly cheap, but you do get what you pay for, and I dont know that I would want to rely on them for more than one use, since what your essentially using is chicken wire. The SAM can also be fairly effectively cleaned for re-use with a solution of water and bleach in a ration of 13:1 respectively. Much more than that, while perhaps providing more cleaning power tends to degrade some of the padding materials on the SAM.
how about the v-notch board splint for traction purposes....thats really old school.
mk
When was the last time anyone in CAP carried out a survivor of a plane crash without activating and using 911/EMS? My experience is that survivors won't live or die based on what CAP does in the next hour. Either they are stable or in shock, the latter usually results in death sooner or later. To carry someone out any distance usually requires more people than we have.
Quote from: SARPilotNY on July 04, 2007, 09:25:59 PM
When was the last time anyone in CAP carried out a survivor of a plane crash without activating and using 911/EMS? My experience is that survivors won't live or die based on what CAP does in the next hour. Either they are stable or in shock, the latter usually results in death sooner or later. To carry someone out any distance usually requires more people than we have.
These are the kinds of discussions I truly enjoy, in large part because my (in progress) masters degree is in the field of disaster medicine. Lets look at your questions individually:
1. I dont know. Ive asked this question in a few different places but havent really .gotten any responses.
2. Addressing that 1 hour: As has been previously stated in can be some time before CAP gets to a crash site and gets to the pilot. Adding time for things like extrication, an assessment by a HSO with the ground team to determine whether or not the pilot should be moved or not and if you have a pilot in shock, you are looking at a significant period of time. That being said, I should think that the likelihood of a pilot who has survived a crash being in some type of shock would be relatively high, but...
3. We have to ask what type of shock? Given that shock is defined in general terms as inadequate perfusion at the cellular level, ie the exhange of co2 and oxygen, for our purposes we should think of the two biggest categories of shock: compensating and decompensating. In the first, a state of shock exists but the person's physiological functions are such that they are still strong enough to withstand the effects of this insufficient perfusion. In decompensating shock, this is not the case and a person's chances of living are decreasing over time. We could sort of think of it as a person who faints or passes out and recovers is in compensating shock. A person who is shot or otherwise otherwise severely injured and losing blood, either internally or externally sufficient to cause unconsciousness with out recovery is not compensating and will almost certainly die over time if emergency interventions are not performed.
4. The pilot or other victim living or dying depending on what CAP does in the next hour: how long ago was the person injured and when does CAP encounter them, thus starting the above mentioned hour. The golden hour (the time between injury and corrective medical measures (generally, surgery) has almost certainly passed. Now the question becomes how soon is EMS activated, how soon do they reach the patient and how soon are they able to begin medical intervention. Here's where CAP comes in...
5. Lets say that our pilot has crashed his a/c in a heavily wooded area such that EMS cannot get to him directly, ie they cannot get to him directly by ambulance nor by helo. Now CAP is in a situation of having to "evacuate" that patient. Assuming that there is a HSO on the ground team with sufficient skills to stabilize the patient, given that per regs we cannot start IV fluids, give meds, etc, stabilization would essentially consist of getting that patient onto some form of stretcher, litter, backboard, etc, into a c-collar and evacuating them by carrying them out to such a point where EMS can access them. Lets say this distance is a mile. Given that an unencumbered adult male can cross 3 miles on foot in one hour, this evacuation would would take approximately 20 minutes. Of course we have to factor in how heavy the patient is, on what they are being carried, the terrain, how many GT members we have, etc.
The long and short of it is, CAP accessing that injured pilot could well mean the difference between life and death. There are so many factors that act as variables, but the one thing that is not variable is that if a patient is in decompensating shock, the WILL die. If CAP is able to carry that patient out, access EMS and emergency interventions including IV access are able to be achieved, that patient may well live. If there is a HSO who is an EMT or medic on that GT, the odds of survival increase. If that EMT or medic is able to stabilize the patient even a little, the odds of survival increase again. So yes, what CAP does can make the difference between life and death for the injured pilot. While it could be difficult depending on the abilities, strength and physical capabilities of the individual GT members, 4 people would be sufficient to carry an injured person. It is possible with three, and very difficult but possible with only 2 depending on type of litter or stretcher. We are almost certainly going to have more than two people on a GT. If we have an entire search line, and the patient can be transferred between GT members as they become tired, getting that pilot out over the above mentioned 1 mile is well within our capabilities. What CAP does after finding that injured pilot increases his chances of survival exponentially. If bleeding is stopped, chances go up. If respiratory assistance is necessary and can be provided via bag valve (which is why I carry one in my pack) or mouth to mask methods chances go up.
Quite simply, the mere act of finding that downed pilot increases his likelihood of survival. Remember, if he is in shock and his body can still compensate, simple fluids given by mouth from a canteen can increase the chance of survival.
Bravo...good answers but my experience with a Stokes litter or equivalent over rough, rocky, brush covered terrain would be different. My dream team: (remember, even the FAA has upped the weight of a pilot to 200 pounds) 8 persons on the litter, 8 for relief and 8 extras for lifting over rocks, getting through heavy brush, carrying hand over hand up slope , carring the kits and supplies. One mile, at least one hour. The only way to get 24 folks is find a fire department hand crew or two, good luck in the winter. Our "first alarm" rescue response is 2 engines, (medic) 1 truck, 1 rescue (transport capable box) one ambulance and a chief. 17 people than minus the chief...too old to be doing this. If we had that type of a hike w/o any helo, go for a second...now that is luxury! My greatest fear in SAR is finding a survivor, it changes everyone's plans and makes everything go sour. As a rescuer what is a bad plane crash is?? ? one with a survivor a mile or two from the road.
In my CAP experience with survivors is that the ones that did survive, survived in spite of what little we did (blankets, reassurance, comfort) once we made contact with them. Those that died were so far gone that there was no chance for their survival. Airway management was useless since PPV was impractical, suction almost impossible, BP and core temp 86P86degrees...
Quote from: SARPilotNY on July 05, 2007, 12:37:12 AM
Bravo...good answers but my experience with a Stokes litter or equivalent over rough, rocky, brush covered terrain would be different. My dream team: (remember, even the FAA has upped the weight of a pilot to 200 pounds) 8 persons on the litter, 8 for relief and 8 extras for lifting over rocks, getting through heavy brush, carrying hand over hand up slope , carring the kits and supplies. One mile, at least one hour. The only way to get 24 folks is find a fire department hand crew or two, good luck in the winter. Our "first alarm" rescue response is 2 engines, (medic) 1 truck, 1 rescue (transport capable box) one ambulance and a chief. 17 people than minus the chief...too old to be doing this. If we had that type of a hike w/o any helo, go for a second...now that is luxury! My greatest fear in SAR is finding a survivor, it changes everyone's plans and makes everything go sour. As a rescuer what is a bad plane crash is?? ? one with a survivor a mile or two from the road.
In my CAP experience with survivors is that the ones that did survive, survived in spite of what little we did (blankets, reassurance, comfort) once we made contact with them. Those that died were so far gone that there was no chance for their survival. Airway management was useless since PPV was impractical, suction almost impossible, BP and core temp 86P86degrees...
I didnt realize you were also an EMT. BTW, the core temp considered unrecoverable is 80f. At 86, passive re-warming is key. Once the temp has reached 90, active rewarming should begin. Also, unless you are taking temps "the old fashioned way" you arent getting what are medically considered core temps. Why on gods earth are you involved with search and rescue. You should be involved with search and recovery because you apparently have neither the interest the knowledge or skills, nor grasp of reality do be of any good on a ground team. Do me a favor...stay away from any SAR team I am a part of.
Quote from: SARMedTech on July 05, 2007, 12:43:43 AM
Quote from: SARPilotNY on July 05, 2007, 12:37:12 AM
Bravo...good answers but my experience with a Stokes litter or equivalent over rough, rocky, brush covered terrain would be different. My dream team: (remember, even the FAA has upped the weight of a pilot to 200 pounds) 8 persons on the litter, 8 for relief and 8 extras for lifting over rocks, getting through heavy brush, carrying hand over hand up slope , carring the kits and supplies. One mile, at least one hour. The only way to get 24 folks is find a fire department hand crew or two, good luck in the winter. Our "first alarm" rescue response is 2 engines, (medic) 1 truck, 1 rescue (transport capable box) one ambulance and a chief. 17 people than minus the chief...too old to be doing this. If we had that type of a hike w/o any helo, go for a second...now that is luxury! My greatest fear in SAR is finding a survivor, it changes everyone's plans and makes everything go sour. As a rescuer what is a bad plane crash is?? ? one with a survivor a mile or two from the road.
In my CAP experience with survivors is that the ones that did survive, survived in spite of what little we did (blankets, reassurance, comfort) once we made contact with them. Those that died were so far gone that there was no chance for their survival. Airway management was useless since PPV was impractical, suction almost impossible, BP and core temp 86P86degrees...
I didnt realize you were also an EMT. BTW, the core temp considered unrecoverable is 80f. At 86, passive re-warming is key. Once the temp has reached 90, active rewarming should begin. Also, unless you are taking temps "the old fashioned way" you arent getting what are medically considered core temps. Why on gods earth are you involved with search and rescue. You should be involved with search and recovery because you apparently have neither the interest the knowledge or skills, nor grasp of reality do be of any good on a ground team. Do me a favor...stay away from any SAR team I am a part of.
No...I am worse than an EMT...You missed the point w/ VS, this victim needs immediate ALS to survive, not BLS. Yes...I would be useless on a ground team because all my training reverts to BLS since I would otherwise be working outside of my scope. My problem must be that I know my limitations, know my teams limitations and now the laws and rules that govern our ability to render aid. And yes with CAP, most of what we do is a. search and silence, b. search and recover, run across the vehicle accident and treat/assist and d. search and rescue. Do you get much of any of these? Trust me, I will be miles in front of you and the SAR team you are on. By the time you get there you can pick up the biohazards if you want. And if you do crash in an aircraft (do you fly or are you even on a team) and want somebody to find you, you will wish that me and our team are looking for you. OK, I give up...how many distress finds and CAP saves do you have? How many missions do you go on a years? Ante up or fold.
BTW, I just think of myself as an underpaid doctor.
(http://www.tedda.net/IMGS/peecontest.gif)
Quote from: SARPilotNY on July 05, 2007, 01:38:05 AM
Quote from: SARMedTech on July 05, 2007, 12:43:43 AM
Quote from: SARPilotNY on July 05, 2007, 12:37:12 AM
Bravo...good answers but my experience with a Stokes litter or equivalent over rough, rocky, brush covered terrain would be different. My dream team: (remember, even the FAA has upped the weight of a pilot to 200 pounds) 8 persons on the litter, 8 for relief and 8 extras for lifting over rocks, getting through heavy brush, carrying hand over hand up slope , carring the kits and supplies. One mile, at least one hour. The only way to get 24 folks is find a fire department hand crew or two, good luck in the winter. Our "first alarm" rescue response is 2 engines, (medic) 1 truck, 1 rescue (transport capable box) one ambulance and a chief. 17 people than minus the chief...too old to be doing this. If we had that type of a hike w/o any helo, go for a second...now that is luxury! My greatest fear in SAR is finding a survivor, it changes everyone's plans and makes everything go sour. As a rescuer what is a bad plane crash is?? ? one with a survivor a mile or two from the road.
In my CAP experience with survivors is that the ones that did survive, survived in spite of what little we did (blankets, reassurance, comfort) once we made contact with them. Those that died were so far gone that there was no chance for their survival. Airway management was useless since PPV was impractical, suction almost impossible, BP and core temp 86P86degrees...
I didnt realize you were also an EMT. BTW, the core temp considered unrecoverable is 80f. At 86, passive re-warming is key. Once the temp has reached 90, active rewarming should begin. Also, unless you are taking temps "the old fashioned way" you arent getting what are medically considered core temps. Why on gods earth are you involved with search and rescue. You should be involved with search and recovery because you apparently have neither the interest the knowledge or skills, nor grasp of reality do be of any good on a ground team. Do me a favor...stay away from any SAR team I am a part of.
No...I am worse than an EMT...You missed the point w/ VS, this victim needs immediate ALS to survive, not BLS. Yes...I would be useless on a ground team because all my training reverts to BLS since I would otherwise be working outside of my scope. My problem must be that I know my limitations, know my teams limitations and now the laws and rules that govern our ability to render aid. And yes with CAP, most of what we do is a. search and silence, b. search and recover, run across the vehicle accident and treat/assist and d. search and rescue. Do you get much of any of these? Trust me, I will be miles in front of you and the SAR team you are on. By the time you get there you can pick up the biohazards if you want. And if you do crash in an aircraft (do you fly or are you even on a team) and want somebody to find you, you will wish that me and our team are looking for you. OK, I give up...how many distress finds and CAP saves do you have? How many missions do you go on a years? Ante up or fold.
BTW, I just think of myself as an underpaid doctor.
The fact is "doctor" that BLS saves lives. Airway, Breathing, Circulation. Without these, all of the ALS in the world is useless. As the post just before mine says, this seems to have turned in a contest by you. You dont think CAP saves lives? You dont think what we do is important? Then turn in your letter of resignation and get out. Im sure no one will try to stop you. Before joining CAP, I served with a private SAR organization in New Mexico and have participated in approximately 50 full blown SAR operations so far, all lasting 3 days or more with all of that time being spent in the field. About 43 of them involved "saves" of one type or another. in desert condition/extreme weather conditions and I teach advanced field first aide designed specifically for SAR operators. But they arent MY saves because I function as part of a team. A concept which seems to be a little foreign to you and your plane.
To SARPilotNY: Since when are we allowed search and recover? As having been told numerous times, when it is KNOWN that the subjects are beyond rescue, we are pulled off, and others take over.
I seem to be losing power here...I will try it again...
Read JAMA or call the AHA, ABCs w/o a defib has little value, that is why there has been a push for defibs all over the place. Than one still need ALS to keep the heart going. You may be shocked, but I served on the Board of Directors for the AHA...another hat without a ribbon or uniform.
As far as resigning...I don't think so. Is what we do important? Yes. Is how we do it important? Yes. Is this a contest, no, you challenged my credentials, I am standing by them. As far as a team...you have no idea what my qualifications are as a team player.
I do believe that the reason you are losing steam or "power" is that your posts show that your attitudes do not seem to mesh with what we all to know as CAP Culture. It may not be that way where you are located, but we represent much more diverse aspect. To be blunt, sir; your posts have been not been in a positive manner. While that is your right, it is not endearing.
Quote from: RogueLeader on July 05, 2007, 05:02:48 AM
To SARPilotNY: Since when are we allowed search and recover? As having been told numerous times, when it is KNOWN that the subjects are beyond rescue, we are pulled off, and others take over.
Air search and rescue? How does CAP pull that one off? When a crash is located and there are no survivors, it is now a recovery operation. We often assist the local agencies in recovering the deceased. We don't put them in the body bag, but we can help carry them out. The USCG as an example will change a search and rescue mission into a search and recover mission once there is little chance for survival. The AFRCC will typically not order a helicopter for a body recovery as it is too risky. It is terminology used as we wind a mission down and allow for the troops, family and media to wind down too. My point was most of our missions result in locating a crash with no survivors...we are more often search and recover vs. search and rescue. ;)
Quote from: RogueLeader on July 05, 2007, 05:15:06 AM
I do believe that the reason you are losing steam or "power" is that your posts show that your attitudes do not seem to mesh with what we all to know as CAP Culture. It may not be that way where you are located, but we represent much more diverse aspect. To be blunt, sir; your posts have been not been in a positive manner. While that is your right, it is not endearing.
There are those that see change as good as well as diverse thought. And than there are those that like the status quo. Columbus would never gone to the new would if he had listened to others. Many say CAP is flat, I say with some exploration we can find some new opportunities.
Quote from: SARPilotNY on July 05, 2007, 05:03:56 AM
I seem to be losing power here...I will try it again...
Read JAMA or call the AHA, ABCs w/o a defib has little value, that is why there has been a push for defibs all over the place. Than one still need ALS to keep the heart going.
Having an AED means nothing in a trauma situation. On a search, if an AED is needed, it was needed well before anyone got to the victim because the victim is dead. There is a relatively small window of opportunity to use an AED before the heart goes into an unshockable rhythm. By the time a SAR team gets there, the AED is dead weight. In the city, AED's everywhere can make a difference.
ABC's are CRITICAL for trauma. Not every medical incident requires an AED, but every one requires ABC's. That is what emergency medicine is based on.
QuoteYou may be shocked, but I served on the Board of Directors for the AHA...another hat without a ribbon or uniform.
Then you should realize that AED"s have limitations.
I know AEDs have limitations, next thing everone will want them on ground teams...better saved for conferences and bases. But with any successful save with, or without CPR, is airway management. Suction anyone? Shouldn't go there either, next we will have everyone wanting ET or Combi tubes. I have seen a few end results of AEDs w/lay rescuers, seems that nobody touched the airway or in another case kept the airway clear. Barf!
Quote from: SARPilotNY on July 06, 2007, 09:06:18 PM
I know AEDs have limitations, next thing everone will want them on ground teams...better saved for conferences and bases. But with any successful save with or without CPR is airway management. Suction anyone? Shouldn't go there either, next we will have everyone wanting ET or Combi tubes. I have seen a few end results of AEDs w/lay rescuers, seems that nobody touched the airway or in another case kept the airway clear. Barf!
Sir, your posts really arent consistent with someone familiar with SAR operations or to any great extent EMS or field emergency medicine. You say with or without CPR, airway is key. That statement doesnt make any sense. Without CPR, you can have a clear airway, but if your not compressing and actively ventilating a patient, that clear airway on someone who is pulseless and breathless is useless. Most people who code do not spontaneously regain pulse and respirations.
Im not sure either about your concern over suction? Ever hear of a V-Vac? Its virtually impossible to do airway damage with manual suction, especially since if a person is carrying the thing, he is probably trained in its use.
You are concerned about combitubes in the field. Thats where they belong. They were originally designed as a combat field (read as blind) intubation option of last resort. Their use and evolution has moved forward now such that if a patient has no gag reflex, is over 5 ft tall (there are now combis that allow for shorter patients) and has no visible sign of esophageal or tracheal trauma, a combitube is a viable asset. I have put down several in the field and can say that they were the only thing that allowed for successful ventilation of a patient in many cases. I have the process down to about 45 seconds once CPR is halted. However, this is a moot conversation since, with CAP regs as they currently stand, we are not operating as EMS and therefore do not have combitubes available to us. These cannot be purchased by individuals without authorization. They must be purchased by agencies OR individuals operating with a licensed EMS agency. Since CAP is neither, we wont be seeing these little gems in the field anytime soon.
As for AEDs, they are getting smaller and lighter and if they can be afforded, there really isnt any reason that they shouldnt be carried in the field. Since there is no mandatory certification for their use and since they are designed for the lay person to use with NO training, I dont see the problem. In the hands of a trained user, we are going to clear the airway and provide two minutes (the AHA now says at least one) of continuous CPR before attempting to provide a shock. An AED wont allow a shock that is ill-advised, but they do allow for shocks to rhythm which might not be shocked in a hospital setting since there may be no other alternative.
You seem to be getting a bad reaction all the way around and perhaps it is not because you are challenging the way things are done, but you are not offering VIABLE alternatives. Its useless to pick apart what someone else is saying without offering an alternative plan.
As for someone being dead, thats for the coroner to decide. Absent obvious signs of death (ie decapitation, etc) we dont make that call. Thats not our job. One of the cardinal rules of EMS is that if you arrive on scene and find a pulseless and breathless patient who is still warm without any presumptive signs of death, as mentioned above, you proceed as if that patient "coded" just before you got to them until you can determine otherwise. Since we dont have equipment to measure liver temp or other means to establish time of death other that lavidity and rigor, we assume we have a patient who just now stopped breathing. Now obviously if there is sign of animal damage, decomp, etc, we can assume otherwise since we can be reasonably sure that a living person capable of movement would not allow themselves to be chewed on by a passing coyote. In any case, as has been said, we simply get the call and activate a search. We do not PRESUME that a search has become a recovery operation and frankly, neither does AFRCC since they may be hundreds of miles away from the scene and other than an ELT ping and location, they have no information as to the situation. Now we may believe that due to weather, etc that its likely that a person not yet found may be dead, and we may even think that, but that call is not ours. We keep searching, as does any SAR organization, until we are called off or the search becomes impossible. There are also times where to continue searching would put the ground team in harms way, and then a command decision may be made to call it off, but that is still not made by the members of the team. that is a COMMAND decision. As a SAR operator, I assume that I am looking for a living human until someone higher up the operational chain tells me to change that assumption.
If you have been at this 30+ years, I would say you still have a lot to learn. I can suggest a few SAR operations in the desert southwest that can provide you with some valuable experience and facts.
PS- AEDs are designed with the "lay rescuer" in mind.
OK Sar Med Tech...I will get down to your level.
The quote"...with any successful save with or without CPR is airway management."
I really thought since your are an expert that you would have known that many non breathing patients just require the A and or B of CPR. NO, we do not need to compress on everone's chest. You should Always assess the ABCs before assuming somebody is a non breather or in full arrest. Many patients only need the airway opened, managed or maintained without breathing or circulation. And yes, the AFRCC does award Saves to rescuers that locate people that did not need CPR. I know that, I have a few and been on many missions where saves were earned. Non of those saves received CPR.
My concern over suction is that a clean airway will give the victim their best chance of survival. Basics in most CPR classes as well as EMT. Any fluids that get into the victim's lungs will more than likely cause a very nasty pneumonia later in an already weakened and ill patient. Mostly preventable. Did they teach you that or are you forcing vomit with your PPV devices? V-Vac...great... my point is when carring a stokes with a patient, it is difficult and time consuming keeping up with suction and an ambu bag. I have done it, not easy, but in your flat world on the city streets and desert, I am sure it is a cinch. Maybe some will believe you just how easy it is as an expert, maybe some will believe me, maybe not since you seem to have a need to show just how smart (or not) you are.
AEDs are a wonderful tool, and just that. Without good skills and airway management , the odds of it being effective are decreased. You say Combi tubes belong in the field, we use them in the ER too, there great as a second choice for us in the field. But, not for CAP. Want them???...maybe, but not for everyone and to say or infer they belong in CAP is wrong, and possibly illegal. Most states would require I'm sure at least 4 to 8 hours ADDITIONAL MINIMUM training before having it added to anyones scope.
We can't get most people in CAP to take a CPR or First Aid class...let alone an EMT course.
AEDs in the field? I doubt by the time we arrive as CAP to a crash victim that an AED will provide any value (as in near 0%), Maybe as I said it would serve a better purpose for use on our own membership at mettings and conferences. The equipment still is not cheap, requires some periodic checks and TLC. Maybe having team members fit in the field should be a PRIORITY. As for determining death. In every state that I have been in over the past few years, they have allowed me, my partners and even EMTs to pronounce a death, no coroner if the family MD waives and just LE to write paper. Even after we have performed CPR, under standing orders. I guess many states place a high level of confidence in their first responders training, I guess just not yours.
After 30 plus years I still learn lot of new things. I have had the opportunity to work in the Southwestern deserts, having been assigned to the border from San Diego to Nogales to Flagstaff, and even trained with "N.E.L.T." from New Mexico. Are you on that team too? Seems like you have had the luxury to work from the back of an air conditioned ambulance with an old fashioned biocom where you get permission from the BSH/BSP for everything. (Squad 51 calling Rampart, come in Dixie) Our guys run on standing orders, have poor or no direct radio communications with any hospital that requires skills above and beyond most. Our closest hospital or trauma center is often hours away by the time we secure a patient, get him to the helo or ambulance and transport them to the hospital. As far as the SW goes, I have been stuck on the ground due to WX that closed in that required an 8 hours litter haul, up and down washes and ravines that was followed by a two hour drive to the hospital. Didn't turn my back on that one either. We did that with myself and my partner, all ALS, all standing orders on a trauma patient, and a few volunteers from the local fire department in a very used type 3, un airconditioned van. Again, if you want to go head on with me, one on one with the old man, bring it on!
I normally am a team player, but I will still beat you! Or if you want to go one on one with medals and ribbons, I am sure I will beat you there to. Just don't try one on one with a Glock...you will lose! (unless you have an M-16)
Words of wisdom (police) Don't bring a knife to a gun fight!
(fire) don't bring a squirtgun to a fire!
(EMS) don't go in where there are weapons...unless its the cops with the guns...remember...be nice to the cops because they have the gun!
Isn't it about time this little peeing contest is taken to PM?
Quote from: tedda on July 07, 2007, 01:49:13 AM
Isn't it about time this little peeing contest is taken to PM?
I tried...but he just wants to show...well you know. I even complimented him on several postings but, I am not worthy! My original point to this post was to demonstrate the need for fast and professional responses to missions and agree to what SARGUY said and wham...we both got blasted. So much for offering an opinion.
Back to my original point...
better not!
Good thing I have some time to do this, wx won't let us fly, paperwork is caught up and the boss is out of town!
Quote from: SARPilotNY on July 07, 2007, 02:09:34 AM
Quote from: tedda on July 07, 2007, 01:49:13 AM
Isn't it about time this little peeing contest is taken to PM?
I tried...but he just wants to show...well you know. I even complimented him on several postings but, I am not worthy! My original point to this post was to demonstrate the need for fast and professional responses to missions and agree to what SARGUY said and wham...we both got blasted. So much for offering an opinion.
Back to my original point...
better not!
Good thing I have some time to do this, wx won't let us fly, paperwork is caught up and the boss is out of town!
Im not going to continue with these postings, going toe to toe with the Good Doctor, since there is obviously no end to his skill and the depth of his experience. I am but an EMT. The only thing that I do disagree with because I think its important to point out an error for those who may need to use CPR. Cardio-pulmonary resusitation is really a misnomer. What we are attempting to do is to function as a human heart/lung machine for our patient. The American Heart Association places the likelihood for actually "bringing someone back" at between 0-7%. That likelihood goes up when you add an AED to the mix to something like between 0 and 13%. Make no mistake, this machines save lives, especially newer models like the Phillips MRX which not only monitors 12 leads simultaneously but interprets them and offers treatment possibilities, records events like the administration of cardioverting drugs, filters out artifact from bumpy roads, etc. In any case...
Again I apologize to all members for having allowed myself to be taken down to the level of discourse in which I have engaged in this post. What I can bring to the CAP table in my experience in emergency services (and not just in the back of an air conditioned ambulance) and in EMS in particular. Though the role of an EMT in CAP is different than for an EMS provider, all of the members that I have met so far that are EMS certified to one level or another can add a great deal to any team they are on, particularly in being able to take care of the other team members, monitor for dehydration and exposure, etc. I have allowed myself to sink the level of personal comments against the SARPilot and I regret that. Regardless of how I may feel, I generally pride myself on not attacking someone personally, so I apologize to him and to all for that as well. I think that when we get down to talking about facing off with numbers of saves, and ribbons and commendations and even our abilities as marksman (I have no idea where that came from) I think we have gotten pretty pathetic and that serves as a wake up call for me that thats not the level of discourse I wish to participate in and will no longer do so.
I had forgotten something here in lowering myself to SARPilots level which is that the person in a situation like this who can refrain from personal attacks will always come out the winner. Where I felt it necessary to challenge certain things was in the area of field medicine where i feel that SARPilot, regardless of what type of physician he is, has made errors and stated things incorrectly which could be costly if someone chose to follow his advice in the field when assisting medically. We all makes mistakes, make errors based on faulty information, etc. Fortunately, those errors have not cost me the life of any of my patients so far.
So I am going to chose to take my own advice and focus on the positive aspects of CAP, which I believe I have also done a great deal of in this forum so far. SARPilot seems to want to focus on whats wrong with the organization and I chose to try to focus on whats right about it. The fact is, that though CAP may not be primarily a SAR organization, it does rank among one of the premier organizations of its type in the country...actually thats a hard comparison to make because there is no other organization that has the diversity of assets and capabilities that CAP does and as we continue to bring in new generations of cadets and officers from more diverse fields, we will only grown and get better.
So I apologize to you SARPilot for any personal attacks I have made or anything that you perceived as a personal attack. You may well have a great deal to offer CAP, but its hard to get past your negativity and fault finding and I would encourage you to do what I am going to attempt to do which is to be the best I can at what I have to offer CAP and constantly increase my skill set so that I may better serve others, because, when all is said and done it isnt about ribbons, or grades or titles, its about how we serve our country. If we maintain that focus, its hard to go wrong.
10-4 10-8 10-19
Regardless, this forum isn't a place for Roy and Johnny to argue over whose CombiTube is bigger.
Nobody gives a flying squirrel what you feel you have to point out anymore because you're both acting like raging babies.
Since you guys can't help yourselves, even while admitting you're done, I'd simply invoke Godwin's Law by calling you both Nazis and ask for a lock.
^ ;D Die thread, die! Lock.