Ground Team composition

[DNall]

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.

[SAR-EMT1]

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

[DNall]

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.

[flyerthom]

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?

[sardak]

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.

So, 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.

Far 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

[SAR-EMT1]

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 
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.

[DNall]

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.

So, 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.

Far 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.

[Major Lord]

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!

[SAR-EMT1]

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)

[DNall]

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.

[SAR-EMT1]

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    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. ...

[DNall]

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.

[IronRangerMN]

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

[connelly]

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.

[IronRangerMN]

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.

[SARMedTech]

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.

[ELTHunter]

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.

[SARMedTech]

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 
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.)

[SARMedTech]

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.

[Major Lord]

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