First Aid requirements

[RogueLeader]

True story: July 2008, Ft Sill OK, Alpha Battery 1/19 FA.  Combat Lifesaver Course:  I'm trained to start IV's, and I'm a 1st time go with the needle stick.  Yeah me.

Fast forward about 8-9 months. . . .

3rd Platoon, 161st ESC, 27th EN BN,  we are on a Platoon FTX out in the woods on Ft Bragg.  PFC Joe Johnson is looking very pale, and is dehydrated.  SFC Rodriguez calls "Seng!  Grab the CLS bag and get over here.  Johnson needs an IV."  So I grab the bag, get him set at the table, and go through the process of cleaning the arm, and getting him stuck.

Bam.  1st time go with an actual IV start.

They all thought I was going to miss due to my "Crazy Eye.s"
Just goes to show you that it can be done, even by those that are not Combat Medics.

[lordmonar]

What would be the point of CAP starting IVs anyways?
Even if the member was an AEMT, Paramedic, Nurse, etc...

Not being a medic/EMT/Doctor/etc.....one would assume for some medically required condition.

[sarmed1]

Nothing against the 11B types out there, but honestly, if we can teach an infantry grunt to do it, and they know when to do and they consistently do it correctly, teaching even cadets is really a non issue.  However, there are almost no places that I know of in the US (except the military) that "self train"  non licensed personnel on "IV's".  They almost always are part of an organized training program leading towards certification. (ie EMT-I, Advanced, paramedic etc etc)

If in the far reaching world of drastic changes and authorizations to CAP when it comes to "medical stuff" there would undoubtedly be a "...must be certified/licensed..." sort of requirement.

I have on a few occasions in and similar to CAP (not in a CAP status mind you)  started IV's on people, or have been told of incidents that IV access and therapy would be appropriate, both in the training environment and actual operations.

mk

[SARDOC]

What would be the point of CAP starting IVs anyways?
Even if the member was an AEMT, Paramedic, Nurse, etc...

I'm not advocating it but, starting  IV's can be beneficial in the Treatment of Shock.  Just a thought.

[Eclipse]

I'm not advocating it but, starting  IV's can be beneficial in the Treatment of Shock.  Just a thought.

I keep a few around the house for those really hot summer days - squeeze in a couple lemons and some sugar and you have a no-fuss cooler!
I'll start the drip in the morning and just change the bag as the day goes by...

[lordmonar]

Nothing against the 11B types out there, but honestly, if we can teach an infantry grunt to do it, and they know when to do and they consistently do it correctly, teaching even cadets is really a non issue.  However, there are almost no places that I know of in the US (except the military) that "self train"  non licensed personnel on "IV's".  They almost always are part of an organized training program leading towards certification. (ie EMT-I, Advanced, paramedic etc etc)

If in the far reaching world of drastic changes and authorizations to CAP when it comes to "medical stuff" there would undoubtedly be a "...must be certified/licensed..." sort of requirement.

I have on a few occasions in and similar to CAP (not in a CAP status mind you)  started IV's on people, or have been told of incidents that IV access and therapy would be appropriate, both in the training environment and actual operations.

mk

I don't think anyone is advocating "self training" on anything beyond Wilderness First Aid and CPR skills.   I would love to see CAP embrace EMT's as part of GT.......and encourage our members to actually go out and get licensed and certified.

Having said that how ever........just a hypothetical........how do you think the very first agency came about starting laymen training for first aid, CPR or even flying?

Becoming a "certified and licensed" skydiver for instance is totally up to the USPA in the united states.   There are no government rules governing sky diving certification.  Same story for SCUBA diving. 

So in theory......and this just a hypothetical....I am not advocating this in any way......really.......If CAP decided that our GTs would be trained in starting and IV........there is not any reason why would could not develop and implement in house training that meets government licensing criteria.

Any more so then any of the hundred of "First Aid and CPR" certification providers we can find on the internet.   They find out what the government standards/recommendations/ball park guesses are, they read the applicable literature from the industry, they hire a writer or two and publish a training program

A doctor may be lincensed by the state and board certified by the state.......but he is taught by JIM BOB's UNIVESITY OF Medicine in Grenada.  CAP can certainly devlope the training, do the training and the send the potential IV'er off to do his state tests.

[SARDOC]

Nothing against the 11B types out there, but honestly, if we can teach an infantry grunt to do it, and they know when to do and they consistently do it correctly, teaching even cadets is really a non issue.  However, there are almost no places that I know of in the US (except the military) that "self train"  non licensed personnel on "IV's".  They almost always are part of an organized training program leading towards certification. (ie EMT-I, Advanced, paramedic etc etc)

If in the far reaching world of drastic changes and authorizations to CAP when it comes to "medical stuff" there would undoubtedly be a "...must be certified/licensed..." sort of requirement.

I have on a few occasions in and similar to CAP (not in a CAP status mind you)  started IV's on people, or have been told of incidents that IV access and therapy would be appropriate, both in the training environment and actual operations.

mk

I'm not sure where you are located, but I know in my area that there is no state Phlebotomy standard, so the hospitals have all created their own programs for starting IV's.  The Hospital requires that Phlebotomy personnel as well as new nurses attend the class.  It seems that even new nurses don't always get trained in most procedures until they are working in a field that requires it.  The Hospital has been waiving EMT-E, EMT-I and EMT-P's since it's part of their training curriculum and standard practice.

The problem with teaching the Grunt to do it, is that's what the Grunt focuses on when SHTF happens.  They were ignoring basic ABC's and focusing on this instead of addressing the "B" portion.  So the Tactical Combat Casualty Care removed it and focused more on the early application of tourniquets.

There is a matter of liability involved in doing IV therapy enough to the point that I'm sure that CAP doesn't need to engage in that practice.  Instead of Focusing on any Advanced Life Support Procedures, we should just focus on our search tactics and proficiency in the Basic First Aid measures. 

[SARDOC]

I'm not advocating it but, starting  IV's can be beneficial in the Treatment of Shock.  Just a thought.

I keep a few around the house for those really hot summer days - squeeze in a couple lemons and some sugar and you have a no-fuss cooler!
I'll start the drip in the morning and just change the bag as the day goes by...

I've heard they can be awfully helpful after an evening of inebriation as well.

[SARDOC]

So in theory......and this just a hypothetical....I am not advocating this in any way......really.......If CAP decided that our GTs would be trained in starting and IV........there is not any reason why would could not develop and implement in house training that meets government licensing criteria.

Well, the purchase of Intravenous Supplies may be difficult.  They are identified under the United States Pharmacopeia and as such regulated like drugs and other medical devices.  You'll need a physician order (prescription) in order to obtain supplies.  Every State has different requirements for Medical licensure/training.  The easiest way to accomplish this is probably just by establishing an EMS training program because they'll want the additional training in addition to just IV Therapy, There is more to it than just sticking.  I don't even want to get into the requirements involved in the creation of a program.

[Al Sayre]

Or just go get the IV stuff at the local feed store and tell them it's for your horse or Great Dane if they even ask...

[JayT]

What would be the point of CAP starting IVs anyways?
Even if the member was an AEMT, Paramedic, Nurse, etc...

I'm not advocating it but, starting  IV's can be beneficial in the Treatment of Shock.  Just a thought.

Depends on the type and origin of the hypoperfusion.


People advocating CAP being able to place IV lines clearly do not have experience in civilian prehospital emergency medicine.

[sarmed1]

......
That is an advanced prehospital skill that takes hours of patient contact to be certified with.  Unless you want cadets running around ERs starting IVs on people, or starting them one themselves at the squadron for months on end in order to get the proficiency, it's best left alone.

Not to mention the physiological knowledge needed to know when an IV is and isn't indicated cannot be taught in one lesson.

Thats where the "self training" comment came from.

Even here, the hospitals do their own internal training programs; in that scenario, CAP would more than likely fall into the realm of special EMS service, which means in my area anyway complying with the state EMS act which restricts IV therapy to  certified prehospital providers (medics, PHRN's and Health professionals... ie EMS PA's/physician's.

The grunts were worrying about it because that's what we were teaching them, I still beat people around the ears in the civilian world, when they want to start 2 large bore IV's and push in fluid just because its a trauma....

IV fluids almost never are going to save your life, in fact in the case of GSW & IED issues the practice was killing more than saving.  Its diluting your already screwed clotting ability, on top of that what little clots you are forming are being blown out by having your BP jacked up by extra volume that does nothing more than keep the container expanded.  This still shocks some people (no pun intended) but patients can live just fine for awhile with a pressure in the 70's.  In the tactical sense, the availability of IO access has also limited the need for early IV access by the CLS....even if they have started to decomponsate and peripheral veins start collapsing due to shunting, you can still pop them in the chest and have a ready point to dump in fluids, drugs and blood.....

mk

[lordmonar]

So.....anyway......we have established that EMT and IV bags are probably too far down the "PITA" route........I still think that something like NOLS WFA for first responders is probably the cert/level of training that we should be pushing our GTMs to get.

ARC First Aid is probably just fine for UDF.


Also.....I think....just because I'm and old Boy Scout.......that ALL ES personnel should have basic first aid AND CPR to be GES qualified.
But that's just me.

[tsrup]

What would be the point of CAP starting IVs anyways?
Even if the member was an AEMT, Paramedic, Nurse, etc...

Not being a medic/EMT/Doctor/etc.....one would assume for some medically required condition.

The problem with IV administration in a CAP context is the fact that once we have an IV established, then what?

WE have no medical direction, no Doctor on the other end giving orders (verbal or through protocol) and willing to allow us to practice on his ticket which is essential for licensed personel to have in order to do these things.  In the absence of a medical director a Paramedic or Nurse is just able to give really good first aid (legally). 

In order for CAP to do this, CAP would either need to start staffing Doctors to write our protocol at a national level and accept responsibility and liability for every licensed or certified provider in CAP, or local units need to find Doctors willing to volunteer and provide medical direction at a smaller scale, but would have to be willing to accept the liability that goes along with that.  I'm not saying that the second scenario is impossible, but it sure is unlikely. 


IVs in CAP are a bad idea.  Administering medication in CAP is a bad idea.  Medication includes Normal Saline and even Oxygen.  Even the IV catheters themselves are not to be placed without a Physician's order (EMS gets around this by having a physician establish protocols dictating when administering an IV is appropriate).




I'm not trying to jump on you lordmonar, please understand that, you just brought up a very valid point that many laymen don't realize.

[tsrup]

So.....anyway......we have established that EMT and IV bags are probably too far down the "PITA" route........I still think that something like NOLS WFA for first responders is probably the cert/level of training that we should be pushing our GTMs to get.

This^^

[Luis R. Ramos]

I once worked as an orderly in an Emergency Room. Eleven pm to seven am.

One of the doctors there would order coffee and whenever we were out of sugar, would ask for a DW5 IV to sweeten the coffee. For those of you that do not know it, DW5 is 5 percent dextrose in water. Dextrose, a type of sugar...

And whenever I got sick, he suggested I could use a saline IV to gargle...

Flyer

[sarmed1]

What would be the point of CAP starting IVs anyways?
Even if the member was an AEMT, Paramedic, Nurse, etc...

Not being a medic/EMT/Doctor/etc.....one would assume for some medically required condition.

The problem with IV administration in a CAP context is the fact that once we have an IV established, then what?

WE have no medical direction, no Doctor on the other end giving orders (verbal or through protocol) and willing to allow us to practice on his ticket which is essential for licensed personel to have in order to do these things.  In the absence of a medical director a Paramedic or Nurse is just able to give really good first aid (legally). 

In order for CAP to do this, CAP would either need to start staffing Doctors to write our protocol at a national level and accept responsibility and liability for every licensed or certified provider in CAP, or local units need to find Doctors willing to volunteer and provide medical direction at a smaller scale, but would have to be willing to accept the liability that goes along with that.  I'm not saying that the second scenario is impossible, but it sure is unlikely. 


IVs in CAP are a bad idea.  Administering medication in CAP is a bad idea.  Medication includes Normal Saline and even Oxygen.  Even the IV catheters themselves are not to be placed without a Physician's order (EMS gets around this by having a physician establish protocols dictating when administering an IV is appropriate).




I'm not trying to jump on you lordmonar, please understand that, you just brought up a very valid point that many laymen don't realize.

I dont think anyone was advocating just running off and starting IV's like you would take a tylenol!?.... It would in a hypothetical world be one small part of an encompasing medical program of all of the things you mentioned and more......

Its a unrealistic pipe dream, individual EMS agencies have a difficult time managing all of the issues associated with the provision of adavanced level medical care;  CAP has difficulty managing the programs that it does now in a safe, consistant and compliant manner on the 2 hours a day/once a week sort of management plan.  In a carte blanche go forth and ALS folks type of system, the potential for oops is pretty high, and higher than I imagine the corporate "loose my home go to jail pay big fines" fearing folks are willing to risk.    If there was a way to make that work I think it would be a fantastic boon in certain situations, but until that happy medium is found I dont believe it will happen, and begrudgingly believe that might be a good thing.

The often referenced FEMA typing guide actually reccomended for type II search team a wilderness first responder level as the mecical component.  I think that would be a good standard to try and meet if you want to have a level II capable team (which is 32 people, in 4 8 person teams.... 4 TL/28 TM, 1 on each team must meet the WFR-medical specialist requirement)

Every member (and I'll concede GES type and up) should have a basic first aid training-thinking SABC type (and honestly there is no reason why that program couldnt be extended to cover CAP by the USAF)

mk

[Eclipse]

Every member (and I'll concede GES type and up)

I agree - First Aid, whatever CAP decides is appropriate, should be happening before GES is awarded, and I would argue as part of Level I and Curry.

I would argue that just as an increase in encampment participation requirements would increase the number of encampments required by each wing,
requiring First Aid as a part of basic membership would not only increase the general awareness and competence of the membership, it would also
force the training to be better defined and probably brought in-house.

[Ed Bos]

Every member (and I'll concede GES type and up)

I agree - First Aid, whatever CAP decides is appropriate, should be happening before GES is awarded, and I would argue as part of Level I and Curry.

I would argue that just as an increase in encampment participation requirements would increase the number of encampments required by each wing, requiring First Aid as a part of basic membership would not only increase the general awareness and competence of the membership, it would also force the training to be better defined and probably brought in-house.

This sounds like a good proposal to send up the Chain of Command in several Wings simultaneously.

Let's require a Basic First Aid/CPR/AED course for membership. Maybe something along the lines of "Must be completed within 6 months of membership." ... And Wing's could host the training twice annually.

If that was the case, we could remove the 1st aid requirement from the ES SQTRs, unless it was to add a requirement to keep it current.

[Eclipse]

Well, then the next question is, what happens if you don't get it?

Suspension? 

I suppose you could delay promotion until it's completed, but is that a reasonable expectation in the attrition-averse culture that is NHQ right now?
I'd have to concede that suspending someone in their first six months of membership isn't going to reduce churn.

At least if it could be done in-house, then yo would eliminate the cost and access excuse.