CAP and EMT's

[Ned]

I'm not sure you understand what a combat medic does. They are never the mission. They don't go out to provide care.

As a former mech infantry battalion XO, I have a vague idea of what all those guys in the medical platoon were doing.

Maybe it's perspective, but I'd say that the only reason they go out is to provide care.  That's kinda their whole reason to exist.  They lived, breathed, and ate combat medicine.  Trained incessently, and went out of their way to put what they learned into practice.  They were not just cross-trained infantry soldiers (like combat lifesavers), they were a stand-alone MOS.  IOW, medical stuff is pretty much all they do.

(Tip:  Never, ever, complain about being a little dizzy when standing up quickly during a hot summer FTX.  At least not near the medics who are desparate to practice their IV skills.  )

And they lugged a whole lot of equipment around the battlefield.  Not counting the battalion aid station, the medics assigned to the line companies had hundreds of pounds of gear.

So, I'm thinking that combat medic paradigm is a pretty poor fit for CAP, unless you are suggesting that we have dedicated medical personnel equipped and trained for major trauma.

[For example, in a Galveston-type environment] I need someone qualified & capable of taking care of us so that we can operate in that environment. That's just sound risk mgmt, which is why it's in the FEMA standards. You don't need it for UDF & you don't need it for 90% of missions. When you do need it though, you really need it.

In these types of scenarios, CAP is not operating in a vacuum.  The Galveston cops do not have organic medics.  They relied on the fire department or other providers.

Why are we different?  We can and should give first aid in emergencies while expecting the victim to be treated subsequently by a medical professional.

I've been a cadet programs officer almost my whole career, and I'll tell you flat out that half a dozen employees, scholarships, additional NCSAs, etc are all very very low priorities next to getting our act together on the ES side.

Strong statement of personal opinion noted.  But given that over half of our members work almost exclusively in CP, I'm not sure that your opinion is held by most members.

That's a misleading statement about retention. It's leveled back out now to where it was prior to 9/11. We took on a lot of people after that & lost most of them when they realized CAP doesn't do nearly as much as the charter says. And leveled out to absolutely unacceptable percentages. CAP's retention has always been horrible. That's chiefly because we over sell & under deliver. The over-sell part of that is a recruiting education issue. The under-deliver part is not. We need to start delivering.

Honestly, don't you think that conversations like this are part of the "over-sell."?

We really don't sell ourselves as a rescue force.  If rogue squadron members do that at the local level, then we deserve crappy retention figures.

Maybe the answer is not to over-sell in the first place rather than engage in mission creep to allow us to catch up to our sales pitch. Spacing - MIKE

[DNall]

You missed a key point in your diatribe below.  You did not give us a single name of a person we can use to verify your claims.

In other words it's still rumor.

If you have concrete knowlege that someone at FEMA or someone at your TAG who decided to exclude CAP because of a lack of NIMS compliance, just give me a name, a job title and a phone number.  I'll call 'em and have a chat.

If you can't do it, it's just rumor.  Sorry.  There are many possible reasons that your wing didn't get to do more.  The most common reason is that the decision maker didn't know what CAP could provide, not that they know CAP and decided that because of a lack of NIMS, they'd exclude us.

By the way, so far not a single person has provided a credible example of CAP being excluded for this reason.  And without evidence.......

The issue is not quote unquote NIMS compliance, it's not being qualified for the work, which is judged by FEMA resource typing standards, which are part of NIMS. It's not IC100-800 or lack thereof.

And who do you want to talk to?

I don't know who the overall federal (FEMA) IC in clear lake was. That was way above my pay grade. We weren't even informed that the place existed till the mission was 1/2 - 3/4ths over with. I found that out from CG when the guy at dist 8 tried to call back there looking for me on a referral we passed them. We weren't assigned any federal mission of consequence. The one major state mission we did was not life saving or critical response shaping. That stuff is supposed to be our bread & butter.

[DNall]

I'm not sure you understand what a combat medic does. They are never the mission. They don't go out to provide care.

As a former mech infantry battalion XO, I have a vague idea of what all those guys in the medical platoon were doing.

Maybe it's perspective, but I'd say that the only reason they go out is to provide care.  That's kinda their whole reason to exist.  They lived, breathed, and ate combat medicine.  Trained incessently, and went out of their way to put what they learned into practice.  They were not just cross-trained infantry soldiers (like combat lifesavers), they were a stand-alone MOS.  IOW, medical stuff is pretty much all they do.

So, I'm thinking that combat medic paradigm is a pretty poor fit for CAP, unless you are suggesting that we have dedicated medical personnel equipped and trained for major trauma.

And I'm not trying to insult your intelligence here, but I'm not remotely talking about a medical platoon either. I'm talking about a single light infantry squad or platoon medic. (Mech guys got a whole freakin medic track & all kinds of junk)

When that infantry Sqd/Plt goes outside the wire, it's not to support the combat medic (well in theory it could be, but again that's not what we're talking about). The mission is the infantry objective. Certainly the medic is there to provide care IF the need arises, which is exactly what I'm talking about. Just like the RTO is there for comm, but the mission isn't comm.

A type I/II team by definition is responding to incidents where it's not safe for them to go with just basic first aid. There is no (or very limited) existing EMS system that can back them up. They aren't going into areas to rescue anyone. They're in there turning off an ELT, taking damage photos, or rucking into the woods looking for missing a missing person or plane. BUT, if someone gets hurt or they encounter hurt people, and there's a good chance that'll happen, then there's no one else to turn to for help.

CAP's response in the past has been that we just won't do those missions, that we don't want to put volunteers at risk. No one in the field is happy with that answer.

You have to be able to stabilize - not field surgery or anything insane, just stabilize -  that person till you can get them help. That is exactly what first aid is. However, the level of medical care required to accomplish the same thing in that environment is higher - FEMA says EMT-B. I'm not sure if I absolutely agree with them, but I don't make that call, and they do decide who gets missions & who doesn't.

[For example, in a Galveston-type environment] I need someone qualified & capable of taking care of us so that we can operate in that environment. That's just sound risk mgmt, which is why it's in the FEMA standards. You don't need it for UDF & you don't need it for 90% of missions. When you do need it though, you really need it.

In these types of scenarios, CAP is not operating in a vacuum.  The Galveston cops do not have organic medics.  They relied on the fire department or other providers.

Why are we different?  We can and should give first aid in emergencies while expecting the victim to be treated subsequently by a medical professional.

What Galveston Cops? What fire dept? The local depts were wiped off the earth. DPS held the bridge. There was no fire or EMS service on the island for quite a while. It was a 90min trip on/off the island at times. Literally the only medical service would have been getting our highbird to call DPS & request a lifeflight or Coast Guard helo. That would be at least an hour delay & require us to move the patient to an LZ.

After about a week I could put them in the van & move them to the airport on the island where there was a guard security detachment that sometimes had a medic with them. By that time though we were into more of a type III or maybe low type II environment. Type I is operating in a vacuum.

Yes we can & should give first aid while relying on EMS providers to provide subsequent care. I'm in absolute agreement with that. The issue is, in certain environments like my couple examples, the level of care necessary to bridge to that subsequent care is greater than first aid. Again, FEMA says it rises to EMT-B. That may or may not be slightly overkill, but it's not my call.

I've been a cadet programs officer almost my whole career, and I'll tell you flat out that half a dozen employees, scholarships, additional NCSAs, etc are all very very low priorities next to getting our act together on the ES side.

Strong statement of personal opinion noted.  But given that over half of our members work almost exclusively in CP, I'm not sure that your opinion is held by most members.

While I appreciate the hard work our staffers at NHQ do, I doubt VERY seriously most members have any idea how many work in CP, what impact 1 or 6 or 20 more in that shop would make, and I can about assure you that they'd vote for any of a hundred other priorities before additional staff. Obviously any unit out here in the field could do huge things with just a few grand. And the total national budget for CAP is a whole lot of millions every year.

That's a misleading statement about retention. It's leveled back out now to where it was prior to 9/11. We took on a lot of people after that & lost most of them when they realized CAP doesn't do nearly as much as the charter says. And leveled out to absolutely unacceptable percentages. CAP's retention has always been horrible. That's chiefly because we over sell & under deliver. The over-sell part of that is a recruiting education issue. The under-deliver part is not. We need to start delivering.

Honestly, don't you think that conversations like this are part of the "over-sell."?

We really don't sell ourselves as a rescue force.  If rogue squadron members do that at the local level, then we deserve crappy retention figures.

Maybe the answer is not to over-sell in the first place rather than engage in mission creep to allow us to catch up to our sales pitch.

We've ALWAYS sold ourselves as a SaR organization. And for a really long pert of our history we did actually attempt to make good on the rescue part of that too. I don't think we were ever qualified to do that, but it did happen. Now, standards are more tightly controlled & all we do is search.

Look, I don't care about finding non-distress ELTs. I don't care very much about finding downed planes with dead people in them. I don't care about taking pictures of damage for some academic study down the road. I don't care about running shelters or filling sand bags or handing out food/water. I train for ES so I can maybe someday save someone's life. Anybody that has anything to do with ES is here for that reason. Saving lives involves more than search.

[Dragoon]

You missed a key point in your diatribe below.  You did not give us a single name of a person we can use to verify your claims.

In other words it's still rumor.

If you have concrete knowlege that someone at FEMA or someone at your TAG who decided to exclude CAP because of a lack of NIMS compliance, just give me a name, a job title and a phone number.  I'll call 'em and have a chat.

If you can't do it, it's just rumor.  Sorry.  There are many possible reasons that your wing didn't get to do more.  The most common reason is that the decision maker didn't know what CAP could provide, not that they know CAP and decided that because of a lack of NIMS, they'd exclude us.

By the way, so far not a single person has provided a credible example of CAP being excluded for this reason.  And without evidence.......

The issue is not quote unquote NIMS compliance, it's not being qualified for the work, which is judged by FEMA resource typing standards, which are part of NIMS. It's not IC100-800 or lack thereof.

And who do you want to talk to?

I don't know who the overall federal (FEMA) IC in clear lake was. That was way above my pay grade. We weren't even informed that the place existed till the mission was 1/2 - 3/4ths over with. I found that out from CG when the guy at dist 8 tried to call back there looking for me on a referral we passed them. We weren't assigned any federal mission of consequence. The one major state mission we did was not life saving or critical response shaping. That stuff is supposed to be our bread & butter.

In other words, you know that you didn't get called out  but you have no first hand knowledge as to why.

This makes the rest just conjecture.

Again, it may be as simple as the guys doing the call outs didn't have a current phone roster.  Or never had a CAP guy explain what CAP could do for them.  In fact, these are the two most common reasons we don't get called for DR work.

Unless you know why, it's hard to know what needs fixing.

Here's your quote

It's only within the last decade that we've let legal issues change that, and in doing so have given up significant capabilities, that because of major changes in the larger SaR sector (mostly NIMS driven) that's lost us significant reputation & mission taskings.

All I'm asking for is for you to back up this bold assertion with facts.  Tell me how lack of NIMS has lost us missions.  Give me a name of someone who you  know for a fact could have called us out but didn't  because of lack of NIMS.

I know you THINK that this is why, but I really don't see any hard evidence to back this up.

[RiverAux]

Incidentally, up until very recently you had to have "Advanced First Aid" to be a Ground Team Leader.  They never really defined that in the regulations, but there was some sort of handout from NHQ saying that it meant a 40 hour first aid course --- which would basically mean the First Responder course.  We've dropped that now and I tend to agree that it is asking a bit much for every GTL to be a First Responder, but that certification, or something similar should be part of the program. 

[Ned]

And I'm not trying to insult your intelligence here, but I'm not remotely talking about a medical platoon either. I'm talking about a single light infantry squad or platoon medic. (Mech guys got a whole freakin medic track & all kinds of junk)

As I said I suspect this is just a matter of perspective.

I can only agree that the infantry unit's objective is normally some warfighting task.

But I suspect you'd agree that the medic's sole supporting mission is to render aid as needed.

A type I/II team by definition is responding to incidents where it's not safe for them to go with just basic first aid. There is no (or very limited) existing EMS system that can back them up. They aren't going into areas to rescue anyone. They're in there turning off an ELT, taking damage photos, or rucking into the woods looking for missing a missing person or plane. BUT, if someone gets hurt or they encounter hurt people, and there's a good chance that'll happen, then there's no one else to turn to for help.

Dennis, the whole point of the OP was that FEMA wants a FR or better on teams. 

As others have pointed out, there is no CAP regulation that would prohibit or even discourage us from having a FR or better on our teams.

The only restriction is that CAP HSOs are restricted in the kind of care they can give.

But they can certainly be on the teams.  As a practical matter, I suspect they should be cross trained in other specialties.  Kinda like SF guys.

CAP's response in the past has been that we just won't do those missions, that we don't want to put volunteers at risk. No one in the field is happy with that answer.

CAP is clearly always going to decline missions that are too risky for our teams after consideration of the team's experience, training, and equipment. 

That's just common sense and ORM.

And good leadership.

Look, I don't care about finding non-distress ELTs. I don't care very much about finding downed planes with dead people in them. I don't care about taking pictures of damage for some academic study down the road. I don't care about running shelters or filling sand bags or handing out food/water. I train for ES so I can maybe someday save someone's life. Anybody that has anything to do with ES is here for that reason. Saving lives involves more than search.

Absolutely.  But contrary to your assertiions, sometimes saving lives does indeed involve running shelters, filling sand bags, and handing out food/water.

It is important and worthy work.  We are privileged to perform it when needed and requested.


But that critically important work isn't as flashy or fun as pulling victims out of collapsed buildings.

[PHall]

Look, I don't care about finding non-distress ELTs. I don't care very much about finding downed planes with dead people in them. I don't care about taking pictures of damage for some academic study down the road. I don't care about running shelters or filling sand bags or handing out food/water. I train for ES so I can maybe someday save someone's life. Anybody that has anything to do with ES is here for that reason. Saving lives involves more than search.

Then I think you may be in the wrong organization. You want to do RESCUE, then you may want to join a SEARCH and RESCUE TEAM.
Because CAP is neither trained or equipped for that mission.

[isuhawkeye]

Maybe he was recruited into cap based upon the idea that CAP does Search and Rescue


http://www.cap.gov/visitors/about/our_programs/operations.cfm
http://level2.cap.gov/index.cfm?nodeID=5243
http://www.af.mil/news/story.asp?id=123116954
http://www.pawingcap.com/hawk/

If CAP doesnt do search and rescue, then someone should tell these people ^^^

[sarmed1]

As we have hashed out in many (many) previous discussions.  It doesnt matter if you are an EMT (B, I or P) it depends how your state defines your scope of practice at your certification level, more specifically what you are allowed to do at that level of certification and more over under whose license you are performing that skill. 

For example: as a paramedic I dont carry a drug box and cardiac monitor in my car, I just cant stop on the side of the road and start and  IV and intubate someone just because I am a paramedic.  I have to be operating under the direction (off line or on line) of a medical command physician, more specifically the Medical Director of the service I am working for.  Even as a volunteer firefighter, my department provides first responder level care only, I cant operate as a paramedic (performing ALS skills) because we are not licensed to or have the equipment or the insurance to cover that.  Now that is specifically how Pennsylvania works currently, most other states are some what similar.  The EMT level here is pretty much the same (though the skill set is smaller)

How does this relate to CAP SAR capability and NIMS?
It may be assumed that there is a certain "skill set" that is expected of an EMT (remember that this too varies from state to state so a "Federal" document assumes the DOT standard I guess) but no where in the original or revised FEMA standard does it state what equipment or skill set it expects the EMT/ WFR to have/perform. Might say BLS equipment which is: splinting, bandaging and basic airway,  Oxygen and AED may fall into that but remeber in most states AED use is a lay persone skill and so is oxygen in some places (honestly you cant carry enough oxygen to be effective for the length of time it takes to do a wilderness rescue anyway nor is the AED going to be commonly effective in the same enviropnment....CPR for 2 plus hours is going to be counterproductive)

So really, you can have an EMT/WFR on your team and meet the standard, the only "problem" is that they may not be able to perform to the full extent of their level of trianig due to CAP's restrictions....(which I have even had as an ALS provider....I was a paramedic at a FD in Texas that the medical directer limited our range of drugs because we were only a first responder service) but you still meet the standard of an EMT/WFR on your team.  Either way the real restriction applies to "routine" care; providing EMT level care in an emergency is within the letter of CAP's "restrictive" regulation.
(as quoted above)

personally I think that solves the FEMA/NIMS issue.   
Now on a seperate issue, the area I would like to see clarification on is if CAP HS personnel are covered under by the USAF on AFM.  Since it seems that most other liability issues fall under USAF for AFM why wouldnt medical liability and malpractice?  The issues I see with that are multifold: 2ish really stand out: 
Firstly as a USAF enlisted medical guy I have a folder of like what seems like 1000 tasks that I have to demonstrate knowledge and competency in (some 1 time some 20 month re-occuring) to be current an qualified and I know that RN's, PA's and MD's have similar requirements.  I see that (or something similar)  being a core requirement of the AF if they are going to assume the risk of CAP's HSO acting on the USAF behalf to render medical care (routine or emergency), and I see that as a difficult one (my current and every reserve unit I have been in always gets dinged on their inspections for these folders being messed up, out of date or not there entirely) 
Secondly, similar to the NG this protection would only apply to CAP while on AFM status...(when I was in the NG, we could only perform medic skills...IV, drugs etc....if we were on Federal Status...ie annual tour or activation) So all of the weekly meetings, weekend activites, NCSA, encampments etc that HSO's support would still be not covered.  So like Ned pointed out the benefit would only apply to a small percentage of CAP's folks....and I am sure the other 2/3 of the folks would still be upset because their "hands are tied"

mk

[Dragoon]

Maybe he was recruited into cap based upon the idea that CAP does Search and Rescue


http://www.cap.gov/visitors/about/our_programs/operations.cfm
http://level2.cap.gov/index.cfm?nodeID=5243
http://www.af.mil/news/story.asp?id=123116954
http://www.pawingcap.com/hawk/

If CAP doesnt do search and rescue, then someone should tell these people ^^^

It's true - we do primarily "S" not "SAR."  It's been that way for some time, and by that I mean a whole bunch of decades.

We CONTRIBUTE to "SAR" by doing "S".  I'd agree that more straightforward advertising would make mroe sense.

[RiverAux]

Folks, "Rescue" does not always equal "provide medical care". 

[Eclipse]

Folks, "Rescue" does not always equal "provide medical care". 

Double ditto - just one part of the team.

[Dragoon]

Folks, "Rescue" does not always equal "provide medical care". 

Absolutly true - but we also don't do a heck of a lot of rescue either.  Not only are we lacking medical assets, we also don't invest in extraction stuff.  Not that there's anything wrong with that - but when you say "We do Search and Rescue" to someone you know that the image you just put in their head doesn't match what CAP really does.

[RiverAux]

Yeah, we really wasted our time looking for and finding those 90 people last fiscal year.  Why even bother.

[DNall]

Again, it may be as simple as the guys doing the call outs didn't have a current phone roster.  Or never had a CAP guy explain what CAP could do for them.  In fact, these are the two most common reasons we don't get called for DR work.

There is ALWAYS an AFRes liaison from 1AF (not CAP-USAF) in that ICP. Always has been since well before there was a 1AF or anything remotely like NIMS. That person is very knowledgeable about CAP & our full capabilities, as well as everything the AF has to offer. They advise that IC staff of those capabilities, and coordinate requests to 1AF (who is the overall air commander for federal response anyway).

Could we do a better job of selling those officers on selling CAP in those situations? Sure, and we should. But, their job is plug the right resource into the right job, regardless of cost.

Now, no I'm certainly not in a position to be a fly on the wall during that process. I can't tell you if 1AF believes we are not qualified to do the kind of response needed on the ground, or if 1AF is offering & FEMA isn't buying because they don't believe we're either capable at all or at least the most capable resource they have in the tool box. I would guess it's a healthy combination of the two.

If you want to say the answer is marketing... well, okay to a certain extent that's true, but that's really just hype. I think it's reasonable to also say we can & should bump up our capabilities to become a more competitive resource - to make ourselves more marketable.

I don't think we can hide our head in the sand & say we're good enough, that we don't need to train to these higher standards cause it's too hard; and that the answer is all on the national marketing level. To me that's just passing the buck. If we do that & it turns out very successful, aren't we just going to find ourselves in situations we're not prepared for?

What I got taught was dress for the job you want - train to the industry standard for the level of work you want to do, THEN market that capability. When billions of dollars are being spent on a response, the difference between 150/hr and 1,000 isn't a factor. Being the cheapest way to get a passable job done on limited things isn't going to be enough.

I don't think the sky is falling by any means. But, I do very strongly believe in "excellence in all we do." Resting on our laurels isn't acceptable. Seeing in this situation a challenge we can overcome & become great by that process... that's where the vision of this org needs to be.

It's only within the last decade that we've let legal issues change that, and in doing so have given up significant capabilities, that because of major changes in the larger SaR sector (mostly NIMS driven) that's lost us significant reputation & mission taskings.

All I'm asking for is for you to back up this bold assertion with facts.  Tell me how lack of NIMS has lost us missions.  Give me a name of someone who you  know for a fact could have called us out but didn't  because of lack of NIMS.

I know you THINK that this is why, but I really don't see any hard evidence to back this up.

NIMS as a black & white standard isn't the key. Being competent, and seen as competent, is.

I came into CAP in 94. For the first 5 years, we were heavily involved in multi-agency large scale operations where we were treated and tasked as equals by agencies like Coast Guard & FEMA. I deployed out as a GTL & MO on many many of those missions doing all the sorts of things you now see professional agencies out there doing.

Since becoming active again in ES things have been significantly different. Since about 2003/4 in particular, CAP ES has been a very small shadow of what we were previously being tasked with.

I have worked with CG & FEMA since that time, and it's not remotely the same. I don't think we've changed significantly, but I do think they have. And they're the big players that we have to adapt to. We haven't been doing that. In some respects for legal reasons, but for the large part it's because it'd be hard & leadership didn't have a vision or drive to do it. I don't think that works. I don't think that's acceptable going into the future. I think we have to drive forward and set an example, not wait it out & lemming along behind hoping to pick up some bread crumbs here & there.

PS - I can slide in some more cliches if you think it'd help.

[DNall]

I can only agree that the infantry unit's objective is normally some warfighting task.

But I suspect you'd agree that the medic's sole supporting mission is to render aid as needed.

Absolutely.... and the role of an MRO on a GT is what? To run the radio right? Is that the GT mission, to go out into the field & run comms? Absolutely not. It's a support task necessary to complete the overall objective.

So what role does a GTM with first aid have on a GT? Be a GTM & render aid as needed, right?

So what if you're putting that GT out to do the same GT missions we do now (mostly find ELTs & take damage pictures), but you're putting them in an environment where first aid isn't going to be adequate medical support for them to accomplish the mission & there are NOT available outside resources to back them up?

That is what a type I incident is. That was the situation on Galveston Island for over a week, and longer then that on Bolivar Peninsula.

As I said, no one is arguing to operate EMS or set up some kind of field hospital. That's first of all nuts, and second of all what DMAT is there for. What I am saying is our very tip of the spear units, organized on a wing or even region level, should be able to respond into those more challenging circumstances. Right now that is not the case.

Dennis, the whole point of the OP was that FEMA wants a FR or better on teams. 

As others have pointed out, there is no CAP regulation that would prohibit or even discourage us from having a FR or better on our teams.

The only restriction is that CAP HSOs are restricted in the kind of care they can give.

But they can certainly be on the teams.  As a practical matter, I suspect they should be cross trained in other specialties.  Kinda like SF guys.

If you defer the liability to the responder, and don't provide them a designated or required role, why are they going to put themselves in that situation? If we don't have them but by chance & against the odds, then we can't field teams that meet the standard, so we don't have the capability.

CAP's response in the past has been that we just won't do those missions, that we don't want to put volunteers at risk. No one in the field is happy with that answer.

CAP is clearly always going to decline missions that are too risky for our teams after consideration of the team's experience, training, and equipment. 

That's just common sense and ORM.

And good leadership.[/quote]
Yes it is good ORM/leadership. However, if you change the experience, training, equipment factors prior to the engagement, don't you then change the decision to engage or not?

Look, I don't care about finding non-distress ELTs. I don't care very much about finding downed planes with dead people in them. I don't care about taking pictures of damage for some academic study down the road. I don't care about running shelters or filling sand bags or handing out food/water. I train for ES so I can maybe someday save someone's life. Anybody that has anything to do with ES is here for that reason. Saving lives involves more than search.

Absolutely.  But contrary to your assertiions, sometimes saving lives does indeed involve running shelters, filling sand bags, and handing out food/water.

It is important and worthy work.  We are privileged to perform it when needed and requested.

But that critically important work isn't as flashy or fun as pulling victims out of collapsed buildings.

It is important and worthy in the same way the finance guy back here at home makes sure I get paid when I'm downrange in contact. It's not what you engage highly trained, experienced, line personnel to do. That's a huge waste of resources.

You were an infantry officer with PL & CO time. I don't know if you ever had to do a rotation as S1 or 4 or anything like that, but I'm sure you know fellow officers that did. When that's a quality line officer in that role. You know darn well how they feel about it.

That's how I and a lot of my experienced operators feel about the state of high level ES in CAP right now. It's frustrating, and it drives those best people away, which just hurts our capability even more.

I'm not saying a 13yo cadet needs to be able to go into hell with me, they certainly do not need to be there. But, there's some people around here that can & should be there, and CAP as an org should be there doing what we've always done, and what we say we can do.

I'm sorry if people see that as pessimism. It's not! It's an optimistic vision about what we can and should be if we're willing to earn it. I want to be part of that solution, my operators want to be part of that solution, what we need is the national organization to take up that challenge and drive forward.

[RiverAux]

I think some good points have been made in regards to varying standards for EMTs across the country and their licensing requirements and incorporating them into CAP's GSAR mission may not be feasible. 

Instead, I believe that the First Responder training might be more appropriate to have for our teams.  I'm familiar with the regular Red Cross First Responder course (actually called Emergency Response), which is 40-50 hours, but not the Wildnerness First Responder course referenced earlier on in this thread. 

According to the web, there are several organizations that teach this course, which is about 80 hours and conforms to standards of the Wilderness Medical Society.  I've looked at the topics covered and am not seeing a lot of bang for the buck in terms of comparing what you learn in the regular course vs the wilderness course, so I'm not convinced that the trade-off in terms ofa 2-week vs 1-week course is worth it. 

[SARMedTech]

So, is this a NIMS resource typing question, or a thread about medical directors for EMS providers.  Either way we have hashed both issues to death many many times

We have??

This topis relates to CAP and EMT's on the teams.  Is there a time where we can deliver aid in the field to our targets, or are we opening our selves to lawsuits?

That is the major reason there is not a program for HSOs to progress through. Read CAPR 160-1 for more details.

Does Good Sam laws relate to EMT's?

Varies from state to state. Check with your wing HSO or Legal Officer.

Also I don't understand where I was in-correct.  My statement was about needing EMT's or FR or higher to be type I certified.  Thats what NIMS states in your link as well.  Can you elaborate where I am wrong?

A Type I team requires EMT, ACLS, BTLS, not FR. A Type II team requires EMT or Wilderness First Responder. which is a specific skill set not covered in the generic First Responder certification.

As for elaboration,

So in the world of NIMS and MINS compliance we need a FR or higher on our ground teams to act as a Type I Team.

FR doesn't cut it for Type I teams.

Couple of problems here:

1. BTLS is no longer called BTLS. It has been changed to ITLS or International Trauma Life Support. Its semantics by the company that basically holds the monopoly but it behooves us in such conversations to get our terminology straight.

2. If an EMT (meaning an EMT-B) is required for a Type I team, the ACLS does not come into play. ACLS involves the use of not only synchronized defibrilation (a technique not generally allowed for use by Basics), it also involves the use of cardio-verting drugs, which are definitely out of bounds for basics, unless your state considers ASA a cardioverter and allows its administration by Basics.

[SARMedTech]

I think you are misunderstanding what is meant by that phrase.  To me that says we don't sell ourselves as an emergency ambulance service that will come to your house when you have a heart attack or go to motor vehicle accidents. 

It specifically allows for care to be given within the skill level of the person giving it.  It doesn't restrict that skill level in any way.  If they didn't want a CAP member who was an EMT giving an EMT level of care to someone that needed it in order to survive, they could have easily said so by specifically restricting CAP from doing anything beyond the level of basic first aid. 

Having an EMT or first responder on your ground team doesn't somehow magically transform it into some sort of rogue team not sanctioned by CAP. 

Telling the county sheriff that you have an EMT on your team doesn't make you a paramedic organization.  What it means is that if we find the target and they need care to save their life, we have an EMT that could provide that care up to the level of their training if no other medical care is available. 

WRONG, WRONG, WRONGITY WRONG!

You do not understand, apparently, regardless of how many times this conversation is had, that EMT-Bs or Paramedics cannot, under CAP regulations (not to mention insurance and medical direction issues) operate to their full level of training. I'll give you some examples:

I can, in the state of IL, as an EMT place a combitube to maintain a patent airway. Given that all EMTs operate as surrogates under the medical license of a medical director/physician, absent that regulated medical director being part of CAP and providing either direct (on scene) or indirect (off scene by phone, radio, etc) medical control, I as an EMT cannot drop that combi into an airway.

An EMT-B is allowed to administer oxygen under standing medical orders. Medical oxygen is considered a drug. Given that CAP has no standing medical orders or medical control, no CAP EMT can give oxygen. Sounds silly, but its the law. The standing order must be in place. There is a tendency to think that because its air, no medical control or orders, standing or otherwise, are needed. That assumption is incorrect.

An EMT-P can perform a crycho-thyrotomoy (surgical airway).  Wanna see what would happen if a CAP paramedic did this? Wanna try for decompression of a tensioned lung?

The fact remains that i have seen CAP Basics and Paramedics hauling around STOMP packs with oxygen cylinders, syringes, airways of all sorts, scalpels, etc. What exactly are you going to do with that stuff?  You'd be better off to throw it to a non EMS CAPster and let them do something under good samaritan laws than you would be to do it yourself. Seriously. Just because you are an EMT or Paramedic and good samaritan laws do, to an extent, cover EMS personnel off duty (which they are when they are in the field with CAP...an on duty EMT of any level is only "on duty" when on the clock with the service that pays him/her or with which he/she volunteers) a CAP EMT of any level doing the things that they could do in the field or in the ambulance of the agency they work for (ie non-CAP) on a CAP mission or SAR-X is going to be sued until they dont have two nickels to rub together and will never hold a medical license anywhere ever again. I have seen CAP EMTs carrying around oral and nasal pharyngeal airways?  What are you going to do with that?  That is an invasive medical procedure.

No, having an EMT of any level doesnt make your team a rogue. But having an EMT performing up to his/her level of skill and license without direct or indirect medical control makes that EMT a rogue and you can bet your brass buttons that he will get his head handed to him when the spit hits the spam, and so will the CC, National and just about everyone associated with CAP or at least that CAP team.

RiverAux-

it surprises me after all this time that A) you misread these regulations so severely and B) that you dont know that what CAP wants is EMTs and paramedics to be taking risks with their licenses and livelihoods in the field with absolutely no backup (legally) of any kind at the wing, region or national level.

[SARMedTech]

I think some good points have been made in regards to varying standards for EMTs across the country and their licensing requirements and incorporating them into CAP's GSAR mission may not be feasible. 

Instead, I believe that the First Responder training might be more appropriate to have for our teams.  I'm familiar with the regular Red Cross First Responder course (actually called Emergency Response), which is 40-50 hours, but not the Wildnerness First Responder course referenced earlier on in this thread. 

According to the web, there are several organizations that teach this course, which is about 80 hours and conforms to standards of the Wilderness Medical Society.  I've looked at the topics covered and am not seeing a lot of bang for the buck in terms of comparing what you learn in the regular course vs the wilderness course, so I'm not convinced that the trade-off in terms ofa 2-week vs 1-week course is worth it. 

The difference between MFRs and WMFRs lies not so much in what they are taught, but where they are taught to do it. Wildnerness Medical First Responders are trained to provide stabilizing first aide and evacuation in austere, remote and wilderness environments.