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USE OF EMT's

Started by Dutchboy, July 16, 2009, 08:36:52 AM

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JayT

Quote from: arajca on July 20, 2009, 02:35:34 AM
I advise you contact your wing legal officer, if this involves CAP.

Something I have seen a SOME Good Sam laws is a provision to provide care up to your level of TRAINING, not CERTIFICATION. In theory, if you've been a paramedic, but have let your cert slip, you would still be expected to perform up to the paramedic level, taking into account the equipment/situation, if you decide to help.

That's a really dicey area. Using that logic of the law, why bother recerting at all? Just keep showing up and saying "I'm still trained, and it just so happens I have a larygoscope, an ATV, and a size seven ET tube here!"

A lot of the stuff that EMT-B level isn't really that far beyond first aid, which is why I would be curious what he's carrying in that bag that's causing such an issue. It's only when you get into some of the more advanced EMT-B skills that I would see could cause a legal headache (Eppie pens, Albuterol, ASA, glucose, Activated Charcoal, Combitube/King AW and the like.)

"Eagerness and thrill seeking in others' misery is psychologically corrosive, and is also rampant in EMS. It's a natural danger of the job. It will be something to keep under control, something to fight against."

arajca

That's why the FIRST line is to contact the wing legal officer.

I do agree that the training vs cert issue is problematic, although I have only seen it in SOME Good Sam laws. If you are a professional (paid or volunteer), you still need to maintain the cert.

Eclipse

#22
IANAL, but have had to address this issue repeatedly for encampments and other large activities.

If your medical plan is to call 9-1-1 for anything beyond a blister or bruise, someone has a grabber, and
an EMT who happens to be a staffer performs life-saving care on that person (while waiting for the pros) within their training, you're probably going to be fine.

However, if your medical plan includes things like "medical flights", "triage facilities" and/or has cadets running around with stethoscopes or some of the other nonsense that we see go on in some CAP activities, and you delay professional care while a CAP person diagnoses the same heart attack, or worse, decides that situation is just gas and sends the member back to work, you're on less than thin ice if they die or are permanently disabled.

In 99% of the cases, any activity that is so remote as to require a medical staff needs to be reconsidered.  Any activity where CAP is acting as the medical staff for an outside party or the general public (i.e. airshows, etc.) is a violation of regulations.

This is what needs to be explained to the member in question.  If they choose to disengage, so be it, at least they won't lose their house trying to help someone, and if providing medical care is why they joined CAP, they are wasting their time anyway.

"That Others May Zoom"

Lt Oliv

Quote from: Eclipse on July 20, 2009, 02:55:27 PM
This is what needs to be explained to the member in question.  If they choose to disengage, so be it, at least they won't lose their house trying to help someone, and if providing medical care is why they joined CAP, they are wasting their time anyway.

Well put.  There are plenty of volunteer fire departments that I'm sure would LOVE to pay for him to recert and have him carry around his bag for them. 

I have seen too many EMTs (current and former) who are chomping at the bit to do something heroic. I'm afraid to cough near them because they might jam a pen in my trachea.  If you have the skills and someone right then and there requires immediate medical attention, your guy can be a great resource.  But if he thinks he's setting up his own little MASH unit on encampment, you might be better off without him in the long run.

EDIT:  I also saw a mention of an eppie pen.  Is there any legal requirement for someone to be carrying those?  I've heard of school teachers having them on hand if they have a kid with a known allergy.  Always sounded like kind of a gray area to me.

Major Lord

I think the real issue is whether the CAP member is operating outside of his scope of practice. In my State, an EMT-B can't do anything beyond what a private citizen can do, although they are specifically trained in a number of tasks outside the normal first aid realm ( The mostly-outdated MAST trousers, administering oxygen, shutting off IV's, traction splints,  etc) If your guy is practicing medicine" in CAP, the problem is probaly not his certification, but his sanity. You can tell him though that there is no EMT badge for him he is not currently certified in the State in which  he is a member. If he is carrying a sternal saw or a bunch of morphine is his jump kit, you need to send the problem up the chain of command. If he maintains a well stocked jump kit, I say "good for him!"  There are some medical supplies that although he may never use, if he ( or a higher-quaified medical professional needs) when the merde' hits the ventilateur, it could save your life. Like a pistol, there are some things you don't need until you need badly.

Major Lord
"The path of the righteous man is beset on all sides by the iniquities of the selfish and the tyranny of evil men. Blessed is he, who in the name of charity and good will, shepherds the weak through the valley of darkness, for he is truly his brother's keeper and the finder of lost children. And I will strike down upon thee with great vengeance and furious anger those who would attempt to poison and destroy my brothers. And you will know my name is the Lord when I lay my vengeance upon thee."

RiverAux

mess, are you going to clarify whether or not this is a CAP issue?  Your first post wasn't clear about that. 

Dutchboy

Sir, I just figured this was a CAP related site and it would be thought of as a CAP issue. Yes it is a CAP ISSUE

Dutchboy

They also have had in the past dispensed over the counter drugs to a cadet from what I have heard. I always thought that was a no no. Is it a no no?  if the member had their kid join, would they be able to administer Over the counter drugs to their son that is a cadet?

CadetProgramGuy

Quote from: messofficer on July 21, 2009, 05:34:24 AM
They also have had in the past dispensed over the counter drugs to a cadet from what I have heard. I always thought that was a no no. Is it a no no?  if the member had their kid join, would they be able to administer Over the counter drugs to their son that is a cadet?

OTC drugs needs parental permission.  Otherwise would be opening up to liability issues.

JayT

Quote from: messofficer on July 21, 2009, 05:34:24 AM
They also have had in the past dispensed over the counter drugs to a cadet from what I have heard. I always thought that was a no no. Is it a no no?  if the member had their kid join, would they be able to administer Over the counter drugs to their son that is a cadet?

That's a big big big no no, unless it's a Parent/Child relationship.
"Eagerness and thrill seeking in others' misery is psychologically corrosive, and is also rampant in EMS. It's a natural danger of the job. It will be something to keep under control, something to fight against."

Eclipse

Quote from: JThemann on July 21, 2009, 12:37:29 PM
Quote from: messofficer on July 21, 2009, 05:34:24 AM
They also have had in the past dispensed over the counter drugs to a cadet from what I have heard. I always thought that was a no no. Is it a no no?  if the member had their kid join, would they be able to administer Over the counter drugs to their son that is a cadet?

That's a big big big no no, unless it's a Parent/Child relationship.

Roger that times 2.

In no case does CAP prescribe or dispense.  Even in cases where meds are being secured by staff during encampments and similar activities, that staff is simply securing the drugs from being abused, and facilitating / confirming the cadet is taking them per the dosage indicated on the container.

In those cases there is no requirement the person doing the facilitation is even a medical professional.

"That Others May Zoom"

John Bryan

Quote from: Ollie on July 20, 2009, 04:18:04 PM
Quote from: Eclipse on July 20, 2009, 02:55:27 PM
This is what needs to be explained to the member in question.  If they choose to disengage, so be it, at least they won't lose their house trying to help someone, and if providing medical care is why they joined CAP, they are wasting their time anyway.

Well put.  There are plenty of volunteer fire departments that I'm sure would LOVE to pay for him to recert and have him carry around his bag for them. 

I have seen too many EMTs (current and former) who are chomping at the bit to do something heroic. I'm afraid to cough near them because they might jam a pen in my trachea.  If you have the skills and someone right then and there requires immediate medical attention, your guy can be a great resource.  But if he thinks he's setting up his own little MASH unit on encampment, you might be better off without him in the long run.

EDIT:  I also saw a mention of an eppie pen.  Is there any legal requirement for someone to be carrying those?  I've heard of school teachers having them on hand if they have a kid with a known allergy.  Always sounded like kind of a gray area to me.


1. Helping someone administer their own epi pen and inhaler is now a basic first aid skill taught by the American Red Cross.

2. How is this topic about safety...seems this is a legal debate

3. CAP's fear to use medical folks is interesting. What about Medical Units under the Logistics section in ICS????  CAP has directed us to follow NIMS and yet we don't provide this support to our members at large missions/events.

N Harmon

Quote from: John Bryan on July 21, 2009, 07:23:33 PM
What about Medical Units under the Logistics section in ICS????  CAP has directed us to follow NIMS and yet we don't provide this support to our members at large missions/events.

Following NIMS doesn't mean we have to contribute every type of unit, just that we know where we fit in the ICS and type our resources appropriately.
NATHAN A. HARMON, Capt, CAP
Monroe Composite Squadron

davidsinn

Quote from: John Bryan on July 21, 2009, 07:23:33 PM
Quote from: Ollie on July 20, 2009, 04:18:04 PM
Quote from: Eclipse on July 20, 2009, 02:55:27 PM
This is what needs to be explained to the member in question.  If they choose to disengage, so be it, at least they won't lose their house trying to help someone, and if providing medical care is why they joined CAP, they are wasting their time anyway.

Well put.  There are plenty of volunteer fire departments that I'm sure would LOVE to pay for him to recert and have him carry around his bag for them. 

I have seen too many EMTs (current and former) who are chomping at the bit to do something heroic. I'm afraid to cough near them because they might jam a pen in my trachea.  If you have the skills and someone right then and there requires immediate medical attention, your guy can be a great resource.  But if he thinks he's setting up his own little MASH unit on encampment, you might be better off without him in the long run.

EDIT:  I also saw a mention of an eppie pen.  Is there any legal requirement for someone to be carrying those?  I've heard of school teachers having them on hand if they have a kid with a known allergy.  Always sounded like kind of a gray area to me.


1. Helping someone administer their own epi pen and inhaler is now a basic first aid skill taught by the American Red Cross.

2. How is this topic about safety...seems this is a legal debate

3. CAP's fear to use medical folks is interesting. What about Medical Units under the Logistics section in ICS????  CAP has directed us to follow NIMS and yet we don't provide this support to our members at large missions/events.

I took the ARC course with you and you did teach us to use epi pens. But when I got to RST for GLRSE, Eclipse told us that if we were to stick someone with an epi pen we were violating IL law.
Former CAP Captain
David Sinn

Thom

Quote from: davidsinn on July 21, 2009, 07:53:26 PM
I took the ARC course with you and you did teach us to use epi pens. But when I got to RST for GLRSE, Eclipse told us that if we were to stick someone with an epi pen we were violating IL law.

And, there you have the crux of the problem.

Another poster above (I'm sorry, I'm not going to try and untangle that nested mass of quotes...) said that this was sounding more like a LEGAL issue now than a SAFETY issue.  Unfortunately, it is both.

CAP tries to implement SAFETY to protect our Members and Resources, and hopefully accomplish the Mission.  Part of Safety is utilizing CAP personnel who, in their non-CAP lives, have acquired Medical skills, training, and certification.

HOWEVER, the actual use of those skills is always governed not only by CAP's restrictions/admonishments, but by the governing law of the location where care is given.  Usually, this means State laws in the US.

Currently each and every State in the US has their own laws regarding most Medical treatments, resulting in plenty of situations where a simple treatment that is legal and proper in one State is treated as 'practicing medicine without a license' in another State.  And, this is just the Criminal Law side of things.  The differences in Civil Law, who can be sued for doing (or NOT doing...) what, varies also by State, and sometimes locality.

Yikes!  I hate these legal/medical furballs.

If you really want to know what you (or anyone else) can or cannot do in a given State or Locality, my suggestion would be to have Wing reach out to a Legal Officer who can try to get you some definitive guidance.  They should have the capability to research and give you the basic do's and don'ts of Medical treatment in any given State.  Does anyone have any more specific/correct guidance than that?

Good Luck!

Thom Hamilton

D2SK

Quote from: davidsinn on July 21, 2009, 07:53:26 PM
Quote from: John Bryan on July 21, 2009, 07:23:33 PM
Quote from: Ollie on July 20, 2009, 04:18:04 PM
Quote from: Eclipse on July 20, 2009, 02:55:27 PM
This is what needs to be explained to the member in question.  If they choose to disengage, so be it, at least they won't lose their house trying to help someone, and if providing medical care is why they joined CAP, they are wasting their time anyway.

Well put.  There are plenty of volunteer fire departments that I'm sure would LOVE to pay for him to recert and have him carry around his bag for them. 

I have seen too many EMTs (current and former) who are chomping at the bit to do something heroic. I'm afraid to cough near them because they might jam a pen in my trachea.  If you have the skills and someone right then and there requires immediate medical attention, your guy can be a great resource.  But if he thinks he's setting up his own little MASH unit on encampment, you might be better off without him in the long run.

EDIT:  I also saw a mention of an eppie pen.  Is there any legal requirement for someone to be carrying those?  I've heard of school teachers having them on hand if they have a kid with a known allergy.  Always sounded like kind of a gray area to me.


1. Helping someone administer their own epi pen and inhaler is now a basic first aid skill taught by the American Red Cross.

2. How is this topic about safety...seems this is a legal debate

3. CAP's fear to use medical folks is interesting. What about Medical Units under the Logistics section in ICS????  CAP has directed us to follow NIMS and yet we don't provide this support to our members at large missions/events.

I took the ARC course with you and you did teach us to use epi pens. But when I got to RST for GLRSE, Eclipse told us that if we were to stick someone with an epi pen we were violating IL law.

Perhaps one day Illinois will become part of America.  If I am in anaphylactic shock and dying, please stick me with an epi pen. I don't care if IL thinks it is a crime or not.

The best thing to come out of Illinois is 35-South.
Lighten up, Francis.

Eclipse

Quote from: davidsinn on July 21, 2009, 07:53:26 PM
I took the ARC course with you and you did teach us to use epi pens. But when I got to RST for GLRSE, Eclipse told us that if we were to stick someone with an epi pen we were violating IL law.

I honestly don't recall that conversation.

"That Others May Zoom"

Thom

Quote from: N Harmon on July 21, 2009, 07:42:57 PM
Quote from: John Bryan on July 21, 2009, 07:23:33 PM
What about Medical Units under the Logistics section in ICS????  CAP has directed us to follow NIMS and yet we don't provide this support to our members at large missions/events.

Following NIMS doesn't mean we have to contribute every type of unit, just that we know where we fit in the ICS and type our resources appropriately.

BINGO!!!  Someone was paying attention to what NIMS/ICS does for us.

Before, in a large Disaster scenario, you would have exactly what John Bryan suggested, each Entity involved would provide every service for themselves, with their own Transport, Medical, Air Ops, Logistics, etc.  You might, literally, have had 3 Aid Stations set up within sight of each other, to treat members of 3 different Entities.

Now, the single IC can say that Air Ops will be CAP, Medical will be the local EMS, Ground will be the local Sheriff's SAR, etc.  (I'm grossly simplifying there, but it makes the point.)

Now, each Entity can interrelate and interact with the other Entities, without needing to provide EVERY possible service for themselves.  Each Entity providing any sort of function can be counted on to participate in the overall ICS chain of command.  Well, ideally.

And, each Entity can focus on providing ONLY those Resources that it specializes in.  The local EMS and Disaster Triage teams from the local Hospitals will likely be tasked with Medical support, so that CAP, the local Sheriff, ARC, etc. do not have to provide trained, licensed Medical Professionals.  Similarly, CAP provides the Air Ops aerial observation capability, so that the local Sheriff's Office doesn't need to have their own aerial capability, which many still lack.

In short (too late), we don't need to have ALL the pieces anymore.  We just need to know WHICH pieces we have, and how they fit with everyone else's pieces.  ICS/NIMS may suck, but it sucks much less than the alternative chaos.

Thom Hamilton

heliodoc

And if CAP wants to REALLLY be in the arena of true first responders...

It may need to rethink and start complying with State laws regarding this subject. 

"SAFETY", Wanting DHS missions, wanting to be recognized by Congress to do DHS type missions and what not to get CAP into the forefront of more response type missions, may need to have those CAP legal types back at the drawing board 'cuz when the day comes.... if CAP wants to play with the BIG boyz, then it is time it reevaluates itself in this arena of EMT issues.  Wanna play? get certified.  Maybe there is some Wing training money to help the members who want to retain EMT at the Sqdn level.

This round and round about EMT's in CAP sure gets threaded ALOT.  Time for CAP to get with the real world of EM response, kick the "INC" out of CAP and really roll with the real world rather than reading alot of pontification...

Simple....maintain State and federal currency per those  regs  and keep them current and then let the lawyers sort it out.......OH WAIT....they already did....so sorry CAP ....sit by the sidelines and tell your folks they are not useful or needed when they do have the REAL licenses not "CAP licenses"

John Bryan

Quote from: Thom on July 21, 2009, 08:26:30 PM
Quote from: N Harmon on July 21, 2009, 07:42:57 PM
Quote from: John Bryan on July 21, 2009, 07:23:33 PM
What about Medical Units under the Logistics section in ICS????  CAP has directed us to follow NIMS and yet we don't provide this support to our members at large missions/events.

Following NIMS doesn't mean we have to contribute every type of unit, just that we know where we fit in the ICS and type our resources appropriately.

BINGO!!!  Someone was paying attention to what NIMS/ICS does for us.

Before, in a large Disaster scenario, you would have exactly what John Bryan suggested, each Entity involved would provide every service for themselves, with their own Transport, Medical, Air Ops, Logistics, etc.  You might, literally, have had 3 Aid Stations set up within sight of each other, to treat members of 3 different Entities.

Now, the single IC can say that Air Ops will be CAP, Medical will be the local EMS, Ground will be the local Sheriff's SAR, etc.  (I'm grossly simplifying there, but it makes the point.)

Now, each Entity can interrelate and interact with the other Entities, without needing to provide EVERY possible service for themselves.  Each Entity providing any sort of function can be counted on to participate in the overall ICS chain of command.  Well, ideally.

And, each Entity can focus on providing ONLY those Resources that it specializes in.  The local EMS and Disaster Triage teams from the local Hospitals will likely be tasked with Medical support, so that CAP, the local Sheriff, ARC, etc. do not have to provide trained, licensed Medical Professionals.  Similarly, CAP provides the Air Ops aerial observation capability, so that the local Sheriff's Office doesn't need to have their own aerial capability, which many still lack.

In short (too late), we don't need to have ALL the pieces anymore.  We just need to know WHICH pieces we have, and how they fit with everyone else's pieces.  ICS/NIMS may suck, but it sucks much less than the alternative chaos.

Thom Hamilton

Well this is off topic but what they heck......we dont use most of the ICS/NIMS system. We have one thing in CAP we certify under LG and that CUL.  CAP's use or lack of use of ICS/NIMS is another topic so I wont drag this too far, except to say read most SAR EVAL reports and you will find its mission (incident) management we fail at the most.

As for the epi pen breaking the law.....I will check with our ARC chapter but I have never heard that before. Our chapter is just outside Chicago (in Indiana) and this is the first I have heard of this.