Physicals Required for Encampment on Your Wing?

[CaptMedic]

As the wing nurse officer assigned to a fairly large wing, we have had numerous discussions this spring within our wing staff regarding the paperwork we require for application to encampment-type activities.  As an RN, I feel like it is a safety issue for us to not require our cadets to have a recent medical physical before participation in activities where there may be medical issues present.  I have staffed a few encampments and have seen cadets come into the first aid area for triage/first aid for injuries or issues that were cause for great concern.  Last summer we were at "black flag" status every single day of encampment with temperatures over 100 and the humidity not far behind - and unfortunately, that is more typical than not for my neck of the woods! 

The area schools will not allow any athlete to train or compete without a physical.  The boy scouts here will not allow the members to participate without a physical.  These physicals can be obtained easily enough at a fairly minimal cost ($25 - $30) at a walk-in clinic and would go a long way toward making me feel much better about my license when I am responsible for the safety of the cadets in an encampment. 

I am at the point now where I am losing my licensed medical staff because they are uncomfortable with the condition(s) some of the parents choose to gloss over.  We do a fairly strenuous obstacle course, orientation flights, firing range and of course, miles of marching at our encampments.  This might not be an issue if we didn't have to factor in the heat or humidity but here these are very real problems! 

You get the point without me telling war stories...I would like to hear from as many wings as I can regarding the requirements for encampment or physically demanding activities for cadets.  Do you require physicals?  Any information you can share would be greatly appreciated!

Regards,

Capt. Naomi Hays, RN
Texas Wing Nurse Officer
Thunderbird Squadron NO

[PHall]

Not required in California Wing. Never have been either.

[NCRblues]

Parents have to disclose medical conditions on special activity applications. If they don't, it's on them. As an RN in CAP you can as much as the M.D. and the EMT - B and the person with no training at all. Call 911 or take them to see on duty official medical care.

[a2capt]

I've never heard of physicals required outside of high stress stuff like PJOC, and that sounds like possibly a regulation change  which is a whole other issue that you wouldn't want to deal with.. at your level.

Some wings have created an alternate to the Form 17/31 that asks more detail. Take a look at CAWG Form 150 for example.

[PA Guy]

COWG and CAWG have fairly good medical screening forms for encampments and other activities.  Pos. responses require an explanation and usually a call to the parent for a full explanation and any limitations or restrictions.

[Woodsy]

OK.... I had to have a full physical (including the "turn your head and cough" stuff) as a 12 year old going to a week-long boy scout camp...  And the most physically demanding stuff I ever had to do there was roll off of the cot in the morning and walk a half a mile to the chow hall... 

I personally see no reason not to require a physical for encampment or other physically demanding activities.  I fully support it as being required...  For those of you that say "let the parents write it on a form," sorry, once I was past the age of diapers, my mother was never welcome to give me that "turn your head and cough" exam! 

Also, I am 26, so I didn't grow up in the era of naked swimming in the high school pool... Or heck, even the locker room...  But really...  It's a doctor... 

As far as the expense...  We had a father in my boy scout troop that was an MD...  We'd have a few nights before summer camp that he'd do our physicals for free.   You could probably find a parent/uncle/distant relative of a cadet that would do them for free also.  If not, talk to your local high school football coach, I bet he knows an MD that'll do them for free!  If that doesn't work out, start making calls! As an RN, you probably know people who would be willing to spend a couple hours pro bono helping out some "kids."  I believe it would even be tax deductable, and (at least in my state) pro bono medical work my a licensed MD is exempt from professional insurance and carries immunity from any civil cases, so it's a win/win for the doc... 

[SABRE17]

I don't think it's a bad Idea personally to require a physical, considering what we do at encampment, the level of physical and mental stress, and what I've seen in the past with cadets going down, it might be worth it. I had to get a physical to have my job pumping jet fuel, and all us pilots need a physical to fly. The precedent has definitely been set.

[jeders]

Being a member of the OPs wing, and having been to a TXWG encampment where it was mostly black flag, I have to call BS on this one.

If the staff are doing there job and restricting physical activity to the bare minimum during black flag conditions, then there is no problem. If they aren't doing this, then no physical exam in the world will do anything to mitigate the risk.

Of course you have better information than I do, working in the first aid/sick call area. But when I went to encampment, most of the sick calls were cadets who wanted sympathy, or locked there knees in the heat, or didn't drink enough water. Again, no physical exam in the world is going to mitigate that. Only good training and good staff work can do that job.

[ol'fido]

The problem I see is that if we start requiring them for encampments will we start requiring them before each ES mission? Those can be a lot more strenuous and hazardous than the controlled environment of an encampment .

[Pylon]

NYWG doesn't require physical exams for their encampment. 

CAP Cadets all do need to have a physical examination to join the organization if they answered "Yes" to any one of the health condition questions on the membership application (CAPF 15).

I don't see why your license or the licenses of others would be at risk since the only role of the HSO in Civil Air Patrol is to provide health & medical related advice to the commander.  That's it.  You cannot treat CAP members.  Unless it's a dire emergency (like applying a tourniqet because someone is about to bleed out and won't make it to the hospital) when acting as a CAP member, you cannot treat people.  Not to resurrect this debate, because there are plenty of existing threads on CAPTalk where a discussion on this point more fully would be more appropriate, but I cannot imagine your license at risk for providing the best advice to the commander given your medical training and conscionce with a reasoned explanation as to your recommendations.   The commander is under no obligation to implement your advice, however.

[Eclipse]

^ Perfect summation of the issue.

Neither ILWG not GLR requires more than the F31.

The PT for an encampment should not be more strenuous then grade-level expectations for the respective cadet.  There are legitimate issues with Phase IV cadets leading slick-sleeves at a level which is in appropriate for the average couch-hugging 12-year-old, but that would not be solved with a physical exam.

If the base is black-flagged, you're not doing much of anything outside, so PT should be mostly a non-issue.  If heat stress at these activities is a legitimate concern, then the Encampment SE, Commander, and Wing DCP need to reconsider what is included at your wing's encampments.

The vast majority of our cadets are enrolled in public schools, which are already mandating a certain level of medical exams, inoculations, etc.  CAP is not, and should not be in the business of trying to intervene in that, especially since it would be largely based on someone's "feeling" there's a problem, versus an actual problem which is demonstrated via statistics.

As to cost, $25-30 would be 1/3rd to 1/2 the cost of the activity in some areas, and parents not inclined to already be accessing preventative healthcare aren't going to be more inclined just because CAP said they had to, further, a routine store-front physical is not likely to reveal any hidden problems in an otherwise healthy-appearing cadet.

The F31 asks all of the pertinent medical questions necessary for CAP's needs in these activities.  The process certainly allows for questions to be raised by the encampment HSO as to a cadet's fitness and appropriateness for the activity, but I can tell you from 11 years experience running encampments,
that the majority of issues are emotional / behavioral (i.e. psychotropic cocktails), with few being actual physical limitations or concerns (a recently broken bone, or major surgery, etc), and when the parents and unit CC sign the form 31, they are certifying that the cadet is, in their opinion, prepared mentally and physically for the encampment or other activity.

To further agree with Pylon, if you have licensed practitioners resigning over this or related issues, they likely did not understand their role to begin with.

[sarmed1]

HMRS has been doing follow ups for a few years now; any positive medication or other "Yes" on the CAPF 31 gets a supplemental for further explanation, depending on the severity, a direct call from our supporting physician.  It has cut down on the OMG responses during the school when it turns out there is more to someones probem than mom and dads 2 liner explanation; but also has cleared some participants that might have been rejected out right due to"paranoia" of their condition.  They dont require an exam prior to the school.  Likely 99% of the applicants are in satisfatory condition and the physical would be a waste of time/money.  The form 31 and if needed further documentation solves 99.9% of the issues.  (most of the severe medical emergencies have been senior member support staff.....who likey would fall under the "...you need to have a curren physical to play..." group at encampment any wa)

mk

[CaptMedic]

All very good points...and valid.  As far as my license not being of concern, that is incorrect.  I'm not certain how things are done in other states, but in Texas if I see any person in need of medical assistance, I am bound by law to provide that assistance to the best of my ability and at the level of my training.  This means if I see a vehicle accident occur in front of me, I must stop and render aid.  I am not going to walk away from a CAP member needing medical attention just because they are a CAP member.  If the member happens to be a cadet and the parent of said cadet chooses to file a complaint against my license, they are free to do so.  The worst thing that can happen to me within CAP is to be invited to excel elsewhere...the worst thing that can happen to my license is that I can have it revoked!  Believe me, I take that VERY seriously!

Having said that, our encampment generally takes place some distance from medical care (hospitals etc) and since it is within my medical capability to treat sunburn, blisters, scraped knees and chapped lips, I will continue to do so.  (Please don't throw rotton tomatoes at me!) 

Yes, I have had cadets show up at encampment in absolutely wretched physical condition.  We have an advanced training squadron that involves much more rigorous training than routine PT within a squadron.  I do understand that the parents are signing that these kids are okay but after speaking with several of them, I am fairly certain that few of them read it very carefully or understand that they are certifying that their child is capable or able to participate. 

My point, (and I do have one) is that I have had RN's, PA's and paramedics decline their assistance at encampments due to this issue.  With the declining numbers of personnel available for me and some issues that have arisen, I am simply hunting a way to resolve this and hopefully intercept a sentinel event before it occurs.

Capt. Naomi Hays, RN
Texas Wing Nurse Officer
Thunderbird Squadron NO

[PA Guy]

Does TX have a "Duty to Act" law?  Or is there something in the Nurse Practice Act that requires you to act when off duty?

[Eclipse]

My point, (and I do have one) is that I have had RN's, PA's and paramedics decline their assistance at encampments due to this issue.  With the declining numbers of personnel available for me and some issues that have arisen, I am simply hunting a way to resolve this and hopefully intercept a sentinel event before it occurs.

Physicals will not, in any way, impact injuries sustained due to inappropriate PT, nor will it get you more people willing to do the job.  There is no requirement that encampment Health Service / Safety Officers be anything more than trained in basic first aid at the same level as EMT's, etc. , in fact there's actually no requirement that there be any HSO's on staff at all.

Medical professionals have a tendency to triage and treat instead of calling 911 or sending members home, and this is in appropriate and against regulations.

If you have concerns about the level of intensity of an activity, then it needs to be addressed before the first staff member arrives.

As to the "duty of care" arguments, they don't fly.  There is a huge difference between the random (and nearly non-existent) major emergency where anyone of good conscious would act to save a life, regs be darned, and trying to set up a preventative care program under the auspices that you have no choice but to intervene in even the most minor of circumstances, and any activity that is so far removed from EMS response that it must rely on
staffers to provide care, probably exceeds reasonable ORM and the venue should be reconsidered.

Yes, you may well have a legal duty to provide care to someone who is sick or injured, however CAP is clear that they will not provide you protection when your personal / professional responsibilities exceed the authorization of the regulations.  If this honestly concerns you, you should consider removing yourself from any activities where the odds are likely that you would need to intervene, this is not an uncommon stance of CAP members who are medical professionals, and based on my experience, not necessarily a bad idea.

[Fubar]

Having said that, our encampment generally takes place some distance from medical care (hospitals etc) and since it is within my medical capability to treat sunburn, blisters, scraped knees and chapped lips, I will continue to do so.  (Please don't throw rotton tomatoes at me!)

This seems to run contrary to CAPR 60-3 sec 1-24f which states "The only type of medical aid that should be administered by CAP personnel or by any other person at CAP's request is reasonable treatment deemed necessary to save a life or prevent human suffering."

Yet, I can't find a reasonable way to handle minor cuts, road rash, indigestion, headaches, etc other than to have a staffer handle those issues. Calling 911 for those issues is of course ridiculous. I think this puts cadet actives in a bind where regulation doesn't seem to match reality.

Eclipse - given your veteran status of running encampments, I'm very curious how you handled these issues.

[Eclipse]

Yet, I can't find a reasonable way to handle minor cuts, road rash, indigestion, headaches, etc other than to have a staffer handle those issues. Calling 911 for those issues is of course ridiculous. I think this puts cadet actives in a bind where regulation doesn't seem to match reality.

Eclipse - given your veteran status of running encampments, I'm very curious how you handled these issues.

In the last few years of my tenure, we moved from a designation of "Health Services Officer" to "Health Safety Officer" with the indication that this could be any senior member willing to track meds (per the new regs), and provide basic first aid at the allowed level.  While we've had everything from EMT's to MD's in this position, especially just before I took over where the encampment had a typical CAP "medical staff"  , as things evolved and we paid more attention to reality,  and the regs, it became increasingly clear that having medical staff on site was potentially just as much of a problem and potential liability and not having them.

Now, we're in an urban area with normal 911 support (3333 in this case).  Ambulance response times are typical, if not faster, then your local municipality.  The problem is having to weigh the desires of a parent (which I am), vs. the protection of the corporation and its members, without which this is a moot argument.

IMHO, at the point that someone is concerned enough to get a stethoscope out, we're walking down a path we should not be, because rarely
should our members be so far removed from EMS response that we can't call in people not in a CAP uniform, and barring a traumatic accident,
the typical dehydration / exhaustion conditions of a CAP encampment should not be allowed to evolve to the point that EMS is needed.

As we've discussed a number of times on CT, as well as in this thread, the "problem" with medical professionals is that they are generally compassionate, skilled, medical professionals, who are also, many times, very sensitive to injecting people into the EMS system unnecessarily.
When you're an ER doctor who is tired of treating scrapes and tummy aches, you're also going to try and avoid sending things which you don't
feel are appropriate to the local ER.  It's just human nature.  It's also quite arguably against regs, since those decisions are essentially triage,
and the wrong decision could be disastrous.

I am not going to get into specifics beyond saying that I've personally been involved in situations where the above conflict was an issue.

As a parent, I want to have a full trauma team and mobile ER following my kids around 24x7, but as an officer in a benevolent organization with
clear rules and mandates, I have to balance that with practical reality.

[Fubar]

In the last few years of my tenure, we moved from a designation of "Health Services Officer" to "Health Safety Officer" with the indication that this could be any senior member willing to track meds (per the new regs), and provide basic first aid at the allowed level.

Thank you for your response. I too have seen, especially among cadets, the idea of being the "medic" bringing great excitement to the appointee. What seems to cause the greatest confusion is where is the line of appropriate medical care (or to use your term, what is the "allowed level")? As mentioned previously, the regulation states only life-saving care can be given, apparently rendering the (hopefully) common practice of designating a responsible senior member as the person who throws band-aids on small cuts, cleans up the road rash on the skinned knees, and throws some moleskin around blisters. This is the part I'm having a hard time de-conflicting. In fact in a recent discussion in my wing, there wasn't a consensus if handing out ibuprofen or acetaminophen to a cadet with a headache was acceptable.

I do like the example you provided - the moment any sort of medical equipment needs to come out of the trunk-sized medical bag some of these folks carry around, it's time for professional medical care (and a call to the parents). We simply need to recognize that as the temporary guardians of a group of minors, there are some medical treatments we will need to perform and have that added to a regulation to allow our senior members some breathing room.