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capchiro
Salty & Seasoned Contributor

Posts: 577

« Reply #20 on: June 11, 2007, 11:16:08 PM »

Amen, but it's not open ended as it states level of training and qualifications so that means that a podiatrist shouldn't engage in the same level of care that an ER doctor could, but you've got the problem of EMT's that have done nothing but transport sick people versus those that have worked active MVA'S and seen trauma on a daily basis.  However, that same EMT may not have seen a Strep throat or Pink eye in years.  There is so much diversity and experience among certifications that I guess we have to go with the lowest level, or rely on each person to stay within their level of expertise?  Unfortunately, just as some cadets think they are Rambos', some EMT's think they are battlefield medics and they are not.  We are often judged by the worse of us and CAP has been known to attract some bad eggs because of little if any standards for enlistment/joining.  As a commander, someone that seems too enthusiastic, is sometimes someone I need to watch closely.  I have had people attempt to join as both medical personnel and Chaplains with advanced rank that didn't have the documentation to back there qualifications up, but I digress..
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Lt. Col. Harry E. Siegrist III, CAP
Commander
Sweetwater Comp. Sqdn.
GA154
SARMedTech
Salty & Seasoned Contributor

Posts: 798

« Reply #21 on: June 12, 2007, 01:56:54 AM »

re-sent as a personal message.
« Last Edit: June 12, 2007, 02:01:59 AM by SARMedTech » Logged
"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."
Eclipse
Too Much Free Time Award

Posts: 29,352

« Reply #22 on: June 12, 2007, 12:18:24 PM »

In the Army Guard, most units have their own medical sections, usually with enlisted medics and on occasion, a nurse. Does anyone know if there is any similar concept for CAP operations?

I know that some encampments have a doctor, maybe a nurse or two, and a few medics to provide some basic routine medical care (such as runny noses, or mild "boo-boos"). Is there ever a similarly staffed section for large activities, such as SAR-EX's, missions or other activities of similar size? I know there are people that would like CAP to provide a First Responder type of medical care, but what about routine care for our own members?

Don't know if this would be the right section to put this post in, but it didn't seem to be exclusively ES related.

Yes.  911.  Anything else is all but essentially prohibited by regs.  Please feel free to argue about it...

I dont want this thread to get locked down, but... the regs say emergency stabilizing first aide up to the level of training and licensure of the provider and this is also the the stance of CAP Health Services. First Aide is a big area to cover and in fact could be considered almost any emergency care which is non-invasive. Many members have made it pretty clear that CAP is not a paramedical orgranization, not a health care organization, but if they fall and get hurt, get bitten/envenomated by something, cut themselves or break a bone, they are going to want anybody and everybody with licensed medical training their working on them. I will just wear my EMT patch/badge, and do what the regs allow until they can be changed by an administration that is truly worried about the safety and well-being of its members. If you want emergency first aide, emergency first aide is what you shall get.  ;D

There is a big difference between providing first aid for stabilization, and staffing a "medical section" with cadets walking around wearing stethoscopes (as many encampments have).

In Armageddon scenarios (which most members seem to think should be the basis of our OPSLANS and training), anyone will take assistance from anyone.

During encampments, etc., (in all but the most extreme cases), this is almost completely unnecessary.
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sardak
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Posts: 1,216

« Reply #23 on: June 12, 2007, 05:10:19 PM »

Screening test for medical personnel at encampments:
Medical Personnel Evaluation

Mike
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sarmed1
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Posts: 936

« Reply #24 on: June 12, 2007, 10:56:42 PM »

When I was in AZ they had a huge problem they year before with medical problems.  They did like many people here advocate, they called 911 for everything.  The base EMS got real tired real fast for showing up 2 or 3 times a day for a week for what we in EMS kindly term "BS" calls.  As a paramedic they wanted me to help them solve their problem.  My solution was in place medical support (the same as the military does) Citing CAPs restricvtive regs and the lack of medical direction or insurance we were at a little bit of an impass.  The solution we came up with was military medical personnel (myself as a NG medic) and an actiuve duty RN I conned into going permisive TDY. (I had one or two other nurses and techs come down and help out during some busier times)  We had established assessment guidelines, routine and emergency treatment protocols approved by and signed off by a base physician.  ( Limited ALS level care and the usual tums, motrins and benadryls etc) We coordinated with their clinic (non emergency room) for duty hours evaluation and follow up and with an off base urgent care for after hours.  We provided our own transport via military ambualnce for routine and used 911 for ALS level emergencies. 
We did all of the other expected mecical support stuff, monitor water intake, ensure extra water at outdoor activites on site standby for things like PIR and obstacle and Land Nav course.  We went from something like 2 dozen transported cadets with a similar number sent home the previous year  to only 2 patients sent for serious care (spider bite & ear infection) and none sent home.  The biggest argument I hear is the liability CAP would have, either in the outlay for insuracne or the cost of lawsuit payment if something goes wrong.  Look at the amount of money we potentially saved the corportation with our medical support operation.  The average EMS ride costs about $500-$700 (theres $12000 to $17000 right off the bat), and whats the average doc in the box visit cost $100-$300 ish? (so another 3 or 4 grand) The only outlay they had was for the limited amount of supplies we used...maybe $50 to $100 in over the counter meds and some other boo boo supplies. 

In my CAP time I have seen more serious illness and injuries at encampment type activites than I have ever seen doing SAR missions.  This is definetly one area that CAP needs to get its head above water in regards to medical support.  Be it an internal exception or a requirement for some type of military support.  Most encampment activities are held on a military base of some kind (they usually have some kind of medical support or a higher headquarters that has it) and somewhere in a wing there is at least one active duty, guard or reserve medical type person who is also a CAP member.  It takes more work than your state director asking for a medic or a nurse or even a PA but if you are serious about solving the problem and staying legal about it the resources are out there.

mk
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Mark Kleibscheidel
TSgt USAFR
capchiro
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Posts: 577

« Reply #25 on: June 12, 2007, 11:11:38 PM »

Mark, the magic words were "signed off by a base physician".  Therein lies the rub.  It is hard to get any physician to sign off on such items.  The fact that you are an NG medic and had active duty nurses participating goes a long way to help when we want to do something like this.  This was an unusual situation and not one that is easily or consistently able to be done.  I applaud you for your efforts and successes, but, don't get everyones hopes up that such can be done everywhere.  I personally wish it could, but alas, t'ain't so universally and if something did go wrong, the Reg's would be of no help to you.  This world doesn't work on common sense anymore.  I don't know why.  Life used to be easier and we used to get all of our encampments on Air Force bases and they used to shower us with support.. But I digress..
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Lt. Col. Harry E. Siegrist III, CAP
Commander
Sweetwater Comp. Sqdn.
GA154
Eclipse
Too Much Free Time Award

Posts: 29,352

« Reply #26 on: June 13, 2007, 02:03:32 AM »

Essentially, the base accepted responsibility for this situation.

I assume you had a Wing CC sign the authorizations, as they are the only commanders who are legally allowed to sign contracts.

I can't even imagine the mess this would have been if someone had died or been seriously hurt.

Too bad if the EMTs didn't like the "BS" calls - that's what they are there for.
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SARMedTech
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Posts: 798

« Reply #27 on: June 13, 2007, 02:36:27 AM »

I have had shifts where the same people go to the hospital three or four times in a 24 hour period in civilian EMS and we had to finally give them some "education" about abusing the 911 system and how their continued calls (often when they had signed out AMA the time before) could well prevent us from responding in a timely fashion to a trauma or mass casuality incident. But many, many shifts are consumed with "BS" calls, a term which I personally dont use. If a person calls 911 or calls our post for a direct call out, we go. If its an old person who is scared in the middle of the night because their tummy hurts, or someone who cut their finger eating a bagel at 2am or the ever popular "I just dont feel right" these are all the duty of EMS. As much as I like to be challenged by a call, you will never hear me talk about a BS call or a BS patient. Fact is, most people are reluctant, if not embarrased, to ask for medical assistance. Yes, I would like to be covered and have medical direction for the big things that could happen, but while I work to try to change that so those of us who are licensed do have those things, I am happy to care a better than average first aide kit and stock of OTC meds and remedies. I personally think it would be a good feeling to be able to give a cadet or senior for that matter who feels like they are getting a cold some alka-seltzer, take a temp and basically play medical mommy. That might well be the difference between losing a team member on a search because they feel rotten enough to want to go home, or a cadet not being able to finish out an encampment because what they really need is some attention and someone to give them something for dysentary. Like I say, I think a CAP medical corps would be a great thing a prove to do alot of good, but until it happens (and it will) I am more than happy to help out in whatever way I can within the regs. And remember folks...stabilizing first aide is an awfully broad term.
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"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."
sarmed1
Salty & Seasoned Contributor

Posts: 936

« Reply #28 on: June 13, 2007, 03:20:14 AM »

The important part is to coodrinate with the State Director, they are the POC for coordinating military support for CAP needs.  (of course they were still called the liason officer at that time).

Quote
I can't even imagine the mess this would have been if someone had died or been seriously hurt
Bob, for who?  CAP is not in a liability positon here, its military members providing medical care during an AF authorized activity.  (there is a whole CAP reg citing the authoriztion of military medical care) The medical support is no differant than getting billiting, mess facilities using the obstacle course or use of buses or O flight's on C-130's. 

The important part (which is where many people go wrong) is that there is no  dual shirting here, you are either there as a military member on orders or you are there as a CAP memeber.  Not both when it suits your convenience.

mk
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Mark Kleibscheidel
TSgt USAFR
SARMedTech
Salty & Seasoned Contributor

Posts: 798

« Reply #29 on: June 13, 2007, 03:51:25 AM »



Quote
   (there is a whole CAP reg citing the authoriztion of military medical care)

Could you please site that reg? I would be interested to read it in its entirety. Thanks.
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"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."
Ned
Resident Philosopher

Posts: 2,206

« Reply #30 on: June 13, 2007, 05:30:31 AM »

I have commanded a number of large CAP encampments (200-300 pax), and have used the following medical support models:

a.  "Doc in the Box."  Under this model, TACs perform in loco parentis type care (band aids, blisters, hoarse voices, mild sunburn, etc) while members who have more severe symptoms who need to be seen by professionals are taken as needed to the local urgent care center.  True emergencies = 9-1-1.

Advantages:  No "medical overhead" in the sense that we don't have CAP HSOs on staff.

Disadvantages:  Some cadets are uninsured, leading to significant costs.  Significant time for staff to transport and monitor cadets at the urgent care facility -- usually 6-8 manhours/day. 

b.  "Camp Nurse".  In this model, we "employ" a non-member RN who volunteers his/her time (usually the spouse of a member).  The RN gets protocols from a local urgent care clinic in exchange for the overflow business.  We buy a commercial "camp nurse" malpractice policy to cover the nurse with CAP, Inc as a named insured.  (Cost - about $10/head).  TACS still cover the blisters and band-aids.

Advantages:  The nurse works for us -- a tremendous advantage when it comes to communicating potential restrictions for activities.  Huge savings in staff time (many fewer trips to urgent care clinic.)

Disadvantages:  Some minor logistical concerns about housing a non-member on military base, cost of policy ($2-3k), and availability of non-member nurse is not assured.

c.  "The Military is Your Friend."  Here, we get a Guard/Reserve/AD medic/nurse/PA to work some mandays during the encampment.  The military person performs triage and routine care (well, the TACS still do band-aids and blisters).

Advantages:  Little/no cost.  Cadets get good care.  Staff avoids urgent care runs.

Disadvantages:  Sometimes the military person does not fully understand the encampment program and tends to be rather conservative about marking cadets for "quarters."  The SD may not have mandays to support this option.

Of the three, the clear choice is having a military medical support.  This is what has worked well in CAWG for the last several years.

We still have issues with uninsured cadets -- but that is a good topic for another thread.

Needs and resources will, of course, vary among the wings.

But the only "wrong" model is the one with CAP personnel performing routine medical care.  This happens in several wings each summer.  And it is very frightening.

And it bears repeating, such illegal actions threaten the very existence of CAP.

Ned Lee
Encampment Guy and Former Legal Officer
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capchiro
Salty & Seasoned Contributor

Posts: 577

« Reply #31 on: June 13, 2007, 11:22:55 AM »

SarMedTech,
I don't think there is a whole CAP reg that sites such.  However, in CAPM52-16, Cadet Programs, under encampment, there is an Air Force Reg mentioned that applies in some situations to on base military health care:

 b. Government Medical Care. See AFH 41-114, Military Health Services Systems Matrix, for guidance on using military medical care facilities during an encampment.

I haven't read it in a long time and if you do, please post and let us know the gist of it.  Thanks, 
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Lt. Col. Harry E. Siegrist III, CAP
Commander
Sweetwater Comp. Sqdn.
GA154
jimmydeanno
Salty & Seasoned Contributor

Posts: 4,155
Unit: ǝnƃoɹ

« Reply #32 on: June 13, 2007, 12:49:54 PM »

Here's the lowdown from my experience with medical staff at encampments.

1) 'Medic' Cadets: These cadets focus on making sure the cadets have water available.  They also carry around some band-aids, glucose tabs, and watch for heat related injuries.  They carry a radio to call for aid if something outside that happens.  All of these cadets were EMT-B's.

2) TACO's: These wonderful people don't carry around anything with them, but at night perform blister checks to head off any blisters that may be forming (hot spots).  They also aided in checking for ticks and performed tick removal.  Ensured that cadets were showering regularly and eating regularly.  Carried a radio to call for aid if needed.

3) Encampment Nurse: Licensed nurse, ran the medical bay in day to day operations.  Maintained a good supply of Gatorade powder, glucose tabs, simple OTC medications (Tylenol, aspirin, Advil, alka-seltzer, pepto, etc) as well as a more complex first aid kit with bandages, dressings, compression bandages, etc.  She also maintained prescription medications and ensured the cadets got them every time they were supposed to.  She treated blisters, headaches, dehydration, and other simple 'first aid' type injuries.

4) DOCTOR: The last encampment I went to had all the above as well as a licensed orthopedic surgeon.  He aided the nurse when nothing was going on, but handled more complicated injuries.  Sprains, twists, etc.  He was vital in determining if something needed to go to the hospital or could be handled at the encampment.  In a pinch, if a cadets medication ran out or treatment needed a prescription medication, after consultation with the parents and consent- BAM prescription written and filled.  He carried his own liability and malpractice insurance.

There was never in the last 10 encampments I've been to a need for any true 'emergency' care at encampment, and things that merited a hospital visit were brought and someone else dealt with it. What I have seen the need for is someone trained to recognize the symptoms of things and the proper course of action to take.

I do think that every major CAP activity should have assigned medical personnel. 

[TRUE STORY]
For instance, I was at an NCSA (won't say which one or when), but a cadet showed up with flu like symptoms.  He was lethargic, slept frequently, had glazed eyes and was perspiring.

They kept an eye on him for the first day.  The next morning, the cadets symptoms had worsened.  The AD didn't want to take him to a hospital or urgent care facility saying he only had a cold.

Two seniors present (not medically trained in any way) made the decision to take him, even though the cadet had no insurance (sorry, was 'self-insured'), and didn't want to go.  They brought him to an Urgent Care facility and the nurse took a look at him and told the seniors to get him to the emergency room as fast as they could.

Upon arrival at the emergency room the two seniors handed the paperwork to the nurse at the front desk of the emergency room, looked it over and quickly rushed the cadet to a room.

This cadet had developed juvenile diabetes and had a blood sugar of over 700.  They could smell the sugar coming out of his pores. (for those of you who don't know, blood sugar of 120 is normal).  Had that cadet gone untreated for even a few more hours, he may not have made it home alive.
[/TRUE STORY]

So that is why I think they should have trained medical personnel at a lot of CAP activities.  I'm not sure if this cleared or muddied the conversation, but if it helps, great.
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If you have ten thousand regulations you destroy all respect for the law. - Winston Churchill
jimmydeanno
Salty & Seasoned Contributor

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« Reply #33 on: June 13, 2007, 01:11:44 PM »

Screening test for medical personnel at encampments:
Medical Personnel Evaluation

Mike

Whew...I'm glad I can diagnose Ebola and Typhus, but I am a 'Surgeon General' according to that quiz, I don't have any med quals except 1st/CPT/BBP...
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If you have ten thousand regulations you destroy all respect for the law. - Winston Churchill
Eclipse
Too Much Free Time Award

Posts: 29,352

« Reply #34 on: June 13, 2007, 01:29:19 PM »



Quote
   (there is a whole CAP reg citing the authorization of military medical care)

Could you please site that reg? I would be interested to read it in its entirety. Thanks.

AFI 2701 indicates USAF / Military support of CAP.

Specifically,
Quote from: AFI 2701, section 3.15
3.15. Use of DoD Medical Facilities. CAP personnel incurring an injury or illness during an AFAM are
entitled to limited military medical care in accordance with AFH 41-114, Military Health Services System
(MHSS) Matrix. CAP personnel participating in an official function on a military Installation may be entitled
to emergency medical care, like any other civilian, in accordance with AFH 41-114.

Note the use of the word "may".

For all intents and purposes we are civilians in this regard.
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Eclipse
Too Much Free Time Award

Posts: 29,352

« Reply #35 on: June 13, 2007, 01:32:19 PM »

For instance, I was at an NCSA (won't say which one or when), but a cadet showed up with flu like symptoms.  He was lethargic, slept frequently, had glazed eyes and was perspiring.

They kept an eye on him for the first day.  The next morning, the cadets symptoms had worsened.

There shouldn't have been a "next morning" he's that ill "looking" he goes home.  This is not BMT.

We had a similar situation this year at Spring with a cadet who had a history of seizures and "forgot" his meds.  Mom says "let him lie down in a quiet spot and give him some Advil..."

Mom picked him up from the ER that night.  Our people are not paid for, trained for, or protected against this kind of thing.  Why should I, as a CC, put them at risk?

I also don't want cadets "passing out glucose tablets" - they give a couple to someone with a sugar imbalance and that cadet and it can be as much trouble as low blood sugar.
« Last Edit: June 13, 2007, 01:41:06 PM by Eclipse » Logged


jimmydeanno
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Posts: 4,155
Unit: ǝnƃoɹ

« Reply #36 on: June 13, 2007, 01:35:57 PM »

^Except 'home' was 2000 miles away and even if they sent him home immediately, the next plane wouldn't have left until the next day anyway.  Then you have a cadet with this illness wandering through airports for connector flights <--that's so much better...
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If you have ten thousand regulations you destroy all respect for the law. - Winston Churchill
Eclipse
Too Much Free Time Award

Posts: 29,352

« Reply #37 on: June 13, 2007, 01:45:11 PM »

^Except 'home' was 2000 miles away and even if they sent him home immediately, the next plane wouldn't have left until the next day anyway.  Then you have a cadet with this illness wandering through airports for connector flights <--that's so much better...

No, you have a cadet who is the care of local EMS, with a senior from the event as chaperone, with parents enroute to pick them up.

Cadets who are ill enough to need EMS go home.  Period.
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jimmydeanno
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Posts: 4,155
Unit: ǝnƃoɹ

« Reply #38 on: June 13, 2007, 02:05:50 PM »

Ummm...I thought I said they brought them to the hospital and he was admitted.  Sorry for not specifically saying..."the parents were notified, the seniors stayed until the parents arrived two days later and he went home..."

and just because a cadet needs to go to the hospital doesn't mean they need to go home.  They may have cut their finger or sprained an ankle, that sometimes requires a hospital visit, not necessarily a go home though. 

One encampment I was at had a cadet with epilepsy and mild retardation.  About three times a day he'd have a siezure, we didn't send him home and guess what, he actually completed the encampment.
« Last Edit: June 13, 2007, 02:11:49 PM by jimmydeanno » Logged
If you have ten thousand regulations you destroy all respect for the law. - Winston Churchill
SARMedTech
Salty & Seasoned Contributor

Posts: 798

« Reply #39 on: June 13, 2007, 02:44:32 PM »

The story of the cadet with diabetes and a BGL of 700 is exactly why medical staff of whatever level are needed in CAP and need to be able to render a certain level of care and also to examine a cadet or senior who is not feeling well. An EMT is qualified to take a BGL with a glucometer, (by the way, normal human blood glucose level is between 90 and 120, therefore 120 is at the high end of the medically acceptable level) and had someone done so on the first night the cadet did not feel well, they would have seen his BGL was sky-rocketed and that in fact he was in diabetic ketoacidosis,  a form of potentially fatal shock which very well could have ended that cadets life as he slept slept on his first night. This story only serves to bolster my assertion that EMS personnel are necessary for CAP. If we do nothing but do field medical assessments, its worth it. Obviously, there was no one who looked at this cadet and said "something aint right" or he never would have been allowed to go without medical attention overnight. A simple finger stick would have sent him to the hospital immediately. Given the signs of symptoms of this cadet, a BGL check would have been just about the first thing I did. There are many who seem to think that EMTs only want to be at CAP activities  for the major stuff, and they can be. But there are also those of us who know that when you put a bunch of kids out in the field or anywhere away from home for an extended period of time, you should have health care and assessment available on scene. And there are those who say the treatment for true medical emergencies is 911 and of course that is true. But when members, either cadet or senior, are operating or on exercise somewhere where EMS may be 45-60 minutes away, the ill or injured person may be decompensating so you have a much worse situation by the time "civilian" EMS arrives. Again I say that what this comes down to is finances. There is really no logical argument to be made that and EMS presence at CAP activities is a good idea and I have heard plenty of non-sensical arguments against it. Make no mistakes folks, its about the money. I am willing to bet that if tomorrow CAP said we are going to insure and provide medical directions for CAP EMTs, everyone would be for it. So when it comes down to a matter of money, people need to start pressing command to make a change. I really would like to see some statistics about medical and traumatic cases at CAP events. By shear law of averages, they occur. Just saying they dont doesnt make it so. At auto races, marathons, etc EMS is standing by for the just in case type scenarios. Why should CAP be any different? Of course in the case of serious trouble you want EMS inbound...but what happens to the sick or injured cadet or senior in the mean time could make all the difference in the world. (Climbs down from soap box, puts on fire suit).

PS-there is alot of talk about cadets being certified first responders. There is a big difference between a first responder and an EMT and in most states, you must be at least 18 years old to even train as an EMT.
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"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."
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