Comments on: CERT Training Initial Impressions

By: theotherryan

theotherryan — Sat, 30 Jan 2010 21:44:09 +0000

I’ve gone over triage in Combat Lifesaver. To say the least it is a pretty heartless and dispassionate affair. Also I have had the unfortunate circumstances to see it for real.

On the CPR topic I used to do a lot of back country hiking and skiing with a Doctor. He said out in the sticks he would not do CPR on someone. That if they needed CPR and could not be rapidly evacuated to a hospital they would be dead anyway.

By: ke4sky

ke4sky — Mon, 28 Dec 2009 20:48:07 +0000

Good discussion. I’ve been involved with CERT here in the Washington, DC area since right after the program was implemented. We have a 3-tiered program in which CERTS are eligible to take additional training at the fire & rescue academy on a space-available basis in addition to required annual refresher training, local and regional exercises such as Capitol Shield.

Level 1 is the standard FEMA classroom course,

Level 2 is taught in ten 3-hour sessions evenings at the fire academy. It is scenario based and taught by fire academy cadre. Subjects include but are not limited to land navigation, signalling; field sign cutting; building search, casualty extraction lifts and carries; lifting, cribbing, ropes, knots, slings and hoists; chainsaw; vehicle extrication; infectious disease awareness; hazmat awareness; nuclear-chem-bio awareness and field expedient decon;
IS-100, 200 and 700.

Level 3 in addition to the above requires IS-240, IS-300, WebEOCUser, intro to public safety radio, fingerprint and criminal background check to be issued an ID card for assignment to an EMAC team.

By: Ben Branam

Ben Branam — Fri, 20 Nov 2009 01:05:02 +0000

By categorizing the people in CERT as sheeple, you are giving them a tag as others give us. They are trying to do good, and preparing for things different then most of us are prepared for.

I’m a member of CERT and understand the principles and ideas. Do the most good for the most people is a good idea. If it was one person I would do CPR until help arrived and would refuse to give up. In a mass casualty situation I only have a 2% chance (by your friends numbers) of saving this person. But if I stop the bleeding on someone else the chances are a lot better that I can save someone. Or I may be able to stop the bleeding for three people, or more. That’s the hole idea behind triage, and it’s been working all over the world since WWI, and continues to work in Iraq, Afghanistan, and anywhere else a lot of people are hurt.

You could relate it to tactical patience. If I wait someone could die in a shooting, but if I move to cover first, and then engage, there is a better chance of me stopping the shooter.

It’s a crappy thing to be involved in, and I hope you never have to use your CERT skills.

Stay Safe,

Ben

By: Erik Day

Erik Day — Tue, 17 Nov 2009 17:05:19 +0000

TacZen has a good point. You do have to know what you’re doing, within the scope of your mission, and know it well enough to prepare to defend your actions if questioned. That’s good policy, though, and beyond just legal defense but into personal accountability and confidence that you’re mission ready.

On the other hand…

The legal aspects of “Scope of Practice” do count, even at the CERT level, and goes beyond Duty to Act and deep into issues of competence and Scope of Practice. It’s enough that the CERT curriculum itself mentions liability protection, citing good samaritan laws as liability coverage. If you haven’t gone over this portion yet, you will soon. Problem is: a lot of the coverage they talk about varies from state to state

In California, the Good Samaritan protections just experienced a massive fail and allowed a good samaritan to be sued (see: Van Horn vs. Torti). This was exactly over Scope of Practice and who could do what, when and how. I won’t go into details of the case (it was all kinds of wrong, from every angle), but it did have CERT programs on edge because of the reinterpretation of the language of the Good Sam law (in particular, the word “medical”).

In some respects, I can see the semantic weakness of the previous view and how the recent judgment closed a gap that could be harmful to victims. OTOH, that decision assured Joe Average will keep driving when he sees you limply hanging out of a burning car.

There is a happy ending, though; at least in California. The State Legislature passed a new law (Assembly Bill No. 83) that exactly covers where the original Good Samaritan law was supposed to (and failed). California was testing and setting legal precedent, but until your state follows similar suit, this may be a story that gets repeated.

By: Jason

Jason — Mon, 16 Nov 2009 21:03:56 +0000

Regarding your comment about CPR: CPR is not actually designed to resuscitate someone, and will rarely do so. CPR is designed to keep oxygenated blood moving around so that organs remain viable until/while advanced interventions – defibrillation, drugs and/or airway management – are being delivered. Done right – meaning 0 interruption in compressions for any reason (i.e. no stopping compressions to give breaths, place airways, etc.), it can maintain brain and other tissue viability for a surprisingly long time.

With good CPR and full advanced interventions, the best save rates anywhere in the country are overall something like 15% for medical arrests. For traumatic arrest, they are much lower. These rates are for people without a pulse.

Regarding survival for trauma patients in general: Elsewhere on your site you mention that 90% of preventable trauma deaths are from limb hemorrhage or tension pneumothorax; meaning that only in 10% of injured persons will anything other than direct pressure, tourniquet or needle decompression make any difference in their survival. For the rest, either they would have lived without you, or nothing you did could have saved them. (Note that these numbers are specifically for victims of penetrating injury; serious blunt injury outcomes are even worse, since they tend to produce bleeding or other problems internally, which you can’t do anything about.) Working these people means investing huge amounts of personnel time and medical resources for a marginal return; whereas the external bleeds, simple airway management, simple shock people provide high returns for minimal investment, resulting in more lives saved.

By: Voodoo

Voodoo — Mon, 16 Nov 2009 19:22:38 +0000

Jason,

Thank you for your comment and perspective. I do understand the scenario you’ve described where many others could potentially die by me helping that one person in front of me, but it’s still a hard pill to swallow. I just hope in that kind of situation there are so many responders that having to follow CERT protocols about this isn’t an issue.

I sincerely hope, as you’ve stated, that local Fire and EMS don’t have the same protocols CERT does in regards to handing out black tags. There are so many people I present this scenario to that say “Well, CPR only works blank% of the time.” That’s great… why even bother teaching it at all then!

Regards,
Bryan

By: Jason

Jason — Mon, 16 Nov 2009 18:46:11 +0000

Bryan – Hey, no easy words here, I know you understand triage and the reasons for it so I won’t go into them. Basically you have to decide if some will die, maybe even somebody right in front of you, or if MORE will die. You say you don’t know if you could walk away from someone you could maybe help. You have an emotional problem with this, which is a natural consequence of being a human being. However, the question you finally have to answer is: Are you going to let MORE people die to make yourself feel better? It’s hard, but that’s what it is. This is from a paramedic, so I’ve been there.

I will say that the notion of not helping black tags at all is not normal, and is probably not what your local fire & EMS are doing. Basically you help reds, then yellows, then greens & then blacks; and in reality people sort of fudge blacks up above greens if they can get to them right away. Basically if there are 20 victims and 30 responders, everybody gets help. But we aren’t always so lucky.

By: TacZen

TacZen — Mon, 16 Nov 2009 04:37:02 +0000

Well, here is the real scoop on “EMS Law’ such as Scope of Practice etc… contrary to what you will hear over and over there is very little actual “Law”, at least in such Black & White terms that will be presented to you in just about every EMS / rescue class you take. You will hear many stories and many “Facts”, but you won’t see any documentation to back anything up.
“Negligence” (”Liability”) in terms of law requires a duty to act, but you will rarely see a true duty to act requirement in writing in law (that isn’t to say a court won’t determine you have a duty… just that it isn’t generally in writing). Point is, when someone teaches duty as a fact, it usually isn’t.
Scope of practice refers to what you are allowed to do (there are differences in what you are taught, certified to do, authorized to do etc…). But until you get into “practiceing medicine” and that requires an MD to sign off (such as medication administration and surgical procedures) most medical skills fall under “Basic life Support / First aid” and you are only limited to what you have been taught… “what would a person with similar training / experience do in a similar situation”.
Also, understand that every organization has policies and procedures… but contrary to how they will present them to you… these are NOT law. I have worked for amulance companies that had policies that directly went against law and they were sued, but until that law suit, they enforced and preached these policies as law… polices can be great, but again, in a courtroom, they are not law. If you are sued, understand this, if you fail to follow a policy, they will ask you why and use it against you. If you follow a policy, they will point out that it is not law and that you had a duty to disregard it and use it against you. If you treat someone you can be sued, if you don’t d treat someone, you can be sued. In court, it all comes down to what you can intelligently articulate… not what CERT or anyone says, but what a judge or jury thinks. If you blindly follow what someone tells you, you will not understand it and not be able to defend your actions, if you use your head, some common sense and do what you feel is best for the patients, then even a wrong decison is defensable.
so yes… follow your gut and do what you beleive is right, that is your best guard against a law suit or anything else. Good luck lifesaver, and be safe.

By: Voodoo

Voodoo — Fri, 13 Nov 2009 19:29:57 +0000

Erik,

I completely agree. It’s wonderful that so many people are interested in the topic, and I do hope it leads to more people volunteering and eventually saving lives.

Good point on the litigation issue, and I’m hoping that is why it was brought up so often.

Thank you for the detailed explanation of the human impact, it’s definitely what I’m having the hardest time with, but I don’t think I’ll ever be able to just walk past someone I have the ability of helping. Even in a MCI.

I really appreciate your perspective and thank you for sharing and commenting.
Bryan

By: Voodoo

Voodoo — Fri, 13 Nov 2009 19:22:48 +0000

TacZen,

Your “scope of practice” comments do run contrary to what I’ve been told by my specific CERT instructors, unless they just left our some important details, which I’m hoping.

Honestly on my story from a friend, there’s no telling if that was 100% exactly as it happened because I wasn’t there when the incident happened, I’m just restating what I was told.
I’m glad though that you’ve never experienced or heard about EMS ever stopping CPR on a child, but stopping or never starting on someone does concern me.

It does seem to me that while CERT is a great organization, I might be presented with the situation where I have to follow my gut and do what I know is right.
That’s pretty much with anything in life though if you ask me.

Thanks for the comment,
Bryan