# MCSP



## starlight_745 (6 Jun 2004)

One of the changes in all this restructuring has been the introduction of MCSP training for medical staff.  I am familiar with the reserve MCSP ( not as much with the reg force version) and my question is how are units across the country delivering it and/or is there any changes on the horizon?  I think having a standardized continuing ed program is an excellent idea, however I question the value of many of the mods that came from Borden.  Doing CPR/BTLS has obvious benefits, my question pertains to the Mods 1-8 of death by power point.  How is it that a lecture on wound care can have no practical component?
Also, do we need to do every single mod every single year.  In a time where training dollars are tight, it seems like a lot of cash down the drain.  Why not have a rotating schedule for refreshers? (abd/msk one year, thorax/head&neck the next etc)


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## Fraser.g (6 Jun 2004)

It could easily become death by powerpoint. What has to happen is that the leadership has to use some imagination in augmenting the PPT presentations. I know that my troops are getting tired of BTLS every year. CPR has to be done to continue their certification. Hell I have to do it each year or teach it several times to keep my qualification up and I work in an ER.

I think that some of the MCSP could be written off if we were to bring our QL4 qualified pers into a hospital environment under proper supervision to continue the skills.
For example you have to maintain your skills for two years by doing the death by PPT and then once you have done that you are brought into the hospital environment to do some of those assessment and practical skills on real patients. 
The perfect place to start would be a general surgical unit where they do thoracic and vascular surg. 
Once there and with good evaluations they can move into an ER setting. A bit (allot) more chaotic, more acute patients, more diversity.

I think that this would also be a boon for retention. As it is the smart medics are getting board by doing the same scenarios and courses over and over again with no progression in sight.


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## Armymedic (6 Jun 2004)

We are all limited by time money and the experience of instructors. 

But to me MCSP should be more experienced based ie on civilian amb, hospitals etc....but that takes MOU's and lots of preplanning and coordination, not to mention people free to go,  which our depleted manning is too tight to handle.


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## Fraser.g (6 Jun 2004)

It would certainly require coordination and pre-planning as well as experienced instructors but all this boils down to the will to do it and the support from the higher headquarters. If we have those two things then the rest will fall into place.

We are screaming for civilian qualified pers but to have them and not use them for the betterment of the rest of the unit would be foolish.

We have NO's, EMTs and MOs. Why don't we use them to the fullest and use their civilian network as well as the personnel?

As for the financial limitations all it would cost would be the man days once the infrastructure was worked out.


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## Fraser.g (4 Jul 2004)

I have attached a list of all the skills from MCSP that could be filled in a clinical practicum on a Surgical unit. The one I am proposing for my unit is a 47 bed general, thoracic and vascular surgical unit. 8 beds are close Observation. 
Hmmmm sounds like the holding capability of a FSH.

What was it that was pounded into our skulls during leasership training....never lecture a skill.

GF


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## Fraser.g (13 Jul 2004)

Once upon a time every member of the CF was required to maintain our CPR and Standard First Aid under CFAO 9-5. I see that this has now been canceled. 

Medics have to be qualified under the MCSP but what about all the other trades.

Does any one know what the new standard is. This is important when we are teaching First aid on BMQ courses and teaching first aid at other units.


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## vr (14 Jul 2004)

CFAO 9-5 has been replaced by a new draft policy on First Aid.  The exact title of which I am not geeky enough to have at home.  The requirement is the same:  all CF members must maintain a St Johns SFA & CPR-A (adult only) and renew every three years.  All pers in a medical role must maintain a CPR-C and renew annually.  There are also lesser requirements for civilian employees, cadets et al.

For BMQ out here we teach the 2 day SFA with CPR-A and the 5 compulsary mods, upper/lower limb #'s, chest inj, eyes, burns, CSR, enviro, personal care, rescue carries, wound care,secondary survey, and head/spinal/pelvic inj.  It may seem like a lot but most of these subj are barely touched on by the St Johns prog.  Certificates are not issued for the original courses or recerts; only UER entries.

We try to run recert courses for the Bde but get a minute response.  Which means that either FA is a low priority or most of the Bde has been in > 3 yrs.  I hope it's the former because the way money is going if units are not required in Orders to have a Med A for a range or activity they likely won't get one.


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## Fraser.g (14 Jul 2004)

If you can get the policy so that I can ref it to the other units in my area it would be appreciated.
The only reason that I know 9-5 is because I had to remind people that the O in CFAO was not for strong suggestion.

Grant


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## HCA (16 Jul 2004)

The MCSP program has just been updated with a new draft. (A couple of days ago) This draft incorporates the AMFR2 skills with the past skills. Of course this will take more time but this really is what the Med A's want and need. The challenge will be to deliver it in an interesting and challenging manner year after year.


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## starlight_745 (16 Jul 2004)

HCA thanks for the info.  Would you be able to give us a brief outline if you have it i.e. how many training days, PO's covered etc.


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## combat_medic (19 Jul 2004)

Also, wouldn't it make a lot more sense to offer an exam for those who want to exempt the training? While not everyone has a civilian certification, many people will do their own refreshers on A&P on a regular basis and having them spend months of training time doing repitition is quite a waste of their time and training budget. If someone can be tested on their skills and pass with 80%+, should they not be able to be exempt for a year from the training and pursue more advanced training?


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## Fraser.g (19 Jul 2004)

It is my understanding that all members have to demonstrate the skill once a year to maintain their certifications. This does not mean that they have to sit through "death by powerpoint" every year to get their MCSP written off.

If they can not demonstrate the skill to an adequate level then it is time for a refresher. The only other time that the skills should have to be reviewed is when there is a change in protocol.


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## Brad Sallows (19 Jul 2004)

Ask the question "must the soldiers attend the presentations to complete MCSP?" and see what sort of response you get.


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## vr (19 Jul 2004)

The subjects & skills covered under the MCSP are not things we do often in the Reserves.  Unless you are employed in an MIR or do nursing civvy-side most members won't practice these skills at all.  Having the unit go through the program yearly is an opportunity to refresh our skills.  It is especially vital for members in outlaying units to attend yearly as they tend to do very little medical training if any at their home units.

The material doesn't have to be presented through those lame power-point presentations.  As long as the material is covered the instructors can present it as they see fit.  There are no boring lessons only boring instructors.

Now that AMFR-2 is part of MCSP do we still have to do BTLS which is complementry and not even taught on QL-3 anymore.  An enquiring mind wants to know. :dontpanic:


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## Fraser.g (21 Jul 2004)

I have herd that the MCSP standards are changing and skills are being added or at least modified for September. Has anyone seen the changes? What are they?

Are we converting over to AMFR2 exclusively and if so what are we doing with EMR and BTLS?

GF


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## elliott.t (4 Aug 2004)

Does MCSP replace MOCOMP or is it integrated into it, or what?
Terribly confusing from the outside.


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## Brad Sallows (4 Aug 2004)

MOCOMP is a general expression (maintenance of competency); MCSP (maintenance of clinical skills program) is a specific instance of a MOCOMP program.


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## HCA (14 Aug 2004)

As requested.

DRAFT of the new elements for the MCSP 04/05:
> 
> a. Test Hearing; 
> b. Test Vision;
> c. Monitor/Discontinue Intravenous Therapy;
> d. Practice Asepsis;
> e. Assist with Minor Surgery; 
> f. AMFR2 Sessions:
> 1. Roles and Responsibilities, session 1;
> 2. Automated External Defibrillation, session 13;
> 3. Behavioural Emergencies, session 20;
> 4. Substance Abuse, session 24; and
> 5. Communication, session 25.
> g. Provide Emergency Treatment in a Nuclear,
> Biological or Chemical (NBC) Environment.

Additional information expected within the next few weeks after draft has been approved.


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## vr (16 Aug 2004)

Hopefully additional funding as well.... :dontpanic:


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## Armymedic (16 Aug 2004)

Is AMFR-2 the new advanced first aid?

if so then....


			
				RN PRN said:
			
		

> Are we converting over to AMFR2 exclusively and if so what are we doing with EMR and BTLS?



BTLS is still deployment standard for all reg force Med Techs, why would Res drop it?


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## Fraser.g (16 Aug 2004)

This was my question. The skill sets are similar but the protocol sequence is slightly different.

GF


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## HCA (17 Aug 2004)

As far as I understand we are to continue to ensure everyone remains BTLS certified as well.


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## Armymedic (17 Aug 2004)

Excellent, then teach it all....can't complain about being bored then.

Because one trauma assessment technique (i call them drills, because thats really what they are) may not reflect a pers preference, then giving pers options of several diffrent techniques may produce better individual results. The end result being the same regardless...rapid evacuation to further care.

Has any thought been put to doing BTLS Access, or practicing difficult enviromental senarios for both trauma and medical prehospital training.


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## Brad Sallows (17 Aug 2004)

>Monitor/Discontinue Intravenous Therapy

Interesting distinction.  Can "Decide to Start IV Therapy" and "Start an IV" not be separated?


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## Donut (18 Aug 2004)

WRT the IV start v decision to start, that's pretty much what is already done out here with the military BTLS we teach, out here in BC anyway--Students have to know the indications for an IV in trauma, but we're not expecting our reserve-only qualified mbrs to demonstrate IV starts anymore.   That's in keeping with the EMR/AFMR standard of care we're training to.   And there's, I think, one of the sources of confusion between the EMR/AFMR and BTLS standards of care--BTLS will expect you to start a line, BTLS will expect you to know how to percuss a chest, expect you to know fluid resuscitation calculations, etc.   Very few, if any, NOCP EMR programs will expect that out of their students.

DF


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## MedCorps (20 Aug 2004)

Danger... 

One of the 10 skills I want from any medic is the ability to start an IV.  This is a skill that should not be lost by the Res F!   We are now crossing the line of no return if you drop skills like this.... 

Cheers, 

MC


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## Armymedic (20 Aug 2004)

Hear, Hear, MC...

Any basic skill taught during BTLS that med techs are allowed to do by delegated acts should be maintained....


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## vr (21 Aug 2004)

It doesn't look like the Pres is teaching it's Medics IV's anymore.  We went throught the QL3/4/6A syllabi and couldn't find any mention of starting IV's.  It appears that giving injections has disappeared as well.  If anyone has more up to date info please correct me gently.

The IV portion of BTLS was always meant to be only a refresher for those who had previously been taught.  We didn't even do this on our last 2 BTLS courses due to the logistic and time constraints involved.  A 2 day BTLS course isn't supposed to really teach any particular skills but provides a framework and protocols to use those skills in.

Putting on my conspiracy hat I think this represents further emasculation of the non-civvie qualified Reserve Med A trade.  It also allows NO's to adopt IV starting as reason to justify their existance in field medical units.

Conspiracy hat off, beret back on, and back at 'er..... :dontpanic:


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## Fraser.g (22 Aug 2004)

I hate to break your conspiracy theory but if you think that I went and got a BScN so that I could start the occasional IV in a Field Hospital then you are sadly mistaken. I will probably me more busy with the arterial lines, complex IV treatments, Drains, Gastric decompression, potassium balance, and other skills to worry about a bolus of a crystaloid or getting peripheral access.

Yes I believe that there is a slow deletion of skill sets from the reserve Med A and it has to STOP! I have even herd scuttlebutt that the regular force wants reservist medics only to be rudimentary ambulance drivers so that they can act as human IV poles and litter bearers. I have not seen anything to justify this rumor. 

Yes the BTLS IV portion is designed as a refresher and the actual IV portion is still in MCSP as a unit responsibility.

This year I intend to teach IV initiation, solutions as well as maintenance to my medics unless told otherwise by my chain of command. We have been issued these wonderful training aids and IV arms to practice this skill set so that is what I will do. I do not intend to go around and hold my medics arm every time an IV blows or has to be started. Now if a medic is having problems with a hard start then I will be glad to use my skills to help him or her out.


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## Donut (8 Sep 2004)

I thought I'd give this thread a kick, and start a new line of discussion in reply to Armymedic.

When I was in Edmonton, 15 (then Med Coy) Fd Amb loaded all sorts of pers onto the variety of BTLS courses that GMCC used to run.  I recall doing a unit-run BTLS in September, a BTLS Access in Oct, and a BTLS Pediatric in December.  I don't recall the unit paying the costs of the second two, but I did get Cl A days for those.  Our Doc loved it, she stripped apart an Econovan in about 15 minutes and then went looking for any un-punched windows in the training area!

I've also given some thought about the potential for a need to arise for extrication or disentaglement in the field;  At WATC, Pet or Gagetown there's a fire department with the Hurst tools, lifting bags etc fairly close, but what has been done on deployments?  It's not like we didn't have MVC's in Bosnia, Croatia, etc.

Has it just never come up, or has it always been a case of improvise, adapt, and overcome, with lucky outcomes? 

I've always thought that a small "battle box" kit (probably small enough to fit in the crowsnest of the LS amb) could hold all the stores needed for a BTLS extrication of anything in the CF that isn't armoured.  Our Engr friends also have a pretty nifty hydraulic trailor with lifting bags, impact wrenches,  etc for building Accro bridges.  I bet with the right tools you could access anything in our inventory without much difficulty.  

Slap a Stokes basket onto the roof, throw some static line and a haulage rig into the side bin (ok, not that easy, but you see where it's going) .  Maybe remove one stretcher bench in the back, add more storage and crew it with three and you'd actually have a light rescue unit capable of dealing with most forseeable events.  Oh, yeah, you'd need to train the freakin' crew, too.  How many Mtn Ops medics are there?  

So, despite the fact that we can't equip or properly crew many of our existing ambs, what's the thinking on this?

DF


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## RatCatcher (12 Sep 2004)

WRT the kit additions "wanted" for the LSVW to do extrication...why don't we look at the fact that we need a new vehicle which is capable of being an "effective" ambulance.  As a Med Tech I remember trans a pt with a back injury in Wainwright and unfortunately it is not an effective Veh in offroad situation.  

As for skills... one of my pet peeves with the new training of Med Techs (ie BCJI) (and one of the reasons for my remuster to PMed) is the fact that we, as military medical pers, are NOT civillian paramedics.  The fact that new Med Techs arrive at Fd Amb and "want" all the new fangled equipment does not constitute the fact that no matter how much high tech equipment you have or don't have you must be able to addapt to the situation at hand.  The Med Tech must be able to work withought the aid of high tech since Murphys Law does play a role IE the eqpt might not last a combat/field environment meaning the military would have to pay to have the eqpt repaired contantly which in turn means that it is not in the hands of the medic anyway.  

With that said ...I am not entirely against the civillian involvement in the training... it has it's place.  BUT the staff needs to remind the candidates that they may not have the eqpt all the time and will have to adapt.  My training in the 90s always emphasized the "what are you going to do... cause you don't have X piece of eqpt."  

The training is always evolving... thats another problem...for another day though....


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## Armymedic (12 Sep 2004)

> no matter how much high tech equipment you have or don't have you must be able to addapt to the situation at hand.   The Med Tech must be able to work withought the aid of high tech since Murphys Law does play a role IE the eqpt might not last a combat/field environment meaning the military would have to pay to have the eqpt repaired contantly which in turn means that it is not in the hands of the medic anyway.
> 
> With that said ...I am not entirely against the civillian involvement in the training... it has it's place.   BUT the staff needs to remind the candidates that they may not have the eqpt all the time and will have to adapt.   My training in the 90s always emphasized the "what are you going to do... cause you don't have X piece of eqpt."


Words from another who obviously has BTDT as well...
What you say is too true and is my greatest asset in knocking the chip off some baby medics shoulder who is fresh out of ql 3 PCP and think they are more "qualified" then I am.



> I've also given some thought about the potential for a need to arise for extrication or disentanglement in the field; At WATC, Pet or Gagetown there's a fire department with the Hurst tools, lifting bags etc fairly close, but what has been done on deployments? It's not like we didn't have MVC's in Bosnia, Croatia, etc.
> 
> Has it just never come up, or has it always been a case of improvise, adapt, and overcome, with lucky outcomes?
> 
> ...



para 1:Yes there are Fire fighter both in Canada and overseas...but who's to say how long they are going to be in getting there, or if they are able to get there at all...In Bosnia the IRT helo had limited space. If the Fire/Extraction crew had to come out, they would, at the expense of other assets that could come out (ie EOD, aneathisist, etc) because of the amount of equip they had to bring. Having the skills/knowledge about what is needed to help extract whoever, whenever allows me to make that on scene decisions about what said assets I need the most. Further, we are the only true army emergency services, no one else has a need for that type of skill set or requirement for that knowledge.

para 3: battle box: really all we need other then good gloves and eye protection is the Force Axe, which is standard issue to any Bison Amb, pioneers and veh tools, and a sturdy hacksaw with a few multiuse blades. Hacksaws are fairly easy to acquire thru your CQ. 

para 3: engineers: such said equipment is held in the rear with 25 Sqn (support Sqn, 15, 25, 55 etc depending what brigade) it also is great IF you can get it but then again is the time/avail factor which really makes it an unrealistic option to count on.

para 4: Stokes: not enough to fit every amb, but they are avail on call. On roto 13 we had it readily avail and it was on my discretion as Med comd to bring it based on the info from scene. If we were supporting another camp, then it was always brought. As for Mtn Ops, we try to get as many qual as we can. On this falls 3 RCR BMO serials we are qual 4 more (In my UMS, that will give me 7 of 10 MA's BMO qualified). But BMO isn't a req, as the pertinent skills can be specifically taught to medics. (Armymedic don't got BMO, but can still tie a knot or two)

In all and all, I totally agree with your points, and hence the reason things like these ideas and skills can supplement those boring death by PP lectures.

For those reserve fd ambs, you can do this in a class room...try evacing a cas on a backboard using BTLS protocols, from one side of class to the door without anyone getting any part of their body, or equipment above the level of the top of the desk, and without moving anything in contact with the floor....Do it FFO for a bigger challenge.

Not easy...give it a try.


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## starlight_745 (16 Sep 2004)

I think the move to incorporate civilian qualifications into our training is generally the right thing however it needs to be done prudently.  we must maintain the field medical skill set as well as the do more with less mentality.  Having a defined qualification is good as I think it (may) hopefully give CF health professionals better access into the civilian system for MOCOMP.  I.E.  we can say hey we have x number of PCP qualified med techs can we hook up with some hospital rotations and ambulance time etc.  The thing that I find very disturbing in the reserves is how we are essentially moving to a 2 tiered system.  If you have civvy quals then fine but if you don't you're out of luck.  Now myself, I have PCP quals so it doesn't affect me but I have troops who essentially have very little chance to do anything.  After QL3/4 their only option is doing very limited med support or working in a cadet camp MIR.  There is practically no further medical training beyond annual MCSP?CPR/BTLS etc.  There is no QL5 for reserves, they cannot deploy with the regs so a good learning opportunity is lost there, and 6A's has very little new medical training.  It's no wonder you see all kinds of reserve senior Cpls and Mcpls clearing out or remustering.  There is no way for the system to be sustainable with these kind of losses.  We focus on recruiting but then we're ending up with sections full of green as grass QL3's and virtually nobody to mentor them.


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## RatCatcher (16 Sep 2004)

Although I am out of the Med Tech trade I have the chance to view the issue from outside/ex-medic eyes.... and ex-militia also.  The problems with the CFHSvsGp right now is both in the regs and the res. The simple fact is that they have to concentrate on one side first then fix the other.  Right now the Gp Chief and the Br Chief are hard at work trying to sort out the Reg F 737 MOC. Once they come to a final stream of training for the Regs I'm sure the Res system is going to start to come into line.  The simple fact is you can't run a 7-8 month reserve course cause all of the new reservists won't be able to attend...therefore they are not equal to the Reg F unless they come in with civvy quals. It is the same in a way with the Regs, if you come in with PCP, they take that into consideration. 

As for the branch in general... I had a briefing from the DGHS and the Br Chief today and they are happy (at least with the Regs) with the way things are proceeding.  All I know is I happy to have changed to another 700 series MOC

BTW ArmyMedic...god is my butt sore from sitting in front of my computer all day!!! LOL


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