BASICS type responders

ambo112 · 03-06-2013 10:13PM

I'm making headway with the insurance -
Hopefully..

What about NEMRA?
National Emergency Medical Responders Association?

Easy to remember and straight to the point?

Old diesel · 03-06-2013 10:15PM

another post - yet another model (hopefully if the video works.

This is the London air ambulance and their rapid response car - double crewed with Paramedic and doctor.

Of course these guys are trained up to the full whack highly advanced high end stuff like anesthetics.

However what it demonstrates is a doctor and Paramedic (advanced paramedic) working together as a two man crew.

http://www.youtube.com/watch?v=_CagfJ5_fcU

Again - not saying its the answer all the different models have their own advantages and disadvantages - and it may be possible to combine aspects of certain models. For example Ambo112 - you mention having an off duty garda do the driving if the doctor is not trained.

But could the driver not be a Paramedic or Advanced Paramedic???. Meaning that at the serious 999 emergency - you could have 2 medical professionals which would be very useful imo in serious situations.

Oh - and the doctors in London - are NHS funded I believe - a bit early to think that far ahead - but something to think about in the long term??? - but if you linked in through a GP practice that in turn was hooked up to primary care - could Primary care fund payment of responders for these 999 first responder type services provided by Doctors, Paramedics and Nurses???

Just looking at different options

.

Eugene

ambo112 · 03-06-2013 10:29PM

Old diesel wrote: »

another post - yet another model (hopefully if the video works.

This is the London air ambulance and their rapid response car - double crewed with Paramedic and doctor.

Of course these guys are trained up to the full whack highly advanced high end stuff like anesthetics.

However what it demonstrates is a doctor and Paramedic (advanced paramedic) working together as a two man crew.

http://www.youtube.com/watch?v=_CagfJ5_fcU

Again - not saying its the answer all the different models have their own advantages and disadvantages - and it may be possible to combine aspects of certain models. For example Ambo112 - you mention having an off duty garda do the driving if the doctor is not trained.

But could the driver not be a Paramedic or Advanced Paramedic???.

Oh - and the doctors in London - are NHS funded I believe - a bit early to think that far ahead - but something to think about in the long term??? - but if you linked in through a GP practice that in turn was hooked up to primary care - could Primary care fund payment of responders for these 999 first responder type services provided by Doctors, Paramedics and Nurses???

Just looking at different options .

Eugene

They could most definitely be driven by a paramedic/AP.

As for funding, it would need to be very big and proven its worth before the HSE could be approached for funding.

I don't think we will every see any form of pay being made available to members. However, the insurance for all the vehicles could be looked at, if the HSE was to pay the car insurance every year, that would be a great show of appreciation, but again that is dreaming at this early stage.

Old diesel · 03-06-2013 10:56PM

ambo112 wrote: »

They could most definitely be driven by a paramedic/AP.

As for funding, it would need to be very big and proven its worth before the HSE could be approached for funding.

I don't think we will every see any form of pay being made available to members. However, the insurance for all the vehicles could be looked at, if the HSE was to pay the car insurance every year, that would be a great show of appreciation, but again that is dreaming at this early stage.

Fair points on the funding - and to be fair theres an element of trying to run before weve even started to walk.

My angle on that (feel free to ignore me - I do tangents far too well) is that you'have say a primary care team consisting (im making this up as an example) of GPs, Physio, Speech therapist, wound care nurse, practice nurse, phsychologist.

So could you have that same primary care team - but this time - added to the list - is pre hospital emergency care response doctor and Advanced Paramedic

I need to go away and have a rethink - my thinking on primary care may well be different to the guys in charge of primary care.

See - I did warn you I do tangents very well

.

Eugene

resus · 03-06-2013 11:10PM

ambo112 wrote: »

All we need is a single entity that all the responders and future responders could link up with. That PHECC could regulate, that NAS could manage and direct, that members can link into for insurance and a range of other benefits. For donations to be channeled into etc...

Start with pure basics, a kit bag, vehicle insurance and the PHECC app for the national control room.

Have you spoken yet to anyone from WCRR or ECRR? Irish Communities Rapid Response (ICRR) is already this very entity you're trying to create!

nsa75 · 03-06-2013 11:38PM

Might I also suggest making contact with some other experts in this field - Mr Brian Carlin, as referenced as the author of the article posted earlier, may well be a very good place to start.

The concept of a nationwide BASICS-type scheme has long been thought about and there are some excellent physician-led volunteer services leading the way in Cork, as already eluded to. This level of pre-hospital care is akin to that provided by trauma teams in the UK operating under HEMS/MAGPAS/BASICS schemes and as such requires strict clinical governance and constant review. It is important to note that such schemes are mostly (if not all)physician-led - this is something which Ireland is slowly coming around to with the rapid develpoment of Immediate Care interests and the sub-speciailty of Pre-Hospital care itself creeping ever more into Emergency Medicine/Critical Care.

The ideas put forward so far are great and reflect the desire for PHC providers at all levels to drive services in Ireland to their full potiental - I just think it might be better to focus efforts through the relevant avenues of expertise in order to avoid the fragmentation mentioned above by another poster.

Old diesel · 03-06-2013 11:49PM

resus wrote: »

Have you spoken yet to anyone from WCRR or ECRR? Irish Communities Rapid Response (ICRR) is already this very entity you're trying to create!

And a brilliant entity it is to be fair.

However in the expansion of immediate care - we do need imo - to look at various models - develop the systems more.

As it stands - ive linked to a Scottish system earlier which is different to the Cork system - and while not as good - I think its more suited to a system that's depending on volunteers.

It can of course be tweaked further to make it better imo - we are not compelled to copy a complete system in its entirety.

Cork system is superb - but if we are thinking 10 to 15 years down the line - I think that it imposes far too much demand on a volunteer doctor who also has to do a day job. To be frank with you - I don't know how guys like Doctor Hugh Doran manage it all.

You would need to go the London air ambulance route and fund the doctors through state funding/health service etc.

Sorry for the tangents lads - just thinking outloud here - want to create a good system that's sustainable and will keep going well for many years to come if its set up right

Eugene

ambo112 · 04-06-2013 11:10AM

Great posts folks, all extremely valid points. For the response doctor and ALS side of things, it will absolutely have to be run by a physician led team, of which there are highly respected people out there keen to get involved.

However, I see the advanced areas, such as doctors and anaesthetics etc... As being the pinnacle of Pre hospital care, but to get there we need to start small.

We need to build from grass roots, starting with paramedics, in their private vehicles, responding to calls in all areas of Ireland, rural and urban. Delivering basic care while awaiting an ambulance.

If the charity takes off and that's a big IF, then once funding improves, we can approach the relevant physicians and nurses and see if we can come up with a training programme for GP's and Nurses and look at how to deploy it, such as vehicle leasing? Private vehicle for a practice? Etc...

All the current charities have doctor led response but are limited to one or two vehicles.

This will be a nation wide responder scheme for all areas of Ireland, each member will be able to respond themselves with insurance in their vehicles. Blue lights for those who have the emergency driver training and normal response for those who don't.

Theoretically if this takes of, you could have 1,500 responders and 1,500 vehicles.

Without the need for maintenance costs, fuel costs, service costs etc...

Easy to join and work under. As time goes by, purchasing bags and AED's for each member would be a priority.

But this is all only a vision at the moment, baby steps....

resus · 04-06-2013 01:44PM

ambo112 wrote: »

We need to build from grass roots, starting with paramedics, in their private vehicles, responding to calls in all areas of Ireland, rural and urban. Delivering basic care while awaiting an ambulance.

Ah... just realised there might be a slight misunderstanding and we are indeed on the same page!!!

Despite their initial beginnings (East Cork 40yr ago! and West Cork 6yr ago) WCRR and ECRR both are heavily focused on developing BLS and ALS support to the Emergency Services. ECRR has its entire model focused around Cardiac first responders. WCRR has APs according to their website and Twitter, and is known to be really involved with Fire, Coast Guard and Garda BLS development.

The IRCC model is firmly based on grassroots Paramedics & APs with slow incorporation and development of Prehospital Emergency medicine. ie. EXACTLY as you in visage ambo112 ! PM me if you want contact details

ambo112 · 04-06-2013 03:30PM

resus wrote: »

Ah... just realised there might be a slight misunderstanding and we are indeed on the same page!!!

Despite their initial beginnings (East Cork 40yr ago! and West Cork 6yr ago) WCRR and ECRR both are heavily focused on developing BLS and ALS support to the Emergency Services. ECRR has its entire model focused around Cardiac first responders. WCRR has APs according to their website and Twitter, and is known to be really involved with Fire, Coast Guard and Garda BLS development.

The IRCC model is firmly based on grassroots Paramedics & APs with slow incorporation and development of Prehospital Emergency medicine. ie. EXACTLY as you in visage ambo112 ! PM me if you want contact details

Thanks a million, I will certainly keep it in mind.

For the minute, I'm going to keep on the insurance policy side as this will be the great decider.

If I can get fully comp, standard insurance with the addition of blue light for around 400 euro per annum for each member then hopefully a lot will join up and replace their current insurance.

We immediately have first responders who can respond. As simple as a membership form, membership payment and Garda clearance.

As I said earlier, blue light will only be for those with advanced driver training, but even then they can decide to drive under normal conditions if they wish.

My aim is to make membership as simple as possible. Then when funds are available, we can look at bulk purchase of kit, such as bags, AED's etc...

Ah, to have a dream......

drvr · 04-06-2013 04:36PM

If you decide to set up an organisation and to respond as a member of that organisation, then you will probably need other insurance policies, Public liability and malpractice (or similar). The organisation as an entity could take out policies and their members could be covered whilst responding (similar to any of the voluntary orgs).

I certainly would be very interested in getting involved in such a scheme, as in my area, a waiting time for ambulance response can be well over an hour.

I've gotten a few calls from friends and neighbours etc to respond to incidents where an ambulance has been delayed and I'm sure many other Paramedics and EMT's have similar experiences. And there are truckloads of equipment lying idle around the country that could be utilised for such schemes.

ambo112 · 04-06-2013 05:32PM

drvr wrote: »

If you decide to set up an organisation and to respond as a member of that organisation, then you will probably need other insurance policies, Public liability and malpractice (or similar). The organisation as an entity could take out policies and their members could be covered whilst responding (similar to any of the voluntary orgs).

I certainly would be very interested in getting involved in such a scheme, as in my area, a waiting time for ambulance response can be well over an hour.

I've gotten a few calls from friends and neighbours etc to respond to incidents where an ambulance has been delayed and I'm sure many other Paramedics and EMT's have similar experiences. And there are truckloads of equipment lying idle around the country that could be utilised for such schemes.

Absolutely, the resources are there. The vehicle insurance would be for members but the public liability and malpractice would be organisational.

If this takes off I will most definitely be seeking as much help as possible and then some.

ambo112 · 04-06-2013 05:49PM

From an insurance point of view, as this will not be public events, public liability is not needed. The individual vehicle policies will cover an incident.

The individual responder will be responsible if they want to get personal insurance as the legal advice which PHECC sought states that if a practitioner acts within their scope of training then a legal claim would not be successful.

The majority of public clubs and local AED schemes have no insurance for malpractice as it would not be needed unless they done something grossly negligent, which the organisation would not cover anyway.

Provided you don't step outside your guidelines, you are covered. However, if the HSE was to back this organisation they would have the added security of the that states clinical cover.

drvr · 04-06-2013 06:19PM

Acting as Devil's advocate, How different would this organisation be from any other Vol org ? Could the HSE not operate with vol organisations in an area and ask them to respond (BLS / AED / First Responder level) to incidents as needed.

ambo112 · 04-06-2013 06:45PM

drvr wrote: »

Acting as Devil's advocate, How different would this organisation be from any other Vol org ? Could the HSE not operate with vol organisations in an area and ask them to respond (BLS / AED / First Responder level) to incidents as needed.

Dedicated to first responders not events, but I would welcome any other charity to do this, I would be the first to sign up!!

ectoraige · 05-06-2013 09:43AM

I've been thinking along similar lines for some time, looking from the bottom up. We have probably tens of thousands of CFRs trained across the country through clubs, businesses and other organisations. The vols have, I'm sure, thousands more EFRs and EMTs, all of whom will have some level of experience of treating casualties. PHECC have their Responder Alert app which I believe has worked well where it has been deployed. If the dots could just be joined I believe pre-hospital care could be improved for very little extra expenditure.

There's room for an organisation that could act as the administrative liason between these trained volunteers, the voluntary organisations, PHECC, and NAS to allow members to respond to calls in their locality. Obviously the Ps would still be required to respond, but I'm sure in many instances locals can reach an incident first and at least begin treatment within their training.
This could be done without blue lights, without drugs, and without additional equipment beyond a basic first-aid kit. Some induction training would be necessary, mostly about how to make themselves available, how NOT to place themselves and others at risk, and how to best prepare the scene/casualty for the arrival of paramedics. I'm sure a lot of vols would be willing to provide this training to their own members.

I believe this could be achieved with relatively little funding, just the expenditure of time. Once established and the organisation is better placed to obtain funding it could facilitate pre-hospital care training for practictioners such as doctors and nurses, or help provide the equipment/resources required. Advanced driver training and facilitation of blue-light insurance (and blue lights!) would come more to the fore then. Given enough funding this resource could be extended to the 'lay' responders too. Many vols would already have given this training to their members too.

I'd definitely be interested in helping out on something along these lines.

ambo112 · 05-06-2013 01:51PM

ectoraige wrote: »

I've been thinking along similar lines for some time, looking from the bottom up. We have probably tens of thousands of CFRs trained across the country through clubs, businesses and other organisations. The vols have, I'm sure, thousands more EFRs and EMTs, all of whom will have some level of experience of treating casualties. PHECC have their Responder Alert app which I believe has worked well where it has been deployed. If the dots could just be joined I believe pre-hospital care could be improved for very little extra expenditure.

There's room for an organisation that could act as the administrative liason between these trained volunteers, the voluntary organisations, PHECC, and NAS to allow members to respond to calls in their locality. Obviously the Ps would still be required to respond, but I'm sure in many instances locals can reach an incident first and at least begin treatment within their training.
This could be done without blue lights, without drugs, and without additional equipment beyond a basic first-aid kit. Some induction training would be necessary, mostly about how to make themselves available, how NOT to place themselves and others at risk, and how to best prepare the scene/casualty for the arrival of paramedics. I'm sure a lot of vols would be willing to provide this training to their own members.

I believe this could be achieved with relatively little funding, just the expenditure of time. Once established and the organisation is better placed to obtain funding it could facilitate pre-hospital care training for practictioners such as doctors and nurses, or help provide the equipment/resources required. Advanced driver training and facilitation of blue-light insurance (and blue lights!) would come more to the fore then. Given enough funding this resource could be extended to the 'lay' responders too. Many vols would already have given this training to their members too.

I'd definitely be interested in helping out on something along these lines.

That is exactly what I am aiming to achieve, staring with Paramedics first, purely because of the ease to which they would adjust to this role. It would be very straight forward, once up and running everything else would come into its own with time.

Old diesel · 05-06-2013 01:59PM

The West and East Cork rapid response set ups are fantastic.

However do you think one would be obliged to follow their set up to the exact letter of the law. The training and governance side - that's great no concerns following the system there

But in terms of expanding out this kind of service - I think that the idea of having amazing doctors who have very high training for this kind of work - with anesthetics and other superb skills - doing the role for nothing may need a rethink.

I know lots of people would disagree with me - ie get the service set up - that's the first priority.

I agree - but would argue that the model has been on the road in West Cork for 5 years (and for considerably longer in East Cork courtesy of Dr Hugh Doran) - so the system is already proven in terms of what it can do.

Thanks to everyone for this discussion - some fantastic points made - and I wish Ambo112 all the best with what hes looking to do.

I hope he succeeds because I think it will make a difference.

In terms of a North Cork "rapid response" - im going off to have a long think about it. I want to (as Ambo112 said earlier in the tread "ah to have dreams":)) to research primary care more and how extra things could be added to the local primary care set up.

So having a doctor and/or Advanced Paramedic working as part of the primary care team - responding to 999 calls.

Probably thinking about it the wrong way - but im determined to figure it out and see if a service could be set up in North Cork.

Id like to stress though that the East and West Cork Rapid Response set ups are doing fantastic work - can't stress that enough.

Eugene

Eugene

nsa75 · 05-06-2013 02:22PM

I think things were a little confusing towards the beginning of the thread with reagrds to the type of service that people were aiming for here - it's clear now that what is being discussed is more so a nationwide expansion of a Community First Responder scheme. This would be a highly valuable asset for the NAS to draw on and it beggars believe as to why this isn't the norm already in Ireland due to the lack of complexity involved in such a service.

I know it has been mentioned above about trying to incorporate a BASICS level of input from GP's/Docs at some point down the road into the same scheme - this level and type of service is indeed where PHC in Ireland needs to (and will) go in the next few years. I think it's a different beast entirely though to what's being discussed here, and as such, should be led from top the down by the likes of Brian Carlin with significant input from the Cork groups.

Wish you all the best with the new venture!

ambo112 · 05-06-2013 04:24PM

nsa75 wrote: »

I think things were a little confusing towards the beginning of the thread with reagrds to the type of service that people were aiming for here - it's clear now that what is being discussed is more so a nationwide expansion of a Community First Responder scheme. This would be a highly valuable asset for the NAS to draw on and it beggars believe as to why this isn't the norm already in Ireland due to the lack of complexity involved in such a service.

I know it has been mentioned above about trying to incorporate a BASICS level of input from GP's/Docs at some point down the road into the same scheme - this level and type of service is indeed where PHC in Ireland needs to (and will) go in the next few years. I think it's a different beast entirely though to what's being discussed here, and as such, should be led from top the down by the likes of Brian Carlin with significant input from the Cork groups.

Wish you all the best with the new venture!

Loving the support folks, worried I might get abuse :-)

It will be a basic set up at first, but if funding was to increase it could expand into a nationwide entity.

If that dream comes through, it won't be me leading it, it would most certainly be handed over the the likes of ECRR and WCRR and any other appropriate physicians to direct that.

But if we start small and get national funding we may be in a position to fund more schemes or just amalgamate existing ones like BASICs have done.

But again, that's sprinting before we even took the first step.

Keep an eye on here, if it takes off I will need as many hands as possible to help.

dredre · 05-06-2013 07:20PM

ambo112 wrote: »

Loving the support folks, worried I might get abuse :-)

It will be a basic set up at first, but if funding was to increase it could expand into a nationwide entity.

If that dream comes through, it won't be me leading it, it would most certainly be handed over the the likes of ECRR and WCRR and any other appropriate physicians to direct that.

But if we start small and get national funding we may be in a position to fund more schemes or just amalgamate existing ones like BASICs have done.

But again, that's sprinting before we even took the first step.

Keep an eye on here, if it takes off I will need as many hands as possible to help.

If you are looking at this in any sort of CFR capacity, you will have to satisfy NAS that you meet their requirements.

http://www.hse.ie/eng/services/list/3/nas/rptspoliciesandprocedures/firstresponderschemes.pdf

Note the stipulations re training, vehicles and driving.

I think you'd have to go by this policy if you expect NAS to task you to calls.

ambo112 · 05-06-2013 07:49PM

dredre wrote: »

If you are looking at this in any sort of CFR capacity, you will have to satisfy NAS that you meet their requirements.

http://www.hse.ie/eng/services/list/3/nas/rptspoliciesandprocedures/firstresponderschemes.pdf

Note the stipulations re training, vehicles and driving.

I think you'd have to go by this policy if you expect NAS to task you to calls.

I appreciate the input, will take it on board.

drvr · 06-06-2013 09:01AM

Don't forget to keep us filled in in how you're getting on.

Old diesel · 06-06-2013 10:31AM

drvr wrote: »

Don't forget to keep us filled in in how you're getting on.

Absolutely

would be great to hear updates of any progress made.

Eugene

ambo112 · 06-06-2013 07:17PM

Old diesel wrote: »

Absolutely would be great to hear updates of any progress made.

Eugene

Big thing is the insurance I envisage, this will be the first stone, I have made a few enquiries and contacts and the wheels are definitely moving.

Parallel to that is trying to get a constitution as its called as an unincorporated entity to start with, that will allow me to get charity status with revenue, IF I get the insurance.

Wheels turn slow, unfortunately.

Once it is established, then comes committees, that's when I will need all interested persons to meet up, but as I say it would most likely be a few months away.

limericklad87 · 06-06-2013 09:36PM

From reading this it seems that advanced primary care is the aim. However there are many trained volunteers spread throughout the country and indeed north cork

Would there be any plans to link up with existing volunteers/organizations who are trained to CFR-EMT with existing equipment vehicles and insurance

ambo112 · 06-06-2013 09:50PM

limericklad87 wrote: »

From reading this it seems that advanced primary care is the aim. However there are many trained volunteers spread throughout the country and indeed north cork

Would there be any plans to link up with existing volunteers/organizations who are trained to CFR-EMT with existing equipment vehicles and insurance

Advanced care is a long way off. As for linking with other groups. I don't think so, with the possible exception of Doctor based schemes, but that would be a long way off and it would be up to a physician to develop that aspect, if it ever got there.

The vols that are there are all very skilled, well equipped and have good vehicle capabilities.

But this would be a stand alone entity, with the exception of GP schemes, if it got that far.

The reason is that the vols are established and responsible for their groups, they are already capable of approaching the HSE and offering a responder service but haven't, for their own valid reasons.

If this takes off, starting with Paramedics, then there would most certainly be scope for EMT's to join this new charity as members and responders. But this charity would have to get much bigger to allow local training, refreshers and support for those who don't do this as a career, also appropriate age, Garda clearance etc...

All the other grades below practitioners are very skilled and valuable but I don't see it as being a feasible option in terms of this charity.

How ever there is the possibility of future accreditation and courses that may lead members to be trained from all levels up to EMT, but again, that's sprinting before our first step :-)

miju · 10-06-2013 03:05PM

I think with the insurance issue your running before you can walk.

Theres many organisations that WILL have to be part of this which will most definitely have to include NAS.

Having been down this road already NAS and the IHF have charge of responder schemes. Brigid Sinnott in the IHF would be best person to talk to first.

Insurance can be done at ZERO additional cost through the responders own private insurance company and the sending to them of a templated letter that NAS, IHF and the insurance companies have agreed upon.

Because has it stands NAS will only task a responder scheme with Echo calls regardless of the clinical level of the responder

And when your talking APs, Ps and EMTs you are most definitely talking about having to obtain PHECC CPG approval and that is a big undertaking to get approval and they do require various insurance which is VERY expensive regardless of charity status.

If you include training accreditation costs that insurance mounts again.

I think this is potentially a great idea and i'd be happy to help but CLEAR initial focus, goals and aims needs to be the order of the day.

Not thinking of future what ifs etc

Old diesel · 10-06-2013 03:52PM

miju wrote: »

I think with the insurance issue your running before you can walk.

Theres many organisations that WILL have to be part of this which will most definitely have to include NAS.

Having been down this road already NAS and the IHF have charge of responder schemes. Brigid Sinnott in the IHF would be best person to talk to first.

Insurance can be done at ZERO additional cost through the responders own private insurance company and the sending to them of a templated letter that NAS, IHF and the insurance companies have agreed upon.

Because has it stands NAS will only task a responder scheme with Echo calls regardless of the clinical level of the responder

And when your talking APs, Ps and EMTs you are most definitely talking about having to obtain PHECC CPG approval and that is a big undertaking to get approval and they do require various insurance which is VERY expensive regardless of charity status.

If you include training accreditation costs that insurance mounts again.

I think this is potentially a great idea and i'd be happy to help but CLEAR initial focus, goals and aims needs to be the order of the day.

Not thinking of future what ifs etc

West Cork rapid response are suggesting here http://www.westcorkrapidresponse.ie/about-us/ that they have advanced paramedics as part of their team???

.

If another organisation like say the Irish Red Cross/Order of Malta etc - have CPG approval - would a link up with them get around the issue.

In other words - if Ambo112 and other interested people were members of the Order of Malta and if the Order of Malta were CPG approved - and responded to 999 calls off duty - as part of a link up between NAS and Order of Malta - would that be within the rules and be okay.

Not saying that's the way forward - just thinking outloud.

Failing that - is there any possibility of changing the rules so that an Advanced Paramedic (for example) is fully covered under these rules simply on the basis if being tasked to the call by NAS who are CPG approved.

Eugene

stevie06 · 10-06-2013 05:34PM

Old diesel wrote: »

West Cork rapid response are suggesting here http://www.westcorkrapidresponse.ie/about-us/ that they have advanced paramedics as part of their team???

Failing that - is there any possibility of changing the rules so that an Advanced Paramedic (for example) is fully covered under these rules simply on the basis if being tasked to the call by NAS who are CPG approved.

Eugene

The issue of being a CPG approved organisation is dealt with by the WCRR being tasked by NAS and as such they fall into the NAS CPG role. The doctors are also phecc registered.
It is the same way that off duty NAS P and AP can treat up to the CPG level, they just call control and tell them they are on scene. They are then covered by NAS.

BASICS type responders

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