MEDICAL UPDATEMEDICAL UPDATE2015-20162015-2016

Col (Dr) Carey CapellCol (Dr) Carey CapellCitadel SurgeonCitadel Surgeon

OverviewOverview

• Infirmary StaffInfirmary Staff• Medical Services Medical Services • Hours of Operation Hours of Operation • Blue Book IssuesBlue Book Issues• When to Call EMSWhen to Call EMS

Infirmary StaffInfirmary Staff• Dr. Carey Capell, ’71Dr. Carey Capell, ’71

• Flight Surgeon / PediatricianFlight Surgeon / Pediatrician

• Dr. Kenny Caldwell, ’79Dr. Kenny Caldwell, ’79• Orthopedic Surgeon / Citadel Team DocOrthopedic Surgeon / Citadel Team Doc

• Ms. Celeste Conlon, Ms. Celeste Conlon, MSN, CFNPMSN, CFNP• Family Nurse Practitioner / Chief NurseFamily Nurse Practitioner / Chief Nurse

7 RNs 7 RNs && 2 CNAs 2 CNAs

1 Admin. Assistant1 Admin. Assistant

• Mr. Andy Clawson, MS ATCMr. Andy Clawson, MS ATC• Sports Medicine DirectorSports Medicine Director

7 Athletic Trainers7 Athletic Trainers

Infirmary ServicesInfirmary Services• Clinics:Clinics:

• Acute/Urgent Care ClinicAcute/Urgent Care Clinic• Sports Med/Ortho ClinicSports Med/Ortho Clinic• Women’s Health ClinicWomen’s Health Clinic• Allergy Shots/ImmunizationsAllergy Shots/Immunizations

• Inpatient Inpatient (36 Beds):(36 Beds):

• Daytime & Overnight AdmissionsDaytime & Overnight Admissions

• Emergencies:Emergencies: • Minor - InfirmaryMinor - Infirmary• Major – ER (Roper, MUSC, etc)Major – ER (Roper, MUSC, etc)

Services (Cont.)Services (Cont.)

• Pharmacy Pharmacy • Laboratory Laboratory • X-Ray X-Ray • EKGEKG• Specialist ReferralsSpecialist Referrals• Dental ReferralsDental Referrals

Hours of OperationHours of Operation

• OutpatientOutpatient (Clinics) (Clinics)• ““Sick Call”Sick Call”(Doc, NP):(Doc, NP): 0630-11000630-1100 & 1230-1230-

14301430 M-F M-F

• Walk-InWalk-In ClinicClinic (Nurse):(Nurse): 1430-21001430-2100 M-F M-F && W/E W/E

• Sports MedSports Med Clinic Clinic (Trainer):(Trainer): 07000700 Mon-Fri Mon-Fri

• Orthopedic Clinic Orthopedic Clinic (Doc):(Doc): 07000700 Mon Mon && Fri (only) Fri (only)

• InpatientInpatient (Admissions) (Admissions) 24 hrs/day 24 hrs/day

• Emergencies:Emergencies: 24 24 hrs/dayhrs/day

Clinics are closed for lunch: 1200-1230 M-F

Blue Book Blue Book • Medical LeaveMedical Leave::

• Appointment confirmation (Dr. office)Appointment confirmation (Dr. office)• AccountabilityAccountability (date, time, address, phone #) (date, time, address, phone #)

• Med Leave usually approved…but…Med Leave usually approved…but…• May adjust appointment dates/times (SMI, etc) May adjust appointment dates/times (SMI, etc) • Save an unnecessary trip (time, gas, and $$) Save an unnecessary trip (time, gas, and $$)

• PT UniformsPT Uniforms: : • AuthorizedAuthorized onlyonly for in-patients, X-Uniform for in-patients, X-Uniform• X-Uniform is an uncommon restrictionX-Uniform is an uncommon restriction• NotNot authorized for TDS, XMD, XPT, SS, etc. authorized for TDS, XMD, XPT, SS, etc.

Blue Book (Cont.)Blue Book (Cont.)• Excused Duty Status:Excused Duty Status:

• XMDXMD • “XMD includes: XPT, X-Brace, X-Run, X-Push-Ups, X-

Pull-Ups, X-Sit-Ups, X-Rifle, and X-Instrument. “• “XMD prohibits participation in inspections, parade, drill,

rifle manual, rapid gallery walking, driving the stairs, sweep detail and all other official military duties.”

• XPTXPT• “XPT: Not required to perform official physical training

but must be present, in PT uniform, to observe instruction during PT sessions.”

• “XPT status does not prohibit light, conditioning exercise, such as walking and swimming, unless specifically prohibited by the Infirmary or Sports Medicine staffs.”

Blue Book (Cont.)Blue Book (Cont.)• Excused Duty Status:Excused Duty Status:

• SSSS (Soft Shoe): (Soft Shoe):• “Must wear athletic shoes when in uniform. “• “May not leave campus in uniform while wearing

athletic shoes.”

• ““R”R” (Restricted to Campus): (Restricted to Campus):• “R” (restricted) designation added to any of the above

restricts the cadet to campus. “• “Typically, restriction to campus for the weekend will

accompany any excused disposition (XMD, XPT, etc.) initiated on a Friday afternoon. “

• “Except as noted above, cadets in restricted status are subject to all cadet rules and regulations.”

Blue Book (Cont.)Blue Book (Cont.)• Temporary Disability Status (TDS)Temporary Disability Status (TDS)

• “A cadet is placed on TDS when a medical condition requires that he/she be excused from military duties or physical training for an extended period of time (normally several weeks), but not permanently. “

• “TDS will always be accompanied by excused duty (e.g., TDS and XMD, or TDS and SS). TDS does NOT make a cadet “X-Uniform.”

• “A cadet placed on TDS will not be referred to the Campus Assessment Team (CAT) for medical review except under unusual circumstances; e.g., recovery taking longer than expected or extending into a new semester. “

• “TDS typically ends with the current semester. If more time is required for rehabilitation, then TDS must be renewed based on orders from the treating physician(s).”

Blue Book (Cont.)Blue Book (Cont.)• Infirmary Slip (Duty Excuse):Infirmary Slip (Duty Excuse):

• ““Cadets are given two (2) Cadets are given two (2) Infirmary SlipsInfirmary Slips after leaving after leaving the Infirmary.”the Infirmary.”

• ““Grace periodGrace period: 20 minutes to report for next duty.”: 20 minutes to report for next duty.”• ““Upon arrival for duty or class, cadets will present a Upon arrival for duty or class, cadets will present a

copy of their Infirmary Slip to a member of the copy of their Infirmary Slip to a member of the Chain‑of‑Command or to their Instructor, who will Chain‑of‑Command or to their Instructor, who will annotate time of arrival and sign the slip. “annotate time of arrival and sign the slip. “

• ““This copy of the Infirmary Slip will then be presented This copy of the Infirmary Slip will then be presented to the Company Clerk upon return to the Company to the Company Clerk upon return to the Company area.”area.”

• ““Cadets must carry the second copy of the Infirmary Cadets must carry the second copy of the Infirmary Slip with them as proof of excused status (XPT, X-Slip with them as proof of excused status (XPT, X-Cover, etc.), as appropriate.”Cover, etc.), as appropriate.”

Blue Book (Cont.)Blue Book (Cont.)• Intoxicated:Intoxicated:

• ““Cadets who return to the barracks when Cadets who return to the barracks when intoxicatedintoxicated must must be identified to the barracks guard, TAC Officer, COC, or OC be identified to the barracks guard, TAC Officer, COC, or OC and escorted to the Infirmary for further evaluation.”and escorted to the Infirmary for further evaluation.”

• ““Those who are Those who are unable to walkunable to walk may be transported to the may be transported to the Infirmary by Public Safety, (843) 953-5114.”Infirmary by Public Safety, (843) 953-5114.”

• DispositionDisposition: : Infirmary will (1) send the cadet back to the Infirmary will (1) send the cadet back to the barracks or (2) arrange transport to ER; cadets can’t sleep barracks or (2) arrange transport to ER; cadets can’t sleep it off in Infirmary it off in Infirmary

• Too Ill for Duty:Too Ill for Duty:• “Cadets considering themselves “Too Ill for Duty” MUST

report to the Infirmary for evaluation and treatment.”• “Transportation and necessary assistance can be arranged

for cadets unable to walk to the Infirmary. “• “Those cadets who have not reported to the Infirmary and

signed in will not be excused from duty.”• “Sleeping in due to ‘illness’ is not an excuse for missed

duty. “

Blue Book (Cont.)Blue Book (Cont.)• In-Patients:In-Patients:

• Duty uniform while in-patient in Infirmary:Duty uniform while in-patient in Infirmary:• Complete PT uniform; duty uniform optionalComplete PT uniform; duty uniform optional

• In-Patients cannot leave campus unless:In-Patients cannot leave campus unless:• Medical Pass (doctor’s appt, hospital visit, etc.) Medical Pass (doctor’s appt, hospital visit, etc.) • Medical Leave (proper leave uniform)Medical Leave (proper leave uniform)

• In-Patients are excused from all duties In-Patients are excused from all duties • ““Class Status.” When placed on CS, Class Status.” When placed on CS,

cadet…cadet…• Must attend class if medically able to do soMust attend class if medically able to do so• Must sign out to class, library, barracks, etc.Must sign out to class, library, barracks, etc.

The Blue BookThe Blue Book• Campus Assessment TeamCampus Assessment Team (CAT): (CAT):

• Assoc. Provost, Asst. Cmdt, Surgeon, Police, CCC, Assoc. Provost, Asst. Cmdt, Surgeon, Police, CCC, Acad. Supt. Center; Gen’l Counsel (advisor) Acad. Supt. Center; Gen’l Counsel (advisor)

• Ad Hoc: Admissions, TAC, Prof., Coach, CARE Ad Hoc: Admissions, TAC, Prof., Coach, CARE

• CATCAT TriggersTriggers:: • Applicant Applicant notnot meeting phys/behavioral meeting phys/behavioral standards standards • Knob Knob missesmisses >30%>30% of the cadre training period of the cadre training period• >21+>21+ visits/sem:visits/sem: Infirmary, medical/dental appt. Infirmary, medical/dental appt.• >21+>21+ days/sem:days/sem: excused duty (XMD, SS, etc) excused duty (XMD, SS, etc)• Major illness or injuryMajor illness or injury limiting military, athletic, or limiting military, athletic, or

academic participation for a “protracted period” academic participation for a “protracted period”

When to Call EMS? When to Call EMS? • InfirmaryInfirmary….or…….or…911911??

• A knob “passes out” driving the stairs to 4A knob “passes out” driving the stairs to 4thth Div; he is sweating, pale, breathing rapidly, Div; he is sweating, pale, breathing rapidly, not responding to cadets…just moaning a bit not responding to cadets…just moaning a bit

• Cadet responder: “I think he’s unconscious!”Cadet responder: “I think he’s unconscious!”• Cadet calls 911 Cadet calls 911 • Costs: Costs:

• Ambulance = $400Ambulance = $400• ER visit = ER visit = $600+ $600+• Lab, etc. = Lab, etc. = $400+ $400+• Hospital admission = $1000/nightHospital admission = $1000/night

• If in doubt, call us… or get him to the InfirmaryIf in doubt, call us… or get him to the Infirmary

When to Call EMS? (Cont.)When to Call EMS? (Cont.)• For patient For patient transporttransport on campus: on campus:

• Call:Call: JOD, Public Safety, Sports Med (golf cart) JOD, Public Safety, Sports Med (golf cart) • Note:Note: Infirmary is not manned for house calls Infirmary is not manned for house calls

• Gen. Order No. 1Gen. Order No. 1 – “Call 911 if”: – “Call 911 if”:• Severe TraumaSevere Trauma (fall > 10’, bone sticking out, etc) (fall > 10’, bone sticking out, etc)• Profuse BleedingProfuse Bleeding from an open wound from an open wound• Not Breathing Not Breathing (chest is still, no breath sounds)(chest is still, no breath sounds)• Totally Totally Unconscious Unconscious • Unable to Walk (even with assistance)Unable to Walk (even with assistance) to a to a

vehicle for transport to the Infirmaryvehicle for transport to the Infirmary

Questions?Questions?• Call:Call: 3-4827/68473-4827/6847 • E-mail:E-mail: carey.capell@citadel.educarey.capell@citadel.edu