1. MEDICAL UPDATE 2015-2016 Col (Dr) Carey Capell Citadel Surgeon

2. Overview Infirmary StaffInfirmary Staff Medical ServicesMedical Services Hours of OperationHours of Operation Blue Book IssuesBlue Book Issues When to Call EMSWhen to Call EMS

3. Infirmary 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, MSN, CFNPMs. Celeste Conlon, MSN, CFNP Family Nurse Practitioner / Chief NurseFamily Nurse Practitioner / Chief Nurse 7 RNs & 2 CNAs 1 Admin. Assistant Mr. Andy Clawson, MS ATCMr. Andy Clawson, MS ATC Sports Medicine DirectorSports Medicine Director 7 Athletic Trainers

4. Infirmary 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 (36 Beds):Inpatient (36 Beds): Daytime & Overnight AdmissionsDaytime & Overnight Admissions Emergencies:Emergencies: Minor - InfirmaryMinor - Infirmary Major – ER (Roper, MUSC, etc)Major – ER (Roper, MUSC, etc)

5. Services (Cont.) PharmacyPharmacy LaboratoryLaboratory X-RayX-Ray EKGEKG Specialist ReferralsSpecialist Referrals Dental ReferralsDental Referrals

6. Hours of Operation Outpatient (Clinics)Outpatient (Clinics) “Sick Call” (Doc, NP): 0630-1100 1230-1430 M-F“Sick Call” (Doc, NP): 0630-1100 & 1230-1430 M-F Walk-In Clinic (Nurse): 1430-2100 M-F & W/EWalk-In Clinic (Nurse): 1430-2100 M-F & W/E Sports Med Clinic (Trainer): 0700 Mon-FriSports Med Clinic (Trainer): 0700 Mon-Fri Orthopedic Clinic (Doc): 0700 Mon & Fri (only)Orthopedic Clinic (Doc): 0700 Mon & Fri (only) Inpatient (Admissions) 24 hrs/dayInpatient (Admissions) 24 hrs/day Emergencies: 24 hrs/day Emergencies: 24 hrs/day Clinics are closed for lunch: 1200-1230 M-F

7. Blue Book Medical Leave:Medical Leave: Appointment confirmation (Dr. office)Appointment confirmation (Dr. office) Accountability (date, time, address, phone #)Accountability (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 Uniforms:PT Uniforms: Authorized only for in-patients, X-UniformAuthorized only for in-patients, X-Uniform X-Uniform is an uncommon restrictionX-Uniform is an uncommon restriction Not authorized for TDS, XMD, XPT, SS, etc.Not authorized for TDS, XMD, XPT, SS, etc.

8. 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.”

9. Blue Book (Cont.) Excused Duty Status:Excused Duty Status: SS (Soft Shoe):SS (Soft Shoe): “ Must wear athletic shoes when in uniform. “ “May not leave campus in uniform while wearing athletic shoes.” “R” (Restricted to Campus):“R” (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.”

10. 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).”

11. Blue Book (Cont.) Infirmary Slip (Duty Excuse):Infirmary Slip (Duty Excuse): “Cadets are given two (2) Infirmary Slips after leaving the Infirmary.”“Cadets are given two (2) Infirmary Slips after leaving the Infirmary.” “Grace period: 20 minutes to report for next duty.”“Grace period: 20 minutes to report for next duty.” “Upon arrival for duty or class, cadets will present a copy of their Infirmary Slip to a member of the Chain ‑ of ‑ Command or to their Instructor, who will annotate time of arrival and sign the slip. ““Upon arrival for duty or class, cadets will present a copy of their Infirmary Slip to a member of the Chain ‑ of ‑ Command or to their Instructor, who will annotate time of arrival and sign the slip. “ “This copy of the Infirmary Slip will then be presented to the Company Clerk upon return to the Company area.”“This copy of the Infirmary Slip will then be presented to the Company Clerk upon return to the Company area.” “Cadets must carry the second copy of the Infirmary Slip with them as proof of excused status (XPT, X-Cover, etc.), as appropriate.”“Cadets must carry the second copy of the Infirmary Slip with them as proof of excused status (XPT, X-Cover, etc.), as appropriate.”

12. Blue Book (Cont.) Intoxicated:Intoxicated: “Cadets who return to the barracks when intoxicated must be identified to the barracks guard, TAC Officer, COC, or OC and escorted to the Infirmary for further evaluation.”“Cadets who return to the barracks when intoxicated must be identified to the barracks guard, TAC Officer, COC, or OC and escorted to the Infirmary for further evaluation.” “Those who are unable to walk may be transported to the Infirmary by Public Safety, (843) 953-5114.”“Those who are unable to walk may be transported to the Infirmary by Public Safety, (843) 953-5114.” Disposition: Infirmary will (1) send the cadet back to the barracks or (2) arrange transport to ER; cadets can’t sleep it off in InfirmaryDisposition: Infirmary will (1) send the cadet back to the barracks or (2) arrange transport to ER; cadets can’t sleep 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. “

13. 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 dutiesIn-Patients are excused from all duties “Class Status.” When placed on CS, cadet…“Class Status.” When placed on CS, 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.

14. The Blue Book Campus Assessment Team (CAT):Campus Assessment Team (CAT): Assoc. Provost, Asst. Cmdt, Surgeon, Police, CCC, Acad. Supt. Center; Gen’l Counsel (advisor)Assoc. Provost, Asst. Cmdt, Surgeon, Police, CCC, Acad. Supt. Center; Gen’l Counsel (advisor) Ad Hoc: Admissions, TAC, Prof., Coach, CAREAd Hoc: Admissions, TAC, Prof., Coach, CARE CAT Triggers :CAT Triggers : Applicant not meeting phys/behavioral standardsApplicant not meeting phys/behavioral standards Knob misses >30% of the cadre training periodKnob misses >30% of the cadre training period >21+ visits/sem: Infirmary, medical/dental appt.>21+ visits/sem: Infirmary, medical/dental appt. >21+ days/sem: excused duty (XMD, SS, etc)>21+ days/sem: excused duty (XMD, SS, etc) Major illness or injury limiting military, athletic, or academic participation for a “protracted period”Major illness or injury limiting military, athletic, or academic participation for a “protracted period”

15. When to Call EMS? Infirmary….or…911?Infirmary….or…911? A knob “passes out” driving the stairs to 4 th Div; he is sweating, pale, breathing rapidly, not responding to cadets…just moaning a bitA knob “passes out” driving the stairs to 4 th Div; he is sweating, pale, breathing rapidly, not responding to cadets…just moaning a bit Cadet responder: “I think he’s unconscious!”Cadet responder: “I think he’s unconscious!” Cadet calls 911Cadet calls 911 Costs:Costs: Ambulance = $400Ambulance = $400 ER visit = $600+ER visit = $600+ Lab, etc. = $400+Lab, etc. = $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

16. When to Call EMS? (Cont.) For patient transport on campus:For patient transport on campus: Call: JOD, Public Safety, Sports Med (golf cart)Call: JOD, Public Safety, Sports Med (golf cart) Note: Infirmary is not manned for house callsNote: Infirmary is not manned for house calls Gen. Order No. 1 – “Call 911 if”: Gen. Order No. 1 – “Call 911 if”: Severe Trauma (fall > 10’, bone sticking out, etc)Severe Trauma (fall > 10’, bone sticking out, etc) Profuse Bleeding from an open woundProfuse Bleeding from an open wound Not Breathing (chest is still, no breath sounds)Not Breathing (chest is still, no breath sounds) Totally UnconsciousTotally Unconscious Unable to Walk (even with assistance) to a vehicle for transport to the InfirmaryUnable to Walk (even with assistance) to a vehicle for transport to the Infirmary

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