Beavah

As Merlyn correctly noted, in science nothing is proven absolutely. Nothin' different about religion, by and large. God far surpasses human understandin'. He can do what he wants, rewrite da rules, become incarnate. Your buddy St. Augustine said that faith seeks understanding. Not that it has understanding. For matters of faith, proof is not necessary - for faith, alone, is sufficient. Which is why, as I've observed before, there are few religions that qualify their statements of belief or doctrines in a way that implies potential error...or end those statements with a qualifier, "but we could be wrong". Oh, scientists don't do that too much either, eh? Especially on things where they've formed a general consensus. It remains implied, if yeh understand science, but to a non-scientist it sure looks like yeh all are pretty definitive about stuff that could be wrong. No different for religion. In da Christian tradition, with the exception of creeds, doctrine is only defined in da negative, eh? The great councils that decided central tenets of Christian faith never declared what was "right", because God is unknowable and beyond definitive human understanding. Rather, they declared what was anathema, what was in error. Western science developed that notion of falsifiability because of its roots in Christian theology. I think there can be a conflict between science and religion, but it's da exact opposite of packsaddle's. Science too often quests after what might be possible, without stoppin' to consider whether it should be pursued. In fact, it wants to pursue anything that's an interestin' challenge. In astonishin' arrogance, it seeks to increase da scope of mankind's power, but not of its judgment. By disavowing any responsibility for ethics, or any basis for universal ethics, it's willin' to hand a child a stick of dynamite and say "it's up to you." It's as if those who do not understand religion believe that just because they've done a better job of stacking blocks or lighting a house than those in the past that they are more qualified to answer questions about love, and personal choice, and family, and ethics, and joy, and sadness, and suffering, and fulfillment. I dunno which way that goes in terms of null hypothesis, eh? But da mistake is that a success in one area means yeh understand and are qualified to comment on an unrelated field. Beavah

Yah, I'm mostly fascinated by how much some folks seem to want there to be a "policy" or "right answer" to everything, eh? It's a kids' program, not a federal regulatory agency. And anyone with experience with federal regulators knows how good they are at developin' coherent policy for everything. It's that quest for some sort of definitive, I-told-you-so, I-know-better-than-you "right" answer that leads to da overstating of claims. That's the same attitude that often hurts units when adults start to go at each other. It's the same attitude that makes trainers ignore da syllabus and create tales of da Liability Monster. The threads on meds were interestin' that way. Lots of good points, and no single right answer that applies everywhere. Rather than discussin' when and how certain things should be considered and helpin' folks with options and ways of thinkin' about things, there's lots of that overly definitive stuff. And, of course, da Liability Monster. I'm da opposite of fgoodwin, eh? I think there's lots of ways to do good things for kids, and only a finite set of things that are wrong or poor choices. It's more like cookin'. There are some wrong things yeh can do while cookin' (burning the food), and a few dangerous things (refuelin' stoves with an open flame nearby...). Beyond that, a lot depends on your resources, ingredients, and taste, eh? Recipes help a lot, especially for novices, but there's no one right recipe for any dish (though I am partial to a couple of Ma Beavah's old recipes, eh? ). And it's OK if someone's stew isn't as good as someone else's, as long as it's enjoyable or at least filling! So that's where I figure forums are helpful, eh? They allow us to share ideas and recipes... yah, sure, and occasional advice on how not to burn food. It's really interestin' to learn a new technique or find out what someone else who cares about Scoutin' and kids has tried. I might use it, or share it with someone who could use it! I'm with Eamonn, though. I don't think forums are helpful when there's a bunch of folks declarin' their opinion on what BSA policy or state law is. Nobody here is authorized to speak on behalf of da BSA in this medium, and anybody with legal experience knows better than to offer real advice in such a venue. So what shows up is mostly about as valuable as a fresh cow pie. But sharin' recipes with fellow scouters from across da country? That's a treasure. I wish we could do more of it, without bein' interrupted by da rest. Beavah

But they agree on basic things like how many suns our solar system has. Well, religious folks can agree on how many Dalai Llamas there are too, eh? That's a fairly direct observable. But as soon as yeh start talkin' about things yeh can't observe directly, those astronomers and physicists aren't any better than da theologians you disparage, eh? They can't agree on how many mysterious, invisible forces there are, can they? Is one force really an aspect of da other forces? Is there a Grand Unified Force? Thinkin' about science as a cut-and-dried, factual description of da world that's somehow "privileged" over other human ideas may be comforting to those who cling to that faith, eh? But recognize it for what it is, eh? Just another system of belief. B

Ah, now, Merlyn. You're not really gonna claim that astronomers agree on everything, eh? How many different figures are there for da age of the universe? How many different figures have their been in the last 20 years? At da moment, the physicists can't even agree on how many mysterious invisible "forces" there are, eh? Heck, they can't even agree on how many dimensions there are! You'd think they'd be able to get somethin' that simple right, wouldn't yeh? Both science and religion make up theories to try to describe da mysteries of the universe, based on observation and experience. They just come at it from different perspectives, one more focused on da physical world, the other more focused on personal growth and fulfillment/salvation/happiness/service of da community and all that. If you choose to favor one over the other, that's an act of bias, eh? Or, if not, it's an act of Faith. B

Yah, didn't really want to comment on this without seein' all da materials, but what the heck? My comment: Blech! What a ham-handed, awkward, inappropriate way to try to teach reverence. Rather than teach specific obligation and worship, religion that challenges da individual to be his/her best, we're substituting a bogus "uplifting and positive experience" to make everybody feel good. Have da dessert, but not the meal. Worse still is da kind of "Scout Law idolatry" it seems to recommend. I'm a big fan of the Scout Law, eh? It's a fine thing to teach kids. But it's got nothing to do with God or Spirituality. The Scout Law ain't a religion. And putting it in place of a religion, as a pseudo-worship service or a replacement for scripture or whatnot... that's idolatry, pure and simple. It cheapens those deeper Laws and Commandments which are God-given by elevating a youth program saying to the same (or higher!) level. As a few others have mentioned, rather than creatin' a fake service, we might encourage scouts and venturers to go to their own services, and to visit each others' services respectfully. Or, in the woods, to have each share a prayer from their own tradition, to encourage da practice and development of their individual spirituality, and mutual respect. This make-believe "generic" stuff really is anathema. Beavah

Or, Merlyn, it's an appeal to da science crowd to have a little bit of humility, eh? We have theories of lift and drag, eh? One says that a mysterious force per unit area called "pressure" can be increased by creating idols, I mean objects of a certain magical shape and wavin' 'em through the air. This happens because of mysterious things that can only be described in a special language called algebra. Another theory says that invisible chunks of air hit da airplane and transfer a magical, invisible thing called momentum, thus causin' the airplane to fly. A special priesthood attends to this theory, speakin' yet another language called statistical mechanics. They claim they have da real truth, even though their method doesn't seem to be as useful as those who believe in Pressure. Mostly, like theology, all da invisible critters and funky language got developed after the fact, eh? Successful plane flight happened because a couple of young bicycle mechanics kept tinkerin' until they found somethin' that worked. Then people, many of whom predicted flyin' machines were impossible, came along and developed da "theory." I reckon don't kill, don't commit adultery, don't steal, love your neighbor, care about things enough that you are willing to sacrifice for 'em, care enough to be willing to lay down your life for a friend - are all things we've found that worked, eh? Perhaps then we developed a few theories, each with their own special language, to explain this and go further. Along da way we might have even discovered that those "theories" are successful at inspiring and cajolin' people to do the things that we discovered worked, and so they were reinforced and considered valuable. Is belief in God really that much different than belief in invisible air molecules or mystical "pressure"? Didn't, as Gern put it, man "create science to explain the mysteries that man did not understand?" My problem with literal creation has little to do with science, eh? Da problem with literal creation is the claim it makes about God. If God placed evidence of erosion, continental drift, dinosaurs, expandin' universe and all the rest into a world only 4,000 years old, then yeh have to conclude that God is a deceiver, who is either tryin' to lead us astray or is just havin' fun at our expense. I'm a Christian, eh? I don't believe in Loki. That means we must be screwin' up da 4,000 years bit somehow. B

(see http://www.scouter.com/forums/viewThread.asp?threadID=184944#id_184944). That was an R2, R7, R11, with an R3 chaser. I say J2, J9, J11, J16, J21, with a J4 chaser in some circumstances (like states dat at least nominally require camps to have prior parental permission for topical medications like sunscreen). I think abstractin' the discussion to issues of "rules" and such (especially when Trek Safely tells us to bring meds...) ain't da right way to go. Specifics make for a better discussion. dScouter, do yeh have any issue with the care given in the two scenarios? As for da abstract stuff, there was a reason I asked that folks without legal trainin' keep those issues and speculations off of this thread, eh? Not pooh-poohin', just that those comments make about as much sense as an attorney with no medical trainin' commenting on da risks of establishing a central line. Once again, nobody has argued "that untrained scouters should be able to give whatever meds, or do whatever procedures they feel comfortable doing". It's a fun straw man to bring out on Halloween, but I just don't know any scouters like that, eh? The ones who aren't trained tend to shy away from meds entirely. Rather than encouragin' the untrained, we've encouraged scouters to get appropriate wilderness medical training, consult with physicians, establish the same sorts of protocols for handling allergies as schools and camps, and to follow that training in the service of kids. I understand that folks with urban medical training seem to disagree with some of those professional medical opinions and courses, but that's a debate to be had within da medical not the scoutin' community, dontcha think? And I reckon it's worth rememberin' that da rules as a professional urban EMS employee just don't apply to a volunteer civilian on a campin' trip. Apples and asparagus. Secondarily, we've argued that scouters should behave like ordinary, reasonable, and prudent parents, who don't need to be aware of da complexities of medical licensing and protocols in order to take children on camping trips and be responsible. Ordinary, reasonable, and prudent parents (and grandparents, and Uncle Joe who takes Billy on a fishing trip, etc.) give kids OTC medications on an occasional basis without da permission of the state board of public health. To argue that a 13-year-old child's grandmother giving him a tylenol for a simple headache is a legal issue is ludicrous. Could it be a medical issue? Sure, on a 1-in-a-million basis. But 1-in-a-million issues are not what we should set policy on, eh? Nor medical practice, for that matter. Beavah Happy Mother's Day to all! Especially to those of yeh who still have your moms around, take the time to enjoy that, eh? (This message has been edited by Beavah)

Yah, BW, I reckon we all should take a few minutes and read what others write before respondin', eh? I was not present in the appendicitis scenario. No one made a field diagnosis. No pain remedies, antacids, or laxatives were used. My current level of trainin' is EMT-W. What you present is a conjecture, not a protocol. The troop in da field did call local EMS, just as you suggested. The troop in da field was praised by local EMS for their preparedness and actions. No one at any point said anything about frequent ER trips. No one at any point said anything about relative experience of Sea Scout vs. Boy Scout leaders. The list I gave enumerated statistical reasons why your statement criticizing fellow leaders for being unsafe was unfair. The list had nothing to do with first aid at all. Your third link involves a prescription, not OTC product. Your fourth link involves a prescription not OTC product. A statin no less! No one suggested untrained persons administer meds except for you (limited to topical meds... perhaps like lidocaine, hydrocortisone, or scopolamine? ). In da inaccuracy department: It would be incorrect to prolong evacuation time for an appendicitis patient. Training and preparation will not always keep a scout "safe" or prevent ER visits. The risks from sailing are not as high as many other scouting activities. You can confirm this through da national Wilderness Risk Management Committee, or the several organizations which collect data on sports-related injuries. Biking, for example, is an order of magnitude more dangerous. The risks for stroke from OTC cough syrup are not significant in children (or anybody who does not already have a chronic condition). The risks for bleeding stomach ulcers are not significant in children (or anybody who does not already have a chronic condition) for occasional NSAID use. PFD's do not decrease evacuation time unless you have a man overboard. In that case they might, because you'll definitely trigger a massive coast guard and other vessel response, eh? And yeh missed yellin' at me about da contraindications for pink bismuth, like kids' age or allergies to salicylates! Trainin' can really help with all of these things, eh? Not just avoidin' inaccuracies, but understandin' what other people are really talkin' about. But I suppose we each have to make our own decisions about the level of trainin' we feel is important. Beavah(This message has been edited by Beavah)

Yah, there's functional and dysfunctional councils out there, shortridge. In da functional councils, it's a hard job. In da dysfunctional councils it's an impossible job. It's possible to have no fundraisin' experience when yeh come in, as long as you have a good "people personality" and such. If you have been successful in sales of any kind, that should be a good indicator. Then make formal trainin' in NFP development a condition of your employment. Make da council pay for a couple full-semester classes on institutional development for you, and get da release time. It's a trade yeh have to learn, and BSA doesn't teach it all that well. Never, ever take a DE job in a weak district. Da evaluation metrics and timetable are such that you'll get shafted. District health takes a lot of time to build, and is very strongly associated with demographics that you have no control over. Seek out and accept jobs only in districts that have easily made their performance goals for many years. Don't believe SE's on that, either. Dig into it yourself, in detail. It's certainly possible to stay in a DE job for many years, and slowly move up to senior DE or DD, or even FD. But dat's often the "slow promotion/slow salary growth" route, eh? Yeh just have to balance your priorities. I think BadenP is spot on when he says it's an evening and weekends and odd-hours job, eh? That can be tough on a family. At very least, push to make compensatory time clear in your contract or an attached memorandum of agreement. Find an SE who da secretarial/office staff really likes, and who has also "topped out" and is likely to stay around for a while. Yeh want a good boss, and da office staff knows best. Keep to an exercise plan. As an odd-hours, semi-stressful job that involves a lot of meetings with people (with food!), I've seen DE's put on a lot of weight, eh? And finally, decide before you enter what your ethics and morals are, and resolve never to violate 'em, no matter what da pressure, or tolerate others in da professional ranks who do. Never fudge a number or pad a statistic, never misrepresent at an FOS presentation, never blame a volunteer, and never, ever tolerate anyone who shouldn't be around kids. We've had too much of all of that, eh? Beavah

Our mission, together, is Service. Da other stuff is just drivel. Don't start out with a hole to fill and then go look for a person. Start with a person who is willin' to help and then find something they like to do and are good at doin'. Organizational charts are easier to change than people. B

Aw, GW... Yeh left off da attorney to consult on liability and legality of care! I think you're prejudiced. He'll also need at least one intern for research, and an accountant with a stopwatch (preferably one dat runs fast) for billing purposes. B

Yah, BW, why the resistance to training? WFA is pretty basic stuff, the lowest level available. Yeh seem to be interested enough in da topic to want to comment on it a lot, and yeh support units havin' well-trained scouters. So get trained! We carry no drugs other than antibiotics as a Ship Hmmmm.... yeh know, antibiotics are fairly serious drugs, right? Units that are frequently taking scouts for emergency medical attention (as two posters have already said they do) are doing many things incorrectly. I might suggest alternate theories. The units are more active. The units have more members. The units go on longer trips farther from home. The scouter reportin' has had more years experience. The scouter reportin' attends a higher percentage of unit activities. The unit is in a state which has more natural hazards than flat midwestern farmland. The unit is in a state which has more variable weather (colder winters, etc.) The units are engaged in activities with a higher risk profile than sailin'. The units are accommodatin' more special-needs scouts. Probably unfair to judge, if we're bein' honest, courteous, and kind, eh? And if someone was presenting syptoms of severe stomach pain or fever the last thing I would do is give them anything internal other than water Which may or may not be da right course of action, but definitely points up why it's important to get training! While many things can be classified a poison you well know that it is extremely, extremely, rare that an external medication such as an alcohol swap, anti-biotic, calamine, ivy dry etc causes any adverse symptom, EVER. and that when it does it is almost always a skin irriitation taht is quickly remedied simply by rinsing of the medication. Internal medications that have negative side effects are not going to be that easy to mitigate without professional medical care. Yah, hmmm... Sorry, scoutldr's got da right of this, IMO. What yeh say is partly true, but yeh reach the wrong conclusion. Fact is, it's extremely rare that any OTC medication, oral or topical, causes serious negative side effects in its recommended dosage. That's why it's sold over the counter. FDA spends a lot of our tax dollars on that, eh? In da eyes of the law and regulators, there's often no formal distinction between topical and oral medications, eh? Delivery mechanism, by itself, is irrelevant. Most of da time "rinsing off" a topical med is pretty ineffective. Da stuff is designed to be absorbed quickly. Response times I appreciate that your Ship seems to follow da norms of Safety Afloat. Good job, that's as it should be. But wearin' a PFD has little bearing on evacuation time, eh? Instead yeh have to look at things like what's your maximum distance/time from port? How 'bout in weather / headwinds? What if a youth (or adult) skipper gets navigationally confused or has engine trouble? Do the areas where you're travein' have BLS or ALS ambulances when yeh get to port? If there's weather (and consequent car accidents and such that can tie up county resources), what will da likely response time be? How long to transport? How far from port is da nearest Trauma Center? And especially... how well trained are da leaders to make da differential diagnosis between simple seasickness and, say, appendicitis? Be prepared is our motto for a reason! Beavah (This message has been edited by Beavah)

Interestin' thought, Calico, and a good point, eh? You're right, with da exception of severe anaphylaxis we really don't need meds or wilderness skills in the county park. That's why I tried to be clear in da OP about "a relatively remote location with long evac times". I think a lot depends on your state. There are lots of states with true wilderness, where even da scout camp is functionally in true wilderness. Also plenty of states like mine where in rural areas, response and evacuation time even from that state park can be pretty darn long, eh? Especially if yeh add in rougher terrain, weather, etc. Activity matters too, eh? I was figurin' an Illinois Sea Scout Ship might well be cruisin' Lake Michigan by sail. I think da risk of "super first aider" is overstated. All the research goes the other way, eh? Most first aiders, when confronted with a "live" emergency, fail to take action. They don't tend to go off into lala land. Just look at da depressin' figures for CPR. Folks with limited trainin' freeze up mostly. Freaked out parents do random, bizarre things sometimes, but that's not what we're talkin' about either, eh? To my mind, it's worth replayin' your two scenarios but substitutin' in a reasonably responsible scouter in place of da lobotomized scouter (who gives tylenol instead of pepto bismol/mylanta/etc. to a tummy ache? ). Boy with appendicitis. Let's put him 3 miles from trailhead on a backpackin' trip in an ordinary midwestern national forest. Complains of stomach ache, scouter talks about symptoms, gives him a chewable pepto bismol tablet. Like a good, conscientious scouter he/she checks on him a bit later, notes no improvement, starts to pay closer attention. Scout's assigned older buddy comes a bit later and says things lookin' still worse, now lookin' very ill, vomiting, slight fever, localized pain. Scouter says "Aha!", and is faced with a really challengin' evac. Hikes to ridge for cell reception (maybe!), makes call. Now an evacuation from a location like that, 3 trail miles over moderate hills in a forest, is a daunting endeavor, especially as a litter carry. Maybe in weather, perhaps in dark. Dozens of people, many hours, risks of collateral injuries. But, happily, scouter is prepared and carries a broad-spectrum antibiotic. He obtains orders from medcontrol through county dispatch while on da phone, and starts the lad on oral antibiotics. Result: boy is in less pain, at less risk, and is able to assist in his evacuation dramatically reducin' evacuation time. Local hospital continues treatment, allowin' boy to return home for monitoring and potential surgery. Parents happy, local volunteer rescuers praise Boy Scouts for bein' prepared. Boy with greenstick fracture. Boy comes with PL to scouter, complainin' of pain in his arm. PL describes injury mechanism. Presumably, both scouter and PL are competent at First Class first aid, eh? So they are capable of recognizin' the signs and symptoms of a fracture! Additional examination yields sharp point tenderness. PL gets to practice splinting under scouter's supervision. Scouter administers NSAID to control pain & swelling during long walk-out. Call to parent, parent prefers boy to be brought home to local hospital because of insurance plan, quality of care. Boy still comfortable, arm doin' fine because of medication. Parent meets scouter, is grateful for care. ER docs say treatment was excellent, everything done right. I actually lived da second one, eh? Boy's dad was an orthopedic surgeon. He was particularly impressed/grateful that we properly managed pain and inflamation with medication. I also know a troop that lived da first one, eh? I think dat's about how it went down. So both are "real life" scoutin' examples. There's good reasons why BSA Trek Safely training tells us to carry appropriate, current medications, eh? Beavah

BobWhite, you're an assistant unit leader for a Sea Scout Ship, right? That virtually guarantees a long response and transport time whenever you're on da water. First aid requires current knowledge and a well developed sense of judgment. Some cases require evacuation to a parent's care, some require evacuation to professional medical care, and others do not. Many cases require field care, for a fairly extended period, before professional personnel can take over. I reckon it's important for adults to know about all of 'em, eh, because da real purpose of first aid is to deal with each properly. Your responses share a worthwhile perspective about da limits of an untrained leader, but are also scarin' me a little, especially when you're takin' potshots at other folks who are really quite right. WFA is pretty minimal trainin' for your position. Yeh should go find a high-quality course in your area. Sign up with SOLO, WMA, WMI, or WMTC or such (avoid ARC and BSA, da instruction is too spotty). Trainin' is important, especially trainin' that actually tests your knowledge and makes you meet practical performance requirements beyond quotin' books. I think you'd be surprised at how much yeh learn. And surely your Sea Scouts deserve that example and that level of care. In fact, I'd encourage your whole Ship to take the course. I figure for us old folks, them havin' aspirin around and knowin' how and when to administer it is a good thing, eh? B

Yah, da parent thread is now debatin' the relative merits of carryin' OTC and other meds, eh? That's a good discussion, and worth followin'. This thread is for units who do carry meds in first aid kits, or for units faced with the (many!) different kids with special needs where the availability and administration of meds is important to allowing a boy or girl to participate. What are your "best practices" that yeh can share? What are your challenges? I'll again ask that posters refrain from discussion of liability and law and such. Let's limit it to our area of expertise: how we help and provide for kids. Beavah

Sunspots? I reckon some folks might not have gotten their hot coffee yet this afternoon, eh? BobWhite, I think yeh have to be a bit more circumspect about your declaratives, eh? I don't reckon anybody can speculate on the authority or effect of a "form" without both readin' the form and knowing da state, eh? Least of all docs speculatin' on legal issues . Besides, a doc refusin' treatment to a sufferin' child because it ain't immediately life threatening would be a malpractice attorney's delight. It's also worth rememberin' that a topical medication is still a medication, eh? Ain't a special difference between "internal" and "external". That neosporin we choose to slap on a wound could put a child in serious hurt in da wrong circumstances. I'm glad some folks are lucky and have never had lads or lasses get ill on trips, eh? I still figure "Be Prepared" is a better motto than "Rely on Luck". I think all Scouters should take the time to do a high-quality WFA course, and high adventure trip leaders should complete WFR. Yeh know, reasonable standard of care for "other people's children." Then they should follow their trainin', which does include proper use of meds in remote environments. If they haven't done at least that, well, I reckon at least bein' somewhat circumspect about givin' advice is in order, eh? I think another good rule is that scouters should act in loco parentis, standin' in place of the parents, and take care of a child in da same way they would if it was their own. Aside from da Christian Scientists among us, I reckon that makes the choice straightforward, eh? Beavah (This message has been edited by Beavah)

I'd say safety-by-control followed from folks plunging ahead with no knowledge and no desire to get any knowledge. Yah, F, was there some other way to interpret that statement? It sure sounded to me like you were sayin' that safety-by-control (aka a law/policy response) followed from folks plunging ahead with no knowledge (aka someone, somewhere does something dumb). But I may be mistaken, eh? It'd help me and everyone readin', I expect, if instead of just publicly critiqueing my "bad habits" yeh actually responded to da substance of the discussion. That way we'd all learn how I may have misinterpreted your thoughts, and da discussion would continue to be interestin' for everyone and not personal snipin'. Just a thought. B

Really interestin'. I'm curious what folks think G2SS means when it says "[hiking] crew equipment includes a first aid kit stocked with current medications." Note that's different than the instructions for Rx meds - "the leader reminds youth and adults to bring and take prescribed medications." Sure sounds like a unit first aid kit should have OTC meds, eh? And then we pick up any WFA or WFR text, and the professional recommendation of physician authors is for trip leaders to carry and dispense medications. And then we go to any store and buy a first aid kit, especially an outdoor first aid kit, and it will contain a bunch of medications. It's important to remember that da procedures medical professionals use for urban stuff aren't necessarily applicable. Yes, in a hospital or pre-hospital EMS environment strict control of even OTC meds is maintained, precisely because the person is very ill and many potentially interacting and potent meds are likely to be administered. Those procedures are right for that environment, eh? But when we're talkin' about regularly healthy folks in an outdoor, wilderness environment, I reckon that gets a bit ridiculous, eh? More important, it becomes irresponsible to my mind. We are not providing the standard of care that we should to da kids we serve. I don't think there's any excuse for leavin' a kid with an ordinary illness untreated and miserable in a wilderness setting, eh? That is a safety hazard. The kid you refuse to give an immodium to can get hurt when he has to run off into da woods, and yeh don't have a washer-dryer to deal with aftermath. The girl with cramps hikin' a trail or walkin' around camp can slip and fall and become more seriously injured. And how could anyone claim it's responsible to leave a child spikin' a high fever untreated? Dangerously irresponsible, it is. Inconsistent with da recommended practice guidelines for wilderness settings. And not very compassionate either, eh? Good judgment is about balancin' risks with benefits. There's real benefit to lay treatment with OTC meds, eh? That's why they exist. And risks in a non-hospital setting are minimal. Dat's why they're sold OTC. I'm an EMT-W and I actually know somethin' about liability, too, eh? I definitely do carry meds with me in da field, and I would not hesitate to give 'em to kids in a wilderness setting when they were indicated. Personally, I'd have a hard time viewin' an adult leader who was not carryin' field meds as anything other than incompetent and unprepared. Beavah(This message has been edited by Beavah)

Gee, I dunno. I'd say safety-by-control followed from folks plunging ahead with no knowledge and no desire to get any knowledge. If folks all had knowledge and "understanding" we wouldn't need control. But that's not the case. Yah, OK, OK!! That was a pithy statement that merited bein' beat up on. I surrender! But let me try to explain what I meant. There are some environments, like manufacturing, where safety by control is an important thing, eh? You've got very well-defined risks from da equipment, and you've got full-time employees who can be trained and held accountable for followin' a tight, well-defined set of policies and procedures. That can work, eh? Not quite as well as everyone thinks, but it can work. Scoutin' really ain't the same. We don't have well-defined risks, because our "work" environment isn't with da same machine every day, it's in the wide open complex world of kids and the outdoors. And we don't have full-time employees and managers, so we can't create the policy and oversight systems that an employer can. Dat's why it's nowhere near as effective for us, eh? Sometimes, we generate policy because of isolated incidents, just as FScouter suggests. Someone, somewhere, does somethin' dumb and suddenly there's a policy response. That is poor policy-making. Yeh don't place a burden on everyone for one person's foolishness. If we did that, we'd never let any kids do high adventure because a few kids are immature and can't handle it. Policy can't fix a fool, but it can hogtie da competent. Sometimes, though, we generate controls because we borrow 'em from professional environments. Da medication stuff, like acco takin' all his kids meds away and then administering them himself, is a good example. That's da system used in hospitals, complete with logs of administration times and such. It got introduced because we asked full-time nurses what to do, eh? But we're not the tight, controlled environment of a hospital, and we don't have a professional nursing staff. Da tight, highly regulated world of urban EMS is another example, when compared with the far more fluid world of wilderness first response. Ironically, most of G2SS is a safety-by-understandin' document, eh? Sweet 16, Safety Afloat, Trek Safely, and on and on. All of 'em describe important understanding needed for good risk management. "The supervisor must be sufficiently trained, experienced, skilled and confident of his/her ability to lead and teach...". Ever notice that policy is 1/32 of the BSA "Sweet" principles for safety? Half of one point. Da reason is that proper risk management encompasses a much, much wider range. But if yeh read these forums and talk to many scouters, they focus most of their energy on 1/32 of proper risk management. What are da rules? Add another point for law and we get 3/32. That's a culture we've created, eh? A culture where we're content to do only a fraction of our job, and where we make point number 7 of the Sweet 16 most important. (Yah, yah, before BW says it, I know point 1 on supervision includes "follow policy" language, eh? A good example of how da culture of "safety by control" creeps in, eh? So up it to 1/8 if yeh like. Point is da same.) This thread was a good example, eh? Lots on law and policy. Much less on trustin' qualified supervision, safe area, equipment selection, skill level, planning, first aid resources, etc. Maybe our forum rule should be that after someone mentions policy, there needs to be 31 messages on other aspects of risk management before anyone mentions policy again, eh? Beavah

The parent thread got into a bunch of issues with respect to an Rx medication (epinephrine) in the field, eh? This thread is more an open discussion of handling medications in general, including OTC (over-the-counter) meds. For da purposes of discussion, consider such things as a high adventure wilderness trip, an international trip, or a troop trip to a relatively remote location with long evac times (rural weekend backpack, paddlin' a river corridor, etc.). And don't limit it to emergencies, eh? Consider a lad with a headache, a young female venturer with cramps, etc. What, if any, OTC or other meds do you carry in your troop or adult first aid kits? * How do yeh handle administration? * How do you support kids with special medication needs? * Do yeh include provision of medication in your permission slips for your unit? * Any other related questions or stuff to share! I'd ask as a favor that folks without legal background not speculate on legality or liability, since that tends to just send these discussions into da swamp, eh? For those interested in G2SS, I present the relevant quotes below. Prescription Medications: The taking of prescription medication is the responsibility of the individual taking the medication or that individual's parent or guardian. A Scout leader, after obtaining all the necessary information, can agree to accept the responsibility of making sure a Scout takes the necessary medication at the appropriate time, but BSA does not mandate nor necessarily encourage the Scout leader to do so. Also, if your state laws are more limiting, they must be followed. Snorkeling Safety Those with known adverse reactions to stings from marine life, or with chronic conditions such as diabetes or asthma, may need special medications at hand. Trek Safely Crew equipment includes a first-aid kit stocked with current medications and supplies. The leader reminds youth and adults to bring and take prescribed medications.

So, what is the result of the debate? Missed this while I was bein' longwinded, eh? I don't think there was any debate. Wilderness and her group should pursue acquirin' premeasured epi kits under da direction of the physician they've identified, eh? Scoutin' is a tougher game. I just don't know, myself. I'm fully supportive of da troops and crews who carry Rx meds under standing orders (and with appropriate training) for high adventure and international trips, eh? I think dat's a standard of care we should aspire to in many ways, especially as da nation's preeminent outdoor program for youth. I think we, like da schools, also owe it to kids with disabilities to be properly prepared to deal with da issues those disabilities may generate. That means gettin' better trainin', and bein' more savvy about having established protocols in place, eh? There are probably some risks if we do not. Where it's hard, I figure, is that our volunteer pool doesn't consist of bright college kids with time and interest in training, eh? Plus we've established a culture of safety-by-control rather than safety-by-knowledge, especially with respect to meds. That's why I was curious about da OTC meds, without gettin' into Rx stuff, eh? Perhaps a different thread... Beavah

But you said that Wilderness Student by virtue of having WFR was certified to for the use of epi...and that wasn't correct was it? Yah, BW, it's a bit tough to be clear because I think you're just not familiar with da issues and language, eh? Like there's no such thing as bein' "certified for the use of epi", leastways not in most jurisdictions. Dat's just not how the system works. If you're interested, I'd encourage yeh to take an EMT-W course. That's also a great thing to have as a scout leader. Nobody should be carryin' epi without appropriate trainin' and physician direction (or state approval). I completely agree. To get it, they'd have to rob a pharmacy, and I figure that's against da Scout Law in some way, eh? But that wasn't Wilderness's question. Wilderness's question was about pursuin' somethin' fairly ordinary - carryin' epi under standing orders as trained WFRs. In fact, they already had a physician identified who had agreed, eh? (I think yeh missed that, dScouter...) Now, if yeh back up, what I said was that WFR trainin' and certification includes epinephrine trainin'. That's true, I stand by it, and I've presented evidence from da major providers of that certification. I also said that it was common for outdoor education programs to carry epi for use by trained leaders under physician's standing orders. Dat's also true, I stand by it, and have presented statements from both professional and collegiate programs, eh? Yeh now have da formal position statement of the board of physicians with the most experience in the matter which says that even volunteer scout leaders should be trained and should carry epi in their first aid kits. So I don't think I've been misleadin' anybody in any way. I think it's important not to get stuck on da fatality rates for bee stings. Medical pros aren't just concerned about fatality rates and bee stings, eh? There are a lot more allergies out there! Food allergies, asthma with triggers that can result in severe anaphylaxis, exercise-induced anaphylaxis, latex allergies to da gloves in a scouting first aid kit or drug allergies to neosporin that we might put on the wound and the like. Kids don't always carry their meds, nor do parents always report what's relevant (especially in split families). And there are a lot of very bad things that happen to someone's body goin' through that kind of reaction which may stop short of fatality. Is it acceptable to watch a lad suffer and be hospitalized, when we could have provided proactive treatment? Anaphylaxis overall is in da range of tens of thousands of hospitalizations each year, and a significant and growin' percentage of the population at risk. Finally, if we dig a bit deeper in the stats, we realize that the risks are greatly elevated for adolescents and for remote areas. 1-2% of the population is allergic to bees, but most of 'em don't go out where there are a lot of bees, eh? That keeps the incident numbers low overall. However, scouts and outdoor programs like Wilderness's do go out. A lot. 1-2% means that there's a pretty good chance scout units and outdoor programs are gonna run into this, eh? And that's not countin' other allergies. Until yeh get that EMT-W, BobWhite, I wouldn't recommend that you carry epi, eh? But I'll stick by da notion that Wilderness is doin' her "due diligence" (as you put it), which all good outdoor leaders should. Includin' Scouters, eh? Beavah [dScouter, I think we're in complete agreement, eh? I think yeh just might have misread Wilderness's circumstances and background](This message has been edited by Beavah)

I can tell you that it would be illegal to do that. Yah, we gotta be a bit careful here, dScouter. Hard cases make for bad law. It may very well not be "illegal" for someone to do that dependin' on what state they live in, eh? And even in the other states, I can't see a county prosecutor pursuin' the matter, or the courts not dismissin' it on public policy grounds and the like. Despite folks who like tellin' ghost stories, the law by and large is a reasonable fellow, eh? The trend in legislation has moved to includin' epi explicitly in Good Sam laws. For da first case, the trend is also sharply in favor of supportin' lay responder access to lifesaving meds. For example, way back in '99 the state of New York began making epi available to medically untrained (not even FR level) camp and school staff for emergency use. Naturally, they get trainin' on epi administration. Massachusetts has done somethin' similar through regulation. I can't say how many states have gone that route overall, eh? Interestingly, I found an American Academy of of Allergy/Asthma/Immunology position statement directly on point, which I copy below. These folks are docs who specialize in this area, eh? Qualified lay personnel in positions of responsibility for public safety (e.g.,lifeguards, park and forest rangers, scout leaders, paramedics, school and industrial nurses, teachers, camp counselors) should be educated in the appropriate use of epinephrine and should be authorized to administer epinephrine for suspected anaphylaxis in conjunction with arrangements for complete medical management of the reaction... Epinephrine for injection should be included in all emergency medical treatment kits. (http://www.aaaai.org/media/resources/academy_statements/position_statements/ps26.asp So again, da medical community is ahead of the law a bit on this, eh? I was actually a bit surprised that they even specifically recommend that scout leaders be authorized to administer epinephrine. This is how "standards of care" develop, eh, and we have to keep pace or be held accountable. Da legal world is catchin' up, and in the meantime I don't reckon anybody's gonna get hanged if they respond in good faith in an emergency. Even if da legal world is slow to catch up, each person has to ask whether we want lawyers or doctors to determine our medical practice, eh? Now da question is what do we do about givin' that kid with the headache a Tylenol? Beavah (This message has been edited by Beavah)

You cannot say people are going overboard with rules when there are NO rules in the BSA on this activity. Are you sayin' that there's no rules in da BSA regarding base jumping? B

Having Benadryl on hand in the group first aid kit seems like a reasonable and fairly safe start. Yah, but as dScouter pointed out, even this has its traps, eh? The layman isn't qualified to administer any meds. What would your Benadryl dosage be, for a given body weight youth? How 'bout if yeh were substituting chlortrimeton or one of da other antihistimines? In some ways, we should not carry any OTC meds in our first aid kits, at least not for anybody but ourselves. Best legal advice, eh? And good advice, too, in many ways. Lots of OTC meds can interact with a child's other meds, some pose odd low-probability risks, etc. So an interestin' question for all of us would be whether we do carry OTC's, and would administer, for example, a Tylenol to a boy who had an ordinary headache? Knowing it would give him relief and make him comfortable, and also knowing that in certain very-low-probability situations it might make an underlying serious condition worse, or mask symptoms so as to delay evacuation. Do yeh allow a female Venturer to carry and self-administer Midol as a minor? As a female Venturing leader if you have Midol do you provide it to a venturer who is havin' bad cramps? Do we have "zero tolerance" policies that forbid scouts and venturers from even possessing any medications? There's a big, broad grey area here. Da legal community is on one side, givin' the best legal advice. The medical community's view I've found is quite different and more relaxed. Da wilderness medical community's view is fairly hard-nosed practical. This is probably a good discussion to have, at least for Scouting units that do "high adventure" trips. Beavah