When do we call for help?

[LongHaul]

I don't want to high jack the "retaliation" thread but I'm curious as to the expectations of heath care at summer camp. We have to remember the actual job description of the "camp nurse" or "EMT" hired for that position. They are there to provide immediate health care for minor injuries and to determine if transportation to a hospital is indicated. They don't have access to the diagnostic tools available in emergency room settings and they can not reasonably refer every complaint to such a facility the camp would go broke. At what point do we expect referral to a hospital setting? Obvious major injury of course but if it isn't broken or bleeding what are the bench marks? In not talking from a medical professional's view point I'm asking from the view point of a parent or unit leader. At what point would you expect a boy to be referred to a hospital?

LH

(This message has been edited by LongHaul)

[Gold Winger]

In my experience, the camp nurse is that, an RN. At one camp I've been to, the nurse is an RN as well as an EMT. The guys in the first aid hut call him if the injury or illness goes beyond, "I have a headache" or "I skinned my knee."

 

I think that there are many injuries that can wait until you get home. "My knee hurts but I can still walk." However, a vision problem should have been sent to the hospital right away. It's been my experience that anything other than "my eyes itch" doesn't usually get better on its on and may go downhill quickly.

 

 

[Beavah]

Yah, interestin' question LongHaul. And it doesn't have to involve camp, eh? When should a unit leader take a kid in to a hospital or clinic on a troop outing? For me back when I was a unit leader in camp, I never would have referred the eyesight case to the camp first aid staff. I would have signed the lad out with a second adult and had him in the local ER. First Aid staff is just that - first aid staff. Can't expect full-out medical care from 'em.

 

A second question is when should a unit leader call for an ambulance or a rapid evac like a helicopter? Those things are expensive, eh?

 

Beavah

 

[scoutldr]

A nurse, EMT, LNP, or PA cannot practice beyond the scope of their license, which in most states, requires the supervision of an MD or DO. They can provide first aid, but we all can do that. They can administer meds, but only with a physician's order. Recognizing when a situation is beyond "first aid", is a professional judgement. In this case, it didn't appear to be a life threatening emergency, so I would have called a parent and said "this is what's going on, what do you want to do?"

[Eamonn]

I agree with scoutldr.

Call the parents, report what is going on and have them tell you what they want done.

If the parents can't be contacted? I see nothing wrong with talking with and asking the Lad.

HWMBO works in our local ER and unless it's something big, the staff there don't do anything till they have spoken with the parent.

Even with all the Medical forms and permission slips signed they will keep the child comfortable and wait till the parent has been contacted.

Eamonn.

 

[Eamonn]

Have just talked with HWMBO.

She informs me.

That in cases of dire emergency the Doctors will do what is needed to be done.

They do make every effort to contact the parents and do prefer to talk with and have permission from the parents before doing anything.

However if the parents can't be reached they will treat a Scout with a signed permission slip.

Depending on how serious the ailment is??

For example a Lad who needs a couple of stitches in a finger?

The Doctor might see this as not being a big deal and go ahead.

A Lad having chest problems might be labeled "Dire"

But a surgery that can be delayed will be delayed till the parent is reached or the situation becomes serious.

 

Have to admit that when it comes to making the determination if the Lad goes to the ER, I'm far happier making the decision and not leaving it to the camp staff.

I might ask for their opinion, but the final decision would be mine.

As a rule in our area the EMT on site would be the one to determine if a life-flight was needed.

Eamonn

 

[Gold Winger]

It's been my experience with Summer Camp runs to the hospital for everything poison ivy to major gashes that the hospital medics go with the permission slip and treat the boy. When it's all over, I call the parents and say, "Johnny just got stitches."

[LongHaul]

Question for ya Beavah, now I assume when you go to sign this boy out you would ask for his medical form which is being held in the first aid office. What happens when the "nurse" says she does not see the need for a hospital trip and refuses to relinquish the form? Had something like this happen to me a while back just curious how you would handle it.

LH

[kbandit]

Our troop always keeps original medical form. Scout camp gets a copy.

[eolesen]

Same here. Camp gets a copy, and we keep the rest in the binder with the permission slips and contact info.

 

If it's bad enough, we bypass the camp medical shack and head to town. Knowing where the nearest ER is one of the things you should be seeking out in advance.

[Beavah]

Yah, what eolesen and kbandit said, eh?

 

Plus we used to also use our separate unit permission slip for summer camp as well, and we always kept those to hand.

 

Beavah

 

[SSScout]

In this era of litigation and medical miracles , why have I not heard the phrase " err on the side of caution"?

 

At my WB weekend, I had TWO embedded ticks in my leg, at the same time. When I realized what the discomfort was, I reported it to the first aider (a paramedic in 'real life').I offered to drive myself home(a 45 minute drive away), but she insisted that this was an ER thing, could be infected, mebbe deer ticks, Rocky Mountain fever, Lyme desease, needs to be documented, surgical removal, etc. Well, I can drive myself, nearest ER's about 25 minutes away. No, no, this is too serious, call the LSU from the fire station down the road...and so I was wisked away in the back of a state-of-the-art ambulance in the company of a crusty old veteran paramedic and her cute, blonde, 19 year old 'apprentice', both of which insisted on inspecting the sites, on the old mans inner thigh. ummm.

Oh well, the ER doc excised the remains of the ticks, took them in for culturing and some time later my home doc put me on a 'profilactic course of antibiotic'. All is well.

I doubt if a camp RN would have done less.

In the older days, that RN would've swabbed the sites with alcohol, gently teased the ticks out with some tweezers and sent the Scout back to camp. This is better? I don't think so.

 

As I told a friend who had broken his foot, "That's why God created orthopedic surgeons".

[LongHaul]

One of my reasons for posting this thread is that I had a really close call at camp some time back. We also keep the original and give camp a copy but recent rules from the council attorney say the camp must have the originals with the legal signatures of doctor and parents. Anyway two of our guys were horsing around and one ended up falling down hard on his chest, this was mid afternoon. Got the wind knocked out of him and felt really sick, went to lie down, NO adult was informed at the time. Comes dinner, we do dining hall, no Johnnie. Story comes out I head up to camp with second adult and find Johnie in his bunk says he just wants to rest. We take him to the med center to report incident and have RN look him over. She says let him rest he just got the wind knocked out of him. Johnnie goes to bed early. Next morning Johnnie does not want to go to breakfast says he still feels sick. Back to med center. RN does not want to transport to Hospital spend 45 minutes getting Johnnie "officially" signed out of camp RN will not relinquish med form unless Johnnie leaves camp permanently. Get to town with copy of med form can't contact parents. Hospital can not discuss case with me because I am not parent, legal guardian, and privacy laws prevent disclosure of medical info blah blah blah. In the end the boy had internal injuries and the doctor said that he was surprised Johnnie survived the night. Story #2 While at camp, on a day hike into town, Richie twists his ankle really bad. Call local FDP transport to hospital, severe sprain, cast. Get back home and start paper work, BSA insurance will not cover because we did not go through Med Center. Richie was not on BSA property and was signed out of camp so no longer covered blah blah blah. Single mom limited insurance ended up our CO stepped up and covered the bill.

LH

[mtm25653]

Middle son slipped on wet rocks (he was SPL and was warning the scouts about the wet rocks) and split open his chin. SM and other leaders looked at it and had decision to make - hike out 5 miles to the cars, then find an emergency room somewhere or just tape it up. The split was under the chin (not visible from front) where a scar wouldn't show, so they cleaned it up and taped it well. When they got home, I confirmed they made the right call.

 

Two years later, youngest son fell on a ski trip and split open his chin, leaving a several foot long streak of blood on the slope. Ski patrol stopped and took him down the slope. This split, too, was under the chin (not visible from front). Scout leaders (or maybe ski patrol, I'm not sure) cleaned it up good and taped it - he continued to ski the rest of the day. Again, I agreed they made the right call.

 

In both cases, if the splits had been in the front, I would have been fine with the boys not getting stitches even if they ended up with a small visible scar. I trust their leaders to make an appropriate call, and they trust me that I wouldn't get freaked out either way.

[Beavah]

Yah, LongHaul makes out an interestin' point, and I had a PM conversation with someone else.

 

Your unit permission slips should have HIPAA (Health Insurance Portability and Accountability Act) confidentiality waiver language, and if possible a limited health care power of attorney. Some ER's I've been hearin' about have gotten all weird over this stuff, and often the ones who are the most persnickety about legalism and paperwork are the least competent in terms of medical practice. Just the way it tends to go, eh? While a good attorney might make 'em pay for their foolishness after the fact, that's no comfort for the lad.

 

If you're with a kid in the hospital, yeh need to be able to protect the kid and manage the care until the parents can take over. That means havin' the paperwork to knock down the foolishment, eh? And speakin' up if yeh feel anything doesn't feel right, demand a second opinion, remove the kid to a different facility, whatever. Medical errors are the number one killer in hospitals.

 

Beavah