How much First Aid Training is enough?

[resqman]

Every couple of years, a scout is seriously injured, lost or dies while on a scout outing. The media swoops in and says the adults lacked adequate training to provide adequate supervision or care.

 

Currently the only first aid training required for adult leaders is CPR. In reality the most likely canidate to need CPR are the adult leaders and the lads are the ones who really need the CPR training! Should a basic first aid component be added to SM/ASM training? Is Wilderness First Aid training too much training to require for uniformed adults leading weekend camping trips?

[shortridge]

WFA in my neck of the woods is a two-day course, offered only infrequently by the council (for only the cost of materials) and not at all by the local Red Cross. Without expanding the infrastructure, it wouldn't make sense to require this.

 

ARC first aid, however, is a day-long course that includes CPR, and is offered many times during the year. I don't think that would be too much to require. It could easily be offered at summer camp or a camporee with a little advance planning.

[Twocubdad]

I have a slightly different tact onthe first aid issue. I started to spin another thread, but this seems appropriate here.

 

In the thread regarding the young man in south Florida who died on a Scout hike, presumably of heat stroke, much is made of the Scoutmasters' failure to recognize and properly treat heat stroke. But how easy is to to do that? Sure, we can all rattle off the classic symptoms of heat exhaustion or stroke, but in the field, with actual patients, how easy is it for a layman with only book training to recognize and diagnose a medical conditions?

 

This is purely hypothetical, but in the situation in the parent thread, I can easily imagine myself out with a bunch of boys in the heat of the summer when one or more of them complain of being hot, tired and thirsty. A couple of them have headaches. Clearly these guys are in the beginning stages of heat exhaustion and dehydration. So we find a shady spot for everyone to rest and cool down. Everyone is drinking plenty. Everyone is hot and on a day hike we don't have a thermometer, so we don't really know what anyone's temperature is. With the maybe a litte sunburn and the exertion, no one notices one Scout who is maybe a bit more red-faced than the others.

 

All the Scouts are quietly resting in the shade, so it's a half-hour before the SM rousts the guys and notices that the one boy is lethargic and disoriented. We start focusing on him, getting him to drink, pouring water on him to cool him off. He throws up and we roll him on his side where he becomes unresponsive. Clearly, now we have an emergency situation and send for help, but the boy goes into convulsions.....

 

Sorry for torturing a hypothetical here, but I'm trying to paint a picture where a leader has acted reasonably, in my opinion, and done what he was trained to do. But having never seen a real case of heat stroke, he miss the subtle symptoms which should have told him the boy was in real trouble.

 

My hunch is many medical emergencies (and I'm differentating medical emergencies from traumatic injuries) are like that. I'm curious to hear from Resqman and Scoutfish and some of you other guys in the emergency services about the difficulties of real-world diagnosis for a nonprofessional first aider.(This message has been edited by Twocubdad)

[Gunny2862]

Without requiring EMT's who are themselves limited, you aren't going to do better than ARC CPR/FA and WFA. but they are still extremely limited and are in no way the panacea some posters in the Everglades accident thread think they would be.

I did the Army Combat Lifesaver Training while I was in the Corps and even that is no guarantee that it would solve these problems, even if it were applicable for use on and available to Civilians to use for training- even EMTS are limited in what they can do. At times the situation develops and in ways that, no matter what you planned, is going to kick your butt - and you just have to hope that what you CAN do is enough to get everyone out.

 

Without hauling a Surgeon, M.D. and EMT along you couldn't be safe enough for some of these folks. And my argument is that if you are forced to do a lightning halt on top of a bald, even dragging those folks and their tools along - will probably not be enough if one of the Crew is hit by lightning.

 

We have to come to terms with the FACT that we put ourselves and these kids in harms way anytime we get more than a mile off the road - that is just the plain truth.

[Gunny2862]

Twocubdad,

Navy Corpsmen lose Marines on Training runs on base in PT gear, happens enough it's usually not a big story. Professional usually EMT level trained medical professionals working on a regular basis with people they know who are in EXCELLENT shape especially when compared to the avg. civilian.

 

Heat and Cold signs are easy to miss - self-diagnosis and buddy diagnosis - or in our case Scouts who have actually LEARNED what we are teaching them, is the best defense here.

Does that mean the SM has no responsibility - of course not, but barring becoming paid full time pros - there is no way to meet the safety demand of some posters in the other thread.

[Eagle007]

An EMT/Paramedic, D.O., M.D. and even a Truama Surgeon are very limited without their equipment. Having said that, our troop has several MDs that are scouters and I guarantee that they don't bring anything but their brains and maybe some pills on our trips.

 

I bring my EMS jump kit on every outing I can attend but it has limitations. And we've had to have sunshine pumped in on some of the trips because they were so far from civilization.

 

It doesn't matter what level of training you are at there will be limitations. You do the best you can with what you have.

 

Field medicine comes with a price = limitations (such as time and equipment).

[Eagle92]

Tried to post, was rejected, and when starting to retype, realized Gunny beat me to it. (bloody Devil Dogs )

 

Scouts who have actually LEARNED what we are teaching them, is the best defense here.

 

Scouts are required to learn about Heat Stroke and Exhaustion at the 2nd Class level and for FA MB. While self diagnosing can be challening, having your patrol look out for you DOES WORK. I am living proof of that as I had hypothermia, my patrol members diagnosed it and treated me.

 

So if the adults are liable, the youth, if they were not minors, would also be liable as they should have had the training if 2nd Class or higher. Don't underestimate the abilities of the youth.

 

now in reference to classes, best FA class i ever took was as a 12y.o. 2nd Class Scout taking FA MB ast camp. Counselor was either an EMT to W-EMT, and put us through our paces in an outdoor setting rather than a classroom setting. We did brief hikes aroudn the health lodge, had scenarios laid out, and had to adapt and improvise using what was on us to treat. I teach AHA FA today, and think that that method: teaching in the outdoors and using your resources, is the best method for both scouts and leaders. I know that BSA worked with several agencies to create WFA courses, i would love to see elements of that incorporated into FA MB.

[Beavah]

One of the hard things about environmental and exertional stresses is that different people respond differently, eh? Whether it's heat, or cold, or altitude or whatever. One person can be doin' just fine, and the fellow right next to him who is doin' the exact same hike collapses and is in trouble. Until you've actually seen a bunch of cases "live", yeh really aren't likely to make a correct and timely diagnosis based on basic First Aid training. That's why professional certifications include clinical time treatin' real patients in the field or ER.

 

Florida case could have been heat stroke. Could also have been hyponatremia (low sodium serum level from too much water drinking without enough food/salts). Could also have been cardiac-related. And da way it initially presented, it could also have been tired and out of shape. Even a doc isn't goin' to make that diagnosis in the field without equipment. Core temperature and skin temperature can be quite different, eh?

 

And even if the diagnosis was made, I'm not sure any field treatment would have been successful. Definitive treatments involve intravenous therapy and packin' the person in ice. Heat stroke, cardiac issues, and severe hyponatremia are time-critical things, eh? Sometimes there's just no cure. Remember the Boston Marathoner who died of hyponatremia despite drinkin' Gatorade and having medical help right there and a hospital around the corner?

 

I think we should encourage and even fund scouters to pursue a level of first response training that makes them comfortable. I'd love to see every scout and scouter with WFA. There's no reason at all why WFA shouldn't be da standard for First Aid MB at least. I think it would be nice for every high adventure leader and participant to have WFR or better. It'd be a good training investment for us to support those who want to pursue that level of training.

 

But to expect it of everybody? Da costs exceed the benefits. I don't think yeh can point to a single scouting fatality and say that better first responder training definitely would have changed the outcome. I see it more as a personal confidence and good citizenship thing.

 

The other problem I've noticed with most of da first aid training is that it tends not to focus on kids or common ailments. Kids are different than adults, and da most common things yeh see in the field aren't usually given as much time as some other stuff. Like heat injury vs. CPR. CPR cert. will take yeh a few hours, while even in WFA heat injury might be covered in less than half an hour. I don't know if it's even touched on in ARC standard first aid anymore. Again, nuthin' wrong with CPR, it's good for citizens to know it to give in-town heart attack victims a chance. Just sayin' that most first aid trainin' isn't well tailored to what's most needed in a scouting environment.

 

Beavah

 

 

[rdclements]

I agree with the comments that there are limits to what can be expected of volunteers as well as limits to what is reasonable in a remote setting.

 

The new Red Cross Wilderness and Remote First Aid course was made to fit BSA's needs. It is a good course, well structured, runs a minimum of 16 hours and includes field practice scenarios.

 

Getting certified to teach it took some effort, but now our district training team is running the course twice a year; next in March.

[The Blancmange]

 

I don't know if it's [heat injuries] even touched on in ARC standard first aid anymore.

In the materials from when I last took it in in 2009 (the book is copyright 2006), it devotes roughly 2/3 of a page to heat-related emergencies. The only symptoms which it indicates emergent care (calling 911 or otherwise seeking medical attention) is necessary are refusing water, vomiting, or starting to lose consciousness. For the lesser stages of heat exhaustion, it does not specify immediate medical attention, but rather the more common steps of moving the person to a cooler place, removing tight or perspiration-soaked clothing, applying cool, wet towels and offering small amounts of water.

[Beavah]

Interestin' Blancmange. Thanks for postin'.

 

So the Florida scouters actually followed da protocol by the book for ARC standard first aid.

 

 

[Stosh]

I used to be a Nationally Certified EMT-A with 15 year's experience and having been in the business, I know that I probably could not have done any better in the field with limited resources than the SM on the FL trek. Everyone is different!

 

As an active Captain of a reenactment group dealing with adults wearing heavy wool uniforms on very hot summer days, I have had heat related problems many many times in the past 10 years. One can expect a 15-20 minute wait for an ambulance with advanced equipment and I've considered myself to be a very lucky person never having lost anyone. Even then I have had more resources available to me than the FL SM. Battlefield Ice Angels carry ice for the boys in the field and I have actually packed downed soldiers in ice and brought them back from convulsions. Without the ice I probably wouldn't have been so lucky.

 

Knowledge, equipment, time and a ton of luck! To think more training to provide more knowledge is enough is only putting a bandaid on a serious problem.

 

Prevention is the key with any medical situation. When I was with the reenacting Venture Crew I required each boy to carry two 2.5 qt canteens and at least every 15 minutes were required to take a long drink! If a boy said he just did and I didn't notice, he did it again! I never had a boy go down. As a matter of fact, I've never had anyone in my command go down. Prevention is the key!

 

True leadership - take care of your people!

 

Your mileage may vary

 

Stosh

[Eagle92]

If memory serves, AHA's course does basically the same thing as ARC. Sorry I only teach the Heartsaver FA with CPR and AED once per year. And since that course is not a "professional" course, we don't keep those books in my library. Plus with the updates coming out within the next month or so, I won't be getting a "current" book any time soon as we will be buying the 2011 ones as soon as they are out.

[CalicoPenn]

Whatever your first aid training is isn't enough. I'm not trying to be facetious. Rather, I'm suggesting that no matter how much first aid training you've got, it's important to keep getting more training - even if the training is a review of what you've already learned. EMT's, Nurses, Doctors - all have to go through continuing education to maintain their certification. The continuing education doesn't always present something new - often it's a review of things you already learned. If you were certified in CPR back in the 80's and diligently got recertified every 2 years, there were no groundbreaking changes to procedures until fairly recently.

 

But what does that really mean within the confines of the BSA? Let's face it, the BSA doesn't do a very good job of training adults in First Aid anyway. There may be something in IOLS, and now they're mandating that someone be certified in WFA, but for the most part, they seem content with the hope that people will do it on their own.

 

The worst part is the BSA has a ready-made basic first aid training course, complete with book, that pretty much every Boy Scout goes through (if they remain in the program long enough). It's called the First Aid Merit Badge. As part of adult training, it seems it would be a simple procedure to add a requirement that in the first year, all new leaders will earn the First Aid "Merit Badge" using the existing materials. Heck, the BSA could even create a unique patch similar to the actual merit badge that could be worn in a permanent position on the Adult leader's shirt. Earned it as a Scout? You have to earn it again as an Adult (continuing education).

 

To make things more interesting, create the badges in a way that recognize further training. Go through a CPR/AED course? Get a rocker (if a round badge) or a strip (if a square badge) to add to it. WFA? Get the strip too. ARC First Aid? EMT? Another strip. At a minimum, all your adults will be trained in basic first aid, units can have their own instructors (just like merit badge counselors) or share instructors - and scheduling can be done at the convenience of units/instructors at any time of the year.

 

If the requirements change dramatically? Change the color of the basic patch - and encourage people to update.

 

 

 

 

[Venividi]

"There's no reason at all why WFA shouldn't be da standard for First Aid MB at least"

 

I like that. Too often I have seen First Aid MB offered at MB Universities, where scouts can complete the badge in a classroom type setting in half a day, or at summer camp in 4 2-hour sessions, (with some pre-class work, such as putting together a first aid kit). That amount of First Aid training is not enough (in my opinion).