How much First Aid Training is enough?

[Eagle007]

Calico, I couldn't agree more. Continuing education is the key in the medical profession. I just completed well over 100 hours of continuing ed for EMS. And it will start over again April 1st.

 

I also agree that scouts and scouters alike need to continue increasing their medical knowledge. The fact that National Registry of Emergency Medical Technicians is upgrading EMT-Basic to Advanced EMT and EMT-Paramedic to Critical Care Paramedic says a lot about the need to continue learning new, advanced treatments.

[Eagle007]

Another thing to think about is that if you don't constantly train, practice and/or use your medical skills in the field or hospital based setting you will lose those skills. Learning from a textbook is fine and dandy but constantly and continually applying what you learn in real life situations is altogether different.

[Twocubdad]

And that's really my point. I've been trained in first aid as some level for 40 years. Knock wood, but I've never seen anything more serious that a cut requiring a couple stitches -- the worse one was my own thumb. No clinical experience what so ever.

 

Let me re-phrase my question to you professional guys -- what is your experience riding up on a scene and taking over for a basic first aider? Particularly a medical situation like cardiac problems, heat stroke, stroke or the like where the symptoms aren't as obvious as an arterial bleed.

 

I a Scouter invested the time to take EMT-level training, but never used it beyond the classroom, is he or she really going to make a big difference in the field?

[vol_scouter]

TwoCubDad,

 

You ask a good question. I am an MD (internist) and have taken and taught many first aid courses. I agree with Beavah and other posters that WFA or WFR should be training goals for scouters in the back country. That said, when I am on an outing, I have experience that makes me more calm and training that makes me more preceptive. That is an advantage for EMT, MD, etc. trained people but I have no abilities in the field beyond that of most anyone else. In the case being considered, in the field I could have done no more than the SM and ASMs. Whether they went on instead evacuating the boy would not have been my decision, I cannot determine. Even then, I would have to rely partly on my medical intuition as to 'how ill' someone is. Thus, someone mastering WFA or better WFR would be for the most part able to do most anything that an MD could do. At the hospital, it is clearly different and I can do many effective interventions.

 

A point to Beavah, for most things the age group of Boy Scouts and Venturers can e treated as adults, there are few changes in medication doses etc. I agree that some attention should be paid to the fact that we deal with youth in training. hat said, I suspect that most scouting related deaths are in the adults. It is not national news worthy if some old goat like my self dies on the trail but it always is if it is a youth. At Philmont, there is a death every other year or so but it is almost always an adult.

 

This topic best exemplifies why we should ask scouts and scouters to master skills and not learn them for the day in a training exercise.

[CalicoPenn]

Very fair question, Twocub. If it's not being used, is EMT training helpful?

 

I would say yes, if only in the sense that the training opens the mind to think beyond the obvious.

 

I was serving emergency services at a camporee when we got a report of a 16 year old vomiting, stumbling, slurring his speech and acting confused. When we got to the campsite, the adults were sure that he was drunk and asked us to take him to our campsite to watch over him while they packed his gear and called his parents to come pick him up. From all the physical evidence, it didn't appear to be a medical emergency. The risk of heat emergencys was pretty non-existent (temps in the 60's). The ASM found an empty Crown Royal bag in the Scout's gear. It certainly was a reasonable assumption to believe the Scout had gotten hammered.

 

As I was talking to the lad, (while trying to ignore the camp ranger who came roaring up to the campsite on his ATV demanding that the lad be taken off the property) I detected the faint odor of fruit on the lad's mostly vomit-scented breath. Because of my EMT training, the gears in my head started to move and click in to place. I asked the Scoutmaster if the lad was diabetic by any chance and was told yes. The next words out of my mouth, to the ranger, was something to the affect of "Call 911 - get an ambulance out here - NOW". If I never went through the training, I never would have connected a fruity smell, vomiting, and confusion with a medical condition, ketoacidosis, related to diabetes. Oh - and I had never personally witnessed it before - it was just something I remembered from training, not from the field.

 

The empty Crown Royal bag? The Scout used it to carry his equipment and medicines needed to keep his diabetes under control. He had crawled into his tent not feeling 100% and realized he had forgotten to give himself his insulin shot that morning - he was going to do so, and was getting ready to prepare his shot when he fell asleep. Either while sleeping, or, upon waking, he managed to kick his insulin gear under his tentmates sleeping bag - and in his confusion and vomiting, couldn't find it. Why a Crown Royal bag? Because it's readily identifiable - and if he needed someone to fetch it, it would be easy for someone to get in an emergency - a trick he learned from a former Scoutmaster.

 

Does that mean I suggest every Scouter get EMT training? No - but it does make me think that there should be some kind of additional training available that goes beyond First Aid to help Scouters identify (not necessarily treat) potential medical emergencies.

[SeattlePioneer]

This thread has the typical bias that evryone should be protected and that those providing aid ---first aid, should be subject to ever higher standards of care.

 

That seems to be the direction Scouting is moving all right, but just how realistic is it? Not just having taken First Aid, but WILDERNESS First Aid. With annual followups perhaps, to remain CERTIFIED.

 

Traditionally, one of the bulwarks of personal freedom and liberty has been the concept of "assumption of risk," the idea that people (adults) were free to take chances with their lives and that if the worst happened, they were responsible for the consequences of their actions.

 

And parents were entitled to authorize other adults or youth to take custody of their children and to do risky activities they authorized them to do.

 

 

As a society we seem to be increasingly turning away from tyhe concept of assumption of risk, and therefore turning away from the concept of personal freedom and liberty. We must all be wrapped in ample margins of protections, and if something bad happens the bias is that somebody did something wrong and that someone should pay.

 

In Scouting that appears to be playing itself out by increasing restriction upon what leaders and participants can do as activities, and making activities increasingly complicated so that often they aren't used in the program any longer.

[vol_scouter]

SeattlePioneer,

 

I could not agree more with your observations. The direction that society is going will take away much of freedom and liberty for a facade of safety. Unfortunately, it pervades society and, as leaders, we will be held responsible. Society wants life to be risk free which is impossible. This is easily seen in high profile accidents where congressmen quickly lineup to say that they will find 'who is to blame'. Sometimes there is blame but often the accidents are unforeseen circumstances and no one 'is to blame'. That does not mean that lessons cannot be learned. So if society always wants someone to blame and will be happy with a scapegoat, people feel the need to protect themselves. It is not good for the country and is a sad comment on our people who were at one time independent and self reliant.

[rdclements]

The "new" ARC Wilderness materials were release early in 2010. A great next step would be to update the First Aid Merit Badge to the same level. BSA was a major contributor in the development of the new course, so it only follows that the course content represents the training that BSA desires in the field.

 

The ARC course addresses "Heat-Related Illnesses" in lesson 13, suggesting an hour to cover the lesson. After the lesson, participants should be able to:

- Define heat exhaustion, heat stroke and hyponatremia

- Describe the prevention of heat-related illnesses

- List the signs and symptoms of heat exhaustion, heat stroke and hyponatremia

- Describe the emergency treatment of and long-term care for heat exhaustion, heat stroke and hyponatremia

- Describe situations that would require an evacuation versus a rapid evacuation

 

For comparison, lesson 12 covers Hypothermia in about 45 minutes and includes a hands on exercise constructing an improvised hypothermia wrap.

 

[resqman]

Years ago I went rappelling with a Paramedic. I was part way through my EMT training at the time. It was not a scout outing and the only Guide to Safe Outing was what we felt like doing. It was a 1.5 hr drive to the mountains. Last 1/2 hour was into the back country. This was before cellphones. He carried a pocket air mask, examination gloves, and couple of 4x4 guaze pads. That was his entire first aid kit.

 

If it was a medical emergency, either the paitent would have his prescription meds or not. We could not carry a portable pharmacy of every potential med. If the patient had meds, we could assist the patient. If they did not have meds, then they would suffer until the patient could be transported to the nearest medical facility.

 

If it was a traumatic injury, the only thing we could effectively do in the field anyway would be to stop the bleeding. Broken bones are splinted to limit further damage while moving the patient. Most patients won't die from a broken bone, unless an artery is cut. Gloves to protect the Rescuer and gauze to help clotting and keep the wound clean. If we had an ambulance the only thing we would do differently is start an IV to keep volume up and keep a vein open to be able to push drugs. Gotta have Dr. OK to start an IV and we weren't gonna carry IV fluids and setup since we couldn't contact a Dr.

 

The face mask was to protect the rescuer from the patients vomit and trasmitted diseases. Clear the airway and blow. After a few minutes the rescurer is going to feel dizzy and will not be able to continue mouth to mouth. If the patient isn't able to resume breathing on their own after 15 minutes, they are probably gonna die unless they are hypothermic. No other field treatment is likely save them.

 

Everything else is so minor as not to worry or too major to fix in the field. In EMS lingo, the patient is commonly known as DRT (dead right there).

 

WFA explains how the body works and how it compensate when injured. First Aid helps the body to compensate when injured to slow or prevent the body from spiraling into death.

 

The biggest thing people should take away from any first aid training is think about how the body is going to react to the injury. A broken bone is painful but basically otherwise the body can tolerate a broken bone for days. A bone sticking out of the skin is gruesome to many but it is not a life threatening emergency. Keep the victim calm and limit further damage to the break site.

 

Diabetic shock means the brain is not getting enough sugar and is going to shutdown all other activities in an effort to supply sugar to the brain. No blood gushing from the vicitim but much more life threatening than a broken bone. Get the sugar level up in the body and everything will be fine.

 

The best medical providers understand how the body is reacting to the medical or traumtic injury. Then the "first aid" is to help the body heal itself. People also need to learn that sometimes there is no field treatment and the only real solution is to get the patient to a medical facility. Preventing injury is much more effective then field treatment. Pushing water and regulating body temp all along the trip is much more effective than trying to cool or "save" a person from heat exhaustion.

 

Taking first aid training helps the rescurer to remain calm when everyone else around is spinning out of control. It helps the rescuer plan a course of action. Often that course in the field is stop and to rest for a bit. Apply direct pressure to stop bleeding. Otherwise transport the patient to definitive care.

 

To answer my question, I think a basic 8 hr first aid course should be a requirement added to SM/ASM training.

[Eagle007]

I agree with what Doc, Calico and resqman have said. Out in the field on hiking/camping trips, we may not have very much equipment to work with but recognizing signs and symptoms of illnesses and injuries (patient assessment)is a big part of taking care of the person.

 

I'll use the case of the diabetic that Calico used. Unless one has knowledge of what to look for in a diabetic emergency, one would probably assume like the scoutmasters did that the scout had taken a good snootful of alcoholic beverage. In that situation, shouldn't the scoutmasters have had prior knowledge of the scout's medical history? I think I would be letting all parties involved know something that serious if it were my son.

 

One of my EMS instructors always liked to add "a rapid infusion of diesel" as part of the patient's treatment, meaning, get to definitive care in the quickest and safest possible manner. Having said that it has been my experience that a great deal of 911 calls are not what would be considered "true emergencies." Most are just calls for the orange and white taxi (ambulance) to take them to the ER because they have the system figured out. The system abusers know they will be seen quicker if an ambulance brings them vs having family or friends bring them. After asking how much a ride would cost, I have actually had a person to tell me that they wouldn't be paying for the ambulance bill because the taxpayers who pay medicaid and medicare would be picking up the tab. There was nothing medically wrong with the person. What was wrong was that the person and its spouse didn't have a car and wanted a free ride to the hospital. (Sorry for the rant.)

 

 

Also, as ounce of prevention is worth a pound of cure. Knowledge is power. Let's be safe out there.

 

I'm glad I'm not the only one who uses DRT.

 

 

[vol_scouter]

A few comments on CalicoPenn's post, first - Calico is to be commended for picking up on the sweet smell of the young man's breath and realizing the situation.

 

Second, this is an example of why medical forms should be available on all outings and, in my opinion, such things as Type I Diabetes Mellitus needs to be known by several adults.

 

Third, a Type I diabetic with a high blood sugar and one or more of the following: emesis (vomiting), diaphoresis (cold sweating), high or low temperature, symptoms of an infection of any sort (cold, cough, infected cut, etc.), or altered mental status NEEDS PROMPT MEDICAL CARE!!! Even if given insulin results in their blood sugar comes down somewhat and they feel better they still need professional medical care. They are likely to need LITERS of fluid, be acidotic, and can have dangerous electrolyte shifts.

 

Fourth, it is important to know if the person is a Type I or Type II diabetic. Type I diabetics tend to be young when it begins, thin, and MUST have insulin from the beginning of their illness because their islet cells which produce insulin have been destroyed. Type I diabetics can easily develop diabetic ketoacidosis which is a medical emergency/urgency. As noted above, it should not be treated in the field.

 

Type II diabetics are obese and typically develop the disorder later in life though with morbidly obese children, this is rapidly changing. Type II diabetics do produce insulin but the insulin does not work as well as it should (insulin resistance), can initially be controlled by oral drugs, and rarely do Type II diabetics develop diabetic ketoacidosis.

 

Type I diabetics can participate and should participate in all activities. They tend to know a lot about their disease and can usually take care of themselves (obviously, age and maturity related) but they can get into trouble quickly. I encourage everyone to read about Type I diabetes for themselves and certainly do not take my comments as definitive. Remember that evidence of diabetic ketoacidosis means that the person needs prompt, definitive medical care.

[BrotherhoodWWW]

I've had several full day first aid courses over the years. I learned more about first aid as a Scout. As a Scout in the early 80's I went with my Troop to a local fire station for two evening sessions in CPR. I think a refresher would be good. I agree that a basic first aid course should be part of every direct contact leaders training. Offering it at summer camp is a great idea and one that I will be presenting to my Council.

 

IMHO the required training we have now is not nearly as important as first aid. YPT once and then a test every two years should be enough, yet it is not. Weather hazards was a total waste of my time. Safe swim and safety afloat was ok but the emphasis on some parts I did not care for. I would much rather volunteers spend the time learning first aid.

[Eagle707]

I always make sure to keep my CPR and First Aid certs up to date. As far as WFA, while it sounds like the answer to everything, here's what the American Red Cross has to say about its own WFA course:

 

"The course is based on the Boy Scouts of America Wilderness First Aid Curriculum and Doctrine Guidelines "

 

I absolutely think that, because this is based on our materials, councils need to work with the Red Cross to make the formal (certified) training accessible to all leaders. Until then, the best thing to do is review the Boy Scout Handbook and make sure we know how to handle all of the emergencies that a First Class Scout should be able to recognize. If we're the foundation for the Red Cross, then let's build that foundation. That being said, if you have access to additional training, take it!

[rdclements]

I don't know if WRFA training is the "answer to everything". I think we're struggling to define a reasonable level of training: adequate for the field, but also attainable by many volunteers.

 

If your council is not already taking advantage of the BSA partnership with the ARC, make some calls and get a starter program going. Here's a link to some information about the BSA/ARC arrangement:

http://www.scouting.org/scoutsource/HealthandSafety/amredcross.aspx

 

[Eagle92]

I think councils need to offer FA and CPRw/AED at summer camp. I know that when I went through BSA Lifeguard, if I didn't already have it, I would have had to taken it over 2 nites at camp.

 

Bea advised that there is a FA survey over on Scouting.org's safety subpage. They are trying to get people's opinions on FA and WFA for both youth and adults.