ARC Wilderness First Aid vs. Others

[Gunny2862]

I've taken the local ARC WFA and my take on it is that it does introduce ideas that may not have occurred to the average layman BSA volunteer. Otherwise it is largely a re-hash of ARC First Aid and CPR.

 

I think it is worthwhile and while I'm thankful for EMT's and other Medical Pro's who volunteer in the BSA I also think it's ridiculous that some would try to hold the rest of us to those standards.

 

As regards the quality of the ARC WFA course I think it is purely a result of the Instructor and their background in both First Aid and the Outdoors setting. I also think that while being prepared and having a good kit is important, that most of us need IMPROVISATIONAL skills more than we need more kit that requires more and more training to use.

 

Even better is the comment posted above that thinking thru your activity and making every effort to avoid being in extremis is as if not more important than reacting after a poor choice. OTOH, that should not be construed to mean one shouldn't seek out a basic knowledge.

[rdclements]

Seattle:

 

From your description, it might be that the mountaineering course is more detailed about specific situations and environments. In creating the ARC WRFA course, the goal was to get more training that the basic FA course, and fit the most common situations/environments. Technical rescue techniques often required in mountain settings are also outside the scope of the ARC course.

[wayne@gctel.net]

In my classes, I teach that you do not need to have a big physical "kit" to take care of problems in the wilderness. The single most important item in the "kit" is your brain and common sense. With that and some limited supplies one should be able to stabilize and maintain a victim until they are either self evacuated or evacuated by rescuers. During scenarios we spend time working on how to improvise with the items one would normally have with them on a camping or hiking trip. To some scouts who have taken the program, it has helped to solidify the reasons for the ten essentials. I consider it a success when a class can show they can think on their feet, use what they have and provide reasonable care for a patient.

[SeattlePioneer]

Clements,

 

 

The Mountaineerring Oriented First Aid course (MOFA) I sdescribed didn't involve or practice technical rescues.

 

The practical problems presented were ones you might encounter on a hike or climb in the backcountry. What to do if you encounter a party suffering hypothermia or a hit by a falling rock, for example.

 

You might need to deal with the panic and confusion an injury often causes in a group, find someone to take charge and identify someone to provide first aid while others need to determine whether someone can be evacuated or a procedure for sending people out for aid.

 

It's remarkable how a group usually becomes unglued when a significant injury occurs. The need for SOMEONE to take charge and for others to cooperate with that person is an important learned skill

 

Are those kinds of things emphasized in the Wilderness First Aid course?

 

 

(This message has been edited by seattlepioneer)

[rdclements]

Seattle,

 

You're right; those are important considerations. A common element in each of the WRFA course sections is how to prevent injuries, manage situations, and consider the impact of the event on the rest of a group. It is a real challenge to get so much into only a 16 hour course, but those topics are some of the best ones for participants to learn from each others' experiences.

 

Your comments remind me that one of the challenges that I've seen multiple times is the tension that can occur when the first aid expert is not the group leader. The leader must maintain command and control of the overall situation while listening to the recommendations of the primary aider. That can be a serious challenge for some.

[dScouter15]

As a paramedic myself, I'd like to try to offer some perspective on the matter. There are a couple areas I'd like to clarify.

 

First, I think there is room for some confusion where there is overlap in terminology between certifications offered by private organizations, and certifications granted by governmental entities. Yes, the ARC offers "certifications" in a variety of topics. But, these certifications really only indicate that you attended some course of dubious quality, and potentially completed some examination of knowledge and skills administered in a questionable setting. The reason these certifications expire within a couple years is mainly just to generate income for the issuing organization in the form of refresher courses. Contrast those with the certifications or licenses granted by state or federal government entities, which legally allow the holder to practice medicine in accordance with the laws and regulations that apply to the given certification. Clearly, there is a huge difference in both the oversight of the training programs, and the testing procedures. A school wishing to train paramedics, for example, undergoes a lengthy preparation period, needs to supply documentation that their curriculum is in accordance with state and federal guidelines, and is subject to close oversight and audit by the state. The instructors typically need to have a minimum amount of field experience, and complete an approved instructors course and exam before being permitted to teach in a paramedic education program. Once students complete the education program (both classroom time and approximately 400 hours of clinical rotations) they must sit for both a written and practical exam that is administered in a controlled setting.

 

There is further confusion where professional titles overlap. For example, in most states, an emergency medical technician (EMT, EMT-B, or other professional initials depending on the state) is a state-certified and/or licensed health care provider, who primarily provides advanced first aid as part of an ambulance crew. Many states also have a "first responder" (FR) or "medical first responder" (MFR or CFR) level of certification. In these states, an FR is also a state-certified and/or licensed health care provider, who is able to provide basic first aid, often non as part of an ambulance crew. Contrast these titles with "Wilderness EMT", "EMT-W", or "Wilderness First Responder." Persons holding these titles may also have official legal certification or license as an EMT or FR, and have completed additional training on performing their duties in the back country. But, these courses and "certifications" typically do not provide any additional legal authority to practice emergency medicine with an expanded scope of practice.

 

That's not to say that these types of courses are not valuable, or should be avoided. I'm very much in favor of providing training to Scouts and Scouters that will be enable them to provide quality first aid care to an ill or injured victim until professional health care providers can start providing definitive care. And, as a professional provider myself, its always nice to arrive on a scene where a bystander is able to rely on some training they've taken to provide initial care to the patient, remain calm, and explain to me the background of the situation.

 

The flip side of the coin is when I arrive on scene, and have to deal with a bystander who is actively making the situation worse, but feels qualified to tell me how to do the job I've been doing every day for the past 5 years, on account of the fact that he has an 8 hour first aid class under his belt, complete with an official "certification card" signed by an unknown volunteer affiliated with the local Red Cross chapter. The point is, while I'd definitely recommend seeking out additional first aid training whenever you can, its important to be aware that, since these courses are conducted without any real oversight, their quality can vary widely. Also, that certification card you got really doesn't mean anything other than that you showed up at a class taught with no real oversight, of unknown quality. Not to say that there's nothing valuable that can be taken away from these courses. But, as a volunteer Scouter, its important to me that I know that the training I'm receiving is of adequate quality, is accurate, and is beneficial. And, as a professional paramedic, its important to me that we don't blur the distinction between professional health care providers, and volunteers with some basic first aid training under their belt.

[rdclements]

As a professional first responder, you have significant influence over how others think about preparedness and how lay persons deal with professionals. Be careful how easily you throw around terms like 'dubious' and 'questionable'. Just because a lay person has limited training and experience does not diminish their value in an emergency response.

 

I have advanced skills in my profession too, and I can easily point out the ignorance of those without it. I prefer to offer my assistance and coaching when and where it might be helpful.

 

It is possible, maybe even likely, to encounter enthusiastic lay responders who believe that they are more capable than they really are. If persons exceed their abilities does not indicate a failure with the training course. The ARC stresses that their lay responder courses are for lay responders. They don't suggest anything more.

 

I was in a situation responding to an athletic injury (fibula fracture). A parent who was a orthopedic surgeon came over to help. He then yielded 'our case' to an EMT because the EMT had more experience with field work. It's about leveraging abilities at the right place and time.

 

The term 'certification' is used by ARC and by BSA, not to suggest a professional capability, but to quantify training in consistent terms. There are also lay responders who need 'certification' in order to satisfy an employment requirement. That doesn't make them professionals nor does it make them pretenders.

 

Maybe you'd get a better response from your patients if you approached them with less arrogance?

[BrentAllen]

rdclements,

I was thinking the same thing. The ARC has been around for 130 years, and is the leader in training lay responders in First Aid. To say certifications expire just to generate revenue is simply ignorant. Anyone who has taught First Aid or CPR/AED to either Scouts, Scouters or in the workplace has seen that people simply don't retain the knowledge or skills indefinitely. Even professionals have to go through continuing education courses or exams to maintain their certification, and last I checked, those weren't free. Instead of poo-pooing the ARC, he should be thankful that they have partnered with the BSA to offer classes such as WFA.

 

Our Council has partnered up with the local ARC to offer CPR Saturdays at our Council Volunteer Service Center. We will have 250 - 300 participants come through the CPR/AED course this coming Saturday. The ARC has gone to DVDs for most of the training, to offer a standardized program. Instructors are there to spend more time watching the participants do the skills and correcting form than to demonstrate the skill. The test required for passing is also standardized, so to label the training "dubious" is, again, ignorant.

 

dScouter15,

When my wife broke her knee, the "professionals" in the ambulance that arrived knew less about how to treat her than I did. They literally couldn't figure out how to use tape or an ace bandage to hold a cool pack on her knee during transport. Then they had to follow me to the hospital because they didn't know how to get there - it was less than 5 miles away on a route requiring exactly 2 turns. Were they EMTs or paramedics? I have no idea - they just showed up in the ambulance, in uniform. Point being, we can't tell when you guys show up who is the real McCoy and who is the wanna-be. So, yes, after that experience you may have to push me out of the way to help one of my family members or my Scouts.(This message has been edited by BrentAllen)

[Eagle92]

I know that a healthcare workers, whether clinical or non-clinical, must do a certain amount of continuing education every year in order to keep their licenses current. You don't do the required amount of CE, your licesnse gets suspended.

 

And while volunteers can have strengths and weaknesses in teaching FA and CPR classes, I know AHA has gone to a video format to standardize the courses even more. Seems like all the instuctors do is supervise the skills, check off the skills, grade the exams, and conduct remediation if needed.

[ScoutBox]

I got the standard Military and advance life savings training while in the Army, Even EMT qualifications. But since I've been back in Scouting, I have taken again CPR, and last month took a Mountain First Aid Course here. I didn't learn anything new, and felt that although it was good to not only get the certification, but I didn't learn anything new, in fact I learned that I know more then the class was able to teach.. I would like to take a more advance First Aid course if I can..

[dScouter15]

I certainly did not intend to take on an arrogant tone in my last post. Blunt? Sure. Frustrated? Yes. Cynical? Maybe.

 

To defend and clarify a couple points: I understand that no nationwide training initiative can be truly standardized, and delivered in a uniform, consistent way. This applies to BSA training, ARC training, EMS and nursing training, and even medical school. However, there is clearly a difference between courses geared towards lay persons and training programs geared towards professional providers. Professional courses typically operate under the oversight of an independent, 3rd party entity, often a government organization. Testing is generally also administered by a 3rd party agency not affiliated with the training organization. The ARC, for example, may use standardized presentation materials, and standardized tests. But, there is no oversight to verify that they are administered and graded accurately and fairly. So, its not ignorant to call the quality of the training and testing "dubious" or "questionable". I certainly don't want to offend quality instructors of these programs, or students who participated in a quality course. And there are absolutely superbly qualified instructors that put on fantastic courses. Though, as others have pointed out in this thread, there is a great deal of variance in the quality of instruction in these courses.

 

And, to be perfectly clear: THERE'S NOTHING WRONG WITH THIS. Training programs like those provided by the ARC are intended to strengthen one's the knowledge of basic first aid skills. They are not intended to be used as a means to grant any legal authority to provide medical care in a professional sense.

 

Problems start to develop, though, when this distinction is blurred. I personally think that it was a poor choice to name these some of these programs using titles that are typically given only to those with state or federal license or certification, as that is guaranteed to generate confusion among lay people. What if there was a course called "Wilderness Nursing," that awarded an "Emergency Wilderness Nurse" certification, but didn't require its participants to actually be registered nurses? Don't you think that actual nurses might be upset about that?

 

This problem is amplified by lay persons who attempt to present themselves as anything other than lay persons. You may have valuable first aid training that allows you to provide quality first aid care until providers arrive to start definitive treatment, and that is terrific. But, there is clearly a difference between lay persons with first aid training, and medical providers with a professional and legal duty to provide a certain standard of care. By saying this, please understand that I am not pointing fingers at anyone on this forum. I'm just trying to generally highlight a problem facing the pre-hospital health care industry.

 

And, to respond to some of the annecdotes offered:

 

rdclements, I have never once asserted that lay persons with advanced first aid training are not valuable in an emergency situation. I do, however, have some criticism of some of these training programs, and of some of the decisions made the the organizations which offer these programs. I have nothing but praise, admiration and respect for lay persons who take the initiative to improve their first aid training, and put it into practice when neccesary. However, I have seen first hand some of the negative consequences that occur when people have an innaccurate understanding of the role of these providers, and when these providers actively add to this misperception of their role.

 

And there's always cases where physicians "yield" care to lower level providers in certain situations. Some of that is due to professional courtesy and cooperation. Some of it is due to "Physician Bystander" laws that most states have, that make it moderately unpleasant for a physician to assume care of a patient at a scene at which they are a bystander.

 

BrentAllen - I'm very sorry to hear that you had that kind of experience. Without knowing the details, it sounds like those providers clearly did not meet the standard of care they were obligated to provide in that situation, and I certainly don't blame you for being skeptical of the profession. But, to further highlight the differences between professional EMS and ARC certified lay persons: if you wanted to, you could follow up regarding the poor care those EMTs provided, and reasonably expect to situation to be addressed and resolved. If, however, an ARC certified first aider drops the ball, there's really no professional standard that he can be held to. And, no, I really don't have to be grateful that the ARC has partnered with the BSA to provide training. The ARC has earned itself a great deal of well-deserved criticism. I am grateful for the individual instructors and training programs which provide quality training to BSA volunteers, but the quality of these programs is definitely not a direct result of ARC affiliation.

 

And rdclements, which patients am I not getting a good "response" from?(This message has been edited by dScouter15)

[BrentAllen]

dScouter15,

Maybe we are talking in different circles, but I am very glad the ARC teamed up with the BSA to offer an affordable WFA Course. I'm glad that Philmont and other High Adventure Bases are requiring Crews to have a member currently certified in the course. How do you feel about that? Do you think the ARC/ BSA WFA courses are a good or bad thing? I know I'm no EMT, but I also know there isn't likely to be an EMT within many hours of us on some of our trips. WFA has helped me better prepare for trips from a health & safety standpoint, and to also be better prepared for any emergencies we may face, knowledge and skills-wise.

 

I'm curious what "well-deserved criticism" the ARC has earned?

[KC9DDI]

Wow. I don't post very often on this forum, but I want to jump in real quick. dScouter15, I too am a paramedic, and, as a paramedic, I don't necessarily disagree with anything you've posted here. As a Scouter, though, I have to ask why you chose this forum to to have this discussion. I know that matters of training and professionalism are kind of "hot button" issues within the EMS industry right now, but your comments on the subject don't really have anything to do with what Beavah originally posted, nor do they really fit in the context of this thread. Maybe that's why arrogance was perceived in your first comment on this thread - because your average Scouter doesn't know or really care about the issues internal to our profession, and interpreted some of your criticism to be towards them personally.

 

As a medic who is fairly involved in training and education, both for EMS providers and non-EMS community members, I can assure you that the quality of EMS training programs varies just as must as the quality of ARC trainings. Like you, I'm not overly impressed with the ARC as an organization, but I wouldn't extend that attitude towards volunteers who are trying to better themselves by taking advantage of first training.

[dScouter15]

Brent - I'm not saying that its at all a bad thing that you, or anyone else, receives advanced first aid training. It's the responsible thing to do when leader a back country trek where you may be far away from professional medical assistance. At no point did I ever portray this as anything but a good thing.

 

I don't think it makes a lot of sense to try to simplify my position into a black and white "Is the BSA/ARC partnership good or bad?" If you're asking me if I think that its a good thing that the BSA is requiring more advanced first aid training for various activities, and working to make that advanced training available to its volunteers, then the answer is an absolute YES! If you're asking me whether I think that a BSA/ARC partnership is the best way to accomplish those goals, then the answer is no. Its better than nothing, its a step in the right direction, but many of those who have posted here have shown that its not an ideal solution.

 

As far as criticism goes, at a national level, they are routinely criticised for the way donations are solicited and used, the methods through which aid is given out, their blood drive and distribution plans, etc. At a more local level... well, the last three pages of this discussion have pointed out some flaws in their first aid training programs. I think its also telling that many states and professional organizations require CPR training through the AHA rather than ARC's competing program.

 

KC9DDI - You may be right that some of my comments are drawn from my feelings on internal industry issues, but I think that its still important to highlight how to issues apply to the people EMS serves.(This message has been edited by dScouter15)

[Eagle92]

'Box

 

Wait until April 1st, at least in the AHA world. that is when we start doing the 2010 Science classes. Won't go into details, but I'll give some hints.

 

 

Compressions, Airway, Breathing instead of ABC

 

100+ compressions per minute

 

Infant AED use.

 

I went through the online instructor update, and will be taking my update class Friday.