Managing Food Allergies & Diet Restrictions

[Gone]

A good BBQ brisket will cure veganism.

 

Nothing like burnt ends, chopped brisket and a fried pickle!

Edited April 11, 2015 by Mozartbrau

[mattman578]

Anaphylactic shock really scares me and I have never understood why epi pens are so hard to get a hold of in the US.  I man a bee sting or a missed placed peanut can cause major issues and make me have to make a phone call I never want to have to make.   Has anybody had any experience with giving a kid going in to anaphylactic shock a hole bottle of Benadryl ?

[Hedgehog]

Anaphylactic shock really scares me and I have never understood why epi pens are so hard to get a hold of in the US.  I man a bee sting or a missed placed peanut can cause major issues and make me have to make a phone call I never want to have to make.   Has anybody had any experience with giving a kid going in to anaphylactic shock a hole bottle of Benadryl ?

 

Typically, people with severe allergic reactions will be aware of that ahead of time.  The proper proceedure is that there should be two EpiPens - one on the body of the scout (with a buddy knowing where it is located) and the other with a leader trained (at a minimum) in Wilderness First Aid.  I was trained to have the scout hold the pen and to assist them in administering it.  

 

i know you are joking, but Benadryl is not an appropriate treatment for anaphylactic shock and under no conditions should you ever use a whole bottle.  For proper treatment see here:  http://www.mayoclinic.org/first-aid/first-aid-anaphylaxis/basics/art-20056608

 

New Jersey recently passed legislation permitting colleges to administer EpiPens through "trained designees" under a "licensed campus medical professional" without a prescription.

 

http://www.njleg.state.nj.us/2012/Bills/PL13/211_.HTM

 

The bill was supported by Princeton University's Outdoor Action group which activities very similar to scouting.  A good idea would be to expand to scouting for people with Wilderness First Aid training.

Edited April 15, 2015 by Hedgehog

[Stosh]

My son had a severe food allergy for a period of time but the doctor "did feel it was necessary" for him to carry an epi pen.  He said there was only a slim change the allergy could worsen and he could have a life threatening reaction.  So we were not certified, we were not authorized, we didn't take any training, and didn't jump through any hoops to protect our child.  Instead we both learned how to do a tracheotomy.  According to the doctor there was only a slim chance we would have to do it.  Neither of us was prepared to stand around and watch our son die waiting for an ambulance who at that time couldn't save him anyway.

 

Have I ever had to use an epi pen?  Nope.  Have I been trained?  Am I certified? Am I authorized? Nope, nope, nope.  If I ever have to help someone will I do it anyway?  Yep.  They can sue me for saving their life afterwards.

 

Would I do a tracheotomy on another parents child?  Never been in a situation where I had to answer that question.  Don't know what I would do. 

 

Oh, by the way, yes I have stood by and watched a person die from Anaphylactic shock as an ambulance attendant waiting for the train to clear a crossing. We were not authorized to administer drugs of any sort back then.

 

Remember this is a legal issue, not a medical issue.

Edited April 15, 2015 by Stosh

[Gone]

Anaphylactic shock really scares me and I have never understood why epi pens are so hard to get a hold of in the US.  I man a bee sting or a missed placed peanut can cause major issues and make me have to make a phone call I never want to have to make.   Has anybody had any experience with giving a kid going in to anaphylactic shock a hole bottle of Benadryl ?

 

Yes, and the first aid and WFA training I had (and keep current) really helped. Using the epi pens and benadryl to counter the anaphylaxis was a HUGE help. As part of any tour prep we ALWAYS make sure we have hospital directions, a treatment protocol for any anaphylactic situation and a communication method (cell phone, personal locator beacon, care flight/air ambulance contact info, etc.). All of our scouters have this training so that we don't have a single point of failure. Thankfully we have a few physicians on our ASM staff too. That helps.

 

Typically the first hit of the epi pen will take a min or so take begin to work, sometimes 3-5 mins and sometimes not at all. If you don't see any improvement immediately we usually administer a dose of benadryll. If we see improvement in the airway we monitor and are prepared to give the next epi pen hit. You might see some nausea or vomiting, which is why we give liquid or chewable benadryll. If we don't see any improvement we do the second pen hit. 

 

Obviously, at the first sign of an problem we have a two-deep (or more) team heading/calling for help. Always better safe than sorry.

 

Any person (scout or adult) with an anaphylactic issue or history (or possibility of such a reaction) MUST have one, sometimes two, epi pens on store with our medical team. We know which people this issue affects and we keep an eye on them on all events. If we are hiking, we have the med forms and med bad with us...always. Think corpsman. We style our support on that model. Yes, former military. It works!

[Gone]

i know you are joking, but Benadryl is not an appropriate treatment for anaphylactic shock and under no conditions should you ever use a whole bottle.  For proper treatment see here:  http://www.mayoclinic.org/first-aid/first-aid-anaphylaxis/basics/art-20056608

 

 

There is a difference between treating someone with anaphylaxis and anaphylatic shock. Bendryll for the former is an acceptable first aid treatment under certain conditions. I agree that you never give if for the latter. But if you are in a remote situation and days away from first aid, you may not have a choice.

[Gone]

 

Remember this is a legal issue, not a medical issue.

 

Hmmmm. Yes and no.

 

If I am in a situation where I have a person who is going to die unless they get treatment I have just as much a chance of getting sued if I do something rather than do nothing.

 

Having been in this situation more than once I can tell you the LAST thing I was concerned about was being sued. I was concerned about saving a life. My training helped me stay calm and administer the treatment. Our protocols helped make sure that professional help was obtained ASAP. The people made it to the hospital and the outcome was always good (thanking God and knocking wood).

 

I agree with @@Hedgehog, we as leaders need to be HIGHLY trained in first aid. The basic and advanced Red Cross first aid courses are great. Basic and advanced WRFA will help MASSIVELY.

 

BTW, in case anyone hasn't seen them, here's the BSA advice on food allergies.

[eagle90]

The drug maufacturers of the epi-pens have training models available so you can practice to get the feel and how they operate.  All of our leaders and PLC members have been trained on how to use the pen, as 2 of our scouts have peanut allergies.

 

Dale

[Stosh]

Hopefully things have changed since I took medical training.  If you were not certified or trained in a technique, NOT DOING ANYTHING is the legal right answer.  Medically and morally it sucked.

 

Remember you can be sued either way. 

 

If you do something and you're untrained, you can be sued.

If you don't do something and your're untrained, you're safe.

If you do something and you're trained, you can be sued.  You didn't do it right, fast enough, etc.

If you don't do something and you're trained, YOU'RE SAFE unless you're getting paid for the medical service and that's what malpractice insurance is for.

 

Just rely on your safety protocols and hope for the best.

 

Legal stuff is fun, just ask any lawyer.

[Hedgehog]

Most states have passed good samaritan laws to protect people who are acting within their level of training.  That changes the outcome of your third situation.  That is, if you do something by acting within your training you can't be held liable (unless of course your actions are grossly negligent - i.e. putting on a torniquet for a mesquito bite).

 

 

However, the EpiPen is different in that it is only availabe for use under a doctor's (direct or indirect) supervision.  Even the use of EpiPens by EMTs is required to be under a doctor's supervision.  I cannot obtain an EpiPen to have "just in case" a scout who never had a bee sting before has a severe reaction.  However, I see that the law is catching up with common sense in developing workarounds for schools and colleges.  

 

@ - Agreed, Benadryl is proper to use for an allergic reaction and may serve as a last resort to treat anaphalactic shock.  I didn't think about carrying the quick dissolve or liquid - just have the generic tablets in the medical bag.

[Stosh]

Yes, you can be sued under the Good Samaritan laws and as you have indicated, negligence is always floating up near the top of the lists lawyers like.

 

Epi pens can be used only by the person who needs them.  To train one's SPL how to use an epi pen sounds noble, but legally they can't give a controlled substance (prescription medicine) to another person.  Add to that there is no doctor supervision and no parental consent.  That's way too much thin ice for me.

 

As a former EMT, do I know how epi pens work?  Yep.  have I been trained?  That needs clarification, but legally the answer is no.  If someone was going into shock and the pen is handy, would I do something, yes, I would help in the legal sense of the word.

 

A school nurse can hand out prescription medication to students who have proper doctor supervision and control.  Can they give out an aspirin or any other over-the-counter medications?  Nope.  Benadryl is an OTC drug which is being given without parental consent,  I do believe that the only person that can treat a patient without parental consent is an ER doctor in order to do the minimal to keep a person alive.  If a kid breaks an arm and is in extreme pain, they will just sit there until the parents approve treatment.

 

Unless things have changed, sugar, syrup of ipecac and/or charcoal are the only "invasive" treatments a non-medical person can use. 

[mattman578]

New Jersey recently passed legislation permitting colleges to administer EpiPens through "trained designees" under a "licensed campus medical professional" without a prescription.

 

http://www.njleg.state.nj.us/2012/Bills/PL13/211_.HTM

 

The bill was supported by Princeton University's Outdoor Action group which activities very similar to scouting.  A good idea would be to expand to scouting for people with Wilderness First Aid training.

Looks like I will have to wait for this to come to Maryland they do allow schools to have epi pens

[eagle90]

The scout who has the extreme allergy has the epi pens with him at all times.  His mother has given permission for us to administer the pen if needed.  In fact, she was the trainer.  Am I going to stand around and watch my scout go into shock, worrying about liability, or am I going to stab him in the thigh with the epi pen?  I'm gonna stab, possibly save a life, and worry about the consequences later.  We have used it once on a bee sting allergy.

[MattR]

We had a kid eat a peanut and when I asked him where his epi pin was he said he forgot to bring it. We were an hour from the nearest hospital. We gave him benadryl. He threw it up. We gave him more. Another kid did have an epi pin and I asked for it. He was smaller so I assumed the dose would be less. I was only going to use it if I really had to. We met an ambulance half way to the town and they took over from there. They told us we did the right thing. They also told us epi pins are not a solution, they are a temporary fix. I don't know why benadryl is not a standard first aid kit item. We put it in ours.

[RichardB]

This has gotten a little off of the original topic but I'd suggest everyone who is involved with BSA review the policy on prescriptions:  http://www.scouting.org/scoutsource/HealthandSafety/GSS/gss05.aspx#g is a direct link.  

 

Prescriptions

The taking of prescription medication is the responsibility of the individual taking the medication and/or that individual’s parent or guardian. A leader, after obtaining all the necessary information, can agree to accept the responsibility of making sure a youth takes the necessary medication at the appropriate time, but BSA does not mandate or necessarily encourage the leader to do so. Also, if state laws are more limiting, they must be followed. BSA camp standards may modify this for specific camp operation.