Wilderness First Aid: Training Disucssion Thread

[Eagle94-A1]

Hedge nails it. Stabilize and call 911 is the current in basic first aid. When I helped teach/recertified a AHA first aid class in June, the only hands on stuff required was putting on gloves; bandaging, and one other item I can't remember. But it was either treating for shock, cut off finger, or epi pen.  Yeh we do some extras in the class.

 

What's interesting is that when I got injured in August, it was the leaders and the SPL that took care of me. Grant you we sent the scouts back to camp to cook. But those who took an AHA class probably could not treat me.

[Stosh]

As a former EMT, let me ask the question....

 

A boy breaks his leg, SM with S-FC training splints it and treats for shock, sends 4 boys back down the trail 20 miles for help.

 

What more is the SM going to do except keep the boy calm for the next day or two until medical rescue personnel arrive?

 

And as morbid as it sounds, if it's a compound fracture and he's bleeding out, the SM using his S-FC training, applies pressure bandages and before the boy bleeds completely out, applies a tourniquet as a last ditch to save his life.  What more would a leader with WFC do?  Help is still 2 days away.

 

I seriously don't see what WFC is going to accomplish that S-FC won't do just as well given the circumstances.  Oh?  I see, it's just legalese fine print for Irving to CYA in case someone gets hurt on a scout outing that they can say they have pedigree first aid people on-site that can't do jack to help their kid in an emergency, but they have the paperwork done.  Am I close? 

[Rick_in_CA]

Oh?  I see, it's just legalese fine print for Irving to CYA in case someone gets hurt on a scout outing that they can say they have pedigree first aid people on-site that can't do jack to help their kid in an emergency, but they have the paperwork done.  Am I close?

I think @@Stosh is right that this change (if it is real - it's still just a rumor for now), is mostly "safety theater".

[SpEdScouter]

I'd say it would be better to have some sort of emergency radio. Sending 2-4 scouts 20 miles away to find help would be crazy and besides, how often are we more than an hour or two away from where we can get help? Efven at Philmont arent they no more than 3-4 hours away from a checkpoint? Maybe a better plan is to teach someone how to get to a high point and call for help?

[Stosh]

A lot depends on the type of adventure one is providing the scouts.

 

Philmont is not really all that remote.  In an emergency, 4 of the best runners having dropped packs you reach help rather quickly.  However, fly-in remote fishing camp is a different story.  AT is well traveled and may even have cell coverage in parts, canoeing the Yukon is a whole different animal.  Back country Yellowstone?  Whole different story.

 

25 miles into a 50 miler in BWCA could mean a day or two travel for help.  One can't paddle as fast as a scout can run if necessary.

 

So a lot of fire and fury on the subject, but in only a very few cases is it really going to make any difference.  In those cases, the extra $150 to have some extra training to increase the comfort and confidence level would be nice.

 

Also, cross certification means nothing.  Anyone with MD after his/her name may mean that person is a trauma ER doctor which would do well IF he were in a fully staffed and equipped ER trauma center otherwise it might mean  that person is a psychiatrist who hasn't seen a trauma patient since residency rotation 30 years ago.  Give me an EMT over a MD any day.

[SeattlePioneer]

<<

Not sure if it is a national requirement or not, but having one WFA trained adult is required for all backcountry outing in our Council.  I can't imagine any parent letting their child go on a backcountry adventure without having someone appropriately trained and I can't imaging being responsible for the safety of a group of boys without having that training.

 

We have at least 4 adults in our Troop that have WFA training -- typicaly two of them go on every outing - backcountry or not.>>

 

 

 

Fine,  for your troop. 

 

But it's pointlessly burdensome for a lot of troops.  The list of training required for a SM or AS is already too long.

 

And frankly,  it's overkill for backpacking,  in my experience.  In the Seattle area,  the Seattle Mountaineers organizes a lot of outdoor outings. Mountaineering Oriented First Aid is required for climbers,  not backpackers, snowshoers, cyclists, cross country skiers and so on.

 

My council recently started requiring annual YPT  --- another pointlessly excessive regulation.

 

I took a test to get my driver's license forty years ago  --- do you think they should start requiring annual driver's tests to drive high speed vehicles around with current accident rates?

 

Frankly,  I've about had it with Scouting.  They are driving the program into the ground.

[Stosh]

@@SeattlePioneer you are correct, the youth are at greater danger driving/riding to the back country trail head than they are on the trail. 

 

There was a big push nationally to make play grounds safer.  No more pavement, no exposed bolts, etc.  Now the only deaths/injuries the kids have is getting to the playground.  Of course extensive studies showing playground deaths and playground injuries stayed pretty much the same.

Edited September 27, 2015 by Stosh

[Hedgehog]

But it's pointlessly burdensome for a lot of troops.  The list of training required for a SM or AS is already too long.

 

From my perspective, the first aid training given to SMs and ASMs as part of IOLS is insufficient in case of a real emergency.  Initially, it starts with the premise you know what the injury is, assumes that a full fledged first aid kit is available and ends with the premise that help is on the way -- all covered in about an hour on powerpoint slides.  I'd have to check, but I'm not sure they even taught how to take a pulse or to count respirations per minute.

 

WFA teaches assessment and diagnosis.  A scout doubles over while backpacking -- what do you do to find out what the problem is?  My WFA training had us run through 12 different scenarios where we didn't know what the problem was, requiring us to diagnose and treat the injured person.  WFA teaches how to improvise on bandages, splints, stretchers, etc.  It also requires CPR certification -- which is not a requirement for T-1st.  It also taught how to use an Epi-Pen.  

 

I hope the $150 I spent on WFA training and the $100 I spent on building a backpacking medical kit which includes SAM splints, Quickclot, an Ice Pack, Iodine and everything else is a complete waste of money.  That just means that I will have made it 7 years in scouting without someone getting seriously injured.  

[Eagle94-A1]

Hedge,

 

I admit first aid in ITOLS is not enough. Heck IMHO even a basic AHA first aid course is not enough, and I teach those courses. Those courses are designed for urban environments with easy access to medical care.

 

But basic first aid courses were not always that way. Especially FA MB.  It taught skills that would be considered WFA.

 

Back in the day, First Aid MB, or at least where I was taught,  was outdoor based. it taught us how to recognize problems, and how to improvise using stuff found on a trail, on ourselves, and in a backpack. We learned the skills, then practiced on hikes with scenarios. Out of all my first aid classes over the years, it was the best one. In reading the BS WFA book ( http://www.scoutstuff.org/bsar-wilderness-first-aid-manual.html#.Vgh8YW7ig40)  about 90% is what I was taught for FA MB.

 

As for CPR, you are correct CPR certification is not needed for T-2-1. However, CPR is used for an unconscious choking victim which is a 2nd Class requirement. And being able to demonstrate CPR and AED usage is a FA MB requirement. IMHO certification is more CYA.

 

BUT I also know that CPR changes every five years, Waiting to get back to work and find out what the new changes will be in 2016 and get my instructor update, as well as finding out when the new books come out.

 

As for Epi-pens I don't know why they are not taught for T-2-1 or FA MB, especially since it seems as if more and more folks are developing allergies that require them. The only thing I can think for NOT teaching them  is that it is a controlled substance requiring a prescription to obtain. And I bet some lawyers do NOT want "kids" administering them. That and in some jurisdictions, only the person who it is prescribed to can administer them, although you can help them out

 

What I've found interesting is that techniques I was taught back in the day, went out of vogue, but are not coming back.

 

And I too hope that you have "wasted" all of that money on training and supplies.  But it's good that you are prepared for when things hit the fan. From multiple experiences as both a victim and responder, "Being Prepared" is key.

[Stosh]

From my perspective, the first aid training given to SMs and ASMs as part of IOLS is insufficient in case of a real emergency.  Initially, it starts with the premise you know what the injury is, assumes that a full fledged first aid kit is available and ends with the premise that help is on the way -- all covered in about an hour on powerpoint slides.  I'd have to check, but I'm not sure they even taught how to take a pulse or to count respirations per minute.

 

WFA teaches assessment and diagnosis.  A scout doubles over while backpacking -- what do you do to find out what the problem is?  My WFA training had us run through 12 different scenarios where we didn't know what the problem was, requiring us to diagnose and treat the injured person.  WFA teaches how to improvise on bandages, splints, stretchers, etc.  It also requires CPR certification -- which is not a requirement for T-1st.  It also taught how to use an Epi-Pen.  

 

I hope the $150 I spent on WFA training and the $100 I spent on building a backpacking medical kit which includes SAM splints, Quickclot, an Ice Pack, Iodine and everything else is a complete waste of money.  That just means that I will have made it 7 years in scouting without someone getting seriously injured.  

 

I understand the value of extended first aid training and from the perspective of one who just dished out $150 for the course it will mean a lot to you.

 

But stop and think for a moment.  CPR certification is not needed for S-FC, but it is for WFC class.  Okay, you are two days into the back country.  SM goes down with a heart attack, Does that mean the boys that don't go for help are to do CPR for the 2 days it's going to be necessary to be done until help arrives?  No, in this case WFA is of no value.  By the way, I can guarantee the average person will get 20 to maybe 30 minutes of doing CPR before they are totally exhausted.  Unless you are backpacking with a defib unit and it's effective, the person simply isn't going to survive.  Even if there's cell phone reception where you are, 2 days into the back country will take more than the Golden Hour for rescue personnel to get to the site for rescue. 

 

If a boy is bitten by a rattle snake and took a full dose of venom.  You're two days out, what can be done at that point?  One doesn't need any special training to determine the problem, and there's nothing beyond S-FC that will be of any benefit.

 

A boy is burned badly by a backpack stove flare up.  What beyond S-FC is going to be done while waiting for help? 

 

A boy cuts his finger off while filleting a fish.  If one doesn't stop the bleeding as taught by S-FC, the boy will bleed to death long before help arrives.

 

I haven't taken WFA, but please inform me of what is taught that is beyond S-FC that would actually be of benefit 2 days into a back country trek?  I'm not asking to be snarky, I'm just super curious.  

 

Bites, stings, cuts, choking, CPR, are all covered, what am I missing?

 

And here's another bit of information the gloss over in the WFA training .... once you are certified, you are no longer held to the Good Samaritan Laws, you are certified to a higher standard of training and legally are held accountable to that as well.

 

Like the South African Scout commercial, the training I learned many years ago is no longer certified, but I still know the basics and as a Good Samaritan I might be able to help someone in a medical emergency.  But I am held accountable to the level of any average untrained person in the crowed who also is not certified.

 

I'm just not seeing $150 worth of benefit of any program other than a good solid understanding of S-FC first aid.

Edited September 28, 2015 by Stosh

[John-in-KC]

Moderator's Note:

 

This is rumor.  What say we let the Moderator Team make a call or two to Professional Staff, and see what shaking the trees actually yields???

 

In the meantime, everyone relax.  One of two things is going to happen:

- This will be a policy, and there's no use in whining.  It will be a done deal.

- There won't be a policy, and everyone is getting excited over a rumor.

[Stosh]

I don't think anyone thinks it's a done deal, but the discussion revolves around the value of whether or not the deal is all that beneficial for the boys in the first place.

 

If boys are going out into the back country they should have enough training in S-FC to handle emergency situations.  If not, maybe the issue is not more training but less pencil whipping.

 

If the adults aren't qualified to train S-FC first aid, then they shouldn't be heading out into the back country either.

 

But if S-FC skills are up to snuff, what more is WFA going to add that will make a difference 2-3 day into a trek that can't be handled with S-FC skills?

 

I'm not hearing any conversation on that and that would be more important than some $150 certification process designed by lawyers to avoid legal negligence which wouldn't necessarily be prevented by any amount of training.

Edited September 28, 2015 by Stosh

[Hedgehog]

@@Eagle94-A1, I agree - the IOLS and T-1st and First Aid MB could teach skills better and teach them in a wilderness concept.  My son wants to take a First Aid class from the local fire department because as he puts it, "I learned the stuff for the Merit Badge, but I'm not sure I'd remember it or be able to do it in an emergency."  Even if the First Aid Merit Badge was sufficient, adults are not required to have it.

 

I also agree on the Epi-Pens and have been taught how to assist in administering them.  My thought is that trained leaders should be able to carry Epi-Pens and administer in case of an emergency to any person in their group.  You never know if Johnny will have an alergic reaction the first time he is stung by a bee.

 

@@Stosh, I agree that many of the skills are taught in T-1st.  But how many adult leaders master those skills in the 1 hour IOLS powerpoint presentation?  

 

Without doing a side by side comparison, I think that knowing when (if you are unable to see signs of capilation) and how to realign a broken bone was one thing that was different.  Also, as I mentioned above, my WFA class focused on assessment and diagnosis.  That means you can tell the difference between a sprain and a break.  That means you know what to look for when examining the injured person and what questions to ask.

 

I also agree that CPR is most likely useless unless you can get an AED machine.  But heck if I'm at a scout camp having a heart attack and there is an AED machine 10 minutes away, I"m not going to complain if a WFA trained leader performs CPR while they run to get the machine or that the WFA trained leader knows how to use the machine.

 

As for being held to a higher standard of care, that is true but you can only be liable for things you do (not for omissions) and only liable if you do something that is incorrect based on your training (i.e. cut open a snake bite and suck out the venom) or do something that is outside the scope of your training (cut open a scout's arm to try and reset a bone).

 

I also agree that the current training is too expensive and should last for more than 2 years.  I had to take it so that our Troop can undertake backcountry adventures based on our Council's requirements to obtain a tour permit.  If I'm correct, First Aid certification is recommended for all trips; we have to certifiy that we have a first aid kit and emergency roadside kit for all trips; hazardous weather certification is required for all trips; and WFA is required for backcountry (i.e. backpacking) trips.  I also wanted to take it because I really didn't feel that I was proficient enough at First Aid to be responsible for the boys in my troop's safety.

 

@@Stosh, I think you would agree that there needs to be some First Aid training for adult leaders beyond the IOLS Powerpoint presentation (which some council's don't even require IOLS).  Absent any dictate from council or national, what would you reccomend the rule should be?

[Krampus]

Could you imagine BSA making this mandatory for adults in scouting? I can't find a class now as it is without extreme difficulty. In my area we'd have to train or hire dozens of groups to offer this course to meet the demand. I suspect the same is true with everyone else's districts.

 

I totally agree that this is a great course and solely needed, but I agree with whoever it was who said it should be just as much for the scouts as the adults. We sent three crews to Philmont in 2013 the last week it was open. During that time two adults (not in our crews) died as a result of heart-related issues. Sadly only faster medical evac would have saved them as the first responders were well trained.

[Stosh]

@@Hedgehog

 

 

@@Eagle94-A1, I agree - the IOLS and T-1st and First Aid MB could teach skills better and teach them in a wilderness concept.  My son wants to take a First Aid class from the local fire department because as he puts it, "I learned the stuff for the Merit Badge, but I'm not sure I'd remember it or be able to do it in an emergency."  Even if the First Aid Merit Badge was sufficient, adults are not required to have it.

 

Having adults master S-FC skills and FA MB is probably the core basis for some sort of BSA, put on by Councils,  with cover the cost of lunch expense.  $150 for a mandatory or all your activities are shut down approach is really ridiculous.

 

I also agree on the Epi-Pens and have been taught how to assist in administering them.  My thought is that trained leaders should be able to carry Epi-Pens and administer in case of an emergency to any person in their group.  You never know if Johnny will have an alergic reaction the first time he is stung by a bee.

 

Should the leaders also carry insulin? Maybe they should be taught how to do a tracheotomy too for when the Heimlich doesn't work.    How far do we carry invasive medicine in BSA training?  These, too, are lifesaving techniques for advanced care in the field. 

 

@@Stosh, I agree that many of the skills are taught in T-1st.  But how many adult leaders master those skills in the 1 hour IOLS powerpoint presentation?  

 

Unfortunately the case can be also made for mastering those skills in a one day trainer led presentation with 6 hours of practice putting on splints and bandaging cuts?  When I did EMT-A training it was 120 hours of training to begin with and 20 hours every year thereafter to keep the certification current.  That didn't count the 8 hour CPR course that needed to be done annually as well.  I think there's got to be some happy medium somewhere in the process.

 

Without doing a side by side comparison, I think that knowing when (if you are unable to see signs of capilation) and how to realign a broken bone was one thing that was different.  Also, as I mentioned above, my WFA class focused on assessment and diagnosis.  That means you can tell the difference between a sprain and a break.  That means you know what to look for when examining the injured person and what questions to ask.

 

And do they teach that if one were to realign a broken bone on a closed fracture, the chance of doubling the damage increases?  An artery next to a close fracture may get pinched and cut off circulation?  That's a technique I would NEVER attempt.  Splint as-is, do not do more damage than what has already been done.  So that part of the training I would have been exposed to, but I would never do .... ever.

 

As far as the difference between a sprain and a break?  If it is in the lower extremity what difference does it make, the scout isn't going to walk out on a sprained ankle any more than they would with a broken ankle.  Knowing the difference makes no difference.  The boy's ankle hurts and he isn't going to walk anywhere.  End of  diagnosis.  

 

Knowing what to look for and what questions to ask may lead one to diagnosing a problem one can't do anything about anyway.  You're still stuck with nothing more than treat for shock, do no harm and get help there ASAP.

 

I also agree that CPR is most likely useless unless you can get an AED machine.  But heck if I'm at a scout camp having a heart attack and there is an AED machine 10 minutes away, I"m not going to complain if a WFA trained leader performs CPR while they run to get the machine or that the WFA trained leader knows how to use the machine.

 

At a scout camp they have staff medical personnel that can handle it.  A SM doesn't need to know WFA if help is five minutes away.

 

As for being held to a higher standard of care, that is true but you can only be liable for things you do (not for omissions) and only liable if you do something that is incorrect based on your training (i.e. cut open a snake bite and suck out the venom) or do something that is outside the scope of your training (cut open a scout's arm to try and reset a bone).

 

But of course you can be sued for medical omissions.  You are out with the boys  5 adults, 15 boys, you are the only one with WFA certification.  A boy gets hurt and the parents feel the need to sue.  Of the 5 adults, who's going to get sued?  Okay, you are certified to help and you didn't.  How do you think that's going to play out in court?  I carry a million dollars worth of personal liability insurance as well as the BSA policy for just such occasions.  If I was WFA trained I would have to double that.  Why do you think the largest expense for any medical profession today is liability insurance?!!!  Once certified, you better get with the program.  By the way, it's almost certain they won't win the law suit, but how much money can you afford defending yourself?  And how aggressive do you think BSA is going to be with hundreds if not thousands of petty law suits because people know about the WFA training of the scout leadership?

 

I also agree that the current training is too expensive and should last for more than 2 years.  I had to take it so that our Troop can undertake backcountry adventures based on our Council's requirements to obtain a tour permit.  If I'm correct, First Aid certification is recommended for all trips; we have to certifiy that we have a first aid kit and emergency roadside kit for all trips; hazardous weather certification is required for all trips; and WFA is required for backcountry (i.e. backpacking) trips.  I also wanted to take it because I really didn't feel that I was proficient enough at First Aid to be responsible for the boys in my troop's safety.

 

@@Stosh, I think you would agree that there needs to be some First Aid training for adult leaders beyond the IOLS Powerpoint presentation (which some council's don't even require IOLS).  Absent any dictate from council or national, what would you reccomend the rule should be?

 

Keep it in mind Hedge, I'm not trying to argue the point only pass along further information that you have put out there.  I think it is a wise decision to get further training if you personally feel inadequate to handle medical emergencies in the field with the training BSA currently provides.  Yes, the cost is way over the top for a 2 year cycle.

 

So my recommendation would be:  I'd say 2-3 heavy-duty weekends with lots of hands on training on techniques that CAN be used in the field while waiting an extended period of time, i.e. shock, bleeding,  etc.  CPR is useless but handy for non-Wilderness settings.  Once the initial certification is completed, an ANNUAL one day (8-10 hours) refresher on new techniques or changes in treatment techniques is useful to maintain certification.  We have American Red Cross Lifesaving and we have BSA Lifesaving, why do we need all these outside expensive classes?  Wouldn't it be more cost effective to develop a training course that is specific to medical emergencies that address issues where the wait for medical personnel is going to be more than 8 hours away?  Dump the PowerPoint crutches, go out into the woods at the local scout camp and use only materials at hand and what is normally used on the average backpack, canoe, bike trek activity.  Two items seldom worn by scouts, neckers and belts, are the best first aid equipment in the field.  I have even applied pressure bandages on minor bleeding with a scout belt and necker.  Those web belts are fantastic for adjusting for circulation.  They are also adjustable for applying splints where circulation is important.  Being prepared for life and death issues is greatly magnified in the wilderness experience.  It has it's dangers, but so does driving 40 miles to the local council summer camp.  There will be unique challenges in the wilderness experience, the training needs to focus on what those are and to train to be prepared to deal with them.  There really isn't that much one can do 3 days out.  The WFA or whatever FA training the Council does should extend ALL SCOUTERS' knowledge base to handle medical emergencies if nothing more than making sure their cell phone is charged and they have a signal, if not, what does one do?

Edited September 28, 2015 by Stosh