Wilderness First Aid: Training Disucssion Thread

[gumbymaster]

Sorry, I should clarify.

 

I meant that in the communitty at large, if they think of someone performing first aid (not professional EMS) they probably think of Red Cross and their CPR training first, and a boy scout second.  Even AHA, since their training is typically more to professional workplace needs, might not be as well recognized.

 

Actually in our area, they have some deal with the ARC, and we have quite a lot of BSA sponsored ARC certified training.

[JoeBob]

Realistically, is there any real reason that the BSA could not create our own self-certified course in WFA,

 

Two reasons pop to mind:

1- Liability.  The lawyers would never allow it, nor should they because of reason 2:

2- BSA training usually drops to the level of competence of the individual trainer, and sometimes lower.  Are there any BSA training courses that have close to 50% approval?  WFA can't be shoe-horned into a power-point.  It's more about a mindset: this human is broken in this manner.  Now that you understand the basic causes and potential problems, how are you going to deal with it using the supplies you have on hand?

[Stosh]

I don't think WFA involves much more than.

 

1) A boy hurts himself.

2) What can I do to make him comfortable for 2-3 days.

3) From my training what's his chance of survival?

4) If he doesn't make it, what's the name of a good lawyer.

 

Let's face it, one is at the mercy of a lot of factors piled against you when you get beyond immediate or even somewhat quick medical rescue. 

 

Other than stopping the bleeding, there's really not much to know when you're 3 days out.

 

Splinting a broken bone isn't going to improve a person's chance for survival.  If it's a compound fracture, stop the bleeding. Remember if you do split it, after 3 days of swelling the circulation could have been cut off and now your liable for the loss of the limb.

 

Instead of the misnomer of WFA, how about, "First Aid for those who will be waiting 3-5 days for medical assistance."    Oooh, I diagnosed he has broken a rib.  So what, you can't splint a broken rib.  .... it punctured a lung.... now you are up S... Creek without a paddle and you still can't do anything about it.  His lung collapsed..... the canoe just sank.

 

As mentioned by others, Wilderness Safety would probably be a better course that teaches prevention of injuries because after the fact is too late.

[Horizon]

Stosh - I don't understand why you continue to critique the WFA curriculum. Those of us who have taken it, appreciated with the various scenarios, the hands on work, the in-depth instruction, etc. It was a great, detailed and applied first aid course that covered many subjects. It was a heck of a lot more than than just make someone comfortable and wait for help.

 

Please take a look at the link provider previously, or ask someone who has taken the course to see their book. You will find some great material that can be used in your own training for Scouts (that is how I am using it - as a reference guide that goes beyond the Scout handbook and the First Aid merit badge book). I found it a very useful course. I was charged $50 for the class, and if I wanted to keep the book it was another $20. I spent ~15 hours in the course during summer camp picking up a ton of knowledge that was in addition to my Red Cross First Aid that I do every year. 

 

It would be interesting to compare the differences between WFA, EMT, and other first responder training curriculums - and use it to better build out our own training in the BSA. I am taking my book next time I visit my parents. Dad is the fire chief, and mom runs the training for everyone who staffs the QRU for the county. They are far out in the hills, the golden hour is non-existent, so they bridge the gap of medical care in the countryside.

 

Should it be required if the BSA is not going to make it available and affordable? No. 

Have the people in this thread who have taken it found it a useful course? Yes.

[Stosh]

Stosh - I don't understand why you continue to critique the WFA curriculum. Those of us who have taken it, appreciated with the various scenarios, the hands on work, the in-depth instruction, etc. It was a great, detailed and applied first aid course that covered many subjects. It was a heck of a lot more than than just make someone comfortable and wait for help.

 

Please take a look at the link provider previously, or ask someone who has taken the course to see their book. You will find some great material that can be used in your own training for Scouts (that is how I am using it - as a reference guide that goes beyond the Scout handbook and the First Aid merit badge book). I found it a very useful course. I was charged $50 for the class, and if I wanted to keep the book it was another $20. I spent ~15 hours in the course during summer camp picking up a ton of knowledge that was in addition to my Red Cross First Aid that I do every year. 

 

It would be interesting to compare the differences between WFA, EMT, and other first responder training curriculums - and use it to better build out our own training in the BSA. I am taking my book next time I visit my parents. Dad is the fire chief, and mom runs the training for everyone who staffs the QRU for the county. They are far out in the hills, the golden hour is non-existent, so they bridge the gap of medical care in the countryside.

 

Should it be required if the BSA is not going to make it available and affordable? No. 

Have the people in this thread who have taken it found it a useful course? Yes.

 

Any emergency training is good for building confidence and allowing someone to at least give someone a chance of survival in an emergency situation.  In that respect I have no problem with WFA.  No, I have not taken the course, but after looking at what is covered in the curriculum, I am in no hurry to take it.  It would not offer me $150 worth of new material.  

 

Yes, it's going to be impressive to the novice, it's going to be quite a confidence booster and unfortunately it will often give a false sense of security.  What people can do to their bodies is unbelievable to say the least.  15 years running with an EMT service in the rural areas of the country might not sound all that challenging as an urban setting, but cutting a young kid out of a corn picker in the dark can be as much fun as a gunshot from a mugging.  Crawling around in the rain in the dark looking for kids that were thrown out of the car in chest high weeds is not something they make TV shows out of either.

 

The one of the worse thing in the world is not knowing what to do in an emergency situation.  Standing there watching someone suffer and being helpless to do anything is not what life should be about.  But on the other hand training will take care of that.......  BUT  Another one of the worse things in the world is knowing that without more skill and knowledge than what you can provide in an emergency situation means that you're going to stand there and watch and be helpless to do anything about it anyway.  Training is one thing, time is even more important.

 

A fully equipt ambulance staffed with nurses and highly skilled trauma doctor would find it very difficult to have to wait even a day or two before engaging the patient.  Time is not an ally.  As an EMT I was used to dealing with minutes (we were 20 minutes from the nearest medical facility and 45 minutes from LifeFlight and advanced trauma care.  20 and 45 minutes made the difference between life and death in a lot of those cases.  

 

I had a case where I pinched off the severed femoral artery of an 8 year old girl who was in a car accident.  We didn't wait for the ambulance (20 minutes out and 20 minutes back), but took my car and headed for the hospital hoping to cut those minutes in half..  We met the ambulance and transferred, but I held the artery all the way to pre-surgery where they clamped it off and I could let go.  Not only did I save her life, but when dealing with just minutes I saved her leg as well.  If that had been a jackknife slip into a boy's thigh, 3 days before medical help can arrive?  I know how much the odds would be stacked against me and no amount of WFA is going to be of any value whatsoever.  Apply a tourniquet and hope for the best is all you can do, you have just made the decision to sacrifice the leg for a chance to save the boy's life.  You will live with that decision for the rest of your life.  That technique is taught in S-FC and FA-MB.  EMTs are trained NOT to do it because it is a technique of last resort.

 

WFA is a great beginning but look at the situation realistically.  I just don't want WFA to leave the participants with a false sense of security or confidence and have them let their guard down.  The only that that will keep your boys safe is prevention.  I would much rather see a major course in that because I'm really afraid that WFA is going to be quite useless after the first 5-6 hours.  It may be that the last resort is really the first resort depending on how far into the back country you are.

 

Polling those who have taken the course will produce a certain set point of satisfaction.

Polling those who have had to deal with trauma in the back country is going to produce a whole different set of satisfaction points...guaranteed.

 

I guess my vantage point is a bit different from many of the others on the forum.  It would be interesting to know how many of the instructors of WFA had had to actually deal with an actual case of what they are teaching about or whether or not they are just reading out of some book.  It always reminds me of the ER doctor that got all over my case because the patient I brought in was covered with mud and I hadn't done anything to clean him up before bringing him into the sterile ER Room.  Well, Doc, the car went off the road it was spring, the ditch was muddy, the car went upside down, windshield blew back onto the patient.  After the FD cut the car open the best they could, we extricated him upside down kneeling in mud ourselves.  We had all we could do to get a basic assessment let alone clean him up.    The patient survived and the doctor got over what I had to say to him that day.  

 

Am I overly critical of the WFA curriculum or am I just aware of what is NOT covered that should be in such a program?

[Hedgehog]

I spent ~15 hours in the course during summer camp picking up a ton of knowledge that was in addition to my Red Cross First Aid that I do every year. 

 

Probably would have been a better use of your time to take riflery -- that way you can shoot them and put them out of their misery because nothing we learned in WFA will help anyway.

 

It would be interesting to know how many of the instructors of WFA had had to actually deal with an actual case of what they are teaching about or whether or not they are just reading out of some book.

 

Both people who taught my WFA class were EMTs. Wildnerness First Resonders and EMT training instructors.

[gumbymaster]

I've been an EMT/NREMT; I've been an Advance First Aid (when they had that course), CPR, First Aid, BLS, and a bunch of other ARC courses instructor - I am not currently certified as an instructor.

 

Before any of that, I was a Boy Scout with First Aid MB and Emergency Prep MB.  The worst "wilderness" case I had to deal with was as summer camp staff (~18), we were leading a group of ~ 30 first year campers to an overnight camping site off the camp property (only about 1-1.5 miles, very hilly terrain), and my co-leader took a brown recluse bite to the calf.  I had to send my CIT and two scouts back to the camp for help, and control the situation for the ~ 30 mins to an hour before other staff arrived with the stretcher to bring him back to camp, coenciding with the approximate time an ambulance could get to the camp.

 

In the end, everything was fine, but I look back at that and my subsequent training; for the wilderness, the Advanced First Aid course was actually more appropriate than the EMT, but was not much different than the Scouting background.

 

While I recognize many of our scout training programs are over powerpointed, they don't have to be, and even when they are, we still usually do a pretty good job of a practical (field) component (BALOO, IOLS, others I do not have personal experience with).  I still think the BSA could run their own program to cover the content in the earlier pdf link.

[Stosh]

 

Both people who taught my WFA class were EMTs. Wildnerness First Resonders and EMT training instructors.

 

That's their training, what about their experience?  

 

I was an American Heart Association CPR Instructor.  I taught professionals.  I was involved in 14 CPR attempts and was unsuccessful with all of them.  All of the calls were more than 30 minutes from advanced medical assistance.  30 minutes is a long time.  The longest I ever had to attend to a trauma victim was a car accident in a blizzard.  We managed to get back to the local fire station, but there was no way we were going to make it to a hospital.  One had head trauma and the other a broken back.  We monitored them for 27 hours before we could transport to the hospital and then it was with snow plow escort.  Even then we were in radio contact with the hospital ER but I don't know how much that really helped.

 

Like I said, being book taught and living the situation are two entirely different things.

 

When they went into the field as Wilderness First Responders did they carry more equipment than you will?  And how much time passed between when the injury occurred and they were notified?  First Responders by definition do not transport patients.

 

I'm thinking there's a lot more to the story than what's being said, and maybe others need to think that way as well.

 

However, when all is said and done, I truly hope you never have to use what you've been taught.

[Stosh]

I've been an EMT/NREMT; I've been an Advance First Aid (when they had that course), CPR, First Aid, BLS, and a bunch of other ARC courses instructor - I am not currently certified as an instructor.

 

Before any of that, I was a Boy Scout with First Aid MB and Emergency Prep MB.  The worst "wilderness" case I had to deal with was as summer camp staff (~18), we were leading a group of ~ 30 first year campers to an overnight camping site off the camp property (only about 1-1.5 miles, very hilly terrain), and my co-leader took a brown recluse bite to the calf.  I had to send my CIT and two scouts back to the camp for help, and control the situation for the ~ 30 mins to an hour before other staff arrived with the stretcher to bring him back to camp, coenciding with the approximate time an ambulance could get to the camp.

 

In the end, everything was fine, but I look back at that and my subsequent training; for the wilderness, the Advanced First Aid course was actually more appropriate than the EMT, but was not much different than the Scouting background.

 

While I recognize many of our scout training programs are over powerpointed, they don't have to be, and even when they are, we still usually do a pretty good job of a practical (field) component (BALOO, IOLS, others I do not have personal experience with).  I still think the BSA could run their own program to cover the content in the earlier pdf link.

 

I'd second that.  Combine S-FC, FA MB, and a bit of extra for prolonged waiting for medical assistance and that's all that one really needs, except maybe any legalese stuff to help you from getting sued.

[Krampus]

@@Stosh, you have training most people don't. If two leaders from each unit are required to take the WFA the unit in my area offers, they will get some pretty serious training. One of the ASMs in that troop who is an EMT, says the training their unit gives if pretty darn near what he took to get his EMT-Basic certification. He said it was far better than his ECA training, at least as far as covering how to care for wounded when medical care is many hours or even days away.

 

As far as worst medical case I have seen away from care. A scout opened up his knee cap and was bleeding bad. We stabilized him, stopped the bleeding, immobilized the leg, and got him to care a few hours later (carried out). I was a scout...we were 14.

 

In terms of getting sued, let's face it, as soon as you take a group anywhere the likelihood of a lawsuit rears its head. Whether you give aid or not, if ANYTHING happens on that trip, as an adult leader you open yourself up to a lawsuit. I can live with a lawsuit. I could not live with myself if there was a child injured and I was ill-prepared to do everything within my power to save him. On that I know we feel the same.

 

As long as the WFA training is comprehensive and standardized so that everyone gets the same training (and not just powerpoint or glorified band-aid care) I am all for it.

[Stosh]

@@Krampus

 

Keep it in mind I'm not being critical of the idea of having training, I'm concerned about spending big bucks and a lot of time on training that according to the offered up curriculum isn't going to be of much help in the field.  By doing so, it could offer a false sense of security to the leaders thinking they are prepared when in fact they aren't.

 

With your example of the boy with the cut knee.  Depending on the bleeding, I don't know as if I would have tried to carry the boy out.  I'd just wait for rescue personnel with better equipment to do that.  A Stokes basket would do better than 2 poles and a blanket for extricating the boy safely.  If the bleeding was under control, you are no longer in a life-threatening situation and time isn't an issue.  Treating for shock and comfort still are.

 

It is these kinds of things that need to be addressed in the WFA class, not patient assessment to conclude a diagnosis.  No.  Treat the injuries in life-threatening to non life-threatening order.  You are not dealing with injury, you are dealing with time, and that's what the class should be about.  Yes, the techniques are nothing more than what is taught in S-FC, and maybe a bit more from FA MB.  But like in the analogy I used.  You have a major cut, One has but a minute or two to decide whether this is going to be able to be controlled before he bleeds out in the next couple of minutes.  Okay you got the bleeding to stop.  Now the decision is, how severe is the shock.  Do I take 3 days to carry him out or do I put 4 of my fastest scouts on the trail to get help headed my way.  They can travel faster than I can carry a kid on a stretcher.  I cover the trail in 3 days.  The running boys do it in one day and the helicopter rescue team in in flight 30 minutes later.  Why did I bother to jostle this shocky kid down the trail in a makeshift stretcher when I could have just as well stayed where I was or moved a few hundred yards to a clearing where a helicopter could land.

 

We played the game as ambulance attendants all the time.  Do we make a 30 minute run to the hospital or wait at the scene for 45 minutes but get better care from LifeFlight?  Is there a close place for the chopper to land?  Do you know how to mark it so that the flight crew can land safely?  Do you know how to bring in a helicopter safely for landing?  What's the weather like, can they even get in the air?  Remember, peoples' lives are at stake on your decisions.

 

The WFA class I would suggest would be 25% learning basic skills for the injuries that could be dealt with in the field In depth review of S-FC skills, and 75% of the time, learning how to make good medical decisions for the patient.  CPR training in the WFA class?  Nope, total waste of time that could be used for training on issues that would be more productive.

[RichardB]

Everyone seems to have an opinion of WFA.  

 

1) BSA has no desire at this time to be in the certification business.  

2) WFA curriculum was developed and will be revised from time to time.  However, it is delivered thru organizations - systems already set up to deliver.  

3) In many cases, units, districts, councils use their network of ARC or ECSI instructors (who are BSA volunteers) to deliver the training at low or reduced costs.

4) There are three scheduled train the trainer courses - two at PTC and one at SBR if you know folks who would like to become more knowledgeable or deliver the WFA training locally.   

Edited September 30, 2015 by RichardB

[Stosh]

I'm not so worried about what BSA is up to with the WFA situation,but I am definitely concerned about why.  Is this going to be quality training or just CYA for legal reasons?  Jury still seems to be out on that.

[Krampus]

 

The WFA class I would suggest would be 25% learning basic skills for the injuries that could be dealt with in the field In depth review of S-FC skills, and 75% of the time, learning how to make good medical decisions for the patient.  CPR training in the WFA class?  Nope, total waste of time that could be used for training on issues that would be more productive.

 

This reminds me of my CERT training and the use of the "black tag". I thought CERT was going to teach all this advance EMT-type stuff. When I saw the black tags and why we use them, I learned quickly that we don't do CPR in CERT situations. Not sure I'd agree if I was in the situation and saw the kid dying.

 

Agree the training should focus on making good medical decisions (e.g., leave the knife in, don't pull the stick out, stabilize the patient and send runners, pop smoke and wait for care flight, etc.).

[Stosh]

As a volunteer medical responder it always increases the possibility of getting into a situation that's going to affect you for the rest of your life.  Most Scouters can go many years and never have to face one of these situations.  But not everyone is going to be lucky.  I knew a policeman who served the community and never drew his gun his entire career.  A SM friend of mine in the next town over on the other hand ended up in a gunfight and fortunately he won.

 

We all need to be ready for the lot that might be drawn for us and sometimes it just plain stinks.  The one thing that I did learn from that experience is that dealing with trauma to children is the worst.  This is maybe why I'm a bit anal when it comes to providing a FA class that is designed mainly to deal with children.  Nothing anyone does to have the WFA class taught perfectly is going to be enough to prepare you for the situation, the situation itself is terrifying for all involved because it is real, nothing is going to ever erase the memory of what happened and you will second guess every second of that experience for the rest of your life.  Been there done that.  Sometimes you win and a life is saved, but in medical, especially trauma situations, the odds are always stacked against you, that's why being prepared for the worst is worth whatever it takes.