Dilemma

[FScouter]

"Plus we've established a culture of safety-by-control rather than safety-by-knowledge,..."

 

Gee, I dunno. I'd say safety-by-control followed from folks plunging ahead with no knowledge and no desire to get any knowledge. If folks all had knowledge and "understanding" we wouldn't need control. But that's not the case.

 

[ozemu]

Needing to assist someone with adrenaline we also thought to be unlikely. Yes I have had kids turn up who I found out were anaphylactic after we had left base for a few days. But it generally takes some time to come on. People who have never had a reaction generally build up the condition over several exposures to the sing etc. The instant reaction types are not common. BW's % goes way down. Miniscule. Having to use adrenalin unexpectadly is quite remote.

 

So are we.

 

What is the worst case I could think of? Watching someone die and trying to ease that passing with 17 of their peers nearby and just one totally untrained teacher to help. That's pretty much the worst.

 

Are we prepared for that? If we never use it was the training and prep useful in other scenario's? Does it make us better first aiders if we don't use it?

 

My team certainly feels better. Lots of myth's were dispelled. Our customers are releaved. Some parents allow their children to participate. Advice is that the coroner will take our prep into consideration. My staff member might not curse themselves, me, the workload, etc for the rest of their lives after having had the extraordinarily remote possibility land on them.

 

Be prepared. Train, equip, hypothise, manage risks. Then do it again. And again.

 

 

 

 

 

[Gunny2862]

WHoa, Whoa, Whoa!!!!

Don't denigrate safety by controls!!!

 

Safety by control is always better than rectifying the failure to put a limit on an activity and then dealing with the aftermath with our medical training no matter how expert or lay trained!

 

Do you not ensure you have properly placed anchors when rappelling/rock climbing? Do you not ensure you have an "expert" to place those anchors?

Do you not plan our route, water, food when hiking - leave word with someone not on the trip about your itinerary and your - "come find us - we're overdue timeline".

 

We use controls all of the time and they are always better than "fixing" a problem caused by a lack of planning - another control.

[SctDad]

I looked over this thread quickly so if I repeat something then please excuse me.

 

Just as a little side note of qualifications, I have been a medic with the Army for 10 years and have been working in the civilian sector as and EMT - I for 7. Currently going through Paramedic school

 

Not everyone who is allergic to something (we will say bees for this example) will so allergic reactions the first time. There is a histamine response that must be triggered. Sometimes this does not happen til the second time they get stung.

 

I carry an Epi-pen for some of my adults. There are 2 different types of epi-pens. The big yellow one for adults and there is an Epi-Jr for pediatrics (Anyone under the age of 18) That is how the national registry explains it.

 

If they have had previous reactions to bee stings then they should have one with them. THat is something that we as leaders need to be checking on. Yes some of the MD's may give you a RX for this but it is their license that is on the line, just as it is if they the Med Director for EMS.

 

As for the benadryl. THat is mostly for mild reactions and skin reactions. will not help as much with anaphylaxis due to bee sting.

 

If you have anymore questions, please feel free to contact me. I will help with what I can.

[Beavah]

Gee, I dunno. I'd say safety-by-control followed from folks plunging ahead with no knowledge and no desire to get any knowledge. If folks all had knowledge and "understanding" we wouldn't need control. But that's not the case.

 

Yah, OK, OK!! That was a pithy statement that merited bein' beat up on. I surrender!

 

But let me try to explain what I meant.

 

There are some environments, like manufacturing, where safety by control is an important thing, eh? You've got very well-defined risks from da equipment, and you've got full-time employees who can be trained and held accountable for followin' a tight, well-defined set of policies and procedures. That can work, eh? Not quite as well as everyone thinks, but it can work.

 

Scoutin' really ain't the same. We don't have well-defined risks, because our "work" environment isn't with da same machine every day, it's in the wide open complex world of kids and the outdoors. And we don't have full-time employees and managers, so we can't create the policy and oversight systems that an employer can. Dat's why it's nowhere near as effective for us, eh?

 

Sometimes, we generate policy because of isolated incidents, just as FScouter suggests. Someone, somewhere, does somethin' dumb and suddenly there's a policy response. That is poor policy-making. Yeh don't place a burden on everyone for one person's foolishness. If we did that, we'd never let any kids do high adventure because a few kids are immature and can't handle it. Policy can't fix a fool, but it can hogtie da competent.

 

Sometimes, though, we generate controls because we borrow 'em from professional environments. Da medication stuff, like acco takin' all his kids meds away and then administering them himself, is a good example. That's da system used in hospitals, complete with logs of administration times and such. It got introduced because we asked full-time nurses what to do, eh? But we're not the tight, controlled environment of a hospital, and we don't have a professional nursing staff. Da tight, highly regulated world of urban EMS is another example, when compared with the far more fluid world of wilderness first response.

 

Ironically, most of G2SS is a safety-by-understandin' document, eh? Sweet 16, Safety Afloat, Trek Safely, and on and on. All of 'em describe important understanding needed for good risk management. "The supervisor must be sufficiently trained, experienced, skilled and confident of his/her ability to lead and teach...". Ever notice that policy is 1/32 of the BSA "Sweet" principles for safety? Half of one point. Da reason is that proper risk management encompasses a much, much wider range.

 

But if yeh read these forums and talk to many scouters, they focus most of their energy on 1/32 of proper risk management. What are da rules? Add another point for law and we get 3/32. That's a culture we've created, eh? A culture where we're content to do only a fraction of our job, and where we make point number 7 of the Sweet 16 most important. (Yah, yah, before BW says it, I know point 1 on supervision includes "follow policy" language, eh? A good example of how da culture of "safety by control" creeps in, eh? So up it to 1/8 if yeh like. Point is da same.)

 

This thread was a good example, eh? Lots on law and policy. Much less on trustin' qualified supervision, safe area, equipment selection, skill level, planning, first aid resources, etc. Maybe our forum rule should be that after someone mentions policy, there needs to be 31 messages on other aspects of risk management before anyone mentions policy again, eh?

 

Beavah

 

 

[FScouter]

"... just as FScouter suggests."

 

Beavah, you have a bad habit of rewriting what other folks post; apparently you believe that bolsters your case.

[Beavah]

I'd say safety-by-control followed from folks plunging ahead with no knowledge and no desire to get any knowledge.

 

Yah, F, was there some other way to interpret that statement? It sure sounded to me like you were sayin' that safety-by-control (aka a law/policy response) followed from folks plunging ahead with no knowledge (aka someone, somewhere does something dumb).

 

But I may be mistaken, eh?

 

It'd help me and everyone readin', I expect, if instead of just publicly critiqueing my "bad habits" yeh actually responded to da substance of the discussion. That way we'd all learn how I may have misinterpreted your thoughts, and da discussion would continue to be interestin' for everyone and not personal snipin'.

 

Just a thought.

 

B

 

[FScouter]

What I did or didnt say isnt really much to get excited about. If you want to make the case that policy derives from isolated incidents by all means you should do so. But I really dont see any furthering of your argument by drawing my name into it as the source of that statement. It is YOUR statement that we generate policy because of isolated incidents.

 

Now if you dont understand what I said, its easy enough to question it, or ignore it. To clarify, I would say that rules have their basis in common and pervasive practices that are detrimental to the common welfare, not because of isolated instances. You may argue otherwise.

[Bob White]

All risk management (safety)is safety by control...ALL of it! Safety by its very definition is about actions taken to avoid or minimize injury.

 

Proper medical training is required to be effective AFTER the incident takes place to treat the illness or injury. That medical action has very different protols then the safety protocols will have.

 

Then, after the injury or illness occurts, other risk management (safety) protocols kick in to do two things. 1) reduce the risk of further injury or harm to the patient while they are treated or wait for treatment, 2) reduce the risk of injury or harm to the care giver.

 

Part of that secondary level of safety is don't do procedures that you are not trained and competent in. It is a risk to the patient and to the care giver.

 

No one has said that properly trained people should not carry and use emergency meds such as epi. But Beavah said that Wilderness Student had that skill and competency based on her level of first aid training, and that just is not true.

 

When you were a tiny Beavah your mom taught you to stop and look both ways before crossing the street. This was not an option was it? Even if she could not see any cars coming you were to stop. And if you looked only one way rather than two you probably heard about it because the process is stop, look, then cross.

 

So now that you have years and years of crossing the street do you just charge out without stopping and looking based on your years of experience? Or do you follow the protocols to avaoid injury? Would you tell another person that based on your years of experience of never getting hit by a car that they don't have to look both ways before they venture into the road?

 

That is basically what you do when you discount the need for proper training before dispensing or injecting other people with pharmaceuticals when they are not trained to do so. 'Nah, ya'll jist go head and giv'm that there epi, heck I ain't never had a problem.'

 

Your experiences does not override the required training and protocols for handling drugs. No matter what they do, no matter what the circumstances, if a person crosses the line and takes on the risks associated with administering drugs it should be because they were informed and knowedgeable of the risks they take based on their level of training and certification and are willing to accept the possible results, and not because someone convinced them that the risks didn't matter and that they should do what they want.

 

There have been a number of legitimate medical and legal reasons for advising Wilderness Student to not take or administer epi based on the current level of medical training she has (or more accurately doesn't have.) That advice is far more responsible and concerned for both her and her patient than the counseling that she has gotten to the contrary.