Medication Issues

[Beavah]

The parent thread got into a bunch of issues with respect to an Rx medication (epinephrine) in the field, eh?

 

This thread is more an open discussion of handling medications in general, including OTC (over-the-counter) meds. For da purposes of discussion, consider such things as a high adventure wilderness trip, an international trip, or a troop trip to a relatively remote location with long evac times (rural weekend backpack, paddlin' a river corridor, etc.). And don't limit it to emergencies, eh? Consider a lad with a headache, a young female venturer with cramps, etc.

 

What, if any, OTC or other meds do you carry in your troop or adult first aid kits?

 

* How do yeh handle administration?

 

* How do you support kids with special medication needs?

 

* Do yeh include provision of medication in your permission slips for your unit?

 

* Any other related questions or stuff to share!

 

I'd ask as a favor that folks without legal background not speculate on legality or liability, since that tends to just send these discussions into da swamp, eh? For those interested in G2SS, I present the relevant quotes below.

 

Prescription Medications:

The taking of prescription medication is the responsibility

of the individual taking the medication or that individual's

parent or guardian. A Scout leader, after obtaining all the

necessary information, can agree to accept the responsibility

of making sure a Scout takes the necessary medication at the

appropriate time, but BSA does not mandate nor necessarily

encourage the Scout leader to do so. Also, if your state laws

are more limiting, they must be followed.

 

Snorkeling Safety

Those with known adverse reactions to stings from marine life,

or with chronic conditions such as diabetes or asthma, may need

special medications at hand.

 

Trek Safely

Crew equipment includes a first-aid kit stocked with current

medications and supplies. The leader reminds youth and adults to

bring and take prescribed medications.

 

[Bob White]

Our first aid kit contains external medications only.

It is unwise and dangerous to give oral medications even OTC products to other people's children. One does not need to be a doctor or a laywer to understand the dangers of such behavior.

 

Unless you are specifically trained you take great risk with the welfare of the child by pretending to be a doctor or pharmacist with the scouts you serve.

 

Even OTC medications can be altered by age and temperature and be rendured ineffective or even toxic. In addition you have the dangers of allergies to medicines and dangerous interactions between medications as well as with other maladies the individual has that you could be unaware of.

 

We are not diagnosticians. We are first aiders, and first aid does not include oral medications. The only possible exception I can think of is when instructed to induce vomiting in case of poisonings.

 

Whether it is tylenol or epi, the scout should bring their own medication and it should be used with that scout only, in accordance with the instructions from a physician.(This message has been edited by Bob White)

[scoutldr]

Gotta agree with Bob here. As I have stated here before, my wife is an elementary school nurse (licensed RN). In this state, she cannot even give a child a TUMS without a written order from a physician. A note from the parent is not good enough, and the child is not allowed to possess the meds. If the parent wants to drive up to school and administer it, that's fine. I follow the same rule in scouting. If a scout needs meds, he has to bring them, and be responsible for taking them. I will be happy to store them in my briefcase, but that's it. Yes, we will give a gentle reminder if needed, but we will not actually administer.

[Gold Winger]

" Yes, we will give a gentle reminder if needed, but we will not actually administer. "

 

What do we mean by administer? If it is an injection, that's pretty obvious. However, when you have pills does adminster mean to force them down his throat or is it the simple act of giving them to him? "Here Bobby, take your meds."

 

I yearn for the good old days when kids took their meds to school and worried about them themselves. Of course that was before the black market in adderal.

 

 

[scoutldr]

No, I say, "Bobby, are you supposed to be taking some meds?" If he says "yes", I show him where the briefcase is. If he says "No", I'm done. I remember buying Ludens Cherry cough drops for 10 cents at school. Nowadays, kids get suspended for having them on their person, and even worse if they give them to another student.

[Gold Winger]

" If he says "yes", I show him where the briefcase is. If he says "No", I'm done."

 

I see a danger there. What if Bobby goes into your briefcase and palms another Scout's adderall?

[ASM416]

Why wouldn't you assist your scouts with prescription medication? They already have an order from a doctor (or other health care professional) and all they my need is a reminder. I wouldn't want to be responsible for what happens if one of my scouts did not take the prescribed medication.

 

Over the counter is another problem all together. I think a lot depends on were you are going and the experience level of your "first aiders." If your out in the wilderness a day or more from getting help, sometimes you may need to make some arrangements. If you have experienced health care providers with you it becomes easier, we have a Nurse and a Paramedic.

 

I think the best way to go is to include it on your medical forms. List the OTC medication you will have and let the scouts doctor decide if they should have it. Also have them list reasons and dosages. This way the decisions are from the doctor in consultation with the parents and all you have to do is follow the directions, just like a prescription. Lets face it, sometimes stuff happens and when your out of the loop you might need to take care of something you wouldn't if you were closer to civilization.

 

Its also important to have someone "in charge" of your medical supplies. This should be the most experienced provider and everything should be done based on their comfort level. If they are uncomfortable giving OTC medication then don't have them with you.

 

As for Epi Pens, I wouldn't recommend it. We have carried them with us on backwoods trips "for personal use" but using them on someone without a prescription would probably get you into some trouble. On the other hand, if it means saving a life, I would use it and worry about it later. If you don't have the knowledge base to know when you need to use it I would stay away. Epinephrine has a lot of side effects that could kill someone who doesnt need it.

 

If I am leaving something out I apologize, I am a bit tired today. As Beavah mentioned, I am not a lawyer or a doctor and did not stay in a Holiday Inn Express last night. Everything mentioned my not be legal, its just how I see things and I have been wrong once or twice.

[GaHillBilly]

"As I have stated here before, my wife is an elementary school nurse (licensed RN). In this state, she cannot even give a child a TUMS without a written order from a physician."

 

Arg-g-gh!

 

My wife is an elementary school teacher, at a school with an RN school nurse who operates under the same restrictions you describe. A friend of my wife's is a school nurse at another school. Her friend is a very, very competent RN. The nurse at my wife's school probably is, though we have no evidence one way or another. I'm sure your wife is competent as well.

 

But it doesn't really matter. Anyone with a high school degree could learn EVERYTHING they needed to do the job in a single week training course. I mean, how hard is it to learn to distinguish clear snot from yellow bloody snot, or to take a temperature electronically. Most job applicants come already possessing the essential care skill (using a phone), since the primary care such nurses provide is to call the parent(s).

 

All the prescription & OTC drug restrictions, as well as all the other restrictions you didn't mention essentially turn the school nurse into a functionally useless school employee. Those restrictions have far, far more to do with the CYA principle, as it applies to the school board, the superintendent and the local principals, then it does to the well-being of the students. What the teachers REALLY use the nurse for, since they can't paddle whining students who've elected to fake illness, is to provide a place to park such students to keep them from disrupting the classroom. Since the nurse can't do anything for the students who are actually sick, there's no reason to send them out, unless they are barfing all over the classroom. The teachers just call the parents themselves, for the kids who are genuinely sick!

 

The no-care for Scouts approach may be necessary, at least until our country manages to export 90% of its lawyers to Siberia or some such. But, don't try to perfume the pig by suggesting that these restrictions benefit either the student OR the Scout!

 

I realize not every SM has the training to do more than scoutldr. But, with the prevalence of allergies, including severe food allergies, and allergically triggered asthma, such an approach essentially excludes a large number of boys from outdoor Scouting.

 

To list just a few of the conditions Scouters may need to deal with:

+ peanut allergies

+ other severe food allergies

+ bee and wasp sting allergies

+ fire ant sensitivity and allergies

+ exercise induced asthma

+ allergically triggered asthma

+ diabetic hypoglycemia and coma

There's no way an ADD asthmatic boy will, at age 12 or 13, remember to take all his meds appropriately on his own.

 

Fortunately, if we accept scoutldr's approach, there's a simple solution: just require a parent to come along on all trips, and require the Scout to tent and hang out with the parent! That way, there's no risk to the SM or troop or sponsoring organization, and no requirement of additional training.

 

Of course, such an approach might have the downside of giving the boys the idea the all the Scout first aid training doesn't apply to real world situations, since the SM's example is to hand over all such care, whenever it's actually needed, to more legally acceptable persons, such as parents, EMT's, paramedics, and physicians. Gee, if they follow that example, the boys might get the idea the the only thing they really need in their first aid kit is a cell phone, and a list of numbers!

 

GaHillBilly

 

PS: for those who think a different approach might be better, there are some good eMedicine articles here:

http://www.emedicinehealth.com/script/main/art.asp?articlekey=60041

 

Since they are authored by legally recognized physicians, these articles might even meet scoutldr's and Bob White's approval so long as it was understood that this information was purely theoretical, and not to be actually employed by any non-certified person, or even a certified person unless the parent was present, and busily signing all papers handed to him / her.

[Lisabob]

Here's what our troop has done. We have a medical officer. That med officer is responsible for maintaining health forms for the troop. We require parents to sign in any meds that their scout needs to have on a camp out, with the medical officer. This can be prescription or otherwise. Meds must be in original bottles with original labels and will not be dispensed in ways that contradict instructions on the label. The medical officer holds onto these medications, with exceptions of inhalers and epis (parents must explicitly sign off on allowing their scout to keep these with him).

 

For OTC meds like pepto, calamine, aspirin, on the bottom of each activity permission slip is a check-off for parents. If parents check those OTC meds, then the medical officer will dispense them to the scout if needed. If the parent doesn't check those OTC meds, the medical officer will not dispense them.

 

I don't know what else, beyond the above, is in the med officer's 1st aid kit for the troop. A good question, and one I'll have to ask. We are lucky enough to have a couple of people who are professionals in medical fields in the troop so I hope they'd be able to offer advice.

 

 

[Gold Winger]

At my kids' school, they don't have a nurse, they have a health technician who is overseen by a nurse that is responsible for about six schools. The HT hands out meds (with the right paperwork), keeps a log, checks temps, and is deals with boo-boos. The HTs and nurse are not school employees, they work for the Health Department.

 

What does it take to be an HT? Apparently just a pulse. The funny thing is that the HT at my kids' elementary school was afraid of blood. If someone had a bleeding injury such as scraped knee or a cut finger, she had to call for help which usually involved an ambulance because no one else was supposed to render first aid outside of critical emergencies. Talk about a waste of tax money!

 

 

[ozemu]

One of our tests for a required badge for advancement is to make a personal first aid kit. I require that it contains one dose of an over the counter pain relief used at home. It comes from home. They buy and provide it. I advise them when to take it and watch it happening. I do not force the issue.

 

Would that work with you guys?

[evmori]

The only time meds were an issue for us was at summer camp. One of our ASM's would tell all the parents at the pre-camp meeting he would collect & store all the Scouts meds. He would also make sure they took them as the prescription read. This worked great & we never had any trouble.

 

Ed Mori

1 Peter 4:10

[scoutldr]

"But it doesn't really matter. Anyone with a high school degree could learn EVERYTHING they needed to do the job in a single week training course. I mean, how hard is it to learn to distinguish clear snot from yellow bloody snot, or to take a temperature electronically. Most job applicants come already possessing the essential care skill (using a phone), since the primary care such nurses provide is to call the parent(s)." Ahhh, GAHillBilly...if my wife saw this, she'd rip your throat out. Seriously, in this state (YMMV), and in her school, she has children with major health issues, since it is their "right" to be included in mainstream education. She has had a kindergartner with HIV (which she only discovered because she had an immunization exemption from a local HIV specialist, and was not allowed to tell anyone else, even the Principal and teacher), children with tracheostomies, feeding tubes, terminal cancer, diabetes, quadraplegics, etc. She also conducts primary health screenings for vision, hearing, scoliosis, and yes, headlice. About a week ago, she discovered an advanced bone tumor on a third grader's upper arm. The parents were mortified that they had not noticed the baseball sized lump, since the kid now bathes himself. For many of the lower income students, she is the ONLY primary care provider. She is also responsible for the adult staff, and has handled strokes, heart attacks, and diabetic reactions. Yes, she hands out a lot of ADHD meds, but nearly so much now that they have the long-acting ones. A few months ago, she did have a student with an anaphylactic reaction to some insect bite and she used another student's epi-pen. The kid was in full respiratory arrest. EMS took 20 minutes to get there, and by then the kid was bouncing off the walls from the adrenaline. She rode in the ambulance with the kid and the ER doc complimented her for saving his life. But her nursing license was on the line, should it have turned out differently. Her response was, "I could live without a license, but I could never have lived with myself if I had to watch one of my kids die and I didn't try something." The parents were eternally grateful and replaced the epi-pen. The kid had one at home, but they never bothered to bring one to school because they were just too busy.

 

PS: My wife wants your phone number...(This message has been edited by scoutldr)

[OldGreyEagle]

I beleive someone in the forum advocates the correct recruiting for positions and you know, it works. The Troop I serve keeps all the Troops prescription drugs and OTC drugs in a trunk locked with a combination lock and only the owner of the trunk knows the combination. She is the Troop Committee Chair and Certified Pediatrician.

 

Last year she was in demand at summer camp as multiple staff had the "creeping crud" or something like that, most likely mono, and she nearly wiped out her prescription pad writting amoxicillin scripts. We add that to the Critical Care Physician's Assistant who just completed his Wood Badge and we are pretty much safer on the road than at home. Choosing the correct person for the job is so important.

[GaHillBilly]

"I could live without a license, but I could never have lived with myself if I had to watch one of my kids die and I didn't try something."

 

Gee, I couldn't have said it better myself . . . whose side are you arguing for? Mine or yours?

 

It sounds like your wife's school has some heavy duty inclusion classrooms, which would increase the job requirements, compared to those that prevail at my wife's school.

 

But it also sounds like your wife is DOING much more than the defined job envisions. And you yourself described how she skirted, or even operated outside, the CYA restrictions that are in place.

 

What it doesn't sound like is that you are really supporting the validity of those restrictions, either for schools or Scouts, except in a purely legal CYA sense. If we were in court, as opposing witnesses, I think your side's attorney would be rolling his eyes right about now!

 

Please understand: I AM not advocating that an SM, who doesn't know which end of an EpiPen goes against the thigh, use one. Or that an SM who can't distinguish diphenyhydramine from psuedephedrine administer either. But I am saying that it appears that the REAL first aid and medical requirements of a troop that's actively outdoors reflect a 'learnable' and 'trainable' skill sit, that Scout leaders should see to acquire AND teach.

 

I also believe that the problem stems, in part, from the medical industry's successful effort to create an aura of expertise, unattainable by mortal men, around everything they do.

 

But this is nonsense.

 

MD's have to learn, and retain, enormous bodies of information about all sorts of things that have almost no relevance to Scouting. The medical and first aid skills and info needed by Scouters represents a tiny subset of what MD's have to acquire. So, it's no great feat for Scouters to acquire that knowledge, if they are willing, and can find some one to teach them.

 

GaHillBilly

 

 

PS: For what it's worth, my son's current SM is an internist with an active practice, and I'm pretty sure everything I've said here reflects his opinions as well.

 

 

PPS: Some of my "trust but verify" attitude to medicine as it's practiced is a result of my experiences over the years. I've been removing stitches from myself and my family for years -- a practice which began when I had to remove, not once but twice, stitches each MD *assured* me was no longer there. One stitch, I picked out of the back of my own head, with the scissors of my Swiss Army knife. I've had to help an RN correct tubing connection errors on my wife's IV; I've had to call a doctor down for TOTALLY mis-prescribing medication to treat my son's episodes of EIA (exercise induced asthma), I've had to help a new Respiratory Therapist correct problems with his pulse oximeter, so he could correctly measure my son's blood oxygen saturation level, etc. I've worked out an effective treatment regimen for some recurrent ringworm episodes, after being told I'd have to just 'live with it', since the common OTC and prescription medications provided 'control', but not 'cure'. And so on.

 

The skills I have, other Scouters AND Scouts can, and often should, have. In many cases, the biggest obstacle is the fear that 'I can't learn that'!

 

So much basic medical tech is concealed behind a specialized vocabulary. "Pulse oximetry" *sounds* really complicated, but virtually any Scout knows you can shine a flashlight through a fingertip, and can understand how it might be possible to use that technique to see how 'red' the blood was. And, they should already know the difference between bright red arterial blood -- which is saturated in oxygen -- and darker venous blood. They probably don't know that the "redness" offers a proportional indication of HOW saturated the blood is . . . but it's a concept they can easily grasp. Remove the mystery, and many Scouts could have fixed the pulse oximeter just like I did, using some athletic tape to supplement a weak hinge spring in the finger clamp!