Medication Issues

[Bob White]

I doubt that fear plays any role in this. More likely the biggest factor is that most adults realize that it would be irresponsible to practice medicine beyond the limits of their formal training.

 

Bringing internal medications to distribute to someone else's child without formal medical training in the storage, administration and potential dangers of each drug is irresponsible and dangerous.

 

Doctors are not qualified to be scout leaders simply because they are doctors, and scout leaders are not qualified to be doctors siomply because they are scout leaders.

 

I think most adult know that.

[dScouter15]

GaHillBilly - I agree with the gist of what you're saying. However, as I alluded to in the other thread, there is a bigger issue here than the legal and CYA issues. Take your pulse oximetry example - you're right, it is really simple, and works beautifully 90% of the time. But, do you know what your pulse-ox device is actually measuring? What external (environmental) conditions might alter the pulse-ox reading? When might a person have too little or NO oxygen in their blood, but still read 100% on the pulse-ox? Like giving a tylenol, if you distribute it to youth, you might never have a problem 99.9% of the time. But, it is that 0.1% of the time that we focus on in the emergency medicine. I guess, my point is, if you feel you want to be administering medications, or performing any medical procedure beyond basic first aid, you have a duty to get the necessary education to know how to perform those skills safely. Just because you think you know how to some something, and even if you haven't had a problem yet, doesn't mean you actually do. However, a number of training, education and certifications programs give you an opportunity to prove that you are competent to perform a given skill set.

[evmori]

I doubt that fear plays any role in this. More likely the biggest factor is that most adults realize that it would be irresponsible to practice medicine beyond the limits of their formal training.

 

I think fear is the biggest factor - fear of being sued!

 

Bringing internal medications to distribute to someone else's child without formal medical training in the storage, administration and potential dangers of each drug is irresponsible and dangerous.

 

Your opinion.

 

If the medication is given according to the prescription and stored in a secure place, the risk is virtually non-existent.

 

Doctors are not qualified to be scout leaders simply because they are doctors, and scout leaders are not qualified to be doctors siomply because they are scout leaders.

 

I better get on the phone right now & tell all the doctors I know who are Scout leader they aren't qualified to be Scout leaders! And visa versa!

 

 

Ed Mori

1 Peter 4:10

[johnmbowen]

Hey Folks

 

All these questions and answers are addressed in a good Wilderness First Aid Class (or better a Wilderness First Responder course).

 

FIND ONE AND ENROLL! The Sierra Club (y'know - the tree huggers that y'all look down on) require WFA as a MINIMUM for their outings leaders who take out primarily adults! What do we do? We require our leaders to take an hour long class on how not to abuse children - and then we take them into the wilderness!

 

JB

[Gunny2862]

dScouter15 said,

" Like giving a tylenol, if you distribute it to youth, you might never have a problem 99.9% of the time. But, it is that 0.1% of the time that we focus on in the emergency medicine."

 

And this is part of my point, I also don't believe in routinely giving any meds for "I don't feel so good." I will increase my monitoring of them and determine whether I think I should call a parent if necessary(assuming they're reachable), to get their view and or reaffirm any permissions for any OTC's or meds the Scout might have forgotten they brought and were supposed to be taking that hadn't been brought to my attention. And I can't think of very many times that tylenol is going to be an emergency med other than for patient management. Would you care to expand on this one?

 

But for the Scout/Scouter in extremis I still hold that I don't think that anything I feel capable of doing/administering is something that I would withhold if it might prevent their death, especially if it actually falls into something I either am currently trained/certified in or a little less so if the cert. has lapsed but the knowledge is still onboard.

I also thought it was weird when I got my first, second and third epi kit (for MY protection/use) that there was no training - "just read the instructions". I bounced and talked to a couple of different doctors/allergists about that rx.

 

[scoutldr]

The point of my post was not to shoot GaHillBilly (although he needed shootin', which I understand is a valid defense in GA). :-)

 

The point is, kids with major health issues are being mainstreamed, not only in the schools, but also in Scouts. I always tell the HIV story when I teach BSA Lifeguard. There are HIV positive folks among us, we don't know who they are and they ain't tellin'. Universal precautions are required, no matter who it is. To use my wife's line, "if it's wet and it's not yours, DON'T TOUCH IT!!!"

 

Likewise, for the novice Scouters who may be reading this Board, CYA is not a bad policy. For myself, I have had more than a little First Aid training and was an ARC instructor in both First Aid and WSI at one point. When faced with a crisis, I don't know what I would do, but like Gunny, I hope I wouldn't freeze with panic if I had resources available. Like my wife, I'll deal with the lawyers later, but I need to be able to look at myself in the mirror the rest of my life. And I would expect any of you to do the same for me if it came to it.

[dScouter15]

Ed - you do realize that sometimes, when somebody gets sued, its because they actually did something they weren't supposed to?

 

In all of my posts pertaining to this topic, I've tried to focus on the medical side, rather than the legal side, as that's where my relative "expertise" lies. But, there is a lot of overlap...

 

For starters, I believe this thread was focusing on OTC meds. Personally, Ed, I feel you're correct on the minimal risk regarding the administration (depending on how we define "administration" of Rx meds to scouts who have that Rx. OTC meds are something completely different. Even though I am a paramedic, I do not have the training required to administer a number of common OTC meds. I'd like to think that I have enough common sense, and enough medical experience that I've "picked up on" to know when its OK to give a tylenol or tums. However, I am not qualified to administer these medications, so I will not - both because I am not legally allowed to, but also because I am aware of the limits of my education and training on this topic. Its not just about not getting sued - its actually about our scouts' health! As I do not have the training necessary to administer OTC meds, I have no idea whether a given med might be good or bad for a given scout. And, because I care about the scout's health, I will not jeopardize it just because I "think" I know what I'm doing.

 

Also, I think Bob makes an excellent point in his comment about scouters not being qualified to be doctors just because they are scouters. (I'll let Bob explain to Ed how he completely misinterpreted that point) - but its a good point. First aid training is exactly that - aid given first. NOT health care. Think about your first aid training - doesn't the majority of it concern treating "trauma" type injuries - blisters, burns, broken bones, sprains, etc? Isn't calling 911 and/or getting the victim to definitive health care providers a major component of first aid training? Where in your first aid training did it discuss physiology, pharmacology and chemistry - you need to have at least a general understanding of all of these topics before you should even think about giving any medication to anybody without a physicians instruction.

[FScouter]

"(I'll let Bob explain to Ed how he completely misinterpreted that point)"

 

Speaking as a moderator, that would best be handled in a PM.

 

[Gold Winger]

"Bringing internal medications to distribute to someone else's child without formal medical training in the storage, administration and potential dangers of each drug is irresponsible and dangerous."

 

Yep Bob, it is really difficult to read a prescription label or the parent's note and know that Johnny needs one pill with breakfast and one after dinner. I'm glad that you pointed that out to me.

 

You remind me of the ASM in my son's troop who declared, "I'd rather that camp keep the meds because I don't know how to give medication out since my boys don't take any."

[Gold Winger]

" As I do not have the training necessary to administer OTC meds, I have no idea whether a given med might be good or bad for a given scout."

 

That's why our permission slip has a medical release section which asks for a list of known adverse reactions to OTC medications and says, "unless otherwise noted, I give permission for my son to be given Tylenol, immodium, benedryl, [and a few others]"

 

A parent should know what can be given to his child. A Boy Scout aged child should know what he can and can't take.

[OldGreyEagle]

Hey, I resemble that crack about how "y'all" feel about the Sierra club. We have a mighty diverse group and you never know, a Sierra Club member may be responding to you at any time

[johnmbowen]

Well, that remark resembles me too, I went into Scouts through the ICO program.

[Beavah]

Really interestin'.

 

I'm curious what folks think G2SS means when it says "[hiking] crew equipment includes a first aid kit stocked with current medications." Note that's different than the instructions for Rx meds - "the leader reminds youth and adults to bring and take prescribed medications."

 

Sure sounds like a unit first aid kit should have OTC meds, eh?

 

And then we pick up any WFA or WFR text, and the professional recommendation of physician authors is for trip leaders to carry and dispense medications.

 

And then we go to any store and buy a first aid kit, especially an outdoor first aid kit, and it will contain a bunch of medications.

 

It's important to remember that da procedures medical professionals use for urban stuff aren't necessarily applicable. Yes, in a hospital or pre-hospital EMS environment strict control of even OTC meds is maintained, precisely because the person is very ill and many potentially interacting and potent meds are likely to be administered. Those procedures are right for that environment, eh?

 

But when we're talkin' about regularly healthy folks in an outdoor, wilderness environment, I reckon that gets a bit ridiculous, eh? More important, it becomes irresponsible to my mind. We are not providing the standard of care that we should to da kids we serve.

 

I don't think there's any excuse for leavin' a kid with an ordinary illness untreated and miserable in a wilderness setting, eh? That is a safety hazard. The kid you refuse to give an immodium to can get hurt when he has to run off into da woods, and yeh don't have a washer-dryer to deal with aftermath. The girl with cramps hikin' a trail or walkin' around camp can slip and fall and become more seriously injured. And how could anyone claim it's responsible to leave a child spikin' a high fever untreated?

 

Dangerously irresponsible, it is. Inconsistent with da recommended practice guidelines for wilderness settings. And not very compassionate either, eh?

 

Good judgment is about balancin' risks with benefits. There's real benefit to lay treatment with OTC meds, eh? That's why they exist. And risks in a non-hospital setting are minimal. Dat's why they're sold OTC.

 

I'm an EMT-W and I actually know somethin' about liability, too, eh? I definitely do carry meds with me in da field, and I would not hesitate to give 'em to kids in a wilderness setting when they were indicated.

 

Personally, I'd have a hard time viewin' an adult leader who was not carryin' field meds as anything other than incompetent and unprepared.

 

Beavah(This message has been edited by Beavah)

[evmori]

Ed - you do realize that sometimes, when somebody gets sued, its because they actually did something they weren't supposed to?

 

Not always dScouter15. A lot of times people get sued because someone did something stupid & they want someone else to be responsible for their stupidity or because they just want someone to blame. Remember the lady who sued McDonald's because she went to the drive thru, got a coffee & decided to hold it between her legs & it spilled & she was burned? Yeah that was McDonald's fault!

 

Ed Mori

1 Peter 4:10

[Sylvar]

Ok Ed, I can't let that one slide. I apologize to all for the thread jacking that is about to occur.

 

The woman in question did not sue McDonalds for millions of dollars trying to get rich. All she wanted was for McDonalds to pay for the SKIN GRAFTS required to repair the damage to her legs. Why? Because the coffee was held at temp that could cause a full thickness burn in 2 seconds to save money. I could go into the details of this case further, but its already been done in great detail here: http://www.lectlaw.com/files/cur78.htm

 

Without a doubt McDonalds was negligent in that case. Get the facts before you pass judgement.