Medication Issues

[evmori]

Sylvar,

 

Did McDonald's tell her to put it between her legs as she drove? Nope! That was 100% her decision.

[Sylvar]

True and the original Jurys award reflects that. They found her to be 20% responsible for the injury and reduced the award accordingly. What this boils down to is what does a reasonable person expect to happen in that situation....A reasonable person expects to get burned ..A reasonable person does not expect their skin to be removed. The coffee was held at a temp in excess of 180 degrees. A household hot water heater only goes to 145 for a reason. Temps above that cause severe burns. I happen to deal with a lot of hot water on the farm. At 145 degrees I can perfectly scald a chicken. At 155 degrees the skin cooks quickly and tissue damage can occur in 15 seconds. Every 3 degrees beyond 155 causes exponentially more damage.

 

Read the link. Imagine thats your Grandmother/Mother/Wife. I am not arguing this to change your mind so much as to make sure folks understand that particular story since it is sited so often as a frivolous lawsuitthere are plenty of lawsuits that match that description to a T (how about the guy that wanted 50 million for a pair pants that the Dry Cleaner lost?) Go after themmock and ridicule to your hearts content and Ill be right there by your side.but leave this poor lady alone.

 

[Bob White]

Having a signed permission slip from the parent is for the most part useless. While rules may vary in sopme States, I can tell you based on the advice of medical doctors I have talked with i at least 4 States (and I welcome you actually talk with a doctor), even they will not give internal medications of any kind to a minor without talking directly to their parent or legal guardian first unless it is a matter of life or death.

 

In all the years and hundreds of days and nights camping and doing high adventure activiies as a unit leader, I have only had 3 medical situations that required internal mediciations for a scout. In every case the doctor would only do exteral treatment until he or she spoke personally with the parent or guardian before giving then a pill or injection dispite the fact that we had a complete nedical history, recent ohysical and parents waiver for medical treatment.

 

Having a form signed by the parents does not give untrained persons the authority or knowledge to handle pharmaceuticals for other people's children. If a doctor knows that about your forms then you should be aware of it too.

 

As far as medications the scouts bring, here is what we do. If the scout is not capable of managing the drugs themselves then the parent can come and administer them. The leaders will, if asked by the scout or parents, remind the scout to take their meds and even watch the scout take their meds. We do not hold them, he do not hand them out. This policy has never been a problem with the parents and we are not aware of it ever keeping a scout from participating. I had this same procedure as a Cub leader, a Boy Scout leader and in Venturing

 

If a scout were to become seriously ill we get doctors, we don't pretend to be them.

 

Being trained in first aid is not the same as being training and permitted to store or distribute internal medications.

 

 

 

[scoutldr]

We now return you to your regularly scheduled program...the difficulty you were experiencing was not in your receiver.

[FScouter]

Must be sunspots ....or mosquitoes. Affects all the forums. PM's too.

[Beavah]

Sunspots? I reckon some folks might not have gotten their hot coffee yet this afternoon, eh?

 

BobWhite, I think yeh have to be a bit more circumspect about your declaratives, eh? I don't reckon anybody can speculate on the authority or effect of a "form" without both readin' the form and knowing da state, eh? Least of all docs speculatin' on legal issues . Besides, a doc refusin' treatment to a sufferin' child because it ain't immediately life threatening would be a malpractice attorney's delight.

 

It's also worth rememberin' that a topical medication is still a medication, eh? Ain't a special difference between "internal" and "external". That neosporin we choose to slap on a wound could put a child in serious hurt in da wrong circumstances.

 

I'm glad some folks are lucky and have never had lads or lasses get ill on trips, eh? I still figure "Be Prepared" is a better motto than "Rely on Luck". I think all Scouters should take the time to do a high-quality WFA course, and high adventure trip leaders should complete WFR. Yeh know, reasonable standard of care for "other people's children." Then they should follow their trainin', which does include proper use of meds in remote environments. If they haven't done at least that, well, I reckon at least bein' somewhat circumspect about givin' advice is in order, eh?

 

I think another good rule is that scouters should act in loco parentis, standin' in place of the parents, and take care of a child in da same way they would if it was their own. Aside from da Christian Scientists among us, I reckon that makes the choice straightforward, eh?

 

Beavah

(This message has been edited by Beavah)

[Bob White]

"Besides, a doc refusin' treatment to a sufferin' child because it ain't immediately life threatening would be a malpractice attorney's delight."

 

Not at all Beavah,

Treating a minor without the knowledge of the parents or without verification of drug allergies and medical history would be far more dangerous. Pain is uncomfortable but the doctor while not treating with medications can use other treatments to reduce the discomfort.

 

Beavah writes..."Ain't a special difference between "internal" and "external". That neosporin we choose to slap on a wound could put a child in serious hurt in da wrong circumstances."

 

That's not actually true either.

External medications are far less likely to cause additional harm. Side effects from external meds usually manifest as skin irritations and in nearly every situation can be mitigated or reversed simply by removing the sustance. The same is not true of internal medications.

 

"I think all Scouters should take the time to do a high-quality WFA course, and high adventure trip leaders should complete WFR.

 

I understand that is what you think, but the BSA and a lot of others do not think that way. For one reason it's impractical. Not ALL scouters are involved in wildernes activities that would require that level of expertise. What is is need is that leaders have a good understanding of the possible injuries taht may occur on a particular outing and have an emergency plan suitable to provide appropriate care of the injured or ill parties. For some units (such as ones I have been part of, we have always had professionally trained medical personnel with us for high adventure and backcountry activities. Having EVERYONE training is nice buit certainly not necesarry.

 

"I'm glad some folks are lucky and have never had lads or lasses get ill on trips, eh? "

 

Yeah sure dats not da case at all don'tcha know..For the few times I have had a sout get ill on a campout we always did one of two things. We got the scout back into the custody of the parent, or we got the scout into the care of professional medical personnel. The purpose of first aid is to be able to get the patient to professional medical help as quickly as possible.

 

"I think another good rule is that scouters should act in loco parentis, standin' in place of the parents, and take care of a child in da same way they would if it was their own."

 

For all your comlainin' you use more legal jargon than ANY other poster. While you may think the Scoutmaster should have the authority to act 'in Loco Parentis' (in place of the parent) for every child, there are LOTS of parents who are not about to give that much authority to ANYONE. (not to mention that it is doubtful that this is related to the one of two conditions in which it is applied: in universities, or with a non-blood relative custodial parent. It is not actually applicable in relationship to this topic. But you can check that out with the real lawyers and see.) Before you go putting medications into their son that their doctor or they themselves did not supply, most parents are going to want more to go on then the opinion of a medically undertrained scout leader and they are not going to want to hear about it after the fact.

 

I agree that training is important I hope you agree that staying within the limits of that training is important as well..

 

 

(This message has been edited by Bob White)

[Eamonn]

Not sure if I'm going to be guilty of hijacking this thread or not?

If it seems that I have? Just ignore me.

 

I'm with Bob White's camp -I think.

I do carry OTC meds either in in my car on the boat or in my own First Aid kit.

 

I know just about all the Scouts that parents entrust me with.

 

On the rare occasion when a Scout has some kind of an ailment (Strange thing is that it doesn't happen that often. Maybe I'm just lucky?) He or she will come to me and say something like "Eamonn do you have any Tylenol" or other common everyday OTC med.

I'll normally reply "There is some... " in where ever they happen to be. They will then go to where they are and take the recommended dose.

I know I have supplied the drug and I suppose this is not really that different than if I had handed it to them.

Of course the average age of the Scouts in the Ship is about 16 years old.

If we are some place or event where a person is in charge of this kinda thing I'm more than happy to pass the buck to them.

 

I do at times offer to keep a Scouts meds in a safe place. While at times the safe place I offer might not be the ideal place, most times it's safer than where he or she might store them. I don't as a rule accept the responsibility of ensuring that they do take their meds. Truth is I'm sometimes not good at remembering to take my own!!

 

My big gripe about this goes in the other direction.

People who seem to want to not allow my kid to take his meds on his own.

They insist (or have tried to insist!!) That he hands over any and all meds to them.

As his parent I was (He will be 20 in a couple of months) happy to allow him to take charge of his own meds. Mainly allergy meds.

He knew when and how much to take. I was fine with this. But these, sometimes not very well qualified people who seemed to want to play doctor, would try and it was some kind of "Policy".

This sort of thing really gave me a head-ache!!

Anyone got a couple of aspirin?

 

 

For the record. I rarely if ever dwell on all this Liability type of stuff.

I tend to do what I think is for the best and act in what I would call good faith.

I would never do anything to harm or hurt a kid.

Suing me?

I think would be a waste of time!!

I don't own anything.

Ea.

[CalicoPenn]

Little Johnny comes to you complaining of pains in his stomach. You give him an acetaminophen tablet, and the pain goes away. A couple of hours later, Johnny collapses, and is out like a light. You can't get him to respond and rush him to the hospital, where it's discovered he has a nasty little case of appendicitis and needs emergency surgery now, before it bursts. Why wasn't it discovered before? The acetaminophin masked the pain.

 

Bobby falls off a log while on a day hike then complains his arm hurts and asks for a pain killer. You give him ibuprofen and the pain goes away. That night, his arm swells up to twice its size - Mom brings him to the emergency room in a panic where it's discovered Bobby has a green stick fracture of the radius which was probably the result of the fall off the log. Why wasn't it discovered before? The ibuprofen not only masked the pain but also acted like the anti-inflammatory it is and helped prevent the swelling until it started wearing out.

 

How did this happen? An untrained person, or a person not following the standards of their licensing, gave a "harmless" OTC medicine that masked a symptom of a serious medical issue. Pain is not, in and of itself, a condition to be treated - Pain is a symptom of other conditions that need to be treated - and it is also useful for a diagnostician to try to determine the underlying cause. It's not that uncommon for emergency room doctors to keep someone under observation for a while to allow for OTC pain meds to wear off so they can "find out where it hurts".

 

The lesson is to be very cautious when tempted to give someone other than yourself (or family member) an OTC Medication, even if its counterintuitive to you because of your own experiences. 99+% of the time, we aren't somewhere where we face a 12 hour trek just to get somewhere where we can be evacuated. If you're at a weekend away and Billy starts complaining about hayfever acting up, or migraines, or a case of the screaming trots, and he brought no meds along with him, you would be wise to consider contacting his parents to either bring him up some meds, or take him home. You may not want to do that because it will spoil his weekend, but those are the kinds of decisions that we, as adults, have to make all the time - unpopular as it may be.

 

Calico

[johnmbowen]

I agree with all, but again all this is usually covered (at least in my course), medical releases, to scenarios, to legal topics to responses for stomach pains to insect stings to anaphalaxis to plain broken bones, to Expedition Behavior that hopefully keeps it all from happening in a good Wilderness First Aid course.

 

Don't just talk about it on the webpage, actively get out and find a course! Several good organizations from NOLS, to WEA, to ARC and others provide this very valuable course. If you take kids into the wilderness without it, in my opinion you are not only unprepared, but irresponsible!

 

JB

[Gold Winger]

", I have only had 3 medical situations that required internal mediciations for a scout. In every case the doctor would only do exteral treatment until he or she spoke personally with the parent or guardian before giving then a pill or injection dispite the fact that we had a complete nedical history, recent ohysical and parents waiver for medical treatment."

 

That must be the midwest for you. Here in the East, we've taken Scouts to the hospital for quite a few things and just armed with our official Scout documents, the docs have medicated and sutured ill and injured Scouts without ever speaking with the parents. A permission slip is just that, permission. At least here in the east.

 

The same goes at camp. "Johnny has a fever." Health lodge guy says, "Have two tylenol. Good night."

 

As for the McDonald's thing, I can't count the number of times that I've wound up wearing a drink at a fast food joint because the presenter didn't bother to apply the lid correctly. It's gotten to the point where I don't even take the cup into the car before I check the lid.

[Bob White]

"That must be the midwest for you. Here in the East, we've taken Scouts to the hospital for quite a few things and just armed with our official Scout documents, the docs have medicated and sutured ill and injured Scouts without ever speaking with the parents."

 

If you are frequently needing to take scouts to the hospital maybe forms aren't your biggest problem.

(This message has been edited by Bob White)

[Beavah]

BobWhite, you're an assistant unit leader for a Sea Scout Ship, right? That virtually guarantees a long response and transport time whenever you're on da water. First aid requires current knowledge and a well developed sense of judgment. Some cases require evacuation to a parent's care, some require evacuation to professional medical care, and others do not. Many cases require field care, for a fairly extended period, before professional personnel can take over. I reckon it's important for adults to know about all of 'em, eh, because da real purpose of first aid is to deal with each properly. Your responses share a worthwhile perspective about da limits of an untrained leader, but are also scarin' me a little, especially when you're takin' potshots at other folks who are really quite right.

 

WFA is pretty minimal trainin' for your position. Yeh should go find a high-quality course in your area. Sign up with SOLO, WMA, WMI, or WMTC or such (avoid ARC and BSA, da instruction is too spotty). Trainin' is important, especially trainin' that actually tests your knowledge and makes you meet practical performance requirements beyond quotin' books. I think you'd be surprised at how much yeh learn. And surely your Sea Scouts deserve that example and that level of care.

 

In fact, I'd encourage your whole Ship to take the course. I figure for us old folks, them havin' aspirin around and knowin' how and when to administer it is a good thing, eh?

 

B

 

[scoutldr]

"External medications are far less likely to cause additional harm. Side effects from external meds usually manifest as skin irritations and in nearly every situation can be mitigated or reversed simply by removing the sustance. The same is not true of internal medications."

 

Bob, you need to quit spouting things about which you obviously know little. I am not a physician or nurse, but I do have formal graduate level training in Toxicology and physiology...my profession deals with industrial poisons and other health hazards. Your statement above is just plain wrong. We call these "routes of entry" and one of the most common ways for a poison (or medication) to reach a target organ is via transcutaneous absorption. As the father of my profession, Paracelsus said, "All things are poisons...only the dose determines which are toxic."

 

[CalicoPenn]

As I'm reading through this thread, it occurs to me that one of the Give Meds/Do Not Give Meds dividing lines is WFA/WFR and non-WFA/WFR training, and it seems to point to a challenge to WFA/WFR instructors to do a much better job in defining when wilderness first aid skills are appropriate to be used.

 

I became W-EMT certified in the 1980's, back when I was going to school in Maine. The state has large swaths of true wilderness - miles away from an evacuation point, multiple (over 100 or so) miles from the nearest trauma center so it becomes much easier to conceptualize the meaning of wilderness in comparison to someplace like Illinois where most of the state is one giant evacuation point, and most of the population is within minutes of professionally trained help.

 

One thing that was stressed in my course was that just because we have now learned these "new" skills (I knew 3/4 of them just from reading the Boy Scout Field Book), doesn't mean we had license to use those skills in any situation we found ourselves in.

 

As I've stated elsewhere - in the vast majority of the cases, we do not find ourselves in a true wilderness emergency. Just because we're out camping in the woods at a scout camp, or state park, does not mean we are in the wilderness, and wilderness first aid training is overkill for the situation. Red Cross Standard First Aid (which doesn't teach that giving out meds is an appropriate treatment for anything) is sufficient for these times.

 

Unfortunately, WFA training doesn't always impart the judgement one needs to determine when not to cross that line to the more "advanced" first aid one might do in the field. I'm sad to say that I see the "Super First Aider" phenomenon (people who have Red Cross First Aid or Wilderness First Aid certs refusing to give up care to licensed care providers, providing care they shouldn't because they think they know things beyond their training, or even worse, trying to take over/overrule care) among Boy Scout leaders more often than among non-Boy Scout leaders (probably because, well, we're Boy Scouts - that's what we are - prepared to help other people).

 

I'm truly starting to think it might actually be counterproductive for the BSA to start pushing WFA training as opposed to standard first aid training on Scout Leaders since those skills aren't really going to be needed in 99% of the cases we'll be involved in. It might be appropriate for a leader (or older youth) to have that training for a wilderness high adventure trip - but you don't need it for a trip to Summer Camp. Do Scout Leaders in Illinois really need WFA training? In reality, except for possibly some pockets in Southern Illinois (and even then it's doubtful), WFA techniques should never be neccessary, and that holds true for pretty much most of the rest of the country as well.

 

Calico