Medication Issues

[evmori]

Yep GW! Took many a kid to the emergency room for many a thing just armed with their medical form & a parent signed permission slip. Never had a problem!

 

If a Scout came to me complaining of stomach pain I would take him to the camp doctor. Again, common sense! I would never give a Scout any OTC meds unless I had cleared it with the parents 1st.

 

Maybe we here in the East just let the Scouts do more without getting all skittish about what might happen.

 

Ed Mori

1 Peter 4:10

[Bob White]

"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."

 

Well Beavah you are half right. I am a Mate on a Sea Scout Ship. However being on the water does not mean a prolonged response time.

Not being prepared is what prolongs responce time. Here is how we prepare in the Ship.

 

Safety Controls:

All our members are swimmers

Everyone wears a personal flotation device when underway

We have three certified life guards

We have first aid kits aboard each boat (or in the case of the smallest boats there us a safety vessel near by with a first aid kit.

We use buddy boats

Many of our members have various ARC first aid training

We have radios aboard each vessel and the scouts are trained in their operation.

We have safety protocols for the operation of each vessel that the scouts must know before they go out. There is a responsible skipper (youth or adult) aboard each vessel who is the single person of authority when the boat is underway and is trained in responding to emergencies.

In accordance with the BSA regulations we stay in sight of our home port OR we have a float plan filed so we know the routes and whereabouts of every vessel and who is onboard.

When out of sight of the home port we know our location and the location of the nearest port.

All our vessels except for the smallest boats have outboard motors on board and operational.

 

In response to an emergency.

If not already onboard we can retrieve a person overboard quickly and safely. We can radio for assistance and have professional medical care come to us, or be moving under to power to meet professional medical care on shore in moments. In the mean time we can give the injured party aid that is within the boundaries of our knowledge and training.

 

We carry no drugs other than antibiotics as a Ship, each scout and leader however carries a duffel or sport bag that includes a personal first aid kit and personal medication along with other safety controls such as foul weather gear, suntan lotion, and drinking water.

 

We have had ZERO medical emergencies within our membership. Because of our preparation we have been able to respond to other boaters with emergencies and never had reason for supplying them with any internal medications.

 

Units that are frequently taking scouts for emergency medical attention (as two posters have already said they do) are doing many things incorrectly. With proper training and planning, along with responsible supervision, the need for emergency medical care is rarely needed if ever. And if someone was presenting syptoms of severe stomach pain or fever the last thing I would do is give them anything internal other than water, without the advice of a medical professional.

 

scoutldr

While many things can be classified a poison you well know that it is extremely, extremely, rare that an external medication such as an alcohol swap, anti-biotic, calamine, ivy dry etc causes any adverse symptom, EVER. and that when it does it is almost always a skin irriitation taht is quickly remedied simply by rinsing of the medication. Internal medications that have negative side effects are not going to be that easy to mitigate without professional medical care.

 

 

 

 

 

(This message has been edited by Bob White)

[Gold Winger]

(This message has been edited by a staff member.)

[Gold Winger]

The masked moderators have struck again!

 

(This message has been edited by Gold Winger)

[Bob White]

(This message has been edited by a staff member.)

[Gold Winger]

(This message has been edited by a staff member.)

[Beavah]

Interestin' thought, Calico, and a good point, eh? You're right, with da exception of severe anaphylaxis we really don't need meds or wilderness skills in the county park. That's why I tried to be clear in da OP about "a relatively remote location with long evac times".

 

I think a lot depends on your state. There are lots of states with true wilderness, where even da scout camp is functionally in true wilderness. Also plenty of states like mine where in rural areas, response and evacuation time even from that state park can be pretty darn long, eh? Especially if yeh add in rougher terrain, weather, etc. Activity matters too, eh? I was figurin' an Illinois Sea Scout Ship might well be cruisin' Lake Michigan by sail.

 

I think da risk of "super first aider" is overstated. All the research goes the other way, eh? Most first aiders, when confronted with a "live" emergency, fail to take action. They don't tend to go off into lala land. Just look at da depressin' figures for CPR. Folks with limited trainin' freeze up mostly. Freaked out parents do random, bizarre things sometimes, but that's not what we're talkin' about either, eh?

 

To my mind, it's worth replayin' your two scenarios but substitutin' in a reasonably responsible scouter in place of da lobotomized scouter (who gives tylenol instead of pepto bismol/mylanta/etc. to a tummy ache? ).

 

Boy with appendicitis. Let's put him 3 miles from trailhead on a backpackin' trip in an ordinary midwestern national forest. Complains of stomach ache, scouter talks about symptoms, gives him a chewable pepto bismol tablet. Like a good, conscientious scouter he/she checks on him a bit later, notes no improvement, starts to pay closer attention. Scout's assigned older buddy comes a bit later and says things lookin' still worse, now lookin' very ill, vomiting, slight fever, localized pain. Scouter says "Aha!", and is faced with a really challengin' evac. Hikes to ridge for cell reception (maybe!), makes call.

 

Now an evacuation from a location like that, 3 trail miles over moderate hills in a forest, is a daunting endeavor, especially as a litter carry. Maybe in weather, perhaps in dark. Dozens of people, many hours, risks of collateral injuries. But, happily, scouter is prepared and carries a broad-spectrum antibiotic. He obtains orders from medcontrol through county dispatch while on da phone, and starts the lad on oral antibiotics. Result: boy is in less pain, at less risk, and is able to assist in his evacuation dramatically reducin' evacuation time. Local hospital continues treatment, allowin' boy to return home for monitoring and potential surgery. Parents happy, local volunteer rescuers praise Boy Scouts for bein' prepared.

 

Boy with greenstick fracture. Boy comes with PL to scouter, complainin' of pain in his arm. PL describes injury mechanism. Presumably, both scouter and PL are competent at First Class first aid, eh? So they are capable of recognizin' the signs and symptoms of a fracture! Additional examination yields sharp point tenderness. PL gets to practice splinting under scouter's supervision. Scouter administers NSAID to control pain & swelling during long walk-out. Call to parent, parent prefers boy to be brought home to local hospital because of insurance plan, quality of care. Boy still comfortable, arm doin' fine because of medication. Parent meets scouter, is grateful for care. ER docs say treatment was excellent, everything done right.

 

I actually lived da second one, eh? Boy's dad was an orthopedic surgeon. He was particularly impressed/grateful that we properly managed pain and inflamation with medication. I also know a troop that lived da first one, eh? I think dat's about how it went down. So both are "real life" scoutin' examples.

 

There's good reasons why BSA Trek Safely training tells us to carry appropriate, current medications, eh?

 

Beavah

 

[Gold Winger]

Beaver, obviously both of those examples are the result of bad planning on the part of the involved Scouters.

 

In the first situation, you should have had all of the Scouts' appendixes removed before the hike began. Possibly, you should have had all internal organs removed.

 

In the second situation, your mistake was twofold. First you took Scouts with bones. Secondly, you went outside.

 

Both situations could have been avoided if you had done virtual outings. Much like POWs would have virtual meals in which they'd eat their rations and describe what they'd really like to be eating. You could stay in a safe location (no stairs, padded walls and floor) and just talk about going outside and what you might see. This method also prevents dehydration, sunburn, bee stings and poison ivy.

 

 

[Beavah]

Yah, BW, why the resistance to training? WFA is pretty basic stuff, the lowest level available. Yeh seem to be interested enough in da topic to want to comment on it a lot, and yeh support units havin' well-trained scouters. So get trained!

 

We carry no drugs other than antibiotics as a Ship

Hmmmm.... yeh know, antibiotics are fairly serious drugs, right?

 

Units that are frequently taking scouts for emergency medical attention (as two posters have already said they do) are doing many things incorrectly.

I might suggest alternate theories.

 

The units are more active.

The units have more members.

The units go on longer trips farther from home.

The scouter reportin' has had more years experience.

The scouter reportin' attends a higher percentage of unit activities.

The unit is in a state which has more natural hazards than flat midwestern farmland.

The unit is in a state which has more variable weather (colder winters, etc.)

The units are engaged in activities with a higher risk profile than sailin'.

The units are accommodatin' more special-needs scouts.

 

Probably unfair to judge, if we're bein' honest, courteous, and kind, eh?

 

And if someone was presenting syptoms of severe stomach pain or fever the last thing I would do is give them anything internal other than water

 

Which may or may not be da right course of action, but definitely points up why it's important to get training!

 

While many things can be classified a poison you well know that it is extremely, extremely, rare that an external medication such as an alcohol swap, anti-biotic, calamine, ivy dry etc causes any adverse symptom, EVER. and that when it does it is almost always a skin irriitation taht is quickly remedied simply by rinsing of the medication. Internal medications that have negative side effects are not going to be that easy to mitigate without professional medical care.

 

Yah, hmmm... Sorry, scoutldr's got da right of this, IMO. What yeh say is partly true, but yeh reach the wrong conclusion. Fact is, it's extremely rare that any OTC medication, oral or topical, causes serious negative side effects in its recommended dosage. That's why it's sold over the counter. FDA spends a lot of our tax dollars on that, eh?

 

In da eyes of the law and regulators, there's often no formal distinction between topical and oral medications, eh? Delivery mechanism, by itself, is irrelevant. Most of da time "rinsing off" a topical med is pretty ineffective. Da stuff is designed to be absorbed quickly.

 

Response times

I appreciate that your Ship seems to follow da norms of Safety Afloat. Good job, that's as it should be. But wearin' a PFD has little bearing on evacuation time, eh? Instead yeh have to look at things like what's your maximum distance/time from port? How 'bout in weather / headwinds? What if a youth (or adult) skipper gets navigationally confused or has engine trouble? Do the areas where you're travein' have BLS or ALS ambulances when yeh get to port? If there's weather (and consequent car accidents and such that can tie up county resources), what will da likely response time be? How long to transport? How far from port is da nearest Trauma Center?

 

And especially... how well trained are da leaders to make da differential diagnosis between simple seasickness and, say, appendicitis?

 

Be prepared is our motto for a reason!

 

Beavah

(This message has been edited by Beavah)

[Gold Winger]

"But wearin' a PFD has little bearing on evacuation time, eh?"

 

Maybe they toss the ailing sailor overboard and let him float to better qualified help. :-)

 

I'm sure that this one will be moderated. :-(

[FScouter]

"I'm sure that this one will be moderated."

 

Not likely. It doesn't contain any foul language, doesn't disparage any other forum members, and doesn't seem to be an attempt to pick a fight.

[Bob White]

I am curious how you managed to determine it was appendicitis in the field?

 

Appendicitis presents itself with many of the same symptoms of several other illnesses such as gall bladder problems, bladder and urinary infection, and intestinal infections.

 

Accurate diagnosis usually requires urine and blood analysis, and sometimes a cat scan. That aside the first aid teatment for potential appendecitis is...Do not eat, drink, or use any pain remedies, antacids, or laxatives, because they can inflame the appendicts and cause it to rupture which can quickly be fatal.

 

Unfortunately at your current level of training you were unaware of this protocol. So not only was your field diagnosis questionable, both treatments used would potentially be fatal.

 

First aid protocol is that if you cannot safely transport the victim to medical aid then you bring the medical aid to the victim. Having the scout sit quietly, had you "diagnosed" appendicitis, would have been less likely to produce a perforation or rupture due to inflamation and would have been far less painful to the patient.

 

The better procedure would probably have been to contact professional medical aid and bring them to the victim. You had at least two methods for contacting help; send two people hiking to the nearest trailhead while two others went to the nearest eleveated ground with a cell phone to call emergency services. If the patient needed to be transported the local emergency services could have told you the best place to take him to for pick up.

 

Now lets look at this list you offered.

 

The units are more active.

 

Units that train and prepare will not be frequently taking scouts to the emergency room no matter how active they are.

 

The units have more members.

Training and preparation along with responsible leadership can keep any size scout unit safe.

 

The scouter reportin' has had more years experience.

 

Another generalization. Do you honestly believe that leaders in Sea Scouts have less experience than leaders in Boy Scouts? Based on what evidence? I for instance likely have more unit leadership experience than say...you. It's possible isn't it? Besides when it comes to first aid proper training and application is more impotrtant than having a lot of experience doing the wrong thing.

 

The scouter reportin' attends a higher percentage of unit activities.

 

Again a generalization that has no bearing on the ability to correctly follow first aid procedures or know how to handle medications.

 

The unit is in a state which has more natural hazards than flat midwestern farmland.

 

Even here in the farmlands we have them their horseless carraiges. To think that with today's transportation resources that units do not travel is silly. To thing that most locations is the country do not offer a variety of topography withing a small radius is simply ill-informed.

 

The unit is in a state which has more variable weather (colder winters, etc.)

 

Again irrelevant to knowing proper first aid procedures and medication protocols.

 

The units are engaged in activities with a higher risk profile than sailin'.

 

You evidently know very little about 'sailin'

 

 

Fact is, it's extremely rare that any OTC medication

 

Really?

http://www.webmd.com/stroke/news/20030711/over-the-counter-drugs-may-cause-strokes

 

http://www.chiropracticresearch.org/NEWSDrugEffects.htm

 

http://www.associatedcontent.com/article/652775/prescription_cough_medicine_linked.html

 

http://www.timesonline.co.uk/tol/news/uk/article420341.ece

 

All OTC, all oral. I welcome you to find an article on fatalities caused by Neosporin or a similar product.

 

I have not resisted training, I have all kinds of trainng experience. You are again being purposely inaccurate in recounting what I have posted. (and I am not the only poster who has pointed this out to you.)

 

I have maintained that not only is training important but that staying within the actual limits of that training is vital for the safety of the patient as well as the caregiver.

 

To recommend or support the distribution of internal medications (oral or injected) by people who do not have the training or certification to do be allowed to do that is not safe or responsible advice to give others.

 

PS

PDFs like other personal protection equipment helps reduce evacuaton time greatly. Through proper training and prearation and reasonable precautions (like wearing PDFs on boats underway) the likelyhood of an emergency requiring evacuation is greatly reduced.

(This message has been edited by Bob White)(This message has been edited by Bob White)

[Beavah]

 

Yah, BW, I reckon we all should take a few minutes and read what others write before respondin', eh?

 

I was not present in the appendicitis scenario.

No one made a field diagnosis.

No pain remedies, antacids, or laxatives were used.

My current level of trainin' is EMT-W.

What you present is a conjecture, not a protocol.

The troop in da field did call local EMS, just as you suggested.

The troop in da field was praised by local EMS for their preparedness and actions.

No one at any point said anything about frequent ER trips.

No one at any point said anything about relative experience of Sea Scout vs. Boy Scout leaders.

The list I gave enumerated statistical reasons why your statement criticizing fellow leaders for being unsafe was unfair. The list had nothing to do with first aid at all.

Your third link involves a prescription, not OTC product.

Your fourth link involves a prescription not OTC product. A statin no less!

No one suggested untrained persons administer meds except for you (limited to topical meds... perhaps like lidocaine, hydrocortisone, or scopolamine? ).

 

In da inaccuracy department:

 

It would be incorrect to prolong evacuation time for an appendicitis patient.

Training and preparation will not always keep a scout "safe" or prevent ER visits.

The risks from sailing are not as high as many other scouting activities. You can confirm this through da national Wilderness Risk Management Committee, or the several organizations which collect data on sports-related injuries. Biking, for example, is an order of magnitude more dangerous.

The risks for stroke from OTC cough syrup are not significant in children (or anybody who does not already have a chronic condition).

The risks for bleeding stomach ulcers are not significant in children (or anybody who does not already have a chronic condition) for occasional NSAID use.

PFD's do not decrease evacuation time unless you have a man overboard. In that case they might, because you'll definitely trigger a massive coast guard and other vessel response, eh?

 

And yeh missed yellin' at me about da contraindications for pink bismuth, like kids' age or allergies to salicylates!

 

Trainin' can really help with all of these things, eh? Not just avoidin' inaccuracies, but understandin' what other people are really talkin' about.

 

But I suppose we each have to make our own decisions about the level of trainin' we feel is important.

 

Beavah(This message has been edited by Beavah)

[FScouter]

Thanks guys. It's always helpful to know what the other guy posted is ridiculous and a bunch of hooey. So I suppose we can just consider that one cancels the other and make a mental note to ignore both.

[Gold Winger]

"and doesn't seem to be an attempt to pick a fight."

 

For the record, I never attempt to pick a fight. I state facts and if the other person chooses to fight, that is up to him.