First Aid Requirement Deficiencies

[dScouter15]

As I've mentioned before on this forum, my day job is working on an ambulance as a paramedic. As such, I have a bit of an interest in the first aid requirements for each of the Scouting ranks, as well as the first aid MB. I think that in general the current requirements are very good, and have certainly improved in recent revisions. However, there are a couple items I'd like to see added, or emphasized:

 

#1, and most important to me, would be to add/emphasize the priority of personal safety when rendering first aid. In other words, don't become a victim yourself. For example, if someone is having an allergic reaction to bee stings after upsetting a wasps nest, make sure that the danger of the angry wasps has past before beginning treatment, so that you too don't get stung.

 

#2, and directly related to #1, is the importance of "body-substance isolation (BSI)", also know as "personal protection equipment (PPE)", but most commonly known as "rubber gloves". When dealing with ANY body fluid (blood, saliva, vomit, urine, etc), it is essential to wear gloves to protect yourself from the possibility of infection. It is also a good idea to prevent germs and dirt being transferred from the first aid-er to the patient. Anyone whose ever taken any kind of medical training in recent years has probably had this rule beaten into them, and I'm surprised that its not emphasized more strongly in the BSA's program.

 

#3: at least a bit of exposure to certain rescue devices which a first aid-er can assist a patient in using. The two examples that immediately come to mind are EpiPens and rescue inhalers. Both of these devices have the potential to "save a life," or at least buy yourself enough time for an ambulance to respond to the scene to begin providing definitive care. Much like AED's, these devices are incredibly simple to use, but do require a little bit of training, demonstration and practice to use correctly. I was pleased to see AED's have recently been added to the first aid MB, but I'd like to see the material expanded a bit to cover a few other similar devices.

 

Now, as a paramedic, I know I'm at risk for being a little too demanding when it comes to BSA program areas that overlap into my profession, but I think the cases I've described above are pretty reasonable to introduce in a Scouting context. Any other thoughts or concerns?

[Scoutfish]

As a former Certified level III firefighter , Water Rescue III ,and EMT in North Carolina... I totally get where you are coming from.

 

Just let a scout know about how victem vomit happens while performing CPR and you will have everyybody's attention!

 

It is a tough call: as a p[aramedic, you know the standards can be soooooo much higher. Yet, you are seeing it through a paramedic's eyes.

 

I think the biggest issue wouyld be people who do not understand Good citizen mentality. Know what I mean?

 

"You saved me from the buring car I was trapped in just before oit exploded, but know my foot tingles so I am going to sue you!"

 

Doesn't matter that a foot tingle is better than being blown up...they blame everybody else.

 

Anyway, I see the need for a certain amount of CYA and other precautions, but it has to be judged against being overwhelming to the troop/pack too.

[shortridge]

What, exactly, would you like to see improved about your item No. 2?

 

My current copy of the BSHB is AWOL, but the Eleventh Edition has a page with large, boldfaced type about bloodborne pathogen protection. One page later, the protocol for treating severe bleeding includes: "Put on latex gloves from your first aid kit" before taking any action. And advice to wash with soap and water and change out of any contacted clothing is reiterated on the next page.

 

And First Aid MB requirement 2© is: "Explain the standard precautions as applied to bloodborne pathogens."

 

How would you beef that up?

[dScouter15]

Shortridge: in my opinion, the BSA would need to dramatically increase the emphasis on "BSI" throughout its first aid material in order to come into line with the "conventional wisdom" of today's health care and emergency services industries. Mentioning blood bourne pathogens only in the context of severe bleeding control is not adequate. The importance of BSI should be discussed whenever providing first aid involves making physical contact with another person, regardless of whether or not that person has any apparent bleeding. Pathogens can be transmitted in blood, saliva, mucous, emesis (vomit), urine, stool and any other bodily fluid. I would think that a requirement that specifically addresses appropriate precautions that a first aid-er should take in every first aid encounter would be appropriate in the first aid merit badge, at the very least. Also, I'd be in favor of requiring personal, patrol and troop first aid kits to contain a reasonable amount of protective equipment - at a very minimum, several pairs of latex-free gloves, and possibly barrier devices with one-way valves for performing mouth-to-mask rescue breathing.

[Beavah]

Yah, I agree with yeh dScouter15. Particularly on #1, I think that scene management and safety is completely neglected in da BSA materials. And on #3. AEDs, Epi pens, assisting with nitro tabs & inhalers, etc. I would add that I think we should teach kids the proper use (and risks) of over-the-counter medications. By high school, most kids are self-medicating with OTCs, and someone should teach 'em about such things.

 

I'd add a #4, we do a very poor job teaching/emphasizing C-spine precautions.

 

Personally, I think our first aid training is weak all around. I'd like to see First Aid MB bumped up to at least the level of a standard WFA course.

 

I have one reservation about #2, though I agree absolutely that the emphasis should be increased. A civilian first responder is a bit different than a professional responder or even a scout with his first aid kit handy. We each have to make our own informed ethical decisions, of course, but my personal ethics are that I'm not goin' to refrain from assisting a person in need because of the small risk of disease transmission from a single incident. Health care providers and EMS workers experience hundreds of incidents with a different population demographic, so the risk profile is a lot different. So I think we should fully inform the boys of good practice, but keep that in mind as well.

 

Beavah

 

(This message has been edited by Beavah)

[shortridge]

So you're suggesting more of a revamp of the handbook and MB pamphlet content, rather than a reworking of the actual requirements? OK, I get that.

 

I remember sitting through my first bloodborne pathogen protection training session as a summer camp CIT at age 14. It was incredibly eye-opening.

 

Beavah - I agree with you on improving FA MB, but I don't know how practical it would be to essentially turn it into a WFA-like course. The nearest WFA course around where I live is four hours away, offered maybe once every 3-4 months. There just aren't enough instructors to handle the load - while there are plenty of nurses, doctors, EMTs, etc., who are qualified to teach regular, non-backcountry first aid.

[GKlose]

I don't necessarily get warm fuzzies that the national program committee is reviewing the first aid merit badge requirements on a periodic basis, or at least as often as it should, but I do know that Red Cross does review their curricula and protocols often, and I would hope that in the best case the BSA would do the same thing.

 

I'm pretty comfortable with T, 2C and 1C ranks and their graduated sets of first aid requirements, but I also think there is some room for either improvement, or expansion, in first aid merit badge, or at least in an extension of it.

 

For example, make sure at the very least that first aid MB is in lock-step with the Red Cross. I've been through that certificaton twice in the last few years, along with CPR and AED, and honestly, I think it is a comprehensive and well thought-out curriculum. I've also been through WFA (not the ARC version, but SOLO's version) and I'm due for recertification by this next March. I think most of that curriculum is within the grasp of an average 15 to 16 year old Scout. Intro to Wilderness EMT, or something like that? There's certainly room for it, and the world could be a better place with more people certified.

 

Guy

[RememberSchiff]

In keeping with making the world a better place...imagine if scouts had to re-certify (like Red Cross and WFA certificate holders) in first aid skills periodically. So the scout who got a speed-pass of T-SC-FC first aid and then first merit badge by age 12, now had to re-certify say at age 14 before he could advance or maybe complete WFA at age 14 and maintain current certification if he wanted to advance in rank.

 

Of course, adult leaders could still be considered "Trained" and have no first aid training whatsoever.

 

My $0.02

[GKlose]

RS -- funny you should mention that. The main reason why I decided to take ARC first aid, WFA and ARC CPR/AED (this one through work), was because the last time I had a first aid course was on a speed-pass through First Aid MB at summer camp when I was 12. I realized that I don't know squat about first aid, and that I should remedy that.

[VigilEagle04]

Ah, a thread that hits home. I used to be a volunteer paramedic (back when I actually had free time to do volunteer work) and worked as the camp medic here for a summer. I must say that the additions described in the original post are very spot on, with Beavah's addition of nitro tabs.

 

Part of my job as medic was to teach FAMB at camp. I just made sure I had the requirements covered, but the kids got so much more. They did learn about epi-pens, inhalers, AEDs (before they were added) and nitro tabs. They learned about scene safety (I even taught them the Haz-Mat rule of thumb ) and proper BSI precautions.

 

I had Scoutmasters sitting in on every one of my classes because after the first day of the first week, word spread that it was no regular FAMB course. I had the adults taking my little quizzes even. It was a really great time.

 

That was one of three of my biggest contributions to the council as a medic.

[rdclements]

I ran my first course last month using the new ARC Wilderness and Remote curriculum. It is well put together and was made to match the new BSA wilderness guidelines. The participants were all BSA adult volunteers with high adventure plans.

 

Getting qualified as an ARC instructor requires a specific process, but it is not difficult. Check your local conditions and see if that is an option for your unit, district, council to add an instructor corps just for the WRFA course.

[dScouter15]

I generally agree with everyone's suggestions, especially about synchronising the BSA's requirements with current Red Cross standards. I'm not sure I'd go so far as to bring the First Aid MB to the same standard as a Wilderness First Aid course, but I would definitely support requiring some advanced first aid training as a prerequisite for approving certain types of tour permits for back country or high adventure trips.

 

I'm a little skeptical about including Nitro tabs. If the patient is having a certain type of MI, or has already has a low blood pressure, the nitro could be fatal, and I don't think its within a Scout's capability to assess for that. I would be a little more comfortable with instructing Scouts about Aspirin, and telling them to remind chest pain patients to take some ASA if they're not allergic, as there are not as many side effects or precautions.

 

Beav, not really sure where you're going with "civilian responders." 99% of Boy Scouts are going to be "civilian responders," but I feel we still have the obligation to live the Scout Motto when instructing them in first aid. I'm not sure the "risk profile" is as different as you might believe. I suppose EMS and health care workers might deal more contagious diseases in mucous/urine/stool/airbourne, etc, but some diseases, such as HIV and HepC, kind of transcend population demographics. Clearly we can't force Scouts to always wear gloves, but we certainly can require knowledge of why BSI is essential before awarding a rank or merit badge.