Re: Aquatics Merit Badges and CPR (training

On Sat, 8 Jun 1996, Tom Grim wrote:

> Now that I have posted an introduction, let's move on to my first question.
> Advancement people here in the Northwest Suburban Council are trying to
> decide how to advise Merit Badge Counselors who are required to evaluate a
> Scout's demonstration of CPR by the new requirements for most of the
> aquatic merit badges. What level of competence does it take to evaluate
> and improve someone else's performance of CPR?
>
> Should we suggest that they should become certified in CPR?
(CAUTION: LONG POST)
This is far more than you asked about, but I hope that it will stimulate
some productive thought about a very critical need in Scout Training.

STANDARD of CARE AND DUTY TO ACT:
Performing CPR correctly and within the AHA and Red Cross protocols is
important. It is one thing to be competent in performing the skills; it
is a little more difficult to evaluate them if you are not experienced in
doing so. On the other hand, it is not "rocket science." In an ideal
setting, and in order to have some degree of "certification" it would be
preferable to have those evaluating CPR performance be at least certified
in Basic Life Support (BLS) through the Red Cross or Heart Association.
Even better would be to have them be certified as instructors. Reality,
however, dictates that this probably is not an immediately attainable
goal, at least in the near future, but it is definitely worth working
towards as soon as possible!

BECOMING A CPR/FIRST AID INSTRUCTOR
Becoming CPR instructor for the Red Cross or Heart Association is neither
difficult nor expensive. In the case of Red Cross, it is merely a matter
of taking the basic class, then an Instructor Candidate Training (ICT)of
about four hours, then a CPR Instructor training class of about 8 hours.
Much of this class is devoted to practice teaching under supervision of an
Instructor-trainer, and here is where the new instructor learns how to
effectively teach and evaluate performance skills of students and to point
out errors in technique. If a person has not taken instructor training,
they may not be as perceptive in noting performance errors.

The Boy Scouting advancement requirement only requires demonstration of
the adult CPR protocol for three minutes. Unfortunately, some of the
other protocols such as CPR for infants, airway obstruction, and other
knowledge areas are not covered by these requirements.

BLOOD BORNE PATHOGENS: Disease Prevention and Universal Precautions:

There is an appalling lack of knowledge by Scouts and Scouters about the
rampant dangers of
blood-borne pathogens such as AIDS, Hepatitis-B, and Drug-resistant
tuberculosis, all of which are incurable and serious threats to life and
health of anyone administering emergency care. Although Universal
precautions (gloves, masks, and eye protection) are mentioned in Scout
merit badge requirements, they need MAJOR emphasis and demonstration to
make the serious risk impact to Scouts who simply don't understand or
appreciate the dangers. The "old days" teachings of administering direct
"Mouth-to-Mouth Resuscitation or unprotected bandaging of wounds with
exposure to blood
and body fluids are simply not acceptable! Moreover, the use of
"adjunct devices" such as pocket masks, gloves, and face shields are
absoutely mandatory in the training of both Scouts and Scouters.

COMPREHENSIVE CERTIFICATED TRAINING NEEDED:
Again, something
is always better than nothing when it comes to basic life support. But
ideally, I would strongly encourage that anyone who is to be trained in
CPR and first aid be given the benefit of the full range of protocols. As
you probably know, Red Cross requires re-certification after one year due
to skill deterioration. Studies have shown that retention of correct
protocols without practice and refreshment in CPR diminish signficantly
after one year.

MEDICAL/LEGAL ASPECTS: Documentation of Training

There is some concern that instruction in CPR be certificated so that most
of the protocols are documented and a matter of record if it ever comes to
litigation following administration of CPR by a Scout or Scouter. In
reality, the probability of litigation is not significantly high. But it
is still possible. Under the "good samaritan laws" of most states,
persons who render care voluntarily, without compensation or in particular
who do NOT have a duty to act, are generally given immunity from civil
liability, provided that a STANDARD OF CARE (i.e. properly administered
CPR/first aid protocols) is correctly followed.

Conversely, , if it can be
shown that the treatment rendered was incompetent and actually caused
further harm to a victim, it could be construed as negligence and
therefore not given protection from civil liability under the "good sam"
laws. Those who are responsible for teaching those skills can also be
included under "vicarious liability" if it can be shown that their
teaching of the skill was incompetent or inadequate for the student (who
then administers CPR/first aid incorrectly) resulting in harm
being done to the patient. Having a certificate as an instructor through
an accredited agency such as Red Cross would be considered an affirmative
defense in such a proceeding, where having no certification could be
construed as possibly negligent. More importantly, if documentation exists
that the student was duly certified under an accredited program such as
Red Cross, such records are also an affirmative defense in a negligence
case, making it much more difficult for a plaintiff to claim incompetence
on the part of the rescuer. A lack of certification or documentation of
the skills of the rescuer becomes somewhat more problematic in a legal
proceeding. Documentation is always admissable as prima facie evidence of
competence and a record that a "standard of care" was met at the time
certification was issued to the student.

Again, these are extreme possibilities, and case law under such
circumstances is probably minimal. In point of fact, the
courts are very forgiving of efforts made in good faith even if in error,,
and conversely
they are very unforgiving of no effort when it could or should have been
provided by someone who had the knowledge and ability to provide care.
However, in our litigious society, the possibility of negligence lawsuits
cannot be ruled out, so forewarned is forearmed.

We have to assume that if we teach a Scout how to give CPR, there is a
statistical probability that at some point during his career as a Scout he
may actually administer CPR to an unresponsive patient. If/when this does
occur, it is certainly in the best interests of the Scout as well as the
person who taught the Scout CPR to be sure the assessment of the patient's
vital signs (pulse/respiration) and the Scout's CPR skills were correctly
demonstrated at the time of certification. And of course
the patient would like to be given the "best possible care."

CPR/FIRST AID TRAINING SHOULD BE MANDATORY FOR SCOUTS AND SCOUTERS

It is my contention that anyone who is registered in the role of a Scout
leader has an automatic "duty to act" for the care of Scouts to whom
he/she is entrusted. Having certificated CPR/First Aid training should be
absolutely mandatory for all leaders, and whenever possible, for as many
Scouts as can be. Giving a Red Cross certificated "community first aid
and CPR course for Scouts
is equally beneficial and goes a long way in fulfilling the first aid
merit badge requirements at a high and appropriate level. If the Scouter
is a certified Red Cross Instructor, and provides their own equipment for
the training, the cost of certification in most chapters is only about
$6.00 per person. If you obtain a supply of workbooks that can be
"recycled" to new students, there is no added cost for training materials.
Training manikins are often available through fire departments and other
public safety agencies without charge; or if you can obtain some funding,
purchase of the new "little anne" manikins is now within reasonable cost
for about $125 per manikin. Our Explorer Post received a donation of $500
from the company of a parent who had an Explorer in our Post; we used the
money to buy manikins and first aid training supplies which we continue to
use each year. Sometimes all you have to do is ask; service clubs and
other agencies are often very eager to fund such equipment for a worthy
cause.

I train my
Explorers and Venture Scouts in the 50 hour Red Cross "Emergency Response"
class because they are very interested and extremely competent when they
complete the training, and they are a lot more aware of risks and dealing
with emergent situations when they go on trips both Scouting and personal.
Emergency Response is the "first responder" training given to most
firefighters, law enforcement officers and is open to Scouts who cannot
take the EMT class due to age and legal restrictions. Scouters also
benefit greatly from this class which is far more comprehensive than the
typical minimum requirements of community first aid/cpr training. In
particular, the older Scouts who have this training are absolutely
wonderful as instructors for younger Scouts working on lower rank first
aid and aquatics requirements, and for first aid merit badge. Our
Explorers run the "first aid" city at Klondike Derby and make it a great
"realistic first aid" learning experience for younger Scouts by using
simulated injuries, "blood" and theatrics. The "hands-on scenarios" are
the most talked about and memorable experiences for the Scouts who
compete. We also have Explorers teach the first aid merit badge class at
our Merit Badge University, and again they do so magnificently. I proctor
the class to meet merit badge counselor certification requirements, but
the Explorers
do the teaching, run the scenarios, and evaluate the Scouts; and what a
match it is for the Explorers and the younger Scouts!

Because our "mission" is among other things to "be prepared" is it not
axiomatic that training in such lifesaving skills should be given highest
priority? In my experience in Scouting, I have been very frustrated at
the lack of comprehensive first aid/cpr training for adult leaders. It is
my contention that such training should be a mandatory part of any basic
leader training, and that a grace period should be provided in which
anyone registered as a leader must obtain such training, or no longer be
able to register in that capacity. That sounds a little "harsh," but it
seems to me that this training is just as important as the other training
required to be a leader and if you are going to take on such high
responsibility, you definitely need the "tools" to do it properly!

We tend to be complacent about such priorities, thinking that our EMS
system will always be there for us...WRONG. Much of the death and
disability which occurs is attributable to a lack of prompt and initial
care for a patient. By the time EMS is called and arrives, it is often
too late. Those who were present initially on the scene often do nothing,
except maybe call 9-1-1. This is a national tragedy that Scouting can
help "fix" by proper comprehensive training. The fact that the "outing"
part of Scouting occurs in remote and isolated areas makes it all the more
important to have self-sufficient emergency skills.

Sorry about the "soap-box" but this really is a serious concern that needs
attention, and your efforts in making this happen are essential. Scouters
themselves need to get good training, and pass it on to their Scouts. It
is OK to use outside resources such as trained firefighters, paramedics,or
EMS personnel to help teach EMS skills, but often they are not available,
so it falls back to the Scouters to do the training; and it is axiomatic
that the training needs to be the best possible!

I commend your efforts on setting standards, and hope that others will
take heed and embark on similar programs.

Bob Amick, EMT-B, Explorer Advisor, High Adventure Explorer Post 72,
Boulder, CO; Longs Peak Council Exploring Training Chair; and Red Cross
Emergency Reponse/CPR Instructor

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