Re: First Aid Kits (AED's, EMS availability)

Discussion on appropriate first aid equipment for Scouting Units

The amount and sophistication of equipment carried on outings and
activities for Scouting units obviously will vary according to levels of
training and experience of the unit leaders and/or Scouts. Units which
carry advanced life support equipment presumably do so because they have
paramedics/EMT/First Responders that are certified and experienced in
their use, and by definition, have physician advisors who provide
oversight for any acts or care administered if they follow normal EMS
guidelines and regulations provided in their licensure or certification.

The new Red Cross Emergency
Response/First Responder training course has included information on AED's
in its training materials, as has the revised Emergency Medical
Technician Training guidelines. Each State Emergency Medical Services
Division will have protocols and regulations for training and
certification in the use of the devices. Folks with current certifications
are taking transition courses to include the new materials.

Certainly, if you have certified EMS personnel as leaders on trips, and
have the availability of advanced equipment and the know-how to use it, so
much the better. This is particularly true in relation to the
availability or lack thereof in remote/isolated areas such as wilderness
area backpacks, canoe trips, remote summer camps/high adventure events,
etc.

AED's (automatic electronic defibrillators) have been approved for use by
individuals trained at the first responder level for a very good reason.
The incidence of sudden cardiac arrest among mostly adults, is the leading
cause of death in the U.S. today. Over 1.5 million suffer heart attacks
each year. Nearly 500,000 of those result in fatalities, many of which
could be reversed if recognized and treated in a timely manner.

Dr. Roger White, a leading physician
in the promotion of AED availability has stated that the widespread
availability and use of this device alone will probably have the most
significant impact on the reduction of deaths from sudden Cardiac
Arrests/disrhythmias. It is probable that the AED's will be available in
nearly every workplace, public transportation units, schools, multi-unit
dwellings, and even in homes at some point.

While broadbased training in CPR remains an important national goal, AED unit
are an important addition since they can automatically detect
life-threatening disrhythmias
and electronically "shock" the heart back into a normal sinus rhythm
before significant brain damage from lack of circulation occurs. Most of
all they require minimal training and have very few "pitfalls" or a need
for advanced training and knowledge as did their predecessors. And they
are becoming more and more affordable. Some units are less than $3000 and
others are expected to drop even lower as technology and distribution
increases.

In National studies, even in areas where CPR training has been implemented
for one in every three persons (e.g., Seattle, WA) the mortality rate was
improved by only 30%. This is due mostly to time-critical delays in
calling 9-1-1 for advanced life support units, travel time for ALS units
to the scene, and the fact that CPR is only moderately effective in
perfusing the brain with blood and oxygen; the longer the heart is not
beating normally, the less effective resuscitation and advanced life
support measures become.

Hence, it makes sense that eventually, all Scout camps, High Adventure
Bases, and many other venues will come to have AEDs and personnel who are
trained to use them. And, with advancing technology and miniaturization,
the size and weight of the units continues to shrink, making them
increasingly appealing as items to carry on remote outdoor activities
where rapid EMS response is not available.

Scout leaders should not underestimate the importance of assuming direct
responsibility for competent emergency care both for themselves and for
their Scouts. Scouts and Explorers can be effectively trained in EMS
skills just as effectively as can adults, and should be. When the "doctor
needs a doctor" it is a good idea to have more than one person trained in
emergency medical skills, and the more you have the better off the group
will be. Scout Leaders are probably at greater risk for sudden Cardiac
disrhytmia than are Scouts; However, there are documented incidents where
young otherwise healthy teens have suffered sudden cardiac arrests due to
undiscovered cardiac abnormalities, so no one is "immune" from the
possibility at any time. There are other "natural hazard" risk factors
which can cause cardiac arrest or disrhythmias such
as lightning strikes, drownings, etc., where victims who receive rapid
treatment can benefit greatly from prompt application of AED units and
CPR.

Also included in the new protocols for first responders and EMTs are the
use of "epi-pens" for treating anaphylactic shock. There are over 600
deaths per year attributed to allergic reactions from bee stings alone,
not even including reactions to food, medications, etc. Rapid response
for victims of these maladies can be life-saving. Again, since the
devices are controlled by prescription, they must be authorized by a
physician advisor with standing orders for use by medically
trained/certified personnel operating under medical protocols.

Epi-pens provide a pre-measured injection of epinephrine to reverse
anaphylaxis and are relatively easy to use, as they are a spring loaded
needle/syringe which is placed on the thigh muscle and activated to inject
the epinephrine. This can be invaluable in critical allergic reactions,
especially where local EMS is not readily available.

It is not unreasonable to suggest that Leaders and older Scouts/Explorers
take Red Cross Emergency Response/First Responder training. Adding in a
"Wilderness First Responder" module or course is even better, since it
trains you on how to handle back country emergencies where EMS is not
readily available. For those who wish to go even further, Wilderness EMT
training is available through various outdoor leadership schools, and some
of those have web pages. Enter Wilderness First Responder or Wilderness
EMT on your web browser to find resources for such training.

Those who are interested in additional discussion may wish to see the
topic discussed in the Wilderness Emergency Preparedness, Communications
and Training article at:

http://www.macscouter.com/Survival/WildPrep.html

Bob Amick, EMT-B Explorer Advisor, High Adventure Explorer Post 72,
Boulder, CO; Longs Peak Council Exploring Training Chair

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