wayne@gctel.net

KC9DDI de KD0AAA....I agree 100% with what you are saying. I instruct EMT and First Responders and while we teach to National Curriculum, we do a lot of scenario based training with situations that are more complicated to make the students problem solve and get out of the cookbook mentality.

As for an expanded scope of practice...I am not sure of any states that do, and at the current level of training within the WEMT, in fact a quick search on the internet shown Maine as being the only state (I could find) that officially recognizes the designation.

And as you mentioned about not being dissuaded from getting the training, I can not agree more...if nothing else it is a great way to get those CE hours for NREMT in a fun, different, and challenging situation.

73's......KC9DDI de KD0AAA

I attended the WEMT upgrade course offered by Wilderness Medical Associates last year in Hill City, SD. I attended the course with a number of individuals from diverse backgrounds, US Secret Service Agents, Firefighter/EMT's, and even a woman who spends summers at the South Pole.

The skills I learned in this course did not take me out of legally authorized scope of practice. But did challenge me to look differently at how I would operate in a remote environment with limited personnel, equipment and supplies. Living and working in a rural community, I have incorporated a lot of this into my practice. As an EMS educator, I found the course to be interesting in how it forced the participants to get out of the "this is the protocol" mentality and begin to think and problem solve.

Most EMT's will only be with their patients for a few minutes to an hour at most. If you find yourself in the woods, on a canoe trip or something like that, you may be needing to care for that patient for a much longer period of time.....several hours to maybe a day or too. This adds a whole other dimension to patient care for some EMS providers. This course helps to provide some basic training in this.

Did I learn any new basic skills in this course...No. In fact I was expected to be knowledgeable and proficient when I arrived on day one. But I did have a wonderful experience delving into problem solving of what if scenarios in less than ideal conditions out in the middle of nowhere and you and your team are the only ones to care for the injured or ill.

It was an awesome experience.

Wayne

You will be happy to know the Part C has been updated just a few weeks ago to allow the healthcare practitioner to check either true or false to each of those things they were attesting to on the form. Not perfect, but a movement in the right direction.

The new form is available online

Wayne

At the end of the camping week, we will be placing forms in envelopes by unit number. Envelopes will be sealed and these envelopes will be placed into storage boxes, which will be sealed at the end of the camping season. The boxes will then be stored in locked storage. Forms will be destroyed after seven years. This is not a repository for forms, we will not be making copies of forms for scouts and scouters who need forms for other purposes, no forms will be accessed or copied unless necessary to comply with state or federal laws, or court orders.

Eagle92, Definitely understand the HIPAA thing on the mind. I am an EMS Instructor and preceptor. Seems as though it can be hard at times to get the idea of privacy through some students heads! lol

5yearscouter, I understand what you are saying about the security of the forms. I have the same concerns. At my camp, I keep the forms locked up in my health lodge where only certain people have access to the information. Security of these forms is very important to me, not because HIPAA applies, but because it is the right thing to do, and there are additional state statutes regarding the security of private health information. As for returning the forms at the end of the session, that is something that will be changing this year. We have been told by the Youth Camp licensing authority in the State of Minnesota these forms have to be retained per state statute. Speaking with some of the folks at National, this is becoming a national trend. So, do not be surprised if one of these days you ask for forms at the end of a session, only to find out they will not be returned. Make sure to send copies only to any activity!

Eagle92....

Actually withholding the medical screening for the presence and treatement of a severe medical condition would be a violation of the Emergency Medical Treatment and Labor Act (EMTALA), not HIPAA.

TITLE 42 CFR > CHAPTER 7 > SUBCHAPTER XVIII > Part E > 1395dd

In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individuals behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospitals emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1) of this section) exists.

The term emergency medical condition means

(A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in

(i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,

(ii) serious impairment to bodily functions, or

(iii) serious dysfunction of any bodily organ or part

Now, with this being said, the patient would have to be screened for the presence of a qualifying emergency medical condition and if one is found necessary stabilizing treatment rendered. However, for minor injuries or illnesses, the provider could refuse treatment after the screening exam. Likely...no... Patients report to the hospital and clinics all the time without SSN,or even insurance information. That is what hospital business office staff is for, they should be following up with patient/parent/guardian afterward to get the necessary information for proper billing...

As for do I see the SSN on the forms turned into camp....I would say it is about a 50-50 split. Personally, I would much rather see someone attach copies front and back of their insurance card over putting the SSN on the form. The card has much more value to the provider and through the online systems provided by the insurance companies, the provider can get a lot of the other admitting information they need.

National just released a 2/2011 revision to the health form which addresses the problem of the examiners certification. For each of the items the examiner is attesting to, they have added a true/false box allowing the examiner to check the appropriate box. Additionally, in the Policy section, it refers to "See the FAQs for when this does not apply" in reference to the height/weight chart. In the FAQ, they have clarified that for the most part council camps would be exempt.

Here is a link to the new form:

http://www.scouting.org/filestore/HealthSafety/pdf/whole.pdf

Wayne

I sent off a hypothetical case to a few physicians I know along with copies of the health form. The scenario was 14 year old male who exceeded his weight/height requirement and had a seizure six months ago. As was predicted here in this forum, the physicians indicated they would not sign the form.

Here in MN, that of course causes a huge problem since no signature means denial of admittance to a licensed youth camp for all ages. I have been working with my council on this issue, National is well aware of the issue and indicated they are working on the form...we may be able to expect changes sometime in the next couple of weeks.

In my classes, I teach that you do not need to have a big physical "kit" to take care of problems in the wilderness. The single most important item in the "kit" is your brain and common sense. With that and some limited supplies one should be able to stabilize and maintain a victim until they are either self evacuated or evacuated by rescuers. During scenarios we spend time working on how to improvise with the items one would normally have with them on a camping or hiking trip. To some scouts who have taken the program, it has helped to solidify the reasons for the ten essentials. I consider it a success when a class can show they can think on their feet, use what they have and provide reasonable care for a patient.

I am a camp health officer at a council run camp. I operate under the authority of a Camp Medical Director who is a licensed Physician. He and I meet to discuss the health and safety plans of the camp as well as to review the standing orders for emergency care at the camp. He is available to me 24 hours a day in case I have health issues arise at camp for which I may need additional guidance. He comes to camp at various times during the season to review the operations and provide staff training as necessary.

As for the health screening, as mentioned this is not a physical, but a review to make sure the health form is properly completed, make sure participants are not ill upon arrival at camp, and identify participants who may have health concerns which we must be aware of during their stay. This screening is required by National Camp Standards and Minnesota State Law.

This screening is not a physical examination, which must be conducted by a licensed practitioner of the healing arts.

As a camp health officer, I am happy to see some of the changes made to the health history forms this fall. I believe rearranging some of the information on the form will help my staff to more efficiently review these forms and get scouts and scouters through the health checks quicker on arrival day.

I found it interesting some persons are asserting that Part C may not be required for summer camp. That is far from the truth as the length of the event lasts longer than the 72 hours, and summer camps are considered to be residential camps. Per both the form and the FAQ document,this would necessitate completion of that section of the form. Additionally, State Law trumps BSA policy. For example, in Minnesota any person who is attending a licensed youth camp regardless of length of stay is required to present a health certificate with health history, documentation of immunization status, and certification of lack of communicable diseases signed by a licensed healthcare practitioner. This certification must be within 90 days of the first day of camp.

There has also been a lot of discussion about troops might not be able to attend camp because leaders cannot meet the weight/height requirements of Part C. The wording inside the box in the top section of Part C indicates this is mandatory for High Adventure treks and events where the participant would be more than 30 minutes from an emergency vehicle acceptable road. Most council camps would not fit this criteria. Information in the forms FAQ reads:

"Q. Our camp is at least 30 minutes from the local hospital by ambulance or EMS. Does this mean that we automatically have to meet the height/weight requirements for all activities at the camp?

A. While response time for basic or advanced life support should be a consideration for a camps emergency action plan, it is not the records intent. If your travels by foot, bicycle, horseback, afloat, or whatever the mode of transportation take you more than 30 minutes off of an accessible roadway where in an emergency vehicle can reach you, you will be required to meet the height/weight requirements to make sure that a rescue can be made safely. "

Again, most camps would not meet this criteria and would not be subject to the mandated requirements unless the local council was to deem it necessary.

I am the camp health officer at a local boy scout camp. I am a WEMT and was working to create a wilderness first aid program for camp when the BSA released the doctrine. I have my own ECSI training center and adopted their Wilderness First Aid program for camp. Their support material is adequate and the program is flexible allowing me to meet the requirements of the doctrine. I utilize a lot of scenarios in the training as I believe this is one of the best ways to solidify ideas to the students (I do the same in EMT and First Responder Courses I teach). I run the class as a 20 hour class during summer camp, 16 hours for the WFA and additional hours for the CPR training. The course seems to be well received and we receive rave reviews and a lot of referrals from those completing the course. It has become so popular we are now offering it once every couple of months and have plans to take the class to scouters in distant parts of our council.