Dilemma

[WildernesStudent 10]

"Wilderness student. My point I was working toward is that to carry every medication t=you might need for any possible emergency is not practical, especially for your level of experience."

 

Carrying every medication one might need isn't practical believe me I know (I have a history of diabetes in my family and you don't see me carrying around insulin just in case) I do want to state though that one of the reasons the club has been thinking about this is because of their training (While I might not have experience remember that everyone else is a certified WFR). I know at least four people that are allergic to bee stings and yes they do carry their own EpiPens with them but given that you are hiking with a larger group (20 or so people) I don't think it would be to impractical to carry some 'just in case'. Lots of things can trigger it: if you've been stung several times before who's to say that this one time (of course when you are away from a hospital. which would be my luck) might not be the 'overdose' people don't build up an immunity to bee venom it gets worse. What if someone's runs into a bee or a hornet nest? (I've seen it happen) even if you've been stung a couple times before without a reaction, this amount of venom is dangerous (assuming around 2-300 stings) and some people can have a reaction to 8 stings when they haven't had one to 4-6.

 

Of course there are negative sides to everything and I plan on bringing some of them up in the meeting next time. One, of course, being how many EpiPens to take. Giving someone a shot of epinephrine only bys you like what? 10-20 minutes max and then you have a second reaction (which is usually worse then the first because of the epinephrine) and some people even have a third reaction (which probably really sucks bad for them). So what do you do? Give them Benadryl a shot of epinephrine and start evac and then stab them again (the second shot btw lasts a shorter amount of time then the first one). That, to me at least, doesn't sound practical or even helpful...but then again not breathing is kind of bad too.

 

Personally, I would say stock up on Benadryl (I take it with me on long hikes...after reactions I've had to some 'normal' bug bites I really don't want to be stung by something with venom in it).

 

We figured out btw that we can get EpiPens legally from a licensed MD. The risks in using it of course is if a person has a reaction to the epinephrine itself (which actually is impossible people are technically allergic to one of the antioxidants that's mixed with the epinephrine...fun fact!) but I suppose that's when training comes in (not that I would know about that yet) from what I'm hearing from people training pretty much dictates that you must do 'something' in an emergency (in this case whether you give them Benadryl or anything else) Some people don't actually develop symptoms for a couple hours or even a day others can go into shock within 1-2 minutes (I saw it happen in 2 minutes once...will never forget it!) and then I suppose It's up to your training and discretion...I get the feeling that when it comes to all the legal crap if someone is lying there not breathing you're not going to think about it, your gonna stab the hell out of 'em!

 

[Beavah 205]

You have stated in earlier posts that you are a novice at the outdoor stuff. So perhaps finding back door ways to carry controlled phamaceuticals is a little more than you and your group should be biting off at this time.

 

Yah, I must be havin' a hard time readin' these days. I'm pretty sure Wilderness indicated that he was WFR certified, eh? Wilderness First Responder is a professional certification. A licensed medical practitioner in many states.

 

One poster says that "most" volunteer groups of this sort carry epi-pens. Not only am I sure that it is untrue, I am sure it is unprovable. I would welcome the poster to provide us the reference source of that data, as I am confident no such data exists.

 

"The use of epinephrine in Outdoor and Adventure Education programs has become an 'industry standard' in the last decade, driven by the imminent emergency that anaphylaxis poses, especially in a delayed transport context. This would certainly be the standard of care that your staff would be measured against in the event of an incident gone awry." John Jacobs, Adventure Risk Management, Wilderness Medical Associates

 

Jacobs goes on to say "In my experience with programs across the US, there are more programs who have had incidents with anaphylaxis than those who have not." And of course, we have to remember that there's more at risk than just fatalities, eh? Severe anaphylaxis is quite a trauma for the body, with both high short-term costs and long term morbidity.

 

Jacobs and WMA are of course one of da premiere providers of Wilderness Medicine education and outdoor adventure risk management consulting in the nation.

 

Now for collegiate programs, Rick Curtis at Princeton's Outdoor Action program is a recognized leader. He did a survey of programs on this issue a few years back that I remember from a risk management conference. I'll try to post it if I find it. Of course da Princeton OA volunteers carry epi, partly because they take a lot of novices into the field each year. So it seems like those collegians leadin' an outdoor program in beautiful Georgia wouldn't be out of line, eh?

 

[added since I overlapped with Wilderness's post]

 

Yah, Wilderness, if you're lookin' for a dose to carry, yeh should consider the Verus Twinject. http://www.twinject.com/. Yeh administer a first dose like an epi pen, then can add a second dose a bit later while you're tryin' to get antihistimines aboard, eh?

 

Beavah

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[Bob White 20]

Neither quote you supplied suggests or supports that "most " volunteer groups carry epi-pens. I think supplying the actual data would be needed to support that statement.

 

Jacob's comment seems clearly aimed at professional outdoor ed groups, notivce that he is talking about an "industry" standard. And a professional group such as he represents probably has licensed medical people on staff

 

I would expect that most volunteer groups that utilize the outdoors, (Scout units for instance) are likely only have epi on hand if it is carried by a member with a prescription, or if the have a licensed medical practioner on the trip . This might be a good survey to try at roundtables.

 

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[OldGreyEagle 5]

I suggest a trip to the Student health Center at the college you attend. There you will find someone who can tell you what you can and can't carry around with you on your excursions and may be able to supply you with, well supplies for cost or something close. I am sure they would love to be part of your pro active thinking

[Beavah 205]

Jacob's comment seems clearly aimed at professional outdoor ed groups, notivce that he is talking about an "industry" standard.

 

 

Yah, well. There's this whole world out there outside of Scoutin' that does outdoor education. And believe it or not, Scoutin' is actually a part of that "industry."

 

It's pretty easy to recognize. Take, for example, the collegiate outdoor programs. They typically have a very small "professional" staff consistin' of one director and a few paid student staffers, eh? Then all of their trips and activities run on volunteer power. Just like us, eh? Except BSA professionals at the director level are often paid more. John's comment was actually made in addressin' such groups.

 

Biggest difference between BSA and the collegiate programs is that the trainin' and screenin' of leaders is usually better and more comprehensive in the collegiate programs, despite the fact that leader turnover is probably higher. As Wilderness describes, all of his compadres are WFR certified, eh? Most BSA volunteers aren't even WFA. So it is correct to say that Scoutin', at both the unit and council level, typically operates below the industry standard level of care.

 

That havin' been said, I do know of several BSA units that carry Rx meds under standin' orders on wilderness trips. And these days with food and other allergies, if we aren't willin' to do that, we'd have to be excluding a lot of fine boys from Scouting.

 

Beavah

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[Bob White 20]

Any adult leader in the BSA who is not licensed to handle medication (excluding than external ointments) had better have some really good lawyers behind them if they administer them to someone else's child.

 

Usually the medication needed and used on a scouting activity is for a known condition for which the individual scout has a normal prescription.

[Beavah 205]

Any adult leader in the BSA who is not licensed to handle medication (excluding than external ointments) had better have some really good lawyers behind them if they administer them to someone else's child.

 

[Channellin' Ronald Reagan] "There you go again!"

 

There's no such thing as a "license to handle medication." There's differences between practicing medicine and responding in an emergency. There's BSA adult leaders who are First Responders and EMTs and nurses and docs. It is in fact common practice, from home care givers to school personnel to wilderness leaders, for physicians to write scrips under standing orders. For epi, it is increasingly becomin' a regulatory or statutory imperative for those that work with kids, in part because da negative side effects are very unlikely in younger people, eh? And da consequences are so severe.

 

In short, da world is complex, BobWhite. It ain't easily reduced to a single pithy statement or rule. Understanding is key.

 

But there's one important reality, eh? If someone is in anaphylaxis and you are unable to respond due to fear of "handling" medications, you get the satisfaction of watching them suffer and perhaps die. Promotin' irrational fear has a real cost. Not just to life, but to our soul.

 

Beavah

 

[Oak Tree 15]

Beavah - just FYI, I believe that WildernesStudent is actually a "she" - so it would be "all of her compadres are WFR certified".

[Bob White 20]

With only 50 deaths annually nationwide (and not all of those happening during outoor ed activities) who is the one promoting fear here?

 

Statistically this is one of the least likely causes of death or even illness that you will ever encounter in an outdoor program.

 

By licensed I am sure you know I was referring to a professional medical personal who are legally approved to store or disburse phamaceuticals.

 

I have spend hundreds of nights camping, hiking, caving, climbing, skiing, etc. as have many scout leaders, with not only the absence of epi but without occassion where we needed epi, no fatalities of any kind.

 

I am sorry, but to suggest that going out without epi is going to lead to watching someone die in agony is absolute silliness and fear mongering.

 

 

 

 

 

 

[evmori 11]

If medication is administered per the dosage on the container, a whole country of lawyers don't make a bit of difference! And administering medication such as an epi-pen in an emergency situation is the correct thing to do!!

[FScouter 24]

Im far more fearful of the idiot that thinks he has understanding and thereby excuses himself from rules, guidelines, and training.

[evmori 11]

I'm fearful of idiots regardless of the circumstances!

[Beavah 205]

Im far more fearful of the idiot that thinks he has understanding and thereby excuses himself from rules, guidelines

 

Yah, I'm never sure where this comes from, eh? Nobody said a word about excusin' anybody from rules, guidelines, or trainin'. Almost exactly da opposite, in fact.

 

Those with trainin' know that a First Responder is trained on the protocols for administration of epinephrine, and so would anyone else be who was operatin' under a physician's direction. That's why this is consistent with da rules and practice guidelines of many outdoor groups, and increasingly of in-town schools. Those Scouters familiar with NCS know that BSA summer camps are required to have a licensed physician to write protocols and standing orders for the camp. It would be well within his/her purview to include standin' orders for epi and other Rx meds. Almost all camps are dealin' with this these days, as we struggle with special needs kids, food allergies and da like.

 

Da more important question is whether we should be content not having the trainin' or guidelines in place. Wilderness isn't. She's alert to the issue (sorry 'bout da gender mixup, W!), and thinkin' about the best way to improve safety in her program.

 

Happily, many outdoor programs aren't led by "idiots." They're payin' attention, and thinkin' about these things, because they care about kids.

 

Beavah

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[WildernesStudent 10]

I dont think that everyone should be required to carry an EpiPen in their first aid kit its situational depending on where you are going (away from civilization), whos going (someone who can use it or who needs it) etc. As is aid were not even required to have a first aid kit much less carry EpiPens in one, but were doing it because of the situations we know well be in. Were also considering it because of the training the officers haveif they werent WFRs we probably wouldnt be have thought about carrying syringes filled with epinephrine much less on how to get them with the purpose being that we might have to use them. Also, officers in our club arent required to be certified in anything but most are just in case. It is true that only about 1 in 100 people die from a bee sting and they are usually over the age of 26 (you knowthe elderlyhehe sorry, couldnt resist . But you have to keep in mind that most people get help within minutes of being stung (some people dont even have to use an EpiPen, they simply get into the car in go to the ER) the whole point of an EpiPen is to buy more time for a person to get medical help (because it is kinda hard to call 911 when you are unconscious). Keeping in mind that as an outdoor club we will be in the woods a lot (were talking about hiking several miles, camping, rock climbing etc...) and away from immediate medical attention buying more time for a person who stops breathing really doesnt seem like a bad idea . Im actually very surprised that the BSA doesnt require scout leaders to know at least WFA (I kinda would like to know why) I do know that most likely if a child is stung (even if they are allergic) though they tend to have worse reactions they most likely wont die (kids are amazing).

 

But yeah, I dont think someone who isnt trained to use an EpiPen should unless in extreme emergency but for those who are certified using one shouldnt be a big deal but they key with that is to use one you have to have one first.

 

Would love to keep going but I have a cake in the oven

[Bob White 20]

"It is true that only about 1 in 100 people die from a bee sting"

 

Oh mercy no! It's nowhere near that high. The stats are that only 3% of all adults would even have a serious reaction to a sting and only a tiny percentage of them would have a fatal reaction.

 

You are statistically more likley to get struck and killed by lightning than to die from a bee sting. Perhaps your personal fear of bees is what is prompting you in this matter.

 

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