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Annual Health and Medical Record Replaces Class 1,2, &3 Health Forms

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Bob White asked: "In your summer camp is there a program or campsite area where yo could not be evacuated from in in thirty minutes be on your way by vehicle or air transport to medical a medical facility?"

 

First of all, if I understand what you're asking, I think your interpretation differs from that of the other posters here. I don't understand "emergency evacuation" to mean that you're carried by other Scouts and Scouters to a site where you are met by an ambulance. The term "ground transportation" that describes the method of emergency evacuation generally refers to vehicle travel, not foot power.

 

I interpret the form to mean that if your backpacking trip, high-adventure site or conservation project is more than a half-hour away from a hospital as the ambulance drives, you're barred.

 

And yes, BW, my local summer camp would fall into that category. It's located in a rural area, and the main entrance is 30 minutes from the nearest hospital. It takes at least five more minutes to traverse the main camp road without getting stuck in a ditch or hitting a deer. If a unit is out backpacking in the undeveloped area of camp, on the COPE course or even working on a conservation project in main camp, Scouts and Scouters who fall into this category would be prohibited from taking part.(This message has been edited by shortridge)

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That's my interpretation, as well. And I have a 30 year career in interpreting government rules and regulations. In the past, I have been medically "cleared for all activities" on the annual medical form. Unless the intent is to require a new form for each activity...there's a big difference between teaching swimming for a week at summer camp and a two week trip in the Northern Tier. I can't believe the BSA released such a form without going through a "murder board" to uncover all the ambiguities, loopholes and unintended consequences. Or maybe they did, and the consequences are intended.

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I have re-read the form, especially the passage printed in red on the form, and I don't think I agree with BW's interpretation:

 

Individuals desiring to participate in any high-adventure activity or events in which emergency evacuation would take longer than 30 minutes by ground transportation will not be permitted to do so if they exceed the weight limit as documented at the bottom of this page. Enforcing the height/weight limit is strongly encouraged for all other events, but it is not mandatory.

(For healthy height/weight guidelines, visit www.cdc.gov.)

 

The key phrase seems to be "... events in which emergency evacuation would that longer than 30 minutes by ground transportation..." The question is evacuation to what? To medical care (ie an MD in the camp health lodge) or to a full service emergency department? If it is to an ER by ground transportation (ambulance) then many if not most camps would not pass muster.

 

Of course the loop hole is that enforcement is not mandatory so presumably councils may opt to not enforce the rule at council camps I suspect it may be somewhat driven by whether the Council Executive, the camping committee chair and/or the camp director meet the standards. Hopefully it will be driven by common sense. Is their intermediate health care available (MD on site)? Is helicopter evacuation feasible? How well trained/equipped is the local rescue squad? EMTs with advanced life support equipment and training would be better than minimally trained paramedics or ambulance drivers from a rural volunteer ambulance squad.

 

At this point there is no reference to the weight limits on the FAQs. Perhaps that is because the meaning is so crystal clear (to some). I hope that BSA and/or the council camps will provide some clarity in the near future.

 

 

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Not all summer camps are the same. If the council determines that their program or thier topography makes your participation a "high adventure" activity then Yes, you will be subject to the weight policies that will soon go into effect.

 

If your Council determines that your participation is not a hihg adventure activity then No, the elements of the weight limitation policies do not apply.

 

This really is not hard to understand unless you choose to make it hard.

 

This is a about reducing the difficulty to evacuate an injured person in order to expidite their transportation to professional medical assistance.

 

"I interpret the form to mean that if your backpacking trip, high-adventure site or conservation project is more than a half-hour away from a hospital as the ambulance drives, you're barred."

 

I see nothing in the policy regarding the amout of time prior to recieving medial care, only the amount of time it would take to evacuate the injured person. "Evacuate" and "recieve treatment" are not the same thing.

 

Again if you wish to make the policy tougher than it states then that is your perogative. I see no benefit in doing that.

 

 

 

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Maybe the National Council, Council Solutions Group (and wherever HA falls now), H&S folks ought to publish a position paper, saying exactly what they mean to say in simple declarative English.

 

Of course, common standard definitions, so each Council/Scout Reservation is working from a datum point, should also be part of amended National Camp Standards.

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By not clarifying the health standards - though I'm really hoping they are in the near future - National leaves open a ton of loopholes and questions that are going to be answered very inconsistently on the local and council levels.

 

My biggie: What about a day hike in a backcountry area? It's not backpacking, but the Scouts are still more than 30 minutes away from medical care, still engaging in vigorous physical activity.

 

Whether these standards are uniformly applied or not, the mere fact of their existence on the health charts means obesity will be an in-your-face topic for Scouting over the next few years. That can only be a good thing for the youth.

 

Hal,

 

Wow - an MD in the health lodge? That must be nice. My camp is lucky to have had some pretty dedicated, experienced EMTs in that area, but an MD... wow, again. That would be great.

 

Somewhat ironically, I can think of a few health lodge volunteers at OA weekends - mostly adults with RN or EMT training - who wouldn't pass the weight standards. I'm talking people who can't walk more than a few hundred feet without stopping to rest, and take 4x4s to the ceremony sites. And forget about getting onto the mountain to help a candidate who's collapsed during a trail maintenance project.

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Since you're into being precise, Bob, the word is "prerogative".

 

It's not the local council or your SE who has to sign off on the form...it's your health care provider. If you were an MD, would the language and intent as written on the form be sufficient for you to put your medical license on the line? I can't see arguing with my Doc over the meaning of "evacuate" or whether my summer camp is considered "high adventure" or not. After all, the form is good for a year...not for a single event. He doesn't have time for that...nor should he be required to deal with such ambiguities. My camp does not employ a licensed doctor or nurse. Some years we had junior corpsmen from the Navy (E-2 to be exact, and the last one pointed his ear thermometer down my throat and wondered why it didn't work). Recent years, we had an EMT, who by the way, weighed at least 400 lbs and had to use a golf cart to get around. So I would interpret "evacuate" to mean the time it takes to get an ambulance (i.e., "ground transportation") to the camp and back to the nearest competent medical care (hospital)...at least an hour...on a good day. I'm not trying to make it more difficult...but I DO wish the BSA would hire writers who can say what exactly they mean.

 

PS: Perhaps it's also a cost-saving move...now they only have to stock uniforms in S/M/L.(This message has been edited by scoutldr)

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Yes, I guess we are fortunate at Goshen. The reservation has 3 boy scout camps, 2 cub scout camps and a high adventure base camp. All these are supported by a camp that contains the camp headquarters and health lodge, cabins for some senior staff and visitors, a climbing tower and a COPE course.

 

Still, it probably takes more than 30 minutes to evacuate a casualty to Lexington (Virginia) General via ambulance. In my experience there (12 years between cubs, scouts and high adventure) our unit has had one scout evacuated to Lexington (cracked rib, evaluated for possible spine injury-back in camp the next day) and a number that have been treated and sometimes stayed overnight in the Health Lodge.

 

I understand that all the camps at Goshen now have AEDs and hopefully staff that are trained/certified to use them.

 

My only other experience with scout camps was as a scout in the 60s (Camp Theodore Roosevelt-Calvert county, MD. If I recall we had an Army nurse detailed to the camp for the summer (and Marines ran the rifle range).

 

Hal

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Mr. White,

 

You wrote: "Evacuate" and "recieve treatment" are not the same thing.

 

I agree, but "evacuate" can mean a great many things depending on the context, and the great brains who developed the form didn't give us any sense of what they were thinking - not yet, anyway. I'm glad that you understand it, but the rest of us sure don't.

 

The 30-minute standard only makes sense in the context of receiving medical treatment. That's what matters in an emergency situation. Evacuating to Location X won't do the patient a darn bit of good if there's no medical help there.

 

Here's a question. Do you meet the standards if your troop is able to "evacuate" you within 30 minutes to a backcountry ranger's station where you then have to wait an hour for an ambulance with EMTs to arrive? That isn't logical.

 

Here's another example. If you're out on a boat at Sea Base (undeniably "high adventure") that can reach shore in 30 minutes, you're fine, according to your reasoning. But if you then have to wait 30 more minutes for an ambulance to arrive, and then another 30 for it to take you to the hospital, that's an hour and a half total spent waiting for treatment.

 

So what is the point?

 

The point, I think, is not so much to have camp directors and Scoutmasters crunching numbers and figuring out how long it'll take to get somewhere, but rather to put a new focus on physical fitness. Hopefully it'll work out, on the whole.

 

Unfortunately, by promulgating such a poorly written standard without providing guidance, the powers that be have opened themselves up to a ton of questions, and possibly legal liability. Leaders in the field cannot implement best practices or follow the rules if the rules and practices are as clear as mud.

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A boat at sea is definitely high adventure and nothing in the requirement says that you must reach shore in 30 minutes. It would appear that the requirement would not come into play until the boat reached shore. At that point if the victime could not be evacuated by ground within thirty minutes then the policy would apply.

 

It would depend on the area in which you were boating and your resources.

 

A canoe in the backcountry would likely fall within the conditions of the policy, a boat cruising a few miles of shore near marinas would probably not.

 

However as a matter of good boating safety the weight limits given are not unreasonable for high adventure boating. The greatest hazard is not someone who gets injured while on the boat. The problem is when an injured victim is overboard and must be brought back onboard.

 

 

 

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I'm not sure if guys aren't reading too much into it..

 

Here's how I see it.. why would weight matter if one is in an ambulance?

 

The thing where weight for evac would matter, IMO, is if you are CARRYING the individual via a stretcher, backboard, etc.

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Gentlemen, Gentlemen, Gentlemen,

BW is probably closer to interpreting the passage correctly then the rest. I all know that we are all getting older, and the the alzheimer's is slowly setting in, but do we remember a few months ago National came out with a policy that any unit traveling to Philmont (? other HA locations) needed someone trained in Wilderness First Aid?

 

The definition of a wilderness medical emergency is "WHEN EVACUATION OUT OF THE WILDERNESS SCENE TO AN EXCESSIBLE PICKUP SITE IS LONGER THEN A 30 MINUTE TREK.

 

Sound familiar?

 

Nationals wording is bad. Now I'm not a telepath, (don't tell my kids that) but I bet "By" should have been "FROM" in the statement "...Emergency evacuation is more then 30 minutes BY (replace with FROM) ground transportation...", which coincides with a wilderness medical emergency.

 

1) Most camps are at least 30 minutes to the nearest ED.

2) Most camps (which have easy access) are in rural areas with volunteer EMS systems. Your looking at 10 minutes just to get the rig on the road, then how ever long it takes to get to camp. It's 10-15 minutes just to get EMS to our camp. It's then 35-45 minutes to the closest ED, and that is with a private EMS company 10 minutes away.

3) Most camps with exception of some out west, have roads that make access within 30 minutes not an issues, whether it be trained EMS camp staff, or Muni EMS's.

 

What it boils down to is that National does not want people trying to carry us big ones out more then 30 minutes to the EMS unit, and medically jeopardizing the litter bearers. But then again, a 71" 300lb'er isn't any easier then a 60" 300lb'er to lug around, other then you'll have more room on the sides for extra hands to grab onto the litter. Either way, one will be hanging out over the side rails and the other off of both ends of the litter.

Just think about how you would handle a Northern Tier situation?

 

As for me, I need to come down 20 lb's just to get started.

 

BW, the boat all depends on how fast the USCG can get there, yes?

 

Merry Christmas, Happy Hanukkah to everyone and Solstice to Trev.

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"BW, the boat all depends on how fast the USCG can get there, yes?

 

Not necessarily ASM915, for a few reasons. USCG is not the only agency on the water with emergency services for one thing. Depending on the vessel, you might have professional medical services on board. Not all boating will be High Adventure. Crewing a race boat yes, whitewater rafting certainly. But pleasure cruising in a light breeze in sight of a marina, not so much.

 

Just as not all land activity is high adventure not all water activity is. But when it is if ground evacuation would exceed 30 minutes then the policy would apply

 

(This message has been edited by Bob White)

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