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BSA470Firstaider

Scout Meds

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Well, people can be foolish and hide their medical condition if they want. They can also run the risk of singing with heavenly choir in the very near future.

 

I am an insulin dependent diabetic. Several people in my son's Webelos Den know it. Especially the Den Leader who is a nurse and the Asst. Den Leader who is an EMT. I wear an insulin pump and have my diabetes under good control. I've only had teo near dangerous situations in 29 years. Not all diabetics are so lucky. When I'm 100 miles from home on a campout, have my blood sugar fall so low I pass out and fall into the fire, I sure hope someone will drag me out, put me out, treat my burns.....after getting some sugar down me. In this case, sugar becomes a med for me and it must be taken internally. The irony is too much sugar can also put me in jeopardy. I make sure people know even though I've never needed somone else's help...YET. I would hope my fellow scouters wouldn't look at me lying in the fire and say, I didn't know, don't want to know and am not responsible".

 

Before anyone jumps on me, I know this is an extreme example. But to say that we don't want to know is mighty selfish and seems unethical. If a scout and his parents choose not to tell anyone, then the onus is theirs. But they could get a brain damamged or dead scout back from a campout as a result.

 

Another example would be frying something in peanut oil and having a scout who is highly allergic to peanuts. Someone should have told someone beforehand and both the scout and his leadership should work together to give him the Youth Protection he deserves. I would hope someone would search the boy and his belongings to find his inhaler or other meds instead of watch him swell up, turn blue and die.

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No one said the leader may 'want' to know. The question is does the leader need to know, or does the leader have the right to know.

 

The rights all belong to the scout and his parents or guardians. The need to know is determined by the scout and his parents or guardian.

 

The leader can "want" as much as they like. That gives them neither the "need" or the "right" to know unless the scout and parents choose to share that information with them.

 

I agree that medical information needs to be available, and parents need to share information that will keep their sons healthy while scouting. But what they share and to whom they share it is the parents choice. As long as professional medical personnel can obtain the information they need if a scout is ill or injured that's all that is important.

 

I've been to camps where older scouts collected medical forms. I think that's improper. I've seen leaders leave the medical form file with the first aid kid or even on a table where anyone could access it. That too is improper. this os personal information and needs to be treated as such. Until needed it should be locked up or in the posession of a specific adult who understands the confidentiality of the contents.

 

Bob White

 

 

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I resent that last comment maybe its me taking it too personal. I work at a scout camp nationally accredited. I work in the health lodge i'm 15 BLS there was a 17 year old First Responder a 16 year old EMT and an 30somethin year old paramedic/RN. We all did checkin and we did look at the form. Any parent who would rather have the first aid staff not treat because we don't know if they are allergic to latex or if they are on a medicine. Are you trying to say that only the paramedic/RN should treat and we should sit there when some kid got stung is in anaphalactic shock??? Please respond to this either in the forum or pm.

 

-Jeff

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Jeff,

I'm saying that this information for many people is personal and confidential and should be handled by professionals and legal adults.

 

I have had many scouts who were were allergic to bee stings and carried their epi-sticks with them and I knew how to use them as well. But that was by the choice of the scout and parents.

 

I'm not saying that medical information shouldn't be available, or that it can't be shared. My point is it is not the scoutleaders "need" or "right". Sharing that information is the choice of the individual not the right of the leader.

 

I am sure you are very qualified to treat the injuries that you have been trained to handle. That does not give you the right to know my medical condition, until it becomes your responsibility to treat me.

 

This is a not about the ability or qualifications of the medical staff. This is about the right to confidentiality of the individual.

 

Help me with this one Jeff. You and I have both had a lot of First Aid training both in or out of scouting. When it comes to First Aid, I have never been told to first look at the health history, or had to consider what medications the person was on. Remember we are talking First Aid only. Allergy to latex is another matter, I guess I would ask the patient if they knew if they were allergic. If the patient was unconscious I would not recommend waiting for the Health History before treating. Right?

 

So you could still do your part until professional medical aid arrived. Isn't that what counts?

 

Bob White

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Mr. White,

Maybe the problem is that i work with first year scouts. When someone comes in we have a good chuck of them who can't even tell us if they are allergic to latex. We do pull medicals in those cases and review them. We have to know if this kid has a low white blood cell count and therefore can't stop his own bleeding. Now no i don't look at a form for a hoemsick kid but the point is that we as medical staff and i'm sure you know what i mean are required to respond. I have been worken up at 3am for a scout who got bored, couldn't sleep and started playin with his knife. in this case we had to look up tetnas because his knife was rusty. Since he had it all we did was call the parent and let them know what happened. had we not know we would have had to send him to the hospital.

 

Respectfully,

 

-jeff

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BSA470Firstaider; to put this gently, you're in over your head. I would recommend that you talk to a medical professional (emergency medical professional) or a medical legal professional regarding the confidentiality of medical records and the legal aspects of treatment at your level of training and expertise. You also need a thorough understanding of the limitations of your treatment parameters as related to what is permitted under the medical control guidelines established for the camp.

 

I agree that parents have an obligation to inform leaders of potentially life-threatening conditions. Potential complications from the administration of meds beyond those prescribed and/or permitted by parents should not be an issue since they shouldn't be administered - including over-the-counter meds. Should something still happen - mom says OK give him aspirin for instance and there is an adverse reaction - the medical form is an adjunct for use by the medical professional(s) (EMS and physician) that will be providing definitive treatment for the condition. Under these circumstances the medical information on the form is of little or no value within the realm of "first aid" - first aid is exactly that; aid given first (at a basic level) until the patient can be turned over to a more advanced level of medical care or until arrival at a medical care facility. The contact information however, is becomes critical during an emergency situation.

 

Note: Please do not construe this as any form of legal advice. You will need to consult a professional in your locale for advice specific to that area.

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Bob,

Yes I do need to know! If I have a Scout who has sever asthema & he can't do extended physical stuff then I need to know. What if this Scout is tapped out for the OA & dies while completint his Ordeal? I don't want that on my conscience.

 

We are responsible for the Scouts while they are in our care.

 

Ed Mori

Scoutmaster

Troop 1

1 Peter 4:10

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Ed,

Try to look at this from another vantage pointr. I understand and agree you want to know. But my son has asthma, he carries an inhaler with him. He knows how and when to use it, he knows his limitations. It's a mild case and not life threatening. He has a right to choose who to share this information with and when. He has a right to privacy and an expectation of confidentiality with his medical form. You don't "need" to know about it until he has a "need" to tell you.

 

The Guide to Safe Scouting says that medication is the responsibility of the parents and the scout. So as long as you have access to his health history should a problem arise, there is seldom need for you to know it's content unless you are the treating physician.

 

If I told you what medication my son took for a current condition, unless your were a trained physician or pharmacist, you wouldn't have the slightest idea whether or not you could even give him an aspirin. You wouldn't know side-effects, what to do in case of over medication, or if he were undermedicated. So you knowing his personal medical info would not service you or the scout in any way, unless you were a medical professional treating him. You "need" to know his physical restrictions. "Billie can't eat seafood, Billie needs to eat a candy bar after strenuous physical activity. Billy will need to see a doctor in case of any bleeding wound."

 

Why Blly needs these things is no ones business unless the parent or scout "chooses" to share it, or if you are the physician treating billy. I grant you that it certainly is helpfull to have some of this information up front, but the parents need to make that choice. It is not a need or right on our part, it is simply a want.

Right?

 

 

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Bob,

OK your son loses his inhaler & can't breath nor talk! I as his unit leader am asked if he has any medical problems & I answer "I am aware of none".

 

Another scenario:

 

Your son is on medication. He is walking along & all of a sudden he falls over. He is breathing but his pulse rate is low. No one in the camp knows he is on medication & the reason he is now in peril is because he forgot to take his medication. If I as a leader had known this, I would have been able to ensure the medication was taken & prevented the problem.

 

Common sense must prevail or we put the Scouts in our care at risk!

 

And HIPPA doesn't apply to the BSA.

 

Ed Mori

Scoutmaster

Troop 1

1 Peter 4:10

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Never one to remain "defiantly ignorant", I checked and Ed is correct, HIPAA (correct acronym) does not apply to BSA since they are not a "covered entity" (do not accept or transmit payment for health care or transmit medical information electronically...yet).

 

However...if I ever find out that personnel OTHER THAN the camp medic have free access to my medical information, the Scout Executive and I are going to have a very unpleasant, pretty much one-way discussion.

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I rather like the GSUSA answer to this problem. The medications and dosages are listed on the medical form. The meds and the form go to the first aid adult in charge, in their original prescription containers with accurate doses listed. That adult does have a responsibility for making sure the kids get it when they're supposed to, but there's not a big judgement issue involved since it's all in writing. When that adult is ME, I put each kid's meds in a baggie with a stick on label and record the date/time of doses on the label. Yes, I guess there's a responsibility thing there but gee, it's not too much different from the responsibility of making sure everyone wears their shoes at camp or gets to the mess hall on time for lunch - while it is true that meds should be taken precisely on schedule, it is also true that for 90% of the meds that we're talking about, 30 minutes one way or the other is not a big deal. For most kids, being late to lunch is a more serious health hazard.

 

On the medical forms, there is a place for the child's current weight in case OTC meds are needed. There is a checklist of common OTC items that the parent can initial permissions for use - including, BTW, sunscreen and bug repellent as well as the more obvious aspirin/acetominophen, Tums, cough syrup, and so on. Some kids are allergic to some sunscreens and borrowing "troop" sunscreen or another child's can ruin a kid's day if that's the case. The medical forms are on the person of the troop first aid person or leader all the time. ALL the time. Think belt pack. No opportunity for any other interested parties to look 'em over. Some troops reduce them in size, I just fold mine up tight. Minimal basic first aid kit is also on the same person all the time, and I mean while walking, eating, building a fire, going to the john, whenever. A child wants an aspirin, it's in the belt pack of the first aid person or troop leader, and so is the form that says whether or not that's OK with Mom and Dad. This doesn't have to be hard.

 

About the rusty knife. A boy should not be at summer camp without a current tetanus shot. Period. My son will require a huge dose of Xanax to be able to get his, but he will by golly have it. Any physician that would let a teen boy go to camp unprotected by TT would be highly exposed to suit.

 

All of this said, when I had a Brownie in my troop with a scary and complicated medical history and a really serious scheduling issue with her meds, her mom decided to volunteer as the first-aider so that she could be there to handle it. I was glad since her daughter needed eye drops every 2 hours all day, other eye drops every 6 hours, oral meds on some weird schedule with food interferences and so on. Mom's help was much appreciated. She was a good camper too. Other kids like brittle diabetics and so on have similar situations and sometimes, dadgum it, a mom or dad does have to come along because the risk is just too great for an inexperienced person to deal with. On the other hand, there's actually a whole troop of girls in my service unit, all of whom are insulin-dependent - a nurse is the troop leader, and they have tons of fun together. They just have to stay places with electricity for their portable refrigerator.

 

But even with the best of planning, stuff happens. As many of you know, my son has moderately severe asthma. One time he had an abrupt onset of anaphylactic-like symptoms with no warning and no apparent cause. One minute he was watching TV, cheerfully said "Hi mom" when I came in. Moments later he was standing in my home office, bright beet red from scalp to shoes, and unable to talk through his rapidly closing throat and audible raspy wheezing - the onset was so fast he couldn't even call out from the next room. We started a nebulizer treatment (he couldn't use an inhaler as he couldn't get air in very fast) and called 911. He was still rocky by the time they got here and we went to the hospital, where he was treated and released with a steroid prescription - only to be admitted a couple of days later for about a week's R&R. We never knew why the sudden onset - turned out he had a virus but it had never come on him like that before. The EMT's were just certain he'd been stung by something, but he didn't feel anything and we couldn't find a bite.

 

There is nothing I would have said on his medical form for an episode like that - it never happened like that before, and hasn't happened since. Thank God we were at home where the neb machine was handy, at the rate he was shutting down he could have easily just have dropped dead if we'd been at the mall or riding in the car or something like that - there's not much you can do with CPR when the throat is swollen shut, and he most likely would not have had an inhaler on him anyway since he hadn't had any asthma trouble for months and felt just fine.

 

NOW, would I hold a scouter liable for not saving him if that had happened at camp? Of course not - I nearly wasn't able to deal with it at home in the suburbs, with an ambulance on the way and a veritable pharmacy at my fingertips (parents of asthmatics know what I mean). Would I be very upset if that occurred and the scouter had - say - Primatene mist in his pocket -OTC epinephrine- and didn't at least attempt to use it? It easily still might not have worked , but even if absorbed through the mucous membranes of the mouth it might have bought a few seconds. Or if another kid had an EpiPen - no doubt prescribed for him and not my son -and didn't use it? YES I would. If it's life-threatening and coming on fast, you need to "do your best," and use WHATEVER you have - and in a case like this one, doing something, even if wrong, is probably better than doing nothing. Because doing nothing in this case would have meant death, and you didn't have to be a doctor or an EMT to know it.

 

 

 

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I'm no medical expert, but I take presciption meds and so does my son. Neither are for "life threatening problems". My concern is that if I get seriously hurt that the EMTs or whoever know what I'm taking in case something they want to give me would cause a bad reaction. Maybe that could never happen, but better safe than sorry.

 

Unfortunately in our society being on medication for depression or ADHD is considered being weak, a bad thing, something you should "be able to control", etc.

 

How to convince other parents? I don't have a clue.

 

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Mr. White,

Respectfully we DO have a PDR on site to use. Second we have a scale in the health lodge. So yes we can know the proper dosage. Second there are many OTC meds that can react with one of the many things EMT's will admnisiter to you.

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Ed,

Please don't ask me to respond to any more of your strange hypothetical situations. (What if the scout loses his inhaler but doesn't know if he has a medical condition? What did he think the inhaler was for?)

 

Lets stick to the facts.

 

1) The fact is no SM or any other leader has a legal right or need to any medical information. They get whatever the scout or parents choose to share, and they only have to share that with professional medical personnel if they so choose. Don't confuse 'want to know' with 'need to know'

 

2) The Guide to safe scouting says that the scout and his [parents are responsible for the storage and administration of medication. In fact the BSA prefers and recommends that the adult leaders have nothing to do with medications.

 

3) No matter what equipment or knowledge you have in first aid or emergency care, unless you have a medical certificate authorizing you to supply or administer medications you cannot give so much as half an aspirin to a minor until you talk with the parent or guardian. If you were physician, unless that scout was in grave peril, you would not provide any medication until you talked with the parent or guardian.

 

I've sat in an emergency room with a scout with an obvious broken collarbone, with his health history and treatment authorization in hand, and other than taking x-rays the doctors would do nothing until he spoke with the a parent. We waited nearly two hours. So that history and waiver is not going to do help you unless your life or limb is in danger. In which case the doctor can open the envelope and read the info.

 

4) More important than what the scout is taking or what condition they have is what their limitations or restrictions are. You can provide a safe and healthy program without knowing what causes those restrictions as long as you abide by them.

 

Kids go to school everyday without their teachers or principals knowing what medications they take or why. The nurse (the medical professional) has that information and she cannot share it without permission from...the parents or guardians. How many of your kids this summer will be out doing all sorts of activities (outside of scouting) without health histories, or physical with them? How many of you carry health histories and physicals with you?

 

What happens when your kids are away from you and get hurt? Hopefully their friends don't give them medication. If they end up in the doctors office what treatment will they recieve? None, until the doctor reaches you.

 

5) Most of us have taken a number of first aid training courses, plus there is all the information in the handbook. I have had BSA and ARC traing and I have yet had one that said before you give first aid ask for their medical history and physical form.

 

6) Should you have a health history on every scout? Yes. Do you or anyone else "need" to know what a scout has or is taking? No, unless the parent chooses to tell you. Will they tell you? yes, in many cases, but only what you need to know to keep their son safe and healthy. They do not have to tell you anything they do not wish to share and you do not have a "right" to that information.

 

example:I can tell you "my son has a difficulty focusing on multiple tasks. You will need to see that he recieves instructions one step at a time in order for him to understand. He is taking medication to assist him. He knows what to take and when."

 

You can ask what he takes, but I don't have to tell you. You can ask what his clinical problem is, but I don't have to tell you. That is private information. I told you his restriction. That is enough information for you to work successfully with my son. If he needs to see a phycisian, you can take my envelope with his health history in with him amd give it to the physician.

 

You are not a physician, as the parent I promise not to treat you like one, as a scout volunteer try not to act like one.

 

Bob White

 

Firstaider,

No EMT is going to give meds whether OTC or not to a minor without talking with the parents first.(This message has been edited by Bob White)

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First at the army youth center that I volunteer at we requir medicals on every person attending. ALL the staff are aware of what meds the child may be on and any special conditions.

Second, while as I respect your opinion the truth is that I have as health and safety director at our past ordeal had one scout with dehydration, 98.7F temp, and the EMT and I were taking his BP, HR, P, Temp., and checking his pupils(this kid came in looking pretty bad. We prepared to give 1/2 strength gatorade to help replenish his electrolites. He saw us prepare the gatorade never said a word. His BP was a little high so we pulled his medical and found out that he has an allergy to red dye. He could have had an allergic reaction and haad to leave because we didn't look. Thanks to the fact we did we used oral rehydration salts and he was fine. This is NOT a hypothetical situation. This DID happen. Now if this had been your son what would you have prefered we did???

 

-Jeff

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