Boy Scout Camp Health Officer

[Handsome Robb]

Sounds like a medical director to me.

As long as you have a physician in charge of writing protocols and available by phone just in case, you should be good.

Provided those orders are within your scope of practice as defined by the state or LEMSA you are operating in.

 

[d0nk3yk0n9]

Provided those orders are within your scope of practice as defined by the state or LEMSA you are operating in.

True enough. Although sometimes it's unclear as to whether the defined scope of practice is a minimum or maximum. Some states or areas are good at saying something to the effect of "but a doctor can tell you you can do more," but other places leave it a little vague on whether a physician can order you to do things not specifically listed.

 

[JPINFV]

One of the things is that a lot of LEMSAs are borrowing the language directly from the state scope of practice. Which again means, "How do you define "including but not limited to..."? Since the scope of practice for EMTs in California includes, "Obtain diagnostic signs to include, but not limited to, assessing..." does that mean that an EMT can perform and interpret a 12 lead based on the "not limited to"?

 

[mycrofft]

"NLT" means "you can do other stuff but if anyone asks we didn't specifically tell you it was ok to do it". Sort of like the phrase "Nursing Judgement", which boils down to "Why didn't you use for 'nursing judgement' ?" when you are involved in something where following the protocols ends in a death or disability.(And if you DO break protocol because it won't work, and it works, and someone reports you, then why didn't you use discipline to keep from breaking it?).
I love "assisting" with the use of an inhaler or epipen!
ANd the reason for the deal with epipens? They have different doses.

 

[Milla3P]

Hopefully that doctor is cool and is willing to help you out. TECHNICALLY according to BSA standards, that doctor has to be available by phone 24/7.

Every Doc, NP, PA, RN, ABC i've ever dealt with in my clinic is usually cooler than most of the EMTs i've worked with. Found alot of real whackers who think kids need an Ambo trip / ED visit for a sprained thumb. This is not "doing it"

Hopefully this isnt your first camp gig, just the first medical one.

What scenarios would come up when you take hundreds of kids and set them loose in the woods with axes, knives, fire and close proximity to animals and their poop? Plan for those, throw in inactive, overweight adults with sleep apnea, HTN, NIDDM, and 7 stents (read: all adult leaders) and it makes for a fun diagnostic day.

Bear in mind, most kids that are sick monday morning are either sick from home or in electronics withdrawal. For the latter, the largest needle you have will cure the kid AND all his friends through word of mouth, also cheer up the adult he's with.

A sense of humor is the most important tool you have in the outdated, undersuplied, moldy, dirt and leaf covered cave you will call your clinic.

 

[mycrofft]

RULE OF THUMB (pun unintended):
CATEGORIES OF CASES YOU NEVER TRY TO TREAT YOURSELF BECAUSE THE JURY ALWAYS AWARDS FOR PLAINTIFF:
1. Hands
2. Eyes
3. Pregnancy/deliveries/babies
4. Children
5. Gonads.

If the kid comes in presenting with a painful thumb, I can't tell if it is sprained, or if a tendon has ruptured, or there is an intra-articular fracture, or a ruptured bursa, or what; without diagnostic equipment and personnel, the answer is wait (past the period of best treatment) and see how bad it gets, so the kid can sit on the sidelines and watch the others swim and make lanyards while (s)he holds ice on a splinted throbbing digit. Or try a back pain case, blow to the eye, abdominal pain lasting longer than thirty minutes or so. (Kids can be stoic or histrionic).

I don't know about other locations, but here one distinction of the RN is that it is the first level of licensure where you can make a decision (says so right here on this-here paper). We know EMT-B's and even Emergency First Responders make decisions, but a licensed registered nurse is supposed to be able to use their body of knowledge and be able to act prudently when the protocols are not there or go wrong. Technicians and licensed (not registered) nurses legally must have a specific order (or specific protocol they are certified by training to perform) for all actions; hence the really thick protocol books.

 

[johnrsemt]

Our camp protocols were basically written as:

Headache; water first (first symptom of dehyrdation is usually headache); then either Ibuprofen or Tylenol.

Nausea: try to find out cause then Pepto Bismo

Vomiting: try to find out cause: then what ever medication

Diarrhea: cause then Lomotil

Sprains/Strains: Ice; and depending on findings send to urgent care or ED (urgent care was only open 0900-2100).

Etc and so forth.


For the people who state that EMT-B or P's cant give out OTC or perscription meds: Basics in most areas do Baby ASA for cardiac symptoms and alot of areas do Epi-pens, and Albuterol. and Basics across the country give out Oxygen. So it depends on what your Medical Director has to say.

If you want; ask the Medical Director for the service that you work at now. But something to think about: what if you work for an EMS service that is very backwards and doesn't let you do much. and you get a second job in the next county for a service that the director has you doing alot more: are you going to get fired from the first service because you are doing more than that MD allows you to do?

All a Camp is; is going to work for a different service that lets you do more.


We talked about how good it would be for most EMT-B's if they could work for a camp somewhere and learn what does and doesn't need to go to the hospital.

 

[mycrofft]

You must follow your company's legal protocols if you want to work for them. They deserve to know you will do as they hired you to legally do. Doesn't matter what your former employer said.

If you were hired by a company that said "No defib", then no defib. If you did it against their orders and it was within your scope, they can fire you but you are legally OK, you can keep your ticket.

If you were hired by a company that said "Cricothyrotomy OK" and it was outside your legal scope and they did not specifically train you and supply a legal protocol and equipment, and you did not follow that protocol exactly and used your Tom Mix penknife, then you could still be held responsible even if the company said it was OK and nothing bad happened.

Know your protocols. Know your legal scope (see for governing EMSA). Don't use EMTLIFE as a medico-legal reference, because what I'm told and where I work does not mean it will work where you do.
PS: applies to sequential editions of protocols. You can't say "I liked those 2009 protocols, I'm not going to use the 2011 ones". Cherrypicking is not allowed.

 

[mycrofft]

johnrsemt, protocols are pretty darn good! Suggest to med director to consider that Pepto is good for undiagnosed/no lab diarrhea also as it address most common causes but doesn't plug up bad stuff like C.difficele. Any provision for the appearance of the vomitus or stool? (hint: blood, dark yellow vomitus, watery stool versus just loose).

Also, glad toy see nothing ordered for constipation; nothing like a laxative to take care of that appendicitis-related ileus!

 

[Tigger]

The fact that I can't legally give an adult with chest pain an aspirin because I have some medical training but the kid next to me can because he has no training doesn't seem to make a whole lot of sense. Who made up these laws? What's even funnier is that we can assist with an epi-pen but cannot administer one. Fact is epi-pens are ready-made and require no drawing of medication...and we are able to identify anaphylaxis/severe asthma...so what is the reasoning we can't administer the most basic of emergency meds (which has no contraindications in emergencies btw)? Are they afraid we might drop it in the mud before we use it? Crazy system we live in. :wacko:

Solution: leave California.

 

[JPINFV]

For the people who state that EMT-B or P's cant give out OTC or perscription meds: Basics in most areas do Baby ASA for cardiac symptoms and alot of areas do Epi-pens, and Albuterol. and Basics across the country give out Oxygen. So it depends on what your Medical Director has to say.

What does ASA for cardiac, epi-pens, and albuterol have to do with OTC medication given for symptom relief? How many systems allow their EMTs to give out NSAIDS for pain relief?

 

[johnrsemt]

To JPINFV: If you work at a Camp of some kind that has a Medical Director that has given you protocols (and trained you on them) that state "give XYZ OTC med for ABC symptoms then you are working for a service that allows you to do that.

Just like if you go to work for a service that allows you to do something new due to a different Medical Director. There is nothing different than working in a new service; think of Camp as a EMS service that doesn't transport everything.
We couldn't transport everyone to the hospital or even to Urgent care for everything that they came in with: the ED and Urgent Care would have shot us.
If Scout has a headache; and they aren't drinking enough water (drinking what they do when they are at home), not in AC constantly (like at home); give the 20oz of water to drink over 20-30 minutes if headache not gone give them weight based Ibuprofen: that is no different than protocols that state: if they are having cardiac symptom chest pain give them 2-4 Baby ASA to chew and O2.

 

[JPINFV]

John, I never would argue otherwise that a medical director can change protocols and often increase the scope via waviers and other processes. I'd argue that that isn't nearly as clear cut in California where the medical director that matters for ambulance services is at the county level instead of the service level, but that is neither here nor there.

However, when you argue that EMTs are using OTC medications with the examples being "Basics in most areas do Baby ASA for cardiac symptoms and alot of areas do Epi-pens, and Albuterol. and Basics across the country give out Oxygen," then what you're saying is patently false. Out of those only ASA is over the counter, and none of those are for symptom relief. ASA (being the only OTC medication listed) isn't given to reduce the patient's pain, but is given as a platelet aggregation inhibitor, thus not being used for symptom relief.

 

[Mountain Res-Q]

John, I never would argue otherwise that a medical director can change protocols and often increase the scope via waviers and other processes. I'd argue that that isn't nearly as clear cut in California where the medical director that matters for ambulance services is at the county level instead of the service level, but that is neither here nor there.

However, when you argue that EMTs are using OTC medications with the examples being "Basics in most areas do Baby ASA for cardiac symptoms and alot of areas do Epi-pens, and Albuterol. and Basics across the country give out Oxygen," then what you're saying is patently false. Out of those only ASA is over the counter, and none of those are for symptom relief. ASA (being the only OTC medication listed) isn't given to reduce the patient's pain, but is given as a platelet aggregation inhibitor, thus not being used for symptom relief.

Yep...

When I worked at a youth coorectional facility there were specific regulations that accompanied our license to operate, includng the need to have medical staff on site 24/7. Problem is that it was impossible to (financially and logistically) an RN on staff. EMTs and CNAs were the staff. To allow this, the local Medical Dirrector had to give permission for us to provide treatment that was not in the scope of an EMT; neb tx, tb testing, pulse ox, bgl, otc meds, even rx meds ranging from vicoden to abx to psych meds.

You have to verify that this is not just hear-say or approved by someone without the power.

In regard to otc, asa is used by EMTs (where able) for cardiac issues, not as a NSAID type medication. Nothing else EMTs routinely have in their scope is OTC. Even something like TAO is outside the scope because "neosporyn kills!" J/K

The right to expand a scope depends on state and EMSA, however regional expansion of a scope should not be rationalized based on incomplete logic.

 

[frdude1000]

I have worked numerous boy scout overnight events. Some were more rural than others. I worked a 3 night campout in very rural, VA. We were mostly First Responders and EMT's, with a few nurses. A physician from our post served as medical director and gave us the ability to administer OTC meds after consulting him. Everything worked out well, mostly minor injures and sicknesses. Only major event was a chest pain that we transported out, physician was on scene to help us.

This weekend, my post is going to our local Klondike 2 night campout. We do this every year--usually just minor injuries, sicknesses, and hypothermia as well. One year we had a scout that fell into a campfire. Small percentage of full thickness burns, transported to burn center.

PM me for more info on Boy Scout medical.

 

[mycrofft]

I was surprised to read the State regs that allowed LVN's to do many technical things (airways, etc) which were otherwise reserved for either specialized techs (EMT-P's) or RN's. The loophole was that the employer had to create a protocol, train and independently certify their LVN's for each skill. The protocol had to very specifically spell out what the indicators indicating the technique's use were. I don't know if they still apply, but evidence of them used to be the varying permissions different facilities had regarding LVN's starting IV's and giving fluids. (Some allowed IV start with TKO sterile normal saline, others allowed just the start with a saline flush).
Sidebar, the local "doc in a boxes" are NOT employing RN's, the MD directly supervises and orders the techs.

 

[mycrofft]

Watch out for "The MD gave us the ability". We once fired a MD who pulled that. He didn't like to be woken up on his on-call nights (instead of their being on site at night, they were on call), so he declared some of his own protocols. By our regs (unknown legal basis) any standardized procedures were to be formulated and signed off by medical director, director of nurses, and program administrator.
A MD does not have the ability singlehandedly to legally permit subordinate staff to perform outside what their protocols call for, or law allows, unless (S)he is the medical director and it meets other hurdles.

And the "I'll let you" verbal deal goes south fast when the lawsuit appears.<_<

 

[johnrsemt]

Your all right about Baby ASA; sorry wasn't thinking when I wrote that. And since I know nothing about CA I can't answer that; I missed that the OP is going to be working at a Camp in CA.

Maybe it is just where I used to work; we checked with the Medical Director at our service that was also the medical director for most of the county and a good chunk of the state; and the state EMS commission about working at a camp under a GP as a Medical Director. They both said that it was the same as working under a different Director in a different service; you do what they allow you to do.

 

[Jon]

Yeah, I did this for a year. It was a fun job. I was the primary health officer at a small-ish camp. That meant that I was pretty much on duty / on call 24x7. That meant that when the other staff went out for a night off - I didn't get to go. And if I did, I had to stay sober, because I was back on duty when I got back. (Camp Director was an RN, and the Business Manger was a MFR - They were my backup)

I felt more like Mom and less like a EMT for most of the time. Most severe thing I saw was an impressive laceration to the thumb of my handicraft director. Went to our bigger, sister camp to have the Camp Doc sew him up. Think it was 6-8 stitches.

Other big issue I had to deal with was the constant threat of Norovirus. We'd closed one of our camps for 2 weeks the year before because of a Norovirus outbreak - so we were VERY cautious about not letting it happen again. It's something that should be on your mind with a population living in close proximity, especially with questionable hygiene on the part of some youth.

scouting.org/filestore/ppt/19-141.ppt is still current, as best I know. Medical forms are different, everything else seems correct.

My camp had written orders from our camp physician for many things - We had epi pens for use if needed, as well as a wide selection of OTC meds.

We had it interpreted that we were trained as a "Camp Health Officer", and acted under that, as opposed to our given certification.

Another comment - Dealing with camper's prescription meds is like opening Pandora's box. There is no right answer, but a bunch of ways that can work... or fail.

 

[mycrofft]

Hand sanitation

Where I am right now, you have to wash your hands as you enter the dining facility. Dyson air blade hand driers too, no towels, no dripping hands.