Other Things I Learned at Wilderness First Aid

I expected to learn first aid in the Wilderness First Aid course, but I did not expect to learn so much about planning and teamwork.

I first took Wilderness First Aid (WFA) in 2009 and I’ve taken the course again three times since then to recertify. The material hasn’t changed much, but I always learn or re-learn something.

Our WFA class uses a lot of practical scenarios. All of them require teamwork, and they are planned to stretch your skills. That means that you kill the patient most of the time. We learn a lot more from failure than from success.

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Hand Sanitizer is not Enough

I’m seeing more and more backcountry books that suggest using hand sanitizer by itself. That does not work. Soap and water is necessary, sanitizer is optional.

The Scouts Backpacking Cookbook is one of those with that bad advice. The BSA Handbook gets it right. Wash your hands with soap and water.

Clean hands are important in the backcountry. People who know, like Tod Schimelpfenig, Curriculum Director at the Wilderness Medicine Institute of the National Outdoor Leadership School, believe that dirty hands are a bigger health risk than dirty water.

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BSA Incident Reporting

I’m excited about the incident reporting that the BSA requires now, but there may be a few kinks to work out.

How are they going to handle the volume with paper reporting? Using the back of a virtual envelope, we have 40,000 troops and five reports/year from each one. That is 200,000 reports. They’ll be lucky to get a few thousand this year, but on-line reporting is a must.

Any “first aid” is a Marginal incident, which must be reported within five days. That means a report for every blister. With about 900,000 Scouts and Venturers, 100% reporting could mean a million reports per year.

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New Checklists and Reporting Requirements in Guide to Safe Scouting

The quarterly update of the Guide to Safe Scouting includes two new checklists in the appendix.

The Campout Safety Checklist (PDF) is two pages long with 35 items, and a big improvement in BSA risk management. Some of the checklist items:

  • Have weather conditions been checked and communicated?
  • Has an adult been assigned to help Scouts with taking meds?
  • Is a mechanism in place for contacting a camp ranger or camp office (e.g., walkie-talkie, mobile phone, etc.)?
  • Has the location of the nearest hospital/ER been identified and announced to all adults?
  • Is the unit first-aid kit in a conspicuous location and readily available?
  • Have any incidents been recorded and reported, if necessary, to BSA professionals?
  • Have the adult and youth leaders captured any lessons learned from the campout?

There is a similar Event Safety Checklist (PDF) for non-camping activities.

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Lowering the Risk of Acute Mountain Sickness (AMS)

The journal Wilderness & Environmental Medicine published an article in June with new evidence-based guidelines on acute mountain sickness (AMS), also known as altitude sickness, as well as HAPE and HACE. The article, Wilderness Medical Society Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness (also: the erratum, with a corrected risk table), is worth reading in full, but I’m going to pull out two highlights.

First, how to keep our risk low. The paper lists three risk categories: low, medium, and high. The description of the “low” category is a good rule for planning mountain trips. Note that the altitudes listed are sleeping altitudes. You can hike higher, but you need to sleep low.\

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BSA neckerchiefs are finally big enough

Our troop is considering a new source and maybe a new design for neckerchiefs, so I checked out the price for official BSA neckerchiefs and got a big surprise. The BSA has made them a lot bigger. They say:

Design reverts back to the standard larger size offering a variety of uses, as a sling, signal, bandage, belt, patrol ID, and more. Standard size is now 49.5 inch X 35 inch X 35 inch.

The previous size wasn’t documented anywhere I could find, but I measured mine as 41 X 29 X 29 for my post with a table of sizes for different Scout neckerchiefs. I’ve updated that table with the 2011 BSA neckerchief.

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How big is a Scout neckerchief?

Note: Updated Jan 2011 with the new larger BSA neckerchief size. Updated again Sep 2018 with new URLs and the 2015 edition of the ANSI standard.

The BSA’s Insignia Guide says this about the size and shape of the neckerchief, “Official neckerchiefs are triangular in shape.” There is a more info about how to wear it, who chooses the neckerchief (the troop), who approves special neckerchiefs (the council), and so on. It does say that special neckerchiefs are “the same size as official ones”. Oddly, they don’t say what size that is.

How to wear neckerchief

So I researched it. One reason to have a bigger neckerchief is so it can be used as a triangular bandage, so I also checked the common sizes for those, including the ANSI-standard size.

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CPR Rhythm

A study at the University of Illinois medical school had success using “Stayin’ Alive” by the Bee Gees to maintain the proper 100 compressions per minute.

Yuk. Way too cute. And listening to that song would sap my will to live.

My CPR instructor (USCG Retired) suggested any Sousa march. March tempo is around 110-120 and you’ll be slowing down, so that tempo helps keep you moving. Given the low success rate of bystander CPR (~5%), I’d really rather send someone out to “The Stars and Stripes Forever” than to disco. After all, that duck may be be somebody’s mother.

For the emo or contrarian rescuer, an alternative is Queen‘s “Another One Bites The Dust”. Whatever keeps you going.

Uncle Bill’s Tweezers

Cool Tools has a post on Uncle Bill’s Tweezers. These are excellent tweezers that hook onto your key ring and don’t get taken away at airports (so far). I’ve carried a pair of these for nearly fifteen years, ever since our youngest started crawling. It is my default small gift for new fathers. As soon as their child starts crawling, they’ll need to pick splinters out of baby knees. Works for adults, too.

I get mine from the display beside the cash register at Barron Park Plumbing Supply. They are a fine plumbing store and right next door to the original site of Shockley Semiconductor.

The Army Tests Backcountry Water Treatment

Given the current explosion of water treatment options (UV, chemical, filters), I’m really happy to see the comprehensive test of products by the US Army Center for Health Promotion and Preventive Medicine. They don’t test the UV purifiers, but the they have great coverage of filters and chemical treatment with a clear presentation — green, yellow, red for coverage of pathogens and one, two, or three checks for degree of purification for each class of pathogen.

In chemical purification, the Katadyn Micropur MP 1 Tablets (link to REI) are the clear winner. Reading the detailed writeup, the MSR MIOX gets three checks across the chart when used with an “overkill” dosage — the 8X option in the MIOX instructions. That’s good, because I already own that one.

No water purifier is a substitute for washing hands. We had clean, pure water at Scout camp this summer but still had a few kids get the barfs and runs. Use soap and water, and scrub for the length of time it takes to sing Happy Birthday twice. Not at The Chimpmunks tempo. No cheating. If your patrol gets sick, the fingers point at the cook.

Side note: REI has really improved the linkability of their URL, stripping lots of paramjunk off the end. Let’s all give them some linklove.