Public Comment Period Now Open for New Wilderness First Aid Curriculum
The Health and Safety Support Committee Wilderness First Aid Task Force is meeting in February to consider changes to the current Wilderness First Aid Curriculum and Doctrine Guidelines, initially published in 2009. The public comment period is now open, and comments will be considered until Feb. 1.
Comments should be submitted to the Health and Safety team via email and include supporting rationale, documentation, and/or evidence for proposed changes.
With the recent school shooting in CT, it got me to thinking about Boy Scout First Aid requirements. Since you’re seeking feedback for Wilderness First Aid, I think that Boy Scouts should learn basic first aid for gunshot wounds. Since there are shooting sport merit badges, it only makes sense to teach Scouts how to treat injuries from gunshots, whether they’re caused by intent or accident. Accidental gunshot deaths are one of the leading causes of death in children today.* (* Source http://suite101.com/article/preventing-accidental-gunshot-deaths-in-children-a381157)
I completely agree that part of Scout and Leader first aid requirements should be the treatment of things like stab/gun shot wounds.
However, the purpose of the WRFA course is the long-term care of injuries and illnesses in a wilderness setting, and typically for Scouting at least, shooting sports are not a part of the activities. Granted, being in a wilderness setting, Scouts or Leaders could be shot by others.
Gun shot wound care can and should be taught as a part of the regular first aid course materials for both Scouts and Leaders, but not so much in the WRFA course.
Just my $0.02 worth.
Respectfully Mr Ernest,
I would disagree with you there, Shooting sports are very important a part of scouting. I remember when growing up the first time I shot a bow or a BB gun I was in Cub scouts. When I was in Boy scouts I shot shotgun and .22 there are merit badges for both as well as archery! When I went to Philmount I shot black powder rifle which I had never done before. The point of boy scouts at least in my mind, is to let boys and young men experience new and fun things in a supportive and safe environment. Also in Venturing Pistol shooting is allowed and there is a whole elective based on just shooting, also there is hunting of course!
WRFA is for remote incidents (more than 1 hour) any is now being pushed for people to have. For instance to got to ANY high adventure camp you need 2 people trained in WRFA. I would strongly push it also for any backpacking trip, But it being a relatively new program the size is not ready for that just yet maybe in a year or 2.
Sure it might not be the most use full right now, but Boy Scouts is there to help scouts “Be Prepared” and by teaching how to care for a GSW now in both curriculum’s basic in First aid and more advanced in WRFA. Can help in the future to safe scouts!
Yes–Include in curriculum.
As an Eagle Scout and Oral & Maxillofacial Surgeon who is trained in WFA, and who has been trained in Advanced Trauma Life Support, I would agree with treated of GSW’s being included in First Aid training of Boy Scouts.
I listened to a segment on Public Radio recently, that was very informative about shootings in the US. There are approx. 20 mass shootings a year in the US (like the one recently in CT), that claim approx. 150 lifes. This apparently has not changed for decades! But approx. 150,000 lifes are lost each year in the US to violence, and most of which involve firearms! If a Scout, Scout Leader or former Scout saved just one of these lifes, the additional training would be well worth it.
Besides, we Scouts and Scout Leaders made training and learning fun.
GSW’s should be covered as hurry cases as the scout works on rank advancement. Don’t add to WFA course.
As a WFA instrutor, former EMT-B, and US Navy Hospitalcorpsman I think that GSW can/should be included in the First Aid Merit Badge. The MB talks about immediate care and the trained first responders will be rolling quickly to provide more definative care to the victim of a GSW. The youth can learn the basics of treating the would like any other bleeding wound.
In a wilderness situation there can be a more detailed coverage dealing with stablization and transportation.
For the actual course i would recommend changing the order that some items are presented i.e. shock and hypothermia earlier in the syallbus. I would also include more on methods of transportation on stretchers and carrys and such.
My instructor had changed the order to flow much easier it goes as follows 1,2,3,4,5,6,7,8,10,12,179,11,13,14,15,16 This is by lesson numbers and has so far for me worked very well!
I would think that GSWs would be treated in the wilderness setting as any other major puncture wound that causes severe bleeding. Care would be determined, as with any puncture wound, by location and severity, do stabilization……..then do evacuation considerations for slow vs. rapid evacuation based on the individual situation. Not all GSWs are immediately life-threatening.
This leads me into my comments for consideration of modifications in the course.
The one comment we get most often and consistently on evaluations, and in speaking with participants at the end of WRFA is that they do not have meaningful scenarios or enough of them. It is important to practice a skill when taught, but our students want to be able to take the “whole” of what they learn and practice in realistic scenarios where they have to use critical thinking skills and teamwork to make decisions about care and considerations regarding evacuation. They feel this is what will help their confidence level in acting appropriately with an actual wilderness situation.
Since we cannot make additions or changes to the course (which both instructors and students understand), our participants have even asked us if we would do a day of scenarios separate from the course so they could practice what they learned.
In a past course (pre-WRFA), we had scenarios about 1/3 through the course that were approximately 30-40 minutes. By the end of the course, we held scenarios that were approximately 1 1/2 hours. On evaluations, these scenarios were tagged as the most beneficial part of the course.
As a scouter, interesting to find these details when unable to get from council. Will watch in future.
In looking at requirements, I’m wondering in being a TRAINED Ski Patroller (I’m not, but friends are) , who recertificies yearly with “Outdoor Emergency Care” http://www.nsp.org/EduPrograms/emergencycare.aspx could also qualify as WFA.
Would like to see response to idea from national staff, please.
As a WFA/CPR Director, Instructor for four different organizations and a Council Venturing Committee Associate Advisor for the last four years along with being certified as a PADI Dive Master and part of our local county search and recover team. I was asked by our Council’s Program Director to comment and provide input to the current BSA Wilderness First Aid Curriculum and Doctrine Guidelines.
BSA currently has set standards for a 16 hour WFA course which does not include any CPR or AED training. With this in mind, the following changes should be considered and made in order to include:
1) The Venturing program,
2) Crews that are co-ed,
3) Scuba Diving adventures and
4) Informational gaps and missing topics.
1) There is a need to add guidelines on who can and should teach the WFA course and the First Aid Merit Badge. What qualifications and training are needed to be an instructor? This course is too important and can be life-changing if not taught correctly and to current standards. Instructors need to hold certification with a nationally accredited organization(s). These should be listed as to which ones are approved by BSA. For Example: ECSI, PADI, ARC and ASHI.
2) CPR and AED sections should be added to the guidelines either as part or as a separate course section. These should be completed before taking any First Aid or Wilderness First Aid courses. Time would need to be extended to cover these topics.
3) There needs to be a 25 hour version of this course to meet the Venturing First Aid elective requirement for the Ranger Award.
The following are suggestions should be looked at and considered for the next revision.
4) Add the following to the Introduction Objective on pg. 3.
• Duty to act
• Legal and ethical concerns
• Psychological and emotional concerns
• Add information on seeking help and accessing resources.
5) Add to Hands-On Physical Exam on pg. 5
• Under HEAD add Eyes and Mouth. Are their eyes equal, open, closed, fluttering and can they focus? Is there anything in the mouth that would obstruct breathing?
• Under LEGS add check Toes for feeling, circulation and strength of feet.
• Under ARMS add check for feeling, circulation and strength of grip, are both hands equal?
6) Additions should be made to Vital Signs and Heart Rate where to check and to find pressure points, the use of blood pressure cuff and stethoscope to obtain BP and vital signs during the secondary assessment phase.
7) Under SAMPLE on pg. 7 add the differences between Signs and Symptoms. For the most part, if you cannot see it you cannot fix it. Signs are important and can be dealt with easier than symptoms.
8) Under Shock Guidelines and Treatment, pg. 10. There are mixed opinions on the effectiveness of raising the legs at all and in many cases it can do more harm than good. Yet there are times when raising the legs are warranted for example to help control bleeding. Under Protect Patient from Loss of Body Heat, add being “Over-Heated”. This is a common problem living in the Southwest desert. So both scenarios need to be covered.
9) Under Heart Attacks add what the signs are and that these are different between men and woman.
10) On pg. 13 add bullet points to Head and Brain Injuries. Under Visual Disturbances, check eyes. Are the eyes equal, open, closed, fluttering and can they focus? Is there bruising around the eyes? Is there fluid and/or bruising around the ears? Check for DOTS: Deformation, Open Wounds, Tenderness, Swelling.
11) Pg. 14, under Log Roll, there needs to a statement of when to do it and how. There should be added a section on the use of C-Collars and Backboard. This is needed for Climbing and Aquatic activities where you have a greater chance of head and spinal injuries and proper techniques are needed.
12) Under Bone and Joint Injuries, there need to be more information on splinting techniques, traction devices, SAM splinting and thinking outside the box when dealing with long bone injuries. On Pg. 18 under realignment may be attempted: when, and how many times?
13) Under Bleeding – pg. 20, add Abrasions, finding Pressure points and using pressure points when direct pressure does not work. On pg. 21, add how much blood can be lost before it becomes dangerous or life threating. Under Wounds: add Puncture Bites, Abrasions, Incisions, Avulsion, Gun Shot and Amputations and the care and treatment of each. On pg. 21 as well, I question the word usage and method of caring for a dirty wound and that it should be left open.
14) Under Burns, pg. 22 also add the terms 1st degree to superficial, 2nd degree to Partial Thickness, and 3rd degree to Full Thickness degree burns. Burns also needs to be added to Table of Contents. There needs to be added an explanation of the Rule of 9% or 10% TBSA, to burn extent. It might be better to put on pg. 25 or even in both places. There is no mention on Electrical or Chemical Burns and how to handle them.
15) Under Insect Bites you need to add and cover Bee Stings, Spider Bites, Wasps, Scorpion Stings, and Kissing Beatles, and Centipedes to mention only a few. This section should cover insect bites and stings that area common throughout the different regions in the US. For example, there is no mention of the US SW region in the BSA handbook, the Venturing handbook and here in this WFA guideline.
16) On pg. 26 under Abdominal Pain, add sections dealing with hernia, protruding organs and open wounds to the abdominal area and how treat each of them. Also in this area there needs to be more information provided that deals with female issues. The reason for this is we have co-ed Crew and female leaders and it is just a good idea that everyone has a basic idea of how to handle these issues.
17) I would like to see added to Treatment of Hypothermia the temperature of mild hypothermia 99 to 95 degrees, moderate hypothermia 95 to 90 degrees and severe hypothermia 90 to 75 degrees. The temperatures are important when dealing with aquatic and scuba diving issues. In this section you also need to add treatment for frostbite and even snow blindness.
18) Under Heat Issues on pg. 30 there needs to be added information that deals with Dehydration, since this happens before Heat Exhaustion, and with proper signs and treatment the more advanced problems dealing with heat injuries are lessened.
19) On pg. 32 under Lightning, there needs to be a section that is dealing with electrical burns from lightning or this could be added to the burn section as well.
20) Submersion Incidents pg. 36, a section needs to be added for Scuba Diving and decompression issues as well as the use of O2 for both aquatic and scuba diving injuries. O2 requires special training yet it is a good idea to expose the student to the need and use of it, in the event they are assisting a professional provider.
21) There needs to be a section added to deal with aquadic, scuba diving and marine injuries, along with bites and stings for example: Sting Ray, Lion Fish, Sea Snakes, Jelly Fish, and Ells.
22) There needs to be a section added covering female issues, when dealing with female leaders and girls in co-ed crews.
23) There is no mention of how to handle diabetic emergencies, poison plants like poison ivy, oak and sumac. Again there needs to be an asserted effort to cover typically encountered toxic or poisonous plants throughout the US. For example: Mushrooms, Oleander, Caster Bean, Eucalyptus, Mistletoe, Foxglove and Jimson. There is no mention of CO2 and chemical poisoning.
24) There are several times that medications are mentioned. Guidelines should be added to when, who and how medication can be provided and dispensed at Scouting events and treks, per Guide to Safe Scouting.
25) The Table of Contents needs to be more detailed on where to find the different topics. For example where do I find information on animal bites, which I do not see anywhere where this topic is covered, as well burns and toxic poisoning issues? If not covered in the Table Contents then there should be an Index to locate topics quicker and easier.
In the last three years that I have been teaching WFA, I have found that doing hands-on practice and scenarios is the best approach to teaching this course. There needs to be a series of demonstrations, practice ideas, and scenarios layed out throughout this course. Each scenario should develop skills that the student just learned as well as building on previous topics covered. In the last scenario, I will have multiple injuries ranging from non-serious to life threating and possible death.
I would also like to see a refresher version of this course, as well as details to what BSA thanks should be covered and the time frame for this course. I do not see any national standards for this.
I hope this feedback helps in improving the WFA program for both Boy Scouts and Venturing Scouts as well. Thank you for providing the opportunity to offer this feedback.
John,
Thank you for your feedback … To ensure your comments are considered, please be sure to also send them to the email address listed in the article above (click “email”).
John Churchill
BSA Internal Communications