By Bob Amick
Rex brings up an interesting point about field care for hypothermia. A later
post expresses concern about "good samaritan laws," and the legal*
ramifications for rendering care. Perhaps the following will clarify some of the
concerns. (*-Please note that I am not an attorney and the following information
is not to be construed as legal advice. It is primarily information which I have
gathered as an EMT and Red Cross Emergency response Instructor over about 25
years, and working on National Scout Jamboree Medical Centers and many high
adventure Scout/Explorer trips and events. The information discussed here was
derived in consultation with physician/attorneys and other knowledgeable
individuals.)
If you need specific legal advice on these matters it is recommended that you
consult with your local council risk manager/attorney or other qualified
professional.
First, as a Scout leader, by virtue of assuming the role of a person
entrusted to care for youth on Scouting activities, you also assume a "duty
to act." That is, if a Scout is ill or injured, you are legally responsible
for providing emergency medical care (i.e., first aid) for that the best of your
training and ability, and to ensure that the Scout is promptly given more
"definitive care" (i.e., notifying emergency medical services,
responding an ambulance, and/or hospitalization/emergency room care) if the
injury or illness warrant such care.
To fail to provide such care especially if it can be shown that you have been
trained in appropriate procedures would legally be considered
"abandonment" of the victim and would constitute negligence on your
part. You may only relinquish care of the victim to a person with equal or
greater qualifications than yours (e.g., an EMT, Paramedic, nurse, or physician)
and you must be able to verify that the person is qualified.
As far as "permission to treat" goes, any Scout trip must have a
parental consent and medical treatment consent/waiver filled out and signed by
the Scout's parent or legal guardian. This gives the leader blanket permission
to treat or arrange for treatment of emergent AND non-emergent medical/trauma
problems while the Scout is under the care of the leader. I posted a copy of our
permission slip in January, and would be happy to send another copy to anyone
interested. As noted in another post, anyone with life threatening illness or
injury who is mentally incapable of refusing or consenting to treatment, gives
"implied" consent for treatment under the law. This applies to minors
(under age 18 in most states) and to adults. It also applies to those who object
to any medical treatment on religious grounds, if the injury/illness is
immediately life threatening, and/or the individual is under the age of majority
(18)or is not an "emancipated minor." (check with your legal/medical
advisor in your area to clarify these issues for your situation).
It is always essential and appropriate to get verbal consent from anyone you
treat, even if you have written permission, and as noted this should be done in
the presence of a witness. Nontheless if you have a "standing written
consent" from parents, there is no question, and it may save you a lot of
time and frustration in an emergency room if you are far away from home.
Hypothermia treatment utilizing heat transfer by body contact in a field
setting when other options are not immediately available is uniformly defined in
wilderness medical treatment protocols and literature, and considerable evidence
has shown this method to have saved lives. It is defined as a "standard of
care" for hypothermia which any "reasonable and prudent" person
with appropriate knowledge and training would administer given the circumstances
and lack of other options.
Certainly,if you are in "civilized" surroundings where sources of
external heat such as vehicles, warm water, warmed beverages, etc., are
available, and the patient is still capable of ingesting warmed beverages, those
are appropriate. The body heat transfer is usually a "last resort"
effort for severe hypothermia in remote settings. It has frequently been used in
wilderness mountain climbing or other expeditions as a lifesaving measure.
Nontheless, it is always appropriate when other techniques are unavailable or
ineffective. So long as the treatment is conducted appropriately (as noted in
another post) in the presence of of other adults/scouts, and the treatment is
obviously necessary, there is little cause for concern. Most of all it may save
someone's life.
It is somewhat frightening to realize that many (especially new) Scout
leaders, and particularly parents of Scouts are extremely uninformed about the
life threatening dangers of hypothermia (and other facets of trauma and illness
recognition and treatment), and would tend to err on the side of
"avoiding" treatment for fear of legal entanglements. In point of
fact, they would place themselves in much greater legal peril by witholding
treatment, and subsequently causing the serious injury or death of a Scout.
Good Samaritan laws (for the most part, the language varies from State to
State) only protect those individuals who render care voluntarily, without an
expectation or "duty to act" as a part of their job or volunteer
position. For example, if you are driving down the road and stop at the scene of
an accident, voluntarily, to assist, AND if you render care according to the
"standard of care" under which you are trained/experienced without
negligent acts or omissions, you are given immunity from litigation should the
person you assisted choose to file suit against you.
Although anyone may file a lawsuit against you for nearly any reason, the
probability of the suit being successful is negligible if you have acted in
"good faith, and in a reasonable and prudent manner" to assist someone
to the "best of your training and ability." On the other hand, if you
are a Scout leader,(or volunteer firefighter, volunteer ambulance technician, or
Scout camp staff member et al, whether you get paid or not), and if you are
acting in an "official capacity" at the time, you still have a
"duty to act" and (unless your state laws are written differently than
most) are NOT protected by "good Samaritan laws."
The good news, however, is that there are virtually NO successful lawsuits
against anyone in these categories who provide care appropriately according to
the "standard of care" under which they have been trained.
In point of fact, far more successful lawsuits have been filed against those
persons who knowingly withheld care of a victim, without a legitimate reason.
You are much better off trying to do something you are trained and/or qualified
to do to the best of your knowledge and ability. Conversely if you try to do
something you are not qualified to do, you may also be at risk, so just maintain
your efforts to the "standard of care" that you have been trained
in..no more and no less.
The legal system is very understanding of those who make a good faith effort
even if unsuccesful. Conversely it is very unforgiving of those who fail to act
without good cause, or of those who act recklessly and negligently.
I would especially say AMEN to the post saying that hypothermia is largely
preventable!. It is important to remember that little folks (i.e. young
Scouts/children) are far more susceptible to hypothermia than older Scouts or
adults. There have been cases in which leaders have dismissed or ignored initial
complaints of being "cold" or chilled by Scouts as
"whining." In fact, some of those cases resulted in Scouts suffering
mild hypothermia, and had action not been quickly taken, could have been tragic.
Simple precautions such as not wearing cotton clothing for any reason, and using
adequate synthetic underwear and outer garments, as well as proper hydration and
nutrition go a long way it preventing a problem.
Sometimes, it is necessary to just inform a Scout that he needs to "put
on his hat" to forestall chilling.. Many times they just miss little things
that can save them from a lot of discomfort.
The other factors are just recognizing when wind-chill is serious and taking
prompt action to remove the source of heat loss. Most Scouters know, if you
become hypothermic yourself, your brain tends not to function very well, and you
make bad decisions, which may be tragic. Someone who is still in control needs
to take control and remove the person or group from any further exposure, and to
reverse the effects of the wind chill.
Finally, I would strongly encourage anyone who is in a Scout leadership
position, as well as the Scouts themselves, to take a Red Cross or equivalent
training class in first aid and CPR. If you can get an experienced instructor,
(i.e. someone who has actually worked in the emergency medical services field as
an EMT, Paramedic, Rescue squad, firefighter, outdoor guide, etc., and has first
hand experience, your class will be greatly enhanced). The Red Cross has a new
class called "emergency response" and "CPR for the Professional
Rescuer" which is designed for volunteer and professional "first
responders." It is extremely well designed, and well suited to Scout
leaders and older Scouts.
I currently teach this class to Explorers in my high adventure and emergency
management posts, and to Venture crews and Scout leaders in my district. They
find the training extremely useful, and sufficiently thorough that they often
assist in teaching future classes. A few have also become instructors when they
turn 17 and are quite good at teaching their fellow Scouts! Most of all they are
much more aware of the dangers of a variety of outdoor risk factors and know not
only how to treat them, but more importantly how to avoid them in the first
place!
Good Scouting!
Bob Amick, EMT-B, is Exploring Training Chair at Longs Peak Council,
Boulder, CO
Heath & Safety
