10/31/2011

TROOP 764

FIRST AID

A Guide to Earning the Merit Badge | Glen Hoshizaki

About this document

Earning any merit badge starts first of all with a scouts curiosity about something that simply strikes his fancy, for whatever reason. Then, with his Scoutmasters blessing and under the guidance of a merit badge counselor, the scout pursues a course of self-directed learning, armed only with a merit badge book and a list of requirements -- a fairly simple and straightforward process, dependent only on a scouts desire and commitment to learn. And so it should be with the First Aid merit badge. The First Aid merit badge, however, presents a couple of obstacles. First of all, the list of requirements for the First Aid merit badge is quite long and involved compared to most merit badges, and is thus difficult for a scout to complete. Secondly, nearly every scout pursues the First Aid merit badge every year it is the most commonly awarded merit badge throughout the country making it difficult for a scout to maintain enough contact with his merit badge counselor. This document -- written specifically for the scouts of Troop 764 is not a substitute for the merit badge book, nor is it a substitute for a scouts meetings with a merit badge counselor. Instead, it is simply a guide to help the scout meet the merit badge requirements while keeping to the spirit of the merit badge program as one of self-directed learning. There are 5 sections to this document:
Welcome to the Troop 764 First Aid merit badge program a page to get you started How to meet the First Aid merit badge requirements the 3 parts of meeting the requirements The First Aid merit badge book a guide to help you get the most out of reading the merit badge book Where to go from here some suggestions about furthering your first aid journey Appendix: Requirements by chapter a reorganization of first aid advancement and merit badge requirements to match the merit badge book

Contents
About this document ..................................................................................................................................... i Welcome to the Troop 764 First Aid Merit Badge Program! ........................................................................ 1 Getting Started.......................................................................................................................................... 1 How to Meet the First Aid Merit Badge Requirements ................................................................................ 2 1. The Non-Show Requirements ........................................................................................................ 3 First Aid Merit Badge Cases .................................................................................................................. 3 2. The Show Requirements ................................................................................................................ 7 First Aid Kits .......................................................................................................................................... 7 Basic Life Support .................................................................................................................................. 9 Severe Bleeding................................................................................................................................... 10 Fractures ............................................................................................................................................. 10 Head, Neck, and Back Injuries ............................................................................................................. 11 Assists .................................................................................................................................................. 11 Stretchers ............................................................................................................................................ 12 Automated External Defibrillator Demonstration .............................................................................. 13 3. The Teaching Requirement ............................................................................................................. 14

The First Aid Merit Badge Book .................................................................................................................. 15 Chapter Notes: Introduction ................................................................................................................... 16 Definition and Goals of First Aid ......................................................................................................... 16 Rank Requirements ............................................................................................................................. 16 Reducing Risk ...................................................................................................................................... 16 Teaching First Aid ................................................................................................................................ 16 Chapter Notes: How to Handle an Emergency ....................................................................................... 17 The First Aid Method .......................................................................................................................... 17 Chapter Notes: First-Aid Supplies and Skills ........................................................................................... 19 First Aid Kits ........................................................................................................................................ 19 Transport............................................................................................................................................. 19 Chapter Notes: Minor Wounds and Injuries ........................................................................................... 20 Bruises ................................................................................................................................................. 20 Puncture Wounds ............................................................................................................................... 20 Cuts and Scrapes ................................................................................................................................. 20

Blisters................................................................................................................................................. 20 Bloodborne Pathogen Protection ....................................................................................................... 20 Chapter Notes: Muscle, Joint, and Bone Injuries .................................................................................... 21 Muscle Cramps.................................................................................................................................... 21 Sprains and Strains .............................................................................................................................. 21 Broken Bones ...................................................................................................................................... 21 Head, Neck, and Back Injuries ............................................................................................................. 21 Chapter Notes: Cold- and Heat-Related Conditions and Injuries ........................................................... 23 Hypothermia ....................................................................................................................................... 23 Frostbite .............................................................................................................................................. 23 Dehydration ........................................................................................................................................ 23 Heat Exhaustion .................................................................................................................................. 23 Heatstroke........................................................................................................................................... 23 Chapter Notes: Burns .............................................................................................................................. 24 Superficial (First-Degree) Burns .......................................................................................................... 24 Partial Thickness (Second-Degree) Burns ........................................................................................... 24 Full-Thickness (Third-Degree Burns) ................................................................................................... 24 Chemical Burns ................................................................................................................................... 24 Electrical Burns.................................................................................................................................... 24 Sunburn ............................................................................................................................................... 24 Chapter Notes: Other First-Aid Cases ..................................................................................................... 25 Fainting................................................................................................................................................ 25 Hyperventilation ................................................................................................................................. 25 Loss of Consciousness ......................................................................................................................... 25 Seizures ............................................................................................................................................... 25 Recovery Position................................................................................................................................ 25 Diabetes .............................................................................................................................................. 25 Foreign Object in the Eye .................................................................................................................... 25 Nosebleeds.......................................................................................................................................... 26 Internal Poisoning ............................................................................................................................... 26 Poisonous Plants ................................................................................................................................. 26 Abdominal Pain ................................................................................................................................... 26

Dental Injuries ..................................................................................................................................... 26 Bites and Stings ................................................................................................................................... 27 Chapter Notes: Life-Threatening Emergencies ....................................................................................... 29 A-B-C-D ................................................................................................................................................ 29 Heart Attack ........................................................................................................................................ 29 Stroke .................................................................................................................................................. 29 Choking ............................................................................................................................................... 29 Severe Bleeding................................................................................................................................... 29 Tourniquets ......................................................................................................................................... 30 Anaphylactic Shock (Anaphylaxis)....................................................................................................... 30 Chapter Notes: First-Aid Resources ........................................................................................................ 31 Scouting Literature.............................................................................................................................. 31 Books ................................................................................................................................................... 31 Organizations and Web Sites .............................................................................................................. 31 Where to go from here ............................................................................................................................... 32 Appendix ..................................................................................................................................................... 33 Requirements by Chapter ....................................................................................................................... 34 Introduction ........................................................................................................................................ 34 How to Handle an Emergency............................................................................................................. 34 First-Aid Supplies and Skills ................................................................................................................. 34 Minor Wounds and Injuries ................................................................................................................ 34 Muscle, Joint, and Bone Injuries ......................................................................................................... 34 Cold- and Heat-Related Conditions and Injuries ................................................................................. 35 Burns ................................................................................................................................................... 35 Other First-Aid Cases........................................................................................................................... 35 Life-Threatening Emergencies ............................................................................................................ 36

Welcome to the Troop 764 First Aid Merit Badge Program!

By now you have been learning and practicing first aid for a good while. Each rank, from Tenderfoot, through Second Class, to First Class, requires that you learn and demonstrate specific aspects of first aid. (If you were a Cub Scout, you started this learning process even earlier, through the Cub Scout Readyman program.) And now you have decided that you want to learn even more about first aid. Perhaps you see pursuing the first aid merit badge as an opportunity to learn about healthcare careers. Or perhaps you just want to be better able to help those in need. Whatever your reasons might be, we applaud your decision, and you can be assured that we will be there to guide you through the learning process. GETTING STARTED
1. Get First Class First. Although there are no formal rank requirements that a scout must meet before working on any merit badge, we generally advise scouts to attain First Class before they begin the First Aid merit badge. This is in part because the First Aid merit badge requires that a scout show current knowledge of all first aid rank requirements, but also because it is more important to gain the knowledge and skills of the rank of First Class than it is to earn any merit badge. Read Introduction to Merit Badges. Youll find it online on the Boy Scouts of America website at http://www.scouting.org/scoutsource/BoyScouts/AdvancementandAwards/MeritBadges.aspx. Understand that the merit badge program is a way to pursue your personal interests, selecting from over a hundred merit badges. It is self-directed learning, but under the guidance of a merit badge counselor. The merit badge counselor is there to provide help as needed, but in the end it is you the scout tackling the merit badge requirements. Get the blue card. Note: If you are a Troop 764 scout you will no longer have to get a signed merit badge application (blue card) from your Scoutmaster. Instead, notify the Troop 764 First Aid merit badge counselor of your intent to pursue this merit badge. He will then notify your Scoutmaster and get your blue card squared away. This is a new change in procedure. However, the principle is still the same you must have a blue card before you can officially begin working towards the merit badge. Get the current First Aid merit badge book. Get the 2007 edition (either the 2007 black-and-white printing or the 2008 color printing), not the 2002 edition. The new edition has been nearly completely reorganized and rewritten from the previous edition. Read the requirements. The list of requirements for the merit badge can be found near the beginning of the merit badge book, or in the Boy Scout Requirements book, or online. Since the requirements are updated fairly often, make sure that you have the current requirements. As with any merit badge, these requirements are exactly what you must do (no more and no less) to earn the merit badge. Review what you have already learned. Since the very first merit badge requirement for First Aid is that you demonstrate current knowledge of all Tenderfoot, Second Class, and First Class first aid rank requirements you should read and review all these in your Boy Scout Handbook. You will also find helpful the nine rank requirement videos for first aid on the BSA website at http://www.scouting.org/scoutsource/Applications/RankVideo.aspx.

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How to Meet the First Aid Merit Badge Requirements

You can think of the First Aid merit badge requirements as being of 3 types:
1. 2. 3. Non-Show Requirements These are the requirements that ask the scout to explain, tell, or describe, plus Requirement 1 (the Tenderfoot, Second Class, and First Class requirements). Show Requirements These are the requirements that ask the scout to, e.g., demonstrate or show something. Skill-Teaching Requirement This is Requirement 7, the last requirement. Once a scout has done the non-show and the show requirements, he must teach another scout (typically a younger scout in his patrol) a skill selected by his merit badge counselor.

In Troop 764s First Aid Merit Badge Program the scout can meet all the above merit badge requirements by taking the following steps:
1. 1. 2. To meet the non-show requirements the scout will answer in writing a number of questions related to various first aid cases and scenarios and submit the completed cases to me via email. To meet the show requirements the scout will meet with the merit badge counselor in scheduled small group hands-on first aid skill sessions (about six one-hour sessions or the equivalent). Finally, after the scout meets the above two requirements (which can be worked on simultaneously), the scout will teach another scout a selected first aid skill on his own (for example, at a patrol meeting or patrol camp) and describe his experience to the counselor.

The following pages provide further details on each of the above three items. (Note: It is possible to meet the requirements in other ways. If you are interested in this please see your merit badge counselor.)

1. THE NON-SHOW REQUIREMENTS Download the file First Aid Merit Badge Cases and Questions. You can find it by 1) logging on to the Troop 764 website at http://www.troop764.com, 2) navigating to the Files section, then to the First Aid folder, and then to the First Aid Merit Badge folder. Or, if youre already logged in, go to: http://www.troop764.com/system/files/FAMBCases.dotx This file is in Microsoft Word 2007-2010 format. If you need it in another format please let me know. These case questions provide a challenging but interesting way to learn first aid and fulfill the non"show" requirements. Here are some tips to help you find the answers to the case questions:
1. 2. Read the case description and questions. Pay particular attention to what the questions are actually asking. If you're not quite sure what the questions are asking, look at the number-letter code in parentheses located immediately after the questions. This indicates the specific merit badge requirement the case is concerned with. Look up this number-letter code in the Requirements by Chapter appendix of this Guide. Once you understand the question and know which chapter in the merit badge book it concerns go to that chapter and answer the question using the information there. Since this is not a test so much as a way to learn first aid, you can always ask your merit badge counselor or anyone else (including your fellow scouts) for help.

3. 4.

There are other ways besides reading the First Aid merit badge book to figure out the answers to these cases. For example, you can search the internet (using, for example, Google) for answers, or go to one or more of the internet sites in the First Aid folder in the Links section of the troop website: http://www.troop764.com/taxonomy/term/1116 However, for the purposes of earning the merit badge you can consider the First Aid merit badge book as being an at-least-adequate source for the case question answers, even though some information in any first aid book is inevitably going to be outdated. Keep in mind that researchers continually discover new information that causes us to change how we handle first aid situations. For your convenience the cases are included below. But remember, do not answer the questions here. Instead, download the file described above, answer the questions on that document using Microsoft Word, and then email your completed cases to your merit badge counselor. First Aid Merit Badge Cases Case 1
You and a friend are the only ones at your home. The two of you are playing a video game when your friend has a seizure. You provide first aid to your friend during the seizure, but you become concerned that the seizure does not appear to be stopping. You decide to follow Step 2 of the First Aid Method and call for help. How would you do that? (Bonus Question: What should you tell the emergency dispatcher?) (2a)

Case 2

Your patrol is on the return leg of a week-long backpacking trip in the Sierras when it is overtaken by a thunderstorm. Lightning strikes a nearby tree and throws your entire patrol to the ground. One of your scouts suffers a severe burn on the sole of his foot, a second suffers an obvious leg fracture, while a third is barely responsive to voice. You provide first aid, but decide that you need to get help. You are about 5 miles from base camp, not in cell phone range, and without any other means of electronic communication. How would you get emergency medical assistance? What information do you need to get out? Finally, what is triage, and how does it apply here? (2a, 2b)) Your troop is on a boat half-way between Marina del Rey and Catalina when your captain passes out. You render first aid and make sure he is breathing. To your chagrin you discover that no one left knows how to operate the boat and that it is dead in the water. What are your options for getting help? (2a)

Case 3

Case 4

Its night and it is pitch black. Your patrol is playing German Spotlight and youve found the perfect hiding place. All of a sudden you hear a yell and a loud crash, followed by a low moan. You and the other scouts click on your flashlights and find a scout sprawled out on his back on top of the patrols fishing poles. Using the steps for handling an emergency you determine that things arent too bad. However, the hapless scout does have an assortment of bruises, cuts and scrapes. In addition, hes got a fishhook embedded in the skin of one arm, which youre able to remove using the string-yank technique. How do you know the scout has bruises? How would you treat them? What precautions would you take to protect yourself from bloodborne pathogens? What would you do for the scouts cuts and scrapes? How about the puncture wound? (5e.1, SC 7c.3, T 12b.1, 2c) Case 5 Youre on a hike at Circle X in the Santa Monica Mountains. At the very first stop one of the scouts removes his shoe and reveals multiple blisters, which he says he got playing basketball in street shoes at school the previous day. How would you treat the blisters? (T 12b.1)

Case 6

Its hot. Youre on the home stretch of a 20 mile Pacific Crest Trail section hike when one of your scouts yelps in pain, plops down to the ground, and grabs his right calf. You think hes got a muscle cramp. What makes you thing that? How can you help your scout? What could have been done to prevent this? (5j) Your scouts muscle cramp abates and he is able to continue the hike. However, about 500 yards before the end his left ankle gives way under the weight of his 50-pound backpack and he crumples to the ground. You determine that he has suffered an ankle sprain. What evidence would lead you to that conclusion? What first aid would you render? Is there anything that could have been done to prevent this? (5e.3) Its the morning after your section hike. Your unlucky scouts calf is fine and his ankle sprain isnt too swollen. However, hes complaining of some mild pain in his back. You think its a muscle strain. What makes you think that? How can it be treated? How could it have been prevented? (5e.2) Summer is ending and youre on your last patrol camp at Frazier Park before school starts. Youre determined to take your patrol on one final outing, so you take them out on a day hike. However, you neglect to check the weather forecast ahead of time and now you find yourselves underdressed in the middle of a rather severe temperature drop miles from camp. One of your younger scouts has been shivering uncontrollably and now is mumbling incoherently, stumbling, and pulling off his sweatshirt. You think he is hypothermic. What would lead you to that conclusion? How can you help him? You also notice that his gloveless hands appear frostbitten. What would make you think that? How can you treat it? How could the hypothermia and frostbite have been prevented? (SC 7c.7.c, 5a, T 12b.7, 5c) Your patrol is hiking the Kaunala Loop in the Pupukea Paumalu Forest Reserve, near Haleiwa and not far from the North Shore of Oahu. Your scouts are excited to be there and are hiking their hearts out.

Case 7

Case 8

Case 9

Case 10

However, its a hot day, and the boys start showing the effects of the heat. Theyre all starting to drag, but youre particularly concerned with one of them, hatless and red-faced. Is he dehydrated? How would you know? Does he have heat exhaustion? Or perhaps its even worse and hes spiraling into heat stroke. How would you know? How would you treat dehydration? How would you treat heat exhaustion? How would you treat heat stroke? Could any of this have been prevented? (SC 7c.b, 5d, SC 7c.5, SC 7c.7.a, 3f)

Case 11

Its Sunday morning at your patrol camp and you cant wait to get home and hit those school books. One of your younger scouts is heating up some water in a saucepan for some ramen and daydreaming at the same time. You yell at him to pay attention. That only succeeds in startling him and causing him to jostle the overly full pan, splashing near boiling water all over his hands and the front of his shirt. You yell at him some more and rush over to take care of him. Yep. First degree burns on his hands. But its when the scout lifts up his shirt that you get scared. Youre pretty sure thats not a six-pack that you see, but second degree burns instead. How would you know that your scout has first and second degree burns? What first aid would you render? How could this have been prevented? (T12b.3, SC 7c.4, T12b.7, 5f) Go back to the case where you and your friend are playing video games when he has a seizure. What might you have seen that told you that this was a seizure? What first aid should you provide? (5b)

Case 12 Case 13

Youre overseeing some trail maintenance at Mishe Mokwa in the Santa Monica Mountains as part of your Eagle project. One of your more enthusiastic scouts is chopping away at a wooden railroad tie when he yelps, drops his ax, and starts rubbing his right eye. He foolishly neglected to wear eye protection. How can you help him? (SC 7c.1) Case 14 Its a real scorcher at Camp Whitsett, and one your scouts comes to you with his nose in the air and blood streaming from his nose, down his upper lip, and dripping onto his Class A. How can you help? (How long should you hold pressure?) (T 12b.6)

Case 15

One of the adult leaders at your patrol camp takes a swig from a Nalgene bottle. He quickly realizes that hes made a mistake and spits the mouthful out the best he can. Its the bottle he uses to store his white gas for his backpacking stove. How can you help him? (SC 7a.3) One of your shorts-wearing scouts begins complaining of itching around his ankles shortly after a local hike. Of the three most notable poisonous plants, which is the one we see around here? How can you identify this plant? How can you help the scout? (T 11) While on a patrol campout one of your scouts begins complaining of abdominal pain. What should you watch for? What should you do? (5g) A couple of your younger scouts are having a contest to see which one can blow up his sleep pad the fastest. The winner quickly stands up, throws his arms up in the air triumphantly, and proceeds to keel over in a near faint. In a few seconds he slowly stands up and appears to be okay, except for that fact that hes now holding in his hand one of his teeth, roots and all, knocked out cleanly in his fall. You take a look in his now bloody mouth and see that theres another tooth thats badly chipped. Why did your young scout nearly faint? What can you do about his teeth? (SC 7c.7.d, 5h, 5i) Despite your warning one of your scouts takes a shortcut through a grassy meadow during your hike. Later that day he comes to you and points out a tick with his head buried beneath the skin of the scouts ankle. What should you do? (T 12b.4) Youre at New Scout Camp at Castaic Lake. Its night, lights out, and youre just drifting off to sleep when you hear the tent zipper being pulled, someone entering, following by rather noisy rummaging around. You and the two other scouts in your tent sleepily sit up, and one of you switches on a lantern. To your great surprise you find two rather large raccoons ransacking your tent and munching on some corn chips that one of the scouts had forgotten in his backpack. The scout closest to the raccoons

Case 16

Case 17 Case 18

Case 19

Case 20

jumps up in a panic, and one of the raccoons whos even more frightened than the scout takes a bites out of the scouts arm before they both hightail it out of the tent. A spot of blood gleams from the small bite mark on the scouts arm. What should you do? (SC 7c.2)

Case 21 Case 22

Your two most boisterous scouts have wandered off yet again, this time right into the path of a juvenile Western Diamondback. How should you treat this snakebite? (T 12b.5) Its Shinnenkai and youre looking quite snazzy in your Class A. However, one of the guests comes to you and says hes not feeling well and thinks it might be his heart thats bothering him. What might you look for to tell whether or not hes having a heart attack? What should you do if you think it really might be a heart attack? (FC 8.d, 3a.2) Youve done a good job in dealing with one problem at this years Shinnenkai until the paramedics arrive to take over. Youre feeling pretty good about yourself, until another guest rushes over to you and tells you that she thinks her husband is having a stroke. What should you do? (3a.3) Its VJCC Carnival and youre scheduled for your snow cone gig in just a few minutes. Youre in the auditorium, just about to sit down to a plate of teriyaki chicken when one of the guests suddenly stands up from his chicken plate, grabs his neck with both hands, and staggers to you. What do you do? (T 12a) Dinner is over and its nearing the end of the day at patrol camp. Youre trying to relax with a game of cards at the picnic table but the bees are being a bit of a nuisance. Suddenly one of the bees singles out one of your scouts and stings him. The other scouts laugh. Except for you, that is. For you know that the scout who was stung has an allergy to bee stings. Why are you so worried? What protection should the scout have brought along? How can you help? (3e)

Case 23

Case 24

Case 25

2. THE SHOW REQUIREMENTS The show requirements have components whereupon the scout is called to actually do or demonstrate something, instead of simply describing or explaining something. These requirements are:
2d: Prepare a first-aid kit for your home. Display and discuss its contents with your counselor. 3b: Identify the conditions that must exist before performing CPR on a person. Then demonstrate proper technique in performing CPR using a training device approved by your counselor. 3d: Show the steps that need to be taken for someone suffering from a severe cut on the leg and on the wrist. Tell the dangers in the use of a tourniquet and the conditions under which its use is justified. 4a: Describe the signals of a broken bone. Show first-aid procedures for handling fractures (broken bones), including open (compound) fractures of the forearm, wrist, upper leg, and lower leg using improvised materials. 4b: Describe the symptoms and possible complications and demonstrate proper procedures for treating suspected injuries to the head, neck, and back. Explain what measures should be taken to reduce the possibility of further complicating these injuries. 6a: If a sick or an injured person must be moved, tell how you determine the best method. Demonstrate this method. 6b: With helpers under your supervision, improvise a stretcher and move a presumably unconscious person. 6c: With your counselor's approval, arrange a visit with your patrol or troop to an emergency medical facility or through an American Red Cross chapter for a demonstration of how an AED is used.

Below you will find notes on each of these requirements. In addition, Requirement 1 asks that you demonstrate that you have current knowledge of all advancement requirements (Tenderfoot, Second Class, and First Class) pertinent to first aid. Thus you will find comments related to these as well.

First Aid Kits

REQUIREMENT 2D: PREPARE A FIRST-AID KIT FOR YOUR HOME. DISPLAY AND DISCUSS ITS CONTENTS WITH YOUR COUNSELOR.

In addition, merit badge Requirement 1 asks that you have current knowledge of the following related advancement requirement:
REQUIREMENT SC 7B: PREPARE A PERSONAL FIRST AID KIT TO TAKE WITH YOU ON A HIKE.

Keep in mind that there is no single perfect first aid kit. The contents must be selected keeping a number of factors in mind, including the person or person who will be using the kit, the injuries or illnesses targeted, space constraints, and so on. To meet Requirement 2d you must show your home first aid kit and justify its contents. The merit badge book gives the following suggested contents:

Home or Patrol/Troop First-Aid Kit Roller bandage, 2-inch (1) Roller bandage, 1-inch (2) Adhesive tape, 1-inch (1 roll) Alcohol swabs (24) Assorted adhesive bandages (1 box) Elastic bandages, 3-inch-wide (2) Sterile gauze pads, 3-by-3-inch (12) Moleskin, 3-by-6-inch (4) Gel pads for blisters and burns (2 packets) Triple antibiotic ointment (1 tube) Triangular bandages (4) Soap (1 small bar) or alcohol-based hand sanitizing gel (1 travel bottle) Scissors (1 pair) Tweezers (1 pair) Safety pins (12) Nonlatex disposable gloves (6 pairs) Protective goggles/safety glasses (1 pair) CPR breathing barrier (1) Pencil and paper

You must also discuss your personal first aid kit, specifically stocked for a hike. The merit badge book gives suggested contents for a personal first aid kit: Personal First Aid Kit Adhesive bandages (6) Sterile gauze pads, 3-by-3 inch (2) Adhesive tape (1 small roll) Moleskin, 3-by-6-inch (1) Soap (1 small bar) or alcohol-based hand sanitizing gel (1 travel-size bottle) Triple antibiotic ointment (1 small tube) Scissors (1 pair) Nonlatex disposable gloves (1 pair) CPR breathing barrier (1) Pencil and paper

Basic Life Support (CPR)

REQUIREMENT 3B: IDENTIFY THE CONDITIONS THAT MUST EXIST BEFORE PERFORMING CPR ON A PERSON. THEN DEMONSTRATE PROPER TECHNIQUE IN PERFORMING CPR USING A TRAINING DEVICE APPROVED BY YOUR COUNSELOR.

A related merit badge requirements is:

REQUIREMENT 3C: EXPLAIN THE USE OF AN AUTOMATED EXTERNAL DEFIBRILLATOR (AED).

In addition, merit badge Requirement 1 asks that you have current knowledge of the following advancement requirements:
REQUIREMENT SC 7A.1: SHOW WHAT TO DO FOR A HURRY CASE OF STOPPED BREATHING. REQUIREMENT FC 8D: EXPLAIN THE STEPS (PROCEDURES) IN CARDIOPULMONARY RESUSCITATION.

To meet Requirement 3b, plus the relevant part of Requirement 1, you must demonstrate the appropriate assessment of an unconscious patient and the proper performance of CPR using our CPR manikin. The following describes the steps that you must take, and are based on the 2011 American Red Cross First Aid/CPR/AED course. (The procedure described in your merit badge book is based on older guidelines.) In addition, because the AED is now considered a part of basic life support, you must explain the use of an AED (Requirement 3c). Steps for adult basic life support/CPR
1. 2. 3. Check the scene for safety. Check the person for consciousness (tap on the shoulder and shout, Are you okay?). If no response, call or have someone call 911 or the local emergency number. a. If the person is lying face-down, gently roll the person face-up, keeping the head, neck and back in a straight line Open the airway. (Head tilt/chin lift) Quickly check for breathing. Quickly scan for severe bleeding. Give 30 chest compressions. a. Place your hands on the center of the chest, and keep your arms as straight as possible with your shoulders directly over your hands. b. Push hard, push fast. i. Compress the chest at least 2 inches for an adult ii. Compress at a rate of at least 100 times a minute. iii. Let the chest rise completely before pushing down again. Give 2 rescue breaths a. Each rescue breath should last about 1 second and make the chest clearly rise. Repeat steps 7 & 8 for a total of 5 cycles)

4. 5. 6. 7.

8. 9.

Severe Bleeding
REQUIREMENT 3D: SHOW THE STEPS THAT NEED TO BE TAKEN FOR SOMEONE SUFFERING FROM A SEVERE CUT ON THE LEG AND ON THE WRIST. TELL THE DANGERS IN THE USE OF A TOURNIQUET AND THE CONDITIONS UNDER WHICH ITS USE IS JUSTIFIED.

The following advancement requirement is similar to the above:

REQUIREMENT SC 7A.2: SHOW WHAT TO DO FOR A HURRY CASE OF SERIOUS BLEEDING.

In order to meet Requirement 3d you must demonstrate the following steps for bleeding to your merit badge counselor. First Aid Steps for Severe Bleeding
1. 2. Protect yourself and your patient from infection -- put on gloves and goggles. Apply firm direct pressure over the bleeding site using a sterile dressing (or clean cloth) as a pad. Depending on the bleeding source and the size of the wound, you might have to hold pressure for a long time 10-20 minutes or so. Dont let up pressure too soon! If the bleeding is so severe that the pad begins to soak through, add a second pad without letting up on your pressure for more than is necessary. Once the bleeding stops (or at least slows down considerably), maintain pressure by placing a pressure bandage on the wound. To make a pressure bandage, place several additional pads (5-10) on top of the original pads and secure the entire stack of pads with a bandage, such as a roller bandage, an elastic bandage, or a triangular bandage made into a cravat. Periodically check circulation. Numbness/tingling, loss of pink color, or loss of warmth might indicate that the pressure dressing is interfering with circulation and must be loosened.

3. 4.

5.

Keep in mind that common mistakes in controlling severe bleeding are not applying enough pressure and not holding pressure long enough. In addition, you must explain the risks of tourniquet use for severe bleeding and tell when its use might be appropriate. Materials:
Gloves disposable, nonlatex Eye protection e.g., plastic goggles, disposable goggles, safety glasses Dressing material e.g., sterile gauze pads Bandage material e.g., roller bandages, elastic bandages, triangular bandages

Fractures
REQUIREMENT 4A: DESCRIBE THE SIGNALS OF A BROKEN BONE. SHOW FIRST-AID PROCEDURES FOR HANDLING FRACTURES (BROKEN BONES), INCLUDING OPEN (COMPOUND) FRACTURES OF THE FOREARM, WRIST, UPPER LEG, AND LOWER LEG USING IMPROVISED MATERIALS.

In addition, merit badge Requirement 1 asks that you have current knowledge of the following related advancement requirement:
REQUIREMENT FC 8B: DEMONSTRATE BANDAGES FOR A SPRAINED ANKLE AND FOR INJURIES ON THE HEAD, THE UPPER ARM, AND THE COLLARBONE.

To satisfy Requirement 6a (and Requirement 1) you must describe how you might tell that the victim likely has a fracture, and how you would care for someone with a fracture. In addition you must demonstrate splints, slings, and/or swathes for the following fractures:
Collarbone -- Sling & swathe (page 48) Upper arm Splint, sling, & swathe (page 47). (For this injury you can either explain or demonstrate.) Lower arm/wrist -- Splint & sling (page 43 & 48), & possibly swathe Upper leg -- Splint (page 45) Lower leg -- Splint (page 45)

Remember to check periodically for circulation, sensation, and movement (CSM). Specifically, check skin color (it should not be blue) or the quick return of a nice pink color after squeezing and releasing pressure on the nail beds at the tips of the victims finger or toes, ask the victim to report any numbness or tingling or loss of touch sensation, and check the victims ability to wiggle his or her fingers or toes. If CSM is not normal consider this a likely medical emergency. You must also either explain or demonstrate bandaging for an ankle sprain and a head injury.

Head, Neck, and Back Injuries

REQUIREMENT 4B: DESCRIBE THE SYMPTOMS AND POSSIBLE COMPLICATIONS AND DEMONSTRATE PROPER PROCEDURES FOR TREATING SUSPECTED INJURIES TO THE HEAD, NECK, AND BACK. EXPLAIN WHAT MEASURES SHOULD BE TAKEN TO REDUCE THE POSSIBILITY OF FURTHER COMPLICATING THESE INJURIES.

To meet Requirement 4b you must describe what you might see in possible brain and spinal cord injuries, how you might care for such a victim, and then demonstrate how to stabilize a victims head and neck (pages 16, 48-49).

Assists
REQUIREMENT 6A: IF A SICK OR AN INJURED PERSON MUST BE MOVED, TELL HOW YOU DETERMINE THE BEST METHOD. DEMONSTRATE THIS METHOD.

In addition, merit badge Requirement 1 asks that you have current knowledge of the following related advancement requirement:

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REQUIREMENT FC 8C.1: SHOW HOW TO TRANSPORT BY YOURSELF, AND WITH ONE OTHER PERSON, A PERSON FROM A SMOKE-FILLED ROOM. REQUIREMENT FC 8C.2: SHOW HOW TO TRANSPORT BY YOURSELF, AND WITH ONE OTHER PERSON, A PERSON WITH A SPRAINED ANKLE, FOR AT LEAST 25 YARDS.

To meet Requirements 6a and 6b, plus Requirement 1, you must compare and contrast the various single- and multiple-rescuer assists in various scenarios and then demonstrate one of them. Single-Rescuer Assists The following 5 single-rescuer assists are described in the Handbook as part of First Class requirement 8c:
Walking assist (Human crutch, Supporting carry) Ankle drag Shoulder drag (Clothes drag) Blanket drag Pack-strap carry

The following 2 single-rescuer assists are introduced in the merit badge book and require more strength and stamina:
One-person lift (Cradle carry, Arms carry) Firefighter carry

Multiple-Rescuer Assists The following 2 multiple-rescuer assists are described in the Handbook as part of First Class requirement 8c:
Two-handed seat Four-handed seat

The following 3 multiple-rescuer assists are introduced in the merit badge book:
Helping the person walk (Two-person assist, Two-man support carry) Chair carry Hammock carry

Stretchers
REQUIREMENT 6B: WITH HELPERS UNDER YOUR SUPERVISION, IMPROVISE A STRETCHER AND MOVE A PRESUMABLY UNCONSCIOUS PERSON.

You must direct the improvisation of a stretcher and the transport of an unconscious victim. As with multiple-rescuer assists (but perhaps even more so), safe and smooth stretcher transport requires close coordination among those bearing the stretcher. Thus, this is in part a demonstration of leadership.

Improvised Stretchers
Shirt stretcher Blanket stretcher Board stretcher

Automated External Defibrillator (AED) Demonstration

6C: WITH YOUR COUNSELOR'S APPROVAL, ARRANGE A VISIT WITH YOUR PATROL OR TROOP TO AN EMERGENCY MEDICAL FACILITY OR THROUGH AN AMERICAN RED CROSS CHAPTER FOR A DEMONSTRATION OF HOW AN AED IS USED.

Of the Requirements 6a, 6b, and 6c, a scout must choose two out of the three. Requirement 6c is an exercise in logistics and leadership, and has not been chosen very often by scouts. However, it is very doable and valuable. Eventually the AED will become a part of Requirement 3b and will no longer be considered optional.

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3. THE TEACHING REQUIREMENT

REQUIREMENT 7: TEACH ANOTHER SCOUT A FIRST-AID SKILL SELECTED BY YOUR COUNSELOR.

The merit badge program is a means for scouts to explore any of over a hundred subjects, discovering new interests and developing new skills. This is meant to serve the process of finding out who you might become and how you might get there. Finding information by doing research is an integral part of this, and the 12th edition of the Scout Handbook lists several ways to research information, including:
Observing Asking and learning Reading Writing Teaching

The last listed means of researching information teaching is the focus of Requirement 7, the final requirement for the First Aid Merit Badge. Teaching another scout a first aid skill not only helps that scout by sharing what you know, it also helps you become better at that skill. What skill should you teach? Although Requirement 7 says that the skill you teach should be selected by your merit badge counselor, you should be a part of this selection process as well. Think about what skill you would like to teach another scout. Discuss this with your merit badge counselor and the two of you can come to a decision. How should you teach? Described in Chapter 1 of the new Scout Handbook (the 12th edition) is a simple step-by-step system for teaching called the Teaching EDGE model. These 4 steps are as follows:
1. 2. 3. 4. Explain how it is done. Using the example of CPR, you might explain that the scout needs to push hard and fast on the center of the chest. Demonstrate the steps. You might next demonstrate to the scout just how to do chest compressions. Guide learners as they practice. Next you would have the scout do chest compressions while offering him helpful advice to correct any errors and positive reinforcement for the things he does right. Enable them to succeed on their own. Once he has got the hang of things just let him do it on his own.

Use of the EDGE method is now required for advancement to the rank of Life. First Aid merit badge Requirement 7 is a good opportunity for you to use the EDGE method. After you have done teaching the selected first aid skill you should spend a bit of time reflecting on this teaching experience. Sit down with your merit badge counselor and discuss this. Consider the following questions:
1. 2. 3. 4. 5. Which skill did you teach? How did you teach the skill? Did you use the EDGE method, or did you choose to teach another way? Were you successful in getting the scout to learn the skill? How do you know? Would you do anything differently if you had to teach the skill again? Did you yourself learn anything through teaching the skill? If so, what?

The First Aid Merit Badge Book

A favorite way for scouts is to learn first aid is directly from other more experienced scouts. And that is as it should be (see First Aid merit badge requirement 7). However, along with the many gems of good information that get passed from one scout to another, outdated information and outright misinformation tends to get mixed in there as well. That is where the First Aid Merit Badge book comes in. It serves in part as a check against bad first aid information being passed around. Thus, at the risk of simply adding to the amount of stuff that does not get read, the following several pages serve as a merit badge counselors chapter-by-chapter commentary to the First Aid Merit Badge book (2007 edition). Please refer to the following pages as you read the merit badge book. Sometimes they will provide answers to questions that your reading generates. Even better, sometimes they will cause you to think up even more questions about your reading.

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CHAPTER NOTES: INTRODUCTION This first chapter contains no specific knowledge or skills you need to meet the current merit badge requirements. Nevertheless, the contained information is important and should be read carefully and considered seriously. Definition and Goals of First Aid The book starts with a simple definition of first aid and lists three goals of first aid. Can you state the definition and the goals in your own words? Think about what you yourself might get out of working on the first aid merit badge. Yes, it is an Eaglerequired merit badge, and that might be reason enough, but do you personally have any other reasons for wanting to work on this particular merit badge at this time? It might interest you to consider that your most likely first aid victim is you yourself. Yes, what you learn from earning the first aid merit badge could very well help you when you yourself are injured. In addition, what you learn can also help prevent you from getting injured. Rank Requirements The First Aid merit badge builds upon the first aid knowledge and skills you gained while pursuing the Tenderfoot, Second Class, and First Class ranks. Merit badge requirement 1 asks that you convince your merit badge counselor that you have current knowledge of all first aid rank requirements. You will meet this requirement simply by discussing the various rank requirement topics as they come up in the merit badge book, plus presenting and discussing the contents of your personal first aid kit (as described in Second Class rank requirement 6b). Dont be surprised if you gain new insights as you look at these various first aid topics the second time around. This will happen to you time and time again throughout your life. Reducing Risk This short section is new to this edition of the First Aid merit badge book and is material from a chapter in the BSA Fieldbook, the manual for BSA high adventure activities. Most scouts dont pay enough attention to the fact that there is some risk involved in scouting activities. It is sobering for parents to realize that the leading cause of death in your age group is unintentional injuries. Consider that hardly an outing goes by where there is not some injury. These have been minor -- bee stings, jelly fish stings, blisters, nosebleeds, fractured hand, fractured footso far, but the threat of serious injury is always lurking around. This section of the merit badge book lists six things that a scout can do to decrease risk. Are you doing these things? Will you do these things now that you know? It also lists four things that your patrol and your troop should do. Remember them, particularly as you fulfill leadership roles within your patrol and within your troop. Teaching First Aid Merit badge requirement 7 asks that you teach a first aid skill to a fellow scout. Although it is mentioned in this first chapter in general it should be the last requirement you fulfill. As you work through this merit badge book think about what you can teach the scouts under your leadership.

CHAPTER NOTES: HOW TO HANDLE AN EMERGENCY This second chapter presents a step-by-step approach to handling a first aid emergency. This is new to both this edition (2007) of the merit badge book as well as the new (2009) edition of the Boy Scout Handbook, where it is called the First-Aid Method. The First Aid Method The First Aid Method (not named as such in the First Aid merit badge book) is an eight-step system of taking care of things where time is of the essence, so that the right things are done at the right time. The First Aid Method was designed specifically to be used by Scouts. Similar systematic approaches to handling emergencies have been developed for other groups of healthcare providers, such as Community Emergency Response Team (CERT) members or First Responders (FR) or Emergency Medical Technicians (EMT). They are sometimes called Patient Assessment Systems. The eight steps are described in detail in the merit badge book. Here are the eight steps with some comments:
1. 2. Check the Scene This is sometimes called Scene Survey or Scene Sizeup. Call for Help Requirement 2a asks that you know how to call for help in three separate situations home, a wilderness camping trip, and the open water. The merit badge book (2007 edition) now directly addresses these requirements. Although not part of the requirement, at some point you should also learn what to say and do once you contact the 911 dispatcher. Also, you will learn how to signal for help if you pursue the wilderness survival merit badge, and you might learn the proper use of a marine VHF radio to call for help if you get experience with boating. Approach Safely This section contains three parts plus a fourth. The fourth part triage -- is rd Requirement 2b. Its not really part of this 3 step of the First Aid Method, but is related. Provide Urgent Treatment This is sometimes called the Initial Assessment or Primary Assessment. This is where you diagnose and treat what are referred to in the Handbook as hurry cases Such problems are described in detail in the last chapter (Life-Threatening Emergencies) of the merit badge book. Protect from Further Injury This can be harder to accomplish than you might realize. Spinal stabilization, unpretzeling (changing the victims body position to one in which he can be better examined and treated), and extrication (moving the victim away from danger) can be major challenges in protecting the vulnerable victim. Treat Every Accident Victim for Shock This is part of Requirement 3a. Shock is indeed potentially deadly. But please be warned that the authors appear to include acute psychological stress in their definition of shock, which is not really accurate. The subject of shock is actually complex and problematic. Scouts are only asked to have a basic understanding of shock. Make a Thorough Examination This is sometimes called Secondary Assessment, Focused History & Physical Examination, or SAMPLE History & Head-to-Toe Examination. All refer to the more complete evaluation that should be done only after all preceding steps have been addressed. Plan a Course of Action This is where you summarize all the discovered problems plus any anticipated problems and develop plans for dealing with them.

3. 4.

5.

6.

7.

8.

For the purposes of meeting the current merit badge requirements, you need only learn the information relevant to requirements 2a, 2b, and 3a. For the purposes of becoming a competent first aider, you should learn the complete 8-step First Aid Method. Teach it to the younger scouts under your charge, 17

and practice putting it into action at the First Aid Day event, where youre confronted with various first aid scenarios.

CHAPTER NOTES: FIRST-AID SUPPLIES AND SKILLS First Aid Kits What should go into a first aid kit? That depends on a number of factors, including the anticipated injuries and illnesses you wish to treat, the number of people you need to be prepared to treat and any individual needs they might have, what weight and space limitations there are, and so on. Second Class rank requirement 6b had you prepare a personal first aid kit specifically supplied for a hike. Now is a good time to revisit your personal first aid kit. Reconsider its contents, as well as its container. A common mistake is to make a first aid kit that is too big to carry with you. Note that the personal first aid kit described in the merit badge book is designed to fit in a simple resealable plastic bag. First Aid merit badge requirement 2d has you prepare a home first aid kit. In contrast to your personal first aid kit, there are fewer weight and space constraints, in addition to other differences. Note that the section on a home first aid kit also describes a patrol first aid kit, sized to fit into a fanny pack. Does your patrol have its own first aid kit? If not, why not? To meet the requirements for the merit badge please be prepared to show both your personal first aid kit and your home first aid kit, and explain how their size and contents are appropriate to their intended uses. Your kits do not need to be identical to those described in BSA publications but instead should reflect your thoughts on what is appropriate for you and your family. Transport Moving an ill or injured person was one of the considerations introduced in Step 2: Call for Help of the First Aid Method, as described in the How to Handle an Emergency chapter. The current chapter includes a discussion of which patients should and which patients should not be moved. Please remember that such transport is fraught with difficulty and peril, both for the victim as well as for the rescuers. Dont do it unless you have to, particularly in unstable patients. This chapter includes seven single-rescuer assists (including two not described in the Handbook) and five multiple-rescuer assists (including two not described in the Handbook). These can be quite challenging and even dangerous. (Question: For a firefighter carry in an unconscious victim, how would you get the victim over your shoulder? If you have a chance, why dont you ask Mr. Dunleavy?) The chapter also includes three improvised stretchers. If you take a course in wilderness first aid you might learn of other options for litters and stretchers. Requirement 6a includes a demonstration of either a single-rescuer or a multiple-rescuer move, and 6b has you improvise a stretcher. (Note that only two of 6a, b, or c are required.)

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CHAPTER NOTES: MINOR WOUNDS AND INJURIES Bruises This is merit badge requirement 5e. Also known as contusions, the garden variety ones respond to RICE (Rest, Ice, Compression, and Elevation). As it heals over the following several days you might notice it go through gradual color changes, with shades of red, purple, green, yellow, and so on. Bruises can sometimes indicate problems with blood vessels, platelets, or the clotting system. A large and deep contusion can sometimes cause serious problems. Puncture Wounds An embedded fishhook is a typical puncture wound. The First Aid merit badge book describes two techniques for removal, the String-Yank and the Advance-and-Cut (not referred to by those names). There are others. The 11th edition of the Handbook (the one that most of you use) describes only the Advance-and-Cut (not referred to by name), but the new Handbook describes only the String-Yank (not referred to by name), and the new First Aid merit badge book now seems to favor the String-Yank, only suggesting the Advance-and-Cut if the barb is already protruding through the skin. If youre a fisherman you might be familiar with other techniques for removing fishhooks. Note that infection is a big concern in puncture wounds. This is Second Class Requirement 6c. Cuts and Scrapes Cuts are also called lacerations and incisions, and scrapes are called abrasions. We undoubtedly see more of these than we should. Good thing this is a Tenderfoot requirement and not a First Class requirement. It is most important that these wounds be thoroughly cleaned of foreign matter (e.g., dirt, gravel) with large volumes of clean warm or room temperature water, with or without soap. This is Tenderfoot Requirement 12b. Blisters Read closely the preventive measures described. Its better not to have to practice first aid. But if you must, moleskin works well for our needs. Be sure to use it on your hot spots, before they turn into blisters. This is also Tenderfoot requirement 12b. Bloodborne Pathogen Protection This is merit badge requirement 2c. Bloodborne pathogen protection is a long overdue addition to both the Handbook and the merit badge book. (Question: Do you know how to take off dirty gloves without contaminating yourself?)

CHAPTER NOTES: MUSCLE, JOINT, AND BONE INJURIES Muscle Cramps This is merit badge requirement 5j. Muscle cramping can be associated with a lot of medical conditions, but the kind were concerned with here are those that happen when youve been playing or working really hard and long, and your muscles are quite fatigued, such as on a long hike in the hot sun. The muscles in the back of your legs either upper (hamstrings) or lower (calf) are common sites, but many other muscles can be affected. The merit badge book gives several possible treatments, but stretching the muscle is your best bet. For example, if you have a cramp in your calf, extend your leg straight out and grab the tip of your foot and pull it towards you to stretch the calf. Or better yet, have someone help you stretch the muscle. Sprains and Strains This is merit badge requirement 5e (and First Class requirement 8b). Now might be a good time to read again the section on reducing risk in the Introduction chapter, particularly if youre planning on hitting the backcountry. If ligament sprains or muscle/tendon strains happen anyway, remember RICE. Practice stabilizing an ankle sprain with a cravat. Those of you in Sports Medicine, keep up your taping skills. Broken Bones This is merit badge requirement 4a. Weve had at least a couple of these in recent years. Nothing too horrible yet. Note that open fractures and thigh bone fractures should generally be considered true emergencies and the victims should be evacuated. Spend plenty of time practicing your splinting. Dont forget the padding. And dont forget to check circulation and sensation both before and after splinting, and at frequent intervals thereafter. Make some triangular bandages and practice your slings. The second triangle bandage in Step 5, fashioned into a cravat and used to secure the injured extremity, is called a swath (or swathe). Youll need to show your splinting, slinging, and swathing skills for a number of injuries. Head, Neck, and Back Injuries This is merit badge requirement 4b. Perhaps youve heard about the increased focus on the devastating effects of traumatic brain injury (TBI) experienced by many soldiers in battle, or the increased realization that concussion suffered in youth sports can have serious consequences. There is probably no specific first aid treatment, but provide supportive care as described in the merit badge book. For spinal cord injuries (SCI) see Step 5 (Protect From Further Injury) in the How to Handle an Emergency chapter (page 16). The illustration demonstrates in-line manual stabilization of the cervical spine. It 21

might not look so hard in the photo, but in practice it can prove very difficult or impossible to achieve and maintain stabilization. Imagine yourself trying to maintain that position for more than a couple of minutes with a disoriented victim who is thrashing around.

CHAPTER NOTES: COLD- AND HEAT-RELATED CONDITIONS AND INJURIES Those Scouts who have earned the Wilderness Survival merit badge know that protecting oneself against things that want to make one too hot or too cold is key to living to see another day. Even in Southern California. Hypothermia This is merit badge requirement 5a (and Second Class requirement 7c). The onset of hypothermia can be insidious. If youre leading your patrol on an outing where theyre subject to the cold (e.g., snowboarding, swimming) and one of your scouts starts acting really odd, think hypothermia. Better yet, as a leader dont let them get into situations where they might become hypothermic. Frostbite This is merit badge requirement 5c (and Second Class requirement 7c). Perhaps youve heard the stories of climbers conquering Everest but losing digits (fingers or toes) or limbs (hands, feet, arms, legs) to frostbite. And sometimes they consider themselves lucky for not losing more (e.g., their life). Be prepared! Did you know that you can cause frostbite if in applying RICE (for say an ankle sprain) you leave ice directly against the skin for too long a period? Beware! Dehydration This is merit badge requirement 5d (and Second Class requirement 7c). You might have been in the neighborhood of 70% water when you were a baby, but youre probably closer to 60% now, despite what the merit badge book says. All quibbling about numbers aside, you do need to consider the possibility of dehydration in a number of situations, such as on a troop hike in the hot weather, in a scout with gastrointestinal illness at camp with vomiting or diarrhea, or in a patrol on a high altitude trek. Heat Exhaustion If it happens to be a hot day at Circle X, be wary of heat exhaustion during the hike. Adequate attention paid to hydration will help stave off heat exhaustion, but nevertheless if its hot and your scouts are working hard their temperatures will rise. This is Second Class requirement 7c. Heatstroke This is requirement 3f (and Second Class requirement 7c). OK. Youve passed the point and your bodys defenses against heat have been overwhelmed. Welcome to heatstroke, a true emergency. This calls for immediate cooling maneuvers. Act fast!

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CHAPTER NOTES: BURNS This is merit badge requirement 5f. How hot is that pot of boiling water on the camp stove? 212 degrees Fahrenheit, if youre at sea level. How hot is that pot of boiling oil that youre using to make doughnut holes or dangos? Around twice as hot -- about 400 degrees. And how about that campfire? Really hot! Perhaps around 1000 degrees. Superficial (First-Degree) Burns Dissipate the heat with cold water until pain is relieved. Fast! This is Tenderfoot requirement 12b. Partial Thickness (Second-Degree) Burns A camp stove accident resulting in a scalding burn is one of the more common serious wilderness injuries. Blistering might not happen right away. Such injuries are typically partial thickness but can be worse. Leave any blisters intact and cover them with a sterile dressing. Partial thickness burns can be superficial, with return to normal after a few weeks, or deep, perhaps with scarring and permanent disability. This is Second Class requirement 7c. Full-Thickness (Third-Degree Burns) If a water heater is set to a high enough temperature (e.g., 140-150 degrees) it can cause a full thickness burn in a few seconds. Now take another look at those temperatures mentioned at the beginning above. Big trouble! Chemical Burns At camp we often add a little household bleach (sodium or calcium hypochlorite) to one of our dishwashing basins as a disinfectant. As chemicals go, household bleach is fairly weak, but it can still cause burns. Electrical Burns These are in essence high intensity heat burns. As described in the merit badge book, an electric shock (such as a lightning strike) can cause cardiac arrest, in addition to the burn injury. It is vital that you ensure that the electrical power is off before you render first aid. Dont make yourself a second victim! Sunburn You learned about sunburn a long time ago, when you were working on your Tenderfoot advancement requirements (12b). Nevertheless, it bears mentioning again that sun exposure has a definite downside, and protective measures (hat, long sleeves and pants, and sunscreen) are in order. If your scouts dont heed that advice regularly the pain of sunburn could be the least of their problems.

CHAPTER NOTES: OTHER FIRST-AID CASES This is the biggest chapter and includes a number of related and unrelated maladies. Fainting A simple faint (the technical term is vasovagal syncope) is a temporary failure of the circulatory system to maintain adequate blood flow to the brain. It is self-limited in that the act of fainting itself tends to bring the body to a horizontal position and increase blood flow to the brain. Make sure the person didnt get hurt in falling down. Remember Step 7 (Make a Thorough Examination) of the First Aid Method. And dont forget to wonder why the person suffered a temporary loss of responsiveness. Is this more than a simple faint? Hyperventilation This is actually a somewhat complex topic and requires some knowledge of acid-base physiology and respiratory control to understand. The bottom line is that hyperventilation (breathing deeper and faster than usual) could respond to simple calming measures, but could also be secondary to serious disorders. Hyperventilation is Second Class requirement 7c. (Note: Pay heed to the books warning regarding intentional hyperventilation. It will certainly allow you to hold your breath underwater longer, but it could cause you to drown a phenomenon called shallow water blackout.) Loss of Consciousness Look back at the How to Handle an Emergency chapter, Step 4: Provide Emergency Treatment. One of the first things a first-aider does in a potentially life-threatening emergency is check for level of responsiveness (level of consciousness). This could be a hurry case. See the Life-Threatening Emergencies chapter. Seizures This is merit badge requirement 5b. To the uninitiated observer, a seizure can be a frightening thing to behold. Take simple measures to protect the person from getting hurt during the seizure. Follow the 8 steps outlined in your book. Recovery Position Its neither a merit badge nor a rank requirement, but placing a person in the recovery position would be a good skill to practice and then teach to the Scouts in your patrol. Diabetes Dont forget to ask if the person has eaten today, or has taken any insulin today. Also, if you have a diabetic whose unconsciousness youve assumed is due to low blood sugar, you might still be able to get some sugar to the brain by slipping a few crystals of sugar under the tongue at a time and let it dissolve and absorb. Foreign Object in the Eye Your eyes are precious and vulnerable. Protect them! This is Second Class requirement 7c. 25

Nosebleeds Several minutes of direct pressure, applied by simply pinching the nose, is still your best bet for garden variety nosebleeds. The most common mistake scouts seem to make is just not holding pressure long enough before checking to see if its still bleeding. Use your watch to time yourself. You also need to make sure youre pressing on the correct part of your nose. Pressure generally should be on the entire soft part of your nose. Applying pressure to the upper lip, as described in the merit badge book, might also help by stopping or slowing the blood flow from one of the arteries that might be leading to the site of bleeding. This is Tenderfoot requirement 12b. Internal Poisoning Although included in this chapter and not the next (Life-Threatening Emergencies), poisoning can still be very much a hurry case. Do you know how to contact the Poison Control Center? And forget about using milk or water or activated charcoal or ipecac syrup, unless the Poison Control Center tells you otherwise. This is Second Class requirement 7a. Poisonous Plants Here in Southern California we generally need to worry about only one of the three plants described. Do you know which one it is? Can you recognize it, no matter which season? Youll have plenty of opportunity to spot it on our hikes and campouts. This is Tenderfoot requirement 11. Abdominal Pain This is merit badge requirement 5g. The book understandably chooses to focus on appendicitis, but there are a lot of things in the abdomen hollow organs (stomach, small intestine, large intestine, gall bladder), solid organs (liver, kidney, pancreas, spleen), and dont forget the abdominal lining the peritoneum. All can get into big trouble. Later on, as you learn anatomy and physiology, think about how such knowledge can enrich your first aid skills. Less urgent but more common than appendicitis on campouts and other such activities is acute infectious diarrhea, which is largely preventable with proper attention to handwashing and other hygiene measures. Dental Injuries This is merit badge requirement 5h and 5i. A big but common mistake is to scrub a knocked-out tooth clean. Dont. Instead, follow the steps outlined in your book.

Bites and Stings On some of our outings you might have close encounters with ticks, some of which carry one disease or another. Prevent getting one of those diseases by protecting yourself appropriately, inspecting yourself regularly, and promptly and properly removing any found ticks. Note what the book says not to do to remove a tick. Also, note that the book doesnt say anything about smearing Vaseline or peanut butter on an embedded tick. Thats no longer considered the appropriate thing to do. Our own widow spider in California is the Western black widow or Western widow (Latrodectus hesperus). Stay away, even if you think youre Peter Parker. The brown recluse (Loxosceles recluse) is not found around here. We do have its somewhat less dangerous relative, the desert recluse (Loxosceles deserta). You probably wont see a violin on that one. Look instead for the three sets of eyes that all recluses have -- if you dare. The Red Imported Fire Ant or RIFA (Solenopsis invicta) invaded California just over 10 years ago. They are different from our native ants (including the Southern Fire Ant) and are deadly for the reasons described in the book. When youre at Camp Whitsett watch out for whitish fuzzy Velvet Ants (Mutilla sackeni). It is said that their sting is quite painful. Regarding bee stings, there is evidence that its not as important how you get the stinger out, but that you get it out as quickly as possible. In other words, if its quicker to just pick the stinger out with your fingers or just flick it out, do that instead of taking the time to get a knife or your dads credit card to scrape it out. (Besides, youve probably abused that credit card enough already.) And dont forget about the possibility of anaphylaxis (see the Life-Threatening Emergencies chapter). Regarding mammals, yes, that raccoon is indeed amusingly clever. But keep your distance! We dont have coral snakes or other elapids (members of the snake family Elapidae, which also includes cobras and mambas) here in Southern California, but watch out for them if we ever travel to places like Arizona, Texas, or the southeastern United States. Here in California we have plenty of encounters with rattlesnakes (family Viperidae, subfamily Crotalinae). There are six species of rattlesnakes in Southern California. The Southern Pacific Rattlesnake (Crotalus oreganus helleri) is responsible for most rattlesnake bites in our area, but the smaller Mojave Rattlesnake (Crotalus scutulatus scutulatus) is deadlier. When were at Camp Whitsett its the Northern Pacific Rattlesnake (Crotalus oreganus oreganus) that were most likely to spot. Whichever rattlesnake it is, go through the 5 steps for snakebite first aid outlined in your book (and dont forget to use the 8 steps of the First Aid Method, described in the How to Handle an Emergency chapter). Step 1 is the most important one -- evacuate the victim to medical care ASAP so that he can be evaluated for possible antivenin treatment. (Note: Recently (2010) published first aid guidelines advocate pressure immobilization for rattlesnake bites, as described in Step 3 for coral snake bites. However, not everybody agrees with this recommendation.) Troop 764 does have some unpleasant experience with another kind of sting thats not mentioned in the merit badge book jellyfish! Although it is currently not a serious health problem in Southern California, 27

we nevertheless get hit from time to time with jellyfish swarms. One of those times was in 2009 at the troops Family Camping Trip in Carlsbad near San Diego. Current treatment for most jellyfish stings is to inactivate the stingers by bathing the area with vinegar for 30 seconds and then relieving the pain with a bath or shower using water as hot as the victim can stand for at least 20 minutes. This is Tenderfoot requirement 12b, Second Class requirement 7c, and (again) Tenderfoot requirement 12b.

CHAPTER NOTES: LIFE-THREATENING EMERGENCIES Remember hurry cases? A-B-C-D This is merit badge requirement 3b, 3c, and 6c (as well as Second Class requirement 7a and First Class requirement 8d). This section concerns CPR (cardiopulmonary resuscitation). However, the description of CPR in your merit badge book is no longer consistent with current recommendations. In fact, it is likely that the next edition of this merit badge book will not use A-B-C-D to describe the proper sequence of steps for CPR. Please see page 9, Steps for Adult Basic Life Support/CPR, for the current (2010) recommendation. Heart Attack This is merit badge requirement 3a (and First Class requirement 8d). Prompt recognition of a heart attack and prompt alerting of the emergency response system is the key. Now in many cases the damaging effects of a heart attack can be largely stopped, if that person gets emergency medical care in time. (If you take more advanced first aid courses it is likely that you will be instructed to give an aspirin in cases of heart attack, unless there are contraindications, such as an aspirin allergy or a bleeding disorder.) Stroke This is merit badge requirement 3a. As with a heart attack, prompt medical care can be effective in lessening the severity of certain types of stroke. Choking As with CPR (above), the merit badge book describes the American Red Cross approach to treating a choking victim. In contrast, the American Heart Association omits back blows and goes straight to abdominal thrusts, even though back blows can be effective in some cases. For the purposes of the merit badge, stick with the protocol as described in your book. This is Tenderfoot requirement 12a. Severe Bleeding This is merit badge requirement 3d (and Second Class requirement 7a). Direct pressure pressure applied directly on the site of bleeding is key to stopping most bleeding. How about pressure points and elevation? It might surprise you to hear that neither is recommended in first aid any longer. Pressure points require a bit more familiarity with anatomy than a first-aider typically has (even a scout), and although the technique can be very useful in certain situations and when properly applied, it is generally not as useful as direct pressure, and can even make the bleeding worse when misapplied. Elevation is not likely to have an appreciable effect on severe bleeding and in 29

certain situations can actually lead to serious complications. In addition, in a typical first aid situation either is likely to interfere with or distract one from providing effective direct pressure. For further information see the segment on severe bleeding in the show requirements section earlier in this document. Tourniquets This is also part of merit badge requirement 3d. To reiterate, direct pressure is the way to go for bleeding. But in certain cases, such as major trauma to arms or legs, a tourniquet can be lifesaving. Anaphylactic Shock (Anaphylaxis) This is merit badge requirement 3e. This is the immune system gone amuck. If you have a scout with a known severe allergy (to, e.g., bee stings, peanuts, and so on) he should carry an epinephrine auto-injector (e.g., EpiPen, TwinJect) with him when he goes on any scout activity. As a first-aider you are not expected to administer epinephrine, but you might be able to provide some assistance to the victim so that he can inject himself. If you take the American Red Cross Wilderness and Remote First Aid course you will receive some hands-on instruction on the use of an epinephrine auto-injector. Please note both that anaphylaxis is potentially deadly, and also that epinephrine is not a harmless medication. Seek medical assistance as soon as possible!

CHAPTER NOTES: FIRST-AID RESOURCES Scouting Literature There is a lot more first aid in scouting than just this merit badge. By now youve probably noticed that several merit badges include first aid in their requirements (e.g., Hiking, Lifesaving) or consist of material that is complementary to the First Aid merit badge (e.g., Dentistry, Safety). If youre looking for a first aid book thats a bit more complete than the merit badge book and a bit better as a quick look-up reference, consider BSAs Be Prepared: First Aid, published by DorlingKindersley. In addition, its very nicely illustrated. In addition, BSAs Basic Illustrated Wilderness First Aid is part of a well-known series with a well-known author (William Forgey) and clocks in at under 100 pages at about a penny a page. Books Because new discoveries continue to be made, several of the books listed are already out in updated editions. One of them Wilderness First Aid: Emergency Care for Remote Locations, by Howard Backer, et al, is now out in third edition (2008), is well over 300 pages, is well-illustrated (although a bit gruesome at times for the uninitiated), and could be a good fit for more senior scouts interested in high adventure. If you want more depth, there is the current Schimelpfenig book (now titled NOLS Wilderness Medicine) or the new edition of the Outward Bound Wilderness First-Aid Handbook. For even more, go to the Wilderness Medical Associates books (e.g., Wilderness and Rescue Medicine) or one of Paul Auerbachs books (e.g., Medicine for the Outdoors: The Essential Guide to First Aid and Medical Emergencies). Organizations and Web Sites The First Aid merit badge book lists a number of organizations related to first aid. There are many more. As an example, organizations offering wilderness first aid and wilderness medicine training include Stonehearth Open Learning Opportunities (SOLO), the National Outdoor Leadership School (NOLS), the Wilderness Medical Associates (WMA). All have websites. The Troop 764 website has a selected collection of web site hyperlinks devoted to first aid: http://www.troop764.com/taxonomy/term/1116 There are many more.

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Where to go from here

If youre reading this you have probably met all the First Aid merit badge requirements and are just a step or two away from being awarded the merit badge. Congratulations! Dont forget to turn in your completed Blue Card to the Advancement Committee. You are undoubtedly much smarter about first aid than when you started. You now have a solid base of first aid knowledge and skills. And yet you might be wondering where you should be going from here There is good news -- learning never stops! In coming years you will learn about biology, anatomy, physiology, and the world in general. Virtually everything you will learn has the potential to enrich your knowledge and understanding of first aid. Besides that, there are a number of specific ways a scout can advance his first aid knowledge and skills. Here are a few:
Lead your patrol at First Aid Day. You have likely already participated in Troop 764s First Aid Day, where patrols put their first aid skills to the test in simulated scenarios of gore and mayhem, compliments of the Senior Patrol. However, when you become Patrol Leader you will find that your role changes from an individual first-aider to a team leader. Instead of being the one actually providing direct pressure or chest compressions or doing the splinting, instead you will prepare your patrol for the event by making sure they know their stuff and then whipping them into shape so that they function as a team. Then at the First Aid Day event you will lead your patrol, keeping your focus on the big picture and coordinating your patrols actions. You will need to be both cheerleader and taskmaster. If you have done a good job of preparing your patrol you will only rarely have to provide hands-on first aid yourself at First Aid Day. Take a CPR course. A number of organizations (including American Red Cross, American Heart Association, among others) offer certification courses in CPR or Basic Life Support. You already know the basics of resuscitation so such courses would be a natural extension. Plan on taking such courses at least every two years. Take a Wilderness First Aid course. Recently the Boy Scouts of America developed a wilderness first aid curriculum, and subsequently both the American Red Cross and the Emergency Care and Safety Institute developed wilderness first aid courses based on that curriculum. Become an American Red Cross Instructor. As you have learned, teaching is not only a way to help your community, it is a way for you to build upon and solidify your own knowledge and skills.

If you continue to maintain your interest after you turn 18 and are no longer a boy scout, you might consider getting further training as a member of your local Community Emergency Response Team (CERT) or as a First Responder (e.g., through the National Safety Council). Who knows? You might just end up with a career in emergency medical services or disaster preparedness and response!

Appendix

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REQUIREMENTS BY CHAPTER The order of the First Aid merit badge requirements does not correlated with the order of topics in the First Aid merit badge book. The following takes all first aid rank and merit badge (bold) requirements and sorts them by merit badge book chapter. Introduction
7: Teach another Scout a first-aid skill selected by your counselor.

How to Handle an Emergency

2a: Explain how you would obtain emergency medical assistance from your home, on a wilderness camping trip, and during an activity on open water. 2b: Explain the term triage. SC 7c.6: Demonstrate first aid for shock. 3a.1: Explain what action you should take for someone who shows signals of shock.

First-Aid Supplies and Skills

SC 7b: Prepare a personal first aid kit to take with you on a hike. 2d: Prepare a first-aid kit for your home. Display and discuss its contents with your counselor. 6a: If a sick or an injured person must be moved, tell how you determine the best method. Demonstrate this method. 6b: With helpers under your supervision, improvise a stretcher and move a presumably unconscious person. FC 8c.1: Show how to transport by yourself, and with one other person, a person from a smoke-filled room FC 8c.2: Show how to transport by yourself, and with one other person, a person with a sprained ankle, for at least 25 yards.

Minor Wounds and Injuries

5e.1: Describe the symptoms, proper first-aid procedures, and possible prevention measures for bruises. SC 7c.3: Demonstrate first aid for puncture wounds from a splinter, nail, and fishhook. T 12b.1: Show first aid for simple cuts and scrapes. T 12b.2: Show first aid for blisters on the hand and foot. 2c: Explain the standard precautions as applied to bloodborne pathogens.

Muscle, Joint, and Bone Injuries

5j: Describe the symptoms, proper first-aid procedures, and possible prevention measures for muscle cramps 5e.2: Describe the symptoms, proper first-aid procedures, and possible prevention measures for strains. 5e.3: Describe the symptoms, proper first-aid procedures, and possible prevention measures for sprains.

FC 8b: Demonstrate bandages for a sprained ankle and for injuries on the head, the upper arm, and the collarbone. 4a: Describe the signals of a broken bone. Show first-aid procedures for handling fractures (broken bones), including open (compound) fractures of the forearm, wrist, upper leg, and lower leg using improvised materials. 4b: Describe the symptoms and possible complications and demonstrate proper procedures for treating suspected injuries to the head, neck, and back. Explain what measures should be taken to reduce the possibility of further complicating these injuries.

Cold- and Heat-Related Conditions and Injuries

SC 7c.7.c: Demonstrate first aid for hypothermia. 5a: Describe the symptoms, proper first-aid procedures, and possible prevention measures for hypothermia. T 12b.7: Show first aid for frostbite. 5c: Describe the symptoms, proper first-aid procedures, and possible prevention measures for frostbite. SC 7c.7.b: Demonstrate first aid for dehydration. 5d: Describe the symptoms, proper first-aid procedures, and possible prevention measures for dehydration. SC 7c.5: Demonstrate first aid for heat exhaustion. SC 7c.7.a: Demonstrate first aid for heatstroke. 3f: Explain the symptoms of heatstroke and what action should be taken for first aid and for prevention.

Burns
T12b.3: Show first aid for minor (thermal/heat) burns or scalds (superficial, or first-degree). SC 7c.4: Demonstrate first aid for serious burns (partial thickness, or second-degree). T12b.7: Show first aid for sunburn. 5f: Describe the symptoms, proper first-aid procedures, and possible prevention measures for burns.

Other First-Aid Cases

SC 7c.7.d: Demonstrate first aid for hyperventilation. 5b: Describe the symptoms, proper first-aid procedures, and possible prevention measures for convulsions/seizures. SC 7c.1: Demonstrate first aid for object in the eye. T12b.6: Show first aid for a nosebleed. SC 7a.3: Show what to do for a hurry case of ingested poisoning. T11: Identify local poisonous plants; tell how to treat for exposure to them. 5g: Describe the symptoms, proper first-aid procedures, and possible prevention measures for abdominal pain. 5h: Describe the symptoms, proper first-aid procedures, and possible prevention measures for a broken, chipped, or loosened tooth. 5i: Describe the symptoms, proper first-aid procedures, and possible prevention measures for a knocked out tooth.

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T12b.4: Show first aid for bites or stings of insects and ticks. SC 7c.2: Demonstrate first aid for bite of a suspected rabid animal. T12b.5: Show first aid for a venomous snakebite.

Life-Threatening Emergencies
SC 7a.1: Show what to do for a hurry case of stopped breathing. FC 8d: Explain the steps (procedures) in cardiopulmonary resuscitation (CPR). 3b: Identify the conditions that must exist before performing CPR on a person. Then demonstrate proper technique in performing CPR using a training device approved by your counselor. 3c: Explain the use of an automated external defibrillator (AED). 6c: With your counselor's approval, arrange a visit with your patrol or troop to an emergency medical facility or through an American Red Cross chapter for a demonstration of how an AED is used. FC 8d: Tell the five most common signals of a heart attack. 3a.2: Explain what action you should take for someone who shows signals of a heart attack. 3a.3: Explain what action you should take for someone who shows signals of a stroke. T12a: Demonstrate how to care for someone who is choking. SC 7a.2: Show what to do for a hurry case of serious bleeding. 3d: Show the steps that need to be taken for someone suffering from a severe cut on the leg and on the wrist. Tell the dangers in the use of a tourniquet and the conditions under which its use is justified. 3e: Explain when a bee sting could be life threatening and what action should be taken for prevention and for first aid.