Articles for OR Pros in the latest Wilderness & Environmental Medicine Vol. 23, No. 4 Winter 2012
Posted: December 27, 2012 Filed under: First Aid, Medical | Tags: #HAPE, Accute Mountain Sickness, Altitude Illness, Altitude sickness, AMS, Autoinjector, Epinephrine, Ibuprofen, Wilderness Medical Society, WMS Leave a comment »There are several critical articles here for OR Pros!
· Editorial: Does Ibuprofen Prevent Acute Mountain Sickness
· Altitude Sickness in Climbers and Efficacy of NSAID’s Trial (ASCENT):
· Placebo for Prevention of Altitude Illness
· Predictive Value of Basal Exhaled Nitric Oxide and Carbon Monoxide for Acute Mountain Sickness
· Wilderness Medical Society Practice Guidelines for Treatment of Eye Injuries and Illnesses in the Wilderness
· Use of Human Remains Detection for Dogs for Wide Area Search after Wildfire:
· Fifty-Three Hours of Total Sleep Deprivation has no Effect on Rewarming from Cold Air Exposure
· Injury and Illness in Mountain Bike Stage Racing:
· Letters to the Editor:
· Epinephrine Autoinjector Warning
· Using the 6-Minute Walk Test for Screening Summit Success on Mount Aconcagua
· Assessing Travelers’ Knowledge and Use of Coca for Altitude Sickness
· Possible Association with Amphetamine Usage and Development of High Altitude Pulmonary Edema
You can become a member of the Wilderness Medical Society by going HERE. Sign up today and learn for the rest of the year. Be on the knowledgeable end of wilderness medicine and able to offer your clients the latest in prevention and first aid.
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Online Heart Rescue Simulator
Posted: July 10, 2012 Filed under: First Aid | Tags: AED, Cardiac Arrest, Cardiopulmonary resuscitation, CPR, first aid Leave a comment »You can use this to learn to save a life or to test others in how they would respond.
Heart Rescue Project has created this internet based simulator to teach people how to respond to someone in a cardiac crisis. Click on the link and follow the instructions. It is pretty Amazing!
Click Here!
What do you think? Leave a comment.
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Latest edition of the WMS Wilderness & Environmental Medicine Journal is out.
Posted: April 5, 2012 Filed under: First Aid, Journal, Medical, Wilderness Medical Society (WMS) | Tags: #Edema, #HAPE, #Nifedipine, Altitude, AltitudeSickness, health, High Altitude Pulmonary Edema, Journal, Medicine, Wilderness Medical Society, WMS Leave a comment »If you work in the Outdoor Industry, you should be a member of the WMS.
The Articles in the Volume 23, Number 1, Spring 2012 edition of the Wilderness Medical Society (WMS) journal are great!
· Nifedipine for the Treatment of High Altitude Pulmonary Edema
· Background Rates of Acute Mountain Sickness-Like Symptoms at Low Altitude in Adolescents Using Lake Louise Score
· Peripheral Arterial Desaturation is Further Exacerbated by Exercise Adolescents with Acute Mountain Sickness
· Recombinant Angiotension-Converting Enzyme 2 Suppresses Pulmonary Vasoconstriction in Acute Hypoxia
· Physiological Bone Responses in the Fingers after More than 10 Years of High-Level Sport Climbing: Analysis of Cortical Parameters
· Medical Direction of Wilderness and Other Operational Emergency Medical Services Programs
· Novel Use of a Hemostatic Dressing in the Management of a Bleeding Leech Bite: A Case Report and Review of the Literature
· Wolf Spider Envenomation
· Managing Anaphylaxis in a Jungle Environment
· Increasing Creating Kinase Concentrations at the 161-km Western States Endurance Run
· Improvised Traction Splints: A Wilderness Medicine Tool or Hindrance?
· Animal-related Motorcycle Collisions in North Dakota
You are going to get great information by reading the newsletter, website and journal of the WMS. More importantly, I find the information is just as critical in telling you what not to do.
You can become a member of the WMS by going here. Sign up today and learn for the rest of the year.
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WMS Trailblazer – January 2012
Posted: January 17, 2012 Filed under: First Aid, Utah, Wilderness Medical Society (WMS) | Tags: Conference, first aid, Medical, Physcian, Recreation, Wilderness Medical Society (WMS), WMS Leave a comment »[Wilderness Medical Society (WMS) Updates]
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Leading the worldwide community of Wilderness Medicine
February 4-8, 2012
If you are a physician, spend part of spring on Mt Everest learning!
Posted: October 14, 2011 Filed under: First Aid Leave a comment »| Having trouble viewing this email? Click here |
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 The Wilderness Medical Society and our prestigious Nepal partner, Peak Promotion, invite you to join us for the ultimate CME* adventure during the April-May 2012 climbing season. Together, we are able to offer you a well-priced, educational, all encompassing Khumbu Valley-Everest experience! We’re rolling out this advanced notice now so you can plan ahead for this active CME adventure! Everyone welcome! All who participate in this WMS experience are required to join or be members of the WMS. Also, every participant must carry Evacuation and Medical coverage. Due to the on-going demand for “adventure and hands-on” wilderness medicine training and experience, the WMS has put together this world-class program. This course offers the opportunity for continuing medical education while on an Everest base camp (EBC) trek, plus for those more climbing oriented, we offer a Camp 2, Camp 4 or full summit opportunity. WMS CME credit is available from Kathmandu to Everest base camp, and we are planning on two nights at EBC (not normally offered for Everest treks) in cooperation with Everest ER.
Contact person: |
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| Visit the WMS website wms.org/conferences/everest12 for details, complete schedule and cost breakdown. | ||||||||||||||||||||
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Seriously, you have to send a memo about this, the issue is not what they are doing, it is who you are allowing to instruct.
Posted: October 4, 2011 Filed under: First Aid Leave a comment »To: All OEC Instructors
From: Nat OEC Program Director
Subject: Training Practices
Date: 9/19/11
It has been brought to my attention that during some of the refreshers Being held this year, individuals are being injured as a result of two much enthusiasm being projected during practical exercises. This is not acceptable. We need to insure that during the practical exercises, the students demonstrate that they know how to perform the skills but not to the extent that their volunteer patients sustain real life injuries.
A few examples would be:
Don’t perform real CPR on a pretend patient
Don’t tighten a tourniquet on a pretend patient
Don’t apply tension when demonstrating the Posterior SV dislocation reduction on a pretend patient.
Don’t apply traction when applying a traction splint on a pretend patient.
Don’t apply AED pads to a pretend patient.
Don’t give an Epi pen to a pretend patient.
I know these appear to be common sense but again we have already had some complaints of injuries during refresher training this year. It is incumbent on you as the OEC Instructor to insure safety for your patrollers during this training.
Thanks for your cooperation.
Besides, you are teaching illegal acts if you are teaching EPI use. See 10 First Aid Myths
What do you think? Leave a comment.
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Everyone should write first aid protocols…. Or you could just buy a first aid book!
Posted: May 11, 2011 Filed under: Editorial, First Aid Leave a comment »Why does everyone in the outdoor industry continuously want to reinvent the wheel?
I received an email asking if they should write first aid protocols for the program. I answered no; it is a violation of someone’s copyright!
Everything you need has been written down by someone, why start from scratch. There are dozens of books on Amazon, that talk/teach/explain first aid. Don’t write first aid rules, buy a book. Buy several books and hand them out to your staff.
The books are written correctly most of the time and don’t violate the law, most protocols, I’ve seen if they do not violate the law, they march through the gray area.
On top of that remember, there are no first aid protocols in most states, unless you are a licensed health care provider, and in communication with a physician. Protocols do not exist, unless you are licensed and have no legal or medical value.
See: Letter to the editor: Camp Business to understand the first aid protocols issue.
What do you think? Leave a comment.
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Wilderness Medicine Journal for spring 2011 has some great articles you should know about
Posted: April 29, 2011 Filed under: First Aid, Wilderness Medical Society (WMS) Leave a comment »If you are in the outdoor industry you should be a member of the WMS.
The Wilderness Medical Society (WMS) Journal for Spring 2011 is available. Some of the articles include:
How Deep is your wallet? Dealing with injury, illness or death abroad
All Aboard! Cheap Options for Travel
10 Tips for Enjoying Tempting Food in Exotic Countries and Not Regretting it Later.
Call to Action/Response/Do Something
Read now and Join Now.
What do you think? Leave a comment.
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Stopping a rescue when someone is willing to perform may create liability
Posted: April 25, 2011 Filed under: Case Analysis, First Aid Leave a comment »Barnes v. Dungan et al., 261 A.D.2d 797; 690 N.Y.S.2d 338; 1999 N.Y. App. Div. LEXIS 5556
Supervisor prevented an employee from performing CPR on co-employee having a heart attack.
This is an odd and disturbing case. On top of that we never really learn all the facts. The appellate Court opinion stated the following facts.
An employee of the defendant Peace Plantation Animal Sanctuary suffered a heart attack while working. Another employee who was certified in CPR responded and offered to perform CPR. The responding employee’s supervisor, the defendant Dungan prevented her from performing CPR. The employee suffering the heart attack died.
The surviving spouse of the deceased sued Dungan, Peace Plantation Animal Sanctuary and the National Humane Education Society over the death of his wife. The last two defendants were never clearly articulated as to their relationship with the Peace Plantation, but appear to be associations affiliated somehow with the defendant plantation. The lawsuit was based on a claim of intentional interference with lifesaving medical assistance. The theory was if the CPR has been performed the decedent would still be alive.
The defendants filed a motion to dismiss claiming:
“no legal duty existed which required them to render emergency medical assistance; that workers’ compensation provided the exclusive remedy for decedent’s injuries…”
The trial court denied the motions to dismiss and the issues were immediately appealed. The appellate court looked at the issues and based its decision supporting the trial court on two issues.
The first was the Restatement Second of Torts §326 which states:
One who intentionally prevents a third person from giving to another aid necessary to prevent physical harm to him, is subject to liability for physical harm caused to the other by the absence of the aid which he has prevented the third person from giving
The second is a decision from Idaho, Riggs v Colis (107 Idaho 1028, 695 P2d 413) which held that for a viable claim to be proved there must be three people: “the victim, a rescuer, and on
e who prevents or interferes with the rescuer–and the aid must have been actually prevented.”
The court applying the Restatement and the analysis of Riggs, id., that the three “parties” were present and the rescue was denied.
The court sent the case back to the lower court for trial.
So?
None of the cases quoted by the court in this case had the clear facts which allow such an easy analysis. However, after reading the case, you are dying to find out what happened after the case was sent back. The case also is just disturbing to people who have continually trained and studied to render aid such as the people working in the outdoor recreation community.
Now we will never find out why the defendant Dungan prevented the rescue.
However, it is easy and clear that if you prevent someone from offering or rendering first aid, without a valid reason, you may be liable.
This case will not apply for lapses in time to survey the scene or to stabilize the scene. Valid arguments on why rescue was delayed or not provided should always protect the rescuer. The issue will be if someone has the skills to save someone and those skills are prevented from being used by another person.
This is very different from the issue that there is no duty to rescue. Unless you placed the victim in the peril from which the victim now needs rescued, there is no duty to rescue anyone. This is a basic tenant of US law and has been this way for centuries. Even a physician or EMT is allowed to drive past a car accident with no liability, unless they caused or where part of the accident.
That was an issue in this case. If there was no duty to rescue, the defendants argued there could be no liability for preventing the rescue. However, the court stated that having no duty to rescue was different and not a defense to preventing rescue.
So Now What?
This is a rare case; in fact, I’ve found no other case like it. To some extent, it is bothersome in that it creates another way to litigate in the US. To a major extent, it is comforting to know that people are willing to try and keep each other alive. There is some comfort in knowing that if someone prevents someone from rescuing you, saving your life, then at least their life will be miserable for a while.
For the outdoor industry, there is really nothing to learn from this case; however, it is one you should know about, to use when you are elbowing your way through a crowd to provide first aid to someone who needs it.
Remember unless you are the reason why the rescue is needed you have no duty to rescue. Once you start you cannot stop until you are relieved by a higher medical authority.
What do you think? Leave a comment.
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Barnes v. Dungan et al., 261 A.D.2d 797; 690 N.Y.S.2d 338; 1999 N.Y. App. Div. LEXIS 5556
Posted: April 25, 2011 Filed under: First Aid Leave a comment »Barnes v. Dungan et al., 261 A.D.2d 797; 690 N.Y.S.2d 338; 1999 N.Y. App. Div. LEXIS 5556
Donald R. Barnes, Individually and as Administrator of the Estate of Sharon L. Barnes, Deceased, Respondent, v. Earl Dungan et al., Appellants.
83597
SUPREME COURT OF NEW YORK, APPELLATE DIVISION, THIRD DEPARTMENT
261 A.D.2d 797; 690 N.Y.S.2d 338; 1999 N.Y. App. Div. LEXIS 5556
May 20, 1999, Decided
May 20, 1999, Entered
PRIOR HISTORY: [***1] Appeal from an order of the Supreme Court (Mugglin, J.), entered June 1, 1998 in Delaware County, which denied defendants’ motions to dismiss the complaint for failure to state a cause of action.
DISPOSITION: The order is affirmed, with costs.
COUNSEL: Coughlin & Gerhart LLP (Joseph J. Steflik Jr. of counsel), Binghamton, for Earl Dungan, appellant.
Ryan, Orlando & Smallacombe (Melissa J. Smallacombe of counsel), Albany, for National Humane Education Society, appellant.
Garufi & Garufy (Sandra J. Garufy of counsel), Binghamton, for Peace Plantation Animal Sanctuary, appellant.
Thomas E. Schimmerling, Delhi, for respondent.
JUDGES: Cardona, P. J., Crew III, Carpinello and Graffeo, JJ., concur.
OPINION BY: Peters
OPINION
[*797] [**339] Peters, J.
Sharon L. Barnes (hereinafter decedent) was an employee at defendant Peace Plantation Animal Sanctuary in October 1996 when she suffered a heart attack while on duty. Co-worker Jodi Seeley, certified to perform cardiopulmonary resuscitation (hereinafter CPR), immediately responded and offered to resuscitate decedent but was prohibited from doing so by defendant Earl Dungan, her supervisor at Peace Plantation. Plaintiff (decedent’s husband) [***2] contends that had Seeley been permitted to perform CPR, decedent would have survived the heart attack.
Plaintiff commenced this action, individually and as administrator of decedent’s estate, against Dungan, Peace Plantation and its parent organization, National Humane Education Society (hereinafter the Society), alleging, inter alia, an intentional interference with lifesaving medical assistance. Prior to answering, defendants each moved to dismiss the complaint pursuant to CPLR 3211 (a) (7), alleging that no legal duty existed which required them to render emergency medical assistance; that workers’ compensation provided the exclusive remedy for decedent’s injuries; and that as to the Society, there existed no legal relationship which would make it responsible for the action of either Peace Plantation or Dungan. Supreme Court denied defendants’ motions in their entirety, prompting this appeal.
[HN1] Our review, on a motion of this kind, requires that we liberally construe [**340] the pleadings and accept the allegations as true, yielding every possible inference [***3] in plaintiff’s favor (see, Leon v Martinez, 84 NY2d 83; Parker v State of New York, 242 AD2d 785; MacFawn v Kresler, 214 AD2d 925, affd 88 NY2d 859). From this procedural vantage, we find that Supreme Court properly denied the motions.
[*798] Notably, the complaint alleges that defendants affirmatively prevented Seeley, a coemployee, from administering CPR as opposed to a failure to provide or procure emergency medical assistance (compare, Herman v Lancaster Homes, 145 AD2d 926, lv denied 74 NY2d 601). Upon that basis, plaintiff contends that there existed a legal duty to refrain from interfering with Seeley, a third party, who was willing and able to render necessary medical assistance. The Restatement of Torts so defines that duty: ” [HN2] One who intentionally prevents a third person from giving to another aid necessary to prevent physical harm to him, is subject to liability for physical harm caused to the other by the absence of the aid which he has prevented the third person from [***4] giving” (Restatement [Second] of Torts § 326).
Although no New York court has been directly confronted with this issue and we make no comment as to whether the allegations, taken as true, will ultimately be proven, we acknowledge the standard enunciated by Riggs v Colis (107 Idaho 1028, 695 P2d 413), which addressed this issue in a motion for summary judgment. There, in analyzing whether there was a breach of the aforementioned duty when the defendant prevented a bystander from providing emergency aid to the plaintiff while she was under attack, the court instructed that [HN3] a viable claim must show “the necessary fact situation of three parties–the victim, a rescuer, and one who prevents or interferes with the rescuer–and the aid must have been actually prevented” (id., at 1030, at 415; see, Soldano v O’Daniels, 141 Cal App 3d 443, 190 Cal Rptr 310).
Here, notwithstanding the fact that both Dungan and Seeley were both employees of Peace Plantation at the time that Dungan ordered Seeley not to render aid to the decedent, we find that [***5] upon a liberal viewing of the complaint and an analysis of the claim upon the Riggs v Colis (supra) standard, Seeley may be found to have volunteered emergency medical care outside the scope of her employment, thereby constituting the “rescuer” who was prevented or interfered with by Dungan from rendering needed medical aid to decedent (see, id.).
As to defendant’s remaining contention that workers’ compensation is the exclusive remedy available to plaintiff, we find that such issue is not only an affirmative defense and does not address the sufficiency of the complaint, but [HN4] there also exists an exception to the exclusivity provisions of the Workers’ Compensation Law if the acts can be found to constitute an intentional tort as plaintiff alleges (see, Workers’ Compensation Law § 11; Matter of Blanchard v Integrated Food Sys., 220 AD2d 895; Acevedo v Consolidated Edison Co., 189 AD2d 497, lv dismissed 82 NY2d 748).
[*799] Finally, addressing the Society’s contention that there [***6] exists no relationship between it and decedent, we find that in accepting the allegations in the complaint as true, a cause of action is sufficiently pleaded. Whether there is actual control by the Society over the actions of Peace Plantation will be a question of fact to be determined at trial (see, Pebble Cove Homeowners’ Assn. v Fidelity N. Y., 153 AD2d 843).
Accordingly, we affirm Supreme Court’s order.
[**341] Cardona, P. J., Crew III, Carpinello and Graffeo, JJ., concur.
Ordered that the order is affirmed, with costs.
Be Afraid, be very afraid of pre-printed forms for your recreation business
Posted: April 13, 2011 Filed under: First Aid, Risk Management Leave a comment »This form will tell the plaintiff you screwed up!
I love looking at “risk management” paperwork. At a recent conference where I was speaking, I stumbled across this form. The form was titled Accident/Incident Report Form.
Most incident or accident forms are created to track information and to be used to evaluate and correct problems. 99.95% of the time they are used to fill up file cabinets and kill trees. Think about the purpose of these forms as I work through this one.
These forms are created with the belief that they will help. They are created with good intentions.
However, I practice law and try to do so by dealing with the hard realities of how my clients actually run their programs or businesses.
The form is probably used by lots of people because it is easy, pre-printed and solves their problems. It may also be easy to help you lose a lawsuit if you use it. How?
1. Forms prove you have problems two different ways.
A. You have a stack of forms. You have a problem. You have a lot of people getting injured, and you are not doing anything about it. The stack alone proves you run a bad program.
B. If you sort your forms based on activity, location, etc. You have a problem if you have on item, location or activity that has a stack of forms. If your stack of forms identifies a location or activity, and the injured person was at “that location” then you knew of a problem and did nothing to solve it.
2. Forms eliminate foreseeability. Foreseeability is a defense that you could not have known that an accident could occur because it was not foreseeable. Foreseeability is defined, to some extent, as not something you would expect to happen. Here is the definition of foreseeability from the Colorado Jury Instructions.
CJI-Civ. 9.21 FORESEEABILITY LIMITATION
The negligence, if any, of the defendant, is not a cause of any (injuries) (damages) (losses) to the plaintiff, unless the injury to a person in the plaintiff’s situation was a reasonably foreseeable result of that negligence. The specific injury need not have been foreseeable. It is enough if a reasonably careful person, under the same or similar circumstances, would have anticipated that injury to a person in the plaintiff’s situation might result from the defendant’s conduct.
3. Forms indicate you are behind at best and possibly grossly poor in managing the problems of your program because you have a stack of forms. Everyone has incidents, accidents and injuries (unless you are dead). However, keeping track of them is an indication that you have them and do nothing about them in the mind of plaintiffs and possibly juries.
4. Incident forms, just kill trees, they don’t need to be filled out. First the definition of an incident will vary from a program to program and from day to day in one program. The idea that you would track something that did not happen is just odd.
Stupid Human Tricks in Writing
This particular form has additional issues. On page one the form asks the question: “What could the injured have done to prevent the injury.” Never, ever, never ever put opinions down on paper. Only put facts. Opinions are not information, not a way to evaluate. They are the result, and if you did not see the accident your opinion does not count.
The next issue is a question. After the line for information on where the parents notified there is a question “Parents Response?” What has that got to do with the way you are evaluating the accident or incident? If this is truly a report form, why is the response of a parent on the form? Did you call the parents and ask their response?
If the parent says something that may be of value to you, and there is any possibility of it being introduced at court, write it down on a message to your attorney or risk manager. That may protect the information until it is needed, and it will not show up as part of the report. You do not want to make someone madder when they are reading about what happened to their child and find out what they said on the form.
If the form is truly for gathering information and tracking incidents it does not matter how the parents responded. Besides, how do you expect them to respond? You just called to tell them their child was hurt or worse, and you expect them to be jubilant?
The next “smooth move” on the form is “Person’s notified such as camp owner/sponsor, board of directors, etc.” Why is this on the form? What has this information got to do with incident or accident evaluation?
More importantly how do you think this is going to look when it is provided to the plaintiff’s attorney during discovery? Well, this was bad enough they called the board of directors. Good to know. Alternatively, and even worse, my client has a broken arm, and they did not notify the board of directors?
You should have a plan in place on who to notify if there is a problem. Follow the plan; don’t put it on a form that may come back with a big question. Why did you call those people? Did you know you had screwed up and wanted them to know to prepare for the worse?
Third great line is “Describe any contact made with/by media regarding the situation.” Answer I wanted the local reporter’s opinion on broken arms at summer camps. What does this matter on a form reporting an incident?
Again the information may need to be something that is recorded but separate the information to the correct form.
It was easier to run around and scream in a panic.
One line asked if “Emergency Procedures followed at the time of an accident. If you write no here, how are you going to explain that? You better write yes and if you are always going to write yes, why have the question on a form?
If procedures were not followed there is usually a great reason why, the procedures did not fit the situation. (They never do.)
Now for the best “line” I’ve seen in decades on paper.
“Insurance Notification” Under that heading it has checked boxes if the following insurance companies were notified.
Parent’s Insurance
Camp Health Insurance
Worker’s Compensation
Camp Liability Insurance
The first three make sense to me. You want to write down a claim number for the insurance claim when the claim is based on a duty to provide in a personal health insurance policy or a WC policy. However, why in the world would you write on this form that you contacted the Liability Insurance Carrier of the program? Can you see what this means to the plaintiff’s attorney when he or she receives this from? From the date of the accident onward they knew they had screwed up!
However, even if the information that is being tracked makes sense, what is it doing on that form? That is an accident report form, not an insurance report form.
I saw this tack of forms on a table and just glanced at them, flipped them over and laughed out loud when I saw that last line!
However, these forms are worse than the information they collect. They are worse because the information is collected to begin with. The purpose, although thought to be great and altruistic when started never works and usually becomes a nightmare.
A. Never track incidents. An incident at worse is your good luck that it was not worse. You can never track all the incidents and the definition of an incident will cost you a day on the stand and in deposition as the opposing attorney attempts to understand why you track something’s and not others.
An incident is anything less than an accident. That is the best definition you can reasonably apply. Are these incidents?
I grabbed the salt rather than sugar shaker while making cookies, through the cookie dough out.
Johnny was doing his swim test and panicked. I grabbed him and pulled him to shore.
Suzy fell off the climbing wall but landed on the pads. She is fine.
Jerry, a staff member did not have his locking carabiner on correctly, and it had snagged open on his shirt. I noticed it from the ground and let him know.
All have the potential to be accidents or disasters. Even so, you or your staff corrected the problem before the accident occurred. Track them? Heck no. The staff did what you had trained them to do, prevent accidents.
So?
Don’t write forms worried about lawyers and lawsuits. Do create forms based on what is needed. This form is needed to track first aid and accidents. Nothing more should be on this form than to track first aid issues and accident issues.
Next only create a form to collect facts. Never Opinions. It is not your job to write down an opinion. As soon as you do, more information will surface that may change your opinion. There is nothing worse than a corrected form especially when the changes are in the “what happened” section.
All the problems I’ve listed above violate the above two rules.
No opinions, no information other than what was needed to record information for future use. Record nothing that can come back to haunt you in court or worse make you look foolish or stupid in court.
How should you do it?
If you do record information, for accidents only record what is necessary. One ski area in Colorado could track 80% of the medical calls on the front and back of 5” X 7” cards. Witness statements were on a separate 5” X 7”. Do not collect anything more; who was injured, and their contact information, where they were hurt and any other important information.
Determine what you need? Then collect that and only that information.
What do you think? Leave a comment.
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10 First Aid Myths
Posted: December 8, 2010 Filed under: Association of Outdoor Recreation and Education (AORE), Boy Scouts of America (BSA), First Aid, Wilderness Medical Society (WMS) | Tags: Adventure travel, Epinephrine, first aid, James H. Moss, Myths, Recreation, Ski Resort 3 Comments »This Presentation was given at the 2010 Association of Outdoor Recreation and Education Conference at Keystone Colorado.
Copyright 2010 Recreation Law (720) Edit Law, blog@rec-law.us
Maine Supreme court applies a broad definition to a well worded Good Samaritan Statute.
Posted: November 8, 2010 Filed under: Case Analysis, First Aid Leave a comment »Campbell v. Schwartz, 47 Mass. App. Ct. 360; 712 N.E.2d 1196; 1999 Mass. App. LEXIS 795
The Good Samaritan Statute uses the word “rescue” rather than the more limiting term “emergency care.”
This case is about friends who went searching for a lost snowmobiler. The deceased was the third snowmobiler of a party of three who were traveling late at night in below freezing weather. When the deceased did not arrive with the other two snowmobilers, two people went back to search for him. They found the deceased with a snowmobile that was not working.
Based on the condition of the deceased, time of the night and the 20-degree below zero the pair decided to have the deceased ride behind one of the rescuers. During the ride back the deceased fell off the snowmobile and was run over and killed by the following snowmobile. At the time of this death the deceased had a blood alcohol level of .34, four times the Maine legal limit.
The deceased’s widow sued the two rescuers for the death of her husband. The defendants raised the defense of immunity because of the Maine Good Samaritan Statute.
The Maine Good Samaritan statue reads:
14 M.R.S. § 164 (2009)
§ 164. Immunity from civil liability
Notwithstanding any inconsistent provisions of any public or private and special law, any person who voluntarily, without the expectation of monetary or other compensation from the person aided or treated, renders first aid, emergency treatment or rescue assistance to a person who is unconscious, ill, injured or in need of rescue assistance, shall not be liable for damages for injuries alleged to have been sustained by such person nor for damages for the death of such person alleged to have occurred by reason of an act or omission in the rendering of such first aid, emergency treatment or rescue assistance, unless it is established that such injuries or such death were caused willfully, wantonly or recklessly or by gross negligence on the part of such person. This section shall apply to members or employees of nonprofit volunteer or governmental ambulance, rescue or emergency units, whether or not a user or service fee may be charged by the nonprofit unit or the governmental entity and whether or not the members or employees receive salaries or other compensation from the nonprofit unit or the governmental entity. This section shall not be construed to require a person who is ill or injured to be administered first aid or emergency treatment if such person objects thereto on religious grounds. This section shall not apply if such first aid or emergency treatment or assistance is rendered on the premises of a hospital or clinic.
The statute uses a very broad definition of what type of care will be protected by the act “renders first aid, emergency treatment or rescue assistance to a person who is unconscious, ill, injured or in need of rescue assistance.”
The court found the actions of the Good Samaritans when they started to search for the lost snowmobiler to the time they found him dead was a rescue. The time, the temperature, the distance from safety as well as the fact they knew he had been drinking added up to a rescue.
So?
Because the laws are so different from state to state, you cannot assume that the protection provided, or that you learned about in one state will be the same in another state. The Maine statute, thankfully, is broadly written and broadly interpreted by the courts. For two rescuers, it was a fortunate that there were in a state that looks at rescue as a necessity for the residents of the state and chooses to encourage it rather than discourage it.
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New AHA guidelines for CPR are out.
Posted: November 2, 2010 Filed under: First Aid Leave a comment »American Heart Association has adopted the compression only CPR.
The major change from the old guidelines is compressions are now the first thing to be done. In the past breathing was more important and started first: CAB rather than ABC.
· Compressions
· Airway
· Breathing
The old order was ABC, Airway, Breathing, Compressions.
Compressions are supposed to be 100 per minute or the same beat as the Bee Gee’s Song Staying Alive.
An AHA video about the new guidelines can be found here. The video is excellent!
General information and news about the AHA and the guidelines can be found here at: 2010 AHA Guidelines for CPR and; ECC.
To see the complete guidelines go to: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science
Thanks to Dr. Christopher Van Tilburg for this head’s up on his blog Mountain Rescue Doctor.
Christopher Van Tilburg, M.D. is a well known and respected Wilderness Medicine Doc.
Posted: October 28, 2010 Filed under: First Aid Leave a comment »He also writes a great blog about the medical and first aid issues in the wilderness. And he writes in English.
Dr. van Tilburg’s post of October 7, 2010 is about altitude sickness. In a couple of paragraphs, Dr. van Tilburg has compiled research and solid information about AMS into a layman’s article.
The focus of his post was a study on Kilimanjaro that stated the standard tactics for fighting altitude sickness did not work. The study Incidence and predictors of acute mountain sickness among trekkers on Mount Kilimanjaro showed that neither a single rest day nor drugs stopped AMS.
The post The Golden Rules for Alitude Illness finishes with the Golden Rule for Altitude posted at the International Society for Mountain Medicine created by David Schlimn and Tom Dietz.
GOLDEN RULE I
If you feel unwell at altitude it is altitude illness until proven otherwise.
GOLDEN RULE II
Never ascend with symptoms of AMS.
GOLDEN RULE III
If you are getting worse (or have HACE or HAPE), go down at once.
A quote from Dr. van Tilburg’s website tells of his experience.
I work as a mountain doctor at a ski resort, as a mountain rescue volunteer, and in a local emergency room. In addition to writing seven books, I serve as Editor-in-Chief for Wilderness Medicine, the official magazine for Wilderness Medical Society, for which I write a column called “Great Gear for Work and Play.”
Dr. van Tilburg’s website can be found here. You should follow Dr. van Tilburg’s blog and read the study.
Copyright 2010 Recreation Law (720) Edit Law, Recreaton.Law@Gmail.com
The Wilderness Medical Society Wilderness & Environmental Medicine Journal Vol 21 No 2 2010 Selected Table of Contents
Posted: October 15, 2010 Filed under: First Aid Leave a comment »If you are not a member of the Wilderness Medical Society, and you are in the field of Outdoor Recreation you should be.
- Editorial: In Tribute to Charlie Houston
- Editorial: Search and Rescue Activity on Denali, 1990 to 2008
- Editorial: Sidecountry Rescue—Who Should Respond to Ski Resort Out-of-Bounds Rescues?
- Original Research: Search and Rescue Activity on Denali, 1990 – 2008
- Original Research: End-Tidal Partial Pressure of Carbon Dioxide and Acute Mountain Sickness in the First 24 Hours Upon Ascent to Cusco Peru (3326 meters)
- Original Research: Large Snake Size Suggests Increased Snakebite Severity in Patients Bitten by Rattlesnakes in Southern California
- Case Report: Frostbite in a Sherpa
- Brief Report: Detection and Management of Hypothermia at a Large Outdoor Endurance Event in the United Kingdom
- Review Article: Wilderness Medical Society Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness
- Original Research: Adverse Encounters With Alligators in the United States: An Update
- The Wilderness Instructor: Advanced Wilderness Life Support Education Using High-Technology Patient Simulation
The article Wilderness Medical Society Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness is very important to anyone working in any alpine environment. A new program, possibly a standard of care, has been developed, and you should know about it.
The same goes if you are an instructor in the wilderness medicine field and the article Advanced Wilderness Life Support Education Using High-Technology Patient Simulation.
For information on why a membership to the Wilderness Medical Society is a great idea go here. To subscribe go to the Wilderness Medical Society go here.
Copyright 2010 Recreation Law (720) Edit Law, Recreaton.Law@Gmail.com
If you are out of shape, you face greater risk skiing…….
Posted: October 5, 2010 Filed under: First Aid, Skiing / Snow Boarding Leave a comment »A study out of Stockholm Sweden found that out of shape skiers faced a greater risk of heart attacks. Being out of shape combined with the altitude, and the cold weather increased the risks of medical problems.
Previous studies showed that 40% of all deaths on ski slopes were heart attacks. The study did find some interesting facts.
- 39% of the heart attacks occurred on the first day of skiing.
- 56% of the heart attacks occurred in the first two days of skiing.
- 50% of the heart attacks occurred within the first hour of activity.
- The average time of suffering the first effects was within two hours of hitting the slopes.
- 50% of the people who suffered heart attacks had not done the recommended level of training before skiing. Patients who suffered heart attacks lived at an average elevation of 557 feet and suffered their attacks at an elevation of 4,429 feet.
The report recommended that skiers train by undertaking two hours of exercise each day before heading to the slopes.
One commentator described the exercise, elevation and cold as the perfect storm for heart attacks.
The article suggested that people going to high altitude to ski should:
- Increase physical activity gradually.
- If you’re going to a high-altitude resort, wait a day before hitting the slopes or engaging in other strenuous activities.
- If it’s a very high altitude resort, ask your doctor about strategies for acclimatization.
- Dress warmly, in layers.
See Physically Unprepared Skiers Face Heart Risk
Copyright 2010 Recreation Law (720) Edit Law, Recreaton.Law@Gmail.com
© 2010 James H. Moss
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Another Way to Teach CPR
Posted: July 15, 2010 Filed under: First Aid 1 Comment »When I was teaching knots to Scouts I used to use a Black Rat Snake. I made the knot, I just used the snake to explain the basics. Eleven year olds where 100% attentive and watched my hands while holding the snake.
This is a great way to teach CPR.
Copyright 2010 Recreation Law (720) Edit Law, Recreaton.Law@Gmail.com
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First Aid has its Limits. By law!
Posted: July 13, 2010 Filed under: Criminal Liability, First Aid | Tags: criminal liability, first aid, protocols Leave a comment »However, you need to understand the law as well as first aid. Especially if what you are being taught is an illegal act.
A question posted on Facebook by a first aid training organization asked the question of its face book fans. The responses were all along the lines of a not been trained to perform the illegal act. Most of the answers were correct. However, what has me concerned is the issue that is an issue floating around in the wilderness first aid world.
The question asked about doing an illegal act. The question was, would you stitch a wound if you were in the wilderness? The vast majority of the answers was no. There were a few yes’s, most of them qualified.
There the correct answer is no it is an invasive act. Therefore, it is illegal for anyone other than a physician, or dependent upon the state, someone under a physician’s direct supervision and control. There seems to be a real issue on what someone can do in a first aid situation. Most people who received wilderness first aid training believe they can do anything if they have a doctor or physician advisor or who has taught them how to do it. There are many physicians who have the same belief.
(Remember this is a legal blog: no morals, no ethics just law.)
This blog is not the place to do a complete legal analysis of this issue. However, a short synopsis is appropriate. All first aid training divides the first aid provider into two groups: those who are licensed to provide first aid care and those who are not. A licensed first aid provider is an EMT, paramedic, nurse, nurse practitioner, physician assistant, or physician, etc. A person who has taken a test administered by the state and required by the state to take the test before practicing is a licensed health care provider. Non-licensed first aid providers are everyone else. The non licensed category includes Boy Scouts, wilderness first aiders, Wilderness First Responders, any person happening by the accident. Dependent upon the state where you are operating, a licensed first aid provider may be allowed to do invasive acts. No state allows a non-licensed first aid provider no matter what the training, to do any invasive act.
An invasive act is one where the first aid provider does anything more to an open wound other than clean and bandage the wound. It does not matter what they had been trained to do, or what they think they can do.
If it is a criminal act the person receiving the treatment, the injured person, cannot waive their right and allow the person to do it. It is still a criminal act the matter. The next legal issue is, no criminal act is protected any state Good Samaritan act.
I guess what I find disturbing is the idea that if the person has been trained to do this it would be okay for them to do it. That is not the case. You can be trained to perform heart surgery, but if you do not have a license to practice medicine it does not matter if you are the best heart surgeon in the world it is still a criminal act. If a physician will be standing in the room next to you and has agreed to abide by the state laws you may or may not be able to do something under that physician’s supervision and control. Supervision and control is defined differently in each state. In most states, it means the physician is in the same room where you are performing the procedure you have been trained in.
Does this mean that you get arrested if you do something like this? It totally depends on the outcome. If it’s a good outcome possibly not, if it’s a bad outcome possibly.
The issue is not my paranoia, the issue is the first aid training being received based on the egos of the instructors. And I’m not saying this to condemn any first aid instructor. I’ve met dozens and they are wonderful people. What I’m saying is we all love to impress people; we all love to stand in front of a group of people and tell them how to do things, to educate them. We want them to like us. This is one of the reasons why we teach. If that goes so far as to teach people that if they knew a little more they could do a little more that is where we cross the boundary. Sometimes it’s more than what you have been trained, sometimes it’s whether not you are teaching someone to violate the law.
So am I overly paranoid about that issue? Probably. Is my concern legally correct? Yes.
For more information about these issues see Legal Issues in Wilderness First Aid: Value of various first aid certificates and training, Legal Issues in Wilderness First Aid, and Legal Issues in First Aid #3: The prescription drug conundrum
See http://www.facebook.com/wildernessmedicine?ref=nf
What do you think? Leave a comment.
Copyright 2010 Recreation Law (720) Edit Law, Recreaton.Law@Gmail.com
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CPR is not fool proof
Posted: April 20, 2010 Filed under: First Aid 2 Comments »$7.6 million jury award for seizure that occurs on a school playground. Suit based on a allegation that CPR was not performed fast enough.
It has been said the worst thing to do is outlive your children. Losing a child must be horrendous. Having a child survive but in a barely vegetative state must be close, but with no closure. However, when a child has a seizure, the chances of CPR (Cardio Pulmonary Resuscitation) working is slim at best.
The seizure was an epileptic seizure that occurred when the child was playing on the basketball court. Either the seizure or the fall stopped his heart. The parents argued that the CPR was not soon enough and not adequate.
Now this is where it gets real exciting. The family had received $361,237 from a seizure the child had in 2003. The child fell on a playground and suffered burns from the metal grate he fell on. A nurse and marine administered CPR bringing the child around.
WHAT IS THE KID DOING ON THE PLAYGROUND A SECOND TIME?
The school district offered to transport the child for free to another school where there was a full time nurse. The mother declined because it was too far away. Boy is it tempting to say something about losing opportunity at this point!
This is a sad case. This is also a disgusting case. This is a case where the phrase Fool me once shame on you, fool me twice shame on me fits. This is just stupid.
See Jury awards $7.6M for playground seizure.
Copyright 2010 Recreation Law (720) Edit Law, Recreaton.Law@Gmail.com
Keywords: playground, epileptic, seizure, CPR,
New CPR method: 100 compressions per minute
Posted: April 8, 2010 Filed under: First Aid Leave a comment »
Mayo Clinic produces video about the technique.
A video titled Continuous Chest Compression CPR – Mayo Clinic Presentation explains the new CPR method. The idea is based on several issues. 1 is keeping blood pressure up to force blood all ready enriched with oxygen into the brain. 2 is the idea that most people did not like performing the mouth to mouth part of the compressions.
There is a companion website Cardiopulmonary resuscitation (CPR): First aid. The website explains if you are confident and trained mouth to mouth is still a good idea, but the ratios should be 30 compressions to two breaths.
Keywords: CPR, cardio pulmonary resuscitation, mayo clinic, chest compressions, mouth to mouth
Wilderness & Environmental Medicine Journal
Posted: February 25, 2010 Filed under: First Aid, Wilderness Medical Society (WMS) Leave a comment »Volume 20 # 4 has some great articles
The Wilderness Medical Society has published its latest Wilderness & Environmental Medicine Journal with some great articles.
- Injuries and Medical Conditions Among Kayakers Paddling in the Sea Environment
- A Comparison of Bacterial Colony-Forming Units in Water Bottles and Hydration Bags Among Outdoor Enthusiasts
- Love and Fear of Heights: the Pathophysiology and Psychology of Height Imbalance
- Determinants of Summiting Success and Acute Mountain Sickness on Mt Kilimanjaro (5895 M)
You must be a member to access the current issue. Membership information can be found here.
Copyright 2010 Recreation Law 720 Edit Law, Recreaton.Law@Gmail.com
Letter to the Editor: Wilderness and Environmental Medicine
Posted: November 24, 2009 Filed under: First Aid, Wilderness Medical Society (WMS) 2 Comments »June 23, 2009
Jonna Barry, Managing Editor
Wilderness and Environmental Medicine
1505 N. Royer Street
Colorado Springs, CO 80907
Wilderness First Aid: Is there an “Industry Standard”?
I read with appreciation, interest and concern the article Wilderness First Aid: Is There an “Industry Standard”? in the latest Wilderness and Environmental Medicine. I have the following comments about the article suggestions about future articles and research.
For a defense oriented attorney and possibility for the plaintiff’s bar the use of the word standard creates issues. The word in everyday life, means a reference point or median, it has a different definition in the law. A standard in the law is the lowest level of acceptable level of doing or not doing something that a reasonable person would accept. It may not be the median or average. As such, a statement that something is the standard which is not the lowest acceptable level creates a path for a lawsuit for anyone who may not meet the median but is above the lowest acceptable level of work.
This is important because a violation of a standard is the first step in proving negligence. In general in outdoor recreation activities, the hardest thing to prove is a violation of a standard. By putting in writing what the standard’s are for a particular activity, we have made the plaintiff’s job that much easier.
Plaintiff’s lawyers grasp on to an article using the term from respected publications, such as this Journal, as proof that the outfitter or guide did not meet the industry standard. It then falls on the defense to prove, and normally at a much greater cost, at trial, that the standard is not at issue or was not the legal definition used in the article.
Consequently I was happy to see the article did not really reach a conclusion about what the standard is above that of simple first aid courses.
A major issue is what is wilderness first aid? There few legal references to a definition of first aid, those that do simply reference the American Red Cross definition: immediate and temporary treatment of a victim of sudden illness or injury while awaiting the arrival of medical aid. One court described first aid as anything that did not require training, consequently CPR was not first aid because it required training. L.A. Fitness International, Llc, v. Mayer, 980 So. 2d 550; 2008 Fla. App. LEXIS 5893; 33 Fla. L. Weekly D 1136. If a court determines that an act done was outside the definition of first aid, there is no defense for a non-licensed health care provider. Many wilderness first aid courses teach techniques that are clearly outside of the simple definition of first aid: immediate and temporary treatment. The Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care, 5th at present is the only document that provides wilderness first aid advice for those wanting to understand what is and is not first aid.
Many times articles such as these want to improve the care for those injured in the outdoors. Articles rarely accomplish that goal and mostly encourage litigation, which also fails to accomplish that goal. What does occur is an increase in litigation and a decrease in participation. The Boy Scouts of America and Sierra Club were both referenced in the article. Both groups are led by volunteers. Volunteers do not have more time to take more than a basic first aid course while all ready taking several hours each week to volunteer and then spending your vacation with a group of youth cannot be stretched much father.
This is a classic example of we need to protect more kids by requiring more leader training which protects the kids because they now never leave the city. Volunteers have only so many hours and kids have too many chances to get hurt.
The article speaks to statutes or governmental regulations referencing first aid requirements. There is a misnomer that a legal standard in the industry can be higher or lower than a state statute. The standard for a particular industry is the state statute and in this case the statutes that were recognized in the article would be the standard for medical training needed in that occupation.
The article did miss several dozen state statutes requiring first aid training for guides and outfitters, as well as all federal requirements. Most states put first aid requirements into specific statutes affecting a specific activity. As an example Colorado has no state statute requiring first aid training for outfitters and guides, but the state has no state statutes for outfitters and guides. Colorado does have a statute controlling the first aid requirements for whitewater outfitters and guides. C.R.S. §§ 33-32-105.5 that requires a standard first aid card to work on a river. Colorado horse packer’s statute C.R.S. §§ 12-55.5-103.5 have a similar requirement.
Various state and federal land managers have specific first aid requirements for permittees or concessionaires working on state or federal land. This varies by land manager and the type of service being offered.
The article mentioned the marketing term “wilderness first responder” (WFR) which is not recognized by any state or federal agency as a first aid course. Many state Good Samaritan laws provide coverage for first aid based on the provider of the first aid training. No state Good Samaritan law recognizes WFR or WFR providers as providing training that would be protected by the Good Samaritan law. See Connecticut C.G.S. § 52-557(h) or Illinois I.C.S.A § 745 ILCS 49/67.
Many state statutes require the regulatory agency to specify the first aid training required. Fishing guides in California pursuant to Fish & G Code § 2542 specifies the agency shall prescribe the first aid training required of guides. Maine requires a first aid training M.R.S. § 12853 but leaves the level of training to the regulatory agency with a different level of first aid training for trip leaders M.R.S. § 12860.
Statutes once enacted are difficult to change so many of the statutes requiring first aid training are out of date. Worse are those that specify the items to be in first aid kits. California Gen Ed § 32043 requires a snakebite kit on field trips for some school outings.
There are three agencies chartered by the Federal Government to provide first aid training: The Boy Scouts of America, the American Red Cross and the National Ski Patrol. All three organizations provide training that is recognized by all states as for protection under state Good Samaritan acts recognized by all states and the federal government as first aid training providers.
Litigation that claims the first aid care is rare when brought against outfitters and guides. Litigation against search and rescue groups and volunteers is growing. In both cases the claim that the first aid care was negligent was combined with other claims. Both groups need to be protected in any additional studies done to determine what training is appropriate or necessary.
I agree with Dr. Forgey’s editorial that the issue needs to be reexamined. But instead of a chart of what is being doing, I would strongly urge any study to look at best practices for the industry with an eye to the ever changing future. Instead of listing the standard, which will then allow plaintiff’s to gauge their lawsuits and start advertising for them or the minimums which would guaranty a loss by a defendant the study should look at what is being done and what might work.
More importantly as the article relates too in the beginning and Dr. Forgey mentions is a study of what really occurs and that can be resolved with basic first aid. What can first aid supplies be reasonable carried by a group, what can be used with the knowledge that can be retained by the group and what is actually effective in the outdoors when miles or hours from EMS. The desire to stop litigation is leading groups to wildly divergent and in many cases ridiculous results. One Texas University outdoor program was told to carry AED’s on their wilderness backpacking trips. Another example is the use of helmets in whitewater rafting; an industry that prior to the use of helmets never had a reported head injury. Colorado, West Virginia and California have not received a report of a head injury that a helmet would protect in a whitewater rafting. This would assist outfitters and guides as well as state and federal land management agencies in determining what is really possible and therefore needed. It might also reduce the desire to teach and or carry prescription drugs because of the effectiveness at a distance from EMS and consequently take pressure off physicians to prescribe these drugs in violation of the law or their medmal insurance carrier.
What we need is realistic analysis and study of what is possible and plausible in a wilderness setting. What will save a life and what won’t, what should be done and what is a waste of time. That study should be labeled in such a way as to not create the basis for injured participants to start litigation.
Sincerely,
James H. Moss
Cc Wm Forgey, MD
Who should use a Release? Its November Review your Release for Free Month
Posted: November 4, 2009 Filed under: First Aid, Release / Waivers, Risk Management Leave a comment »Because its November’s Review your release for free month I’m posting articles on Wednesday about Releases and why you should use them.
Anyone who offers activities to the public, where there are numerous risks outside of the control of the operator should use a release.
- Outfitters: business who offer outdoor trips to the public. Whether a hike down a trail to look at wildlife or to the top of Mt Everest to add to your resume.
Anyone who is offering products to the public which the public may not understand or may not be able to comprehend
- Demo’s: Whether a rep, retailer or manufacturer you want your products to be tested and tried. New products may require new skills or new ideas that your guests are not use too.
- Rental Programs: People rent when they want to have fun, want to try, or are interested in having a good time. All of these are done by people who may not have experience with the specific product you are renting.
Anyone who may be involved in a lawsuit do to the actions of someone you can’t control should use a release
- Retailers: a manufacture has sold you a new product. You have agreed to be the guinea pig on whether it works or sells. You should not be a guinea pig on the first lawsuit
- Manufactures: Promises made by sales come back to haunt risk management. If you are manufacturing a product that can be sold incorrectly, you don’t need to learn about it in a summons and complaint
Anyone placing products in the stream of commerce before they are finalized
- Testing: You have hired
Anyone who is offering products for a discount
- Season tickets at resorts or ski areas: you need to recoup your lowered cost by decreasing your insurance and claims costs.
Anyone takes students out of their normal environment to educate them.
- College & University programs: the student does not sue his or her parent or insurance company may. Learning may incorporate more that what you teach in the classroom, it may incorporate the courtroom.
Anyone who hires professional athletes to be a promoter of the product
- Sponsor: You want your product seen by everyone so you pay or provide the product to people to show it off. Showing off usually means bigger, higher, faster or deeper which all can lead to litigation.
Anyone who is taking people outside of their normal environment
- Inner city youth to the country
- Farm kids to large east coast cities
- Anyone taking anyone around animals
Anyone dealing with youth whose parents are not around and consider you a nice alternative to paid babysitters.
- Parents who drop their kids off, don’t know who you are, don’t understand what you are doing, and will never understand why their child was hurt.
If you are worried about being sued and you are located in a state where releases are upheld, you are offering a recreational service or opportunities to the public you might try using a release.
In an opportunity to help generate ideas and interest in this blog and the Outdoor Recreation and Fitness Law Review I am going to make everyone an offer you can’t refuse. During the month of November I am going to review your releases or acknowledgment of risk forms for free.
Stay tuned I’ll come up with the requirements and how the program is going to work, but it will be no cost to you (and hopefully no major headaches for me!)
Pass this on, repost for your friends on Facebook and Re-tweet or just email it to your friends.
Dex works
Posted: October 29, 2009 Filed under: First Aid, Mountaineering Leave a comment »Dexamathasone or Dex as it is commonly known has been shown to improve exercise capacity at high altitude. Dex has been shown to prevent HAPE (high altitude pulmonary edema) and AMS (acute mountain sickness). Now it has been shown to improve oxygen uptake and decreased the anaerobic threshold.
The study was reported in the American Journal of Respiratory and Critical Care Medicine.
See Dex Improves High Altitude Exercise Capacity and Taking Dex Can Improve High Altitude Exercise Capacity In Certain Climbers, Study Finds.
