Scoutmaster Podcast 57

And now for you, Scoutmaster. Well, it was funny to me.

I'm not so sure it was funny to the victim, but I did have the opportunity to care for a young fellow who was fishing and couldn't get his back cast perfect, and so he embedded a treble hook in his nose. When he came to me, I was very concerned about whether he was suffering pain and he said, Doc, you know it doesn't hurt so much, but I'd really appreciate it if you could take the worm off the hook. Hi, this is Dr Paul Auerbach and you are listening to Clarke Green on the Scoutmaster Podcast. Hey, this is Podcast Number 57..

Well, welcome back to the Scoutmaster Podcast. This is Clarke Green.

We're going to look at some email that came in this week and I got to tell you a lot of email came in this week, so I'm spreading out the answers over a couple of podcasts here. So you know, if you got in touch, I definitely emailed you back, and if I said it was going on the podcast and it didn't show up on this one, it'll get on one pretty soon.

So we got a pretty full slate today. Scoutmaster, Tony Place from Troop 911 in Wellsboro, Pennsylvania, wrote in to say this: Thanks for your podcast. I've been a Scoutmaster for 14 years, First in Indiana.

When I left five years ago we were 47 strong and now the troop has split into two troops of around 40 each. I moved to Pennsylvania five years ago with my job and started all over again with a troop of two. It's a whole lot harder to do it a second time and I have to admit I was really down and almost left until I found your podcast. It's very refreshing to hear that there are other Scoutmasters out there who believe in the program and the youth. I'm currently working my way through your older podcasts. Even if I don't always agree with everything you have to say, You've given me a lot of good ideas.

Please keep up the good work. Thanks so much, Tony, for getting in touch.

I'm glad you find the podcast useful And you know you keep up the good work too. Wow, Built a great program out there in Indiana. You're going to do the same here in Pennsylvania. I always thought maybe it would be a lot of fun just to start over from scratch, build up a new troop. Yeah, maybe it's not as much fun, But it's a great challenge.

And, Tony, thanks so much for getting in touch. And, like I say, you, keep up the good work. Jason Pettis from Golden Colorado wrote in. He said thanks for taking my question on the podcast He's talking about. Last week, podcast 56. Jason sent in a question via voicemail about a tidal wave that's about to hit his troop, a tidal wave of new Webelos who are going to cross over into the troop this spring.

Based on your response, I should just relax and let the program do its thing. Well, I have to say too, that Larry Geiger put a very good set of comments and advice on the blog post for podcast 56, and definitely take a look at that. Jason goes on to say: I was talking with a couple of assistant scoutmasters about our tidal wave and we realized that there must be a reason why all these Webelos picked our troop. They obviously like what they saw and they want to be a part of it. Yeah, isn't that great.

You know you build up a program. You have this hot program.

Webelos come and visit and they go: wow, I want to do this. That's a huge paycheck right there, Jason.

I mean, you know you got to love that. Then he said this: when I called I was thinking we were getting 16 to 20 new scouts Turns out- I didn't get an accurate number from the packs- We'll probably end up with 27 new members. Wow, talk about a mixed blessing. Oh, it's going to be a challenge but it's going to be fantastic. Yeah, maybe we kind of calm the program down for the next year. Thanks for the advice he says.

Whatever happens, I'm sure we'll have a good time, And thank you, Jason. I want to hear more about this giant tidal wave, Webelos. It happens every once in a while and it's always interesting, always interesting. Larry Geiger, like I said, wrote in about podcast number 56, and he says: the Webelos tidal wave- very good thoughts on an overall philosophy.

So how does this actually get done? The patrol leaders need to get those new scouts ready for their first campout and there are several months worth of programming right there in that one statement.

And then Larry goes on to give some more advice about that. Look up the podcast number 56 on the blog. Go read Larry's comment. Larry's a pretty smart guy. He listens to my podcast, doesn't he Got to be pretty smart. Frank Maynard from Michigan is a blogger and he has a blog called Bob White's Blather, And I just discovered the blog this week, Frank, and I really like it.

You've got some great stuff there. There's going to be a link to the blog on the post that contains podcast 57.

So do go over, say hi to Frank and make sure that you read Bob White's Blather. Frank emailed me to say I just wanted to drop you a short note to let you know how much I enjoy your podcast and related resources. I've been involved in the Boy Scouting program for the past seven years as a troop committee member. Your discussion of boards of review was excellent.

Well, thank you so much, Frank. I'm glad that you're enjoying what we're putting out. If you'd like to see me kind of, you can come to Middle Tennessee State University for a merit badge university that's being held on Saturday February 26th. There will be a link in the post that contains podcast 57 on the blog at scoutmastertypepadcom where you can get details about that. If you're in the Murfreesboro area, What's going to happen is we're going to have like a virtual hookup over the net and I'm going to do a talk about the patrol method to the adults who are attending the merit badge university.

How about that? Huh? The newsletter went out this week and in February. The newsletter theme is scouting history and we put together some resources that are out there on the web. It's just incredible what's out there. I mean, you have the world's largest virtual scouting library out there and it's fun to learn about history and things like that.

But you know, the other thing is it's very, very relevant to what we're doing today. Over the past century the scouting program has developed and changed slightly, but you know, most of the things that were happening when the scout movement was founded are still very relevant to us today.

So I encourage you to get a look at those. Every newsletter has a giveaway and in February it's from the Nalgene Company with four of their coolest water bottles and that giveaway.

You qualify for that by answering a scouting trivia question and then we do a random draw from the correct answers and they get the giveaway. So make sure you subscribe to the Scoutmaster newsletter and again, scoutmastertypepadcom, and you'll find all the information on how to subscribe and follow things right there.

Now I have a challenge for you. Between this week and next I want you to call and I want you to tell me about your favorite camping trip.

Now, maybe this is a camping trip that you do every single year with the troop. I know there's a lot of perennial ones out there that are very popular with the scouts.

Maybe it's a place that you go, Maybe it's a program that you know, like I say you do from year to year, and it's just outstandingly popular. Let's share that with the wider scouting community through the podcast.

Give me a call, you'll leave a voice message and then we'll feature that in a future podcast. Tell me about your favorite camping trip.

Now here's the number you call: 484-734-0002.. Again, 484-734-0002..

And tell me about your favorite camping trip and you'll hear yourself on a podcast here in the future. Today we're going to talk with Dr Paul Auerbach, and Dr Auerbach is probably the world's foremost authority on wilderness medicine.

He's the author of Wilderness Medicine, which is a comprehensive guide that I think belongs in every single first aid kit that goes out there on a camping trip and have as a ready reference for injuries and illnesses that can happen on camping trips. I think it's especially important to have that going on a high adventure trip. I have some training. I have the Wilderness First Responder training, I have first aid training, I have CPR certification and all that business.

But I want to have that book there in one form or another as a reference. I don't have to refer to those skills very often, but when I do, I want a little bit of a backup, and wilderness medicine is the one that I have. I also have it in a Kindle edition and we'll talk about that a little bit in the interview, but that makes it readily accessible on an iPhone or an Android phone or an iPod Touch or a PDA or something like that.

So I also have that compact electronic edition that we can tote along with us when we're out camping. I really enjoyed talking with Dr Auerbach and the interview is going to take up the rest of the podcast here.

So let's get started, shall we? Let's go.

Today. I'm talking with Dr Paul Auerbach, and he is a Professor of Surgery in the Division of Emergency Medicine at Stanford University.

He's the world's leading authority on wilderness medicine and is one of the world's leading authorities on emergency medicine, and he's the author of Medicine for the Outdoors, which is now in its fifth edition. He's been involved in the Haiti earthquake and he's been involved in the Haiti earthquake and he's been involved in the Haiti earthquake disaster response. He's acted as a volunteer physician in Guatemala and is working with the Nepal ambulance service in Kathmandu, Nepal. Dr Auerbach is certainly a champion of giving back and trying to make the world a better place, and today he joins us from his office there at Stanford. Good to have you, Dr. Thank you for inviting me.

We're talking to scout leaders today. I know a lot of us have read Medicine for the Outdoors and I have the current copy and I keep it close by.

Do you have any scouting background? I do. I was a sea scout for a couple of years growing up in New Jersey.

Oh, okay, Prior to that I was a Cub Scout. I never went on into boy scouting.

I took a bit of a break for athletics and other things and then rejoined scouting as a sea scout because it seemed novel and interesting and I had an interest in the ocean and marine science. Uh-huh, Whereabouts in New Jersey, Central Jersey, a place called North Plainfield? Oh sure, Yeah, I'm very close by there actually.

Well, I can talk like that and you can call me Polly if you want to. Okay, Wilderness medicine- it's kind of a new discipline.

What got you interested in wilderness medicine? It's new, but it's not so new actually, If you think about it historically. Probably medicine at the beginning of time was what we could consider to be wilderness medicine because it was practiced in austere circumstances where people had limited resources.

Modern wilderness medicine, congealed as a specialty over the last 30 years, I would say, beginning particularly with folks interested in mountaineering high altitude, and then amalgamating that with special interests such as dive medicine, military medicine, what people needed to do to survive and prosper in other environments such as the deserts, the forests, et cetera. My interest in it as a specialty began when I served as an extern on an Indian reservation in Montana during the summer of my second year as a medical student. Out there I was asked to help treat victims who had been bitten by snakes or near drowned or struck by lightning or had environmental exposures, and I discovered that while there was some literature about these topics, it was pretty scattered.

So that put the first seeds in my mind for perhaps creating what has become the textbook entitled Wilderness Medicine, which is about to go into its sixth edition and is written for medical professionals. How long ago are we talking? That was in 1975. I would imagine that a lot of the protocols and the things that have developed since then are pretty big steps forward in what you had to work with at the time.

Wilderness medicine is like any other aspect of medicine, I think. We run in cycles and a lot of what we were taught three decades ago has been reevaluated and we see changes constantly.

So, whether it's treatment for snake bite or management of hypothermia, we continually learn new and better ways to manage patients. But, like all of medicine, there are some things that don't change.

So the procedures whereby we splint fractures and manage certain types of wounds, the need for hydration in certain circumstances- One of the most common things that we encounter with scouts is the whole hydration thing. Maybe you can give us kind of an encapsulation on what best practices are at this point. Hydration is actually not all that complicated.

The real issue is recognizing dehydration and then modifying behavior so that people will keep up with their hydration and not only ingest enough water, but ingest enough of the electrolytes- sodium, potassium as examples- that they need for all the systems that they have in their bodies to function well. It's relevant in every single environment: In the cold, at altitude and in the heat.

We know that thirst is not an adequate indicator for hydration, so you have to pay attention to the volumes that you produce. Certainly, we're seeing the life-saving efforts at hydration that are occurring now in Haiti with the cholera epidemic.

Anyone who's a diver knows that when they're under pressure and in the cold that they urinate more and so have to pay attention to hydration. Can you over hydrate Absolutely? For instance, if you are losing large volumes of water at times of high sweating or evaporative heat loss and you only replenish that with water and no electrolytes, then you can drive down the amount of sodium that's in your body and make yourself quite ill. There are definitely techniques and rules for keeping up with oral hydration, and that's why there exist products such as oral rehydration salts, Gatorade and all the other commercial sports beverages and electrolyte beverages. There's a wonderful new product on the market, By the way, I have no commercial interest in this, but I'm seeing things that are out there called ELITE, E-L-E-T-E, which are concentrated electrolyte drops, such that you can replenish electrolytes by putting these completely tasteless drops into water and thereby restore essential electrolytes to your body. These were very important.

We used them constantly when we deployed to Haiti a year ago. It's one of the more common things.

It's highlighted frequently in athletics and we have plenty of tragedies, such as football players that succumb to exhaustion and dehydration because they haven't adequately rehydrated during practices. Military has a huge issue with it because they're deploying into climates in full clothing and regalia and they need to keep the troops hydrated.

Staying well hydrated is a good rule for life in general. What's the difference between first aid and wilderness medicine? First aid is a subset of wilderness medicine and medicine in general. First aid is just what it says: It's the first encounter with the patient and the aid that's rendered.

At the initial encounter You do what you can acutely to hold off the situation or improve the situation, not have it worsen- and then, if necessary, get the victim to more advanced care if that's necessary. Sometimes first aid is sufficient. Cleaning a minor wound and putting antiseptic ointment and a band-aid on it is first aid and that's sufficient aid That takes you all the way through it.

But if someone has, for instance, a severe wrist fracture, first aid might be splitting the fracture, giving some pain medications, fashioning a sling, elevating it and then bringing the victim to advanced care where an orthopedist can reduce the fracture if necessary, operate if necessary and provide the additional care that the victim needs. Have you tracked any trends in outdoor or wilderness-related activity injuries that you could advise us about?

There isn't a new wave of a particular type of injuries that we're seeing associated with outdoor activities, but I think we have better epidemiology to let us know what the common injuries and illnesses are and thereby better educate both the treatment of them and, even more important, the prevention of them. Is there a common set of preventative measures that people who are leading groups in these activities should be aware of?

Well, I'm going to use the Boy Scout model. I'd be prepared. The most important thing is actually to know what you're going to encounter, to carry the appropriate equipment and to be trained ahead of time how you're going to manage it.

So, as much as I'm a fan of my own book, I don't want you to have to read about snake bites and have your first educational encounter with the concept in the middle of the woods after someone's been bitten by a rattlesnake. I would far prefer that you have read something about it, have some familiarity with splinting and what you'll do in the event that the accident occurs.

So preparation is enormous. I'm a big believer in using reasonable safety devices and protection mechanisms that don't interfere with the encounter. One doesn't go through life wearing a helmet, but if you're a rock climber or a mountain biker or a skier or a kayaker, then it's foolish to not wear that. We get into philosophical discussions about personal freedoms et cetera, but they all kind of go out the door when you see a tragic accident where someone suffers a head injury because they weren't wearing a helmet.

So I am willing to fight those battles in pursuit of safety for all people involved. You know, your average adolescent boy not a real good judge of risk.

So it's important to assure their safety and they will push back on occasion. I've taught lots of scouts and lots of youths. What you do is you acknowledge the risks, you teach them how to take care of themselves and others and in the course of that, you talk always about prevention.

So when you teach someone about snake bites, you teach about snake habitat and how to avoid snake bites. When you teach about how to treat burns, you talk about fire safety and how to avoid burns. When you talk about how to bandage wounds, you talk about how to avoid the situations in which you might get these wounds, either by safe handling of knives, how to avoid blisters, et cetera.

So injury prevention should be at least 50% of the educational process. So let me ask you this: What key skills or training would you like to see in a person who's leading a youth group before you would send your own son or daughter out with them? The key skills or knowledge that one would like to see in a leader are those that are particularly relevant to the particular environment in which they're going to be for one.

So, for instance, if it's going to be an experience around bodies of water, I'm going to want the instructor to know water safety particularly well and what to do should someone have a drowning incident. I would also want leaders in scouting groups to have basic, fundamental first aid and health and safety information to treat common disorders that are not necessarily environmental, such as seizures, such as infectious diarrhea, such as headaches, abdominal pain, chest pain, common skin disorders, so that they feel relatively comfortable knowing which kids are sick and which kids are not sick and when to ask for help. You don't have to know exactly how to treat all of these disorders. You need to be able to recognize them. In other words, Yeah, you need to be able to recognize them and you have to have the resources available to either self-help or to get assistance. I mean, that's where the book comes in.

For instance, You don't have to memorize the book Medicine for the Outdoors, but you should have thumbed through it to know how to get to the information you need in a hurry, if it's the kind of information that you'll need in a hurry. So it's more important to know what's in the index than it is to have memorized all the content. What I've done is I have a Kindle edition of the book.

I can put that on a smartphone and I can put it on an iPod Touch so that it's basically carried with me at all times. I'm going to spend enough time to make sure I know how to reference things in it In a situation where those devices might go south on me. I would also want to have a hard copy of it. Yeah, that's an issue that we're going to face in publishing. Going forward across the entire spectrum. The printed page is fading in terms of popularity and it is much easier to carry a PDA or a Kindle with you.

But you have to be able to get to information when the power's off. That's an issue that you decide depending on the environment in which you're going to be.

If you know you're going to be out for five or six hours and you can protect your devices, then you're in good shape. If you know you're going to be out for a month, then you have to have something written down.

What protocol or procedures changed significantly between the fourth and fifth editions of the book? There weren't a tremendous number of changes. There was actually what I would consider updating. Any time you read through a book like this, you have to go through all the medications to make sure that there haven't been recalls. You have to check all the antibiotics and bring those things up to date for different disorders, because those things change. Sometimes there are philosophical changes with regard to certain devices.

For instance, those of us that instructed people to use the extractor device for snake bite therapy had to do a reversal because there were data coming out that showed that not only was it not helpful for snake bites, but in certain circumstances it might be harmful. Medicine changes and we do the best we can to keep up with the best knowledge and literature and to write appropriately, but things change. There are things in the fifth edition that I know that I'll change in the sixth edition, but the good news is none of them are such that there has to be a reprint now. It's just that there will be modifications as techniques improve, as new devices are made available, as we know more about everything that we write about, I notice in the fifth edition too, you've expanded on the idea of making do with what you have in responding to wilderness emergencies.

What can you tell me about that? Well, improvisation is one of the not entirely unique but really interesting features of practicing in an austere environment.

Whether you're doing global humanitarian relief, whether you're on an expedition with scouts for a couple of weeks in the back country, whether you're just in the park and you have to respond to an emergency, it's really about making do with what's at hand, Without making the book get so big that you don't want to carry it in your backpack. I'm going to continue to try and add improvisational techniques in ways that people will see through to solving problems that they might not otherwise figure out on their own.

There was an improvisational technique using dental floss to close a scalp wound that I had never seen before Right, and a way to sew a wound shut without ever stitching the skin by just putting tape on each side, creating a non-sticky edge to the tape and then just sewing the tape strips. Whenever I'm able to discover a technique- and I try all these before they go in the book.

What's the career path for somebody who's interested in wilderness medicine? Wilderness medicine is a bona fide specialty of medicine. There are folks who, at the layperson level, are wilderness medicine instructors. I don't know that they've made complete careers out of wilderness medicine.

So, for instance, people that are involved in outdoor education programs at the high school and collegiate level and are predominantly educators. On the medical professional side, there are physicians, nurses, EMTs- of all specialties who practice wilderness medicine by virtue of being expedition physicians, by virtue of practicing in austere environments and needing the skills. Wilderness EMTs have special training that enable them to be better prepared in those environments. Many of them turn out to be ski patrollers.

Guides of all sorts enhance their education by taking wilderness medicine courses so that they're better able to care for their clients. So, while it's not a traditional career path like being a teacher, a doctor, a lawyer, a chef, it's more of a skill that melds in with whatever a person's primary activity turns out to be.

What expeditions or adventures have you got in the future? Well, quite a few. I've been spending more time in the past couple of years doing international medicine, whether that be responding to a disaster situation like Haiti, or doing humanitarian relief or, for instance, we just returned from a month in Nepal helping to teach the first EMT class that will be engaged in the Nepal ambulance service.

So a lot of my wilderness, outdoor activity is related to professional work that I intend to do in the future. I wish I wasn't working so hard, but I am.

So the amount of time that I can spend purely recreating is diminishing, but that's okay. I'll get back to that at some point. I'm doing less recreational diving, for instance, and more time underwater, involved with a research project, for instance, And I try and sneak in a trek in Nepal when I'm working on an ambulance service.

So I'm trying to mix business with pleasure as best I can. I really appreciate your work. I love the book. Once again, thanks for taking the time. All right, Take care. I wanted to mention, too, that you can follow Dr Auerbach on Healthlinecom.

He puts a couple of posts up there a week that deal with wilderness medicine, and there will be a link on the blog post that contains this podcast- podcast number 57, so that you can find Dr Auerbach on Healthlinecom.