11/27/2011

First Aid Merit Badge Show Requirements:

A Guide for the Merit Badge Counselor
The show requirements call upon the scout to actually do or demonstrate something, instead of simply describing or explaining something. For the First Aid merit badge 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.

Note:
Some of the above requirements also include a non-show component (e.g., describe or discuss or show component). Only one of 6b and 6c is required. Currently in Troop 764 requirement 6c is not usually done and will not be considered in this document.

The following pages describe the above as a series of 6 stations. Each of the 6 will take an estimated 20 minutes to an hour. At its simplest, the MBC need only ask the scout to fulfill the requirement in question. For example, for requirement 4a, the MBC can simply ask the scout to describe the signals (signs and symptoms) of a fracture, then ask him to demonstrate splinting/slinging/swathing for the fractures in question. A well-prepared scout can meet the requirement in a few minutes. In some (or perhaps most) cases, the scout will not be prepared enough and will require a certain amount of instruction, coaching, and practice before he is able to meet the requirement. To this end the EDGE Teaching Method is the teaching model that the BSA has chosen. The EDGE method consists of the following four steps:
1. 2. 3. 4. Explain how it is done. Demonstrate the steps. Guide learners as they practice. Enable them to succeed on their own.

11/27/2011 Using the EDGE method might be helpful to the scout in that the MBC is then modeling behavior for the scout in preparation for his meeting requirement 7. In some cases the scout might present as so unprepared that the MBC will ask the scout to do a bit of woodshedding before trying again.

11/27/2011

Station 1: First Aid Kits

REQUIREMENT 2D: PREPARE A FIRST-AID KIT FOR YOUR HOME. DISPLAY AND DISCUSS ITS CONTENTS WITH YOUR COUNSELOR. REQUIREMENT SC 7B: PREPARE A PERSONAL FIRST AID KIT TO TAKE WITH YOU ON A HIKE.

Materials
Basic first aid supplies and equipment for demonstration purposes (e.g., roller bandages, moleskin and scissors) Sample first aid kits, such as personal and group American Red Cross Wilderness and Remote First Aid kits (optional) Advanced equipment or supplies for demonstration, such as specialized blister supplies, SAM splints, pocket masks, survival items, gear repair kits (optional)

Description
Ask the scout to show you his home (or patrol) first aid kit, pointing out each item and explaining its use. He should be able to justify any inclusions or exclusions. Alternatively, the MBC can ask the scout what materials in his first aid kit would be useful in a given scenario (e.g., a scout on a hike with a hot spot or a blister). Remind the scout that there is no single perfect first aid kit and that in selecting contents for any kit the scout needs to consider a number of factors, including the person or person who will be using the kit, the injuries or illnesses targeted, space constraints, and so on. If there is time you can have the scout practice some skills, such as making a moleskin donut. The merit badge book lists the following 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) 3

11/27/2011 Protective goggles/safety glasses (1 pair) CPR breathing barrier (1) Pencil and paper

The 12th edition of the Handbook lists the following as optional items for the home or patrol/troop kit: Instant cold compress Space blanket SAM Splint

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

The scouts first aid kits do not have to follow the above suggestions, but the scout should be asked to explain why or why not he included or excluded any item.

11/27/2011

Station 2: 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. REQUIREMENT 3C: EXPLAIN THE USE OF AN AUTOMATED EXTERNAL DEFIBRILLATOR (AED). 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.

Materials
CPR manikins, including nose/mouth inserts CPR breathing barriers (one per scout) Pocket masks (optional) Shirts for manikins Non-latex disposable gloves (multiple sizes) AED trainer (optional)

Description
Note: The following is modeled after the American Red Cross CPR/AED training program, as of 2011 (2011 Consensus on Science for CPR and Emergency Cardiovascular Care (ECC). It differs in certain ways from the American Heart Association training program.

The scout should be presented a brief scenario of an adult or child who is found down. He should demonstrate all of the followings steps: 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. If there is no breathing 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.

For step 5, above, the American Red Cross still teaches the look, listen, & feel method, whereas the American Heart Association no longer does. Note that now the rescuer does not give breaths until after the first cycle of 5

11/27/2011 30 breaths. When properly done, 5 cycles take about 2 minutes. Typically at that point a rescuer is fatigued and if possible a second rescuer should take over. Automated External Defibrillator (AED) Although requirement 3c (regarding the AED) is not a show requirement, it makes sense to include it with the CPR show requirement, since the AED is an integral part of emergency cardiac care. Ask the scout when an AED should be used (suspected cardiac arrest) and what it does (determines whether or not the victim has a cardiac arrest rhythm amenable to a defibrillatory shock and walks the rescuer through the process of delivering a shock).

11/27/2011

Station 3: 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. REQUIREMENT SC 7A.2: SHOW WHAT TO DO FOR A HURRY CASE OF SERIOUS BLEEDING.

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 Commercial tourniquet (optional)

Description
The MBC presents the scout with a scenario that includes severe bleeding from an arm or leg wound. After the scout accomplishes appropriate direct pressure, the MBC describes bleeding through the first stack of pads; the scout should then without letting up pressure on the original stack of pads -- apply a second stack. After a while the MBC announces that 10 (or 20) minutes has passed and the bleeding has abated enough to let up on direct manual pressure and apply a pressure bandage with a stack of gauze pads secured with a circumferential bandage. The scout should check for adequate circulation distal to the wound. (Note: the steps below have been modified slightly from the MB book.) First Aid Steps for Severe Bleeding (modified slightly from the MB book)
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. (Note: Neither the Handbook nor the merit badge book use the term pressure bandage.) 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.

Common errors: Scouts tend to not apply enough pressure and to not hold the pressure for enough time. Scouts still often bring up the use of pressure points, even though its use is no longer included in the above. The MBC can choose to discuss their use. The MBC can also choose to include treatment for shock. After the above exercise scouts should describe the risks of a tourniquet (ischemic gangrene)and describe an appropriate situation for a tourniquet (amputated extremity). Although not required, a MBC can choose to 7

11/27/2011 demonstrate a tourniquet (or ask the scout to). Tourniquet use is included in the Wilderness and Remote First Aid course.

11/27/2011

Station 4: 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. REQUIREMENT FC 8B: DEMONSTRATE BANDAGES FOR A SPRAINED ANKLE AND FOR INJURIES ON THE HEAD, THE UPPER ARM, AND THE COLLARBONE.

Materials
Splint materials e.g. boards, trekking poles, sleeping pads, magazines, blanket, pillow; plus padding material Triangular bandages, roller bandages, elastic bandages Dressing material 4x4s, etc. Gloves, eye protection

Description
Before the session, lay out both suitable and unsuitable splint material, plus swathing material. Either directly ask a scout to describe the signs and symptoms of a fracture, or give him a brief scenario and ask him what he would do to help determine whether or not a fracture existed. Using another scout or a volunteer victim, present a brief fracture scenario and have the scout demonstrate treatment. Do this for forearm, wrist, upper leg, and lower leg. Signs (page 41)
Feeling or hearing a snap or pop at time of injury Tenderness to palpation or manipulation Inability to move the injured part normally Deformity Swelling, discoloration

Acronyms/Mnemonics (not in book, but commonly used)

DOTS (deformity, open fracture, tenderness, swelling) to look for on initial evaluation CSM (circulation, sensation, motion) to look for initially and check periodically

Specific Fractures
Collarbone -- Sling & swathe (page 48) Upper arm Splint, sling, & swathe (page 47) Lower arm/wrist -- Splint & sling (page 43 & 48), & possibly swathe Upper leg -- Splint (page 45) Lower leg -- Splint (page 45)

The scout should check periodically for circulation, sensation, and movement (CSM). Specifically, skin color (it should not be blue) or the quick return of a nice pink color after squeezing and releasing pressure on the nail 9

11/27/2011 beds at the tips of the victims finger or toes, report of any numbness or tingling or loss of touch sensation, and the victims ability to wiggle his or her fingers or toes. If CSM is not normal the scout should consider this a likely medical emergency. Additional Bandaging
Ankle sprain Head wound

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11/27/2011

Station 5: Stretchers plus Head, Neck, and Back Injuries

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

Materials
Poles (2) Shirts or sweatshirts (at least 2) Assistants (at least 2, preferably 3) Victim

Description
It is convenient and sensible (but not mandatory) to combine the above two requirements. Present the scout a scenario involving an unconscious victim with suspected spinal cord injury who needs to be transported a fairly long distance by multiple rescuers. Requirement 4b involves central nervous system injury. Ask the scout when a possible head, neck, or back injury should be considered. His answer can include any or all of the following:
Motor vehicle crash Fall from higher than standing height Neck or back pain Tingling or weakness in fingers or toes Not fully alert Appears intoxicated Appears to be frail or older than 65 years

Ask the scout how to treat such a suspected injury. His answer should be comprised of the following:
Step 1. Stabilize the head and neck. Step 2. Provide any indicated urgent treatment. Step 3. Do not move the victim unless necessary (e.g., to remove the rescuers or the victim from immediate danger). Step 4. Maintain an open airway (head tilt/chin lift or jaw thrust) while maintaining head and neck position as much as possible. Step 5. Treat for shock without changing the victims position.

Ask the scout to administer inline stabilization to the victim, and then have him turn that over to an assistant. Ask the scout to direct the improvisation of a stretcher, the safe placement of the victim on the stretcher, and the transport of the victim.

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11/27/2011 Note: maintaining manual inline stabilization is not as easy as it sounds (and might not always be possible or even desirable, since attempts to do so can result in increased voluntary movement by the 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 The scout can choose any of the following (all described in the merit badge book):
Shirt stretcher Blanket stretcher Board stretcher

Other stretchers, such as one made from climbing rope, are possible, but not described in the main scouting literature.

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11/27/2011

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

Materials
Blanket (for blanket drag) Old sweatshirt (for shoulder drag) Illustrations of various assists (optional) Chair (for chair carry) Additional scouts (one for victim and multiple-person assists, except for hammock carry, which can require up to 5)

Description
The MBC should present the scout with a typical scenario, for example:
A scout sprains his ankle on the last leg of a patrol hike; otherwise uninjured A victim with suspected head, neck, or back injury who must be quickly moved a few feet from a fire A small victim without spinal cord injury who must be moved a fair distance by a large rescuer. A visitor trips and falls down the stairs and lies at the bottom, unconscious. Your buddy sprains his ankle on his way to the camp store. After you apply a bandage you then determine he should be moved back to the campsite. Other than the sprained ankle he is OK. There is no one else around. As above, except you have a helper. Your friend decides hes just too tired to make the last 500 yards of a day hike. Your friend gently crumples to the ground while on a beach walk with you at the waterline, just as the tide is rolling in.

Ask a second scout to act as victim. Single-Rescuer Assists Described in the Handbook (FC 8c):
Walking assist (Human crutch, Supporting carry) Ankle drag -- to avoid injury to the second scout victim use only on a smooth surface) Shoulder drag (Clothes drag) Blanket drag Pack-strap carry

Described in MB book:
One-person lift (Cradle carry, Arms carry) larger scout, smaller victim Firefighter carry larger scout, smaller victim

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11/27/2011 Multiple-Rescuer Assists Described in the Handbook (FC 8c):

Two-handed seat Four-handed seat

Described in MB book:
Helping the person walk (Two-person assist, Two-man support carry) Chair carry Hammock carry

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