Medical Information and First Aid
In order to provide better care for its members and to assist them in better understanding their own physical capabilities, the Boy Scouts of America recommends that everyone who participates in a Scouting event have an annual medical evaluation by a certified and licensed health care provider— a physician (M.D. or D.O.), nurse practitioner, or physician assistant. Providing this medical information on the four-part medical record, the Annual Health and Medical Record (found under forms on Scouting Safely at www.scouting.org), will help ensure that the minimum standards for participation in various activities are met. Note that unit leaders must always protect the privacy of unit participants by protecting their medical information. Do not transmit medical information through unsecured devices or programs, such as e-mail or the Web.
Parts A and B are to be completed at least annually by participants in all Scouting events. This health history, parent or guardian informed consent and hold harmless/ release agreement, and talent release statement are to be completed by the participant and parents or guardians.
— Adult unit leaders should review participants’ health history and become knowledgeable about the medical needs of the youth members in their unit.
— This form is to be filled out by participants and parents or guardians, and kept on file for easy reference.
Part C is the physical exam that is required for participants in any event that exceeds 72 consecutive hours, for all high-adventure base participants, or when the nature of the activity is strenuous and demanding. Service projects or work weekends may fit this description.
— Part C is to be completed and signed by a certified and licensed health care provider—physician (M.D. or D.O.), nurse practitioner, or physician assistant.
— It is important to note that the height-to-weight limits must be strictly adhered to when the event will take the unit more than 30 minutes away from an emergency vehicle-accessible roadway, or when the program requires it, such as backpacking trips, high-adventure activities, and conservation projects in remote areas.
Part D is required to be reviewed by all participants of a high-adventure program at one of the national high-adventure bases and shared with the examining health care provider before completing Part C.
For more information, go to www.scouting.org/HealthandSafety/Resources/MedicalFormFAQs.aspx.
Medical Risk Factors for Your Participation in Scouting
Scouting can be physically and mentally demanding. To help its members be better prepared, the Boy Scouts of America recommends that everyone who participates in a Scouting activity have an annual medical evaluation by a certified and licensed health-care provider: a physician (MD or DO), nurse practitioner, or physician assistant. Based on the vast experience of the medical community, the BSA has identified risk factors that could become issues during weekend camping, hikes, treks, tours, or other activities.
Become familiar with the following risk factors to ensure all Scouts and Scouters are prepared.
Excessive Body Weight (Obesity)
Excessive body weight increases risk for numerous health problems. To ensure the best experience, Scouts and Scouters should be of proportional height and weight. One such measure is the Body Mass Index (BMI), which can be calculated using a tool from the Centers for Disease Control here: http://www.cdc.gov/nccdphp/dnpa/bmi/. Calculators for both adults and youth are available. It is recommended that youth fall within the fifth and 85th percentiles. Those in the 85th to 95th percentiles are at risk and should work to achieve a higher level of fitness.
Cardiac or Cardiovascular Disease
- Angina (chest pain caused by blocked blood vessels or coming from the heart)
- Myocardial infarction (heart attack)
- Heart surgery or heart catheterization (including angioplasty to treat blocked blood vessels, balloon dilation, or stents)
- Stroke or transient ischemic attacks (TIAs)
- Claudication (leg pain with exercise, caused by hardening of the arteries)
- Family history of heart disease or a family member who died unexpectedly before age 50
Youth who have congenital heart disease or acquired heart disease such as rheumatic fever, Kawasaki’s disease, or mitral valve prolapse should undergo a thorough exam.
Hypertension (High Blood Pressure)
Scouts and Scouters should have a normal blood pressure (less than 140/90). Persons with significant hypertension should be under treatment and their condition should be under control. If participating in a Scouting event that is physically demanding, it is recommended that hypertension be under control in the six months prior to the date of the event. The goal of the treatment should be to lower blood pressure to normal levels. Those already on antihypertensive therapy with normal blood pressures should continue treatment and should not choose the time they are at any Scouting event to experiment with or change medications.
Diabetes (Insulin-Dependent Diabetes Mellitus)
Any individual with insulin-dependent diabetes mellitus should be able to self-monitor blood glucose and know how to adjust insulin doses based on these factors or be accompanied by a guardian that is knowledgeable in these matters. The individual with diabetes and/or the guardian should also know how to give a self-injection/injection and recognize indications of high and low blood sugar. If planning on participating in an overnight experience of any kind, bring enough medication, testing supplies, and equipment for the entire Scouting event. This includes batteries (without provisions for recharging) to be both brought to and taken away from the event for pumps (remember Leave No Trace guidelines).
An insulin-dependent individual who has been newly diagnosed (within six months of the fitness examination) or who has undergone a change in delivery system (e.g., an insulin pump) in the same period and who desires to participate in a Scouting event that is physically demanding should reconsider participation. This also applies to an individual who has been hospitalized for diabetic ketoacidosis or who has had problems with hypoglycemia in the last year.
Seizure disorder or epilepsy should be well-controlled by medications if an individual desires to participate in a physically demanding Scouting event. A minimum of six seizure-free months prior to the fitness examination is considered under control. Participants with a history of seizures need to limit high-adventure activities (e.g., climbing or rappelling).
Acute or severe bronchial asthma under treatment anytime during the past 24 months should be well-controlled before participating in physically demanding Scouting events. Key indicators of well-controlled are:
- The use of a rescue inhaler zero times to one time a day
- No need for nighttime treatment with a short-acting bronchodilator
Well-controlled asthma may include the use of long-acting bronchodilators, inhaled steroids, or oral medications such as Singulair.
If the Scouting event is physically demanding, individuals with the following asthma conditions should reconsider participation:
- Exercise asthma is not prevented by medication.
- Participant has been hospitalized or has gone to the emergency room for asthma treatment in the six months before the fitness examination.
- Participant has received treatment that required oral steroids (prednisone) in the six months before the fitness examination.
When participating in any overnight Scouting event, participants must bring an adequate and a backup supply of medications and spare rescue inhalers that are current. Participants must carry a rescue inhaler at all times during any Scouting event.
Scouts and Scouters with sleeping disorders may experience health risks due to long days and short nights for many Scouting events. It is recommended for those with sleep apnea requiring a CPAP machine for any overnight Scouting experience that all equipment (e.g., CPAP machine) be provided by the Scout or Scouter and be self-contained. This may include batteries (without provisions for recharging) to be both brought to and taken away from the Scouting event (remember Leave No Trace guidelines).
Allergies or Anaphylaxis
Scouting events have several risks (e.g., nuts, pollens, wasps, hornets, and other stinging insects) that could trigger anaphylactic reactions in individuals prone to reaction. It is recommended that Scouts and Scouters who have had an anaphylactic reaction from any cause contact the appropriate medical personnel of the Scouting event to confirm participation eligibility before arrival, especially if the event includes an overnight experience. Participants will be required to have appropriate treatment with them at all times.
For longer Scouting events such as summer camp, jamborees, and high-adventure programs, allergy shots required for maintenance doses may be acceptable for persons who have not had an anaphylactic reaction. Contact the appropriate medical personnel for the event for confirmation.
Ingrown Toenails, Recent Musculoskeletal Injuries, and Orthopedic Surgery
Many Scouting events put a great deal of strain on feet, ankles, and knees. If the Scouting event is physically demanding, ingrown toenails should be treated within a month prior to the event. Scouts and Scouters who have had orthopedic surgery, including arthroscopic surgery, or significant musculoskeletal injuries, including back problems, should have a release from the surgeon or treating physician to participate in Scouting events.
Psychiatric/Psychological and Emotional Difficulties
Psychiatric/psychological and emotional disorders do not necessarily exclude an individual from Scouting events. Parents and advisers should be aware that most Scouting events are not designed to assist in overcoming psychological or emotional problems and may exacerbate existing conditions. Experience demonstrates that these problems frequently are magnified, not lessened, when participants are subjected to the physical and mental challenges of many Scouting activities.
Any condition must be well-controlled without the services of a mental health practitioner. Under no circumstances should medication be stopped before or during a Scouting activity. If the Scouting event is an overnight experience, Scouts and Scouters are required to bring an appropriate supply of medication for the duration of the event, including travel to and from the event.
Other Risk Factors
Sickle-cell anemia, hemophilia, leukemia, severe blood dyscrasia, and HIV infection provide special challenges to Scouts and Scouters. To plan for, prepare for, and support those having these medical conditions, it is recommended that an individual evaluation of each situation be done by the appropriate medical personnel. There may be instances where proper medical support at the Scouting event is impossible. Under such circumstances, participation may be denied.
For information on any other health issues, contact your personal health care provider.
The Boy Scouts of America encourages all members of the Scouting community to use available vaccines to fully protect themselves from infectious diseases that are dangerous for children and adults living in the United States. Inadequately immunized participants are subject to identification so that they may be located in case of a necessity for isolation or quarantine as per local public health official directives. Verification of the following immunizations is recommended by the BSA:
- Tetanus (must have been received within the last 10 years).
- Chicken pox
- Hepatitis A
- Hepatitis B
More information about immunizations, as well as the Immunization Exemption Request form, is found under Scouting Safely on www.scouting.org.
Protection Consideration for Blood and Bodily Fluids (Universal Precautions)
Treat all blood and bodily fluids as if they were contaminated with blood-borne viruses (i.e., HIV, hepatitis). Do not use bare hands to stop bleeding; always use a protective barrier, and always wash exposed skin areas for at least 15 seconds with soap and water immediately after treating a victim. Consequently, the following personal protective equipment (PPE) is to be included in all first-aid kits and used when rendering first aid:
- Nonlatex gloves to be used when stopping bleeding or dressing wounds.
- A mouth barrier device for rendering rescue breathing or CPR.
- Plastic goggles or eye protection to prevent a victim’s blood from getting into a rescuer’s eyes in the event of serious bleeding.
- Antiseptic for use in cleaning exposed skin areas, particularly if there is no soap or water available.
Clean any blood and bodily fluid spills with an appropriate disinfecting solution, such as 10 parts water to one part bleach.
Occupational Safety and Health Administration (OSHA) regulations for blood-borne pathogens (29 CFR Section 1910.1030) apply to health-care professions employed by local councils to staff camp health facilities or to fulfill health officer functions at BSA camps. In addition, all designated responders, identified in the local council’s medical emergency response plan, are affected by the regulations. Visit www.osha.gov.
Local Council Membership/Participation Guidelines Regarding Communicable Diseases
The BSA policy regarding communicable diseases (acute or chronic)is as follows:
Local Scouting units and their chartered organizationstraditionally determine their own membership and participation, absent any legal constraints. Accordingly, it is the units and chartered organizations that allow youth or adult members who have, or are suspected of having, a communicable disease to continue to participate in Scouting activities.
The chartered organization and/or a local Scouting unit may request local council assistance if needed, absent any legal restraints. (See Local Council Guidelines Regarding Communicable Disease, No. 680-453, for the steps of that process.)
Exemptions for Medical Care, Treatment, and Immunizations
The following is the Boy Scouts of America’s policy regarding medical requirements:
- Medical examinations for camp attendance are required of all campers. The immunization requirement may be exempted because of religious, philosophical, or medical grounds by signing the Immunization Exemption Request form (found under forms on Scouting Safely at www.scouting.org) and receiving a medical evaluation and screening by a licensed health-care practitioner to reduce the possibility of exposing other camp participants to a communicable disease.
- Exemption from all medical treatment may be granted with the signing of the Request for Exemption for Medical Care and Treatment form (found under forms on Scouting Safely at www.scouting.org) and receiving a medical evaluation and screening by a licensed health-care practitioner to reduce the possibility of exposing other camp participants to a communicable disease.
The taking of prescription medication is the responsibility of the individual taking the medication and/or that individual’s parent or guardian. A leader, after obtaining all the necessary information, can agree to accept the responsibility of making sure a youth takes the necessary medication at the appropriate time, but BSA does not mandate or necessarily encourage the leader to do so. Also, if state laws are more limiting, they must be followed. BSA camp standards may modify this for specific camp operation.
First Aid and CPR Training
First aid is the first help given to someone who has had an accident or other health emergency. If more attention is needed, first-aid treatment helps keep an injured or ill person as safe as possible until medical personnel arrive. Wilderness first aid (WFA) is the assessment of and treatment given to an ill or injured person in a remote environment when a physician and/or rapid transport are not readily available.
First aid and WFA are important to participants in BSA programs. Our members’ understanding of first-aid principles is not only concrete evidence that we are striving to put into action the Scouting ideal of doing a Good Turn daily, it helps Scouts and Scouters be prepared and be safe when helping others in need.
We strongly recommend that everyone be trained in first aid and cardiopulmonary resuscitation (CPR) as an endeavor to revive victims of cardiac arrest (no breathing, no pulse). CPR may be taught by instructors currently trained by a nationally certified provider such as the American Red Cross, American Heart Association, Emergency Care and Safety Institute, or American Safety and Health Institute. Cub Scouts can even be taught this valuable skill in a family-type setting.
Depending upon the event or activity planned, it may be required that at least two adults or youth (though three or more is preferable) in each touring group should have current training in WFA and CPR, know how and when to put this knowledge to use, and thoroughly understand the limitations of their knowledge. Further information and advancement in first aid may include wilderness first responder (WFR) and wilderness emergency medical technician (WEMT).
Preliminary skills related to CPR are found in the Boy Scout Handbook and the First Aid merit badge pamphlet.
We strongly recommend that Scouting’s adult leaders avail themselves of CPR with automatic external defibrillator (AED) training, along with first-aid and wilderness first-aid training. Several providers are in compliance with BSA standards. Be sure to ask the desired provider if it is in compliance before completing training.
Personal First-Aid Kit Contents
- 6 adhesive bandages
- 2 sterile, 3-by-3-inch gauze pads
- A small roll of adhesive tape
- A 3-by-6-inch piece of moleskin
- A small bar of soap or small bottle of alcohol-based hand sanitizing gel
- A small tube of triple antibiotic ointment
- Disposable nonlatex gloves
- CPR breathing barrier
- Pencil and paper
Home or Patrol/Troop First-Aid Kit Contents
A more comprehensive group first-aid kit can contain the following items:
- A 2-inch roller bandage
- 2 1-inch roller bandages
- A roll of 1-inch adhesive tape
- 24 alcohol swabs
- A box of assorted adhesive bandages
- 2 3-inch-wide elastic bandages
- 12 sterile, 3-by-3-inch gauze pads
- 4 3-by-6-inch pieces of moleskin
- 2 packets of gel pads for blisters and burns
- A tube of triple antibiotic ointment
- 4 triangular bandages
- A small bar of soap, or a travel-size bottle of alcohol-based hand sanitizing gel
- 12 safety pins
- 6 pairs of nonlatex disposable gloves
- Protective goggles/safety glasses
- CPR breathing barrier
- Pencil and paper
These optional items also are recommended:
- An instant cold compress
- A space blanket
- A SAM® Splint