Medical Information and First Aid

Personal Health and the Annual Health and Medical Record

The Scouting adventure, camping trips, high-adventure excursions, and having fun are important to everyone in Scouting—and so are your safety and well-being. Completing the Annual Health and Medical Record is the first step in making sure you have a great Scouting experience. So what do you need?

All Scouting Events. All participants in all Scouting activities, such as local tours and weekend camping trips of fewer than 72 hours, need to complete and return to their unit leader parts A and B of the Annual Health and Medical Record. These forms need to be updated at least annually. Part A is an informed consent, release agreement, and authorization that needs to be signed by every participant (or a parent and/or legal guardian for all youth under 18). Part B is general information and a health history.

Going to Camp? A pre-participation physical is needed for resident, tour, or trek camps or for a Scouting event of more than 72 hours, such as Wood Badge and NYLT. The exam needs to be completed by a certified and licensed physician (MD, DO), nurse practitioner, or physician assistant. If your camp has provided you with any supplemental risk information, or if your plans include attending one of the four national high-adventure bases, share the venue’s risk advisory with your medical provider when you are having your physical exam. Part C is your pre-participation physical certification.

Planning a High-Adventure Trip? Each of the four national high-adventure bases has provided a supplemental risk advisory that explains in greater detail some of the risks inherent in that program. All high-adventure participants must read and share this information with their medical providers during their pre-participation physicals. Additional information regarding high-adventure activities may be obtained directly from the venue or your local council.

Following are some of the most frequently asked questions about the Annual Health and Medical Record. For a full set of FAQs, visit www.scouting.org/HealthandSafety/Resources/MedicalFormFAQs.aspx.

Q. Why does the BSA require all participants to have an Annual Health and Medical Record?
A.
The AMHR serves many purposes. Completing a health history promotes health awareness, collects necessary data, and provides medical professionals critical information needed to treat a patient in the event of an illness or injury. It also provides emergency contact information.

Poor health and/or lack of awareness of risk factors have led to disabling injuries, illnesses, and even fatalities. Because we care about our participants’ health and safety, the Boy Scouts of America has produced and required use of standardized annual health and medical information since at least the 1930s.

The medical record is used to prepare for high-adventure activities and increased physical activity. In some cases, it is used to review participants’ readiness for gatherings like the national Scout jamboree and other specialized activities.

Because many states regulate the camping industry, the Annual Health and Medical Record also serves as a tool that enables councils to operate day and resident camps and adhere to BSA and state requirements. The Boy Scouts of America’s Annual Health and Medical Record provides a standardized mechanism that can be used by members in all 50 states.

Q. Where can I find the Annual Health and Medical Record?
A.
The only way to assure you have the proper documents is to download from the website: http://www.scouting.org/HealthandSafety/ahmr.aspx. Please only download from the website.

Q. Who needs to complete an Annual Health and Medical Record?
A.
For any and all Scouting activities, all participants must complete Part A and Part B. "All participants" includes parents, guardians, siblings, youth, staff, and unit leaders. Though Part C is only required for participation in events lasting longer than 72 hours, all BSA participants are encouraged to complete this pre-participation physical during an annual physical performed by a medical professional.

Q. What is meant by "Annual"?
A.
An AHMR is valid through the end of the 12th month from the date it was administered by your medical provider. For example, a physical administered March 3, 2014, would be valid until March 31, 2015. The AHMR in use before March 1, 2014, will be valid only until April 1, 2015, and only if it was completed before April 1, 2014.

Q. What do leaders do with the Annual Health and Medical Records they collect?
A.
In all cases, the information gathered is for use in conducting a safe Scouting program. Information gathered in the AHMR must be maintained and shared in a confidential and discreet manner. Some conditions may require communication to ensure the safety of participants. This information should only be shared on a "need-to-know" basis.

Following are some of the best practices for using and storing the records:
  • The Annual Health and Medical Record is secured to maintain the confidentiality of the information, yet at the same time, the forms should be accessible by adult leaders in an emergency. The following guidance will assist leaders in achieving this goal:
    • Leaders are encouraged to maintain the original AHMR forms in a safe location in a binder or file that protects the documents entrusted to the unit leader.
    • The AHMR should be taken on all activities.
    • Designate a leader to keep the files containing the AHMR up to date. This may include reminding participants to update the AHMR annually or as needed.
    • Designate a leader as the point of contact with event or camp health officers. If needed, the leader should arrange to have the AHMR returned tohim or her at the end of the event, if allowed by the state.
    • The unit leader (or his or her designee) is responsible for destroying or returning to the participant (or parent and/or guardian) the AHMR documents when the participant leaves the unit or when the documents become outdated.
  • Records are NOT to be digitized, scanned, sent by email, or stored electronically by unit leaders.
  • To streamline a summer or winter camp check-in, records of all participants are reviewed to make sure they are up to date, completed, and signed before leaving for camp. Be sure to check with the camp for any additional information that may be needed. For example, specific immunization records may be required in some states.

Prepared leaders use the AHMR in the following ways:

  • Review each participant’s health history. This aids the leader in becoming knowledgeable about the medical conditions of adults and youth members in the unit.
  • Review any treatment plans that may exist with participants and/or parents of youth. Examples might include plans for asthma, food or other allergies, anaphylaxis treatment, behavior, hypertension, and other health risks and medical restrictions that may require accommodations. Knowledge of a participant’s use of an inhaler would allow the leader to prompt the youth to bring it on an overnight camping trip.
  • Be knowledgeable of a participant’s restrictions. This may allow the leader to find ways to extend the Scouting program to those with restrictions while also protecting others and providing a positive and safe experience for everyone. The leader may be able to plan alternate activities (within Youth Protection guidelines) for those youth members who are unable to participate in a long hike or a swimming event.
  • Assist leaders to better coordinate ongoing medical care, such as administration of medications or bandage changes, with parents or other authorized and trained leaders in the unit who agree to assist the participant. This kind of assistance is especially necessary during events lasting longer than 72 hours when a parent or guardian may not be present and the youth member must take regularly scheduled medication.

Medical Risk Factors for Your Participation in Scouting

Scouting activities can be physically and mentally demanding. Following are the key risk factors that have been known to become issues during outdoor adventures.

Become familiar with these 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/

Cardiac or Cardiovascular Disease

Natural causes, primarily those that are cardiac- or cardiovascular-related, are the most common reasons for fatalities while participants are engaged in Scouting activities or visiting Scouting properties. Among these causes are a personal or family history of adult or congenital heart disease, heart attacks, chest pain (angina), heart murmurs, and coronary artery disease; any heart surgery or procedure; and a family history of heart disease or any sudden heart-related death of a family member before age 50. Participants should be aware that, in addition to these common indicators that you may be at risk, smoking increases these risks.

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 prior to participation.

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.

Seizures (Epilepsy)

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).

Asthma

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 a well-controlled condition are:

  1. The use of a rescue inhaler zero times to one time a day
  2. 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.

If the Scouting event is physically demanding, individuals with the following asthma conditions should reconsider participation:

  1. Exercise asthma is not prevented by medication.
  2. Participant has been hospitalized or has gone to the emergency room for asthma treatment in the six months before the fitness examination.
  3. 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.

Sleep Apnea

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 who require a CPAP machine that on any overnight Scouting experience, all equipment (e.g., CPAP machine) must be provided by the Scout or Scouter and be self-contained. This may include batteries (without provisions for recharging) to be brought to and taken away from the Scouting event. Be sure to check with the location or camp well in advance if electricity is a requirement for your safety. It may not be available.

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. Guidelines for managing food allergies can be found here: http://www.scouting.org/filestore/HealthSafety/pdf/2013Guidelines_Managing_Food_Allergies.pdf.

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.

Immunizations

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).
  • Pertussis
  • Meningococcal
  • Diptheria
  • Measles
  • Mumps
  • Rubella
  • Polio
  • Chicken pox
  • Hepatitis A
  • Hepatitis B
  • Influenza

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.

Prescriptions

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.

AED Training

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.

First-Aid Kits

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
  • Scissors
  • 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
  • Scissors
  • Tweezers
  • 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