78: The First Aid Skills All Nature-Based Pediatric Therapists Must Know
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[00:00:00] Welcome to Therapy in the Great Outdoors, the podcast where we explore the business and practice of nature based pediatric therapy of all kinds. If you're an outdoor loving pediatric practitioner in the fields of occupational, physical, or speech therapy, social work, or mental health, this podcast will help you start and grow a successful nature based practice or program.
I am the ever honest, always a hundred percent real. You'll hear it all on this podcast. Dr. Laura Park Figueroa. I'm a pediatric OT with over 20 years of experience and I run a thriving nature based practice with profitable locations in two different states and multi six figures in revenue. I also host the free online community at therapyinthegreatoutdoors.
com to help you pursue your nature based therapy dreams too. Are you ready to take action on those dreams? Let's jump [00:01:00] in.
Hello, friends. Welcome to another episode of Therapy in the Great Outdoors. This is part two of our three part series on first aid for nature based pediatric therapists. So, if you did not listen to episode 77 last week with Nicole Roma Thurrell, who is amazing. She has so much experience in this field.
She's the CEO of Institute for Wild Med. They are a online educator, they also do in person education as well on first aid topics, but the reason I say online is because wherever you're listening to this in the world, you can take their classes. So you can get a discount on their classes for being a listener of this podcast by using the discount code TGO20 for any course on their website.
So it's T G O, the number 20, and you'll get 20 percent off. Nicole was so amazing. Last week we talked about risky play [00:02:00] and considerations we need to make as nature based therapists when we run these programs that encourage risky play for children. This week we are delving into the topic of first aid skills that all of us as nature based pediatric therapists should know.
So There's, you know, a huge array of things and this is not going to give you an education in first aid, but it was a very thoughtful discussion that brought up a lot of thinking for me about making sure that my employees know what to do in case of emergency. So I might actually make this required listening, this episode in particular, required listening for my own employees because it's, it's that good.
So next week we will be discussing wilderness mental health. first aid. So if that is a new concept to you, that'll be a whole new thing to learn on our next week episode. But this week we're focusing on critical first aid skills that all nature based pediatric therapists should know. All right, let's dive in.
Laura Park Figueroa: So [00:03:00] shall we talk about critical first aid skills that we all need? I'm so this topic is a little bit, um, I, I told you before we hit record that my daughter at one of my larger group programs, I was running way back.
Like she was probably. 14 maybe? I'm trying to think how old she was. I feel like she was younger than that. She's 22 now. So she was probably 13. She might've been 13. And she was helping with one of my outdoor programs. And just like, there was like a little, you know, a creek bed, very narrow. It wasn't like a major, it wasn't down a ravine or anything, but she just tripped and broke her wrist.
Like she landed put her hand down to catch herself and broke her wrist. And I have to tell you, I probably, as her mom, did not respond in the, in the nicest way because I was like, are you kidding me? My own child broke her wrist at my outdoor program. Yes, I'm like, I'm sure I would have been much more compassionate if it had been a child in the program, but I was like, you're [00:04:00] supposed to be here helping.
I barely remember it, but I, I, I do think that when I look back on that, I really don't know. And maybe I'm just not remembering honestly, because it was so long ago, but I don't know that I actually like, immediately knew what to do with clearly it being super painful and probably broken.
I knew to, I knew to kind of point tenderness, right? I knew that indicates a break. And I guess that it was probably broken before we, and we iced it. But like, you know, there's, there's just, it's just a story of like, you never know what's going to happen even in kind of benign, not, it wasn't necessarily a risky play situation.
So, yeah, let's talk about it. What are your, what are your top things that we need to know to be prepared for things like our child breaking their arm when we're outdoors?
Nicole Roma Thurrell: Okay, so I think I'd like to start with a [00:05:00] principle of care, or, assessment, if you will.
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: Then perhaps we could talk about very specific topics. So I think it's really critical that as caregivers, and this may sound strong, but I think it's really critical as caregivers that we're able to assess the situation immediately and identify whether there are any life threatening risks present currently
Laura Park Figueroa: Mm hmm.
Nicole Roma Thurrell: that need to be addressed. And here's a quick story to affirm that playing in the outdoors, going on a hike on a class trip with a fourth grade class. And the kids were playing on a log that has, so imagine a tree that has fallen, but the tree is caught by the crotch of another tree. So the
Laura Park Figueroa: tree
Yes. Mm
Nicole Roma Thurrell: that has fallen is now at about, I don't know, 45 degree angle. And the kids are playing on it, like balance beam yet one of the kids is down on the earth and the tree actually breaks the [00:06:00] crotch of its support tree and falls down onto the child's foot. The child is wearing bog boots and is in a great deal of pain and everyone there is totally focused on evacuation.
We've got to get her out. This is, it's probably broken. We need to get it checked out. We need to go, go, go.
Laura Park Figueroa: hmm.
Nicole Roma Thurrell: And so I'm about to admit something that I wish I knew. I, for some reason, I had this illusion as an EMT, as a wilderness EMT over a decade, that if someone's clothing or shoes are intact, that what's underneath of them is also intact, the skin would be intact,
Laura Park Figueroa: Right.
Nicole Roma Thurrell: know, like, okay, well,
Laura Park Figueroa: To me, that seems a logical assumption, Nicole. So, you're not.
Nicole Roma Thurrell: there's likely broken bone from that impact. They're in a great deal of pain. We just need to get that out for x rays and
Laura Park Figueroa: casting
Yep.[00:07:00]
Nicole Roma Thurrell: I was surprised to learn that upon impact, her skin had busted open and there was a great deal of bleeding. So this is the perfect example for regardless of whether you think you have a handle on what you're working with, one must assess Right from the start, are there any life threatening situations that I must tend to right now?
Because what's the bigger threat, Laura?
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: bone or the bleeding?
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: The bleeding any
Laura Park Figueroa: Great example. Great example. Yes.
Nicole Roma Thurrell: Bleeding and there was no visual cue that that was going on. And that may be the case. I worked at a, I did a training at a preschool where a child, they must have had some, bone deficiency of some sort.
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: When they tripped in just a very shallow pothole on their [00:08:00] playground. This is not wilderness. This is just a playground
Laura Park Figueroa: Right. Right.
Nicole Roma Thurrell: And so there's another example of a major bleed with zero visual cues. If a femur is broken, that person is losing a lot of blood inside of their body.
Laura Park Figueroa: Yes.
Nicole Roma Thurrell: Easily a court for a child lost, and of the total proportion of their blood volume, that is a lot. A lot of blood and they're on their way to experiencing hypovolemic shock so we must be able to identify life threats So when I think about life threats, I think difficulty breathing
major
Laura Park Figueroa: Mm hmm.
Nicole Roma Thurrell: bleeding or shock Am I dealing with any of those three things just pause the scene? Identify whether you're dealing with any of those things address them and get support Immediately in the form of emergency
Laura Park Figueroa: Yes.
Nicole Roma Thurrell: and stay focused on those things before you make the transition to further assessment and treating the specifics. I've seen this [00:09:00] many times as an EMT showing up on scene where all the bystanders are very compelled by a particular injury because of the deformity that they see or the pain that the patient's experiencing
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: miss. They miss something that's much more acute and life threatening. So that, I just want to put that
Laura Park Figueroa: principal
Okay.
Nicole Roma Thurrell: care out there for everybody.
As soon as something goes wrong,
Laura Park Figueroa: breathing
Nicole Roma Thurrell: bleeding, and shock. if you don't find any of those things, then
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: let's move on to the specific topic.
Laura Park Figueroa: B B S. B B S.
Nicole Roma Thurrell: bleeding.
Laura Park Figueroa: three. Bleeding, breathing, and shock.
Nicole Roma Thurrell: Yes.
Laura Park Figueroa: the signs of shock, let's talk about those. I don't know if everybody knows those. I kind of feel like I might, but I'm vague on it. Like I'm being honest, like, and I'm not doing, so I should be very clear with people. I'm not doing direct work.
I'm managing my practice. I have like five therapists in the online business, so I'm managing people now that do this work. I am not. [00:10:00] I'm helping occasionally outdoors with them, but I'm not. the person that is responding to these kind of things. So, just to give me a little pass here for a minute when I say I can't remember the signs of shock, but, talk to us a little bit about what those are.
Nicole Roma Thurrell: Oh, you've just really, if you don't mind this, there's a little soapbox in here for me if
Laura Park Figueroa: Sure, go ahead.
Nicole Roma Thurrell: So if you were to ask this question or to look in the medical literature, what you would learn is that. The primary sign of shock is pale, cool, and clammy skin. And here's my soapbox, because sure, when shocky, all of us humans are likely to get clammy.
So sweaty, even if we're not hot, and cold to the touch, even if it's warm outdoors.
Laura Park Figueroa: Because the blood is going to the core.
Nicole Roma Thurrell: That's exactly right. Exactly right. The brain is saying, oh no
Laura Park Figueroa: Yeah,
Nicole Roma Thurrell: really bad is going on. We must protect the most important of this body Which is roughly, you know, from, you know, [00:11:00] it's the organs.
It's
Laura Park Figueroa: vital organs. Yeah,
Nicole Roma Thurrell: So the crotch, you know, let's, let's take care of these vital organs. Unfortunately though, the, the adaptive mechanism isn't perfect because the brain actually leaves itself out.
Laura Park Figueroa: right.
Nicole Roma Thurrell: So when the brain vasoconstricts and it tightens up all the vessels in the arms and legs, and it sends the blood to the core to protect all of the organs, that's It's great, it's great that it does that, but it leaves itself out, which is why the skin does often drain of color and why it does become sweaty and cold. But my soapbox is this, these signs do not apply to all humans.
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: with more melanin in our skin may never demonstrate a paler, a paleness to the outside of our skin. And the medical literature is really, does not include people with more melanin in their skin.
Laura Park Figueroa: Wow, that is. A very important point to make.[00:12:00]
Nicole Roma Thurrell: It really is because may be zero change in their baseline. And we are so visual as care providers that we look over to our patient who's hurt and we see them looking just like their baseline and we may miss shock. So it does involve a further investigation for someone who has more melanin. And what you could do is pull down a lower lip and look at the mucosa inside of their mouth.
And any one of us. Regardless of how we look on the outside, in here, we should all look roughly the same. It should be perfused with oxygen rich blood, it should be wet, it should, you know,
Laura Park Figueroa: Reddish, pink. Yeah.
Nicole Roma Thurrell: Pink. Yeah, exactly. So if anyone inside of their lower lip is looking pale, blue, gray, they are shocky.
Laura Park Figueroa: Mmhmm.
Nicole Roma Thurrell: still say pale, cool, and clanny. But I just really want to qualify what pale means, because if we just simply say pale, it really leaves a lot of people out.
Laura Park Figueroa: [00:13:00] Right.
Nicole Roma Thurrell: So pale, cool, clammy skin, that pale may be found outside or inside. disorientation confusion, irritability, being unreasonable, and of course you must know their baseline
Laura Park Figueroa: Right. Right?
Nicole Roma Thurrell: Because if you're working with a three year old, their baseline may be all of those.
Laura Park Figueroa: Yes, exactly.
Nicole Roma Thurrell: confused, combative, and unreasonable. That may be baseline. Right.
Laura Park Figueroa: twos, but I feel like at like terrible twos, they're young enough that they're still cute and you're like, ah, you can give them but at three, you're like, oh my gosh, you You are just doing this to drive me nuts, you know?
That's so funny.
Nicole Roma Thurrell: your job is to really know them well, so that
Laura Park Figueroa: Right.
Nicole Roma Thurrell: is this a deviation from baseline, or is this baseline?
Laura Park Figueroa: Yeah. Yeah. Those are very helpful. So that's, and that's the brain kind of going offline is when they become unreasonable, confused, [00:14:00] combative. Like that's, that's like the brain isn't getting the, the blood at that point.
Nicole Roma Thurrell: For part of the brain going offline as well, often it's part, it's often that confusion, disorientation, combativeness, that's an acute stress response. So
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: where the brain does turn off that frontal lobe. It says, this is not a priority right
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: We don't need. advanced high level reasoning and decision making Right.
now.
We just need to keep ourselves safe immediately,
Laura Park Figueroa: Yes.
Nicole Roma Thurrell: that looks. And so yes, it's, it's a very particular part of the brain going offline. As well as, you're right, oxygen leaving the brain in the blood, going to places where the brain has prioritized over itself.
Laura Park Figueroa: Good. Okay.
Nicole Roma Thurrell: Okay,
Laura Park Figueroa: Blood,
Nicole Roma Thurrell: on that. We've got
Laura Park Figueroa: bleeding, breathing, and shock. Bleeding, breathing, and shock. These are the big three that we all need to remember.
Nicole Roma Thurrell: Exactly. And again, you find those things, you get help and you are completely [00:15:00] focused on those, not the other issues that may be more compelling because of how they look or how the patient's responding to them, but stay focused on the life threats. So as a principal of care, that's really top priority for me, for sure. And then, so do you feel ready to move on to just Other things that may come up in an outdoor setting. Okay, bleeding. I mean, we've already said that as, as a life threat, but you will, you will see, you will, you will, reality check, you will see non life threatening bleeds. You will, it's probably the most common first aid situation that you will respond to.
So I, I really want folks to make sure that they feel really competent in responding to bleeding. there have been major changes in the last few years, particularly around the use of tourniquets, as well as elevation and pressure points. There's, there's quite a lot that has been changed in the protocol. So really making sure that you're solid on the steps to bleeding control, as well as having materials [00:16:00] to control bleeding. Absorbent materials. I'm not stressed about them being sterile at the bleeding stage It's flushing itself out and getting it under control is your top priority, not a
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: at that point. But having absorbent materials, I love, if I could just put it out there, I love hemostatic agents. Hemostatic agents are granules, they're powder that you can keep in your first aid kit that you can shake right into a wound. it will stop the bleeding for all wounds with the exception of like a major arterial bleed.
Laura Park Figueroa: Sure.
Nicole Roma Thurrell: is amazingly effective.
Laura Park Figueroa: That's so cool. I've never even heard of that.
Nicole Roma Thurrell: wish I had some right within arm's reach to show you for those who are watching. I don't have any right here, but it's great. It's really light. It's inexpensive. And
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: just shake it right in there and it coagulates the blood beautifully.
Laura Park Figueroa: hurt. It doesn't like sting or [00:17:00] anything.
Nicole Roma Thurrell: not hot. That's right. So there have been several iterations of hemostatic agents. So your question is It's likely rooted in a historic version that did generate heat and it did sting, and it's not like that anymore.
Laura Park Figueroa: Great.
Nicole Roma Thurrell: no burning. And there's a particular brand that I love called CELOX, C E L O X.
And I
Laura Park Figueroa: love it
Okay.
Nicole Roma Thurrell: because it works even if your patient takes either blood thinning supplements or medications, or, medications that slow clotting down, which you could see.
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: who are referred for OT in particular, example, take cod liver oil. Cod liver oil is known to thin the blood. And so you might find that someone taking a lot of cod liver oil, bleeding is harder to manage than someone
Laura Park Figueroa: Interesting.
Nicole Roma Thurrell: And it is very interesting, especially because many parents or patients, they don't [00:18:00] realize
Laura Park Figueroa: They don't know that.
Nicole Roma Thurrell: Yeah, they don't know.
Laura Park Figueroa: Right.
Nicole Roma Thurrell: but it's significant. And you can really see the difference. when my son was taking it very regularly, it, the blood looked different. It was thinner, brighter, waterier, and
Laura Park Figueroa: Interesting. Which could be really alarming if you aren't prepared for that and don't know that, because that might not even be something that a parent would put on a medical, does your child take any medications? They might not even put that on there, but it can be alarming if the child scrapes their knee and there's just like massive amounts of blood coming out, right?
Like so that's um,
Nicole Roma Thurrell: Right.
Laura Park Figueroa: super important to be aware of.
Nicole Roma Thurrell: not think to put it on there because it's a supplement and not a
Laura Park Figueroa: prescription
Right. Right.
Nicole Roma Thurrell: they may begin using it after your intake and not think to correct the intake.
Laura Park Figueroa: Right. Exactly. Exactly.
Nicole Roma Thurrell: So just a few other examples where we're on the topic, ginger, CBD oil, cod liver oil, turmeric,
Laura Park Figueroa: Okay.[00:19:00]
Nicole Roma Thurrell: and then of course things like aspirin, Coumadin, know,
Laura Park Figueroa: All of those things are blood thinners.
Nicole Roma Thurrell: they
Laura Park Figueroa: what you're saying. Yep.
Nicole Roma Thurrell: all make it harder to control bleeding. Different mechanisms, some actually thin the blood, some thin, slow down platelet production, different mechanisms, but the idea is all the same. It's going to be harder to control the bleeding if they take those supplements. And it's interesting, those are the supplements that people tend to take. As reduce inflammation.
Laura Park Figueroa: Mm hmm.
Nicole Roma Thurrell: are working with conditions of inflammation, they're likely to be taking those. so it's, I think worth, here's a note for therapists. I do think it's worth noting that on your intake forms, specifically saying what supplements are taken and with a note, if you begin, if you change your supplements or prescriptions while we're working together, please reach out and let us know. It
Laura Park Figueroa: That's great advice.
Nicole Roma Thurrell: providing first aid.
Laura Park Figueroa: Yeah, because the, the question of does your child currently take any [00:20:00] medications, prescription or over the counter. That doesn't really ask the question, does your child take any dietary supplements? You know, like that's kind of a very specific question that the parent might say, yeah, they take, we do cod liver oil for, cause don't they take it for constipation sometimes?
Cod liver oil? Is that what it's, I don't remember. Anyway,
I
Nicole Roma Thurrell: don't know.
Laura Park Figueroa: I always thought of it as related to pregnancy or something. Like I can't remember what I, what I know before, but
Nicole Roma Thurrell: but a lot of the kids take the little gummies, the Nordic naturals, cod
Laura Park Figueroa: uh huh.
Nicole Roma Thurrell: gummy fish gummies, and they are suggested for, for brain development, they
Laura Park Figueroa: Oh yeah. Yeah. Like fish oil. Yep.
Nicole Roma Thurrell: Yeah, exactly.
Laura Park Figueroa: Yep.
Nicole Roma Thurrell: for kids with developmental or sensory challenges, it is often suggested.
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: it's definitely worth an ask.
And then otherwise just be prepared for it. You know, I, and this is the beautiful principle of, of, of a lot of how we work, is just expect it, like, expect that [00:21:00] everybody that you're working with is taking blood thinning medications and be prepared for that.
Laura Park Figueroa: Mm hmm.
Nicole Roma Thurrell: having absorbent material, knowing how to make improvised tourniquets, a hemostatic agent.
Laura Park Figueroa: These are things that you teach in your, obviously this is not like first aid training on this podcast episode, but a lot of what you're, I do feel like what I hope is being communicated to, to people listening is the importance of actually getting training in these things. Because like you mentioned, some things may have changed since the last time you took first aid.
And it's important to kind of stay up to date on this and make sure your people are, are all up to date on this as well. I need to check everyone's. things when I hear this call in my practice.
Nicole Roma Thurrell: that. Yes. Yeah. Take a class, take a great class. And I really encourage you to take a class with someone who is oriented toward nature based first aid, even if all you need is a basic first aid for your license. That's fine. You can take a basic first aid, but [00:22:00] do so with someone who will be well oriented to environmental issues.
Hypothermia, frostbite, heat exhaustion, heat stroke, burns, anaphylactic shock. Those are topics that you want to be solid in that you might not be so solid in if you take a really conventional basic first aid class, because a lot of what they're going to say Call 9 1 1. Call 9 1
Laura Park Figueroa: 1
Right.
Nicole Roma Thurrell: And you may be working in a location without reception, or you might be working in a more remote location where 9 1 1, the ambulance is not coming to you in four to six minutes.
Like the teacher's assuming
Laura Park Figueroa: Totally. Yeah.
Nicole Roma Thurrell: and the,
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: six minutes is really a golden time. I mean, that's when we think about choking, someone's got four to six minutes to live if they're not taking in more oxygen, major arterial bleed, four to six minutes. So a lot of these issues that are life threats, anaphylactic shock, Airway is closed four to six minutes. that, that's why I keep throwing that out there.
Laura Park Figueroa: Yeah. Which is real with like bee stings. I mean, if [00:23:00] you don't know that a kid, if they've never been stung by a bee and they go into anaphylactic shock from a bee sting, like that is a real thing that could happen in a nature based setting for therapy. So.
Nicole Roma Thurrell: Absolutely. Or yeah,
Laura Park Figueroa: Yep.
Nicole Roma Thurrell: you're introducing food because you're, you're helping to, to work.
Laura Park Figueroa: Sure.
Nicole Roma Thurrell: around, yeah, eating,
Laura Park Figueroa: Yep.
Nicole Roma Thurrell: introducing foods. Maybe you're introducing things that they've never had before because they've refused
Laura Park Figueroa: Right.
May be unable
Nicole Roma Thurrell: to cope with eating.
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: I recently read a statistic, um, well, it was this amazing study.
It was a very simple study, but it really yielded amazing information. Knolls and Outward Bound, two organizations that lead expeditions.
Laura Park Figueroa: Mm hmm.
Nicole Roma Thurrell: The study was simply that they gathered all of their incident reports since they've got, since they've issued incident reports and they looked at them and they said, who were these people that experienced anaphylactic shock in our programs?
And they found that 20 percent of the people who [00:24:00] experienced anaphylactic shock in their programs had no history of allergies.
Laura Park Figueroa: Wow.
Nicole Roma Thurrell: not telling you that they've never had anaphylactic shock before, which is a true statement. I'm going further to say they have no allergies. So on their intake
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: history, allergies, dietary, environmental, or otherwise?
No, I do not.
Laura Park Figueroa: Right.
Nicole Roma Thurrell: And 20 percent of the participants who experienced anaphylactic shock. Had no history of allergies. So I share that with you all, not to
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: anxiety that you're gonna have
Laura Park Figueroa: Oh, to help us be prepared.
Nicole Roma Thurrell: Be prepared, except just simply be prepared. As well as I want you to remove the veil of illusion. If you're looking through your intake paperwork and you're like, oh sweet, no allergies, no allergies, no allergies, no allergies. We're good to go. We don't need the EpiPens. We don't need Benadryl. We're going to be fine.
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: I just see that as a veil of illusion. You know, it's,
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: it's not a true notion.
Laura Park Figueroa: Do you, [00:25:00] can you talk a, I know we're like low on time, but I do want to, since you mentioned the EpiPen, because I've thought of this, like last time I looked in California, we are not allowed to have in my practice an EpiPen for use. Is this something that we can get somehow? Yeah. Yeah. Is this, you can now.
Okay.
Nicole Roma Thurrell: You have three options. of varying degrees of legitimacy.
Laura Park Figueroa: Okay. I love it.
Nicole Roma Thurrell: let's
Laura Park Figueroa: I love how honest you are. It's so great.
Nicole Roma Thurrell: start We'll start at the lowest degree of legitimacy for fun, yet it works and that's why I'm sharing it. People will often, therapists even, will go to their personal Doctor, their primary care provider and say, this is the work I do. This is who I do it with. And this is where I do it. Probably the most important piece. This is where I do it. I work with children. I provide occupational therapy or physical therapy, and I do so in nature. [00:26:00] We do have cell reception, but an ambulance will not get to us for at least 20 minutes.
Laura Park Figueroa: Right.
Nicole Roma Thurrell: Would you prescribe me with an EpiPen so that I can carry it for programming?
Laura Park Figueroa: Okay.
Doctors
Nicole Roma Thurrell: will often say an enthusiastic yes.
Laura Park Figueroa: Good. Okay. Cause it could save a life. Yeah.
Nicole Roma Thurrell: life. Exactly. And you will be protected by the Good Samaritan Law. If you
Laura Park Figueroa: Right.
Nicole Roma Thurrell: a prescription that was written to you, and you provide it to someone else, and for some reason it causes harm in some way, which it's highly unlikely to,
Laura Park Figueroa: Right.
Nicole Roma Thurrell: you are held accountable for that harm, you will ultimately not. be held accountable for that
Laura Park Figueroa: Okay. Okay.
Nicole Roma Thurrell: will protect you. You can say these are the signs and symptoms I saw. This is the exposure I believe happened. Their airway was closing. I knew they had four to six minutes. I knew that ambulance wasn't coming in 20. You bet I administered my EpiPen to that
Laura Park Figueroa: Right.
Nicole Roma Thurrell: So that's the first least legitimate way to get [00:27:00] EpiPens and Doctors will often oblige. Second is to work with , a doctor and receive what is called standing orders. So typically an MD, an OD, or a nurse practitioner or a physician's assistant can prescribe. Not you, but your program.
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: differentiation there.
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: way, so it's the program that is receiving the prescription so that it may be used as needed for whomever needs it.
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: and the doctor will typically just want to make sure that you've done a training, you know, the signs and symptoms, you know how to administer it. And they will often oblige. And often people find that there's. Someone in their network that's just happy to do that. Maybe it's a parent of a child. It's a friend. Who's a physician They rarely have to actually contract with a physician to receive the standing orders. It's [00:28:00] like I
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: Yeah, then Lastly, and this is probably the most legitimate is to go on to A website, AuviQ. it's A U V as in Victor, I Q. com, AuviQ. AuviQ is a device that administers epinephrine. It is not an EpiPen. It's a square device. And it is injectable and it does go through clothing just like EpiPens.
Laura Park Figueroa: Mm hmm.
Nicole Roma Thurrell: the very interesting aspect of it is that it talks to you, much like an AED would talk to
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: you exactly what to do to administer it.
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: we're actually not They are not available through pharmacies. They're only available from their manufacturing facility and they send them direct to consumer. And when you go to auviq. com, you will see a red button in the upper left hand corner of your screen that says public [00:29:00] access. and then you click on public access and then you'll see a dropdown menu where you can select who you are and what you do. Are you a preschool? Are you
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: summer camp? Are you a pilot? Are you, you know,
Laura Park Figueroa: Right. Right.
Nicole Roma Thurrell: of different options. And then once you select your entity and you'll get creative for what closely
Laura Park Figueroa: I know.
Nicole Roma Thurrell: outdoor
Laura Park Figueroa: occupational therapy for me, and there's never nature based therapy. Like.
Nicole Roma Thurrell: It will not be on the drop down, but you will find something that
Laura Park Figueroa: Sure. Health. Something.
Nicole Roma Thurrell: your entity, distributors will be shown to you, you know, these four distributors are
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: to the entity that you are, and then you print out a form, and then a doctor has to sign it, but they're not actually prescribing it. They're just saying, you know, Yes, this is a human
Laura Park Figueroa: Okay,
Nicole Roma Thurrell: in this industry and they're not going to be selling these on the
Laura Park Figueroa: right.
Nicole Roma Thurrell: really. And it's just a signature. So it's super low stakes for the doctor to sign because it's not a [00:30:00] prescription. And then they send them in the mail.
Laura Park Figueroa: And what's the, what's the drawback? I mean, that third way seems like the simplest way because I'm already in my brain like, okay, I got to find a doc. I don't even have a doctor here because our insurance just changed, you know, like, so is it, is the drawback that it's pricey? Like, is it expensive?
Nicole Roma Thurrell: You
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: That's exactly right. Yeah. It's
Laura Park Figueroa: How much, how much are we talking?
Like thousands or like hundreds?
Nicole Roma Thurrell: checked, they were 250 for a pack of two.
Laura Park Figueroa: Oh, that's nothing. That's nothing. I mean, to avoid the hassle of me having to like, find a doctor who will write the prescription and like, I'm like, buying them today, buying them today, Nicole.
Nicole Roma Thurrell: yeah, auviq. com and
Laura Park Figueroa: great.
Nicole Roma Thurrell: to you and there's, they have junior and adult, so
Laura Park Figueroa: Okay,
Nicole Roma Thurrell: ones you
Laura Park Figueroa: great.
Nicole Roma Thurrell: they're really easy to use. One other thing that I would like to mention for nature based therapists, and this is, it's a problem, but unfortunately I don't have a great solution. EpiPens must be kept clean. in a very [00:31:00] narrow window of temperature, and it's between
Laura Park Figueroa: Uh,
Nicole Roma Thurrell: and 77 degrees. And my guess is you don't get too many days where you're therapy between 68 and 77 degrees.
Laura Park Figueroa: well in California, yes, but here in Wisconsin, we got six months or so where it's very well below that temperature
Nicole Roma Thurrell: right. Yeah. Here in Massachusetts, same well below or well above.
Laura Park Figueroa: Yep.
Nicole Roma Thurrell: so they will begin to degrade as they, they live, they, they exist outside of that window, a little bit out of the window, not a huge deal. The farther from the window, the faster they degrade. There is a viewing window on the device so you can see the fluid. And if the fluid is clear. fine.
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: to turn amber or orange or brown, it truly has degraded.
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: shouldn't say this in public, but I would still use it if it was all that
Laura Park Figueroa: Emergency. Yeah, yeah, yeah. Exactly. Yep.
Nicole Roma Thurrell: going to count on it. [00:32:00] I'm going to lickety split call 9 1 1. We're beginning our evacuation very quickly, but if it's all I have. and I've already called for help and the child is having difficulty breathing, losing consciousness. You bet I'm going to try it. It
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: It will just be less effective.
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: Okay,
Laura Park Figueroa: Wow. Okay. I feel like we've covered a lot. Are there other things like on this critical first aid list that you're like, Oh my gosh, we have to say this before, because I feel like at this point we've given people a very good kind of dip the toe in the water overview of like the, Emergent and critical things that you need to be thinking about around first aid for outdoor programming for kids.
And I definitely feel like it has highlighted the need for good training, not the crappy, like what I've used in the past, because I didn't know about you guys until recently, as silly as that sounds, because I should have known about you. But, um, you [00:33:00] know, I do, I do think that we need to like, make sure that we are training our people well with Like actual good online programs, not just like click the button, go through, get the information.
and don't think about it. So, oh, we didn't talk about, we didn't say this, but, um, maybe I can say it after the last episode. I'll add a little outro, but, um, we're going to do a discount for people who listen to the podcast. Can you talk about like what it would be valid for? We had talked about 20 percent off, but I don't know what courses you guys offer so much.
I don't know what kind of, what you want to say about the discount people can get. Cause clearly we all need more training in this.
Nicole Roma Thurrell: So, WildMed teaches courses both person well as online. And you're welcome to use the discount for either. If you happen to be located where our courses will be happening in person, come in person and use the discount for sure. We train all over. We're going to be [00:34:00] in, you know, Everywhere from North Carolina to Maine in the next couple of months, I'm going to be out in Portland, Oregon in a few weeks,
Laura Park Figueroa: That was so fun.
Nicole Roma Thurrell: heavily concentrated in New England.
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: teach online. So our online courses are a combination of self directed online coursework. These are videos that I produced and actions and quizzes that I have curated for the experience and all courses culminate in a live Hands on experiential skills lab.
Laura Park Figueroa: Oh, wow. Wow.
Nicole Roma Thurrell: video experience.
You also must come to the skills lab online where you are pumping and blowing into your mannequin. We are prepared to send mannequins all over the country so that you can borrow those for the skills labs. Yep. Mm hmm.
Laura Park Figueroa: That's amazing.
Nicole Roma Thurrell: Yes, so you can have a real mannequin or you can improvise. If you've taken CPR many times, feel free to improvise with your stuffed animal or your baby doll. But we're doing [00:35:00] adult, child, infant scenarios, choking scenarios. We can send EpiPens, we send Bleeding control materials all over and people are actually building tourniquets using epipens doing other methods of bleeding control in the skills labs.
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: experiential, very hands on and you are welcome to use the discount for either in person or online courses and we currently teach just three courses.
We teach CPR, we teach first aid, and we teach wilderness first aid.
Laura Park Figueroa: Okay.
Nicole Roma Thurrell: In a few weeks, we are launching our mental health first aid course, which we'll
Laura Park Figueroa: Yay!
Nicole Roma Thurrell: in a bit.
Laura Park Figueroa: Good.
Nicole Roma Thurrell: it's really just those three options. And because there is that live skills lab component, the certifications are legit. We can issue American Heart Association.
We can issue a Red Cross, American Safety and Health Institute, whatever your licensing body requires that you have, we can issue you.
Laura Park Figueroa: Okay. Great. So if y'all want to use the discount code [00:36:00] TGO, that's TGO, like the TGO community, TGO20, and that will get you the 20 percent off for being a listener of the podcast. And I have a little, a little bigger discount for people in my programs, but that's,
Nicole Roma Thurrell: Yes.
Laura Park Figueroa: Great. Nicole, this was just, I feel like probably my guess is you're feeling like, Oh my gosh, there's a million other things we could have talked about.
And also I feel like this was the perfect conversation to have publicly about a lot of the big, the big three. Bleeding, breathing and shock, which I will never forget now. Um, and, and just helping us know the importance of being prepared for whatever may happen, because all of us want the kids in our programs to be happy and healthy for many years to come after being in our program, so.
Thank you for that.
Nicole Roma Thurrell: peace of mind
Laura Park Figueroa: [00:37:00] Yes.
Nicole Roma Thurrell: when I head out, whether I'm in a leadership role or a therapeutic role or a mom role, I truly feel just peace of mind headed out on adventures that I would not feel if I didn't believe that I could manage these issues.
Laura Park Figueroa: Yeah. Well, you're very well trained and I'm thankful for the work you guys do. So thanks for sharing with us so much.
Nicole Roma Thurrell: It's been a pleasure. Thank you
Laura Park Figueroa: Hey, before you go, I have a freebie for you I compiled a list of peer reviewed research studies that can inform nature based pediatric practice for occupational, physical, and speech therapists, as well as mental health specialists. I divided the list into those different professional categories as well as included some references that are applicable to any nature based therapist.
So if you want to get a copy of this reference list to inform your work, you can go to therapyinthegreatoutdoors. com backslash april 2024. Because that [00:38:00] is about the time when I compiled the research. I plan to make many more of these lists in the future to help you all stay up to date on research that can inform your work with children outdoors.
Now go, get outside, connect, reflect, and enjoy therapy in the great outdoors. Bye!
