ST. LOUIS UNIVERSITY HIGH S EMERGENCY TREATMENT CONSENT FORM

Transcription

1 ST. LOUIS UNIVERSITY HIGH S EMERGENCY TREATMENT CONSENT FORM PLEASE PRINT ALL INFORMATION STUDENT-LAST NAME, FIRST NAME ADDRESS PHONE # FAMILY DOCTOR ADDRESS PHONE # FATHER'S NAME FATHER S EMPLOYER ADDRESS PHONE # MOTHER'S NAME MOTHER S EMPLOYER ADDRESS PHONE # In case emergency treatment is needed for your son, he will be taken to St. Mary s Hospital or the nearest hospital to where the injury takes place UNLESS a specific hospital has been indicated on your son s health record in the Assistant Principal/Dean of Student s Office. The coach or moderator has a list of these specific hospitals. I hereby give permission to a physician to administer emergency treatment to the above named student. FATHER S SIGNATURE DATE: MOTHER S SIGNATURE DATE: 1

2 First Aid Kit Requirements Each backpacker MUST have a first aid kit that is fully supplied and maintained in a ready state. This kit must be carried by each backpacker and cannot be shared to save weight. In overview, the kit contents must include an assortment of different types of bandages for wound management, materials for blister management, gauze and tape, antibiotic ointment, antibacterial wipes, cotton swabs, and basic medications (antacids and pain relievers). This kit can be purchased at REI or any other outdoor activities store, or made from individual pieces put together. The entire kit must be in a clearly marked FIRST AID. A full check list is available below. Wound Management: 10 - large bandaids (1 X 3 ) 5-3 X 3 gauze pads 5 - small bandaids (3/4 X 3 ) 1-2 wide gauze roll, at least 24 long 10 - butterfly closures (medium or large) 1 - roll, cloth tape, at least 24 long Blister Care: 1-3 X 4 moleskin pad or equivalent Sprain Management: 1 ace wrap, 2 wide Medications: 10 - acetaminophen tablets 10 - ibuprofen tablets 10 - calcium carbonate or equivalent antacid tablets 5 - loperamide (immodium ad) tablets 1 - small tube of antibiotic ointment/creme (Neosporin, polysporin, etc.) 1 - small tube of hydrocortisone anti-itch creme Miscellaneous: 1 - tweezers 2 - safety pins 1 - scissors 1. The dimensions on the bandages, tape, and wrap are meant to be approximate, not exact. Get as close as you can, and if you don t have a match, choose the bigger size. 2. Backpackers with specific first aid requirements must also pack the additional required items in their first aid kit. This may include items that alleviate allergies (to poison ivy, foods, pollen, or bee stings), medications for specific medical issues, or specific bandages for existing wounds. 3. Individuals without first aid kits ARE NOT ALLOWED ON BACKPACKING OR HIKING TRIPS. While group leaders will have first aid items, the requirements of backpacking and hiking prevent them from carrying large amounts of extra gear for each member of a large group. The vans will always have large first aid kits with ample supplies for hikers or backpackers. The first aid kits are designed to remedy manageable situations. For major medical issues, the backpackers will leave the wilderness, use the large first aid kits in the vans, and, if necessary, seek help at the nearest medical facility. above guidelines and will pack and carry a first aid kit that meets all of the above requirements. 2

3 Science Club Conduct Code It is expected that all SLUH students participating in any club/sport exhibit behavior that demonstrates respect for their peers, leaders, parents, and school. In sports, this is referred to as good sportsmanship. Science Club members are no exception to this rule, and, in addition, must also demonstrate respect for the environments they explore. The following are guidelines: 1. Behave in a way that demonstrates the highest respect for students, leaders, and environment. Always exemplify the highest moral character, conduct, and leadership. Avoid any physical and/or verbal abuse of any other student. This includes any form of hazing. Avoid any act that brings shame or embarrassment on your peers, leaders, or the SLUH community. Any behavior that jeopardizes the success of the activity/group or reflects poorly on the school, moderators, or students will be disciplined accordingly. 2. Follow all instructions given to you by your leaders. This may include additional responsibilities during emergency/first aid situations. Insubordination in the back country cannot be tolerated, just as it is not tolerated in the classroom or on the sports field. 3. Review and abide by the present Tobacco/Alcohol/Chemical Abuse policy at SLUH. Especially note that possession, or being under the influence of alcohol or any other illegal drug or paraphernalia at an event offcampus is not tolerated and will result in professional counseling, suspension, and or expulsion from the club and/or SLUH. 4. Prepare yourself and your equipment properly and as outlined by your instructors. The success and safety of the entire group depends on each individual acting as a member of a team. The group is only as strong as the weakest link. Unprepared participants may be asked to leave the trip if the instructor feels the group safety/success is jeopardized. Please note that some physical conditioning is a basic requirement for any hiking, biking, or backpacking endeavor and all students not actively exercising for a sport must make the appropriate exercise adjustments. Bicycles, daypacks, backpacks and other equipment must be tried out and fitted BEFORE the trip, not during the trip. 5. Use all camping equipment properly and in the manner for which it was intended. This includes knives, axes, multi tools, the use of fire, and any other equipment brought into the back country. A moment of carelessness jeopardizes the safety and success of the efforts of the entire group. 6. Practice Leave no trace principles in the back country. These include the following: a. Plan ahead and prepare - know the special hazards of the area, walk in small groups, repackage food to avoid waste, and avoid trail alterations that mark any paths... b. Travel and camp on durable surfaces - do not alter an area to make a camp, walk single file on the trail, camp in small groups at least 200 of any body of water... c. Dispose of waste properly - pack out all leftover food, litter, and trash, deposit all human waste in catholes 6 to 8 deep at least 200 from the nearest body of water, wash your body or clothes at least 200 from streams and scatter the dishwater... d. Leave what you find - do not alter historical structures or artifacts, do not remove anything from the areas traveled or camped... e. Minimize campfire impacts - use stoves for cooking, use fire rings for campfires, keep fires small, put out campfires completely... f. Respect wildlife - observe at a distance, don t feed animals, hang all food... g. Be considerate of other visitors - be courteous, step to the downhill side when encountering pack stock, avoid loud noises and voices Any major violation of the above guidelines/principles will result in some consequence ranging from suspension from club activities or school, or expulsion from the club or school. above guidelines and will act accordingly on SLUH Science Club trips. Furthermore, I accept the consequences of any violation of the above guidelines as deemed fair by the Principal/Club Moderators at SLUH. 3

4 Science Club Safety Code 1. There will be "two-deep" leadership on every overnight trip. In the event of a mishap, one leader can get help while the other can stay and stabilize the situation. 2. Tenting, stove, and water arrangements must be made ahead of time. All backpackers must have group arrangements in place before leaving for the trip. Each student, unless tenting solo, will have a tenting, stove, and water buddy/group. Students can only tent with students, not with adult leaders, under ANY AND ALL circumstances. 3. Everyone must bring their own small first aid kit. This should consist of any medication that is taken regularly along with a permission form explaining the need for the medication. In addition, each student should bring some bandaids, disinfectant, a 2X2 pad, and moleskin. This will take care of minor cuts, abrasions, and burns. The moleskin will take care of burns on the feet. 4. Everyone MUST HAVE A MAP AND COMPASS!! NO EXCEPTIONS! In the case of an unusual emergency, a single lone hiker would then be equipped to navigate to the nearest safe area. Maps can be printed from the website or obtained (black-and-white) from Mr. Kuensting. 5. Everyone should review the procedures of using a map and compass to navigate. GPS units, while good for indicating position and directions to travel, do not work well as compass and map. DO NOT REPLACE A COMPASS AND MAP WITH A GPS. The GPS helps but does not replace the map and compass. 6. Everyone MUST HAVE A WHISTLE!! The whistle sound carries farther than any voice in a forest and in an emergency, can allow hikers to find one another. 7. All students MUST PRACTICE THE "BUDDY RULE"! Individual students are not allowed to leave the group except for toilet necessities, and then they must immediately return to the group. UNDER NO CIRCUMSTANCES is a lone student allowed to hike, cave, backpack, etc.!!! NO EXCEPTIONS!! 8. Students may split up ONCE THE LEADERSHIP HAS BEEN NOTIFIED OF THE PLAN. The leaders are responsible for the group and they make all final decisions on itineraries. Students may hike or cave in groups of at least two, preferably 3 or more. 9. In the event a student is separated from the group by mistake, he should RETRACE HIS STEPS, GO BACK TO THE NEAREST KNOWN AREA, AND WAIT TO BE REUNITED WITH THE GROUP! Lone navigation to another area only increases the chances of a lost hiker in the wilderness. WE DO NOT WANT TO ORGANIZE A SEARCH TEAM TO FIND YOU!! 10. All equipment must be used for what it is intended. Knives will not be thrown or used to carve trees. Lighters and stoves will not be used to burn anything outside of their intended use. By Signing this Form, I certify that I have read and understand the above guidelines and will act accordingly on SLUH Science Club trips. Furthermore, I accept the consequences of any violation of the above guidelines as deemed fair by the Principal/Club Moderators at SLUH. 4

5 Science Club Equipment Guidelines 1. Each backpacker must have certain pieces of equipment that he cannot share. These items are required because of safety or health. Other pieces of equipment can be shared, but must be available to each backpacker. 2. Major items that cannot be shared and must be borrowed or purchased by the hikers/backpackers for overnight trips: waterproof boots, sleeping bag, sleeping pad, backpack, pack rain cover, toothbrush, toothpaste, washcloth, rope, mess kit, food for the trip, first aid kit, non-cotton clothing for hiking and sleeping, gaiters, toilet paper and trowel, map and compass, safety whistle, headlamp, garbage bag, containers with 2 quarts of water. If a student does not have any one of these items, he CANNOT attend the trip. 3. Major shared items include tents, ground tarps, stoves, and water purifiers, and buckets. Students are encouraged to share these and will be divided into groups to save weight. They will also be part of tenting, cooking, and water groups. They must stay within their groups when satisfying their shelter, food, or water requirements. All students must know their tenting, cooking, and water "buddies" before they leave for any trip. Day hiking requirements are similar, except overnight items and stoves are omitted. Spring break trips will require more items than the list below, including items needed for long van rides. Packing lists for spring break trips will be provided with the trip information packet. 4. Equipment must be of backpacking quality. Tents must have a FULL rainfly that fully covers the tent and reaches near ground. The tent must have a bathtub bottom. Pack rain covers, backpacking ponchos, ground tarps, and gaiters must be nylon or otherwise indestructible. Backpacking ponchos must cover the student and the backpack and still reach their knees. The sleeping bag must be rated for 20 F or less. The compass must be of orienteering quality. The sleeping pad must provide some insulation from the cold ground. Boots must be waterproof. All clothing MUST be non-cotton - nylon, polypropylene, wool, etc. All items, except possibly a sleeping pad, MUST fit INTO the backpack so that it can be rain-proofed with the backpack rain cover. 5. Total backpack weight with ALL items should not exceed 1/3 (33%) of total body weight, with a target of 1/5 (20%) total body weight. 6. Cold weather backpacking requires student to not wear cotton. Students will no longer be allowed to attend trips wearing cotton. The only cotton object in a properly prepared backpacker's bag is a bandana for wiping sweat off of his/her brow! Clothing should be organized in layers. Backpackers should not bring coats!! 7. Everyone must be ready for inclement weather. We do not normally quit because of rain or snow, but we can only do as much as our equipment allows. Some of our best trips have been under difficult weather conditions. One missing poncho can cancel a trip, and some of the trails are hours of driving away. Pack carefully and pack the right equipment! 8. Backpackers should pack according to the sample packing list (available online): a. General - topo map, compass, flashlight + extra batteries, garbage bag, camera, knife, lighter/striker tool, backpack, backpack rain cover, walking stick/hiking poles, 2 extra ziploc bags, binoculars, multitool. b. First Aid - sunscreen, aspirin/ibuprofen, lip balm, tecnu (poison ivy soap - leave in van), bug spray (not in cold weather), first aid kit, nylon repair kit. c. Lodging -tent, ground tarp, sleeping bag, sleeping pad, rope (hang pack), pillow sack. d. Dining -stove + matches, stove fuel, mess kit with pot, utensils, measuring cup, water bottles, water purifier and/or iodine, water bucket (collapsible - for water purification). e. Food - bagels, power bars, raisins, dried food (ramen, mashed potatoes, rice, vegetables), nutrigrain bars, bagged tuna, albacore, or chicken (no cans!); sample breakfast: oatmeal, raisins, poptart, vitamins; sample lunch: powerbar, mashed potatoes, nuts; sample supper: knorr/lipton soup mix, chicken pouch, powerbar; snack: nutrigrain bar f. Clothing (ALL NON-COTTON) -boots, nylon/polypropylene outerwear (non-cotton) including shirt, pants, socks, fleece/jacket; thin long underwear top and bottom (cold weather), hats, sunglasses, spare underwear, socks, spare shirt, gloves, raincoat/poncho, pajamas (long underwear, socks, stocking cap, thin fleece), gaiters. g. Hygiene -soap, toothbrush & toothpaste, washcloth, toilet paper & trowel, hand sanitizer, eyeglass cleaner + cloth. 8. Backpackers that use Science Club equipment must agree to repair or replace, at their cost, any equipment they break or misuse. above guidelines and will pack accordingly for SLUH Science Club trips. Furthermore, I agree to repair or replace, at my cost, any Science Club group equipment that I damage. 5