Conference Medicine for Teens: Health and Safety at the World Leadership Congress

Imagine more than 400 high school sophomores from all 50 states and 17 other nations coming together for nine days in the summer swelter of Washington, DC. For a lot of these students, it was their first time away from home. For 100, it was also their first time to America. As an unfortunate side effect, some also experienced heat exhaustion, dehydration, asthma attacks, seizures and hypoglycemia. Four volunteer EMS professionals who provided medical coverage to the conference for which the students had gathered regularly had to triage and assess these teenage patients and treat their electrolyte imbalances--and an assortment of other problems.

The HOBY World Leadership Congress
The occasion was the Hugh O'Brian Youth Leadership (HOBY) program's World Leadership Congress for young people, held at The George Washington University (GWU) in July 2006. Four medically trained personnel (three paramedics, including the author, and one EMT-B) made up the medic team charged with providing attendees basic medical care, such as bandages and cold packs, and over-the-counter medications such as ibuprofen, acetaminophen and diphenhydramine.

HOBY's policies dictate that students with prescription medications that have a potential for abuse are to have those medications secured by the medic team and made available for the student to self-administer as needed. The medications we secured included Zoloft, Concerta, Paxil, Aricept, Strattera and Percocet. The medication room was opened daily 30 minutes before breakfast and closed 30 minutes before "lights out." Students were responsible for retrieving the needed pills and counting their own dosages, with the medic team responsible solely for logging the students' presence. To maintain privacy, students were not allowed into the room where the prescription bottles were stored, and they were provided a private area in which they could retrieve the pills they needed. This daily encounter also allowed the medic team to meet with students on a one-on-one basis and get to know their baseline mental statuses.

A month before the seminar, we were contacted by the mother of a young attendee who was a hemophiliac--she wanted us to be aware of his condition. Having lived with this all of his life, her son was accustomed to the challenges it presented, knew how to overcome his limitations and carried the appropriate medications to self-administer if he experienced some sort of trauma. One of the team members had worked for a pediatrician who specialized in this condition, and thus became our point person for this student. Among other medications, he was prescribed Tylenol 3 (with codeine) for management of pain associated with joint inflammation due to his hemophilia. Because of his familiarity with his medications, it was decided to allow him to maintain his own narcotics. Fortunately, during the nine days he was in DC, we never experienced a bleeding emergency with this student.

The Heat and the Hurt
We did, though, have several recurring presentations, most of which were caused by the heat. Dehydration and asthma attacks made up the majority of our patient load. Because of a mechanical malfunction during a large dinner cruise, there was no air conditioning as nearly 500 people cruised down the Potomac River. A 16-year-old female began having a severe asthma attack that could not be controlled by her albuterol inhaler. This necessitated calling for Washington's bravest. Arriving back at the dock, the boat was met by a BLS engine company, followed shortly by a BLS ambulance, then an ALS ambulance. After a 10-minute updraft, the student was transported to the ED.