Q: The new medical advisor of our guiding company has advised us not to distribute over-the-counter medication to our clients. What is your opinion?
Technically, one could argue that giving medication under these circumstances (paid guide giving to a client, non-family member) could be considered practicing medicine without a license. Many school nurses are prohibited from dispensing over-the-counter (OTC) medications, let alone specifically prescribed medication to students.
There are some good reasons not to routinely include OTCs in all first aid kits. First, aside from pain medication, antihistamines (for allergic reactions and motion sickness), and maybe some of the gastrointestinal (GI) products for heartburn and diarrhea, most other OTCs have little real value. If we focus on acute problems, you can usually toss out the GI. Symptomatic relief for coughs and runny noses certainly do not change the course of an illness. Second, you should not be dispensing OTC medications without training. To treat, you have to make a diagnosis and then have a realistic expectation of improvement. OTC medications are not innocuous. For example, not only will giving an antihistamine for a cold be useless, it could also cause complications. And third, aside from acute pain from an injury, many of the conditions for which these would be used are either predictable or recurrent. If either of these is true, clients can bring their own.
Each guiding company has its own unique challenges and capabilities. Do you have standardized first aid kits and uniform care protocols? Many have neither. Are all of your trips the same? For a group that could be hours from help, I would expect uniform first aid kits and training that would cover their contents and use. The list of meds would be limited and focused, varying by the environment and duration. A more comprehensive kit makes sense for longer and more remote trips.
Bottom Line
Routinely carrying OTCs often makes no sense. Don’t feel compelled to have them included and don’t think badly of your medical advisors if, based on experience and knowledge of your company’s program, they don’t want you to dispense OTCs. At the very least ensure your guiding service has a clear set of medical protocols and standardized first aid kits that are suited for your adventures. When developing these protocols, take into account liability issues to protect your company.
