Medical Matters

By Bob Carver

Most parents, when they leave their children at a camp facility, have certain expectations that often go unsaid. Will my child be properly supervised? Will he or she be protected from bullying? Will my camper be safe from outside forces or people that may harm him? If he or she is hurt, will proper care be available? In many states, when parents turn over their child to a camp and its staff, they are giving the camp the responsibility of in loco parentis. The term--Latin for "in the place of a parent"--refers to the legal responsibility of a person or organization to take on some of the functions and responsibilities of a parent.

This is extremely important when the camp accepts the responsibility of caring for the child’s medical needs. Some of the questions that need to be addressed are:

• How can we anticipate a camper’s needs?

• What needs have we been made aware of prior to the camp session?

• What have we found out on opening day that has changed since the parents first completed the health form?

• If we have learned of food allergies, how do we communicate those concerns to the food service department?

When we accept responsibility, the list can become long.

Another question to ask is, Do we have the proper procedures in place, not only to protect each child who enters our gates, but to protect the camp as well? Let’s look at important issues that we must address as we seek to accomplish both of these goals

Doctor’s Standing Orders
This is perhaps one of the most difficult issues to address, but no doubt one of the most important. In order to protect the medical personnel at camp, it is necessary to have “standing orders” from a local physician. It is critical that a doctor be willing to oversee your operations by writing these orders, and be available for consultation as the camp doctor. With standing orders in place, the staff medical personnel (whether volunteers or paid staff) have the true authority--issued by a physician--to treat common ailments the camper might present at the first-aid station. They also have the authority to use certain over-the-counter medicines, such as Tylenol and cold medicines, because the standing orders have specified what first-aid supplies are allowed and needed.

It is not unusual for a first-aid station to have a bottle of peroxide for use in cleaning wounds, such as cuts and scrapes. However, with a doctor’s oversight, you learn, for example, that peroxide, while cleaning a wound, actually can damage the healthy tissue around the wound. Simple saline solutions can be used in its place. The same is true for many other over-the-counter medications, which were replaced by bacitracin. Your first-aid station doesn’t have to be stocked with a multitude of products, only those ordered by the doctor. In most cases, the number of items can be reduced to a small group, maintaining a quantity of each type.

Personnel
There are two routes to take when staffing a first-aid station. The first is to hire a nurse for the camping season. This is best if possible. Obstacles to this approach include not only the financial burden but also the possibility of multiple sites; it may not be possible to staff all those sites with paid personnel. States may vary as to nurse qualifications, but in most cases RNs, LPNs, paramedics, first responders, first-aid certified personnel and doctors all qualify. The second approach is to staff a first-aid station with volunteers. This is feasible, but exercise great care making your selections, especially if those volunteers are at your facility for a week or more.

Health Forms
A comprehensive health form should be a part of the registration process. The form includes name, address, emergency contact numbers, parents (or guardian’s) name, allergies, medicines and health insurance. A section should also be available for parents to communicate any information needed to treat their child. A section should list the over-the-counter medications in your health station so parents can opt out of certain meds. Finally, there should be a parental release to be signed, which gives medical personnel the authority to treat the child in case of an emergency. In many states today, online health form signatures are acceptable.

The First-Aid Station
A health station should be properly sized and equipped. The size will be determined by your needs, as well as by local regulations. There are three areas for a first-aid station:

• Triage--The first room a camper enters. It includes most first-aid supplies, a table or medical couch.

• Bed area--This is where a patient stays for a longer period of time. If there is more than one bed, they should be separated from each other.

• Nurse living quarters--This should be adjacent to or near the other two areas.

Health Screening |
A health-screen stop in the registration check-in process is important and should be required. The form should be completed by the parent that day. It can be very simple, but should include updates to the health records, such as recent issues, exposures or current illnesses, since many of these may have changed since the original health form was completed. The second element should be a temperature check, which can be done with either an ear- or forehead thermometer. If the temp is above 100, then the child should sit in air conditioning for a short period of time before being rechecked. If the temp is still high, the child should be sent home until the fever is gone for 24 hours. To do otherwise exposes all the other people at your facility to possible infection. Other health check issues can be dictated by local needs, such as a head lice check, etc. Be sure to consider them when preparing a health-screening checklist.

Food Allergies
No doubt, when parents complete the health form for their child, they may have listed certain food allergies that the office and service staffs need to know about. The food service personnel then need a system (perhaps special ID bracelets) to track these children and their allergies.

Sickness
Various types and levels of sickness may occur when youth and adults live in a resident camp setting. The most common types include upset stomach, homesickness, fever and constipation. If a camper has a fever or potential infection that is contagious, that camper must be isolated and perhaps even sent home. Once again, after treating the camper, the health and safety of all other campers and staff must be considered. The camper’s name, your name, the complaint and the treatment should be compiled in a health log.

In Case Of Injury
No matter how many safety precautions are in place, accidents and injuries will happen. It is critical that camp staff is constantly on the lookout for areas where accidents may occur. A camp facility should be free from as many “potential hazards” as possible. Despite that, accidents happen, and often in the strangest ways. I remember one afternoon when we took three campers to the emergency room due to accidents playing whiffle ball! Most camp accidents fall into the category of minor. They include cuts and scrapes, bruises, twists and sprains. Occasionally, there is a broken bone, and infrequently something more serious, such as a head injury. It is imperative to have in place proper procedures to handle these unexpected events. Who does what? How soon are parents contacted? Who travels with a camper to the emergency room? These are all questions that must be answered prior to any incident.

As with sicknesses, all accidents should be properly documented in a health log. Of course, the treatment of the youth or adult comes first, but then the immediate second step is to document all details. Many camps have policies that require the health personnel to contact management so that accidents can be followed up.

Hazardous Waste Disposal
There should also be a provision in your first-aid station for items such as needles and sharps. Proper containers are available from various vendors that keep these items contained and safe for proper disposal. A policy should be in place for the proper materials for cleanup and disposal of blood and vomit.

Records And Reporting
It is vital to your organization that proper records are kept. Most states require a permanent log of all first-aid station activities. A permanent bound log is essential, not only to keep a record of all activities, but to later serve as a reminder for insurance references, or for testimony if some type of lawsuit or action is taken. These logs should be kept for two years after a child reaches majority, which is 18. This means that a log with 10-year-olds treated should be kept for an additional 8 years. It is not unusual for management to have to dig back through past logs in order to document a question about what happened earlier. This log should contain the date, the treatment provider, the camper, the incident (injury or sickness) being treated and the treatment. Any follow-up actions or visits to the health center should be documented. A good source for a permanent health record log is the American Camping Association (www.acabookstore.org).

As far as reporting the incident, various states have similar reporting guidelines. Rick Braschler, in an article for the Christian Camp and Conference Association, discussed the issue of “Right Reporting.” He broke down incidents into three basic categories:

1. Incurred But Not Reportable--An incident not serious enough to contact your insurance company, camp management or emergency services. As stated previously, it is still important to keep proper records of this incident, especially in the health log. In addition to the log, if an incident is out of the ordinary or more than just a simple health issue, an additional incident report should be completed.

2. Reportable--An incident that causes either bodily injury or property damage, requiring you to contact emergency services, etc. This incident may not necessarily be your fault, but after the person injured is cared for, it is important to protect your organization as well. This is done by proper record-keeping and proper reporting to all entities, including authorities, parents and management. It is important to gather witness statements as well as noting what follow-up is done. Questions of concern are: Did you follow your organization’s written guidelines as well as those available from the industry?

3. Serious--An incident including all issues in the “reportable” category, but also with a degree of direct fault or negligence on the part of your organization. It is critical that any and all information be gathered immediately. Keep in mind this information may not be used for a considerable amount of time, if insurance claims are made, or litigation is sought.

Maintaining a first-aid station at a camp can be a daunting responsibility. Waiting until a child is sick or injured is too late to ask, “What do we do now?” For further assistance, contact local medical personnel for guidance and advice. There are good folks out there who will donate their time to assist you, or at least reduce their fees to a non-profit. In a residential camp setting, the most important thing you can do is to show the children in your care that they are loved and protected.

I never will forget an incident that happened many years ago. A third-grade camper came to the first-aid station with symptoms of homesickness under the guise of an injured finger. When the nurse, who was well-trained and seasoned, deduced what the problem was, she fashioned a splint from two ice cream sticks and some adhesive tape. A little TLC goes a long way. The camper marched from the door of the first-aid station, wearing the splint as a badge of courage, never to return to the nurse for the entire week. Before the week was over, there mysteriously appeared 14 other cases of injured fingers, and only a splint would do. Not one child went home. It was a sight to see all 15 sets of splints. It must have been some contagious!

Bob Carver has been in camp management for the past 33 years. He recently retired as executive director of CampAllendale in Trafalgar, Ind., to become the camp's marketing director. He can be reached via e-mail at bob@camp-allendale.org.