Preparation Points--Ready & Able

By Judy Clayman, Elizabeth Donahue and Dr. Deborah Swanton

The summer camp season is fast approaching. Are you prepared? What about the medical responsibilities the camp will have? Are you in compliance with all medical regulations?



In order to prepare your staff and make sure you are ready to provide a safe environment for your campers, it may be beneficial to use this three-step process as a guide.

Step 1
Get accredited.

The American Camping Association has over 300 standards relating to facilities, management, programming, personnel and health and safety.

Accreditation is a voluntary process but becoming compliant with these standards will help assure the quality of the camp and the safety of the campers. Information on the American Camping Association can be obtained at

Some camps have a local or regional body that serves the same purpose, including inspections and certification, which is addressed in Step 2.

Step 2
Make sure you are in compliance with all medical staff regulations and medical standards.

Each state determines regulations for summer camps. This article will refer to the regulations in Massachusetts to provide an example of the three-step process. To obtain your state's regulations you can use any search engine on the Internet.

In Massachusetts, the Massachusetts Department of Public Health stipulates regulations and then each town's Board of Health enforces them. This document can be accessed at

The standards include the areas of employment, staff orientation, camp staff ratios, athletic equipment, policies and procedures and medical requirements. This article will focus on medical aspects of the document.

Refer to document 430.159 to gain additional information regarding camp requirements determined by the Massachusetts Board of Health.

According to the Massachusetts Board of Health document 430.159 the health care staff to be provided includes: A designated Massachusetts licensed physician, nurse practitioner or physician assistant with pediatric training as the camp's health care consultant.

The duties include: assist in the development of the health care policy, review and approve any changes in the policy annually, review and approve the first aid training of staff, provide consultation and develop and sign written standing orders to be followed by an on-site health supervisor.

Different health care staffing regulations apply for camps offered for mentally and physically handicapped, for residential camps totaling more than 150 campers, and for medical specialty camps. If these situations apply to your camp the health supervisor has to possess the minimum qualifications of either a registered nurse, a physician, a nurse practitioner, a physicians assistant or a licensed practical nurse, all licensed to practice in Massachusetts.

The local Board of Health must approve the written medical policy developed by the camp. The on-site health supervisor must be at least 18 years of age and hold the minimum of First Aid and safety and CPR certification.

Depending on the nature of your camp, the health care supervisor could be a Massachusetts licensed physician, physician assistant, nurse practitioner, registered nurse, licensed practical nurse or athletic trainer.

All campers and staff under 18 years of age must have health records on file. These records include information to reach parents or guardians in an emergency, an authorization to treat form signed by a parent or guardian, a written authorization to administer medication to the camper or staff member if necessary, a certificate of immunization, and a medical history and physical exam (specific for residential, trip, travel or sport camps).

Other medical requirements stipulated by the Massachusetts Department of Public Health include injury reports, medical logs and reporting the outbreak of diseases.

In addition, there are specific regulations pertaining to what must be contained in the health file for all camp staff over the age of 18.

Step 3
Hold a Staff Meeting

Policies and procedures regarding medical aspects need to be addressed at staff meetings prior to the beginning of camp. The medical topics should include the camps Emergency Action Plan (EAP), OSHA standards and guidelines, the process for dispensing medications to campers, contents of a medical kit and prevention and management techniques for common injuries and illnesses which may afflict campers.

A camp's (EAP) should include guidelines on a number of topic areas for general camper and staff safety. A portion of this plan includes a written camp medical policy addressing daily health supervision, infection control, handling of health emergencies and accidents, available ambulance services, provision for medical services and the name of the on-site health supervisor, as required in section 430.159(E) of the Massachusetts Board of Health document.

All staff members should receive a copy of this medical policy as well as training in infection control procedures following OSHA standards.

In addition, parents of campers should receive information pertaining to camp policies on the care of mildly ill campers, emergency health care procedures and medication dispensing practices.

For those campers requiring the use of medication during their camp stay, the Massachusetts Board of Health document, section 430.160, outlines required procedures for storage and administration of any such medication.

In general, all medications must be in their original labeled containers or packages, stored in a locked cabinet or non-removable locked box in the refrigerator, for those medications requiring refrigeration.

These medications may only be administered by the camp's health consultant or health supervisor, under the direction of the health consultant, as described in section 430.159.

The health care staff must closely monitor the storage and administration of medications in an effort to prevent sharing of medications amongst campers or misguided use of a medication by an individual camper.

The health consultant must maintain a list of all medications administered at the camp. This list should include the camper's name, date of administration, medication administered, quantity administered, and any additional comments. These records should be held at least three years following the last entry date.

In addition, section 430.160(D) describes proper procedures for destruction of medications that are no longer needed during a camper's stay.

Staff members should be aware of common injuries and illness that may arise during the camp season. In addition, staff members should be familiar with signs and symptoms of these conditions so they may provide appropriate referral to the camp's health supervisor.

Common injuries include cuts and abrasions, sprains and strains, splinters, fractures, and concussions. First Aid kits should be accessible to staff members and contain, at minimum, the following supplies: sterile gauze, protective gloves, a one-way valve CPR mask, roller bandages, bandage scissors, adhesive tape, non-perfumed soap, a variety of bandaids, antibacterial ointment, tweezers, a triangular bandage and/or sling and a cold pack.

Common illnesses, such as gastroenteritis, upper respiratory conditions, the common cold, swimmer's ear, contact dermatitis and nonspecific coughs are likely to arise during a camp session.

Preventive measures, such as frequent hand washing, should be followed in an effort to avoid the spread of germs amongst campers and staff.

According to 430.157 and 430.158 of the Massachusetts Board of Health document, camp operators are responsible for reporting the outbreak of any communicable disease, suspected case of food poisoning, or any illness accompanied by prominent signs of fever, rash, diarrhea, sore throat, vomiting, or jaundice to their local board of health.

Other concerns are environmental in nature, such as heat conditions or lightening safety awareness. Heat illness most likely (but not always) occurs in times of increased temperature (80 degrees) and increased humidity (70%).

The higher the heat index reading, the more at risk campers are for sustaining heat illness. During this situation the camp staff must look at alternate activities, clothing choices, and policies on hydration. A rule of thumb is to drink 8 oz (one cup) of water every 20 to 30 minutes.

In addition, counselors should be able to recognize conditions of heat exhaustion and heat stroke. Policies and procedures should be reviewed regarding how to protect campers and staff from lightening emergencies. Using the flash to bang theory will assist staff in determining when to end activities or move to a safe environment.

It is not uncommon for campers, as well as the counseling staff, to come in contact with a plant induced poisoning (poison ivy, oak or sumac). Counselors should be prepared to recognize the possible reactions to this problem.

Two other problems that may ruin a camper's experience are a debilitating sunburn or an allergic reaction to something that results in anaphylactic shock.

Sunburns are the most common burns and are usually first or second degree in nature. Counselors must be aware of this possibility and insist on a daily schedule of correct clothing and sunscreen application.

In addition, the medical staff should be prepared to demonstrate the use of an epinephrine kit in case of an allergic reaction brought about by food, insect bite or any other situations, which could result in a life-threatening situation.

The medical aspects of camp preparation should not be taken lightly. In determining the medical guidelines for your summer camp rather than just meeting minimum standards, strive to ensure the safety of the campers and staff.

Begin by hiring competent health care professionals, certifying all camp staff in first aid and CPR, and reviewing the policies and procedures in staff meetings. This guide may assist you in preparing for the summer. It's as easy as 1, 2, 3.

Professor Judith Clayman has been a force behind the growth and revitalization of the programs in the Sports Science & Fitness Studies Division at Endicott College. Over the course of her career at the college, Professor Clayman has taught classes in physical education, sports management, health education, aerobics and weight training. In addition to her work at the college, Professor Clayman serves as an evaluator of continuing education programs for aerobics certification at the national level.

Elizabeth Donahue begins her fifth year as a faculty member of the athletic training curriculum within the Sports Science & Fitness Studies Division at Endicott College. Currently, she is pursuing a doctorate in Higher Education from NOVA Southeastern University. Besides National Athletic Trainers Certification and Massachusetts licensure, Beth holds CPR Instructors Certification from the American Heart Association.

Dr. Deborah Swanton has been with Endicott since 1993 as the Head Athletic Trainer and instructor in the Athletic Training Program. She was appointed Assistant Professor and Chair of the Athletic Training Program in 1995, and under her tenure the Program was granted CAAHEP Accreditation in 1997.