By Warren Katz
It is likely that many of the estimated 10 million campers and the more than 1 million staff members who oversee youngsters in summer camp will experience an illness or injury in a given season.
Although most kids suffer only minor headaches or embarrassing falls during a baseball game, these ailments and injuries are usually “dusted off,” and do not necessitate medical attention.
However, the majority of health problems at camp are sent to the camp medical center--the hub of treatment and triage. Such “centers” are not the large, multidisciplinary institutions often found in urban communities. Rather, they are relatively small facilities that usually provide medical services ranging from tending to scratches and homesickness to dealing with life-threatening emergencies that mandate immediate attention and referral to a more sophisticated off-site hospital.
The terminology can be baffling. The camp medical facility--variously referred to as a health-center camp, dispensary, first-aid station or undoubtedly other names--is not to be confused with an off-site hospital emergency department. It is important that campers and staff understand the appropriate designation for their own camp.
Camp directors need to initially decide the size and purpose of the camp health-center building based upon several variables. These include the level of care that the camp is capable of and willing to offer, the distance from more sophisticated medical attention, the types of activities that pose risk, the skill and training of the medical personnel and the population being served.
For example, are the children and staff generally well, or does the camp deal with special needs, such as diabetes mellitus or disabled children?
The camp health center, as we will refer to it henceforth, is a physical structure of varying size that basically consists of a reception area, treatment rooms, a few beds and storage areas for equipment and drugs.
It should be located in a convenient and central area accessible to emergency vehicles and to the entire camp, especially the sports facilities and bunks. It should also be well-lit and easy to access in the middle of the night in the event of a crisis, especially given the limited outdoor lighting of most camp settings.
To avoid any confusion--especially late at night--campers should be informed of the location of the center on the first day. It is also recommended that camp leaders, counselors and activity instructors notify the center by walkie-talkie when an injured victim is on the way to the center.
Ideally, the building should have sufficient and flexible space paralleling the total number of potential users, particularly in the reception area. No one needs to be reminded of the swine flu epidemic that struck so many camps during the summer of 2009.
Planners of new or renovated facilities need to keep in mind that during “sick call” as many as 5 to 10 percent of the camp population may be present for evaluation. The clinical area requires an open space that allows for initially evaluating campers' illnesses and injuries while protecting their privacy; a contact area for telephone calls to parents; and ample storage areas for computers, charts and paperwork.
Throughout the health center, locked storage space that protects drugs, supplies and equipment from non-essential personnel, the elements and unwanted forest critters is a necessity.
Private examination and evaluation space needs to be sufficient to handle the usual number of patients for a more extended evaluation and triage preparation. A space should be provided for applying ice to musculoskeletal injuries, soaking injured parts for cleansing, and enhancing the overall health process.
Cleanliness is critical, so each examination and assessment area should have access to a sink for hand-washing in order to control the spread of infection and an adequate, safe waste-disposal system that includes a tamper-proof container for used needles and possibly infected materials.
Since many camps are older, it is difficult to keep up with required, often expensive maintenance, repair and renovation. Uneven floors, rusty nails, inadequate plumbing, electrical systems that are not up to code and infection-prone dirty areas--such as dust and bits of rotted debris dropping from the rafters--are impending medical disasters in a facility intended to be a model for healthcare. Remediating these conditions is a top priority in the camp setting.
Effectively managing medication is a challenge. As many as 30 percent of campers bring with them medications that in most instances are stored in the health center, in addition to the drugs that are dispensed in the course of caring for illnesses and injuries that occur at camp.
Camp leadership and health-center staff will do well to recognize that many states have laws that govern the storage of medications at camp. General guidelines for the camp formulary stock comprise a written procedure for administering medicine, a compendium of available drugs with doses and quantities and a list of all campers who are on medications with the prescribed dosing recommendations.
Computerization with a backup system enhances compliance with these guidelines. Prepackaged camper drugs are a convenience but still require safe, reliable storage.
Equipment at modern-day camp health centers, as everywhere, is dependent on power, including electricity with a generator back-up, phone lines, and, preferably, Internet access, even in remote areas.
Refrigeration is a must for drug storage and a source of ice applications. An equipment and supply list is generally readily available and often varies as to whether the health center is at a specialty camp or not.
All camps require automated external defibrillators (AEDs), not only in the health center but distributed strategically throughout the property. The availability of certain equipment, such as ventilators, insulin pumps and assistive devices, depends upon the nature of the specialty camp and the health needs of campers.
No summer camp health center is any better than the quality of the staff that supervises it. Proper staffing and training are critical!
According to Dr. Edward Walton, a board-certified pediatrician and emergency physician, who is an expert in camp health, 45 percent of personnel who care for campers are nurses and 7 percent are physicians; the remainder includes licensed practical nurses, first-aiders and paramedics.
Camp directors cannot assume when hiring candidates to treat children and adults that having “M.D.” or “R.N.” after their name qualifies him or her in camp medicine. Is the intended healthcare provider a pediatric physician or nurse who specializes in emergency medicine, an experienced primary-care provider or a geriatrician or radiologist who hasn’t treated a child in 20 years?
Whereas certain guidelines promulgate administrative procedures for an on-site health center, such as the number of required beds, there are no standards for evaluating the competency or knowledge base of healthcare providers. However, training programs exist.
The bottom line is that the best camp health centers make sure their providers, regardless of formal education and degrees, are trained on how to properly diagnose, manage, and prevent minor or potentially catastrophic conditions in residential campers and staff.
For more resources, see Medical Essentials at www.expertonlinetraining.com or Education Center at www.acn.org.
(Walton, E.A., Maio, R.F., and Hill, E.M. “Camp health services in the State of Michigan.” Wilderness and Environmental Medicine. 15: 274-283, 2004.
Warren A. Katz, MD, is president of Medical Professional Services. He can be reached via e-mail at firstname.lastname@example.org.