Kevin writhed in pain on the basketball court, his left ankle obviously dislocated and fractured. Sam gasped for every breath and was not responding to multiple treatments from his inhaler. Kristi complained of difficulty swallowing and itching all over after accidentally eating a dessert that contained apples. Walter, attending a staff training program, had crushing substernal chest pain. Aaron presented with a sudden onset of severe lower right quadrant pain. Jamie was thrown from a horse and examination found impaired lower extremity sensation. Misty was kicked by a horse and had severe mid-thigh pain and deformity.

These are just a few of the 9-1-1 emergency calls to a summer camp in northern Wisconsin over a 10 year period. According to the American Camp Association (ACA) more than 10 million children and adults will attend more than 12,000 day and resident camps this summer. Nearly every rural or urban EMS service has at least one day or resident camp in its service area. Knowledge of camp activities, on-site health care resources, and facility access will reduce response times and improve patient care.

A study from the University of Michigan summarizes the results of a mail survey of Michigan camp health officers (CHO) during the summer of 2001. The study reports that 45% of the CHOs were registered nurses. The remainder was trained as paramedics, EMTs, or first responders. 47% of CHOs reported caring for campers with significant medical problems, such as asthma (70%), diabetes (54%), ADHD (36%), and seizure disorder (23%). A Camping Magazine article stated that “there are more than two hundred camps for children with special diseases such as diabetes and cancer. The camps serve kids with a range of diseases, including HIV/AIDS, multiple sclerosis, muscular dystrophy, cystic fibrosis, and cerebral palsy.”

CHO knowledge of local EMS is underwhelming. Ten percent (10%) of respondents did not know the response time to camp for the nearest ambulance. Forty-seven (47%) percent of respondents did not know if their local ambulance was staffed with paramedics or EMT-basics.

I know a camp director that assumed his town’s fire department and first responder program had an ambulance. They did not. He did not realize the ambulance was coming from more than 20 minutes away until a child experienced anaphylaxis. Fortunately, trained first responders arrived in less than 5 minutes, but he was surprised to learn the paramedic staffed ambulance was going to be another 15 minutes.

That same camp director will have an Automated External Defibrillator (AED) at camp this summer for the first time. Do the camps in your service area have an AED? He was given an AED from his County’s emergency management office. Given that most camps have an EMS response time of more than 10 minutes, an EMS AED will likely arrive too late for most camp cardiac arrest victims.

This study has several important reminders for Ambulance Service Directors:

  • Learn the first aid qualifications of camp staff in your service area. ACA Standards require, at a minimum, adults be trained in first and CPR from a nationally recognized provider. But some camps will have a physician and or nurses on-site 24 hours a day.
  • Advise the camp to own and know how to use an AED, pocket mask, simple airway adjuncts, and high flow oxygen
  • Learn about the type of campers served and potential health problems.
  • Another ACA standard directs camp to notify local “fire and law enforcement officials” at the start of the operating season. Many camps also notify EMS services and hospitals. This is your invitation to visit the visit the camp during staff training

During a camp visit take time to:

    Ask the camp staff for a current map of roads and buildings.
    Arrange a joint training with the camp waterfront staff to locate, extricate, and treat a drowning victim.
  • Tour camp program areas to learn about activities and potential injuries.
  • Describe how your service is staffed (ALS or BLS), response times, and treatment protocols
  • Finally, most camp patients are children. Schedule a training session for your squad to review pediatric assessment, airway management, defibrillation, and spine immobilization.

References
Walton EA, Maio RF, Hill EM.“Camp Health Services in the State of Michigan.”Wilderness and Environmental Medicine.2004.15: 274-283 [view research article at http://www.wms.org/pubs/i1080-6032-015-04-0274.pdf]
Mayo M. “Camps for Children with Illnesses on the Rise Normalcy and Fun Help with Coping and Healing of Disease and Disabilities.”Camping Magazine.2002.November/December.75(6) 20-24 [view article at http://www.acacamps.org/media_center/view.php?file=camp_trends_article4.html]