As summer begins and all those carefully recruited campers begin to arrive, camp professionals often revisit orientation to assess if they've adequately prepared staff to handle various aspects of camp life. Based on what was presented during last February's Healthy Camp Symposium at the 2011 ACA National Conference, there are several strategies that staff can routinely use to support and maintain the health (wellness) of camper groups. This article discusses some of them and encourages camp professionals to insert the knowledge in orientation messages, in written camp policies, and during in-services scheduled during the camp season.
Set Up Cabin and Activity Processes to Support Mental, Emotional, and Social Health
Recognize that opening day at camp may be tension-filled for campers because the survival skills used in their home setting are very different from those used at camp. At home one would never take things from strangers, undress in front of them, or talk to a stranger. Yet opening day is often filled with experiences like this. In addition, most campers have their own bedroom or share with one sibling. Camp life keeps one among others most of the time; that can be downright wearing! Consequently, talk with campers about their adjustment to camp. Simply ask, "How are you feeling about being here?" on opening day. Talk about the differences between camp and home. Get returning campers to express their opinion about why they feel "safe" at camp. This is an excellent topic for the first evening's "cabin council" in a resident camp or the end-ofday meeting among day campers.
Tell kids who they can go to should a problem arise. Identify options so campers understand the number of people available to them. Talk proactively about common youth challenges such as bullying, what to do when conflict erupts, and being "unplugged" at camp. Include comment about how one copes with stressors at camp. If appropriate, include conflict management skills such as the use of "I statements."
Go into the camp season with a keen grasp not only of group formation skills (we're really great at forming tight groups at camp!) but also group maintenance. At most camps, this is largely an unrecognized skill set. Camp staff spend lots of time working so campers feel part of various groups, but we ignore the work of group maintenance and then wonder why things break down. The group maintenance processes — strategies like debriefing a day, doing anticipatory guidance about what may happen tomorrow, talking about tough or anxious moments, and injecting humor — help a group selfregulate and maintain its cohesion. If looking for resources on this topic, simply Google "group maintenance."
Routinely assess each camper for his/her balance between active and sedentary activity, nutrition and hydration status, and potential for fatigue. Breakdowns in these areas quickly result in people acting more like beasts than beauties, so paying attention to each person's balance of these basic human needs is important. Keep in mind that many youth get to camp with a fatigue deficit; they really do need eight to nine hours of sleep each night (and so does the staff!). Also recognize that campers with pre-existing chronic health concerns (e.g., asthma, allergies) tend to have less resilience, so maintaining their nutrition, sleep, and hydration reserves is even more important.
Know How to Respond to Life-Threatening Situations
There are some emergencies that cannot wait for the camp nurse to arrive. These situations happen infrequently, but when they do, staff must appropriately respond. Examples include:
- Choking: All camp staff should know how to initiate abdominal thrusts should someone present with an obstructed airway. Individuals may not remember the entire sequence for clearing an obstructed airway, but recognizing and initiating abdominal thrusts when needed is critical.
- Responding to fire (both structural and when a person's clothing or hair has caught fire): This potential tends to be minimized because risk management processes — like having a bucket of water handy at the campfire — are so prevalent. Nonetheless, staff should know how to trigger the camp's fire response as well as how to drop, roll, and smother someone whose clothing or hair is flaming. Temper this with a life safety message similar to those used by lifeguards: Act in a way that maintains personal safety.
- Recognizing anaphylaxis: Early signs include swelling (especially of facial features like eyes and mouth) and hives. If one pays attention to the person going into anaphylaxis, the individual may talk about "feeling funny," itching all over, "not feeling right," and/ or make gestures (show behaviors) that indicate an emerging threat. Recognizing the onset means one can activate the camp's emergency response system, thus increasing the likelihood that supports such as adrenalin (e.g., EpiPen), diphenhydramine (Benedryl), and medical attention will be effective. Looking for visual examples of people experiencing anaphylaxis? Search "anaphylaxis" at www.YouTube.com  for clips (for example, this one: www.youtube.com/watch?v=FkB7vT0PHbo ). Information about using an EpiPen is online at www.epipen.com .
- Responding to threatening weather: Whether it's the wind that accompanies a great thunderstorm, the drum of hail, or the potential for lightening, weather can be both intriguing and threatening. Explain weather-specific safety measures to staff and pose questions to help them develop the decision-making skills that will protect groups from weather impacts. Mother Nature will provide an opportunity to exercise these skills at some point during the summer, so work to identify the truly threatening from those moments when it's okay to enjoy what is going on.
Improve Your Camp's Injury/Illness Risk Profile
Completion of the Healthy Camp Study (American Camp Association, 2011) taught camp professionals important things about the injuries and illnesses that occur at camp, as well as what might be done to make it less likely that injury/ illness will occur. Talk with your camp's leadership team; understand what injuries and illnesses have occurred in the past and then make plans to minimize those concerns this summer. Remember: People sign up to enjoy the camp experience, not the health center. Focus staff effort to achieve that goal. Strategies that help accomplish this include:
- Appropriately using the protective gear made available in various activities. • Wearing shoes that are appropriate to the activity.
- Coughing and sneezing into one's shoulder — not into the air or into one's hands.
- Washing hands, washing hands, washing hands — and keeping them away from one's face.
- Minimizing the potential for trips and falls by using adequate light on paths, keeping walkways free of debris (e.g. boxes, open suitcases/ trunks), and allowing people (including staff) adequate time to move from place to place.
- Appropriately supervising campers. Thoroughly discuss both the appropriate and inappropriate behaviors that constitute "supervision" in various situations. For example, if a counselor is "supervising" rest hour, can that counselor fall asleep? If a counselor is supervising "free time," should the counselor stay in one place or rove throughout the area? When counselors supervise a table during a meal, where should staff sit? What behaviors are acceptable during a meal and what actions are not?
Also remember that camp is made up of people, so sometimes things will break down. But when elements controlled by camp — elements such as the camp schedule, the rules people have to follow, the equipment they're given to use, and the facility they are in — cause injury or illness, that warrants attention to risk reduction. (See the article "A Healthy Camp Depends on You " for more tips from ACA's Healthy Camp Study.)
Improve Camper Health by Making It Possible to Connect with Nature
Martha Erickson, Ph.D., spoke eloquently on this topic in her "Healing the Broken Bond between Children and Nature" session at the Healthy Camp Symposium. She noted that children have stopped going outside. Their free exploration of the backyard creek, trees in the park, and capturing bugs has given way to staying "plugged in" indoors and having adults in constant attendance with adultdirected activities. Parents often cite fear as a reason for keeping kids inside; "out there" has become threatening instead of intriguing. In addition, technology has a seductive draw, and some children no longer have access to a natural environment. As a result, children are spending a lot of time inside.
Why should getting outside matter? We know — from research as well as from anecdotal comment — that interaction with the natural world is calming to the human spirit. People who get outside are in better physical health and have reduced stress and anxiety levels. Children allowed to simply play outside improve their cooperative skills, exercise problemsolving in creative ways, and improve their ability to concentrate.
Camp provides a tremendous opportunity for the nature reconnection. For some camps, it may mean providing time for outdoor "free play," time when adults are present but those adults do not direct the activity of campers. The kids are left to come up with games and shape experiences on their own. Perhaps there's a grassy area of camp that could be turned into a "Barefoot Park" where shoes are left at the edge. Maybe campers want to plant vegetables and watch things grow. Perhaps some want to collect bugs or build a fort with cast-off items from the maintenance shed. Sometimes kids just want to lie on their bellies and watch what happens at ground level or flip over to watch the clouds.
This reconnection with the natural world puts people in a better place for nature to work on them. Simply playing outside helps kids work off steam, especially when most of their day is driven by the agenda others — including our camp schedules — impose.
With a bit of forethought, it's possible for camp professionals to creatively shape the camp experience so it promotes the health of everyone. This may mean giving up a directed activity so more time for free play is available, it may mean adapting an area of camp to support children's free play, and it may mean more intentional connections one-on-one between camper and counselor, but the effort is well worth the outcome.
American Camp Association (2011). The healthy camp study impact report. Retrieved from www.ACAcamps.org/research/enhance/reduce-injury-illness
Linda Ebner Erceg, R.N., M.S., P.H.N., is the associate director of Health & Risk Management for Concordia Language Villages and executive director of the Association of Camp Nurses in Bemidji, Minnesota.