A Healthy Camp Community
Three years ago, the camp community placed a capstone on a significant accomplishment by completing the largest, most comprehensive study of camp-related injuries and illnesses ever undertaken. This “Healthy Camp Study” involved close to 300 day and resident camps in monitoring camper and staff injury and illness events over the summer for five years from 2006 through 2010. With leadership from the American Camp Association and the Association of Camp Nurses, and through support from Markel Insurance, the Healthy Camp Study not only provided data that camps can use to benchmark and compare their own rates of injuries and illness, but it also resulted in a set of recommended practices for injury and illness prevention in camps. Although the study showed that camp is generally a safer experience than many other youth activities, a number of lessons were learned that can dramatically improve health-related outcomes for both campers and staff. Many camps made changes to their healthcare and operational policies and protocols because of lessons learned from the study, and this article explores the stories and experiences of two such camps.
Five Promising Practices
One thing made clear from the Healthy Camp Study is that reducing the incidence of injuries and illnesses in camp IS possible, and there are specific things that camp administrators and healthcare staff can do to better their odds of having a safer and healthier summer. Although these strategies are not entirely new, data from the Healthy Camp Study indicate that many camps are not consistently implementing these simple steps. Think about your camp’s policies and practices as you review this list. For an expanded discussion of these five strategies, see Working Toward a Healthier Camp: Five Strategies for Camp Administrators to (Re)Consider Now!  by Linda Erceg and Barry Garst.
Parents are vital for a healthy camp. You can engage parents in injury and illness prevention by embedding health messages into your precamp parent communications. Require parents to adequately prepare and screen their children before they participate in camp. Keep illness away from the camp gate. ACA’s Parent Flyer can help.
You’re more likely to get sick at camp than you are to get injured. In fact, communicable illness (i.e., illness that can be passed from person to person) accounts for 50 percent of all illness in camps. Controlling communicable illness is possible through management of the airborne droplets that transmit microorganisms, which are passed from person to person through coughs and sneezes. Teach your campers appropriate cough and sneeze etiquette and how to keep their hands away from their face. Show your staff how to model these behaviors. Above all else, actively promote good hygiene and hand washing.
In addition to getting sick, you’re also more likely to slip, trip, or fall at camp — the most common causes of a camp injury. These slips, trips, and falls often result in a foot, ankle, or toe injury. A significant factor in slip, trip, and fall incidents was whether or not the injured camper or staff member was wearing footwear appropriate for the activity. In a large percentage of these injuries, the campers or staff either weren’t wearing shoes or they were wearing an open-heel or open-toe shoe. If you haven’t already done so, now is the time to develop and enforce strict footwear policies.
No one would argue that wearing protective equipment is important for reducing injuries. However, in 50 percent of injury events, protective equipment either wasn’t being worn when it should have or campers or staff members were using ill-fitting equipment that didn’t protect them from experiencing an injury. Always require the use of protective equipment, and be sure you’ve got equipment appropriate to the sizes and ages of your participants. No counselor wants to see a camper get injured “on their watch.”
Fatigue was a factor in 40 percent of all injuries and illness events, yet camps often fail to address fatigue-related expectations directly with staff. As employees, camp staff are expected to arrive at camp ready for work, which means being well-rested, well-nourished, and well-hydrated — all of which play an important role in a person’s ability to successfully resist disease. Staff become more susceptible to illness without adequate rest, proper nutrition, and sufficient hydration. They might also be more likely to demonstrate poor decision making, resulting in an injury. Help your staff practice strategies for self-care, clarify your expectations in your staff contracts, and address consequences during staff training. ACA’s online course on a counselor’s role in healthcare  is perfect for training staff on this topic.
Camp Kids and mountains, playing hard, and living in bunk beds: Camp is for kids! Sonlight Camp, a resident camp located in Colorado, enrolled in the Healthy Camp Study at the beginning of the project and remained a participant through the entire study. Early on, we were affirmed that the trends we generally see in our injury and illness patterns were consistent with what the research indicated was happening nationally. Historically, our focus of keeping kids healthy at camp meant we spent more time preventing injuries. The Healthy Camp Study revealed, however, that the greatest attention was needed in the communicable disease arena — preventing disease from entering our camp community and then focusing on preventing the spread of disease once it shows up. The study provided us with solid facts to include in our staff training, reinforcing the importance of communicable disease control on all fronts.
To combat the spread of disease during camp, we built a hand washing station and added “all-camp hand washing” to our daily routine before every meal. We also improved the practices of having our healthcare staff review illness complaints — no matter how minor — and being diligent in sanitizing camp areas where kids or staff with illness might have been playing, resting, or working. We focused on cleaning specific surfaces such as doors, sink handles, light switches, shared equipment, and protective gear in addition to cleaning general areas.
As previously indicated, injuries occurring as a result of improper footwear emerged as a finding early in the Healthy Camp Study. At Sonlight, our program staff reviewed data about our activities, the footwear that was being used, and the injuries that were sustained by campers and staff. Once staff began to look at the data and review activities, it was easy to get them involved in creating footwear guidelines and integrating the guidelines into our camp culture. In the mountainous environment of Sonlight Camp, the biggest concern with regard to possible foot injuries involved running activities that took place on the uneven surface of the mountain meadow. Using closed-toe shoes reduced ankle injuries as well as toe injuries and lacerations.
There were other notable issues that became apparent during the study, including injuries that occurred when protective gear was provided by Sonlight but not used by campers or staff, injuries occurring during “free” time, and injuries and illnesses that increased when campers and staff were fatigued. Fatigue has been a targeted issue at Sonlight Camp. Working with program staff, we looked at schedules to provide the opportunity for a good night’s sleep for staff and campers as well as a balanced daily schedule with the opportunity for “down” time. Healthcare staff kept the possibility of fatigue in mind when doing assessments and had the authority to provide opportunities for more rest for campers and staff if they felt it would be helpful. We were reminded that naps and/ or earlier bedtimes are sometimes all that is needed to get over an illness more quickly.
Sonlight Camp’s “before” and “after” camp routines look different as a result of our involvement in the Healthy Camp Study. Before camp, we are more intentional in our staff training; we spend more time reviewing the guidelines and policies in place for keeping staff and campers safe. We are also more intentional in communication with parents before camp, and we have more specific parameters for parents about whether or not kids can come to camp if they are sick. After camp, we review the injury and illness data we’ve collected during the summer — including information from our health record log, injury and illness forms, and so on — and plan for how we can prevent more injuries and illnesses next summer. As we weave the “healthy camp” theme into to our precamp preparation, our everyday routines, and our postcamp injury and illness review, we see staff becoming more engaged in being aware of a healthy camp environment. As staff are more engaged and mindful, maintaining a “healthy camp” becomes part of what we do.
Crystal Lake Park District
The Crystal Lake Park District is a large district northwest of Chicago offering five different day camp programs. We joined the Healthy Camp Study originally to have a monitoring system of injuries for our park district insurance group. We came away with improved strategies for parent communication, changes in the way we trained our staff, and a number of changes to our policies and procedures. We realized that when it came to parents, we were not preparing them for camp ahead of time, even though we — as a day camp — saw our parents every day. We started to distribute the ACA Parent Flyer as a part of the parent welcome packet, which educated our parents about how they could help campers arrive already prepared for the day’s activities. This improved process of parent communication also helped with our management of the extreme heat last summer, as parents prepared their campers with refillable water bottles each day, proper sunscreen, and appropriate clothes for high temperatures.
When day campers are ill, they just don’t show up. As camp administrators, we knew that we rarely received consistent feedback from parents regarding the reason for camper absences. With the monitoring system provided through the Healthy Camp Study, staff were trained to request that information each morning when parents dropped off their kids. Furthermore, when campers became ill during camp, a parent was contacted to pick up the child, and we were more thorough in our follow up with parents to find out the result of the camper’s doctor visit. These new procedures forewarned us that an illness may have been going around our camp.
We also added use of a hand washing station as a new procedure in the daily routine for both staff and campers. Close health monitoring through the Healthy Camp Study also led us to pay closer attention to seaweed and duck/geese excrement that had to be cleaned off of the beach each morning. With more diligent cleaning and removal procedures, we saw fewer cases of “swimmer’s itch” (also known as schistosome dermatitis) and fewer beach closings for E. coli counts from the health department.
Consistent with the national trends identified through the Healthy Camp Study, the most common causes of injuries in our camp were slips, trips, and falls. We changed our footwear policy to closed-toe shoes for all activities at all times. We also required water shoes be worn on the beach by our lifeguards as well as staff and campers. This new procedure helped campers and staff avoid cuts from a burgeoning zebra mussel problem. Another trend we noticed through the study was the high number of camper injuries that were sustained during the tradition of morning sand soccer. In fact, this activity produced the most injuries. We adapted the location of sand soccer to take place across a walkway in the grass, which resulted in the survival of the soccer tradition with fewer associated injuries.
Staff training was also impacted by our involvement in the Healthy Camp Study. We used ACA’s online injury and illness prevention courses to train staff before they arrived at camp, which was a blessing because we had so many subjects to cover in a short amount of time during our precamp training. We were pleased to learn that these online courses were viable for continuing education units (CEUs) by the National Recreation and Park Association as well as the Illinois Department of Children and Family Services.
Our experience with the Healthy Camp Study as a monitoring system was very beneficial. We encourage other camps to both draw from the lessons already learned and seek an ongoing process for illness and injury surveillance.
Changing Camp Culture
Consider the lessons learned at Sonlight Camp and the Crystal Lake Park District, as well as the promising practices identified through the Healthy Camp Study — how does your camp relate? Being aware of strategies for injury and illness prevention is one thing; fully integrating organizational changes that impact a large number of camp stakeholders is another. Changing camp culture is not easy. For many camps, modifying and implementing parent communication strategies, cleaning protocols, footwear policies, and protective equipment use takes time, resources, and the commitment of staff from across the organization. The keys to success are setting reasonable goals and getting started today. For a wide range of resources to support your efforts to prevent injuries and reduce the prevalence of illness in camp, visit the Healthy Camp Toolbox .
Injury and Illness Prevention Resources
- Healthy Camp Toolbox: www.ACAcamps.org/research/healthy-camp-toolbox 
- Parent Flyer — A Healthy Camp Starts at Home: www.ACAcamps.org/sites/default/files/images/research/enhance/parentflyer.pdf 
- Online Course — “A Counselor’s Role in Healthcare”: www.ACAcamps.org/einstitute/counselors-role-healthcare 
Barry A. Garst, PhD, is ACA’s director of program development and research application and adjunct professor at Virginia Tech. His current research interests include the multiple meanings of nature-based experiences and the workforce development outcomes of camp experiences. Contact: bgarst@ACAcamps.org .
Sandra Thompson, CPRP, has been a recreation supervisor for the Crystal Lake Park District for twenty-seven years and a medic first aid and CPR instructor for twenty years. Sandra is a member of the Healthy Camp Study advisory board. She may be contacted at email@example.com .
Mary Marugg, RN, co-directs Sonlight Christian Camp of Colorado with her husband, Winston. Mary is the clinical chair of the Association of Camp Nurses (ACN) Board. She writes a clinical column for ACN’s newsletter, presents workshops, and coordinates training on camp health management.
Originally published in the 2013 March/April Camping Magazine.
ACA's Healthy Camp Study was sponsored by ACA Mission Partner Markel Insurance.