Camp leaders have long recognized that today's first aid training does not necessarily provide an individual with the skills needed by many camp programs. Camp administrators are expressing a growing concern about performance adequacy among staff with first aid certificates. Today's courses often merely require class attendance and may no longer contain the broad information base and skill/knowledge testing which gave former courses their "teeth."

It is important to realize that some first aid courses are designed for metropolitan living. These curricula assume that someone with more advanced skills — ambulance personnel, paramedics, a physician or nurse — will be on the scene within a 20-minute response time. Some courses, such as the American Red Cross (ARC) "When Help is Delayed," attempt to prepare an individual to care for an ill or injured person during the "Golden Hour," the first 60 minutes post-incident. These courses, with emphasis on urban supports, often meet the needs of camp programs which function within urban or suburban parameters.

Camp Expectations

Many camps, however, operate with a different set of expectancies. Some camps have unreliable communication routes with which to contend. Others are more than 60 minutes from the next level of care. There are camps whose base camp is fairly close to medical support (within 30 to 45 minutes), but whose trips go to remote areas. Other camps may be in a community which is staffed intermittently by ambulance support personnel.

All of this contributes to a growing need for camp directors to assess the type of first aid support needed by their program and decide what type of training best meets program, camper, and staff needs. The revised American Camping Association (ACA) standards (1998) attempt to address these concerns by directing camp management to provide "second level" first aid in addition to CPR when access to EMS is 20 to 60 minutes between the camp location and the next level of help (e.g., hospital, clinic). When response time is beyond 60 minutes, the standards direct camps to provide — at minimum — a person with wilderness first aid and CPR. (Standard *HW-1)

Requirements of Revised ACA Standards

In theory, this is great. In practice, it can be confusing. As directed by the interpretation for standard *HW-1 (ACA, 1998; pg 53), camps determine what level of provider is needed based on the distance between camp and the next level of care and/or the location of programs done off-site. For example, a camp located within 20 minutes of a hospital would be required, according to ACA standards, to have a person with at least first aid and CPR certification on duty when campers are present. If that same camp takes an off-site camping trip to an area where the longest response time to that hospital falls between 20 to 60 minutes, the camping trip would then need a person with second level first aid and CPR. Once the off-site trip is in a more remote area where distance to the next level of help is longer than 60 minutes away, the need for wilderness first aid certification exists.

After determining what level of first aid is minimally expected, the next step involves locating a nationally recognized provider of the training as well as becoming familiar with various curricula and knowing under what category the resulting certificate falls.

Perhaps the toughest part of the evolution in first aid has been the slow response to camp needs by the American Red Cross (ARC), although their recently developed course "When Help Is Delayed" is a positive step. ARC has a national system of instructors in place; those instructors, however, are largely not prepared to function beyond urban first aid courses. Consequently, camps may have to look to other providers. Such a change is not easy since ARC phone numbers appear in most city phone books and are part of camp directors' Rolodex systems. Contact with providers such as the National Safety Council or SOLO aren't as readily apparent. Yet such contact may be needed.

"Second Level" First Aid

Begin by understanding what is intended by the standards. "Second level" first aid training includes a minimum of 12 hours and covers topics necessary to provide emergency care when access to the next level of care is more than 20 minutes but within the Golden Hour (ACA, 1998; pg. 54). Adding "When Help is Delayed" to the standard first aid/CPR course by ARC could satisfy this requirement.

Other programs, such as the National Safety Council's standard and/or advanced first aid, could also meet this requirement. The key is to discuss the time requirement and needs of the camp staff with the instructor and be clear about the need to provide appropriate first aid training of at least 12 hours.

Wilderness First Aid

In addition to second-level first aid courses, some camp personnel will now be seeking wilderness first aid certification. The term "wilderness" was added to the concept of first aid largely due to the efforts of people who took trips in remote areas who quickly discovered that first aid courses based on assumptions appropriate to urban settings did not work in remote settings. In fact, following some of the urban-based practices actually caused harm in a remote setting. For this reason and under the leadership of a group of physicians from the Wilderness Medical Society, a set of practice guidelines was developed (Forgey, 1995). These guidelines provide the framework for courses such as the National Safety Council's wilderness first aid and SOLO's wilderness first aid.


It appears as though the "teeth" of first aid courses from twenty years ago may be coming back. As a result, it is important that camps have access to first aid trainers and courses which meet program needs. Effectiveness of first aid instructors should be just as important as time spent completing a course. Talk with first aid instructors. Visit a class they are currently instructing or have them teach a demonstration class. Then hold them to the standard they set forth.

Begin adjusting to the type of first aid support your camp needs by assessing what course is a good fit with your program in conjunction with that program's travel time to the next level of emergency support. Then select a course provider that can not only provide the needed curriculum but also an instructor willing to adapt content to program needs.

American Camping Association (1998). Accreditation Standards for Camp Programs and Services. Martinsville, IN: American Camping Association.

Forgey, W. (Ed.)(1995). Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care. Merrillville, IN: ICS Books.

This article first appeared in the Association of Camp Nurses' CompassPoint, vol 9 (1). It is reprinted with permission and has been modified for ACA.

Originally published in the 1999 Winter issue of The CampLine.