When it comes to providing safe experiences for children, knowledge is often the most powerful tool an organization possesses. Knowledge about safe conditions and practices and the ability to identify areas for improvement are keys to ensuring the health and safety of program participants and staff and decreasing the likelihood of adverse health events. An important key to developing a sound knowledge base about health and safety conditions is careful monitoring of the factors that cause significant injury and illness events in camps.
National-level monitoring has proven successful in identifying risk factors for decreasing adverse events in several areas, such as the Consumer Products Safety Commission's National Electronic Injury Surveillance System and the National Collegiate Athletic Association's Injury Surveillance System (NCAA ISS). With more than ten million children attending more than 12,000 summer camps each year, camps have lacked access to reliable surveillance methodology. Until now!
The American Camp Association (ACA), in cooperation with Nationwide Children's Hospital and The Ohio State University and the Association of Camp Nurses, has completed three years of the five-year Healthy Camp Study, a national injury and illness monitoring program in U.S. camps. Over 170 day and resident camps have participated in the study to date, submitting weekly online reports of significant injury and illness events experienced by campers and staff (See the sidebar, Monitoring Injuries and Illness, on page 51). The consistency of the results over the past three years of the study has provided insights into organizational best practices for the health and safety of campers and staff. Here are ten strategies that you can implement to improve the well-being of campers and staff involved in your program.
Don't Underestimate Illness
Both campers and staff are more likely to become ill at camp than they are to become injured. In fact, the illness rate for camps is almost double the injury rate. Think about how much time you spend on injury prevention (filling potholes, removing loose nails, inspecting program equipment) compared with illness prevention. Many camps spend more time preventing injury than preventing illness. Given the rates, perhaps that needs to change. Partner with parents by encouraging parents to keep sick children at home. Explain to parents the importance of controlling the spread of illness in camp and build the same information into staff training. When camp staff become ill with an infectious disease, require them to stay home or in staff lodging to reduce or avoid contact with others. See the sidebar, Resources for Healthier Camps, on page 54 for ways to avoid spreading infectious diseases.
Promote Good Hygiene
Infectious diseases account for about 20 percent of illnesses among day and resident campers and staff. Controlling infectious disease is the most important thing you can do to provide a healthier camp environment. Actively promote good hygiene, and engage everyone's participation in this critical task. Teach staff about proper hand washing and challenge them to find new and interesting ways to teach campers this important skill. Review your procedures for hand-washing before meals to ensure it's actually happening. Provide adequate hand-washing stations at the entrances of eating facilities. Don't require sick staff to prepare or serve food.
If you're over the age of eight, it's likely that you learned the wrong way to sneeze, which includes sneezing into a hand or handkerchief. The best way to sneeze, so that you don't expose others to your germs, is to do so directly into the crook of your arm or into your sleeve. Teach campers and staff the right way to sneeze and cough (into an arm or sleeve). Many resources are available to help you — see Resources for Healthier Camps.
Focus on the Feet
Trips, slips, and falls are the most commonly reported causes of injury in day and resident camps. For example, in resident camps, close to 30 percent of all injuries are sprains or strains resulting from a trip, slip, or fall. Review your camp's footwear policy, because ankle, foot, and toe injuries related to a slip are often caused by rough terrain and improper footwear. Review your camp policies regarding footwear. Do you allow flip-flops or sandals during active periods of the day? Do you enforce closed-toed shoe policies for both campers and staff? You also need to consider terrain. Children today have less experience navigating in the outdoors, and the landscapes at many camps will be novel for many campers. Does your camp have steep, uneven, or slippery terrain? Closed-toed shoes are often the best choice. For ideas to protect against foot injuries, see Resources for Healthier Camps.
Increase the Use of Protective Equipment
A variety of camp activities require protective equipment, and ACA standards address the importance of protective equipment in specialized activities like horseback riding and adventure/challenge programs. Unfortunately, results from the Healthy Camp Study indicate that protective equipment wasn't being worn (by campers and/ or staff) in 50 percent of injury events in which protective equipment was applicable. What's really happening at your camp? Protective equipment needs to be worn when appropriate. This is particularly important during active programs.
Consider how you monitor the use of protective equipment in camp. Are there times in which protective equipment is a choice? What's the penalty if protective equipment isn't being worn? These questions are critical, since failure to wear protective equipment can contribute to serious injury and long-term impairment, particularly when injuries involve the back, head, neck, or spine.
Revisit Your "Health Record Log"
Do you annually review your health record logs so that you can identify patterns of injury related to specific camp activities or areas of camp that may be unsafe? A 2008 survey of ACA camps found that many camps fail to systematically review the injuries and illnesses recorded in their health/medical logs. An annual review of your health center information will help you to identify injury patterns and also where injuries are occurring. You'll then be able develop specific safety procedures for each camp activity and camp location where injuries are common.
If you're looking for a system that can help you track your injuries, you should consider ACA's Healthy Camp Study. By participating in the study for each week of the summer, and by investing approximately twenty minutes of staff time to data entry related to significant injury and illness events, your camp will gain a camp-specific report that you can use to better understand what's really happening at your camp. Camps also receive a national report for each year they participate in the study, which allows them to compare their health statistics with national averages. These reports are powerful tools for risk assessment and management.
Take Knife-Safety Seriously
Every summer camp staff are injured while using knives during food preparation. In fact, in one year of the Healthy Camp Study wounds from sharp objects such as knives accounted for 15 percent of injuries to campers and staff in resident camps and 17 percent of injuries in day camps. Be careful not to assume what your staff already know about knife handling and storage. Require staff to attend knife safety training and then have them demonstrate mastery of the safe use of a knife. For additional information, see Resources for Healthier Camps.
Stop Head Injuries Now!
All injuries are not equally dangerous. Severe injuries are those that can lead to long-term impairment or death. You may be surprised to learn that blows-to-the-head, from running into a tree to being hit in the head with a piece of sports equipment, are in the top five list of injuries for campers in day and resident camps. Consider what we know about the physical development of children. A young child's head is large in proportion to the rest of their body, making that child top-heavy and more likely to become offbalance easily. For this reason, head injuries may be more likely for campers under age eight. As you plan camp activities, think carefully about the protective equipment that can help you reduce the likelihood and severity of a head injury during a slip or fall. Think about the surfaces on which camp activities will be played. Take special precautions anywhere potential hazards are identified. Make "plan for the worst" a guiding principle for planning camp activities.
Reduce the Impacts of Fatigue
Fatigue is a contributing factor in many illness and injury events for both campers and staff. Incidents occur more frequently as the day wears on because people get more tired. Incidents are more likely to happen when staff and campers get "worn out" from special camp events. Being over-tired makes one more susceptible to illness and can increase the severity of a simple illness. So monitor the fatigue status of your camp's population. Does your camp schedule reflect a balance between busy and more sedentary activities? Can campers and staff who need more rest take naps or breaks? When staff or campers have a minor health concern, are they expected to recover rather than push themselves and, as a result, get more ill or injured? Fatigue is an insidious factor, one that can make even the most sainted person act like a beast. As you consider your camp's injury-illness profile, don't forget the influence of fatigue.
Understand What Happens During Free Time
What's your perspective on "free time" at camp? For some camps, free time is an important part of the camp schedule, a time for both campers and staff to rest and reflect (see Strategy 8 about reducing fatigue at camp). For other camps, free time is an accident waiting to happen, as campers may use the down time for horseplay and other potentially dangerous activities. Regardless of your perspective, we need to pay attention to what happens to campers and staff during free time. In resident camps, 30 percent of illnesses and 20 percent of injuries were reported during free time. These percentages were even higher for staff. Consider your supervision policies and procedures for free time. What monitoring systems do you use during these times to ensure that free time is being used appropriately? Define for your staff the behaviors that reflect appropriate supervision.
Integrate New Ideas Into Camp Staff Training
Idea #1: Involve your staff in making a plan for reducing the spread of germs in your camp. Assess your facilities and existing procedures, too.
Idea #2: Talk to all of your staff about the importance of protective equipment. Conduct an "activityreview" in which you think about the worst-case scenario for each activity and the protective equipment you'd need to incorporate to keep campers and staff safe during that activity. Share how it is systematically reviewed.
Idea #3: Integrate one or more of ACA's injury and illness prevention online courses from ACA's e-Institute into your staff training. Nine out of ten camp professionals who used the injury/illness prevention courses as part of staff training in 2008 said they would recommend them to other camps.
Idea #4: Train all of your staff in the proper way to handle sharp objects. Consider purchasing knife-safe gloves.
Joining the Healthy Camp Study
Camps across the country are benefitting from the information they're learning about injuries and illnesses at their camp. With two more years left in the Healthy Camp Study, there's still time to get involved, so that you can benefit from camp-specific information to enhance your camp's risk assessment, management, and safety programs. Participation is free and confidential, and no special affiliation is required. Your camp does not have to be ACA accredited to participate. Visit www.ACAcamps.org/research/  for more information.
Monitoring Injuries and Illnesses
Resources for Healthier Camps
Barry Garst, Ph.D., is the director of program development and research application, for the American Camp Association. Contact Garst at bgarst@ACAcamps.org , 765-342-8456, ext. 312.
Linda Ebner Erceg, R.N., M.S., P.H.N., is the associate director for health and risk management for Concordia Language Villages and executive director of the Association of Camp Nurses in Bemidji, Minnesota.
Originally published in the 2009 March/April issue of Camping Magazine.