There are times when general camp staff respond to injury-illness events. These staff are not the camp's officially designated healthcare providers, but rather the staff who, by happenstance, are closest when an incident occurs. They must "do something." There are also times when general staff make decisions about seemingly minor injuries and illnesses that campers may show or talk about: a scraped knee, a scratchy throat, a bruise from a fall.

Camps typically provide training to assist staff with this decision making. Some camps credential everyone in first aid and/or CPR. Others do not. Most camps emphasize referring care to designated providers such as health center staff and recognize that ancillary people may provide care in situations such as overnight camping, at the ropes course, or on a day trip.

While we're great at designating a healthcare provider, we're not particularly adept at describing the scope and limits of the care general staff might provide. We tell them to "do first aid" without giving them a framework within which to exercise that skill. And so the scraped knee gets lost in the fray of a busy camp day, and eventually, shows MRSA infection. Or the scratchy throat really indicates a trigger for asthma and the camper soon needs a nebulizer treatment. Or the bruise camouflages a fracture.

This article discusses some of the parameters that camp administrators might consider as they define and articulate their camp's position regarding injury-illness care provided by general staff. It is not meant to guide the care for designated healthcare providers, but rather to help articulate a framework that enables camp professionals to more clearly communicate the scope and limits of first aid care provided by general staff.

Emergency Response

Perhaps the easiest place to start is the emergency situation. Be it a lost camper, threatening weather, fire, or some other situation, life safety takes priority. Because of this, most camp emergency plans place emphasis for general staff on getting campers to a safe place and letting administration know if someone is missing. Response to personal injury is also pretty clear in an emergency; the camp's designated healthcare providers are on alert and injuries are referred to them.

But what if the emergency overwhelms the designated providers or what if these providers are victims of the incident? Now the reason for adding depth to a response team becomes apparent. A growing number of camps are expanding their response capacity by making sure there are staff who can back-up designated providers and that these staff are appropriately credentialed with advanced first aid courses. In addition, camps are starting to run simulations to build the responders' experience base. Given that one rarely gets to experience an emergency, simulations are growing in popularity.

An enterprising camp might also consider adding first aid / CPR training to its list of camper activities and then allowing campers to act the part of injured people in a simulation, or assuming an appropriate skill level, assisting with the incident response. This creative response builds skill levels in many ways.

Staff would also benefit from knowing what injury-illness situations warrant immediate attention by the camp nurse. In response to this, camp nurses have long used "the Big B's" to describe these situations: bleeding, breathing, barf, burns, bones, and bites. The message is simple: If these occur, refer the individual to the nurse.

Describe the Scope of First Aid Provided by General Staff

It's tougher to describe the care that general staff should provide when dealing with minor injuries and/or illnesses. A person's judgment comes into play. If the person thinks he or she has sufficient knowledge, the risk for minimizing a concern exists. If the individual has no first aid skills or knowledge, the potential to over-refer people to the health center exists.

And so the default is to provide a first aid class during orientation. In so doing, is the intent of credentialing general staff in first aid so they can, indeed, provide care? Or might it be so they can effectively coach self-care among campers and refer cases where self-care is not possible to more appropriate staff? This is an interesting question. It gets to the camp philosophy regarding a camper's perception of self-reliance. By coaching a camper in self-care, that camper's sense of self-reliance builds. But if camp staff provide hands-on care, campers don't get that opportunity from injury-illness situations. It's an interesting dynamic to explore. In our quest to help campers, we may be too quick to provide the actual care; a more thoughtful and growthpromoting response may be to coach self-care when possible.

While this principled decision influences whether staff actually do first aid care or coach campers in self-care, one can also give staff guidelines that further help their decision making in first aid situations. Some of those used include the following:

• Coach and/or provide care only to the level for which you have been trained/credentialed.
• Bleeding wounds that can be controlled by using a band-aid should be washed with soap and water, gently dried, and then covered with the band-aid. Individuals care for their own minor wounds as a way to minimize the potential for blood exposure incidents. Bleeding wounds that cannot be controlled with one band-aid must be referred to the camp nurse.
• Headache, while usually not life-threatening, certainly makes a person feel uncomfortable; so move the camper into a cool spot, provide something to drink, and get them to relax for awhile. Direct the camper to see the nurse the next time the health center is open. On the other hand, headache can also be a symptom of a larger problem, especially if accompanied by vomiting, dizziness, and/or vision disturbances. In these situations, immediately contact the nurse.
• Cold symptoms such as a stuffy nose, cough, and/or sore throat can also make one feel miserable. Expect less than peak performance from this camper (adjust your expectations) and encourage self-care in a way that conserves energy. Ask if the camper has seen the nurse; cold symptoms typically last seven to ten days, and while they are unable to cure the cold, medications can be used to help alleviate symptoms. Cabin counselors need to make sure the camper with a cold gets adequate rest.
• Bug bites can also be irksome. Most can be avoided by using insect repellents. If a camper has a lot of bug bites, assess the effectiveness and use of the camper's repellent. Itchy mosquito bites do not warrant an emergency visit to the health center. Rather, apply a cool compress and instruct the camper to see the nurse the next time the health center is open. That being said, keep in mind that it's normal for a person to swell at the site of a bite. Swelling at places other than the bite area requires quick referral since the person may be reacting systemically. In other words, this may be the start of anaphylaxis.
• In spite of what some campers may believe, homesickness is not terminal, but it can present definite physical symptoms such as nausea and vomiting, headache, and abdominal cramping. If one suspects homesickness, ask about it. The goal of intervention is to engage the camper in camp rather than to focus on being lonesome. Some campers benefit from knowing that one can have fun at camp and still miss home. The two feelings are not mutually exclusive. Consult Chris Thurber's work on homesickness for more discrete information about this topic.
• Note and take action when observing a rash on a camper. Typically this means directing the camper to see the nurse. If complaining of itchiness, direct the camper to gently wash the area with soap and water.
• Coach staff to pay particular attention in these situations and bring them to the attention of the camp's healthcare team:
  • Bleeding that is not controlled by a band-aid
  • Swelling at places other than the bite site
  • A child who is throwing up or threatening to do so again
  • A child who looks sick — is pale or really flushed, tired, and lethargic
  • Any injury to an eye or ear
  • A camper with a chronic health problem who complains of feeling ill
  • Injuries that do not respond to rest, elevation, and cooling
• Counselors have to care for themselves too! Seek care when problems are minor instead of waiting for them to blossom into a bigger issue. Expect camp staff to adjust their personal schedules — like getting more rest — so they remain capable of doing their job effectively. Insert a statement to this effect on your performance appraisal tool.

Document Provided Care

Given this day and age, each first aid kit should have a notebook for documentation accompanied by a camp policy that provided care should be documented. There's no need to write a dissertation, but documentation should reflect the standards of the credential held by the first aid provider. For basic first aid, these elements are typically noted:

• Date and time of the client contact
• Legal name of the injured or ill person
• A description of the incident (what happened?)
• A description of the signs/ symptoms: include objective information (size, location, color, temperature, etc.) as well as comment from the client
• Description of provided first aid
• Summary of follow-up instructions given to client
• Note to whom this injury-illness event was reported
• Signature of person providing care

Coach good documentation by making a label with this information and putting it on a small notebook that is placed in each first aid kit. Another option is to purchase ready-made first aid kit notebooks from providers such as the Association of Camp Nurses (www.ACN.org).

A few final comments about first aid kit documentation: First, have someone periodically check the notebooks. Note who was cared for, by whom, and if the care process appeared appropriate to the situation. Remember to include these notebooks when gathering records at the close of a season and place them with the rest of your documents. Finally, review the situations that triggered first aid care. One often finds tips for risk reduction from these notes.

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.