Volunteering for "First Aid Officer" @ a Camp

[ds15]

Hello - I am currently a paramedic working with a private EMS service. For the past several years I have been involved with a week-long youth summer camp program operated through the Boy Scouts. For this coming summer, I have been asked to take on the "health & safety officer" position.

This involves being available to treat any injuries and illnesses as they occur during the week, and determine whether additional care (calling for an ambulance, or driving to the hospital) is needed. As you might expect, most of the injuries and such that occur are usually minor - cuts, burns, splinters, bee stings, mild dehydration, etc.

The second component of the job involves storing any prescription medications brought by the campers. We store them in a secure, air-conditioned building, and I would be present whenever a scout arrives to take his medication. In the past, the medical staff has insisted upon keeping meds stored in this way (with exceptions made for epi pens, etc) so that the staff can ensure that each child has taken his medications on time, and so that medications will not be lost, mistakenly taken at the wrong time, etc.

I have a couple questions I'd like to try to get some advice on: first, has anyone ever volunteered in such a capacity before? Would it be a worthwhile effort to try to establish any type of medical control and operating protocols? Or just operate under the common sense rule? If anyone with professional EMS credentials has volunteered in such a capacity before, I'd appreciate hearing any general advice you may have.

Second, I'm concerned about the liability implications of storing the kid's medications like we have been doing. I'm worried that it could be construed that I would be "administering" these medications, which is obviously beyond my scope of practice. In reality, I would only be supervising the child as he takes his medication, ensuring that he takes it at the proper time. I don't know if this is "crossing the line" in terms of my scope of practice or not. I've thought about just requiring each individual camper to be responsible for his own medication, however, I believe that the advantages I discussed above outweigh this course of action.

Anyway, if anyone has any advice or comments, I'd appreciate it if you could share them with me.

[Eydawn]

Do not under any circumstances operate as an EMT (BLS level care) without a medical director in the BSA. I worked for 2 summers (paid) as an EMT for the BSA in the summer camp setting, and I can tell you that without a medical director to back you, you will be taking all of the liability yourself. The BSA will not cover your back if something goes awry- if you've spent any time working with them you know how lawsuit-shy they are. My medical director was the same med director for the local FD who did BLS transport... if there's something similar in your area, you may want to get in touch with them and see if they'll sign off on you as well. I'd also put it to your camp directors that it significantly increases legal coverage for the camp if you have a medical director for you.

As far as medications go, you are not administering them, you are storing them and monitoring their administration. As long as you are never counting out the meds and handing them to the kids from the bottles, only handing them the baggie with the bottles in it, you're fine. There's something in BSA protocol (in the millions of pages of camp paperwork that you'll read) that allows a camp to store and monitor medications. As a matter of fact, troops are not ALLOWED to keep meds per BSA national camp standard, save for rescue devices (glucagon kits, Epi pens, rescue inhalers). And if you take this position, MAKE SURE that ANYONE with a history of asthma or allergies requiring an Epi pen has them ON PERSON or goes home. You can get their doc to call in to the nearest local pharmacy if they're an out of state or long-distance troop so that the kids don't get screwed... but DO NOT allow someone to stay without their emergency meds. Good way to get in trouble and a risk that nobody needs.

There are some kids who will need help with their meds. This is where the grey zone emerges. What I used to do is have large tupperware bins with our named campsites on them and a corresponding MAR sheet for each kid in a binder. Sometimes we had a few troops in the same campsite, so every kid's meds went into a separate ziploc baggie with a label on it with the kid's full name, troop number and campsite name. At med times (which you can establish of your own accord... before/after meals and just before bed works pretty well) the kids would come in, line up, and you'd get their info, hand them the baggie, mark off on your sheets that they came in to take the meds and then take the baggie back, putting it back into the bin.

For the kids who seem to struggle with it, get their scoutmaster to help them double check that they're taking the right thing, or do it yourself... but be aware that any mistakes you make helping them could bite you if you're not careful. OR, you could go and get your state's equivalent of the medication administration provider cert that many CNA's get to be able to pass meds to folks in nursing homes, and then you'd be able to dose out the kids' meds without fear of no legal coverage. You don't have to have a CNA to get a med pass cert in the state of Colorado... not sure about where you'll be, but it might be worth looking into. It's pretty simple, to be honest, and you'd be acting separately from your EMS certification/licensure, so no fear of exceeding your legal limits there.

How long will you be out at the camp? Are you the only "medic" "health and safety" type person, or will you have assistance? If you are going to be the only one and the camp runs past 4 weeks, what provisions will be built in for you to get some time off ranch? How far out is the nearest transport agency time wise? Do you have a backboard, transport vehicle (a suburban works quite well) and supplies? Who will be buying supplies- you or the camp? Will you have an AED? Do they already have dedicated helo zones? All questions I'd be asking the people who are asking you to volunteer. Why are they not paying you? Are all the staff volunteer, or are some of the counselors paid? Where will you fall in terms of workman's comp issues- for yourself and as far as who handles the paperwork for the other staff?

PM me if you want a deeper discussion on this... Scouting medicine is where I cut my teeth and I'm very familiar with its modus operandi, lol.

Wendy

CO EMT-B

Medic 2006, 2007

Peaceful Valley Boy Scout Ranch, BSA

[Dustdevil]

I agree with everything Wendy has already said. Camp jobs are like the line in "Hotel California": This could be Heaven, or this could be Hell. I have had some truly wonderful times and experiences working camps. I've done Boy Scout camps, Girl Scout Camps, YMCA camps, and Camp Fire camps, as well as Army, Navy, Air Force, and Marine camps. It's a lot of fun, but it is not always a cushy job. And quite honestly, the average RN is MUCH better prepared for the job than the average medic. It's very rare you will ever see anything on the job that you were prepared for in medic school. It's all common illness stuff which requires medications you have no experience with, as well as minor injuries that you have no training in dealing with. Unless the big one comes along -- which again, is extremely rare -- you're going to be practising out of your element from day 1, and that can be a very uncomfortable place to be when you're used to just taking every patient to the ER for them to deal with.

There are a lot of absolute horror stories from camp nurses and medics over the years. Whether yours will be Heaven or Hell, there's not much way to tell until you get into it. Some camps give you free rein to just send every earache and tummyache to the nearest doc in town, and may in fact have a shuttle set up every day to do just that. Others will expect you to be a gatekeeper to prevent patients from going to a doctor or ER and running up their insurance costs. There have been some REALLY bad situations at camps where the camp director decided that s/he was the ultimate medical authority on the camp and prohibited you from taking or sending anyone for outside medical care without his/her prior approval, which of course puts you in all sorts of legal predicaments, HIPAA being the least of them. It's not uncommon to see camps looking for a replacement medic/nurse in the middle of a session because the original one couldn't or wouldn't put up with such nonsense, or they simply realised the risk to their licence from working so far out of their scope and left.

You have to determine very early on what the atmosphere at that camp. And it's a potentially dangerous line to walk too. If you start sending a lot of people to the doctor or ER -- or worse yet, calling EMS -- when they did not need it, you're going to cost the camp money and they are likely going to sack you. If you dick around with what you thought was a tummyache and the kid goes into shock, getting sacked will be the least of your problems. This is not an EMS job. And if you try to practise with the same philosophy that you practise with on the streets, you're going to suck.

You will absolutely want to establish a relationship with a Medical Director before camp ever begins. Sometimes the district provides one. In my experience, most of the time the camp has an established relationship with a local FP, GP, or ER group who has agreed to see your patients without hassle. That doc is usually open to providing you with very limited medical control on a verbal agreement basis. He/she will usually script you some adrenaline and possibly some Benadryl and a few other necessities you might talk them out of. That's about it though, besides OTCs.

And speaking of OTC's, that is a legal slippery slope. If you give a camper or staff an OTC med, you are practising outside of your scope. If they come in and ask for a couple aspirin, and you point them to the bottle to help themselves, that's one thing. That's cool. If they come in only saying they have a headache, and you choose a med for them, that's a no-no, unless you have a written protocol from a medical director, which you will not get.

As for storing meds, that has been the policy at every camp I have ever worked, and it is a written ACA policy that they have to adhere to. While I am certainly no medico-legal expert, and no policy is 100 percent sure to keep you out of court, I have never experienced any significant problem with the policy. What your "scope" allows will vary according to your state or county. However, in Texas at least, dispensing prescribed drugs is not considered outside the scope of a paramedic. I would expect that it is in many states, though. Take that into consideration when deciding how to handle your dispensing. There are two basic ways to run it, as Wendy alluded to. First, you can just hold them at the clinic for the kids to pick up on their schedule. Problem with this is:

• 1. Kids forget and don't come to get their medicine.

2. Kids come to get their medicine when you are out of the clinic.

• 1. It is extremely time intensive for you, interfering with other duties, including patient care.

2. It subjects patients to undue attention as you pass their meds out in public.

3. It is something you probably are not qualified to do, and greatly increases your liability on several levels.

• I will also agree with Wendy in that I hope by "volunteering" you do not mean you are doing this for free. Bad, bad idea. These camps can and will pay for medical personnel. It may not be top dollar, but most every other person at the camp is getting paid, so you should be too. If you're going to be a professional, act like one.

Best of luck, man! Some of my fondest memories come from years working youth camps. I hope it is a positive experience for you.

[firedoc5]

I also agree with Wendy. One of the best things to do is ask the BSA's top level people.

I will hit on a couple of little things. One big little thing is, do not let two scouts share their meds, even if they may be taking the same thing. I've heard at camps where one scout had a problem and another kid was trying to get the camp nurse to let him have some of his medicine.

And I would just give the scout a baggie or complete bottle of meds. They may try to take more what was due. And make sure that they have swallowed any pills correctly. You know how some kids hate to take some of their medicines, and will try to hold it under their tongue or cheek.

And document, document, document. If someone get's a headache or something, be sure it is in their record whether or not the parents have given permission to give ASA, Motrin, anything OTC, etc. in writing.

Sorry if I sound like rambling. I'm doing without a coffee pot for about another week and a half. :coffee:

How large is this camp? If it's fairly large I'm surprised they would have a nurse.

[Eydawn]

The BSA won't pay for nurses unless they're afraid something will happen and they will get sued. For example: Had a nurse my first summer on ranch because the year previous had an epidemic of norovirus (mm, 120 pukers all at once...) and they were afraid of another epidemic. So we got a really interesting nurse. Some of you know my opinions and experiences with that and I'll leave it to anyone else to PM me if you really want to know more. They couldn't find a nurse to work for the shitty pay my second summer, so we had our FD intermediate as our boss. Last summer they found a nurse and it worked well because she was married to another high level staffer, so it was easy to pull off.

You really need to go in to your local council office and ask to see the camp rules and regs and have a sit-down meeting with your DE's and so on to really hammer out details before you accept.

As far as sharing medications, that's a *duh* moment. And many parents will send OTC's or signed authorization for you to give certain OTC's at certain doses.

Wendy

CO EMT-B

[Spock]

I volunteer every summer for the Pennsylvania Special Olympics State games and have run into this problem. Athletes are required to manage their own meds (and they take a bunch) under the supervision of their parents and coaches. I wear three hats working these games: nurse anesthetist, athletic trainer and paramedic and switch between them depending upon the injury. I am also an employee of the University Ambulance Service which covers the games so I am under their EMS medical director as a paramedic. I always err on the side of caution and stick to the basics. Otherwise you have already gotten some very good information from Dust and Eyedawn. I do have to agree with dust that most of the EMT's are not familiar with the significant medical conditions these athletes have and a good nurse is more appropriate. At least with the Boy Scouts you are dealing with a healthier population.

Live long and prosper.

Spock

[Dustdevil]

At least with the Boy Scouts you are dealing with a healthier population.

Excellent point. You will be much less busy at a Boy Scout camp than you would be at a co-ed or girls camp, that is for sure. The troops tend to take care of their own. You won't see half the injuries or illnesses that occur there, because the scoutmaster or ASM will take care of it within their camp. Boys tend to not run to the nurse for every little thing like the girls do. It's a machismo thing. Plus, they don't want to miss out on any activities. If there are any females on the camp, you will get to know them very well. I've worked BSA camps with thousands of campers and staff on site at any given time, and yet my patient log would show a fifty percent patient load of females just from the half dozen on site (staff, wives, and daughters). It's amazing.

The busiest day will be the first day of camp, when you have to check in each and every camper and inspect his or her health form. Look over them closely and make sure there isn't anything on there you need to discuss with them before they disappear into the wilderness. Some will try to take their meds with them, and if you don't catch them then, you might never catch them. I had one entire troop show up once with every one of their health forms signed by a friggin' chiropractor instead of a physician. The DE ruled to allow it, but I darn sure gave those kids an extra once-over.

[Blue Goose]

I worked at a Boy Scout camp once. Applicable state laws required that all medications be locked in the medical office. Our medication policy was that nothing would be given to a minor by the medical staff. Both OTC and prescription medications were given to an adult leader from a youth's troop; the adult would then administer the medication in loco parentis. This avoided the problem of acting outside the scope of practice, as the medical staff simply provided the adult with all the prescription medications for that particular troop and/or the requested OTC medication. The dissociation between the medical staff and the medications also forced parents to communicate dosing instructions with the boy's leaders, something that needs to be done, as they are the ones responsible for the boy's well-being. While your job may not fall under the jurisdiction of the respective state's EMS legislation, if you are going to be anything more than the proverbial "Good Samaritan," you need medical direction. That is to say, if there you accept any obligation (paid or unpaid) to provide medical care at any level you must have the appropriate medical oversight. It needn't be complex, but is required by by the national standards of the Boy Scouts (M-33).

The 2008 national standards:

http://www.wrbsa.org/program/cv/2008%20Res...20Standards.pdf

See M-33 and 34 for standards about medical personnel; M-20, 21 and 22 for standards about medical procedures are record keeping. Of course, you will need to comply with any laws as well. PM me with questions.

[fiznat]

My personal feeling, and what I am taking away from those who have experience, is that you should only even remotely consider this job if it is extremely well organized and has sensible (and legal!) policies in place that will dictate your practice. That includes a medical director and a protocol that you can rely on.

If this is anything other than that, or if this camp expects you to take on a more casual role with these responsibilities, I would run far far away. Unless the pay is outrageously good. Everyone has their price haha.

[tniuqs]

Well interesting topic really:

Rule#1- In Canukistan "Girl Guide Camps" are exclusive to the female plumbing, if you are not of this flavour then one can not provide medical or any other services for that matter ... wierd eh ? A girl can be a Boy Scout due to a rights challenge in court here, but a boy can not be a " Girl Guide" nor even a REMT-P Father volunteer to assist in a camp, don't get me going.

Rule# 2- I did a paid standby for Junior XXXXX Rangers ... co-ed, 14 to 18 y/o more or less if you are doing any assesments on a female, make dang certian a female leader is present.

Rule #3 OTCs ... regs much more relaxed here, I provide only one dose ... AND assure that med is taken before my very eyes, then ALL must return for reassesment and insist that a Leader be informed to drag their asses back, sometime's kicking and screaming ... this is called the "Positive I Want To Camp Sign" ! :twisted:

RULE #4 .... Never, Never, Never turn the lights on in the Ambulance after daylight hours ... it attracts them ALL like moths to the lights ... I "think" I twisted my ankle 12 hours ago, I have a "sore" knee since I was 7 y/0 , I have a cough ... >insert phoney hack< for 3 months ? ... and the list goes on, actually quite entertaining at times

cheers and document document document !

My biggest worries are the Cooks and Camp Staff for serious medical ... can you believe a ETOH withdrawl DT's ... one did the funky chicken for > 8 minutes and "just" as I drew up the Sux (lots of versed before that) did he take a breath ... a "campie" narrowly missed chewing on plastic.