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HomeMy WebLinkAboutCamp Medical Policies & Procedures t j in Camp Casco 1A-k) w Camp Medical Policies&Procedures The Camp Medical Policy is based on guidelines from the American Camp Association's(ACA) Standards and State Department of Health regulations. It has been developed by the Camp Operator, Camp Health Supervisor, Health Care Consultant, and Medical Advisory Board for the Camp Operator and Camp Health Supervisor to carry out during the week of camp. Each full-time staff member, medical volunteer, and member of camp leadership team shall receive a copy of the policy, and shall be trained in the program's infection control procedures and implementation of the policy prior to or during volunteer orientation. Prior to admitting a child to Camp Casco, parents shall be provided a copy of the policy pertaining to the care of mildly ill campers, administration of medication, and procedures for providing emergency health care. A complete copy of the policy shall be furnished to parents upon their request. Overview: 1. Health Care Providers a. Health Supervisor b. Health Care Consultant c. Additional On-Site Medical Volunteers d. Ratios 2. Camper Eligibility &Application a. Eligibility b. Health Records c. Pre-Camp Health Screening d. Medical Approval 3. Daily Health Supervision a. The Med Shed b. Initial Health Screening c. Prevention of Sunburn and Insect-Borne Illnesses d. Allergy Awareness e. First Aid Services f. Care of Mildly III Campers g. Facilities and Sanitation 4. Management &Administration of Medication a. Requirements b. Storage c. Administration of Medication d. Administration of Epinephrine Injections e. Self-Administration of Insulin Injections f. Return 5. Infection Prevention and Control a. Hygiene b. Prevention c. Infection Control d. Disease Reporting 6. Medical Emergencies and Accidents a. Emergency Communication at Camp b. Parent/Guardian Notification c. Emergency Transportation 7. Record Keeping a. Medical Log b. Injury Reports c. Availability of Health Records and Logs 1. Health Care Providers a. Health Supervisor In accordance with 105 CMR 430.159(E),the on-site Health Supervisor shall be: i. A nurse registered to practice in the Commonwealth; ii. A physician licensed to practice in the Commonwealth; iii. A nurse practitioner or physician assistant licensed to practice in the Commonwealth; or iv. A Massachusetts-licensed practical nurse. The Health Supervisor shall be a Massachusetts-licensed physician, physician assistant, nurse practitioner, registered nurse, licensed practical nurse, or other person specially trained in first aid. First aid training shall mean at least current certification in American Red Cross Standard First Aid, or its equivalent and CPR. The Health Supervisor or his qualified designee shall at all times be available at the camp to render emergency first aid. Health Supervisor: Kellyann Schmitt, RN b. Health Care Consultant In accordance with 105 CMR 430.159(A), the Health Care Consultant will be a designated Massachusetts licensed physician, certified nurse practitioner, or physician assistant having documented pediatric training, and shall: i. Assist in the development of the camp's health care policy as described in 105 CMR 430.159(B); ii. Review and approve the policy initially and at least annually thereafter; iii. Approve any changes in the policy; iv. Review and approve the first aid training of staff; v. Be available for consultation at all times; and vi. Develop and sign written orders, including for prescription medication administration, to be followed by the on-site camp health care supervisor in the administration of his or her health related duties; and vii. Provide trainings as required by 105 CMR 430.160 to the health care supervisor(s)and other camp staff. Healthcare Consultant: Christine Duncan, MD Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215 617-632-4882 c. Additional On-Site Medical Volunteers Any additional on-site medical volunteer shall be a licensed physician, physician assistant, nurse practitioner, registered nurse, licensed practical nurse, or other person specially trained in first aid. First aid training shall mean at least current certification in American Red Cross Standard First Aid, or its equivalent and CPR. All on-site medical volunteers shall be appropriately prepared with camper medical backgrounds, and trained on Camp Casco's medical policies. They will also be provided training on the signs and symptoms of hypo- or hyperglycemia, signs of concussion, administration of epinephrine auto-injectors, and appropriate diabetic plan management. d. Ratios At a minimum, Camp Casco shall have at least one licensed medical professional for every thirty campers on-site at all times. 2. Camper Eligibility&Application a. Eligibility Children who have been diagnosed with cancer, live in New England, and will be either age 5-10 on the first day of Day Camp (for day campers), and/or age 7-17 on the first day of Overnight Camp(for overnight campers), are eligible to attend Camp Casco. Children who qualify for both camps are welcome to apply to both camps. Camp Casco is available to all eligible children on a first-come, first-served basis, without regard to gender, race, color, religion or national origin. b. Health Records Offer of camper space is contingent upon parents/guardians providing the following materials in a timely manner.All information shall be maintained in a camper's health record, which will be readily available at all times in electronic or hard copy form that is secure from unauthorized access.Authorized medication lists and copies of injury reports, if any, will also be stored in the camper's health record. i. Up-to-date Certificate of Immunization in accordance with 105 CMR 430.150-153 and the most current Department immunization schedules. 1. The following up-to-date vaccines or laboratory evidence of immunity are required to attend Camp Casco: a. MMR- 2 doses b. Polio- 3 doses c. DTaP-4 doses d. Td or Tdap- 1 dose e. Hepatitis B-3 doses f. Varicella- 1 dose 2. Exceptions a. Religious exceptions: If a camper has religious objections to physical examinations or immunizations, the parent or guardian shall submit a written &signed statement to the effect that the individual is in good health and stating the reason for such objections. b. Contraindications: Any immunization specified in 105 CMR 430.152 shall not be required if the health history required by 105 CMR 430.151 includes a certification by a physician that he or she has examined the individual and that in the physician's opinion the physical condition of the individual is such that his or her health would be endangered by such immunization. c. Exclusion: In situations when one or more cases of a vaccine-preventable or any other communicable disease are present in a camp, all susceptible children, including those with medical or religious exemptions, are subject to exclusion as described in 105 CMR 300.000: Reportable Diseases and isolation and Quarantine Requirements. 3. Missing or Lapsed Vaccinations Applicants whose vaccinations are missing or have lapsed, and do not qualify for the exceptions listed above, will be asked to meet the above specifications for up-to-date vaccines prior to arriving to camp. Any associated costs will not be paid or reimbursed by Camp Casco. ii. Relevant general and health information in accordance with 105 CMR 430.150-151. 1. General background and emergency contact information, including camper name, home address, parent name(s), parent contact information, and a list of individuals to whom the camper may be released in case of an emergency. 2. A written authorization for emergency medical care signed by a parent or guardian 3. A current health history a. Health history should list allergies, required medications, and any health conditions or impairments which may affect the individual's activities while attending the camp. b. Health history should be prepared and signed by a licensed health care provider, stating that he or she feels confident that the child may attend a week-long camp safely. 4. Report of physical examination conducted during the preceding 18 months. 5. Name and contact information of the camper's health care provider. iii. Up-to-date health insurance policy information Health insurance policy, if applicable, should be scanned or written and submitted with all other supplementary application materials. c. Pre-Camp Health Screening Before arriving to camp, each child's parent or guardian will provide the information above, which shall be reviewed by our Camp Health Supervisor or his/her qualified designee to ensure a child is of adequate health to attend Camp Casco safely. Additionally, camp acceptance packets will be distributed to the parents and guardians of all accepted campers shortly before camp begins. Packets will include general information about attending camp, induding, but not limited to, the following: i. Camp contact information 1. Camp Casco contacts 2. Campsite contacts 3. Directions to campsite 4. Bus site information ii. Camp policies 1. Care of mildly ill campers 2. Administration of medication 3. Procedures for providing emergency health care iii. Information regarding meningococcal disease and immunization 1. Information regarding meningococcal disease and immunization shall be provided annually to the parent or legal guardian of each camper in accordance with M.G.L. c. 111, § 219. iv. Medication form 1. A final medication list should be submitted prior to arriving at camp. During camper check-in at either the bus site or the campsite, volunteers will review the full medication list with the parent or guardian, confirm receipt of the appropriate medications, and timing/dosage. 2. In the case of discrepancies or new medication changes that were not reported on the final medication list, changes will be added manually and initialed by the parent/guardian. 3. Every medication list will be signed by both the parent/guardian and camp Health Supervisor or qualified designee(s)to confirm the camper's final medication schedule for the week. 4. Any changes to medication must be reviewed and approved by the Health Care Consultant and Camp Health Supervisor v. Change of health status form In the event of a significant change in health status since initial application or supplementary materials, including, but not limited to, removal of catheter, new allergy, significant injury, change in child's ability to safely participate in any camp activity, or change in cancer therapy or disease course, a form will be provided for the family to complete and return before camp. Failure to provide all above information in a timely manner may disqualify the child from attending Camp Casco. All camper medical information will be reviewed by Camp Casco's Health Supervisor and/or the Health Supervisor's qualified designee(s). Any offer of a camper space is contingent upon Camp Casco's Health Supervisor's final approval. Any child whose health is deemed to be at risk by attending Camp Casco, or who may jeopardize others' health by attending, will not be permitted to attend Camp Casco. This includes, but is not limited to, any child who displays evidence of symptoms of tuberculosis in a communicable form, or having evidence of symptoms thereof, as well as any child who does not meet the vaccination requirements outlined in 105 CMR 430.152 and does not meet the exceptions listed in 105 CMR 430.153. d. Medical Approval Any offer of a camper space is contingent upon the Camp Health Supervisor's final approval. Any child whose health is deemed to be at risk by attending Camp Casco, or who may jeopardize others' health by attending, will not be permitted to attend Camp Casco. In addition, Camp Casco's medical team does not administer intravenous medication, access ports, or perform blood draws, so children who require these types of care should plan their visit to camp accordingly. 3. Daily Health Supervision a. The Med Shed The Med Shed is a designated area of camp that serves as Camp Casco's infirmary. At Day Camp, the Med Shed is located in a private luxury RV parked at the campsite. At Overnight Camp, the Med Shed is the designated infirmary of Camp Wingate*Kirkland. In the Med Shed, a licensed medical volunteer is easily accessible at all hours, including throughout the night at Overnight Camp. All camper prescription and over-the-counter medications are stored in the Med Shed, and extra beds are available for any child who would like to take a nap or rest during the day. At Overnight Camp, the Med Shed remains lit throughout the evening. Campers who require medical assistance during the night are just a minute or two away from medical care, and need only wake a counselor in their cabin to be escorted to the Med Shed. b. Initial Health Screening Within 1 hour of being driven to camp or prior to boarding a bus to camp, a healthy baseline for each child will be established. During this initial visit, volunteers will ask how the child is feeling, how tired he is, and ask about any symptoms that may signal early signs of illness(cough, fever, sneezing, etc.)This initial screening shall provide insights into any preexisting health concerns before the camp activities begin, including asking about exposure to communicable disease and screening for lice. It is expected that campers, volunteers, visitors and staff arrive for their camp experience in good health. The camp reserves the right not to admit any ill person. c. Prevention of Sunburn and Insect-Borne Illnesses Campers will be regularly encouraged to reduce exposure to ultraviolet exposure from the sun. Such measures shall include encouraging the use of wide brim hats, long sleeve shirts, long pants, screens with a solar protection factor of 25 or greater and lip balm. Sunscreen will be made available for all campers and volunteers to use in both the Med Shed and in cabin backpacks at all times. Use of sunscreen shall be encouraged regularly throughout the day, and especially before and during outdoor activities. Bug spray shall be available for all campers and volunteers to use in both the Med Shed and in cabin backpacks at all times. Use of insect repellant shall be encouraged regularly throughout the day, and especially prior to evening activities. Tick spray is also available and shall be encouraged regularly throughout the day. Campers will be instructed on how to check themselves for ticks by their counselors, and will be reminded to do so multiple times per day. d. Allergy Awareness The camp operator will collect as much information as possible on each child's allergies prior to the child arriving to camp. All medical volunteers and members of the leadership team are trained on camper allergies prior to camper arrival. Counselors of campers with allergies are notified in advance to be aware of any potential exposure to allergens. The campsite will be notified ahead of time of any food allergies to ensure that all meals and meal preparation are safe from potential allergy risks. e. First Aid Services First aid supplies shall be readily available to the staff in the Med Shed, during any transportation to or from camp, and wherever the Health Care Consultant deems necessary. First aid kits shall meet American National Standards Institute Z308.1-2015 requirements including, at a minimum, one Class B Kit and one or more Class A Kits, as necessary. f. Care of Mildly Ill Campers Camp counselors are trained to keep a close eye on all campers throughout the week, and to take notice of early signs of illness, dehydration, or exhaustion. A camper who is found to be suffering from any type of illness shall be immediately directed to the Med Shed for evaluation. In the case of a mild illness (sniffles, headache, stomach discomfort, sore throat, etc.), the camper will be instructed to rest in the Med Shed and rehydrate.A medical professional may recommend and administer an over-the-counter medication if appropriate. If the mild illness persists,the child's parents will be notified by the health supervisor or camp operator. Next steps will be decided through a discussion between the health supervisor and the child's parents, based on the child's current cancer status, the symptoms of concern, and the duration of mild illness. If a child on active treatment for cancer is found to have a fever, regardless of any other symptoms, the child's parents will be contacted immediately by the health supervisor or camp operator, and the child will be transported to the nearest emergency facility for immediate attention. g. Facilities and Sanitation Any medical waste, as defined in 105 CMR 480.000: Minimum Requirements for the Management of Medical or Biological Waste (State Sanitary Code. Chapter VIII), shall be maintained and disposed of in accordance with 105 CMR 480.000. Camp Casco logs disposal of medical waste following each camp session. 4. Management&Administration of Medication a. Requirements All prescription medications must be kept in original containers bearing the original pharmacy label, showing the date of filing, the pharmacy name and address, the filling pharmacist's initials, the serial number of the prescription, the name of the patient, the name of the prescribing practitioner, the name of the prescribed medication, directions for use and cautionary statements, if any, contained in such prescription or required by law. In addition, if the medication is in tablets or capsules, the number in the container should also be listed. All over-the-counter medications for campers shall be kept in the original containers containing the original label, which shall include the directions for use. b. Storage All medication prescribed for campers shall be kept in a secure manner(e.g., locked storage or in the controlled possession of the individual responsible for administering them, according to American Camp Association Standard HW 19). Medications requiring refrigeration shall be stored at temperatures of 36°to 46°F. c. Administration of Medication Medication schedules are submitted by families prior to camp, and camp representatives confirm all medication schedules with parents upon camper arrival. The camp health supervisor shall be responsible for ensuring that every medication is administered in a timely manner. Medication shall only be administered by the health supervisor or by a licensed health care professional authorized to administer prescription medications(e.g. nurse, physician, or physician assistant). The health care consultant shall acknowledge in writing a list of all medications administered at the camp. Medication prescribed for campers brought from home shall only be administered if it is from the original container, and there is written permission from the parent/guardian. d. Administration of Epinephrine Injections A camper prescribed an epinephrine auto-injector for a known allergy or pre-existing medical condition may receive an epinephrine auto-injection only by the health care consultant or a licensed health care provider(e.g. health care supervisor or other licensed medical volunteer). The camper may self-administer and carry an epinephrine auto-injector with him or her at all times for the purposes of self-administration if: i. the camper is capable of self-administration; and ii. the health care consultant and camper's parent/guardian have given written approval e. Self-Administration of Insulin Injections If a diabetic child requires his or her blood sugar be monitored, or requires insulin injections, and the parent or guardian and the camp health care consultant give written approval, the camper, who is capable, may be allowed to self-monitor and/or self-inject himself or herself. Blood monitoring activities such as insulin pump calibration, etc. and self-injection must take place in the presence of the properly trained health care supervisor who may support the child's process of self-administration. f. Return When no longer needed, medications shall be returned to the child's parent or guardian whenever possible. If the medication cannot be returned, it shall be destroyed as follows: i. Destruction of prescription medication shall be accomplished by the health care consultant, witnessed by a second person and recorded in a log maintained by the camp for this purpose. Said log shall include the name of the camper, the name of the medication, the quantity of the medication destroyed, and the date and method of destruction. Both the health care consultant and witness shall sign each entry in the medication destruction log. ii. The medication destruction log shall be maintained by the camp operator for at least three years following the date of the last entry. 5. Infection Prevention &Control a. Hygiene Good hygiene is very important while at Camp Casco. Regular hand washing throughout the day is required for all campers, and antibacterial soap is available at all hand-washing stations. At Overnight Camp,tooth brushing twice per day and bathing once per day are required, and hand sanitizer is available throughout the cabin and in the Med Shed. The campsite shall provide adequate facilities and time for the campers and staff to carry out good personal hygiene practices. Laundry facilities are available and will be utilized to ensure each child has clean clothing, bedding, and linens available to use at all times. b. Prevention Prior to arriving to camp, vaccination status of all campers is screened in accordance with 105 CMR 430.150-153. Within 1 hour of being driven to camp or prior to boarding a bus to camp, a healthy baseline for each child will be established. During this initial visit, volunteers will ask how the child is feeling, how tired he is, and ask about any symptoms that may signal early signs of illness (cough, fever, sneezing, etc.) This initial screening shall provide insights into any preexisting health concerns before the camp activities begin, including asking about exposure to communicable disease and screening for lice. It is expected that campers and staff arrive for their camp experience in good health. The camp reserves the right not to admit an ill person. c. Infection Control The parent or guardian of any child suspected of being ill with a communicable disease, or diagnosed as such, shall be contacted immediately by the health supervisor or camp operator to make arrangements for the camper to receive necessary medical attention. The child will either be brought to the hospital for immediate attention, or discharged from camp to a parent/guardian, or the parent/guardian's approved designee, depending on the nature and severity of the illness. Space shall be designated for isolation of a child ill with a communicable disease or suspected of such illness or otherwise in need of quiet and rest while the health supervisor, camp operator, and parent/guardian make the necessary arrangements for appropriate medical care. This space shall be separate from regular living and sleeping quarters so as to ensure both quiet to the child and and safety to others. The space shall be suitably equipped and not utilized for any other purpose. An isolated child shall be provided with adequate adult supervision and all basic necessities, in accordance with the procedures for isolation and quarantine outlined in 105 CMR 300.210. Parents or guardians shall be notified as soon as possible if their child is isolated. A child will only be kept in isolation if medically necessary and only until the necessary arrangements for appropriate medical care can be made. d. Disease Reporting Any suspected case of food poisoning or any unusual prevalence of any illness in which fever, rash, diarrhea, sore throat, vomiting, or jaundice is a prominent symptom shall be immediately reported to the local board of health and to the Massachusetts Department of Public Health by the camp operator. The camp operator shall immediately report each case of communicable disease listed as reportable under 105 CMR 300.000: Reportable Diseases and Isolation and Quarantine Requirements occurring in a camp to the Board of Health and the Department. Such report shall include the name and home address of any individual in the camp known to have or suspected of having such disease. Until action on such case has been taken by the camp health care consultant, strict isolation of affected individuals shall be maintained. 6. Medical Emergencies and Accidents a. Emergency Communication at Camp Every cabin group is equipped with a 2-way communication device (ie: walkie-talkie)throughout the week. In the case of medical emergency or accident at camp, a cabin counselor will use the walkie-talkie to immediately page the Med Shed for assistance. The child, in an expeditious manner, be brought to the Med Shed for care if appropriate; if the child cannot be safely moved to the Med Shed, a medical volunteer shall immediately report to the child. A medical emergency or accident shall be declared by the health supervisor or camp operator. b. Parent/Guardian Notification The health supervisor and camp operator shall immediately establish phone contact with parents/guardians in such an emergency. Each camper's health form contains contact information, including travel information for parents or guardians who may be travelling during the camp session. All health forms also designate alternate contacts if the parents/guardians cannot be reached. This process is initiated by the camp operator or health supervisor, but can be delegated to another team member if necessary. Since the program has no way of determining what each person considers an emergency, the general camp practice is to contact parents when there is concern about a child's health and/or when a situation is not progressing as expected. Because many people remotely access their voicemail, it is expected that camp personnel leave voice messages on answering machines that appropriately communicate the need for a given parent to call the camp. If the parent/guardian cannot be reached, alternate contacts will be contacted. All attempts at contact, successful and unsuccessful, is documented in the child's health records. c. Emergency Transportation Emergency transportation to the nearest hospital is provided by the camp operator's vehicle, the camp rental car, or the area's ambulance services. The health supervisor and camp operator cooperatively decide which mode of travel will be used. In general, the ambulance service is used when the victim is not stable and/or has need for special equipment(e.g., life support systems) and/or requires immediate care. If a child requires emergency transportation, he or she will be accompanied at all times by at least one medical volunteer, camp operator, camp director, or other camp leadership as appropriate. The child shall continue to be accompanied by a camp representative until released to a parent, guardian, or alternate contact as explicitly listed by a parent or guardian. 7. Record Keeping a. Medical Log A medical log shall be maintained that contains a record of all camper health complaints and treatment. The medical log shall list the date and time, name of patient, complaint, and treatment for each incident. The medical log shall be maintained in a readily available format and shall be signed by a volunteer medical professional. b. Injury Reports In the case of any fatality or serious injury as a result of which a camper is sent home or brought to the hospital or physician's office, and where a positive diagnosis is made, a report shall be completed on a form available from the Department. Such injuries shall include, but shall not necessarily be limited to, those for which suturing or resuscitation is required, bones are broken, or the camper is admitted to the hospital.A copy of each injury report shall be sent to the Department, as well as the Board of Health, as soon as possible but no later than seven calendar days after the occurrence of the injury. c. Availability of Health Records and Logs All medical records and logs shall be readily available to the health care supervisor, camp nurse or camp doctor or other health personnel.All medical records and logs shall be made available upon request to authorized representatives of the Department and of the Board of Health which licenses the camp. The Department and the Board of Health shall maintain the confidentiality of information relating to individual campers and staff. In accordance with 105 CMR 430.145, Camp Casco shall maintain all records relating to campers for a minimum of three years. This policy has been reviewed and approved by: Christine Duncan, MD w\�\ eai \ a crgvied 2018 Healthcare Consultant rf �' Dana-Farber Cancer Institute W� \V\� Y CV ea I 450 Brookline Ave. J Boston, MA 02215 617-632-4882