|
Linda Ebner Erceg, RN, MS Health and Safety Coordinator, Concordia
Language Villages, Bemidji, MN
Executive Director, Association of Camp Nurses
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.
Summary
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.
|
