Camp Nursing and Occupational Health

Many new camp nurses are just trying to get their heads around caring for all their campers. When the issue of staff health comes up for the first time they are often completely stumped at how to handle both the routine and the odd situations that our staffers find themselves in. 

Many camps take the approach that their staffers are adults and so will need no assistance from the camp health department. In fact, some camps forbid nurses from assessing, treating, or advising staffers in any way. However, most camps have no real policy at all, choosing to rely on the nurse's judgment in coordination with the director's experience to navigate issues as they come up. 

Personally, I was a very responsible and independent young adult. When I first started as a camp nurse I was very much of the opinion that the staff should take care of their own needs. I was happy to provide them with any OTC medication that they requested and a phone line if they needed. I thought that was all a 20-year-old would need to handle most any health issue. That was absolutely true for me at twenty, but as I came to realize my logic was flawed, and my position was ill informed.

What I didn't appreciate is that not everyone had the same upbringing that encouraged independence as I did. To a large degree, the 18-25-year-old age group are still quite dependent on their parents and have little to no idea how to navigate the issues surrounding their own health. I also realized that these big kids were far from home, many even in a strange country. They were at a severe disadvantage, even if they were able to handle their own health concerns normally, as camp was a complete shakeup of their world.  We really do, in my opinion, and experience, need to provide services, and guidance to these young adults who often have more action than sense, in a location where they may be far removed from social supports that they are used to depending on. 

There are a few things that nurses have to remember when dealing with staff. Realize that staff may need to be seen and cared for at odd hours. Many staff on camp really don't get any assigned time off. Yes, it's very inconvenient to see an adult staffer at an odd or late hour, but that staffer may have had to make a lot of adjustments, and accommodations to even get to see you at all. You may find yourself doing more leg work for simple things like prescription refills and scheduling outside appointments because you are available and able to do the job during business hours when the staffer is tied up. Remember that your job as the nurse is to keep the staffer on the job as much as possible, while simultaneously addressing their health needs. 

Another issue that camp nurses must be careful around is the confidentiality and HIPPA rights of the staffer. You will find yourself being asked potentially sensitive information from many sources. The camp director will what to know why the employee is not able to work, and when they are expected to return. Drivers will want to know why a person is going to a particular doctor's office. Campers and coworkers will be concerned about the sick staffer. The staffer's parents may call concerned about their adult child. It is important to remember in these situations that you are required to respect the privacy and autonomy of the staffer who is under your care. 

Finally, it is my belief that camp health services should be able to provide health items, that may be urgently needed, but not easily obtained by staffers. At most camps I have worked at there are only trips to the store once or twice a week for staff, and sometimes no runs for weeks at a time. This makes losing a toothbrush, or suddenly finding you need your Zyrtec every day, a real problem. These folks can't just stop into the store on their way home. The health service should be able and willing to supply OTC drugs, and incidental items for a brief time until the staff can reach the store. 

One of the more controversial issues that I have had to address as a camp nurse is the staffer who is concerned about an unplanned pregnancy. It is an excellent idea to stock a pregnancy test in the health center, they sell them at the dollar store.  I also recommend that some form of emergency contraception is made available if it is an over the counter item in your state. Time is a factor with these drugs, so having them on hand is important to a good outcome. 

Nurses who will be in a charge or management capacity should also be familiar with the camps policy around workman compensation claims. Generally this is as simple as filling out an incident report for any serious injury, however, it can be more involved depending your camps insurance provider and policy. 

Most new and experienced camp nurses are often caught off guard by the occupational health duties of the job. I know this inst a comprehensive guide, I simply want to inspire thought in the direction of employee health. Care and management of employee illness and injury is a small, but important part of the camp nurses job. 

All opinions expressed are my own and to not represent those of my employer. 
Remember, anyone can pretend to be anyone on the internet, so please verify all information presented. NEVER take advice from strangers on the internet

I'm back.. but not better than ever

I'm happy to say that I have completed my sixth contract with Indian Head Camp. I would be lying if I said that it was a great time, or that I really enjoyed it. I had hands down the toughest year of my camp career. I knew being a single parent on camp would be a challenge, but personally, it was a grueling haul.

My son is amazing, easy going and well behaved. The camp hired a very intelligent and savvy nanny who I trusted completely. I am however at heart an introvert and a reluctant parent. So having to haul so much water as far as child care was exhausting emotionally and physically. I'm used to spending lots of time with my son, I watch him while my wife is at work during the day, every day. I think that being on camp was where a lot of the stress comes from. As an active 18-month-old, he spent the vast majority of time out and about. 18-month-olds, by the way, are the camp equivalent of movie stars. He was so popular that we had constant and amazing interactions with so many campers and staff. The parent in my loved it, the introvert in me was exhausted.

My son flourished and grew at camp, but I felt constantly stressed. As camp went on it got better, I learned that I had to frequently call home, and take every opportunity to get off camp, and change the scenery. The introvert in me needed lots of self-care, the workaholic in me hated that. I had to spend so much time away from the job, where there is always so much to do. I felt like I was constantly dropping the ball around work. Not just because I couldn't be there physically, but because my brain was in two places. I was not fully present at work because a part of my brain was always with Willaim and at home. When we were pregnant I used to hate all the cliche things that people would say, but now I see that they were all true. My world has changed. I am a different person. A part of my brain always is on my kid. I never noticed when I was at home because my day job is not mentally taxing. At camp, I needed every part of my person and brain and found them not fully there. That was a scary feeling for me. Camp has always taught me about myself and made me grow as a person. This year I was shocked to learn that I changed, way more than camp did. I had to grow as a parent, and as a person to try and make ends meet mentally.

I however, can't shake the feeling of personal failure. The thing that makes me a good nurse is also my biggest weakness, I take things very personally. I took every little screw-up, every missed thing, and every mistake on my part VERY hard. I do this every year, but this year it just felt like a lot. I think it all really tracks back to that feeling that I was not 100% mentally there.

I feel like the chaos of the job beat me, I just gave up the last few days. I wasn't able to stand up and fight anymore. My boss, the doctor, and my coworkers really tried to be encouraging, but I really did feel that way...beat up, and sore. I have never had that feeling in my professional life before, I really hit bottom in a way that was new to me this summer.

Time heals all wounds, and I know that as I start to assume the responsibilities of my regular life, that stress will edge out some of these feelings. It feels good to get this all out in writing. I also hope to find some more topics to write about as the winter progresses, and I hope to take some continuing education that will benefit my camp career and this blog.

If you're out there...thanks for listening, friend. I needed to get this out. If you were there this summer thank you for your support, I really do appreciate it.

It has been a few weeks since I originally wrote the above. As expected I have gained a bit of perspective. I found a wonderful quote "Anything worth doing is worth doing badly" G. K. Chesterton, a Christian philosopher who argued that most of what must be done to make the world go 'round is done by the average Joe who does not do it perfectly--or sometimes even well. Most of us live with the paradox of working toward “excellence” while making do with "good enough." Perfectionism is a heavy burden. I forgive others so easily, but myself not at all. I expect 101% from myself, and I have to work on enjoying being less than perfect in my professional life, or at least not emotionally abusing myself for failing. 

S'mores and Sanitizer-Groovy curtains, careless chipmunks

S'mores and Sanitizer is a blog run by contributor Susan Sultzman. It can be found here This content was created on 6/24/14

It’s 6:30am but I’ve been up for an hour already. The three beautiful windows in my small room in the back corner of the Health Center lets in the early summer light and wakes me up early. The curtains, which clearly date back to the 70’s, are not much help in blocking the light, but they sure make my room look groovy. After three days of greeting the dawn personally, I add “sleep mask” to my list of things to buy when I make my way into town.

I love a short commute to work, so this year I’ve hit the jackpot. Instead of a room at the lodge, I am living in the Health Center due to a change in my job description. I’m now the night nurse 6 nights a week, so it makes no sense to have a room in the Lodge that I will never sleep in. I’m perfectly okay w this; I’m a night owl anyway and the other two nurses are not. I’m on duty 8p-8a and I do get to sleep (albeit lightly) if there are no pressing concerns. Last year I had only one sleepless night with a sick kid in five weeks.

So after all the meds are distributed, boo boos cared for, floors swept, trash put out, the day’s visits entered into the computer, and tomorrow’s meds pulled, I close the HC doors, leave the porch light on, and retire at about midnight.

The memory of my 6-night a week third shift schedule that I worked during the long, cold, extremely snowy winter is effortlessly blocked out from my memory and I sit alone now at the cold fire circle listening to the birds and watching the chipmunks scurry about. Two chipmunks were just dashing around the fire circle, oblivious to my presence, until they both just crashed into my hot pink Croc.

This is day 2 with the campers. My role with the camp is still evolving; during the day I’m doing all sorts of things. Yesterday I did some office work and made some calls to parents who have not yet sent in paperwork. This year I can expect to do a bit of everything, as I’m slated to be a jack-of-all-trades during the day. The first camp bell just rang, almost time for breakfast. I have no idea what today will bring!

S'mores and Sanitizer-Wearing many hats/sombreros

S'mores and Sanitizer is a blog run by contributor Susan Sultzman. It can be found here This content was created on 6/4/14

I’m home today.  I get a day off once a week.  Because I’m the night nurse my day off starts at 8am when I’m off duty, and ends at 8pm the following day. Coming home and briefly going back to my “real” life helps me put things in perspective, and helps me reflect about my week.  My hubby and I work it out so we both are home at the same time (he is on the road all week in the summer.) So we end up chatting about everything about our week, go out to lunch, do shopping/errands, and then hang out in the evening on the deck or if it’s raining (like last night) we catch some Netflix shows together. Last night there was a break in the rain and we walked down the street to the local bar, which was having an outdoor party with fireworks.   It feels exactly like life was before the kids, since they stay up at camp. My day at home is a nice little shot in the arm to energize me and make me feel good about returning for another week of camp.

So the 8p-8a night nurse gig is working out so far for everyone.  I love my room in the Health Center and it’s turned out to be quieter than I thought during the day. (Only once was I up late – 2am – with a camper, and although I could have slept in, I just settled for a quick afternoon nap.)  When the morning nurse(s) arrive, I grab a quick breakfast, shower, and take some personal time before 10am when I grab a clipboard at the office and do camp and cabin inspections. First, I go to all the camp areas- the shower houses, gathering areas, arts buildings, etc. and determine if the cabin assigned to that area had done a decent job of cleanup.  Then I go back up to the cabins and inspect those. Most cabins are extremely competitive and strive to get 10’s. They lose half points if certain things are not done, like if their assigned camp area not adequate, beds not made, trash or clothes on floor, trash not emptied, etc.  So that takes me about an hour. I want to get my routine down and cut my time, but so far so good.

After that, my day is potpourri.  If you scroll further and read my blog from last year, you’ll see that I had lamented about feeling like a fly on the wall, always on the outside looking in to all the fun and activities from the Health Center porch.  My new work schedule this year has granted me my wish while allowing me to still practice nursing.  I do a bit of everything, and I never know what they’ll have me do next.  Often I drive people into town to the doctor or to pick up stuff at Walmart for various departments.  I help out in the office making phone calls, sorting mail, various clerical duties, work the camp store when it’s open, etc. I pitch in down at Arts and Crafts, cover at the Health Center for others’ days off, and pretty much anything that comes up.  I usually have down time from 5-8pm,. At 8p I go back to the HC and the rest of the nurses retire.  Then, I see and treat a parade of boo-boos, turned ankles, sour tummies, headaches, etc. until 9-9:30 when things finally settle down. Also kids w evening meds come in.  There’s usually one or two that forget to come by (ahem… Claudia)… so I call the Rover on duty to retrieve the girl to escort her down. Often a camper who’s feeling poorly will come down with her counselor some time between lights out and midnight.  But mostly, after 10pm I pour the next day’s meds, tidy up, sweep, take out trash, enter all visits into the computer, do my own laundry, and I’m in bed (hopefully) around midnight.  If a group comes back in late, I need to do lice checks on them.

Sometimes a counselor with the night off will come by for a medical reason and then stay and chat for a while.  Or I’ll drive them into town for a doctor visit and engage in some quality talk time on the way.  This is one of my favorite things about camp, getting to know these great people.  Most of our counselors are from the UK, another European country, Latin America and Australia.  (We have some Americans too, they’re just as great!)  They are all intelligent, thoughtful, open-minded, and adventurous.  Our director really has a knack for choosing quality individuals to work at camp. I really admire anyone who can take such a leap of faith to leave their families and life as they know it to fly far away to to live and work in a foreign country for nearly three months.  I love to pick their brains, ask them questions about everything- school systems, uni (college), their healthcare system, tax system, their politics, the EU and their place in it, food, language/accents, culture, current trends, social problems, other countries they’ve visited, families, etc.  The way I see it, if I cannot go travelling myself, I can still experience the world through what they tell me.  I’ve met several amazing, articulate, interesting ladies so far and look forward to getting to know more of them. I also enjoy fielding questions about America if they ask. When I take people to the doctor, they learn a bit about our healthcare system whether they like it or not. Sometimes they comment on the ubiquitous American flags displayed in public and we talk about the culture of our patriotism.  I’ve also described the day of September 11 and how it felt to live in the moment of it, not knowing at the time how the day would play out, the fear we had not knowing what was going on and life in the weeks that followed.

Also, I’ve been able to practice my Spanish with several of the ladies.  I’ve been brushing up on my skills for my New Year’s resolution (I quit Candy Crush and replaced that wasted time with . I think the thing that’s hampering me the most is my reluctance to sound less than perfect when I speak. I don’t mind having an accent but I’m a Grammar Nazi at heart and I know I’m butchering Spanish when I speak it. (I call it my Tarzan Spanish.)  I try to remind myself that as long as I get the point across it’s all good, and they probably welcome a break from the onslaught of English in their ears all day. These ladies earn special admiration from me- they take their rudimentary high school English knowledge, immerse themselves in a foreign land, and muddle their way to fluency over the summer, smiling through it all as they go!

So that’s my camp experience so far.  I’ve committed to an extra week now, since they lost a nurse before camp began and they need someone. There’s two more weeks that I’m contemplating, but at this point, Steve and I aren’t sure it’s feasible. I know Natasha and Claudia would love to stay the whole time!  More on my girls later!

S'mores and Sanitizer-The silence is over

S'mores and Sanitizer is a blog run by contributor Susan Sultzman. It can be found here This content was created on 6/13/14

Several weeks before I came to camp, I was here for staff orientation. We had a meeting where the nurses read down a whole list of special needs campers. This was a special opportunity for me to be able to explain to everybody firsthand about selective mutism, what it is, and how it affects my daughter Claudia. I also was able to make suggestions on how to interact with her best. For example: don’t push for answers if she does not respond. Ask yes or no questions when possible. Don’t be too friendly, or make a fuss over her, don’t ask for high-fives or hugs, and if she doesn’t respond verbally, act like you really didn’t notice she was mute.

The positive reaction from the counselors was astounding. Several came up to me throughout the day and told me how excited they were to work with Claudia. They found SM fascinating and saw it as a challenge to be the one to bring her around. (Of course in my mind I was thinking “Oh good luck with that one, get in line!”) Most of the counselors were from other countries, and one girl from England said that she had worked with a little boy with selective mutism. She was very excited to tell me all the techniques she used to bring this little boy out of the shell. I was very encouraged to know that Claudia would be surrounded by caretakers all committed to try their best to make her comfortable. But deep down I felt that it was impractical to get my hopes up too much.

So Camp Day finally arrived. I helped them unpack and settle in, bid them farewell, and then moved my own things into the Lodge. The first day or two, I was getting reports from Claudia’s counselors that she was doing well, but being very, very shy. No surprise there. They told me that they were just ignoring the fact that she wasn’t talking too much, and just asking her basic yes or no questions that she could respond to easily without words. By the second day one of the counselors was saying that she muttered some words very quietly only when it was absolutely necessary. However she was talking just fine with some of the girls and did not seem to mind that she was speaking in front of adults in a normal voice. She did not introduce introduce herself at the campfire, but the counselor did it for her. When I saw a Claudia around camp, she seemed happy and calm. She was really enjoying herself and I was content with that. Several counselors came up to me to tell me that they had introduced themselves to Claudia, And described their exchange using the techniques I had suggested. I was so impressed with their kindness and their consideration.

At about the third day, a counselor from the waterfront told me that Claudia had spoken quietly to her. “I don’t have a swimming buddy.” A whole sentence. To an adult. And to my surprise, I started to cry. In the next day or so, more reports of Claudia speaking started to trickle in. A few days after that, the reports started to pour in! Finally one cabin counselor came to me and said “does this girl have an ‘off’ switch?”

At Camp Netimus, my daughter Claudia does not have selective mutism. Last night at the campfire with the new girls that arrived earlier that day, Claudia introduced herself when it was her turn. There were about 175 people in attendance. And it’s all because the tailored attention and genuine caring that the these lovely mature young women have shown my daughter. People who did not even know us a month ago have been just as excited about Claudia’s emergence from her silence as my family, friends and I have been. I am overwhelmed by the magic that the staff here has created.

S'mores and Sanitizer-Doing more with less

S'mores and Sanitizer is a blog run by contributor Susan Sultzman. It can be found here This content was created on 6/13/14

Cloudy Sue.jpg

Although I thoroughly enjoy working as a camp nurse, it’s probably not something I would choose to do on my own.  At the very heart of the matter, it’s all for my daughters, Natasha and Claudia, so I can give them an amazing experience for which I could otherwise never manage to pay rack price.  For those nurses whose economic situations can endure it (and relationships that can withstand it), working at a summer camp is a unique way to offer their children the experience of a lifetime.  According to the American Camping Association’s website, there are approximately 9,500 summer camps of all types in this country, and every one of them needs a handful of medical professionals to staff their health centers.  These camps cannot possibly pay the doctors and nurses the same salaries they receive at home, so it’s a common industry standard to reduce or even waive the camp tuition for their children in exchange for professional services provided.  It’s a win-win situation.

When I was “shopping” for the perfect camp (both times), all I had to do was surf the web, find the human resources contacts, shoot emails, and watch the offers come in.  It was mind-boggling. Last year I searched in late May and thought there would be no jobs left, and I was so wrong! I sent out at least a dozen inquiries the first morning and 8 hours later I had about 5 opportunities to choose from.  Most camps emailed, but the director of my camp got back to me via phone.  I still remember when I saw her number buzzing my cell phone, and getting this strange feeling that I should pick that up, not let it go to voice mail.  Hours earlier, I had already given a “yes” to a fine arts camp and was busy with my “no thank you’s” to the other camps, but I picked that call up anyway. And it’s a good thing I did, because she sold her camp to me just with the enthusiastic love in her voice as she described it.  (I shudder to think what my girls and I would have missed out on if I hadn’t taken that call.)   I often wonder how many hundreds of camp nursing jobs remain unfilled out there each summer.

So, back to my original point… although we’re not wealthy, Steve and I do okay, but only because we’ve been creative with our finances from the start.  We purchased a small townhouse in 1997 with a price tag way below what the bank told us we could borrow. Our mortgage is under $1000 including taxes.  Because of this we are not a slave to our finances and largely avoided the woes others have faced in the Great Recession. We endured when I quit teaching and went to nursing school.  We endure in the winters when Steve gets laid off. 

We have always been able to get by with one of us being a stay-at-home parent for our children (except during times when our schedules overlapped, and we resorted to professional child care only a few months at a time).   This is a lifestyle that we chose so one of us would always be with the girls, so we could raise them ourselves and be actively involved in their lives.  We don’t give our kids lots of Things. We give our kids a lot of Time.  This costs our household a lot of potential income, but it’s worth every penny we never see.  And because we live below our means, Steve and I are in the unique position to be able to provide our kids with summer camp.  I find it deliciously serendipitous that because we live frugally, it’s something we can afford to do.

S'mores and Sanitizer-How did I get here?

S'mores and Sanitizer is a blog run by contributor Susan Sultzman. It can be found here This content was created on 6/19/13

From December until May I had a contract with a different camp. It was signed sealed and delivered. Unfortunately, for some reason I did not understand the fine print, but there was a problem w a major detail in the contract that I did not discover until May. It was slipped in so quietly, and not what we had discussed at all. I had to quickly disengage myself from the agreement to work for them. I felt terrible about it and didn’t want to leave them high and dry so close to the season but I truly had no choice.

Desperately, I started googling different camps. I sent in inquiries by email or phone to perhaps close to two dozen camps. I promised kids camp. I wanted to deliver that promise. Within two hours of my initial search I had landed a verbal agreement with a camp way up close to the New York border. It was a lovely fine arts camp. However once I agreed to go to this camp, all of the other offers started rolling in within hours. I got emails and phone calls and I was starting to realize that a camp nurse in late May really has a wide selection of options for their summer experience.

After writing about five no-thank-you emails, and returning phone calls saying no thank you, one number popped up on my iPhone. It rang and rang. I was going to let it go to voicemail and call back later to say no thank you, but I felt a last-minute gut feeling that I should pick that call up.

It was the director of Camp Netimus. She sounded like such a lovely person that she won me over within the first five minutes of our conversation. She was kind, friendly, and just had a way about her that was irresistible not to love. I had to meet this woman. I have spoken to at least 20 different directors of camps in the last several years, and nobody, I mean nobody, exuded the enthusiasm and love for their camp as much as she did.

So I had a difficult decision. The director didn’t want to steal me from the other camp, but she was very enthusiastic about having me and hoped I’d choose Netimus. In the end the kids made the decision for me. In a side to side comparison, a fine arts Camp was no comparison for a camp with zip lining, a rock climbing wall, gaga courts, basketball, and exciting outdoor activities like that. So I sheepishly told the fine arts camp that I really appreciated the offer but my children did not think they would be happy there and I regretted not checking with them first.

Coming to Camp Netimus was one of the best decisions we ever made. I don’t truly believe in magic or miracles, but I have seen and felt things that came close to such in my two weeks here. The real “magic” of this place comes from the people whose love and regard for each other make great things happen. If I didn’t have to report to the health center to work in 15 minutes, I would tell you about them right now. But that will have to wait. Sorry!

The Cutting Edge of Hemorrhage Control

“The application of a tourniquet is only ok if you are in a life or limb scenario, loose the limb to save the life” That was the extent of my training ontourniquets in my EMT training in the year 2004. The common knowledge at that time was that tourniquets caused damage, often irreparable damage to the limbs they were applied to, and that generally bleeding could be controlled with direct pressure only. While direct pressure remains the first step to treatment,  there has been a rapid evolution in the control of severe hemorrhage, and arterial bleeding in the past several years. Advances that many nurses not involved in emergency care may be unaware of. Tourniquets are back in use, and if nurses in the camp setting are not prepared to apply tourniquets in cases of severe hemorrhage, they are not meeting the standards of care on this topic.

Tourniquets have been a fixture in medicine since the late 1600s especially in battlefield injuries and surgery. By the 1900s problems with prolongedtourniquet use were well known, and the use of them in the field began to loose popularity.(1) Many Harsh criticisms of tourniquet use were voiced after both world wars, mostly due to the devices being applied improperly, or forgotten under blankets, or in the confusion of evacuation. In World War Two the army surgical division established the directive that tourniquets should be used only for active spurting hemorrhage from a major artery and established guidelines on care and time restrictions in tourniquet use. (2) Through the 19th century military use of the tourniquet continued, with the opinion of military surgeons becoming slightly more favorable by the end of the Vietnam War. Civilian use of tourniquets was minimal to nonexistent, being used primarily in vascular surgery, field use was strongly discouraged.

Going into our most recent war the routine use of tourniquets was still generally frowned upon. The implamation of the Joint Theater Trauma System, allowed for real-time evidence-based practice evaluations of both causality treatments and outcomes. This clear and ample data demonstrated very clearly that hemorrhage was a leading cause of death, and that tourniquet application in the field made a huge difference in outcomes. It also demonstrated that the concern over limb loss and nerve damage was overstated, in the present medical system definitive surgical intervention is almost always achieved before any serious side effects of tourniquet application can set in.  Over the past decade military training has focused on early hemorrhage control, and has seen a dramatic rise in causality survival. The US armed forced have made the Combat Application Tourniquet (CAT) standard issue to all ground forces, deploying over 400,000 CATs in the field. (3) 

As with many other advances in emergency care, the military medical community leeds the civilian community in techniques and science. The tourniquet has returned to civilian EMS, and first aid, in a big way.  Most recently with the Department of Homeland Security's “Stop The Bleed” Program. This program provides information to the lay person as well as professional rescuer ontourniquet use. (4)

Tourniquet application in the camp setting is important for a few reasons. Most camps are in rural locations, prompt and complete control of severe arterial hemorrhage is very important, as EMS response and transport times may be prolonged. Camps should also be equipped and trained in tourniquet use due to the low, but present risk of active shooting scenarios. Many nurses are not especially familiar withtourniquet application and may fail to recognize when a tourniquet is necessary.

Direct pressure over absorbent dressings remain the first step in control of most hemorrhage. In cases where bleeding from an extremity is severe, the victim presents with hypovolemic shock, or the injury's are from explosive devices, atourniquet should be applied as close to the site of the would as possible. A secondtourniquet may be applied even closer to the would if bleeding doesn't cease. (5).

Having established that tourniquet use has been added back into the first aid skill set for hemorrhage control, and established the parameters and techniques for application. The next issue to confront is what type of tourniquet to use. There are many commercial options on the market today, however many nurses may be most familiar with basic improvised tourniquet, that uses a triangle bandage folded so the with is about 1-2 inches, and tied tightly around the limb with a square knot. An improvised windless, such as a stick, is slid under the bandage and twisted until arterial occlusion is achieved, the windless is secured and time noted. (6)This style of tourniquet is cheap and effective, the major drawback being that it requires a bit of skill to apply, and there never seems to be a good sturdy enough stick around when you need it.

The most popular commercially available tourniquet is the Combat Application Tourniquet CAT. This easy to apply device has an attached durable windless, that tightens an internal band, that applies circumferential pressure. The windless is easily secured with a hook and Velcro fastener, and a label is prominent on the front to note the time of the application of the device. (6)The CAT has been extensively used by the armed forces, gaining more time in the filed and more real life applications than most other commercially available devices. It will be a familiar device for veterans and most EMS providers, for that reason if you decide to buy a tourniquet, I would recommend the CAT. However there are any number of options for commercial tourniquets, and any can be used with proper preparation and training.

Whatever type of tourniquet your camp employs, all nurses regardless of experience and background should be able to demonstrate its use, and articulate the conditions where a tourniquet will be necessary. Training is important to insure that providers are able to correctly use tourniquets in a correct and timely fashion in an emergency.

Severe hemorrhageand arterial bleeding, are low occurrence high acuity events in the camp setting. However preparation for such events is key to good outcomes an patent survival. Camps offer a wide verity of potential for injury's and as nurse we must be prepared to cope with any level of event that occurs at our camps. Tourniquets must be a readily available tool for camp nurses to use in the event of emergency, and modern science supports their use in the civilian realm when necessary.

1.David R Welling MD, A brief history of the tourniquet, Journal of Vascular Surgery, 2012

2.G.A. Cosmas, A.E Cowdry, The Medical Department: Medical service In the European Theater of Operations, 1992, Center of Military History, United States Army

3.Alec C Beekley, Prehospital Tourniquet use in Opperation Iraqi Freedom: Effect on Hemorrhage Control and Outcome, Journal of Trauma, Injury, Infection, and Critical Care, 2/2008

4.Stop The Bleed,, 11/20/2015

5.Bleeding Control Statewide BLS Protocol, PA BLS Protocol 601, 6/1/2015

6.Dan White EMT-P, Return of the Tourniquet,