As camp nurses we are asked to fulfill the role of emergency response for our organizations. This article is meant to help nurses get a handle on what can often be a difficult topic to approach. It is written based on my experiences, as a LPN and EMT. However as I have said in previous posts,I do not claim to be an expert, and the information below may not be applicable to your particular camp or situation.
Making sure your camp's emergency response plan is in place and well understood prior to an emergency is critical to success. No response plan can be comprehensive, you cannot produce a protocol for every situation. Also realize at some camps, response plans are less a written procedure and more of a "this is how we did it last time" thing. In the absence of a written procedure, or the desire to create one, a clear understanding of the roles and responsibilities of all involved is vital. A written or verbal response plan should include the following components.
Staff requirements: Who do you require to respond to your emergencies? These persons, and these persons ONLY, should respond to an emergency. For my camp; head staff, a nurse, and operations will automatically respond to any medical emergency. Any persons trained in first aid in the immediate area are encouraged to help, but cross camp freakout runs are discouraged. The camp director and the doctor are located and advised they may be needed to attend the incident. Make sure every member of the team is clear on their role, and discourage moonlighting or sightseeing by staff who do not really need to respond.
Communication: Once an emergency is recognized; how will you, or the required staff, be contacted? Can bystanders communicate the nature and location of the emergency to everyone from anyplace? My camps communications are handled via radio. Emergency traffic is assigned to specific channels to keep the soccer roster change announcement from stepping on the emergency traffic. Whatever means of communication you use be sure all staff are familiar with the equipment itself and how to use it.
Equipment: What equipment is required in your emergency plan and who is responsible to bring it? At my camp the response bag and oxygen are the standard equipment brought by the nurse from the Health Center. Unless the emergency occurs at meal time, in which case operations will bring it to the incident. We have other equipment located around camp that we can access such as, backboards, stokes baskets, AEDs, and emergency drugs. The response bag easily handles 99% of our emergencies. In the rare case that we need the special equipment the operations person assigned to the incident will fetch it. You will need to assess what is required for your particular situation, however remember sometimes less is more.
Escalation: Who determines when an incident is beyond the scope of what the camp staff can handle? Who is responsible for notifying 911, and what procedures will be started when EMS is activated? At my camp any nurse can decide to activate the EMS system if they believe it is necessary. We prefer when possible to have the doctor decide, however in the absence of a physician, the nurse will be supported in their decision. Once 911 has been called operations is notified to open the secondary entrance to camp and wait there to guide the responding ambulance to the incident. The camp director responds to the incident location, as they generally escort the child to the hospital. The child's chart is located and brought to the incident location as it will accompany the child to the hospital.
Resolution: If escalation to an EMS response is not required, the child is transported to the health center for evaluation. The physician may still decideto have the child evaluated or treated in the ED. In that case the child is generally transported via camp vehicle with report being called to the ED by the charge nurse. A nurse, or senior staff member, should accompany the child and handle all communications between the hospital and camp, and more importantly the hospital and the family.
Evaluation: When an incident is over, have all parties involved think about how it could have been made easier or better. Generally there is some way to tighten up the procedure. The goal should be quality improvement, not finger pointing. Revising or creating a written response plan, or more clearly establishing a verbal plan, should be the goal of a successful evaluation.
In addition to establishing and understanding your plan, some specialized training may be in order to make the nurse more confident in their abilities and refresh basic but important skills. A basic first aid course through the Red Cross or Heart Association is a one day class that can refresh little used skills such as splinting, burn first aid, and envenomations. I highly recommend a more involved course such as first responder, or even EMT-B if your time allows. These offer vary basic assessments and more extensive skills practice. They also teach skills such as spinal immobilization, basic airway adjuncts, and management of trauma patient. If your camp has a robust excursion or trips program they may also run a Wilderness First Responder course through ASHI. I attended a WFR course,as an EMT, found it quite interesting. Even a few hours speaking with a more experienced provider about some of your questions, can be very beneficial.
If you are part of a smaller camp you may want to seek out trained staff that are functioning other roles on camp. EMTs, athletic trainers, or even nurses licensed in other countries can be hiding in the ranks, and could useful to add to your emergency plan, or kept in a roster to be called on if needed.
Another useful task is to interface with your local EMS squad and get a feel for the local resources and response plans. A quick chat with the local chief, or community resource officer can be enlightening. Be sure to ask how the time of day may effect EMS resources. What hospitals are commonly used, and what speciality hospitals will be used for situations such as burns, trauma, or stroke.
Emergency response and management is only a small part of the camp nurses role, however it is often a part that causes a lot of anxiety. It is not a skill especially focused on in nursing education, or a role that many nurses may feel entirely comfortable in. I hope this article helps you in your practice at camp and gives you a starting point to establishing, or improving your camps emergency plans.
All opinions expressed here are my own and do 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.