My camp is having difficulty finding potential nurse candidates to staff the health center this year, no doubt due to the seasonal nature of the employment, and people need the health insurance that full-time year-round employment provides. This is especially pressing now that we will be tracked and then fined by the government if we do not have it. So this year my role is only that of a resource person as I will be holding on to my full-time job. Basically I'll be helping guide them through the processes of setting up the center and helping with staff orientation. Meanwhile, one of our former camp nurses knows a paramedic who might be interested in working at camp this year. I know what a paramedic can do within an EMS system (a lot!) But legally speaking, what can they do, or not do (independently) in a camp setting? What about an EMT?
If I remember correctly your in PA. All this is the law and camp regulations as understand it.
My understanding of paramedic use in camp is that there are two approaches. The first and most common is to just consider them UAPs (unlicensed assistive personnel). As UAPs any nursing task can be
delegated to them as directed by the nurse practice act. As a general rule, there is some level of supervision required in delegation, and a pretty universal tenet of nurse practice acts is that nursing judgment, and assessment cannot be delegated. In this model, the meds wouldn't be an issue because you would delegate the routine meds to the medic, who has adequate training to safely deliver them. The issue is with PRN meds and sick call. Any PRN med that doesn't have specific parameters requires an assessment to determine need and then another for effectiveness. I think this is where the issue really lies in using medics as primary providers. An RN cannot delegate the assessment portion, so they cannot (to my understanding) independently handle a sick call. Even a sore throat requires assessment and nursing judgment to decide to treat with PRN OTCs or see the MD.
Now some camps have language on their parental permission forms that allows staff to give over the counter medications that the parents authorize, this can be a work around for administering PRN medications, as the parents authorize basically anyone with a pulse, and the directors permission, to give medications. The nuts and bolts of this and the liability ramifications are beyond my knowledge and would require a lawyer and insurance agent to even consider.
The other model is what's called a closed medical system. This is the system that allows medics and athletic trainers to function with extreme autonomy on sports teams and such. Basically, a physician
establishes practice and protocols and delegates authority directly to the provider. This is how a medical assistant with no license can give you injections and other interventions, they are considered an
extension of the physician. The issue here is the doctor who is in charge is assuming all risk and liability for the person they delegate to.
Paramedics generally function on a similar, but better established medical model where they have strict protocols from the state, and to provide ALS skills they need the blessing of a medical command physician (MCP). The MCP is responsible for supervising, QA, and assure the competency of the medics they supervise. In some services, the MCP will set up additional protocols for their medics to follow in addition to a state protocol thus setting up a closed medical system where the medics under that particular doctor can do skill over and above the state regulations. This is, to my understanding, what's happening with community paramedicine, where medics are visiting chronic system users and assessing them routinely to try and prevent 911 use for what is a non-emergency medical issue, or could be handled in a non-emergency fashion. Admittedly I am not as up on community paramedicine programs, as they are fairly new, and are not in my part of the state yet. However, they may be a good bridge for camp use eventually as they set the precedent for paramedic use in a none emergency setting, but to my understanding, there are no state protocols for community paramedicine at this time in PA.
As far as who can supervise health services on camp, that is an interesting question. It depends on who you ask. The state of PA is very silent on camps and healthcare, all the regulations that I can find are really related to facilities and sanitation. See PA code chapter 19 on organized camps and campgrounds. This is how boy scouts and other organizations get away with using EMTs and "health officers" they basically find someone who is willing to do the job, in the case of EMTs they are ignorant of their own practice restrictions, and then set them loose. The state does have extensive regulations on residential care and facilities in state code 3800, but most camps are
exempt from these regulations because they are in operation for less than 90 days.
The Amercian Camp Association, however, is pretty clear they want under the following health standards.
HW.1 Health Care Provider: Resident camp must have a licensed physician or registered nurse on site daily. Day camp may have prearranged phone access.
*HW.2 First Aid and Emergency Care Personnel: A staff member with training in the appropriate level of first aid and CPR must be on duty at all times in camp and on camp trips.
HW.4 Staff Training: Staff must be trained in role/responsibilities in health care.
HW.11 HealthCare Policies: Written policies must include scope and limits of services provided and authority/responsibilities of camp staff, and supplies, emergency health care assistance, etc.
HW.12 Treatment Procedures: Health care staff must follow written treatment procedures for reasonably anticipated injury/illness
Of course, these standards only matter if the camp is accredited.
I hope this helps.