A. Standing orders are to provide general guidance to the camp health officer.

Transcription

1 2018 GAC CAMP PROPERTY/PROGRAM TREATMENT PROCEDURES (STANDING ORDERS) (HS05-C; HS06-B; HS08-C3) Prepared by Lawrence I. Lee, MS, MD Council Health Supervisor, Greater Alabama Council A. Standing orders are to provide general guidance to the camp health officer. B. When anything is in question, contact medical control (on-call physician, Greater Alabama Council Health Supervisor Dr. Lawrence (Larry) I. Lee at (205) , local emergency department, local pharmacist, EMS, or anyone designated by the council health supervisor). EMS should be contacted for any medical emergency that cannot be safely managed by the camp health officer or other medical professionals. C. No treatment should be rendered without a review of the patient s medical form for pertinent history, allergies, current medications, etc. D. If in doubt, contacting the participant s parent/guardian/primary care physician may also be considered. Protocols/standard orders available as needed: i. Camper/staff immunizations: All campers and camp staff will submit an updated Annual Health and Medical Record (AHMR) as per BSA policy prior to the beginning of camp that will show immunization records of that individual. ii. Treatment provided by those other than camp staff (visiting physicians, etc.): All individuals who are capable of rendering medical care as outlined in standards HS-505 (B2, B3, B4, D); HS-506 (D, E) will report to the Camp Health Officer, present their qualifications for their level of expertise to render care, and be assigned by the Camp Health Officer their role in the treatment of campers and staff. iii. Notification guidelines who to call and when: 1. All conditions that require medical intervention performed outside of the Camp Health Lodge will be reported to the Camp Health Officer and recorded into the BSA First Aid Log, No at the Camp Health Lodge. iv. Communicable diseases treatment and prevention: FEVER: a) Isolate the affected individual. b) Acetaminophen per package instructions by mouth, may use ibuprofen 200 mg per package instructions by mouth if patient is allergic to acetaminophen Greater Alabama Council Camp Property/Program Treatment Procedures Page 1 of 12

2 c) If fever persists for more than four hours, notify the individual parent/guardian. INFECTIONS: a) Wash affected area with soap and warm water. b) Apply antibiotic cream to affected area. c) If appropriate/necessary, may apply and secure a sterile gauze to the affected area. d) If affected area is red, hot to touch, painful, or has purulent drainage, notify the affected individual s parent/guardian and transport to hospital for further evaluation and treatment. ISOLATION PROCEDURES: a) Place affected individual in the Camp Health Lodge. b) Take appropriate medical history and vital signs. c) Observe the affected individual in a treatment room or room area made exclusively for isolation. HAND WASHING PROCEDURES: a) Wash and scrub hands with antibacterial soap and water for 10 seconds then rinse thoroughly under warm tap water. b) Dry hands with clean paper towels. v. Use of emergency equipment/supplies AED: a) If an individual is found unresponsive, immediately call 911. b) Remove upper body clothing, activate AED unit and follow the instructions dictated by the unit until EMS arrives. c) Notify Camp Health Officer if AED is administered by another camp staff. OXYGEN: a) When oxygen is necessary, assemble the appropriate hoses and mask or nasal prongs, attach the hose to the oxygen tank, and administer oxygen flow at 2 liters per minute. May increase by one liter per minute as needed to maximum of 5 liters per minute. EPINEPHRINE BY AUTOINJECTOR (EPIPEN): a) Remove trousers/pants from the affected individual. b) Clean an area of the individual s thigh with an alcohol pad. c) Administer EpiPen according to package instructions Greater Alabama Council Camp Property/Program Treatment Procedures Page 2 of 12

3 vi. d) Observe individual for changes. e) Notify parent/guardian. f) If necessary, call 911 for immediate transport to the hospital. Emergency transport procedures GROUND TRANSPORT BY CAMP STAFF/VEHICLES: a) A vehicle designated as an emergency vehicle will made available at all times during camp. b) A copy of the Annual Health and Medical Record (AHMR) and medical insurance card of the affected individual is to accompany the staff member transporting the individual. c) Notify affected individual s parent/guardian prior to transport. d) Notify the affected individual s unit leader. e) Either the Camp Health Officer or a designated camp staff member will accompany and transport the affected individual to the hospital/medical facility. GROUND TRANSPORT BY PRIVATE AUTO (ADULTS/PARENTS): a) A copy of the Annual Health and Medical Record (AHMR) and medical insurance card of the affected individual is to accompany the parent transporting the individual. b) Notify affected individual s parent/guardian if those transporting the affected individual are not the individual s parent or guardian. c) Notify the individual s unit leader. GROUND TRANSPORT BY EMS: a) To be utilized if an affected individual is medically unstable with conditions requiring continuous monitoring only possible by an ambulance/ems, such as but not limited to chest pain, shock, respiratory distress, seizure, stroke, loss of consciousness. b) Designated EMS is called by the Camp Health Officer. c) A copy of the Annual Health and Medical Record (AHMR) and medical insurance card of the affected individual is to accompany the EMS staff transporting the individual. d) Notify parent/guardian prior to transport. e) Notify the individual s unit leader Greater Alabama Council Camp Property/Program Treatment Procedures Page 3 of 12

4 vii. f) Notify hospital emergency room with a summary of the reason of transport and condition of the individual. AIR TRANSPORT BY EMS: a) To be utilized if an affected individual is medically unstable with conditions requiring continuous monitoring and transport not possible by ground, such as but not limited to life-threatening trauma. b) Designated Air Transport is called by the Camp Health Officer. c) A copy of the Annual Health and Medical Record (AHMR) and medical insurance card of the affected individual is to accompany the air transport staff transporting the individual. d) Notify the affected individual s parent/guardian prior to transport. e) Notify the individual s unit leader. f) Notify hospital emergency room with a summary of the reason of transport and condition of the individual. Treatment guidelines: ABDOMINAL PAIN: a) If an individual s abdominal pain is mild (5 out of 10 or less), may administer Peptol-Bismol tablets or liquid per package instructions. b) Provide rest and clear liquids by mouth until abdominal pain has subsided. c) If an individual s abdominal pain is severe (6 out of 10 or greater), or abdomen is tender to palpation, especially in the right lower quadrant, notify the parent, and transport to the hospital for further evaluation and treatment. ALLERGIC REACTION/ANAPHYLAXIS: Mild: Administer Benadryl 25 mg (either capsule or elixir) by mouth. If there is an observed worsening of an individual s condition, bring the individual back to the Camp Heath Lodge immediately. Moderate: Administer Benadryl 25 mg (either capsule or elixir) by mouth. Observe individual for 15 minutes for changes at the Camp Health Lodge. If there is an observed worsening of an individual s condition such as shortness of breath, throat swelling, or decreased responsiveness, administer EpiPen as per package instructions and transport to hospital Greater Alabama Council Camp Property/Program Treatment Procedures Page 4 of 12

5 Severe (EpiPen): Administer EpiPen as per package instructions. Call 911 for immediate transport the hospital. Give Benadryl 50 mg (capsule or elixir) by mouth. May give oxygen if individual is short of breath or having labored breathing. Notify parent. COMMON FUNGAL INFECTIONS ATHLETE S FOOT: a) Wash affected foot with soap and water, rinse and dry thoroughly. b) Spray Tinactin, Desenex or similar aerosol as per package instructions. c) Instruct the individual to wear clean dry socks. d) May repeat above three times a day until rash resolves. JOCK ITCH: b) Spray Tinactin, Desenex or similar aerosol as per package instructions. c) Instruct individual to wear clean dry undergarment. d) May repeat above three times a day until rash resolves. SWIMMER S EAR: a) Place VoSol or equilvalent acetic acid otic preparation into affected ear as per package instructions. b) May repeat above three times a day until earache and other symptoms resolved. INSECT STINGS: BEES: b) Administer Benadryl 25 mg capsule or elixir by mouth. c) Administer Acetaminophen by mouth per package instructions. MOSQUITOES: b) Apply Benadryl gel or cream to affected area TICKS: a) Using a clean forceps, carefully pull tick off of skin without detaching the tick body from the head Greater Alabama Council Camp Property/Program Treatment Procedures Page 5 of 12

6 b) Wash affected area with soap and water, dry thoroughly. BREATHING DIFFICULTIES (ASTHMA, SHORTNESS OF BREATH) a) Treat the individual with their prescribed medications and inhalers. b) If shortness of breath and wheezing persists after 5 minutes, may administer an albuterol nebulized aerosolized treatment. c) If shortness of breath and wheezing persists after 5 minutes, call 911 and transport to the hospital for further evaluation and treatment. d) May administer supplemental oxygen if shortness of breath persists with facemask. BURNS: a) For all first and second degree burns, wash affected area with soap and water, rinse with warm water, and pat dry. b) Apply burn cream or ointment to affected area. c) Administer Acetaminophen according to the package instructions. d) Apply a Band-Aid to any blisters. e) Third degree burns, notify parent, and transport to the hospital immediately for further evaluation and treatment. CHEST PAIN (ADULT): a) Give aspirin 81 mg four tablets chew and swallow. b) Call 911 for transport to the hospital. c) If short of breath, may administer oxygen. CONSTIPATION: a) May administer Milk of Magnesia or Senekot liquid or tablets according to the package instructions. b) Encourage increased fluid intake and fiber including more fruits and vegetables, juices (if not a diabetic). CONTUSIONS/BRUISES: b) Administer Acetaminophen according to the package instructions. CUTS/LACERATIONS/ABRASIONS: b) If there is bleeding, apply pressure with a sterile gauze and hold until homeostasis has been achieved Greater Alabama Council Camp Property/Program Treatment Procedures Page 6 of 12

7 c) For superficial lacerations and abrasions, apply antibiotic ointment to the affected area, and apply a sterile bandage to the site. d) Administer Acetaminophen according to the package instructions. e) For deep lacerations, apply a sterile bandage to the site, notify parent/guardian, and transport individual to the hospital for further evaluation and treatment including suturing. DIARRHEA: a) May administer Imodium AD by mouth according to package instructions. b) Clear liquids by mouth for at least three hours or until diarrhea resolves. c) If the individual has fever, abdominal pain, or diarrhea persists, notify parent/guardian and send home. MUSCULOSKELETAL INJURIES FRACTURES/DISLOCATIONS: a) If there is bleeding, apply pressure with a sterile gauze and hold until homeostasis has been achieved. b) Immobilize affected limb or joint and apply splint to affected area if applicable. c) Administer Acetaminophen according to the package instructions. d) Notify parent/guardian. e) Transport immediately to the hospital for further evaluation and treatment. STRAINS/SPRAINS: b) Immobilize affected limb or joint and apply splint or ACE bandage to affected area if applicable. c) Administer Acetaminophen according to the package instructions. d) Notify parent/guardian. HEADACHE: a) Administer acetaminophen every six hours as needed according to the package instructions. b) If the individual is allergic to acetaminophen, administer ibuprofen every six hours as needed according to the package instructions. HEAD LICE: a) Isolate the individual Greater Alabama Council Camp Property/Program Treatment Procedures Page 7 of 12

8 b) Call parent/guardian and send home. Suggest the individual be treated with Nix or permethrin equivalent agent once the individual is home. c) Keep all of the affected individual s personal belongings separate from the rest of the camp. d) Wipe-down sleeping quarters and mattress with diluted bleach solution and spray surfaces with a disinfectant spray (e.g., Lysol). e) May return to camp only after individual is nit-free and has been re-evaluated by the Camp Health Officer. HEAT-RELATED ILLNESS HEAT CRAMPS: a) Place individual in an air-conditioned room. b) Take a clean towel, run under hot water, wring water out, and have the individual wipe face and body with the towel. c) Give judicious amounts of cold water by mouth. d) Administer acetaminophen every six hours as needed according to the package instructions. e) Rest until the individual s condition has returned to baseline. DEHYDRATION: a) Place individual in an air-conditioned room. b) Take a clean towel, run under hot water, wring water out, and have the individual wipe face and body with the towel. c) Give judicious amounts of cold water by mouth. d) Rest until the individual s condition has returned to baseline HEAT EXHAUSTION: a) Place individual in an air-conditioned room in a supine position. b) Take a clean towel, run under hot water, wring water out, and have the individual wipe face and body with the towel. c) Give judicious amounts of cold water by mouth. d) Apply towels soaked in cold water onto the individual s body. e) Rest until the individual s condition has returned to baseline. HEAT STROKE: a) Place individual in an air-conditioned room in a supine position. b) Apply towels soaked in cold water onto the individual s body Greater Alabama Council Camp Property/Program Treatment Procedures Page 8 of 12

9 c) Give judicious amounts of cold water by mouth if the individual is conscious and able to drink. d) Call 911 for immediate transport to the hospital. POISONOUS PLANTS: POISON IVY/OAK: b) Apply Caladryl or Calamine lotion to affected area. c) Administer Benadryl 25 mg (capsule or elixir) by mouth. May repeat every six hours as needed for itching. NETTLES: b) Apply a layer of paste made from baking soda and water onto the affected area until pain and stinging has resolved. c) Rinse off paste. d) Using either duct tape or masking tape, apply the adhesive side onto the affected area and remove to remove stinging needles embedded into the skin. e) Re-wash affected area with soap and water, dry thoroughly. f) Apply Benadryl gel or ointment onto the affected area. g) Administer acetaminophen according to the package instructions. SEIZURES: a) If an individual is found actively seizing, remove furniture and objects around the individual to prevent injury. b) Place the individual on their side to prevent aspiration. c) DO NOT place any objects, medications or fingers inside the individual s mouth. d) Observe the patient during the seizure, when the seizure has subsided, assess the patient and call 911 for immediate transport to the hospital. e) Notify the parent/guardian. SNAKEBITE: b) Notify parent/guardian. c) Call 911 for immediate transport to the hospital for further evaluation and treatment Greater Alabama Council Camp Property/Program Treatment Procedures Page 9 of 12

10 d) Do NOT use tourniquet or ice packs. e) Notify hospital of the type snake if known. COUGH/COLD/SORE THROAT/UPPER RESPIRATORY ILLNESS: a) For coughs, administer Robitussin DM 15 ml by mouth every four hours as needed for cough. b) For sore throat, spray 4 sprays of Chloroseptic Spray to back of throat, then administer acetaminophen according to the package instructions. c) If the individual has fever with the above symptoms, notify parent and send home. FOLLOW-UP CARE: STITCHES: a) Gently wash wound with sterile saline solution and sterile gauze removing any dried blood and drainage. b) Using a suture removal kit or cleaned suture scissors and cleaned forceps, cut and gently remove sutures. c) After all sutures have been removed, gently wash wound with soap and water, dry thoroughly. d) Place a dry Band-Aid over the wound. CASTS/SPLINTS/BANDAGES: a) Casts and splints should only be removed and changed by an orthopedic surgeon or another qualified medical personnel. b) Bandages may be changed if necessary. Wound beneath a bandage should be gently cleaned with sterile saline solution, pat dried, and a fresh dry sterile bandage applied and secured to the wound. DENTAL ISSUES: LOST TOOTH: a) Take loose tooth and place it either in a clean cold milk solution or sterile saline solution and wrapped in a sterile gauze. b) Notify the parent/guardian. c) The afflicted individual should be taken to a dentist for further evaluation or treatment along with the recovered tooth Greater Alabama Council Camp Property/Program Treatment Procedures Page 10 of 12

11 TOOTHACHE: a) Administer acetaminophen according to the package instructions every 4 hours as needed for pain. b) May also apply OraGel to the affected tooth every 4 hours as needed for pain in addition to acetaminophen. BRACES ISSUES: a) Any issues requiring manipulation or adjustment of oral braces should be referred to a dentist or orthodontist. b) If there is pain, may administer acetaminophen according to the package instructions every 4 hours as needed for pain. NAUSEA/VOMITING/STOMACH UPSET: a) Isolate the individual. b) Administer Peptol Bismol tablets or liquid by mouth according to package instructions. c) Begin a clear liquid diet for 8 hours or until symptoms have resolved. If the individual has fever and/or abdominal pain, notify parent/guardian and send home Greater Alabama Council Camp Property/Program Treatment Procedures Page 11 of 12

12 Appendix Checklist of documents required for operation of camp health lodge: 1. Policy and procedure manual 2. Printed copy of Camp Health Officer Training, No Standing orders as approved 4. Medication reference book 5. Guide to Safe Scouting 6. First-aid logs for participants and staff 7. Medication/equipment list (as approved) 8. Reorder/restock form for medication and supplies 9. Camp health lodge opening checklist 10. Camp health lodge closing checklist 11. Protocol/checklist for screening of campers/staff 12. Medication administration logs for use by adults/leaders 13. Incident report form 14. Phone list EMS, local hospitals, council health supervisor, local pharmacy, camp ranger, etc. 15. User manuals for any equipment on-site (AEDs, etc.) 16. Form for collecting the names and contact information of health providers in camp 17. Program Hazard Analysis, No , to assist staff in identifying and mitigating health-related risks identified before or during camping activities Greater Alabama Council Camp Property/Program Treatment Procedures Page 12 of 12