Virginia 4-H Camping Volunteer Training Modules

1. Virginia 4-H CampingVolunteer Training Modules MODULE 12: 4-H CAMP MEDICAL TREATMENT (including Blood-borne Pathogens) Developed by Barry A. Garst, Ph.D., Assistant Professor and Extension Specialist 4-H Youth Development, March 2006

2. How to Use this Information • If you are a 4-H adult volunteer leader: • 1. Review the 4-H camp-related information contained in this presentation. • 2. Consider the “Discussion Questions” listed on the last page. • 3. Contact your local 4-H Extension Agent (or other person responsible for 4-H camping in your county/city) to review this information. • If you are a VCE faculty or staff member responsible for 4-H camping in your unit: • 1. Review the 4-H camp-related information contained in this presentation. • 2. Use this presentation to support your 4-H camp teen/adult volunteer leader training. • 3. Use the “Discussion Questions” listed on the last page as a resource in reviewing this information with your 4-H camp volunteers.

3. Overview • NOTE: This Module focuses on medical treatment provided during Junior 4-H camp conducted at 4-H Centers. • Health and wellness at 4-H camp • 4-H Health History Report Form • Who provides medical treatment at 4-H camp? • Role of 4-H volunteers in 4-H camp medical treatment • Health screening at 4-H camp • Medication procedures • Blood-borne Pathogens and “Universal Precautions”

4. Health and Wellness at 4-H Camp • As discussed in previous Modules, 4-H Center paid and volunteer staff act “in place of the parents” and have a “duty of care” to act in the best interest of the youth who are participating in 4-H camp. • This responsibility includes providing appropriate medical treatment (according to the directives of a consulting physician).

5. 4-H Health History Report Form • Prior to 4-H camp, a current (within the current year) signed4-H Health History Report Form must be completed and on-file for each 4-H camp participant (i.e., campers, C.I.T.s, teen counselors, adult volunteers, and Extension faculty/staff). • Participants without a signed 4-H Health History Report Form cannot be allowed to stay in camp.

6. 4-H Health History Report Form • The 4-H Health History Report Form is also important because it provides parent/guardian permission to: • Administer over-the-counter medication • Provide medical treatment (as needed)

7. Who provides medical treatment at 4-H camp? • For Junior 4-H camp conducted at a 4-H Center, each 4-H Center provides medical staff. • The level of certification of the medical staff depends upon the distance of the 4-H Center from emergency medical service (i.e., how long it takes an ambulance to get to the 4-H Center and then get to a hospital). • Many 4-H Centers utilize nurses, emergency-medial technicians (EMT), or staff who are certified in first aid and CPR.

8. Who provides medical treatment at 4-H camp? • The 4-H Center’s medical staff are responsible for providing medical treatment and making assessments of health condition (within the scope of their training and certification). • The 4-H Center’s medical staff are responsible for administering all over-the-counter and prescription medications.

9. “Standing Orders” • The 4-H Center’s medical staff person is responsible for providing medical treatment according to the “standing orders” that have been approved by a consulting physician (usually a Dr. that practices medicine at a location close to the 4-H Center). • Talk to your 4-H Center Program Director if you would like to learn more about your 4-H Center’s “standing orders”

10. What is the role of 4-H camp volunteers? • In general, 4-H camp volunteers are responsible for assisting with the following aspects of medical treatment: • Walking 4-H youth to the infirmary/health center (in a group of 3) and/or back to a 4-H camp program/activity after they have received medical treatment • Providing support to 4-H youth who might be waiting for medical treatment. (In other words, sit with them and help them to stay calm.)

11. What is the role of 4-H camp volunteers? • Transporting 4-H youth to the hospital (as needed in a group of 3) • If you come upon an injured or ill camper/teen who needs medical assistance, and you do not know what to do, seek help from the 4-H Center medical staff immediately and be sure that the injured/ill person is not left alone. • Other responsibilities as defined by your 4-H Extension Agent (or other person responsible or your county/city 4-H camping program)

12. What is the role of 4-H camp volunteers? • Although 4-H camp volunteers are generally not required to become trained in basic first aid and CPR, this training is always recommended to 4-H volunteers who work with youth in an outdoor-based camp setting.

13. Health Screening at 4-H Camp • During the first 24 hours of 4-H camp, each 4-H Center must provide a health information review and screening of all 4-H camp participants. • This health information review and screening is conducted by the 4-H Center medical staff at each 4-H Center. • All 4-H camp participants under age 18 years old (i.e., campers, CITs, teen counselors) are required to attend the health information review and screening. Adults are encouraged to attend.

14. Health Screening at 4-H Camp • 4-H camp adult volunteer and staff screening is determined by each 4-H Center. • You can assist with this process by ensuring that all of the youth and teens under your supervision have been through the health information review and screening on the first day of 4-H camp

15. Health Screening at 4-H Camp • The health information review and screening includes: • Review of the 4-H Health History Report Form, • Collection/review of any medications to be administered, • Review of medical forms and other documentation provided by parents/guardians. • Check for observable evidence of illness, injury, or communicable disease, and • Discussion with the 4-H camp participant to verify information on the 4-H Health History Report Form and to update information where needed.

16. Medications at 4-H Camp • It is critical that all medications at 4-H camp are collected, handled, administered, and stored correctly. • Although 4-H camp volunteers are not responsible for medications, it is important that volunteers are aware of these procedures.

17. Medications at 4-H Camp • A “Medication Form” must be completed for all 4-H camp participants (youth, volunteers, adults) who bring medication to camp. • The Medication Form identifies the following: (1) name of medication, (2) purpose of medication, (3) appropriate dosage, and (4) special directions for the administration of the medication.

18. Medications at 4-H Camp • Medication can only be dispensed from its original container. • Zip lock bags, other bottles, bottles printed with someone else’s name, or any other type of container besides the original will not be accepted.

19. Medications at 4-H Camp • Medication must be clearly labeled with the 4-H participant’s name, medication name, dosage, and instructions. • Medications must be administered according to the actual dosage listed on the bottle, unless there is a written note from the prescribing physician outlining different instructions for the administration of medications.

20. Medications at 4-H Camp • Instructions for all medications must be listed in English. If instructions are not in English, the appropriate translation must be provided. • Medications must be stored in a secure, locked area. Any exceptions for special medical needs (i.e., medications that may be in the “controlled possession” of the user such as inhalers, epi-pens, etc.) must be approved by the medical staff for the 4-H program/event.

21. Medications at 4-H Camp • If the medication is refused, then parents/guardians must be contacted. • If anything out of the ordinary occurs, or is requested by the person who is supposed to be taking the medication, then parents/guardians must be contacted.

22. Medications at 4-H Camp • Be sure that none of the 4-H campers and teens under your supervision have medications in the cabins/lodges. • If you observe any medications in the cabins/lodges, please ensure that they are taken to the 4-H Center medical staff so that they can be properly stored and administered according to the 4-H medication policy.

23. Blood-borne Pathogens and Universal Precautions • During camp, 4-H camp volunteers may be exposed to infections substances through the bodily fluids of others. • The following information related to “blood-borne pathogens” and “universal precautions” is designed to educate 4-H paid and volunteer staff about the risks associated with “exposures” to infectious substances and to inform them about the procedures to follow if they are exposed.”

24. Blood-Borne Pathogens Guidelines • “Blood-borne Pathogens” are microorganisms that can be present in human blood and are capable of producing disease in humans. Some examples of blood-borne pathogens are: • Syphilis • Hepatitis B virus (HBV) • Human immunodeficiency virus (HIV)

25. Exposure • An “exposure” is contact with any potentially infectious substance (i.e., blood, urine, semen, vaginal secretions, saliva, and sweat), through inhalation, needles, contact with an open wound, non-intact skin, eyes or other mucus membrane. • Please note that contact of blood or bodily fluids onto intact skin does not signify an exposure

26. High-Risk Positions at 4-H Camp • Roles at 4-H Camp that Hold a “High Occupational Risk of Exposure” • EMT/Nurse/Medical Staff • Lifeguards • Maintenance Staff • Any summer camp staff member required to have First Aid and CPR certification.

27. Primary Responders • Each 4-H Center has identified “primary responders” - those individuals who can respond to situations involving potentially infections substances because of training, vaccinations, etc. • In most cases, the “primary responder” is the medical staff person, EMT, nurse, and/or Program Director.

28. Universal Precautions • The concept of “universal precautions” means that 4-H camp paid and volunteer staff should treat all bodily fluids as if they are hazardous. • 4-H camp paid and volunteer staff should take “universal precautions” (i.e., precautions in all situations) by wearing disposable (non-latex) gloves in all first aid situations. (NOTE: 4-H Centers provide acrylic gloves due to patients’ potential latex allergies.)

29. What does a volunteer do if “exposed?” • If a potentially infectious agent comes into contact with an open wound, broken skin, or mucous membrane, you have been exposed. • If exposed, you should first contact the 4-H Center medial staff person and then you must contact the office listed below, who will give you instructions on how to proceed. • ENVIRONMENTAL HEALTH AND SAFETY OFFICE (540) 231-8751

30. Protection Kits • Each 4-H Center is responsible for providing first aid/protection kits that include: • Disposable towels • Disposable non-latex gloves • Waterless medicated hand cleaner such as a germicidal hand wash • Small equal size bottles of water and chlorine bleach • Small Plastic Bag

31. Washing Exposed Areas • 4-H camp paid and volunteer staff should wash their hands and any other exposed skin as soon as possible after the removal of gloves (with appropriate hand washing agents, followed by soap and water.) • If eyes or mucus membranes are exposed, then these areas should also be flushed with water immediately or as soon as possible following contact of these body areas with blood or other potentially infectious materials.

32. Washing Exposed Areas • When clothing, sheets, furniture, etc. become contaminated with bodily fluids, the 4-H Center’s medical staff (or other “primary responder”) is responsible for cleaning the contaminated materials.

33. Discussion Questions • If a camper receives a cut on his/her leg, what is your role in medical treatment as a 4-H camp volunteer? • Who is required to attend a health screening during the first 24 hours of camp? • With regards to medical treatment, why is it important the 4-H Health History Report Form to be signed? • What is the #1 thing that you can do be avoid being exposure to an infectious substance from someone else’s bodily fluids?

34. References • Garst, B.A. (2005). Virginia 4-H Camping Handbook. Virginia Cooperative Extension. Publication 388-562. • Virginia Cooperative Extension. (2004). Risk Management Information. Retrieved on March 19, 2004 from http://www.ext.vt.edu/vce/policies/riskmgt.html