Health Service Plan

Camp Henry Health Service Plan Table of Contents

I. Health Care Needs of Participants

II. Responsibility and Authority of Camp Staff in Health Care

III. General Routines for Camp Health Care and Sanitation

IV. Record Keeping & Incident/Illness Reporting

V. Provision of Supplies and Equipment

VI. Emergency Communications & Relationships with Providers of Medical Care

VII. Bloodborne Pathogens Exposure Control Plan

VIII. Standing Orders for Camp Medical Team I. Health Care Needs of Participants Camp Sunshine’s camp population has a variety of medical needs—most requiring individual attention by the camp’s medical team. Camp Sunshine’s medical team does not provide invasive medication administration except as needed in emergency response. The health services goal in programs operated by Camp Sunshine is to maintain good health and promote wellness through an appropriate health care program addressing the needs of the attending population. The plan establishes practices to meet camper needs in…

. … providing an organized, efficient camp health system which compliments the daily needs of participants. . … providing appropriately trained medical staff to assess health issues and implement a pre-established course of treatment to address those issues and evaluate results. . … securing relations with professional medical service providers to handle concerns beyond camp staff’s ability to treat. . … monitoring the camp environment in order to minimizes the risk of spreading communicable diseases and maintain a risk management plan to reduce/eliminate accidents due to foreseeable hazards. . … acknowledging and respecting the medical traditions of diverse backgrounds as determined by camper’s parents/guardians and conveyed to camp administration. . … educating campers to increase their knowledge about and remain responsible for personal health care practices. . … assuring parents/guardians that health care is a camp priority and establishing guidelines for contact in the necessity of non-routine care for a camper.

II. Responsibility and Authority of Camp Staff in Health Care A. Camp Administration – The health and safety of everyone in the camp must be the primary concern of camp administration. This includes all campers, visitors, and staff members. It is necessary to establish policies and procedures that comply with all legal requirements of the locale. The Director is responsible for supervision of personnel in the proper health and safety procedures of the overall camp operation. They are also responsible for promoting safety to all campers and staff. To fulfill these obligations, an in-depth Health Care Plan for the camp's total operation is a requisite. This plan should be reviewed annually by a health care professional for approval and additional recommendations.

B. Health Care Staff –

1. Qualifications – The medical team’s qualifications must meet or exceed the standards set by the State of Michigan’s rules for Children and Adult Foster Care Camps. Current minimum qualifications are:

o The ARC First Responder Certification o Must be at least 19 years of age o Must have some previous experience or education in health care or nursing o Persons certified as a registered nurse, emergency medical technician or paramedic qualify for the position of camp medical officer as training exceeds the ARC First Responder Training o Must be able to be on call 24/7 when summer youth camps are in session and to live residentially on the camp grounds Other qualifications that are considered essential for the medical team are the abilities to assume responsibility and leadership, to function proficiently and confidently as an independent practitioner, and to be genuinely concerned with children's health and happiness. The medical team must assume responsibility for all aspects of health care at the camp. This responsibility includes the medical, nutritional and environmental needs of the campers related to health and health services. The medical team must also function as leaders in the supervision of health care, the instructors of health related concerns to staff members, and the role models who maintains basic health standards.

The medical team’s ability to effectively assess problems and to make intelligent, as well as immediate decisions, greatly determine their ability to function in this role. Confidence in their abilities is a prerequisite. A genuine concern for campers is an essential quality of the medical team. To be able to communicate with a camper, to be able to see beyond shyness, fear, or tears to the reason for problems, and to care enough to find some way to help are qualities that best enable the medical team to serve as a health provider.

2. Job Description – The job description for the medical team accompanies this plan and is a part of the staff manual.

3. On-site and on-call services – The camp medical team live on campus and are available for 24/7 coverage.

o Pine Medical Group, Fremont Center (231) 924-4200 . Medical Director – Dr. Richard Boss . ask for phone nurse o Pine Medical Group, Newaygo Office (231) 652-1631 . Ask for phone nurse o Poison Control Central 1-800-222-1222. o 911 – will bring emergency personnel (and ambulances) as needed to camp. o A volunteer medical physician, Dr. Richard Boss will review the health plan & standing orders annually. The Camp Health Center is located in the lower level of Office in a central location of the Camp. The medical team lives at Camp Henry. There is always communication with the medical team either through two-way radios or through cell phones.

C. General Camp Staff –

1. Responsibility in providing first aid – The medical team, emergency medical technician, paramedic or American Red Cross Standard First Aid may provide first aid. A person certified in Cardiopulmonary Resuscitation may provide CPR. All other staff members must render assistance as they are able but are to seek direct assistance from the medical team immediately..

2. Location of first aid-certified persons – The medical team’s base of operation is located in the health center at the center of the camp. In addition, the waterfront staff, all first-aid/CPR certified, are available during waterfront activities at the waterfront. First aid supplies are kept in the first aid kits located as follows, waterfront boat house, vehicles, camp office, maintenance office, Nicely Center, ropes course, barn and in the kitchen. III. General Routines for Camp Health Care and Sanitation A. Policies concerning written health record requirements –

1. Health history – Every camper and staff member must present a current health history (completed within six months of attendance at camp) to the camp administration to participate in the camping program. The health history should be recorded on a Health History section of the application. The form includes: description of camp activities from which the camper should be exempted for health reasons, record of past medical treatment, record of allergies, statement of immunizations (including date of most recent tetanus), record of current medications, both prescribed and over-the-counter, and description of any current physical, mental, or psychological conditions requiring medications, treatment or restrictions while at camp.

2. Permission for Emergency Care – Each summer camper and staff member under the age of 18, must have a signed Parent/Guardian Authorization statement authorizing the camp to provide routine medical care and to seek necessary emergency medical treatment as part of the health record.

3. Record retention policy – Health records are maintained by the camp in a secure and locked environment. Records are confidential, but readily available in case of emergency.

4. Health Record Log in Camp Doc– The medical team is responsible for maintaining a medical treatment record during camp operation which includes the date, time, patient’s name, housing unit (optional), general description of injury or illness, description of treatment and initials of person evaluating or treating the individual. All camper concerns as well as phone calls or contact with parents should be documented in the Camp Doc. Camp Doc should be retained in accordance with record retention policies previously established in this health plan.

B. Procedures for health screening –

1. Who administers –The medical team will review medications and each individual health history before a camper arrives. The screening should also include an observation of the camper’s general physical condition with any irregularities or suspicions of abuse reported immediately according to camp policy.

2. When – Campers are screened within the first 24 hours on camp as part of their orientation process. Additional observation is made throughout the camp visit by counselors and waterfront staff in the course of the day. Particular attention is paid to each camper on the first day for any signs of abuse. Report of such evidence should be made according to the procedures of the Child Abuse Prevention section of the staff manual. Pre-prepared reports based on the pertinent details of camper health histories are provided to the medical team, counselor in the case of the campers in their charge and the Food Service Director in the case of nutritional or allergy issues. Counselor reports and Food Service reports are to be returned at the end of each session where they will be destroyed for confidentiality.

3. Communication of significant findings to counseling and program staff – The medical team reports any additional findings to counselors, program staff and Food Service Director. This includes any special diet restrictions, activity restrictions, required medicine and time to report to the medical team, allergies and any other concerns staff members might need to know for camper safety. The information must remain confidential.

C. First-Aid –

1. Who administers – The medical team provide all first-aid. 2. Qualifications – The medical team’s qualifications have already been noted and must meet or exceed minimum state and ACA standards. Additionally, First Aid/CPR certification is required for aquatics staff. Prudent judgment for minor incidents should be used for self-rendered aid. Any indefinable injury should be referred to the medical team.

3. Location of first-aid supplies – All primary first-aid supplies are located in the health center.

4. Record keeping – As noted earlier, all records relating to health care are kept in Camp Doc.. Any treatment provided in the health center is to be documented in Camp Doc. Camper early departures are also documented in Camp Doc as part of the medical check out process and serves as the permanent record of the departure. Any exposure of staff or other campers to bodily fluids should be reported immediately to the health director and documented in Camp Doc. Any care given at the waterfront should be documented in the waterfront log and referred to the health director as needed.

5. Standing orders/procedures – Standing orders and the health plan should be kept in the health manual at the health center and referred to for all medical treatment. Additional copies of approved plans and standing orders are kept in the administration office for licensing and accreditation inspection. The plan and orders should be reviewed periodically by the health director and shall be revised and approved annually by a medical physician.

6. Training of all staff – The staff is trained in health service procedures during staff training prior to the camper’s arrival. Resident staff is trained in emergency communications procedures for contacting the health director and conditions for the use of “911" Staff are receive training in universal precautions to protect themselves in first response care.

D. Emergency Medical Care –

1. Who administers – The medical team are responsible for performing all medical emergency care within the scope of that individual’s experience and certification. They are responsible for determining in consultation with the Director if a camper/staff member should be transported to a Medical Center for further treatment. EMT professionals will be contacted in severe emergencies. Any staff member trained in CPR would administer such care if they are the first responder to the scene of an incident requiring it.

2. Person's qualifications – Minimum requirements as set forth by the state, presently, the ARC First Responder Certification.

3. Provision and procurement of emergency transportation – An assigned vehicle is available for emergency transportation. The Director's car is the back-up vehicle. One counselor will always accompany the camper. Severe emergencies will be transported by ambulance through the "911" response system. Camp Henry is serviced primarily by Life EMS out of Newaygo and the volunteer fire department / EMT service.

4. Standing orders/procedures – The standing orders of the camp physician list those areas in which emergency medical care is needed as noted before.

5. Training of all staff – During the orientation, staff members are taught to recognize an emergency situation which requires the immediate attention of the medical team. Staff are also trained in calling for emergency medical assistance in life threatening situations. When calling for assistance, give clear directions and locations to responding staff. After alerting a person on the medical team, contact the Director at the earliest opportunity. Wait for a person from the medical team or other support to arrive at the clearly designated area and lead them to the emergency. When EMS is required, the responder in charge will designate an individual to meet the ambulance at the camp entrance or at the point nearest the injury. If another staff member is present be sure to consider the other campers present when dealing with an emergency. Do not leave an injured camper alone if at all possible. Remember, your calmness and quick action can make all the difference in any emergency situation.

6. Communication with parents/guardians – Parents/guardians should be contacted immediately by the Director in a "911" life threatening emergency. A fatal camper incident or one involving admission to a medical facility overnight should be reported to the proper state licensing authority within 24 hours using approved forms

For incidents involving invasive treatment or transport to a medical facility, parents/guardians should be contacted before medical treatment is rendered if possible. Hourly attempts should be made to reach parents until they are reached. A person from the medical team may be designated to make that contact when appropriate.

7. Procedures for documentation – All illnesses and injuries must be accurately documented in Camp Doc. Additional reporting must be made in the following scenarios.

. Incidents involving campers/staff receiving medical care beyond camp medical team. . Incidents requiring care beyond camp medical taem or that may have the potential to require future care must have an incident report filed with the camp director within 24 hours. . Incidents that result in hospitalization (overnight) or fatality of a camper/minor staff must be additionally reported to the state within 48 hours on the appropriate form . Copies of all reports beyond Camp Doc must be submitted to the director for processing through the appropriate support services. E. Daily medical care –

1. Who administers – The camp medical team are responsible for camper’s regular daily health care.

2. Hours – The health center is open during all activity periods. A person from the medical team is on-call at all times and can be reached with two-way radio or phone. Emergency care is available 24 hours.

3. Record keeping – All those who receive any attention from the medical team are carefully documented in Camp Doc. Health history, special health concerns and observations are kept on file in Camp Doc.

Standing orders: The camp standing orders/procedures include instruction for treating conditions that may occur in daily medical care.

4. Medication policies – Upon arrival all campers with medications, prescriptions or over-the-counter medicines must turn them over to the medical team. These are stored in locked cabinets in the health center. Additionally, the cabin is locked any time that a person from the medical is not present in the building. Prescription drugs must be brought in the containers in which they were issued from the pharmacy. Medications must be clearly prescribed to the camper according to the prescribing physicians instructions. If any questions arise, parents and doctors will be consulted directly.

Volunteer/Permanent staff not rooming with campers bringing non-narcotic medications may retain them if their living quarters secured (locked) and/or if the need for the medication is clearly for immediate emergency use i.e. angina, asthma.

All medications will be given by the camp medical team at the appropriate times. Counselors will assist campers in remembering to get medications as needed.

On the final day at check-out, any medication that is left, is handed to the person responsible to pick up the camper. Campers should never be in possession of their medication. 5. Communication with parents/guardians – The medical team may communicate directly with parents/guardians on any health issue. Parents/guardians may call the Director at any time for further communication.

F. Routine health care –

1. Who is Responsible for Supervision – The medical team is responsible for all phases of camp programming, camper’s participation or restriction and the maintenance of high health standards.

2. Monitoring of Personal Hygiene – The medical team will instruct counselors, kitchen staff and program staff regarding personal hygiene matters during orientation. They will encourage campers in good health practices. All staff are instructed during staff training to make daily observations of the campers in matters of personal hygiene, proper diet, physical condition and emotional state.

3. Supervision of Orders for Daily Medications: The medical team is responsible to see that campers take daily medications. They may enlist the help of counselors to ensure the camper takes their medicine at the proper time.

4. Supervision of Health Center: A camper is never to be left alone in the health center. All medicine is locked in cabinets. Two staff members (at least one staff must be of the same gender as the camper) must always be present when administering care or monitoring campers in isolation.

G. Supervision of overall camp practices –

1. Sanitation facilities/practices – Responsibilities for camp sanitation rests with the director, medical team and housekeeper in consult with local or state health authorities. The medical team does daily and periodic checking of cleaning procedures and facility conditions. This includes the cleaning of bathrooms and the correction of any new or unusual hazards. The medical team and food service supervisors will instruct and remind staff in proper handwashing to prevent the spread of bacteria. A work order should be completed for any situation causing concern.

2. Food service facilities/staff: The medical team is responsible for checking food servers for symptoms of ill health. Those who are ill cannot handle food. The dining and service areas are to be thoroughly cleaned after each meal. Kitchen cleaning and sanitization practices should be continual during meal preparation with a complete cleaning after each serving day consistent with established health practices. The food service director will check the washing of dishes and pots/pans frequently for proper handling and sanitization. They will also see that food storage temperatures are checked daily and that dry storage is well maintained. Staff receives training in safe food handling.

3. Grounds: The medical team should observe and assess the cleanliness and safety of the camp grounds. Report problem areas to the Director as well as to the Maintenance Request Form for immediate action.

4. Living accommodations: The Director should assess the health and safety of all living accommodations on camp property during summer accommodations. Recommendations concerning any potential safety or health hazard will be made to the appropriate staff member.

5. Program areas: Each activity leader will observe and assess their perspective program areas for health and safety concerns as part of the activity routine. The swimming area must have staff certified in life-saving. Recreational grounds and equipment should be checked for potential hazards as part of the annual safety inspection and by maintenance staff during quarterlies. All program staff is trained and observed in appropriate health and safety procedures. All staff is instructed in risk management awareness during orientation.

IV. Record Keeping and Incident/Illness Reporting A. Documentation – The medical team maintains record keeping in Camp Doc. The administration of drugs and any medical attention is carefully logged. Accident/incident reports are also maintained and filed according to the guidelines of Camp Sunshine and are available for inspection by appropriate parties. Any phone calls made to parents/guardians regarding the care of the camper or health care concerns are also documented in the Camp Doc by time and conversation.

B. Record Keeping – All records relating to health care are kept on file in the health center for the season in process.. Any treatment provided in the health center is to be documented in Camp Doc.

C. Incident Reports – Incident reports are completed by the medical team and delivered to the Director for proper processing to other departments and insurance. Copies of the reports are kept in the camp office.

D. State Reporting – Notification of county health services for communicable illness or illness due to environmental impact shall be made within 24 hours of occurrences in accordance with Reporting Diseases in Child Care to your local health department, included with this document in its entirety as published by the health department. V. Provision of Supplies and Equipment

A. Health care facility and supplies – The health center is located in the center of the camp. There are two isolation rooms with one bed always provided. Medications are kept in locked cabinets. A refrigerator with a locked box is available for medications that require refrigeration. Running water, bathroom facilities, lights and air conditioning are provided. The cabin is well marked with first aid signs and a communications board is on the door to alert people as to the location of the Health Director. In 2008, an AED was acquired by the camp and is maintained in the health station during summer months and in the camp office the rest of the year.

B. Supplies to be available

 Desk, file and chair  Work table  Cupboards  Locked cabinets  Soap  Sink (access to water)  Lighting  Wastebasket  Paper/pen  Log book  Waiting bench  Fire extinguisher  Refrigerator  Paper towels  Tissues  Backboard (waterfront)  Sharps disposal  Disposable gloves  Bedding  Scissors  Tweezers  Drinking cups  Medicine cups  Medicine droppers  Thermometers  Blood pressure cuff  Stethoscope  Ace bandages (assorted)  Splints  Bandages  Triangular bandages  Absorbent cotton  Ice packs  First aid kits  Rubbing alcohol  Antiseptics  Disinfectants  Alcohol wipes  Anti-bacterial ointment  Hydrogen peroxide  Dressings  Cotton Q-tips  Lotions  Eye pads  Saline solution  Pain reliever  Cough syrups  Throat sprays  Antihistamines/cold tablets  Tylenol  Calamine lotion  Athlete’s foot powder  Sucrets/throat gargles  Benadryl  Maalox  Epi-pen  Epi-pen Jr  ...other items as recommended by consulting physician (use of generic equivalents is permissible Page 12 of 24 VI. Emergency Communications and Relationships with Providers of Medical Care

A. Standing Orders & Plan Review – The health care plan, standing orders and procedures are to be reviewed and approved annually by a physician. The medical team will also review annually the health care policy and recommend changes that improve Camp Sunshine's health service relative to population and environment. The approved plan and standing orders will be kept in the health station as part of the health care manual with a copy maintained in the Director's office.

B. Local Emergency Notification – Annually, the local emergency care facilities will be notified by letter of the camp's operation and our intent to use their facilities as primary care givers in emergency situations. Notification should include but not be limited to the following:

. Gerber Hospital, 212 S. Sullivan, Fremont, MI (231) 924-3300 . Pine Medical Group – Dr. Richard Boss, 230 West Oak, Fremont, MI 49412, (231) 924-4200 Newaygo Office, (231)-652-1631 . Newaygo Fire Department, 177 Cooperative Center Drive, Newaygo, MI 49337 . Life EMS, 33 Westwood, Fremont, MI 49412, (231) 928-5433 . State Police Newaygo Post, 360 Adams, Newaygo, MI 49337, (231) 652-1661 C. Emergency Communications– When a life threatening crisis exists, any staff should dial “911" for emergency medical care immediately and without seeking out camp administration for permission. Contact a person from the medical team and Director as soon as possible thereafter.

VII. Bloodborne Pathogens Exposure Control Plan

In accordance with the OSHA Bloodborne Pathogens standard, 29 CFR 1910.1030, the following exposure control plan has been developed:

A. Exposure Determination – OSHA requires staff to perform an exposure determination concerning which staff may incur occupational exposure to blood or other potentially infectious materials. The exposure determination is made without regard to the use of personal protective equipment (i.e. staff are considered to be exposed even if they wear personal protective equipment.) This exposure determination is required to list all job classifications in which all staff may be expected to incur such occupational exposure, regardless of frequency. At this facility the following job classifications are in this category:

1. Category I Employees – Employees in Category I are those who are designated as responsible for rendering medical assistance. Category I job classifications include: Health Director, Waterfront Directors, Wranglers, Camp Counselors

2. Category II Employees – Employees in Category II are those whose primary job assignment is not the rendering of first aid and are not expected to become exposed on a regular basis. Category II

of 24 employees include: Program staff, Clerical Staff, Program Director, Food Service Staff, Maintenance staff

3. Tasks and Procedures – The tasks and procedures indicated below may be performed by Category I staff during the performance of their duties. Category II staff have minimal likelihood of exposure since their performance of these tasks and procedures is limited.

. Care of minor injuries that occur within the camp setting (bloody nose, scrape, cut, etc.) . Care of an injured person in a program activity . Care of an injured activity in a sport activity . Sanitation of restroom and other camp facilities (cleaning blood or vomit) . Conducting CPR, mouth-to-mouth resuscitation or other first-aid procedures B. Implementation Schedule and Methodology – OSHA also requires that this plan include a schedule and method of implementation for the various requirements of the standard. The following complies with this requirement:

1. Compliance Methods – Universal precautions will be observed at this facility in order to prevent contact with blood or other potentially infectious materials. All blood or other potentially infectious material will be considered infectious regardless of the perceived status of the source individual.

Engineering and work practice controls will be utilized to eliminate or minimize exposure to employees at this facility. Where occupational exposure remains after institution of these controls, personal protective equipment shall also be utilized in accordance with the standard. At this facility the following engineering controls among others will be utilized:

a. Hand washing – This organization shall provide handwashing facilities which are readily accessible to employees, or when provision for hand washing facilities is not feasible, an appropriate antiseptic hand cleanser in conjunction with antiseptic towelettes.

Staff shall wash hands or any other skin with soap and water, or flush mucous membranes with water immediately or as soon as feasible following contact of such body areas with blood or other potentially infectious materials.

Staff shall wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment. When antiseptic towelettes are used, hands shall be washed with soap and water as soon as feasible.

b. Mess Kits – This organization shall provide each program unit with a mess kit, containing the following: latex gloves, mouth-to-mouth face guard, antiseptic, goggles, face mask, apron

c. Gloves – Staff shall wear latex gloves whenever they attempt any of the items listed in the task and procedures of part 1 of this document, or whenever exposure is anticipated.

d. Sharps Handling – Broken glass shall not be picked up directly with the hands. It shall be cleaned up using mechanical means, such as a brush and dustpan, tongs, or forceps.

of 24 Contaminated sharps, broken glass, plastic or other sharp objects shall be placed into appropriate sharps containers.

After removal of personal protective gloves, staff shall wash hands and any other potentially contaminated skin area immediately or as soon as feasible with soap and water.

If staff incurs exposure to their skin or mucous membranes, then those areas shall be washed or flushed with water as appropriate as soon as feasible following contact.

2. Needles – Contaminated needles and other contaminated sharps will not be bent, recapped, sheared or purposely broken. OSHA allows an exception to this if the procedure would require that the contaminated needle be recapped or removed and no alternative is feasible and the action is required by medical procedure. If such action is required then the recapping or removal of the needle must be done by the use of a mechanical device or a one-handed technique. At this facility recapping or removal is not permitted.

3. Work Area Restrictions – In work areas where there is a reasonable likelihood of exposure to blood or other potentially infectious materials, such as in a laundry room, staff are not to eat, drink, apply cosmetics or lip balm, smoke, or handle contact lenses. Food and beverages are not to be kept in refrigerators, freezers, shelves, cabinets, or on counter tops or bench tops where blood or other potentially infectious materials are present.

All procedures will be conducted in a manner which will minimize splashing, spraying, splattering, and generation of droplets of blood or other potentially infectious materials. Methods which will be employed at this facility to accomplish this goal are:

. When cleaning up a blood spill of any size, do not spray the decontamination solution (1 part household bleach, to 10 parts water) directly on the spill as this can result in splattering. . With gloved hands place paper towel over the spill and spray the top of the paper towel with the solution. . Do not pat down but wait for the blood and solution to be absorbed. . Then pick up the paper towels and dispose of them as regulated trash. . If a residue remains spray the area with the decontamination solution and wipe up. . Remove and care for gloves properly and wash hands. 4. Personal Protective Equipment – All personal protective equipment required by the standard and used at this facility will be provided without cost to staff. Personal protective equipment will be chosen based on the anticipated exposure to blood or other potentially infectious materials. The protective equipment will be considered appropriate only if it does not permit blood or other potentially infectious materials to pass through or reach the staff clothing, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used.

Forms of personal protective equipment available are gloves and CPR micro shields. Gloves shall be worn when it can be reasonably anticipated that the employee may have contact with blood, other

of 24 potentially infectious materials, mucous membranes, and non-intact skin; and when handling or touching contaminated items or surfaces.

Gloves shall be replaced as soon as practical when contaminated or as soon as feasible if they are torn, punctured, or when the ability to function as a barrier is compromised. Gloves will not be washed for re-use. Utility gloves may be decontaminated for re-use provided that the integrity of the glove is not compromised. Utility gloves will be discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a barrier is compromised. Every mess kit will have a set of gloves. Gloves will also be kept in the Health Center and in the Office. Staff should notify their immediate supervisor when situations warrant additional gloves.

Masks, in combination with eye protection devices, such as goggles or glasses with solid side shields, or chin-length face shields, shall be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated (cleaning a clogged toilet). Eye protectors are kept in the Camp Office.

All garments which are penetrated by blood shall be removed immediately or as soon as feasible. All personal protective equipment will be removed prior to leaving the work area. The following protocol has been developed to facilitate leaving the equipment at the work area. When personal protective equipment/supplies are removed, they shall be placed in an appropriately designated area or container for storage, washing, decontamination or disposal. This container shall be labeled with a red biohazard symbol.

5. Housekeeping – This facility will be cleaned and decontaminated according to the following schedule:

Area Frequency

Camp bathrooms daily

Camp Health Center daily

Staff bathrooms weekly

The foregoing decontamination will be accomplished by utilizing the following materials:

a. Mixture of 10% household bleach and tap water. This solution will be kept in the supply closet of the kitchen, maintenance building, office supply cabinet, and the infirmary. All chemicals and or products with chemical substances are clearly labeled and held away from any food or within the reach of campers.

b. All contaminated work surfaces will be decontaminated after completion of procedures and immediately or as soon as feasible after any spill of blood or other potentially infectious materials, as well as the end of the work shift if the surface may have become contaminated since the last cleaning.

of 24 c. All bins, pails, cans, and similar receptacles shall be inspected and decontaminated on a regularly scheduled basis and decontaminated immediately or as soon as feasible upon visible contamination. Cleaning shall be done with a small mop - not hand scrubbed. Gloves shall be worn for this task.

6. Regulated Waste Disposal – All contaminated sharps shall be discarded as soon as feasible in sharps containers which are located in the facility. Sharps containers are located in: Maintenance building and Health Center.

Materials such as paper towels, gauze or clothing soaked or caked with blood are considered hazardous. These items will be bagged, tied and designated as a biohazard. The following shall have a regulated waste contained with a biohazard label: Infirmary, kitchen, cabins, and the maintenance building. Red bags will be used as liners.

7. Laundry Procedures – Laundry contaminated with blood or other potentially infectious materials will be handled as little as possible. Such laundry will be placed in appropriately marked bags at the location where it was used. Such laundry will not be sorted or rinsed in the area of use.

All staff who handle contaminated laundry will utilize gloves to prevent contact with blood or other potentially infectious materials. Laundry at this facility will be cleaned at the Camp's laundry facility.

8. Exposure Incident Reporting – All unprotected first aid incidents involving the presence of blood or OPIUM must be reported to your supervisor before the end of the workday. The Health Director will complete an Exposure Incident Investigation Form. This report will include the names of all first aid providers who rendered unprotected assistance and a description of the incident with date and time. The report will include a determination of whether an "exposure incident" as defined by the standard occurred. The report will be recorded on a list of first aid incidents kept in the Camp Office.

Following completion of the incident report, the Director will evaluate the circumstances surrounding the exposure incident to determine ways to prevent another occurrence. A protective exposure is defined as, "Contact with blood or OPIUM occurring and staff having used universal precaution (gloves, face shield, etc.). An incident investigation form is not required as this is considered a non-exposure since protected."

9. Training – Training for all staff will be conducted prior to initial assignment to tasks where occupational exposure may occur. Training will be conducted in the following manner:

a. Annual training for staff will include the following explanations of:

a. The OSHA standard for Blood borne Pathogens b. Epidemiology and symptomatology of blood borne diseases c. Modes of transmission of blood borne pathogens d. The exposure control plan (points of the plan, lines of responsibility, how the plan will be implemented, etc.) e. Procedures which might cause exposure to blood or other potentially infectious materials f. The use and limitation of control methods which will be used to control exposure to blood and other potentially infectious materials.

of 24 g. The use and limitations of personal protective equipment available at this facility and who should be contacted concerning personal protective equipment h. Signs and labels used at the facility b. Training records will be kept for three years from the training date and will include:

1. Dates 2. Contents of training program 3. Trainer's name and qualifications 4. Names and job titles of persons attending c. Medical and training records will be made available upon request to the Assistant Secretary and the Director of MIOSHA for examination and copying.

VII. Standing Orders for Camp Medical Team

Abrasions, Scratches, Cuts – Clean with soap (Dial soap preferred) and water, slush H20, apply Neosporin ointment, band aid and or dressing, prn. If excessive bleeding, apply pressure, elevate part and notify M.D. on call.

Abdominal Pain – Maalox 5c.c, Tums, 2 tablets; If severe tenderness or rigidity present, if bowel tones absent, notify M.D. on call, keep quiet and monitor vital signs.

Allergies, Hayfever – Benadryl, Claritin, Zyrtec, Antihistamine (Chlotrimeton syrup or Dimetapp) or generic equivalents. Dosages as instructed on package per patient weight and age.

Anaphylactic Shock – CALL 911, Epinephrine 0.3-0.5mg (0.3ml-0.5ml of 1;1000 solution)S.Q

Animal Bites (non-insect) – Follow instructions above for Abrasions and Scratches. If skin is broken, contact M.D. on call to consider further treatment.

Asthma – Follow patients asthma action plan. If patient is not responding to treatment guidelines within the action plan, contact the MD on call. Call 911 if patient appears to be in severe respiratory distress.

of 24 Burns – Remove any clothing that is in contact with the injury. Apply cool water immediately, apply Neosporin ointment or silvadene cream (if available) on mild first degree. If second degree or greater, apply dry sterile dressing and notify M.D. on call. Administer fluids if alert. If hot H20 burns, remove clothing immediately to prevent further burning.

Cold, Coughs – Vicks Nyquil as recommended. Robitussin, expectorant or suppressant prn. Dosages as prescribed on package per patient weight and age. Throat spray for irritation. If temperature greater than 102 degrees, notify M.D.

Constipation – Miralax, glycerin suppository, fleets enema prn. All doses as prescribed on package per patient weight and age.

Diarrhea – Imodium as recommended. Dosages as prescribed on package per patient weight and age. Restrict dairy products.

Earaches – Domboro ear gtts or Debrox as recommended tid to affected ear. Restrict swimming. If persistent, or temperature greater than 100 degrees notify parents and have them pick up child from camp. In the event the parents cannot be reached, notify the MD on call.

Fever – Tylenol or Motrin dosage as recommended for weight and age; rest, isolation, prn. Notify parents if temperature is 100 degrees or higher. Notify M.D. if temperature greater than 102 degrees p.r. for over 12 hours.

Foreign Body in Eye – Flush eye with water, notify M.D. on call. If irritation is great, apply cold pack.

Headaches – Tylenol or Motrin as prescribed on package per patient weight and age. Tylenol elixir as recommended. Also consider dehydration. Give patient fluids.

Head Injuries – If dizziness, unconsciousness, headache, nausea & vomiting, change in pulse, severe nose bleed, or other symptoms present. Notify M.D. on call. If severe head or neck injury suspected, do not move victim and contact 911. If there is any doubt as to severity, call 911.

of 24 Insect Bites, Poison Ivy – Ice, calamine or aveeno baths, baking soda paste or similar commercial treatment for washing infected area. If excessive swelling or itching, give Benadryl 25 mg. p.o. xl. May use 1% hydrocortizone ointment 3 times a day.

Insomnia – Support, warm milk. Consider Benadryl 25 mg dosage per package instructions. (not recommended for children with ADD or ADHD)

Insulin Injection – Administer as per doctor's orders.

Nose Bleeds – Head forward and apply pressure to nose bridge for 5-10 minutes. Notify M.D. if excessive or persistent.

Nausea and/or Vomiting – 1-2 0z. Sprite or 7up and water mixture (1:1) at frequent intervals or Lemon- lime Gatorade to hydrate. Rest and cool compress. If persists beyond 24 hours, notify M.D. on call.

Pink eye – Isolate camper from the rest of camp. Check the children and staff in child’s cabin group. Contact MD on call. Notify parents. If pink eye is confirmed child must be sent home and may return to camp 24 hours after medical treatment has begun.

Poisoning – If poisoning is suspected, support patient and symptoms and call Poison Control and follow directions given. 1-800-222-1222

Poison Ivy – Wash area thoroughly with soap and water or Technu, Calamine lotion, Caladryl Lotion, as directed on package.

Rashes – A & D ointment, calamine, aveeno bath. Also may try Benadryl cream or tabs as prescribed on package. Baby powder can help reduce rubbing in areas as well.

Sore throat – Gargle with warm salt water. Throat lozenges or spray for irritation, restrict swimming. Notify M.D. if reddened, persistent, and/or accompanied with temperature greater than 102 degrees.

of 24 Sprains, strains, fractures – Apply ice immediately and immobilize part. If pain or swelling severe, keep extremity elevated. Notify M.D. on call. If severe injury is suspected, call 911. Splint a suspected fracture and continue to ice, apply heat after 12 hours for comfort.

Strep Throat – If strep throat is confirmed camper must be isolated until he or she can be sent home. Camper may return to camp 24 hours after medical treatment is begun and symptoms subside.

Sunburns – Solarcaine, Aloe, fluids.

Sunstroke – Remove victim to cool, shaded area; apply cool sponge bath. If no response to cool washes, notify M.D.

Toothache – Tylenol or generic as recommended on package. Oil of cloves for comfort.

Prescription Medication – All camper and staff medications must be secured in the health center. Prescription medication must be in the original container from the doctor or pharmacy. Medications will be administered exactly as prescribed on original container unless there are written instructions from the prescribing physician or parent/guardian that instruct otherwise.

Sending a camper home – If a camper has an illness or injury that requires they remain in the health center for more than 4 hours, call the parent/guardian and arrange for the camper to leave camp. Any conversation with the parent/guardian must be documented in the Camp Doc. The camper may return to camp 24 hours after the symptoms are gone or after appropriate treatment is begun.

Additional treatments as recommended for:

Condition Treatment

of 24 ______

Physician’s Signature Date

______

Health Director’s Signature Date

HEALTH SERVICE POLICY FOR CAMP HENRY

Refer to State document

A. Staffing: The camp’s health officer will be a licensed registered nurse and will live on the camp grounds. B. Health Office Qualifications

of 24 Physician – Licensed to practice in Michigan & CPR

Registered Nurse – Certified to practice in Michigan & CPR

Practical Nurse – Licensed to practice in Michigan & CPR

EMT – Licensed to practice in Michigan & CPR

Camp Health Officers – An adult with Basic Standard First Aid & CPR

C. Consultation Services:  Camp Henry strives to secure a volunteer health care professional (RN, LPN, PA) to remain on site for each summer camp session. This professional is a resource for the health director.  Pine Medical Group – Dr Richard Boss, 230 West Oak, Fremont, MI 49412, (231) 924- 4200 Newaygo Office, (231)-652-1631  Newaygo Fire Department, 177 Cooperative Center Drive, Newaygo, MI 49337  Gerber Hospital, 212 S. Sullivan, Fremont, MI (231) 924-3300  Life EMS, 33 Westwood, Fremont, MI 49412, (231) 928-5433  State Police Newaygo Post, 360 Adams, Newaygo, MI 49337, (231) 652-1661  Poison Control Central 1-800-222-1222.  911 – will bring emergency personnel (and ambulances) as needed to camp.  A volunteer medical physician, Dr. Richard Boss will review the health plan & standing orders annually. D. Emergency Transportation and Services:  The camp will have the capability to provide emergency transportation utilizing the designated vehicle. The camp has advanced emergency transportation agreements with: Severe emergencies will be transported by ambulance through the "911" response system. Camp Henry is serviced primarily by Life EMS out of Newaygo and the volunteer fire department / EMT service. The Camp Hospital is Gerber Hospital, 212 S. Sullivan, Fremont, MI (231) 924-3300 E. Authorized Person Notification

The Camp Director or the Camp Nurse will make all contacts with a camper’s authorized person(s). Such notifications are to occur as follows:

1. Immediately in the event of death. 2. Immediately following admission to a hospital. 3. The day following an overnight stay in the camp’s infirmary. 4. As directed, in writing, by the camper’s authorized person.

of 24 F. Daily Observations  It is the cabin counselor’s responsibility to be aware, on a daily basis, of each camper’s physical state. Any changes in appearance, appetite, activity level, or health habits hare to be reported to the Camp Nurse.

G. Screening of Campers A camper shall be screened at the time of Camper Registration. The health screening shall include all of the following:  The checking in of prescription and non-prescription drugs and medications.  A review of the camper’s health history.  A discussion with the camper concerning current health needs.  An observation of the camper’s physical state, paying particular attention to potential contagious diseases and possible abuse or neglect. Any and all unusual physical condition will be logged. H. Supplies and Equipment:  Inventory attached. I. Drug and Medicine Storage and Administration:  All camper and staff medications and drugs must be turned into the Camp Nurse. Medications must be clearly marked. The Camp Nurse is responsible for keeping all medications and drugs under locked storage. The nurses will bring meds to the campers during meal times. Counselors may see nurses for their medications. J. Follow Up  A Camp Nurse will return all medications at check out and check at that time for any continuing problems that should be taken care of once home. Parents will be able to talk to a Camp Nurse if there is anything they need to know. K. Preventing Disease Transmission  Staff with primary health care responsibilities will know and follow the proper procedures for handling injuries, cleanup of spills, and for sanitizing the facility and equipment. L. Field Trips  Camp Sunshine does not do field trips on a regular basis. M. Standing Orders See attached