275
Camp Health Services
A total of 350 000 campers attend camp in the state each
year.
7
Michigan defines a camp as ``a residential expe-
rience in a natural environment where more than 4
school-aged children or adults who require supervision
live apart from their guardians for 5 or more days in a
14 day period.''
8
Camps in Michigan are required to be
licensed and inspected, but ACA accreditation is ac-
cepted in lieu of state inspection.
All licensed camps in Michigan are required to have
a camp health officer (CHO).
8
The minimum training
required of a CHO includes American Red Cross First
Aid, cardiopulmonary resuscitation, and bloodborne
pathogens training.
8
Each camp must have a camp health
policy that is reviewed annually by a consulting physi-
cian, who also agrees to provide medical support.
8
This
policy must include camper health screening, arrange-
ments for on-call consultation and emergency services,
and standing orders, as well as mechanisms for parental
notification and medication administration.
8
Family members entrust the health of their campers to
CHOs, and yet the training and medical support of CHOs
has never, to our knowledge, been studied. The purpose of
our survey was to determine the medical training, the de-
gree of support from local physician and emergency med-
ical services (EMS), and the off-site facility use of CHOs
in Michigan during the summer of 2001.
Methods
This project was reviewed and approved by the institu-
tional review board of the University of Michigan. A list
of all licensed camps in the state of Michigan was ob-
tained from the Department of Consumer and Industry
Services under the Freedom of Information Act. All
CHOs were sent an anonymous, self-administered ques-
tionnaire (Appendix). Return envelopes were provided,
which were labeled with a tracking number. Returned
questionnaires were immediately separated from the re-
turn envelope to maintain anonymity. The response pe-
riod was July 27, 2001, to August 9, 2001. At that time,
a reminder card was sent to all camps to encourage fur-
ther returns.
A questionnaire and cover letter were sent to the
CHOs. The cover letter stated the purpose of the ques-
tionnaire and emphasized that the study was focusing on
the training and medical support of CHOs.
The questionnaire consisted of 3 sections. Section 1
was devoted to determining the medical training of the
CHOs and the types of campers they cared for, whether
well campers or those with special needs. Section 2 re-
lated to medical backup and included questions about
ambulance and hospital backup. It included a section of
Likert scales that addressed their level of confidence in
themselves and their medical backup, with response
codes ranging from 1 to 5 (1
strongly agree, and 5
strongly disagree). Section 3 included demographic
questions about their camp, including size, gender dis-
tribution, location, and duration of camp stay. The sur-
vey was reviewed by camp health professionals, and
modifications were made prior to the distribution of the
final version.
Descriptive statistics (means, SDs, percentages, and
95% CIs) were calculated. Additional analyses compared
the CHOs by 2 training levels: those with licensed prac-
tical nurse (LPN) training or greater (level 1) and those
who had emergency medical technician--paramedic
training or less as defined by the National Highway Traf-
fic Safety Administration
9
(level 2). An overall ``comfort
score'' was also created by combining the 5 confidence
ratings, resulting in a minimum score of 5 (strongly
agree with all questions) and a maximum score of 25
(strongly disagree with all questions). Bivariate analyses
included z and t tests. Statistical analyses used Microsoft
Excel 2002 and SAS version 8 software.
To determine whether the sample was representative
of the Michigan population, several characteristics were
compared by using the tracking number of the camps
that responded. Along with tracking numbers and ad-
dresses, the state of Michigan provided information
about 2 variables for each camp. These variables were
whether the camp was winterized and whether it was
available for rent to outside groups. Thus, for the entire
population of Michigan camps, percentages for these 2
measures could be calculated and then compared with
those of the survey sample. Unfortunately, more infor-
mative characteristics, such as the average size of the
camp or the age of the camper, were not available for
the population as a whole.
Results
CHARACTERISTICS OF THE SAMPLE
A total of 258 surveys were mailed to all licensed camps
in the state of Michigan. Three were returned as unde-
liverable. A total of 129 surveys were returned com-
pleted, giving a response rate of 50%. All of these com-
pleted surveys were included in the analysis.
Camps varied in size from 20 campers to 1500 camp-
ers, with a mean of 162 and a median of 110 campers
present. A camp was defined as single sex if it had more
than 90% of one sex of campers. Thirteen percent of
camps were boys only, 10% were girls only, and the
remaining 77% were co-ed.
Campers stayed from 1 day to 9 weeks, with a mean
stay of 17 days and a median stay of 7.5 days. The mean
