Wilderness and Environmental Medicine, 15, 274 283 (2004)
Camp Health Services in the State of Michigan
Edward A. Walton, MD; Ronald F. Maio, MS, DO; Elizabeth M. Hill, PhD
From the Departments of Emergency Medicine (Drs Walton and Maio) and Pediatrics (Dr Walton) and the Injury Research Center (Drs
Walton, Maio, and Hill), University of Michigan, Ann Arbor, MI; and the Department of Psychology, University of Detroit Mercy, Detroit,
MI (Dr Hill).
Context.--Every summer, 10 million campers attend summer camp in the United States. In Mich-
igan, each camp is required to have a camp health officer (CHO) on-site.
Objective.--To document the medical training, local emergency medical services and physician
support, and off-camp medical facility use of CHOs.
Design.--Anonymous institutional review boardapproved mail survey of all Michigan CHOs dur-
ing the summer of 2001.
Results.--A total of 129 responses (50% response rate). Forty-seven percent of the CHOs reported
caring for campers with significant medical needs. Almost half (45%) of the CHOs were registered
nurses; however, 44% of the CHOs had paramedic training or less. Forty percent reported an ambu-
lance response time of more than 10 minutes. Nearly all (97%) reported having a physician who
reviewed their standing orders, and yet 75% reported using an acute care facility (emergency depart-
ment or urgent care) more than half of the time for medical care not on-site. The CHOs reported that
a small or rural hospital was the ambulance-receiving hospital 71% of the time. Two of the camps
that responded have an automatic external defibrillator, and 22% are planning to buy one.
Conclusions.--In Michigan, CHOs have limited training, tend to use emergency department or
urgent care facilities as their medical backup, and, in some instances, have prolonged times to defin-
itive care. This preliminary study shows some of the opportunities that exist to improve health care
for campers on a local and national level.
Key words: camping, recreation, child, adolescent, questionnaires, delivery of health care
Summer camp is an extremely popular activity for chil-
dren. For 140 years, parents have been sending their
children to rural settings to provide for a break from
their familiar routine.
Every year, approximately 10
million children attend camp, supported by 1.2 million
Interest in camp has been increasing,
with an annual rate of growth in the industry of 8% to
10% per year.
Campers include both well children and
children with special needs, such as those having dia-
betes, cancer, human immunodeficiency virus, physical
disabilities, and a myriad of other medical problems.
The goals of camp include improving skills, increasing
independence, making friends, experiencing a new en-
vironment, being exposed to positive role models, and
most importantly, having fun.
Research has shown that
summer camps have a lasting effect on self-esteem.
Corresponding author: Edward A. Walton, MD, Department of
Emergency Medicine, TC B1380, 1500 E Medical Center Dr, Ann
Arbor, MI 48109-0305 (e-mail: firstname.lastname@example.org).
The health and safety of campers is an understudied
area. The legislative control for camp licensing falls to
the states. In 1989, the General Accounting Office
(GAO) was asked to report on existing regulations re-
garding health and safety at youth camps. The GAO
found a wide variation in state regulations that were re-
lated to camps and little information available on death,
accidents, and illnesses.
The GAO used a set of mini-
mum standards created by the Centers for Disease Con-
trol (CDC) to compare the laws of individual states. The
GAO found that, at best, states met only 65% of the
minimum standards for health and safety at youth camps
set by the CDC and that 26 states met less than 50%.
Approximately 20% of the camps voluntarily apply to
the American Camping Association (ACA) for accredi-
The standards for health care required by the
ACA are more stringent than those required by the states
and include a registered nurse on-site in most instances.
Michigan was cited as one of the states that met at
least 65% of the model standards provided by the CDC.