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Being a Camp Doc

Parul Bhatia, MD and Solomon Behar, MD
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27:35

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Sol and Parul discuss the ins and outs of being a camp physician. There discuss pitfalls both medically and logistically as well as practical advice for anyone wanting to become a camp doc.

 

Pearls:

  • Some common clinical scenarios encountered by a camp physician include anaphylaxis, status asthmaticus, traumatic eye injuries, syncope, heat exhaustion, concussions, small lacerations, fractures, environmental exposures and UTIs.  

  • Camp infirmary support staff generally includes a nurse to assist with triaging, procedures and medication administration.

  • The camp generally covers malpractice insurance for the physician.

 

  • Who can be a camp doctor?  A general pediatrician is capable of being a camp doctor as camp infirmaries are not meant to be emergency rooms or even mini-urgent care centers.  In a sense, they are triage units and set up to care for children minor injuries and routine pediatric triage care.

    • When at camp, the doctor is not considered a PALS provider, simply a BLS provider.  This makes sense in that you would provide basic CPR and know how to call for help, but simply do not have the resources to run a full code.

      • Specifically, many camps do not have access to advanced airway equipment, pulse oximetry, bag/valve mask and/or oxygen.

  • What resources are available to the camp doctor?  Many camps also staff a nurse in the camp clinic.  The nurses assist with medication sorting and distribution, in addition to some of the triaging.  The camp usually has a contract with a pharmacy or an account in which you can call in common medications.  For example, you may order azithromycin and aerochambers, even though not for a specific patient, you want to have that on hand in the camp clinic.  Additionally, the camp provides emergency transport to the local ED for orthopedic care and/or any other medical emergencies.  The MD generally can not leave the camp site, and thus, ED transport is already set up if needed.  Often, emergency transport works like a well oiled machine and is handled by the camp after the doctor deems it necessary.  

  • How are specific medical conditions addressed?

    • Anaphylaxis:  Epi pens are always stocked in the camp infirmary and any child with a known allergy who travels off site, brings his/her emergency equipment.

    • Status Asthmaticus:  As stated, there is no pulse oximetry.  If a child looks like he/she may have mild hypoxemia and/or increased work of breathing than that child should go to the ED.  

    • Traumatic eye injuries: Again, these patients should be treated in the ED.

    • Syncope and Heat Exhaustion:  As the camp doctor, it is important to remind the entire camp staff to be aggressive with hydration.

    • Concussions:  A camp doctor should be up to date on the concussion guidelines and return to play criteria.  Any camper with a suspected concussion should be excluded from activity for at least 24 hours and then reassessed.

      • While of the utmost importance to enforce, be prepared for potential pushback from the family as they have paid money to have their child engage in camp activities.

    • Small lacerations: The camp doctor can use Dermabond, if available, or use the hair apposition technique (HAT) to close the wound.  HAT involves separating the strands of hair on either side of the laceration and tying the pieces together until the wound is closed.  If Dermabond is available, you can Dermabond over those knots.

      • Suture material and anesthetic, such as lidocaine/epinephrine/tetracaine (LET) might be available.  If comfortable, suturing on non-cosmetic places could be done in the camp infirmary.      

    • Fractures or suspected fractures:  Splinting material is available and often, a child can be splinted and then sent to the ED for xrays and further orthopedic care.

    • Toxic plants: It is a good idea to be familiar with the local flora and which, if any, toxic plants a camper may encounter.  

    • UTI: Many camp infirmaries will stock urine dipsticks.  If the camp does not, you could bring your own.  Generally, if suspected, a UTI is treated with antibiotics that are pre-stocked in the infirmary.  

  • What about routine medication administration?  Each camper comes with their medication and a form filled out with the administration instructions, the rational and the potential side effects of that medication.  The nurse and other infirmary staff will help ensure this is well organized.

    • If a child is going off site, their routine and emergency meds such as inhalers, antihistamines and/or epi pens are taken with them.

    • Some families do not want certain routine medications, such as diphenhydramine or acetaminophen given to their children.  This should be specified before the camp session and available to the camp doctor.

    • The camp will provide

  • What about documentation?  As is good practice, all encounters should be documented.  Many camps do not have EMR, and handwritten notes are still the norm.

Editor’s note: There are actually statements relating to HIPPA compliance and camp documentation.  More can be found here.    

  • What equipment do you bring with you?  Although the camp might have one, bringing your own otoscope, ophthalmoscope, stethoscope and/or blood pressure cuff might be valuable.  

What about malpractice insurance?  The camp should cover the doctor’s malpractice insurance for that time at camp.  It is good practice to review the policy the camp has and know your limits and coverage.

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Unhappy Campers Full episode audio for MD edition 185:03 min - 87 MB - M4AHippo Peds RAP June 2017 Summary 319 KB - PDF

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