Staying Healthy

Contents Safety & Quality Guide
Part of Safety & Quality - Part 1: Policies & Procedures
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Systemic Allergies

Systemic-level allergies are on the rise. A student may not even know they are allergic. Anaphylaxis due to a systemic allergic reaction is a heart-wrenching trauma to deal with. It is a horrific feeling to be unable to breathe. Our duty is to mitigate situations that could lead to systemic allergic reactions and to be prepared with proper emergency measures.

Prevention Tools

Review rosters: Triple check. Caring for any student means careful review of medical information ahead of time, especially pertaining to allergies.
Check in with participant or guardian at drop-off to make sure nothing was left off form.
If anything is questionable, unclear or sounds severe, check in with your Coordinator, who may contact guardian prior to program for clarification.
As soon as possible (ideally during Check-In), discreetly encourage the student to report an allergic reaction that may be starting, even if it is only a suspicion and not yet visible. Never let them withdraw and keep a reaction to themselves. Let them know that as a teacher you are there to help them.

Epinephrine

Epinephrine is a temporary treatment for anaphylaxis.

Students with known allergies may carry their own epinephrine dose.
In states where regulations allow, a minimum of one teacher on site (preferably the Coordinator) should be carrying epinephrine and trained in its use. This person should be reachable within 2 minutes at all.
Even if you do not have an epinephrine injector for your first aid kit, get proper training if you have to assist a student with their personal medication.
Administration of epinephrine is done with timely and thoughtful assessment based on proper training protocols.
Call 911. Epinephrine treatment is a stopgap measure, it may slow down but it will not stop the allergic systemic reaction. After this emergency treatment, the patient must be taken to proper medical care immediately.

Personal Student Medications

Students often carry personal medications for systemic allergies, such as an inhaler or epinephrine. They may also carry medications for other personal health needs, including vitamins. Make sure students understand these personal medication protocols:

Each program day during morning Check-In (of day programs), assure the medication is labeled well (date and student’s full name), packed in a waterproof container and you clearly identify where it is in the student’s gear.
Insure the remains immediately accessible to the student (on their person) at all times: especially emergency medication such as epinephrine and asthma inhalers.
Monitor to assure other students do not have access to the medication.
If a parent feels their child is unable to properly care for the medication, please work through strategies with your Coordinator and the parent of how to keep the medication immediately accessible.
Medication should ideally be self-administered based on the student’s own experience with their medical needs and under the prescription and advisement of their physician. Yet make sure you have the proper training if a student is unable to administer his or her own epinephrine.
Review rosters: check medical information ahead of time. All allergies must be listed on medical form.
If you find a participant with a severe food allergy, consider contacting other participants to make sure they don’t bring the allergen in their lunch. As always, don’t use names—keep participants’ medical information confidential.
At Check-In, check with parents/participants to make sure no one has packed the offending food product.
Avoid using cooking with tree nuts whenever possible.
Avoid latex whenever possible. Use non-latex gloves in first-aid kits.
No sharing of food that comes from non-camp or non-commercial kitchens. These foods don’t have ingredient lists and may contain dangerous allergens.

Allergens

Avoiding allergens that could lead to a severe reaction begins with reviewing rosters and medical information. It is up to the Coordinator to enact a strategy of accommodation given that the capacity to eliminate certain allergens is relative. For example, in a seafood foraging camp we cannot avoid shellfish, but in an archery camp this is reasonable need to accommodate. Here are some prevention strategies:

Insects & Blood Suckers

Paying attention is the best strategy for preventing insect stings. Use your Whiskers to stay aware of insects flying out of wood debris, the ground, stumps, and hidden areas. You can gauge how attuned a teacher is to both their natural environment and their students based on how successful they are at avoiding stings. Here are some prevention strategies:

Do a site assessment to identify insect risk, especially looking for nests.
Be vigilant of insects flying out of the ground or logs, as that indicates a hidden nest.
Be even more cautious in warm weather.
When going off-trail, lead the way for participants so you can scout ahead. Set a policy with group of “teacher goes first.”
Review how to act around insects: calm and controlled.
Empower your students through conversation.
- Tell relevant stories to illustrate need for caution. Cultivate healthy paranoia.
- Ask, “Who has been stung before and what happened?”
- Explain how to recognize hidden nests, especially when hiking off-trail.

If you discover a nest of stinging insects, follow these steps:

Flag or mark the hazard (e.g. with a bandana).
Inform your Coordinator of the hazard location and how you flagged it.
Coordinators will relay that information to other groups currently on-site. They will also mark the hazard with tape and return your flag to you.
The hazard should be marked on a map for other Teachers who may use that site in the future.

If a student(s) are stung:

Get them and other students away from any immediate danger.
Immediately call your coordinator or closest individual carrying an epinephrine injector to the area. This person should swiftly move to the site.
Monitor for symptoms of anaphylaxis.
Quickly review allergy history and pinpoint location epinephrine injectors of students who carry it.
If anaphylactic symptoms onset call 911 and take proper emergency procedures. See Epinephrine Injector.
Keep all students calm, comfortable, and in good humor.
Remember to consistently check-in with every student in case they did not report or initially feel they got a sting.

Blood-Suckers

Ticks and other blood-sucking creatures can be vectors for serious diseases. Mosquitoes cause more deaths each year than any other animal on the planet. They are more prevalent in certain regions. It is up to the Coordinator to determine the risk and what protocols are necessary.

In areas known for ticks, have students perform regular tick checks. See Tick Protocol.
If a tick is found on a student:
- Notify the Coordinator, who will decide if it is necessary to notify parents so they can perform their own tick checks on returning students.
- Remove only with approved tools and techniques.
- File an Incident Report.

Snakes, Spiders & Othe r Hazards

Many bites of different animals can be dangerous or carry disease:

Know the area you are traveling and how best to avoid the hazard.
Carry and train on whatever first aid tools are available relative to the hazard.

Hydration: Drinking Water

Staying hydrated prevents countless health concerns. If someone is feeling low, keep them hydrated. If they are sick, keep them hydrated. If they are grumpy, keep them hydrated. Yes, it’s mind-blowing that not only will you have to remind kids (and adults) to drink water, but that sometimes they will fight you on it.

Under no circumstances are sports drinks or soda a substitute for water. Kids often try to avoid drinking plain water because they are not used to it. Encourage them drink it—it’s part of survival. Lead by example—drink plenty of water yourself.

Remember Everyone must drink water frequently and with enthusiasm.

Guidelines for helping students stay hydrated:

Provide ample and set times to check and fill up water bottles.
Schedule water breaks into your program—it’s a great opportunity for a Head Count.
Two teachers should work together to ensure everyone is drinking enough water: One teacher gathers participants together for water breaks. The other teacher makes sure they actually drink the water.
Watch out for fakers! You will be amazed by many kids fake drinking water to avoid it! Make sure every student finishes at least one water bottle by the end of the day.
Refusing to drink water is a safety concern. If it’s a youth participant, address it with parents at Check-Out. If it’s an adult participant, consider dismissing them from the program.
Water bottles should be a minimum of 16 ounces for children.

Remember If traveling, bring water with you. Your site may not have potable water available.

Never let guardians bully you into thinking their child has a choice about drinking water. That is not the case. If you feel like a parent is an obstacle to their child’s proper hydration, involve your Coordinator immediately. You are responsible to make sure your students drink plenty of water throughout the day. A average child needs five to ten 8-ounce glasses of water per day. That’s several large water bottles each day.

Food & Drinking Water Safety

Improper harvest, preparation and storage of food and water can cause serious illness. Even minor unsanitary conditions during food preparation and handling is unacceptable. Here’s the bottom line: if you think you’re food safe, think again. For example, if more than one student vomits during a program, the food, water and practices will be immediately called into question. The Health Department will likely send a representative out. Having procedures in place and enforced is a must

The Big 3 Rules of Food & Drinking Water Safety

Follow all local food handling and preparation regulations and health laws. See Staff Qualifications for Food Handlers Permit.
Only drink and serve potable water! Know your filtration, quality, and treating requirements. Have water tested if it’s a well or you are unsure.
All staff preparing and serving meals must have a current food handler’s card and, more importantly, actual competency and respect for proper food handling techniques.

Hand Washing

One of the best ways to prevent food- or waterborne illness is by thoroughly washing hands. All staff are required to wash hands in the following situations:

Before starting work.
Before putting on single service gloves.
After touching raw, fresh or frozen beef, poultry, fish, or meat.
After mopping, sweeping, or removing garbage.
After using the telephone.
After using the bathroom.
After eating, drinking, or smoking.
After touching anything that might result in hand contamination.
Double wash after sneezing or coughing.

Safe Drinking Water

All water at sites must meet potable standards and health regulations.
All water in wilderness sites must be appropriately treated and/or filtered.
Do not drink from taps or hoses that are not certified as potable.

Preparing & Serving Meals

All staff helping to prepare and serve meals must have a current foodhandler’s card.
Copies of all food handler’s card should be kept on file, on-site.
All staff must reread seasonally the food handler’s regulations manual.
All meat must be thoroughly cooked to proper USDA-recommended temperature (use meat thermometer).
Immediately dispose of any food with the slightest sign of spoilage.
Surfaces and utensils must be cleaned properly and consistently.

Food Storage

The kitchen must be “buttoned up” tightly. No Scrappy Junk!
Refrigeration must be adequately maintained.
Food storage areas must be cleaned once a week or as needed.
When storing food in coolers with ice:
- Use only block ice.
- Store all raw meat in a separate meat cooler away from other food.
- Always store coolers in the shade.
- Drain coolers every day.
- Change ice every 1-3 days, depending on outside temperatures.
Leftovers must be cooled quickly and tossed out within one day.
Food storage, especially in wild areas, must be monitored to prevent vermin access.

Scrappy Junk Scrappy Junk is any material lying around with no defined human or purpose. Everything should have a place. Make sure Scrappy Junk finds a home!

Bathroom Breaks

Like hydration, restroom breaks are essential. Younger students may soil themselves if they do not have proper opportunities for relief. This severely detracts from their camp experience. There are also safety issues around restroom use, including problems with older students or bullies sharing the restroom with more reserved students; or even the concern of stranger danger when relieving out of doors or in public restrooms. Camps have been sued because of claims of abuse in restrooms.

Restroom Rules

Restrooms are one of the few places we do not visually observe our students. Follow these guidelines for safest practices:

Schedule enough time for restroom breaks. Don’t fall behind because you had an emergency potty stop! Ask kids to be expedient out of respect for those waiting.
Ask every 2 hours (or more frequently) who needs restroom breaks.
Use the restroom whenever boarding for a trip in a vehicle.
Bring Truddies to the restroom.
Do not go into the restroom with the student. If an emergency requires it, take a fellow staff person or two other students.
Only send students of the same age group into restroom facilities together. Wait outside the door and listen for trouble.
Be aware if a child is not using the restroom. They may do this out of fear of strange facilities. Encourage them discreetly. Talk with parents or your Coordinator about the issue later.
Prioritize safety and privacy, not gender segregation. Provide options: “This is the girls’ restroom. This is the boys’ restroom. This is a restroom anyone can use.”

Public Restrooms

Public restroom facilities have the added issue of stranger danger. Do your best to keep your kids separate from the public while using public facilities.

If it’s a multi-toilet facility, scout the restroom to be sure no one is occupying it and for other safety concerns before sending kids in. If someone is there, wait for them to leave.
Wait outside the door to ensure the kids have privacy.
If a civilian (member of the public) needs to use the restroom, request with good humor that they please wait and explain why. Encourage your kids to move more quickly out of respect.
If the civilian insists on using the facilities, do not prevent them fromdoing so.
If it’s your gender restroom, go inside and observe until civilian leaves. Be cool, don’t make it awkward.
If it’s not your gender restroom, send student in with a Truddy, if possible.
If it’s not your gender restroom and no student is available, continually talk to the student using the restroom. You can “observe” in this way.
If there’s no way to avoid going into a restroom, insist that students wait near the sinks with you until other students are finished. Exit restroom as a group.
If you cannot go into the restroom with a student, putting your foot in the door to create an Open Space is a good alternative.

Wild Potty

At certain wilderness sites it is necessary to go to the restroom out in the woods. Know the regulations of the site you visit. For many kids, going to the restroom in the wilderness is a new skill and even a rite of passage. Some have never gone to the restroom outside before and may be afraid. It’s up to you to alleviate those concerns. Be aware of stranger danger. Follow these guideline when going to the restroom in the great outdoors:

Explain to students that they may need to go to the restroom in the great outdoors: by a tree, behind a bush or in a cathole (see below).
Make it a humorous discussion, but keep it appropriate. Laughter can alleviate concerns. Be inspiring and give real techniques (see below).
When a child needs to go, have two other students go with them to make a Truddy. Be careful not to send a big group off to pee together. That can be messy and inappropriate.
Find a place just off-trail with plenty of cover.
- Make sure it’s at least 100 feet away from water.
- Scout area for poison oak, stinging insects and anything else that could be suspect (needles, garbage, etc.).
- Ensure location is not exposed to other trails where a person can walk up.
Step back to the trail with other two students and give the student specific directions and boundaries on how far to go off-trail and how to maintain privacy (e.g. “Go behind that tree”).
Listen for difficulties and approaching strangers.
Check-in verbally if it seems to be taking too long. Be patient, new skills take time to learn.
If a child is very nervous about peeing on their pants, give them permission to take their pants and underwear off entirely. But not in front of you.
Once the child is finished, have them turn 360 degrees so you can check that they haven’t soiled their clothing. Pay special attention to hands, shoes and seat of pants.
Wash hands, or, at minimum, use hand sanitizer.
Sometimes kids, especially younger ones, are challenged learning this new skill. If you have any problems, get help from your Coordinator.
Staff should avoid using the “wild potty” whenever possible. Students may see you and in many states it’s illegal to “expose yourself” in public even while using the restroom the wilderness. Take extreme care if you have to do it and make sure your presence is known to those around you.

Digging a Cathole

What is a cathole, you ask? It is a way to hide your waste matter, to keep others from being exposed to it. You only need to dig a cathole if you’re going #2.

Find a stick. Use it to dig a hole (deep enough for what you’re leaving behind).
Squat with your bottom over the hole and fire away.
When you’re finished, drop in some organic matter (dead leaves, bark, fir needles, etc).
Cover hole with dirt you originally dug out.
Mark the spot with two sticks forming an X, so that others know not to dig there.

Squatting to Pee in the Woods

This is an outdoor skill that takes practice to perfect. Here are some tips for teaching it successfully:

Clearly explain the steps involved (and we recognize that everyone has their own personal style and tips):
- Find a private spot. Some people think a hill is the easiest spot.
- Pull pants and underwear down below your knees.
- Stance: face uphill with rear downhill, squat with your feet spread beyond shoulder-width. Your bottom should almost be touching

the ground. If available, leaning against a tree or fallen log can help with balance. Or holding onto a low branch.

- Make sure the pee goes under your pants and underwear, not on them.
- Be clear with students that a little “splashback” is normal and okay. Normalize accidents. There should be no shame or worry while learning this skill.
- Do not rush the process or accidents will ensue. Tell students to take their time.
- Emphasize: Practice makes perfect.

Inclement Weather

Being out in the elements is what outdoor education is all about. Yet many participants are more used to life indoors. It is up to us to help them prepare for and acclimatize to inclement weather.

Hot Weather

Sunburn and overheating (or heat stroke) are serious issues in hot weather. People can die quickly from heat stroke. Children and the elderly are especially vulnerable. Sunburns, especially those covering large areas of the body, can lead to serious medical problems both in the short-term (blistering, discomfort) and the long-term (skin cancer). Follow these guidelines to avoid problems with sun and heat:

At drop-off ask parents if they applied sunscreen and if the student has it with them.
Designate one teacher in your group to assure every student applies sunscreen.
Before all outdoor activities, ask participants if they applied sunscreen.
Insist everyone reapplies at lunch or midday. Put this in your schedule.
Verify that every student has applied sunscreen each morning and midday.
Tell participants relevant stories to illustrate need (i.e. horrific third-degree sunburns while wind surfing in Hawaii).
Prevent dehydration: stay hydrated, stay hydrated, stay hydrated.
Lead teacher assures group is staying cool, not getting overheated, and minimizing activity during hottest parts of the day.
On hot days, don’t stage activities in the sun. Do activities in the shade whenever possible.
Know the signs of dehydration, including lethargy, irritability, and even vomiting.

Cold Weather

People can become hypothermic even in mild conditions. Being wet conducts heat away from the body 25 times faster than air. The rule is: Keep students in dry and warm clothing. Effects of cold exposure could range from crankiness to a deadly drop in core body temperature. In cold or wet weather, things can change quickly. Monitor your students for how the cold is affecting their temperament and well-being. Follow these guidelines to avoid problems in cold conditions:

Before going outdoors, gauge participant clothing. Insist they add layers or appropriate clothing as needed.
Check to see that everyone has a change of dry clothes.
Make sure footwear is waterproof and appropriate for weather and terrain.
Bring several changes of warm and dry emergency clothes for each vehicle (sized to participants).
Consistently check in with participants verbally and non-verbally to assess if they are warm enough.
Keep yourself and participants hydrated, even in cold weather. You can still get dehydrated in the cold.
If you start seeing emotional signs of discomfort due to cold, you need to provide not only physical warmth, but emotional warmth as well. Emotional comfort can go a long way to alleviating physical discomfort.
Be on alert for signs of hypothermia.

Hypothermia

If you observe any hypothermia signs (see below), get participant dry and warm ASAP. Remove wet layers and add additional dry layers. Get hot liquids into them immediately.

Don’t forget:

It does not need to be freezing to get hypothermia. Mild wet temperatures can be more dangerous than cold dry temperatures.
Don’t solely focus in on one cold participant. If one student is exhibiting signs of hypothermia, you and all of your students may be in danger of cold injuries.

Signs of Hypothermia

Early stage symptoms may include loss of fine-motor functions and increased emotional volatility. If your student shows early symptoms, take corrective measures (see tips above).
Later stages may include symptoms like shivering, lethargy, and blue lips. If you see any symptoms beyond early stage, immediate action is required. Contact your Coordinator for assistance.

The Umbles

A helpful pneumonic list for identifying the progression of hypothermia. Keep your Whiskers tuned for any of these signs and take action early:

Fumble: loss of fine-motor functions.
Grumble: increased emotional volatility.
Stumble: loss of major-motor functions.
Crumble: emotional breakdown.
Mumble: incoherent speech.
Tumble: inability to stand or move.

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