‘A Large Amount of Trauma’: Camp Doctors Fix More Than Cuts

This discussion was recorded on August 23, 2024. This transcript has been edited for clarity. 
Robert D. Glatter, MD: Hi. I’m Dr Robert Glatter, medical advisor for Medscape Emergency Medicine. 
Joining me today to discuss the common conditions and skill set required to serve as an overnight summer camp doctor is Dr Peter Antevy, a pediatric emergency physician and medical director at Coral Springs-Parkland Fire Department in Palm Beach County, Florida. Also joining me is Dr Matt Harris, a pediatric emergency physician with Northwell Health in New York. 
Welcome to both of you.
One of the great summertime adventures of so many children and teens is going to summer camp.Both of you have served as camp physicians, and I want to get into the mechanics of what it requires because many people think any kind of physician can do this, but it’s not true.
Pete, I’ll start with you. Tell me about your experience. How long have you been doing it? What are the common conditions you’ve seen over the years you’ve been serving as a camp physician? 
Peter M. Antevy, MD: Thanks, Rob. When I grew up, my parents couldn’t afford camp, so this is nice for me to go and be a camp doctor. 
It’s a sleepaway camp up in the Northeast. I’ve been doing it for 8 years, and I have three boys who have gone through the camp. One of them is still a camper, so I still have a few years left. The camp has about 400 children and there’s about 200-250 staff, so you’re dealing with many people. There is one doctor per week, and oftentimes, camp lasts 8 weeks, so they have to get eight different doctors to cover the entire camp season.
The types of things we see are as if you were working in a pediatric urgent care. You see a large amount of trauma. We have a skate park, basketball, swimming, and speck fishing on the lake where they’re jumping on and off a dock. There’s a small craft, there’s [water]-skiing, there’s wakeboarding. You can imagine that there are typical head injuries, concussions, many lacerations, and abrasions. Kids have lost their teeth because things have hit them in the mouth, and we see many rashes. 
Because you have kids coming from across the world and many counselors coming from Australia and the UK, invariably, people are bringing in their illnesses. Every year, that illness just spreads through camp. For weeks, it seems you’re dealing with cough and cold and flu, and it just seems like at the clinic is a rotating door of kids coming in and out, and it’s very busy. I’d love to hear what Matt has to say as well. 
Glatter: Matt, please go ahead. I’d love to hear your experience as well.
Matthew I. Harris, MD: I’d echo much of what Pete said. A great deal of this can be sort of “mom and dad care.” We always tell the counselors before you come to the clinic, what would you be doing at home with this kid? There are cuts and scrapes, runny noses and coughs, and early in the summer, a large number of allergy symptoms. 
Kids are coming up to the country after living in the city all year. It’s a great opportunity to think about your differential for cough. Is this infectious? Is this allergic? We have this term at camp called “camp crud.” There’s something always running around camp. 
I think Pete hit on some of the really interesting challenges. These are the same things that walk into urgent care and the pediatric emergency department (ED), and you don’t have the full arsenal of tools you would otherwise have. You certainly don’t want to start sending kids unnecessarily out of camp for care, not just because they’re going to miss camp but also because it’s difficult to find the high-quality care that you want. Many of these camps are in very remote environments, so the access to pediatric subspecialty services, even pediatric EDs, is really hard.
One of the wonderful challenges is using your clinical intuition. Many of the rules that seem so academic to us in training about concussions or how to decide who needs an ankle x-ray, you really get to practice these in real time. I felt this was a really wonderful academic opportunity to use this information that perhaps falls to the wayside when you have all the tools in the typical ED or urgent care at your disposal. 
Glatter: Let me ask both of you, what do you keep? What kind of instruments? What’s your toolkit look like? How is it set up?
Antevy: I’ll start. Obviously, everyone has a stethoscope, an otoscope, and a flashlight. Those are the important ones. We have the big cabinet of every over-the-counter medicine and then all the creams that you would need for all these rashes. Then there’s a “trauma section,” if you will, with all the bandages, Coban, splints, and so on. 
Based on some things that I’ve experienced and based on some stories that you hear at other camps, in the past couple of years I loaded up with some higher-end things (an intravenous [IV] kit, IV fluids, some airway adjuncts, airway supplies) just in case. You do hear about those kids who have drowning issues at some of these camps, and you always want to be prepared for that. 
As Matt alluded to, we’re pretty remote. Even if I call 911, which I have on certain occasions, because of where we’re located, they’re not going to come for maybe 15-20 minutes and it’s a basic life support crew. Then the advanced life support medic comes 30 minutes after that. I decided to go a little higher. I actually have all the suturing equipment. I brought that with me as well. 
There are kids who get eye issues, so you want to have fluorescein. You want to be able to check for any corneal abrasions. 
The prescription medicine cabinet is highly used. If I’m going to start somebody on antibiotics for strep throat or what have you, I have that first dose ready. I’m also carrying ondansetron. I have many steroids on board in case I need to use those — and I did quite a bit. There are many allergies, like Matt had mentioned, so you really have to have a nice complement of that. 
The camp that I specifically work for is well staffed. I have nurses who are incredible and I’m there just to help the overall camp see that many patients each and every day. 
Harris: Yeah, our camp is pretty similar in how we stock things as to what Dr Antevy was saying. 
One of the things to consider is that although we bring much of this to camp, we have to match the resources to the skill set of the pediatricians and other physicians who are coming. We have suture equipment, we have things to help with orthopedic injuries, but the reality is that we have a wide variety of the types of physicians who come to camp, many of whom have been the camp physician for many years and are quite talented. We have pediatricians and adult emergency medicine physicians, a pediatric emergency medicine physician, and also some internists. There is a family medicine physician who has been doing this for many years, but that skillset is somewhat different. 
One of the interesting challenges is, how do we decide what the par level of care can and should be? Part of that is the comfort level, but I think Pete brought up a really important point. We heard a story (not from our camp, thank goodness) from a camp farther upstate that had a young man with commotio cordis who was struck on the chest and went into cardiac arrest. Because they had multiple automated external defibrillators at the camp, multiple go-bags with first-line medications, and area equipment, that child is alive and well today. 
Those are the “never events,” right? Ninety-nine percent of what we see are rashes, upper respiratory infection symptoms, coughs and scrapes, and whether you need or don’t need an x-ray. One of the things I’ve really enjoyed this summer is helping build the capacity at our camp to respond to those very, very few emergencies. 
Like Pete, we called 911 perhaps three times over the summer. One was for pretty significant sepsis and hypotension — for which, thank goodness, we had IV fluids because it was 35 minutes before emergency medical services (EMS) got there. We are bound to think about what is common, and then really responsible for what is that one out of the 600 people that we care for over the course of the summer between staff and campers that could have that life-threatening emergency — anaphylaxis, significant trauma, drowning, and so forth. I think we’re very much in lockstep.
Glatter: In terms of airway equipment, do you keep a glide scope available, intubation medications, and all the standard things? 
Harris: I think what we decided to do, and again, recognizing that the skill set is variable among our providers, you know, one of the things that may be a tangent to this is everyone has to have a recent pediatric advanced life support certificate. 
Now, there are many in our field, emergency medicine, and pediatric critical care who do recognize that these are often somewhat considered like a merit badge course. For the general pediatrician who maybe hasn’t been part of a resuscitation in many years, or the family medicine doc, or our emergency medicine colleagues, who are increasingly becoming more subspecialized into the adult world unless they work in the community, having that skill set and refreshing it is important. 
We had bag-valve masks around the camp and in the clinic. We brought supraglottic devices because I think there’s a strong amount of evidence. Pete and I both work in the EMS world, and I think both of us recognize that the first-pass success rates, even for a novice user for a supraglottic device, is much higher than any attempt at intubation. Knock on wood here that we did not have to use any of it, but it’s there. 
One of the other things I’ll mention is that we are talking about some degree of simulation next summer. Not the high-fidelity computer feedback, but bringing some old-fashioned dummies to camp and running a simulation down by the waterfront, going to the ropes course, and walking through what’s common (eg, anaphylaxis, drowning, and head trauma). I think that equipment should match our needs as well. 
Antevy: I would say that at a baseline, there should be a go-bag. Whoever’s working, whether you’re a gastrointestinal doctor, a pediatrician, or internist, you ought to know every piece of equipment in that go-bag and you should probably know how to use it. 
I would always recommend coming in a little early to the camp if it’s your first time there, meeting the people, and understanding what their skill sets are. As Matt said, it’s also important to do some sort of simulation. It doesn’t have to be high-fidelity simulation. 
Then I make it a point of speaking to every single counselor. We put them all into a room and we go over some of the basics. 
We haven’t discussed this yet, but many of these kids have their own medications. Many of them carry EpiPens. There are now many intranasal seizure medications, such as Valtoco (diazepam). These kids have bags, and we coach them to put their rescue meds in the bags. For example, I have a child who’s diabetic, and he has his Baqsimi (nasal glucagon). Everyone knows that child exists, what their issue is, and where to find their rescue medication.
There are some basic things that could be done.We have the supraglottic airway devices, but I have video laryngoscopy with disposable blades. I carry that with me, but I’m the only person probably who does that in the camp that I go to. These are “never events” until it happens to you. That’s why I think that we ought to take these types of things seriously as the physician managing this number of people. 
Harris: Also to keep in mind are two points, and they’re somewhat in different directions. The first is, leverage the fact that there are other people in camp who have some degree of experience as well. All of the lifeguards are certified in cardiopulmonary resuscitation (CPR). [We’ve developed] a mechanism that, if somebody goes down in camp somewhere, I might be a mile away at the clinic, but the lifeguards are pretty darn close. All of the ropes course people are trained in CPR and first aid as well.
On a more benign course, one of the things we decided this summer, which they hadn’t done in a while, is [to find out] how to reduce the number of kids who come to the clinic for bumps and scrapes and things that don’t really need to be seen. Again, the clinic is a place where people are coughing and have a fever. We started putting simple things like calamine lotion in the bunk — I can’t tell you how many kids come to the clinic, and we have to write a full chart note just to put on some calamine lotion, bacitracin, and Band-Aids. Certainly, we don’t want anyone sitting there giving themselves home meds, but I think there’s also a recognition that some of these things are okay. 
We also worked closely with the camp. We were seeing tons of kids for dehydration. It was really hot, so we bought some fans with misters for the camp, kind of like on the side of a football field. We put Gatorade and ice packs around camp in different places. 
On the less malignant side of the world, helping keep kids in camp and away from the clinic is just as important as the conversation of reducing unnecessary ED-to-ED transfers — trying to keep kids back where they’re supposed to be.
Glatter: With climate change and heat-related illnesses increasing, parents are concerned about taking breaks and certainly hydration. Have either of you had any significant heat-related illnesses come up such that you had a transfer patient?
Antevy: We haven’t really had that issue. On very hot days, the camp does a wonderful job of pushing fluids. If you don’t have a water bottle, they say, “Hey, where’s your water bottle?” It’s a very big thing at our camp. Thankfully, we haven’t had an issue with that.
Harris: We certainly had days where our resting room, which is a room in the clinic that does not allow febrile patients into it, definitely filled up until we discussed some of those mitigation strategies with the camp. They were quite responsive to getting things out quicker. Water bottles, Gatorade around camp, ice packs, and misters. I agree. It wasn’t an issue, but I also think it’s something we’re going to pay increasing attention to. 
Glatter: How about in terms of infectious disease outbreaks? Have either of you had any infectious disease issues that you’ve had to scale up in terms of getting additional help or transferring children out?
Antevy: With us, strep is common. Once that first strep case comes in, you’ll tend to see it continue. We isolate the child for at least 24 hours, we start some antibiotics, and so on. 
The other common one is methicillin-resistant Staphylococcus aureus (MRSA). Once you see some kids with MRSA, you see many kids with MRSA. The camp has done a great job this year of starting a towel service where they used to have the kids bring their own towels. Once I got rid of that, this past year, it was much reduced. 
Then the last one is when we had COVID-19 — and we’re talking about the height of COVID-19. One year, the camp was shut down, but when we came back the following year, everyone was still concerned about it. We had all the testing capabilities, and we would test people before they even arrived at the camp. 
You have to be able to scale up if you know that there’s an issue. You also have to be scaled up if you’re at the camp and something happens unexpectedly during that camp season. You have to have some mitigation strategies and plan ahead what you’re going to do, where you’re going to put some kids if you have to isolate them, or send them home completely from the camp, which we have done in the past. 
Glatter: Certainly, this summer has been challenging with COVID-19 spreading throughout the country. Did either of you have any issues in that capacity? Matt, I’ll let you go. 
Harris: Testing is really an interesting question at camp because most of us know that the majority of viruses that go around are clearly communicable, but also relatively benign — eg, fever and cough for a couple of days. There are many enteroviruses during the summer.
Similar to Pete, we will isolate people until they’re fever-free for 24 hours. It’s sort of a rule of thumb that if you’re febrile for more than 3 days, you’re going home because at that point we want to minimize the impact on the campers in their bunk. 
It’s also pretty miserable to be in the clinic even though it’s air conditioned, which all the kids love, and we have TV for them to watch. It’s not how they want to spend their summer. Often, if it’s feasible after 3 days, they go home.
Now, I will say that our camp, like many camps in our region, had an outbreak of pertussis toward the end of the summer, which is not something we had thought about ahead of time. Though I think Pete’s point is important, in that we had discussed ahead of time mitigation strategies for COVID-19. The infrastructure and some of that muscle memory was there. 
I do think it’s an important opportunity for us as camp physicians physician leaders to think about our reporting responsibilities. How do we leverage testing that’s not traditional, such as for COVID-19 or flu? How do you partner with local pharmacies? Especially near us, where there are only two or three pharmacies in the area. If you need to have them for even more benign things — for example we have an outbreak of impetigo almost every year, where it just spreads through the bunk like wildfire. It was certainly an interesting part of our camp, and we were proud to say that we were able to successfully mitigate it. We know of several other camps in the area that really have large numbers of kids. 
I should say that at our camp — and this is a decision made by leadership — you must be fully vaccinated to come to camp. There are some discussions about COVID-19, but all other vaccines are mandatory. If you’re not vaccinated, we come up with recommendations for your camper for an alternative location for the summer. 
I will say that this was an interesting, unexpected challenge, but because we had talked about mitigation strategies ahead of time, it was something we were able to do. It took some time to stand up, but we were able to do it. 
Glatter: In terms of mental health, that certainly is at the forefront of many parents’ concerns, and the campers’, for that matter. Many are taking medication or psychiatric medicines that are affected by the heat, but also stimulants and so forth. What are your procedures and protocols in each camp that you’re with? 
Antevy: This is a fascinating topic.It just seems to me that the kids every single year are having a tougher time from an emotional well-being perspective. So much so that the camp I’m at has done a fantastic job of having someone on the boys side and on the girls side who really focuses specifically on those kids who may need more help, especially in the beginning. Obviously, the first couple of days or the first week are tough for some children.
Rob, as you mentioned, many children are on antianxiety medication. If you’re not attuned to this, and the camp staff doesn’t understand how to manage it or have the right personnel in place, it can be challenging. Often, it’s not the doctor or nurse who handles these issues, as their focus is more on acute medical care. There have to be people across the camp who are very in tune with these children, and you almost have to know that individual item about that kid. Over the years, what’s nice is that you know these kids, and if the camp is very sturdy in their staff and the staff comes back year after year, you find the transition from week 1 into week 2 until you’re finally home free to be much smoother.
Harris: Our camp has a very strong “camper care group.” It includes a couple of psychologists because we know that the incidence of behavioral health disorders is increasing in both our campers and our counselors. Their care needs to continue, especially for what could be a big stressor for them, leaving their home environments for 2 months.
We see the same type of stressors in camp as we see in schools. Not all the campers always get along. Maybe there’s some bullying, someone you don’t get along with, or some degree of embarrassment. These are common things for adolescents and younger kids to deal with every day, but now they don’t have their parents and they don’t have their home environment.
One of the more ubiquitously used electronic records is Campminder, I think Dr Antevy’s camp uses that as well. One of the nice things about this (and I certainly have no stake in the Campminder business) is that you can see the notes from other parts of camp. While our medical notes are protected for HIPAA reasons, the physicians can see the camper care notes and if there’s someone who’s a concern. 
I’ll also say that what’s been nice is the collaboration. I imagine this happens at Dr Antevy’s camp as well, in that we met weekly with the camper care group. Who were you worried about? We would bring up some campers to them and say, “We’ve seen So-and-So every day for the past 7 days, and we’ve had a very reassuring exam. We’ve spoken to the parents. Maybe it’s time to think if this is something less organic and something that needs to be dealt with on more of a psychosocial level.” 
For the more benign things like “I miss Mom and Dad” to, ” I’m struggling because I’m on a new medication and I don’t like how it makes me feel,” I think that the collaboration between these groups, just like in our other clinical settings, is really important. 
Antevy: I had mentioned earlier that there are many staff that are not United States–based. They come from the United Kingdom or Australia, and they’re very far from home. They’re a little bit more resilient, they’re older, and so forth. However, what I’ve recognized about them is that they are very lacking in their healthcare, either because of the system in their home country or what have you. 
I find myself dealing with a whole bunch of chronic issues that really bother these kids. I had one kid whose anterior cruciate ligament had ruptured a year and a half ago. I asked, “Why haven’t you gotten that fixed yet?” He said, “I’m waiting in line.” 
These kids, from a mental health and well-being perspective, many of them come to the United States because they think that they’re going to get healthcare here, and they do lean on us at the camp. We often find ourselves referring them to people outside the camp with their overseas insurance.
When you’re in camp, it’s very interesting where you have one kid from an affluent part of the world who’s got everything, and then you have another staff member working right alongside them who hasn’t gotten good care for quite a long time, especially something that they really needed to have been taken care of. It’s a fascinating view of the world from a healthcare perspective, coming to a sleepaway camp. 
Glatter: I’m not clear about the policies at your camps regarding social media and having a cell phone. Is it always accessible to a camper, or are there restricted hours when they can use it? How is this affecting their ability to integrate and make friends, in terms of their mental health? 
Antevy: This is a great question. Our camp has a no-phone policy. As soon as you get to the camp, if you have a phone, you put it in a bag, and they take it from you until you leave.
What’s very interesting, though, and I alluded to it with the whole mental health issue, is that many of these kids now (I have three kids and I’m not saying that we do everything perfectly by any stretch of the imagination), if they’re leaning on social media all the time or if they’re disconnected from other children, what we see as a big issue is that when these kids now come to a camp, they’re in a bunk with 15 or 16 other children and if something happens between two campers, those coping skills are not like they used to be. They are not able to just go into their room, close the door, open TikTok, and start doomscrolling. They can’t do that. We see many children who have anxiety or depression, and they don’t have the coping skills to enable them.
Like Matt had mentioned — and I love the concept of having psychologists there — our folks end up educating these kids on how to behave with other human beings. That’s a big part of the greatness of camp, which is that we’re doing for them what they can’t do at home because of the society and the social media world that we live in. It’s a great question, and a fascinating topic. 
Glatter: Matt, what is your experience in terms of managing campers? Is it similar? 
Harris: There are no phones allowed at our camp either. There are some exceptions when our older campers will go on a 2- or 3-day trip to some other large city in the area, in which case they can have their phones back just for safety reasons. As a rule of thumb in camp, there are no phones. 
An interesting phenomenon is that, when I was a camper many years ago, I’d write a letter and 2 weeks later, I get a letter back from a friend or a family member. Now they can email their letters, and so there’s some unidirectional information. I’ll sometimes get a call from a parent saying, I just heard from my son or my daughter about X, Y, and Z, and I think, Oh, they got an email. Until I got my first email from my children, I was a little confused about that. 
I think it’s important to have time away from the phones. We are guilty as charged in my house, too. I think we’re somewhat dependent on our phones. 
The other part, where I’m just being somewhat greedy about this, is that I also wasn’t on my phone. It’s kind of a nice break. There’s no TV at camp, so at night I found myself doing the work I needed to do in the clinic and then reading outside on the porch, catching up with some work, or going for a run around camp and shooting some hoops with my kids. Camp was a great opportunity to get away from the world of social media for the campers, counselors, and for me. 
Glatter: If either of you have a couple of pearls to take away for our audience, we’d love that. Peter, I’ll start with you. 
Antevy: The biggest pearl for me is the interface with the parent when something goes wrong. That’s a skillset that most clinicians should have. 
When the child comes to the clinic, what I love is that they handle themselves beautifully. They could be 6 or 7 years old. They’re amazing. 
Then you pick up the phone to the family member and you never know what you’re going to get on the other line. That’s understandable because their child could be across the world. We have kids coming from Spain and Dominican Republic, and then the family member is getting a call from a doctor. 
You should probably learn the typical way of how to call and ease the parent’s fear because it could be something minor like a little scratch and they hear “doctor,” and they have a heart attack. Those little nuances and then working with camp administrators who understand what good healthcare is, is always a bonus. 
Glatter: Absolutely. Matt? 
Harris: I’m going to echo what Peter said. Communication in many respects is super important. Also, setting expectations for the campers, counselors, and parents about what we’re going to call for and what we’re not going to call for. 
We want to make sure that parents know that we have set up a medical system at camp that inspires confidence, and that their children are all well taken care of in terms of their daily medications. Many kids are on injectable medications for growth hormone and other things, and we want them to know that they’re getting their routine medications and they’re getting their care. When we call you, we’re going to be good communicators, but you’re not going to hear about every scratch and rash. 
Pete really hit the nail on the head. I always joke that every time I call, I say, “Hey, it’s Dr Harris, everything is okay.” Except for maybe the one or two cases where it wasn’t so okay. As ED doctors, Pete and I are used to making these phone calls. The parents who really had some of the more challenging medical experiences with their campers were so thankful for that.
It’s not how frequently you communicate, but how effectively you communicate. Sometimes you have to read the room a little bit; some parents don’t want six phone calls with updates, and some parents need to know that they’re not going to get six phone calls with updates.
Let’s set expectations up front at the beginning of the summer, and let’s harness that robust relationship they already have with the camp to build confidence in the medical system that we’ve developed to keep their camper safe. 
Glatter: I want to thank you both for your service taking care of campers, counselors, and parents because it’s all a community. Again, thank you for your time. Our audience will truly appreciate your pearls.
Robert D. Glatter, MD, is an assistant professor of emergency medicine at Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York. He is a medical advisor for Medscape and hosts the Hot Topics in EM series. 
Peter M. Antevy, MD, is a pediatric emergency medicine physician and medical director for Davie Fire Rescue and Coral Springs-Parkland Fire Department in Florida. He is also a member of the EMS Eagles Global Alliance. 
Matthew Isaac Harris, MD, is a pediatric emergency medicine physician and medical director at Cohen Children’s Medical Center in New Hyde Park, New York. Harris is also an associate professor of pediatrics at the Zucker School of Medicine at Hofstra/Northwell in Old Westbury, New York.