Camp Nejeda Medical Forms & Policies
Our goal is to keep the campers out of the Health Center and in their activities. There are few problems that require a camper to stay in the Health Center. Minor illnesses will be cared for at camp. Major illnesses/and other problems, such as fractures and lacerations, will be cared for at Newton Medical Center. Parents do not need to be notified of a minor illness, but will be called for major illnesses/problems (see below).”Homesickness” is not a medical problem and will be handled by the camp director and counselors.
The medical staff is available 24 hours a day for emergencies. Non-emergency problems and follow-up care, will be handled only during sick call hours, which are from 9:00 a.m. to 9:30 a.m. (after breakfast). All routine medications are dispensed during meals by each cabin nurse. Nurses must watch each camper swallow each pill. Medication cards will be made out on Intake Day, and camper meds will be stored in locked cabinets in the Health Center. Controlled medicines are stored in a lockbox to which only the Charge Nurse and Assistant Charge Nurse have keys.
The Senior on Duty (SOD) is often needed to find a camper scheduled for Health Center follow-up. The SOD schedule (day and night) along with their cell phone numbers will be kept at the HC desk.
CONTINUOUS GLUCOSE MONITORS (CGM)
While CGMs potentially reduce the risk of missing important hypo- or hyperglycemia, they also increase the burden on the campers, counselors and medical staff. They are only FDA approved for use in addition to routine monitoring (not as a replacement) because they are not as accurate as blood glucose monitors. In addition to “managing” an extra device, CGMs require responding to their alarms, which requires at least one check of blood glucose with a meter. Since CGMs monitor the glucose surrounding the cells (interstitial) instead of blood glucose, the readings are delayed by about 15 minutes compared to blood glucose.
This policy and procedure is intended to allow the maximum benefit from CGMs with the least effort for the camper, counselor and medical staff.
1. Counselors and medical staff will NOT be routinely checking the monitor recordings. Changes in insulin management at camp will be based, as always, on blood glucose records.
2. Camp is noisy and tired people sleep soundly. The monitor alarm will be set at its loudest.
3. The camper must be able to insert the monitor probe and manage the CGM settings independently. We are not yet able to train staff to assist in this process. The camper must have been using the CGM for at least one month prior to using it at camp to assure that he/she has gotten beyond the often difficult initial learning period.
4. The low glucose alarm cannot be set any higher than 70 mg/dl. A setting of 80 or 90 (standard on at least one “pediatric” CGM) creates too many false alarms. Similarly, the high alarm cannot be set any lower than 200 mg/dl.
5. If the camper so chooses or at the discretion of the pediatric endocrinologist at camp, use of the CGM may be discontinued for all or part of the day. The endocrinologist will most likely discontinue use of the CGM if the camper’s unit has many false alarms.
6. Any time the CGM alarms, blood glucose will be checked by the camper under the supervision of the nearest counselor, just as would be done if the camper felt as though his/her glucose was too high or too low. Each test will be recorded on an “Event Card” as is done for any glucose testing outside of the routine four times daily. The Event Card record will include “CGM high/low alarm” so the medical staff knows why glucose was tested at that time. Responses to low and high glucoses will follow the same protocols as followed when they are detected without CGM. If the blood glucose results after a CGM alarm is in the expected range, no further action will be taken. The repeat alarm interval will be set at 30 minutes for a low glucose and 90 minutes for a high glucose. More frequent CGM alarms are not helpful because those situations are managed at shorter interval under the routine camp protocols.