Five things camps need to know about life-threatening allergies
Years ago, before the idea of becoming an allergy coach was a glimmer in my mind, I was a camper. I attended summer camps for seven years, and four of these were at overnight camp. Back then, in the mists of time, allergy awareness was minimal. Let’s face it, it was non-existent. The approach taken in schools and camps alike in the days before epinephrine auto-injectors was to call an ambulance in response to anaphylactic reactions, and hope for the best. Allergy risk reduction? Clear ingredient labels? Neither were part of the allergy landscape.
But then, in the late 1970s and 1980s, I was the only kid I knew with deadly allergies to peanuts, tree nuts, and sesame (and egg to a lesser degree). In a sense, being among this very early wave of food allergic children, I was a canary in a coalmine. I did not have an ‘allergy mom’. I did not carry an EpiPen®, as they had not yet been invented. The term ‘cross-contact’ was not part of our vocabulary. My pediatric allergist at the time simply instructed us to keep my allergens out of my food, and to ask restaurants to be sure they weren’t served to me.
In those days, prior to the tighter food labeling regulations we now have in place in Canada and the United Stated (not perfect, but certainly an improvement), I suffered a severe allergic reaction nearly every summer. Two summers saw me sent home with allergic reactions that had triggered my asthma.
During one summer at overnight camp, when I was eleven, I was rushed to a nearby town emergency room with anaphylaxis. I was given emergency treatment, and transported by ambulance to the closest trauma centre in Montreal, my home city. I remember the feeling of not being able to breathe — of feeling as if every breath was made through a very thin straw. I remember the feeling of fear, and praying that I would survive to see my family again. It was weeks before I was fully recovered. This, as you might imagine, was my final summer at overnight camp.
Years later, much has changed, and most, if not all, summer camps have emergency protocols in place, including epinephrine first response. This has represented a tremendous improvement.
And yet, the reports of food allergy deaths at summer camps continue to appear in the news. The camper who ate a mislabeled cookie. The pb&j sandwich packed in the same bag as the peanut-allergic camper’s sandwich, the camper who did not carry an epinephrine auto-injector. I read the reports as they appear in the news, and I feel heartbroken. These examples of recent allergy deaths at camp highlight several key points that all camp directors and staff need to know. For the sake of brevity, I’ll consolidate them into five main take-aways:
- Emergency first response goes beyond knowing how to inject an epinephrine auto-injector.
It goes — or should go — without saying that training in administering an epinephrine auto-injector is critical for camp staff members. But this should also be contained within a broader allergic emergency plan so that all camp staff members know what to do, and when. Acting quickly at the first signs of anaphylaxis can make the difference between life and death. An excellent summary of the steps to follow is available here, on the Food Allergy Canada web site.
2. An emergency first response must be accompanied by a thorough allergy risk-reduction plan that all camp staff members know backward and forward
Emergency first response is essential, but it is not in itself sufficient to keep allergic campers safer. The ideal response to severe allergies to foods, insect stings, latex, or other known allergies begins well before the summer begins, and consists of such preparation as rigourous ingredient sourcing and cross-contact elimination, label reading proficiency, excellent communication among staff members regarding camper (and staff) allergies, and scenario rehearsals. Points 3–5 will now address these.
3. Ingredient label reading, ingredient sourcing, and cross-contact risk reduction skills must be solid.
When it comes to reading ingredient labels and sourcing ingredients from suppliers, a camp can’t be too careful. In the United States and Canada, food labels have become far clearer, but in both countries, ‘may contain ______’ or ‘manufactured in a plant that also uses _____’ labeling reflecting the possibility of cross-contact with allergens is voluntary. I strongly recommend calling food manufacturers prior to the beginning of the camp session to make inquiries regarding cross-contact and shared equipment, and doing a thorough ingredient inventory in the kitchen. Foods and ingredients for allergic campers and staff must also be kept and prepared in separate areas to reduce the risk of cross-contact.
4. Communication among all stakeholders is key
Parents, counsellors, section heads, camp directors, allergic campers’ allergists, and camp medical staff should all be on the same page and have all the information required to ensure that risk is minimized for campers with allergies. This information should be visible and accessible to all camp staff.
5. Make rehearsals, case studies, and role playing your friends!
There’s no question about it. Managing severe and potentially life-threatening allergies can be stressful. This background anxiety is only amplified when a counsellor or other staff member has the theoretical knowledge to help manage a camper’s allergies, but has not yet had real-world experience.
I encourage camps to hold rehearsals to practice various potential allergy scenarios, and to make them specific. Here are but a few possible examples of response simulations that this role-playing might include:
A venom-allergic camper being stung by a bee on a canoe trip
Accidental ingestion of a food allergen in the dining hall
A camper with known asthma and food allergy who is having an anaphylactic reaction in their cabin
A camper with known food allergies displaying seemingly mild symptoms that may or may not be anaphylaxis — calling upon camp staff to rely on communications from the camper’s allergist and parent/s, good judgment, and, above all, the emergency plan
By rehearsing these types of allergic reaction scenarios, camp staff can better prime themselves to be ready to act quickly should a real life emergency occur.
It’s my wish that all camps and child care settings come to implement best practices in allergy risk reduction with the help of local allergists, allergy coaches, and allergy associations in their area. And most of all, it’s my fervent hope that the summer of 2016 is free of allergy death headlines, and is a healthy one for campers and camp staff alike.
A.D. Shainblum is President of Allercom Allergy Consulting, Inc. Allercom provides a non-medical service, helping organizations reduce the risk of allergic reactions to foods, latex, insect stings, medications, and environmental allergens. Allercom also provides allergy coach support services to adults, children, and families coping with allergies. For more information, please visit www.allercom.com or e-mail firstname.lastname@example.org