Fall 2006

Using Your Inhaler

A Look Back: Fun at Camp

Promoting Compliance with Asthma Care Plans

Saving a Life on a Baseball Field

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What to Pack for Camp:
Shorts, T-Shirts, Flip-Flops, Peak Flow Meters, Inhalers, Ventilator

By Debbie Bunch

It’s a time-honored tradition in homes all across the nation: As soon as school is out, the kids don shorts and t-shirts and head off to summer camp. In the past, however, one group of children was usually left standing in the doorway, forced to wave goodbye to their healthier peers due to medical conditions that, for them, made summer camp an impossibility.

Not anymore. Thanks to literally hundreds of respiratory therapists and other health care professionals who volunteer their time every year, these children now have summer camps of their very own. Two such camps in South Carolina and New York — one for kids with asthma and the other for children on mechanical ventilation — serve as shining examples of how these camps are bringing joy into the lives of kids while delivering important information and education to them and their families as well.

A perfect solution
Back in the mid-1990s, the respiratory care department at Beaufort Memorial Hospital (BMH) in Beaufort, SC, was faced with a problem common to many facilities: an unacceptably high emergency department admission rate for asthma-related incidents. RT Department Manager Bill Chapman, RRT, and his staff met with their medical director, Peter Manos, MD, and another physician, Lawrence Coleman, MD, to discuss possible solutions. “Different avenues of training were discussed from short, one-on-one training sessions to group training with the patient and family,” Chapman recalls. “Due to the location constraints and disruptions, we found that the hospital setting was not the most suitable learning environment for the children and parents. Also, we needed to give out more information than time allowed in the hospital setting.”

A summer day camp seemed like the perfect solution. Not only would it provide enough time to disseminate all the information the group wanted to deliver to the kids and their parents, it would also give children who might not get to go to camp a camping experience. The group contacted their local American Lung Association (ALA) representative, Sally Catlin, for advice on the best way to organize the camp; and she suggested basing the program on Camp Puff ’n Stuff in Charleston, SC, which is one of the oldest residential asthma camps in the country. They took that program, modified it to fit their unique needs, and Camp Sea Breeze was off and running.

“A general consensus was made that eight to 10 hours of class time would be necessary to present the information,” says Chapman. “Approximately two hours per day are set aside for instruction. The rest of the time is used for physical activity and arts and crafts.” The camp was initially funded by the BMH Foundation and the ALA, along with donations from the community, says the manager. Once it gained a successful track record, the Foundation decided to pick up the entire tab. “The Beaufort Memorial Hospital Foundation has awarded funding indefinitely,” says Chapman. While campers do pay a small fee, scholarships are also available, making the camp essentially free-of-charge to many participants.

Parent orientation
The camp takes place every year at the Hospital Education Center, says Toni Rehkop, CRT, Camp Sea Breeze director. She and her fellow volunteers work hard to make the area as inviting as possible for the kids. “The classroom is decorated with the camp theme. Decorations consist of things associated with the ocean, such as fish and beach scenes, as well as pictures of previous campers.”

Campers are solicited in a variety of ways — flyers are handed out in schools and churches and notices placed in the newspaper — but the majority of the kids arrive at camp via their pediatrician’s office. “Criteria for acceptance to the camp consists of ER visits, hospitalizations, or more than two doctor visits in one calendar year for their asthma,” says Rehkop, noting physician approval is necessary for camp attendance.

Parents are required to attend an orientation session lasting about an hour and a half the evening before the camp begins. Rehkop and Drs. Manos and Coleman (who serves as the camp medical director) go over anatomy and physiology and cover asthma medications and how to use them properly to avoid symptoms. The session is vital to improving the lives of the kids, says the therapist, because often parents know little more about their child’s asthma than does their child.

“After the orientation … they feel more in tune with the early signs and symptoms of an asthma attack and how to treat them,” she says. The physicians believe the parent session — along with the camp itself — has done a lot to reduce ER visits and medical office visits alike, and also report that when they do see campers in their office, both they and their parents are better informed, resulting in shorter office visits and streamlined care.

Real-world situations
Camp itself begins promptly at eight in the morning as the children are greeted by Rehkop, Chapman, and volunteers from the respiratory care department who give up their free time to spend the week with the kids. An exercise physiologist is also on hand to oversee the morning exercise program, and a nutritionist comes in to teach the kids about good eating habits. Several junior counselors staff the camp as well. These high school seniors are part of a medical career program, and some have even been former Camp Sea Breeze campers themselves.

The day starts with peak flows, MDI instruction, and therapist evaluations, says Chapman, followed by an education class. Then kids and counselors alike gear up for a field trip, which can range from swimming, hiking, and climbing walls to bowling, kayaking, roller-skating, and beach activities. The idea is to have fun — but also to test the kids in real-world situations.

“We want to have activities that provide physical challenges for the campers,” explains Rehkop. “This allows the therapists the opportunity to evaluate the camper’s response to their asthma triggers — such as exercise, dust, grass, humidity, and hot weather conditions.” If a camper shows signs of distress, the respiratory therapist will perform an immediate assessment, have the child administer the appropriate medications, and initiate some relaxation exercises. Once the child is rested, he is allowed to resume the activity, under close observation by the therapist. Children who have problems are then classified as high risk, says Rehkop, and “we educate the parents and notify the child’s pediatrician for further follow up.”

Chapman, Rehkop, and their colleagues have traditionally kept track of camp outcomes via pre- and post-camp questionnaires. This year, the group initiated a daily oral questionnaire instead, which they believe is helping them gain an even better understanding of how well the children are learning about asthma and how to avoid its symptoms. The group also evaluates asthma ER visits and hospitalizations on a regular basis to determine the ongoing impact of the instruction delivered at the camp.

Strong RT presence
At Camp Inspiration!, which is located at the Double H “Hole in the Woods” Ranch in Lake Luzerne, NY (a facility funded by the Paul Newman Foundation), the objective is to provide a camping experience for seriously ill children and their whole families. “The idea for the camp for vent-dependent kids was the brain child of Dr. Kathy Braico, a pediatrician from the Glens Falls area and the medical director of the ‘Ranch,’ who had heard about and subsequently visited just such a camp in Florida,” says Tim Carey, MS, RRT, respiratory care department director at Albany Medical Center, which has been involved with the camp since its first year of operation in 2004. “She loved the idea and contacted us through Dr. Ray Walsh, one of our pediatric intensivists.”

Carey and his colleagues joined the physicians and other key players, including the Ranch’s medical advisory board and pediatric ICU nurses from Albany Medical Center, in initial discussions to plan everything from accommodations, patient/family needs, and equipment and gas supplies to emergency response and camp activities. The need for a strong RT presence was clear from the start. “Vest, Cof-a-lator, aerosols, CPT, suction, vent maintenance, medical gas therapy, pulse oximetry, troubleshooting … our skills and expertise are critical to this type of camp,” says Carey.

With the plans in place, the group put the word out that the first camp would be offered that summer; and applications began coming in, some from as far away as Minnesota. “We ended up with eight kids, ranging in age from four to 15,” says Carey. “Four were vent-dependent full time, two vent-dependent overnight, one NIPPV-dependent, and one oxygen dependent.” Having parents and siblings along helps provide peace of mind to parents who might be wary of leaving their medically fragile children while at the same time giving everyone a respite from the stress and strain of caring for children with medical complexities.

Something for everyone
The first camp was a huge success, says Carey, with kids and families alike enjoying an experience they otherwise might never have had. Thanks to the respiratory therapists and other medical professionals there, the children were able to sleep in cabins away from their parents and siblings and participate in all the typical camp activities, including swimming, playing with farm animals, arts and crafts, horse-drawn carriage rides, baseball, and fishing. They also got to sit around the campfire, roast marshmallows, and tell ghosts stories. “It was an unbelievable experience for the kids, the families, the counselors, and the caregivers,” says Carey. “Mo ments that were experienced could — and did — bring you to tears.”

Andrew Slezak, RRT, clinical educator for cardio-respiratory services at Albany Medical Center, volunteered at the third session of the camp held last June and agrees the experience is one that is hard to match. “The work is very demanding and takes a big effort, but the smiles and laughter coming from the kids and their parents make it more than worth it.”

This year’s camp was the largest yet, says Slezak, with more than a dozen children and their families on hand. As in previous years, the children delighted in the camp activities; and their parents and siblings enjoyed themselves as well — taking part not only in events planned for the ventilator-dependent children but also in activities designed just for them. “Massages were provided for the parents in hopes of temporary relief from the stresses of caring for a vent-dependent child. Siblings were able to play softball, hike, and test their skills on a high ropes course built specifically for their use,” says Slezak.

Fulfilling a rite of passage
Going off to summer camp is a rite of passage for American children; and as these camps show, there is no reason why a medical condition should stand in the way of any child’s fulfillment of that goal. As long as respiratory therapists like those who have given their time and talents to Camp Sea Breeze and Camp Inspiration! are around, kids with asthma or other respiratory conditions can rest assured they, too, will be able to head off to new adventures as soon as the last school bell rings. •