Background: Camp experiences contribute to a range of positive developmental youth outcomes, but camp experiences also pose a risk for youth because of potential exposure to injuries and illnesses. The camp community has lacked both a methodology and effective benchmarks for injury and illness monitoring. Furthermore, camp-related policy recommendations have lacked the support of generalizable data addressing the risk of injuries and illnesses at camp. The need for systematic exploration of when, where, and how injuries and illness occur in camps created an opportunity for administrators and healthcare providers to improve camp safety by understanding injury and illness trends and implementing effective practices to better manage risk.

Purpose: The purposes of this study were to benchmark illness and injury rates among campers and staff at U.S. summer camps; to understand risk factors associated with such adverse events; and to use the surveillance methodology to identify intervention strategies to reduce the incidence of camp injuries and illnesses.

Methods: Data were collected using a Web-based injury and illness surveillance program called CampRIO™ (Reporting Information Online). During the 10-week summer data collection period, healthcare staff from participating camps logged into CampRIO™ weekly to enter exposure and illness/injury data. Data were also collected using a post-study camp director survey.

Results: The sample size ranged from 186 (low) to 295 (high) participating camps across the five study years. The overall illness rates indicated that campers and staff in both day and resident camps tended to have twice as many illness events than injury events. In addition, campers and staff involved in day camps tended to have lower rates of illness than campers and staff involved in resident camps. In some study years illnesses associated with the respiratory tract were most prevalent and in other study years illnesses associated with the gastro-intestinal tract were most prevalent. Data indicated that lower extremity injuries were most common and slips, trips, or falls was the most common mechanism of injury. In about 40% of all injuries protective equipment was a required component of a camp activity but not used in about 15% of these cases. Sixty percent of resident camper injuries and almost 30% of day camper injuries occurred during free time. Online modules were created and delivered to participating camps and a number of promising healthcare practices were learned through completion of the online modules.

Conclusion: The systematic monitoring of injuries and illnesses in camps illuminated trends that yielded specific, practical strategies that camp healthcare staff and administrators could use to improve camp experiences for participants and staff. Camps now have an evidence base in the form of national injury and illness benchmarks provided by this study, and these benchmarks can guide both promising practices and effective policies. Methodologies like the one used in this study contribute to the viable tools available to camp providers for illness and injury surveillance.

Key Take Away Points

  • This study provided national injury and illness benchmarks for U.S. day and resident camps.
  • Youth and staff are more likely to become ill at camp—or to spread a communicable disease to someone else at camp—than they are to become injured.
  • Sprains and strains top the list of diagnoses most likely to take youth and staff away from camp for four hours or more and the most common mechanism of injury in camps is slips, trips, and falls.
  • Online education interventions provided to directors and staff are effective for improving camp healthcare practices.

Author Biography

Barry A. Garst, Ph.D., is the Director of Program Development and Research Application with the American Camp Association and a former Assistant Professor of youth development at Virginia Tech. Garst has published many articles on the developmental outcomes of camp experiences and strategies for improving camp experiences for youth and staff.

Linda Erceg, RN, MS, PHN, executive director of the Association of Camp Nurses and Associate Director of Health & Risk Management for Concordia Language Villages, has long championed evidence-based practices to make “Healthier Camping for All” a growing reality. A camp nurse of many moons, Linda practices, writes, speaks and researches on topics similar to this one.

Dr. Edward Walton is the director of Pediatric Emergency Medicine at William Beaumont Hospital in Royal Oak, Michigan. He is board certified in Pediatrics, Emergency Medicine, and Pediatric Emergency Medicine. Dr. Walton was named Michigan "Emergency Physician of the Year" in 2007. He has published numerous articles on pediatric and emergency medicine topics.


This study was funded through the support of Markel Insurance, a Mission Partner of the American Camp Association. Special thanks to Dawn Comstock, Ph.D., Ellen Yard, Ph.D., and Christy Collins for their contributions to this study.



Responses to this Article:

Karla A. Henderson, Beyond Surveillance toward Prevention of Injury and Illness at Camps (December 2013)