An Interview with Dr. Michael Pistiner, Co-creator of AllergyHome.org
With most camps on the verge of holding pre-camp training, we want to make sure you know what resources are right at your fingertips—a click away either on the ACA New England website (in the http://www.acanewengland.org/members/member-home/summer-resources) or on the ACA site. In addition to basic resource information there are several online training courses, which may supplement your pre-camp curriculum nicely. Some are ACA's while others are endorsed by the ACA.
We interviewed Michael Pistiner, MD, MMSc, a pediatric allergist with Harvard Vanguard Medical Associates, practicing in the Greater Boston area and co-creator of AllergyHome.org. He and his colleague John Lee, MD, a pediatric allergist at Boston Children's Hospital, were inspired to develop a free online course for camp nurses to use during pre-camp to assist in their staff training and help provide critical information about caring for campers with food allergies. This brand new course, developed with the interest and support of Linda Ebner Erceg, R.N., M.S., PHN, was recently endorsed by the ACA. Worth one CEC, Food Allergies in Camp: What Staff Needs to Know can be found in the Summer Resource area of our website and in the list of other online trainings that are endorsed.
How did you decide to develop an online training curriculum for camp nurses and camp personnel?
Food allergies are a major national concern and a recent study suggested that 8% of US children has a food allergy. Food allergies have been getting increasing attention in the school setting. Local, state, and in the near future, national guidelines are helping schools address this issue. Food allergy in camps is no less important and certainly no less challenging.
Imagine this: you're a counselor, a child with a known food allergy has hives, is coughing and is throwing up. The nurse is 20 minutes away. Now what? In our perfect world you would know exactly what to do, and know your camp’s food allergy protocol. To help camp directors and nurses teach their staff, Dr. Lee and I, with the help of Lynda Erceg of ACN and the ACA, created a web based teaching module specific to camps, to augment training and management systems that are already in place at camps.
The ACA is known for its emphasis on safety. Prevention and emergency preparedness are the basis of the best food allergy management and safety for campers with food allergies.
Why did you make your curriculum available for free?
Kids with food allergies should be able to participate in all the summer fun that other children experience as well. We need to help camps and camp nurses safely care for children with food allergies. Camp wide food allergy education is absolutely critical but can be time consuming and difficult to coordinate.
We hope to give camp nurses and administrators the tools to help them train their staff and increase an awareness that may save a life. We made them free because in our perfect world every camp would make food allergy education a priority and we want to help encourage and support that. For extra incentive we are providing free CECs for continuing education.
How did you meet Linda Ebner Erceg and get her input in your curriculum?
Linda contacted us after viewing a school staff training module that we created and modified for the MA Dept. of Public Health, School Health Services; she asked if we could create a similar training tool for camp staff. Linda enthusiastically worked with us to modify the content to apply to camps. She is a phenomenal resource and a true child advocate.
What's the most important thing for children with serious food allergies and their families to know about going to camp-the advice you would give your patients and their families?
Food allergy management (prevention and preparedness) is a constant must. These principles must be applied at all times and in all settings. Prior to enrollment confirm with the camp that they have a food allergy policy that takes food allergy management into account at all times and seems feasible. Check to see if the camp has a nurse who is available on site and that staff are all trained on the management of food allergies in camp. If possible, meet with the camp director, camp nurse and potentially nutrition services. Your child should have a care plan completed and reviewed by the camp nurse before the start of camp. Make sure that parents provide a copy of the Food Allergy Action Plan and if prescribed, at least two epinephrine auto-injectors.
What's the most important thing for camps to know about serving children with food allergies?
Knowing how to read a label, knowing about hidden ingredients and how to prevent cross contact are critical components of avoiding accidental exposure. Any camp staff responsible for feeding or caring for a camper with a food allergy will need to be comfortable with these avoidance strategies.
Did you go to camp?
I was a long term day camper. My absolute favorite activity was free swim and practically anything that had to do with the water. After high school I wound up becoming a water safety instructor and teaching at one of the camps where I went as a child. Many of the pictures used in the creation of this module were graciously offered from that very camp.
What else do camp professionals need to know about food allergies at camp?
School nurses in MA have been tracking whenever someone is given epinephrine to treat an allergic reaction. Their data shows that one quarter of all reactions that needed epinephrine were in people without a known allergy. This makes it incredibly important to recognize anaphylaxis (severe, life-threatening allergic reaction) and put the emergency plan in place. Depending on state and local regulations, the camp nurse may then treat with epinephrine, but if the camp nurse is unavailable 911 must be called immediately so that epinephrine can be given. Staff who have been appropriately trained may give epinephrine, but currently only to those with known allergy (discuss with camp nurse/director as this varies state by state and camp by camp).
This emphasizes the importance of having a full time nurse on site.
You work with the MA Dept of Public Health to educate school nurses, has some of your experience from that informed your work with camp nurses and other professionals?
Almost all of the management strategies are the same. The settings are a bit different, each with their own challenges. Children in the camp setting may be a bit further from the camp nurse than if they were in school. Also, many summer camps are in more rural settings, further from hospitals and some have less dependable modes of communication. The age of camp staff also tends to be a bit younger than school staff and this can make educating the staff a bit different.
You developed web-based resources to help camps, schools and families. What kind of resources can folks expect to find there?
We have created food allergy awareness modules for camp staff, parents, and children. Although the parent and child modules were created with the school setting in mind, all aspects of it can relate to the camp setting. Children with food allergies and their families can feel isolated or misunderstood. The hope is that with camp-wide awareness there will be a community of support for children with food allergies.
Can you suggest some additional books, articles, websites or videos that would be great for camp staff or for families?
The Food Allergy & Anaphalaxis Network (see camp guidelines)
Kids With Food Allergies Foundation
Asthma and Allergy Foundation of America, New England Chapter Food Allergy Initiative
6 minute preparedness video on parent awareness of food allergies
4 ½ minute video for kids