419-460-0110 Outdoor Youth Programs: Health Services (1) Required physical examination. Prior to a child in care engaging in an outdoor youth program activity, an outdoor youth program must review and place in the file a physical examination report for the child in care. This information must be shared with the field staff prior to any outdoor youth program activity. The child in care's health history must be provided by a physician prior to admission, and this history plus a new physical examination must be recorded on a form provided by the program, which clearly documents the type and extent of outdoor youth program activity in which the child in care will be engaged. The examination must cover areas required by the Department and, after the appropriate consents are obtained from the child in care or child in care's legal guardian, must be completed by a licensed physician, physician's assistant or nurse practitioner, who signs the form. (a) In addition to any other areas required by the Department, the examination must include a physical assessment based on the climate, temperature, and altitude the child in care will be participating in given the child in care 's age, weight, sex, physical condition, and recent use of drugs or alcohol, if any. The physician must state in the examination report any restrictions on the child in care engaging in strenuous exercise based on these or any other factors; (b) If a child in care is currently taking or has been receiving prescribed medication within the past six months, a specific notation must be made on the physical examination form, by the clearing medical professional, which must include clearance for participation in an outdoor, high impact environment and a description of any possible special needs due to use of the medication in the field environment; and (c) If a child in care is in a risk group for strenuous exercise or extreme conditions due to medical issues, written clearance must be noted on the physical examination form, stating that the child in care may participate in an outdoor youth program activity, which may: (A) Occur in altitudes over 5,000 feet; (B) Include strenuous exercise; and (C) Expose child in care to cold or hot temperatures. (d) Children in care may not participate in an outdoor youth program activity until all blood work and other laboratory work has been received and reviewed by the physician, and the physician has found that the child in care is qualified to start the program. (2) Health information availability. An outdoor youth program must copy the health history and physical exam form and authorization to obtain medical care, maintain the original at the base of operations, and field staff must carry the copy in a waterproof container when the child in care is away from the base of operations. All medications must be listed, including dose and frequency. (3) Appropriate health care. An outdoor youth program must ensure: through staff assignments, training, and program providers: that injuries, illness, or physical complaints by children in care will be promptly and accurately assessed; and that appropriate care is provided. (4) Prompt first aid treatment. An outdoor youth program must provide first aid treatment in as prompt a manner as the location and circumstances allow. (5) First aid. An outdoor youth program must have a first aid kit with sufficient supplies available at all times. The first aid kit must:- (a) Meet the standards of an appropriate national organization for the activity being conducted and the location and environment being used; (b) Be reviewed with new staff for contents and use; (c) Be reviewed at least annually with all staff for contents and use; and (d) Be inventoried after each expedition and restocked as needed. (6) Field treatment. An outdoor youth program must immediately transport to appropriate medical care any child in care with an illness or physical complaint needing care or treatment beyond what can be provided in the field. (7) Documentation of reports and treatment. An outdoor youth program must document complaints or reports by a child in care of illness and injuries in a daily log along with any treatment provided. (8) Negative consequences. An outdoor youth program may impose no negative consequence on a child in care for reporting an injury or illness or for requesting to see a health care professional. (9) Daily physical assessment. Field staff for an outdoor youth program must monitor and document child in care's hydration, skin condition, extremities, and general physical condition on a daily basis. (10) Weekly physical assessment. A Wilderness First Responder (WFR) or equivalent, an Emergency Medical Technician (EMT), or qualified medical professional must assess each child in care's physical condition in an outdoor youth program at least every seven days. The assessment must be documented and shall at a minimum include: (a) Heart rate; (b) Check of extremities; (c) Condition of skin; (d) Allergies if any; (e) General physical condition; (f) Any health issues specific to the individual child in care; and (g) Provision of appropriate medical treatment if needed. (11) Medication storage and administration policies and procedures. An outdoor youth program must have and follow policies and procedures on the storage and administration of prescription and non-prescription medication. The policies and procedures must include contingency planning in the case of medications being lost or destroyed in the field. (12) Medication storage. An outdoor youth program must store prescription and over-the-counter medication under lock and key safeguarded from children in care. For medications taken in the field, medication must be in the possession of a staff member and stored at required temperatures. (13) Documentation of medications. Prescription medication in an outdoor youth program must be issued by a qualified medical professional's valid order that includes the dosage to be given. Senior field staff must administer all medication. Administration of medication must be documented and include: (a) The name of the child in care; (b) The name of the medication; (c) The date and time; (d) The amount of dosage given and whether the child in care did not take the medication; and (e) The person who administered or assisted in self-administration of the medication. (14) Medication changes. An outdoor youth program may not stop or change dosage or administration of prescribed medication nor discontinue any prescription without consulting with a qualified medical professional and documenting the consultation and the change. (15) Disposal of unused medication. (a) For purposes of this rule, "unused medication" means any medication which has not been used for 60 days, or a medication held by the facility which has been prescribed for a child in care who has been released from the facility. (b) For purposes of this rule, "expired medication" means any medication whose designated period of potency, as indicated on the label, has expired. (c) An outdoor youth program must return all unused or expired medication to the base of operations and dispose of it so it is not available to children in care. A field director or senior field staff must witness and document the disposal of the unused medication. Statutory/Other Authority: ORS 409.050, ORS 418.005 & ORS 418.240 Statutes/Other Implemented: ORS 418.990 - 418.998, ORS 409.010 & ORS 418.205 - 418.325 History: CWP 26-2022, renumbered from 413-215-0961, filed 11/28/2022, effective 12/01/2022 CWP 74-2020, minor correction filed 01/15/2020, effective 01/15/2020 CWP 22-2016, f. & cert. ef. 12-1-16 CWP 12-2016(Temp), f. & cert. ef. 7-1-16 thru 12-27-16 CWP 7-2013, f. & cert. ef. 10-1-13 Renumbered from 413-210-0815, 413-210-0839, 413-210-0862, CWP 28-2008, f. & cert. ef. 10-17-08 SOSCF 9-2002, f. & cert. ef. 5-29-02