Health and Safety: Risk Management

No matter how experientially, academically or culturally rich our program, the main priority is to ensure that it is run as safely as possible. By identifying the key risk issues and looking at them both preventatively and in terms of emergency response, we can ensure that the program still maintains an adventurous tone, without taking unnecessary and/or unmanageable risks.
Key Issues

Through personal experience in the field and extensive conversations with experienced leaders, local guides and previous participants, the following have been identified as the primary risk issues associated with Green Camp Bali program elements:

  • Weather
  • Political issues
  • Theft / Mugging
  • Sexual Harassment
  • Adolescent Issues
  • Transportation
  • Food + drinking water
  • Remoteness
  • Sports, activities and challenges
  • High ropes activities
  • Medications / Participant Heath issues
  • Communication
  • Animals, insects, etc
  • Water-based activities

Preventative measures

There are many things we can do in our program preparation and while the program is running to reduce the risks associated with participation in Green Camp activities. The following chart addresses each of the risk issues mentioned above from a pre-trip, in-field and post trip perspective; examining everything we can do to minimize risk while ensuring an adventurous and fulfilling learning experience.
Prevention involves the following:

  • preparing leaders with appropriate materials
  • providing leaders with a comprehensive orientation
  • providing appropriate staff training
  • appropriate screening of participants
  • understanding participant medications and backgrounds
  • preparing comprehensive and effective med kits
  • researching local medical facilities and resources.

The following chart assesses each of the aforementioned risks and looks at what we are currently doing to ensure that our program is running as safely as possible. The section following that looks at Green Camp Bali’ Emergency Response Protocols, which are defined in terms of either medical or non-medical evacuations.

Sports, Activities and Challenges
Before Activity

  • Ensure that participants bring appropriate equipment by distribution of kit lists

  • Emphasize rugged, physically challenging nature of activities

  • Encourage participants to train

  • All sports equipment and facilities must be inspected regularly
During Activity

  • Leaders need to ensure that participants are drinking adequate water in order to avoid dehydration

  • Med kid should be carried WITH the group

  • Participants should be briefed on the relevant dangers and presented with appropriate strategies for dealing with these risks

  • Ensure allocation of appropriately trained staff to the facilitation of the event
After Activity

  • Instructors should document any safety issues that arise
Weather
Before Activity

  • Ensure that participants are bringing enough equipment on program by distribution of kit lists and calls beforehand that cover packing, etc

  • Emphasize rugged aspect of the program in materials

  • Have mentors speak with inexperienced participants about the rigors of the trip

  • Ensure appropriate insulation, quality tents and huts, etc

  • Encourage weekend wilderness excursions in preparation
During Activity

  • Be aware of local weather patterns, incoming storms

  • Be prepared for rapid changes in weather and make sure participants are dressed appropriately

  • Teach participants about layering, how to dress for the outdoors, wet socks, etc…

  • Ensure that participants are carrying ground layers for insulation for camping
After Activity

  • Think about seasonal changes when developing changes

  • Ensure that materials being prepared adequately emphasize the need for warm clothing and waterproof, breathable, quick drying gear
Political Issues
Before Activity

  • Program Director and instructors should be constantly researching political issues through readings, the internet, local contacts, etc

  • Program Director should make sure that leaders are well-informed about in-country issues and how to respond to potential changes
During Activity

  • Stay in close communication with Program Director regarding shifts in the political atmosphere

  • Be aware of current shifts in local political climate by reading local news papers, watching local news, and speaking personally with in country contacts

  • Ensure that participants are well-informed about rallies, protests, etc. and the protocol for getting away from large groups as well as how to contact leaders in this situation
After Activity

  • GCB staff should be constantly researching political issues through readings, the internet, local contacts and the news
Theft / Mugging
Before

  • Ensure that leaders know about safe or unsafe areas for travel

  • Establish protocols for carrying participant passports and plane tickets

  • Discuss with leaders how to respond if a participant is mugged or robbed

  • Ensure that leaders are splitting up the budget

  • Let leaders know that in the case of a theft, that Program Director can help them locate an American Express TC replacement office

  • Encourage participants to carry TCs and to not wear expensive jewelry on the trip

  • Talk to participants about being aware of their personal space, and attentive to their belongings, money belt, etc.

  • Constant reminders about above

  • Talk to participants about known “scams”

  • Ensuring that participants know about unsafe areas in which to travel

  • Ensure that participants are practicing awareness of themselves and their surroundings – not only of their bags but of their body language as well

  • Encourage participants not to “flash” expensive items such as jewelry, MP3 players, cameras, etc
After

  • Carefully document all thefts

  • Know where American Express TC replacement sites are
Sexual Harassment

  • Help leaders to strategize ways to deal with reports of sexual harassment

  • Provide leaders with time to discuss their common ideas about appropriate dress and behavior

  • Provide participants with material outlining GCB’s approach to travel, cultural sensitivity and appropriate dress

  • Have the packing list emphasize our commitment to modest dress

  • Help leaders to figure out ways to establish open lines of communication and emotional safety with participants

  • Leaders should have meetings / conversations about appropriate dress and behavior for participants

  • Leaders should conduct a gender- specific talk regarding perceptions and stereotypes of westerners, especially women

  • Clear communication between leaders and participants so that leaders can be honest with participants about inappropriate behavior and so that participants feel comfortable approaching leaders about something making them uncomfortable

  • Having a clear set of expectations about language and behavior within the group (perhaps solidified in a contract at the beginning of the program)

  • Identify participants with skills in crisis management, women’s self-defense courses, etc. and have them help with instruction about body language and safety.

  • Document any cases of sexual harassment and ensure that parents have been notified and that participant is getting access to counseling, etc. if necessary (to my knowledge, there have not been cases of sexual harassment, nor sexual assault on our courses)
Adolescent Issues

  • Ensure that leaders have adequate training regarding various youth issues such as substance abuse, sexual orientation, eating disorders, self-mutilation and depression, etc.

  • Ensure that leaders have been given all information possible for participants with a history of issues

  • Ensure that leaders feel well-supported going into the field with any participants who have active problems, and that they know how to contact the Program Director should problems arise

  • Provide leaders with materials to educate them

  • Strive to work with leaders who can establish a good rapport with participants, and ensure that leaders know how to cultivate good relationships with their participants

  • Ensure that leaders understand the steps involved with a NON-medical evacuation for behavioral issues

  • Make sure leaders are watching participants carefully for signs of eating disorders or depression

  • Ensure scheduled time for one-on-one check ins

  • Take feedback or comments from other participants seriously

  • Allow for independent time for each participant

  • Ensure open and honest lines of communication with the participants

  • Make sure that intense experiences such as funerals, solos, meditation retreats, etc are followed up by comprehensive debriefing sessions.

  • When issues arise, make sure that the Program Director is alerted to provide leaders with additional support

  • Program Director should constantly be seeking out new information and materials on youth issues to improve the content we provide to our leaders

  • Program Director should also be seeking out leaders with experience in a related field, or people who can speak at our orientation on the subject of youth issues
Transportation
Before Activity

  • Program Director need to work with ground operators to determine safest modes of transport

  • Leaders need to read debriefs from past trips to ensure safest options are being used and avoiding unsafe ground operators or certain vehicles on certain routes

  • Leaders should be budgeting for the cost of upgrading transportation quality if necessary

  • Leaders should make changes to existing plans in-country when necessary to ensure the safest modes of travel are being used

  • Leaders should immediately confront drivers who are driving too fast or recklessly

  • Leaders should arrange private over public transport where appropriate

  • Wherever possible, participants should wear helmets when riding bikes

  • Leaders should visually assess the state of the vehicle

  • Leaders should check that drivers are not intoxicated

  • Leaders should ensure that cars are not overfilled

  • Groups should try to travel during the daytime only
After Activity

  • Researching alternative options to improve transportation safety (alternative jeep companies, research about night vs. day trains, train vs. bus travel, etc)

  • Assess travel routes used, feedback and alternate routes possible

  • Talk with ground operators about maintenance of vehicles and training of drivers
Food, Drink and Water
Before Activity

  • Teach leaders about giving lessons to participants about personal hygiene, water and food cleanliness

  • Teach leaders how to establish an atmosphere where discussing personal health is comfortable for the participants (i.e. In pre-trip interviews, introductory calls, etc)

  • Prepare comprehensive med kits with adequate medications, and sufficient materials for leaders to understand the dosages and conditions for usage

  • Include comprehensive list of medical contacts

  • Include information for AIG and evac plans

  • Include comprehensive medical forms for each participant (clearly photocopied)

  • Double check that all the medication and supplies are included in the med bag or available immediately upon arrival

  • Hire leaders who are familiar with local health problems and risks

  • Hire leaders with medical training

  • Ensure that leaders carry med-kit on planes with them
During Activity

  • Establish regular check-ins with participants

  • Have initial and reminder lessons about personal hygiene, food and water

  • Have additional conversations about health before home-stay

  • Brief home-stay families about health concerns for western participants

  • Carry a med kit with each group at all times

  • Do a talk on food sharing

  • Talk about water bottles and water purification

  • Leaders should be aware of participants’ Emergency Medical Travel Insurance status

  • Leaders should make sure they are familiar with each participant’s medical history, allergies, etc. and the medications they cannot take
After Activity

  • Review debriefs to assess “high-risk” areas (i.e. Did participants get sick during home-stay or during the trek?)

  • Look at ways to improve medical knowledge of leaders about meds in the med kit (i.e. Better info included?)

  • Review “industry standard” and constantly review how we compare in our approach to the distribution of meds in response to illness

  • Review our medical screening and forms, and how we might improve them

  • Be constantly on the lookout for additional medical facilities and reputable health professionals in-country
Meds / Participant Health Issues
Before Activity

  • Ensure that leaders have all of the necessary information regarding participants on medication (either medication for physiological or psychological issues)

  • Ensure leaders have sufficient information from RXList.com regarding prescription drugs, dosages, over-doses, missed doses and contraindications

  • Ensure that leaders have all necessary medications in the med kit and know how and when to administer them
During Activity

  • Be familiar with each kid’s medical history, allergies, etc. any contraindications

  • Early medical check-ins (LA) and confiscation of prescription drugs

  • Establish a routine for either giving participants medications or checking that they have taken their own doses

  • Keep a record of who has taken what medication and when
After Activity

  • GCB program directors should seek to be as well-informed as possible about new drugs on the market, especially psychotropic medications and their side-effects, controversies

  • GCB program directors should seek out people who might be able to speak at leader orientation about medications and “industry standard”
Remoteness
Before Activity

  • Assess risk vs. benefit of traveling to remote areas while developing new itineraries

  • Ensure that parents and participants understand the degree of “remoteness” and inaccessibility to phones/email/etc for long periods of time

  • Ensure that leaders are prepared adequately for evacuations (knowing about best evac routes, etc)

  • Ensure clear check-in points with stateside staff

  • Work with leaders with good medical training
During Activity

  • Program Director should strive to maintain communication with ground operators who are often in cell range of their staff

  • Use cell phones where possible

  • Leaders need to inform GCB program directors of any obstacles regarding evac. plans if they arise on-program

  • Leaders must remind participants of need for additional care (re: health, safety, when in remote areas)

  • Participants should be warned of risk of vicious dogs, especially at check-posts

  • Leaders need to give GCB program director clear guidelines for “next check in” dates

  • Research availability of satellite phones where cell phone access is unavailable

  • Reviewing medical facilities and quality of medical care available on closest points

  • Reviewing accidents and “near miss” incidents in remote areas (cause and response)

  • Seek out new staff members with good medical training
Animals, Insects etc.
Before Activity

  • Ensure that leaders know which participants have had rabies shots

  • Ensure that leaders are aware of local risks relate to animal contact

  • Ensure that leaders know where the nearest medical facilities are and which places carry rabies post exposure vaccines, anti-venom medication, etc, as well as contact information for these places.

  • Med kits should include all necessary materials to deal effectively with bites and stings
During Activity

  • Leaders should give a talk on safe behavior around local animals, especially dogs, monkeys and snakes

  • Leaders should talk about the religious significance of certain animals and the culturally expected behavior around these animals

  • Leaders should talk to participants also about contact with snakes, rats and spiders

  • Leaders should always carry med kit

  • Document all incidents involving animal bites or attacks

  • Find out about the availability of Rabies vaccines

  • Find out about diseases spread by animals
High ropes activities
Before Activity

  • Ensure recruitment of appropriately trained and qualified staff

  • Monitor weather patterns and other safety factors to ensure appropriate conditions at time of activity

  • Ensure adequate and appropriate maintenance of climbing areas (rock faces, anchors, routes on trees, etc) and climbing equipment

  • Participants should be briefed on the relevant dangers and presented with appropriate strategies for dealing with these risks

  • Ensure allocation of appropriately trained staff to the facilitation of the event
During Activity

  • Instructors should document any safety issues that arise and report issues to supervisors
Communication
Before Activity

  • Identify issues relating to communication caused by complex cultural contexts

  • Ensure staff are familiar with reporting procedures and clear about to whom they should direct concerns and questions, etc

  • Develop healthy rapports amongst all staff so that everyone feels comfortable expressing themselves

  • Provide communications training

  • Program Director should strive to maintain clear lines of communication with staff

  • Use a daily briefing and debriefing system
After Activity

  • Address issues that come up in safe, respectful way

  • Cultivate an atmosphere conducive to learning and provide structured opportunities for feedback

  • Seek out new staff members with good communication skills

Response (intervention) Plans

There are two primary response plans that leaders will need to follow depending on the circumstance. One involves evacuation of a participant with behavioral problems and is referred to as a non-medical evacuation. The other involves a participant who has been injured or is extremely ill, and needs immediate medical attention. This response plan will be referred to as a medical evacuation.

Non-medical Evacuation

Unfortunately, we will have to send participants home if they are not willing to abide by the rules set out by Green Camp Bali (and signed to on their Liability Form) and are consistently putting themselves and/or the group at risk as a result. Although sending a participant home is never pleasant, the well-being of the group as a whole must be the first priority of the leaders. Participants who break rules such as drinking alcohol, taking drugs, engaging in sexual and/or exclusive relationships, harming themselves or others in the group or community, consistent cultural insensitivity may be sent home. These are all examples of behaviors that put the participant (and his/her fellow travelers) at risk.
It is important that all problematic behaviors are recorded as a documented running record. The actions taken by leaders such as verbal or written contracts, discussions, warnings or role-playing should also be documented. The GCB program director should be notified of the problems at the onset, and should be made aware of ongoing issues. Parents may or may not be involved in the dialogue depending on the circumstance. By the time the leaders have decided to send a participant home, the GCB program director should have a clear picture of the circumstance, and generally, parents will then be part of the dialogue.
The following list is a step by step approach to sending a participant home which will ensure clear lines of communication between all parties, and the documentation necessary to back up the decision should a legal process be initiated at a later date.
Steps to be taken in a Non-Medical Evacuation:

  • Program Director should be notified immediately if a participant’s behavior is problematic. In this way, the Program Director has the opportunity to “warn” parents about the possibility of expulsion if deemed necessary.
  • If a participant’s behavior is causing the leaders to question whether a participant should remain on program, ALL conversations with the participant, between the leaders, and with family or Program Director should be recorded.

Although every situation is unique and will require slightly different approaches and responses, the following steps should be taken in this order to ensure clear and efficient communication between all parties involved.
1. Leaders should be in unanimous agreement prior to meeting with the Program Director and must be able to provide reasons for the expulsion. They should be clear and unified in their discussion with the Program Director.
2. Program Director should have a document outlining the series of events or single event that has led to the decision. Dates and times should be noted, as well as the leader team’s response in each situation (i.e. one-on-one discussions, curfews, verbal or written contract, etc.)
3. Participant should be informed by the leader team. (Leaders should have already discussed ways to “debrief” the rest of the group if necessary) The timing of this is very important and participants should not have the opportunity to call home BEFORE a well-informed Program Director has the opportunity to speak with a parent.
4. Parents should be notified by the Program Director about the decision by the program leaders.

5. If necessary, parents may contact leaders directly but this is discouraged because parents will often be angry and frustrated and the conversation will not be productive. The participant should have the opportunity to speak with parents on the phone about the series of events but a leader should be present or nearby. If it is deemed appropriate for the leaders to speak directly with the parents on the phone, the Program Director should be informed before the call is made and there should be one primary spokesperson from the leader team but it should be made clear to parents that it is a group decision.
6. Program Director, in-field staff, and/or parents will arrange for appropriate transport home.
7. Participant departs from group.
8. Debriefing with remaining group members begins.
9. Follow-up phone calls to parents or participant if appropriate.


PLEASE REMEMBER: It is best to document every possible detail in the leader journal (time, place, witnesses, behavior, response by leaders, communication with GCB program directors etc…) to ensure an accurate account of the events preceding the decision to send the participant home. Don’t assume that you will be able to recall all the details. Often, it is the cumulative effect of someone’s behavior rather than simply one act which results in an early departure and a well-documented history will be instrumental in communicating with the parents, the necessity of sending their child home

Medical Evacuation

A medical evacuation is a little more difficult to create a step-by-step plan for as each case will require different responses depending on the severity of the incident and the responsibilities / medical knowledge of the leader team.
The primary response should be to care for the injured participant(s) and to ensure that they and the other participants are safe and in a stable environment. Following this, communication with the Program Director will be initiated and parents or other medical staff/facilities will be notified.
The following is a rough guideline for responding to a medical emergency. The first step NEVER changes but those following may, depending on the individual case.
Steps to be taken in a Medical Evacuation:

  • Injured participant must be stabilized and removed from danger with the most experienced/medically-skilled Green Camp Bali leader acting as primary first aid responder.
  • Other Green Camp Bali participants must be moved away from the dangerous situation.

Although every emergency situation will be unique and will require different responses, the following steps should be taken as close to this order as possible to ensure clear and efficient communication between all parties involved.
1. As soon as the participant is stable, a leader should contact the Program Director. The Green Camp Bali leader calling should always call with a call-back number.
2. Administration will ask a list of questions about the incident, the status of the participant, the whereabouts of the group, contact information, plans to evacuate, etc.
3. At the earliest point possible, leaders should begin to document every aspect of the incident from medical care given to calls made to Program Director and medication administered. Participant’s vital signs should be recorded and an incident report form filled out as soon as possible. Every aspect of the incident, actions taken and evacuation should be noted carefully and signed by leaders.
4. Where appropriate, parents will be notified by the Program Director and will become part of the dialogue with the Program Director and NOT leaders directly. The reason for this is that leaders need to remain focused on caring for the participant, not the parents. It is the responsibility of Program Director to ensure that parents are kept well-informed and supported. If both parents and leaders want to be in direct communication, the Program Director should be notified prior to those conversations.
5. Where necessary, the Program Director will arrange for additional medical advice from the appropriate Emergency Medical Travel/Health Insurance providers. Or, if an evacuation is necessary, plans will be made for an efficient evacuation to better medical care through the evacuation insurance policy. Evacuation may mean taking the participant to a bigger urban center in-country or to a medical center in a more developed country.
6. With the help of the Program Director, the evacuation will be facilitated including transport and preparation of receiving facilities.
7. In some cases, Green Camp Bali in-field staff and/or the Program Director may hire additional staff/support to relieve exhausted or traumatized leaders and to help facilitate with the logistics of an evacuation.
The above scenario will likely be comprised of many, many phone calls but the primary message encapsulated here is that the well-being of the participant must take priority, and then the Program Director must be informed IMMEDIATELY. It can be disastrous if parents or friends of participants find out about an incident before the Program Director does. Such situations compromise our ability to respond effectively and put the Program Director and the Green Camp Bali project in an awkward and embarrassing position.
Depending on the severity of the incident, the steps outlined above may take a matter of hours where in other cases, the response may be spread out over a period of days. The key is consistent and calm communication, and detailed documentation.

Incident report forms are included in the Medical Bags.

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