Risks and Prevention of Vector-Borne Diseases Vector-borne diseases (VBDs) are human illnesses caused by parasites, viruses or bacteria that are transmitted by vectors. Common vectors include ticks, mosquitoes, flies and fleas. Vector-borne diseases are a risk in nearly all areas in the United States, whether you are in the wilderness or in your backyard.  Some of the wilderness environments in which our courses travel are home to a variety of vector species, and some of these species carry diseases that can become serious if diagnosis and treatment are delayed. Fortunately, there are prevention steps that are very effective and, in the case of infection, treatment is usually simple and recovery complete, especially when the diagnosis is made early. Students and their families should educate themselves on the risks, prevention measures, and signs and symptoms. We have outlined some of these within this document. For health advice, please consult your physician. Risks The risk of VBDs can be managed, but it cannot be eliminated. Therefore, students and their families need to understand that:

• We judge the benefits of being outdoors to outweigh the risks for most people, provided reasonable precautions are taken on course, and reasonable vigilance is taken at home after course.
• Since we cannot eliminate all risk and still provide our desired outcomes, students (and families) need to decide for themselves whether to accept the inherent risks. Getting bitten by mosquitoes, ticks and fleas is one of the inherent risks of being outdoors.
• Being an active participant in safety management is one of the important life skills our students learn on course. Weighing the benefits of risks, analyzing risks and managing them well are strengths of successful people in all walks of life.

This risk is not static. Bacteria, viruses and parasites evolve continuously. As the global climate changes, so too do the ranges of the vectors. Outward Bound strives to provide the most current references and information, but it is not a substitute for professional medical advice.   Vector-Borne Diseases

Vector	Disease	Areas of Risk (relevant to CBOBS courses)
Ticks	Lyme disease	Northeastern US
	Babesiosis	Northeastern US
	Ehrlichiosis	Eastern US
	Southern Tick-Associated Rash Illness	Southeastern US
	Tularemia	All US
	Anaplasmosis	Northeastern US
	Bourbon virus (rare)	Southern US
	Powassan encephalitis	Northeastern US
Mosquitoes	Eastern equine encephalitis (rare)	Eastern US
	West Nile virus	All US
	Typhus (Murine) (rare)	Southern US

  Signs and Symptoms There are many symptoms associated with vector-borne diseases. Infected people may not have all of these symptoms and many of these symptoms can occur with other diseases as well. It is important to get signs and symptoms checked by a doctor because the patterns are unspecific. Consult your doctor if you have:

• Fever, chills
• Muscle or joint aches and pains (without known athletic or injury causes)
• Rash
• Headache
• Excessive fatigue (some fatigue is normal after a long wilderness course!)
• Confusion
• Facial paralysis
• Nausea, vomiting, diarrhea
• Weight loss, lack of appetite

Seek medical attention if signs and symptoms of an illness appear. Tell your doctor where you have traveled. Vector-borne diseases are diagnosed based on symptoms, blood tests, and the possibility that the person has been exposed to bites. Most cases can be successfully treated with specific types of antibiotics, especially if treatment is started early. However, some people may have symptoms such as arthritis, muscle and joint pain, or fatigue for an extended period of time. Prevention

1. Wear and use protective clothing/equipment (long pants tucked into socks, for instance). Light colors make it easier to see ticks.
2. Use a chemical barrier. Treat clothing and footwear (long-sleeve shirts, jackets, hats, gaiters and boots) with permethrin to repel and disable ticks. Done at home before course, this treatment will last for up to a month. Clothes treated professionally are effective even longer. See protocol for treating clothing with permethrin, below.

3. Use a chemical repellent. Apply insect repellent containing Picaridin or DEET to exposed skin, according to the directions on the container. This lasts for only a few hours before you have to reapply it. Properly used, repellents allow people to live and work outdoors with reduced risk from insect bites.[1]

1. Staff will teach students to recognize ticks and remove them as soon as they are found. This is the BEST form of disease prevention. Removing ticks within 24 hours considerably reduces the risk of being infected with a disease-causing bacterium.
2. When traveling or camping in areas with woods, bushes, high grass or leaf litter, staff and students will check themselves for ticks at least twice every day.

  Protocol for Treatment of Clothing with Permethrin Permethrin is an extremely effective neurotoxin relative to arthropods (including ticks, fleas and mosquitos), does not have significant implications for human health and, when used correctly, poses little environmental risk. The Center for Disease Control and Prevention (CDC) and the Environmental Protection Agency (EPA) have determined that the benefits of using permethrin to prevent tick-borne disease far outweigh the risks. There are two options:

1. Buy a permethrin treatment (such as those made by Sawyer and Repel) and apply it according to the directions. You will need to apply it at least 24 hours before packing your clothes, in a windless, ventilated area.
2. You can send your clothes to Insect Shield®, and they will treat them and ship them back to you. Clothes treated professionally generally provide longer lasting protection.

  Additional Permethrin Information Permethrin is an insecticide in the pyrethroid family. Pyrethroids are synthetic chemicals that act like natural extracts from the chrysanthemum flower. Permethrin has been used for decades in a number of ways to control insects in homes, agriculture and in topical treatments for lice and scabies. Permethrin is applied to clothing rather than skin because it is deactivated on skin within 20-30 minutes, not because it is more toxic than skin-applied chemicals like DEET. It has very low (less than 1% absorbability on human skin (DEET has 20%)[2], and very few people react aversely to contact with permethrin (other than in the eyes). Like all chemicals that do something, there is a small risk of harm, but the risks of vector-borne illness are considerably greater. Permethrin can affect arthropods (such as ticks) and insects if they eat it or touch it. Permethrin is much more (over 2,250 times)[3] toxic to ticks and insects than it is to people because of their much smaller size and because arthropods and insects can’t break it down as quickly as mammals. [1] Maine CDC: Repellent Fact Sheet: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/documents/repellent-fact-sheet.pdf [2] The University of Rhode Island Tick Encounter Resource Center: http://www.tickencounter.org/prevention/permethrin [3] The University of Rhode Island Tick Encounter Resource Center: http://www.tickencounter.org/prevention/permethrin

Participants should come prepared to work hard, have fun and learn new skills. Your time with us will be spent outdoors in the natural world, meeting challenges, practicing leadership, managing risks and working closely within a group. Along the way, you will be guided by your instructors and supported by the camaraderie of fellow students.

Outward Bound has an excellent safety record, and the safety of our participants is a top priority. We invest considerable time and resources in training our staff and reviewing our programs to ensure that they meet Outward Bound’s national standards of safety and quality. The accuracy of the information you provide on medical forms is a safety essential. Families will be notified immediately in the case of an emergency.

In addition to providing a beautiful setting, wild and natural places offer a unique learning environment. The unfamiliar spaces present participants with inherent challenges and logical natural consequences. While learning to face these challenges as individuals and as a group, participants develop the skills they need to step into leadership roles and more effectively face challenges in their daily lives.

Participants will be part of a team comprised of 10 participants and two professionally trained Outward Bound instructors. Expeditions take place in one of our many course areas which included: portions of the Appalachian Trail in Pennsylvania or Maryland, the wilderness of West Virginia, or the Chesapeake Bay. Depending on the course which you are enrolled, you may experience rock climbing, map and compass navigation, environmental ethics, emotional and physical challenges and team leadership skill development.

Outward Bound instructors are highly qualified outdoor professionals and educators, extensively trained and certified in both hard and soft skills. Typical certifications include: Wilderness First Responder, Wilderness Lifeguarding, AMGA Rock Climbing and ACA Canoe instruction. An instructor must be certified and have both personal experience and professional guiding experience before becoming staff. Outward Bound instructors receive an equal level of instruction in soft skills. This includes group management, conflict resolution, goal-setting and action-planning, managing adolescents in the field, and judgment training. Instructors also learn curriculum, lesson planning, and natural history. They are taught by Outward Bound staff, through the Blank-Read Training Institute and by other professionals.

Bringing the proper clothing on your program is crucial. After you are enrolled you will receive a welcome packet that includes a clothing list specific to your course. This list has been carefully compiled based on all the weather conditions you may encounter while on your program. Our clothing list reflects the importance of the layering principle. Dressing in several light layers rather than one heavy layer allows you more flexibility as the weather and workloads change. Wool has been the long-time favorite of outdoors people, as it retains much of its insulating qualities when wet. Both synthetic and wool items are available in backpacking stores, surplus outlets and thrift stores. We advise you not to bring cotton clothing, such as jeans or sweatshirts (t-shirts are okay). Cotton retains moisture and loses almost all of its ability to retain warmth when wet. Also, once cotton gets wet, it stays wet and weighs more. Each participant should have a total of two pairs of closed-toe shoes for any course, one pair for daily use and one pair that can get wet.

Please don’t feel that you must buy anything. Outward Bound provides all technical equipment, including rain gear, sleeping bags, sleeping pads, duffel bags, back packs, stoves, food, etc. Even if you bring your own equipment, we may insist you use ours.

Please do not bring the following items:

• Jewelry and other valuable articles.
• Electronic devices (e.g. cell phone, mp3 players, videogames, etc.)
• Playing cards
• Pocket knives
• Books or magazines

Prescription medications must be approved by the Medical Screening Department before the program starts. If you cannot go for 24-36 hours without your medication, in case of an emergency, we recommend that you bring double the amount needed (with written instructions) in separate, non-breakable, waterproof containers.

While on course you will be eating nutritious and portable food – grains, pasta, cheese, vegetables, fruit and nuts – selected to meet high-energy demands for your program. Typical meals include burritos, macaroni and cheese, and tuna sandwiches. The diet may differ from what you are accustomed to at home. To prepare, we suggest you cut down on soft drinks, coffee and junk food.

We are very aware of basic sanitation in the wilderness. You will wash your hands regularly and learn tricks of the trade to staying clean, even though you will not be able to shower. Deodorant is not advised because it has a tendency to irritate skin when not washed off regularly, and the scent attracts many unwanted insects and animals. Personal soap is not necessary, as we provide all you will need.

The course will continue regardless of weather. Instructors will teach students basic safety precautions and protocols. All participants are provided with rain gear for use during the course.

Participants should come prepared to work hard, have fun and learn new skills. Time with Outward Bound will be spent outdoors in the natural world, meeting challenges, practicing leadership, reaching goals, problem solving and working closely within a group. Along the way, participants will be guided by instructors and supported by the camaraderie of teammates.

There will be a school store selling Outward Bound gear after your course (hats, shirts, mugs, sweatshirts, bandanas, etc). You should also bring money for lost or broken gear. $20-30 should suffice.

Participants may NOT bring cell phones or other electronic devices on course. The instructor team is equipped with an emergency phone. Participants will not be allowed to place or receive calls during the course.

Parents/guardians may contact our Course Director during an emergency 24 hours a day. This emergency number is given to parents/guardians once a participant is enrolled in one of our programs.

In order to participate, each participant must complete a medical form and acknowledgement of personal responsibility form. Each form must be signed by the student and a parent/legal guardian (if participant is under the age of 18). Please fill them out entirely and return them to the appropriate person for your group. Every question is important! Please be sure to include your height, weight and blood pressure. We do not require a doctor’s signature; however missing information may compromise participation in the program. Your forms will be confidentially reviewed by our Medical Screening Department. Outward Bound’s screening process is very thorough and rigorous in order to ensure the safety of our participants. Our Medical Screener may need to contact you for further clarification or to request additional information.

Parents/guardians will be contacted in the event their child develops symptoms consistent with any communicable disease, including COVID-19. Symptomatic individuals will be equipped with PPE, and tested using a rapid test. Students will be cared for, and CBOBS will seek medical care based on the student’s signs and symptoms and local medical advice, involving parents in the conversation as practical. If your child is Covid positive or otherwise too sick continue course, parents will be asked to pick up their child from the field as soon as possible. CBOBS’ emergency on-call team will manage this process, and the admissions team will support all pre- and post-course communication.

If a student tests positive for COVID-19, the student will need to leave the course permanently.   Parents/guardians are required to pick up the student as soon as possible from CBOBS headquarters in Baltimore. CBOBS will seek medical care based on the student’s signs and symptoms and local medical advice, involving parents in the conversation as practical.  CBOBS will notify the parents/guardians of the remaining students of the potential exposure. Parents/guardians will have the opportunity to decide whether or not to remove their child from the course.  If a staff member tests positive for COVID-19, they would leave the course permanently and be replaced by a staff member who has been supporting the group. 

COVID-19 vaccinations and at least one booster  are required for all CBOBS program staff. COVID-19 vaccinations are encouraged but not required for all participants.

Students and staff, regardless of vaccination status, will be required to wear masks at certain points through the course, such as in vehicles or indoors. Be sure to pack at least 2 masks in your gear.  Outdoor activities (such as canoeing, climbing, sea kayaking, or hiking) will not require wearing masks,

Staff will teach and supervise hygiene behaviors on course, including: 

• Handwashing and hand sanitizing 
• Sanitary food preparation and dish sanitizing 
• Covering sneezes and coughs
• Not sharing personal utensils or personal care products 
• Masking and/or distancing when necessary

If travel or other challenges result in enrollment dropping so low that the group size is below what we believe is necessary for the valuable interpersonal dynamics of an Outward Bound course, we will seek to transfer students and combine groups. If this is not possible, we may be forced to cancel a course.  

  CBOBS will provide a shuttle from BWI Airport to base for students only. The shuttle to base from Baltimore-Washington Marshall International Airport (BWI) leaves promptly at 10:30 AM.   Directions to the Outward-Bound Shuttle:  

• From baggage claim, proceed upstairs to the departures level.  
• Leave the terminal through Door #1 (labeled) across from the Southwest Airlines Ticket Counter  
• Cross the crosswalk and turn left towards the Southwest Drop-off area. (This is the first drop-of area that incoming vehicles encounter.) Outward Bound staff will meet you here at 10:30 AM.  

Parents or guardians wishing to travel to base from the airport must arrange their own transportation. BWI Airport is a 20 min drive from our base in Baltimore.  See google map directions here.    CBOBS staff will not meet unaccompanied minors at their arrival gate/departure gate for air travel.  If an airline requires that a minor be accompanied by an adult, the parent or guardian will be responsible.  Airlines vary according to their policies. Please contact your airline for their specific policy.    Here are some of our more commonly used airline policies on Unaccompanied Minor travel: https://www.southwest.com/html/customer-service/family/unaccompanied-minors-pol.html https://www.aa.com/i18n/travel-info/special-assistance/unaccompanied-minors.jsp https://www.delta.com/us/en/children-infant-travel/unaccompanied-minor-program