[For Healthcare, Nursing, and Welfare Professionals] Safe Implementation Manual for Outdoor Recreation!

Outdoor recreation activities conducted in the fields of healthcare, nursing, and welfare hold significant importance for enhancing the quality of life (QOL) of elderly and disabled users and patients. However, there are numerous risks to consider, such as changes in health condition on the day and troubles during transportation. Many may wonder, "What should be checked to ensure safe supervision?" or "How can we prevent omissions in advance preparation?"

This article, compiled by Ayumi, who has been handling barrier-free information for safe outdoor recreation, is aimed at healthcare, nursing, and welfare professionals. It is organized and explained based on insights from the "Universal Tourism Product Development and Sales Manual" issued by the Japan Tourism Agency in March 2023. It covers everything from safety management concepts to role distribution on the day, necessary items, and emergency response.

If you are looking for ideas for planning outdoor recreation or want to prepare handover materials for new staff, please read to the end.

1. Why Welfare and Healthcare Professionals Should Conduct Pre-Checks Before Outdoor Recreation

While outdoor recreation offers a valuable opportunity for users and patients to step away from their daily routines, it requires staff to manage risks that differ from those encountered in regular settings. We will clarify why pre-checks are essential from both safety management and QOL perspectives.

1-1. The Importance of Safety Management and Risk Management

Activities outside the facility come with risks such as transportation, environmental changes, and crowds that are not anticipated within the facility. The "Universal Tourism Product Development and Sales Manual" (issued in March 2023 by the Japan Tourism Agency) categorizes these risks into three categories: "Information Issues," "Mobility Issues," and "Facility and Service Issues.".

For example, even if official information states "wheelchair accessible," the reality on-site may differ. Confirming information from multiple sources, such as phone confirmations and photo requests, is the first step in preventing troubles on the day.

Additionally, systematically identifying risks allows for consistent safety management as an organization, rather than relying on individual judgment on-site.

参照：2-3 旅行における参加者の【お困りごと】（P12）｜ユニバーサルツーリズムの商品造成・販売マニュアル｜観光庁

1-2. Enhancing Participants' (Users and Patients) QOL and Reducing Staff Burden

Outdoor recreation is a vital activity that contributes to the improvement of QOL (Quality of Life) by creating opportunities for social participation and refreshing experiences for participants. New scenery, interaction with people, and seasonal experiences provide stimuli that are difficult to obtain within the facility, contributing to the maintenance of cognitive function and mental stability. This is particularly significant for the elderly.

参照：社会参加（P46）｜あたまとからだを元気にするMCIハンドブック｜厚生労働省・国立長寿医療研究センター

On the other hand, lack of preparation during the planning stage can directly lead to increased staff burden and near-miss incidents on the day. By systematizing pre-check items, you can reduce "initial hesitation" and significantly alleviate the psychological burden on on-site staff. The time spent on preparation will surely pay off as extra time on the day.

2. [Before Departure] Pre-Check List for Outdoor Recreation

2-1. Checking Participants' Health Status, Vital Signs, and Medication

In addition to checking the health condition the day before departure, conduct a final check of all participants' vitals (temperature, blood pressure, pulse, etc.) on the morning of the day. It is recommended to carry extra regular medication in addition to the day's supply to prepare for delays in return or loss.

Additionally, copies of medication notebooks and insurance cards are essential for sharing information during emergency transport, so the supervising leader should manage them collectively. Prepare a "Medical Information Sheet" for each user (summarized on one A4 page with name, age, type of disability, regular medication, allergies, primary care physician, and family contact information) and always carry it during outings.

2-2. Checking the Barrier-Free Status and Wheelchair Routes at the Destination

Do not rely solely on official website information; confirm from multiple sources such as phone confirmations, photo requests, and Google Maps Street View. Discrepancies between "wheelchair accessible" labels and reality are often observed on-site.

Specific items to confirm include:

・Steps, slopes, and surface conditions from the entrance to the destination

・Number and location of barrier-free restrooms

・Corridor width (at least 80cm for wheelchair passage, 90cm for easier passage)

・Seats and rest areas available for use with chairs

・Elevator location and capacity

参照：第2部第3章 基本寸法｜高齢者、障害者等の円滑な移動等に配慮した建築設計標準｜国土交通省

For those who want to understand wheelchair-accessible routes in advance, please refer to the following article.

2-3. Weather and Temperature Forecasts and Measures Against Heatstroke and Cold

In spring and early summer, temperature differences can be significant, with differences of over 10 degrees between day and night not uncommon.Plan 1: "Everyone Can Play Day" at a Local Inclusive Park Area  Nationwide (multiple locations in major cities like Tokyo, Kanagawa, Osaka, etc.) Estimated Duration  Half-day (including travel, 3-4 hours) Wheelchair Accessibility  ★★★ Accessible for wheelchairs and those with mobility issues What is the Plan?  A day spent at a park designed for everyone to play, regardless of disabilities, age, or gender. Unlike regular parks, these parks offer equipment accessible by wheelchair and quiet areas with reduced sensory stimuli. Key Points of the Plan  Recreation in a park often excludes some users from enjoying the equipment. Inclusive parks allow everyone to share the same space. Bringing your own lunch means the day is nearly cost-free. Potential Issues and Tips [Information] You might not know which equipment suits whom until you arrive → Check the park's website or social media for equipment layout, and if possible, visit beforehand. [Facilities] There might only be one accessible restroom → Confirm its location on the park map and carry a health management sheet for users. [Soft Skills] Users with sensory sensitivities may become unstable during crowded times → Opt for weekday mornings or evenings when it's less crowded.

Reference:

Reference:

[Transportation] Rental welfare vehicles are limited in number and region, making it difficult to secure one during peak seasons → Reserve immediately after planning is decided. Recommended at least 2 weeks in advance 

[Software] If the driver has little experience with welfare vehicles, it may lead to issues on the day → Conduct a test drive (including lift operation) by the day before departure 

[Equipment] The parking lot at the destination may not fit the welfare vehicle → Confirm parking lot dimensions in advance (phone confirmation is reliable)

Day-of Check (Items & Pre-confirmation)

□ Rental contract & driver's license (for driver) 

□ Lift operation check at vehicle handover (must be done by staff) 

□ Check quantity of securing belts and wheelchair restraints 

□ Pre-reservation of parking space at destination (for welfare vehicles) 

□ Check if full tank return is required (depends on contract) 

□ Confirm loading space suitable for wheelchair type and size 

□ Pre-discussion on user boarding and alighting positions 

□ Contact for roadside assistance & emergency contact for rental company

Reference:

6. Conclusion

The three key points to keep in mind are:

・Identify risks in advance using the "three concerns" framework from the Tourism Agency manual

・Prepare a medical information sheet and emergency contact card for each participant and ensure they carry them

・When calling 119, do not specify a hospital, but leave it to the paramedics' judgment

Through outdoor recreation, let's create opportunities for elderly and disabled participants and patients to safely encounter new experiences and the colors of the seasons.