Caring for Environmental Emergencies

Caring for Environmental Emergencies
16 Caring for Environmental Emergencies

Define the following terms:
Objectives Define the following terms: Anaphylaxis Conduction Convection Core temperature Drowning Evaporation (continued)

Define the following terms:
Objectives Define the following terms: Frostbite Heat cramps Heat exhaustion Heat stroke Hyperthermia Hypothermia Radiation (continued)

Explain the four ways the body loses excess heat.
Objectives Explain the four ways the body loses excess heat. Describe the signs and symptoms of a patient experiencing a heat-related emergency. Explain the appropriate assessment and care for a patient experiencing a heat-related emergency. Differentiate the signs and symptoms of heat stroke and heat exhaustion. Describe the signs and symptoms of a cold-related emergency. (continued)

Describe common factors leading to submersion injuries.
Objectives Explain the appropriate assessment and care for a patient experiencing a cold-related emergency. Describe the signs and symptoms of emergencies related to bites and stings. Explain the appropriate assessment and care for a patient experiencing an emergency related to a bite or sting. Describe common factors leading to submersion injuries. (continued)

Describe common methods used for water-related rescue.
Objectives Describe common methods used for water-related rescue. Explain the hazards related to a water rescue. Describe the signs and symptoms of a submersion injury. Explain the appropriate care for a victim of a submersion injury. Demonstrate the ability to appropriately assess and care for a patient experiencing a heat-related emergency. (continued)

Objectives Demonstrate the ability to appropriately assess and care for a patient experiencing a cold-related emergency. Demonstrate the ability to appropriately assess and care for a patient experiencing a bite or sting emergency. Value the importance of proper training when attempting to conduct a water rescue.

Topics Temperature and the Body Heat Emergencies Cold Emergencies
Bites and Stings Water-Related Incidents Ice-Related Incidents

TEMPERATURE AND THE BODY

Temperature and the Body
Temperature regulation Process of maintaining proper body temperature. Hypothermia When body loses heat faster than it can produce heat. Hyperthermia When heat gain occurs faster than body can shed heat. Teaching Tip: Stress the prefix “hypo” as meaning “low” and “hyper” as meaning “high” to help students remember the meaning and difference in these terms.

Radiation Body heat is emitted into environment. Conduction Loss of body heat through direct contact with object or ground. Convection Loss of body heat when air close to skin moves away, taking body heat with it. Teaching Tip: Ask students to provide an example of how someone might counter the effects of each of these heat loss mechanisms. Sample Answers: Radiation: wearing a jacket or hat; Conduction: sitting on a cushion at a football game rather than directly on a cold bench; Convection: removing oneself from a breeze or putting on a windbreaker.

Evaporation Loss of body heat through evaporation of moisture in form of sweat on skin. Respiration Heat leaves body with each breath. Teaching Tip: Ask students to provide an example of how someone might counter the effects of each of these heat loss mechanisms. Sample Answers: Evaporation: removing wet clothing, toweling off sweaty skin; Respiration: wearing scarf or face shield.

Mechanisms of heat loss for the body.

Think About It It is late fall and you respond to a call for a teen who has fallen into the river after standing in his canoe. A rescue team has been dispatched. While waiting for help, how might he be losing heat?

HEAT EMERGENCIES

Heat Emergencies Core temperature: temperature in core of body 98.6°F (37°C). Heat generated through digestion, metabolism, movement. Heat lost through breathing and sweating. Hypothalamus: body's thermostat.

Algorithm for the assessment of patients with a heat emergency.
Teaching Tip: Review algorithm; discuss with students how it might be challenging to distinguish between each heat emergency. Algorithm for the assessment of patients with a heat emergency.

Heat Emergencies Effects of heat loss through evaporation greatly reduced when humidity is high. Perform history and physical exam. Very young, very old, those with chronic illnesses susceptible to effects of heat and cold. Critical Thinking: Why are the very young, very old, and those with chronic illnesses especially susceptible to the effects of heat and cold?

Heat Cramps/Exhaustion

Heat Stroke

Heat Emergencies Heat Cramps
Painful muscle spasms following strenuous activity in hot environment. Usually caused by electrolyte imbalance. Patient fully alert and sweaty with normal to warm skin temperature. Move to cool environment; replenish fluids. Critical Thinking: What is an electrolyte imbalance? How can it be treated?

Heat Emergencies Heat Exhaustion
Exposure to excessive heat for prolonged period of time. Body barely able to shed as much heat as it is generating. (continued)

Heat Emergencies Heat Exhaustion Signs and Symptoms
Mild to moderate perspiration Warm or cool skin temperature Skin color may be normal to pale Weakness, exhaustion, dizziness Nausea and vomiting Critical Thinking: In what situations might you expect to see cases of heat exhaustion? What can the EMR do to help prevent predictable cases? Sample Answer: Outdoor festivals in the summer; providing water misters, ensuring adequate shade areas. (continued)

Heat Emergencies Heat Exhaustion Signs and Symptoms
Muscle cramps (usually in legs) Rapid, weak pulse Rapid, shallow breathing Altered mental status (extreme cases)

Heat Emergencies Emergency Care for Heat Exhaustion
Take appropriate BSI precautions. Primary assessment; ensure breathing is adequate. Move patient to cool area. Loosen or remove excess clothing. Discussion Question: Why is it important to explain to patients what you are doing for treatment? (continued)

Heat Emergencies Emergency Care for Heat Exhaustion
Cool patient by fanning. Be careful not to overcool patient. Place patient in recovery position. Provide oxygen per local protocol. Discussion Question: How might the EMR best provide passive cooling?

Algorithm for the emergency care of patients with a heat emergency.

Heat Emergencies Heat Stroke
Temperature-regulating mechanism fails; unable to rid excess heat. Core temperature allowed to rise uncontrolled, causing body to overheat. It is life-threatening emergency. Temperature may increase to 105°F (40.5°C) or higher. Critical Thinking: What are the implications of a body temperature of 105 degrees or higher? (continued)

Heat Emergencies Heat Stroke Signs and Symptoms Altered mental status
Skin hot to touch Skin slightly moist to dry Rapid, shallow breathing Rapid pulse Critical Thinking: Why is altered mental status a significant finding? (continued)

Heat Emergencies Heat Stroke Signs and Symptoms
Weakness, exhaustion, dizziness Nausea and vomiting Convulsions Critical Thinking: How might the EMR suspect that convulsions are due to heat stroke and not simply seizures due to epilepsy?

Heat Emergencies Emergency Care for Heat Stroke
Take appropriate Standard Precautions. Primary assessment; ensure breathing is adequate. Move patient to cool area; remove excess clothing. Cool patient by dowsing or immersing in cool water. Critical Thinking: How might the EMR cool the patient if s/he has limited resources? (continued)

Do not overcool patient to the point of him/her shivering. Wrap cold packs or ice bags; place under armpits, on groin, and each side of neck. Critical Thinking: Why is it important not to overcool the patient? (continued)

Place patient in recovery position. Provide oxygen per local protocol. Monitor vital signs.

Think About It It is a hot summer day and you are dispatched for a “man down.” You arrive to find a 36-year-old male jogger who is seated on the ground. His shirt and shorts are wet from perspiration. He seems confused and has just vomited. What do you suspect? What else should you assess? How will you proceed? Talking Point: Remind students that a person may have stopped sweating even though their clothing appears wet from perspiration.

COLD EMERGENCIES

Cold Emergencies Hypothermia
Body loses heat faster than it can be generated (generalized cold emergency). Young children and elderly more susceptible. Critical Thinking: Why are young children and the elderly more susceptible to hypothermia? (continued)

Cold Emergencies Hypothermia Signs and Symptoms
Cool or cold skin temperature Shivering (may stop later) Altered mental status Abnormal pulse (rapid, then slow) Lack of coordination (continued)

Cold Emergencies Hypothermia Signs and Symptoms Muscle rigidity
Impaired judgment Complaints of joint/muscle stiffness Talking Point: Victims of extreme hypothermia have been known to become confused and perceive that they are actually feeling overheated; leading them to remove their clothing.

Signs and symptoms of hypothermia.

Cold Emergencies Emergency Care for Hypothermia
Take appropriate BSI precautions. Primary assessment; ensure adequate breathing. Remove patient from cold environment. Do not allow patient to walk or exert himself/herself in any way. Critical Thinking: Why is it important not to let a hypothermic patient walk or exert themselves in any way? Sample Answer: Movement can cause cold blood in the extremities to shunt toward the internal organs, potentially leading to cardiac arrest. (continued)

Cold Emergencies Emergency Care for Hypothermia
Protect patient from further heat loss. Remove wet clothing and place blanket over and under patient. Handle patient gently. Administer oxygen per local protocols. Discussion Question: Considering the methods of heat loss; why is it important to remove wet clothing? (continued)

Cold Emergencies Emergency Care for Hypothermia Monitor vital signs.
Do not give patient anything to eat or drink, including hot coffee, tea, alcohol. Critical Thinking: Why should you avoid giving the hypothermic patient anything to eat or drink?

Cold Emergencies Severe Hypothermia
Patient unresponsive with skin cold to the touch; no vital signs. Do not assume patient is dead. Assess pulse for seconds. If no pulse, begin CPR. Not be pronounced dead until core temperature to within normal range. Teaching Tip: Hypothermia Rule of Thumb: “A patient is not dead until they are warm and dead.”

Cold Emergencies Localized Cold Injury
Cold injury or frostbite: freezing or near freezing of body part. Caused by significant exposure to cold temperature (below 0°F or 17°C). Occurs in extremities (fingers, toes, ears, face, nose). Critical Thinking: Why are extremities more susceptible to injury from extreme cold? (continued)

Cold Emergencies Localized Cold Injury
Signs and Symptoms (Early Signs) Numbness, tingling exposed area Slow or absent capillary refill Skin remains soft If thawed, tingling and pain present (continued)

Cold Emergencies Localized Cold Injury Signs and Symptoms (Late Signs)
White, waxy skin Firm to frozen feeling upon palpation Swelling Blisters If thawed, flushed with areas of purple and blanching

Discussion Question: What treatment priorities would you have for a patient presenting with this type of cold injury? Severe frostbite.

Cold Emergencies Emergency Care for Cold Injury
Take appropriate BSI precautions. Primary assessment; ensure adequate breathing. Remove patient from cold environment; protect from cold exposure. Remove wet or constrictive clothing. (continued)

Cold Emergencies Emergency Care for Cold Injury Early injury:
Manually stabilize extremity, affected part. Cover affected part. Do not rub or massage it. Do not re-expose part to cold. Critical Thinking: Why is it important not to rub or massage the affected part? (continued)

Cold Emergencies Emergency Care for Cold Injury Late injury:
Remove jewelry from injured part. Cover injured part with dry, sterile dressings. Place dressing between fingers and toes prior to covering. Do not break blisters. Critical Thinking: Why is it important to remove jewelry (e.g., rings, bracelets) from the affected part? (continued)

Cold Emergencies Emergency Care for Cold Injury Late injury:
Do not rub or massage injured part. Do not apply heat. Do not rewarm. If legs, do not allow patient to walk. Critical Thinking: Why is it important not to rewarm or apply heat to the affected part?

Cold-Related Emergencies

Think About It You respond to a water-filled quarry on a hot sunny day where a couple has been scuba diving. You find a 47-year-old petite female in a wet suit. She is confused and complaining of joint pain. Her husband reports that the water is “warm” at 72 degrees and they had been in the water for about an hour. What might be going on? Critical Thinking: What ELSE could be affecting this diver?

BITES AND STINGS

Bites and Stings Assessment and Emergency Care Signs and Symptoms
Noticeable puncture marks on skin Pain at or around injury site Redness, itching at injury site Weakness, dizziness Teaching Tip: Provide information on dangerous species specific to your geographic location. Discuss appropriate treatment techniques. (continued)

Bites and Stings Assessment and Emergency Care Signs and Symptoms
Difficulty breathing Headache Nausea Altered mental status Critical Thinking: Why might a victim of a bite or sting have difficulty breathing?

Bites and Stings Emergency Care for Localized Reaction
Take appropriate BSI precautions. Perform scene size-up. Primary assessment; ensure adequate breathing. Scrape away bee and wasp stingers and venom sacs. (continued)

Bites and Stings Emergency Care for Localized Reaction
Do not attempt to pinch or pull out stingers. Plastic credit card works as scraper. Place cold pack over injury site. Administer oxygen per local protocols. Critical Thinking: Why is it important to avoid pinching or pulling out stingers?

Class Activity: Direct students to work in pairs and use a credit card to mimic the stinger removal procedure. If the insect stinger is still present, remove it by scraping it away with the edge of a credit card or similar object.

Bites and Stings Anaphylactic Shock
Severe allergic reaction; shock develops. BP decreases. Life-threatening emergency. Causes: bee stings; foods (nuts, spices, shellfish); inhaled substances; dust and pollens; certain chemicals; medications. Teaching Tip: Review local protocols regarding anaphylactic shock and the use of epinephrine auto-injectors by the EMR. (continued)

Bites and Stings Anaphylactic Shock Signs and Symptoms
Burning, itching, breaking out of skin (hives or rash). Breathing difficult, rapid; possible chest pains, wheezing. Pulse rapid, weak, not detected. Lips turn blue (cyanosis). Discussion Question: How can age, medications, and underlying medical conditions affect treatment? (continued)

Bites and Stings Anaphylactic Shock Signs and Symptoms
Swelling of face and tongue Restlessness Changes in mental status (fainting or unresponsiveness) Critical Thinking: Why is swelling of the face and tongue a danger sign? (continued)

Bites and Stings Anaphylactic Shock Emergency Care
Follow same procedures as used in shock. Follow local protocols regarding epinephrine autoinjector. Always call for medical direction before assisting patient with medications.

Bites and Stings Snakebites Signs and Symptoms Noticeable bite to skin
Pain, swelling; may be slow to develop Rapid pulse; labored breathing Weakness Vision problems Nausea and vomiting Teaching Tip: Provide photos of the most common snakes in your area. Compare and contrast venomous from non-venomous.

Bites and Stings Emergency Care for Snakebite
Take appropriate Standard Precautions. Perform scene size-up. Primary assessment; ensure breathing adequate. Locate fang marks; clean site with soap and water. Remove rings, bracelets, other constricting items. Critical Thinking: Why is it important to remove jewelry? (continued)

Bites and Stings Emergency Care for Snakebite
Keep extremity immobilized. Provide supplemental oxygen. Provide care for shock. Monitor vital signs. Do not apply cold pack unless directed by a physician. Discussion Question: Why is it important to know that the signs and symptoms of snake poisoning may take several hours to develop?

Think About It You respond to a golf course for a 62-year-old male complaining of left ankle pain. Upon arrival, you learn the golfer tried to retrieve a ball in the woods and felt a sudden sting. There is an obvious puncture with redness and he is beginning to have trouble breathing. How do you proceed with assessment and care?

WATER-RELATED INCIDENTS

Water-Related Incidents
Drowning Respiratory impairment from submersion in water or other liquid. Airway obstruction from water, foreign matter in airway, swollen airway. Cardiac arrest usually related to respiratory arrest. Injuries to head and neck to be expected. Teaching Tip: Clarify for students that this section is a review of water-related incidents and will not adequately prepare an individual to perform water rescue. EMRs should not attempt water rescue without specialized training.

Look for fractures, soft-tissue injuries, internal bleeding. Water does not have to be very cold and time in water does not have to be very long for hypothermia to occur.

Reaching the Victim Unless trained in water rescue, do not go into water to save someone. If patient is close to shore or poolside, attempt to reach and pull from water. Use branch, fishing pole, oar, stick, towel, shirt, article of clothing. Critical Thinking: What other items can be thrown to the victim to help keep them afloat? (continued)

Reaching the Victim Secure your position so you will not be pulled into water. Throw objects that will float. Throw lines or flotation devices attached to line.

Reach for the victim. Throw an object to him
Reach for the victim. Throw an object to him. If necessary, go to the victim if you are trained to do so.

Care for Patient (No Neck/Spine Injuries) Primary assessment. Mouth-to-mask resuscitation. Check for airway obstruction. Provide CPR. Activate EMS system. Discussion Question: Why is it important to provide CPR to victims of water-related incidents even if it appears they were in the water for an extended length of time? (continued)

Care for Patient (No Neck/Spine Injuries) Breathing and pulse, check and control bleeding. Breathing and pulse, perform patient assessment. Cover patient to conserve body heat. (continued)

Care for Patient (No Neck/Spine Injuries) Hypothermia suspected, remove wet clothing to minimize heat loss. If patient can be moved, take to warm place. Do not allow patient to walk. Handle gently at all times. Care for shock. Discussion Question: Why is it important to handle patient gently when hypothermia is suspected?

Patient with Neck or Spine Injuries Turn patient face up in water. Begin primary assessment. Provide rescue breathing. Float patient to shore; continue to provide back and neck support. (continued)

Patient with Neck or Spine Injuries Patient out of water, attempt resuscitation. Check for and control serious bleeding. Critical Thinking: What should the EMR be prepared to manage while resuscitating the drowning victim? Answer: Vomiting

Water Rescue (continued)

Water Rescue

Submersion Injuries Associated with scuba diving. Air Embolism Signs or Symptoms Personality changes Distorted senses; blurred vision Chest pain Numbness and tingling sensations in arms and/or legs (continued)

Submersion Injuries Air Embolism Signs or Symptoms General weakness; weakness of one or more limbs Frothy blood in mouth or nose Convulsions (continued)

Submersion Injuries Decompression Sickness (Bends) Signs and Symptoms Fatigue Pain to muscles and joints (bends) Numbness or paralysis Choking, coughing, labored breathing (continued)

Submersion Injuries Decompression Sickness (Bends) Signs and Symptoms Chest pains Collapse and unresponsiveness Blotches on the skin (mottling) Talking Point/Critical Thinking: Signs and symptoms of decompression sickness may not appear until one-48 hours after diving. Why is this important for the EMR to know?

For scuba accidents, position the patient head down.
Critical Thinking: Why might it be important for the EMR to ensure that the responding EMS crew knows that the patient appears to be suffering from decompression sickness? For scuba accidents, position the patient head down.

Think About It You respond to the city pool for a 16-year-old male drowning victim. He is unresponsive, breathing, has a pulse, and his skin is cold. What other injuries or conditions are you concerned about at this point? How will you proceed with assessment and treatment?

ICE-RELATED INCIDENTS

Ice-Related Incidents
Unless trained to work on ice, do not attempt rescue. Major problem is reaching victim. Never attempt ice rescue by yourself. Never go onto ice that is rapidly breaking up. Throw line to victim or reach out with stick or pole. Discussion Question: Why is “scene safety” especially important in ice-related incidents?

Ice-Related Incidents
Throw anything that will float. Ice rescues require special training, protective clothing, rescue equipment. Broken legs and hypothermia are often problems. Do not attempt to actively rewarm a severely hypothermic patient. Activate EMS system. Critical Thinking: Why are broken legs and hypothermia often a problem with ice-related incidents?

A safe ice rescue requires teamwork from specially trained responders.

Think About It What injuries or illnesses might not show up immediately in accidents involving cold water and ice? How can an EMR anticipate this and provide proper care?

SUMMARY

Summary Body loses heat through: Radiation Conduction Convection
Evaporation Respiration

Summary Hyperthermia: hot, humid environment may cause body to generate too much heat creating abnormally high body temperature. Signs and symptoms: Cramps Excessive sweating Rapid weak pulse Weakness

Summary Heat cramps: sudden and sometimes severe muscle cramps (often occurring in legs). Heat exhaustion: prolonged exposure to heat; creates moist, pale skin that may feel normal or cool to the touch.

Summary Heat stroke: prolonged exposure to heat; hot, dry or moist skin; altered mental status; rapid breathing. It is a life-threatening emergency. Emergency care for heat emergencies: remove patients from hot environment, cooling with water, fanning.

Summary Hypothermia: rapid heat loss creating state of low body temperature. Cool skin temperature Shivering Decreased mental status Stiff or rigid posture Poor judgment Temperature does not have to be below freezing to occur.

Summary Frostbite Emergency care
Freezing or near freezing of a body part; feeling of cold followed by pain, numbness, or tingling. Emergency care Remove patient from cold environment; remove wet clothes; keep patient calm and warm; stabilize any cold extremity.

Summary Care for injected poisons (other than snakebite):
Care for shock Scrape away stingers and venom sacs Place ice bag or cold pack over area

Summary For snakebite: Keep patient calm and lying down Clean site
Keep bitten extremities immobilized Alert dispatcher Care for shock

Summary Anaphylactic shock (allergy shock): Life-threatening emergency
When people come into contact with substance to which they are allergic (bee stings, insect bites, chemicals, foods, dusts, pollens, drugs)

Summary Signs of anaphylactic shock: Burning or itching skin Hives
Difficulty breathing Rapid, weak pulse Swelling of face and tongue Cyanosis Altered mental status

Summary Care same as for other cases of shock.
Transport patient to hospital and care for according to local protocol. Ask patient about allergies during interview. Look for medical identification device.

Summary Many submersion injuries related to scuba diving and result when a person ascends too quickly. The “bends” result when tiny gas bubbles form in tissues, causing pain. In severe cases, these bubbles can form air embolism that obstructs blood flow, resulting in death.

REVIEW QUESTIONS

What are the four ways the body loses excess heat?
Review Questions What are the four ways the body loses excess heat? What are the signs and symptoms of a patient experiencing a heat-related emergency? You have a patient experiencing a heat-related emergency. What is the appropriate assessment and care? (continued)

What are the signs and symptoms of a cold-related emergency?
Review Questions What is the difference in the signs and symptoms of heat stroke versus heat exhaustion? What are the signs and symptoms of a cold-related emergency? You have a patient experiencing a cold-related emergency. What is the appropriate assessment and care?

What are the signs and symptoms of a bite and sting emergency?
Review Questions What are the signs and symptoms of a bite and sting emergency? You have a patient with a bite or sting emergency. What is the appropriate assessment and care? What are common methods for water-related rescue and their hazards?

What are some common factors that can lead to a submersion injury?
Review Questions What are some common factors that can lead to a submersion injury? What are the signs and symptoms of a submersion injury? How will you provide the appropriate care for a victim of a submersion injury?

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Caring for Environmental Emergencies

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