Environmental Emergencies Chapter 18 Environmental Emergencies

Objectives (1 of 2) Describe the various ways that the body loses heat. List the signs and symptoms of exposure to cold. Explain the steps in providing care to a patient exposed to cold. List the signs and symptoms of exposure to heat. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Objectives (2 of 2) Explain the steps in providing care to a patient exposed to heat. Recognize the signs and symptoms of water-related emergencies. Describe the complications of near-drowning. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Loss of Body Heat (1 of 2) Conduction Transfer of heat from body to colder object Convection Transfer of heat through circulating air Evaporation Cooling of body through sweating Radiation Loss of body heat directly into a colder environment Respirations Loss of body heat during breathing Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Loss of Body Heat (2 of 2) Rate and amount of heat loss can be modified in three ways: Increase heat production. Move to sheltered area where heat loss is decreased. Wear insulated clothing. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Hypothermia Lowering of the body temperature below 95°F (35ºC) Weather does not have to be below freezing for hypothermia to occur. Elderly persons and infants are at higher risk. People with other illnesses and injuries are susceptible to hypothermia. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Signs and Symptoms of Mild Hypothermia Shivering Rapid pulse and respirations Red, pale, cyanotic skin Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Signs and Symptoms of More Severe Hypothermia Shivering stops Muscular activity decreases. Fine muscle activity ceases. Eventually, all muscle activity stops. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Core Temperature Less Than 80ºF Patient may appear dead (or in a coma). Never assume that a cold, pulseless patient is dead. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Emergency Medical Care (1 of 2) Remove patient from cold environment. Do not allow the patient to walk. Remove any wet clothing and cover with blankets. Handle the patient gently. Do not massage extremities or allow patient to eat or to use any stimulants. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Emergency Medical Care (2 of 2) Give warm, humidified oxygen. Assess pulse for 30 to 45 seconds before considering CPR. Begin passive rewarming. Consult medical control. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Management of Cold Exposure in a Sick or Injured Person Remove wet clothing. Prevent conduction heat loss. Insulate all exposed body parts. Prevent convection heat loss. Remove patient from cold environment. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Local Cold Injuries Frostnip Freezing of the skin but not the deeper surface Immersion (trench) foot Prolonged exposure to cold water Frost bite Freezing of a body part, usually an extremity Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Emergency Care for Local Cold Injury Remove the patient from further exposure to the cold Handle the injured part gently. Administer oxygen. Remove any wet or restrictive clothing. Never rub the area. Do not break blisters. Transport. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Warm-Water Bath Water temperature should be between 100-112oF. Recheck water temperature and stir to circulate. Keep body part in water until warm and sensation returns. Dress with dry, sterile dressings. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Cold Exposure and You EMT-Bs are at risk for hypothermia when working in a cold environment. Stay aware of local weather conditions. Dress appropriately and be prepared. Vehicle must be properly equipped and maintained. Never allow yourself to become a casualty! Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Body Temperature Normal body temperature is 98.6ºF. Body attempts to maintain normal temperature despite ambient temperature. Body cools itself by sweating (evaporation) and dilation of blood vessels. High temperature and humidity decrease effectiveness of cooling mechanisms. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Heat Cramps Painful muscle spasms Remove the patient from hot environment. Rest the cramping muscle. Replace fluids by mouth. If cramps persist, transport the patient to hospital. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Signs and Symptoms of Heat Exhaustion (1 of 2) Onset while working hard or exercising in hot environment In elderly and young, onset may occur while at rest in hot, humid, and poorly ventilated areas. Cold, clammy skin Dry tongue and thirst Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Signs and Symptoms of Heat Exhaustion (2 of 2) Dizziness, weakness, or fainting Patients usually have normal vital signs, but pulse can increase and blood pressure can decrease. Normal or slightly elevated body temperature Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Emergency Medical Care Remove extra clothing and remove from hot environment. Give patient oxygen. Have patient lie down and elevate legs. If patient is alert, give water slowly. Be prepared to transport. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Signs and Symptoms of Heatstroke Hot, dry, flushed skin Change in behavior leading to unresponsiveness Pulse rate is rapid, then slows. Blood pressure drops. Death can occur if the patient is not treated. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Care for Heat Stroke (1 of 2) Move patient out of the hot environment. Provide air conditioning at a high setting. Remove the patient’s clothing. Give the patient oxygen. Apply cold packs to the patient’s neck, armpits, and groin. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Care for Heat Stroke (2 of 2) Cover the patient with wet towels or sheets. Aggressively fan the patient. Immediately transport patient. Notify the hospital of patient’s condition. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Drowning and Near Drowning Death as a result of suffocation after submersion in water Near drowning Survival, at least temporarily, after suffocation in water Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Drowning Process Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Emergency Medical Care Begin rescue breathing as soon as possible. Maintain cervical spine stabilization. If air does not enter the patient’s lungs, treat for obstructed airway. Check pulse and start CPR if needed. Keep patient warm and transport. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Spinal Injuries in Submersion Incidents Suspect spinal injury if: Submersion has resulted from a diving mishap or long fall. Patient is unconscious. Patient complains of weakness, paralysis, or numbness. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Spinal Stabilization in Water Turn the patient supine. Restore the airway and begin ventilation. Secure a backboard under the patient. Remove the patient from the water. Cover the patient with a blanket. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Resuscitation Efforts Hypothermia can protect vital organs from hypoxia. Documented case of a survivor of a 66-minute cold water submersion Diving reflex may cause heart rate to slow. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Diving Problems Descent problems Usually due to the sudden increase in pressure on the body as the person dives Bottom problems Not commonly seen Ascent problems Air embolism and decompression sickness Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Signs and Symptoms of Air Embolism (1 of 2) Blotching Froth at the mouth and nose Severe pain in muscle, joints, or abdomen Dyspnea and/or chest pain Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Signs and Symptoms of Air Embolism (2 of 2) Dizziness, nausea, and vomiting Dysphasia Difficulty with vision Paralysis and/or coma Irregular pulse or cardiac arrest Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Decompression Sickness (The Bends) Occurs when bubbles of gas obstruct blood vessels Can result from rapid ascent Most common symptom is abdominal and/or joint pain. Symptoms may develop after hours. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Care for Air Embolism and Decompression Sickness Remove the patient from the water. Keep patient calm. Begin BLS and administer oxygen. Place the patient in the left lateral recumbent position with his or her head down. Provide prompt transport to hyperbaric chamber. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Other Water Hazards Hypothermia from water immersion. Breath-holding syncope Injuries from recreational equipment or marine animals Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Prevention Pools should be surrounded with appropriate enclosures. Alcohol involved in adult and teenage drownings. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

Geriatric Needs Body loses the ability to respond to environment. Decreased muscle mass and body fat results in less insulation. Temperatures that threaten older patients may not seem uncomfortable to responders. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS