Chapter 11 Environmental Emergencies EMR 11-1 1-

Introduction An EMR’s work environment includes excessive heat, cold, rain, snow, fog, and other potentially dangerous conditions Exposure to environmental factors makes emergency responders susceptible to the same medical issues as the patients they treat EMRs must protect themselves from the environment and effectively treat patients while keeping them safe Classifications, assessment tools, signs and symptoms, and management of environmental emergencies EMR 11-2 1-

Cold Exposure Emergencies Learning Objective 1 Cold Exposure Emergencies PRINCIPLES EMR will assess environmental emergencies Critical interventions Baseline vital signs Secondary or rapid survey Provide a hand-off report EMR 11-3

Cold Exposure Emergencies Learning Objective 1 Cold Exposure Emergencies COLD EXPOSURE Overview Cold environment exposure for extended period of time Assessment tools for cold exposure SAMPLE and OPQRST CMS should be performed on any involved limb EMR 11-4

Cold Exposure Emergencies Learning Objective 1 Cold Exposure Emergencies SUPERFICIAL FROSTBITE Signs and symptoms Involves subcutaneous tissues Management of superficial frostbite Active rewarming Passive rewarming Do not rub area EMR 11-5

Cold Exposure Emergencies Learning Objective 1 Cold Exposure Emergencies DEEP FROSTBITE Overview Unprotected skin is frozen Tissue is permanently damaged Signs and symptoms Management of deep frostbite EMR 11-6

Cold Exposure Emergencies Learning Objective 1 Cold Exposure Emergencies HYPOTHERMIA Overview Factors contributing to heat loss Signs and symptoms of hypothermia Management of mild hypothermia Signs and symptoms of severe hypothermia Management of severe hypothermia EMR 11-7

Three Types of Heat Exposure Learning Objective 2 Three Types of Heat Exposure HEAT EXPOSURE Overview Hot or humid weather Hyperthermia Perspiration rate Assessment tools for heat exposure SAMPLE With heat cramps, using OPQRST EMR 11-8

Three Types of Heat Exposure Learning Objective 2 Three Types of Heat Exposure HEAT CRAMPS Overview Brief and painful cramping or spasms Usually calf, thigh, or shoulder muscles Management of heat cramps Water and electrolytes Gently massage cramps to relieve pain EMR 11-9

Three Types of Heat Exposure Learning Objective 2 Three Types of Heat Exposure HEAT EXHAUSTION Overview Generalized heat-related illness Signs and symptoms of heat exhaustion Management of heat exhaustion Stop all activity Remove excess clothing EMR 11-10

Three Types of Heat Exposure Learning Objective 2 Three Types of Heat Exposure HEAT STROKE Overview Core body temperature may exceed 106°F Signs and symptoms of heat stroke Management of heat stroke Passive cooling Aggressive active cooling EMR 11-11

Water-Related Emergencies Learning Objective 3 EMR’s Role During Water-Related Emergencies DROWNING Filling of the lungs with water, fluid, or other substances Gas exchange becomes impossible 40 percent of victims are younger than 5 years old In cold water drowning, survival chances without oxygen are greater EMR 11-12

Water-Related Emergencies Learning Objective 3 EMR’s Role During Water-Related Emergencies NEAR DROWNING Survival after being submerged in water Can cause permanent disability Rapid transport for all near drowning victims Small amount of water in lungs can cause hypoxia Enter the water only if properly trained EMR 11-13

Water-Related Emergencies Learning Objective 3 EMR’s Role During Water-Related Emergencies DIVING EMERGENCIES Shallow water diving Consider MOI, place on long backboard Stabilize patient’s head in the supine position If patient is prone, acquire additional help EMR 11-14

Water-Related Emergencies Learning Objective 3 EMR’s Role During Water-Related Emergencies DEEP WATER DIVING Complications from ascending, descending too quickly Symptoms of compression (squeeze) Problems of expansion during ascent Decompression sickness Management Cont. EMR 11-15

Water-Related Emergencies Learning Objective 3 EMR’s Role During Water-Related Emergencies DEEP WATER DIVING EMR 11-16

Lightning, Altitude, and Acute Mountain Sickness Learning Objective 4 Lightning, Altitude, and Acute Mountain Sickness LIGHTNING EMERGENCIES Overview injuries that are nonlife-threatening Other symptoms Assessment tools for lightning emergencies Management of lightning emergencies Victim does not carry an electrical shock EMR 11-17

Lightning, Altitude, and Acute Mountain Sickness Learning Objective 4 Lightning, Altitude, and Acute Mountain Sickness ALTITUDE EMERGENCIES Overview Acute mountain sickness High-altitude cerebral edema High-altitude pulmonary edema Management of altitude emergencies EMR 11-18

Care for Animal and Insect Bites and Stings Learning Objective 5 Care for Animal and Insect Bites and Stings BITES AND STINGS Overview Can transmit a parasite, virus, or bacteria Anaphylactic shock or long term disease Assessment tools for bites and stings SAMPLE, OPQRST and CMS Information regarding recent travel EMR 11-19

Care for Animal and Insect Bites and Stings Learning Objective 5 Care for Animal and Insect Bites and Stings SNAKE BITES Overview Two types that cause injury and death in U.S. Pit vipers Coral snake Management of snake bite Pressure immobilizaton EMR 11-20

Care for Animal and Insect Bites and Stings Learning Objective 5 Care for Animal and Insect Bites and Stings SPIDER BITES Overview Two most dangerous spiders in U.S. Extensive damage, even death Brown recluse Black widow EMR 11-21

Care for Animal and Insect Bites and Stings Learning Objective 5 Care for Animal and Insect Bites and Stings ANIMAL BITES Domestic and wild animals Animal size and number of bite wounds determine severity Threat of rabies Actions on scene by the EMR EMR 11-22

Care for Animal and Insect Bites and Stings Learning Objective 5 Care for Animal and Insect Bites and Stings HUMAN BITES Safe scene before entering Can cause infection Stop bleeding from the wound Irrigate with water EMR 11-23

Care for Animal and Insect Bites and Stings Learning Objective 5 Care for Animal and Insect Bites and Stings MARINE ANIMAL BITES AND STINGS Range from shark bite to jellyfish sting Symptoms Jellyfish sting Vinegar will inactivate venom load Immerse in hot water to relieve pain Be familiar with marine life in geographic area EMR 11-24

Care for Animal and Insect Bites and Stings Learning Objective 5 Care for Animal and Insect Bites and Stings ADDITIONAL BITES AND STINGS Bee stinger Fire ants Intense pain from fluid-filled vesicles on the skin Scorpions Rarely fatal, stinging or burning on the skin EMR 11-25

Care for Animal and Insect Bites and Stings Learning Objective 5 Care for Animal and Insect Bites and Stings MANAGEMENT OF BITES AND STINGS Make scene safe Critical interventions Patient information Clean area and cover Ice for pain and swelling EMR 11-26

Summary EMRs need to be prepared for various types of environmental emergencies EMRs must have a basic knowledge of heat and cold exposure emergencies; water-related emergencies; lightning emergencies; and animal, human, or insect bites and stings Environmental emergencies can be life threatening EMR 11-27 1-