1. Environmental Illness
CERT
Environmental Illness
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 157
The following WSIB learning objectives have been met in this chapter:
Heat and Cold Injuries - Elective module
16.1. Take measures to prevent cold injuries
Describe five conditions that aggravate the effect of exposure to cold
Name five safety measures to prevent cold injuries
16.2. Recognize cold injuries
Name the signs and symptoms of:
• Superficial frostbite
• Deep frostbite
Environmental Conditions

2. Instructor Notes Continued
List the signs and symptoms of the progressive stages of hypothermia
Name the signs of a frozen casualty
16.3 Provide first aid for cold injuries
Describe the first aid for:
• Superficial frostbite
• Deep frostbite
• Hypothermia
• Frozen casualty
Describe the minimum time for pulse assessment if trained before beginning CPR on a casualty in hypothermia
16.4 Take measures to prevent heat illnesses
List four conditions that cause heat illnesses
List four safety measures to prevent heat illnesses
16.5 Recognize heat illnesses
List the signs and symptoms of:
• Heat cramps
• Heat exhaustion
• Heatstroke
I. Classic heatstroke
II. Exertional heatstroke
16.6 Provide first aid for heat illnesses
Describe the first aid for:

3. Body Works
Our regular body temperature is degrees Celsius or 97.8 – degrees Fahrenheit.
Our body produces heat by turning food to energy and through muscular activity.
We lose heat through sweating and dilation of blood vessels.
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 157
WSIB requirements:
16.1. Take measures to prevent cold injuries.
Describe five conditions that aggravate the effect of exposure to cold.
Name five safety measures to prevent cold injuries.
Instructor Notes
Our regular body temperature is between 36–38 degrees Celsius or 97.8 – degrees Fahrenheit. A thermostat located deep within our brain regulates our body temperature. The body produces heat by converting food to energy (metabolism), and through muscular activity, such as shivering.
To preserve heat, blood vessels constrict, keeping warm blood in the core of the body. Body hairs may also erect so that warm air is trapped close to the skin.
Environmental Conditions

4. Instructor Notes Continued
The body loses heat by dilating (enlarging) blood vessels so that heat may be lost by radiation. Body hairs may also lay flat so that warm air can escape. Sweat glands become active, producing sweat to cool the body.
Frostbite occurs when areas of the skin become so cool (frozen) that regular cellular activities slow down and eventually cease.
Hypothermia results when the body’s core temperature has dropped so low that the body is unable to carry on with its’ regular activities.
Conditions that aggravate the effects of exposure to cold include dehydration, intoxication, physical activity, caffeine, and being dressed poorly.
To help prevent cold injuries one should dress appropriately for the weather (layers work well), stay hydrated, get out of the cold weather if shivering begins, refrain from alcohol, avoid staying in wet clothing or sitting on the cold ground.

5. Signs and Symptoms Frostbite Pins and needles Pale skin
Hard, stiffened skin
White, blue, black in colour
No sensation.
Upon recovery, skin may be red, hot, painful and blistered.
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 158
WSIB requirements:
16.2. Recognize cold injuries
Name the signs and symptoms of:
• Superficial frostbite
• Deep frostbite
Instructor Notes
Signs and Symptoms of Frostbite
A sensation of numbness or “pins and needles”
Pale skin
Hard, stiffened skin
Skin progressively changes colour; first white, then blue, then perhaps black.
Environmental Conditions

6. Instructor Notes Continued
There may be no sensation to the area.
When the skin is warmed, it may be red, hot, painful, and blistered.
Ask participants to discuss their own experience with this condition. Have them describe their symptoms and signs, if any were visible.
Living in the Canadian climate means we must be aware of weather hazards and dress appropriately to avoid temperature extremes.
Discuss workplace specific issues ( example: outdoor work during extreme cold weather alerts) and how these issues can be addressed by employees and employers.
Avoid exposure or reduce the length of time outdoors in extremely cold and damp conditions ( remove casualty to warmth).
Wear layered clothing.
Change into dry clothing, and take extra dry clothes.
Take more frequent breaks.
Keep hydrated but avoid caffeine and pop.

7. Superficial Frostbite
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 158
WSIB requirements: n/a
Instructor Notes
This picture is of a foot that has superficial frostbite. You can tell this by the blister on the toe.
Sept 2007
Environmental Conditions

8. Superficial Frostbite Treatment
Remove wet clothing.
Warm body (if it is not extreme frostbite).
Treat for Shock
Secondary Survey
Ongoing care
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 158
WSIB requirements:
Describe the first aid for:
• Superficial frostbite.
Instructor Notes - Treatment for Superficial Frostbite
Always begin with the steps of ESM. If the casualty is suffering from extreme frostbite, do not attempt to thaw the area — contact 911/EMS and follow directions below.
Remove any wet clothing.
Warm the area by using body heat or hot water bottles filled with warm water. Do not rub the area.
Replace with dry clothing.
Take measures to prevent the area from freezing again.
Environmental Conditions

9. Severe Frostbite Treatment
Always begin with the steps of ESM.
Send someone for 911/EMS right away.
Prevent further heat loss from frozen area and remainder of the body.
Do not rub area.
Casualty should remain as still as possible.
Transport the casualty to a warm area. If they can walk, they should move with care and assistance. They should not walk if their feet and legs are frozen.
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 158
WSIB requirements:
Describe the first aid for:
• Severe frostbite.
Instructor Notes - Treatment for Severe Frostbite
Always begin with the steps of ESM.
Send someone for 911/EMS right away.
Prevent further heat loss from frozen area and remainder of the body.
Do not rub area.
Casualty should remain as still as possible.
Transport the casualty to a warm area. If they can walk they should move with care and assistance. They should not walk if the feet and legs are frozen.

10. When Medical Help is not Available
Remove clothing from affected area.
Find a container large enough to hold the affected area and fill with warm water.
Submerge affected area in water until the colour returns or the colour does not improve anymore.
Pat dry.
Bandage with gauze dressing.
Do not break blisters.
Do not allow area to refreeze.
Get medical help as soon as possible.
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 158
WSIB requirements:
n/a
Instructor Notes - When Medical Help Is Not Available
If medical help is not available and you have moved to a safe warm place and there is no chance of the areas refreezing you may provide the following treatment:
Firstly ensure that the casualty is as warm and comfortable as possible.
Remove clothing from affected area.
Find a container large enough to hold the affected area in and fill it with warm water. The water should be approximately 40°c. It should feel warm if you put your elbow in it.
In order to provide this treatment you must ensure that their is enough warm water to keep the water at this constant temperature for up to forty minutes.

11. Instructor Notes Continued
Submerge affected area in water until the colour returns or the colour does not improve anymore.
Pat dry.
Bandage with gauze dressing.
Do not break blisters.
Do not allow area to refreeze.
Get medical help as soon as possible.

12. Frozen State The entire body moves as a solid unit.
The skin and deeper tissue cannot be depressed.
Joints of the jaw and neck are stiff.
The environment (cold) and state of the casualty (unconscious) indicates freezing.
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 158
WSIB requirements:
Describe the first aid for:
• Frozen casualty.
Instructor Notes - Frozen State
When the weather drops below zero, it is possible that a casualty may become completely frozen. If the casualty is found in this frozen state, we do not attempt ABC’s but seek medical attention immediately. We can transport the casualty to medical attention immediately or if it is not safe to do so, note the location of the casualty and make the location visible (i.e. scarf tied to a tree).
You can tell if a casualty is in a frozen state if:
The entire body moves as a solid unit.
The skin and deeper tissue cannot be depressed.
Joints of the jaw and neck are stiff.
The environment (cold) and state of the casualty (unconscious) indicates freezing.

13. Hypothermia
Our normal body temperature is between 36 and 38 degrees Celsius or 97.8 and degrees Fahrenheit. If the body temperature drops below this by two degrees the body does not function as it normally would. This state is called hypothermia. Hypothermia can fall into three categories: mild, moderate and severe.
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 158
WSIB requirements:
n/a
Instructor Notes – Hypothermia Defined
Our normal body temperature is between 36 and 38 degrees Celsius or 97.8 and degrees Fahrenheit. If the body temperature drops below this by two degrees the body does not function as it normally would. This state is called hypothermia. Hypothermia can fall into three categories, mild, moderate and severe.

14. Hypothermia Signs & Symptoms
Shivering (involuntary muscle contractions)
Cold, dry, pale skin
LOC decline
Slow shallow breathing
Cardiac arrest
Treatment
Remove wet clothing
Warm body (if possible)
Treat for shock
Provide ongoing care
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 158
WSIB requirements:
List the signs and symptoms of the progressive stages of hypothermia
Describe the first aid for:
• Hypothermia
Describe the minimum time for pulse assessment (if trained) before beginning CPR on a casualty in hypothermia.
Instructor Notes - Treatment of Hypothermia
Always begin with ESM.
Call 911/EMS or seek medical attention.
Remove casualty to a warm dry area.
Remove any wet clothing. Replace with warm dry clothing (if possible).
Environmental Conditions

15. Instructor Notes Continued
5. Garbage bags can be used to block wind (which helps reduce the cooling effect wind has). Garbage bags can also be placed over wet clothes the casualty is wearing when dry clothes are not available.
6. Warm the area by using hot water bottles filled with warm water.
7. In mild hypothermia, you can help warm the casualty by giving them a warm, caffeine-free, non-alcoholic drink, as long as they do not feel nauseated.
8. Provide ongoing care until medical help arrives.
9. If the casualty becomes non-breathing, begin CPR. If you have been trained to do a pulse check, it should be performed for at least 45 seconds. Do not delay in transporting the casualty.

16. Heat Cramps
Heat cramps usually occur in hot environments during physical activity.
Decreased fluid intake often makes this worse. Muscle spasms develop in the legs, arms and sometimes the abdomen as well.
Heat cramps are usually a minor illness.
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 158
WSIB requirements:
Describe the first aid for:
• Heat cramps.
Instructor Notes - Heat Cramps
Heat cramps usually occur in hot environments during physical activity. Decreased fluid intake often makes this worse. Muscle spasms develop in the legs, arms and sometimes abdomen as well.
Heat cramps are usually a minor illness. If caught the early, the symptoms may resolve with:
Rest
Cooling down
Drinking juice or sports drink
Stretching
Environmental Conditions

17. Instructor Notes Continued
Treatment
ESM.
Give the casualty water or drinks with electrolytes and carbohydrates.
If the cramps do not subside, seek medical attention.
Provide ongoing care.

18. Heat Exhaustion
Heat Exhaustion is a condition that usually progresses over a period of time due to over exposure to heat and dehydration.
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 159
WSIB requirements:
16.4 Take measures to prevent heat illnesses.
List four conditions that cause heat illnesses.
List four safety measures to prevent heat illnesses.
Instructor Notes
Heat exhaustion is usually a condition that progresses over a period of time due to over exposure to heat and dehydration.
Precautions:
Wear light loose clothing
Drink fluids that are not caffeinated (for example water and sports drinks)
Reduce exposure time to extreme heat
Take more frequent breaks / reduce workload
Attempt to remain in shaded or air conditioned area
Environmental Conditions

19. Instructor Notes Continued
Heat stroke can develop from heat exhaustion, or it may occur on its’ own; quickly and without warning. There are two categories:
Classic heatstroke = Sunstroke
Exertional heatstroke = Due to a combination of environmental factors and exertion.

20. Heat Exhaustion vs. Heat Stroke
Difficulty breathing
Nausea and vomiting
Weakness and dizziness
Pale, cool, clammy skin
Perspiration
Muscle cramps
Heat Stroke
Difficulty breathing
Nausea and vomiting
Confused and disoriented
Hot, flushed and dry skin
Severe headache
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 160
WSIB requirements:
List the signs and symptoms of:
• Heat exhaustion
• Heatstroke
Instructor Notes
Suggested Activity
Ask class to compare the above signs and symptoms to each other.
Question:
What is the easiest way to tell the difference between a casualty with heat exhaustion and heat stroke by comparing the signs and symptoms above?
Answer:
Pale, cool, clammy skin versus hot, flushed and dry skin.
Environmental Conditions

21. Heat Exhaustion Treatment
ESM.
Give the casualty something cool to drink as long as they do not feel nauseated.
Rest in cool area.
Remove excess clothing.
If the casualty loses consciousness, begin primary survey.
Provide ongoing care.
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 160
WSIB requirements:
16.6 Provide first aid for heat illnesses.
Describe the first aid for:
• Heat exhaustion
Instructor Notes
ESM.
Give the casualty sips of cool water or drinks containing electrolytes and carbohydrates (as long as the casualty does not feel nauseated).
They should rest in a cool area in a comfortable position (preferably lying down).
Remove any excess or restrictive clothing.
Environmental Conditions

22. Instructor Notes Continued
5. If the casualty loses consciousness, ensure that 911/EMS is called immediately.
6. Perform a primary survey (ABC’s) and provide aid as needed.
7. Provide ongoing care.

23. Heat Stroke Heat Stroke can occur suddenly and without warning.
This occurs when the thermostat within the brain is unable to regulate body temperature and the person becomes dangerously overheated.
There are two types of heat stroke: Classic and Exertional.
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 160
WSIB requirements: n/a
Instructor Notes
Heat stroke occurs when the thermostat within the brain is unable to regulate body temperature and the person becomes dangerously overheated.
Exposure to heat, dehydration, certain drug overdoses, alcohol consumption combined with heat exposure and being in a high risk group (i.e. elderly people) can all lead to heat exhaustion and stroke.
Classic heat stroke is where the body dangerously overheats because the mechanism within the body responsible for keeping the body cool (thermostat) fails. Exertional is caused when the body temperature suddenly rises due to sudden over exertion and the body dangerously overheats.
Environmental Conditions

24. Heat Stroke Treatment ESM. Call 911/EMS.
Move to a cool area. Remove outer clothing.
Cool casualty by submerging them in cold water.
If the casualty loses consciousness, remove them and begin primary survey.
If it is not possible to submerge them in water, cover the casualty with cool wet sheets.
When the casualty feels cool, dry them off.
If they reheat, repeat the process.
Provide ongoing care
Presentation: Environmental Illness
Time Line: 20 minutes
Participant manual page reference for slide: 160
WSIB requirements:
16.6 Provide first aid for heat illnesses.
Describe the first aid for:
• Heat cramps
• Heat exhaustion
• Heatstroke
Instructor Notes
ESM. Call 911/EMS.
Move the casualty to a cool area.
Remove outer clothing.
Cool the casualty by submerging them in cold water. The water level should not go past the chin.
If the casualty loses consciousness, remove them from the water and perform a primary survey (ABC’s) and provide aid as needed.
Environmental Conditions

25. Instructor Notes Continued
6. If it is not possible to submerge them in water, cover the casualty with cool wet sheets. In addition, you may cool them by fanning the sheets. Sponge the casualty with cool water, particularly in the head, armpits, neck and groin area.
7. When the casualty feels cool, dry them off. If they reheat, repeat the process.
8. Continue this until 911/EMS arrives.
9. Provide ongoing care.