1. © 2011 National Safety Council 15-1 ENVIRONMENTAL EMERGENCIES LESSON 15

2. © 2011 National Safety Council 15-2 Introduction Body temperature problems occur when body becomes too cold or too hot Cold- and heat-related injuries can begin gradually but become an emergency Cold or heat emergencies can lead to serious injury or death Submersion in water can cause a third type of environmental emergency

3. © 2011 National Safety Council 15-3 Body Temperature Constant core body temperature necessary Body has several mechanisms to create or lose heat Mechanisms cannot maintain constant temperature when exposed to temperature extremes for extended period Infants and elderly are more susceptible

4. © 2011 National Safety Council 15-4 Mechanisms For Staying Warm Metabolic processes – most body heat produced this way Contraction of muscle tissue – including shivering Vasoconstriction – less radiation of heat away from skin

5. © 2011 National Safety Council 15-5 Mechanisms For Staying Cool Vasodilation -More warm blood to surface of skin to be radiated away -Primary heat loss method Sweating – evaporation from skin surface cools body

6. © 2011 National Safety Council 15-6 Prolonged Exposure to Cold Especially when wet: -The body cannot conserve heat -Shivering cannot produce enough heat Hypothermia develops Organ systems gradually begin to fail, leading eventually to death

7. © 2011 National Safety Council 15-7 Prolonged Exposure to Heat Body cannot maintain normal temperature Profuse sweating leads to dehydration -Blood volume and blood pressure decrease -Without fluid, body cannot cool itself With activity or exercise, body loses fluid quickly Heatstroke occurs when body temperature rises Without treatment, organ damage or death occurs

8. © 2011 National Safety Council 15-8 Heat and Cold Injuries Risk Factors Young children Elderly Injuries Chronic health problems Mental impairment Dehydration Too little body fat Too much body fat Activity in extreme environments Medications and drugs (including alcohol) Environmental variables (water immersion, wind chill, humidity)

9. © 2011 National Safety Council 15-9 Hypothermia Occurs when body cannot make heat as fast as it loses it Body temperature <95°F Can occur whenever and wherever person feels cold Progressive May occur gradually or quickly About 600 people die each year in United States

10. © 2011 National Safety Council 15-10 Hypothermia with Obvious or Subtle Exposure to Cold Obvious cases involve exposure in cold environment Duration of exposure and exposed skin or thin clothing increases risk More subtle cases may occur with underlying illness, overdose, poisoning or an elderly patient in a cool home

11. © 2011 National Safety Council 15-11 Signs and Symptoms of Hypothermia Pale, cool skin even under clothing Slow breathing Uncontrollable shivering (may stop in severe hypothermia) Decreasing mental status or motor function Patient seems apathetic, confused or irrational Lethargy, clumsy movements, drowsiness, dizziness

12. © 2011 National Safety Council 15-12 Signs and Symptoms of Hypothermia (continued) Memory disturbances or confusion Reduced or loss of touch or sensation Speech difficulty Poor judgment Stiff or rigid posture, muscular rigidity, joint or muscle stiffness

13. © 2011 National Safety Council 15-13 Early Signs and Symptoms of Hypothermia Shivering Numbness Lethargy Poor coordination Slurred speech Infants may have bright red skin and little energy Take early action to prevent progression!

14. © 2011 National Safety Council 15-14 Late Signs and Symptoms of Hypothermia Shivering typically stops Patient may not feel cold Breathing becomes shallow, pulse slows Mental status deteriorates Patient may become unresponsive and stop breathing

15. © 2011 National Safety Council 15-15 Emergency Care for Hypothermia Perform standard patient care Remove patient from cold environment immediately Protect from further heat loss Remove wet clothing, cover with warm blankets Have patient lie down, handle gently Follow local protocol for oxygen Dont allow patient to walk or exert self Dont give patient any food or drink

16. © 2011 National Safety Council 15-16 Emergency Care for Hypothermia (continued) Dont allow patient to use stimulants such as caffeine or nicotine Dont massage skin or extremities Dont immerse patient in hot water Dont use direct heat Assess unresponsive patient for pulse for 30-45 seconds before CPR Follow local protocol to use AED as usual

17. © 2011 National Safety Council 15-17 Remote Location Emergency Care Only if patient is far from medical care, use active rewarming Put patient near heat source or put warm water in containers against skin

18. © 2011 National Safety Council 15-18 Frostbite Freezing of skin or deeper tissues Usually clear demarcation of area of injury More common in exposed skin areas (head, hands, feet) Wind chill increases risk Severe frostbite kills tissue and can result in gangrene and need for amputation

19. © 2011 National Safety Council 15-19 Signs and Symptoms of Frostbite Early or superficial frostbite: Skin color doesnt return after palpation Skin remains soft Area is numb, tingles or aches when rewarmed

20. © 2011 National Safety Council 15-20 Severe Frostbite Skin looks waxy, white, gray, yellow or bluish Area feels firm or frozen hard on palpation Swelling or blisters

21. © 2011 National Safety Council 15-21 Severe Frostbite (continued) Affected area may become painless After warming, area becomes: -Swollen -Blistered and flushed -Mottled and cyanotic

22. © 2011 National Safety Council 15-22 Emergency Care for Frostbite Perform standard patient care Remove patient from environment Remove wet or constrictive clothing Protect patient from further heat loss Handle patient very gently Have patient rest and avoid movement or exertion Check for hypothermia Protect cold-injured area from further injury

23. © 2011 National Safety Council 15-23 Emergency Care for Frostbite (continued) For early or superficial injury: -Manually stabilize and cover extremity -Do not rub or massage area -Prevent another exposure to cold For late or deep cold injury: -Remove jewelry and tight-fitting clothing -Put dry gauze between frostbitten fingers or toes -Protect and elevate area

24. © 2011 National Safety Council 15-24 Emergency Care for Frostbite (continued) Do not: -Break blisters -Rub or massage area -Apply heat -Rewarm area -Allow patient to walk on affected extremity -Give food or drink -Allow tobacco use

25. © 2011 National Safety Council 15-25 Rewarming Frostbite If help is delayed, rewarm severe frostbite by immersing area in lukewarm (not hot) water for 20-30 minutes Do this only if there is no risk of refreezing Never apply a direct heat source

26. © 2011 National Safety Council 15-26 Heat Emergencies Heat exhaustion -Develops when body becomes dehydrated -Can progress to heatstroke Heatstroke -Medical emergency -If untreated, can cause death

27. © 2011 National Safety Council 15-27 Heat Emergencies (continued) Most occur during hot weather but can also occur in hot settings (furnace room, factory, vehicle) Average 400 deaths/year in United States Heatstroke is progressive starts with milder symptoms Recognize signs and symptoms early and treat

28. © 2011 National Safety Council 15-28 Signs and Symptoms of Heat Exhaustion Early signs and symptoms: -Sweating, pale/ashen moist skin -Thirst -Fatigue, weakness, exhaustion -Muscle cramps Later signs and symptoms -Headache, dizziness, fainting -Nausea, vomiting -Fast, shallow breathing -Rapid heart rate

29. © 2011 National Safety Council 15-29 Emergency Care for Heat Exhaustion 1.Move patient from heat to rest in cool place 2.Loosen or remove clothing 3.Give sports drink or water 4.Raise legs 6-12 inches 5.Cool patient

30. © 2011 National Safety Council 15-30 Emergency Care for Heat Exhaustion (continued) Cool patient with one of these methods: -Put wet cloths on forehead and body -Sponge skin with cool water -Spray skin with water from spray bottle and then fan area (ineffective in high humidity) Do not give salt tablets If patient is lethargic, nauseous or vomiting, do not give liquids Seek medical care if condition worsens or does not improve in 30 minutes Seek urgent medical attention if patient has heart condition or high blood pressure

31. © 2011 National Safety Council 15-31 Heatstroke vs. Heat Exhaustion Heatstroke Patients skin is flushed and feels hot to touch Patient becomes confused and irrational and may become unresponsive or have convulsions Heat Exhaustion Skin may be pale, or ashen, and clammy Patient dizzy or tired or may be irritable and have a headache

32. © 2011 National Safety Council 15-32 Signs and Symptoms of Heatstroke Skin is flushed, dry, hot Sweating usually has stopped Fast breathing Headache, dizziness, extreme confusion, other signs of altered mental status Irrational or belligerent behavior Possible convulsions or unresponsiveness

33. © 2011 National Safety Council 15-33 Emergency Care for Heatstroke Perform standard patient care Move to cool place Remove outer clothing Cool quickly with any means at hand Follow local protocol for oxygen Cool until temperature drops to 101°F (38.3°C) Do not apply rubbing alcohol to skin

34. © 2011 National Safety Council 15-34 Emergency Care for Heatstroke (continued) Cool quickly using one or more of these techniques: Immerse patient up to neck in cold water Spray skin with water and then fan (ineffective in high humidity) Wrap patient in wet sheet and keep it wet Sponge patient with cold water Put ice bags or cold packs beside neck, armpits and femoral pressure point area near groin

35. © 2011 National Safety Council 15-35 Emergency Care for Heatstroke (continued) No pain relievers or salt tablets No caffeine or alcohol No liquids if nauseous, vomiting, diminished mental status Monitor patient and provide needed care Put unresponsive patient in recovery position if breathing normally Assist patient with ventilation if breathing is inadequate

36. © 2011 National Safety Council 15-36 Submersion Injury Drowning occurs when airway is surrounded by water or another liquid that prevents breathing About 3,700 people die each year from drowning in United States For every child who dies from drowning, 4 more receive emergency care for submersion injury Often results in permanent disabilities and brain damage

37. © 2011 National Safety Council 15-37 Drowning Patients Begin rescue breaths as soon as possible If possible, begin rescue breaths still in shallow water Must remove patient from water to give CPR If cause of incident is unknown, assume patient may have spinal injury Keep head in line with body when moving or positioning patient Use jaw thrust to open airway

38. © 2011 National Safety Council 15-38 Assessing Submersion Injury Perform standard assessment Severity of patients condition depends on duration of submersion and other factors

39. © 2011 National Safety Council 15-39 Signs and Symptoms of Submersion Injury Patient may still be responsive or may have become unresponsive Coughing Vomiting Difficulty breathing Respiratory arrest Cardiac arrest

40. © 2011 National Safety Council 15-40 Emergency Care for Submersion Injury Perform standard patient care If patient is still in water, maintain your personal safety If spinal injury suspected, manually stabilize patients neck and spine If patient is breathing normally, place in recovery position Follow local protocol for oxygen If patient is not breathing normally, first open airway and give 2 rescue breaths, then quickly check for pulse

41. © 2011 National Safety Council 15-41 Emergency Care for Submersion Injury (continued) If patient has pulse but is still not breathing normally, continue rescue breathing If patient does not have pulse, give CPR immediately – begin with chest compressions Because of high risk for vomiting, be prepared to roll patient on side and to suction mouth