1. Heat-Related Emergencies
Chapter 26
Heat-Related Emergencies

2. Objectives
26.1 Explain the way the body normally adjusts to a hot environment.
26.2 List the signs and symptoms of a patient with each of the four types of heat-related illness.
26.3 Describe and demonstrate the assessment and emergency care of a patient suffering from each of the four types of heat-related illness.
continued

3. Objectives
26.4 List the signs and symptoms of a patient who is a victim of a lightning strike.
26.5 Describe and demonstrate the assessment and emergency care for a patient who has been struck by lightning.
26.6 Explain what one can do to prevent heat-related illness.

4. Topics Anatomy and Physiology Common Heat-Related Emergencies
Heat-Related Illness Prevention
Lightning
Assessment
Management
Chapter Summary
Discussion Points: This chapter serves to remind us that although we specialize in the winter environment, we also participate in hot weather activities where our skills may be needed. It is also worth mentioning that there can be heat-related problems in the winter, such as in the resort kitchen, or other indoor areas where the heat is high. They can also be seen out of doors in the winter if a person is overdressed for the ambient temperature and/or is expending a lot of energy and unable to vent the excess heat/sweat.

5. Case Presentation
On a beautiful desert summer day, with the temperature at about 105°F, while your group is resting in the shade you encounter a female hiker from another group who is slower than the others, staggering, panting, flushed, and asking for rest and water.
Discussion Points:
Since this patient is part of another group, discuss issues you should be aware of, such as whether the other group realizes she has stopped with you. Does anyone else in the other group appear to be struggling?
Assuming this is not your ski area, do you have any responsibility for their well being?
Have you discussed the Good Samaritan Laws?

6. Anatomy and Physiology
Thermoregulation
Sweating
Dilation of blood vessels in skin
Heat Index
Hydration
Adaptation
Prior exposure
Physical training
Discussion Point:
Students will likely be familiar with this content but review A&P as needed.

7. Mechanisms of Heat Loss

8. Common Heat-Related Emergencies
Heat Illnesses
Causes
Characteristics
Progression
Risk groups and factors
Discussion Point:
Discuss experiences with the class. Ask if anyone has experienced heat-related illness.
continued

9. Common Heat-Related Emergencies
Four Levels
Heat-induced syncope
Heat cramps
Heat exhaustion
Heat stroke

10. Common Heat-Related Emergencies
Core body temperatures for heat illnesses and the corresponding efficiencies of hypothalamic regulation.

11. Heat Syncope and Heat Cramps
Cardiovascular
Temporary
Signs and symptoms
Cramps
Muscular
Electrolyte/dehydration issues
Discussion Points:
Syncope is often related to “fainting.” Discuss situations in which syncope is less serious, and when it might be a warning sign for a potential condition.
Heat cramps may be seen by patrollers who work race venues such as mountain biking or marathons.

12. Heat Exhaustion and Heat Stroke
Signs and symptoms of serious heat emergencies.

13. Heat Exhaustion and Heat Stroke
Exposure/dehydration
Signs and symptoms
Stroke
Life threatening
Effects
Discussion Points:
Heat exhaustion and heat stroke are the most serious of the four types of heat-related illness. They should be discussed and understood thoroughly.
Be sure that students know and understand the differences between each.

14. Heat-Related Illness Prevention
Heat acclimatization
Hydration: ensure proper hydration; light yellow urine is a good indicator of being well hydrated.
Behavior: prepare for the heat; wear light colored, layered clothing and a wide brimmed hat.
Discussion Points:
Generally, prevention measures require that a person prepare for heat exposure.
Layered clothing in anticipation of changes in temperature during the day is one way to prevent heat-related illness.

15. Sunburn A superficial burn of the skin
Repeated exposure may lead to degenerative skin changes and possible cancer
High altitudes, snow, and water increase vulnerability
Clouds may not filter the UV rays
Discussion Points:
Most students will have had experience with sunburn.
Those who are new to skiing, and/or who do not ski regularly at high altitude may not be aware of the issues that occur in these conditions.
Note that sunburn and cold injuries can co-exist.

16. Sunburn Prevention Topical creams Clothing/Shade Physical sunscreens
Mechanical blocking
Opaque greases i.e., zinc or titanium dioxide
Chemical sunscreens
SPF factor
Need frequent and sufficient application
Clothing/Shade
May need layers
Thick brimmed hat
Discussion Points:
A single layer of clothing may not give offer full protection and an SPF over 30 may not provide any more protection than a sunscreen of SPF 30.

17. Lightning
Atmospheric discharge of electricity capable of generating 300,000 amps and 2 billion volts
1 in 5,000 chance of being struck
Average of 62 deaths per year
Cannot predict where it will strike

18. Lightning
A “feathering” or “ferning” pattern of a burn caused by a lightning strike.

19. Lightning Injuries
Caused by direct electrical current – high voltage, short duration
Respiratory arrest
Cardiac arrest
Severe tissue damage
Internal may not be obvious, but muscle and internal organs may be affected
Discussion Points:
Students may think that only burns result from lightning strikes.
Note that , in addition to burns, lightning can also cause internal damage, which is likely to be just as significant as internal. Damage may cause long term disability and even death.
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20. Lightning Injuries Severe tissue damage
Kidney injury may result from chemicals released into the blood
Entrance and exit wounds will be present
Skin injuries may occur in a fern leaf pattern
Discussion Point:
Secondary injuries such as the kidney damage and injuries from falls are not the direct result of the heat or electricity, but are consequences of the lightning strike.
continued

21. Lightning Injuries Unpredictable neurologic deficits
Muscular contractions can cause falls resulting in injury
30% fatality rate
Discussion Point:
Neurological effects may occur alone or in combination. See text for further details.

22. Reducing Risk of Lightning Strikes
Seek shelter
Outdoor safety
Building safety
30/30 rule
Clear ski lifts and exposed summit structures
Discussion Points:
Text explains further on what to do if caught in the open during a lightning storm.
Discuss the local terrain to help illustrate optimal locations and dangerous ones.
Discuss the 30/30 rule as a way to determine how far away the lightning may be.
An important patrol function would be to assist in the clearing of lifts and other areas that are most dangerous to resort guests and employees.

23. Case Update
You leave the shade of the rock overhang and walk out into the hot sun of a 105°F day to find a young woman who is sweating, asking for water, and complaining of fatigue, nausea, dizziness, and a headache. You offer to help and suggest that the young woman sit under the rock overhang, rest, and have some water and electrolyte drinks.
Discussion Points:
What do you find when you come to the aid of the young woman?
What steps do you suggest/assist with?
Discuss the treatments outlined in the book as those that would benefit anyone suffering from heat related symptoms.
Discuss other steps that could be taken if the situation were in a different location.

24. Assessment Standard assessment procedures to start – ABCDs and vitals
Check skin temperature and appearance
Check for muscle spasms / cramping
May determine core body temp
Behavior changes?
Burns? Trauma?
Discussion Point:
Discuss the text’s further details on heat-related illness and assessment of each level.

25. Management Move patient to cooler/shaded location
Monitor condition and vitals
Hydration and oxygen as needed
Electrolyte or salt water
Position for comfort, shock care
Limit re-exposure to heat, sun
Treat other injuries
Transport as appropriate
Discussion Points:
This slide includes treatments that are common to all heat-related illnesses.
Discuss the most serious, heat stroke and lightning strike which are covered in the next two slides.

26. Management of Heat Stroke
All of the previous AND
Lower the body temperature by any means possible.
Ice packs for neck, armpits, groin
Remove clothing, apply wet towels, fan
Monitor temp, reduce to about 101º
EMS transport ASAP
If uncertain, treat for this!
Discussion Point:
Although uncommon, especially in the patrolling environment, it is important that OEC technicians know how to address heat stroke.

27. Management of Heat Stroke

28. Managing a Lightning-Strike Injury
Treat as unresponsive
Jaw thrust
Protect c-spine
CPR/AED
Survivability is high
Do first in triage situation
Continue high flow oxygen
Transport
Discussion Points:
The potential for success with CPR is a vital part of this discussion, especially in a triage situation.
Typically, we do counsel NOT to perform CPR on a patient who does not have a pulse; therefore, mention this variation from that practice.

29. Case Disposition
Her respiration is 20; her pulse is 100 BPM. She is responding to questions. She is able to drink a drink containing electrolytes, and once she lies down, she looks more comfortable. You fan her, she continues to rest and sip liquids over the next 30 minutes, her breathing slows, and she becomes more talkative. Her pulse is now 80 BPM. Your findings suggest that she was suffering from heat exhaustion.
Discussion Point:
What did the patrollers find?
What was done to help her?
What was the result of her treatment?
Beyond noting the success of treating heat exhaustion, also note that patrollers should not expect instant results when treating heat-related injuries; it took 30 minutes to resolve this situation. Any situation may take at least that long, especially if the patient remains in a warm environment.

30. Chapter Summary
Allow the body to physiologically adapt to heat gradually, over several days (heat acclimatization).
Exercise in the early-morning or late-evening hours during hot weather.
Evaluate the risk of heat illness using the heat index.
The higher the heat and humidity, the greater the risk for heat illness.
Discussion Points:
Review the major points of the chapter with your class.
continued

31. Chapter Summary Wear loose-fitting, light-colored clothing.
The higher the heat and humidity, the greater the risk for heat illness.
Drink plenty of water or electrolyte drinks.
Heat exhaustion responds rapidly to treatment.
continued

32. Chapter Summary
Heat stroke is characterized by an elevated body temperature and an altered mental status.
Heat stroke is life threatening and does not respond quickly to treatment.
Patients struck by lightning are not electrically charged and (unlike victims of electrical injury) pose no threat to rescuers.
continued

33. Chapter Summary
In a triage situation, care first for lightning-strike victims who appear dead.