1. Illinois EMSC1 Environmental Objectives Upon completion of this lecture, you will be better able to: List the critical components in documenting a bite or sting Describe appropriate interventions for the 3 categories of burns Describe primary interventions for the 3 types of heat related illness Identify early signs of hypothermia State assessment findings and appropriate interventions for a near- drowning episode Describe the role of the poison specialist in evaluating and managing student poisonings List signs and symptoms associated with specific toxic syndromes

2. Illinois EMSC2 ENVIRONMENTAL EMERGENCIES

3. Illinois EMSC3 ENVIRONMENTAL EMERGENCIES Bites and Stings Burns Hyper- and Hypothermia Toxicological Emergencies Water Emergencies –Drowning/Near Drowning –Diving Accidents

4. Illinois EMSC4 BITES Animal or Human Soft tissue damage - Crushing/Lacerations Infection - especially if human bite Functional and Cosmetic Damage Intervention: –Monitor ABCs including shock –Control bleeding –Transport to ED/MD –Report incident if required

5. Illinois EMSC5 POISONOUS SNAKES, SPIDERS, SCORPIONS Important factors to consider: –Age and size of child –Type of venom/toxin or identification of source –Amount of venom injected –Location of bite/sting –Not all are poisonous

6. Illinois EMSC6 Snake Bite with Envenomation

7. Illinois EMSC7 BURNS CATEGORIES: SUPERFICIAL PARTIAL THICKNESS (1ST DEGREE) PARTIAL THICKNESS (2ND DEGREE) FULL THICKNESS (3RD DEGREE)

8. Illinois EMSC8 EXTENT OF BURN INJURY BSA - Body Surface Area Estimate of size/area involved –Palm (of affected student) including fingers equals 1% –Rule of “Nines” chart –Modified chart for children

9. Illinois EMSC9 SEVERITY OF BURN Depth (full thickness or deep partial) Extent - over 10% BSA deep/full thickness Location of injury - hands, face, genitalia Age and health status - chronic problems Associated injury - smoke inhalation or electrical trauma

10. Illinois EMSC10 BURNS

11. Illinois EMSC11 ASSESSMENT OF BURNS ABCD’s are first priority Expose burn area unless clothing adhered Irrigate chemical burns Use sterile gloves, if available Cool thermal burns with tepid water until burned area is no longer warm, then apply dry, sterile dressing Call EMS for major burns or altered LOC

12. Illinois EMSC12 SPECIFIC BURN INJURIES CHEMICAL BURNS ELECTRICAL BURNS –Electric current –Lightning INHALATION INJURIES –Heat –Smoke –Toxic fumes

13. Illinois EMSC13 DOCUMENTATION Source or causative agent Duration of contact Time and site of burn Assessment and interventions Related injury Disposition of student

14. Illinois EMSC14 HYPERTHERMIA HEAT STROKE HEAT EXHAUSTION HEAT CRAMPS

15. Illinois EMSC15 HEAT STROKE ASSESSMENT –Hot, dry skin –Headache, confused, or lethargic –Thirsty INTERVENTION –EMERGENT-CALL EMS! –Remove from heat –Cool quickly

16. Illinois EMSC16 HEAT EXHAUSTION ASSESSMENT –Skin wet, normal temperature –Fatigue, weakness INTERVENTION –ABCDs –Cool skin –Give fluids, unless nauseated or vomiting –Call EMS if not responding to interventions

17. Illinois EMSC17 HEAT CRAMPS ASSESSMENT –Physical exertion, perspiring –Drinking large amounts of water INTERVENTIONS –Remove from heat –Apply moist towels over cramped muscle –Massage muscle to stretch (per protocol) –Replace salt and liquids

18. Illinois EMSC18 HYPOTHERMIA Loss of body heat Respiration Radiation Conduction Convection Evaporation

19. Illinois EMSC19 HYPOTHERMIA SHIVERING THAT STOPS AFTER CONTINUOUS EXPOSURE TO SEVERE COLD, IS AN OMINOUS SIGN!!

20. Illinois EMSC20 ASSESSMENT OF HYPOTHERMIA Call EMS Stabilize ABCs Handle carefully Place in warm area-cover head Monitor LOC and mental status Vital signs may be significantly slowed Do not initiate CPR unless no pulse for 2 min.

21. Illinois EMSC21 FROSTBITE Localized severe cooling of skin Typically involves hands, fingers, feet, toes, nose, ears or face Stages: –Incipient –Superficial –Deep

22. Illinois EMSC22 FROSTBITE

23. Illinois EMSC23 FROSTBITE

24. Illinois EMSC24 FROSTBITE INTERVENTIONS –Warm quickly –Do not rub or cause friction on tissue –If exposure sufficient for deep tissue damage, do not warm, transport immediately –Refer for diagnosis and treatment

25. Illinois EMSC25 NEAR DROWNING Assessment Call EMS ABCs/LOC History –time submerged –water temperature –diving injury Safe removal from water

26. Illinois EMSC26

27. Illinois EMSC27 TOXICOLOGIC EMERGENCIES

28. Illinois EMSC28 POISON CONTROL Know the Poison Control helpline number Give critical information Note substance (if known) –How much was taken ? –What route ? –How long ago ? –NOTE any other substances or daily medications that student takes Current status/symptoms Interventions and effect

29. Illinois EMSC29 INTERVENTIONS FOR SPECIFIC TOXICOLOGICAL EMERGENCIES Dermal exposure –Flush with water, except powders/dust Ocular exposure Inhalation exposure –Removal from source, protect yourself Ingestions –Dilute with sips of water –Wait for directions before inducing vomiting

30. Illinois EMSC30 TOXIC SYNDROMES Illicit drug use Over-the-counter medication abuse –Cough and cold preparations –Diet aids Toxidromes –Opiod –Sympathomimetic –Anticholinergic –Cholinergic

31. Illinois EMSC31 PREVENTION Increase awareness of toxic substances likely to be encountered Obtain copies of MSDS sheets for every chemical on site at school Secure poison awareness educational material through poison control center Assure all school staff are aware of how to contact Poison Control Center as appropriate

32. Illinois EMSC32 SUMMARY Students are subject to a variety of environmental emergencies, from heat-related illness to frostbite, insect stings, scald burns and toxic ingestions to name a few. Use your clinical knowledge and additional resources to provide appropriate interventions when confronted with these types of emergencies.

33. Illinois EMSC33 ANY QUESTIONS??