1. Drill of the Month Developed by Gloria Bizjak Recognizing and Managing Cold Emergencies: Frostbite and Hypothermia Frostbite and Hypothermia

2. Drill of the Month2 Recognizing and Managing Cold Emergencies: Frostbite and Hypothermia Student Performance Objective: Given information, resources, and opportunity for discussion and practice, EMTs will be able to: Describe types of frostbite and hypothermia Describe types of frostbite and hypothermia Describe signs and symptoms Describe signs and symptoms Demonstrate patient assessment and care Demonstrate patient assessment and care EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers.

3. Drill of the Month3 Altered Mental Status: Assessing and Managing Seizure Patients Overview Frostbite description and classifications Frostbite description and classifications Frostbite signs and symptoms Frostbite signs and symptoms Frostbite assessment and emergency care Frostbite assessment and emergency care Hypothermia description and classifications Hypothermia description and classifications Hypothermia signs and symptoms Hypothermia signs and symptoms Hypothermia assessment and emergency care Hypothermia assessment and emergency care Practice assessment and care Practice assessment and care

4. Drill of the Month4 Frostbite Description Description –Freezing of a distal or small body part from prolonged cold exposure  Cold air  Contact with a cold object  Wind and/or water chill

5. Drill of the Month5 Frostbite Description Description –Local cooling injuries to extremities  Feet and toes  Hands and fingers  Face: nose and cheeks  Ears

6. Drill of the Month6 Frostbite Description Description –Known by several names  Frostnip  Immersion foot (trench foot): Injury to skin, blood vessels, and nerves of the feet from continuous immersion in water, even in above freezing conditions  Chilblains (pernio): Inflammation of the hands and feet from repeated exposure to cold and moisture

7. Drill of the Month7 Frostbite Description Description –A result of prolonged cold exposure, outdoors as well as indoors, constricting blood vessels in the extremities, which diverts warm blood flow and oxygen to central vital organs  Constriction cycles with dilation to preserve functions of extremities

8. Drill of the Month8 Frostbite Description Description –As the body temperature continues to drop, the brain permanently constricts vessels in extremities to maintain warmth in vital organs: frostbite begins –Cell death due to exposure  Ice crystals form in the space outside cells  Cells become dehydrated

9. Drill of the Month9 Frostbite Description Description –Cell deterioration from of lack of oxygen and water  Lining of blood vessels is damaged  Blood leaks from vessels on rewarming  Small clots form causing blood flow problems and inflammation  Inflammation causes further tissue damage

10. Drill of the Month10 Frostbite Classifications Classifications –Superficial (early stage)  Blood flow is restricted to body parts  Body parts freeze  Ice crystals form inside tissues –Deep (late stage)  Gangrene sets in due to cell dehydration and oxygen loss  The part may have to be amputated, even after months of trying to heal

11. Drill of the Month11 Frostbite Signs and Symptoms Superficial (early stage) Superficial (early stage) –Patient may complain of burning, numbness, tingling, itching, or cold in affected areas –Affected part first appears red, then turns mottled, bluish, white, or grey as the flesh continues to freeze –Dark skin: the skin color lightens, then blanches and will quickly turn bluish or grey –Skin feels frozen/stiff/rigid; has some pliability when pressed

12. Drill of the Month12 Frostbite Signs and Symptoms Deep (late stage) Deep (late stage) –Patient may complain of decreased sensation, then lose all sensation or feeling –Affected part swells, develops blood-filled blisters over white/yellowish waxy-looking skin –Skin feels hard with no pliability when pressed –Affected part may appear black

13. Drill of the Month13 Frostbite Signs and Symptoms Deep (late stage) Deep (late stage) –On rewarming  Affected part turns purplish-blue  Painful aching as blood flow returns to tissues  Throbbing begins in 2 – 3 days; may last months  Part may never heal and may require amputation

14. Drill of the Month14 Frostbite Assessment and Care Assessment: Perform General Patient Care (Maryland Protocols) Assessment: Perform General Patient Care (Maryland Protocols) –Size up the scene; gather info on approach –Perform initial assessment  Superficial –Look for color changes: light skin reddens; dark skin lightens; both blanch followed by color changes –Feel area for pliability –Ask patient how it feels: patient may report numbness, tingling, burning, etc.

15. Drill of the Month15 Frostbite Assessment and Care Assessment: Perform General Patient Care (Maryland Protocols) Assessment: Perform General Patient Care (Maryland Protocols) –Size up the scene; gather info on approach –Perform initial assessment  Deep –Check skin appearance: white, waxy skin turns mottled or blotchy, then to grayish yellow to grayish blue –Look for swelling and blistering –Gently palpate: Does surface feel frozen w/no pliability in underlying tissue? Do not squeeze affected part –Ask patient how it feels

16. Drill of the Month16 Frostbite Assessment and Care Assessment: Perform General Patient Care (Maryland Protocols) Assessment: Perform General Patient Care (Maryland Protocols) –Perform focused history and physical exam –Follow treatment protocols –Communicate with hospital or other response personnel –Disposition: determine priority and mode of transport

17. Drill of the Month17 Frostbite Assessment and Care Emergency care (adults or peds) Emergency care (adults or peds) –Remove patient from cold environment  Outside: Place patient in heated ambulance, wrap in blankets  Inside: Turn up heat while working in patient’s home, wrap in blankets, move to heated ambulance

18. Drill of the Month18 Frostbite Assessment and Care Emergency care (adults or peds) Emergency care (adults or peds) –Gently handle frostbitten areas  Do not rub affected areas  Ice crystals in tissues cause further damage –Wrap affected area gently, loosely with gauze  Patient may complain of tingling/burning: these are normal sensations

19. Drill of the Month19 Frostbite Assessment and Care Emergency care (adults or peds) Emergency care (adults or peds) –If patient does not respond to simple treatment, begin care for deep frostbite  Provide high-concentration oxygen  Provide rapid transport  If transport is delayed, re-warm affected part only on medical direction  Do not allow patient to smoke or consume caffeine or alcohol (vasoconstrictors, raise blood pressure)  Do not allow patient to use affected part or walk on affected feet

20. Drill of the Month20 Frostbite Assessment and Care Emergency care (adults or peds) Emergency care (adults or peds) –Maintain a warm environment: do not re- expose patient to a cold environment –Reassess: recheck vital signs, recheck injury treatments and medical status –Transport/transfer/transition patient and information

21. Drill of the Month21 Hypothermia Description Description –Generalized body cooling as a result of prolonged cold exposure  Reduces body heat  Prevents body from maintaining proper core body temperature  Can be life-threatening

22. Drill of the Month22 Hypothermia Description Description –Loss of body heat through several methods  Radiation: heat lost to environment from what body gives off (radiates)  Conduction: heat lost by contact with or immersion in cold water or snow  Convection: heat lost by cold water flow or air currents  Evaporation: heat lost through perspiration or wet skin  Respiration: heat lost through expired breaths— warm air to cooler environment

23. Drill of the Month23 Hypothermia Description Description –Abnormally low core body temperature  95°F or below  Life-threatening at 90°F and below –Core body measurements  Oral measurement: 96.8 to 98.6 °F (affected by liquid and food intake and breathing)  Rectal temperature: 0.9 °F higher than oral  Axillary temperature: 0.9 °F lower than oral  Tympanic temperature: very close to oral measurement

24. Drill of the Month24 Hypothermia Classifications: Mild to moderate — 95°F to 90°F core body temperater: Caused by a cold environment Classifications: Mild to moderate — 95°F to 90°F core body temperater: Caused by a cold environment –Affects healthy individuals with prolonged exposure –Can quickly affect at-risk individuals  Patients with major trauma and shock, chronic illness, circulatory disorders, infection, burns, and diabetes

25. Drill of the Month25 Hypothermia Classifications: Mild to moderate — 95°F to 90°F core body temperature: Caused by a cold environment Classifications: Mild to moderate — 95°F to 90°F core body temperature: Caused by a cold environment –Can quickly affect at-risk individuals  Elderly persons in an environment with cool ambient temperature (low thermostat in winter), diet, illnesses, medications, sedentary living

26. Drill of the Month26 Hypothermia Classifications: Mild to moderate—95°F to 90°F core body temperature: Caused by a cold environment Classifications: Mild to moderate—95°F to 90°F core body temperature: Caused by a cold environment –Can quickly affect at-risk individuals  Infants and children with their large skin surface to body mass ratio, little fat, and small muscle mass (resulting in no shivering, a typical early warning sign)

27. Drill of the Month27 Hypothermia Classifications: Severe, or extreme Classifications: Severe, or extreme –Body temperature below 90°F –Presents an unconscious cold patient in a cold environment with no apparent vital signs (heart rate <10 beats per minute)  Patients will not reach biological death for at least 30 minutes: resuscitate  Do not assume death based on body temperature and no vital signs

28. Drill of the Month28 Hypothermia Signs and Symptoms General General –Vary with patient factors, length of exposure  Shivering, becomes intense; ceases in severe hypothermia  Dizziness and confusion  Numbness, stiffness, rigidity in posture, weakness  Impaired judgment, speech, and vision, glassy stare

29. Drill of the Month29 Hypothermia Signs and Symptoms General General –Vary with patient factors, length of exposure  Drowsiness, decrease in consciousness to unconsciousness  Cool abdominal skin temperature to your touch (back of your hand)  Reddened skin turning to pale and cyanotic with prolonged exposure (dark skin initially white turning cyanotic)

30. Drill of the Month30 Hypothermia Signs and Symptoms Specific Specific –Mild to moderate (core body temperature 90 to 95°F  Shivering, which becomes intense (generates body heat until muscles are fatigued)  Pulse and breathing rates and blood pressure initially increase  Vital signs drop as body temperature drops  Apathy: patient becomes clumsy, apathetic, confused, and has slurred speech (as if drunk)

31. Drill of the Month31 Hypothermia Signs and Symptoms Specific Specific –Severe (core body temperature less than 95°F)  Loss of consciousness –Shivering stops –Oxygen intake drops –Heart rhythm becomes irregular –Patient loses consciousness

32. Drill of the Month32 Hypothermia Signs and Symptoms Specific Specific –Severe (core body temperature less than 95°F  Continued decrease of pulse and breathing rates  Appearance of death, close to death –No reflexes –Brain activity slows –Pupils dilate –Risk of lethal irregular heart rhythm increases –Patient appears dead at 82°F

33. Drill of the Month33 Hypothermia Assessment and Emergency Care Assessment: Perform General Patient Care (Maryland Protocols) Assessment: Perform General Patient Care (Maryland Protocols) –Size up the scene and gather info on approach –Perform initial assessment  Assess mental status: check patient’s orientation to person, place, time  Check airway, breathing, circulation

34. Drill of the Month34 Hypothermia Assessment and Emergency Care Assessment: Consider the following Assessment: Consider the following  Air temperature, wind chill or water chill  Patient’s age  Clothing worn by patient  Patient’s general health, illnesses and medications, or injuries  Activity at time of incident  Use of alcohol or drugs  Mental status and motor function, which decreases with degree of hypothermia

35. Drill of the Month35 Hypothermia Assessment and Emergency Care Assessment Assessment –Perform focused history and physical exam –Follow treatment protocols –Communicate with hospital or other response personnel –Disposition: determine priority and mode of transport

36. Drill of the Month36 Hypothermia Assessment and Emergency Care Emergency care (adults or peds) Emergency care (adults or peds) –Quickly remove patient from cold environment –Handle gently—rough handling may cause cardiac arrest –Resuscitate as necessary  Assess pulse for 30 – 45 seconds  No pulse, start CPR  Prepare to use AED if indicated

37. Drill of the Month37 Hypothermia Assessment and Emergency Care Emergency care (adults or peds) Emergency care (adults or peds) –Use passive rewarming methods to prevent further heat loss  Remove wet or frozen clothing  Wrap patient in thermal blankets and other insulating material  Cover the patient’s head  Administer warmed oxygen, if possible/available

38. Drill of the Month38 Hypothermia Assessment and Emergency Care Emergency care (adults or peds) Emergency care (adults or peds) –Maintain a warm environment: do not re- expose to cold environment –Reassess patient  Recheck vital signs  Recheck injuries and treatment  Recheck medical status  Transport/transfer/transition patient and information

39. Drill of the Month39 Practice Demonstrate assessment and care of patients exposed to cold environments based on Maryland Medical Protocols Demonstrate assessment and care of patients exposed to cold environments based on Maryland Medical Protocols –General patient care steps for superficial and deep frostbite patients –General patient care steps for mild to moderate hypothermia patients –General patient care steps for severe hypothermia patients, including resuscitation and AED

40. Drill of the Month40 Recognizing and Managing Cold Emergencies: Frostbite and Hypothermia Student Performance Objective: Given information, resources, and opportunity for discussion and practice, EMTs will be able to: Describe types of frostbite and hypothermia Describe types of frostbite and hypothermia Describe signs and symptoms Describe signs and symptoms Demonstrate patient assessment and care Demonstrate patient assessment and care EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers.

41. Drill of the Month41 Altered Mental Status: Assessing and Managing Seizure Patients Overview Frostbite description and classifications Frostbite description and classifications Frostbite signs and symptoms Frostbite signs and symptoms Frostbite assessment and emergency care Frostbite assessment and emergency care Hypothermia description and classifications Hypothermia description and classifications Hypothermia signs and symptoms Hypothermia signs and symptoms Hypothermia assessment and emergency care Hypothermia assessment and emergency care Practice assessment and care Practice assessment and care