1. ENVIRONMENTAL INJURIES

2. Environmental Injuries
The Patroller is most likely to be called and treat environmental injuries, both on and off the ski hill:
Altitude Sickness
Cold Exposure Injuries
Heat Exposure Injuries
Electrical Shock
Lightning Strikes

3. Altitude Sickness
Altitude sickness can be categorised into three groups:
Mild acute mountain sickness
High altitude pulmonary edema (HAPE)
High altitude cerebral edema (HACE)

4. Mild Acute Mountain Sickness
Can show up at elevations as low as 2,100 to m
Signs and symptoms:
Mild headache
Mild insomnia
Loss of appetite
Shortness of breath when exercising
Treatment:
Symptoms should disappear within 24 hours
If not, take patient to lower altitude
If persist, consider oxygen and further medical care

5. High Altitude Pulmonary Edema
Continued shortage of oxygen increases pressure in arteries which results in damage to the lungs with fluid accumulation
Can become life threatening quickly
Signs and symptoms:
Marked breathlessness on exertion and at rest
Headache and cough
Treatment:
Take to lower altitude ASAP
Oxygen
Keep the patient at rest

6. High Altitude Cerebral Edema
Swelling in the brain due to cell wall damage can lead to cerebral edema
Generally develops slowly over a few days
Signs and symptoms:
Severe headache
Insomnia
Nausea and vomiting
Ataxia (loss of co-ordination)
Lassitude or irrational behaviour
Treatment:
Get to low altitude ASAP
Give oxygen and keep at rest
Treat as Load and Go and seek medical care

7. Heat & Cold Injuries
The systems of the body function less effectively as the internal body temperature falls below its normal temperature.
The body may also be severely damaged if the internal temperature rises above normal.

8. Body Temperature
The temperature-regulating mechanisms of the body continuously attempt to maintain a balance between internal heat production (metabolism) and external heat gains or losses
Heat injuries
systemic - heat stroke
localized – burns
Cold injuries
systemic – hypothermia
localized - frostbite

9. Heat Transfer Mechanisms
Basic heat transfer mechanisms are identical whether applied to cold or heat injuries
Heat transfer occurs as a result of:
Radiation
Conduction
Convection
Evaporation
Respiration
Radiation is the transfer of heat without physical contact from a warm object to a cooler one. Radiation of heat, especially from the head, is the most serious type of body heat loss. At temperatures below 5 °C, over half of the body's total heat production can be lost from an uncovered head.
Conduction is the transfer of heat by contact from a warmer object to a cooler one (e.g. from the skier's body to a chair on the lift in cold weather, or a hot water bottle warming a cold body area).
Convection is the transfer of heat between an object and its fluid environment through the surrounding layer of air or water. For example, in cold weather as the layer of air closest to the skin is warmed by the body, it rises away from the body by convection and is replaced by cooler air or water. In the case of air, wearing clothing with closures at the neck and waist reduces this flow (e.g. turtlenecks, zip-together ski suits).
Evaporation of water requires heat. Evaporation of moisture on the skin draws heat from the body, thereby cooling it. Evaporation is most pronounced in a dry, hot environment, but is also significant in a dry, cold environment.
Respiration heat loss is a combination of convection and evaporation, as inhaled cold dry air is warmed by the body to 37 °C and humidified. Heat and moisture are lost on exhalation. Increased respiration during exercise and at higher altitudes increases the rate of heat loss and contributes to dehydration.

10. Other Factors Affecting Body Heat Balance
Additional factors can affect the basic heat transfer mechanisms:
Wind and wind chill factor
Water
Clothing
Nutrition
Wind vastly increases the amount of heat loss from the body due to convection. It removes the insulating layer of warm air surrounding the body. Even light winds can change mild temperatures into uncomfortably cold conditions.
Wind Chill Temperature is the theoretical temperature which would result in the same heat transfer rate as the combination of actual temperature and wind speed. In simple terms: It's how cold the wind makes the air feel.
Water conducts heat away from the body 32 times faster than air of the same temperature! If the water is moving or the patient is swimming; heat loss is further increased as a result of convection. Any time moisture comes in contact with the body (e.g. rain, immersion in water, perspiration-dampened clothing, etc.), the body loses heat at a rapid rate.
Clothing traps a thin layer of air next to the body. The air is prevented from escaping by closures at the neck, waist, wrist. “Windproof” clothing prevents removal of this insulating layer of air by keeping the underlying layers of clothing dry for maximum insulating value. Multiple layers of clothing are better than a single thick layer, because they trap more layers of air. To avoid overheating, individual layers can be removed without causing excessive cooling.
Food and Nutrition Diet greatly affects the internal production of body heat (metabolism). Food fuels the metabolism. The process of digestion also creates heat. If exposed to cold temperatures, meals should be regular, and frequent snacks should be eaten. Alcohol should be avoided – it dilates peripheral vessels, thus increasing heat loss through the skin, and reduces blood sugar levels. Similarly, smoking should be avoided because it constricts the peripheral vessels, thus pre-disposing the extremities to cooling and frostbite.

11. Cold Exposure - Hypothermia
Hypothermia is a serious cold injury which occurs when the body loses more heat than it can produce or retain.
The nervous, cardiovascular, respiratory and digestive systems function less efficiently as the body core temperature falls below the normal 37°C.
Should the core temperature continue to fall, these functions may cease and death will follow.

12. Types of Hypothermia Acute Hypothermia
May develop over a short period of time as a result of immersion in cold water, or over a period of up to 12 ~ 24 hours exposure to cool or cold weather conditions
Chronic Hypothermia
Develops over a period of time. This is seen most commonly in the elderly as a result of aging processes, some diseases, some medications, and inadequate heating in their homes.

13. Prevention of Hypothermia
Place insulating material between the patient and the snow
Replace clothing if necessary
Put a layer of warm clothing on top of the patient
Provide some shelter and warmth by huddling
Remove the patient from the hill or trail as soon as possible

14. General Treatment of Hypothermia
Ensure that the patient’s airway, breathing and circulation are adequate.
Prevent further heat loss.
For patients in mild to severe condition, add heat to re-warm the patient’s body.
If the patient is fully conscious, give fuel in the form of hot sweet drinks and sweetened foods .
Handle the patient gently.
If the patient in unresponsive, place the patient in a semi-prone position, monitor and treat as Load and Go

15. Localized Cold Injuries
Non-freezing Cold Injury:
Also known as frostnip, immersion foot or trench foot
Skin is cold to the touch and pale, but not frozen
Superficial Frostbite:
Skin surface is hard, but tissue underneath is soft
Frequently occur on tip of nose, earlobes, cheeks, toes and fingers
Deep Frostbite:
Tissue freezes down into and beyond the subcutaneous layers

16. Signs and Symptoms of Localized Hypothermia
Non-freezing cold injury:
Feeling is usually still present to some extent
Usually there will be tingling, pain and redness during the re-warming
Superficial Frostbite:
Skin initially reddens, then blanches and becomes white
Tingling sensation or sharp pain
Deep frostbite:
Injured person cannot feel the frozen area
Skin surface is white, hard and tissue underneath is hard

17. Deep Frostbite Picture A: shows lack of blood flow to frozen areas
Picture B: blood flow returning to foot extremity
Picture C: external picture of same stage of healing

18. Treatment of Localized Hypothermia
Remove the patient from the exposure
Remove wet clothing
Re-warm the part - this can be done by contact with a warm body part such as a hand or armpit, or immersion in warm water
Additionally with superficial frostbite: protect the injured area with dressings and elevate
Deep frostbite: leave frozen until can send patient to a medical aid facility

19. Heat Exposure Injuries
Body heat cannot be dissipated from the body or external heat is added
Rise in body temperature results in severe damage to the central nervous system and the kidneys
The body dissipates heat by:
Conduction
Convection
Radiation
Evaporation

20. Prevention Heat exposure injuries are relatively easy to prevent:
Gradually acclimatize to working in warm or hot environments
Wear light-coloured garments made of materials that allow the easy passage of moisture to facilitate evaporation (fabrics that ‘breathe’)
Increase fluid intake, while avoiding those which contain caffeine
Schedule peak physical work periods to cooler periods of the day

21. Heat Injuries
Heat exposure injuries, in order of increasing severity are:
Heat Cramps
Heat Syncope
Heat Exhaustion
Heat Stroke

22. Heat Cramps
Heat cramps are painful muscular cramps that occur as a result of the depletion of the chemical stores within the muscles as a result of profound sweating.
Usually the cramps occur in the muscles which perform the most work - those in the legs or arms.
The onset of cramps may be delayed into a resting period.
Generally, no lasting damage is found
To replace salts lost in sweating, the patient should drink at least a litre of fluid containing salt. This can be an electrolyte-carbohydrate mixture that can include juice, or a commercial electrolyte-carbohydrate drink such as Gatorade®, or fruit juices / water with added salt.

23. Heat Syncope (Fainting)
Caused by a decrease in blood volume reaching the brain
Hot environment:
increased movement of blood to the skin and muscles
results a temporary insufficiency of blood flow to the brain
A temporary loss of consciousness
Fainting is usually followed by a fall
Horizontal position improves the blood flow to the brain and allows spontaneous recovery

24. Heat Exhaustion Same mechanism as for heat syncope
The patient, however, may not experience a loss of consciousness
Because heat exhaustion is usually accompanied by fluid loss, there may be signs and symptoms of mild hypovolemic shock
NOTE: The greatest danger of heat exhaustion is that it may rapidly progress to heat stroke, which can be life-threatening

25. Heat Exhaustion Signs and Symptoms: Treatment: Pale, cool clammy skin
Body temp normal, but may be low
Weak rapid pulse
Rapid, shallow respiration
Headache
Nausea
Profuse sweating
Treatment:
Remove to a cooler environment
Remove any extra clothing
If conscious, give cool water
Give oxygen
Consider transport to medical aid

26. Heat Stroke Result of the collapse of the body's cooling system
Body's temperature rises
Structures of the central nervous system are usually affected
Death may rapidly ensue if conditions are not corrected
Heat stroke is fatal if not treated and has a fairly high mortality rate even when treated

27. Heat Stroke Signs and symptoms: Treatment: Rapid onset of condition
Hot, dry, flushed skin
Full, rapid pulse initially
Deep respiration then shallow
Muscle twitching or convulsions
Dilated pupils
Very high body temperature
Progressive decrease in LOC
Treatment:
Remove as much clothing as possible
Cool the patient down rapidly (cold shower or immersion in cold water)
Wrap the patient in a sheet and sprinkle with water
Place cold packs under the arms, on the neck, groin and behind each knee
Oxygen and monitor vital signs
Transport to medical aid

28. Burns
A burn is an injury to the skin, or deeper tissues of the body, caused by contact with heat, radiation or chemicals.
The contact causing the burn may be in the form of:
Hot solids
Liquids
Steam, air or other gases
Sunlight or ultraviolet light
Electricity
X-rays, radium
Chemicals such as strong acids or alkalis

29. Classifications of Burns
Burns are classified according to the depth of tissue damage:
First Degree Burns
Second Degree Burns
Third Degree Burns

30. First Degree Burns Superficial skin burn, merely reddens the skin
Minor pain
Could be compared to a mild sunburn
Heals in two to five days
Leaves no scarring

31. Second Degree Burns
Partial thickness skin burns that involve both the epidermis and the dermis, and may blister the skin
Compared to sunburn with blistering
Most painful type of burn as nerve endings are damaged
Take 5 to 21 days to heal, unless infection occurs

32. Third Degree Burns
Full thickness burns destroy the skin completely and may extend into the deeper tissues
Sometimes even charring the muscle and bone
May not be very painful because the nerve endings may also have been destroyed

33. Estimating the Size of the Burn
Any second degree burn involving more than 10% of the body area, around the mouth or the 1% perineal area is serious
Any third degree burn regardless of size is serious. These must be referred to medical aid.
For small areas, it is possible to estimate the size of the burn by comparing it with the size of the patient's outstretched palm and fingers, which represents an area of about 1%.
For larger burn areas, the rule of nines is useful

34. Rule of Nine Head and neck - 9% Upper limbs - 9% each Trunk
18% front
18% back
Lower limbs - 18% each

35. Shock in Burn Injuries
Is due to a fall in effective circulating blood volume due to drainage of fluids from the burn
Drainage of fluid similar to plasma into the area of a burn causes swelling and blistering
The greater the area of the burn, the greater the loss of fluid
As volume of fluid loss increases, hypovolemic shock occurs

36. Treatment Remove the cause Initiate basic life support if necessary
Cool the burn, using sterile water if available, or cool clean water
Apply dry, sterile dressings to the burned area
Treat for shock
Transport to medical aid
For burns over 20% of the body, do not use water, due to the danger of hypothermia. Wrap the patient in clean sheets and transport to medical aid.

37. Electrical Shock
Electrical shock can be caused by contact with or proximity to:
High voltage power lines
Lower voltage used in industrial and house wiring
Current usually travels through the nervous system and through the heart
May result in mild shock to respiratory or cardiac arrest, or cardiac fibrillation
Monitor and apply AR/CPR as needed

38. Lightning Strike
Average voltage may be of the order of 10 to 20 million volts
Duration is short (0.1 to 1 milliseconds)
Often little energy is delivered to the body, and therefore tissue damage and burns tend to be minor.
The major effect are cardiac and respiratory arrest.
The fatality rate is about 30%.

39. Sunburn or Ultraviolet Light Exposure
Cool the burned area and protect it from further injury by applying a damp dressing.
If no other injury exists, encourage a sunburn patient to take fluids orally to replace lost fluid.
Transport to medical aid if:
the burn covers a considerable area
there are blisters
the patient develops a fever

40. Conclusion
Many cold exposure injuries are the result of a failure to take proper precautions.
Most can be prevented by common sense.
In the case of heat injuries, stress the importance of adequate fluid replacement.
Proper first aid treatment of burns will prevent infection, relieve pain, and maintain blood volume.
Consider burns as an emergency potentially leading to the onset of shock.