1. Copyright 2008 Seattle/King County EMS CBT/OTEP 385 Environmental Emergencies

2. Copyright 2008 Seattle/King County EMS Introduction This course will refresh your knowledge of heat illness, cold injuries, diving emergencies, stings and bites, and gas poisoning. Heat and cold illnesses are triggered when the body is unable to maintain a constant temperature

3. Copyright 2008 Seattle/King County EMS New Terms conduction – Transfer process by which heat moves between two touching objects from the warmer object to the colder object. convection – Transfer of heat due to movement of a gas or liquid in response to a temperature or pressure differential. radiation – Occurs when a warm body releases energy without direct contact with another body.

4. Copyright 2008 Seattle/King County EMS Heat Production Metabolism Shivering Exercise External heat sources

5. Copyright 2008 Seattle/King County EMS Factors That Affect Heat Production Core temperature Medical conditions Body fluid status (dehydration) Drugs and chemicals

6. Copyright 2008 Seattle/King County EMS Heat Loss Mechanisms Conduction Convection Radiation Evaporation

7. Copyright 2008 Seattle/King County EMS Conduction Process by which heat moves between two touching objects Image credit: Copyright 2005 Seattle/King County EMS

8. Copyright 2008 Seattle/King County EMS Convection Transfer of heat between body and air or water that surrounds it Image credit: Copyright 2005 Seattle/King County EMS

9. Copyright 2008 Seattle/King County EMS Radiation When warm body releases energy without direct contact Image credit: Copyright 2005 Seattle/King County EMS

10. Copyright 2008 Seattle/King County EMS Evaporation Conversion of liquid to a gas Image credit: Copyright 2005 Seattle/King County EMS

11. Copyright 2008 Seattle/King County EMS Heat Illness Heat cramps, heat exhaustion, and heatstroke are progressive phases of heat illness

12. Copyright 2008 Seattle/King County EMS Heat Cramps Result from an uneven distribution of body fluids and salts Muscle cramps can be mild to severe, involving extremities or the abdomen Dizziness, weakness, and nausea

13. Copyright 2008 Seattle/King County EMS Heatstroke Occurs when body's heat-regulating ability fails Life-threatening Early stages can look similar to heat exhaustion

14. Copyright 2008 Seattle/King County EMS Heatstroke – Clinical Findings Altered LOC Rapid, bounding pulse Rapid, deep respirations Hot, dry, flushed skin* Dilated pupils Seizures *Can be damp if rapid onset

15. Copyright 2008 Seattle/King County EMS Heat Illness – Treatment Provide a cool environment Apply cold packs Remove or loosen clothing Request medics (ALS indicators present) Provide oxygen and/or ventilatory assistance Position patient appropriately Monitor vital signs

16. Copyright 2008 Seattle/King County EMS Hypothermia Caused by loss of body heat or decrease heat production Altered LOC distinguishes mild from severe hypothermia Early recognition increases chances of survival

17. Copyright 2008 Seattle/King County EMS Hypothermia – Treatment Remove patient from cold environment Protect from heat loss Provide high flow oxygen

18. Copyright 2008 Seattle/King County EMS Frostbite Superficial Injury Blanching of skin Loss of feeling and sensation in injured area Tingling sensation if re-warmed

19. Copyright 2008 Seattle/King County EMS Frostbite Deep Injury White, waxy skin Swelling and/or blisters Skin can appear flushed with areas of purple and blanching or mottled and cyanotic

20. Copyright 2008 Seattle/King County EMS Frostbite – Treatment Protect affected area from further injury Remove constricting or wet clothing and jewelry Cover with dry bulky dressing Splint affected extremity, prevent use

21. Copyright 2008 Seattle/King County EMS Drowning and Near Drowning Water can stimulate spasms in larynx and bronchi Victim can aspirate water into lungs Photo credit: Dena Steiner

22. Copyright 2008 Seattle/King County EMS Drowning and Near Drowning Determine: Length of submersion Temperature of water Depth of water

23. Copyright 2008 Seattle/King County EMS Drowning/Near Drowning – Tx Safely remove victim from water Stabilize c-spine and backboard Follow protocols for cardiac or pulmonary arrest Administer oxygen and/or ventilatory assistance Supine position to avoid cerebral edema Prepare suction and expect vomiting Warm up aid unit Monitor vital signs

24. Copyright 2008 Seattle/King County EMS Air Embolism Gas bubbles in bloodstream that obstruct circulation Photo credit: Katrin Iken, NOAA Office of Ocean Exploration

25. Copyright 2008 Seattle/King County EMS Air Embolism – Clinical Findings Dyspnea Unconsciousness Paralysis Mottling of the skin Severe pain in muscles, joints or abdomen Irregular pulse Red, frothy sputum

26. Copyright 2008 Seattle/King County EMS Decompression Illness Nitrogen in the blood forms bubbles due to a rapid ascent Bubbles collect in the tissues and interfere with blood flow

27. Copyright 2008 Seattle/King County EMS Decompression Illness – History Significant history: Number of dives in past 24 hours Depth of dive Length of time underwater Problems encountered while diving Significant medical history (meds)

28. Copyright 2008 Seattle/King County EMS Stings and Bites Severity of reaction depends on type of animal and age, size, and health of victim Significant history: Type of animal or insect Behavior of animal Time of day bite occurred Location of animal

29. Copyright 2008 Seattle/King County EMS Allergic Reaction Two primary components of anaphylaxis: Severe respiratory distress Hypotension

30. Copyright 2008 Seattle/King County EMS Stings/Bites – Treatment Request paramedics if indicated Scrape sting site to remove stinger Wash area Remove jewelry from affected limb before swelling begins, if possible Bandage and immobilize site of injury Treat for shock Administer epinephrine via EpiPen if indicated

31. Copyright 2008 Seattle/King County EMS Anaphylaxis – Treatment Request paramedics Provide oxygen and/or ventilatory assistance Position patient appropriately Administer epinephrine via EpiPen Monitor vital signs

32. Copyright 2008 Seattle/King County EMS Gas Poisoning Carbon monoxide Exposure to cleaning products, industrial chemicals and gases

33. Copyright 2008 Seattle/King County EMS CO Poisoning – Clinical Findings Headache Tachypnea Nausea and vomiting Altered LOC Pink, flushed mucus membranes Coma

34. Copyright 2008 Seattle/King County EMS Inhaled Poisoning – Treatment Scene safety Remove from toxic environment ABCs Monitor airway, provide high flow oxygen Request paramedics, if necessary Contact poison control, if needed

35. Copyright 2008 Seattle/King County EMS Summary 4 mechanisms that cause heat loss: conduction, convection, radiation, and evaporation Heat cramps, heat exhaustion, and heatstroke are managed by reducing core temperature Key to distinguishing mild and severe hypothermia is altered LOC

36. Copyright 2008 Seattle/King County EMS Summary, continued Care for hypothermia: Remove from cold environment Protect from heat loss Provide high flow oxygen

37. Copyright 2008 Seattle/King County EMS Summary, continued Management of drowning/near drowning: Safely remove victim from water Stabilize c-spine and backboard Protocols for cardiac/pulmonary arrest Administer O2 and/or ventilatory assistance Supine position Prepare suction Warm aid unit Monitor vital signs

38. Copyright 2008 Seattle/King County EMS Summary, continued Anaphylaxis: severe respiratory distress and hypotension Care for anaphylaxis: Request paramedics Provide oxygen and/or ventilatory assistance Position patient appropriately Administer EpiPen Monitor vital signs