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

Copyright 2008 Seattle/King County EMS

CBT/OTEP 385Environmental Emergencies


Introduction

This course will refresh your This course will refresh your knowledge of heat illness, cold knowledge of heat illness, cold

injuries, diving emergencies, stings injuries, diving emergencies, stings and bites, and gas poisoning.and bites, and gas poisoning.

This course will refresh your This course will refresh your knowledge of heat illness, cold knowledge of heat illness, cold

injuries, diving emergencies, stings injuries, diving emergencies, stings and bites, and gas poisoning.and bites, and gas poisoning.

Heat and cold illnesses are triggered when the body is unable to maintain a constant temperature


New Termsconduction – 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.


Heat Production

• Metabolism • Shivering • Exercise • External heat sources


Factors That Affect Heat Production • Core temperature • Medical conditions • Body fluid status (dehydration) • Drugs and chemicals


Heat Loss Mechanisms

• Conduction • Convection • Radiation • Evaporation


Conduction

Process by which heat moves between two touching objects

Image credit: Copyright 2005 Seattle/King County EMS


Convection

Transfer of heat between body and air or water that surrounds it



Radiation

• When warm body releases energy without direct contact



Evaporation

• Conversion of liquid to a gas



Heat Illness

Heat cramps, heat exhaustion, and heatstroke are progressive phases of heat illness


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


Heatstroke

• Occurs when body's heat-regulating ability fails

• Life-threatening• Early stages can look similar to heat

exhaustion


Heatstroke – Clinical Findings • Altered LOC • Rapid, bounding pulse • Rapid, deep respirations • Hot, dry, flushed skin* • Dilated pupils • Seizures

*Can be damp if rapid onset


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


Hypothermia

• Caused by loss of body heat or decrease heat production

• Altered LOC distinguishes mild from severe hypothermia

• Early recognition increases chances of survival


Hypothermia – Treatment

• Remove patient from cold environment

• Protect from heat loss• Provide high flow oxygen


Frostbite• Superficial Injury

• Blanching of skin • Loss of feeling and sensation in injured

area• Tingling sensation if re-warmed


Frostbite• Deep Injury

• White, waxy skin• Swelling and/or blisters • Skin can appear flushed with areas of

purple and blanching or mottled and cyanotic


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


Drowning and Near Drowning

• Water can stimulate spasms in larynx and bronchi

• Victim can aspirate water into lungs

Photo credit: Dena Steiner


Drowning and Near Drowning

Determine: • Length of submersion• Temperature of water• Depth of water


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


Air Embolism

• Gas bubbles in bloodstream that obstruct circulation

Photo credit: Katrin Iken, NOAA Office of Ocean Exploration


Air Embolism – Clinical Findings• Dyspnea• Unconsciousness• Paralysis• Mottling of the skin• Severe pain in muscles, joints or abdomen• Irregular pulse• Red, frothy sputum


Decompression Illness

• Nitrogen in the blood forms bubbles due to a rapid ascent

• Bubbles collect in the tissues and interfere with blood flow


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)


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


Allergic Reaction

Two primary components of anaphylaxis:

• Severe respiratory distress• Hypotension


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


Anaphylaxis – Treatment

• Request paramedics• Provide oxygen and/or ventilatory

assistance• Position patient appropriately• Administer epinephrine via EpiPen• Monitor vital signs


Gas Poisoning

• Carbon monoxide • Exposure to cleaning products,

industrial chemicals and gases


CO Poisoning – Clinical Findings • Headache• Tachypnea• Nausea and vomiting• Altered LOC• Pink, flushed mucus membranes• Coma


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


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


Summary, continued

Care for hypothermia:• Remove from cold environment• Protect from heat loss• Provide high flow oxygen


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


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

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

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