© 2011 national safety council 15-1 environmental emergencies lesson 15

© 2011 National Safety Council 15-1

ENVIRONMENTAL EMERGENCIESLESSON 15


Introduction

• Body temperature problems occur when body becomes too cold or too hot

• Cold- and heat-related injuries can begin gradually but become an emergency

• Cold or heat emergencies can lead to serious injury or death

• Submersion in water can cause a third type of environmental emergency


Body Temperature

• Constant core body temperature necessary

• Body has several mechanisms to create or lose heat

• Mechanisms cannot maintain constant temperature when exposed to temperature extremes for extended period

• Infants and elderly are more susceptible


Mechanisms For Staying Warm

• Metabolic processes – most body heat produced this way

• Contraction of muscle tissue – including shivering

• Vasoconstriction – less radiation of heat away from skin


Mechanisms For Staying Cool

• Vasodilation

- More warm blood to surface of skin to be radiated away

- Primary heat loss method

• Sweating – evaporation from skin surface cools body


Prolonged Exposure to Cold

• Especially when wet:

- The body cannot conserve heat

- Shivering cannot produce enough heat

• Hypothermia develops

• Organ systems gradually begin to fail, leading eventually to death


Prolonged Exposure to Heat

• Body cannot maintain normal temperature

• Profuse sweating leads to dehydration

- Blood volume and blood pressure decrease

- Without fluid, body cannot cool itself

• With activity or exercise, body loses fluid quickly

• Heatstroke occurs when body temperature rises

• Without treatment, organ damage or death occurs


Heat and Cold Injuries Risk Factors

• Young children

• Elderly

• Injuries

• Chronic health problems

• Mental impairment

• Dehydration

• Too little body fat

• Too much body fat

• Activity in extreme environments

• Medications and drugs (including alcohol)

• Environmental variables (water immersion, wind chill, humidity)


Hypothermia

• Occurs when body cannot make heat as fast as it loses it

• Body temperature <95°F

• Can occur whenever and wherever person feels cold

• Progressive

• May occur gradually or quickly

• About 600 people die each year in United States


Hypothermia with Obvious or Subtle Exposure to Cold

• Obvious cases involve exposure in cold environment

• Duration of exposure and exposed skin or thin clothing increases risk

• More subtle cases may occur with underlying illness, overdose, poisoning or an elderly patient in a cool home


Signs and Symptomsof Hypothermia

• Pale, cool skin even under clothing

• Slow breathing

• Uncontrollable shivering (may stop in severe hypothermia)

• Decreasing mental status or motor function

• Patient seems apathetic, confused or irrational

• Lethargy, clumsy movements, drowsiness, dizziness


Signs and Symptomsof Hypothermia (continued)

• Memory disturbances or confusion

• Reduced or loss of touch or sensation

• Speech difficulty

• Poor judgment

• Stiff or rigid posture, muscular rigidity, joint or muscle stiffness


Early Signs and Symptomsof Hypothermia

• Shivering

• Numbness

• Lethargy

• Poor coordination

• Slurred speech

• Infants may have bright red skin and little energy

Take early action to prevent progression!


Late Signs and Symptomsof Hypothermia

• Shivering typically stops

• Patient may not feel cold

• Breathing becomes shallow, pulse slows

• Mental status deteriorates

• Patient may become unresponsive and stop breathing


Emergency Care for Hypothermia

• Perform standard patient care

• Remove patient from cold environment immediately

• Protect from further heat loss

• Remove wet clothing, cover with warm blankets

• Have patient lie down, handle gently

• Follow local protocol for oxygen

• Don’t allow patient to walk or exert self

• Don’t give patient any food or drink


Emergency Care forHypothermia (continued)

• Don’t allow patient to use stimulants such as caffeineor nicotine

• Don’t massage skin or extremities

• Don’t immerse patient in hot water

• Don’t use direct heat

• Assess unresponsive patient for pulse for 30-45 seconds before CPR

• Follow local protocol to use AED as usual


Remote LocationEmergency Care

• Only if patient is far from medical care, use active rewarming

• Put patient near heat source or put warm water in containers against skin


Frostbite

• Freezing of skin or deeper tissues

• Usually clear demarcation of area of injury

• More common in exposed skin areas (head, hands, feet)

• Wind chill increases risk

• Severe frostbite kills tissue and can result in gangrene and need for amputation


Signs and Symptomsof Frostbite

Early or superficial frostbite:

• Skin color doesn’t return after palpation

• Skin remains soft

• Area is numb, tingles or aches when rewarmed


Severe Frostbite

• Skin looks waxy, white, gray, yellow or bluish

• Area feels firm or frozen hard on palpation

• Swelling or blisters


Severe Frostbite (continued)

• Affected area may become painless

• After warming, area becomes:

- Swollen- Blistered and flushed- Mottled and cyanotic


Emergency Care for Frostbite


• Remove patient from environment

• Remove wet or constrictive clothing

• Protect patient from further heat loss

• Handle patient very gently

• Have patient rest and avoid movement or exertion

• Check for hypothermia

• Protect cold-injured area from further injury


Emergency Care for Frostbite(continued)

• For early or superficial injury:

- Manually stabilize and cover extremity

- Do not rub or massage area

- Prevent another exposure to cold

• For late or deep cold injury:

- Remove jewelry and tight-fitting clothing

- Put dry gauze between frostbitten fingers or toes

- Protect and elevate area


Emergency Care for Frostbite (continued)

• Do not:

- Break blisters

- Rub or massage area

- Apply heat

- Rewarm area

- Allow patient to walk on affected extremity

- Give food or drink

- Allow tobacco use


Rewarming Frostbite

• If help is delayed, rewarm severe frostbite by immersing area in lukewarm (not hot) water for 20-30 minutes

Do this only if there is norisk of refreezing

Never apply a direct heat source


Heat Emergencies

• Heat exhaustion

- Develops when body becomes dehydrated

- Can progress to heatstroke

• Heatstroke

- Medical emergency

- If untreated, can cause death


Heat Emergencies (continued)

• Most occur during hot weather but can also occur in hot settings (furnace room, factory, vehicle)

• Average 400 deaths/year in United States

• Heatstroke is progressive starts with milder symptoms

• Recognize signs and symptoms early and treat


Signs and Symptoms of Heat Exhaustion

• Early signs and symptoms:- Sweating, pale/ashen moist skin

- Thirst

- Fatigue, weakness, exhaustion

- Muscle cramps

• Later signs and symptoms- Headache, dizziness, fainting

- Nausea, vomiting

- Fast, shallow breathing

- Rapid heart rate


Emergency Care for Heat Exhaustion

1. Move patient from heat to rest in cool place

2. Loosen or remove clothing

3. Give sports drink or water

4. Raise legs 6-12 inches

5. Cool patient


Emergency Care for Heat Exhaustion (continued)

• Cool patient with one of these methods:

- Put wet cloths on forehead and body

- Sponge skin with cool water

- Spray skin with water from spray bottle and then fan area (ineffective in high humidity)

• Do not give salt tablets

• If patient is lethargic, nauseous or vomiting, do not give liquids

• Seek medical care if condition worsens or does not improve in 30 minutes

• Seek urgent medical attention if patient has heart condition or high blood pressure


Heatstroke vs. Heat Exhaustion

Heatstroke

• Patient’s skin is flushed and feels hot to touch

• Patient becomes confused and irrational and may become unresponsive or have convulsions

Heat Exhaustion

• Skin may be pale, or ashen, and clammy

• Patient dizzy or tired or may be irritable and have a headache


Signs and Symptomsof Heatstroke

• Skin is flushed, dry, hot

• Sweating usually has stopped

• Fast breathing

• Headache, dizziness, extreme confusion, other signs of altered mental status

• Irrational or belligerent behavior

• Possible convulsions or unresponsiveness


Emergency Care for Heatstroke


• Move to cool place

• Remove outer clothing

• Cool quickly with any means at hand


• Cool until temperature drops to 101°F (38.3°C)

• Do not apply rubbing alcohol to skin


Emergency Care for Heatstroke (continued)

Cool quickly using one or more of these techniques:

• Immerse patient up to neck in cold water

• Spray skin with water and then fan (ineffective in high humidity)

• Wrap patient in wet sheet and keep it wet

• Sponge patient with cold water

• Put ice bags or cold packs beside neck, armpits and femoral pressure point area near groin


Emergency Care for Heatstroke (continued)

• No pain relievers or salt tablets

• No caffeine or alcohol

• No liquids if nauseous, vomiting, diminished mental status

• Monitor patient and provide needed care

• Put unresponsive patient in recovery position if breathing normally

• Assist patient with ventilation if breathing is inadequate


Submersion Injury

• Drowning occurs when airway is surrounded by water or another liquid that prevents breathing

• About 3,700 people die each year from drowning in United States

• For every child who dies from drowning, 4 more receive emergency care for submersion injury

• Often results in permanent disabilities and brain damage


Drowning Patients

• Begin rescue breaths as soon as possible

• If possible, begin rescue breaths still in shallow water

• Must remove patient from water to give CPR

• If cause of incident is unknown, assume patient may have spinal injury

• Keep head in line with body when moving or positioning patient

• Use jaw thrust to open airway


Assessing Submersion Injury

• Perform standard assessment

• Severity of patient’s condition depends on duration of submersion and other factors


Signs and Symptoms ofSubmersion Injury

• Patient may still be responsive or may have become unresponsive

• Coughing

• Vomiting

• Difficulty breathing

• Respiratory arrest

• Cardiac arrest


Emergency Care for Submersion Injury


• If patient is still in water, maintain your personal safety

• If spinal injury suspected, manually stabilize patient’s neck and spine

• If patient is breathing normally, place in recovery position


• If patient is not breathing normally, first open airway and give 2 rescue breaths, then quickly check for pulse


Emergency Care for Submersion Injury (continued)

• If patient has pulse but is still not breathing normally, continue rescue breathing

• If patient does not have pulse, give CPR immediately – begin with chest compressions

• Because of high risk for vomiting, be prepared to roll patient on side and to suction mouth

© 2011 national safety council 15-1 environmental emergencies lesson 15

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