Planning Your Time: Plan 120 minutes for this chapter.
Exposure to Cold (30 minutes)
Exposure to Heat (30 minutes)
Water-Related Emergencies (30 minutes)
Bites and Stings (30 minutes)
Note: The total teaching time recommended is only a guideline.
Core Concepts
Effects on the body of generalized hypothermia; assessment and care for hypothermia
Effects on the body of local cold injuries; assessment and care for local cold injuries
Personal effects on the body of exposure to heat; assessment and care for patients suffering from heat exposure
Signs, symptoms, and treatment for drowning and other water-related injuries
Signs, symptoms, and treatment for bites and stings
Teaching Time: 30 minutes
Teaching Tips: Use ice to better illustrate your discussion. Use a cold source to show how cold is exchanged and how the body reacts. Use specific examples of factors that influence the body's thermoregulation. Discuss medications, age, and underlying conditions, using real-world situations. Use a fan and a wet cloth to discuss evaporative heat loss. Relate this discussion to removing wet clothing. Know and present local hypothermia rewarming protocols. What methods of rewarming are allowed in your area?
Covers Objective: 31.2
Point to Emphasize: Heat is transferred (and lost) through convection, conduction, evaporation, respiration, and radiation.
Knowledge Application: Have students work in small groups. Assign each group a particular method of heat loss. Have each group give a class presentation about the physics of its particular method of heat loss. Award points for examples, visual aids, and creativity.
Covers Objective: 31.2
Point to Emphasize: Heat is transferred (and lost) through convection, conduction, evaporation, respiration, and radiation.
Knowledge Application: Have students work in small groups. Assign each group a particular method of heat loss. Have each group give a class presentation about the physics of its particular method of heat loss. Award points for examples, visual aids, and creativity.
Covers Objective: 31.2
Point to Emphasize: Heat is transferred (and lost) through convection, conduction, evaporation, respiration, and radiation.
Knowledge Application: Have students work in small groups. Assign each group a particular method of heat loss. Have each group give a class presentation about the physics of its particular method of heat loss. Award points for examples, visual aids, and creativity.
Covers Objective: 31.3
Point to Emphasize: Certain illnesses, medications, and underlying conditions predispose patients to the effects of hypothermia. These conditions include shock, burns, head and spinal-cord injuries, generalized infection, and diabetes with hypoglycemia.
Discussion Topic: Discuss how thermoregulation changes with age. How might this impact your patient who is facing a cold challenge?
Covers Objective: 31.3
Discussion Topic: Discuss specific examples of ways in which medications and underlying conditions can interfere with thermoregulation.
Covers Objective: 31.4
Point to Emphasize: Shivering, numbness, joint/muscle stiffness, decreased level of consciousness, and cool abdominal skin temperature are common signs and symptoms of hypothermia.
Discussion Topic: What information pertaining to a cold injury could an EMT obtain in the scene assessment? Discuss specific examples.
Covers Objective: 31.4
Covers Objective: 31.5
Point to Emphasize: Passive rewarming allows the body to rewarm itself. Active rewarming includes application of an external heat source to the body. Actively rewarm alert and responsive hypothermia patients. Passively rewarm hypothermic patients with altered level of consciousness.
Knowledge Application: Have students work in teams. Provide rewarming supplies and have each team passively rewarm one of its members. Discuss different techniques.
Covers Objective: 31.5
Point to Emphasize: Passive rewarming allows the body to rewarm itself. Active rewarming includes application of an external heat source to the body. Actively rewarm alert and responsive hypothermia patients. Passively rewarm hypothermic patients with altered level of consciousness.
Knowledge Application: Have students work in teams. Provide rewarming supplies and have each team passively rewarm one of its members. Discuss different techniques.
Covers Objective: 31.6
Discussion Topic: Compare and contrast the treatment of a hypothermic patient who has an altered level of consciousness with the treatment of a hypothermic patient who is alert.
Critical Thinking: Many hospitals are now using induced hypothermia to treat cardiac arrest survivors. What benefit does this hypothermia give these patients?
Covers Objective: 31.7
Class Activity: Hand out written scenarios describing different types of hypothermic patients. Ask students to write out treatment plans, based on the assessment findings.
Knowledge Application: Use a programmed patient and create hypothermia scenarios. Have students practice assessment and treatment. Include a discussion about scene size-up.
Covers Objective: 31.7
Covers Objective: 31.7
Covers Objective: 31.7
Covers Objective: 31.7
Class Activity: Hand out written scenarios describing different types of hypothermic patients. Ask students to write out treatment plans, based on the assessment findings.
Knowledge Application: Use a programmed patient and create hypothermia scenarios. Have students practice assessment and treatment. Include a discussion about scene size-up.
Covers Objective: 31.7
Class Activity: Hand out written scenarios describing different types of hypothermic patients. Ask students to write out treatment plans, based on the assessment findings.
Knowledge Application: Use a programmed patient and create hypothermia scenarios. Have students practice assessment and treatment. Include a discussion about scene size-up.
Covers Objective: 31.7
Class Activity: Hand out written scenarios describing different types of hypothermic patients. Ask students to write out treatment plans, based on the assessment findings.
Knowledge Application: Use a programmed patient and create hypothermia scenarios. Have students practice assessment and treatment. Include a discussion about scene size-up.
Covers Objective: 31.7
Class Activity: Hand out written scenarios describing different types of hypothermic patients. Ask students to write out treatment plans, based on the assessment findings.
Knowledge Application: Use a programmed patient and create hypothermia scenarios. Have students practice assessment and treatment. Include a discussion about scene size-up.
Teaching Time: 30 minutes
Teaching Tips: Relate the dilation and constriction of blood vessels to the previous discussion of shock. Discuss the potential impact on the cardiovascular system. It often is difficult to differentiate between heat exhaustion and heat stroke. Teach EMTs always to assume the worst. Relate this lesson to the discussion about cold emergencies. Many of the factors that influence thermoregulation in cold patients impact heat emergencies as well. Use a programmed patient and consider simulating sweat with a spray bottle of water for realism.
Covers Objective: 31.8
Points to Emphasize: The body constantly generates heat. Excess heat must be dispersed through thermoregulation. Certain illnesses, medications, and underlying conditions predispose patients to the effects of hyperthermia.
Discussion Topic: Discuss factors that influence thermoregulation. Consider how these factors might influence a heat emergency.
Covers Objective: 31.8
Points to Emphasize: The body constantly generates heat. Excess heat must be dispersed through thermoregulation. Certain illnesses, medications, and underlying conditions predispose patients to the effects of hyperthermia.
Discussion Topic: Discuss factors that influence thermoregulation. Consider how these factors might influence a heat emergency.
Covers Objective: 31.9
Point to Emphasize: Muscular cramps, weakness, dizziness, rapid and shallow breathing, weak pulse, perspiration, and loss of consciousness indicate heat exhaustion.
Covers Objective: 31.9
Discussion Topic: Describe the steps involved in passive cooling. Provide examples.
Covers Objective: 31.8
Points to Emphasize: The body constantly generates heat. Excess heat must be dispersed through thermoregulation. Certain illnesses, medications, and underlying conditions predispose patients to the effects of hyperthermia.
Discussion Topic: Discuss factors that influence thermoregulation. Consider how these factors might influence a heat emergency.
Covers Objective: 31.9
Point to Emphasize: The EMT must assume that heat stroke is present in a patient with the signs of heat exhaustion and altered mental status.
Class Activity: Discuss with the class the difference between heat exhaustion and heat stroke. Brainstorm ideas about how to differentiate.
Knowledge Applications: Describe a patient with heat-related symptoms. Have students classify the stage of heat injury and discuss treatment strategies. Use a programmed patient to simulate heat emergencies. Have teams of students practice assessment, focusing on identifying heat stroke.
Critical Thinking: The presence of sweat often is an unreliable finding when differentiating heat exhaustion from heat stroke. Consider how a person's clothes might appear sweaty despite the fact that the person has stopped sweating. How might this impact your assessment?
Covers Objective: 31.9
Point to Emphasize: Removing the heat is an important element in treating any hyperthermic patient. Active cooling is essential in heat stroke.
Discussion Topic: Compare and contrast the treatment of an alert hyperthermic patient with the treatment of a hyperthermic patient with altered mental status.
Knowledge Application: Using a manikin and a simulated heat stroke scenario, demonstrate passive and active cooling.
Teaching Time: 30 minutes
Teaching Tips: Emphasize (and reemphasize) safety! Water rescue can be hazardous to unprepared responders. Use multimedia graphics to illustrate the pathophysiology of water-related injuries. Teach humility. Water rescue is a specialized skill that requires specific training and practice. Not everyone will be prepared to dive in and rescue a patient. Discuss the decision-making process. Consult expert advice. Invite a member of the local water rescue team or a local scuba instructor to class to share insights regarding water rescue and dive-related injuries.
Covers Objective: 31.10
Covers Objective: 31.10
Covers Objective: 31.10
Point to Emphasize: The World Health Organization and American Heart Association have adopted this definition of drowning: "Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid. Drowning outcomes are classified as death, morbidity, and no morbidity." Morbidity means the patient experiences illness or other adverse effects, such as unconsciousness or pneumonia. The term near drowning is no longer used.
Covers Objective: 31.10
Point to Emphasize: The World Health Organization and American Heart Association have adopted this definition of drowning: "Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid. Drowning outcomes are classified as death, morbidity, and no morbidity." Morbidity means the patient experiences illness or other adverse effects, such as unconsciousness or pneumonia. The term near drowning is no longer used.
Covers Objective: 31.10
Discussion Topic: Discuss common factors associated with drowning.
Covers Objective: 31.11a
Knowledge Application: Have students work in small groups to design a drowning prevention campaign for their area. Have them relate the factors that influence drowning.
Covers Objective: 31.11b
Covers Objective: 31.11b
Covers Objective: 31.11b
Point to Emphasize: When indicated, EMTs may initiate positive pressure ventilation and spinal immobilization while patients are still in the water.
Class Activity: Take a field trip to a local pool. Practice water rescue techniques and water-based patient care.
Knowledge Application: Have students create a public service advertisement designed to prevent water-related injuries. Have them present it to the class and discuss.
Covers Objective: 31.11c
Point to Emphasize: The two special problems seen in scuba-diving accidents are arterial gas emboli (AGE) and decompression sickness.
Discussion Topic: Describe the two common scuba-related injuries.
Covers Objective: 31.11c
Point to Emphasize: The two special problems seen in scuba-diving accidents are arterial gas emboli (AGE) and decompression sickness.
Discussion Topic: Describe the two common scuba-related injuries.
Covers Objective: 31.11c
Point to Emphasize: The two special problems seen in scuba-diving accidents are arterial gas emboli (AGE) and decompression sickness.
Discussion Topic: Describe the two common scuba-related injuries.
Covers Objective: 31.11c
Point to Emphasize: The two special problems seen in scuba-diving accidents are arterial gas emboli (AGE) and decompression sickness.
Discussion Topic: Describe the two common scuba-related injuries.
Covers Objective: 31.11c
Point to Emphasize: The two special problems seen in scuba-diving accidents are arterial gas emboli (AGE) and decompression sickness.
Discussion Topic: Describe the two common scuba-related injuries.
Covers Objective: 31.11c
Point to Emphasize: The two special problems seen in scuba-diving accidents are arterial gas emboli (AGE) and decompression sickness.
Discussion Topic: Describe the two common scuba-related injuries.
Covers Objective: 31.11c
Point to Emphasize: The two special problems seen in scuba-diving accidents are arterial gas emboli (AGE) and decompression sickness.
Discussion Topic: Describe the two common scuba-related injuries.
Covers Objective: 31.11c
Point to Emphasize: The two special problems seen in scuba-diving accidents are arterial gas emboli (AGE) and decompression sickness.
Discussion Topic: Describe the two common scuba-related injuries.
Covers Objective: 31.12
Point to Emphasize: Providers should never attempt a water rescue unless they have been properly trained to do so.
Discussion Topics: Discuss the shoreline assessment (scene size-up) necessary prior to a water rescue. Use specific examples. How might these examples influence your decision to enter the water? Describe the steps of a Reach-Throw-Row-Go rescue.
Covers Objective: 31.12
Class Activity: Describe a scenario in which a water rescue needs to occur. Discuss the necessary resources and the decision-making process that must occur before the rescue begins.
Critical Thinking: Consider the emotional difficulty of not effecting a water rescue due to limited resources/training. What emotional issues might cloud a safety assessment and create decision-making difficulty?
Covers Objective: 31.12
Covers Objective: 31.12
Covers Objective: 31.10
Video Clip
Emergency: Near Drowning
What happens to a patient after submersion in water?
What is a laryngospasm?
Why does hypoxemia occur as a result of a submersion?
Discuss what is meant by dry drowning.
Teaching Time: 30 minutes
Teaching Tips: Use multimedia graphics to illustrate different poisonous animals. Remember, however, that identification is a low priority for the EMT. Use moulage and toy animals for scenario realism. Emphasize scene safety when dealing with toxic/poisonous animals.
Covers Objective: 31.13a
Points to Emphasize: Certain animals and plants produce toxins that are harmful to humans. EMTs should recognize commonly toxic organisms. The black widow spider, the brown recluse spider, and the centroroides exilcauda scorpion are toxic to humans.
Discussion Topic: Discuss the common types of venomous insects in the U.S. Describe how their venom might harm a human.
Covers Objective: 31.13a
Points to Emphasize: Certain animals and plants produce toxins that are harmful to humans. EMTs should recognize commonly toxic organisms. The black widow spider, the brown recluse spider, and the centroroides exilcauda scorpion are toxic to humans.
Discussion Topic: Discuss the common types of venomous insects in the U.S. Describe how their venom might harm a human.
Covers Objective: 31.13a
Covers Objective: 31.13a
Covers Objective: 31.13a
Covers Objective: 31.13a
Covers Objective: 31.13a
Covers Objective: 31.13b
Point to Emphasize: In the United States there are two types of native venomous snakes—pit vipers (including rattlesnakes, copperheads, and water moccasins) and coral snakes.
Discussion Topic: Discuss the common types of venomous snakes in the U.S. Describe how their venom might harm a human.
Critical Thinking: So far we have discussed toxic American animals. How might an unusual species appear in the U.S.? What specific challenges does this situation pose to the EMT who is treating a bite/sting injury?
Knowledge Application: Use moulage and toy animals to enhance a scenario. Use programmed patients to present bite/sting situations. Practice safety, assessment, and treatment.
Class Activity: Discuss the role of the EMT at the scene of a venomous animal injury. Ask the class to discuss elements such as safety, identification. and treatment.
Covers Objective: 31.13b
Point to Emphasize: A number of people have decided to keep venomous reptiles even though it is illegal to do so in most areas. So even if you live in an area where there are no venomous snakes, it is still important to know how to treat them in case you encounter a patient who has sustained a bite from a snake kept as a pet.
Covers Objective: 31.13b
Point to Emphasize: A number of people have decided to keep venomous reptiles even though it is illegal to do so in most areas. So even if you live in an area where there are no venomous snakes, it is still important to know how to treat them in case you encounter a patient who has sustained a bite from a snake kept as a pet.
Covers Objective: 31.13b
Point to Emphasize: A number of people have decided to keep venomous reptiles even though it is illegal to do so in most areas. So even if you live in an area where there are no venomous snakes, it is still important to know how to treat them in case you encounter a patient who has sustained a bite from a snake kept as a pet.
Covers Objective: 31.13c
Discussion Topic: Describe the common elements of treatment for a person bitten or stung by a poisonous animal.
Knowledge Application: Have students work in small groups. Assign each group a specific type of venomous animal. Ask the group to research and present how that animal might harm a human. Also consider specific assessment findings and treatment.
Talking Points: Remind students that the steps of assessment and treatment of patients in environmental emergencies is similar to that for other emergencies, despite the possibility of the scene being in water or away from population centers.
Talking Points: The EMT's first concern is safety of self and others. If there are other boats on the lake, the best choice might be to use one of those boats to reach the patients.
