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1. Environmental Emergencies

2. Environmental Emergencies
• Body Temperature
• 96.4-99.8 degrees F
• Heat Regulation
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Based on heat lost v heat gained
Variation throughout body core and periphery
Cardiovascular System
• Transports heat through body
• Skin
• Allow heat to be lost/gained to/from environment
• Hypothalamus
• Temperature control center of the brain

3. Heat Production
• Metabolism
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ALL metabolic processes in body produce heat
Basal metabolism
• Metabolic activity to maintain cell function at rest
Generally more than enough heat to maintain core
temp

4. Heat Loss/Gain
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Radiation
Conduction
Convection
Evaporation
Breathing

5. Radiation
• Radiation
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Transfer of heat via infrared rays.
Heat rays are radiated by the
body and other objects in the
environment.
If body temp is greater than the
surroundings heat is lost.
We radiate 550 watts (5 light
bulbs)

6. Conduction
• Conduction
• Transfer of heat to objects
including air that are in
direct contact with body.

7. Convection
• Convection
• Transfer of heat through
movement of currents.
• i.e. Wind chill factor

8. Evaporation
• Evaporation
•
• Loss of heat when moisture
vaporizes on the body
surface.
Depends on temp/air
movement/humidity
•
• Wind currents move saturated
air away from body
Drier air replaces it and
takes up moisture
• Closer to 100% humidity =
Less evaporation

9. Breathing
• Breathing
•
•
• Inhaled air is
heated/cooled by body
temp
Body looses heat when
air is cooler than the
body
Body gains heat when
air is warmer that the
body

10. Mechanisms of Regulation
• Brain
• Hypothalamus
• Body thermostat
• Metabolic Rate
• Heat production
• Cardio
• Heat distribution
• Ski
n • Heat loss
• Vasodilation
• Loss by
conduction/convection/radi
ation/sweating
• Vasoconstricion
• Inhibits sweating,
increased metabolic rate

11. Cardiovascular System
• Cardiovascular
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•
Brings heated blood from
core to extremities
5 % of cardiac output is in
skin
• 250-300 ml/min
• Vasodilation
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•
• More blood contact
with skin
Conduction,
convection,
radiation
Can increase to
3000 ml/min!!!!
• Vasoconstriction
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•
Heat conservation
Can decrease to
30 ml/min!!!!

13. Skin
• Skin
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Heat regulation
Insulation
Vasoconstriction
Vasodilation
Evaporation form sweat

14. Questions to ask
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Source
Environment
Loss of consciousness
Effects
How long exposed

15. Cold Emergencies:
Predisposing Factors
• Cold Environment
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Immersion
Non Immersion
• Age
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Very old
Very young
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Small with LARGE surface area
Small muscle mass – Poor in
children and not existent in infants
Less body fat
Younger children need help to
protect against environment
• Medical Conditions
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Shock
Head injuries, Injuries to spinal cord
Burns
Generalized infection
Diabetes and hypoglycemia
Drugs/poisons

16. Predisposing factor: Idiocy…..

17. Hypothermia
• Hypothermia
• Body core temp falls below
95 degrees F
• Environmental conditions
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Ethanol ingestion
Underlying illness
Overdose/poisoning
Major trauma
Outdoor resuscitation
Ambient temperature
decrease ( i.e. home of
elderly pt)

18. Cold Emergencies
S/S
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Poor coordination
Memory disturbances
Reduce/loss of sensation
Mood changes
Less communicative
Dizziness
Speech difficulty
Stiff/rigid posture
Muscular rigidity
Shivering/absence of shivering
Breathing changes
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Early -Rapid
Late – Shallow, slow, or absent
• Pulse changes
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Early- Rapid
Late – Slow and barely palpable , irregular, absent
• Skin Changes
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Red – early
Pale
Cyanotic
Stiff/hard
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Slowly responding pupils
Low to absent BP
Joint/muscle stiffness
Poor judgment

19. Assessment/Treatment
• Assessment:
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Place hand against pt abdomen
Cool abdomen = Generalized hypothermia
Assess pulse 30-45 seconds before CPR
• Treatment:
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Remove pt from environment
Remove wet clothing
Cover with blankets
Handle pt EXTREMELY carefully
Do not allow pt to walk/exert self
Admin O2 (warmed/humidified if able)
Do not let pt ingest stimulants
Do not massage extremity
If pt responsive : Active rewarming
•
• If pt unresponsive : Passive rewarming
• AFTERDROP…

20. Active Vs. Passive Rewarming
• Active rewarming
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Warm blankets
Heat packs /warm water
bottles
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Groin
Neck
Under arms
• Turn heat on in pt
compartment
• Passive rewarming
• Warm blankets
Turn heat on in pt
compartment

21. Localized Injuries
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Localized to one area of the body
Tend to happen in extremities and exposed ears/nose/face
Early/Superficial Injury
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Blanching of the skin
Loss of feeling/sensation in area
Skin remains soft
If rewarmed – tingling sensation
• Late/Deep Injury
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White, waxy skin
Firm to frozen feeling on palpation
Swelling
Blisters
If thawed – Flushed with area of purple and blanching or mottled and
cyanotic

24. Localized Injuries: Care
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Remove pt from the environment
Protect injured extremity from further injury
Administer O2
Remove wet/constrictive clothing
If early/superficial
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Splint extremity
Cover extremity
Do not massage
Do not re expose to cold
• If late/deep
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Remove jewelry
Cover with dry clothing/dressings
DO NOT:
• Break blisters – Rub/massage area – Apply heat – Rewarm – Allow pt
to walk on affected extremity

25. Prolonged/Delayed Transport
• Active Rapid Rewarming
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Immerse affected part in warm
water bath
Monitor water so that it doesnt
cool from frozen part
Continuously stir water
Continue until the part is soft
and sensation returns
Dress the area with dry sterile
dressings
Protect against refreezing
Expect pt to c/o SEVERE pain

26. Changing Directions…

27. Heat Emergencies: Predisposing
Factors
• Climate
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High ambient temp = Less evaporation
High relative humidity = Less evaporation
• Exercise and activity
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Can lose 1+ Liter of sweat per hour
Loss of electrolytes (Na, Cl, H2O)
• Age
• Elderly
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Poor thermoregulation
Medications
Lack mobility- cannot escape environment
• Newborns
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Poor thermoregulation
Cannot remove own clothing
• Pre existing illness
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Heart disease
Dehydrations
Obesity
Fever
Fatigue
Diabetes
Drugs/medications

28. Heat Emergencies S/S
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Muscular Cramps
Weakness
Exhaustion
Dizziness/faintness
Skin
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Moist, pale, normal to cool temp
• Heat Exhaustion
Hot, dry or moist – Dire emergency
• Heat Stoke
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Rapid Heart Rate
AMS
Unresponsive

29. Treatment: Heat Exhaustion
• Moist, pale, normal to cool skin
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Remove pt from hot
environment and place in cool
one
Administer O2
Loosen or remove clothing
Cool pt by fanning
Put in shock position
If pt responsive and not
nauseated have them drink
water
If pt is unresponsive or
vomiting transport pt left lateral
recumbent

30. Treatment: Heat Stoke
• Hot, dry or moist skin
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Remove pt from hot
environment and place in
cool one
Administer O2
Remove clothing
Apply cold packs to neck,
groin, armpits
Keep skin wet by applying
water by sponge/wet towels
Fan aggressively
Transport IMMEDIATELY

32. Water Related Emergencies
• Near drowning/drowning
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Ensure safety of crew
Suspect spinal injury if diving injury
Consider length of time in cold water
• Any pulseless non breathing pt
submerged in cold water should
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be resuscitated
C-Spine control and removal via LBB if pt
responsive and spinal injury suspected
If injury not suspected, place pt on L
lateral recumbent
Suction as needed
Administer O2
If gastric distention interferes with
ventilation:
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Roll pt to L side
Have suction ready
Apply firm pressure on abdomen
(epigastric are) and decompress
SUCTION

35. Bites and Stings

36. Bites and Stings: S/S
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Hx of bite (spider, snake) or sting (insect, scorpion, marine animal)
Pain
Redness
Swelling
Weakness
Dizziness
Chills
Fever
Nausea
Vomiting
Bite marks
Stinger

37. Bites and Stings Treatment
• If stinger present remove it
• Scraping motion
Wash area gently
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Remove jewelry from area
before swelling occurs
Place injection site slightly
below pt heart
Do not apply cold to snakebites
Consult medical direction for
constricting band for snake bite
Observe and treat for S/S of
allergic reaction

38. Remember… Scene Safe! Its
already injured the patient. So…