Environmental Emergencies, by K.G. EMT-P

One of the most often overlooked and underestimated issues regarding first aid are environmental related injuries.  In the event that ambulance services and advanced medical personnel are unavailable, there are measures that a person can take to alleviate symptoms, prevent organ damage, and possibly save a life.  From my own personal experience as a paramedic, I have found that these emergencies are usually unexpected even in people who are in relatively good medical condition.

Environmental injuries are problems we don’t usually encounter on a regular basis in our daily lives.  While our bodies can usually compensate for extreme environment exposure, the natural protective mechanisms that our body provides can sometimes prove to be inadequate.  When these extremes are too much for our bodies to handle, the result may lead to shock and even death. 
There are basically two extremes that a person is likely to encounter; extreme hot conditions and extreme cold conditions.  Heat related injuries, or hyperthermia (abnormally high body temperature) can result in heat cramps, heat exhaustion, or heat stroke.  Cold related injuries, or hypothermia (abnormally low body temperature), can result in chilblains, frostnip, or frostbite.  Another environmental injury not related to hot or cold conditions is trench foot, also called immersion foot, which is similar to frostbite.

There are preventative measures that should be taken in order to ensure that the chances of these types of injuries occurring are avoided.    Dehydration is a symptom that presents early and can be avoided by drinking plenty of water.   Wear proper attire accordingly for the environment you expect to be exposed to.  Wear loose, light colored clothing, and a wide-brimmed hat to provide shade in hot weather.   In cold weather, make sure to cover all exposed skin, and layer clothing to provide dead air space to act as insulation from the cold.  One should be careful to not layer to the point of sweating.  If sweating occurs, you should begin removing layers, as sweating will quickly lead to hypothermia.  Monitoring the amount of physical exertion in extreme environments, getting plenty of rest, and maintaining a proper diet are also important factors in regulating body temperature.

While anyone can be affected by these extremes of climate and temperature, it is often those with certain risk factors that are at a higher risk of developing an environmental illness.  Risk factors include:

  1.  Age of the individual – Children and elderly are at higher risk because of their inability to tolerate variations in temperature.
  2. Current health of the individual – Fatigue, hypoglycemia, malnutrition, and other chronic health issues such as diabetes, cardiac related illnesses, respiratory disease, and mental instability can interfere with the body’s ability to recover from environmental exposure illness.
  3. Medications – Many medications can affect body temperature.  For instance, diuretics can worsen hyperthermia; beta blockers affect the heart rate and can interfere with the regulation of body temperature.  Anti-psychotics and antihistamine medications can also alter the temperature in certain deep tissues of the body.
  4. Level of acclimatization – This is the person’s ability to adjust to changes in environmental conditions, or climate.
  5. Length and intensity of exposure – Factors such as humidity and wind can contribute to the susceptibility of environmental illnesses, and accelerates the effects of exposure on the human body.

Heat Related Injuries
Signs, symptoms and treatment of heat related injuries are best described as follows:

  1. Dehydration – This occurs when your body does not have as much fluid as it needs, and usually leads to other heat related disorders if not addressed immediately.  Signs and symptoms may include nausea, vomiting, abdominal discomfort, blurry vision, decreased urination, skin loses elasticity, and altered mental status (confusion, disorientation, etc.).  Note:  Thirst is a poor way to identify the level of dehydration.  Treatment includes rehydration by drinking fluids if the person is conscious and able to hold fluids down.  Encourage them to sip small amounts of water frequently, rather than to take large amounts at once.
  2. Heat cramps – This occurs when a person’s muscles are overexerted while exposed to hot temperatures.  Signs and symptoms are sudden painful cramps of fingers, arms, legs, or abdominal muscles, weakness, feeling dizzy, moist and warm skin.  Treatment consists of removing the person from the environment by placing them in a shaded area.  If the person is alert, have them drink a sports drink (such as Gatorade, Powerade, etc.) if available, or substitute by mixing a solution of 4 teaspoons of salt to a gallon of water.  Salt tablets are not recommended because they may cause stomach irritation.  You may even try massaging the painful muscles, and placing moist towels on the forehead to reduce body heat.
  3. Heat exhaustion – A mild reaction to heat exposure.  If not treated, it may lead to heat stroke.  Signs and symptoms include increased body temperature, skin is cool and clammy with heavy sweating, and breathing will be rapid and shallow with a weak pulse.  Other symptoms may include diarrhea, weakness, headache, anxiety, numbness and tingling, impaired judgment, and sometimes loss of consciousness and even psychosis (hallucinations or delusions).  Treatment for heat exhaustion includes placing the person in a shaded area, lay them on their back with the legs elevated, remove or loosen tight clothing especially around the neck and wrists, and cool them by fanning but not to the point of causing them to chill or shiver.  If the person is conscious, have them drink a sports drink if available, or substitute with the salt solution mentioned above. 
  4. Heat stroke – This occurs when the body is unable to regulate its core temperature, and can cause damage to kidneys, liver and brain.  Signs and symptoms are lack of sweating, hot, red, dry skin, but may still be moist from prior sweating, deep respirations that become shallow, rapid respirations that become slow, a rapid pulse that may slow down later, confusion, disorientation, unconsciousness, and possible seizures.  Treatment includes removing the person from the environment to a cooler environment, attempt to rapidly cool the person by removing the clothing and placing a wet sheet over the body.  Fanning and misting with water may also be necessary, but be careful to not cool to the point of shivering.  Please note that cold water immersion or sponge baths should not be attempted, as this can cause a rapid change in body temperature and result in shivering causing further complications.  If the person is alert and able to drink, fluid therapy should be attempted with a sports drink or using the salt solution.  Seek advanced medical care if available.

Cold related injuries
Signs, symptoms and treatment of cold related injuries are best described as follows:

  1.  Hypothermia occurs when a person’s body temperature falls due to heat loss caused by exposure to cold weather.  A person’s body will naturally try to warm itself by producing “goose bumps” or shivering.  Signs of mild hypothermia are shivering, impaired judgment, slurred speech, and stiff muscles that cause uncoordinated movements such as stumbling or staggering.  Person’s with severe hypothermia will become confused and disoriented, possibly to the state of euphoria or a sense of well-being.  Shivering will stop, and muscles will become more rigid.  To treat for hypothermia, begin by removing any wet clothing.  Lay the person down on their back and cover them with blankets, and prevent from further exposure to moisture.  Heat packs may be used, placing them in the armpits and in the groin area or between the thighs.  If heat packs are not available, heated rocks from a campfire may be used.  Be sure to cover heat packs or rocks with a cloth to prevent burns.  You may also use your own body as a heat source to assist re-warming of a partner by simply lying next to them under the blankets.  If you are re-warming specific parts of the body, you may place the frozen areas like, hands or feet, on your chest or abdomen.  Take care to handle the patient gently, as rough handling may cause disturbances in the heart.  If the person is conscious and alert, you may give them something warm and sweet to drink.  Do not give them alcohol or caffeine.
  2. Frostbite occurs when tissues in the body freeze, typically in fingers, toes, ears, nose cheeks, or any exposed skin.  The person may complain of a burning or itching sensation.  The affected area will be red at first, which is known as frostnip.  As the freezing reaches deeper tissue, the skin will become white and waxy in appearance, hard to the touch, and blisters may form.  There may not be any pain at first, but could become numb, leading to severe pain as re-warming occurs.  Do not attempt to re-warm if there is the possibility of re-freezing, such as the need to continue walking from a dangerous situation.  Do not puncture any blisters, and do not massage or rub the frozen area.  Cover the area with loose, dry dressings and seek advanced medical care if available.

Trenchfoot
Also known as immersion foot, trenchfoot is similar to frostbite but does not require freezing temperatures to occur.  The term “trenchfoot” comes from World War I when soldiers were forced to stand in trenches with standing water.  Although today we don’t usually find ourselves standing in trenches, trenchfoot can still be caused by wearing boots and socks that have become wet, either from walking in rainy weather, or from our feet sweating.   The most important thing to remember is prevention.  Keep your feet dry and frequently change into clean socks.   If possible, waterproofing your boots with mink oil or other waterproofing products can help in the prevention of this environmental injury. 

While environmental injuries can encompass anything from altitude sickness to zombie infiltration, the topics discussed here are related to extreme weather conditions only.  Some other topics regarding environmental injuries you may want to investigate are chemical or radiation exposure, drowning or near-drowning, bee stings, snake bites, etc.  With any injury that might require first aid, prevention is the best medicine.  It is always a good idea to keep a well stocked first-aid kit handy.  I would recommend anyone and everyone to take a course in CPR.  An EMT class or other basic first aid training would also be beneficial. 

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