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Chapters 25, 26 & 27: Environmental
Emergencies: Cold, Heat, Lightning,
Plants and Animals
Tom Crocker
Fall 2011
Body temperature
progressively falls
All body functions diminish or
Primary Hypothermia:
Due to environmental exposure
Falling in a cold lake
Secondary Hypothermia
Associated with other trauma in a
cold environment
Continued drop in body temp
even after treatment (Typical)
Progression of Hypothermia
Mild (93.2 - 95°F)
Shivering, stumbling, mumbling,
weakness, difficulty speaking, mild
Moderate (86° - 93.2°F)
Shivering ceases, muscles become
stiff, unable to stand or walk,
impaired responsiveness, slow
breathing and pulse
Severe (< 86°F)
Unresponsive, no pulse, very slow
breathing, cardiac arrest
(ventricular fibrillation)  death
Hypothermia Treatment
“No one is dead until they
are warm and dead”
Mild Tx:
Shivering, body-to-body
contact, heating devices, hot
tub, warm liquids (no caffeine)
Moderate/Severe Tx:
Gentle, prevent further
cooling, rewarm slowly with
active heat source, no CPR (VFib), transport
Monitor – Temp
Who to watch for…
Skiers on stalled chairlifts
Ski racers/gate keepers
Event spectators
All patients
Other patrollers
Cold Injuries
Parts of the body become very
cold or frozen
Extremities (feet, ears, ears, nose,
and face) are particularly
Very cold – Not frozen
Most common
S/S: Gray or yellowish skin,
tingling, pain, numbness
Tx: Direct body heat
Freezing of a body part
Partial Thickness: only skin
Full Thickness: skin, tissues, muscles,
tendons, and bones freeze
Normally hands or feet
Treatment of Frostbite
Consider hypothermia
Rapidly rewarm
Water 102°-108°F
20 – 30 minutes
Do not let it refreeze
Heat Exposure
Heat Syncope
Inadequate perfusion 
Temporary fainting
Tx: Remove from heat,
elevate legs, O2, cool water
Heat Cramps
Dehydration  Muscular
Tx: salt water, massage, rest
Heat Exposure
Heat Exhaustion (<104°F)
Dizziness, nausea, headache,
cramping, dehydration due to
hypovolemia (excessive sweating)
Tx: Remove from heat, elevate
legs, rehydrate with salt water,
loosen clothing, O2
Heat Stroke (>104°F)
High HR & RR, Decreased LOR
Tx: Same, remove clothes, water
and fan the skin, icepacks (armpits
& groin), rapid transport
Signs/Symptoms of Heat Emergencies
Hot Skin
Muscle Cramps
Rapid Breathing
Respirator and cardiac arrest
No breathing but irregular heart
Severe tissue damage
Entry and exit wounds
Scene safety, safe to touch
the patient, c-spine, CPR/AED,
rescue breathing, O2
Toxin vs. Poison
Toxin: from living creature
Poison: from living creature
or non-living substance
Venom: toxin or poison
specific to a certain animal
Toxic Plants
Poison Ivy, Sumac, and Oak,
Stinging Nettle
Rashes, burns, blisters
Monkshood, Autumn Crocus,
Foxglove, Rhododendron
(azalea), Jimson weed
Nausea, cardiovascular effects,
shortness of breath, kidney failure,
headache, dehydration, muscle
spasms, diarrhea, delirium
Tx: clean skin, transport for
cases of ingestion
Black widows
Found under logs/stones in
Bull’s-eye or target appearance
of bite
Pain, swelling, nausea,
abdominal pain, fever, sweating
Brown Recluse
Violin/fiddle shape on back,
found under stones and
backcountry toilets
Prolonged stinging sensation (8
hours), tissue death
Scorpions, Ticks, & Other Insects
Found in the Southwestern U.S.
Severe pain lasting 24-72 hours
Irregular cardiac rhythms, blurred
vision, nausea, muscle spasms
Live in wood piles, grass, on
Painless bite, red rash around bite
Lyme disease: flu-like symptoms and
joint pain
Tx: Scrape stinger with firm flat
object, ice, epi-pen, transport
Snake Bites
Burning pain, swelling, puncture
wound, blood, tissue death,
inability of blood clotting,
paralysis, respiratory failure
Rapid transport, wrap extremity
proximal to distal to the fang
mark with an elastic band, splint
extremity, elevate to heart
DON’T suck the poison out, no ice,
limit physical exertion
Marine Animals
Sharks: eyes and gills!!
Moray Eel: lives in coral reefs
Stingray: think Crocodile Hunter
Jellyfish: stinging chemicals
Skin reactions, paralysis,
respiratory, cardiac, and
neurological distress
Tx: wash skin with vinegar (30secs),
immerse affected site in hot water,
check with local healthcare
personnel to standard procedures
Bites, kicks, scratches, licks, hugs
Clean wound, rapid transport,
typical trauma treatment