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Search and Rescue Medic Course Presented by: 1LT Timothy Paquin, CAP Ground Team Leader, EMT-B Introduction Prerequisites • Valid CAP ID card • Valid CPR/First Aid Card (AED training is optional) • Minimum GES card with 101 qualification as a Ground Team member preferred • Positive mental attitude with ability to devote 110% of your attention and energy to the course • Good interpersonal relationship skills • Good sense of humor • A strong stomach and the ability to deal with views of traumatic injuries TOPICS (not in any specific order) • • • • • • • • • • • • • • • • • • Patient assessment and urgent care Care of bleeding, wounds and burns Musculoskeletal and soft tissue injuries Splinting, dressing and bandages Circulatory emergencies Respiratory emergencies Abdominal emergencies Diabetic emergencies Allergies Physical and environmental hazards Heat injuries Cold injuries Altitude emergencies Poisons, toxins and poisonous animals Bites and stings Patient packaging and transportation First aid kits and improvised supplies Legal and ethical issues What this course will do: -- Provide a form of continuing education to increase your skills in First Aid and CPR during Civil Air Patrol Search and Rescue missions. -- Introduce you to some technical skills and techniques that may be performed by medical professionals. -- Provide an overview of the legal and ethical issues involved in patient care. What this course will NOT do: -- Certify you as a First Responder, Emergency Medical Technician, Paramedic, Nurse, or Doctor. -- Certify you in Wilderness First Aid through any agency or organization. -- Certify you to perform any skill above your current skill level (i.e. tracheotomies, IV’s, or intubations). -- Provide information in diagnosing specific injuries or illnesses. EMS Basics and the Search and Rescue Medic (SAR-Medic) History of EMS 1797 1860’s Napoleon's chief physician implements a pre-hospital system designed to triage and transport the injured from the field to aid stations. Civilian ambulance services begin in Cincinnati and New York City. 1915 First known air medical transport occurs during the retreat of the Serbian army from Albania. 1920’s First volunteer rescue squads organize in Roanoke, Virginia, and along the New Jersey coast. 1958 Dr. Peter Safar demonstrates the efficacy of mouth-to-mouth ventilation. 1960 Cardiopulmonary resuscitation (CPR) is shown to be effective. 1966 The Highway Safety Act of 1966 establishes the Emergency Medical Services Program in the Department of Transportation. 1972 Department of Health, Education, and Welfare allocates 16 million dollars to EMS demonstration programs in five states. 1973 The first “Mike Squadron” is created at the Hawk Mountain Ranger School to train Civil Air Patrol SARMedics. 1973 The Emergency Medical Services Systems (EMSS) Act provides additional federal guidelines and funding for the development of regional EMS systems; the law establishes 15 components of EMS Systems. 1985 National Research Council publishes “Injury in America: A Continuing Public Health Problem,” describing deficiencies in the progress of addressing the problem of accidental death and disability. 1988 The National Highway Traffic Safety Administration initiates the Statewide EMS Technical Assessment program based on ten key components of EMS systems. 1990 The Trauma Care Systems and Development Act encourages development of inclusive trauma systems and provides funding to states for trauma system planning, implementation, and evaluation. 1997 Percentage of Population covered by 911 for Colorado & Surrounding States. Montana 93% Idaho 76% Utah 100% COLORADO 92% Nebraska 70% South Dakota 75% Wyoming 98% Levels of Proficiency in Colorado EMS • • First Aid/CPR Certification – The base level for all EMS providers – Certification is provided by a number of different agencies, including: • The American Red Cross (ARC) • The American Heart Association (AHA) • The American Safety and Health Administration (ASHA) • Heartsmart, Inc. • The National Safety Council – Provides basic CPR and First Aid Skills for the average citizen First Responder – Above First Aid/CPR certification but below the EMT-Basic level – Certification is governed by the US Department of Transportation – Provides certain additional skills to assist EMT’s and other medical professionals Levels of Proficiency in Colorado EMS (cont.) • • • EMT-Basic – Skills include Basic Life Support and EKG – Can Perform Intravenous Therapy (if certified) – Can provide and assist with the following medications, with medical direction: • Oxygen • Activated Charcoal • Oral Glucose • Metered Dose Inhalers (MDI’s) • Nitroglycerin • Epinephrine EMT-Intermediate – Skills are between EMT-B and AMT-P – Can perform IV Therapy with additional medications EMT-Paramedic – Highest skills in the field barring the presence of a Doctor or Nurse – Can provide IV Therapy with a full line of different medications – Advanced Cardiac Life Support, Pediatric Life Support, and Manual Defribulator Qualified – Can perform Tracheotomies and Intubation The CAP SAR-Medic The Civil Air Patrol SAR-Medic is a volunteer who is specially trained in dealing with severe traumatic injuries, as well as common injuries, as related to various operations during Emergency Services Missions. SAR-Medic’s provide emergency treatment of accident victims when no EMS professionals are present, and additional assistance to those professionals upon arrival. Hawk Mountain Medic Creed My task is to provide to the utmost limits of my capability the best possible care to those in need of my aid and assistance. To this end I will aid all those who are needful, paying no heed to my own desires and wants; treating friend, foe and stranger alike, placing their needs above my own. To no man will I cause or permit harm to befall, nor will I refuse aid to any who seek it. I will willingly share my knowledge and skills with all those who seek it. I seek neither reward nor honor for my efforts for the satisfaction of accomplishment is sufficient. These obligations I willingly and freely take upon myself in the tradition of those that have come before me. …These things we do so that others may live. Hippocratic Oath I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help. Medical Direction Medical Direction Medical direction is the process by which a physician or, occasionally, group of physicians guide and oversee the patient care provided by an emergency medical services (EMS) system. Law requires medical direction for all advanced life support (ALS) service providers. Most states require basic life support (BLS) agencies to have a medical director as well. Medical direction from a physician is recommended for all EMS activities. There are two forms of medical direction: on-line and off-line. Off-Line Medical Direction The medical director of an EMS system is responsible for off-line medical control actions, including the following: – Development and implementation of protocols and standing orders – Supervision of any initial and recertification training programs provided by the EMS agency – Retrospective review of the care delivered (to ensure compliance with patient care standards) – Liaison of activities between EMS professionals and others, including other physicians; ED personnel; and regional, state, and local EMS authorities – Providing input on dispatch, mutual aid, disaster planning, and hazardous materials response activities – General supervision of physicians who provide on-line medical control – Acquiring and maintaining up-to-date knowledge of EMS issues – Support of EMS research, where practical – Problem solving Generally, an EMS system has one overall medical director for off-line activities and a group of physicians designated as the source of on-line medical control. On-Line Medical Direction On-line medical control involves directing the care of a single patient. The on-line medical control physician evaluates information given by medics, makes decisions regarding immediate patient care, and gives appropriate orders. Medics and their patients benefit from having immediate access to an emergency physician for advice in difficult or unusual situations. In addition, the EMS medical director may use mandatory on-line physician authorization to maintain tight control of certain potentially dangerous pre-hospital treatment options (i.e., pre-hospital thrombolytic administration, for stroke victims). Legal Issues Advance Directives An advance directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions (if you are in a coma, for example). If you are admitted to the hospital, the hospital staff will probably talk to you about advance directives. A good advance directive describes the kind of treatment you would want depending on how sick you are. For example, the directives would describe what kind of care you want if you have an illness that you are unlikely to recover from, or if you are permanently unconscious. Advance directives usually tell your doctor that you don't want certain kinds of treatment. However, they can also say that you want a certain treatment no matter how ill you are. Advance directives can take many forms. Laws about advance directives are different in each state. Types of Advance Directives The three most common types of Advance Directives are: • Living Wills • Durable Power of Attorney for Health-care • Do Not Resuscitate Orders Living Will A living will is one type of advance directive. It only comes into effect when you are terminally ill. Being terminally ill generally means that you have less than six months to live. In a living will, you can describe the kind of treatment you want in certain situations. A living will doesn't let you select someone to make decisions for you. Durable Power of Attorney for Health Care A durable power of attorney (DPA) for health care is another kind of advance directive. A DPA states whom you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions. A DPA is generally more useful than a living will. But a DPA may not be a good choice if you don't have another person you trust to make these decisions for you. Living wills and DPAs are legal in most states. Even if they aren't officially recognized by the law in your state, they can still guide your loved ones and doctor if you are unable to make decisions about your medical care. Ask your doctor, lawyer or state representative about the law in your state. “Do Not Resuscitate” Orders A “Do Not Resuscitate” (DNR) order is another kind of advance directive. A DNR is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. (Unless given other instructions, EMS staff will try to help all patients whose heart has stopped or who have stopped breathing.) You can use an advance directive form or tell your doctor that you don't want to be resuscitated. In this case, a DNR order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states. Most patients who die in a hospital have had a DNR order written for them. Patients who are not likely to benefit from CPR include people who have cancer that has spread, people whose kidneys don't work well, people who need a lot of help with daily activities, or people who have severe infections such as pneumonia that require hospitalization. What this means to you • If you attempt to resuscitate a person who has an advance directive on their body, you may be held criminally and/or civilly at fault. • The key is that the advance directive must be on the patient’s body where you can see it. Check it to make sure that it is accurate, for the patient, and current before stopping any resuscitation efforts. • Most victims that we treat will not have any form of AD, but always check first. NEVER assume anything. Patient Care Reports (PCR’s) Patient Care Reports (PCR’s) come in many different formats, however they generally contain the same information: - Patient age and sex - Baseline and additional vital signs - Known Patient History - Medical Interventions - Drug Administrations - Name of Agency and Person providing care Filling out the PCR REMEMBER: Anything that you do goes on the PCR. If you do not write it down, it didn’t happen. Make sure all information is as complete, accurate, and legible as humanly possible. Mistakes can lead to improper future care and severe legal issues. Never attempt to diagnose a patient’s specific injury or illness. Leave that to the doctors, that’s what they are paid for. The PCR Scene Safety Blood borne Pathogens Training for Ground Team Members & Leaders Developed as part of the National Emergency Services Curriculum Project What are Bloodborne Pathogens? • BBPs are disease causing microorganisms that may be present in human blood. They may be transmitted with any exposure to blood or other potentially infectious material. – Two pathogens of significance are Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) What is Hepatitis B? • One of the five viruses that causes illness directly affecting the liver • Major cause of viral hepatitis which is preventable through immunization Hepatitis B Symptoms • Weakness, Fatigue, Anorexia, Nausea, Abdominal pain, Fever, Headache, Possible jaundice( a yellow discoloration the skin) • Blood will test of positive for the HBV surface antigen within 2 to 6 weeks after symptoms develop • May show no symptoms, and therefore not be diagnosed HBV Facts • 200 out of 8700 health care workers contracting Hepatitis B yearly will die • HBV is more persistent than HIV in that it is able to survive for at least a week in dried blood on environmental surfaces or contaminated instruments • Approximately 85% of patients recover in 6 to 8 weeks What is HIV? • Human Immunodeficiency Virus is a virus that infects immune system T4 blood cells in humans and renders them less effective in preventing disease • It is the virus identified as being responsible for Acquired Immunodeficiency Syndrome (AIDS) HIV Symptoms • Night sweats, Weight loss, Fever, Fatigue, Gland pain or swelling, Muscle or joint pain • May feel fine and not be aware of exposure to HIV for as much as 8 to 10 years • Blood tests may not show positive for as long as a year, and therefore multiple tests may be required to determine if the person has been infected HIV Facts • Estimates in the US say that 1 out of 250 people are infected with HIV • There are over 100 case reports of health care workers whose HIV infection is associated with occupational exposure • Over 200,000 AIDS patients have been reported to the CDC, 84 of which are health care workers with no other identified reason for infection Exposure Prevention for Bloodborne Pathogens • • • • Engineering Controls Work Practice Controls Personal Protective Equipment Universal Precautions Engineering Controls • Structural or mechanical devices CAP provides for its’ ES personnel – Hand washing facilities – Eye wash stations – Sharps containers – Biohazard labels Work Practice Controls • The behaviors necessary to use engineering controls effectively – Using sharps containers – Using an eye wash station – Washing your hands after removal of personal protective equipment Work Practice Controls Continued • Hand washing is considered to be the most effective method of preventing transmission of • BBPs Alternatives such as hand cleaners and towelettes are acceptable alternatives for those without ready access to wash facilities, but the individual should still wash their hands with soap and warm water after contact with blood or other possible infectious material Work Practice Controls Continued • Procedures involving blood or other potentially infectious material will be performed in such a way as to minimize or eliminate splashing, spraying, splattering, and generation of droplets of these substances • Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses is prohibited in work areas where exposure is likely Personal Protective Equipment • Equipment provided by CAP at no cost to you, which it is to your advantage to use, and should be reported to supervisors when not in working order – Latex gloves – Masks – Aprons, Gowns, or Tyvek suits – Face shields Personal Protective Equipment Continued • Whenever you need to wear a face mask, you must also wear eye protection • When wearing personal glasses, you must use side shields and plan to decontaminate your glasses and side shields according to schedule Personal Protective Equipment Continued • Personal protective Equipment is acceptable if it prevents blood or other possible infectious material from contaminating work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes. What is wrong with this picture? Use your Personal Protective Equipment! Answer: Rubber Gloves were not worn for the patient’s assessment Removing Gloves Grasp the outer surface of one glove with the other gloved hand "rubber to rubber" and pull off the glove. Discard the glove into the designated receptacle. Removing the second glove. Note that the person touches only the "inside" surface of the glove with his bare hand. Contaminated Clothing • Your clothing may be exposed to potentially infectious materials, and must be handled appropriately if that happens – Clearly label contaminated materials and put them into separate leak proof containers to be sent to a facility following OSHA standard – Don't handle contaminated clothing more than absolutely necessary Contaminated Clothing Removal • Remove it in such a way as to avoid contact with the outer surface – Rolling the garment as it is pulled toward removal will decrease chance of contact with the contaminated area – After rolling it up, carefully pull it off to avoid contact – If it cannot be removed without contamination, it is recommended that the item be cut off Universal Precautions • The concept that all blood and certain body fluids are to be treated as if contaminated with HIV, HBV, or other BBPs – Acceptable alternative is Body Substance Isolation: The treating of all fluids and substances as infectious – Personal protective equipment like gloves and a mask must be used whenever you might be exposed to blood or other potentially infectious materials Materials Requiring Universal Precautions • • • • • • • Blood Cerebrospinal fluid Synovial fluid Pleural fluid Any body fluid with visible blood Any unidentifiable body fluid Saliva from dental procedures Materials NOT Requiring Universal Precautions • • • • • • • • Feces Nasal secretions Sputum Sweat Tears Urine Vomitus If there is visible blood then all bets are off Surface Disinfections • Surfaces can be decontaminated with one of many commercial products – Check label directions for use • A bleach solution can be mixed 1:10 with water to disinfect areas – The solution should be made fresh Biohazard Materials Biohazard symbol used to identify biohazard materials Protective gloves Protective face mask with eye shield Biohazard Materials Continued Sharps containers to hold contaminated needles, scalpels, or other sharp instruments Tyvek protective suits for biohazard scenes such as accident sites. Biohazard kit for clean up. BBP Tasks • General Emergency Services Personnel – O-0901: Demonstrate knowledge of BBPs • Ground Team Members – O-0902: Exercise Universal Precautions • Ground Team Leaders – O-0903: Use a BBP Protective Suit Any products shown are for illustrative purposes only. Civil Air Patrol or the United States Air Force endorses, guarantees, or recommends no specific product, business, or services. QUESTIONS? THINK SAFETY Altered Mental Status Vital Signs & Basic Patient Care SAMPLE History • • • • • • S – Signs & Symptoms A – Known Allergies M – Medications P – Past, Pertinent Medical History L – Last Oral Intake E – Events Leading to the Illness/Injury Baseline Vitals Baseline Vitals provide important information in the treatment of trauma patients. By establishing a base line upon first contact with the patient, a medic can instantly determine the effectiveness of any medical intervention. EVERY patient will have the following baseline vital signs checked: Respirations (# of breaths per minute) Pulse Rate (# of heart beats per minute) Blood Pressure Pupils Skin Temperature or appearance Pulse Rate Blood Pressure Respirations Pupils Skin Temperature and Appearance ABC’s Basic Airway Management 1. 2. Check if the patient is breathing. Open the Airway 1. 2. 3. Use an airway adjunct if necessary 1. 2. 4. 5. Use the head tilt / chin lift method if no spinal injury is suspected. Use the jaw thrust method if a spinal cord injury is suspected. DO NOT move the patient’s neck!!! If no gag reflex, use an oro-tracheal tube If gag is present, use a naso-tracheal tube Use a Bag-Valve Mask (BVM)(if necessary) Apply Oxygen (as necessary) 1. 2. 15 lpm for a non-rebreather mask (NRB) 6 lpm for a nasal cannula Remember to reassess your patient after every intervention. Bleeding & Shock Fractures & Splinting DCAP-BTLS Deformities Contusions Abrasions Penetrations Burns • Superficial Burns • Partial Thickness Burns • Full Thickness Burns Tenderness Lacerations Swelling Patient Transport MEDEVAC Procedures MEDEVAC Request Format Line 1: Location of Pickup Site (normally given using the Military Grid Reference System (MGRS)) Line 2: Radio Frequency and Call Sign of Person Requesting the MEDEVAC Line 3: Number of Patients by Precedence A – URGENT B – URGENT SURGICAL C – PRIORITY D – ROUTINE Line 4: Special Equipment Required A – NONE B – HOIST C – EXTRACTION EQUIPMENT D – VENTILATOR Line 5: Number of Patients by Type L + (Number of Litter Patients) A + (Number of Ambulatory Patients) Line 6: Number and types of wounds, injuries, or illnesses and Patient Blood Type (if known) MEDEVAC Request Format (continued) Line 7: Method of Marking the Pickup Site A – PANELS B – PYROTECHNIC SIGNAL C – SMOKE SIGNAL D – NONE E – OTHER Line 8: Patient Nationality and Status A – US MILITARY B – US CIVILIAN C – NON-US MILITARY D – NON-US CIVILIAN Line 9: Terrain Description - Relationship of the pickup site to prominent terrain features (mountains, lakes, or any other feature that would be highly visible on a map. - Any known hazards around the Pickup Site MEDEVAC Aircraft UH-60Q or HH-60L “Dustoff” MEDEVAC Helicopter Crew: 3 (2 pilots and 1 Flight Surgeon) Max Pt. Capacity: 3 Litter Patients - or - 6 Ambulatory Patients Capabilities: Vertical Extraction via winch GPS Guidance Night Vision Capable CH-53 Sea Stallion Crew: 3 (2 pilots, 1 Crew Chief) Max Pt. Capacity: Capabilities: Midair Refueling Vertical Extraction via winch Night Vision Capable HH-65 Dolphin Crew: 3 (2 pilots, 1 Flight Medic) Max Pt. Capacity: Capabilities: Vertical Extraction via winch Night Vision Capable HH-3E Jolly Green Crew: 4 (2 pilots, 2 Flight Medics) Max Capacity: 30 Ambulatory Patients -or15 Litter Patients Capabilities: Vertical Extraction via winch Rear Door Entry Night Vision Capable Can hover on water CH-47 Chinook Crew: 4 (2 pilots, 2 Flight Medics) Max pt cap: 33 ambulatory -or24 Litter Capabilities: Rear Door Entry Vertical Lift Capabilities Civilian MEDEVAC Helicopters Crew: 3 (2 pilots, 1 Flight Nurse/Paramedic) Pt. Capacity: Generally 1 Litter Patient (depending on type of aircraft) Capabilities: Depend upon company providing transport and aircraft used Diabetic Emergencies Allergies Environmental Injuries Insects BLACK WIDOW SPIDER Common Name Scientific Name Black Widow Spider Latrodectus mactans Venom: Black widow venom is primarily a neurotoxin, which as a rule does not cause local tissue death and destruction. Best known for widespread muscle spasm and often mimics that of a severe abdominal problem i.e. acute appendicitis, or ruptured ovarian cyst. The initial bite is very painful, but can go unnoticed. The surface of the skin may display two red bite wounds, one, or none. The worst pain is in the first 812 hours, symptoms may continue for several days. Antivenom is available. Females are 1-2" in diameter Males much smaller The female black widow is shiny black with a red hourglass on abdomen; however this does not always have to be the case. The red hourglass could take the form of a red dot or many variations of shapes. The black widow is common in fields, woodpiles, and unoccupied dwellings. Treatment for Black Widow bites: Clean and irrigate the wound. Apply an ice or cool compress. Provide pain medication, if available. Transport immediately to the nearest medical facility. BROWN RECLUSE SPIDER Common Name Scientific Name Brown Recluse Spider -orViolin Spider Loxosceles reclusa The body of the brown recluse is light tan to dark brown in color. It is about 1/2" to 1/4 " in size. The males are usually smaller than the females. With leg span included they are about the size of a half dollar. The legs are long, thin, and delicate. They have only six eyes. The most distinguishing mark is the violin like dark patch on their head and thorax with the skinny part of violin pointing toward the abdomen. VENOM: The severity of the bite may vary. The symptoms may vary from no harm at all to a reaction that is very severe. Often there is a systemic reaction within 24-36 hours characterized by restlessness, fever, chills, nausea, weakness, and joint pain. Where the bite occurs there is often tissue death and skin is sloughed off. In some severe cases, a wound may develop that lasts several months. Treatment for Brown Recluse bites: Clean and irrigate the wound. Apply an ice or cool compress. Transport immediately to the nearest medical facility with the spider, if possible. MOSQUITOS Mosquito Facts Only the female mosquito bites. She needs the blood meal for egg production. Male mosquitoes are much larger than females, feeding only on flower nectar and not on the blood of mammals. The majority of mosquitoes feed early in the morning or late at night. Mosquitoes locate us primarily by smelling carbon dioxide and lactic acids that are excreted from our bodies. They can find us as far away as 200 feet. Cologne, soaps and lotions can also attract mosquitoes. In order to multiply, they need standing water to lay their eggs. Adults and heavyset or obese humans have an increased risk of being bit by mosquitoes, primarily due to their large body mass and more carbon dioxide being excreted from their skin. Mosquito Bite Treatment Over the counter Hydrocortisone can be very effective in helping with itching. Cool compresses are also very helpful and effective, as well as monitoring the area for signs of infection. Rocky Mountain Spotted Fever RMSF General Facts Rocky Mountain Spotted Fever, also known as spotted fever or tick fever, is a common tickborne illness that has been overshadowed by the publicity regarding Lyme disease. Rocky Mountain Spotted Fever is primarily a western United States illness; however it is found in all states except Hawaii and Alaska. One of the main vectors of the tick is the domestic dog, which has played an important role in the spread of Rocky Mountain Spotted Fever throughout the United States. RMSF Symptoms Incubation period appears to range from 2-14 days, 7 days being about the average. 100% of individuals do develop a fever followed by a rash. Ironically, the rash only occurs in about 87% of cases. Nausea, vomiting and diarrhea are not uncommon. There is often a rapid onset of symptoms. In those individuals who do develop a rash, this generally occurs around the 5th or 6th day, and seen around the wrists, ankles, forearms, soles of feet, palms of the hands, and spreads rapidly to the trunk and buttocks last. Snakes Hot Weather Injuries Heat Exhaustion Heat exhaustion is excessive fluid loss due to sweating, resulting in the depletion of fluid volume, which creates an imbalance of electrolytes in the body. Signs and symptoms of heat exhaustion: The initial sign is when dehydration occurs. The patient will usually have a rapid pulse rate prior to passing out. This is due to the heart trying to pump enough blood to the brain. After the heart is unsuccessful, the patient passes out. The patient will then have a slow and thready pulse. Other signs and symptoms of heat exhaustion include gradual weakness, nausea, and anxiety. Skin is usually pale and clammy or cold, pulse slows and blood pressure may drop. The victim may complain of weakness. Excessive sweating, as opposed to the dry skin in heat stroke, is a common symptom of heat exhaustion. Following these symptoms, the victim may appear to be in shock. Temperatures may range from 100-104 degrees Fahrenheit. It is difficult to differentiate heat exhaustion from other diagnoses like insulin shock or traumatic shock. If you are in the outdoors, the environment is hot, and a companion without a history of diabetes should develop the above symptoms, it is somewhat easier to make the diagnosis. The prognosis is very good in heat exhaustion as opposed to heat stroke. Heat Exhaustion Treatment Outdoor Treatment It is important to first remove the patient from direct sunlight and into a shaded area. The victim should be laid flat, with their feet elevated over the level of the heart. Begin to replace fluids orally, in small amounts. It is important not to push fluids too much, to avoid fluid overload. Healthcare Provider - Medical Treatment Treatment of heat exhaustion when properly diagnosed is fairly simple. Very cool environment, administering glucose and cooling the individual off is essential. Take cool wet towels, or ice packs if available, put them under the arms, the groin area and behind the neck of the individual. It is important to note that you should fan these wet towels, as the cooling process is actually the act of evaporation, which decreases body temperature. Cold Weather Injuries Weather Hazards What is lightning? Lightning is a form of electrical discharge between clouds or between clouds and the ground. The discharge may take place between two parts of the same cloud, between two clouds or between a cloud and the ground. Thunder is the sound waves produced by the explosive heating of the air and the lightning channel during the return. Some specifics: • • • • • Most lightning strikes occur either at the beginning or the end of a storm. Average lightning strike is 6 miles long. Lightning reaches 50,000 degrees farenheit, 4 times as hot as the sun's surface. A cloud to ground lightning channel can be 2-10 miles long. Voltage in a cloud to ground strike is 100 million to one billion volts. Other facts: • Lightning is the most dangerous and frequently encountered weather hazard people experience each year. • Lightning affects all regions. Florida, Michigan, Pennsylvania, North Carolina, New York, Ohio, Texas, Tennessee, Georgia and COLORADO have the most lightning deaths and injuries every year. • Lightning is the #1 cause of storm-related deaths. • Damage costs from lightning are estimated at $4-5 billion each year in the U.S. • Around the earth, there are 100 lightning strikes per second or 8,640,000 lightning strikes per day. • There are approximately 100 thousand storms in the US each year. Lightning strike statistics: o Americans are twice as likely to die from a lightning-related death than from a tornado, hurricane or flood. o The Federal Emergency Management Agency (FEMA) estimates there are 200 deaths and 750 severe injuries from lightning each year in the US. o 20% of all lightning victims die from the strike. o 70% of survivors will suffer serious long-term affects. o Annually there are more than 10,000 forest fires caused by lightning. Who’s at Risk? o 85% of lightning victims are children and young men age 10-35 engaged in outdoor recreation and work activities outside. o 70% of all lightning injuries and fatalities occur in the afternoon. o Lightning in remote terrain creates dangerous conditions. Hikers, campers, backpackers, skiers, fishermen, and hunters are especially vulnerable when they participate in these activities. o Many survivors of lightning strikes report that immediately before being struck, their hair was standing on end and they had a metallic taste in their mouth. o Long-term injuries from lightning strike can include memory and attention loss, chronic numbness, muscle spasms, stiffness, depression, hearing loss and sleep disturbance. What do you do when lightning is near? Lightning can never be prevented, but you can reduce the chances of being struck by: Avoiding high ground, water, solitary trees, open spaces, metallic objects. Search for low ground, ditches, trenches. If they contain water or if the ground is saturated, then find clumps of shrubbery or trees, all of uniform height. Remove all metal objects, bracelets, watches, rings, if possible. Crouch down on the balls of your feet with your hands over your ears. There should be at least 20 feet between you and other people. Do not all huddle together. If you are in a fully enclosed metal automobile, seek refuge with all the windows rolled up and your hands in your lap. Avoid all metal shelters and sun shelters. Stop all bicycles and motorcycles and get away from them. How to handle lightning victims: Seek medical attention as soon as possible. If necessary, begin CPR. Make sure before doing CPR that the person absolutely is NOT breathing or there is no heart rate before starting resuscitation. REMEMBER: Victims DO NOT retain an electrical charge. They are safe to handle. Check for burns along the extremities and around areas. Treat the burns the same as other types of burns. Some common after effects: Short, but not long term impaired eyesight Loss of hearing Mass Casualty Incidents & Triage Procedures Critical Incident Stress Debriefing (CISD) Questions?