Chapter 8: Safety in SAR Environments

 

Objectives

o       Acute Mountain Sickness (AMS) (p. 121-122)

o       Blisters (p. 122)

o       Dehydration (p. 122)

o       Frostbite (p. 119-120)

o       Heat cramps (p. 120)

o       Heat exhaustion (p. 120)

o       Heat stroke (p. 120-121)

o       Hypothermia (p. 118-119)

o       Immersion foot (p. 119-120)

o       Insect bites (p. 124)

o       Poisonous plants (p. 125)

o       Snake bites (p. 123-124)

o       Tick bites (p. 124-125)

 

I. Resources

PowerPoint slides, Chapter 8

Photos of various types of ice (frazil, clear, snow, candle, and rotten), swift-water, PFDs, and the different types of medical emergencies (AMS, hot spots and blisters, frostbite, etc.)

 

II. Teaching Points

A. Lightning (p. 116)

  1. Lightning
    1. A release of light and energy produced by discharge of atmospheric electricity
    2. This discharge may occur within a cloud, between clouds, or between cloud and ground.
    3. Discharges between the cloud and ground pose the greatest threat to life and limb.

 

  1. Thunder
    1. A sound caused by expansion of air heated by the intensity of the lighting stroke.
    2. Distance can be estimated in miles to the lightning by counting the number of seconds between lightning and thunder and dividing by five.
  2. Protection
    1. Being aware and following safety guidelines can greatly reduce the risk.
    2. Large enclosed structures are safer than smaller, open structures.
    3. Vehicles with windows closed tend to provide good shelter. Avoid contact with metal surfaces on the inside of the vehicle.
    4. Avoid being in or near high places, open fields, and isolated trees.
    5. When inside a building, avoid using the telephone, taking a shower, or using any electrical appliances.
    6. Many lightning casualties occur before and after the storm threat has occurred.

 

B. Hypothermia (p. 118)

  1. A medical condition or illness that is caused by the body’s inner temperature being lowered so far below normal as to cause a person to become ill.
    1. Sometimes called “exposure”
  2. A person can be considered hypothermic when their core temperature drops below 95°F.
  3. Four primary methods of heat transfer
    1. Radiation
    2. Conduction
    3. Evaporation
    4. Convection

 

  1. Hydration plays a significant role in temperature regulation.
  2. Dehydration occurs at a faster rate in cold dry environments and at elevation.
  3. Use a special “hypothermia” thermometer to diagnose hypothermia.

 

C. Mild hypothermia

  1. Core temperature between 97° to 91°F
  2. Signs and symptoms
    1. Complaining of “feeling cold”
    2. Goose bumps
    3. Frequently wet from rain, snow, or other sources
    4. Shivering
    5. May develop problems with muscular coordination
    6. Inability to keep up with others
    7. Approaching 90°F core temperature: difficulty speaking, sluggish thinking, amnesia, or signs of depression

 

D. Severe hypothermia

  1. Core temperature of 90°F and below
  2. Signs and symptoms
    1. Shivering stops
    2. Blue and swollen skin
    3. Unable to walk
    4. Confusion, irrational behavior
    5. Careless about protecting themselves from the environment
    6. At less than 87°F, muscles become severely rigid.
    7. Decreased level of consciousness
    8. Pulse may seem absent.
    9. Heartbeat and respirations are erratic¾less than 79°F, cardiac and respiratory arrest occur.

 

E. Treatment

    1. Must distinguish mild hypothermia from severe hypothermia
    2. Mild hypothermia is treated primarily by preventing further heat loss.

3.      Severe hypothermia is a serious medical emergency that requires advanced medical intervention.

4.      Remove wet clothes and replace with dry clothing.

 

F. Freezing injuries (p. 119)

    1. Localized cold injuries include:

a.       Frostbite¾general term for frozen tissue

b.      Frostnip¾very superficial frostbite

c.       Trench foot (immersion foot)¾caused by exposure of tissue to wet, cold conditions

d.      Chilblain¾exposure of dry skin to cool or cold temperature

 

    1. Frostbite

a.       Toes are most often affected.

b.      Frostnip occurs on the ears, tip of the nose, and cheeks.

c.       Frostnip is described as a burning sensation.

d.      Frostbite is described as a burning pain that dissipates.

e.       Earliest sign is usually pain in the associated tissue.

f.        Pale or white skin

g.       Treatment 

 

 

 

i. Frostnip¾Rewarm as quickly as possible.

ii. Frostbite

(a) Evacuate patient before rewarming.

(b) Promote circulation to injured area.

(c) Elevate injured area during transport.

3. Other cold-related injuries

a.       Immersion foot

                                                                                                                     i.     Remove from environment.

                                                                                                                   ii.     Rewarm in water 100°-108°F.

                                                                                                                  iii.     Keep dry.

 

b.      Chillblain

                                                                                                                     i.     Remove from environment.

                                                                                                                   ii.     Rewarm the affected area.

c.       Preventive measures for cold-related injuries

                                                                                                                     i.     Proper nutrition

                                                                                                                   ii.     Proper hydration

                                                                                                                  iii.     Proper clothing

                                                                                                                 iv.     Avoid touching metal of organic liquids (solvents, gasoline, or alcohol)

 

G. Heat-related injuries (p. 120)

1. Generally, but not always, heat cramps occur before heat exhaustion and if not treated can lead to heat stroke.

2.      Heat cramps

a.       Muscle pains

b.      Occurs often in environments of high humidity and temperature

c.       Profuse sweating that leads to salt depletion

d.      Signs and symptoms: Cramping in lower extremities, abdomen, or both

e.       Treatment

                                                                                                                     i.     Remove affected person from the warm environment.

                                                                                                                   ii.     Rest, water (sports drinks such as Gatorade)

                                                                                                                  iii.     Salt tablets are not usually suggested.

 

  1. Heat exhaustion
    1. Sometimes referred as heat prostration
    2. General (whole body) affliction whereas heat cramps are local (single area)
    3. More likely to have associated dehydration
    4. Signs and symptoms

                                                                                                         i.     May be first apparent by sudden unconsciousness

                                                                                                       ii.     Headaches, fatigue, dizziness, nausea, and related cramping

                                                                                                      iii.     Profuse sweating

                                                                                                     iv.     Skin is COOL to the touch.

    1. Treatment

                                                                                                         i.     Remove from environment.

                                                                                                       ii.     Minor heat exhaustion: same as heat cramps

                                                                                                      iii.     Severe heat exhaustion: IV fluids; keep comfortable and cool while evacuating

 

  1. Heat stroke
    1. Caused by a severe disturbance in the body’s heat regulating mechanism
    2. Body temperature can reach 106°F and higher within minutes.
    3. Frequently strikes older persons.
    4. Often strikes when someone has ignored the warning signs
    5. Signs and symptoms

                                                                                                         i.     Skin is HOT, reddened, and dry.

                                                                                                       ii.     May be aware of heat, but become confused, uncoordinated, delirious, or unconscious

                                                                                                      iii.     Experience headaches, dry mouth, dizziness, coma, and seizures

    1. Treatment

                                                                                                         i.     Lower body temperature as soon as possible without causing shivering.

                                                                                                       ii.     Immerse body in cool water, apply cold packs to pulse points, and remove clothing.

                                                                                                      iii.     Massaging extremities during cooling process may help.

 

H. Solar injuries: sunburn and snow blindness (p. 121)

1.      1. Sunburn

a.                                                                   a. A first degree burn

b.                                                                  b. Reddening and pain

c.                                                                   c. Chills, fever, and headaches may develop.

d.                                                                  d. If lips are sunburned, cold sores can occur.

e.                                                                   e. Prevention

                                                                                                                     i.     Wear clothing when exposed to the sun.

                                                                                                                   ii.     Chemical preparations are available that block harmful rays of the sun.

                                                                                                                  iii.     Should have SPF 30 or higher and should be reapplied frequently.

                                    f. Treatment

i. Prevent further exposure and protect the affected area.

ii. Cold, wet dressing

iii. Medicated lotions may reduce discomfort.

iv. Large areas should be treated as a major burn.

 

2.      Snow blindness: otherwise known as “photopthalmia”

a.                                                                   a. Simply sunburn of the eyes

b.                                                                  b. Prevention

                                                                                                                     i.     Wear proper eye protection that block no less than 91% of UV rays.

                                                                                                                   ii.     Prevent reflected light from the sides of the glasses (e.g., side shields, dirt on face)

                                                                                                                  iii.     Eye protection is just as important on cloudy days.

c. Treatment

i. Prevent further damage.

                                                                                                       ii.     Cool, moist coverings may relieve some of the discomfort.

                                                                                                      iii.     The condition should clear up within a few days if the eyes are allowed to rest while kept closed.

 

I. Altitude-related problems (p. 121)

1. Acute mountain sickness (AMS)

a.       A collection of symptoms (not a disease)

b.      Commonly occurs when traveling over 8000 feet in altitude without acclimating

c.       Prevention

                                                                                                                     i.     Attain higher elevations slowly.

                                                                                                                   ii.     Spend time resting at lower elevations then progress higher at a slow rate.

                                                                                                                  iii.     Descend at the first sign of illness.

                                                                                                                 iv.     Some medications (acetazolamide, dexamethasone) may be helpful in preventing AMS when they are administered by a physician familiar with altitude problems.

d.      Signs and symptoms

                                                                                                                     i.     Begin with fatigue

                                                                                                                   ii.     Loss of appetite

                                                                                                                  iii.     Sleepiness

                                                                                                                 iv.     Weakness

                                                                                                                   v.     Headache (by far the most common and irritating symptom)

                                                                                                                 vi.     Nausea and vomiting

                                                                                                                vii.     After a few days, the headache may be complicated by memory lapses, ringing in ears, and difficulty walking.

                                                                                                              viii.     Severe indicators include difficulty in walking, unconsciousness, hallucinations, HAPE, HACE, impaired judgment

e.       Treatment

                                                                                                                     i.     Rest

                                                                                                                   ii.     Fluid ingestion

                                                                                                                  iii.     Pain medication for the headaches

                                                                                                                 iv.     Sleeping aids may make the problem worse.

                                                                                                                   v.     If recovery is not quick, the patient needs to be evacuated to lower elevation for treatment.

                                                                                                                 vi.     Never travel to higher elevations if a member of your team has AMS symptoms.

 

2. High altitude pulmonary edema (HAPE)

a.       Fluid in the lungs brought on by ascending to an elevation exceeding 8000 feet too rapidly

b.      Can compromise a person’s ability to breath

c.       Prevention: Never travel over 8000 feet.

d.      Signs and symptoms

i. Include those of AMS

ii. Coughing that produces white or reddish (bloody) mucus

iii. Weakness

                                                                                                     iv.     Shortness of breath

                                                                                                       v.     Confusion

                                                                                                     vi.     Cyanosis

                                                                                                    vii.     Loud breathing sounds

                                                                                                  viii.     Rapid heart and breathing rates

 

e. Treatment

                                                                                                                                       i.      Evacuation to lower elevation quickly after the first signs occur

                                                                                                                                     ii.      Do not allow the patient to walk.

3. High altitude cerebral edema (HACE)

a. Fluid on the brain that occurs from exposure to altitude without acclimating

b. Prevention and treatment: Same as for HAPE

c. Signs and symptoms

                                                                                                                     i.     Progressive neurological deterioration

                                                                                                                   ii.     Changes in consciousness

                                                                                                                  iii.     Inability to walk a straight line

                                                                                                                 iv.     Impaired judgment

                                                                                                                   v.     Hallucinations

                                                                                                                 vi.     Coma

 

 

J. Water deprivation (p. 122)

1. Dehydration is a condition that results from excessive loss of body water.

2. Prevention

a.       Drink plenty of fluids.

b.      Water needs increase at elevation and in both warm and cold climates.

c.       Push fluids at elevations and consume at least 4 liters per day in extremely cold or hot environments.

d.      Signs and symptoms

                                                                                                                                       i.      At elevation, thirst may be absent.

                                                                                                                                     ii.      Fatigue

                                                                                                                                    iii.      Lightheadedness

                                                                                                                                   iv.      Weakness

                                                                                                                                     v.      Dry mouth

                                                                                                                                   vi.      vi. Dry eyes

                                                                                                                                  vii.      “Loose” skin (tenting)

                                                                                                                                viii.      May lead to unconsciousness and death

 

e. Treatment

i. Rest

ii. Fluid ingestion

iii. Immediate evacuation

 

K. Blisters (p. 122)

1. Blisters are highly underrated and the bane of SAR personnel.

2. Fluid-filled pockets under the surface of the skin

3. Caused by friction against a particular part of the body (usually the feet) and are usually caused by ill-fitting footwear

 

L. Snakes (p. 122)

1. Snake bites are quite rare.

2. 45,000 snake bites in United States yearly but only about 9,000 bites are made by venomous snakes

3. 20%-30% of the bites will not have envenomation even when fang marks are present.

4. Only 12-15 deaths per year in the United States due to snake bites

  1. Prevention
    1. Never stick your arm, hand, or fingers in a hole; use a branch or stick.
    2. Stay clear of any snake and certainly never back one into a corner.
    3. Any snake bite where the snake type is unknown should be considered poisonous until proven otherwise.
    4. Watch where you put your feet.
    5. Don’t step over obstacles such as logs or large rocks¾step on top first and check before moving forward.
    6. Signs and symptoms: Pain at location of bite
    7. Treatment

                                                                                                         i.     Identify the snake.

                                                                                                       ii.     Immobilize the affected area and keep the victim from moving.

                                                                                                      iii.     Evacuate the patient and seek medical attention.

                                                                                                     iv.     Do not incise the site.

                                                                                                       v.     Do not use oral suction.

                                                                                                     vi.     Question about use of constricting bands; never use tourniquets.

 

M. Insects (p. 124)

1.      Stinging and biting insects can be a nuisance and possibly dangerous (vectors of human disease and allergies): honeybees, wasps, ants, caterpillars, spiders, ticks, scorpions, and beetles

2.      Prevention

a.       Directed at proper dress and use of repellents

b.      Keep head and neck covered.

c.       Use slippery materials (silk, nylon) instead of loose weave materials (cotton, wool).

d.      Tie clothing at wrist and ankles to prevent entry of bugs.

e.       Use chemical repellents containing DEET; watch for allergic reactions when using insect repellents.

f.        Apply liquid repellent to skin and spray on clothes; keep both out of eyes.

g.       Avoid wearing bright colored clothing.

h.       Avoid wearing perfumes, colognes, and deodorant soaps.

i.         Some repellents do not affect fleas, black flies, horseflies, deerflies, chiggers, and gnats, so use netting around the head, neck, and hands.

3.      Ticks (p. 124)

a. Ticks are second only to mosquitoes as vectors of human disease.

b. Tick-borne illnesses include:

i. Rocky Mountain spotted fever

ii. Colorado tick fever

iii. Relapsing fever

iv. Tularemia

c. Prevention

                                                                                                                     i.     Wear protective clothing in tick-infested areas, especially long pants.

                                                                                                                   ii.     Spray clothes with an insect repellent (DEET may repel ticks but will not kill them; “Permanone” kills ticks on contact and lasts for weeks on clothing and tents.)

                                                                                                                  iii.     Inspect all parts of your body at least twice a day.

 

d. Removal

i. Grasp the tick as close to the skin surface as possible with forceps, tweezers, or protected fingers.

ii. Pull with steady pressure; do not crush or squeeze the tick’s head or body.

iii. Ineffective removal methods, such as fingernail polish, isopropyl alcohol, and a hot match head, may force the tick deeper into the skin or to salivate or regurgitate.

iv. After removal, wash and disinfect the site.

v. Prophylactic antibiotics are not recommended.

 

N. Poisonous plants:  poison ivy, poison sumac, and poison oak (p. 125)

1. Not truly poisonous, but can irritate the skin

2.      85% of the U.S. population is allergic.

3.      The sap of these plants contains urushiol, a clear, sticky, oily resin that causes rashes and itching of the skin.

4.      Urushiol remains stable even if the plant is dead or dried.

5.      Resin can be carried by smoke and inhaled if the plant is burned.

6.      Generally, soap and water used immediately after exposure can significantly reduce effects.

7.      Do not submerge the affected area in a bath because the resin can spread over entire body.

8.      Some plants have hair-like projections that get caught in the skin, so merely washing does not help. Washing with a rough towel may work.

9.      Signs and symptoms

a.       Rash

b.      Itching

c.       Blisters

10.  Treatment

a.                                                                   a. Drying with lotions such as calamine

b.                                                                  b. Itching control (calamine and antihistamine)

c.                                                                   c. Alcohol, bleach, and topical steroids may do more harm than good and should not be used.