Environmental Medical Emergencies – Hypothermia

Environmental Medical Emergencies – Hypothermia

Hypothermia: Causes, Symptoms and Treatments

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Download Hypothermia Poster

Hypothermia, or abnormally low body temperature, is a dangerous condition that can occur when a person is exposed to extremely cold temperatures.

Stay safe this winter by learning more about hypothermia, including who is most at risk, signs and symptoms, and what to do if someone develops hypothermia.

What is Hypothermia?

  • Hypothermia is caused by prolonged exposures to very cold temperatures. When exposed to cold temperatures, your body begins to lose heat faster than it’s produced. Lengthy exposures will eventually use up your body’s stored energy, which leads to lower body temperature.
  • Body temperature that is too low affects the brain, making the victim unable to think clearly or move well. This makes hypothermia especially dangerous, because a person may not know that it’s happening and won’t be able to do anything about it.
  • While hypothermia is most likely at very cold temperatures, it can occur even at cool temperatures (above 40°F) if a person becomes chilled from rain, sweat, or submersion in cold water.

Who’s Most at Risk?

Victims of hypothermia are often:

  • Older adults with inadequate food, clothing, or heating
  • Babies sleeping in cold bedrooms
  • People who remain outdoors for long periods—the homeless, hikers, hunters, etc.
  • People who drink alcohol or use illicit drugs.

Recognizing Hypothermia

Warnings signs of hypothermia:

Adults:

  • shivering, exhaustion
  • confusion, fumbling hands
  • memory loss, slurred speech drowsiness

Infants:

  • bright red, cold skin
  • very low energy

Don’t Wait- Take Action

If you notice any of these signs, take the person’s temperature. If it is below 95° F, the situation is an emergency—get medical attention immediately.

If medical care is not available, begin warming the person, as follows:

  • Get the victim into a warm room or shelter.
  • If the victim has on any wet clothing, remove it.
  • Warm the center of the body first—chest, neck, head, and groin—using an electric blanket, if available. You can also use skin-to-skin contact under loose, dry layers of blankets, clothing, towels, or sheets.
  • Warm beverages can help increase body temperature, but do not give alcoholic beverages. Do not try to give beverages to an unconscious person.
  • After body temperature has increased, keep the person dry and wrapped in a warm blanket, including the head and neck.
  • Get medical attention as soon as possible.

A person with severe hypothermia may be unconscious and may not seem to have a pulse or to be breathing. In this case, handle the victim gently, and get emergency assistance immediately.

Do not Rapidly Rewarm a Severely Hypothermic Person:

  • Even if the victim appears dead, CPR should be provided. CPR should continue while the victim is being warmed, until the victim responds or medical aid becomes available. In some cases, hypothermia victims who appear to be dead can be successfully resuscitated.

Be Prepared

Taking a first aid and emergency resuscitation (CPR) course is a good way to prepare for cold-weather health problems. Knowing what to do is an important part of protecting your health and the health of others.

Taking preventive action is your best defense against having to deal with extreme cold-weather conditions. By preparing your home and car in advance for winter emergencies, and by observing safety precautions during times of extremely cold weather, you can reduce the risk of weather-related health problems.

From the CDC

Dr. Heimlich Performs Heimlich

Dr. Heimlich Performs Heimlich

Dr. Heimlich’s, Heimlich Save

Dr. Henry Heimlich, 96, performed the lifesaving technique he invented for the FIRST TIME when a woman choked on her hamburger in the seat beside him.

By  in New York For The Guardian

The surgeon who gave his name to the simple but dramatic procedure used to rescue people from choking saved someone’s life with the Heimlich Manoeuvre for the first time this week aged 96.

Dr Henry Heimlich’s technique for dislodging food or objects caught in people’s throats has been credited with saving untold thousands of lives around the world since he invented it in 1974 – but he had never once had cause to use it in an emergency situation himself.

Last Monday, however, the retired chest surgeon encountered a female resident at his retirement home in Cincinnati who was choking at the dinner table.

Without hesitation, Heimlich spun her around in her chair so he could get behind her and administered several upward thrusts with a fist below the chest until the piece of meat she was choking on popped out of her throat and she could breathe again.

Dr. Henry Heimlich and Patty Gill Ris

Dr. Henry Heimlich and Patty Gill Ris.

Heimlich told the Guardian by telephone from Cincinnati.

“That moment was very important to me. I knew about all the lives my manoeuvre has saved over the years and I have demonstrated it so many times but here, for the first time, was someone sitting right next to me who was about to die.”

Heimlich and his son Philip declared this was the first time the retired surgeon had used his technique to treat someone who was choking. Philip stated that he had no knowledge of his father using the technique in any prior emergency.

How to perform the Heimlich Manouvre

  1. Stand behind the victim with your legs separated, to form a ‘tripod’ shape. If the victim faints or becomes unconscious, this will help you to catch them.
  2.  Reach around the victim from behind. Circle your hands around the victim’s abdomen (stomach).
  3. Make a fist with your dominant hand. The thumb of this fist should point into the fist. Place this fist just above the victim’s belly button and under the breastbone.
  4. Wrap your other hand firmly around this fist. Be sure to keep your thumb away from the victim’s body, to prevent injury to the victim.
  5. Pull inward and upward, pressing into the victim’s abdomen with quick upward thrusts, using force.
  6. Perform abdominal thrusts in quick succession.
  7. Repeat the series of thrusts until the object is dislodged and expelled.

Heimlich lived in Deupree House, a senior assisted living centre in the city, where he and other residents had their own apartments but got together for meals in a communal dining room.

Fellow resident 87-year-old Patty Ris, who was quite new to the facility, sat down near Heimlich for dinner when she suddenly began choking on a piece of hamburger meat. A member of staff was heading over to attend to the emergency, when Heimlich calmly stepped in.

“I did the Heimlich Manoeuvre – of course,” Heimlich said. “She was going to die if she wasn’t treated. I did it, and a piece of food with some bone in it flew out of her mouth.”

Heimlich demonstrates the manoeuvre on Johnny Carson in 1979. Photograph: NBC/NBC via Getty Images

Heimlich demonstrates the manoeuvre on Johnny Carson in 1979. Photograph: NBC/NBC via Getty Images

Heimlich said that the woman never lost consciousness, but after being able to breathe again she was so startled she was unable to talk at first.

“I, however, just sat there absolutely smiling as big as I could,” Heimlich said.

The two had dinner together the following night in celebration.

“She told me how wonderful and fortunate she felt,” he said.

Standard practice for dealing with choking prior to 1974 was to thump the afflicted person on the back. But Heimlich argued that that can force the obstruction further into the gullet, not dislodge it.

He worked on various theories until he finally came up with the procedure in 1974, designed for use by the general public, not just medical personnel, of putting one’s arms around the casualty and exerting upward abdominal thrusts, just above the navel and below the ribs, with the linked hands in a fist, until the obstruction is dislodged.

In June 1974 Heimlich published preliminary findings from his experiments with anti-choking techniques in a US medical journal. Newspapers around the US quickly began picking up on examples where readers, including restaurant owners, had caught word of Heimlich’s article and had tried the maneouvre on choking casualties, with successful results.

Word spread, and that summer the Journal of the American Medical Association published an editorial in which, with the surgeon’s permission, the technique was officially referred to for the first time as the “Heimlich Manoeuvre”. A year later, Heimlich wrote a peer-reviewed paper for the JAMA on his life-saving discovery. The technique became widely adopted nationally and internationally and is today explained via diagrams on posters in most US restaurants and is also taught in many schools, according to his son, Philip Heimlich.

The surgeon studied at Cornell University in upstate New York, and was also well known in the medical community for pioneering various surgical techniques and a device called the Heimlich valve that can be used for administering triage on chest wounds in the field, including in battle.

Heimlich’s son Philip, who lives near his father in Cincinnati, said the elder Heimlich was widowed lived in assisted accommodation for the elderly but was very fit for his age.

“He swam three or four times a week and went to the symphony and the ballet. I hear he performed his manoeuvre with great agility. I have always been very proud of my dad and I believe he is the person who has saved more lives than anyone living,” he said.

In the US just over 4,800 people die annually from choking through various causes, with around 3,000 of those believed to be from choking on food, according to the US National Safety Council. Between 175 and 200 people die a year in the UK from choking on food, according to the Office for National Statistics.

After her brush with death, Patty Ris wrote Dr Heimlich a note, saying: “God put me in this seat next to you,” she told the Cincinnati Enquirer.

How to Stop the Bleed

How to Stop the Bleed

How to Stop the Bleed

Today we live in a world where terrorism, the actions of unstable people, and the dangerous impulses of friends and relatives are very real and becoming increasingly more frequent.

Massive bleeding from any cause, but particularly from an active shooter or explosive event where a response is delayed can result in death. Similar to how the general public learns and performs CPR, the public must learn proper bleeding control techniques, including how to use their hands, dressings, and tourniquets. Victims can quickly die from uncontrolled bleeding, within 5 to 10 minutes.

However, anyone at the scene can act as immediate responder and save lives if they know what to do. BleedingControl.org supports the President’s policy for national preparedness as a shared responsibility of the government, the private and nonprofit sectors, and individual citizens.

BleedingControl.org is an initiative of the American College of Surgeons and the Hartford Consensus and contains diagrams, news, videos, and other resources contributed by a variety of other private and nonprofit partners to help prepare you in the event you are witness to one of these unspeakable events.

Our shared goal is to provide you with a one-stop, online resource to credible information on bleeding control. We hope you will never need to use this information, but if you do, at least you will have the assurance that the information is credible and timely.

The Event

  • Call 9-1-1 yourself

OR

  • Tell someone to call 9-1-1

Ensure Your Safety

  • Before you offer any help, you must ensure your own safety!
  • If you become injured, you will not be able to help the victim.
  • Provide care to the injured person if the scene is safe for you to do so.
  • If, at any time, your safety is threatened, attempt to remove yourself (and the victim if possible) from danger and find a safe location.
  • Protect yourself from blood-borne infections by wearing gloves, if available.

Look for Life-Threatening Bleeding

  • Find the source of bleeding
  • Open or remove the clothing over the wound so you can clearly see it. By removing clothing, you will be able to see injuries that may have been hidden or covered.
  • Look for and identify “life-threatening” bleeding. Examples include:
    • Blood that is spurting out of the wound.
    • Blood that won’t stop coming out of the wound.
    • Blood that is pooling on the ground.
    • Clothing that is soaked with blood.
    • Bandages that are soaked with blood.
    • Loss of all or part of an arm or leg.
    • Bleeding in a victim who is now confused or unconscious.

Compress and Control

Key Point

There are a number of methods that can be used to stop bleeding and they all have one thing in common—compressing a bleeding blood vessel in order to stop the bleeding.

If you don’t have a trauma first aid kit:

Direct PressureApply direct pressure on the wound (Cover the wound with a clean cloth and apply pressure by pushing directly on it with both hands)

  1. Take any clean cloth (for example, a shirt) and cover the wound.
  2. If the wound is large and deep, try to “stuff” the cloth down into the wound.
  3. Apply continuous pressure with both hands directly on top of the bleeding wound.
  4. Push down as hard as you can.
  5. Hold pressure to stop bleeding. Continue pressure until relieved by medical responders.

If you do have a trauma first aid kit:

For life-threatening bleeding from an arm or leg and a tourniquet is NOT available OR for bleeding from the neck, shoulder or groin:

  • Pack (stuff) the wound with a bleeding control (also called a hemostatic) gauze, plain gauze, or a clean cloth and then apply pressure with both hands
  1. Open the clothing over the bleeding wound. (A)
  2. Wipe away any pooled blood.
  3. Pack (stuff) the wound with bleeding control gauze (preferred), plain gauze, or clean cloth. (B)
  4. Apply steady pressure with both hands directly on top of the bleeding wound. (C)
  5. Push down as hard as you can.
  6. Hold pressure to stop bleeding. Continue pressure until relieved by medical responders.

Packing the Wound

For life-threatening bleeding from an arm or leg and a tourniquet is available:

  • Apply the tourniquet
  1. Wrap the tourniquet around the bleeding arm or leg about 2 to 3 inches above the bleeding site (be sure NOT to place the tourniquet onto a joint—go above the joint if necessary).
  2. Pull the free end of the tourniquet to make it as tight as possible and secure the free end. (A)
  3. Twist or wind the windlass until bleeding stops. (B)
  4. Secure the windlass to keep the tourniquet tight. (C)
  5. Note the time the tourniquet was applied. (D)

Note: A tourniquet will cause pain but it is necessary to stop life-threatening bleeding.

Using a Tourniquet

How to Use a Tourniquet Video

Instructions and photos have been taken from the Save a Life booklet. Download the booklet for additional information on how to stop the bleed.

Pons PT, Jacobs L. Save a life: What everyone should know to stop bleeding after an injury. Chicago, IL: American College of Surgeons; 2016.

First Aid Rules

First Aid Rules

“If my basic HazMat training has taught me nothing else,
it’s that if you see a glowing green monkey running away
from something, follow that monkey!”

Author Unknown, but he/she must be a teacher!

The above comment is amusing, but it does emphasize the need to “size up the scene” to know its safe before you administer care!

The next step is consent.

There are some cases that “consent” can be implied, and you’ll know it when you see it. However, always try to make contact with either the victim, or a party with the victim, especially is the victim is a child.

Briefly explain your level of skill to the victim or others with the victim what you can do, and ask for consent to help.

Never assume anything!

Awake During CPR?? WHAT NOW?

Awake During CPR?? WHAT NOW?

This video is from my favorite Doc, ZUBIN DAMANIA, MD.  

UCSF/Stanford trained internal medicine physician and founder of Turntable Health, an innovative primary care clinic and model for Health 3.0 that was part of an ambitious urban revitalization movement in Las Vegas spearheaded by Zappos CEO Tony Hsieh. During a decade-long career as a hospitalist at Stanford, Doctor Damania led a shadow life performing stand-up comedy for medical audiences worldwide as a way to address his own burnout. His videos and live shows have since gone epidemically viral with nearly a half a billion views on Facebook and YouTube, educating patients and providers while mercilessly satirizing our dysfunctional healthcare system. The goal of the movement is to rapidly catalyze transformation by leveraging the awesome power of our passionate, engaged tribe of healthcare professionals. Join the ZPac and help us reclaim our calling!

Vessel or Ship Emergency Medical Response Checklist

Vessel or Ship Emergency Medical Response Checklist

Medical Emergency at Sea

What do we do? What do we ask?

If you boat, you should be current in First Aid, CPR/AED! If you aren’t, then now is the time to take a class, because stuff happens on boats; just sayin.

I’m often asked how do I remember all the questions and checks for a sudden illness event? Well the simple answer is because it’s my job as a trainer and provider. I do it all the time so it’s become part of my DNA.

For the rest of you, I’ve uploaded a simple list you can download for your First Aid kits. Print it and place a copy or two in your kit.

Here is the link: Patient Care Report

Captain Thomas Bliss; a self-described “safety nerd,” is founder and director of Northwest Response.