'Tis the season for a myriad of cold-weather emergencies. Every winter hundreds of Americans are injured or killed by exposure to cold, vehicle accidents on wintry roads, and fires caused by the improper use of heaters.
The seasonal increase in fire-injuries is due to the use of heating devices and combustible materials. The heating sources combined with all of the closed windows to keep the cold out definitely makes things more risky for carbon monoxide poisoning. Then there are falls on ice and exposure to the elements; And certainly we can’t forget about hazardous driving situations and car accidents, which can also affect emergency response vehicles.
Now is the time to refresh your skills treating and recognizing all stages of hypothermia from mild to severe. Any patient with a body temp of less than 95-degrees should be suspected and treated for exposure. Be sure to take into account age, medical conditions, whether there was submersion or other wet conditions, drugs (both prescribed and illicit), and any use of alcohol. Mild cases can include shivering, increased heart rate, respiratory rate and blood pressure, slurred speech and loss of motor coordination.
Moderate hypothermia is usually when the patient’s body temp is between 86 to 93 degrees, shivering stops and cold diuresis (frequent cold induced urination), which can lead to dehydration. In severe hypothermia the body temp can be below 86-degrees, the patient may be comatose, non-reactive to normal reflexes, exhibit depressed vital signs, have heart arrhythmias, fixed and dilated pupils, and MAY even appear to be dead. Hypothermia and frostbite can be life or limb threatening.
Get the victim of hypothermia out of the cold environment and shelter them from wind. Remove any wet clothing, gently re-warm with blankets, and in mild cases, insulated moist heat packs — never rewarm frostbite if there is a chance of refreezing. Remove constricting jewelry. Provide oxygen and/or CPR if necessary. If the patient is conscious, do NOT administer alcohol, caffeinated beverages or allow them to smoke. Don’t rub frostbite, as you can cause tissue damage. Remember that NO ONE IS DEAD UNTIL THEY ARE WARM AND DEAD.
Carbon Monoxide poisoning can be very difficult to recognize, as many times the only warning comes from a working CO detector in a house. According to the CDC, carbon monoxide kills more Americans than any other acute toxicant. The most important response is to get a victim of CO poisoning into fresh air and deliver oxygen. Many CO poisoning symptoms can mimic the flu, complete with headaches. The proverbial red coloring is a very dangerous late-stage sign of CO poisoning. Be prepared to administer CPR if necessary. Immediate transport to the hospital is vital since the methods of oxygen delivery can range from a simple face mask to a hyperbaric chamber.
Ice and snow related falls and vehicular accidents occur frequently during the winter months and can cause obvious physical injuries including broken bones, bleeding, head injuries and other visible trauma. Severe trauma combined with cold weather can also lead to hypothermia. Going through your ABCs, treating and packaging the patient is not enough; it’s necessary to check and monitor for internal injuries. And it's very important to learn patient history — never assume that the fall or auto accident was caused only by icy conditions, don’t rule out syncope, seizures, or medications that could cause dizziness or impaired mental function.
All emergency response personnel are exposed to the dangers of cold weather related injuries as well; we are not invincible. Our vehicles travel the same hazardous roads, or worse, that all the traffic accidents occur on and we are out there even when a state-of-emergency keeps most people indoors. The ice that accumulates at a fire scene threatens everyone including EMS personnel, firefighters and police officers.
Finally, response to outdoor emergencies means standing in the cold weather elements so it’s necessary to be aware of wind chill. Use gloves and hats as necessary. Drink plenty of warm fluids between calls, but avoid caffeine or alcohol, as that can affect your body’s response to the cold. Don’t stay out in the cold unless it's necessary.