Ch. 32 Environmental Emergencies

21. Describe the process of providing emergency care to a patient who has been stung by a coelenterate or other marine animal. (p 1173)

-Remove the patient from the water, and remove the remaining tentacles by scraping them off with the edge of a stiff object such as a credit card. -Limit further discharge of nematocysts by avoiding fresh water, wet sand, showers, or careless manipulation of the tentacles. -Toxins from the spines of urchins; stingrays; and certain spiny fish such as the lionfish, scorpion fish, or stonefish are heat sensitive. -Persistent pain may respond to immersion in hot water (110°F to 115°F [43.3°C to 46.1°C]) for 30 minutes. -immersion in vinegar can help too

general management of cold emergencies

-do not allow pt to walk -remove wet clothing, and put dry blankets on pt -give warm humidified oxygen -do not massage extremities -do not allow food or stimulants (coffee, tea,etc) -Begin passive rewarming slowly, which includes placing the patient in a warm environment; removing wet clothing; and applying heat packs or hot water bottles to the groin, axillary, and cervical regions. -goal is to prevent further heat loss: remove pt from environment, remove wet clothes, cover pt with blankets, and transport

2. Demonstrate how to use a warm-water bath to rewarm the limb of a patient who has sustained a local cold injury. (p 1150)

-immerse frostbitten part in water with a temp btw 102 and 104 degrees F. Temp should not exceed 10 -stir water continuously -keep frostbitten part in water until it feels warm and sensation has returned -dress area with drty sterile dressings and place btw fingers and toes -expect pt to report severe pain

7. Demonstrate how to care for a patient who is suspected of having an air embolism or decompression sickness following a drowning or diving emergency. (p 1164)

-immobilize and support spine if indicated -when necessary, begin artificial ventilation asap -Frothy sputum in the patient's airway does not require removal with suctioning. -for a drown victim, address A and B first, rather than CAB (compressions, airway, breathing) like normal -Treat all drowning patients for hypothermia by removing wet clothing and wrapping them in warm blankets.

17. Discuss lightning injuries, including their incidence, risk factors, signs and symptoms, and emergency medical treatment. (pp 1165-1166)

-kills 60-70 people per year -3rd most common cause of death from isolated environmental phenomena -Because the duration of a lightning strike is short, skin burns are usually superficial; full-thickness (third-degree) burns are rare. -occurs most during summer months when people are enjoying outdoor activities -lightening injuries are categorized as: Mild: Loss of consciousness, amnesia, confusion, tingling, and other nonspecific signs and symptoms. Burns, if present, are typically superficial. Moderate: Seizures, respiratory arrest, dysrhythmias that spontaneously resolve, and superficial burns Severe: Cardiopulmonary arrest. Because of the delay in resuscitation, often the result of occurrence in a remote location, many of these patients do not survive. Emergency medical treatment -Move the patient to a place of safety, preferably in a sheltered area. -If you suddenly feel a tingling sensation or your hair stands on end, the area around you has become charged—a sure sign of an imminent lightning strike. -Make yourself as small a target as possible by squatting down into a ball, with only your feet touching the ground. -move away from objects -When a person is struck by lightning, respiratory or cardiac arrest, if it occurs, usually occurs immediately. -Focus your efforts on those who are in respiratory or cardiac arrest. -This process, called reverse triage, differs from conventional triage, where such patients would ordinarily be classified as deceased. -if the patient is in respiratory arrest with a pulse, begin immediate BVM ventilations with 100% oxygen. -If the patient is in cardiac arrest, attach an AED as soon as possible and provide defibrillation if indicated.

6. Explain the importance of following local protocols when rewarming a patient who is experiencing moderate or severe hypothermia. (p 1149)

-local protocols may allow you to give the pt warm liquids -local protocols dictate the appropriate types of rewarming strategies based on pt's core body temp -for moderate to severe hypothermia, rewarming is best accomplished in the ED

6. Demonstrate how to stabilize a patient with a suspected spinal injury in the water. (pp 1157-1160, Skill Drill 32-2)

-most spinal injuries in diving incidents affect the cervical spine -protect neck from further injury 1. turn the pt to supine position by rotating the entire upper half of the body as a single unit 2. as soon as the pt is turned, begin artificial ventilation using the mouth-to-mouth method or a pocket mask 3. float a buoyant backboard under the pt 4. secure the pt to the backboard 5. remove the pt from the water 6. maintain the body's normal temp and apply oxygen if the pt is breathing. Begin CPR if breathing and pulse are absent

3. Demonstrate how to treat a patient with heat cramps. (p 1154)

-remove pts from hot environment -administer oxygen -rest cramping muscles -replace fluids by mouth -Cool the patient with cool water spray or mist, and add convection to the cooling method by manually or mechanically fanning the patient. -best preventative and treatment strategy is hydration

9. Demonstrate how to care for a patient who has been bitten by a coral snake and is showing signs of envenomation. (p 1171)

-support respiration. identify snake propery. antivenin is available, but most hospitals dont stock it. Notify receiving facility asap so they can get the antivenin -steps for emergency care are the same as a pit viper

12. List five conditions that may result in a spinal injury following a submersion incident and the steps for stabilizing a patient with a suspected spinal injury in the water. (pp 1157-1160)

-the submersion has resulted from a diving mishap or fall from a significant height -the pt is unconscious and no information is availbale to rule out the possibility of a neck injury -the pt is conscious but reports weakness, paralysis, or numbness in the arms or legs -you suspect the possibility of spinal injury despite what witnesses say steps are in skill drill 32-2...

5. Demonstrate how to treat a patient with heat stroke. (pp 1156-1157)

1. Move the patient out of the hot environment and into the ambulance. 2. Set the air conditioning to maximum cooling. 3. Remove the patient's clothing. 4. Administer high-flow oxygen if indicated, if this was not already done as part of the primary assessment 5. Provide cold-water immersion in an ice bath, if possible. Cooling should begin immediately and continue en route to the hospital. 6. Cover the patient with wet towels or sheets, or spray the patient with cool water and fan him or her to quickly evaporate the moisture on the skin. 7. Aggressively and repeatedly fan the patient with or without dampening the skin. 8. Exclude other causes of altered mental status and check blood glucose level, if possible. 9. Provide rapid transport to the hospital. 10. Notify the hospital as soon as possible. 11. Do not overcool the patient. Call for ALS assistance if the patient begins to shiver.

8. Demonstrate how to care for a patient who has been bitten by a pit viper and is showing signs of envenomation. (pp 1170-1171)

1. calm pt; assure him or her that venomous snake bites are rarely fatal. place pt supine and explain the staying still will prevent the spread of any venom throughout the system. determine approximate time of bite and document your time en route to the receiving facility. 2. Locate the bite area; clean it gently with soap and water or a mild antiseptic. Do not apply ice to the area. 3. If the bite occurred on an arm or leg, consider the use of a pressure immobilization bandage of the extremity and place the affected extremity below the level of the heart. 4. be alert for an anaphylactic reaction to the venom and treat with an epinephrine autoinjector 5. do not give anything by mouth, and be alert for vomiting 6. if, as rarely happens, the pt was bitten on the trunk, keep him supoine and quiet and transport as quickly as possible. 7. Monitor the patient's vital signs and mark the skin with a pen over the area that is swollen, proximal to the swelling, to note whether swelling is spreading. 8. if there are signs of shock, place pt supine and administer O2 9. if the snake is killed, bring it to the hospital so it can be identified for the proper antivenin. or take pic 10. notify hospital that you are bringing a pt with a snake bite and describe snake 11. transport proptly -If the patient shows no sign of envenomation, provide BLS as needed, place a sterile dressing over the suspected bite area, and immobilize the injury site.

10. Demonstrate how to care for a patient who has sustained a coelenterate envenomation. (p 1173)

1. limit further discharge of nematocytes by avoiding fresh water, wet sands, showers, or careless manipulation of the tentacles. Keep pt calm, and reduce motion of the affected extremity 2.Remove the patient from the water, and remove the remaining tentacles by scraping them off with the edge of a stiff object such as a credit card. Do not use your ungloved hand to remove the tentacles, because self-envenomation will occur. Persistent pain may respond to immersion in hot water (110°F to 115°F [43.3°C to 46.1°C]) for 30 minutes. If available, immersion in vinegar may also help alleviate the symptoms. 3. provide prompt transport to the ED

4. Demonstrate how to treat a patient with heat exhaustion. (pp 1154-1156, Skill Drill 32-1)

1. move the pt to a cooler environment. Remove extra clothing 2. give oxygen if indicated. Check the pt's blood glucose level if indicated. Perform cold-water immersion or other cooling measures as available. Place the pt in a supine position and fan the pt. 3. if the pt is fully alert, give water by mouth 4. if nausea develops, secure and transport the pt on his or her left side

10. List the basic rules of performing a water and ice rescue. (p 1158)

1. reach -reach for person from shore. Wade closer if you cant reach them 2. throw -throw the pt a rope, life preserver, or floatable object 3. row -use a boat if one is available 4. go -if you must swim to the person, use a towel or board for him or her to hold onto. Do not let the person grab you

Skills Objectives 1. Demonstrate the emergency medical treatment of local cold injuries in the field. (p 1150)

1. remove pt from further exposure to the cold 2. handle the injured part gently and protect it from further injury 3. remove any wet or restricting clothing from the pt, especially over the injured partr

2. Describe the five ways heat loss occurs in the body, and how the rate and amount of heat loss or gain can be modified in an emergency situation. (pp 1142-1143)

Conduction- transfer of heat from a part of the body to a colder object or substance by direct contact Convection- occurs when heat is transferred to circulating air, such as when cool air moves across the body surface. Evaporation- liquid to gas. This is how sweating works to cool you off. Radiation- transfer of heat from radiant energy. ex: person stands by a fire and becomes warm Respiration- causes body heat loss as warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled.

14. Describe the three types of diving emergencies, how they may occur, and their signs and symptoms. (pp 1160-1162)

Diving injuries are separated into three phases of the dive: ascent, decent, and bottom. descent emergencies -usually caused by the sudden increase in pressure on the body as the person dives deeper -Usually, the pain caused by these "squeeze problems" forces the diver to return to the surface to equalize the pressures, and the problem clears up by itself. -some body cavities cannot adjust to the increased external pressure of the water -pt may have a ruptured eardrum (tympanic membrane) while diving -If cold water enters the middle ear through a ruptured eardrum, the diver may sustain a loss of balance and orientation. emergencies at the bottom -rarely seen -They include inadequate mixing of oxygen and carbon dioxide in the air the diver breathes and accidental feeding of poisonous carbon monoxide into the breathing apparatus. ascent emergencies 1. air embolism: air bubbles in blood vessels -most common emergency in scuba diving -problem starts when the diver holds his breath during a rapid ascent. Air in lungs is high while the external chest pressure decreases. Result= air inside lungs expands rapidly, causing alveoli in the lungs to rupture -air released can caues a pneumothorax, Pneumomediastinum, and air emboli -signs and symptoms: Blotching (mottling of the skin) Froth (often pink or bloody) at the nose and mouth Severe pain in muscles, joints, or abdomen Dyspnea and/or chest pain Dizziness, nausea, and vomiting Dysphasia (difficulty speaking) Cough Cyanosis 2. decompression sickness A painful condition seen in divers who ascend too quickly, in which gas, especially nitrogen, forms bubbles in blood vessels and other tissues; also called bends. -result of too rapid an ascent, too long of a dive thats too deep, repeated dives within a short period of time -The most striking symptom is abdominal and/or joint pain so severe that the patient literally doubles up or "bends." -symptoms dont develop until hours later, whereas as air emboli will occur immediately upon surfacing -The emergency treatment is the same for both: basic life support (BLS) followed by recompression in a hyperbaric chamber.

9. Describe drowning, including its incidence, risk factors, and prevention. (pp 1157-1158, 1165)

Drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. -Major risk factors for drowning include: Alcohol consumption Preexisting seizure disorders Geriatric patients with cardiovascular disease Unsupervised access to water -

18. Describe the process of providing emergency care to patients who have been bitten by each of the following venomous spiders: (pp 1166-1167) • Black widow spider • Brown recluse spider

Female black widow spider They prefer dry, dim places around buildings, in woodpiles, and among debris. -Most black widow spider bites cause localized pain and symptoms, including agonizing muscle spasms. -The main danger is that the black widow's venom can damage nerve tissues, as it is a neurotoxin. -Other systemic symptoms include dizziness, sweating, nausea, vomiting, and rashes. -Tightness in the chest and difficulty breathing develop within 24 hours, as well as severe cramps, with boardlike rigidity of the abdominal muscles. -If necessary, a physician can administer a specific antivenin, but because of a high incidence of side effects, its use is reserved for very severe bites, for older or very feeble patients, and for children younger than 5 years. Brown recluse spider -The spider tends to live in dark areas—in corners of old, unused buildings; under rocks; and in woodpiles. In cooler areas, it moves indoors to closets, drawers, cellars, and clothing. -The venom of the brown recluse spider is cytotoxic; that is, it causes severe local tissue damage. -The area becomes swollen and tender, developing a pale, mottled, cyanotic center and possibly a small blister. -Over the next several days, a scab of dead skin, fat, and debris forms and digs down into the skin, producing a large ulcer that may not heal unless treated promptly.

19. Describe the process of providing emergency care to a patient who has sustained a bite or sting from each of the following insects and arachnids, including steps the EMT should follow if a patient develops a severe reaction to the sting or bite: (pp 1167-1168, 1171-1172) • Hymenoptera (bees, wasps, yellow jackets, and ants) • Scorpions • Ticks

Hymenoptera -painful stings, but not medical emergency -remove stinger -use ice packs to control pain -The signs and symptoms of anaphylaxis are: Flushed skin Low blood pressure Difficulty breathing, usually associated with reactive airway sounds such as wheezes, or, in severe cases, diminished or absent breath sounds Hives (urticaria) may develop near the site of envenomation or centrally on the body. The patient can also have swelling to the throat and tongue. Scorpions -painful, but only the Centrurodes sculpturatus is the venomous scorpion in the United States. -The venom may produce a severe systemic reaction that leads to: Circulatory collapse Severe muscle contractions Excessive salivation Hypertension Convulsions Cardiac failure tick bites -can cause rocky mountain spotted fever -Symptoms include: Nausea and vomiting Headache Weakness Paralysis Possible cardiorespiratory collapse -Lyme disease -The first symptoms are generally fever and flulike symptoms, sometimes associated with a bull's-eye rash that may spread to several parts of the body. -after a few days or weeks, joint pain and swelling occurs. -both diseases are spread through the saliva -To remove a tick: -Using fine tweezers, grasp the tick by the head and pull gently but firmly straight up so that the skin is tented. -Hold this position until the tick releases. -Cleanse the area with antiseptic and save the tick in a glass jar or other container so that it can be identified.

1. Identify the four factors that affect how a person deals with exposure to a cold or hot environment. (pp 1141-1142)

Physical condition -ill people cannot tolerate extreme temps -exertion raises body temp in hot and cold environments Age -children and older adults are higher risk for temp-related illness -infants cannot shiver until 12-18 months -older people lose subcutaneous tissue as they age -older people also have worse circulation, are on meds that affect their thermostat, and have a high risk for falls (and lying immobile on a hot or cold surface) Nutrition and hydration -food fuels metabolism -water is the catalyst for much of this metabolism -alcohol may increase fluid loss, putting the pt at a higher risk for a temp-relate emergency Environmental conditions -Factors such as air temperature, humidity level, and wind can complicate or improve environmental situations. -many hypothermia cases can occur btw 30-50°F -most heat stroke cases occur when the temp is 80°F and the humidity is 80%

8. Describe the process of providing emergency care to a patient who is experiencing a heat emergency, including assessment of the patient, review of signs and symptoms, and management of care. (pp 1152-1157)

Scene Size-up -assess environment; heat emergency may be secondary - If the patient is placed in a cold-water immersion bath upon your arrival, monitor the patient in the water and assist as necessary. -do not remove pt from bath until temp is normalized btw 101 and 102°F -wear long sleeves and pants to protect from blood or body fluids Primary Assessment -ask about CC -prolonged heat exposure can stress the heart and result in a heart attack -AVPU -airway and breathing, and treat life threats -assess for perfusion and bleeding -treat for shock History Taking -investigate CC -med history -SAMPLE -Determine your patient's exposure to heat and humidity and activities prior to the onset of symptoms. Secondary Assessment -If your patient is unresponsive, perform a secondary assessment of the entire body. -vitals -Pay special attention to the patient's skin temperature, turgor, and level of moisture. -perform neurologic assessment -check temperature Reassessment -remove pt as quickly as possible from environment -Any decline in LOC is an ominous sign. - in the cooled ambulance, spray pt with water and fan to enhance evaporation. Also remove clothing for passive cooling

15. Describe the process of providing emergency care to a patient who has been involved in a drowning or diving emergency, including assessment of the patient, review of signs and symptoms, and management of care. (pp 1162-1164)

Scene Size-up -minimum of gloves and eye protection -look for MOI Primary Assessment -pay attention to chest pain, dyspnea, and complaints related to sensory changes -determine LOV via AVPU -open the airway and assess breathing in unresponsive pts -Provide ventilations with a BVM for inadequate breathing. Use an airway adjunct to facilitate BVM ventilations as necessary. -for responsive pts, give O2 via nonrebreathing mask -auscultate for breath sounds -check for pulse -if no pulse, begin CPR History Taking -investigate CC -med history -SAMPLE with regard to dive parameters -note drug or alcohol consumption Secondary Assessment -focus on CC -full exam of pt's lungs -assess for indications of decompression sickness or an air embolism -Focus on pain in the joints and the abdomen. -check pulse quality -check respiration quality Reassessment -Reassess vital signs and the chief complaint. -Recheck patient interventions. -review everything... -document the circumstances of the drowning and the extrication

5. Describe the process of providing emergency care to a patient who has sustained a cold injury, including assessment of the patient, review of signs and symptoms, and management of care. (pp 1146-1150)

Scene Size-up -note the weather environment -identify safety hazards -look for MOI Primary Assessment -determine and treat life threats -If the chief complaint is simply feeling cold, quickly assess the patient's core temperature by placing the back of your hand on the abdomen. -use AVPU to assess mental status -If you believe the patient is in cardiac arrest, proceed directly to ("C") by providing high-quality chest compressions, then address airway and breathing ("A" and "B") afterward. -Use warmed and humidified oxygen if it is available -feel for a pulse for 60 seconds before deciding if the pt is pulseless History Taking -chief complaint -Obtain a medical history and be alert for injury-specific signs and symptoms as well as any pertinent negatives. -meds and med conditions can affect how a body manages the cold Secondary Assessment -focus on severity of hypothermia -exam whole body -vitals signs -changes in mental status? -Determine a core body temperature using a hypothermia thermometer Reassessment -reassess vials and CC -changes in condition? if so, treat -cardiac dysrhythmias may occur as body rewarms -document changes in mental status

16. Discuss the types of dysbarism injuries, including their incidence, risk factors, signs and symptoms, and emergency medical treatment. (p 1165)

dysbarism injuries Any signs and symptoms caused by the difference between the surrounding atmospheric pressure and the total gas pressure in various tissues, fluids, and cavities of the body. acute mountain sickness -Caused by diminished oxygen pressure in the air at altitudes above 5,000 feet (1.5 km), resulting in diminished oxygen in the blood (hypoxia) -Signs and symptoms include a headache, light-headedness, fatigue, loss of appetite, nausea, difficulty sleeping, shortness of breath during physical exertion, and a swollen face. -Treatment primarily consists of stopping the ascent and descending to a lower altitude. High-altitude pulmonary edema (HAPE) -Fluid collects in the lungs, hindering the passage of oxygen into the bloodstream. -It can occur at altitudes of 8,000 feet (2 km) or greater. -Signs and symptoms include shortness of breath, cough with pink sputum, cyanosis, and a rapid pulse. High-altitude cerebral edema (HACE) -Usually occurs in climbers and may accompany HAPE -It can quickly become life threatening. -Signs and symptoms include a severe, constant, throbbing headache; ataxia (lack of muscle coordination and balance); extreme fatigue; vomiting; and loss of consciousness. -The symptoms of HACE and HAPE may overlap. -In the field, treatment for HAPE and/or HACE consists of providing oxygen, descending to a lower altitude, and prompt transport. -provide pos. pressure vents with a BVM for inadequate respirations

4. Describe local cold injuries and their underlying causes. (pp 1145-1146)

frostnip- skin may freeze, but deeper tissues are unaffected -painless -contact with a warm object may be all that the patient needs. -Use your hands or the patient's own body (for example, have the patient tuck his or her hands into the armpits). immersion foot- aka trenchfoot. Occurs after prolonged exposure to cold water -with frostnip and immersion foot, feet are blanched and cold to the touch -remove wet shoes, boots, and socks, and rewarm the foot gradually, protecting it from further cold exposure. -Splint the extremity and cover it loosely with a dry, sterile dressing. frostbite- most serious local cold injury because the tissues are actually frozen. -freezing permanently damages cells -When the ice thaws, further chemical changes occur in the cell, causing permanent damage or cell death, called necrosis or gangrene. -Frostbite can be identified by the hard, waxy feel of the affected tissues. -blisters and swelling may be present -cover the injury loosely with a dry, sterile dressing. -Do not break blisters or rub or massage the area. -Do not apply heat or rewarm the part. -Cover the frostbitten part with soft, padded, sterile cotton dressings.

7. Describe the three emergencies that are caused by heat exposure, including their risk factors, signs, and symptoms. (pp 1151-1152)

hyperthermia A condition in which the body core temperature rises to 101°F (38.3°C) or more. 1. heat cramps -painful muscle spasms that occur after vigorous exercise -exact cause is not well understood -change in electrolyte balance -dehydration may play a role -cramps occur in the legs or abdominal muscles 2. heat exhaustion -A heat emergency in which a significant amount of fluid and electrolyte loss occurs because of heavy sweating; also called heat prostration or heat collapse. -causes are heat exposure, stress, and fatigue which trigger hypovolemia as a result of water loss and electrolyte loss from heavy sweating -signs and symptoms of heat exhaustion and subsequently hypovolemia include: -Dizziness, weakness, or syncope signifying a change in level of consciousness with accompanying nausea, vomiting, or headache -Muscle cramping, including abdominal cramping -Onset while working vigorously or exercising in a hot, humid, or poorly ventilated environment and sweating heavily -dry tongue and thirst -many more... 3. heat stroke -heat exhaustion may progress to heat stroke -people at greatest risk are children; geriatric pts; pts with heart disease, COPD, diabetes, dehydration, and obesity; and people with limited mobility -heat stroke A life-threatening condition of severe hyperthermia caused by exposure to excessive natural or artificial heat, marked by warm, dry skin; severely altered mental status; and often irreversible coma -tissues are destroyed -can occur during vigorous physical activity, buildings with no AC (mostly geriatric ppl), and children left unattended in locked hot cars -many pts have hot, dry, flushed skin because their sweating mechanism has been overwhelmed. -LOC decreases until unconsciousness results -pulse is rapid and strong at first, but then pulse becomes weaker and the BP falls -One of the telltale signs of heat stroke is when your patient no longer perspires, which means the body has lost its thermoregulatory mechanisms. If you are perspiring in the environment, your patient should also be perspiring.

3. Describe the four general stages of hypothermia. (pp 1143-1144)

hypothermia- when core body temp falls below 95°F

20. Describe the process of providing emergency care to a patient who has been bitten by each of the following types of snake and is showing signs of envenomation: (pp 1168-1171) • Pit viper • Coral snake

pit vipers -consist of: Rattlesnakes -most common pit viper Copperheads Cottonmouths -signs and symptoms of pit viper envenomation: swelling, ecchymosis, weakness, nausea, vomiting, sweating, seizures, fainting, vision problems, changes in LOC, and shock -If swelling has occurred, use a pen to mark its edges on the skin. -treat: -calm pt; assure him or her that venomous snake bites are rarely fatal. -Locate the bite area; clean it gently with soap and water or a mild antiseptic. Do not apply ice to the area. -If the bite occurred on an arm or leg, consider the use of a pressure immobilization bandage of the extremity and place the affected extremity below the level of the heart. -Monitor the patient's vital signs and mark the skin with a pen over the area that is swollen, proximal to the swelling, to note whether swelling is spreading. -if the snake is killed, bring it to the hospital so it can be identified for the proper antivenin -If the patient shows no sign of envenomation, provide BLS as needed, place a sterile dressing over the suspected bite area, and immobilize the injury site. Coral snake -venom causes paralysis of nervous system -red on yellow will kill a fellow, red on black, venom will lack -emergency care is the same for a pit viper -Antivenin is also available for coral snake bites, but most hospitals do not stock it. Therefore, you should notify the receiving hospital of the need for it as soon as possible.

13. Discuss recovery techniques and resuscitation efforts EMTs may need to follow when managing a patient who has been involved in a submersion incident. (p 1160)

recovery techniques: An organized rescue effort in these circumstances calls for providers who are experienced with recovery techniques and equipment, including snorkel, mask, and scuba gear. resuscitation efforts: -if water is colder than body temp, heat will be conducted from body to water -The resulting hypothermia can protect vital organs from the lack of oxygen. -diving reflex: The slowing of the heart rate caused by submersion in cold water. -Resuscitative efforts are not initiated for unwitnessed drowning victims who are found in a state of decomposition.

11. Explain why EMTs should have a prearranged rescue plan based on the environment in which they work. (p 1158)

rescuers have become victims while attempting a swimming rescue. hypothermia is also a concern, so be prepared -plan should include access and cooperation with local providers who are trained in water rescue -make sure to have personal flotation device -success of any water rescue depends on how rapidly the pt is removed from the water and ventilated