Environmental Emergencies

Heat, cold, drowning, bites, stings, and environmental hazards.

The thread running through this chapter is scene safety. The water that took the swimmer can take you. The lightning that struck once can strike again. The heat that put the hiker down is still there. Treat the environment first, then the patient.

Heat Emergencies

Heat Spectrum

Heat Cramps

Treatment:

1. Move to cool place
2. Rest
3. Drink water or electrolyte drink
4. Gently stretch cramped muscle
5. Don't return to activity until cramps stop

Heat Exhaustion

Signs:

• Heavy sweating
• Cold, pale, clammy skin
• Weak, rapid pulse
• Nausea or vomiting
• Muscle cramps
• Tiredness, weakness
• Dizziness
• Headache
• Fainting

Treatment:

1. Move to cool place
2. Loosen clothing
3. Apply cool, wet cloths
4. Fan while misting with water
5. Sip water (if conscious and not vomiting)
6. Seek medical care if:
   • Vomiting
   • Symptoms worsen
   • Symptoms last more than 1 hour

Heat Stroke

Life-threatening emergency. Call 911.

Signs:

• High body temperature (103°F+)
• Hot, red, dry OR damp skin
• Fast, strong pulse
• Confusion, altered mental state
• May become unconscious
• May stop sweating

Treatment:

1. Call 911 immediately
2. Move to cool place
3. Cool rapidly by any means:
   • Ice packs to neck, armpits, groin
   • Cool water over body
   • Fan while misting with water
   • Cool bath/shower if conscious
4. Do NOT give fluids
5. Monitor for shock
6. Be ready for CPR

Cold Emergencies

Hypothermia

Body core temperature drops below 95°F (35°C).

Stages:

Treatment:

1. Call 911 for moderate/severe hypothermia
2. Get to warm environment
3. Remove wet clothing
4. Warm gradually:
   • Blankets, dry clothing
   • Skin-to-skin contact in blankets
   • Warm (not hot) drinks if conscious and able to swallow
5. Focus on core (torso) first
6. Handle gently (heart is vulnerable)
7. Monitor breathing, be ready for CPR

Do NOT:

• Apply direct heat (heating pads, hot water)
• Rub extremities
• Give alcohol
• Warm too rapidly

Frostbite

Tissue freezing, usually extremities (fingers, toes, ears, nose).

Stages:

Treatment:

1. Get to warm environment
2. Remove wet clothing and jewelry
3. Do NOT:
   • Rub or massage
   • Walk on frostbitten feet (unless necessary to evacuate)
   • Apply direct heat
   • Break blisters
4. If help is hours away and no risk of refreezing:
   • Immerse in warm water (100-104°F/37-40°C)
   • Keep water warm
   • Takes 20-30 minutes
   • Will be painful as it thaws
5. Loosely wrap in sterile dressing
6. Separate fingers/toes with gauze
7. Seek medical care

Do NOT rewarm if there's risk of refreezing. Refreezing causes worse damage.

Drowning

Rescue

Water rescue priorities:

1. Reach (extend object from shore)
2. Throw (flotation device)
3. Row (boat)
4. Go (swim only if trained and last resort)

Don't become a second victim.

After Removal from Water

1. Check responsiveness and breathing
2. If not breathing: Begin CPR immediately
   • Do not try to drain water from lungs
   • Start rescue breaths then compressions
3. Call 911
4. Assume spinal injury if:
   • Diving accident
   • Unknown circumstances
   • Signs of trauma
5. Treat for hypothermia
6. All near-drowning victims should be evaluated medically
   • Delayed drowning can occur hours later

Bites and Stings

Snake Bites

Venomous snake signs:

• Fang marks (1-2 punctures)
• Severe pain and swelling
• Discoloration around bite
• Nausea, vomiting
• Difficulty breathing
• Blurred vision

Treatment:

1. Call 911
2. Keep calm and still (slows venom spread)
3. Remove jewelry/tight clothing before swelling
4. Position bite below heart level if possible
5. Clean wound
6. Do NOT:
   • Cut the wound
   • Suck out venom
   • Apply tourniquet
   • Apply ice
7. Try to remember snake appearance (don't try to catch it)

Spider Bites

Dangerous spiders (US):

• Black widow: Red hourglass on abdomen
• Brown recluse: Violin shape on back

Treatment:

1. Clean wound with soap and water
2. Apply cold pack
3. Elevate if possible
4. Over-the-counter pain medication
5. Seek medical care for:
   • Bite from dangerous spider
   • Severe pain
   • Spreading redness
   • Fever
   • Muscle cramps
   • Difficulty breathing

Bee/Wasp Stings

Normal reaction:

• Local pain, redness, swelling
• Usually resolves in hours

Treatment:

1. Remove stinger (scrape, don't squeeze)
2. Clean area
3. Apply cold pack
4. Consider antihistamine for itching
5. Over-the-counter pain medication

Watch for anaphylaxis:

• Difficulty breathing
• Swelling of face/throat
• Hives beyond sting site
• Dizziness
• Rapid pulse

If anaphylaxis: Call 911, use epinephrine auto-injector

Tick Bites

Removal:

1. Use fine-tipped tweezers
2. Grasp tick as close to skin as possible
3. Pull upward with steady, even pressure
4. Don't twist or jerk
5. Clean area with alcohol or soap/water
6. Save tick in sealed container (in case of illness)

Watch for (over following weeks):

• Bull's eye rash (Lyme disease)
• Fever
• Fatigue
• Joint pain
• Seek medical care if any develop

Animal Bites

Treatment:

1. Control bleeding
2. Clean wound thoroughly with soap and water
3. Apply antibiotic ointment
4. Cover with bandage
5. Seek medical care for:
   • All animal bites (rabies risk)
   • Deep bites
   • Bites on face, hands, feet
   • Signs of infection

Report bite to animal control.

Marine Life

Jellyfish stings:

1. Rinse with vinegar (except Portuguese man-of-war)
2. Remove tentacles with tweezers
3. Immerse in hot water (110-113°F/43-45°C) for 20+ minutes
4. Seek care for severe reactions

Stingray:

1. Immerse in hot water
2. Seek medical care

Altitude Sickness

Types

Treatment

1. Stop ascending
2. Rest
3. Descend if symptoms don't improve
4. Descend immediately for HACE or HAPE
5. Supplemental oxygen if available
6. Seek medical care

Lightning

Prevention:

• Check weather before outdoor activities
• Seek shelter when thunder heard
• Avoid: water, high ground, isolated trees, metal

If struck:

1. Safe to touch victim (no retained charge)
2. Call 911
3. Check breathing and pulse
4. Start CPR if needed
5. Treat burns
6. Look for entry/exit wounds
7. Monitor for cardiac issues

Key Points

1. Heat stroke is an emergency - Cool rapidly, call 911
2. Hypothermia: warm gradually - Don't use direct heat
3. Frostbite: don't rewarm if refreezing is possible
4. Drowning: CPR immediately - Don't try to drain water
5. Snake bites: keep calm and still - Don't cut, suck, or tourniquet
6. Watch for anaphylaxis after any sting
7. All animal bites need medical evaluation - Rabies risk
8. Altitude: descend if symptoms worsen

Next Steps

Continue to 10-first-aid-kit.md to build and maintain the supplies that make every chapter in this tutorial possible.