Transcript On-Line Medical Direction

Search and Rescue Medic Course
Presented by:
1LT Timothy Paquin, CAP
Ground Team Leader, EMT-B
Introduction
Prerequisites
• Valid CAP ID card
• Valid CPR/First Aid Card (AED training is
optional)
• Minimum GES card with 101 qualification as a
Ground Team member preferred
• Positive mental attitude with ability to devote
110% of your attention and energy to the course
• Good interpersonal relationship skills
• Good sense of humor
• A strong stomach and the ability to deal with
views of traumatic injuries
TOPICS
(not in any specific order)
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Patient assessment and urgent care
Care of bleeding, wounds and burns
Musculoskeletal and soft tissue injuries
Splinting, dressing and bandages
Circulatory emergencies
Respiratory emergencies
Abdominal emergencies
Diabetic emergencies
Allergies
Physical and environmental hazards
Heat injuries
Cold injuries
Altitude emergencies
Poisons, toxins and poisonous animals
Bites and stings
Patient packaging and transportation
First aid kits and improvised supplies
Legal and ethical issues
What this course will do:
-- Provide a form of continuing education to increase
your skills in First Aid and CPR during Civil Air Patrol
Search and Rescue missions.
-- Introduce you to some technical skills and
techniques that may be performed by medical
professionals.
-- Provide an overview of the legal and ethical issues
involved in patient care.
What this course will NOT do:
-- Certify you as a First Responder, Emergency
Medical Technician, Paramedic, Nurse, or Doctor.
-- Certify you in Wilderness First Aid through any
agency or organization.
-- Certify you to perform any skill above your current
skill level (i.e. tracheotomies, IV’s, or intubations).
-- Provide information in diagnosing specific injuries
or illnesses.
EMS Basics
and
the Search and Rescue
Medic
(SAR-Medic)
History of EMS
1797
1860’s
Napoleon's chief physician implements a pre-hospital system designed to triage and transport the injured
from the field to aid stations.
Civilian ambulance services begin in Cincinnati and New York City.
1915
First known air medical transport occurs during the retreat of the Serbian army from Albania.
1920’s
First volunteer rescue squads organize in Roanoke, Virginia, and along the New Jersey coast.
1958
Dr. Peter Safar demonstrates the efficacy of mouth-to-mouth ventilation.
1960
Cardiopulmonary resuscitation (CPR) is shown to be effective.
1966
The Highway Safety Act of 1966 establishes the Emergency Medical Services Program in the Department of
Transportation.
1972
Department of Health, Education, and Welfare allocates 16 million dollars to EMS demonstration programs
in five states.
1973
The first “Mike Squadron” is created at the Hawk Mountain Ranger School to train Civil Air Patrol SARMedics.
1973
The Emergency Medical Services Systems (EMSS) Act provides additional federal guidelines and funding
for the development of regional EMS systems; the law establishes 15 components of EMS Systems.
1985
National Research Council publishes “Injury in America: A Continuing Public Health Problem,” describing
deficiencies in the progress of addressing the problem of accidental death and disability.
1988
The National Highway Traffic Safety Administration initiates the Statewide EMS Technical Assessment
program based on ten key components of EMS systems.
1990
The Trauma Care Systems and Development Act encourages development of inclusive trauma systems and
provides funding to states for trauma system planning, implementation, and evaluation.
1997
Percentage of Population covered by 911 for Colorado & Surrounding States.
Montana 93%
Idaho 76%
Utah 100%
COLORADO 92%
Nebraska 70%
South Dakota 75%
Wyoming 98%
Levels of Proficiency
in Colorado EMS
•
•
First Aid/CPR Certification
– The base level for all EMS providers
– Certification is provided by a number of different agencies, including:
• The American Red Cross (ARC)
• The American Heart Association (AHA)
• The American Safety and Health Administration (ASHA)
• Heartsmart, Inc.
• The National Safety Council
– Provides basic CPR and First Aid Skills for the average citizen
First Responder
– Above First Aid/CPR certification but below the EMT-Basic level
– Certification is governed by the US Department of Transportation
– Provides certain additional skills to assist EMT’s and other medical
professionals
Levels of Proficiency
in Colorado EMS (cont.)
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•
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EMT-Basic
– Skills include Basic Life Support and EKG
– Can Perform Intravenous Therapy (if certified)
– Can provide and assist with the following medications, with medical direction:
• Oxygen
• Activated Charcoal
• Oral Glucose
• Metered Dose Inhalers (MDI’s)
• Nitroglycerin
• Epinephrine
EMT-Intermediate
– Skills are between EMT-B and AMT-P
– Can perform IV Therapy with additional medications
EMT-Paramedic
– Highest skills in the field barring the presence of a Doctor or Nurse
– Can provide IV Therapy with a full line of different medications
– Advanced Cardiac Life Support, Pediatric Life Support, and Manual Defribulator
Qualified
– Can perform Tracheotomies and Intubation
The CAP SAR-Medic
The Civil Air Patrol SAR-Medic is a volunteer
who is specially trained in dealing with
severe traumatic injuries, as well as
common injuries, as related to various
operations during Emergency Services
Missions. SAR-Medic’s provide
emergency treatment of accident victims
when no EMS professionals are present,
and additional assistance to those
professionals upon arrival.
Hawk Mountain Medic Creed
My task is to provide to the utmost limits of my capability the best
possible care to those in need of my aid and assistance.
To this end I will aid all those who are needful, paying no heed to my
own desires and wants; treating friend, foe and stranger alike, placing
their needs above my own.
To no man will I cause or permit harm to befall, nor will I refuse aid to
any who seek it.
I will willingly share my knowledge and skills with all those who seek it.
I seek neither reward nor honor for my efforts for the satisfaction of
accomplishment is sufficient.
These obligations I willingly and freely take upon myself in the tradition
of those that have come before me.
…These things we do so that others may live.
Hippocratic Oath
I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine
with those who are to follow.
I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic
nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the
surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's
recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I
tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a
life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play
at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's
family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and
body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always
act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
Medical Direction
Medical Direction
Medical direction is the process by which a
physician or, occasionally, group of physicians
guide and oversee the patient care provided by
an emergency medical services (EMS) system.
Law requires medical direction for all advanced life
support (ALS) service providers. Most states
require basic life support (BLS) agencies to have
a medical director as well. Medical direction from
a physician is recommended for all EMS
activities.
There are two forms of medical direction: on-line
and off-line.
Off-Line Medical Direction
The medical director of an EMS system is responsible for off-line medical control
actions, including the following:
– Development and implementation of protocols and standing orders
– Supervision of any initial and recertification training programs provided by
the EMS agency
– Retrospective review of the care delivered (to ensure compliance with
patient care standards)
– Liaison of activities between EMS professionals and others, including
other physicians; ED personnel; and regional, state, and local EMS
authorities
– Providing input on dispatch, mutual aid, disaster planning, and hazardous
materials response activities
– General supervision of physicians who provide on-line medical control
– Acquiring and maintaining up-to-date knowledge of EMS issues
– Support of EMS research, where practical
– Problem solving
Generally, an EMS system has one overall medical director for off-line activities
and a group of physicians designated as the source of on-line medical control.
On-Line Medical Direction
On-line medical control involves directing the care of a
single patient. The on-line medical control physician
evaluates information given by medics, makes decisions
regarding immediate patient care, and gives appropriate
orders. Medics and their patients benefit from having
immediate access to an emergency physician for advice
in difficult or unusual situations.
In addition, the EMS medical director may use mandatory
on-line physician authorization to maintain tight control of
certain potentially dangerous pre-hospital treatment
options (i.e., pre-hospital thrombolytic administration, for
stroke victims).
Legal Issues
Advance Directives
An advance directive tells your doctor what kind of care you
would like to have if you become unable to make medical
decisions (if you are in a coma, for example). If you are
admitted to the hospital, the hospital staff will probably talk
to you about advance directives.
A good advance directive describes the kind of treatment you
would want depending on how sick you are. For example,
the directives would describe what kind of care you want if
you have an illness that you are unlikely to recover from, or
if you are permanently unconscious. Advance directives
usually tell your doctor that you don't want certain kinds of
treatment. However, they can also say that you want a
certain treatment no matter how ill you are.
Advance directives can take many forms. Laws about
advance directives are different in each state.
Types of Advance Directives
The three most common types of Advance
Directives are:
• Living Wills
• Durable Power of Attorney for Health-care
• Do Not Resuscitate Orders
Living Will
A living will is one type of advance directive.
It only comes into effect when you are
terminally ill. Being terminally ill generally
means that you have less than six months
to live. In a living will, you can describe the
kind of treatment you want in certain
situations. A living will doesn't let you
select someone to make decisions for you.
Durable Power of Attorney for
Health Care
A durable power of attorney (DPA) for health care is another
kind of advance directive. A DPA states whom you have
chosen to make health care decisions for you. It becomes
active any time you are unconscious or unable to make
medical decisions. A DPA is generally more useful than a
living will. But a DPA may not be a good choice if you don't
have another person you trust to make these decisions for
you.
Living wills and DPAs are legal in most states. Even if they
aren't officially recognized by the law in your state, they
can still guide your loved ones and doctor if you are unable
to make decisions about your medical care. Ask your
doctor, lawyer or state representative about the law in your
state.
“Do Not Resuscitate” Orders
A “Do Not Resuscitate” (DNR) order is another kind of advance
directive. A DNR is a request not to have cardiopulmonary
resuscitation (CPR) if your heart stops or if you stop
breathing. (Unless given other instructions, EMS staff will try
to help all patients whose heart has stopped or who have
stopped breathing.) You can use an advance directive form
or tell your doctor that you don't want to be resuscitated. In
this case, a DNR order is put in your medical chart by your
doctor. DNR orders are accepted by doctors and hospitals in
all states.
Most patients who die in a hospital have had a DNR order
written for them. Patients who are not likely to benefit from
CPR include people who have cancer that has spread,
people whose kidneys don't work well, people who need a
lot of help with daily activities, or people who have severe
infections such as pneumonia that require hospitalization.
What this means to you
• If you attempt to resuscitate a person who has
an advance directive on their body, you may be
held criminally and/or civilly at fault.
• The key is that the advance directive must be on
the patient’s body where you can see it. Check it
to make sure that it is accurate, for the patient,
and current before stopping any resuscitation
efforts.
• Most victims that we treat will not have any form
of AD, but always check first. NEVER assume
anything.
Patient Care Reports
(PCR’s)
Patient Care Reports (PCR’s) come in many
different formats, however they generally contain
the same information:
- Patient age and sex
- Baseline and additional vital signs
- Known Patient History
- Medical Interventions
- Drug Administrations
- Name of Agency and Person providing care
Filling out the PCR
REMEMBER: Anything that you do goes on the
PCR. If you do not write it down, it didn’t happen.
Make sure all information is as complete, accurate,
and legible as humanly possible. Mistakes can
lead to improper future care and severe legal
issues.
Never attempt to diagnose a patient’s specific
injury or illness. Leave that to the doctors, that’s
what they are paid for.
The PCR
Scene Safety
Blood borne Pathogens
Training for Ground Team
Members & Leaders
Developed as part of the National
Emergency Services Curriculum
Project
What are Bloodborne
Pathogens?
• BBPs are disease causing
microorganisms that may be present in
human blood. They may be transmitted
with any exposure to blood or other
potentially infectious material.
– Two pathogens of significance are Hepatitis B
Virus (HBV) and Human Immunodeficiency
Virus (HIV)
What is Hepatitis B?
• One of the five viruses that causes
illness directly affecting the liver
• Major cause of viral hepatitis which is
preventable through immunization
Hepatitis B Symptoms
• Weakness, Fatigue, Anorexia, Nausea,
Abdominal pain, Fever, Headache,
Possible jaundice( a yellow
discoloration
the skin)
• Blood
will test of
positive
for the HBV surface
antigen within 2 to 6 weeks after symptoms
develop
• May show no symptoms, and therefore not
be diagnosed
HBV Facts
• 200 out of 8700 health care workers
contracting Hepatitis B yearly will die
• HBV is more persistent than HIV in that it is able to
survive for at least a week in dried blood on
environmental surfaces or contaminated
instruments
• Approximately 85% of patients recover in 6 to 8
weeks
What is HIV?
• Human Immunodeficiency Virus is a virus that
infects immune system T4 blood cells in
humans and renders them less effective in
preventing disease
• It is the virus identified as being responsible for
Acquired Immunodeficiency Syndrome (AIDS)
HIV Symptoms
• Night sweats, Weight loss, Fever, Fatigue,
Gland pain or swelling, Muscle or joint
pain
• May feel fine and not be aware of exposure
to HIV for as much as 8 to 10 years
• Blood tests may not show positive for as
long as a year, and therefore multiple tests
may be required to determine if the person
has been infected
HIV Facts
• Estimates in the US say that 1 out of 250
people are infected with HIV
• There are over 100 case reports of health care
workers whose HIV infection is associated
with occupational exposure
• Over 200,000 AIDS patients have been
reported to the CDC, 84 of which are health
care workers with no other identified reason
for infection
Exposure Prevention for
Bloodborne Pathogens
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Engineering Controls
Work Practice Controls
Personal Protective Equipment
Universal Precautions
Engineering Controls
• Structural or mechanical devices CAP
provides for its’ ES personnel
– Hand washing facilities
– Eye wash stations
– Sharps containers
– Biohazard labels
Work Practice Controls
• The behaviors necessary to use engineering
controls effectively
– Using sharps containers
– Using an eye wash station
– Washing your hands after removal of personal
protective equipment
Work Practice Controls
Continued
• Hand washing is considered to be the most
effective method of preventing transmission of
• BBPs
Alternatives such as hand cleaners and towelettes
are acceptable alternatives for those without ready
access to wash facilities, but the individual should
still wash their hands with soap and warm water
after contact with blood or other possible infectious
material
Work Practice Controls
Continued
• Procedures involving blood or other potentially
infectious material will be performed in such a
way as to minimize or eliminate splashing,
spraying, splattering, and generation of
droplets of these substances
• Eating, drinking, smoking, applying cosmetics or
lip balm, and handling contact lenses is prohibited
in work areas where exposure is likely
Personal Protective
Equipment
• Equipment provided by CAP at no cost to
you, which it is to your advantage to use, and
should be reported to supervisors when not in
working order
– Latex gloves
– Masks
– Aprons, Gowns, or Tyvek suits
– Face shields
Personal Protective Equipment
Continued
• Whenever you need to wear a face mask,
you must also wear eye protection
• When wearing personal glasses, you
must use side shields and plan to
decontaminate your glasses and side
shields according to schedule
Personal Protective
Equipment Continued
• Personal protective Equipment is acceptable
if it prevents blood or other possible
infectious material from contaminating work
clothes, street clothes, undergarments, skin,
eyes, mouth, or other mucous membranes.
What is wrong with this picture?
Use your Personal Protective
Equipment!
Answer: Rubber Gloves were not worn for the
patient’s assessment
Removing Gloves
Grasp the outer surface of one
glove with the other gloved
hand "rubber to rubber" and
pull off the glove. Discard the
glove into the designated
receptacle.
Removing the second
glove. Note that the
person touches only the
"inside" surface of the
glove with his bare
hand.
Contaminated Clothing
• Your clothing may be exposed to potentially
infectious materials, and must be handled
appropriately if that happens
– Clearly label contaminated materials and put them into
separate leak proof containers to be sent to a facility
following OSHA standard
– Don't handle contaminated clothing more than
absolutely necessary
Contaminated Clothing
Removal
• Remove it in such a way as to avoid contact
with the outer surface
– Rolling the garment as it is pulled toward removal
will decrease chance of contact with the
contaminated area
– After rolling it up, carefully pull it off to avoid
contact
– If it cannot be removed without contamination, it is
recommended that the item be cut off
Universal Precautions
• The concept that all blood and certain body
fluids are to be treated as if contaminated with
HIV, HBV, or other BBPs
– Acceptable alternative is Body Substance Isolation:
The treating of all fluids and substances as infectious
– Personal protective equipment like gloves and a mask
must be used whenever you might be exposed to blood
or other potentially infectious materials
Materials Requiring Universal
Precautions
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•
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Blood
Cerebrospinal fluid
Synovial fluid
Pleural fluid
Any body fluid with visible blood
Any unidentifiable body fluid
Saliva from dental procedures
Materials NOT Requiring
Universal Precautions
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Feces
Nasal secretions
Sputum
Sweat
Tears
Urine
Vomitus
If there is visible blood then all bets are off
Surface Disinfections
• Surfaces can be decontaminated
with one of many commercial
products
– Check label directions for use
• A bleach solution can be mixed 1:10
with water to disinfect areas
– The solution should be made fresh
Biohazard Materials
Biohazard symbol used to identify biohazard
materials
Protective gloves
Protective face mask with eye shield
Biohazard Materials Continued
Sharps containers to hold contaminated
needles, scalpels, or other sharp instruments
Tyvek protective suits for biohazard scenes
such as accident sites.
Biohazard kit for clean up.
BBP Tasks
• General Emergency Services Personnel
– O-0901: Demonstrate knowledge of BBPs
• Ground Team Members
– O-0902: Exercise Universal Precautions
• Ground Team Leaders
– O-0903: Use a BBP Protective Suit
Any products shown are for illustrative purposes only.
Civil Air Patrol or the United States Air Force endorses,
guarantees, or recommends no specific product, business, or
services.
QUESTIONS?
THINK SAFETY
Altered Mental
Status
Vital Signs
&
Basic Patient Care
SAMPLE History
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S – Signs & Symptoms
A – Known Allergies
M – Medications
P – Past, Pertinent Medical History
L – Last Oral Intake
E – Events Leading to the Illness/Injury
Baseline Vitals
Baseline Vitals provide important information in the treatment of
trauma patients. By establishing a base line upon first contact with
the patient, a medic can instantly determine the effectiveness of
any medical intervention.
EVERY patient will have the following baseline vital signs checked:
Respirations (# of breaths per minute)
Pulse Rate (# of heart beats per minute)
Blood Pressure
Pupils
Skin Temperature or appearance
Pulse Rate
Blood Pressure
Respirations
Pupils
Skin Temperature and Appearance
ABC’s
Basic Airway Management
1.
2.
Check if the patient is breathing.
Open the Airway
1.
2.
3.
Use an airway adjunct if necessary
1.
2.
4.
5.
Use the head tilt / chin lift method if no spinal injury is
suspected.
Use the jaw thrust method if a spinal cord injury is suspected.
DO NOT move the patient’s neck!!!
If no gag reflex, use an oro-tracheal tube
If gag is present, use a naso-tracheal tube
Use a Bag-Valve Mask (BVM)(if necessary)
Apply Oxygen (as necessary)
1.
2.
15 lpm for a non-rebreather mask (NRB)
6 lpm for a nasal cannula
Remember to reassess your patient after every intervention.
Bleeding
&
Shock
Fractures
&
Splinting
DCAP-BTLS
Deformities
Contusions
Abrasions
Penetrations
Burns
• Superficial Burns
• Partial Thickness Burns
• Full Thickness Burns
Tenderness
Lacerations
Swelling
Patient
Transport
MEDEVAC
Procedures
MEDEVAC Request Format
Line 1: Location of Pickup Site (normally given using the Military Grid Reference System (MGRS))
Line 2: Radio Frequency and Call Sign of Person Requesting the MEDEVAC
Line 3: Number of Patients by Precedence
A – URGENT
B – URGENT SURGICAL
C – PRIORITY
D – ROUTINE
Line 4: Special Equipment Required
A – NONE
B – HOIST
C – EXTRACTION EQUIPMENT
D – VENTILATOR
Line 5: Number of Patients by Type
L + (Number of Litter Patients)
A + (Number of Ambulatory Patients)
Line 6: Number and types of wounds, injuries, or illnesses and Patient Blood Type (if known)
MEDEVAC Request Format (continued)
Line 7: Method of Marking the Pickup Site
A – PANELS
B – PYROTECHNIC SIGNAL
C – SMOKE SIGNAL
D – NONE
E – OTHER
Line 8: Patient Nationality and Status
A – US MILITARY
B – US CIVILIAN
C – NON-US MILITARY
D – NON-US CIVILIAN
Line 9: Terrain Description
- Relationship of the pickup site to prominent terrain features (mountains, lakes, or any
other feature that would be highly visible on a map.
- Any known hazards around the Pickup Site
MEDEVAC
Aircraft
UH-60Q or HH-60L “Dustoff”
MEDEVAC Helicopter
Crew: 3 (2 pilots and 1 Flight Surgeon)
Max Pt. Capacity: 3 Litter Patients
- or -
6 Ambulatory Patients
Capabilities: Vertical Extraction via winch
GPS Guidance
Night Vision Capable
CH-53 Sea Stallion
Crew: 3 (2 pilots, 1 Crew Chief)
Max Pt. Capacity:
Capabilities: Midair Refueling
Vertical Extraction via winch
Night Vision Capable
HH-65 Dolphin
Crew: 3 (2 pilots, 1 Flight Medic)
Max Pt. Capacity:
Capabilities: Vertical Extraction via winch
Night Vision Capable
HH-3E Jolly Green
Crew: 4 (2 pilots, 2 Flight Medics)
Max Capacity: 30 Ambulatory Patients -or15 Litter Patients
Capabilities: Vertical Extraction via winch
Rear Door Entry
Night Vision Capable
Can hover on water
CH-47 Chinook
Crew: 4 (2 pilots, 2 Flight Medics)
Max pt cap: 33 ambulatory -or24 Litter
Capabilities: Rear Door Entry
Vertical Lift Capabilities
Civilian MEDEVAC Helicopters
Crew: 3 (2 pilots, 1 Flight Nurse/Paramedic)
Pt. Capacity: Generally 1 Litter Patient
(depending on type of aircraft)
Capabilities: Depend upon company providing
transport and aircraft used
Diabetic Emergencies
Allergies
Environmental Injuries
Insects
BLACK WIDOW SPIDER
Common Name
Scientific Name
Black Widow Spider
Latrodectus mactans
Venom: Black widow venom is
primarily a neurotoxin, which as a rule
does not cause local tissue death and
destruction. Best known for widespread
muscle spasm and often mimics that of
a severe abdominal problem i.e. acute
appendicitis, or ruptured ovarian cyst.
The initial bite is very painful, but can
go unnoticed. The surface of the skin
may display two red bite wounds, one,
or none. The worst pain is in the first 812 hours, symptoms may continue for
several days. Antivenom is available.
Females are 1-2" in diameter
Males much smaller
The female black widow is shiny
black with a red hourglass on
abdomen; however this does not
always have to be the case. The
red hourglass could take the
form of a red dot or many
variations of shapes.
The black widow is common in
fields, woodpiles, and
unoccupied dwellings.
Treatment for Black Widow bites:
 Clean and irrigate the wound.
 Apply an ice or cool compress.
 Provide pain medication, if available.
 Transport immediately to the nearest medical facility.
BROWN RECLUSE SPIDER
Common Name
Scientific Name
Brown Recluse Spider
-orViolin Spider
Loxosceles reclusa
The body of the brown recluse is
light tan to dark brown in color. It
is about 1/2" to 1/4 " in size. The
males are usually smaller than
the females. With leg span
included they are about the size
of a half dollar. The legs are
long, thin, and delicate. They
have only six eyes. The most
distinguishing mark is the violin
like dark patch on their head
and thorax with the skinny part
of violin pointing toward the
abdomen.
VENOM: The severity of the bite
may vary. The symptoms may
vary from no harm at all to a
reaction that is very severe.
Often there is a systemic
reaction within 24-36 hours
characterized by restlessness,
fever, chills, nausea, weakness,
and joint pain. Where the bite
occurs there is often tissue
death and skin is sloughed off.
In some severe cases, a wound
may develop that lasts several
months.
Treatment for Brown Recluse bites:
 Clean and irrigate the wound.
 Apply an ice or cool compress.
 Transport immediately to the nearest medical facility with the spider, if possible.
MOSQUITOS
Mosquito Facts
Only the female mosquito bites. She needs the blood meal for egg production. Male
mosquitoes are much larger than females, feeding only on flower nectar and not on the blood
of mammals. The majority of mosquitoes feed early in the morning or late at night.
Mosquitoes locate us primarily by smelling carbon dioxide and lactic acids that are excreted
from our bodies. They can find us as far away as 200 feet. Cologne, soaps and lotions can also
attract mosquitoes. In order to multiply, they need standing water to lay their eggs. Adults
and heavyset or obese humans have an increased risk of being bit by mosquitoes, primarily
due to their large body mass and more carbon dioxide being excreted from their skin.
Mosquito Bite Treatment
Over the counter Hydrocortisone can be very effective in helping with itching. Cool compresses
are also very helpful and effective, as well as monitoring the area for signs of infection.
Rocky Mountain Spotted Fever
RMSF General Facts
Rocky Mountain Spotted Fever, also known as spotted fever or tick fever, is a common tickborne illness that has been overshadowed by the publicity regarding Lyme disease. Rocky
Mountain Spotted Fever is primarily a western United States illness; however it is found in
all states except Hawaii and Alaska. One of the main vectors of the tick is the domestic dog,
which has played an important role in the spread of Rocky Mountain Spotted Fever
throughout the United States.
RMSF Symptoms
Incubation period appears to range from 2-14 days, 7 days being about the average. 100%
of individuals do develop a fever followed by a rash. Ironically, the rash only occurs in about
87% of cases. Nausea, vomiting and diarrhea are not uncommon. There is often a rapid
onset of symptoms. In those individuals who do develop a rash, this generally occurs around
the 5th or 6th day, and seen around the wrists, ankles, forearms, soles of feet, palms of the
hands, and spreads rapidly to the trunk and buttocks last.
Snakes
Hot Weather Injuries
Heat Exhaustion
Heat exhaustion is excessive fluid loss due to sweating, resulting in the depletion
of fluid volume, which creates an imbalance of electrolytes in the body.
Signs and symptoms of heat exhaustion:
The initial sign is when dehydration occurs. The patient will usually have a rapid
pulse rate prior to passing out. This is due to the heart trying to pump enough
blood to the brain. After the heart is unsuccessful, the patient passes out. The
patient will then have a slow and thready pulse. Other signs and symptoms of
heat exhaustion include gradual weakness, nausea, and anxiety. Skin is usually
pale and clammy or cold, pulse slows and blood pressure may drop. The victim
may complain of weakness. Excessive sweating, as opposed to the dry skin in
heat stroke, is a common symptom of heat exhaustion. Following these
symptoms, the victim may appear to be in shock. Temperatures may range from
100-104 degrees Fahrenheit.
It is difficult to differentiate heat exhaustion from other diagnoses like insulin
shock or traumatic shock. If you are in the outdoors, the environment is hot, and
a companion without a history of diabetes should develop the above symptoms, it
is somewhat easier to make the diagnosis. The prognosis is very good in heat
exhaustion as opposed to heat stroke.
Heat Exhaustion Treatment
Outdoor Treatment
It is important to first remove the patient from direct sunlight and into a shaded
area. The victim should be laid flat, with their feet elevated over the level of the
heart. Begin to replace fluids orally, in small amounts. It is important not to push
fluids too much, to avoid fluid overload.
Healthcare Provider - Medical Treatment
Treatment of heat exhaustion when properly diagnosed is fairly simple. Very cool
environment, administering glucose and cooling the individual off is essential.
Take cool wet towels, or ice packs if available, put them under the arms, the groin
area and behind the neck of the individual. It is important to note that you should
fan these wet towels, as the cooling process is actually the act of evaporation,
which decreases body temperature.
Cold Weather Injuries
Weather Hazards
What is lightning?
Lightning is a form of electrical discharge between clouds or between clouds
and the ground. The discharge may take place between two parts of the
same cloud, between two clouds or between a cloud and the ground.
Thunder is the sound waves produced by the explosive heating of the air
and the lightning channel during the return.
Some specifics:
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Most lightning strikes occur either at the beginning or the end of a storm.
Average lightning strike is 6 miles long.
Lightning reaches 50,000 degrees farenheit, 4 times as hot as the sun's surface.
A cloud to ground lightning channel can be 2-10 miles long.
Voltage in a cloud to ground strike is 100 million to one billion volts.
Other facts:
• Lightning is the most dangerous and frequently encountered weather hazard people experience each year.
• Lightning affects all regions. Florida, Michigan, Pennsylvania, North Carolina, New York, Ohio, Texas,
Tennessee, Georgia and COLORADO have the most lightning deaths and injuries every year.
• Lightning is the #1 cause of storm-related deaths.
• Damage costs from lightning are estimated at $4-5 billion each year in the U.S.
• Around the earth, there are 100 lightning strikes per second or 8,640,000 lightning strikes per day.
• There are approximately 100 thousand storms in the US each year.
Lightning strike statistics:
o Americans are twice as likely to die from a lightning-related death than from a tornado, hurricane
or flood.
o The Federal Emergency Management Agency (FEMA) estimates there are 200 deaths and 750
severe injuries from lightning each year in the US.
o 20% of all lightning victims die from the strike.
o 70% of survivors will suffer serious long-term affects.
o Annually there are more than 10,000 forest fires caused by lightning.
Who’s at Risk?
o 85% of lightning victims are children and young men age 10-35 engaged in outdoor
recreation and work activities outside.
o 70% of all lightning injuries and fatalities occur in the afternoon.
o Lightning in remote terrain creates dangerous conditions. Hikers, campers,
backpackers, skiers, fishermen, and hunters are especially vulnerable when they
participate in these activities.
o Many survivors of lightning strikes report that immediately before being struck, their
hair was standing on end and they had a metallic taste in their mouth.
o Long-term injuries from lightning strike can include memory and attention loss, chronic
numbness, muscle spasms, stiffness, depression, hearing loss and sleep disturbance.
What do you do when lightning
is near?
Lightning can never be prevented, but you can reduce the chances of being
struck by:
Avoiding high ground, water, solitary trees, open spaces, metallic objects.
Search for low ground, ditches, trenches. If they contain water or if the
ground is
saturated, then find clumps of shrubbery or trees, all of uniform height.
Remove all metal objects, bracelets, watches, rings, if possible.
Crouch down on the balls of your feet with your hands over your ears.
There should be at least 20 feet between you and other people. Do not all
huddle
together.
If you are in a fully enclosed metal automobile, seek refuge with all the
windows
rolled up and your hands in your lap.
 Avoid all metal shelters and sun shelters.
Stop all bicycles and motorcycles and get away from them.
How to handle lightning victims:
Seek medical attention as soon as possible.
If necessary, begin CPR. Make sure before doing CPR that the person
absolutely is NOT breathing or there is no heart rate before starting
resuscitation.
REMEMBER: Victims DO NOT retain an electrical charge. They are safe to
handle. Check for burns along the extremities and around areas.
Treat the burns the same as other types of burns.
Some common after effects:
Short, but not long term impaired eyesight
Loss of hearing
Mass Casualty Incidents
&
Triage Procedures
Critical Incident Stress Debriefing
(CISD)
Questions?