First Responder EMS Curriculum for Training Centers in Eurasia

this internal temperature, adverse effects result throughout the entire body. Generalizedcold emergencies may result from many contributing factors, including (1) a coldenvironment, (2) age (very young or very old), (3) medical conditions such ashypothyroidism, and (4) alcohol, drugs, or poisons. Remember that hypothermia is notjust seen in typically colder regions of the world.Signs and SymptomsPatients may have an obvious exposure to cold environmental conditions such asprolonged exposure to cold temperatures, water immersion or submersion, snow, rain,and wind. Or hypothermic patients may have a more subtle exposure resulting from anunderlying illness, alcohol or drug poisoning, chemical exposure, or generalizeddecreased ambient temperatures such as in the cool home of an elderly patient.The first sign may simply be cool/cold skin temperature. To assess the patient’s generaltemperature, simply place the back of your hand between the clothing and the patient’sabdomen. The patient may be shivering. Shivering is the one of the body’s intrinsicmechanisms to generate heat by muscle spasm or fasciculation. Unfortunately, shiveringoften leads to further heat loss through the skin. Decreasing mental status or motorfunction often correlates with the degree of hypothermia. These signs and symptomsinclude poor coordination, memory disturbances or confusion, reduced or lost touchsensation, mood changes, decreased verbal communication, speech difficulty, anddizziness. Other signs and symptoms may include a stiff or rigid posture, musclerigidity, joint pain or stiffness, and poor judgment. Ironically, patients suffering fromhypothermia may remove their clothing. Untreated mild hypothermia may result intemporary physical and mental impairment. Untreated severe hypothermia may lead topermanent organ damage or even death.Role of the First ResponderComplete the First Responder assessment. Complete a scene size-up before initiatingemergency medical care. Complete an initial assessment on all patients. Complete aphysical exam as needed. Complete ongoing assessments. Comfort, calm, and reassurepatients until additional EMS help arrives.Management1. Check the airway, breathing, and circulation of the patient.2. Assess pulses for 30 to 45 seconds before starting cardiopulmonary resuscitation.3. Remove the patient from the cold environment.4. Protect the patient from further heat loss.5. Remove any wet clothing and cover the patient with a dry blanket.6. Handle the patient extremely gently. Undue force or stress may cause external tissueinjury or internal cardiac dysrhythmias or arrest.7. Do not allow the patient to walk or exert himself/herself.8. Do not give the patient anything by mouth. Do not allow the patient to eat or drinkstimulants. Coffee, tea, or smoking may worsen the condition.9. Do not massage extremities.10. Cover the patient with a blanket. Try to keep the patient warm.g. Local Cold EmergenciesGeneral hypothermia was discussed above. Now, we will discuss the assessment andtreatment of local cold emergencies. Isolated injuries usually result from the freezing orFirst Responder EMS Curriculum/AIHA, July 2002 129