First Responder EMS Curriculum for Training Centers in Eurasia

near freezing of a body part, which usually occurs in the exposed areas of the body suchas the fingers, toes, face, ears, and nose. Injuries resulting from such exposure to coldmay range from temporary or permanent sensory or motor dysfunction of a body part, oreven loss of that body part.Signs and Symptoms of Local Cold InjuriesSigns and symptoms vary according to the temperature of exposure and length ofexposure of a particular body part. We can divide these signs and symptoms intosuperficial and deep injuries.Superficial, or early, injuries result in blanching of the skin. Blanching of the skin isapparent when normal color does not return after palpation of the skin. Loss of feelingand sensation in the injured area also occurs. The skin remains soft in superficialinjuries. If rewarmed, a tingling sensation results. This type of cold injury may result intemporary or partial dysfunction of the injured area.Deep, or late, injuries result in white, waxy skin. Upon palpation, the skin feels firm tofrozen. There may be swelling and blister formation. If thawed or partially thawed, theskin may appear flushed with areas of purple and blanching or may be mottled andcyanotic. These cold injuries may result in severe pain for the patient, which you shouldconsider when caring for the patient. These deep cold injuries often lead to permanenttissue dysfunction and 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 reassurethe patient while waiting for additional EMS personnel to arrive.Management1. Always try to remove the patient from the environment.2. Protect the cold-injured extremity from further injury.3. Remove wet or restrictive clothing.4. If the injury appears to be early or superficial, manually stabilize the extremity andcover it with a dry cloth or dressings. Do not rub or massage. Do not re-expose theinjured area to the cold.5. If the injury appears to be late or deep, remove jewelry and cover with dry cloth ordressings. Do not break blisters. Do not rub or massage the area. Do not apply heator rewarm the injured area. Do not allow the patient to walk on the affectedextremity.h. Exposure to HeatExposure to excessive heat may result in local tissue injury as well as generalizedhyperthermia. Patients who suffer heat exposure injuries will often have predisposingfactors that lead to such injuries. Climate plays an important role. High ambienttemperature reduces the body’s ability to lose heat by radiation. High relative humidityreduces the body’s ability to lose heat through evaporation. Exercise and excessiveactivity can lead to significant volume (water) loss, in some cases, more than a liter perhour. Other predisposing factors include extremes of age (very old/young), pre-existingmedical illnesses or conditions, as well as drugs and certain medications.130 First Responder EMS Curriculum/AIHA, July 2002