Emergency Vehicle Safety

Cold Weather Emergencies

• Most serious injuries in ambulance crashes are unrestrained medical attendants in the rear compartment. • You are 2.6 times more likely to be injured while running “code”.

Presented by: Wade Scoles RRT, NREMT Staff Education Coordinator, NW MedStar

Cold Weather Assessment & Mngt • Exposing your patient – Bring them inside the ambulance – Keep them warm – Remove wet clothing – Cutting Coats & Snowsuits…

Cold Weather Assessment & Mngt • Assessing skin color, temperature and perfusion

•Normal cap refill of 2-3 seconds will be longer in cold weather due to vasoconstriction •Will not necessarily reflect hemodynamic status

1

Patient #1 • Typical winter conditions (more than an inch of snowfall and temperatures that dip below 20 degrees) cause death rates from heart attacks to triple among men 35 to 49 years old.

Patient #1 • 55 year old having chest pain while shoveling snow • Initial assessment: – Pale, diaphoretic, no resp. distress – Vital signs: • Pulse 110, RR 16, BP 158/90, SpO2 96%

Video

Patient #1 • Management: – Rapid transport, call for ALS if available – Monitor with AED, Oximetry – Oxygen – Nitroglycerin • Contraindicated if BP < 100 systolic

– Aspirin

Patient #1 • Why is shoveling a potentially dangerous activity? – Strenuous activity in cold weather – HR & BP increase – Body constricts vessels when exposed to the cold

2

Patient #2 • Approximately 1,000 Americans fall through ice each year

Patient #2 • • • • •

11 year old, cold water submersion Pale, cold, unresponsive, not breathing To resuscitate or not? In the water 40-45 minutes Water temp 33 degrees

Video

Patient #2 • Assessing hypothermic patients – Take extra time to assess pulse & RR in hypothermic patients – Allow for slow heart & respiratory rates – Don’t start chest compressions if severe hypothermic patient shows any signs of life

Patient #2 • Management – Rapid transport, call for ALS if available – High quality BLS – Remove wet clothing – Begin active re-warming of truncal area while administering BLS – May attempt defibrillation once if AED says “Shock indicated”

3

Patient #2

Patient #2

• Management – Withhold further defib or meds until body temp reaches >30°C (86°F) – Will need transport to facility capable of active internal rewarming for severe hypothermia

• Sudden submersion into cold water triggers the Mammalian Dive Reflex • HR & RR slows and blood flow diverts from the extremities to the core • This slowing of metabolism and diversion of blood allows longer survival times. • How cold must the water be, to be “protective”? – 34°C or 93.2°F

Shivering, Tachycardia

External rewarming all areas

Moderate: 30-34°C or 86-93.2°F

Confusion, disorientation, apathy, bradycardia or AFib

External rewarming, truncal areas only

Severe: