Climate Injuries- Hyperthermia/Heat Hyperpyrexia treatment

[asy]

(Hello all. It's good to be back in the City. Thanks for everybody's concern, I appreciate it. )

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For an unknown reason, some people find it fun to go hiking. Lately they seem to enjoy it more, when temp. is above 43 degrees Celsius (/110 Fahrenheit) in the shade. Apparently these strange people like it most if they had just arrived in this hell-like environment and are not yet acclimatized.

It is hot.

So.. looking for ideas on how to cool down Pt's body temperature at hot weather wilderness scenarios.

I am referring to remote areas where evacuation takes place on foot, and rescuers have to carry equipment and Pt in rough terrain. Evaporation is limited or non-existent at certain climates, while fluids (IV or on the skin) warm up to air temperature on the way. Cooling pads are not very effective for lowering body core temperature. And no, there is no wind. Or rivers. Or glaciers. Just salt, sand and rocks. HOT rocks.

Please tell about your way of treatment or link me to related articles.

(Hi Dust, thanks for your posts 8). How are you? )

Thanks,

asy

[tniuqs]

asy:

Firstly GREAT to see a post from you.

Wow that's quite the scenario you have there, perhaps convince those tourist to GO HOME or perhaps visit Hell instead.

Being from a country notorious for the opposite environmental challenges I am no expert but I will look for you, would really like share some of my conditions ie "snow" with treats of it soon, I doubt that Fed EX delivers in refrigerated units where you are, this is intended make you smile.

I have heard that an improvised Camping Chair is being used in warmer climes for firefighters, (in bunker gear that is difficult to remove similar to conditions you may be seeing) the ARM REST portion has sewn-in, and lined plastic bags filled with water and ice in which to place their forearms but if the ambient temperature of available water is higher than body core temperature this may be problematic. I have heard that this was trialed in Chicago ? and New York ? I sure hope there is more input here from those others that support you when they see your post.

There are a few really expensive high teck. very expensive body suits but I promise I will keep looking for you and ask some experts.

cheers.

[Timmy]

(Hello all. It's good to be back in the City. Thanks for everybody's concern, I appreciate it. )

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For an unknown reason, some people find it fun to go hiking. Lately they seem to enjoy it more, when temp. is above 43 degrees Celsius (/110 Fahrenheit) in the shade. Apparently these strange people like it most if they had just arrived in this hell-like environment and are not yet acclimatized.

It is hot.

So.. looking for ideas on how to cool down Pt's body temperature at hot weather wilderness scenarios.

I am referring to remote areas where evacuation takes place on foot, and rescuers have to carry equipment and Pt in rough terrain. Evaporation is limited or non-existent at certain climates, while fluids (IV or on the skin) warm up to air temperature on the way. Cooling pads are not very effective for lowering body core temperature. And no, there is no wind. Or rivers. Or glaciers. Just salt, sand and rocks. HOT rocks.

Please tell about your way of treatment or link me to related articles.

(Hi Dust, thanks for your posts 8). How are you? )

Thanks,

asy

Hey asy,

In Australia it is also very hot. We use instant ice packs on the patients pressure points to help cool the them. Pressure points being under the knees, under the arm pits, back of neck and sometimes depending how bad they are on the grown area. When we do standbys at marathons ect. in the heat the paramedics will sometimes put the IV fluid bag on ice but you must be carefully, sometimes it can send them into shock. We also sometimes use cool down vests which are filled with gel, when put in the freezer for about 30mins are very useful are the stay dry.

Hope This Helps

[Scaramedic]

I bet your talking about the people who feel the need for a pilgrimage to some site in the middle of nowhere.

The cooling suggestions above are good but let me throw out some other ideas on cooling the pt and to keep you from getting overheated during the rescue.

#1. The first thing to do is get the patient out of the direct sun, I know out in the middle of nowhere that might be an issue. One idea is a small lite weight hiking shelter like this. Granted it's kind of spendy (REI always is) but I am sure you can find a cheaper one on other sites. Once they are out of the direct sun it will be easier to cool them. I would also use ice packs, they last for a while and are not that heavy to carry in.

#2. I am sure you know the desert survival stuff but let me throw it out anyway. Dress in lite colored clothing that covers you well. There is a reason you see the photos of the explorers with their Pith helmets and tan clothing. Use a white sheet to cover your patient if they are non-ambulatory, white reflects heat and will help the patient stay cool. Also try to avoid movement in the heat of the day. If the patient is stable enough you might sit with them until it cools and take them out then. Once again I am not sure how far of a hike you are talking.

#3. If the patient is non-ambulatory I would suggest a stretcher carrier like this one. It will help you carry you equipment in and the patient out. They work well in rough environments and will save your back. This will also decrease your workload which will keep you from overheating also.

Most of all enjoy that wonderful heat.

[EMT-B 55]

In one of the Wilderness first aid courses I had, it was recommended that the PT be placed out of direct sun light and instant pack or rubbing alcohol to the points mentioned above

[EMS49393]

Rubbing alcohol is NOT recommended as it closes the pores in the skin making it even more difficult for heat to escape the body. The new standard guideline for cooling a patient is using wet sheets and blankets. The idea behind this new concept is to keep patients from getting cold too quickly which can cause shivering and thus generating even more body heat. Even if the wet sheets become warm, they will keep the skin moist, and the pores open. It's also a great deal more comfortable then an ice pack to the groin. I'm not sure how feasible it is to keep wet sheets packed in coolers where you happen to be, however i hope it helps.

[tniuqs]

These comments forward from another listserver from Aussie friend on an offshore Platform.

Hey asy:

This may sound uber basic but how about some of those 'instant ice packs'. The ones that you punch to activate. Fairly light and very economical. About six of these in a small first aid pack. One under each armpit and one on the back of the neck (wrapped in a wet cloth as per normal). Always worked for me trying to get core temps down from 40-41 etc. Couple this with initial cool water intake and IVT and you may have a win there. The 3 spares are for evacs over 20 mins as they will heat up in about this time. Patients with temps hate these so it gives you some revenge on them for being such a twit in the first place.

Very basic but also very economical.

Also, get the 'rescuers' to carry a 'Camel Back' type device that you hold at the first aid station next to the ice machine. Slap some ice in it on the way out and this gives you a good lightwieght source of cold water for the casualty to inbibe as they see fit. And the usual rehydration salts at the first aid station for arrival.

Let me know if it works mate.

Cheers,

Mick

PS: Are these people inducted and if so, the safety officer should be getting into them in the induction about monitoring urine output and adequate fluid intake.

[tniuqs]

These comments forward from another listserver from another experianced desert "Hiker"

squint dude....

Having spent time in hot places, our doctrine at the time was very specific in terms of rigid acclimatization schedules and hydration. The key being prevention. Now if it still happens the best way of cooling down without the benefit of immersion /conduction is by convection saturate body with water and fan, cool packs to neck, groin, pits, paying particular attention to keeping the noggin cooled down, IV's & benzodiazapines also help with prevention of seizures and internal cooling. As I stated the key is prevention and timely acclimatization over time, color of clothes and type is also critical. I have attached a link to the guide we used, if it doesn't work contact me directly and I'll send you the PDF.

http://www.usariem.army.mil/download/heata...%20schedules%22

Also see this link for more info on heat treatment and prevention

http://www.usariem.army.mil/somalia/heat.htm

[tniuqs]

These comments forward from another listserver from another experianced desert "Hiker"

Hey squint, as she probably knows she in a bad spot without much help. We found here in the Iraq desert that prevention is key. So we hammer it in at every morning meeting and pay attention to the weather. For us we usually have problems early in the summer and when it grows hotter then 110 F. We were able to obtain a small freezer which is loaded only with water bottles which of course freeze over night. We then load the portable ice chest with these bottles and on most days we maintain a decent supply all day even when we hit 130F. If we need the ice the we either use them as is or crush them and put the remains in plastic bags. You can also wrap the IV line around the bottle and it will cool the fluids as they flow from the bag. But prevention is key

Patrick C.

[asy]

tniuqs,

THANKS for all of your trouble! Please thank your aussie and "hikers" Friends as well.

I don't know, people PAY to get to this place and survivers even say they had a great time.

"SNOW"? I have heard of that phenomenon. They say Inuit has more than a 100 words for it, don't they? Hebrew has 1.

The chair you mentioned is very interesting but will not work at this particular S&R unit; Both New York and Chicago have colder climates. But it IS interesting.

Thanks for the link for body suits, if not for the Pt I'd really like to have one for myself! :thumbright:

THANKS for Timmy and all those who suggested the ice packs. We also have the breaking kind, but Israeli medics who were more experienced, whom I asked, were skeptical about this method. Maybe we have different brands and ours is less effective..? Do you have a link to maybe a research results about it? Maybe I should try Mick's kind.

Again, wish we had those gel vests. I should visit Australia.

scaramedic, yes, we do get the Jerusalem Syndrome a lot, but not only. Either way it is psychiatrically fascinating.

I love that REI stuff! Do you think you can convince them to branch in this direction? BTW, it is also HOT at 4 am when it's totally dark . About sitting still - evidently getting the Pt (and us) into an air conditioned room is best. Sometimes sitting still also means getting warm.

I like that PSC, not for this particular terrain but it's nice to have this kind of a rickshaw.

EMT-B 55, we DO NOT use alcohol pads as it is not recommended the last few years, as EMS49393 mentioned.

Mick, liked your attitude. Don't know what a "camel back" device is but we do have camels, maybe we can just install a freezer on one.

"hiker", thanks. We do use benzos at times, when it's clinically needed. Of course prevention is the best way, but when dealing with civilians there is less ability to control or predict their actions. Same goes for Patrick (BTW those methods are also customary in the Israeli army but again, they have their own legislation).

Thank you all. Till next summer I will do my best to obtain that cool gel vest.

asy