Environmental Injury and Illnesses

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Our growing quest for outdoor adventures often leads to injury and illness as a result of specific factors related to the environment that frequently require first aid care.

Bites and Stings

Insect bites and stings are a common and an annoying occurrence. Most bites are minor but the potential for a serious allergic reaction does exist.

Be alert for any signs or symptoms of a severe allergic reaction, as this must prompt immediate 911 notification.

Bites and stings caused by insects such as spiders, scorpions, and fire ants can cause local reactions, but on occasion more serious systemic reactions can occur (Figure 12a).

Bites and Stings

Figure 12a

Signs and symptoms that suggest a more
serious reaction include:

  • Nausea or vomiting
  • Severe pain at the site
  • Abdominal pain
  • Difficulty breathing
  • Muscle rigidity
  • Headache
  • Decreased responsiveness

The black widow spider bite is known to cause severe abdominal pain that can mimic appendicitis in children.

Ticks carry a variety of diseases, and one must be vigilant for signs and symptoms for up to one month after exposure. Signs of a tick-borne disease include fever, headache, joint pain, and skin rash. To remove an attached tick, grasp it by the head with tweezers and pull straight out. Clean the area with soap and water or an alcohol swab. If the tick bite occurred in a geographic area where tick-borne disease occurs, seek medical treatment for possible prophylactic antibiotic therapy.

Lyme Disease

Figure 12b

Lyme disease can produce a distinctive “bull’s eye” rash (Figure 12b). Seek medical treatment.

If visible, remove a bee stinger by scraping it away. Wash the area with cold water and apply ice. Stay with the person for at least 30 minutes as some allergic reactions can be delayed in onset.

A bite from an animal such as a raccoon, bat, skunk, fox, or coyote carries the highest risk of rabies. Always make sure the scene is safe when giving first aid to any person with an animal bite. Contact the emergency response system as an animal control officer may be able to capture the animal and determine the risk of rabies. Clean the wound with soap and water and control bleeding by applying direct pressure. Animal bites are prone to infection and can cause further injury due to the puncture nature of the wound. Seek medical care by a qualified health care professional for any bite that breaks the skin, or if there is concern about rabies or other infection.

Snake bites require medical attention. If the pain is getting worse, swelling occurs, bruising develops, or systemic signs (nausea and vomiting) develop, a poisonous snakebite has occurred. Call 911 and do not delay medical attention. Make sure the scene is safe, and the snake is no longer a threat. Keep the person calm and try to avoid moving the extremity that was bitten. Remove any constricting clothing and jewelry from the affected area. Gently wash the affected area with soap and water if available. Additional care is required in a hospital setting. Do not apply a tourniquet.

Temperature Related Illnesses

Heat-related illnesses can occur due to extremes of temperature, particularly in the elderly, and during vigorous exercise. Illnesses include heat cramps, heat exhaustion, and heat stroke.

Heat cramps result in painful muscle spasms of the extremities, the back, and the stomach. Sweating and headache may accompany the cramps. Symptoms most often resolve with resting, cooling-off, and drinking water, a sports drink, or a similar electrolyte solution. Light stretching and massage can also be helpful.

Heat exhaustion is more serious. Signs of heat exhaustion include dizziness, vomiting, muscle cramps, fatigue, increased sweating, and lightheadedness.

Immediately move the person to a cooler environment if possible. Have the person lie down and loosen or remove as much clothing as possible. Use cool water to spray them and fan if available. A cool damp cloth can be used as an alternative. Encourage them to drink water or a sports drink. Remain with them until the emergency medical response arrives.

Heat stroke is life-threatening, and immediate action is required. Signs and symptoms of heat stroke include confusion, loss of consciousness, dizziness, muscle cramps, vomiting, and seizures. If you think the person is having a heat stroke, immediately call 911.

When treating a person with heat stroke, immediately do the following:

  1. Assess scene safety, wear protective equipment, and obtain first aid kit and AED.
  2. Use a spray bottle with cold water and a fan, if available, as rapid cooling is imperative.
  3. If the person is able, encourage them to drink water, a sports drinks, or an electrolyte solution.
  4. Continue to cool the person until their behavior returns to normal or until advanced help arrives.
Sunburn

Figure 13

Sunburn

Exposure to the UV radiation from sunlight can result in sunburn. Sunburn can be minor or result in blistering and sloughing (Figure 13) of skin. Avoidance of additional sun exposure is key. Encourage hydration and drinking of extra fluids. Topical aloe vera can provide symptomatic relief. If not allergic, ibuprofen can also help alleviate some of the discomfort.

Frostbite

Exposure to cold can result in frostbite and is most common in extremities such as ears, nose, fingers and toes. Wind chill increases the risk of frostbite. In severe frostbite cases, ice crystals form in the tissues and destroy cells resulting in permanent damage. The skin will appear waxy and white or yellow-gray. The area will be cold and numb and may feel like a block of wood. The tissue will be firm and will not move or compress easily when squeezed.

To provide first aid for frostbite, do the following:

  1. Get the person to a warm place.
  2. Call 911.
  3. Remove any constricting clothing and all jewelry from the affected body part.
  4. Remove all wet clothing.
  5. Redress in dry, warm clothing and cover with a heavy blanket.
  6. The frostbitten extremity should be quickly rewarmed in hot water (104°F).

Do not rub, squeeze, or slap the affected extremity as this may increase tissue damage. Do not rewarm a frozen extremity if there is a risk of refreezing. Seek further care from a health care professional.

Hypothermia

Hypothermia is a potentially life-threatening condition when the body temperature falls dangerously low. Hypothermia can even develop in non-freezing temperatures.

Signs and symptoms of hypothermia are:

  • Behavior change (confusion or lethargy)
  • Paradoxical undressing
  • Shivering (but stops as hypothermia worsens)
  • Muscle stiffness
  • Cold skin
  • Decreased respiratory effort
  • Progression to unresponsiveness and death

Rapid action is required to care for a hypothermic person.

Call 911 immediately and do the following:

  1. Remove the person from the cold and get them to a warm environment.
  2. Remove any wet clothing and dry the person.
  3. Redress in dry, warm clothing and cover with a blanket.
  4. Cover the head as it is a source of significant heat loss.
  5. Be prepared to perform CPR. Stay with the person until advanced help arrives.

Toxin and Poison Exposure

The list of toxins and potential poison exposures is extensive and beyond the scope of this handbook. Some basic concepts that are universally applicable for first aid providers are included in this handbook.

A material safety data sheet (MSDS) is required to be available where chemicals are in use in businesses and institutions. The data sheets provide information about the composition of various chemicals and are useful when contacting poison control.

To provide first aid in these situations, do the following:

  1. Call 911.
  2. Ensure the scene is safe and wear personal protective equipment.
  3. Get the first aid kit and the AED.
  4. Tell the dispatcher the chemicals involved if possible.
  5. Remove the person from the toxin or poison and seek a well-ventilated area if possible.
  6. Remove saturated clothing if present.
  7. Follow any recommendations from the 911 dispatcher or the MSDS sheet.
  8. Stay with the person until advanced help arrives.
  9. If CPR is required, ensure a mask is used if possible.

When treating any toxin and poison exposures, the eyes should be flushed with copious amounts of water. Acids and alkaline solutions are particularly caustic and can lead to permanent vision impairments or loss.

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