Environmental Emergencies
Environmental emergencies are pattern-recognition questions. Match the exposure to the syndrome, treat the ABCs, and correct temperature or toxin — in that order.
EMT · AEMT · Paramedic
Heat emergencies
Heat cramps → oral fluids and rest. Heat exhaustion → cool environment, remove clothing, IV fluids. Heat stroke → altered mental status + hyperthermia, this is a true emergency. Aggressive cooling (ice packs to neck/axilla/groin, cool water misting), airway management, and rapid transport.
Cold emergencies
Mild hypothermia (32–35 °C): passive rewarming, warm blankets, warm oral fluids if alert. Severe (< 30 °C): handle gently — rough movement can trigger V-fib. Active external rewarming, warmed IV fluids, and remember: 'not dead until warm and dead.'
Drowning
New guidelines drop the 'wet vs dry' distinction. Start ventilations first — hypoxia is the primary problem. C-spine only if diving/trauma MOI. All symptomatic patients transport; even a well-appearing drowning victim can decompensate hours later.
Lightning and electrical injuries
Lightning: reverse triage — treat the apneic first, they're most salvageable. Cardiac arrest, tympanic membrane rupture, and keraunoparalysis are classic. Electrical: look for entry/exit wounds and expect deep tissue injury and rhabdomyolysis.
Envenomation
Pit viper (rattlesnake, copperhead): remove jewelry, immobilize limb below heart level, mark advancing edema, rapid transport. Do NOT cut, suck, or apply ice or a tourniquet. Coral snake: pressure immobilization bandage.
Frequently asked
- How do I tell heat exhaustion from heat stroke?
- Mental status. Heat exhaustion patients are alert; heat stroke patients have altered LOC. Skin can be either wet or dry — don't rely on it.
- Why is hypothermic V-fib so hard to convert?
- Cold myocardium doesn't respond well to defibrillation or drugs. Follow AHA guidance: consider withholding repeated shocks/drugs until core temp > 30 °C, and continue CPR during rewarming.
Test yourself
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