Temperature & Environmental Emergencies 11.0
All Providers
- Scene and patient management
- Remove patient from offending environment, when possible
- Focused history and physical exam
- Body temperature and glucose assessment
- Assess level of consciousness
- Assess for underlying causes if level of consciousness is abnormal: medications, toxins,
medical conditions
- Cardiac monitor, consider ETCO2, pulse oximetry
- Treatment Plan
- Heat Related
- Elevated temperature WITHOUT altered LOC
- cool with ice packs, wet towels, and/or fans
- oral rehydration with water or electrolyte solution
- gentle stretching for cramps
- Elevated temperature WITH altered LOC
- aggressive cooling after removing as much patient clothing as practical
- fine mist, fans, ice packs
- aggressive cooling is not recommended for pediatric patients
- Cold related
- Protect from further heat loss (apply blankets, removal of wet clothing, warm
environment
- Suspicion of cardiac arrest in cold environment: assess pulse for 30-45 seconds to
confirm
- warm packs, gentle handling
- frostbite precautions: do not rub affected parts, re-warm with 40◦ water, if
possible
Key Considerations
- Avoid refreezing of cold extremities
ADULT
EMT
AEMT
- IV/IO access and Fluid Therapy Protocol
- Heat Emergencies
- Cool fluid therapy: 500 cc LR
- Cold Emergencies
Paramedic
- Cold Emergencies
- Withhold anti-arrhythmic therapy until rewarmed
- Heat Emergencies
- Shivering: midazolam 2 mg IV/IN
Pediatric
EMT
AEMT
- IV/IO access and Fluid Therapy Protocol
- Heat Emergencies
- Cool fluid therapy: 20ml/kg LR
- Cold Emergencies
- Warm IV fluid: 20ml/kg LR
Paramedic
- Cold Emergencies
- Withhold anti-arrhythmic therapy until rewarmed
- Heat Emergencies
- Shivering: midazolam 0.3mg/kg IV/IN