*** First Aid - Review Topics: Introduction I. Heat Injuries 1. Heat Cramps 2. Heat Exhaustion 3. Heat Stroke II. Bites & Stings 1. Snakes 2. Insects 3. Ticks 4. Spiders and Scorpions III. Burns (& Acid Burns) IV. Bleeding V. Shock ______________________________________________________________________ * Introduction: This is a basic review of some first-aid skills that are relevant to our field work. Due to the hot, dry environment the main concern is to avoid heat related injuires. The best prevention is to continually drink water all day long (do not drink a whole bunch at once and then none for a long time), and to keep an eye on each other. If you notice anyone not drinking, remind them to drink. Also, there are snakes in the desert, that are poisonous and unfortunately for us are actually kind of agressive (ie. if approached they will attack). Please be aware of your surroundings at all times -- look where your walking, don't go poking around under rocks. If you see a snake slowly back off and go another way. Please take the time to read through this hand-out at least once before the trip, so you will know what warning signs to look for in others, and how to prevent problems for yourself. ______________________________________________________________________ I. Heat Injuries 1. Heat cramps: are painful muscle spasms often occurring in the legs or abdomen. This is the first warning that the body is having trouble handling the heat. While the exact cause of these cramps is not understood, it is generally agreed that sweating caused by strenuous exercise in a hot environment causes a change in the body's electrolyte (salt) balance. Dehydration may also contribute to the problem. Ok, so what do you do about it? ** Treatment: 1. Get the victim out of the heat. Have them sit or lie down. 2. Water them! Give them cool water or an electrolyte-balanced sports drink (e.g. Gatorade®). 3. DO NOT give them salt tablets or salt water. They already have all the salt they need, its just not in the right places. The body is wonderfully made and will balance itself if it is allowed to rest. 4. It is ok for them to lightly stretch or gently massage the muscle. 5. The victim is free to go back to whatever it is they were doing once the cramps subside, just have them slow it down a bit and keep drinking plenty of fluids. 2. Heat Exhaustion (a.k.a. heat prostration, heat collapse): is the most common heat related illness. Fire fighters, construction workers, athletes are especially prone to this sort of heat injury. Why? Sweat is your body's built in air conditioner. You sweat, air hits the sweat, the sweat evaporates, you feel cooler. Sweat does not evaporate as well when its very humid, or when a person is wearing heavy clothing or exercising hard while in a hot, humid environment. The person may be sweating like crazy, but if the sweat is not allowed to evaporate then the body is going to keep getting hotter. ** Signals of Heat Exhaustion: Skin may feel Cool and clammy or moist,/pale, gray, or flushed looking. Headache Nausea Dizziness, Weakness, or Exhaustion ** Treatment: 1. Get the victim out of the heat 2. Loosen tight clothing and remove sweat-soaked clothing. 3. Apply cool, wet towels or cloths to the skin (use ice packs if necessary) and fan the victim. (Just think of what would cool you off if you were extremely hot and do it for them.) 4. If the victim is conscious, give them cool water to sip, but don't let them gulp it, which could result in vomiting. If necessary, regulate how much water they are given. (Once 4 oz. glass every 15 minutes.) 5. The victim should continue resting and should not resume normal activities the same day. 6. IF the victim refuses water, vomits, or shows signs of changes in consciousness, the condition is getting worse. CALL FOR AN AMBULANCE IMMEDIATELY! 3. Heat Stroke Lets take this one step further. If you don't recognize the signs of heat exhaustion or choose to ignore them (or in some unfortunate cases are unable to do anything about them), here is what can happen. ** Signals of Heat Stroke: - Red, hot, dry skin. (Remember our little talk about sweat? The heat stroke victim has lost the ability to sweat, which is why the skin will be hot and dry). - Changes in consciousness - rapid, weak pulse - rapid, shallow breathing ** Treatment of Heat Stroke 1. Call for an ambulance immediately! 2. If the victim vomits, position them on their side. STOP GIVING FLUIDS. 3. Keep the victim lying down. 4. Continue cooling the body using any means necessary. Place ice packs or cold packs under armpits, on the groin, on the neck, on wrists, and on ankles. (TIP: Cold cans of soda or beer work well for this if you don't have ice packs.) 5. DO NOT apply rubbing alcohol. ______________________________________________________________________ II. Bites and Stings 1. Snake Bites According to the American Red Cross, snakebites actually kill very few people in the USA. Of the 8,000 people bitten every year, fewer than 12 die. These deaths are attributed to allergic reactions, poor health, and allowing too much time to pass before medical treatment is received. ** Care for Snakebites: 1. Wash the wound 2. Immobilize the area, and keep it lower than the level of the heart. 3. Seek advanced medical treatment immediately! If you transport the victim yourself, its a good idea to carry them if the bite is on a lower extremity. Obviously, this is not always possible. If this is the case, have them walk slowly. 4. Watch the victim for signals of an allergic reaction. Although most snakebites occur near home, they are a definite possibility in the wild. If you are away from civilization and you know the victim cannot get professional medical care within 30 minutes you may suction the wound using a snakebite kit, if one is available. This is something to think about when you are packing your first aid kit. Not only should you have a snakebite kit if you are at risk, but you should be familiar with the contents and their use. ** DO-NOTs: - Do not apply ice to a snakebite - Do not cut the wound - Do not apply a tourniquet Finally, wear shoes and socks or hiking boots when you are outdoors, especially in the wild. Walk away slowly if you do encounter a snake, taking care not to startle or threaten it (they are as scared of you as you are of them). 2. Insect Stings Insect stings are usually more painful and annoying than they are fatal. Stings become a problem when the victim has an allergic reaction to the sting which often results in respiratory difficulty. Bee allergies are the most common. You may want to keep a bee sting kit on hand if you know you are allergic to bees. You should also familiarize yourself with the kit and know how to use it before an emergency. ** Care for an Insect Sting: - Remove the stinger. Scrape it away from the skin using a fingernail or credit card. If you use tweezers, be sure to grab the stinger and not the venom sac. - Wash the site with soap and water. - (Optional) You may use a sting-easing preparation, following package directions, of course. - Cover the site and keep it clean. - Apply a cold pack to the area to reduce pain and swelling. - Watch the victim for signals of an allergic reaction . 3. Ticks Ticks present a special problem. Rather than just biting and being done with it, ticks like to hang around and soak up the atmosphere, along with a little of the victim's blood. These parasites, much like an unwanted houseguest, often have to be forced to leave. ** Removing a Tick: 1. Grasp the tick with a pair of tweezers. Grab for the area closest to the skin. (You want to be sure to get the head as well as the body of the tick) 2. Pull steadily, slowly, and firmly until tick is removed. 3. Wash the area with soap and water. 4. You may apply an antiseptic or antibiotic ointment to help prevent infection. 5. If the site becomes infected, seek medical treatment. DO NOT try to burn the tick off with a hot match or cigarette. It is also a bad idea to coat the tick with nail polish or Vaseline. All this will give you is a pink, greasy, or upset tick who will burrow deeper into your skin to get away from whatever pain you are causing it. You have probably heard of Lyme Disease. It is spread mainly by infected Deer ticks, which are very small and difficult to see. They are, thankfully, not as common as dog ticks or wood ticks, but they are out there. Symptoms of Lyme disease include a rash around the bite area, fever, headache, weakness, and flu-like muscle and joint pain. Lyme disease can get worse if not treated; seek medical treatment! ** Prevention Use insect repellant (according to directions) when spending time outdoors, especially in wooded areas. Tuck in your clothes-this makes it harder for ticks to get under them. Have a "tick inspection" after being outdoors; check your scalp and other favorite tick hiding places. 4. Spiders & Scorpions If you live in the United States, there are only two types of spiders whose bite can be fatal . The first is the infamous black widow, which is black, with a reddish marking on the underbelly that resembles an hourglass. The other is the brown recluse, which is light brown with a darker brown violin-shaped marking on its back. Both spiders inhabit dark, quiet places such as brush piles, garages, and attics. Bites are usually the result of unwary humans reaching into their areas. For this reason, choice sites for a spider bite are arms and hands. The victim may not even realize that they have been bitten until they begin to feel sick and/or notice the swelling bite mark. Scorpions, on the other hand, are a bit harder to miss. Scorpions live in the southwestern United States and Mexico, where it is dry and warm. Their hang-outs are under rocks, logs, and on the bark of certain trees. They are most active at night. Although a scorpion sting is quite painful, there are only a few species whose sting can cause death. ** Symptons: The symptoms for both spider bites and scorpion stings are similar to other sudden illnesses. Their victim may experience nausea and vomiting, difficulty breathing or swallowing, sweating, and increased salivating, severe pain in the affected area, swelling, and redness or some indication of a bite/sting. ** Care for a scorpion sting or spider bite: 1. Get medical help immediately! Antivenin is needed for both Black Widow bites and scorpion stings. Meanwhile: 2. Wash the wound 3. Apply a cold pack to the site ______________________________________________________________________ III. Burns Burn Chart Tissue Severity Affected Skin Appears Pain Healing 1st Top layer of 5-6 Degree skin Red and dry YES Days 2nd Top layers of Red with 3-4 Degree skin blistering YES Weeks Total Dry, destruction leathery, 3rd of skin and and Depends Degree some or all discolored (see Depends underlying (charred, note) tissue or brown, or bone white) Note: A third degree burn may be painless if the nerves are severely damaged. ** Thermal Burn Treatment 1. Stop The Burning: Put out the fire. Get the victim away from whatever is causing the burning. 2. Cool The Burn: Use lots of COOL water. Be creative. You can use wet towels - this works well for cooling areas that cannot be immersed in a tub. (Be sure you re-wet the towels often as they will get warm.) Garden hoses, bathtubs, rivers, streams, whatever you can get to. A word of caution: DO NOT USE ICE OR ICE WATER ON ANYTHING OTHER THAN A MINOR BURN! It will cause body heat loss. 3. Cover The Burn It seems like the last thing you would want to do if you have just burned yourself, but it works. It will keep air from entering the wound; this will help to alleviate the pain and prevent infection. Use a dry sterile dressing or a clean cloth and loosely bandage in place. ** DO-NOTS - Do not apply ice to a burn unless it is VERY minor. - Do not touch the burn with anything other than a dressing. - Do not try to clean a severe burn. - DO NOT BREAK BLISTERS! - Do Not apply butter, oil, lard, or ointment to a severe burn. - Do not remove pieces of cloth that stick to a burned area - leave this to the nice people at the hospital. ** Acid Burn Treatment: 1. Do the same as for a Thermal burn treatment, but also remove any clothing that had been in contact with the acid. 2. You can also take tylenol or ibuprofen (as directed on the label) to help relieve the pain. ________________________________________________________________________ IV. Bleeding The most effective means of controlling bleeding is: 1. Cover the wound with a dressing and apply direct pressure with your hand. 2. Still applying pressure, elevate the wound above the level of the heart. 3. Secure the dressing with a roller bandage, use overlapping turns to cover the entire dressing , then tie or tape in place. Be sure you haven't wrapped it too tight by feeling for warmth and checking color below the wound. (e.g. If the wound is on the forearm, you would check the hand.) ** When the Bleeding won't Stop: Follow steps 1-3 for cuts again, placing them ON TOP of the original dressings and bandages. Do not remove the original dressing. If bleeding continues, apply direct pressure to the "pressure point" above the wound. This works by pressing the artery against the bone, which constricts the flow of blood. For example, if the wound is on the leg, you would place the heel of your hand and press where the leg bends at the hip. Generally, if you can feel a pulse at a spot, it will work as a pressure point. However, this should not be the sole means of controlling bleeding; think of it as a last resort. SEEK MEDICAL ATTENTION for any severe bleeding! ______________________________________________________________________ IV. Shock Shock develops in an injured or sick person whose circulatory system fails to deliver blood to all parts of the body. Without this blood, the body's organs cannot function properly. This is a life-threatening condition that requires immediate medical attention. You should watch any injured person for the following signs: - Restlessness or Irritability (Usually the first signal) - Altered level of consciousness - Skin: Pale or ashen Cool Moist or Clammy - Breathing: Rapid or labored Shallow - Pulse: Weak Rapid - Other signals: Nausea Vomiting Complains of thirst ** Treatment: 1. Call your local emergency number. 2. Have the person lie down. (Breathing difficulty may make sitting or semi-sitting a more comfortable position for some victims; the most important thing is that the victim rests.) 3. Control any external bleeding. 4. Keep the person warm. 5. Elevate the legs above the level of the head, unless there is the possibility of a head, neck, or back injury. 6. Do not give the person anything to eat or drink! They will probably be thirsty, but don't give in.