Ice rescue and immersion hypothermia slide share

Ice Rescue & Hypothermia Training in Ice Rescue and Treatment of Immersion Hypothermia Rommie L. Duckworth, LP Tuesday, February 21, 2012

IntroductionIt‟s 10 O‟clock in the morning on a Saturday in February and the tones go off for a man through the ice. You arrive as first on scene with the engine to find a 2 ft. hole in the ice surrounded by fishing gear. Inside that hole is a man desperately holding on to the edge of the ice crying out weakly for help. As a Police officer on the scene pulls a rescue suit off the engine and hands it to you and says „Get out there and save him!‟ you ask yourself, „Do I know what to do?‟”

IntroductionAt the end of today, the answer to thatquestion will be… YES!

Objectives: The Rescuer will demonstrate the ability to initiate appropriate field treatment for drowning and immersion hypothermia. The Rescuer will understand the proper techniques and equipment to be used to prevent injury to emergency personnel operating in cold temperature environments. The Rescuer will demonstrate the ability to correctly perform ice rescue techniques under realistic environmental conditions.

Course Outline:4 Introduction4 Objectivesn Recognition and Treatment: Drowning & Immersion Hypothermian Rescuer Safetyn Incident Size Upn Ice conditionsn Available resources

Course Outline:n Course Equipmentn Set up and donningn Hand signals / Tender‟s dutiesn Live Rescuen Extrication Techniquesn Conclusionn FOOD!!!

Recognition & TreatmentIn order to understand any rescue techniques, one must understand the injury to the victim and the treatment necessary as well as prevention of the same injury to the rescuer.In a bad car wreck, why don‟twe jump in without protectivegear and yank the victim outby the head?

Definition of HypothermiaClinically defined as body core temp of<95 deg. F (<35 deg. C)Simply defined as the body ‟ stemperature lowering below the normalfunctioning temperature range.

Human EnvironmentHuman beings are tropical beings better designed to shed, not retain heat.

CoolingTypes of Cooling (heat loss)  Conduction Direct Contact  Convection Water / Air Movement  Radiation Surface area vs temp.  Evaporation Sweating & Breathing

CoolingEnvironmental Factors Accelerating Cold  Wind Chill More convection increases RATE of heat loss. Objects do NOT cool to Wind Chill Temp.  Immersion Heat loss in water is 10-25x loss in air of same temp. Cooling rates vary greatly with changes in...

CoolingCooling rates vary greatly with change in  Water temperature and circulation  Time and degree of immersion  Thermal protection - Clothing  Muscle Mass vs Body Fat  Physical Activity  Age of the victim  Aerobic fitness vs Illness  Last oral intake  ETOH

FrostbiteFrostbite, trench foot and Chilblains: Cold injury localized to an extremity, usually associated with chilled, humid environment and poor circulation.

Frostbite

FrostbiteDegrees  1deg.=numbness and erythemia  2deg.=blisters / clear or milky fluid  3deg.=purple or bloody blisters  4deg.=almost solid ice

FrostbitePrevention for Rescuers!  Stay dry  Dress warm but…  Do NOT overdress  Do NOT induce sweating (antiperspirant) (Eskimo Saying:You sweat, you die!)  No use of ETOH or tobacco  Proper fitting clothes & equipment  Be aware of respiratory heat loss  Beware of touching metals or liquids

FrostbiteSigns and Symptoms  Numbness  Tingling - Electric shock feeling  Decreased motor function  Pain  Necrosis  Burning Sensation

FrostbiteTreatment  Remove from cold  Stabilize temperature  Protect the skin  DO NOT RUB  DO NOT initiate rewarming if there is any likelihood of re-freezing.  Leave blisters intact  NO ETOH ingestion!

General Hypothermia The body‟s reaction to heat loss and the cold environment.

THE BODY‟S REACTIONHeat senses (primarily through the skin) are connected to the hypothalamus.The body attempts to increase heat production and decrease heat loss.The body primarily increases heat production by increasing two things:  Activity (metabolism)  Food digestion (chemical reaction)

THE BODY‟S REACTIONThe body reduces heat loss by...  Peripheral Vasoconstriction Blood shunting from extremities to core  Reducing Respirations.For protection the body also uses...  Cold Induced VasoDilation (C.I.V.D.) Due to vascular smooth muscle paralysis Constriction relaxes momentarily Cycles in 5-10 minute cycles Theory as to amount of protection is in doubt

AssessmentReading temperatures in the field are usually NOT practical.  Field temp. instruments must be both calibrated and capable of reading to <20C, 68F.  Preferred rectal or esophageal NOT tympanic or oral!What do we use for assessment?  Physical Observations  Signs and Symptoms  BRAINS!

AssessmentMild Hypothermia (98.6-96 f)  Feeling Cold  Piloerection  Involuntary Shivering  Unable to perform complex functions Skiing Climbing  “Normal” Vitals  Peripherally Cold  Peripheral Cyanosis

AssessmentModerate Hypothermia (95-90 f)  Dazed & Confused  Violent Shivering  Difficulty performing simple functions Walking Undressing  Slurred Speech  Centrally Cold  “Umbles” Mumbles, Stumbles, Grumbles, Fumbles

AssessmentSevere Hypothermia (Below 90 f)  Intermittent or No Shivering  Inability to move  Unconsciousness  Muscle Rigidity  Internally Cold  Depressed Vitals

The Body‟s ReactionNervous System  Depression  Impaired memory  Impaired Judgment  Excessive Radio Use  Loss of reflexes  Sluggish to Fixed Pupils

The Body‟s ReactionMetabolism  Increased Catecholamine Production  Major Muscle Groups increase rate 2-5X  Increased digestion  Changes in O2 Consumption  Disseminated Intravascular Coagulation Systemic blood coagulation Initiated by blood chemicals Process poorly understood

The Body‟s ReactionRenal System  Decreased ADH  Increase in urinary output 200-350%  Increased pressure on system (Immersion) Relative hypotension after hydrostatic squeeze is like rapid deflation of MAST  Further increase in blood viscosity  Change in blood pH-acidosis

The Body‟s ReactionCardiac  Initial Tachycardia  Progressive Bradycardia  Conduction irregularities due to many mechanisms Acidosis Electrolyte imbalance Hypoxia  More on this in the ACLS section

The Body‟s ReactionRespiratory System  Increased viscosity of surfactant  Decreased elasticity  Decreased muscle energy (reserves)

AfterdropBEFORE we start to treat, understand…How the watermelon freezes, orPATHOPHYSIOLOGY OF AFTER DROP  Shivering  Peripheral Vasoconstriction  Extremities numb and useless  Wastes build up in extremities  Core remains warm (for now)  Influx of fluid causes more diuresis

Afterdrop continued Blood begins to “sludge” Skin senses warming resulting in peripheral vasodilation Pressure Drops (relative hypotension) Frigid Wastes flush back to warm core Pt. Feels warmer but core organs temperature drop. Cardiac complications, renal failure, etc.

Treatment - Mild - Mod.Stop the cooling!Stabilize temperatureApplication of Blankets / CoveringsApplication of heat to heat pointsTx of signs / symptoms as they presentTx of other illness / injuries as neededACLS Hypothermia Algorithm

Treatment - SevereStop the cooling!Stabilize temperatureHeat from inside out  Heated humidified O2  Warmed IV fluidsDirect skin application of heat to skin is discouraged (possible burns)May need to check pulse >1 minuteTx of signs / symptoms as they presentACLS Hypothermia Algorithm

INTERMISSION

Drowning

Drowning DefinitionsDROWNING: Death by asphyxiation following submersion.NEAR-DROWNING: NEAR-death by asphyxiation following submersion.SUBMERSION INCIDENT: Refers to any in-water drowning-type event, regardless of eventual outcome.

Drowning Statistics As of 1986 drowning was second only to motor vehicle accidents as a cause of accidental death in America for ages < 44. It ranks third for all age groups, just behind automobile accidents and falls, but well above alien abductions. Many experts suggest that the numbers of drownings are actually much higher due to the fact that many incidents (as with alien abductions) go unreported.

Ice Rescue VictimsTypical Victims of Ice Related Accidents-Animals-Children-Ice fishermen-Ice Skaters-Snomobilers (4-wheelers, etc)

Common Factors:Unprepared for immersion: Two thirds of all drowning victims could not swim and did not intend to be in the water.Non Use Of A PFD (life jacket)Alcohol / Drug Use: Several studies have shown that as many as fifty percent of drowning victims were legally drunk.

Common Factors:Underlying Disease: Hypoglycemia, MI, cardiac arrythmias, syncope, seizures, stroke and many other disease statesTrauma: As previously discussed.Hypothermia: As previously discussed.

PathophysiologyWet Drownings. In 85% of all drownings the victim immediately aspirates water upon submersion. This is termed a “Wet” drowning.Dry Drownings. In the remaining cases, cold water stimulates laryngospasm, an uncontrolled shutting off of the trachea by the epiglottis. Because of this laryngospasm, no water enters the lungs.

PATHOPHYSIOLOGYSalt vs. Fresh: Regardless of submersion in Salt or any variation of fresh water, the end result is the washing out surfactant and causing atelectasis, decreased ventilatory compliance and again inducing massive shunting.

PATHOPHYSIOLOGYContaminants, whether they be from sand, vomit, chemicals, bacteria or suspended particles, are also of concern. While there are no direct treatments in the field for contaminants in the lungs of a drowning other than suctioning it is important to notify the hospital of what contaminates are suspected.

Cold Water Reflex:This is an involuntary reflex of the diaphragm stimulated by cold water. When the victim is splashed in the face with cold water the diaphragm spasms causing a sharp inhalation gasp. Unfortunately, because the victim’s airway is often partially or fully submerged during this gasp, the victim will simply suck in water leading to increased panic. RESCUERS…-COVER YOUR MOUTH!!!

Mammalian Diving Reflex: Marine mammals’ physiological response when stimulated by cold water submersion is the shunting blood from their peripheral tissues to their body’s core. The increased blood volume in the core then stimulates a vagal response which produces profound bradycardia. This shunting of blood from non-essential organs and lowered oxygen demand allows the diving mammal to remain underwater for a prolonged period.

Mammalian Diving Reflex: Mammalian Dive Reflex theory purports that some humans, notably children under 5, may also use this reflex to survive prolonged submersion. The mammalian diving reflex theory was developed in the 1960’s as an explanation for the well publicized survival of exceptional submersion times of some near drowning victims.

Post Immersion Synd.This term describes the occurrence of Adult Respiratory Distress Syndrome (ARDS) in near drowning victims after an asymptomatic post submersion interval from several hours to several days. This syndrome occurs through different means depending on what type of fluid the victim was immersed in (salt vs. fresh water) although the end result is the same.

Treatment for DrowningAsymptomatic: The asymptomatic patient will most often wish to go home and forget the incident. Because of the threat of Post Immersion Syndrome it is important that all patients be observed in a hospital for four to six hours. At a minimum, patients should be convinced to have a follow up visit with a physician within twenty four hours.

Treatment for DrowningSymptomatic: “No one is dead until they are warm and dead”Always consider C-Spine PrecautionsAirway:Tube and suctionBreathing: VentilateCirculation: CPR (in water, like on stairs do it if you can, if not, MOVE!)Disability

Treatment for DrowningHistory to note for drowning victims  Age  PMHx  Medications  Trauma  H2O temp  Depth of submersion  Length of time in water vs. submerged  Breathing off compressed air source  Contaminates aspirated

ACLS Interventions

Rewarming Methods34°C to 36°C: Passive rewarming (remove wet clothing; warm blankets) Active external rewarming (most convenient: IV solution bags heated in microwave; convective heating methods [eg, Bair blankets], radiant heat shield, convective heat, heating pads)30°C to 34°C: Passive rewarming (completely dried off; warm blankets) Active external rewarming to truncal areas only<30°C: Activeinternal rewarming under controlled circumstances (ED or OR).

Active Internal Rewarming Warm, humidified O2 (42°C to 46°C) Warmed IV fluids (42°C to 44°C) Warm lavage: gastric, pleural (through chest tubes), bladder Peritoneal dialysis Esophageal rewarming tubes Extracorporeal rewarming (cardiopulmonary bypass) Continuous arterial / venous rewarming (CAVR)

Active Internal RewarmingPatient Warming Devices

BREAK TIME!Rest your… Butts Books Brains

Ice Rescue & Safety “Well its about freakin‟ time!”

Ice Rescue Safety: According to national statistics, more rescuers die each year trying to perform water rescues than victims are saved from the water. Most of these victims are firefighters. We are part of the problem, not the solution. Like everything else we do, “If you don’t know, don’t go!” You must be properly trained, equipped and prepared. Don’t do anything uncomfortable.

Safety for the Rescuer Dangers are Drowning, Hypothermia and other bodily injury. Take a break when you need it so you can go out again. Stay warm and dry! Ambulance standing by for rehab. and Tx. Always wear a PFD H.E.L.P. & Huddle Self-Rescue / Elbow Crawl

Safety for the Rescuer The turn out gear vapor barrier will trap air. DEMO

Safety for the RescuerHAZARDS: Physical Hazards  Rocky approach  Steep Approach Hazardous Materials  Chemicals  Biologicals Vehicles in the water Swift / moving water Large Moving Ice Blocks

Size Up:Begins while enrouteWeatherTime of Day / Day of weekLight Conditions (Glare / Dark)Available ResourcesIce ConditionsType of incident

Size Up:On Scene  Spotters (For point-last-seen) Binoculars  911 Caller Reliability Point & Time Last Seen  Number of Victims  Access to Victims  Risk vs. Benefit  Strategy & Tactics

Types of Ice Rescue-Animal rescue Risk vs. benefit NEVER risk human life for an animal rescue Civilians may go to retrieve animal-Vehicle through the ice Occupants in vehicle Extrication of occupants Haz-Mat release Associated Trauma

Ice ConditionsQuality: much more important than thickness for weight bearingThickness and quality can vary greatly in different areas at different times.

Available ResourcesGeneral rules Call early, can always send back Keep it close, but not too close Boats Different boats for different jobs Useful trailers & sleds Can be deceptive hindrance DO NOT bother trying to break ice Either paddle or slide flat bottom boat through H20

Available ResourcesDispatch : Coordinate multiple resources Fire Engine Personnel Lighting EquipmentSpecial Rescue Equipment

Available ResourcesEquipment NOT to call or use  Any person not wearing PFD  Untrained persons  Human chains If 1 fell through will 10 people?  Anything that SINKS!

Specialty Ice Rescue DevicesMany different rescue devices are available.

Specialty Ice Rescue Devices Start on shore

Specialty Ice Rescue Devices Ice Rescue and Immersion Suits

Specialty Ice Rescue Devices For the perfect ensemble: Accessorize!!!

Specialty Ice Rescue Devices Getting to the victim fast.

Specialty Ice Rescue DevicesGrabbing the victim

Specialty Ice Rescue DevicesLet them see you!

Specialty Ice Rescue Devices Rescue sleds and small boats

Specialty Ice Rescue Devices

Specialty Ice Rescue Devices Slide across ice or paddle across water.

Specialty Ice Rescue Devices Pull the victim onto the sled and signal your crew to pull you both in smoothly.

Specialty Ice Rescue Devices

TODAY’S EQUIPMENT 1) Suit: a) 16 lbs. buoyant. b) NOT Water proof c) Secure seals as best you can d) Be careful of zipper (bees wax) e) Do NOT wear shoes if possible f) Watch where you walk 2) Harness: a) Chest Harness to keep upright & disperse weight b) Carries additional. Equip. c) DO NOT substitute waist harness or looped rope

TODAY’S EQUIPMENT FORNFVFD 3) Rope: Reeled or bagged. Poly preferred! 4) Rescue Tube: To reach and/or secure victim 5) Knife: Used on rope, not on Victim! Disposable! 6) Drop Marker Buoy: One hand release to mark location 7) Cyalume: increase rescuer vis. & hand signals 8) Sled, SKED, Backboard or Boat: For sliding Victim 9) Pole: Huh, huh, he said “pole”. Reach & Grab victim & ice 10) ICE PICKS:Home-made or Commercial 11) Whistle

Ice Rescue TechniquesTender Duties Prep Equipment Assist dressing Rescuer Check Rescuer Signals Assist Rescuer Mobility Standby with Rescuer Coordinate Line Manipulation

Ice Rescue TechniquesRescuer Duties Prep Equipment Get Dressed Check Tender Signals Move into position Standby with Tender

Ice Rescue TechniquesIn any form of water rescue Reach Throw Row GO!

Ice Rescue TechniquesREACH! Pike Pole Ladder Specialized Rescue Devices Inflated Hose (less than 50‟ away)NO! HUMAN CHAIN LADDER

Ice Rescue TechniquesTHROW! Throw Bag Flotation Devices Specialized Rescue DevicesNO! SPARE TIRE PFD

Ice Rescue TechniquesROW! Sled Boat Specialized Rescue DevicesNO! OPEN PROP ICE CHUNKS

Ice Rescue TechniquesGO! Coordinate w/ IC Use spotters Prep equipmentNO! NOT EQUIPPED NOT READY

Ice Rescue TechniquesMove to Patient Swim Slide Crawl Tap Talk

Ice Rescue TechniquesReach to Patient Pole Flotation Device Harness

Ice Rescue TechniquesContact Patient Grab them from behind If not already done, connect harness Remember to talk & reassure

Ice Rescue TechniquesLift / Push Patient If possible use floatation device, harness, special rescue device, etc. Use spec rescue devices as directed Communicate w/tender to pull pull Pull must be smooth and gentle  No Jostling of the patient, remember.

Ice Rescue TechniquesLift / Push Patient If necessary make direct pt. Contact Use YOUR buoyancy to lift pt. Use bobbing technique to lift pt. You must get the patient UP AND OUT OF THE HOLE! If needed, immobilize the patient‟s spine prior to moving to shore.

Ice Rescue Techniques

Ice Rescue TechniquesDon‟t forget the water / land interface!IC should coordinate RESCUE re-sources with EMS resources.The ambulance should be at theextrication point, ready to receive thepattient (s).

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Ice rescue and immersion hypothermia slide share

by Rommie Duckworth

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