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CAP Talk  |  Operations  |  Safety  |  Topic: Cold water immersion for heat stroke
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Luis R. Ramos
Salty & Seasoned Contributor

Posts: 2,664

« Reply #20 on: July 26, 2016, 10:48:07 PM »

Garibaldi,

Don't smack him. Just immerse him in a pool of cold water. Or drop a bucket full of ice on him. That will fit in right with the nature of this thread.

 >:D

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Squadron Administrative Officer
Squadron Communication Officer
Squadron Emergency Services Officer
RNOfficer
Seasoned Member

Posts: 232

« Reply #21 on: July 26, 2016, 11:36:42 PM »


I haven't met a doctor or nurse, yet, in my 16 year career as a professional firefighter paramedic that would ever tell anybody to DELAY transport of a person having a medical emergency.

Apparently you did not view the video that Col Beckett linked from UConn. It clearly stated TREAT FIRST, TRANSPORT later.

My opinion is that whether to treat or transport first depends upon the circumstances. If the hospital was very close, say within 5 minutes, I would agree that transport first is correct. If EMS response time is long or the hospital is some distance, then treat first.

Also my decision would. be based upon the quality of EMS. If only EMT-Bs are the responder, then I would treat first. If paramedics (EMT-Ps) were responding and they would be there SOON (<5 minutes)., I would wait for them.

As Col Beckett and the video you did not watch state, the length of time the victim is at a critical temperature in the determinate of organ damage Waiting a long period for transport to arrive and  then a long ride to a medical facility would not be in the patient's interest.

If a patient's life were at risk I would have no problem risking the loss of my license if that was necessary for appropriate treatment.

Quote
BTW, we call it a CVA, or Cerebrovascular Accident, and have stroke centers up here in Wisconsin and Illinois. I didn't coin the term, some big wig, supper smart brain doctor did.

I know what a CVA is. However this is a board for the general CAP membership so I use non-technical
terms like "brain attack" that are more likely to stick in a layperson's memory.
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DakRadz
Salty & Seasoned Contributor

Posts: 1,365

« Reply #22 on: July 27, 2016, 12:00:38 AM »

Have I already mentioned that locally they use body bags for this immersion?

How well will that go over with parents, wing, or EMS?

The athletic trainers round here expect we will transport in the body bag, filled with ice, their charges. But that's also specifically their job.

But seriously, that is the most efficient way to do this. And to me, it's a medical treatment, not first aid.... did I mention the body bag?

Sent from my SM-N910T using Tapatalk

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Luis R. Ramos
Salty & Seasoned Contributor

Posts: 2,664

« Reply #23 on: July 27, 2016, 12:04:31 AM »

Wouldn't it be more professional for our members to know and be able to use the technical term of CVA?
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Squadron Administrative Officer
Squadron Communication Officer
Squadron Emergency Services Officer
LSThiker
Salty & Seasoned Contributor

Posts: 1,830
Unit: Earth

« Reply #24 on: July 27, 2016, 12:39:02 AM »

BTW, we call it a CVA, or Cerebrovascular Accident, and have stroke centers up here in Wisconsin and Illinois. I didn't coin the term, some big wig, supper smart brain doctor did.

CVA was first used in 1927 after a consensus of physicians and scientists.  Unfortunately, due to the poor understanding of medicine, physiology, and pathophysiology, I do not think a single person can be credited to the term CVA.  Prior to 1927, Hippocrates described sudden deaths (such as strokes, heart attacks, etc) as apoplexia.  Over time, apoplexia meant specifically "stroke".  This term was the predominate term until 1927.  In the 1600s, it was finally discovered that a blood blockage was responsible for strokes.  The term stroke was first used to mean "CVA" somewhere between 1500 and 1970 (the journal Stroke was started in 1970).  Again, it is difficult to determine exactly simply because stroke for some time also meant seizures.

(we preserve the right to arm bears)?
   



It was not mean to be a what if scenario.  Rather pointing out that calling something "inadequate" is not necessarily "inadequate" if it is the only thing you can do.  Stripping some person and moving them to the shade may be less effective than cooling them with water, but that does not mean it is inadequate if that is the best you can do given the current situation.  A particular scenario may mean that the actions are the most adequate for the conditions.

Anyway, sorry to sidetrack the discussion.  Moving on now.
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sarmed1
Salty & Seasoned Contributor

Posts: 932

« Reply #25 on: July 27, 2016, 01:16:12 PM »

The lay person information out there is Stroke:  most of the "ways to recognize" type public info lists them as signs and symptoms of a stroke. 

I have worked multiple EMS agencies in 4 different states all different parts of the country.  No one in everyday EMS uses the term brain attack.  The only exception is some "classes" for shock value.  Stroke or CVA are the common EMS terms.  the only reason Brain Attack has even surfaced is to try to draw a similarity of severity to Heart Attack, which is so common and misused its ridiculous.

back on topic, Rapid Cooling would be the best way to describe prefered Heat Stroke treatment.  Its sort of universally applicable to your resources and capabilities.  If you can immerse, immerse, if you just have AC and ice packs go with that, if you are ALS run in cool IV fluids at the same time.

MK

PS:  As a personal note based on how the last conversation went, using the word "quality" to describe the different level of EMS provider is a poor choice of wording.
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Mark Kleibscheidel
TSgt USAFR
LTC Don
Seasoned Member

Posts: 354
Unit: MER-NC-143

JoCo CAP
« Reply #26 on: July 27, 2016, 02:38:04 PM »

This is kind of a tough webinar to listen to, but give due course.  The information is very relevant, recent, and interesting.  Certainly, it is geared to EMS providers, but there are some definite takeaways for the layperson first-aiders like CAP members.  It pulls a lot of information from the Korey Stringer site, and discusses some extreme temperature cases and incidents.

https://www.youtube.com/watch?v=6YH8ZopxUdw


To note:
There has been mention in earlier posts about the 'classic' signs of:

Red flushed skin
Lack of sweating or dry skin

These are LATE signs.  If you have someone truly exhibiting these signs, you should be prepared to do CPR, or pronounce.  These victims are about to die no matter what you do.  This means IMMEDIATE CWI is their only hope of even staying alive, not necessarily without serious brain damage.

Also, the mention of not delaying transport.  The idea of the body bag filled with water and ice is great, if it can be done in conjunction with transport.  Great.  Otherwise, the goal is to AT LEAST START THE DOWNWARD trend of the temperature.  If the temp is above 102, CWI is preferred, but once the temp has trended down to 102 or under, transport should be managed without further delay, with ice and water continuously applied.

REMEMBER: It's not how high the temp, but how long at that high temp, that causes the most severe brain damage.  Get the temp down as fast as possible or start the downward trend, then transport.

ALWAYS, ALWAYS treat for the more severe condition, if unsure.  If you have members at an airshow (or other event) showing mental status changes, severe fatigue, and severe diaphoresis, and/or acting like they just can't get cooled off -- Contact CFR and get a firehose on them.  Immediately.  Since we don't carry thermometers, you have to assess the event and activity and other environmental factors.  It's  just water, and if it's a case of 'Heat Fatigue' or the more common 'Heat Exhaustion', then no harm no foul.  You still helped a fellow member avoid more serious, potentially life-threatening problems.

Heat Stroke is a HEAT problem, NOT a hydration problem.  Just drinking lots of water will not prevent the onset of heat stroke.  It helps certainly, but it's still a HEAT issue.

Oh yeah, watch the webinar.


For my fellow EMS colleagues -- Remember, we don't do CPR like we did back in the eighties.  Modalities and standards change.  Research improves.  Life goes on.
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Donald A. Beckett, Lt Col, CAP
Commander
MER-NC-143
Gill Rob Wilson #1891
LSThiker
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Posts: 1,830
Unit: Earth

« Reply #27 on: July 27, 2016, 03:12:54 PM »

Heat Stroke is a HEAT problem, NOT a hydration problem.  Just drinking lots of water will not prevent the onset of heat stroke.  It helps certainly, but it's still a HEAT issue.

Heat stroke is a heat issue and can be a dehydration issue.  After all, that is why there is exertional heat stroke and nonexertional heat stroke.  This is why avoiding rigorous exercise in extreme heat and/or humid conditions and avoiding dehydration is considered the best means to prevent heat stroke.  Hyperthermia over 41C and/or anhidrosis are the main causes of heat stroke.  Exertional heat stroke are those that raise the body temperatures through vigorous exercise and overwhelm their thermoregulatory mechanisms (e.g. firefighters, military, athletes).   This overwhelming can be due to poor hydration, lack of acclimatization, poor physical fitness, etc.  Nonexetional heat stroke is due to faulty cooling mechanisms such as abnormal sweating or the failure to sweat.  The main cause is dehydration. 

Therefore, while it is a heat issue, the underlying cause of that heat issue can be dehydration.     
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RNOfficer
Seasoned Member

Posts: 232

« Reply #28 on: July 27, 2016, 06:28:45 PM »

Have I already mentioned that locally they use body bags for this immersion?

How well will that go over with parents, wing, or EMS?

The athletic trainers round here expect we will transport in the body bag, filled with ice, their charges. But that's also specifically their job.

But seriously, that is the most efficient way to do this. And to me, it's a medical treatment, not first aid.... did I mention the body bag?

Sent from my SM-N910T using Tapatalk

Body bags are an excellent idea device for cold water immersion:
relatively cheap, readily available, waterproof. Similar bags would be backpacking "bivy bags" or even large plastic trash bags.

Even if the rescuers do not have ice, the body bag would hold hosed water against the skin to speed cooling, compared to just hosing a victim down. For maximum effect the hose should be run continuously at a low rate
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DakRadz
Salty & Seasoned Contributor

Posts: 1,365

« Reply #29 on: July 27, 2016, 06:44:08 PM »

Absolutely. But as I said, we only do first aid, and I'm not sure where this stands on the scale.

And unless we do know it's first aid, the sheer shock value of putting cadets in body bags will certainly draw on scrutiny which may not end with a favorable decision.

Look, if I'm off duty, and I can't be confident I'm performing first aid, which is the only thing CAP allows, and I don't have EMS close, then I will reconsider the situation. But this seems a little farfetched for an average activity.

Sent from my SM-N910T using Tapatalk

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RNOfficer
Seasoned Member

Posts: 232

« Reply #30 on: July 27, 2016, 06:49:33 PM »

This is kind of a tough webinar to listen to, but give due course.  The information is very relevant, recent, and interesting.  Certainly, it is geared to EMS providers, but there are some definite takeaways for the layperson first-aiders like CAP members.  It pulls a lot of information from the Korey Stringer site, and discusses some extreme temperature cases and incidents.

https://www.youtube.com/watch?v=6YH8ZopxUdw


To note:
There has been mention in earlier posts about the 'classic' signs of:

Red flushed skin
Lack of sweating or dry skin

These are LATE signs.  If you have someone truly exhibiting these signs, you should be prepared to do CPR, or pronounce.  These victims are about to die no matter what you do.  This means IMMEDIATE CWI is their only hope of even staying alive, not necessarily without serious brain damage.

Also, the mention of not delaying transport.  The idea of the body bag filled with water and ice is great, if it can be done in conjunction with transport.  Great.  Otherwise, the goal is to AT LEAST START THE DOWNWARD trend of the temperature.  If the temp is above 102, CWI is preferred, but once the temp has trended down to 102 or under, transport should be managed without further delay, with ice and water continuously applied.

REMEMBER: It's not how high the temp, but how long at that high temp, that causes the most severe brain damage.  Get the temp down as fast as possible or start the downward trend, then transport.

ALWAYS, ALWAYS treat for the more severe condition, if unsure.  If you have members at an airshow (or other event) showing mental status changes, severe fatigue, and severe diaphoresis, and/or acting like they just can't get cooled off -- Contact CFR and get a firehose on them.  Immediately.  Since we don't carry thermometers, you have to assess the event and activity and other environmental factors.  It's  just water, and if it's a case of 'Heat Fatigue' or the more common 'Heat Exhaustion', then no harm no foul.  You still helped a fellow member avoid more serious, potentially life-threatening problems.

Heat Stroke is a HEAT problem, NOT a hydration problem.  Just drinking lots of water will not prevent the onset of heat stroke.  It helps certainly, but it's still a HEAT issue.

Oh yeah, watch the webinar.


For my fellow EMS colleagues -- Remember, we don't do CPR like we did back in the eighties.  Modalities and standards change.  Research improves.  Life goes on.

Thanks for the excellent video and for reminding me that the signs like hot skin are late symptoms. In practice and teaching, I always emphasize that heat injuries are on a continuum and a victim teated for heat exhaustion should be monitored for worsening condition eg: heat stroke. But your point about early intervention is well-taken.
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CAP Talk  |  Operations  |  Safety  |  Topic: Cold water immersion for heat stroke
 


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