Environmental Emergencies – Bites, Stings, Poisoning & More…

environmental emergencies
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Environmental Emergencies are emergencies arising from the surrounding environment. These typically include bites and stings, poisoning, envenomation, intoxication, as well as hyperthermia and hypothermia triggered by environmental exposure.

Bites & Stings Environmental Emergencies

environmental emergencies
Retrieved from https://www.communityhikingclub.org/information/what-bit-me/ on 10th October 2022

Bites and stings are considered to be environmental emergencies resulting from insect stings, animal bites, human bites, fish stings, and jelly fish stings. Possible complications to bites and stings include pain, bleeding, infection, envenomation, and anaphylaxis.

Bites & Stings Signs & Symptoms

  • bite marks
  • bite wounds
  • localised pain
  • localised tenderness
  • redness, swelling and warmth to touch – indication of inflammation & possible infection: check casualty’s temperature to confirm

First Aid for Bites & Stings

  1. take necessary precautions – assess possible dangers and wear gloves
  2. provide reassurance
  3. assess for any ABC compromise
  4. identify signs of anaphylaxis or envenomation
  5. provide first aid based on casualty’s condition or injury
  6. call 112
  7. monitor casualty for possible respiratory compromise or development of shock

For Animal & Human Bites…

  1. control bleeding by applying direct pressure on site
  2. once bleeding is under control, wash wound with soap and water to get the wound clean from any saliva etc.
  3. rinse wound thoroughly
  4. cover with a clean dressing or if unavailable, a clean cloth or clothes
  5. take or send casualty to the hospital or to a health centre to be reassessed

For Snake or Spider Bites…

  1. limit casualty’s movements
  2. lower bitten area
  3. wash bitten area gently with soap and water to remove any saliva
  4. irrigate area but DO NOT RUB and DO NOT USE ANY TOURNIQUETS
  5. provide stabilisation of the bitten limb so that chemical absorption is slowed down

For Insect Stings…

  1. limit casualty’s movements
  2. remove any embedded sting or insect part by scraping the area gently with a credit card or a knife (using its blunt side)
  3. wash area gently with soap and water
  4. apply ice over stung area to promote vasoconstriction
  5. DO NOT USE ANY OINTMENTS
  6. monitor for signs of inflammation and/or infection eg. for Lyme Disease following a tick bite

For Jelly Fish Stings…

  1. irrigate stung area with white vinegar so as to stop the chemical reaction on the skin; if unavailable use sea water or saline to irrigate…DO NOT USE FRESH WATER!
  2. using forceps or tweezers remove any visible remaining tentacles from the skin’s surface
  3. monitor ABCs
  4. watch out for possible signs of anaphylaxis, envenomation, and shock

For Fish Stings…

  1. remove any visible remaining pieces of the fish’s stinger
  2. irrigate area with water
  3. immerse wound area in hot water for a minimum of 30 minutes so as to kill the enzymes found in the venom; this stops absorption and spreading of the venom throughout the body
  4. help casualty into a supine position, keeping immobilised the affected limb

For Sea Urchins…

In the case of sea urchins DO NOT ATTEMPT TO TAKE STINGERS OUT! Help the casualty to the hospital or health centre since a cream may be prescribed to help the skin expel any sea urchin remaining pieces.

For Contact Irritants…

  1. scrub and irrigate wound bed with sea water or saline water
  2. remove any visible debris
  3. cover wound if required
  4. monitor casualty for signs of infection such as swelling, redness, pus and fever, in which case encourage casualty to seek medical advice

Poisoning, Envenomation and Intoxication

environmental emergencies

Poisoning happens when one eats something poisonous, and in return gets poisoned.

Envenomation happens when venom penetrates the skin by means of a snake bite, scorpion sting, spider bite, or any other environmental factors. While venom is not always lethal, it can still lead to complications.

Intoxication happens when one self-ingests or self-injects a chemical, such as alcohol and drugs, which are toxic to the body and thus may cause severe consequences.

Poisoning, envenomation and intoxication can happen through 4 different modes of entry, namely through inhalation, ingestion, absorption, or injection.

Poisoning Signs & Symptoms

  • history
  • visible signs surrounding casualty eg. drug/poison containers, used syringes, drug-abuse related material
  • needle marks
  • animal bite marks

Respiratory Signs & Symptoms…

  • burns
  • odours
  • stains around mouth
  • coughing
  • dyspnoea
  • respiratory distress

Circulatory Signs & Symptoms…

  • sweating
  • fainting
  • shock
  • discomfort in chest area

Digestive Signs & Symptoms…

  • nausea and vomiting
  • abdominal discomfort and/or cramping
  • diarrhoea

Consciousness Signs & Symptoms…

  • headache
  • dizziness
  • drowsiness
  • confusion
  • altered level of consciousness
  • pupillary changes eg. dilation or constriction of the pupil/s

Poisoning First Aid

  1. use the S.A.F.E. approach
  2. if casualty is responsive, establish cause of poisoning, monitor, and be prepared to resuscitate if needed
  3. if casualty is unresponsive but breathing, put in recovery position
  4. if casualty is unresponsive and not breathing start CPR
  5. call 112 for medical assistance
  6. DO NOT ADMINISTER ORAL FLUIDS as that would dilute poison
  7. DO NOT INDUCE VOMITING
  8. DO NOT WASTE TIME trying to identify type of poison if uncertain
  9. DO NOT SUCK ANIMAL VENOM OUT OF WOUND
  10. DO NOT APPLY A TOURNIQUET or compression bandage

Alcohol & Drugs First Aid

  1. use the S.A.F.E. approach
  2. provide first aid for any injuries incurred
  3. if casualty is unresponsive but breathing, assist in recovery position
  4. if casualty is unresponsive and not breathing, resuscitate by performing CPR
  5. if casualty is responsive with altered level of response, call 112 for medical assistance since this indicates intoxication

Hyperthermia & Hypothermia Environmental Emergencies

environmental emergencies
Retrieved from https://www.mymed.com/diseases-conditions/hyperthermia on 10th October 2022

Temperature extremes a.k.a. hyperthermia and hypothermia can be incurred either through environmental exposure or else as a disease process. They are both considered to be environmental emergencies.

NOTE: For accuracy purposes, core temperature should always be measured either rectally or through the ear by infrared.

Thermoregulation factors include:

  • illness
  • awareness
  • age
  • nutrition
  • infection
  • substance misuse
  • environmental conditions

Hypothermia Indications

  • core temperature of 20 = increased risk for cardiac arrest
  • core temperature of 25 = increased risk of cardiac arrhythmias
  • core temperature of <30 = severe hypothermia
  • core temperature of 30-32 = moderate hypothermia
  • core temperature of 32-35 = mild hypothermia
  • temperature <35oc
  • cold pale skin
  • uncontrollable shivering which may eventually stop
  • rapid pulse which eventually decreases
  • slow breathing
  • cyanosis
  • slow and uncoordinated reflexes
  • altered level of consciousness
  • loss of consciousness
  • respiratory arrest
  • cardiac arrest

Hypothermia First Aid

  1. cover casualty and take any necessary environmental considerations
  2. assist into a comfortable position to reduce respiratory effort
  3. if available administer high-concentration oxygen
  4. call 112 and ask for an ambulance since hypothermia can only be properly treated in a hospital environment
  5. monitor casualty and be prepared to resuscitate if necessary

Hyperthermia Indications

  • temperature of >37 = pyrexia = risk of heat exhaustion
  • temperature of > 40.6 = hyperpyrexia = risk of heat stroke
  • temperature of > 42 = increased risk of irreversible brain injury

A casualty with heat exhaustion…

  • temperature of >37
  • sweating
  • thirst
  • headache
  • dizziness
  • nausea
  • vomiting
  • weakness
  • fainting
  • rapid pulse

A casualty with heat stroke…

  • temperature of >40
  • heat exhaustion signs as per above PLUS
  • disorientation
  • confusion
  • altered level of response
  • seizures

Hyperthermia First Aid

  1. assist casualty in a cool area to rest
  2. elevate casualty’s legs
  3. apply cold tepid sponging
  4. promote rehydration
  5. call 112 in case of severe heat exhaustion signs OR if symptoms do not lessen within 30 mins OR in case of heat stroke symptoms

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Claire
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Author: Claire

Claire Galea is a mum of three currently in her final year following a Degree in Nursing at the Faculty of Health Sciences, University of Malta, as a mature student. Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading awareness on the negative effects that domestic abuse leaves on its victims’ mental, emotional, social and physical wellbeing. Claire aspires to continue studying following completion of her Nursing Degree, because she truly believes in lifelong education.