Emergency Procedures & Primary

Care in Physical Therapy

ENVIRONMENT-RELATED
CONDITIONS
HAFSA SYED
Lecturer Physiotherapy @ NIPRM
ENVIRONMENT-RELATED
CONDITIONS
Outline
Heat related emergencies and their prevention
Cold related injuries
Lightning
Altitude related emergency
ENVIRONMENT-RELATED
CONDITIONS
More Physically active individuals participation in outdoor
athletic activities results, increase in environmentally related
illnesses.
Heat-related illness, hypothermia, lightning strikes, and high
altitude illnesses are multi system emergencies that require
IMMEDIATE, specific therapy treatments.
ENVIRONMENT-RELATED
CONDITIONS
Heat Exposure illness including heat exhaustion and heat stroke
Cold exposure and illness including hypothermia and frostbite
Severe thunderstorms and lightning emergencies
Altitude illness including acute mountain sickness
Prevention and care of environmental emergencies
HEAT-RELATED
EMERGENCIES
Claims the lives while it is preventable of sports related health
problems

Controlled by Simple measures and proper education of health

care professionals and coaching staff
 HEAT-RELATED EMERGENCIES

Body Temperature Regulation

Body depends on water for normal function
Long duration of sweating or excessive sweating without fluid
replacement could be dangerous
Muscles work during exercise results in tremendous amount of
heat generation
HEAT-RELATED
EMERGENCIES
Efficient function of many of the body’s various organs and
system require that core temp: be maintained
As the body core temp: rises and water and electrolytes
deplete, heat illnesses can become a reality if immediate proper
care does not take place
HEAT-RELATED
EMERGENCIES
Heat Cramps
First stage of heat-related emergencies
Occur mainly in the leg area such as the calf and hamstring
muscles.
Recognized by intense pain with persistent muscle spasms in
the working muscle during prolong exercise
HEAT-RELATED
EMERGENCIES
Heat-Cramps; cont..
Thought to be caused by muscle fatigue with rapid water and
electrolyte loss via the sweating mechanism
Other factors may include less-efficient sweat mechanism and
excessive sweating; irregular meals, resulting in less than
optimal electrolyte stores; and a history of cramping.
Weight loss between practice sessions should be kept to only 2%
to 3% of the athlete’s pre-practice bodyweight, or less if at all
possible. Excessive weight loss of approximately 5% or more of
an athlete’s body weight during one practice session should be
closely monitored; activity limits should be strongly considered
for these athletes until they have replaced their fluid losses.
Before and after athletic events, including practices, during
warm weather months the athletic trainer should use weight
charts to track weight changes. It is commonly recommended
that athletes drink approximately 15 ounces of fluid for every
pound of body weight lost during a practice session. These fluids
should also contain some electrolytes.
HEAT-RELATED
EMERGENCIES
Heat Exhaust
Conditions where the body is near to total collapse because of
dehydration elevated core temperature.
Not considered as medical emergency, although it is a serious
condition and considered to be a precursor to heat stroke
HEAT-RELATED
EMERGENCIES
Heat exhaust cont..
An athlete suffering from heat exhaustion, the body’s cooling
mechanism will remain intact but are no longer functioning
efficiently
The sign and symptoms are progressive in nature and health-
care professionals should take notice of them as soon as the
athlete exhibits any of the signs
 HEAT-RELATED
EMERGENCIES
Heat Stroke
The most severe heat-related condition
Involves a breakdown of the body’s heat regulation mechanism
resulting in a dangerously high core temp.
The most notable symptoms of heat stroke are hot and red-colored
skin.
HEAT-RELATED
EMERGENCIES
Common misconception that a victim will first suffer from heat
exhaustion before heat stroke. This can occur , NOT ALWAYS.
HEAT-RELATED
EMERGENCIES
Prevention of Heat-Related Emergencies
Recognition of all environmental factors and on site emergency
action plan (EAP)
Conduct pre-participation physical examination; athletes
MAYBE predisposed to heat illness
Educate athletes and coaches
Practice and game guidelines for weather
HEAT-RELATED
EMERGENCIES
Consider practice and game times with respect to weather
Ensure sufficient fluid replacement is available and consumed
before, during and after athletic activities.
Weight athlete before and after athletic activities when weather
is hot and humid
COLD-RELATED
EMERGENCIES
Serious health conditions can result from prolonged exposure
to cold weather. The most common cold-related emergencies
are hypothermia and frostbite. Signs and symptoms for cold-
related emergencies, especially hypothermia, can be subtle, and
an accurate diagnosis often is difficult because they can occur
even when temperatures outside are not considered very low.
Cold-related emergencies occur when the body is unable to
protect itself from the outdoor environment.
Inadequately clothed athletes are at risk for accidental cold
injuries caused by prolonged exposure to low air temperature,
humidity, and wind.
Clothing made wet as a result of perspiration from activity or
from wet weather conditions may also contribute to an athlete’s
risk. Exposed body parts not protected by clothing are
particularly susceptible to freezing in frigid temperatures.
Hypothermia
Hypothermia is a condition in which the body’s temperature
becomes dangerously low.Many of the body’s organs can be
damaged by hypothermia. Normal body temperature ranges
between 97.2°F and 99.5°F. If the body temperature is just a
few degrees lower than this, bodily functions tend to slow
down and become less efficient. If the body temperature drops
too low and stays low for more than a couple of hours, the
body’s organs can begin to shut down, and death will
ultimately result.
Rewarming the athlete must be done slowly to prevent a rush
of blood to the surface of the body away from the vital organs
that need blood.
The duration of the effects of hypothermia depends on how
badly the athlete’s organs have been damaged.
In many cases the athlete will recover in 3 to 12 hours with
treatment. In some cases, hypothermia can result in permanent
disability or death.
Frostbite
Frostbite is a medical condition in which the nerves, blood
vessels, and other cells of the body are temporarily frozen by
exposure to cold temperature.
Frostbite commonly occurs at the extremities: toes, fingers, tip
of the nose, earlobes, and cheeks.
Frostbite comes in three different levels of severity
1. Frostnip: skin appears white and waxy. There is possible
numbness or pain in affected areas. No skin blistering occurs.
2. Superficial frostbite: skin appears white, blue, or gray.
Superficial skin feels hard but deeper tissue is soft and
insensitive to touch. This is a serious medical condition;
permanent damage is imminent. Skin blistering to affected areas
is possible.
3. Deep frostbite: skin is white or blue and has a hard, wooden
feel. The tissue underneath is hard and cold to touch. The entire
area is numb. Skin blistering occurs to affected areas. It is a life-
threatening emergency because of probable hypothermia and
later risk of infection to affected body parts.
Prevention of Cold-Related Emergencies
1. Have a wind chill chart on hand to determine the possibility of
hypothermia or frostbite.
2. Dress in layers.
3. Cover the head to prevent excessive heat loss.
4. Stay dry by wearing breathable and water-repellent clothing
materials.
5. Stay adequately hydrated before and during activity.
6. Eat regular and nutritious meals so the body is well fueled and
therefore more efficient; this also ensures adequate calories
available for shivering.
7. Avoid alcohol and nicotine because they accelerate heat loss.
8. Educate athletes, coaches, officials, and parents to recognize
cold-related emergencies.
9. If unsure whether an athlete is suffering from hypothermia
and/or frostbite, always stay on the side of caution and treat
LIGHTNING
LIGHTNING
Most consistent and significant weather hazard that may affect
athletics.

The chance of being struck by lightning is very low, if proper

safety precautions are followed.

Many peoples do not understand how lighting strikes occur and

how to reduce their risk.
Five Mechanisms of Lightning Injuries:
1. Direct strike: most commonly occur to the head, and
lightning current enters the orifices.
2. Contact strike: most occurs when the lightning victim is
touching an object that is in the pathway of the lightning
current.
3. Side flash: most commonly occurs when the lightning
strikes an object near the victim and then jumps from the
object to the victim.
4. Ground current: most commonly occurs when the lightning
current flowing in the ground radiates outward in waves from
the strike point.
5. Blunt injury: Most commonly occurs when the lightning
current causes violent muscular contractions that throw victims
a distance from strike point.
Guidelines on Lightning Safety
Establish a chain of command that identifies who is to make
the call to remove individuals from that athletic field.
Have a means to subscription to a weather monitoring system
to receive forecasts and warnings
Designate a safe shelter for each outdoor venue. A safe shelter
should be a building with four solid walls, electrical wiring,
and plumbing, all of which aid in the grounding of the
structure.
Use the flash-to-bang count to determine when to go safety.
Wait at least 30 minutes after the last lightning flash before
resuming a activity
Avoid being, or being near, the highest point in an open field. Do
not take shelter under or near trees, flagpoles, or light poles.
For those individuals who are caught in the open and who feel
their hair stand on end, feel their skin tingle, or hear “crackling”
noises, assume the lightning safety position. This position
includes crouching on the ground, with weight on balls of the
feet, feet together, head lowered, and ears covered
An individual should never lie flat on the ground.
Observe the emergency first aid procedures in managing victims
of a lightning strike
All individuals have the right to leave an athletic site to seek a
safe shelter if the person feels in danger of impending lightning
activity—without fear of penalty from anyone.
Blue sky and the absence of rain are not protection from
lightning. lightning can, and does, strike as far as 10 miles away
from the rain shaft. It does not have to be raining for lightning to
strike
ALTITUDE-RELATED
EMERGENCIES
ALTITUDE-RELATED
EMERGENCIES
In high-altitude sports participation, the most obvious change is
an increase in pulmonary ventilation, which can give the
feeling of being out of breath. The response is highly variable
among athletes and may not be felt for a few days. Because
there is less oxygen in the atmosphere at altitude, the heart rate
in an athlete may be elevated to increase cardiac output and
maintain an adequate oxygen supply to the body, both at rest
and during exercise.
Acute Mountain Sickness
Common in athletes who ascend from near sea level to altitudes
higher than approximately 3000 m, but it may occur in altitudes
as low as 2000 m.
General symptoms for acute mountain sickness are characterized
by headache, lightheadedness, breathlessness, fatigue, insomnia,
loss of appetite, and nausea. Usually, these symptoms will begin
2 to 3 hours after the athlete has reached peak ascent, but the
condition is generally self-limiting and most of the symptoms
disappear after 2 to 3 days
The best way to prevent acute mountain sickness is by
ascending gradually and allowing for acclimatization.
Acclimatization is the process of the body adjusting to the
decreasing availability of oxygen. Some authors suggest that
with any ascent to an altitude above 3000 m, there should be a
2- to 3-day rest before further heavy athletic activity occurs.
Treatment of acute mountain sickness by oxygen or descent is
not usually required; aspirin, or ibuprofen may relieve most
headaches.
High-Altitude Pulmonary Edema
Another form of altitude illness is high-altitude pulmonary
edema, or fluid in the lungs. Although it often occurs with
acute mountain sickness, it is not felt to be related and the
symptoms for acute mountain sickness may be absent.
Causes of the edema are not clearly understood; it may have to
do with changes in cellular permeability in some people at
altitude. Signs and symptoms of high-altitude pulmonary edema
may include extreme fatigue, breathlessness at rest, severe
cough with sputum, gurgling breaths, chest tightness, and blue-
or gray-colored lips and fingernails.
The treatment for high-altitude pulmonary edema is immediate
descent to a safe altitude level. This must be done with the
utmost urgency. Delay may be fatal.
A safe altitude is usually described as the last elevation where
the athlete felt well on awakening from a restful sleep.
Oxygen should be administered if available. Medications may
be given by a physician to help relieve the symptoms of high-
altitude pulmonary edema.
High-Altitude Cerebral Edema
rare but potentially serious, even fatal. It is defined as a
condition in which the brain swells and ceases to function
properly.
Like high-altitude pulmonary edema, the cause of high-altitude
cerebral edema is poorly understood but is again likely related to
changes in cellular permeability.
Once high-altitude cerebral edema is present, it can progress
rapidly and can be fatal within a few hours. Athletes with this
illness are often confused and may not recognize that they are ill.
The classic sign of high-altitude cerebral edema is a change in
mental status. Signs and symptoms may include confusion,
changes in behavior, unusual or irrational behavior, and
lethargy.
It may be easier to recognize a characteristic loss of
coordination called ataxia. This is a staggering walk that
resembles the way a person walks while intoxicated on alcohol.
The most extreme cases of high-altitude cerebral edema may
involve the athlete going into a coma with death occurring
within hours.
The treatment for high-altitude cerebral edema is descent to a lower
altitude as quickly as possible. Oxygen should be administered if
available. Medications can be given by a physician to decrease the
severity of the symptoms.
Athletes with high-altitude cerebral edema sometimes recover rapidly
after descent to a lower and safer altitude. Practicing sports medicine in
high-altitude environments can be challenging for the athletic trainer.
Medical conditions related to the altitude require additional training and
experience because they can be unique to the standard practice setting.
As sport medicine knowledge progresses, the athletic trainer will have
increasing resources to better serve the athlete at high altitudes.