Cold Weather Trauma - Expose?

RedAirplane

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I just saw a video about a rescue on a cold mountain, and I started thinking-- if I ever have to do that, how do I go about the rapid trauma assessment?

In such a situation, two of the steps in the procedure would contradict each other-- (expose patient and assess/backboard prior to moving vs. treat for shock).

When taking tests etc for EMT class I would say "expose patient, cover with blanket," but I somehow would feel like an idiot removing layers and layers of winter clothing only to put on a thin blanket.

Thoughts?

Thanks,
New EMT
 

cruiseforever

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I try to get them out of the weather as soon as possible. I do not remove any clothing until I have them in the back of the ambulance. As I write this I am picturing it is below zero.

Make sure the airway is open and the pt. is breathing, major bleeding is controlled. Out side of that I feel there is very little you can do for the pt when it is that cold staying outside.
 

Tigger

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I am having a hard time coming up with a good reason to expose a patient that you aren't doing CPR on when it's that cold. If they're conscious it shouldn't be a big deal. If you can't get the answers you need, expose in parts very quickly I suppose.
 

EpiEMS

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You can do assessment without cutting clothes.

^This.

ABCs can be assessed (remember to check for hemorrhage as part of your "C" assessment) without too much removal. I suggest a blood sweep-type technique under the clothes, as shown in the video.

If there's a warm area available, don't bother doing much exposing until you can place the patient there...barring ABC threats.
 
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RedAirplane

RedAirplane

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Thanks.

So, when would you expose a patient?

In EMT class we defaulted to trauma naked as part of the C in ABC. Why expose if you can do your assessment clothed?
 

Tigger

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Get them to the ambulance/warmth, then expose.
 

Aprz

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Using sound judgement is going to supersede everything you learn in EMT school. You will not always be able to completely do things in the order that the NREMT wants you to. Do what you can.

At your school, are you learning to size up the scene by doing:

BSI
Scene safety
Mechanism of injury
Number of patients
Consider need to additional resources
C-spine

Or are you using ENAMES? The 2nd E is extrication, which some schools use too. In this case, I would consider this an extrication issue. You need to move the patient to a warmer area to do a better assessment. This is true with everyday type of calls too such as a patient being in a small room, narrow hallway, or in a vehicle where you need to move them to a better spot to assess them. This is also true if you are in a public place and should move the patient to give them some privacy too. You need to think about things to do that can make it easier to assess the pt such as turning on the lights, moving furniture, or changing the patient's position.

*ENAMES: environment (scene safety), number of patients, additional resources, mechanism of injury, extrication, and spinal immobilization/stabilization.

Do a quick assessment with them with their clothes on. Move them to an area that's warmer such as the back of a rig or in a building, and then expose.

Many calls, you are not exposing the entire patient. You will be doing a focus exam. For example, if the patient is complaining of chest pain, you don't need to take ALL of his clothes off. You might just lift up their shirt or unbutton it, look and feel quickly, and then lower or rebutton their shirt.

When I took the NREMT, it wasn't throwing tricky questions or unreasonable things. It asked mostly pretty straight forward things. Don't over think these things too much for the test itself. If you haven't done a ride along yet or you have, you should have noticed that the people you were with probably didn't do things exactly to the book of NREMT. Sometimes things were done in different order or delayed. I think the biggest most important things that are done are scene safety and ABC (pretty much scene size up and initial assessment), but pretty much scene safety and ABC are the most important of everything in my opinion and what is usually addressed the quickest.
 

climberslacker

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So to compound things, maybe too far (though it is 100% based on a call I ran).

BLS First Response, dispatched to a slip-and-fall on ice. It is currently -2*F outside, in a parking lot, at midnight.

Patient experienced loss of consciousness and complained of neck pain. I decided to do my assessment with removing as few clothes as possible before immediately covering her up and giving her a blanket. I began backboarding her and was criticized that because of the layers of hoods/hair/etc my C-collar was not on appropriately and the straps weren't tight enough.

What would you do in this situation? Hold off on the backboard until the ambulance comes? Strip, then backboard and cover?
 

OnceAnEMT

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I would hold off on boarding in that situation until I knoa that as soon as we are done boarding the patient will be taken to the warm ambulance. You won't get anything out of getting her cold then on a cold board early. Your blankets are nothing compared to her jackets.
 

vcuemt

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Thanks.

So, when would you expose a patient?

In EMT class we defaulted to trauma naked as part of the C in ABC. Why expose if you can do your assessment clothed?
In my opinion - within the strict confines of the class - your primary circulatory concern with a patient in a dangerously cold environment is to remove them from that environment.
 

irishboxer384

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I just saw a video about a rescue on a cold mountain, and I started thinking-- if I ever have to do that, how do I go about the rapid trauma assessment?

In such a situation, two of the steps in the procedure would contradict each other-- (expose patient and assess/backboard prior to moving vs. treat for shock).

When taking tests etc for EMT class I would say "expose patient, cover with blanket," but I somehow would feel like an idiot removing layers and layers of winter clothing only to put on a thin blanket.

Thoughts?

Thanks,
New EMT

I'll chip in here as a cold weather warfare/survival instructor. First of all it's a very open ended question- is the pt accessible by vehicle, on foot, helicopter access? How cold is it? Uncovering a patient in mild chill... compared to -40 are two very different things. Is there more severe weather due in? What happens if you are halfway through your assessment but the weather conditions can severely deteriorate within minutes- is your patient then going to be more at risk from dying of cold-weather injuries rather than trying to immobilise perfectly?

Iff you feel getting the patient fully naked to perform an assessment will not present any further risk to him/her- then do it, if you feel there is too much exposure to the elements then you'll have to use your own judgement how to perform the assessment.

If moving the patient 15 feet behind a large rock to get him/her out of the wind then do it, THEN do your assessment...the possibilities are endless.

As @Aprz stated using sound judgement comes into play...especially with more obscure environments and patients. You cannot cover the what-ifs for EVERY possible patient, but it is excellent you are taking your own time to at least think about it.
 
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RedAirplane

RedAirplane

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I would hold off on boarding in that situation until I knoa that as soon as we are done boarding the patient will be taken to the warm ambulance. You won't get anything out of getting her cold then on a cold board early. Your blankets are nothing compared to her jackets.

Hypothetically, if you had a long transport (30 min) by foot to the base of the mountain where the road/ambulance was, would you board them with their clothes on?
 

OnceAnEMT

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Hypothetically, if you had a long transport (30 min) by foot to the base of the mountain where the road/ambulance was, would you board them with their clothes on?

This situation went from parking lot to dire. :p Cutting some slits at the top of the jackets if I am truly suspecting Cspine and needing a ccollar. Pt will be in a ferno or stokes basket, not on a backboard. Not dragging a backboard through snowy mountain. Going to need some webbing for the basket, and quite possibly some equipment for a lowering system.
 
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