Heat injuries and hyperthermia

LucidResq

LucidResq

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Hello everyone. I'm going to be working at a busy amusement park this summer. The place is mostly paved with black, and in the sunny, hot and very dry Colorado summer... well you can imagine how many people overcook. I've been told that I will have requests for band-aids and heat injuries more than anything else this summer. Not surprised.

Just wanted to open a discussion on heat injuries/illness. Heat exhaustion, heat stroke, sunburn, dehydration, etc.

Assessment or treatment tips anyone? Suggestions? Stories?
 
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Be aware of hyponytremia. Lots of people drink water but few splurge for food while at parks.
 
Just the usual;

Coldpacks for under armpits/groin

Gatorade cut with water for exhaustion
 
i work at a pretty busy flea market. and it can get pretty crazy during the summer. i found that instead of using cold packs, i bought a pack of cheap wash clothes from walmart and we have 2 small coolers that i would fill with ice water and stick a few of the cloth's in each one. i kept one on my cart and either kept the other in the first aid station or gave it to one of the troopers there working security(most of the time they got there before i did since it's only one emt or medic and 2 of them) then all you have to do is get them washed. that way you can just use the cold packs for sprains.

i got to know the fd pretty quick cause of all the times they had to come out there to transport.
 
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LucidResq said:
Hello everyone. I'm going to be working at a busy amusement park this summer. The place is mostly paved with black, and in the sunny, hot and very dry Colorado summer... well you can imagine how many people overcook. I've been told that I will have requests for band-aids and heat injuries more than anything else this summer. Not surprised.

Just wanted to open a discussion on heat injuries/illness. Heat exhaustion, heat stroke, sunburn, dehydration, etc.

Assessment or treatment tips anyone? Suggestions? Stories?
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So many stories I could write a book. I did a summer of amuzement park EMS.

Start by looking at the extrance pass. Everything it says not to do, people will do. Even had a heart transplant patient go into vtach on a roller coaster. he got a helo ride followed by admit to the ECU

You will need to hand out a lot of band aids. Get good at treating blisters. For some reason people always buy new shoes to wear at the park for the first time.

Depending on park size, you will see a lot of heat illness. We averaged 68 a day. We treated most things on site, had very inclusive protocols and the goal was not to go to the hospital unless absolutely required. We were also responsible for employee health, including drug tests, HCG tests, etc.

You will get real familiar with OTC meds. What's in them, what they do, how well they work.

Many people also don't consult their doctor before a new workout routine. At the park I was at 1 lap was 4 miles. You will see the most outrageous heart rythms. Particularly in the older set that brought the grandkids.

Beer and chips and nachos Oh my...
Nobody eats a decent meal all day, starting about 3pm you will have extremely dehydrated people. People who have spent all their money and have hours to drive home. So you will have to find creative ways to feed them.

KEDs work great for extricating out of rollercoaster.

I could go on for days. But remember what an amuzement park really is:

Giant industrial machines, water, sun, and alcohol. It is a winning combination.

Oh and of course the most important advice:

"Do not sit on the Que Line!!!"

for it was not designed to support your weight and when it collapses it will penetrate your urinary bladder via your buttox and that needs to be fixed.
 
Veneficus said:
Depending on park size, you will see a lot of heat illness. We averaged 68 a day. We treated most things on site, had very inclusive protocols and the goal was not to go to the hospital unless absolutely required. We were also responsible for employee health, including drug tests, HCG tests, etc.
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I was told that they peak at about 15,000 - 20,000 people daily. How big was your park?

We don't do drug testing or HCG or anything like that, but we do handle all worker's comp stuff. That I am not looking forward to... especially the paperwork.

I've worked medical tents at marathons so I feel like that experience is pretty relevant... thousands of exhausted people with lots of blisters, heat issues, and one year... cold injuries.

Veneficus said:
"Do not sit on the Que Line!!!"

for it was not designed to support your weight and when it collapses it will penetrate your urinary bladder via your buttox and that needs to be fixed.
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Ouch. :wacko:
 
LucidResq said:
I was told that they peak at about 15,000 - 20,000 people daily. How big was your park?
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6000 onsite employees (about 1000 from other countries) average 80K per day guests. Our top day that year was 140K in one day.

LucidResq said:
We don't do drug testing or HCG or anything like that,
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Too bad, the everyday health stuff is pretty interesting.

LucidResq said:
but we do handle all worker's comp stuff. That I am not looking forward to... especially the paperwork.
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I did that at 2 places, better you than me. It is kinds cool to sign sick notes though. Makes you feel important, like a doctor.

LucidResq said:
I've worked medical tents at marathons so I feel like that experience is pretty relevant... thousands of exhausted people with lots of blisters, heat issues, and one year... cold injuries.
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Very much so, in my experience it was like providing medical care to a small town.
 
No kidding, we ought to publish an E book or something

Coming as a RN from Guard exercises, lifeguarding at 7,000 feet and event first aid for cheerleaders/jr high football players and girl scouts, I'm once again hearing most of what I already learned from the responses above, and then some.

Watch out for people who zoom up to your altitude from far below, they get tired, they get really drunk, and they do stoopid things.

Hot but breezy days, especially at altitude, can be killer dehydrators because folks don't feel so overheated/thirsty. Slightly overcast days especially when it is cooler and/or breezy, can produce magnificant sunburns!

SUNBURN: coool em off, get water into em. If not shocky, advil and the green generic aloe with lidocaine topical is good. Advise they go to a good movie instead of back to the heat etc.

LOOK at people: while they stand in line, as they walk up to you, after you have treated them and they are ready to continue the day. If you have life guarded, you know you can spot some folks as going to need help, or more help, or help later on. Follow your "spidey sense".
PS: use search about hyperthermia, cooling, firefighter remediation, water parks etc.
PPS: hope you get some cute co-workers.;)
 
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If i wrote a book, the names would have to be changed to protect the guilty.
 
Of Course!

I have worked the past few summers at a classical music venue in a fairly rural area. The towns and cities in the area swell 10x in population size over the summer, and we hake between 5,000 and 25,000 patrons on the grounds 4 nights a week. Our average patron age is increasing, steadily, and we get a lot of dehydration, syncopals, slip/trip/falls, etc.

We have found that careful observation and skillful neglect are the best policies. We send a lot of syncopals to the hospital, especially if the patient is elderly and with a cardiac hx. Otherwise, we observe in the cool shade (with an RN), and release after all feel comfortable. Make sure you have good policies for RMAs, documentation, etc.
 
Scout said:
Personal story?

Whats a que line.????
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que is short for queue, as in to wait or line up. For some reason at the park we called the line you stand in waiting for the ride a queue. (but on all the paperwork we shortened it to que, don't know if the British would approve :) but that is what we did) But you couldn't go ten feet during park hours without hearing a ride operator announcing not to sit on the rails that formed the queue line.

One of the heavier patrons was sitting on the aluminum bar when it folded and broke. One of the broken pieces penetrated his urinary bladder from the buttox about 4 cm superior lateral from his anus. When we got there he had urine leaking from both holes. (there were also many jokes if you sit on the que you will be chewed a new hole)

Scout said:
Are you allowed to give dehydration drinks instead of just water?
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We used lemon gatorade PO diluted 50/50 with water. Commonly in the heat exhausted after a cup or 2 they would vomit, (common occurence) drink another cup and feel good as new, go back out to the park promising to lay off the nachos coke and beer and drink more water. (which was free as long as it was in a cup not a bottle)

Actual heat stroke was rare, but usually employees who were working in buildings that were not airconditioned and making hot food. In my 40-50 hour work weeks from may to october, I think I saw 3, but it was almost 7 years ago so I may have left one out.

Even the basics could hand out OTC meds, we had all kinds, from burn aloe to tylenol, dramamine, fem releif (the best OTC headache medicine ever I must say), immodium, (we don't like anything with bismol as it turns stool black and starts a GI workup at the hospital) and just about any other you can think of. As a learning experience I can still spout out the doses for many of them from memory, as well as combination ones like midol, nyquil, etc.

everyone shold try to work at a park if they have the opportunity. In addition to an interesting experience, it really is a lot of fun.
 
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Kids and the elderly are most at risk because they regulate body temp less well. Prevention is key. I would see if the park would be interested in lowering the instance by posting information regarding dehydration and hypothermia. A hand out at the gate with posters throughout might help, also could increase sales of water within the park.

I'd be a bit concerned about handing out ice cold cloths. The general rule with both hyper and hypothermia is not to give extreme treatment but a more gentle change. Lukewarm water is going to feel cold to someone with hyperthermia. It is the evaporation of the water from the skin that cools, not the temp of the water itself. Unless you are talking someone dangerously close to heat stroke, a gentle slow cooling off is going to be equally effective but less stressful.

Also, a wet T-shirt is going to cool someone off faster than wetting naked skin. I am also not a big fan of gatorade and its cousins. Most of the people at the park are not super athletes who have depleted their electrolytes through copious sweating. Gatorade can be very irritating to the stomach and its also full of sugar. Water is the best rehydrator unless you just ran a marathon or engaged in some other long term, ultra strenuous activity. It's not going to rehydrate the person if it only spends a minute or two in their stomach and then comes back out to decorate the pavement.

Cold packs are over-rated. They are expensive, they don't last very long and you need to make sure they are not left in place for more than 10 - 15 minutes. Cool (not icy)water on a cloth and some air flow across the wet area is going to work much better. Save the cold packs for the more extreme cases.
 
Well, Lucid, update us!

Any "good saves", "bonehead newbie moves" or anything else to share with us? Hmmmmmm?;)
 
BossyCow said:
Cold packs are over-rated. They are expensive, they don't last very long and you need to make sure they are not left in place for more than 10 - 15 minutes. Cool (not icy)water on a cloth and some air flow across the wet area is going to work much better. Save the cold packs for the more extreme cases.
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...but if the job is at any sort of park with a concessions stand, commercial cold packs are stupid for general use anyways. When I worked at a water park we kept a small ice chest full of ice in first aid to make ice packs for simple injuries. The only time I used commercial cold packs was if I was in the field treating someone, which was rare.
 
mycrofft said:
Any "good saves", "bonehead newbie moves" or anything else to share with us? Hmmmmmm?;)
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I have become an expert at splinter removal, and I really wish I still had a handle on my taping skills from sports medicine because I saw this employee that totally had plantar fasciitis. You know, as far as I can "diagnose."

Nothing serious yet. I might be a white cloud. They've had crazy stuff on other shifts. Like a really drunk guy swan-diving into the shallow end of the wave pool... got all combative. That was a transport. ;)
 
When I worked at a doc in a box...

Ozzie Osbourne's crew were partying at the local water park (CalExpo) and trying to surf down the waterslides. One just flew off the top, landed on both feet and broke both ankles.

You using lg gauge hypo needles for splinter removal? Get some 16 or 14 gague-ers.
 
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