Signs and symptoms

• High body temperature. A core body temperature of 104 F (40 C) or higher, obtained with a rectal thermometer, is the main sign of heatstroke.
• Altered mental state or behavior. Confusion, agitation, slurred speech, irritability, delirium, seizures and coma can all result from heatstroke.
• Alteration in sweating. In heatstroke brought on by hot weather, your skin will feel hot and dry to the touch. However, in heatstroke brought on by strenuous exercise, your skin may feel dry or slightly moist.
• Nausea and vomiting. You may feel sick to your stomach or vomit.
• Flushed skin. Your skin may turn red as your body temperature increases.
• Rapid breathing. Your breathing may become rapid and shallow.
• Racing heart rate. Your pulse may significantly increase because heat stress places a tremendous burden on your heart to help cool your body.
• Headache. Your head may throb.

What causes heatstroke?

• Exposure to a hot environment. In a type of heatstroke, called nonexertional (classic) heatstroke, being in a hot environment leads to a rise in core body temperature. This type of heatstroke typically occurs after exposure to hot, humid weather, especially for prolonged periods. It occurs most often in older adults and in people with chronic illness.
• Strenuous activity. Exertional heatstroke is caused by an increase in core body temperature brought on by intense physical activity in hot weather. Anyone exercising or working in hot weather can get exertional heatstroke, but it’s most likely to occur if you’re not used to high temperatures.

In either type of heatstroke, your condition can be brought on by:

• Wearing excess clothing that prevents sweat from evaporating easily and cooling your body
• Drinking alcohol, which can affect your body’s ability to regulate your temperature
• Becoming dehydrated by not drinking enough water to replenish fluids lost through sweating

How to prevent heatstroke

Heatstroke is preventable and predictable.  Take the following steps to prevent heatstroke during hot weather:

• Wear loosefitting, lightweight clothing. Wearing excess clothing or clothing that fits tightly won’t allow your body to cool properly.
• Protect against sunburn. Sunburn affects your body’s ability to cool itself, so protect yourself outdoors with a wide-brimmed hat and sunglasses and use a broad-spectrum sunscreen with an SPF of at least 15. Apply sunscreen generously, and reapply every two hours — or more often if you’re swimming or sweating.
• Drink plenty of fluids. Staying hydrated will help your body sweat and maintain a normal body temperature.
• Take extra precautions with certain medications. Be on the lookout for heat-related problems if you take medications that can affect your body’s ability to stay hydrated and dissipate heat.
• Never leave anyone in a parked car. This is a common cause of heat-related deaths in children. When parked in the sun, the temperature in your car can rise 20 degrees F (more than 11 C) in 10 minutes. It’s not safe to leave a person in a parked car in warm or hot weather, even if the windows are cracked or the car is in shade. When your car is parked, keep it locked to prevent a child from getting inside.
• Take it easy during the hottest parts of the day. If you can’t avoid strenuous activity in hot weather, drink fluids and rest frequently in a cool spot. Try to schedule exercise or physical labour for cooler parts of the day, such as early morning or evening.
• Get acclimated. Limit time spent working or exercising in heat until you’re conditioned to it. People who are not used to hot weather are especially susceptible to heat-related illness. It can take several weeks for your body to adjust to hot weather.
• Be cautious if you’re at increased risk. If you take medications or have a condition that increases your risk of heat-related problems, avoid the heat and act quickly if you notice symptoms of overheating. If you participate in a strenuous sporting event or activity in hot weather, make sure there are medical services available in case of a heat emergency.

Treatment

• If you suspect someone is suffering from heatstroke then it is best to act immediately. Depending on your location, make contact with the emergency services ASAP (mobile phone, HF radio, UHF radio, satellite phone)
• Get the patient into the shade or indoors.  If there is no shade then you need to fashion some with whatever you have nearby.
• Remove excess clothing
• Cool the patient by whatever means available. Immerse in water, sponge with wet cloth or flannel, ice packs or wet towels on the patient’s head, back of their neck, armpits and groin.
• If you are remote and unable to call for help then get the patient to the nearest medical facility by the quickest means possible.

A snake bite is always fatal

This is NOT correct.  Snake venom is not a poison that kills its victim quickly.  Snake venom breaks down the internal organs, allowing the snake to then ingest it. For it to do significant injury to a human, it must first travel through the lymphatic system and enter the blood stream.

Left untreated, snake venom will result in serious complications and even death.

Snake venom travels through the body via the lymphatic system and only enters the blood stream once it has travelled along the bitten limb and enters through either the thoracic duct or subclavian vein (depending on what side of the body the patient is bitten).

The entry into the lymphatic system is directly related to the size of Australian snake’s fangs. They are quite small and only able to puncture the skin a short way.

Slow the flow

The lymphatic system uses MUSCLE CONTRACTIONS to move the lymph fluid around the body. By not moving, staying calm and applying compression to the affected area you will slow down the movement of lymph.

Pressure

The most effective treatment for snake bite is PRESSURE and IMMOBILISATION.  In the event of a snake bite, take the following steps:

1. Calm the patient. Sit them down as soon as it is safe to do so. Assure them that they are going to be OK and that by bandaging the bite you are slowing the movement of the venom to a trickle.
2. Have someone call 000 or make contact using what ever communications method you have.
3. Remove any watches or jewellery that the patient is wearing on the bitten limb. Remove their shoe and sock (if it is a leg bite) but DO NOT remove their pants as this will create excessive movement and speed up the movement of the venom.
4. Apply your first bandage. Start approximately 20 cm above the bite site and bandage DOWN the limb.  The pressure should be tight enough that you can push one finger under the wrapping. Each wrap should cover 50% of the width of the previous wrap.  Leave fingers or toes uncovered so that circulation can be monitored.
5. The SECOND bandage should start where the first started but you will bandage UP the limb.
6. Excess bandage should be rolled up and tucked into itself (do not continue wrapping the limb to use up excess bandage)
7. If the bite is on a leg then you may need a third bandage to be able to reach the groin.
8. Ensure you mark the bite site with a pen or marker directly onto the bandage. Also include the time of the bite and any known allergies (ask the patient) and include that in your bandage notes.

DO NOT TRY TO KILL OR CAPTURE THE SNAKE.

Check circulation

Once you have completed bandaging the limb, check the patient’s circulation by gently squeezing the blood out of a finger or toe.  Within 4 seconds you should see the blood return.  If the blood does not return or the patient reports the bandage is too tight or painful, remove and rewrap one bandage at a time.  Recheck the circulation.

What about the immobilisation?

Once you have completed the bandaging you need to ensure that the patient cannot move.

• If the patient was bitten on the leg, bandage their legs together.
• For an arm bite, consider securing their arm to their leg.

Keep your patient comfortable and DO NOT allow them to move.  They will need to be carried or another means of moving them found.

What about if the bite is not a limb?

The majority of snake bites will be on an arm or leg.  If the patient is somehow bitten on their body, face or neck then you must apply pressure immediately and seek medical assistance by the fastest possible means.  Where possible, apply a bandage but do not restrict the movement of the chest.

Snake bite myths

DO NOT:

• wash the bite site
• use a tourniquet
• elevate the limb
• apply an ice pack
• attempt to catch or kill the snake
• try and suck out the venom

Signs and symptoms of snake bite

It is not always obvious that someone has been bitten by a snake. The following symptoms start to manifest themselves once the venom has entered their blood stream:

• blurred vision
• abdominal pain
• headache, nausea and vomiting
• irritability and confusion
• blood coloured urine
• painful and tender muscles
• difficulty in breathing
• they may go into shock, collapse or become unconscious

How to avoid getting bitten

Not getting bitten should be everyone’s first priority.  There are some very simple things you can do to reduce your chances of getting bitten:

• Wear closed in footwear when bushwalking (thongs are NOT suitable footwear).
• Wear loose-fitting long pants or gaiters. Remember, Australian snakes have small fangs and cannot penetrate through material of pants or gaiters AND your skin.
• Use a walking pole or stick to probe in front of you if walking in long grass.
• Never approach a snake. We are much bigger than they are and they only want to get away from us.
• Stay calm and do not wave your arms around. Keep your feet grounded and shuffle backwards away from the snake.  Lifting your foot up could initiate a strike from the reptile.
• Avoid letting your shadow fall over the snake.
• Always carry a snake bit kit with you.
• Don’t reach under logs or place your hand into rock crevices.

Can I carry antivenom?

The simple answer is NO.  Snake antivenom can causes an allergic reaction in a small percentage of the population (which cannot be tested for) and therefore should only be administered at a medical facility.

Two types of bites

Snakes don’t always deliver venom when they bite.

A Dry bite involves the snake striking the patient but not releasing any venom.  They are almost always painful and will cause redness and swelling around the bite site.

A Venomous bite is the same as a dry bite but also involves the release of venom.

There is no way for you to tell in the field what sort of bite the snake has delivered. Treat all bites as venomous and apply pressure and immobilisation. Seek medical advise ASAP.

Remove

Remove all jewellery from around the burn area. Remove any clothing and nappies around the burn area unless stuck to the skin.

Cool

Cool the burn under cool running water for no more and no less than 20 minutes.

DO NOT use ice or creams as this can further damage the skin.

Cover

Cover the burn loosely with cling wrap or a clean, damp lint-free cloth

Seek

Seek immediate medical advice if the burn is:

• larger than a 20-cent coin
• on the face, hands, groin or feet
• deep or infected
• caused by chemicals or electricity

DRSABCD

1. Check for Danger
2. Look for a Response
3. Send for help
4. Check Airway
5. Check Breathing
6. Start CPR (if required)
7. Attach Defibrillator (if required)

Cover

Cover wounds and apply pressure to halt bleeding

Check

Check for other fractures (open, closed or complicated)

Immobilise

Request casualty does not move

Bandage

Immobilise the fracture with wide bandages above and below joints to prevent movement.

• Apply the bandages under the natural hollows of the body to support the limb (handle with care)
• Create a splint with padding and apply to the injured area
• If it is a leg fracture you must immobilise the foot and ankle
• After applying the splint you must check that it is not too tight or too loose in 15-minute intervals
• Check for signs or circulation loss in the foot or hand.
• Observe casualty closely

DRSABCD

1. Check for Danger
2. Look for a Response
3. Send for help
4. Check Airway
5. Check Breathing
6. Start CPR (if required)
7. Attach Defibrillator (if required)

Glove up

If you have gloves, put them on.

Take a load off

Help the patient to lie down. Remove or cut away the patient’s clothes to expose the wound.

Pressure

Apply firm, direct and continuous pressure to the wound, initially with your hands, until the bleeding stops.

When available, apply a pad or dressing in or directly over the wound and continue to apply the same firm, direct and continuous pressure until the bleeding stops.

If there is an object protruding from the wound, apply pressure to either side of the wound and place pads around the object before bandaging.

Secure the wound

Once the bleeding is under control, secure the wound by bandaging firmly, ensuring the pad remains directly over the wound.

Continue to observe for further bleeding.

Ensure that the patient’s vital signs (consciousness, breathing and pulse) are monitored.

DO NOT give them anything to eat or drink.

Uncontrolled bleeding

If you cannot control the bleeding and it is on a limb, you may need to apply an arterial tourniquet (if you have one) and tighten until the bleeding stops.

This WILL cause the patient pain and you need to let them know before hand.

If the wound is NOT on a limb, remove existing dressings and apply a haemostatic dressing (if you have one) in or directly over the wound.  Reapply firm, direct and continuous pressure until the bleeding stops.

A haemostatic dressing is a type of field dressing which is impregnated with an inert mineral that, on direct contact with blood, initiates the clotting process.

Eye wound

1. DRSABCD
2. Place an eye pad or clean dressing over the injured eye.
3. Get the patient comfortable.
4. Ask the patient to reframe from moving their eyes.
5. Seek medical assistance.

Object in the eye

1. DRSABCD
2. Ask the patient to look up.
3. Draw the lower eyelid down. If the object is visible, attempt to remove it with a moist cloth.
4. If the object is not visible, pull the upper eyelid down.
5. If unsuccessful, wash the eye with sterile saline or clean, cool water.
6. If unsuccessful, cover the injured eye and seek medical assistance.

Embedded object in the eye

1. DRSABCD
2. Cover the injured eye with an eye pad or clean wound dressing.
3. Seek medical assistance.

Penetrating object from the eye

1. DRSABCD
2. Call 000 by any means available.
3. Lie the patient down.
4. DO NOT try and remove the object.
5. Cover the injured eye by placing thick pads or clean cloth, above and below the eye, or cover with a paper/plastic cup.
6. Bandage the cover in place, ensuring that there is NO pressure on the eyelids.
7. Ask the patient to keep their eyes as still as possible.
8. DO NOT give the patient anything to eat or drink.

If in a remote location, common sense needs to prevail with the giving of water to drink.  You will need to ensure that the patient does not become dehydrated (and then introducing new complications) while waiting for medical assistance.

Burns

1. DRSABCD
2. Gently open the eyelid and wash it with cool, flowing water for 20 minutes.
3. Cover with an eyelid or clean dressing.
4. Seek medical assistance.

Smoke

1. DRSABCD
2. Ask the patient to not rub their eyes.
3. Wash the eyes with sterile saline or cold water.
4. Seek medical aid if necessary.

Severe reaction

1. Lay the person flat and keep them laying down.
2. Give adrenaline injector
3. Make contact with medical assistance
4. If there is no response after 5 minutes then a second round of adrenaline may be given
5. Convey the patient to the nearest medical facility for observation.
6. Be prepared to start CPR if the patient becomes unresponsive or stops breathing

While waiting or transporting the patient to medical assistance, they MUST remain under constant observation.

Adrenaline first

Even if the patient has an asthma puffer and is having difficulty breathing, ALWAYS give them the adrenalin FIRST.

Be prepared

If you are at risk of a severe allergic reaction, make sure:

• You have an action plan (consult with your Dr)
• Have a means of contacting help if needed
• Always carry an adrenaline injector (EpiPen or Anapen)
• Wear medical identification jewellery
• Avoid medication (where it is possible) that nay increase the severity of an allergic reaction.
• Avoid the allergen where possible