“Camels & Bats & MERS Oh My”
The Economist May 14, 2014
w w w.economist.com/node/ 21602198
Andrea L. Williams, PhD, RN
EMS Education Specialist
Clinical Associate Professor
UW Emergency Education Center & UW-SON
Recent MERS–nCoV News
Reports
 CNN Medical Repor t - MERS CoV Virus Repor t
4-29-14
http://www.cnn.com/ 2014/04/29/health/m
ers-camels/
 USA Today Repor t 5-17-14
http://www.usatoday.com/stor y/news/usano
w/2014/05/17/mer s-corona-virus-saudiarabia-illinois-indiana-infection/9217731/
 CNN MERS CoV Camel Repor t 5-3-14
http://www.cnn.com/2014/04/29/health/m
ers-camels
Saudi Arabia – To prevent Middle East Respiratory
Syndrome, Saudis wear mouth and nose masks to
watch camels at their farm, outside Riyadh.
Photographer: Fayez Nureldine/AFP via Getty Images
OBJECTIVES
 Understand the possible mechanisms of
transmission, pathophysiology, signs & symptoms
and treatment for Middle East Respiratory Syndrome
 Describe precautions that need to occur for pre hospital & hospital providers
MERS-nCoV: Mechanism of Transmission
 Identified in September
2012
 Similar to coronaviruses
found in bats
 Isolated in camels in
Qatar, Egypt and Saudi
Arabia-unknown if camels
are the source of the
virus
 Human to human
infection in health care
workers noted
 Lab test for active
infection and antibody
test for previous infection
MERS-nCoV Transmission
 Transmitted through the air
through droplets from coughing
or sneezing
 Transmitted through close
personal contact: touching or
shaking hands
 Spread by touching
contaminated objects or
sur faces and then touching
your eyes, nose, or mouth
 Transmitted in the Middle East
by the same mechanisms when
in close contact with
dromedar y camels used for
racing, transpor tation, food,
and as pets.
 Virus found in camel feces &
urine, unpasteurized camel
milk & cheese, and in camel
Countries in the Arabian Peninsula
with Lab-Confirmed MERS Cases
 Saudi Arabia
 United Arab Emirates
(UAE)
 Qatar
 Oman
 Jordan
 Kuwait
 Yemen
 Lebanon
 Iran
Countries with Travel-Associated
Cases
 United Kingdom (UK)
 France
 Tunisia
 Italy
 Malaysia
 Philippines
 Greece
 Egypt
 United States of
America (USA)
 Netherlands
***CDC takes back report of MERS spread
person to person in U.S.
MERS nCoV Cases and Deaths
 562 Cases of MERS CoV
worldwide with 180
deaths
 Recently spread to Iran
 Saudi Health Minister
fired after a spike in
Mers CoV cases (49 new
cases), in April 2014
http://www.cidrap.umn.edu/news perspective/2014/04/two-mer santibody -studies-may -helpquest-treatment
Middle East Respiratory Syndrome
 Middle East Respiratory Syndrome (MERS -nCoV
is caused by a novel beta coronavirus that
usually causes a severe respiratory illness
which has resulted in deaths in ~ 30% of
individuals with confirmed infections. It is
called a coronal virus because it appears to be
surrounded by a crown.
History & Symptoms of MERS-nCoV
 Histor y of travel to Middle
Eastern Countries where MERS nCoV is prevalent
 Upper Respirator y Symptoms
Fever
Cough
Shortness of breath
Hypoxemia
Pneumonia
 Gastrointestinal Symptoms
Nausea
Vomiting
Diarrhea
 Kidney Failure
Treatment
Supportive Care
No vaccine to date
Researchers have
found that
monoclonal
antibodies - MERS-4
and MERS-27, have
strong neutralizing
activity against
MERS-CoV.
Prevention While in Flying
 Wash hands often
 Avoid touching your face
 Avoid close contact with sick people
 Don’t share cups or eating utensils.
 Clean and disinfect surfaces like door handles, toys,
tray tops, etc.
 Practice the "Canadian salute" of coughing and
sneezing into your elbow.
Prevention in Middle East
 MERS-CoV can survive for a long time in milk and suggested
that consumption of unpasteruized milk, common on the
Arabian Peninsula, could be a source of infection.
Pasteurization kills the virus.
 Don’t drink unpasteurized milk or eat unpasteurized cheese.
 Camel meat should be thoroughly cooked, not eaten raw
 Don’t drink camel urine (Believed to have medicinal benefits)
 What should be done about camel feces dried for fuel?
New Prevention Guidelines Qatar June
2014
Qatari has put into
effect standards for
protection of camel
workers.
 Frequent hand washing
 Use of protective
facemasks—although
temperatures of up to
50°C make this almost
impossible
 Use of protective
clothing and gloves
Prevention of Transmission to Healthcare
Providers
 Airborne Infection Isolation Room (AIIR)
 Limit the number of healthcare providers present during the
aerosol-generating procedures (ETT placement) to only those
essential for patient care and support.
 Conduct the procedures in a private room and ideally in an
AIIR Gloves
 Gowns
 Eye protection (goggles or face shield)
 Respiratory protection that is at least as protective as a fit tested NIOSH-certified disposable N 95 filtering face piece
respirator.
 If a respirator is unavailable, a facemask should be worn. In
this situation respirators should be made available as quickly
as possible
 Monitor healthcare providers for 14 days after the last known
Do Not Eat Anything You Cannot
Positively ID
“ Ever y
mushroom is edible, but
some only once."
 Galerina autumnalis
 Brown cap, small fragile ring on
the stem. The lower part of the
stem is usually darker brown,
sometimes with little tufts of
hyphae. Above the ring the stem is
usually lighter tan in color and
lacks ornamentation. The gills are
~ the same color as the top of the
stem and darken with age. The
mushrooms are only about 2-5 cm
in diameter and the stems are
usually less than 2 inches (5 cm).
The spore print is a rusty brown.
False Chanterelle
 False Chanterelle, is an
orange funnel-shaped
mushroom which has
been confused at times
with the true chanterelle
 Orange cap up to 8 cm
across, initially convex but
becoming funnel-shaped.
The decurrent gill-like
structures are orange, riblike folds and forked. The
orange stem is ~ 5 cm
high and lacks a ring
 The spore print is white.
Chanterelle Look-a-like Mushrooms
 Jack O'lanterns grow in
large groups with the
stems attached.
Chanterelles are usually
solitary or in a small
bunch with separate
stems.
 Jack o'lanterns are
more orange, less
yellow.
 Chanterelles will always
be near trees due as
they are mycorrhizal
False Chanterelle “Poisoning” Symptoms
 Tom Volk, a leader in mycology from the University of
Wisconsin, describes the False Chanterelle or Jack -o-lantern
mushroom poisoning as, " Omphalotus olearius won't kill you it will just make you wish you were dead." Due to vomiting
and diarrhea for several days after ingestion.
Isoxazole Derivatives Poisoning
Mushrooms - Amanita muscaria , A.
pantherina , A. gemmata , A. cothurnata , A.
frostiana , A. crenulata, A. strobiliformus ,
Tricholoma muscarium
Symptoms occur 30 minute to 2 hours after
ingestion, and last for several hours.
Symptoms of Isoxazole Derivatives
Poisoning
 Nausea and vomiting are
quite common,
 Central nervous system
effects: confusion, visual
distortion, a feeling of
greater strength, delusions,
convulsions, drowsiness, fall
asleep and can not be
roused. In rare cases the
coma-like state can last for
more than 24 hours.
 No deaths in 100 years
 Spontaneously awaken
Case Presentation
 A 24 y/o calls 911 with complaints of abdominal pain and
sweating. On arrival to the scene or on arrival to your ED you
find the patient to be diaphoretic, with drenching sweats,
copious salivation and lacrimation, as well as crampy
abdominal pain. He vomits twice and has another episode of
diarrhea. Otherwise, his vital signs were stable. His pupils
were measured at 3 mm bilaterally and were reactive to light.
On auscultation of the lungs, there were coarse crackles up to
the mid lung bilaterally.
 What is your differential diagnosis?
 A 32 y/o family member calls 911 after having episodes of
crampy abdominal pain with diarrhea and vomiting as well as
blurred vision 2 h after consuming the mushrooms. She also
had profuse sweating, lacrimation, and coarse crackles
Inocybe species, Clitocybe dealbata Muscarine Symptoms of Poisoning
 GI Symptoms
 20 minutes to 4 hours of ingesting
the mushrooms, and include
nausea, vomiting, cramps, and
diarrhea
 Muscarine Symptoms –
SLUDGE-M
 Excessive salivation, sweating,
tears, lactation (in pregnant
women), severe vomiting and
diarrhea. May be accompanied by
visual disturbances, constriction of
the pupils, irregular pulse,
decreased blood pressure, and
difficulty breathing. Death can
Treatment of Muscarine Poisoning
 Supportive care
 Atropine
2014 Muscoda Morel Mushroom Festival
2014 Muscoda Morel
Mushroom Festival
Case Presentation
 The Communication Center
dispatches you to the home of an
elderly couple (or an elderly couple
arrive in the ED), who are complaining
of headache, severe nausea, vomiting
and diarrhea a couple of hours after
eating Morel mushrooms they picked
in the woods near their home.
Gyromitrin Poisoning Symptoms
 Symptoms occur within 2 to 24
hours after eating a False
Morel/Gyromitra esculenta s
 Headaches
 Abdominal distress
 Severe diarrhea, and vomiting
 In severe cases, liver and kidney
damage
 Red blood cell damage
 Convulsions & coma can occur
Gyromitrin Poisoning Treatment
 Supportive Care
 Gastric decontamination with activated charcoal may
be beneficial within a few hours of consumption.
 Treat severe vomiting or diarrhea with intravenous
fluids. Monitoring of methemoglobin levels,
electrolytes, liver and kidney function
 Dialysis
 Blood transfusions for hemolysis of red blood cells
 Methylene blue for methemogloinemia
 Vitamine B6 Pyridoxine for neurologic symptoms
 Folinic acid replacement
Case Presentation
 You receive a 911 call or the 55 y/o female is
admitted to your ED with complaints of severe
abdominal pain and bloody diarrhea. They are
lightheaded with dizziness.
 What are your concerns?
 What is your differential diagnosis?
Amanitas - The Death Cap & the Destroying
Angel
 M ushrooms : Amanita phallodies, A . ocreata, A .
verna, A . bisporigera, Conocybe filaris, Galerina
autumnalis, G. marginata, G. venenata, Lepiotia
castanea, L. helveola, L. josserandii & close
relatives.
 Account for 90 percent of all poisonous
mushroom cases.
 Amanitas have a bulbous base
 Death Cap
 Caps are generally greenish in color, with a white stem
and gills.
 The Death Destroying Angel smells sickly sweet
 White stalk and gills
 Bulbous base
 The cap can be pure white, or white at the edge and
yellowish, pinkish, or tan at the center.
 Has a partial veil, or ring (annulus) circling the upper
stalk, and the gills are "free," not attached to the
stalk.
 The most telltale of the features is the presence of a
Mechanism and Symptoms of Amanitas
Poisoning
 a-amanitin slowly attacks the
enzyme RNA polymerase in all
body cells, par ticularly the
liver. Ultimately af fects the
central ner vous system and
kidneys.
 As little as 1/3 of the cap may
be eaten resulting in death
Stages & Symptoms of Amanita
Poisoning
 First stage is a latency period of 5 to 24 hours after ingestion,
in which the toxins are actively destroying the victim's kidneys
and liver, but the victim experiences no discomfort. There may
be a feeling of unease
 Second stage is a period of about 24 hours characterized by
violent vomiting, bloody diarrhea (cholera -like), and severe
abdominal cramps.
 Third stage is a period of 24 hours during which the victim
appears to recover (if hospitalized, the patient is sometimes
released!)
 Fourth stage is a relapse, during which kidney and liver failure
often occurs, leading to death. There may be more than one
relapse.
Amanitas Poisoning Treatment
Fluid and electrolyte replacement
Oral activated charcoal and lactulose
IV penicillin
Combined hemodialysis and hemoperfusion in two 8-hour
sessions some with "IV thioctic acid, others IV silibinin
 Milk thistle




Prevention of Mushroom Poisoning
 Only eat mushrooms you have positively identified yourself.
 Identify mushrooms a second time during preparation and
cook them properly, unless you know that the species can be
eaten raw.
 Do not combine mushroom types.
 Retain a sample of any mushroom you are not well experienced with for analysis in case of poisoning.
 Inform yourself about deadly mushrooms that are look -alikes
of edible ones. "Deadly twins" dif fer regionally, so take into
account regional variation.
 Do not gather mushrooms that are dif ficult to identify, unless
you have expert knowledge.
 Consume only a small amount the first time
Mushroom Safety Tips
 Be cautious with white-capped mushrooms or mushrooms with
white gills; this eliminates many hard -to-identify species,
including several deadly species.
 Do not eat wrinkled, brain -like, or saddle-shaped mushrooms.
 Beware of any mushroom with a ring on its stalk or any
mushroom that grows out of a cup or has an enlarged base.
 Avoid LBM's. Species of Little Brown Mushrooms can rarely be
determined by non-professionals.
 Avoid Boletes which have red pore mouths or which bruise
blue or taste bitter.
 Do not eat any puf fball that is not pure white and uniform in
texture inside.
 Keep each species that you collect in a separate container.
 Be aware that some mushrooms cause reactions when
consumed with alcohol.
Wisconsin Creates New Crossbow Season
“With the official signature of Governor Scott
Walker the dawn of a new age is finally upon
Wisconsin hunters. Once only legal for
hunters age 65 or older, or those with physical
disabilities preventing them from using a
compound or traditional bow, crossbows will
now be legal for hunters of all ages
throughout the state's archery deer hunting
season.”
Longbows, Crossbows, Composite Bows &
Arrow Injuries
 A Wisconsin man was injured
when fired the crossbow and
stuck his thumb in the path of
the bow string. In so doing, he
severed par t of his thumb.
EMS and fir st responders had a
dif ficult time locating the
amputated par t, which could
not be attached.
 Injur y prevention education –
Teach user s to, “Never allow
your fore-grip hand’s finger s or
thumb to move above the
barrel’s flight deck or into the
bow string or cables’ release
path.”
Types of Bows
Crossbow Injury
Case
 A 16-year-old boy sustained a penetrating injury to
his left wrist and hand from a broken arrow shaft.
This occurred when a hollow carbon fiber arrow
broke while he was attempting to shoot it from a
compound bow. The shaft of the arrow, broken at its
mid portion, entered the left wrist
Arrow Injuries
Treatment of Patient with Arrow
Impalement
 Xray
 CT scan to map the
track
 Surgical Removal
Pre-hospital & Emergency Treatment of Arrow
Impalement
1 . Stabilize the arrow/treat as an impaled object by applying
adhesive tape or another stabilizer to the base of the shaft.
2. Wrap a clean towel or gauze around the base of the shaft,
and then apply direct pressure on the bleeding wound.
3. Assess for and treat airway, breathing issues and shock
4. Avoid moving or bumping the arrow during transport.
5. Provide a duplicate arrow if possible to healthcare providers.
A duplicate arrow will help medical professionals determine
the size and shape of the arrow and know if they have
retrieved all the pieces of the arrow from the victim.
Pro’s and Con’s of Crossbow Hunting
 Pro’s - Crossbows allow hunters to get out in the woods
more often, and allow them to be more successful
hunters.
 Pro’s - Crossbow hunting has increased hunting license
revenue and has increased the number of bow hunters.
 Pro’s – Crossbows provide an effective game control
management tool.
 Con’s – Increased harvest of deer will decrease the
numbers available for gun season.
 Con’s – Bow Season may need to be shortened in the
future due to increases in harvest affecting long bow
hunters.
 Con’s – Rifle hunters will move to crossbows shifting
Flood Warnings are in Effect for Nearly all of
the Local River Gauge Sites in Southern
Wisconsin.
www.youtube.com/watch?v=5ibCL6zMeOk
Firefighters Save 2 from Truck that Rolled
into Flooded Ditch – A s h l ey L u t h e r n M i l w a u ke e J o u r n a l
S e n t i n e l J u n e 1 8 , 2 01 4
 Two men were injured when their truck rolled over on Highway
41/45 on Wednesday morning and landed in a flooded ditch,
the Germantown fire chief said.
 "They were very lucky it didn't end up upside down because
they could have drowned," Fire Chief Gary Weiss said.
Firefighters Save 2 from Truck that
Rolled into Flooded Ditch
Firefighters had to deal with chest-high water
in the ditch from heavy rainfall and crossed
the ditch by laying ladders across the water to
the truck.
Flash Flooding in Wisconsin
 LAKE DELTON, Wis. — Flash
floods inundated a southwest
Wisconsin town Monday for the
second time in 10 months,
while 60 miles away an
embankment along a man made lake gave way,
unleashing a power ful current
that ripped homes of f their
foundations.
 The swollen Kickapoo River
engulfed nearly the entire
village of Gays Mills, WI,
forcing about 150 people to
evacuate. The town was
reduced to a grid of canals
with cars submerged up to
their windows and parking lots
http://www.youtube.com/watch?v=JME8XU8rZNI
Flash Flood Statistics
 Thousands of Wisconsinites live along
rivers that are periodically swollen
from melting snow or rains associated
with thunderstorms
 Flash flooding is the Number One killer
during thunderstorms
 One of the most common and
widespread of all natural disasters
 84 Americans died from floods in 2013
 Six inches of fast moving water can
move a vehicle & knock over an adult
 Two feet of water is enough to make
most cars float
 At least a couple people in Wisconsin
had to be saved from raging waters in
April 2014
Flooding in McFarland, WI
Flash Floods - Floods That Happen in a
Flash!
 Flash floods generally develop within 6
hours of the immediate cause .
 A rapid rise of water over low -lying
areas.
 Flooding may occur well away from
where heavy rain initially fell . (This is
especially common in the western
United States where low lying areas
may be very dry one minute, and filled
with rushing water from upstream the
next)
 Rainfall from slow -moving or multiple
thunderstorms over the same area,
rapidly changing the water levels in
stream or creeks and can turn small
waterways into violent, raging rivers
 Urban areas are especially prone to
flash floods due to the large amounts
of concrete and asphalt surfaces that
do not allow water to penetrate into
Causes & Effects of Flash Floods
 Heavy rains falling over a short period of time (a few hours or less)
 Ice jams or debris jams on rivers
 Dam or levee breaks. The sudden buildup of water can cause a
large crest of water to move quickly downstream, wiping out
most everything in its path.
 Capable of rolling boulders, tearing out trees and destroying
buildings quickly with little or no warning
 Can cause mudslides. June 2013 a mudslide from a flash flood &
debris left on Highway 78 outside of Mazomanie resulted in rerouting
traffic
Flash Floods from Rainfall & Snow Melt
Wisconsin Flash Floods
 1 884 Eau Claire – A 27-foot flood carried away houses and all the
bridges in Eau Claire, WI
 1911 Spar ta - Heavy rains filled the upstream tributaries to the
Black River, two dams above Black River Falls gave way. The river
rose 20 feet over its already high level and rushed through city all
day. 80 buildings and 42 acres of land, including entire hillside
neighborhoods, were swept away
 1943 Black River Falls - Bear Creek jumped its banks af ter
torrential rains. Homes and businesses were inundated 3-4 feet
deep, bridges were washed out, and roads destroyed. In addition,
water mains broke, which not only reduced the water supply but
contaminated water still available. At least one person drowned
 1993 Statewide Flooding in WI – Snowy winter, 2-3 times normal
rainfall in Upper Mississippi Valley. Thunder storms with 2 to 7
inches of additional rain on June 17-1 8 resulted in ever y major river
in Wisconsin flooding; 20 dams were over topped, broken, or washed
away.
 2008 Southern Wisconsin – Seven southern counties received more
than a foot of rainfall in June. The town of Ontario received more
the 6 inches on June 8, and Baraboo more than 17 inches during
the month. Lake Delton, in the Wisconsin Dells, breached its dam
and emptied into the nearby Wisconsin River on the 9th
Dangers of a Flash Flood Rescue
Land Rescues from Raging Water
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Most rescue boats can only accommodate
three or four people
Boat Rescues of Flash Flood
Victims
 If someone falls into the water,
a spotter on the boat would tr y
to keep them in sight for as
long as possible.
 Rescuer s need to prioritize the
injured, young and elderly
 Most rescue boats can only
accommodate three or four
people
Hazards to Rescuers
 Environmental Hazards
 Extreme temperatures
 Heat & Cold – Hypothermia, hyperthermia, exhaustion
 Weather – rain, snow, winds, fog
 Water/Aquatic Hazards – Seaweed, bacteria/viruses, biohazards,
sharp objects, crushing objects, raging water
 Electrical hazards
 Operation hazards
 Sieves, Strainers
 Eddies, waves, upstream V’s, downstream V’s
 Personal hazards







Tripping
Steep slippery terrain
Drop offs
Stationary objects
Holes, manholes
Entanglement or injury from hidden obstructions above and below the water
Drowning
Swift Water Characteristics
 Eddies - Upstream water flows around obstructions in the
current leaving a void on the downstream side of the
obstruction, causing the downstream to flow upstream to fill
in the void behind the obstruction.
 Upstream V's – Caused by water striking an object and water
going around it. An area that may be trapping a subject
against an obstacle.
 Downstream V's - Caused by water moving around several
obstacles coming together in the path of least resistance.
These Downstream V's will contain some of the fastest moving
water in the channel. If the subject does not become trapped,
the downstream V's have the highest probability of containing
the subject.
 Pillows are also indicators of a submerged or partially
submerged obstacle. The pillow will lie upstream if the
obstacle is completely below the surface & downstream if the
Swift Water Characteristics
 Strainers – Debris forms
a colander to trap
 A Sluice is a narrow
section of the waterway.
PPE
 Proper PPE
 Wet suit, dry suit,
exposure suit
 Personal Floatation
Device
 Kayak Helmet
 Lifelines/ropes
 Leather gloves
 Hiking or work boots
 Waterproof flashlight or
headlamp
 Whistle
 Knife
Scene Assessment
 Scope, magnitude and type of water rescue
 Equipment & resource needs






Boats
Tow trucks
Rescue lines
Pike poles
Air-charged hoselines
Inflatables that can be dropped
 Environmental factors including








Changing weather
Amount of remaining daylight
Water levels
Current change
Hazards
Number of victims
Risk:Benefit – Rescue vs Recovery
Access
 Evaluate the victim – Condition of the victim. Can they assist in the
rescue
Water-Rescue Principles
 Reach – Throw - Row – Go
 Reach using long, handled tools, such as pike poles, to try to reach
victims.
 Throw ropes with life rings or other floating devices victims. Air -filled
objects, such as footballs or soccer balls, can be thrown to victims so
they have something to hold onto while in the water.
 Push, motor or row boats to victims if necessary.
 Row - Boats can be extremely dangerous in fast water rescues.
Propellers on outboard motors can become entangled in branches,
vines or other debris or even in fences in higher floodwaters
 Go - Rescuers entering the water, need PPE floatation gear, head and
foot protection, survival or flotation suits. Boots are tied tightly to
reduce the amount of water, hydrocarbons, chemicals or other
hazards that can get in.
Tie off rescuers so they can be retrieved quickly. They need to carry a
knife to cut the rope if they become entangled
Reach
Throw
Receiver Position Instructions
Stabilization Line
Allows victim to maintain head above water
Row
Shallow Water Crossing
Crossing to Vehicle
Go For Help!
Mechanism of Injury in Flash Floods
 Low water crossings – drownings
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 Most vehicles will then tend to roll
over, trapping those inside and
washing them downstream
 Electrocution - Water covering the
electrical outlets or cords are
submerged. If you see sparks or
hear buzzing, crackling, snapping
or popping noises --get out! Stay
out of water that may have
electricity in it!
 Trauma due to fast moving sharp
and dull objects in the water –
punctures, lacerations, crush
injuries
Assessment of Victims of Flash Floods
 Scene Safety
 ABC’s or
 MARCH = Massive Bleeding, Air way,
Respirations, Circulation, Head &
Hypothermia
 Secondar y Sur vey
Features of Hypothermia
Temperature
Clinical Findings
 37 (98.6)
 36
 35 (95)
 Normal
 Increased metabolism
 Maximal shivering
 33 (91.4)
 32 (89.6)
 31 (87.8)
 Altered mental status
 Shivering stops/pupils dilate
 Non-palpable pulses
 28-30 (82.4-86)
 27 (80.6)
 20 (68)
 LOC / V-fib / Muscle rigidity
 No DTR / No pupillary reflex
 Asystole
Rewarming Techniques
Passive External Rewarming
Active External Rewarming
Active Core Rewarming
Core Temperature Afterdrop
 Core temperature continues to fall after
rewarming is instituted
 Simple temperature equilibration
 Restoration of peripheral circulation sets up
a countercurrent flow with cold, acidotic
blood shunted to the core
Treatment
 Hypothermia can be rewarmed passively if
mild (> 32 o C) and the patient is stable
 Unstable and temp < 32 o C - aggressive active
core rewarming & partial cardiac bypass if
condition deteriorates
 Cardiac instability and risk of V-fib begins <
30 o C
 Vital signs are difficult to assess at
temperatures < 30 o C
 Do not begin CPR if organized rhythm is
present and temp is < 30 o C
Soft Tissue, Musculoskeletal & a Variety of
Injuries from Debris in Flood Water
 Abrasions
 Lacerations
 Puncture wounds
 Avulsions
 Hematomas
 Crush injuries
 Limb entrapment
 Sprains & strains
 Fractures & dislocations
 Head injries
 Other
Drowning
 Half of the drowning deaths in 48 states occur in motor
vehicles
Steps to Get Out of a Vehicle that is Submerging
Don’t Panic, Don’t Use Cell Phone – You have ~ 1 minute to
get out
1st Unclick seatbelts
2 nd Roll down or break the window (Preferably back)
3rd Don’t open the door
4th Children out first (Youngest to oldest)
5th Get out through the open window ASAP!
6th If you can’t break the window hold your breath till the pressures equalize
then open the door.
http://www.popularmechanics.com/outdoors/survival/tips/how -toescape-a-submerged-car-15510924
Prevention of Injury During Flash Floods
 Avoid flooded bridges
 Never drive through flooded roadways. Turn around, don't drown.
 Be especially cautious at night when it is harder to recognize flood
dangers.
 When a flash flood is headed your way, you may only have seconds
to save your life.
 Abandon all per sonal proper ty and flee to higher ground if a flash
flood is approaching. Any delay, even for a second, could be the
dif ference between life and death
 If your vehicle stalls, abandon it and seek higher ground
immediately
 Camp well above the stream level . It is also a good idea to plan an
escape route in advance should a flood occur
 Don’t allow c hildren to play near high water, storm drains, or
ditches
 Flash Flood Watch is a warning to be aler t to rising water & prepare
to move to higher ground
 Flash Flood Warning a flash flood is occurring or is imminent in a
Turn Around Don’t Drown
Flooding can undermine roadbeds
Other Injury Prevention Reminders
 Stay out of basement , or any
room, if water cover s the
electrical outlets or if cords
are submerged.
 Monitor local radio and
television (including NOAA
Weather Radio), internet and
social media for information
and updates.
 Get out of areas subject to
flooding and get to higher
ground.
 If told to evacuate, do so
immediately. Be sure to lock
your home as you leave. If you
have time, disconnect utilities
and appliances
Disaster Supplies & Communications
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Have disaster supplies on hand.
Flashlights, headlights & extra batteries
Portable, battery -operated radio and extra batteries
First aid kit and manual
Emergency food and water/pet provisions
Non-electric can opener
Essential medicines
Cash and credit cards
Sturdy shoes
Ask an out-of-state relative or friend to serve as the "family
contact” since it is easier to call out on long distance lines
Remember Post Traumatic Stress for Victims
& Rescuers
Don’t Let the Rains Fall