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CASE REVIEW 16 JUNE 2015 | EMSWORLD.com when they arrive, it's a serious problem, and we'd head to a hospital. Most of the fire- fighters do fine with about 15 minutes of cooling and some oral fluids. If they don't act right and clear quickly, they go to the hospital." The Operation Changes The training is going well, with members hydrating between evolutions. But then there's a call for help inside the training building, and the crews scramble to drag out a captain who has collapsed. They bring him to the rehab area and remove his equipment. He'd reportedly passed out in the building but is now speaking, although confused and disoriented. He complains of being chilled. The members of his crew exit the build- ing and report their engine had a busy morning, working a couple of car fires, and they missed breakfast. The captain had been outside most of the afternoon, and no one could remember seeing him drink anything. He started "acting funny" as they were climbing ladders and moving through the training building, and gave some unusu- al orders to his crew. He then slumped to the ground. The Attack One paramedic takes control of the care. He notes the patient's skin is blotchy, and his pupils are dilated. "Get an ambulance here immediately," he quickly directs his crew. "Get a bunch of cold, wet towels and put them on him. Roll him on his side, because he'll be vomit- ing soon. "Command, stop the training. We have a medical emergency and will need to dedicate the rehab crew to the care of this patient. An ambulance is en route, and we'll be making an emergency removal. When a backup crew can replace us and reopen the rehab area, the training can resume." The paramedic asks for another mem- ber of the Attack One crew to conduct a focused evaluation of the other members of the captain's engine crew—if he's that ill, there's a risk to them as well. The para- medic then dedicates himself to care of the captain and preparing him for rapid transport. The crew performs continuous surface cooling, provides supplemental oxygen and keeps him on his side as he begins vomiting. The ambulance arrives, and the captain is rapidly moved to it. The Attack One para- medic accompanies him to the hospital. IV access cannot be obtained, and it's difficult Serving our nation's EMS pr actitioners Improve Patient Care With NAEMT Education EMS practitioners make the best decisions on behalf of their patients when given a sound foundation of evidence-based knowledge and critical thinking skills. NAEMT education provides that foundation... Advanced Medical Life Support (AMLS) Bleeding Control for the Injured (B-Con) Emergency Pediatric Care (EPC) EMS Safety Geriatric Education for Emergency Medical Services (GEMS) Law Enforcement and First Response Tactical Casualty Care (LEFR-TCC) Principles of Ethics and Personal Leadership (PEPL) Prehospital Trauma Life Support (PHTLS) Tactical Combat Casualty Care (TCCC) Tactical Emergency Casualty Care (TECC) High Quality, Evidence-based Education for EMS Practitioners www.naemt.org For More Information Circle 16 on Reader Service Card THE PATIENT HAS A RECTAL TEMPERATURE OF 105ºF DESPITE ABOUT 30 MINUTES OF PREHOSPITAL COOLING.