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CASE REVIEW 18 JUNE 2015 | EMSWORLD.com violent, similar to a patient having an insulin reaction. The skin temperature may not be warm, and many heatstroke patients appear pale or ashen. A few have the classic red, hot and dry skin and are not sweating. A victim may complain of cramps, throbbing SEVERE HEAT ILLNESS WILL CAUSE PERMANENT DISABILITY OR DEATH IF EMERGENCY CARE DOES NOT BEGIN PROMPTLY. headache, nausea, vomiting and dizziness. In later stages the victim will be uncon- scious or seizing. It is difficult to obtain an oral temperaure, as the victim is typically breathing very fast, may be vomiting and will have difficulty holding a thermometer in a closed mouth. The hospital will rely on a rectal tempera- ture to get an accurate reading on heat- stroke patients. Severe heat illness will cause permanent disability or death if emergency care does not begin promptly. Aggressive internal methods of cooling will be needed at a hospital. The victim may be slightly dehy- drated, but large volumes of IV fluids are rarely needed and may be dangerous. External cooling is typically not effective by itself, but it needs to be started in the field: • Get the victim to a sun-shaded location; • Remove whatever clothing you can while maintaining modesty; • Put the victim on his/her side, as most will vomit; • Cool the victim rapidly using anything available. Spraying with cool water and a fan is effective; • Use cold compresses (cold/iced towels are most useful) to the forehead, axilla and groin areas; • If available, immerse the victim in a pool or tub of cool water or a cool shower; • Do not give the victim large volumes of fluids to drink, as this will likely result in vomiting; • If it does not delay transport, start an IV and give a small bolus of fluids. Incident Rehabilitation NFPA 1584: Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises was insti- tuted in 2008, and the second revision will be published shortly. The standard states, "Procedures shall be in place to ensure that rehabilitation operations commence when- ever emergency operations pose the risk of members exceeding a safe level of physical or mental endurance." The standard calls for liberal applica- tion of rehabilitation services at working incidents and training operations. This is We believe in knowing emergency medical services so deeply that we've created the smartest customized suite of insurance products and risk management services in the industry, bar none. That's because our team of experts doesn't just write policies for emergency services— we partner with our clients for the long haul. ESIP and ASIP give you the advantage of mitigating risk and preventing losses before they happen, saving time, money and resources while delivering the ultimate benefit: peace of mind. Mark Harrington ASIP Program Manager EMS Industry Specialist Find out how we can help protect your business. www.mcneilandcompany.com/ems (800) 822-3747 ext. 380 EMS INSURANCE BY EMS EXPERTS 25 YEARS OF LEADERSHIP IN SPECIALIZED INSURANCE We are who we insure For More Information Circle 18 on Reader Service Card