Monday Morning Medical Director’s Message
Responders work in some of the most extreme environmental conditions imaginable: blazing fires, freezing temperatures, and hazardous atmospheres. Each presents unique physiological and operational risks that require proactive management.
Heat stress remains a major threat to responder health. High temperatures, heavy PPE, and prolonged exertion can quickly raise core body temperatures. The human body mainly cools through sweating, but dehydration and PPE barriers can make this mechanism ineffective. Active cooling methods like air conditioning, forearm immersion, misting fans, and other techniques should be available during all large-scale operations, including training exercises. Passive cooling, such as removing PPE, moving to shaded areas, and using air movers, is equally important.
| 
|
Heat-related illnesses develop along a spectrum from mild to life-threatening, starting with heat rash and sunburn, then progressing to heat cramps, heat exhaustion, and finally heat stroke. Heat cramps happen when heavy sweating depletes the body’s salt and water, leading to sudden, painful muscle spasms in the arms, legs, or abdomen. Treatment includes moving the responder to a cool environment, loosening clothing, and rehydrating with electrolyte drinks. Heat exhaustion results from significant fluid and electrolyte loss and is marked by heavy sweating, pale, clammy skin, weakness, dizziness, nausea, and high temperature. Managing it involves resting in a cool or air-conditioned space, active cooling methods like forearm immersion or misting fans, and oral or IV fluids. Heat stroke is a medical emergency caused by failure of the body’s thermoregulation. Sweating stops, skin becomes hot and dry, and mental status declines with confusion or unconsciousness. Definitive treatment is immediate ice-water immersion up to the neck and continued until the core temperature drops below 102°F or normal mental function returns. The patient shall then be transported to the hospital for further care. Every department should have a plan for field ice-water immersion, as loading and going only delays treatment.
Cold environments pose the opposite threat. Responders may suffer from trench foot, frostnip, frostbite, or hypothermia when exposed to freezing temperatures or wet conditions without freezing temperatures. Warming methods include removing wet clothing, applying blankets, and using warm packs (not directly on the skin) to gradually rewarm the body. Handle these patients very gently, as they can often experience cardiac arrest with ventricular tachycardia (VT) or ventricular fibrillation (VF) caused by hypothermia. If they go into cardiac arrest, start CPR, deliver a single defibrillation for VT or VF, continue CPR, and transport the patient to a hospital, preferably to an ECMO center if available.
NFPA mandates hazard control zones to segregate contaminated, partially contaminated, and clean areas. Initial exposure reduction must happen in the warm zone before personnel enter rehab, preventing contaminants from being tracked into rest areas and reducing carcinogen exposure. Rehab should be shielded from environmental conditions, be free of exhaust fumes from apparatus, vehicles, or equipment, and not be located downwind of the hot zone.
Responder safety depends on anticipating environmental stressors and implementing structured rehabilitation at every incident. Whether facing searing heat, bitter cold, or toxic contamination, protect the provider to preserve the mission. NFPA 1584 establishes that rehab is not optional but an integral component of operational readiness, ensuring responders recover physiologically and mentally before returning to duty. By planning for cooling, warming, hydration, and contamination control, departments not only comply with standards but also demonstrate a commitment to the health, performance, and longevity of their personnel. The best operations are those where everyone goes home safely: recovered, rehydrated, and ready for the next call.
Until next week,
John B. Hill, MD
Emergency Medicine Physician
UH EMS Medical Director
UH Portage ED Associate Medical Director
NEOMED Clinical Assistant Professor